El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos

Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey

PURPOSE

To compare the EQ-5D, SF-6D, and SF-12 in terms of their capacity to discriminate between groups defined by relevant socio-demographic and health characteristics in a general population survey.

METHODS

Data were obtained from the 2006 Catalan Health Interview Survey, a representative sample (n = 4,319) of the general population of Catalonia (Spain). Effect sizes (ES) and Receiver Operating Characteristic (ROC) curves were calculated to evaluate the instruments' capacity to distinguish between groups based on socio-demographic variables, recent health problems, perceived health, psychological distress, and selected chronic conditions.

RESULTS

All instruments showed a similar discriminative capacity between groups based on socio-demographic variables, recent medical visit (ES = 0.47-0.55), activity limitations (ES = 0.92-0.98), perceived health (ES = 0.97-1.33), and psychological well-being (ES = 1.17-1.57). Effect sizes between respondents with and without any of fourteen selected chronic conditions were large (0.76-1.04) for 4, moderate (0.55-0.74) for 8, and small (0.17-0.39) for two on the EQ-5D index. A similar pattern was observed for the SF-12 but ES were predominantly moderate (7 conditions) or small (6 conditions) on the SF-6D.

CONCLUSIONS

The EQ-5D and SF-12 were largely comparable in estimating the health burden of chronic conditions, recent health problems, and social inequalities. The SF-6D was less sensitive than the EQ-5D index and SF-12, particularly for physical chronic conditions.

The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings

Background

To evaluate the influence of heart disease on clinical characteristics, quality of life, use of health resources, and costs of patients with COPD followed at primary care settings under common clinical practice conditions.

Methods

Epidemiologic, observational, and descriptive study (EPIDEPOC study). Patients ≥ 40 years of age with stable COPD attending primary care settings were included. Demographic, clinical characteristics, quality of life (SF-12), seriousness of the disease, and treatment data were collected. Results were compared between patients with or without associated heart disease.

Results

A total of 9,390 patients with COPD were examined of whom 1,770 (18.8%) had heart disease and 78% were males. When comparing both patient groups, significant differences were found in the socio-demographic characteristics, health profile, comorbidities, and severity of the airway obstruction, which was greater in patients with heart disease. Differences were also found in both components of quality of life, physical and mental, with lower scores among those patients with heart disease. Higher frequency of primary care and pneumologist visits, emergency-room visits and number of hospital admissions were observed among patients with heart diseases. The annual total cost per patient was significantly higher in patients with heart disease; 2,937 ± 2,957 vs. 1,749 ± 2,120, p < 0.05. Variables that were showed to be independently associated to COPD in subjects with hearth conditions were age, being inactive, ex-smokers, moderate physical exercise, body mass index, concomitant blood hypertension, diabetes, anxiety, the SF-12 physical and mental components and per patient per year total cost.

Conclusion

Patients with COPD plus heart disease had greater disease severity and worse quality of life, used more healthcare resources and were associated with greater costs compared to COPD patients without known hearth disease.

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of "disc herniation", less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results.

The levonorgestrel intrauterine system as an alternative to hysterectomy for the treatment of idiopathic menorrhagia

AIM OF THE STUDY

Prospective, observational study to determine the percentage of hysterectomies cancelled after a year of treatment with levonorgestrel intrauterine system (LNG-IUS) among women diagnosed with idiopathic menorrhagia.

MAIN FINDINGS

Eighty-two women with a mean age of 44.3 + or - 4.9 were enrolled. Throughout 1-year follow-up, progressive and significant reduction was observed in number of days of bleeding (8.9 + or - 4.0 vs. 5.0 + or - 5.4), number of sanitary measures (29.3 + or - 19.4 vs. 8.1 + or - 10.8) and percentage of patients having intense/very intense bleeding (98.8%vs. 6.4%). Duration of menstrual cycle significantly increased from 26.9 + or - 5.5 to 52.6 + or - 33.6 days. Significant improvement in overall health-related quality of life was achieved. Patient satisfaction was good/very good in 70.7%. Considering only women who attended 12-month visit satisfaction reached 91.2%. 75.6% of scheduled hysterectomies were cancelled. Adverse effects were recorded in less than 40% of patients with no significant differences between visits. Adverse effects led to premature discontinuation of treatment in seven cases. No serious adverse effects were encountered.

