Relationship between health-related quality of life and subjective wellbeing in asthma

Validity and Responsiveness of EQ-5D in Asthma: A Systematic Review and Meta-analysis

OBJECTIVE

We aimed to synthesize the evidence on the construct validity and responsiveness of the EQ-5D and compare them with asthma-specific health-related quality-of-life scales, to guide further research and clinical applications in asthma.

METHODS

We searched key databases from inception to 1 June, 2024 and used the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) method to appraise the evidence. The effect size estimates were aggregated using the inverse variance method to evaluate the relative efficiency of EQ-5D measures against the Asthma Quality of Life Questionnaire (AQLQ) and/or its corresponding preference-based index, Asthma Quality of Life-5 Dimensions (AQL-5D).

RESULTS

There were 493 tests (construct validity: 428; responsiveness: 65) drawn from 37 selected articles (validation: 7; clinical: 30). Overall, 78.4% and 76.9% of the a priori hypotheses for assessing construct validity (convergent validity: 56.4%; known groups: 88.5%) and responsiveness, respectively, were satisfied. The methodological quality was "very good" or "adequate" in 78.2% of construct validity tests and 92.3% of responsiveness tests. The pooled correlation coefficient between EQ-5D index and AQLQ total scores was 0.52 (95% confidence interval 0.43-0.59), and between EQ visual analog scale and AQLQ total scores was 0.53 (95% confidence interval 0.34-0.69). The Cohen's d ratios for the index, level sum scores, and visual analog scale compared to AQLQ were 0.56 (n = 27), 1.16 (n = 16), and 0.75 (n = 37). The EQ-5D index's Cohen's d ratio compared to AQL-5D was 0.49 (n = 5). The standardized response mean ratios for the index and visual analog scale compared to AQLQ were 0.26 (n = 11) and 0.63 (n = 9).

CONCLUSIONS

The EQ-5D demonstrated overall good validity and responsiveness in the adult asthma population. However, a comparison against disease-specific instruments suggested scope for improvement in its psychometric performance for this population.

A Comparison of Items and Constructs of Standardized Health-Related Quality of Life and Mental Well-Being Measures

OBJECTIVES

This study aimed to explore the internal constructs of the concepts being measured by EQ-5D-5L (a health-related quality of life measure that can produce preference-based utility values) and the 12-item General Health Questionnaire (GHQ-12, a mental well-being measure) and to understand to what extent the items of EQ-5D-5L and GHQ-12 associate with each other.

METHODS

We used data from 12 701 respondents participating in a Belgian survey in 2022. Correlation coefficients between GHQ-12 and EQ-5D-5L were calculated at both the aggregate and item levels. Multidimensional scaling, exploratory factor analysis, and regression models were performed to investigate the underlying constructs that are associated with the items.

RESULTS

Despite a moderate correlation (0.39) between the EQ-5D-5L and GHQ-12 total scores, only a trivial or weak correlation (<0.3) was observed between the first 4 EQ-5D-5L items and any GHQ-12 item. Multidimensional scaling and exploratory factor analysis showed the first 4 EQ-5D-5L dimensions were clustered together with EuroQol visual analog scale and positively phrased GHQ-12 items were close to each other, whereas EQ-anxiety/depression and negatively phrased GHQ-12 items were grouped with overall life satisfaction. In the regression models, not all GHQ-12 items had a significant coefficient to predict EQ-5D-5L responses.

CONCLUSIONS

To the best of our knowledge, we present the first comparison of items and underlying constructs of GHQ-12 and EQ-5D-5L. The results showed that GHQ-12 can only partially predict the responses of EQ-5D-5L and the 2 instruments measure different constructs. Researchers should carefully consider conceptual legitimacy while applying the mapping technique and consider sensitivity analyses for the mapping estimates.

Differences in the health-related quality of life in patients with asthma living in urban and rural areas in the Amur Region of Russian Federation

BACKGROUND

Asthma usually arises from an interaction between host and environmental factors. Growing attention has been paid to a place of residence as a factor shaping health-related quality of life (QoL). This study investigated the rural-urban disparity in QoL among adult asthma patients in the Amur region of Russian Federation.

MATERIALS AND METHODS

This cross-sectional study included 351 randomly selected adults with asthma. We analyzed QoL (SF-36 and AQLQ scores), asthma control (ACT), and anxiety and depression (HADS) depending on the place of residence (urban vs. rural).

