Evaluating quality-of-life measures for clinical trials in Germany

The majority of patients with newly diagnosed juvenile idiopathic arthritis achieve a health-related quality of life that is similar to that of healthy peers: results of the German multicenter inception cohort (ICON)

Background

Achieving the best possible health-related quality of life (HRQoL) for a patient is an important treatment goal in juvenile idiopathic arthritis (JIA). We investigated the 36-month trajectories of HRQoL in children with JIA compared with healthy peers and identified the predictors of an unfavorable HRQoL.

Methods

Patients with a recent JIA diagnosis were enrolled in the German inception cohort study ICON. As a peer group, friends of patients of the same age and sex were asked to cooperate. Children were prospectively followed and regularly questioned about their HRQoL using the Pediatric Quality of Life Inventory 4.0 (PedsQL). Disease activity was assessed by the clinical Juvenile Arthritis Disease Activity Score (cJADAS-10), and the burden of the child’s chronic illness on their family was assessed by the Family Burden Questionnaire (FaBel). Linear mixed models were used to compare the HRQoL of the patients and their peers. Associations between the health status of a patient at enrollment and an unfavorable HRQoL (PedsQL total < 79.3) at their 3-year follow-up (FU) were analyzed by logistic regression.

Results

Data from 953 patients (median symptom duration 6 months, mean age 7.9 years) and 491 healthy peers (aged 8.4 years) were analyzed. During 3 years of FU, the disease activity and HRQoL of the patients improved significantly (cJADAS-10 from 9.8 (6.2) to 2.7 (3.6) and PedsQL total score from 71.7 (18.2) to 87.3 (13.9)). While the HRQoL of the patients varied among the several JIA categories at the time of enrollment, no significant differences were found at the 3-year FU. After 36 months, the HRQoL of the patients had largely converged with that of their healthy peers. JIA patients had a psychosocial health status comparable with their healthy peers, whereas a small significant mean difference remained in physical health (5.8, 95% confidence interval (CI) 4.1–7.6). Up to the 36-month FU, three-quarters of JIA patients attained a favorable HRQoL (PedsQL ≥ 79.3) which was achieved by 90% of the peers. A higher family burden, higher pain level, and lower well-being at enrollment were associated with an unfavorable HRQoL.

Conclusions

Under current therapeutic conditions, an HRQoL corresponding with that of healthy children is a realistic treatment goal in JIA.

[Transfusion in elderly: Take account frailty]

The conjunction of the demographic aging and the increase in the frequency of anemia with the advancing age, mean that the number of globular concentrates delivered each year increases with a consequent heavy pressure on blood collection. The etiologies of anemia in the elderly are often multifactorial and their investigation is an indispensable step and prior to any treatment. Transfusion thresholds, particularly in the elderly, are gradually evolving and a so-called restrictive strategy is now favored. Immediate and delayed complications of transfusion are more frequent in the elderly due to vulnerability factors associated with frailty and the risk of multiple transfusions. The screening of complications related to transfusion of RBCs is essential and makes it possible to avoid their recurrence. The impact of transfusion on the quality of life of elderly patients is not obvious and is a controversial issue. In addition, transfusion of red blood cells (RBCs) is accompanied by an increase in health expenditure and an increase in morbidity and mortality, whose risks can be reduced through alternatives to transfusion. Longitudinal studies, including elderly subjects, would allow a better understanding of the issues involved in the transfusion of RBCs in this population.

Psychometric performance of the Quality of Life in Short Stature Youth (QoLISSY) questionnaire in the Netherlands

The European Quality of Life in Short Stature Youth (QoLISSY) questionnaire is a disease-specific instrument assessing quality of life (QoL) in children with short stature from the child and parent perspectives. In order to use the QoLISSY in Dutch samples, a translation process and psychometric testing is needed. Children diagnosed with short stature (8 to 18 years) and their parents were recruited from a Dutch growth clinic. Reliability was assessed using Cronbach's α and intraclass correlation coefficients (ICCs). Pearsons' correlations with the generic KIDSCREEN and a confirmatory factor analysis (CFA) were performed to test validity. Scales showed good internal consistency with α ranging from 0.80 to 0.94 (child report) and from 0.85 to 0.95 (parent report). Test-retest reliability (ICC) ranged from 0.15 to 0.91 (child report) and from 0.14 to 0.83 (parent report). Correlations with the KIDSCREEN in the mean range indicated criterion validity. The models' goodness of fit was confirmed by CFA results in the Dutch and in comparison with the European sample.

