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Further Validation of the Crohn's and Ulcerative Colitis Questionnaire-32 (CUCQ-32) to Measure the Quality of Life in Patients Treated with Biologics Therapy. Clin Pract 2022; 12:436-448. [PMID: 35735667 PMCID: PMC9221812 DOI: 10.3390/clinpract12030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Crohn’s and Ulcerative Colitis Questionnaire-32 (CUCQ-32) is a validated questionnaire to measure the quality of life (QoL) in Inflammatory Bowel Disease (IBD). However, it does not have stoma-specific questions and can be lengthy. This study aimed to validate a subset of the CUCQ-32 that would be suitable for patients with a stoma. Methods: Baseline data were collected from a cohort of patients with acute ulcerative colitis who were participating in the CONSTRUCT multicentre clinical trial. A subset of the CUCQ-32 questions was selected by stepwise regression. Further validation was examined using data from the UK IBD biological therapies audit. Construct validity was carried out using the EuroQol 5 dimensions (EQ5D) questionnaire, Simple Clinical Colitis Activity Index (SCCAI), and the Harvey−Bradshaw Index (HBI). Results: Using the data from 124 patients, a short-version questionnaire (CUCQ-12) was developed. Data from 484 patients with IBD (382 patients with Crohn’s disease, 76 patients with ulcerative colitis, and 26 patients with IBD-Unclassified) and 61 patients with stoma provided further validation of the CUCQ-12. A literature review and an expert focus group identified supplementary stoma-specific questions for the CUCQ-12+. The CUCQ-12+ demonstrated excellent internal consistency (Cronbach’s α = 0.86); established effective reproducibility (intra-class correlation coefficient = 0.74); correlated well with the EQ5D (r= −0.48), HBI (r = 0.45), and SCCAI (r = 0.43); and represented good responsiveness statistics (>0.5). Conclusions: CUCQ-12+ is a valid and reliable QoL measure used for all patients with IBD in clinical practice, including patients with a stoma.
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Sun D, Chi L, Liu J, Liang J, Guo S, Li S. Psychometric validation of the Chinese version of the Short Inflammatory Bowel Disease Questionnaire and evaluation of its measurement invariance across sex. Health Qual Life Outcomes 2021; 19:253. [PMID: 34743727 PMCID: PMC8572570 DOI: 10.1186/s12955-021-01890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/31/2021] [Indexed: 12/07/2022] Open
Abstract
Background This study aimed to evaluate the psychometric properties of the Chinese version of the Short Inflammatory Bowel Disease Questionnaire (C-SIBDQ), and its measurement invariance across sex in Chinese patients with inflammatory bowel disease (IBD). Methods Between September 2018 and July 2021, 284 patients with IBD were recruited from a spleen and stomach clinic. All participants completed the C-SIBDQ, 12-item Short-Form Health Survey (SF-12), nine-item Patient Health Questionnaire Depression Scale (PHQ-9), and the seven-item Generalized Anxiety Disorder Scale (GAD-7). Floor and ceiling effects were evaluated by testing frequencies and composition ratios for the minimum and maximum C-SIBDQ scores. Exploratory and confirmatory factor analysis (CFA) were used to evaluate the C-SIBDQ’s factor structure and construct validity. Convergent validity was evaluated through examining bivariate correlations between the C-SIBDQ and the SF-12, PHQ-9, and GAD-7. Internal consistency reliability and retest reliability were evaluated by respectively calculating the Cronbach’s α and the intraclass correlation coefficient (ICC) among a subsample (n = 79) after 2 weeks. The measurement invariance across sex was evaluated through multiple-group CFA. Results The C-SIBDQ scores showed no floor or ceiling effects and had a single-factor structure and good convergent validity, with significant correlations with the SF-12, PHQ-9 and GAD-7. Good internal consistency (Cronbach’s α = 0.920) and test–retest reliability (ICC = 959) were observed. The C-SIBDQ also showed measurement invariance across sex, and females showed higher C-SIBDQ scores than males. Conclusions The C-SIBDQ has high reliability, validity, and stability across sex, and can be used in clinics to assess the health-related quality of life of patients with IBD.
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Affiliation(s)
- Dajuan Sun
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.,Department of Spleen and Stomach Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Lili Chi
- Department of Spleen and Stomach Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China.
| | - Jiahui Liu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Junwei Liang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Song Guo
- Department of Spleen and Stomach Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Shaojie Li
- Department of Social Medicine and Health Service Management, Xiangya School of Public Health, Central South University, Changsha, 410078, China
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Abstract
Crohn's disease is an inflammatory bowel disease that is characterized by chronic inflammation of any part of the gastrointestinal tract, has a progressive and destructive course and is increasing in incidence worldwide. Several factors have been implicated in the cause of Crohn's disease, including a dysregulated immune system, an altered microbiota, genetic susceptibility and environmental factors, but the cause of the disease remains unknown. The onset of the disease at a young age in most cases necessitates prompt but long-term treatment to prevent disease flares and disease progression with intestinal complications. Thus, earlier, more aggressive treatment with biologic therapies or novel small molecules could profoundly change the natural history of the disease and decrease complications and the need for hospitalization and surgery. Although less invasive biomarkers are in development, diagnosis still relies on endoscopy and histological assessment of biopsy specimens. Crohn's disease is a complex disease, and treatment should be personalized to address the underlying pathogenetic mechanism. In the future, disease management might rely on severity scores that incorporate prognostic factors, bowel damage assessment and non-invasive close monitoring of disease activity to reduce the severity of complications.