INTERPRETATION OF RESULTS

LNG-IUS meets the effectiveness and tolerability criteria for being considered as a first choice treatment option for women with idiopathic menorrhagia. Its use may contribute to decrease the large number of hysterectomies scheduled in Spain.

Quality of life in simultaneous pancreas-kidney transplant recipients

BACKGROUND

Simultaneous pancreas-kidney transplantation (SPK Tx) allows dialysis and insulin therapy to be discontinued and improves the complications of diabetes mellitus type 1 (DM1). This study measure quality of life (QoL) in SPK transplant recipients and determine if there are differences in QoL between these patients and those with DM1 in renal replacement therapy (RRT).

METHODS

Short Form Health Survey 36-Item (SF-36) was administered to 69 SPK transplant recipients and 34 patients with DM1 under RRT. A descriptive analysis, multiple linear regression, ANOVA, and ordinal regression (PLUM) models were constructed.

RESULTS

QoL was higher in SPK transplant recipients than in patients receiving RRT. The best results were in the recently transplanted patients. Respect to Spanish population the men with SPK transplants scored higher on vitality and lower on general health, role limitations-physical and role limitations-emotional. Women with SPK transplants scored lower on general health. Among patients under RRT, men scored lower on the general health, physical functioning, vitality, and bodily pain while women scored lower on all dimensions. In both groups, greater age was associated with better mental health.

CONCLUSION

Positive predictive factors of QoL are SPK Tx and age while negative predictive factors are female sex and RRT.

Health-related quality of life in outpatient women with COPD in daily practice: the MUVICE Spanish study

AIMS

A cross-sectional multicenter study was designed to assess health-related quality of life (HRQL) in women with chronic obstructive pulmonary disease (COPD) who were attended in the outpatient setting in actual conditions of the daily practice.

METHODS

A total of 1786 women with COPD (mean age of 66.5 years) and 1661 pairs of men and women matched by age and COPD severity participated in a cross-sectional study. HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12).

RESULTS

The mean PCS-12 and MCS-12 scores were 36.5+/-10.3 and 44.1+/-11.8, respectively. General health and physical functioning domains were those with the lowest scores, whereas role emotional and social functioning were those with the highest scores. The percentage of women with low HRQL increased according to age, whereas the percentage of women with high or normal HRQL decreased significantly. In relation to COPD severity, more women rated HRQL as low in the physical component than in the mental component. HRQL correlated significantly with FEV(1) in both PCS-12 and MCS-12 scales. As expected, an inverse significant correlation between HRQL and degree of dyspnea in the PCS-12 and the MCS-12 scales was observed. Women had also a significantly worse HRQL than men in all physical and mental domains.

CONCLUSIONS

In outpatient women with COPD, HRQL was impaired especially the physical component of the SF-12. For the same age and severity of COPD, women showed significantly lower scores in all physical and mental domains of the SF-12 than men.

The economic costs and health-related quality of life of people with HIV/AIDS in the Canary Islands, Spain

BACKGROUND

The objective was to determine the economic burden, as well as the impact on HRQOL for people with HIV/AIDS in Spain in 2003.

METHODS

A cross-sectional study of 572 people with HIV were recruited from outpatient clinics in the Canary Islands, Spain. Demographic, health resources utilization, indirect costs and quality of life data were collected through medical records and questionnaires filled out by people with HIV. HRQOL was measured with two generic questionnaires: SF-36 and EQ-5D.

RESULTS

In 2003 annual costs of caring for patients with asymptomatic HIV, symptomatic HIV and AIDS were euro10,351, euro14,489 and euro15,750, respectively. The HRQOL with the EQ-5D was 0.78. SF-36 summary results for physical and mental health were 48.30 and 38.80, respectively.