RESULTS

The scale "Role Emotional" (RE) of SF-36 was significantly lower in patients from rural areas compared to urban residents (59.3±3.1 vs. 70.4±2.3 points; p = 0.0042). In the urban group, the correlation analysis demonstrated a clear influence of RE on patients' own assessment of their physical functioning (PF, r = 0.53; p<0.0001). Both groups demonstrated low "Social Functioning" (SF). In the group of urban residents, correlation analysis revealed the presence of positive correlations of SF-36 domains reflecting physical (PF, RP, BP) and social functioning (SF, VT) with most scales of both QoL questionnaires. The domains of the emotional sphere (RE and MH) positively correlated with all scales of both QoL questionnaires among urban residents. In the group of rural residents, a comparative analysis showed the absence of significant correlations between more of the QoL scales. Although Asthma Control Test did not differ between groups, we noted a significantly higher need for β2-agonists in rural areas compared to urban areas (4.2±0.6 vs. 2.7±0.3 inh/day, respectively; p = 0.0221). The frequency of urban residents with a clinically significant level of anxiety (56 persons, or 25.2%) turned out to be lower compared to rural residents (45 persons, or 34.8%; χ2 = 34.08; p<0.001).

CONCLUSION

The burden of asthma introduces a greater imbalance in the health-related QoL of rural residents compared to urban residents in the Amur region of the Russian Federation. The absence of interrelationships of some QoL domains in rural residents suggested a disunity of the physical, psychological and social aspects of life. The rural residents suppress physical discomfort by the more frequent use of short bronchodilators. They often showed emotional instability with a predominance of anxiety, which affected the decrease in QoL in the psycho-emotional sphere.

Association between subjective well-being and all-cause mortality among older adults in China

BACKGROUND

Although several studies in high-income countries have suggested a positive association between subjective well-being (SWB) and mortality, studies conducted in low- and middle-income countries, such as China, are scarce. The purpose of this study is to examine the association between SWB and all-cause mortality among the older Chinese population.

METHODS

Data were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a population-based longitudinal cohort study in 22 of 31 provinces in mainland China. A total of 13,282 individuals aged 65 ≥ years who were recruited in 2002 and followed-up until 2018 were included. SWB was assessed with an eight-item tool covering life satisfaction, positive affect (including optimism, happiness, personal control and conscientiousness) and negative affect (including anxiety, loneliness and uselessness). Cox proportional hazards regression methods were carried out to estimate the association between SWB and total mortality, adjusting for a wide range of potential confounders. Subgroup analyses and interaction analyses were further conducted.

RESULTS

During the 16.5 years of follow-up, 8459 deaths were identified. Greater SWB was independently associated with a reduced risk of all-cause mortality (adjusted hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.81-0.89) after adjustment for age, sex, marital status, education level, place of residence, smoking status, drinking, exercise, diet, BMI, hypertension, diabetes, heart disease, cerebrovascular diseases and cancer. Of the eight individual SWB symptoms, only 2 items, feelings of uselessness (adjusted HR = 0.94, 95% CI = 0.89-0.99) and happiness (adjusted HR = 0.91, 95% CI = 0.86-0.95), were significantly associated with total mortality. Associations remained significant across all subgroups regardless of different characteristics.

CONCLUSIONS

Higher SWB overall and 2 certain symptoms (feelings of uselessness and happiness) were independently associated with all-cause mortality risk among older Chinese adults. The association was consistent across different groups, suggesting that promoting a healthier SWB may be beneficial to all older individuals irrespective of their characteristics.

Measuring the Wellbeing of Cancer Patients with Generic and Disease-Specific Instruments

Different wellbeing measures have been used among cancer patients. This study aimed to first investigate the sensitivity of health state utility (HSU), capability, and subjective wellbeing (SWB) instruments in cancer. A cancer-specific instrument (QLQ-C30) was included and transferred onto the cancer-specific HSU scores. Furthermore, it examined the relative importance of key life domains explaining overall life satisfaction. Data were drawn from the Multi-instrument Comparison survey. Linear regression was used to explore the extent to which the QLQ-C30 sub-scales explain HSU and SWB. Kernel-based Regularized Least Squares (KRLS), a machine learning method, was used to explore the life domain importance of cancer patients. As expected, the QLQ-C30 sub-scales explained the vast majority of the variance in its derived cancer-specific HSU (R² = 0.96), followed by generic HSU instruments (R² of 0.65-0.73) and SWB and capability instruments (R² of 0.33-0.48). The cancer-specific measure was more closely correlated with generic HSU than SWB measures, owing to the construction of these instruments. In addition to health, life achievements, relationships, the standard of living, and future security all play an important role in explaining the overall life satisfaction of cancer patients.