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Sturm A, Maaser C, Calabrese E, Annese V, Fiorino G, Kucharzik T, Vavricka SR, Verstockt B, van Rheenen P, Tolan D, Taylor SA, Rimola J, Rieder F, Limdi JK, Laghi A, Krustiņš E, Kotze PG, Kopylov U, Katsanos K, Halligan S, Gordon H, González Lama Y, Ellul P, Eliakim R, Castiglione F, Burisch J, Borralho Nunes P, Bettenworth D, Baumgart DC, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13:273-284. [PMID: 30137278 DOI: 10.1093/ecco-jcc/jjy114] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Belgium
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza - University of Rome, Rome, Italy
| | - Eduards Krustiņš
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná PUCPR, Curitiba, Brazil
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Hannah Gordon
- Section of Gastroenterology & Hepatology, Royal London Hospital, London, UK
| | - Yago González Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
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Ochoa JB, Magnuson B, Swintowsky M, Loan T, Boulanger B, McClain C, Kearney P. Long-Term Reduction in the Cost of Nutritional Intervention Achieved by a Nutrition Support Service. Nutr Clin Pract 2016. [DOI: 10.1177/088453360001500404] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Alrubaiy L, Rikaby I, Dodds P, Hutchings HA, Williams JG. Systematic review of health-related quality of life measures for inflammatory bowel disease. J Crohns Colitis 2015; 9:284-92. [PMID: 25576752 DOI: 10.1093/ecco-jcc/jjv002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Several measures have been developed to assess the health-related quality of life [HRQoL] of patients with inflammatory bowel disease [IBD]. Our aim is to systematically review the HRQoL measures specific for patients with IBD and to appraise their measurement properties and methodological quality. METHODS We searched the PubMed, Embase, and PsycINFO databases for original articles describing the development and/or evaluation of one or more of the measurement properties [e.g. internal consistency, reliability, validity, responsiveness] of HRQoL measures specific for IBD. We assessed the measurement properties and examined the methodological quality of the measurement properties of each instrument using a standardized checklist. RESULTS We examined the full text of 75 articles that we deemed potentially eligible and identified 10 disease-specific HRQoL measures in IBD that covered different aspects of patients' lives. Internal consistency, construct validity, and content validity were the commonly evaluated measurement properties. Seven HRQoL measures scored positive for at least four of eight measurement properties. The majority of studies were rated as 'fair' to 'poor' when assessing their methodology quality. The most established HRQoL measure in the literature was the Inflammatory Bowel Disease Questionnaire [IBDQ]. CONCLUSIONS Most of the included HRQoL measures did not include all the required measurement properties or had a problem with their methodological quality. The most widely used and validated measure was the IBDQ. Further validation studies are required to support the use of other HRQoL measures.
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Affiliation(s)
- Laith Alrubaiy
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - Ibtihal Rikaby
- Cardiff and Vale University Health Board, Heath Park, Cardiff, UK
| | - Phedra Dodds
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - Hayley Anne Hutchings
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - John Gordon Williams
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
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Alrubaiy L, Cheung WY, Dodds P, Hutchings HA, Russell IT, Watkins A, Williams JG. Development of a short questionnaire to assess the quality of life in Crohn's disease and ulcerative colitis. J Crohns Colitis 2015; 9:66-76. [PMID: 25518049 DOI: 10.1093/ecco-jcc/jju005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Most of the disease-specific quality of life (QoL) measures for inflammatory bowel disease (IBD) are lengthy and time consuming. None have been established for routine use in clinical practice. We designed this study to develop a short QoL measure in IBD. METHODS A 32-item questionnaire, the Crohn's and ulcerative colitis questionnaire (CUCQ)-32 was developed by reviewing the literature of the previously validated questionnaires and by consultation with patients and experts. Construct validity was carried out using the Short Form 12 and the EuroQol 5 dimensions questionnaires and two disease severity measures (the Simple Clinical Colitis Activity Index and the Harvey-Bradshaw Index). Test-retest analysis was done by asking patients to complete the CUCQ questionnaire twice within a period of two weeks. RESULTS Data were obtained from 205 patients with IBD who completed the CUCQ-32. Psychometric analysis showed that Cronbach's α was 0.88, item-total correlations were good, and there were no ceiling or flooring effects. Stepwise regression identified eight items that accounted for >95% of the variance in the CUCQ-32. The resulting CUCQ-8 demonstrated good internal consistency (Cronbach's α = 0.84), had good reproducibility (intraclass correlation coefficient = 0.94), was well correlated with the EuroQol 5 dimensions questionnaire (r = 0.58) and the Short Form-12 (r = 0.65 for physical component and r = 0.63 for mental component), and was responsive to change (responsiveness ratio was 0.64, p-value < 0.05). CONCLUSIONS CUCQ-8 is a short questionnaire that has the potential to be an efficient tool for assessing the QoL of all patients with IBD in clinical practice.
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Affiliation(s)
- Laith Alrubaiy
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - Wai-Yee Cheung
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - Phedra Dodds
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - Hayley Anne Hutchings
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - Ian Trevor Russell
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - Alan Watkins
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
| | - John Gordon Williams
- Patient and Population Health and Informatics Research, College of Medicine, Swansea University, Swansea, UK
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8
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Blumenstein I, McDermott E, Keegan D, Byrne K, Ellison M, Doherty G, Schröder O, Mulcahy H. Sources of information and factual knowledge in Europeans with inflammatory bowel diseases: a cross-cultural comparison between German and Irish patients. J Crohns Colitis 2013; 7:e331-6. [PMID: 23453429 DOI: 10.1016/j.crohns.2013.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/29/2012] [Accepted: 01/08/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Disease related knowledge may be associated with quality of life, coping skills and medication adherence. However, little is known of cross-cultural variations regarding inflammatory bowel disease knowledge or sources of information and no study has assessed knowledge in diverse European IBD populations. AIM To assess sources of information and patient knowledge in Irish and German inflammatory bowel disease patients. METHODS Three hundred and three disease, gender, age and education matched German and Irish patients completed a previously validated knowledge questionnaire. Additional data were collected on age, gender, education, disease type and duration, family history, smoking habits, medication use, previous surgery and quality of life. RESULTS German patients obtained knowledge from a wider range of sources than Irish patients (p<0.001), most notably from the internet (p<0.001), newspapers and magazines (p=0.002). Both cohorts answered a similar number of questions correctly (Irish, mean 4.4 questions (Standard deviation (S.D.) 2.4); German, mean 4.3 (S.D. 2.2); p=0.67). In addition, both nationalities answered "don't know" to a similar number of questions (Irish, mean 3.3 (S.D. 3.1); German, mean 2.7 (S.D. 2.8); p=0.12) while Irish patients answered slightly fewer questions wrongly (Irish, mean 2.4 (S.D. 1.8); German, mean 3.1 (S.D. 1.9); p=0.002). A multivariate analysis included only Crohn's disease, female gender, young age and higher educational status as being significantly and independently associated with knowledge. CONCLUSIONS Our data suggest few differences between German and Irish IBD patients, despite cultural and linguistic differences, with regard to disease related knowledge of IBD.