CONCLUSION

The Dutch QoLISSY is a psychometrically reliable and valid short stature-specific QoL measure. It is now available for use in clinical research and practice to evaluate well-being and possible effects of growth hormone treatment and psychological interventions in the Netherlands.

Implementation of the Kids-CAT in clinical settings: a newly developed computer-adaptive test to facilitate the assessment of patient-reported outcomes of children and adolescents in clinical practice in Germany

PURPOSE

To describe the implementation process of a computer-adaptive test (CAT) for measuring health-related quality of life (HRQoL) of children and adolescents in two pediatric clinics in Germany. The study focuses on the feasibility and user experience with the Kids-CAT, particularly the patients' experience with the tool and the pediatricians' experience with the Kids-CAT Report.

METHODS

The Kids-CAT was completed by 312 children and adolescents with asthma, diabetes or rheumatoid arthritis. The test was applied during four clinical visits over a 1-year period. A feedback report with the test results was made available to the pediatricians. To assess both feasibility and acceptability, a multimethod research design was used. To assess the patients' experience with the tool, the children and adolescents completed a questionnaire. To assess the clinicians' experience, two focus groups were conducted with eight pediatricians.

RESULTS

The children and adolescents indicated that the Kids-CAT was easy to complete. All pediatricians reported that the Kids-CAT was straightforward and easy to understand and integrate into clinical practice; they also expressed that routine implementation of the tool would be desirable and that the report was a valuable source of information, facilitating the assessment of self-reported HRQoL of their patients.

CONCLUSIONS

The Kids-CAT was considered an efficient and valuable tool for assessing HRQoL in children and adolescents. The Kids-CAT Report promises to be a useful adjunct to standard clinical care with the potential to improve patient-physician communication, enabling pediatricians to evaluate and monitor their young patients' self-reported HRQoL.

Pediatric low-grade glioma survivors experience high quality of life

PURPOSE

The purpose of this study was to determine pediatric low-grade glioma survivors' quality of life and late morbidity including motor, sensory, and cognitive deficits.

METHODS

We surveyed 49 survivors and their parents (KINDL questionnaire).

RESULTS

Despite tumor and treatment-associated morbidity, survivors (25 boys and 24 girls, median age at diagnosis 7.8 years), but not their parents, rated their total quality of life higher than their peers. Although all survivors had some late morbidity, half of them were able to conduct their daily lives without restriction.

CONCLUSION

These results reflect survivors' effective coping mechanisms and underscore the difficulties of assessing quality of life in pediatric populations.

Sexual Dysfunction before and after Cardiac Rehabilitation

Background. The aim of this study was to assess sexual function before and after cardiac rehabilitation in relation to medical variables. Methods. Analysis of patients participating in a 12-week exercise-based outpatient cardiac rehabilitation program (OCR) between April 1999 and December 2007. Exercise capacity (ExC) and quality of life including sexual function were assessed before and after OCR. Results. Complete data were available in 896 male patients. No sexual activity at all was indicated by 23.1% at baseline and 21.8% after OCR, no problems with sexual activity by 40.8% at baseline and 38.6% after OCR. Patients showed an increase in specific problems (erectile dysfunction and lack of orgasm) from 18% to 23% (P < .0001) during OCR. We found the following independent positive and negative predictors of sexual problems after OCR: hyperlipidemia, age, CABG, baseline ExC and improvement of ExC, subjective physical and mental capacity, and sense of affiliation. Conclusions. Sexual dysfunction is present in over half of the patients undergoing OCR with no overall improvement during OCR. Age, CABG, low exercise capacity are independent predictors of sexual dysfunction after OCR.

Managing myelodysplastic symptoms in elderly patients

Most patients with myelodysplastic syndromes (MDS) are elderly (median age range 65 to 70 years); as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone marrow function, including the diminished capacity of response to stressors such as infection or myelosuppressive treatments. Through the integration of geriatric and oncological strategies, a personalized approach toward this unique population may be applied. As with many diseases in the elderly, reliance on family members or friends to maintain the prescribed treatments, including travel to and from appointments, may place additional stressors on the patient and his/her support network. Careful evaluation and knowledge of functional status, ability to tolerate treatments, effect of disease progression, and general overall health conditions can provide the best opportunity to support these patients. Immediate assessment of daily living activities may detect deficiencies or deficits that often require early interventions.