CONCLUSION

HIV/AIDS represent a high economic impact from society point of view. the structure of health care costs have changed due to these new drugs, increasing the weight of pharmaceutical treatment over total costs and decreasing the importance of inpatient care costs. In spite of the therapeutic improvements, labour losses/indirect costs still represent a high cost. Costs and HRQOL were strongly associated with severity. Although the latest drug developments have not yet been able to find the definitive cure, they have allowed an improvement in expectancy of life and in the HRQOL of the patients.

Health-related quality of life in outpatients with COPD in daily practice: the VICE Spanish Study

BACKGROUND

The objective of this study was to measure health-related quality of life (HRQL) in outpatients with chronic obstructive pulmonary disease (COPD) and to assess differences in HRQL according to age, gender, and severity of COPD.

METHODS

A total of 9405 patients (79% men, mean age 68 years) participated in a cross-sectional study. HRQL was measured with the Short Form 12 Health Survey Questionnaire (SF-12). Severity of COPD was graded into three levels according to forced expiratory volume in one second value.

RESULTS

COPD severity was mild in 33.8% of cases, moderate in 49.3% and severe in 16.8%. The mean physical component summary (PCS-12) and mental component summary (MCS-12) scores were 36.8 +/- 10.4 and 47.2 +/- 11.2, respectively. General health and physical functioning domains were those with the lowest scores. The mean MCS-12 scores were significantly higher in men (47.9 +/- 10.9) than in women (44.1 +/- 11.8) (P < 0.001). Patients older than 60 years rated HRQL worse than patients aged 40-59 years. There were statistically significant differences according to severity of disease in the mean scores of all domains of the PCS-12 and MCS-12 scales.

CONCLUSIONS

The present findings show the influence of female gender, older age and moderate-to-severe of airflow limitation on HRQL in outpatients with COPD attended in daily practice.

[Reference values of the Spanish version of the SF-12v2 for the diabetic population]

OBJECTIVE

Perceived health status questionnaires provide important information for health outcomes research. Reference measures are required to interpret the health-related quality of life questionnaires belonging to the short form (SF) health survey family. Previous studies have provided these reference measures for the Spanish general population, but not for specific disease conditions. The aim of the present study was to obtain diabetic population-based norms for the Spanish version of the 12-item short form health survey version II (SF-12v2) in the region of Murcia (Spain).

METHODS

We performed a cross-sectional telephone survey in 1,500 non-institutionalized patients with type 1 or 2 diabetes, aged 18 years or older and representative of the region of Murcia. The central position, dispersion statistics and percentiles were calculated for each of the eight SF-12v2 scales and summary components (physical and mental).

RESULTS

The mental component summary (MCS) (mean: 50.5+/-12.8) was higher than the physical component summary (PCS) (42.5+/-11.8). By sex, men had more favorable MCS (53.6+/-11.6) and PCS (44.9+/-11.2) scores than women (MCS: 47.7+/-13.2; PCS: 40.3+/-11.9). The dimension with the highest score was vitality (men: 57.2+/-11.1; women: 51.9+/-12.1), while that with the lowest score was general health (men: 39.0+/-9.7; women: 35.8+/-10.0). When the groups were stratified by age, scores continued to be higher in men than in women.

CONCLUSIONS

The results of the present study should be taken as the diabetic population-based norms for the Spanish version of the SF-12v2 in the region of Murcia. These results may be useful to establish therapeutics targets, as well as for comparisons with the general, healthy and ill populations.

[Changes in health-related quality of life after ICU according to diagnostic category. Comparison of two measurement instruments]

OBJECTIVE

Assessment of health related quality of life (HRQOL) before and 12 months after discharge from a mixed intensive care unit (ICU) according to diagnostic category and the relationship between both instruments.

DESIGN

Prospective observational study.

SETTING

The combined medical/surgical ICU in a secondary university hospital with 450 beds.