Extending the EQ-5D: the case for a complementary set of 4 psycho-social dimensions

OBJECTIVES

The EQ-5D is the most widely applied preference-based health-related quality of life measure. However, concerns have been raised that the existing dimensional structure lacks sufficient components of mental and social aspects of health. This study empirically explored the performance of a coherent set of four psycho-social bolt-ons: Vitality; Sleep; Personal relationships; and Social isolation.

METHODS

Cross-sectional surveys were conducted with online panel members from five countries (Australia, Canada, Norway, UK, US) (total N = 4786). Four bolt-ons were described using terms aligned with EQ nomenclature. Latent structures among all nine dimensions are studied using an exploratory factor analysis (EFA). The Shorrocks-Shapely decomposition analyses are conducted to illustrate the relative importance of the nine dimensions in explaining two outcome measures for health (EQ-VAS, satisfaction with health) and two for subjective well-being (the hedonic approach of global life satisfaction and an eudemonic item on meaningfulness). Sub-group analyses are performed on older adults (65 +) and socially disadvantaged groups.

RESULTS

Strength of correlations among four bolt-ons ranges from 0.34 to 0.49. As for their correlations with the EQ-5D dimensions, they are generally much less correlated with four physical health dimensions than with mental health dimensions (ranged from 0.21 to 0.50). The EFA identifies two latent factors. When explaining health, Vitality is the most important. When explaining subjective well-being, Social isolation is second most important, after Anxiety/depression.

CONCLUSION

We provide evidence that further complementing the current EQ-5D-5L health state classification system with a coherent set of four bolt-on dimensions that will fill its psycho-social gap.

Evaluating health-related quality of life and subjective wellbeing among infertility patients: a cross-sectional study in mainland China

PURPOSE

This study aimed to explore the health-related quality of life (HRQoL) and subjective wellbeing (SWB) of infertility patients in mainland China and to investigate the relationships between HRQoL and SWB instruments in infertility patients.

METHODS

We conducted this cross-sectional study in the Hospital for Reproductive Medicine Affiliated of Shandong University between April 2019 and November 2019. Participants self-completed the five-level EQ-5D (EQ-5D-5L) questionnaire, the Assessment of Quality of Life (AQoL)-8D, and the WHO-5 wellbeing index (WHO-5). The agreements between EQ-5D-5L and AQoL-8D were assessed employing intraclass correlation coefficient (ICC) and Bland-Altman plots. Exploratory factor analysis (EFA) was conducted to examine the difference in descriptive systems among the three instruments.

RESULTS

We analyzed a valid sample of 618 infertility patients (84.4%). The mean scores of the total EQ-5D-5L, AQoL-8D, and WHO-5 were 0.96 (95%CI 0.96, 0.96), 0.80 (95%CI 0.79, 0.81), and 16.92 (95%CI 16.52, 17.31), respectively. Patients diagnosed with primary infertility had significantly lower HRQoL and SWB than those with secondary infertility. The ICC of EQ-5D-5L and AQoL-8D was 0.14. The AQoL-8D (r = 0.625) was more strongly correlated with WHO-5 than with the EQ-5D-5L (r = 0.262). The EFA results indicated that HRQoL instruments and the WHO-5 instruments were complementary rather than substitutable.

CONCLUSIONS

Poorer HRQoL and SWB were found that primary than secondary infertility patients. There exists a poor agreement between EQ-5D-5L and AQoL-8D and the difference in the psychosocial components may explain the difference. Measuring both HRQoL and SWB could provide complementary information for infertility patients.

The feeling of loneliness and the sense of meaning in life in patients with various levels of bronchial asthma control

Background: Previously our team has proved bronchial asthma to be associated with a higher incidence of depression than in the healthy population, and that the severity of depression correlates with the severity of asthma symptoms. However, both, the sense of loneliness and the sense of the meaning of life have been little explored by research in the context of this disease so far.Objective: To compare loneliness and meaning of life among asthmatic patients with healthy individuals and assess the relationship of those constructs to the degree of asthma control.Methods: The level of asthma control was assessed according to the Asthma Control Test (ACT), the feeling of loneliness to the De Jong Gierveld Loneliness Scale (DJGLS), and the sense of life to Life Attitude Profile - Revised (LAP-R). Scores were compared between healthy adults and asthma patients and related to asthma control. All models were adjusted for sex and age.Results: The DJGLS score was higher among patients with asthma compared to healthy adults. All the scores measured by LAP-R except for the Existential Vacuum were higher in controls. Loneliness measured by DJGLS was negatively correlated with the degree of asthma control. Choice/Responsibleness was positively, while the Personal Meaning Index score negatively correlated with the ACT score. In the models including LAP-R and DJGLS, only loneliness was associated with asthma control.Conclusion: Loneliness is significantly related to both the development of asthma and the degree of asthma control.

