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Stanghelle B, Bentzen H, Giangregorio L, Pripp AH, Bergland A. Associations between health-related quality of life, physical function and pain in older women with osteoporosis and vertebral fracture. BMC Geriatr 2019; 19:298. [PMID: 31684886 PMCID: PMC6829800 DOI: 10.1186/s12877-019-1268-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/03/2019] [Indexed: 01/16/2023] Open
Abstract
Background Osteoporosis and vertebral fractures represent a major health burden worldwide, and the prevalence of osteoporosis is expected to increase as the world’s population ages. Suffering from vertebral fracture has a substantial impact on the individual’s health-related quality of life (HRQoL), physical function and pain. Complex health challenges experienced by older people with osteoporosis and vertebral fractures call for identification of factors that may influence HRQoL, as some of these factors may be modifiable. The objective is to examine the independent associations between HRQoL, physical function and pain in older women with osteoporosis and vertebral fracture. Methods This study has a cross-sectional design, using data from 149 home-dwelling Norwegian women with osteoporosis and vertebral fracture, aged 65+. Data on HRQoL (Short Form 36 (SF-36), Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41)), physical function (walking speed, balance and strength), pain, as well as sociodemographic information were collected. Simple linear regression analyses were conducted and multivariable regression models were fitted to investigate the associations. Results Lower levels of HRQoL were significantly associated with lower levels of physical function, measured by walking speed, and higher levels of pain. Pain was significantly associated with all of the subscales in SF-36, with the exception of Mental Health and Mental Component Score, and all the subscales of QUALEFFO-41. Walking speed was significantly associated with 5 of 8 subscales of SF-36 (except Bodily Pain, Vitality, Mental Health and Mental Component Score), and with 4 of 6 subscales of QUALEFFO-41 (except Score Pain and Mood). Conclusion This study shows that pain and walking speed were, independently of one another, associated with HRQoL in older women with osteoporosis and vertebral fracture. These findings can inform clinicians and health managers about the importance of pain management and exercise interventions in health care for this group. Future research should address interventions targeting both physical function and pain with HRQoL as an outcome. Registration ClincialTrials.gov Identifier: NCT02781974. Registered 18.05.16. Retrospectively registered.
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Affiliation(s)
- Brita Stanghelle
- Institute of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - Hege Bentzen
- Leader of the Institute of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Are Hugo Pripp
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Institute of Physiotherapy, Leader of the Research Group Age, health and Welfare, Oslomet - Oslo Metropolitan University, Oslo, Norway
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Wang YF, Shen J, Li SY, Yu X, Zou TM. Kambin triangle approach in percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Medicine (Baltimore) 2019; 98:e17857. [PMID: 31689878 PMCID: PMC6946336 DOI: 10.1097/md.0000000000017857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) in Kambin triangle approach for the treatment of osteoporotic vertebral compression fractures (OVCFs).Between November 2017 and September 2018, 109 patients (144 vertebral bodies) with OVCFs, with a mean age of 76.7 ± 9.9 years (55-96 years), underwent PVP in Kambin triangle approach. The time of operation, the volume of bone cement, the incidence of complication, the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score, the position of puncture needles, and the spread of polymethylmethacrylate (PMMA) in vertebral body (VB) were recorded.All patients had been completed the operation successfully and were followed up 9.1 ± 2.9 months. The average operation time of each VB was 24.0 ± 3.5 minutes. The average volume of cement was 4.8 ± 0.6 ml. The mean VAS scores were 8.4 ± 0.7 preoperatively, 1.6 ± 0.6 at the first day postoperatively, and 1.2 ± 0.6 at the last follow-up. The mean ODI scores were 70.97 ± 7.73 preoperatively, 27.99 ± 4.12 at the first day postoperatively, and 19.65 ± 3.49 at the last follow-up. The position of puncture needles in the VB was: 119 vertebral puncture needles reached the midline, 15 were close to the midline, and 10 exceeded the midline. The spread of PMMA in the VB was: type 1 in 81 levels (56.3%), type 2 in 37 (25.7%), type 3 in 18 (12.5%), type 5 in 8 (5.5%), and no case in type 4. One case developed pneumothorax after operation. No other complications (hematoma, cement embolism, spinal cord, and nerve injury) occurred.Kambin triangle approach in PVP, which can deliver the puncture needle to the midline of VB easily and with excellent cement distribution, is a safe and effective method.