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Affiliation(s)
- Irina Blumenstein
- First Department of Internal Medicine, Johann Wolfgang Goethe University, Frankfurt, Germany
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Construct validation and comparison of a novel postoperative quality-of-life metric and the Short Form-36 in colorectal surgery patients. Surgery 2013; 154:690-5; discussion 695-6. [DOI: 10.1016/j.surg.2013.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 06/25/2013] [Indexed: 11/22/2022]
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10
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Norton C, Dibley LB, Bassett P. Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life. J Crohns Colitis 2013; 7:e302-11. [PMID: 23228710 DOI: 10.1016/j.crohns.2012.11.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS No previous study has reported on faecal incontinence (FI) amongst people with IBD. We aimed to determine the frequency and severity of FI in people with IBD, its association with known FI risk factors, and the effect on quality of life. METHOD We randomly sampled 10,000 members of a national Crohn's and Colitis organisation over 18years old. Demographic information, medical history, FI (ICIQ-B), urinary continence (ICIQ-UI), quality of life (IBD-Q) and free text responses about FI were collected. Current disease activity was reported using the Harvey Bradshaw Index for Crohn's Disease (CD), and the Walmsley Index for ulcerative colitis (UC). Data were managed using Excel, Stata and SPSS 18. RESULTS 4827 responses were received: 3264 were complete and included (32.6% response). 2178 respondents were female (66.7%); mean age 50.26 yrs (range 19-92); CD 1543 (46.98%); UC 1599 (48.97%); other IBD 126 (3.85%); no diagnosis given 6 (0.18%). 74% (2391) of respondents reported FI (95% CI 72-75). Nine percent (299) reported regular FI. No association was found between FI and diagnosis. Significant associations were found in multivariable analysis between FI and age (p=0.005), gender (p<0.001), anal stretch (p=0.004), anal fistula surgery (p<0.001), colo-rectal surgery (p=<0.001), and urinary incontinence (p=<0.001), but not with vaginal delivery. Quality of life was significantly affected by FI (p<0.001). CONCLUSION Even if all non-respondents are continent, FI affects 24% of people with IBD. In our sample 74% reported FI, which can occur without active disease. There is a large currently unmet need for continence care in people with IBD.
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Affiliation(s)
- Christine Norton
- King's College, London & Imperial College Healthcare NHS Trust, London, United Kingdom.
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11
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Umanskiy K, Fichera A. Health related quality of life in inflammatory bowel disease: The impact of surgical therapy. World J Gastroenterol 2010; 16:5024-34. [PMID: 20976838 PMCID: PMC2965278 DOI: 10.3748/wjg.v16.i40.5024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Over the past 30 years, health related quality of life (HRQOL) has developed into a scientific index of subjective health status. Measurement of HRQOL is now clearly a mandatory component in evaluating interventions and management of medical and surgical diseases. In designing comprehensive and meaningful clinical studies particular attention ought to be made of measures of HRQOL. This is clearly very important in inflammatory bowel disease. Both ulcerative colitis (UC) and Crohn’s disease (CD) have a major impact on HRQOL. The chronic and unrelenting nature of these diseases, the often early age of onset, and the impact on social and sexual aspects of life significantly change patient’s perception, body image and quality of life. This manuscript is an overview of the available published data on HRQOL in UC and CD patients focusing on the impact of surgical therapy. While these two diseases may have some similarities in their management, clearly their impact on quality of life and the effects of are significantly different. Hence we are presenting the data separately.
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12
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Hoivik ML, Bernklev T, Moum B. Need for standardization in population-based quality of life studies: a review of the current literature. Inflamm Bowel Dis 2010; 16:525-36. [PMID: 19637337 DOI: 10.1002/ibd.21032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this systematic review we focus on the current use of and knowledge on health related quality of life in unselected, population-based IBD cohorts. We made a systematic literature search and included for comprehensive review papers that described a population-based cohort and that used validated HRQoL instruments. We show that even studies defined by the authors as population-based do not always meet the criteria set for being population-based. The heterogeneity of the study populations we have reviewed emphasizes that "population-based" must be defined very meticulously and that study populations need to be scrutinized with regard to all characteristics of the cohort before one can compare their results. Different definitions of study populations as population-based affect outcomes. We also show that use of the same HRQoL questionnaires does not guarantee comparable results as there are several different versions of the questionnaires, the different translations are not always comparable and at last there are several methods of computing and presenting the data. Detailed accumulation of knowledge and thorough meta analyses is therefore difficult hence we find it necessary to raise a discussion on the need of standardization in this field of research and we make some simple recommendations on factors we find important.
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Affiliation(s)
- Marte Lie Hoivik
- Section of Gastroenterology, Medical Department, Oslo University Hospital, Aker, Norway.
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13
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Delaney CP, Lindsetmo RO, O'Brien-Ermlich B, Cheruvu VK, Laughinghouse M, Champagne B, Marderstein E, Obias V, Reynolds H, Debanne SM. Validation of a novel postoperative quality-of-life scoring system. Am J Surg 2009; 197:382-5. [PMID: 19245919 DOI: 10.1016/j.amjsurg.2008.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 08/22/2008] [Accepted: 11/08/2008] [Indexed: 01/05/2023]
Abstract
BACKGROUND No specific scoring system exists for the assessment of postoperative quality of life (QOL) after major abdominal surgery. This study prospectively validates PQL, a novel prospective scoring system in patients having laparoscopic or open major abdominal colorectal surgery. METHODS Six experienced surgeons developed the questionnaire. Twenty patients reviewed and selected the most relevant questions, yielding 14 questions. One hundred patients undergoing a variety of colorectal procedures completed the questionnaire preoperatively, and on postoperative days (POD) 1, 2, 4, 8, 12, 30, and 60. Internal validation was assessed by Cronbach's alpha and factor analysis. RESULTS Cronbach's alpha revealed excellent internal consistency, ranging from .84 to .94 at all time points, even at POD 1 when Cronbach's alpha was .79, demonstrating that the items in the questionnaire measured the same underlying construct. Factor analysis consistently loaded at each follow-up time on the same 2 factors. CONCLUSIONS Factor analysis consistently loaded at each follow-up time on the same 2 factors, designated the PQL Symptom Score and the PQL Recover Score.