Connecting patient needs with treatment management

OBJECTIVE

To propose ideas for the development of a core strategy for monitoring patients with schizophrenia to ensure physical health and optimal treatment provision.

METHOD

A panel of European experts in the field of schizophrenia met in Bordeaux in June 2006 to discuss, 'Patient management optimisation through improved treatment monitoring.'

RESULTS

Key consensus from the discussion deemed that weight gain, oral health and ECG parameters were core baseline parameters to be monitored in all patients with schizophrenia. Further, an identification of a patient's own barriers to treatment alongside local health service strategies might comprise elements of an individualised management strategy which would contribute to optimisation of treatment. Any monitoring strategy should be kept simple to encourage physician compliance.

CONCLUSION

A practical solution to the difficulties of providing holistic patient care would be to suggest a limited set of physical parameters to be monitored by physicians on a regular basis.

Quality of life in obsessive-compulsive disorder: the different impact of obsessions and compulsions

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) are troubled by repeated obsessions and/or compulsions, which seem senseless and frequently repugnant.

OBJECTIVE

The study examines the differential impact of obsessions and compulsions on the quality of life (QoL) of patients with OCD.

METHODS

Seventy-five patients (43 females, 32 males) between 21 and 62 years old with OCD (ICD 10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. The severity of OCD symptoms was assessed by the Yale Brown Obsessive-Compulsive Scale (a standardized, clinician-administered scale), and depressiveness was assessed with the Beck Depression Inventory (a self-report instrument). QoL was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by WHO.

RESULTS

Compulsions reduced patients' QoL in the WHOQOL-BREF domains 'physical well-being', 'psychological well-being' and 'environment', whereas obsessions did not have any impact on QoL ratings. Depressive symptoms were a strong predictor of poor QoL in OCD patients.

CONCLUSIONS

In order to judge the QoL of OCD patients, obsessions and compulsions have to be considered differently. Diagnosing and treating depressive symptoms is important for improving the QoL in OCD.

Long-term treatment with long-acting risperidone in Korean patients with schizophrenia

OBJECTIVES

We evaluated the efficacy and safety of long-acting risperidone for 48-week period in Korean patients.

METHODS

This was a non-randomized, open-label, single-centered, 48-week study. Each of the participants visited the hospital every 2 weeks, and injections were given at each visit. Complete evaluations were done on five occasions (baseline, 12, 24, 36, 48 weeks). We used Clinical Global Impression, Positive and Negative Syndrome Scale, Global Assessment of Functioning, Subjective Well-being under Neuroleptic treatment scale and Short-form-36 health survey. Drug attitude inventory and Drug Induced Extra-Pyramidal Symptoms Scale were also used.

RESULTS

Forty patients were enrolled, and twenty-five patients completed this study. The therapeutic response rate was 36.1% in LOCF and 48% in completer's analysis. Scores on CGI, PANSS subscales and total were significantly decreased over 48-week period. Scores on other assessments did not show any significant changes over the period. At weeks 48, there was no significant difference in the changes of scores from baseline on self-rated assessments between the clinical improvement and non-improvement groups.

CONCLUSIONS

Our study showed significant improvement of investigator-rated psychiatric symptoms in long-term follow-up using long-acting risperidone. Further researches would be required to find out the effects of the psychiatric symptom improvements on overall changes in perceived functioning and well-being.

PANSS syndromes and quality of life in schizophrenia

BACKGROUND

Results from factor analysis studies have suggested that a five-dimensional structure appears to be a better representation of the psychopathological data of the PANSS. The purpose of this study was the detailed investigation of the association of schizophrenia syndromes and single symptoms with quality of life (QOL) in acute and remitted patients. The leading hypotheses were: (1) affective symptoms, especially depression and anxiety, are mostly associated with QOL longitudinally and (2) in the acute phase, QOL is also associated with positive schizophrenia symptoms.

METHODS

For the present study, schizophrenia and schizophreniform patients were studied on admission, at the end of the acute phase and 6 months after hospitalization. Psychopathology was measured using the PANSS syndromes, QOL was assessed using disease-specific (SWN) and generic (MLDL, EDLQ) scales.

RESULTS

Eighty-four patients entered the study and were assessed during the acute phase taking into account their history and actual treatment. Results revealed anxiety as the most important symptom and depression as the most important syndrome associated with different areas of QOL during and after hospitalization. Also cognitive and negative symptoms were associated with different QOL domains, but both positive symptom clusters showed no substantial association with QOL.

