Cross cultural differences in health related quality of life in adolescents with cystic fibrosis

A Metacognitive Intervention of Narrative Imagery for young people with cystic fibrosis: A feasibility study

Cystic fibrosis and its treatment can have substantial functional and emotional impacts on patients and their families. This feasibility study assessed a new cystic fibrosis treatment, Metacognitive Intervention of Narrative Imagery, integrating narrative and meta-cognitive therapies with mental imagery. A total of 13 patients, aged 10-17 years, received three 1-hour sessions and were assessed on emotional functioning, anxiety, and depression at baseline and 4 and 8 weeks post-baseline. Participants had significant improvements in anxiety, and changes in emotional functioning and anxiety had a medium effect size. Participants and parents rated Metacognitive Intervention of Narrative Imagery highly on usability and favourability. Further clinical trials are indicated.

Impact of Gender on General Health-Related Quality of Life in Patients with Chronic Sinusitis

Background

The aim of this study was to evaluate the impact of gender on health-related quality of life (HRQOL) in patients with chronic sinusitis

Methods

A prospectively administered survey was performed. For measuring HRQOL, we used the German versions of the Short Form 36 (SF-36; eight subscales) and the European Quality of Life—5 Dimensions (EQ-5D) (two subscales). For all SF-36 subscales we used norm-based scoring of the general German population.

Results

One hundred twenty-three patients (45 women and 78 men) underwent HRQOL evaluation at baseline (preoperatively) and 3 months after endonasal sinus surgery. Compared with male patients, female patients scored a significantly worse baseline in all SF-36 and one EQ-5D subscales and 3 months later in only one SF-36 subscale. Compared with the norm-based scores, both women's and men's SF-36 scores reached normal levels in seven subscales after 3 months.

Conclusion

Compared with men, women assessed preoperative HRQOL as being worse. Most women's and men's SF-36 subscales reached normal levels at the 3-month follow-up.

Psychometric evaluation of the Swedish translation of the revised Cystic Fibrosis Questionnaire in adults

AIM

The CFQ-R is one of the most established disease-specific, health-related quality of life (HRQOL) measurements for patients with cystic fibrosis (CF). The aim was to evaluate the psychometric properties of the Swedish translation of CFQ-R in adults.

METHOD

A total of 173 CF patients answered the CFQ-R. The CFQ-R was evaluated with regard to: (1) distributional properties; (2) reliability; and (3) construct validity.

RESULTS

The majority of scales were negatively skewed with ceiling effects. Eight of the 12 scales had satisfactory homogeneity; 10 of the 12 scales had satisfactory test-retest reliability. On many of the CFQ-R scales expected differences were observed when patients were divided regarding disease severity, nutritional status, age, and gender.

CONCLUSION

Some weaknesses were detected, but overall the instrument has satisfactory psychometric properties.

Associations between academic achievement and psychosocial variables in adolescents with cystic fibrosis

BACKGROUND

Cystic fibrosis (CF) is a chronic genetic disease that leads to the accumulation of thick mucus in multiple organ systems, leading to chronic lung infection and affecting the body's ability to absorb nutrients necessary for growth and development. This cross-sectional, correlational study examined the potential effects of CF on students' psychosocial and academic development.

METHODS

Forty adolescents with CF completed a battery of neuropsychological and psychosocial measures. Their school records were reviewed to abstract information about standardized achievement testing results and grade point average (GPA). Academic outcomes were hypothesized to be associated with (1) self-efficacy, (2) disease and school-specific coping strategies, (3) attitude to school, and (4) depression.

RESULTS

Cognitive and academic scores were within the normal range, and self-efficacy had the strongest association with standardized cognitive and academic measures and high school grades. School absences were associated with GPA, but not standardized test scores.

CONCLUSION

Adolescents with CF require supports in school that foster their sense of self-efficacy and accommodations that address the learning time lost from extended health-related absences.

Norms and demographic differences of the short form-12 health survey version 2 in Chinese adolescents

AIM

This study aimed to establish the normative values for the 12-item Short Form Health Survey version 2 (SF-12v2) and examine demographic differences among Hong Kong Chinese adolescents.