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Affiliation(s)
- Conor P Delaney
- Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
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14
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Ren WH, Lai M, Chen Y, Irvine EJ, Zhou YX. Validation of the mainland Chinese version of the Inflammatory Bowel Disease Questionnaire (IBDQ) for ulcerative colitis and Crohn's disease. Inflamm Bowel Dis 2007; 13:903-10. [PMID: 17309070 DOI: 10.1002/ibd.20128] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease affects the quality of a patient's life in many ways, but no validated instrument for measuring disease-specific quality of life in these patients is available for use in Mainland China. The aim of our study was to develop and validate the Mainland Chinese translation of the Inflammatory Bowel Disease Questionnaire for ulcerative colitis (UC) and Crohn's disease (CD) by assessing its construct validity, discriminant ability, reliability, and sensitivity to change. METHODS We administered a developed Mainland Chinese version of the Inflammatory Bowel Disease Questionnaire (IBDQ). Ninety-two Mainland Chinese patients (52 with UC and 40 with CD) completed the Mainland Chinese version of the IBDQ, the Chinese version of SF-36, and the global scale for general well-being. A subgroup of 71 patients also completed the Mainland Chinese version of the IBDQ and the global scales for general well-being on a second occasion. Clinical activity was assessed by the Walmsley and Harvey-Bradshaw simple indices. RESULTS The Mainland Chinese IBDQ scores correlated well with the related SF-36 dimensional scores for all 4 domains (r = 0.51-0.82), SF-36 total scores (r = 0.58-0.87), the colitis activity index (r = -0.56-0.74), and the CD activity index (r = -0.64-0.78) as well as with the global scales. The Mainland Chinese IBDQ was able to discriminate between active and inactive disease. Cronbach's alpha was 0.95 in UC and 0.94 in CD. Test-retest reliability was excellent (intraclass correlation coefficient 0.69-0.93) when it was repeated in patients whose clinical activity index was stable. In contrast, there was a significant difference between the baseline and follow-up measurements in patients whose clinical activity index was changed. CONCLUSIONS The Mainland Chinese IBDQ proved to be a valid, discriminative, and reliable instrument for assessing health-related quality of life in patients with UC and CD in Mainland China.
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Affiliation(s)
- W H Ren
- Department of Nursing, Second Affiliated Hospital, College of Medicine, Zhejiang University, PR China
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15
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Thaler K, Dinnewitzer A, Oberwalder M, Weiss EG, Nogueras JJ, Wexner SD. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn's disease. Colorectal Dis 2005; 7:375-81. [PMID: 15932562 DOI: 10.1111/j.1463-1318.2005.00769.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Surgery for Crohn's disease (CD) is associated with a high recurrence rate and quality of life (QOL) in these patients is controversial. The aim of this study was to assess QOL in patients after laparoscopic and open surgery for CD by two different validated instruments, a generic nonspecific score and a specific gastrointestinal QOL index. PATIENTS AND METHODS Patients with CD who underwent elective laparoscopic or open ileocaecal resection with primary anastomosis between 1992 and 2000 were followed for recurrence and surgery-related complications. QOL was assessed by the SF-36 Health Survey containing a mental (MCS) and a physical (PCS) component summary score and by the Gastrointestinal Quality of Life Index (GIQLI) developed by Eypasch. RESULTS Thirty-seven patients with a mean age of 48.8 +/- 18.4 years including 23 females and 14 males were evaluated at a mean follow-up of 42.6 +/-25.8 months (minimum of 8 months). Twenty-one (57%) patients underwent laparoscopic resection and 16 (43%) open surgery. Both groups were well matched for age, gender, ASA class and body mass index. Fourteen (38%) patients developed recurrent disease and 3 (8%) had postoperative incisional hernias. Overall, QOL scores were 103 +/- 26.8 for the GIQLI, 47.2 +/- 11.8 for the PCS, and 49.2 +/- 11.5 for the MCS. The GIQLI correlated well with the SF36, correlation coefficient = 0.68 for GIQLI vs PCS (95% CI, 0.41,0.95) and 0.67 for GIQLI vs MCS (95%CI, 0.39, 0.95), respectively. When compared to the general US population, mean GIQLI scores (-13.8, P = 0.002) and mean PCS scores (-4.7, P = 0.001) were significantly lower in these patients than in healthy individuals. In a multivariate analysis of impact factors on QOL, recurrence within the follow-up period was the single significant determinant reducing the PCS (-35.1, P = 0.026) and the GIQLI (-36.1, P = 0.018). CONCLUSION QOL is significantly reduced in patients with CD at long-term follow-up after both laparoscopic and open surgery. Recurrence is the only factor adversely affecting QOL of CD patients in remission irrespective of the operative technique applied.
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Affiliation(s)
- K Thaler
- Department of Colorctal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA
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16
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Talley NJ, Wiklund I. Patient reported outcomes in gastroesophageal reflux disease: an overview of available measures. Qual Life Res 2005; 14:21-33. [PMID: 15789938 DOI: 10.1007/s11136-004-0613-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common, chronic disorder. The main symptom of GERD is heartburn, although a diverse range of symptoms can be associated with the disease including acid regurgitation and epigastric pain. GERD is also a risk factor for Barrett's oesophagus and esophageal adenocarcinoma. The impact of GERD symptoms on patients' lives can be profound and is unrelated to the presence or absence of esophagitis. The impact of GERD can be measured by assessing the patient perspective using Patient Reported Outcomes (PROs). There are two categories of questionnaires that can be used to measure the effect of GERD on health-related quality of life (HRQoL), namely generic and disease or treatment specific. The use of PRO instruments has become more accepted in the assessment of disease treatment. Well-designed instruments that assess physical, psychological and emotional factors can provide clinicians with the data that will promote effective management decisions for the treatment of GERD. The most frequently used instruments in GERD are reviewed here, in terms of their psychometric properties.