Bronchial Asthma and Sarcopenia: An Upcoming Potential Interaction

BACKGROUND

Sarcopenia seems to be an emerging health issue worldwide, concerning the progressive loss of skeletal muscle mass, accompanied by adverse outcomes. Asthma is a chronic inflammatory respiratory condition that is widespread in the world, affecting approximately 8% of adults. Although data are scarce, we aim to shed light on the potential association between low muscle mass and asthma and point out any probable negative feedback on each other.

METHODS

We searched within the PubMed, Scopus, MEDLINE, and Google Scholar databases.

STUDY SELECTIONS

Three studies were included in our analysis. Only original studies written in English were included, while the references of the research articles were thoroughly examined for more relevant studies. Moreover, animal model studies were excluded.

RESULTS

2% to 17% of asthmatics had sarcopenia according to the existent literature. Sarcopenic asthmatic patients seem to have reduced lung function, while their mortality risk may be increased. Furthermore, patients with asthma- chronic obstructive pulmonary disease (COPD) overlap syndrome phenotype and sarcopenia might have a higher risk of osteopenia and osteoporosis progression, leading consequently to an increased risk of fractures and disability.

CONCLUSIONS

Emerging data support that pulmonologists should be aware of the sarcopenia concept and be prepared to evaluate the existence of low muscle mass in their asthmatic patients.

A Cognitive Behavior Therapy Chatbot (Otis) for Health Anxiety Management: A Mixed-Methods Pilot Study (Preprint)

Background

An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies.

Objective

The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic.

Methods

Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed.

Results

The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis.

Conclusions

Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety.

Health-Related Quality of Life (HRQoL) of Residents with Persistent Lower Respiratory Symptoms or Asthma Following a Sulphur Stockpile Fire Incident

Background: This study evaluated health-related quality of life (HRQoL) in residents with persistent lower respiratory symptoms (PLRS) or asthma six years after exposure to sulphur dioxide vapours emanating from an ignited sulphur stockpile. Methods: A cross-sectional study was carried out, using interview data collected at three time points (prior to, one- and six-years post incident), medical history, respiratory symptoms and HRQOL using the Medical Outcomes Study Form 36 (SF-36). Results: A total of 246 records, 74 with and 172 without PLRS or asthma, were analysed. The mean age was 42 (SD:12) years in the symptomatic group and 41 (SD:13) years in the asymptomatic group. Mean SF-36 scores were significantly lower for the symptomatic group in the Physical Functioning (24 vs. 39), Role—Physical (33 vs. 48) and General Health (GH) domains (24 vs. 37). Symptomatic residents experienced a significant decline in their Role—Physical (OR = 1.97; CI 1.09, 3.55) and GH (OR = 3.50; CI 1.39, 8.79) at year 6 compared to asymptomatic participants. Residents with co-morbid reactive upper airways dysfunction syndrome demonstrated stronger associations for GH (OR = 7.04; CI 1.61, 30.7) at year 1 and at year 6 (OR = 8.58; CI 1.10, 65.02). Conclusions: This study highlights the long-term adverse impact on HRQoL among residents with PLRS or asthma following a sulphur stockpile fire disaster.

Provision of pulmonary rehabilitation in Latin America 18 months after the COVID-19 pandemic: A survey of the Latin American Thoracic Association

Introduction

The Coronavirus disease (COVID-19) pandemic has significantly altered the provision of rehabilitation services, especially pulmonary rehabilitation (PR). Our objective was to assess the provision of PR services in Latin America 18 months after the COVID-19 pandemic was declared.

Methods

A cross-sectional study that included professionals dedicated to PR in centres in Latin America was applied. Responses to an online questionnaire were collected from May to September 2021. The following data were included for the analysis: demographic data, evaluation strategies, program structure, PR intervention in post-COVID-19 patients, and perception of strategies therapies for the care of post-COVID-19 patients. The questionnaire was distributed in Spanish and Portuguese languages.

Results

Responses were received from 196 PR centres. Exercise tolerance was predominantly measured with the six-minute walk test. Less than 50% of the institutions evaluate quality of life, physical qualities, symptoms, and lung function. Most of the programmes have physiotherapists (90.8%), as well as pulmonologists (60%), and psychologists (35%), among other professionals.

Conclusion

PR services in Latin America have adapted in their way to the requirements of the pandemic, and most continued to provide face-to-face services. It was identified that the application of the programs is heterogeneous both in evaluations and interventions.