PATIENTS

Patients admitted to the ICU over an 18-month period.

MAIN VARIABLES

Variables on demography, diagnosis on admission, severity of acute illness score (APACHE II), length of stay, procedures, mortality and the HRQOL were collected using the Short Form SF-36 and EQ-5D questionnaires. Health status prior to admission was evaluated retrospectively.

RESULTS

Both questionnaires were answered by 189 patients. A significant deterioration in the quality of life was observed 12 months after ICU discharge. Head injury and neurological patients had worse HRQOL one year after discharge. Multiple trauma patients presented severe physical limitations and pain, but without significant differences on the emotional level. The EQ Visual Analogue Scale and the EQ Index score showed clinically relevant differences in these three groups. Respiratory patients are the only group in whom the HRQOL improved. Comparison between both measurement instruments showed a strong correlation on the physical functioning level, but a weaker correlation on the emotional functioning one.

CONCLUSIONS

HRQOL assessment of ICU patients must be done according to a diagnostic category. Both instruments (the EQ-5D and SF-36) are capable of detecting changes in HRQOL. Despite differences in structure and content, both measure similar aspects of quality of life.

Smoking status, changes in smoking status and health-related quality of life: findings from the SUN ("Seguimiento Universidad de Navarra") cohort

We aimed to evaluate the association between smoking, changes in smoking, and quality of life in a cohort of Spanish university graduates. Smoking habits were self-reported at baseline and four years later. Quality of life was assessed using the Short Form-36 (SF-36) at year 4. Statistical differences in SF-36 scores between groups were determined using ANCOVA with age and sex as covariates. Out of 5,234 eligible participants over 2000-2006, there were 2,639 non-smoker participants, 1,419 ex-smokers, and 1,048 smokers. Within the previous four years, 435 participants became recent quitters and 205 starters. Comparing smoking and health status in year 4, non-smokers showed better scores than the other categories of ever smoking in all dimensions except in the vitality scale value, which was similar in non-smokers and in those smoking less than 15 cigarettes/day. Comparing changes in smoking and health in year 4, continuing smokers had statistically significant worse scores than non-smokers in general health, social functioning, role-emotional and mental health, whereas recent quitters showed statistically significant improvements in role-emotional and mental health over those who had continued smoking or those who became smokers. Our findings support a dose-response relationship between cigarette consumption and a worse quality of life in general and mental health in particular. They also support that changes in smoking have an impact on health.

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

GOALS OF WORK

Despite advances in allogeneic hematopoietic stem cell transplantation (HSCT), post-transplant complications are common, and patients' symptom experience has not been well documented.

PURPOSE

To characterize the symptom experience of adult patients pre-transplantation and days 0, 30, and 100 after allogeneic HSCT.

METHODS

Data from 76 participants enrolled in a prospective health-related quality of life (HRQL) study were used. Symptom occurrence, distress, and clusters were determined based on the 11 symptoms of the Symptom Distress Scale (SDS).

RESULTS

Participants were on average 40 years old (SD +/- 13.5). The majority (54%) received reduced intensity conditioning. Prevalent symptoms included fatigue (68%) and worry (68%) at baseline, appetite change (88%) at day 0, and fatigue at days 30 (90%) and 100 (81%). Participants reported the following symptoms as severely distressing: worry (16%) [baseline], insomnia (32%) [day 0], appetite change (22%) [day 30], and fatigue (11%) [day 100]. The total SDS score was highest at day 0 (M = 26.6 +/- 7.6) when the highest number of symptoms were reported [median = 8 (1-11)]. Symptoms formed clusters comprised of fatigue, appearance change, and worry at baseline, and fatigue, insomnia, and bowel changes at days 0 and 30. Compared to those with low symptom distress, participants with moderate/severe symptom distress reported poorer HRQL.

CONCLUSION

Allogeneic HSCT patients present for transplantation with low symptom distress yet experience multiple symptoms and high symptom distress after HSCT conditioning. Understanding the symptom experience of allogeneic HSCT patients can guide management strategies and improve HRQL.

Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border

Understanding influences on health-related quality of life (HRQL) is critical in order to track and improve the health of poor, vulnerable populations and reduce health disparities. However, studies assessing HRQL of minorities are relatively scarce. The purpose of this study was to document personal and socioenvironmental correlates to HRQL. The study population is Mexican Americans in the Texas-Mexico border region living in colonias - unincorporated, impoverished settlements with substandard living conditions along the U.S.-Mexico border. Mexican Americans living in colonias are one of the most disadvantaged, hard-to-reach minority groups in the United States. We used data from the Integrated Health Outreach System Project collected in 2002 and 2003. Our sample included 386 participants randomly selected and interviewed face-to-face with a structured survey. We measured HRQL and examined personal and socioenvironmental correlates. Unadjusted and adjusted (multivariate) logistic regression models were used for data analyses. We found that border Mexican Americans living in colonias were of similar mental health status compared to the general population of the United States, but worse off in terms of physical health. Poor education and long-term residency in colonias were predictors of lower physical health. Women reported worse mental health than men. Length of time living in a colonia, co-morbidity status, and perceived problems with access to healthcare was associated with poorer mental health status. This study provides information for health professionals and policymakers and underscores the need to provide better preventive and medical services for underserved populations. Major findings indicate the need for additional research centered on further exploration of the impact of economic, cultural, and social influences on HRQL among severely disadvantaged populations.

A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items

BACKGROUND

Allergic Rhinitis and its Impact on Asthma (ARIA) differentiates mild from moderate/severe patients on the basis of 4 severity items. The high prevalence of moderate/severe patients suggests the need to differentiate between them.

OBJECTIVES

To identify the categorization that maximizes discrimination between moderate and severe allergic rhinitis (AR) by using ARIA guidelines.

METHODS

Observational, cross-sectional study. Clinical characteristics, nasal symptoms (Total Symptom Score 4), and health-related quality of life (HRQL; Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12) were assessed. The association of severity items (sleep, daily activities/sport, work/school, and troublesome symptoms) with symptoms and HRQL was analyzed using linear regression models. ANOVA and effect sizes were used to assess differences in symptoms and HRQL among groups defined by the number of affected ARIA items.

RESULTS

Nontreated patients (N = 141) with moderate/severe AR were studied. All severity items showed a similar independent association with symptoms and HRQL scores, and there were no interaction effects, indicating that categorization of patients into moderate and severe could be based only on the number of items affected. Effect sizes were highest between patients with 4 affected ARIA items and those with 3, 2, or 1 affected item (effect sizes greater than 0.8 in all comparisons using Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12 Physical Composite Summary, and greater than 0.5 using the Total Symptom Score 4; P < .001).

CONCLUSION

Using ARIA severity items, the criterion that best discriminates AR severity is considering moderate those with 1 to 3 affected items and severe those with 4.

CLINICAL IMPLICATIONS

Discrimination between patients with moderate and severe AR should help to obtain homogeneous populations for both research and clinical purposes.

Estimación de un índice de utilidad mediante el uso de la versión española del Cuestionario de Salud SF-36: validez del índice SF-6D frente al EQ-5D

BACKGROUND AND OBJECTIVE

A new utility index derived of the SF-36, the SF-6D, was recently developed and has been compared with other utility measures. The objective was to validate this index in the Spanish version of SF-36 with respect to the EQ-5D.

METHOD

1,843 complete measures of the SF-36 and the EQ-5D from 1,283 patients who received a solid organ transplant were collected. SF-6D values were calculated using the model proposed by its creator and without tariff values (not weighted). EQ-5D values were calculated using Spanish visual analog scale tariff (VAS-t), the time-trade off tariff (TTO-t) and also without tariff values (not weighted). Spearman correlation coefficients were calculated between SF-6D and EQ-5D values.