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Affiliation(s)
- Nicholas J Talley
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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17
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Abstract
The operative technique of sphincteroplasty is only for isolated disruption of the sphincter muscle. Patients best suited for surgical corrections are those in whom incontinence is secondary to an anterior (obstetrical) sphincter defect. Due to the disappointing long-term results, the operation may be postponed if appropriate. At present, firstline treatment often is a biofeedback training program. It is well known that a persistent defect after repair is associated with an immediate poor outcome From 1995 - 2003 we have performed 40 sphincteroplasty on 38 patients with a mean age of 34 (range 19 - 71) years. The long-term results the of sphincteroplasty are not so promising. 3 techniques are available for measuring quality of life: Descriptive measures. Severity measures, Impact measures Sphincteroplasty, despite poor long-term results, is the best surgical treatment option for isolated, preferably anterior sphincter defects.
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Affiliation(s)
- J Pfeifer
- Physiology Laboratory, Medical University Graz, Austria
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18
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Moyer CA, Sonnad SS, Garetz SL, Helman JI, Chervin RD. Quality of life in obstructive sleep apnea: a systematic review of the literature. Sleep Med 2003; 2:477-91. [PMID: 14592263 DOI: 10.1016/s1389-9457(01)00072-7] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the literature on obstructive sleep apnea (OSA) and health-related quality of life (HRQOL). BACKGROUND OSA affects nearly one in four men and one in ten women aged 30-60 years in the United States. Health consequences of OSA can include neuropsychiatric and cardiovascular sequela that disrupt professional, family, and social life and negatively impact HRQOL. METHODS We conducted a comprehensive review of the literature on HRQOL and OSA, with special attention paid to instruments developed specifically for OSA. RESULTS Generic instruments used to study HRQOL and OSA include: Medical Outcomes Study Short Form-36, Nottingham Health Profile, Sickness Impact Profile, Functional Limitations Profile, EuroQol, and Munich Life Quality Dimension List. Specific instruments include: Calgary Sleep Apnea Quality of Life Instrument, Functional Outcomes of Sleep Questionnaire, OSA Patient Oriented Severity Index, the OSA-18, and Cohen's pediatric OSA surgery quality of life questionnaire. CONCLUSIONS OSA patients have impaired HRQOL when compared with healthy age- and gender-matched controls. Treatment with continuous positive airway pressure appears to improve HRQOL. Other treatment modalities have not been rigorously studied. In addition, more data are needed from preference-based measures that allow conversion to utility scores, which can be used to calculate quality-adjusted life years and cost-effectiveness ratios.
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Affiliation(s)
- C A Moyer
- Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies, Department of Internal Medicine, University of Michigan School of Medicine, 300 North Ingalls Street, 3A00 NIB, Box 0409, Ann Arbor, MI 48109-0409, USA.
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19
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Abstract
The measurement of fecal incontinence is challenging. Because fecal incontinence is a symptom, the subjective perception of the patient must be the foundation of any evaluation of incontinence or the impact of incontinence. The lack of a criterion standard makes testing measures for reliability and validity more difficult. Despite this, many measures are available and can be divided into three broad categories: descriptive measures that do not provide summary scores; severity measures that assess the frequency and type of incontinence; and impact measures that assess the effect of incontinence on quality of life. The strengths and weaknesses of currently available measures are presented in this review.
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Affiliation(s)
- Nancy N Baxter
- Division of Colorectal Surgery, University of Minnesota, Minneapolis, MN, USA
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20
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Mamula P, Markowitz JE, Baldassano RN. Inflammatory bowel disease in early childhood and adolescence: special considerations. Gastroenterol Clin North Am 2003; 32:967-95, viii. [PMID: 14562584 DOI: 10.1016/s0889-8553(03)00046-3] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several aspects of IBD overlap between pediatric and adult population. Those include nutritional issues, bone density, and medical and surgical therapies. Some aspects like natural course of the disease, and epidemiology and genetics are more easily examined and researched in the pediatric population. Others like pubertal and growth delay, and transition of health care are unique to pediatric patients. This article examines some of the similarities, as well as differences of IBD in these two populations.
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Affiliation(s)
- Petar Mamula
- University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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21
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Kiran RP, Delaney CP, Senagore AJ, O'Brien-Ermlich B, Mascha E, Thornton J, Fazio VW. Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn's disease. Am J Gastroenterol 2003; 98:1783-9. [PMID: 12907333 DOI: 10.1111/j.1572-0241.2003.07592.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The Short Form 36 (SF-36) questionnaire is the most widely accepted measure of quality of life (QOL); however, it is cumbersome to use and requires complicated analysis. The Cleveland Global Quality of Life (CGQL) is a simpler tool, which has been validated in patients with ulcerative colitis undergoing restorative proctocolectomy. This study validates CGQL in patients with Crohn's disease and determines the correlation of QOL measurement systems with disease activity as measured by the Crohn's Disease Activity Index (CDAI). METHODS All patients with Crohn's disease presenting to this department between September 2001 and February 2002 were prospectively entered into a database, including demographic data, disease manifestations, Vienna classification, age at diagnosis, and duration of Crohn's disease. SF-36, CGQL, and CDAI scores were entered concurrently. Cronbach's alpha was used to assess the internal consistency among the components of the CGQL score. Correlation among various QOL measures was assessed with Spearman's test. Relationships between QOL measures and various baseline factors were assessed by Wilcoxon rank sum test, Student's t test, Kruskal-Wallis test, and Pearson's test, depending on the type and distribution of data. Change from baseline in the CGQL was assessed with the Wilcoxon signed rank test. RESULTS One hundred seventy-eight (178) patients were entered into the database, and 169 completed QOL and CDAI data. There was a significant correlation between SF-36 and CGQL. CGQL and SF-36 correlated similarly with CDAI. Neither patient age, gender, or smoking history were associated with CGQL. CONCLUSIONS CGQL correlates with disease activity and is a simple measure of QOL in Crohn's disease.