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Schifferdecker KE, Yount SE, Kaiser K, Adachi-Mejia A, Cella D, Carluzzo KL, Eisenstein A, Kallen MA, Greene GJ, Eton DT, Fisher ES. A method to create a standardized generic and condition-specific patient-reported outcome measure for patient care and healthcare improvement. Qual Life Res 2017; 27:367-378. [PMID: 28795261 DOI: 10.1007/s11136-017-1675-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Patient-reported outcome measures (PROMs), which are generic or condition-specific, are used for a number of reasons, including clinical care, clinical trials, and in national-level efforts to monitor the quality of health care delivery. Creating PROMs that meet different purposes without overburdening patients, healthcare systems, providers, and data systems is paramount. The objective of this study was to test a generalizable method to incorporate condition-specific issues into generic PROM measures as a first step to producing PROMs that efficiently provide a standardized score. This paper outlines the method and preliminary findings focused on a PROM for osteoarthritis of the knee (OA-K). METHODS We used a mixed-methods approach and PROMIS® measures to test development of a combined generic and OA-K-specific PROM. Qualitative methods included patient focus groups and provider interviews to identify impacts of OA-K important to patients. We then conducted a thematic analysis and an item gap analysis: identified areas covered by existing generic PROMIS measures, identified "gap" areas not covered, compared gap areas to legacy instruments to verify relevance, and developed new items to address gaps. We then performed cognitive testing on new items and drafted an OA-K-specific instrument based on findings. RESULTS We identified 52 existing PROMIS items and developed 24 new items across 14 domains. CONCLUSIONS We developed a process for creating condition-specific instruments that bridge gaps in existing generic measures. If successful, the methodology will create instruments that efficiently gather the patient's perspective while allowing health systems, researchers, and other interested parties to monitor and compare outcomes over time, conditions, and populations.
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Affiliation(s)
- Karen E Schifferdecker
- Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Center for Program Design and Evaluation at Dartmouth, Geisel School of Medicine at Dartmouth, 21 Lafayette Street, #373, Lebanon, NH, 03766, USA.
| | - Susan E Yount
- Department of Medical Social Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Anna Adachi-Mejia
- Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Center for Program Design and Evaluation at Dartmouth, Geisel School of Medicine at Dartmouth, 21 Lafayette Street, #373, Lebanon, NH, 03766, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - Kathleen L Carluzzo
- Center for Program Design and Evaluation at Dartmouth, Geisel School of Medicine at Dartmouth, 21 Lafayette Street, #373, Lebanon, NH, 03766, USA
| | - Amy Eisenstein
- Department of Medical Social Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA.,Leonard Schanfield Research Institute at CJE SeniorLife, Chicago, IL, USA
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - George J Greene
- Department of Medical Social Sciences, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
| | - David T Eton
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Elliott S Fisher
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Sun H, Li C. Comparison of unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Orthop Surg Res 2016; 11:156. [PMID: 27908277 PMCID: PMC5134099 DOI: 10.1186/s13018-016-0479-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this meta-analysis is to examine the safety and effectiveness of unilateral percutaneous vertebroplasty (PVP) for treatment of osteoporotic vertebral compression fractures (OVCFs) compared with that of bilateral treatment. Methods The multiple databases including PubMed, Springer, EMBASE, OVID, and China Journal Full-text Database were adopted to search for relevant studies in English or Chinese, and full-text articles involving comparison of unilateral and bilateral PVP surgery were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis, and bias analysis for the articles included were also conducted. Results Finally, 1043 patients were included in the 14 studies, which eventually satisfied the eligibility criteria, and unilateral and bilateral surgeries were 550 and 493, respectively. The meta-analysis suggested that there was no significant difference of VAS score, ODI score, and cement leakage rate (MD = 0.12, 95%CI [−0.03, 0.26], P = 0.11; MD = −1.28, 95%CI [−3.59, 1.04], P = 0.28; RR = 0.89, 95%CI [0.61, 1.29], P = 0.52). The surgery time of unilateral PVP is much less than that of bilateral PVP (MD = −16.67, 95%CI [−19.22, −14.12], P < 0.00001). Patients with bilateral PVP surgery have been injected more cement than patients with unilateral PVP surgery (MD = −1.55, 95%CI [−1.94, −1.16], P < 0.00001). Conclusions Both punctures provide excellent pain relief and improvement of life quality. We still encourage the use of the unipedicular approach as the preferred surgical technique for treatment of OVCFs due to less operation time, limited X-ray exposure, and minimal cement introduction and extravasation.