RESULTS

Mean value (standard deviation) of SF-6D was 0.67 (0.15), of VAS-t, 0.69 (0.24) and of TTO-t, 0.70 (0.32). SF-6D values had moderate correlation with VAS-t (r = 0.734) and TTO-t (r = 0.731) (both p < 0.001). The not weighted SF-6D had a high correlation with the weighted version (r = 0.969, p < 0.001), and moderate with the VAS-t (r = 0.754), TTO-t (r = 0.750) and no weighted EQ-5D (r = 0.784) (p < 0.001).

CONCLUSIONS

The SF-6D index derived from the Spanish version of SF-36 seem to be a valid utility index to be used with the SF-36 databases from studies made in Spain.

An open-label study of quetiapine in the treatment of fibromyalgia

The aim of this exploratory study was to systematically assess the potential effectiveness and tolerability of quetiapine, an atypical antipsychotic, for the treatment of patients with fibromyalgia. This was a unicentre, open-label study conducted in thirty-five outpatients, 18 years or older, who met the ACR criteria for fibromyalgia and who had not satisfactorily responded to their previous fibromyalgia treatment. Quetiapine, flexibly dosed (25-100 mg/day), was added to their original treatment regimen for 12 weeks. The primary outcome measure was the mean change from baseline to endpoint in the Fibromyalgia Impact Questionnaire (FIQ) total score. Secondary efficacy measures included mean changes from baseline to endpoint in the scores of the Clinical Global Impression (CGI) of Severity scale, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), 12-Item Short Form Health Survey (SF-12), and individual items of the FIQ. Thirty (85.7%) patients (mean age 47+/-7.9, 93.3% females) had a postbaseline evaluation and constituted the intent-to-treat efficacy sample. Mean FIQ total score decreased significantly by 10.2 points from a baseline of 63.2 to 53.0 at study endpoint (p<0.001). A statistically significant reduction was observed in FIQ stiffness and FIQ fatigue subscores but not in FIQ pain subscore. Large effect sizes were observed for the FIQ total (1.04), CGI-severity (1.00) and PSQI (1.07), while moderate effect sizes (i.e.> or =0.50) were encountered in the FIQ fatigue, FIQ stiffness and SF-12 mental component summary. Quetiapine was safely administered and well tolerated. Despite the lack of effect on pain, the significant and relevant improvement in overall efficacy measures and quality of life suggests that quetiapine may be a valuable drug for treatment of patients with fibromyalgia that should be further tested in double-blind, placebo-controlled trials.

Analysis of the short form-36 (SF-36): the beta-binomial distribution approach

Health-related quality of life (HRQoL) is an important indicator of health status and the Short Form-36 (SF-36) is a generic instrument to measure it. Multiple linear regression (MLR) is often used to study the relationship of HRQoL with patients' characteristics, though HRQoL outcomes tend to be not normally distributed, skewed and bounded (e.g. between 0 and 100). A sample of 193 patients with eating disorders has been analysed to assess the performance of the MLR under non-normality conditions. Normal distribution was rejected for seven out of the eight domains. A beta-binomial distribution is suggested to fit the SF-36 scores. The beta-binomial distribution is not rejected for five out of the eight domains. Thus, a beta-binomial regression (BBR) is suggested to analyse the SF-36 scores. Results using MLR and BBR have been compared for real and simulated data. Performance of the BBR is shown to be better than MLR in the HRQoL domains with few ordered categories and very similar to MLR in the more continuous domains. Moreover, the interpretation of the estimates obtained with BBR is clinically more meaningful. A common technique of statistical analysis is preferable for all the HRQoL dimensions. Therefore, the BBR approach is recommended not only to detect significant predictors of HRQoL when SF-36 is used, but also to analyse and interpret the effect of several explanatory variables on HRQoL. Further work is required to test the better performance of BBR against standard methods for other HRQoL outcomes, populations or interventions.