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Affiliation(s)
- Ravi P Kiran
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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22
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Delaney CP, Kiran RP, Senagore AJ, O'Brien-Ermlich B, Church J, Hull TL, Remzi FH, Fazio VW. Quality of life improves within 30 days of surgery for Crohn's disease. J Am Coll Surg 2003; 196:714-21. [PMID: 12742203 DOI: 10.1016/s1072-7515(03)00131-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The effect of surgery on quality of life (QOL) in the early postoperative period is important in Crohn's disease because of the multiple surgical procedures that patients undergo and the acute QOL benefits that might occur as a result of modifications of medical treatment. Earlier studies of the effect of surgery on QOL have been retrospective and assessed changes 3 to 24 months after surgery. This study prospectively assesses the effect of surgery on QOL in the early postoperative period. STUDY DESIGN Patients requiring surgical management of sequelae of Crohn's disease were obtained from a prospectively entered database including data on QOL. Preoperative and 30-day postoperative QOL were determined in 82 patients using Cleveland Global Quality of Life (CGQL) scores (range from 0 [worst] to 10 [best possible] QOL). Preoperative and postoperative scores were compared using a paired t-test to determine the significance of any change in QOL after surgery. The effect of other variables on change in QOL after surgery was assessed using the t-test or analysis of variance. Multifactor analysis of variance was used to assess the effect of several independent variables. RESULTS Eighty-two patients (41 women) of 142 patients who had had surgery (58%) had complete preoperative and 30-day postoperative scores. The incidence of complications was 23% (11% were major). There was a significant improvement in QOL 30 days after surgery as measured by CGQL (0.6 +/- 0.2 preoperative to 0.7 +/- 0.2 postoperative; mean +/- SD; p < 0.001). The mean preoperative CGQL was 0.56 +/- 0.24 and the mean improvement was 0.11 +/- 0.20 toward a better QOL. Female patients (p < 0.05) and those who did not develop complications within 30 days of surgery (p < 0.05) had a significantly greater improvement in CGQL after surgery than other groups. No other factor was predictive of improved outcomes. CONCLUSIONS QOL as measured by CGQL improves early after surgery (30 days postoperatively). Improvement in CGQL is greater in female patients and patients who do not develop complications in the postoperative period. It is not affected by other patient characteristics, nature of disease, indication, or procedure performed. Most patients who undergo surgery for Crohn's disease feel that surgery has helped them and would undergo surgery again.
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Affiliation(s)
- Conor P Delaney
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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23
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Weinryb RM, Liljeqvist L, Poppen B, Gustavsson JP. A longitudinal study of long-term quality of life after ileal pouch-anal anastomosis. Am J Surg 2003; 185:333-8. [PMID: 12657385 DOI: 10.1016/s0002-9610(02)01424-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is a lack of longitudinal long-term studies of quality of life (QOL) after surgery with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, where cohorts of patients are used as their own controls. METHODS Forty ulcerative colitis patients who had undergone IPAA were prospectively assessed while they had a temporary ileostomy, and at a median of 18 months and 7 years after ileostomy closure. QOL was measured with the Psychosocial Adjustment to Illness Scale and the Well-Being Profile. RESULTS QOL was good at all three time points and, with some exceptions, did not change significantly between the assessments. There was a high degree of stability in the patients' evaluation of their QOL over time. CONCLUSIONS QOL was already good when the patients had a temporary ileostomy and generally did neither improve nor deteriorate during 7 years after ileostomy closure. QOL was also quite stable in terms of individual differences.
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Affiliation(s)
- Robert M Weinryb
- Department of Clinical Neuroscience, Psychotherapy Section, Karolinska Institutet, Björngårdsgatan 25, SE-118 52 Stockholm, Sweden.
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24
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Andersson P, Olaison G, Bendtsen P, Myrelid P, Sjödahl R. Health related quality of life in Crohn's proctocolitis does not differ from a general population when in remission. Colorectal Dis 2003; 5:56-62. [PMID: 12780929 DOI: 10.1046/j.1463-1318.2003.00407.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE All treatment in Crohn's disease, although palliative, aims at restoring full health. The objective of this study was to compare health-related quality of life and psychosocial conditions in patients with Crohn's proctocolitis with a general population. PATIENTS AND METHODS One hundred and twenty-seven patients with Crohn's proctocolitis (median age 44 years, 44.1% men) were compared with 266 controls (median age 45 years, 50.7% men). A questionnaire consisting of the Short Form-36 (SF-36), the Psychological General Well-Being Index (PGWB) and a visual analogue scale (VAS) evaluating general health as well as questions regarding psychosocial conditions was used. Disease activity was evaluated by Best's modification of the classical Crohn's Disease Activity Index. RESULTS Patients in remission had a health related quality of life similar to controls according to the SF-36 apart from general health where scores were lower (P < 0.01). Patients with active disease scored lower in all aspects of the SF-36 (P < 0.001 or P < 0.0001) as well as the PGWB (P < 0.0001). In a model for multiple regression including age, gender, concomitant small bowel disease, permanent stoma, previous colonic surgery, disease activity, duration, and aggressiveness, disease activity was the only variable negatively predicting all 8 domains of the SF-36 in the patient group (P < 0.001). The mean annual sick-leave for patients and controls were 33.9 and 9.5 days (P < 0.0001), respectively. Sixty-eight percent of the patients and 78.4% of the controls (P = 0.04) were married or cohabited, 67.7% and 78.0% (P = 0.04), respectively, had children. CONCLUSION The health related quality of life for patients with Crohn's proctocolitis in remission does not differ from the general population. The disease has, however, a negative impact on parenthood, family life and professional performance.
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Affiliation(s)
- P Andersson
- Department of Surgery, Division of Colorectal Surgery, University Hospital, S-58185 Linköping, Sweden.
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25
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Smolen DM, Topp R. Self-care agency and quality of life among adults diagnosed with inflammatory bowel disease. Qual Life Res 2002; 10:379-87. [PMID: 11763250 DOI: 10.1023/a:1012271520972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Individuals with inflammatory bowel disease (IBD) often exhibit anxiety and depression, pain and reduced energy but may not adequately develop self-care agency (SCA) to manage IBD. The purpose of this study was to examine whether SCA is related to quality of life in adults diagnosed with IBD. The sample of 34 individuals for this descriptive, correlational study completed three questionnaires including the Appraisal of self-care agency scale (A.S.A.-A Scale), the Inflammatory bowel disease questionnaire and a Demographic data questionnaire. Results indicated SCA was unrelated to indicators of quality of life among IBD individuals. This finding may be attributed to the high level of functioning of the sample. However, IBD quality of life (emotional functioning, social functioning, and bowel and systemic symptoms) was negatively correlated with the number of medications individuals took and positively correlated with the number of diagnosed chronic illnesses.
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Affiliation(s)
- D M Smolen
- Medical College of Ohio, School of Nursing, Toledo, USA.
