Generic, Disease-Specific and Individualised Approaches to Measuring Health-Related Quality of Life Among People With Heart Disease - A Comparative Analysis

Coping style and quality of life in elderly patients with vision disturbances

Purpose. This study aims at evaluating coping style and quality of life in patients with glaucoma and cataract. Methods. The participants were patients (N = 237, 130F; mean age: M = 67,8; SD = 9,5) with low vision caused by cataract (N = 188) and glaucoma (N = 49) who answered the Quality of Life Questionnaire (QOLQ) by Schalock and Keith. The participants were divided by means of cluster analysis (k-means) according to coping styles measured by CISS (Endler and Parker) into three groups: (1) high mobilization for coping, (2) task-oriented coping, and (3) low mobilization for coping. Results. In all the group, a general quality of life was moderately lowered; however, in task-oriented group it was relatively high. Moreover, task-oriented group had significantly lower level of anxiety (STAI), hopelessness (HS), and loneliness (UCLA LS-R) and higher level of self-esteem (SES) in comparison to the patients from high mobilization and low mobilization for coping. Conclusions. In an old age, adaptive coping with vision disturbances does not necessarily mean flexibility in combining all coping styles, but rather task-oriented coping and an ability to use social support. Extreme mobilization for coping seems not adaptive similarly like low mobilization for coping because it violates balance between environmental requirements and personal resources.

Usefulness of Patient-Generated Index for HIV to Measure Individual Quality of Life: A Study from Thailand

OBJECTIVES

To measure health-related quality of life (HRQOL) in Thai HIV patients using the patient-generated index for HIV (PGI-HIV) and to compare the psychometric properties of the PGI-HIV with those of the EuroQol five-dimensional (EQ-5D) questionnaire and the Medical Outcome Study HIV Health Survey in terms of practicality, reliability, validity, and responsiveness.

METHODS

In this study, two rounds of interviews were carried out in HIV outpatients who met the eligibility criteria and attended the HIV Clinic of Warinchamrap Hospital between January and March 2010. The patients were interviewed using a data collection form and three HRQOL measures (the PGI-HIV, the EQ-5D questionnaire, and the Medical Outcome Study HIV Health Survey) to assess the practicality and validity. The second interview was performed to check the test-retest reliability and responsiveness.

RESULTS

A total of 210 patients completed the study. They were mostly women (69.5%), with a mean age of 39.2 ± 11.1 years. The majority with the US Centers for Disease Control and Prevention clinical stage C took the current antiretroviral drugs within 1 year. The average PGI score was about 0.60, implying HIV/AIDS and antiretroviral drug therapy decreased the patients' quality of life by 40% from their healthy life. Three mostly cited impact domains were hyperlipidemia, lipid maldistribution and lipodystrophy, and hepatitis. The PGI-HIV was considered as practical, with a mean difficulty score of 3.7 ± 0.8, highly reliable (intraclass correlation coefficient = 0.75; P < 0.001), and responsive to HRQOL changes (effect size = 0.81; standardized response mean = 0.99), but not valid when compared with CD4 levels and viral loads (all Pearson' r < 0.2; P > 0.05).

CONCLUSIONS

The PGI-HIV was used to measure the individual HRQOL in a Thai sample of HIV-positive patients. It proves to be practical, highly reliable, and very responsive to changes in patients' HRQOL.

Quality of life in medically ill persons with comorbid mental disorders: a systematic review and meta-analysis

BACKGROUND

This systematic review aims to investigate the association between comorbid mental disorders and quality of life (QoL) in patients with chronic medical diseases.

METHODS

Studies investigating adults with diabetes mellitus, coronary artery disease, asthma, chronic back pain and colorectal cancer were included. Two reviewers independently extracted data and assessed methodological criteria. Effect sizes for QoL scores were analyzed in random-effects meta-analyses. Subgroup and sensitivity analyses were conducted.

RESULTS

The database search identified 7,291 references and 65 primary studies were included. Medically ill persons with comorbid mental disorders showed a significantly decreased overall (d = -1.10; 95% CI = -1.34 to -0.86), physical (d = -0.64; 95% CI = -0.74 to -0.53) and psychosocial (d = -1.18; 95% CI = -1.42 to -0.95) QoL compared to persons without mental disorders. Subgroup analyses did not reveal significant differences between the examined medical diseases or mental disorders.

CONCLUSION

The review provides evidence of a substantially reduced psychosocial and physical QoL in medically ill patients with comorbid mental disorders. This patient-reported outcome highlights the importance of recognizing and treating comorbid mental disorders in the medically ill.

Effects of trauma on bipolar disorder: the mediational role of interpersonal difficulties and alcohol dependence

OBJECTIVES

This study examined: (i) the prevalence of trauma in a bipolar disorder (BD) sample, and (ii) how trauma histories mediated by interpersonal difficulties and alcohol dependence impact on the severity of BD. The prevalence of posttraumatic stress disorder (PTSD) and its relationship to outcomes in BD were also examined.

METHODS

Sixty participants were recruited from a geographically well-defined mental health service in Northern Ireland. Self-reported trauma histories, PTSD, interpersonal difficulties and alcohol dependence and were examined in relation to illness severity.

RESULTS

A high prevalence of trauma was found. Trauma predicted the frequency of hospital admissions (R(2) = 0.08), quality of life (R(2) = 0.23) and inter-episode depressive symptoms (R(2) = 0.13). Interpersonal difficulties, but not alcohol dependence, appeared to play an important role in mediating these adverse effects. While only 8% of the sample met criteria for active PTSD, this comorbid disorder was associated with BD severity.

CONCLUSIONS

This study indicates that awareness of trauma is important in understanding individual differences in bipolar presentations. The theoretical and clinical implications of evidence that trauma is related to more adverse outcomes in BD are discussed. The finding that interpersonal difficulties mediate the relationship between trauma and BD severity is novel. The need for adjunctive evidence-based treatments targeting interpersonal difficulties is considered.

Twelve years–experience with the Patient Generated Index (PGI) of quality of life: a graded structured review

The Patient Generated Index (PGI) is an individualised quality of life (QoL) measure that has been in use since 1994. Various adaptations have been made to suit a variety of client groups. The PGI's psychometric properties have been studied but their review is necessary to inform instrument choice. This article provides a structured review, using grading criteria adapted from those developed to aid outcome measure selection for use with older people. These criteria grade quality of evidence and strength of findings for psychometric validity, providing a useful model for future reviews. All published articles providing data addressing validity, reliability and/or responsiveness were included in the review. Eighteen relevant articles were identified and analysed using the grading criteria. Variable results and quality of investigation were seen. Generally the measure was found to be adequately reliable for group comparisons. The PGI appeared valid but evidence for responsiveness was unclear. Those versions of the measure using fewer points in their Likert scales may have higher reliability. Cognitions involved in QoL judgements remain little understood and investigations of psychometric properties may be enhanced by examination of appraisal processes.

Quality-of-life measurement in chronic heart failure: do we take account of the patient perspective?

The modern management of chronic heart failure has led to improved life expectancy, functioning and health-related quality of life (HRQL). HRQL measures the effects of an illness or a treatment from the patient's perspective. It is now recognised that the patient's perspective is as legitimate and valid as the clinician's in monitoring health care outcomes. Although there are a number of quality-of-life measures, which can be separated into two types-generic and disease specific-many have been developed, with little or no account being taken of the patient's perspective. Because most of the widely used measures are not patient centred, they may lack sensitivity and specificity in determining those aspects of HRQL important to individual patients. This paper reviews the use of quality-of-life assessment tools in the evaluation of patients with heart failure.