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Affiliation(s)
- Haolin Sun
- Department of Orthopedic Surgery, Peking University First Hospital, No. 8 Xishiku St., Xicheng District, Beijing, 100034, China
| | - Chunde Li
- Department of Orthopedic Surgery, Peking University First Hospital, No. 8 Xishiku St., Xicheng District, Beijing, 100034, China.
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An outcome measure of functionality and quality of life in Iranian women with osteoporotic vertebral fractures: a validation study of the QUALEFFO-41. J Orthop Sci 2014; 19:860-7. [PMID: 25069808 DOI: 10.1007/s00776-014-0609-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Osteoporosis is a very common disease and often results in vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) is a tool to measure health-related quality of life in these patients. This study aimed to cross-culturally translate and validate the QUALEFFO-41 in Iran. METHODS This was a prospective clinical validation study. A forward-backward procedure was used to translate the questionnaire from English into Persian. The translation and cross-cultural adaptation were made in accordance with published guidelines. Patients were divided into two study groups according to the World Health Organization criteria: those with at least one vertebral fracture who had undergone surgery and those with osteoporosis and no fractures as a control group. All of the participants were assessed by both the QUALEFFO-41 and SF-36. The surgery group was asked to respond to the QUALEFFO-41 at two points in time: the pre- and postoperative assessments (6-month follow-up). To test reliability, the internal consistency was evaluated using Cronbach's alpha coefficient. Validity was evaluated by assessing convergent validity between the QUALEFFO-41 and SF-36 and item-scale correlations and discriminatory ability. Internal responsiveness of the QUALEFFO-41 to the clinical intervention (surgery) also was evaluated comparing patients' pre- and postoperative scores. RESULTS A total of 149 patients completed the questionnaire: 48 surgical patients and 101 as a control group. At the pre- and postoperative assessments, the QUALEFFO-41 showed adequate internal consistency in all domains (Cronbach's alpha of 0.71 to 0.81). Additionally, the correlation of each item with its hypothesized domain on the QUALEFFO-41 indicated acceptable results, suggesting that the items had a substantial relationship with their own domains. Further analysis also indicated that the questionnaire was responsive to change (P < 0.0001). Significant correlations existed between scores of similar subscales of the QUALEFFO-41 and SF-36 (P < 0.001). CONCLUSIONS The findings show that the Iranian version of the QUALEFFO-41 is a reliable and valid measure of functionality and quality-of-life evaluation among patients with osteoporotic vertebral fractures.
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Lin SI, Chang KC, Lee HC, Yang YC, Tsauo JY. Problems and fall risk determinants of quality of life in older adults with increased risk of falling. Geriatr Gerontol Int 2014; 15:579-87. [DOI: 10.1111/ggi.12320] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sang-I Lin
- Department of Physical Therapy; National Cheng Kung University; Tainan City Taiwan
| | - Ku-Chou Chang
- Division of Cerebrovascular Diseases; Department of Neurology; Chang Gung Memorial Hospital; Kaohsiung Taiwan
- College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hsuei-Chen Lee
- Department of Physical Therapy and Assistive Technology; Exercise and Health Science Research Center; National Yang-Ming University; Taipei Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine; College of Medicine; National Cheng Kung University; Tainan City Taiwan
| | - Jau-Yih Tsauo
- School and Graduate Institute of Physical Therapy; College of Medicine; National Taiwan University; Taipei Taiwan
- Physical Therapy Center; National Taiwan University Hospital; Taipei City Taiwan
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McPhail SM, Dunstan J, Canning J, Haines TP. Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. BMC Musculoskelet Disord 2012; 13:224. [PMID: 23171034 PMCID: PMC3517753 DOI: 10.1186/1471-2474-13-224] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 11/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. METHODS A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. RESULTS Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. CONCLUSIONS The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome measure can be developed.
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Affiliation(s)
- Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Buranda Plaza, Corner Ipswich Road and Cornwall Street Buranda, Brisbane, Australia.