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26
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Whalen GF, Ferrans CE. Quality of life as an outcome in clinical trials and cancer care: a primer for surgeons. J Surg Oncol 2001; 77:270-6. [PMID: 11473376 DOI: 10.1002/jso.1107] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- G F Whalen
- Department of Surgery, University of Connecticut School of Medicine, UC Health Center, 263 Farmington Ave., Farmington, CT 06030-3955, USA.
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de Rooy EC, Toner BB, Maunder RG, Greenberg GR, Baron D, Steinhart AH, McLeod R, Cohen Z. Concerns of patients with inflammatory bowel disease: results from a clinical population. Am J Gastroenterol 2001; 96:1816-21. [PMID: 11419835 DOI: 10.1111/j.1572-0241.2001.03877.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The impact of chronic illness is influenced not just by physical symptoms but also by psychosocial factors. The aim of this study was to determine the concerns of inflammatory bowel disease (IBD) patients in a clinical sample, if concerns differ between patients from varied clinical and demographic variables, and if concerns influence well-being beyond the influence of physical symptoms. METHODS Subjects (n = 259) completed a validated measure of concerns specific to IBD and provided demographic and disease-related information. RESULTS The most intense concerns involved both physical (e.g., energy level) and psychosocial issues (e.g., achieving full potential). There were numerous differences in disease concerns based on ability to work but none based on disease duration. Factor analysis yielded three indices: body image and interpersonal concerns, general physical impact, and disease stigma. Age and education only affected certain concern indices in subgroups of patients. Greater concerns negatively influenced well-being beyond the influence of physical symptoms. CONCLUSION Psychosocial factors, in addition to physical symptoms, play an important role on the impact of illness in patients with IBD.
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Affiliation(s)
- E C de Rooy
- Department of Psychiatry, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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O'Bichere A, Wilkinson K, Rumbles S, Norton C, Green C, Phillips RK. Functional outcome after restorative panproctocolectomy for ulcerative colitis decreases an otherwise enhanced quality of life. Br J Surg 2000; 87:802-7. [PMID: 10848862 DOI: 10.1046/j.1365-2168.2000.01404.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Restorative panproctocolectomy is a favoured operation for ulcerative colitis, but altered bowel habit may adversely affect overall quality of life. METHODS Specific and generic quality of life questionnaires and an instrument to award money for continuing disability based on government guidelines were sent to 103 patients who had curative surgery for ulcerative colitis between 1995 and 1997. Seventy-one patients returned completed questionnaires: 30 with an ileostomy (representing incontinence and abnormal body image), 11 with a Koch pouch (representing continence and abnormal body image) and 30 with a pelvic pouch (representing continence and normal body image). RESULTS Patients valued the disability of having an ileostomy similar to that for a Koch pouch or a pelvic pouch: pound 40 000, pound 30 000 and pound 40 000 respectively (P = 0. 97). There was no sex difference. Body image measured with a visual analogue scale (least = 1, worst = 10) was worst with the ileostomy and Koch pouch (8 each) and best with a pelvic pouch (5) (P = 0.06). However, pelvic pouches scored significantly worse than an ileostomy with regard to altered bowel emptying (pelvic pouch, 8; Koch pouch, 7; ileostomy, 5) (P = 0.01). CONCLUSION Poor function after pelvic pouch surgery offsets any advantage in body image over an ileostomy. Thus, overall quality of life and perceived monetary damage were the same for the two operations. Improved pelvic pouch function is likely to be reflected in better quality of life after restorative panproctocolectomy.
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Affiliation(s)
- A O'Bichere
- St Mark's Hospital and Northwick Park Institute for Medical Research, Harrow, UK
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30
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Ko CY, Rusin LC, Schoetz DJ, Moreau L, Coller JA, Murray JJ, Roberts PL, Arnell TD. Does better functional result equate with better quality of life? Implications for surgical treatment in familial adenomatous polyposis. Dis Colon Rectum 2000; 43:829-35; discussion 835-7. [PMID: 10859085 DOI: 10.1007/bf02238022] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The main impetus for a patient with familial adenomatous polyposis to choose colectomy with ileorectal anastomosis over ileal pouch-anal anastomosis is the better functional result. However, does better functional result necessarily translate into better overall quality of life? Previous studies of other diseases have demonstrated no such correlation. This study was performed to determine whether any relationship exists between functional result and quality of life in patients with familial adenomatous polyposis after ileorectal anastomosis and ileal pouch-anal anastomosis. METHODS All patients with familial adenomatous polyposis who underwent colectomy with ileorectal anastomosis or proctocolectomy with ileal pouch-anal anastomosis from 1980 to 1998 were studied. Functional data were obtained by questionnaire. Health-related quality of life was assessed by two validated instruments, the SF-36 Physical and Mental Health Summary Scales and the SF-36 Health Survey, which measure physical and mental functioning and eight separate health-quality dimensions, including health perception, physical and social functioning, physical and emotional role limitations, mental health, bodily pain, and energy or fatigue. RESULTS Data were obtained in 44 of 68 patients, 14 with ileorectal anastomosis and 30 with ileal pouch-anal anastomosis. No differences were demonstrated between the two groups for patient age, mean follow-up time, and mean patient age at operation. Functional results were worse for the ileal pouch-anal anastomosis group vs. the ileorectal anastomosis group in number of bowel movements per day (7.5 vs. 5.2; P < 0.05), leakage (43 vs. 0 percent; P < 0.01), pad usage (17 vs. 0 percent; P < 0.01), perianal skin problems (33 vs. 7 percent; P < 0.01), food avoidance (80 vs. 43 percent; P < 0.01), and inability to distinguish gas (37 vs. 7 percent; P < 0.01). Results of the health-related quality-of-life surveys, however, demonstrated no difference between the ileal pouch-anal anastomosis and ileorectal anastomosis groups. The Physical and Mental summary scales for the ileal pouch-anal anastomosis and ileorectal anastomosis groups were not significantly different (Physical Health Scale, 50.3 vs. 50.9; Mental Health Scale, 51.7 vs. 49.6), and none of the eight dimensions of the SF-36 health survey demonstrated statistical differences between the ileal pouch-anal anastomosis and ileorectal anastomosis groups. CONCLUSION Better functional results were not equated with better quality of life in this pilot study. Although patients with the ileorectal anastomosis have better functional results than those with ileal pouch-anal anastomosis, the measured health-related quality of life as determined by a validated generic health-related quality-of-life instrument is the same for both groups. These results suggest that all patients with familial adenomatous polyposis might be optimally treated with an ileal pouch-anal anastomosis. More importantly, this study suggests that health-related quality of life should play a greater role in the evaluation of care and treatment in colon rectal surgery.