CONCLUSIONS

Results of this longitudinal study investigating psychopathology and QOL in schizophrenia provide further support for the need to consider the psychopathological state and treatment setting when measuring QOL in schizophrenia and the need for a differential analysis of schizophrenia symptoms and QOL in the acute, mid-term and long-term phase. Anxiety reduction should be a critical goal of treatment in order to prevent further QOL impairment.

Objective assessment of compliance with treatments in acne

BACKGROUND

Acne occurs in prepubertal individuals, teenagers and adults, and can have a devastating effect on self-esteem and social relationships. Whether an acne sufferer will seek treatment often depends, apart from the severity, on cultural and social aspects, which play a significant role in the attitude of the individuals and how they cope with the condition. Compliance with treatment regimen is an essential element in overall effectiveness of therapy.

OBJECTIVES

To assess patient compliance in acne vulgaris.

METHODS

In an open prospective study at a dermatology outpatient clinic, patients with acne, and on isotretinoin or conventional therapies, were examined and completed a questionnaire consisting of: (i) a brief medical and social history, (ii) a compliance assessment sheet, and (iii) the Dermatology Life Quality Index (DLQI). Patients were re-examined after 3 months and their actual treatment usage was directly assessed and compared with expected use. The objective medication adherence (Med Ad) was calculated as (actual treatment use/expected treatment use) x 100. The interview (self-report) Med Ad was obtained by direct questioning. To avoid influencing the behaviour of the subjects, they were not informed of the specific aim of the study: the Local Research Ethics Committee gave approval for this approach. Patient attendance was recorded by referring to the outpatient clinic appointment charts.

RESULTS

Of 687 patients seen who fulfilled the inclusion criteria, 403 completed the study. The mean +/- SD overall objective Med Ad was 64.7 +/- 24% (range 0-111%). The mean +/- SD DLQI was 17.7 +/- 8.1 (range 2-30). There was a highly significant negative correlation (r = -0.87) between DLQI scores and Med Ad. The correlation between age and Med Ad was significantly negative (P < 0.01). Being female, married, employed and not paying for prescriptions were characteristics associated with increased Med Ad and a lower DLQI. Med Ad was greater for isotretinoin therapy and for first time usage of isotretinoin. The major reasons for missing treatment given by the patients were being fed up, forgetful or too busy. Smoking cigarettes and drinking alcohol resulted in reduced Med Ad. The mean +/- SD interview Med Ad was 93.9 +/- 5% (range 85-100%).

CONCLUSIONS

The study demonstrates that a range of disease-related and social factors may influence compliance with treatment in acne. The inverse relationship between DLQI and Med Ad probably reflects the profound interaction of physical and psychological factors as well as perceived treatment failure.

Determinants of the quality of life of patients with congenital heart disease

OBJECTIVE

The improvement of the quality of life of chronically ill patients has become an important goal in treatment. However, it is seldom taken into account that many other factors, in addition to somatic factors, have an influence on the quality of life of patients. Using patients with congenital heart defects as an example, we examined the relative significance of biological factors, compared to psychological and social factors, for the various quality of life dimensions.

RESEARCH DESIGN AND METHODS

One hundred and eleven patients (aged 33+/-12 years) with different degrees of cardiac dysfunction were examined (NYHA 0: 2 I: 56, II: 38, III: 13, IV: 2). All patients for whom there was no contra-indication underwent a treadmill ergometry in order to determine their level of cardiopulmonary functioning (peak oxygen consumption: VO2max). All patients were asked to fill out questionnaires concerning their quality of life (WHOQOL-Bref), their cardiac complaints (Giessener Complaint Questionnaire GBB), their personality traits (Giessen Test GTS), and the social support they experience (Social Support Questionnaire SOZU-k22). The data were analyzed using a linear structural equation model (SEM).

RESULTS

In all aspects but the social domain, the HRQL of CgHD patients was significantly diminished compared to the normal population. The SEM proposed was valid, showing good indices of fit (chi2 = 1.18; p = 0.55; AGFI = 0.92). The level of cardiopulmonary functioning was most significant for the reporting of specific cardiac complaints (beta = -28) and for the physical component of the general HRQL (beta = 32), although the former was also influenced by a depressed disposition (beta = -0.20) and the extent of social support experienced (beta = 0.18). The objective findings, however, had virtually no individual significance for the psychological (beta = 0.09) and social domains (beta = -0.02). These HRQL domains are primarily influenced by depressive personality traits (beta= -26/-0.16) and the social support experienced (beta = 0.51/0.51).