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Ma XL, Xing D, Ma JX, Xu WG, Wang J, Chen Y. Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1844-59. [PMID: 22832872 DOI: 10.1007/s00586-012-2441-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/19/2012] [Accepted: 07/07/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of balloon kyphoplasty (KP) compared with percutaneous vertebroplasty (VP) and provide recommendations for using these procedures to treat osteoporotic vertebral compression fractures (OVCF). METHODS A systematic search of all studies published through March 2012 was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The randomized controlled trials (RCTs) and non-randomized controlled trials that compared KP to VP and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. The evidence quality levels and recommendations were assessed using the GRADE system. RESULTS Twelve studies encompassing 1,081 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. In the RCT subgroup, there were significant differences between the two procedures in short-term visual analog scale (VAS), long-term kyphosis angles, operative times and anterior vertebrae heights. In the cohort study subgroup, there were significant differences between the two procedures in short- and long-term VAS, short- and long-term Oswestry Disability Index (ODI), cement leakage rates, short- and long-term kyphosis angles, operative times and anterior vertebrae heights. However, there were no significant differences in long-term VAS or adjacent vertebral fracture rates in the RCT subgroup. There were no significant differences in short- or long-term VAS, short- or long-term ODI, cement leakage rates, adjacent vertebral fracture rates, short- or long-term kyphosis angles or anterior vertebrae heights in the CCT subgroup, and the adjacent vertebral fracture rates did not differ significantly in the cohort study subgroup. The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations. CONCLUSIONS KP and VP are both safe and effective surgical procedures for treating OVCF. KP may be superior to VP in patients with large kyphosis angles, vertebral fissures, fractures in the posterior edge of the vertebral body or significant height loss in the fractured vertebrae. Due to the poor quality of the evidence currently available, high-quality RCTs are required.
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Affiliation(s)
- Xin-Long Ma
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Street, Heping District, Tianjin, 300052, China.
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Tadic I, Vujasinovic Stupar N, Tasic L, Stevanovic D, Dimic A, Stamenkovic B, Stojanovic S, Milenkovic S. Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population. Health Qual Life Outcomes 2012; 10:74. [PMID: 22709379 PMCID: PMC3464801 DOI: 10.1186/1477-7525-10-74] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/18/2012] [Indexed: 11/29/2022] Open
Abstract
Background Vertebral fractures could lead to reduced physical, social and mental functioning, and loss of personal independence. Therefore, during the treatment of osteoporosis, it has become necessary to examine the changes in everyday functioning, well-being and health related quality of life (HRQOL). To that effect, this study aims to translate, culturally adapt, and validate the Serbian version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) for patients with vertebral fractures. Methods Nine female patients with osteoporosis participated in the pre-validation study. A validation, case–control study included two groups of female patients: one that consisted of 50 female patients with osteoporosis, and with at least one vertebral fracture, and another one that consisted of 50 control patients with osteoporosis but without fractures. They completed the QUALEFFO-41 and the EuroQol group questionnaire with five dimensions (EQ-5D) twice within a month. The validation study examined internal consistency, concurrent validity, test-retest reliability, sensitivity and specificity. Results During the pre-validation study, three of the items in the QUALEFFO-41 were slightly changed. Afterwards, during the validation study, the statistically significant differences (adjusted for: age, duration of menopause, current employment and marital status) in the mean values of all domains and total scores between the groups were noted. For the case group, the internal consistency of the QUALEFFO-41 domains and of total questionnaire was above 0.70. The test-retest reliability was tested by the intraclass correlation coefficients (ICC) that were in range 0.87 – 0.96 for the case, and 0.15 – 0.83 for the control group. Correlations between the total scores of the QUALEFFO-41 and the EQ-5D health state value, for both groups were negative and statistically significant (r = -0.78, p<0.001 and r = -0.73, p<0.001, respectively). The QUALEFFO-41 had a better prediction of the value of HRQOL of cases compared to the generic questionnaire EQ-5D (the AUC difference was 0.099, p = 0.013). Conclusions The Serbian QUALEFFO-41 version is reliable, valid, sensitive and predictive for examinations of HRQOL in patients with prevalent vertebral fractures and can be used in further studies.
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Affiliation(s)
- Ivana Tadic
- Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade, Faculty of Pharmacy, Vojvode Stepe 450, 11000 Belgrade, Serbia.
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