Linguistic adaptation and validation of the Spanish version of the Benign Prostatic Hyperplasia-Patient Impact Measure (BPH-PIM)

BACKGROUND

The Benign Prostatic Hyperplasia-Patient Impact Measure (BPH-PIM) is a self-reported quality-of-life questionnaire for measuring the impact of urinary/prostate symptoms on the quality of life of patients with BPH. The aim of the present study was to adapt the original instrument to Spanish (for use in Spain) and to assess the psychometric properties of the new version.

METHODS

Linguistic adaptation was performed using the standard processes for establishing conceptual equivalence, and was partially conducted in parallel with original instrument development. Psychometric properties were assessed on a sample of 131 patients with BPH who were receiving treatment with doxazosin gastrointestinal therapeutic system (GITS).

RESULTS

All the standardised items had response rates > 99%; there were no floor or ceiling effects. Reliability in terms of Cronbach's alpha was 0.96 and the intraclass correlation coefficient was 0.97. Construct validity was confirmed by factor analysis. Convergent validity was confirmed in terms of the relationship to the 12-Item Short-Form Health Survey (SF-12) [p < 0.001], Health Utilities Index Mark III (HUI-3) [p < 0.001] and the International Prostate Symptom Score (IPSS) QOL item (p < 0.001). The instrument showed discriminant validity, in terms of IPSS groups (p < 0.001). The instrument was sensitive to change in terms of the correlation of the domain scores of the PIM to improvements in symptom scores (p < 0.001). Significant differences were observed for those who improved > or = 3 points in the IPSS scale (p < 0.001).

CONCLUSION

A psychometrically valid and conceptually equivalent version of the BPH-PIM questionnaire has been produced in Spanish to be used in Spain in patients with BPH.

[Female sexual function and related factors]

OBJECTIVES

To appraise female sexual function and to describe the factors that most commonly accompany dysfunction.

DESIGN

Transversal, descriptive study.

SETTING

Primary care.

PARTICIPANTS

Two-hundred and twenty-three women from 18 to 76 seen at an urban health centre between November 2004 and February 2005 and who wanted to take part in the study.

MAIN MEASUREMENTS

These were collected in an anonymous questionnaire structured in 5 sections with 53 items. The questionnaire comprised social and economic, cultural and life-style variables; female sexual function (FSF); and perception of own state of health (SF-12). A binary logistical regression analysis was run.

RESULTS

Female sexuality reaches its maximum expression at 30-35 years (FSF=30.0, 95% CI, 28.3-31.6). Risk factors for sexual dysfunction were: age over 44 and religion (OR, 6.5; 95% CI, 2.8-15); physical component on the SF-12 below 37 (OR, 3; 95% CI, 1.3-7.2); mental component on the SF-12 below 31 (OR, 3.1; 95% CI, 1.2-7.8). Not having a stable partner was a risk factor for arousal (OR, 9.6; 95% CI, 2.8-24.0); for lubrication (OR, 9.3; 95% CI, 4.0-21.5); for orgasm (OR, 8.8; 95% CI, 3.1-24.8); and for dyspareunia (OR, 8.9; 95% CI, 3.9-20.5). It was not a risk factor for desire or satisfaction with sexual life.

CONCLUSIONS

The profile of sexual dysfunction consisted of a woman aged over 44 without a stable partner, who practised religion, was unemployed and had perception of low quality of life.

Validation of a Spanish version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA)

OBJECTIVES

The purpose of this study was to develop a linguistically appropriate, culturally adapted, and appropriately validated Spanish version of the SMFA (SMFA-Mex).

DESIGN

Validation of a survey-based outcome instrument.

SETTING

Busy state hospital in southern Mexico.

PATIENTS/PARTICIPANTS

Consecutive trauma patients with a variety of orthopedic disorders.

INTERVENTION

N/A.

MAIN OUTCOME MEASUREMENTS

The SMFA-Mex was forward and back translated, administered to orthopedic trauma patients, and compared against the Spanish version of the SF-36s for criterion validity. Statistical analysis included factor analysis, criterion validation with the SF-36, and internal measures of reliability.