METHODS

A total of 28,981 Hong Kong Chinese adolescents aged 12-18 participated in a school-based survey in 2006-2007. Sex- and age-specific SF-12v2 scores were obtained. Ordinal logistic regression models and linear regression models were used to examine the demographic differences for the eight subscales including physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health, and two component summary scores of Physical Component Summary and Mental Component Summary.

RESULTS

The mean (standard deviation) Physical Component Summary score was 50.28 (6.82) for boys and 49.37 (6.47) for girls. The corresponding Mental Component Summary score was 45.86 (9.86) for boys and 44.77 (9.56) for girls. Ceiling effects were observed in some of the eight subscales but not the two component summary scores. Ordinal logistic regression showed that girls had significantly lower scores than boys in most subscales including physical functioning with odds ratio (95% confidence interval) of 0.89 (0.84-0.93); role physical, 0.94 (0.90-0.98); bodily pain, 0.76 (0.73-0.80); general health, 0.55 (0.53-0.57); vitality, 0.72 (0.69-0.75); role emotional, 0.78 (0.74-0.81); and mental health, 0.91 (0.88-0.95). In general, older and non-local-born adolescents had lower component summary scores than their peers.

CONCLUSIONS

This study has provided norms and identified demographic differences of the Chinese SF-12v2.

Health-related quality of life in children with cystic fibrosis: validation of the German CFQ-R

Background

This study evaluates the psychometric properties of the Child and Parent versions of the German CFQ-R (Cystic Fibrosis Questionnaire Revised), a disease-specific measure of Health-Related Quality of Life (HRQoL) in children with cystic fibrosis (CF). Self-Rating is combined with proxy-rating by parents in the use of the questionnaire.

Methods

136 children with CF (6 - 13 years) and their parents were recruited to evaluate internal consistency (Cronbach's α) and validity, 20 children and parents to examine reproducibility (ICC).

Results

Cronbach's α is high in all but two dimensions of the Child version (α = 0.23-0.77) and for all dimensions of the Parent version (α = 0.69-0.89). For both questionnaires, reproducibility is moderate to high (ICC = 0.50-0.94). Factor analysis shows loadings of >0.4 in the majority of items. Higher HRQoL is reported by children with mild disease compared to those with moderate/severe disease and by boys compared to girls. Convergence between self-rating and proxy-rating depends on the dimension.

Conclusion

The German CFQ-R, Child and Parent versions, are reliable and valid measures of HRQoL. They should be administered in combination as both, child and parent, provide important information. The measure offers a new patient-reported outcome for clinical purposes as well as for national and international studies in schoolchildren.

Dimensions of quality of life for Chinese adults with spinal cord injury: A qualitative study

PURPOSE

The purpose of this study was to explore meaning and components of quality of life (QOL) perceived by Chinese adults with a spinal cord injury (SCI) and to examine the frame of reference that this population used to assess quality of their life.

METHOD

A qualitative research approach was used. Six focus group interviews were conducted with 40 adults with SCI from a northeastern city in China. A content analysis was conducted on interview data to determine meaning and components of QOL perceived by the participants.

RESULTS

Participants defined QOL as satisfaction with one's life, which might vary from person to person and change when the circumstance changed. They identified 18 QOL components that could be grouped into five domains: physical, psychological, economic, social well-being, and a least restrictive environment. When assessing quality of their life, participants used both internal (comparing with oneself) and external (comparing with others) comparisons.

CONCLUSIONS

The results of this study contribute to the understanding of dimensions of QOL for people with SCI in China. Although several domains of QOL identified in the present study were similar to those found in previous studies conducted elsewhere, several unique components of QOL, such as relationship with extended family and neighbours, government support, peace in the world and the nation, were identified by the participants. These components appeared to be related to the Chinese culture and socioeconomic system. Specific QOL measurements that address these unique components are needed when assessing QOL of this population.

Validation of the Danish version of the revised cystic fibrosis quality of life questionnaire in adolescents and adults (CFQ-R14+)

BACKGROUND

Quality of life is an important parameter in the evaluation of quality and outcome of health care and treatment, especially in patients with chronic disorders. The aim of this study was to assess the validity and reliability of the Danish version of the revised disease-specific health-related quality of life questionnaire for adolescents and adults with cystic fibrosis (CFQ-R14+).