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Affiliation(s)
- C Y Ko
- Department of Colon Rectal Surgery, The Lahey Clinic, Burlington, Massachusetts 01805, USA
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31
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Moskovitz DN, Maunder RG, Cohen Z, McLeod RS, MacRae H. Coping behavior and social support contribute independently to quality of life after surgery for inflammatory bowel disease. Dis Colon Rectum 2000; 43:517-21. [PMID: 10789749 DOI: 10.1007/bf02237197] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to examine the association between coping behavior at the time of surgery and inflammatory bowel disease-related quality of life after surgery. We also investigated the relationship between perceived social support and both coping style and postsurgical quality of life. Finally, the value of the Medical Outcomes Study Social Support Scale for preoperative screening was assessed. METHODS Eighty-six subjects who had surgery during a 12-month period completed the Inflammatory Bowel Disease Questionnaire, the Ways of Coping, a measure of inflammatory bowel disease symptom severity, and the Medical Outcomes Study Social Support Scale. Analysis of variance was used to test an association between Ways of Coping score and membership in a high quality of life (Inflammatory Bowel Disease Questionnaire > mean) or low quality of life (Inflammatory Bowel Disease Questionnaire < mean) cohort. Comparison of group means between the high quality of life and low quality of life cohorts identified Ways of Coping behavior scales that differed between the high quality of life and low quality of life cohorts. Stepwise linear regression analysis was then used to determine the independent contribution of 1) current inflammatory bowel disease symptoms, 2) current perceived social support, and 3) identified coping behaviors (self-control, self-blame, and escape, summed as a single index named "maladaptive coping") to postsurgical quality of life. The sensitivity, specificity, and negative predictive value of the Medical Outcomes Study Social Support Scale were assessed. RESULTS The lower quality of life group distinguished itself by more frequent use of maladaptive coping. Regression analysis revealed that current inflammatory bowel disease-related symptoms, current perceived social support, and maladaptive coping behaviors at the time of surgery each made a highly significant independent contribution to postsurgical quality of life. The sensitivity of the Medical Outcomes Study Social Support Scale in identifying patients with poor postsurgical quality of life was 81 percent, and the specificity was 77 percent. The negative predictive value was 93 percent. CONCLUSIONS Three coping behaviors which seem to be maladaptive (self-control, self-blame, and escape) are associated with lower quality of life after surgery for inflammatory bowel disease. These coping behaviors make a contribution to postsurgical quality of life independent of the negative effect on quality of life of inflammatory bowel disease symptoms. Perceived social support is a third factor that makes an independent contribution to postsurgical quality of life. The Medical Outcomes Study Social Support Scale has properties associated with an effective screening tool and merits further investigation as an instrument to screen presurgically for individuals at higher risk of poor subjective outcome of inflammatory bowel disease surgery.
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Affiliation(s)
- D N Moskovitz
- Faculty of Medicine, University of Toronto, Ontario, Canada
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Cheung WY, Garratt AM, Russell IT, Williams JG. The UK IBDQ-a British version of the inflammatory bowel disease questionnaire. development and validation. J Clin Epidemiol 2000; 53:297-306. [PMID: 10760641 DOI: 10.1016/s0895-4356(99)00152-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Measurement of health-related quality of life (HRQL) is becoming more important in studies of patients with inflammatory bowel disease. The McMaster IBDQ is the most widely used HRQL instrument for these patients. However, its use with patients in the United Kingdom has not been validated. This study develops and validates a UK version of the McMaster IBDQ (UK IBDQ). The UK IBDQ was tested with two samples of patients for its reliability, validity, reproducibility, and responsiveness. The first sample consisted of 180 patients participating in a randomized clinical trial. The second was recruited from members of the National Association for Colitis and Crohns Disease. Reliability of the subscales and the summary score of the UK IBDQ is demonstrated by Cronbach's alpha and item-total correlations. Their validity is demonstrated by their correlations with SF-36 subscales and an empirical index of disease activity. Good intraclass correlations and responsiveness ratios show their reproducibility and responsiveness. The findings support the reliability, validity, reproducibility, and responsiveness of the UK IBDQ and its acceptability to patients in UK.
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Affiliation(s)
- W Y Cheung
- School of Postgraduate Studies in Medical & Health Care, Maes-y-Gwernen Hall, Morriston Hospital, Swansea, UK.
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Abstract
BACKGROUND Pouch excision is a devastating experience for patients having restorative proctocolectomy for ulcerative colitis. METHODS The quality of life among patients having pouch excision for ulcerative colitis was compared with that in those having proctocolectomy and ileostomy for ulcerative colitis using a validated standardized self-administered questionnaire. RESULTS After pouch excision patients (n = 9) had more troublesome bowel symptoms (mainly from liquid stoma output) than those in the proctocolectomy group (n = 14) (mean(s.d.) score 5.64(0.92) versus 6.13(0.37), P = 0.03). However, the mean scores for the other parameters (systemic symptoms, functional, social and emotional impairment) did not differ significantly. CONCLUSION Patients having pouch excision for ulcerative colitis have more liquid ileostomy loss but a comparable quality of life to those treated by standard proctocolectomy and ileostomy.
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Affiliation(s)
- H T Tan
- University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Abstract
The majority of patients with ulcerative colitis (UC) will run a typical chronic, relapsing course. The proportion with chronic, continuous symptoms diminishes with time. The greatest impact of the disease is in the first few years after diagnosis, especially in patients with extensive or severe colitis. After this time, the likelihood of requiring surgery declines rapidly, and survival is no different from that of the general population. The long-term course can be best predicted by the course in the preceding period. Most patients are able to lead an essentially normal lifestyle, at work and at home, with either medical or surgical treatment. Awareness of how the patient feels the disease affects his or her life is important. Educating the patient about their illness will also help in management.
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Affiliation(s)
- W Selby
- Department of Medicine, University of Sydney, Australia
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