RESULTS

Factor analysis demonstrated three separate subscale dimensions: 1) upper-extremity dysfunction, 2) lower-extremity dysfunction, and 3) lifestyle alterations. Item analysis showed a high degree of internal consistency for the three subscales (subscale 1, r = 0.95; subscale 2, r = 0.94; subscale 3, r = 0.92). Test-retest reliability at 7 days was 0.93 for the upper-extremity dysfunction subscale, 0.95 for the lower-extremity dysfunction subscale, and 0.92 for the lifestyle-alterations subscale. Construct validity was established by comparison of the Brazilian version of the SF-36.

CONCLUSIONS

The SMFA-Mex was successfully translated and culturally adapted from the English original. The SMFA-Mex demonstrated adequate scale reliability and validity and yielded three distinct subscales using factor analysis.

Negative impact of chronic obstructive pulmonary disease on the health-related quality of life of patients. Results of the EPIDEPOC study

BACKGROUND

COPD is currently the fourth cause of morbidity and mortality in the developed world. Patients with COPD experience a progressive deterioration and disability, which lead to a worsening in their health-related quality of life (HRQoL). The aim of this work is to assess the Health-Related Quality of Life (HRQoL) of patients with stable COPD followed in primary care and to identify possible predictors of disease.

METHODS

It is a multicenter, epidemiological, observational, descriptive study. Subjects of both sexes, older than 40 years and diagnosed of COPD at least 12 months before starting the study were included. Sociodemographic data, severity of disease, comorbidity, and use of health resources in the previous 12 months were collected. All patients were administered a generic quality-of-life questionnaire, the SF-12, that enables to calculate two scores, the physical (PCS-12) and the mental (MCS-12) component summary scores.

RESULTS

10,711 patients were evaluated (75.6% men, 24.4% women), with a mean age of 67.1 years (SD 9.66). The mean value of FEV1 was 35.9 +/- 10.0%. Mean PCS-12 and MCS-12 scores were 36.0 +/- 9.9 and 48.3 +/- 10.9, respectively. Compared to the reference population, patients with COPD had a reduction of PCS-12, even in mild stages of the disease. The correlation with FEV1 was higher for PCS-12 (r = 0.38) than for MCS-12 (r = 0.12). Predictors for both HRQoL components were sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions. Other independent predictors of PCS-12 were age, body mass index and educational level.

CONCLUSION

Patients with stable COPD show a reduction of their HRQoL, even in mild stages of the disease. The factors determining the HRQoL include sex, FEV1, use of oxygen therapy, and number of visits to emergency rooms and hospital admissions.

Validation of a minimum outcome core set in the evaluation of patients with back pain

STUDY DESIGN

Prospective study of patients with subacute osteoporotic fracture (SOF) or chronic low back pain (CLBP).

OBJECTIVE

To evaluate reliability, validity, and responsiveness of a purposefully brief outcome instrument.

SUMMARY OF BACKGROUND DATA

A minimum standardized "core set" was proposed for monitoring patients with low back pain in 1998, but an assessment of metric properties was still lacking.

METHODS

The Core Set, SF-36, and Oswestry questionnaires were completed by 154 patients. Test-retest reproducibility was evaluated in a subsample of 43 stable patients with CLBP. Responsiveness was evaluated by estimating effect size (ES) of pre-postsurgery changes in 50 patients with SOF and 23 with CLBP.

RESULTS

The total Core Set showed good reproducibility with intraclass correlation coefficients on test-retest near the highest standard of 0.9, whereas internal consistency differed between patients with CLBP and those with SOF (Cronbach's alpha of 0.92 and 0.64, respectively). Most correlations of the Core Set with SF-36 and Oswestry, previously hypothesized as high, were >0.65, demonstrating good construct validity. Sensitivity to change of the Core Set (ES 0.4-2.3) is similar to the Oswestry (ES 0.7 and 2.3).

CONCLUSIONS

These findings support the potential usefulness of the Core Set when respondent burden is a major concern. However, subscale scores need to be further tested in other populations before they can be widely recommended.