CONCLUSIONS

The patient's organic dysfunction primarily determines illness-specific complaints but has little relevance for the psychological and social aspects of the HRQL. These aspects are predominantly determined by the patient's depressive disposition and by the experienced social support. A successful therapy should therefore take biological as well as psycho-social determinants of the quality of life into account.

Quality of life in children and adolescents: a European public health perspective

OBJECTIVES

The measurement of health-related quality of life (HRQOL) is increasingly important as a means of monitoring population health status over time, of detecting sub-groups within the general population with poor HRQOL, and of assessing the impact of public health interventions within a given population. At present, no standardised instrument exists which can be applied with equal relevance in pediatric populations in different European populations. The collaborative European KIDSCREEN project aims to develop a standardised screening instrument for children's quality of life which will be used in representative national and European health surveys. Participants of the project are centres from Austria, France, Germany, Netherlands, Spain, Switzerland, and United Kingdom. By including the instrument in health services research and health reporting, it also aims at identifying children at risk in terms of their subjective health, thereby allowing the possibility of early intervention.

METHODS

Instrument development will be based on constructing a psychometrically sound HRQOL instrument taking into account the existing state of the art. Development will centre on literature searches, expert consultation (Delphi Methods) and focus groups with children and adolescents (8-17 years). According to international guidelines, items will be translated into the languages of the seven participating countries for a pilot test with 2,100 children and their parents in Europe. The final instrument will be used in representative mail and telephone surveys of HRQOL in 1,800 children and their parents per country (total n = 25,200) and normative data will be produced. The potential for implementing the measurement tool in health services and health reporting will also be evaluated in several different research and public health settings. The final analysis will involve national and cross cultural-analysis of the instrument.

RESULTS

The international, collaborative nature of the KIDSCREEN project means it is likely to provide many challenges in terms of producing an instrument which is conceptually and linguistically appropriate for use in many different countries, but it will also provide the opportunity to develop, test and implement the first truly cross-national HRQOL instrument developed for use in children and adolescents. This will help to contribute to a better understanding of perceived health in children and adolescents and to identify populations at risk.

[Psychometric properties of a psychological well-being test for people with physical impairments]

Measuring the psychological well-being of people with physical impairments could provide relevant information to occupational therapists. The aim of this study was to verify psychometric properties of a psychological well-being test called Test de personnalité PER (PER). This test was administered to two samples of people with physical impairments. Two time measurements were collected within a group of 36 individuals and one single measure within another group of 79 individuals. Comparisons between time measurements, between groups and with the normative group of the PER were performed in an attempt to verify the sensitivity, the capacity to discriminate between known groups, and the construct validity of the PER. One section of the Sickness Impact Profile measuring psychological well-being was administered to the same groups to verify the concurrent criterion validity of the PER. The results indicate that the PER has sufficient psychometric qualities.

Functioning in daily living and psychological well-being of female cancer patients

The objective of this prospective study was to compare outcomes concerning psychological and physical functioning of patients with various gynecological malignancies. A sample of 119 newly diagnosed cancer patients completed two questionnaires evaluating psychological well-being and functioning in daily living. Outcome measures were obtained at three time points: before surgery, 3 months after surgery, and 1 year after surgery. The results showed that the psychological well-being improved significantly from the first to the third time point for the sample as a whole. After surgery, patients with ovarian and cervical cancer showed slightly lower scores than patients with endometrial cancer. The level of functioning in daily living declined 3 months after surgery for all except endometrial cancer patients, but increased significantly at the 1 year follow-up. At all three time points the mean differences for psychological well-being and functioning in daily living were not statistically significant among subgroups. Physical and psychological well-being of the patients treated for gynecological malignancies is affected independently of age, cancer site and stage of disease. However, throughout the observational period the psychological well-being scores were lower than those of patients with other chronic illnesses or healthy subjects. Therefore, we conclude that psychological interventions for patients facing gynecological cancer treatment should be provided as an integral component of cancer management.

The impact of managed care systems on relapse prevention and quality of life for patients with schizophrenia

In general clinical practice, relapse rates for patients with schizophrenia are worse than well-controlled studies suggest are achievable. This paper discusses the reasons for this shortfall and suggests that properly delivered "managed care" could reduce the gap between theory and practice. Shortsighted attempts to limit expenditure can lead to overall increases in expenditure on the care of patients with severe mental illness, as has happened in New Hampshire, where reducing expenditure on psychiatric drugs led to an increase in other costs that exceeded the savings on drugs by seventeen-fold. Other studies have shown that patients with schizophrenia can be managed in the community, and that the provision of proper community-based support services reduces the overall costs of caring for these patients. An analysis of the overall costs of medical care before and after the introduction of risperidone has also revealed that total health care expenditure fell, even though expenditure on medication increased. Proper managed care should ensure that services are integrated and that the appropriate level is provided for patients with severe mental disorders, such as schizophrenia. Drugs, such as risperidone, which have wider therapeutic spectrums than the older conventional neuroleptics, are likely to enable these co-ordinated services to provide better and more comprehensive care of patients with schizophrenia.

German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment

International translation and psychometric testing of generic health outcome measures is increasingly in demand. Following the methodology developed by the International Quality of Life Assessment group (IQOLA) we report the German work with the SF-36 Health Survey. The form was translated using a forward-backward method with accompanying translation quality ratings and pilot tested in terms of translation clarity and applicability. Psychometric evaluation included Thurstone's test of ordinality and equidistance of response choices in 48 subjects as well as testing of reliability, validity, responsiveness and discriminative power of the form in crossectional studies of two samples of healthy persons and longitudinal studies of two samples of pain patients totalling 940 respondents. Quality ratings of translations were favorable, suggesting a high quality of both forward and backward translations. In the pilot study, the form was well understood and easily administered, suggesting high clarity and applicability. Thurstone's test revealed ordinality (in over 90% of the cases) and rough equidistance of response choices also as compared to the American original. On item and scale level, missing data were low and descriptive statistics indicated acceptable distribution characteristics. In all samples studied, discriminative item validity was high (over 90% scaling successes) and Cronbach's alpha reliabilities were above the 0.70 criterion with exception of one scale. Furthermore convergent validity, responsiveness to treatment and discriminative power in distinguishing between healthy and ill respondents was present. The preliminary results suggest that the SF-36 Health Survey in its German form may be a valuable tool in epidemiological and clinical studies. However further work as concerns responsiveness and population based norms is necessary.

The quality of life in adult female patients with congenital adrenal hyperplasia: a comprehensive study of the impact of genital malformations and chronic disease on female patients life

Female patients with congenital adrenal hyperplasia have been frequently studied in order to determine the impact of prenatal androgen exposure on various aspects of psychological, psychosocial and psychosexual development. There is no published study to evaluate the impact of the genital malformation, genital operations and chronic medication on the quality of life in adult females with congenital adrenal hyperplasia. We performed a quality-of-life evaluation in adult female patients with congenital adrenal hyperplasia due to a 21-hydroxylation defect. The patients were asked to fill out questionnaires covering the four domains of health-related quality of life, namely physical state, psychological well-being, social relationships and functional capacity as well as questionnaires covering the areas of psychosexual identification and psychosocial integration. In addition a semistructured interview was performed covering medical history as well as physical, emotional, social and psychosexual development. The results were evaluated using a computerized statistical program for social sciences. Forty-five patients agreed to participate (44 could be interviewed) and their medical data did not differ from the 20 patients (medical data were available from 16 patients) who refused to participate. Median age at diagnosis was below 1 year in 54.8 of the participating patients; range was from 0 to 30 years. Of the participants, 48.6%, 34.2% and 17.2% suffered from the simple-virilizing-, salt-wasting-, and late-onset-form of congenital adrenal hyperplasia, respectively. The mean adult height was 157.8 cm, and mean weight was 56.8 kg. In 35.7% the degree of genital virilization was classified as Prader stage 3 or 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Developing and evaluating cross-cultural instruments from minimum requirements to optimal models

In the age of increased international collaboration in medical research, the necessity of having at hand cross-culturally applicable instruments for the assessment of health-related quality of life (HRQL) in clinical trials has been voiced. Several important theoretical bases leading to cultural bias in HRQL measurement include differences in definitions of HRQL across national and cultural contexts, levels of observation relied upon to indicate HRQL states, and the significance or weight placed upon the various HRQL states or dimensions measured. Despite a growing literature on the development and evaluation of existing HRQL measures in other cultures, comprehensive sets of procedures or requirements for the international part of development and evaluation are lacking. This paper reviews major approaches to developing international HRQL measures, and discusses various methods and criteria that have been recommended for evaluating measurement equivalence in comparisons of research across national and cultural contexts. A summary of recent trends and advances in international HRQL assessment is presented.