METHODS

A total of 196 cystic fibrosis (CF) patients completed the CFQ-R14+ (response rate 71%). Forced expiratory volume in 1 s in percentage of predicted (FEV(1)%) and body mass index (BMI) were included as measures of health status.

RESULTS

Internal consistency coefficients ranged from 0.54 to 0.95. Eight out of the twelve scales had alpha coefficients above 0.7. Test-retest correlations ranged from 0.42 to 0.88 and they were significant in eight scales. All the CFQ-R+14 scales except the digestive symptoms scale discriminated significantly (p<0.05) between patients with mild, moderate, and severe disease. Nine out of the twelve scales discriminated significantly (p<0.05) between nourished (BMI> or =19) and malnourished (BMI<19) patients. Significant differences between participants and non-responders were found for age, sex and FEV(1) (higher age, more males and lower FEV(1) among non-responders). All of the scales met standards for floor effects (<15% of the responders with the lowest score) but five of the scales failed to meet standards for ceiling effects (>15% of the responders with the highest score).

CONCLUSION

The Danish CFQ-R14+ is a reliable and valid instrument for measuring the health-related quality of life in Danish adolescents and adults with CF, though with the exception from a few of its subscales.

Comparing three measures of health status (perceived health with Likert-type scale, EQ-5D, and number of chronic conditions) in Chinese and white Canadians

BACKGROUND

Measures of perceived health status may be vulnerable to ethnic and sociodemographic characteristics. The purpose of this study was to compare self-reported health status in Chinese and whites using 3 measures: physical and mental health status with the 5-point Likert-type scale, the EQ-5D together with a modified health index scale (0-100), and number of chronic conditions.

METHODS

A cross-sectional telephone survey of Chinese and white Canadians was conducted in a large city in Alberta, Canada.

RESULTS

We analyzed 830 Chinese and 789 white respondents. Chinese, compared with whites, reported better health status using the EQ-5D health index (0.94 vs. 0.86) and had fewer chronic conditions surveyed (51.9% vs. 79.2% had one or more conditions). However, Chinese rated their health status fair or poor more often than whites (27.3% vs. 9.7% for physical health and 24.0% vs. 5.0% for mental health) and both groups rated similarly on the health index scale (80.0 for Chinese vs. 77.9 for white).

CONCLUSIONS

Health status measurements performed inconsistently across ethnic populations. The EQ-5D health index was consistent with the number of chronic conditions, whereas results from the 5-point Likert-type scale and the health index scale were not consistent with the number of chronic conditions. Perceived health status differed by the measures used and ethnicity.

Quality of life in paediatric gastrointestinal and liver disease: a systematic review

OBJECTIVES

To identify and appraise all studies relating to and instruments developed to measure quality of life (QOL) in children with gastrointestinal or liver diseases.

METHODS

A literature search was undertaken using MEDLINE, EMBASE, CINAHL, and PsycINFO to identify relevant articles published up to the end of 2005. These were reviewed by both authors and data were extracted using a standardised form. Articles were excluded if no attempt was made to measure QOL, they did not relate to children ages <17 years, they did not relate to gastrointestinal or liver diseases, or they were review articles. Quality of life instruments identified were rated according to proposed criteria.

RESULTS

From a total of 2379 articles identified in the initial search, a total of 2309 were excluded, leaving 70 included studies. These were assigned to the following categories: inflammatory bowel disease, n = 17; cystic fibrosis, n = 20; liver disease, n = 11; surgery, n = 15; and miscellaneous, n = 7. These studies describe the impact that these diseases have on the QOL of affected children. A total of 11 disease-specific QOL instruments and 1 generic instrument with a chronic disease module were identified, but only 5 of these fulfilled the proposed quality criteria and can be recommended for future use.

CONCLUSIONS

Chronic gastrointestinal and liver diseases can have an enormous effect on the QOL of affected individuals and their families. A number of disease-specific paediatric QOL instruments have been developed and validated. Quality of life is an important outcome that should be incorporated into clinical practice and measured when treatments are evaluated. Future research should explore how QOL can best be improved in children in whom it is severely impaired.

The impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults

BACKGROUND

The provision of home enteral tube feeding in adults has increased in the UK. This study explored how percutaneous endoscopic gastrostomy (PEG) feeding impacts on daily lives of adult patients, from the patients' and carers' perspectives.

METHODS

A semi-structured interview approach was developed to obtain participants' views of the impact of living with a PEG. A cross-sectional qualitative purposive sampling design was employed. Thirty-four semi-structured interviews were conducted (15 adult patients and 19 carers) and data were analysed descriptively and thematically.

RESULTS

Difficulties arising from PEG feeding included vomiting, diarrhoea, infection of the PEG site and leakage. The key issues that emerged included relief of pressure to consume an oral diet, disturbed sleep, restricted ability to go out, restricted choice of clothing, difficulties finding a place to feed, missing being able to eat and drink, social occasions, negative attitudes of others towards feeding and the burden placed on family members.

CONCLUSIONS

The key themes that emerged from participants were diverse and highlight a need for increased social support for both patients and their carers, planned on an individual basis.

Monitoring quality of life in outpatients with cystic fibrosis: feasibility and longitudinal results

BACKGROUND

To investigate the feasibility of monitoring quality of life (QL) with cystic fibrosis (CF) in a clinical setting, to explore changes in subjective health and to describe the impact of multiple medical and psychosocial factors on the patients' QL.

METHODS

108 adolescent and adult outpatients (age 15-47 years, FEV(1) 20-125% of the predicted) answered the Questions on Life Satisfaction repeatedly parallel to each pulmonary function test (2-16 assessments per patient within 18 months). Multiple regression analysis determined the contribution of medical and psychosocial factors to the patients' QL.

RESULTS

Good acceptance of the instrument was observed. The completion time was between 5 and 29 min per assessment (median 11 min). QL remained quite stable (r(tt)=.69) with the previous QL score predicting most of the variance of the present score. Additionally, a longer interval between assessments, new colonization with Pseudomonas aeruginosa, infection exacerbations, partnership, vocation and living separately from parents significantly predicted QL at the second assessment. Pulmonary function varied independently of QL.

CONCLUSIONS

Medical factors such as pulmonary exacerbation and social living circumstances have an impact on the QL of patients with CF. Repeated QL assessments in clinical routine are feasible and useful to recognize the individual patient's adaptation to the disease.

Validation and test-retest reliability of the Royal Free Interview for Spiritual and Religious Beliefs when adapted to a Greek population

BACKGROUND: The self-report version of the Royal Free Interview for Religious and Spiritual Beliefs has been confirmed as a valid and reliable scale, assessing the manner and nature in which spiritual beliefs are expressed. The aim of the present study was to evaluate the test-retest reliability and psychometric properties of the Greek version of the Royal Free Interview for Religious and Spiritual Beliefs. METHODS: A total of 209 persons (77 men and 132 women) with a mean age of 28.33 +/- 9.44 years participated in the study (test group). We subsequently approached 139 participants of the test group with a mean age of 28.93 +/- 9.60 years, who were asked to complete the Royal Free Questionnaire a second time two weeks later (retest group). RESULTS: The vast majority of participants (58.9%) reported both a religious and a spiritual belief, compared to 52 (25.1%) who told of a religious belief only. The internal consistency of the spiritual scale for the test group proved to be good, as standardized inter-item reliability / Cronbach's alpha was 0.83. Item-total correlations ranged from 0.51 to 0.73. They indicated very good levels of differentiation, thus showing that the questions were appropriate. Internal consistency of the spiritual scale for the retest group proved as good as for the test group. Standardized inter-item reliability / Cronbach's alpha was 0.84. Item-total correlations ranged from 0.52 to 0.75. The Pearson correlation coefficient for the total test-retest score of the spiritual scale was 0.754 (p < 0.001). CONCLUSION: The Greek version of the Royal Free Interview for Religious and Spiritual Beliefs is reliable and thus suitable for use in Greece.

Validation of the Dutch cystic fibrosis questionnaire (CFQ) in adolescents and adults

BACKGROUND

This study assesses the reliability and validity of the Dutch version of a disease-specific measure of health-related quality of life (HRQOL) for adolescents and adults with CF (CFQ-14+). The 47-item CFQ-14+ covers nine domains, three symptom scales and one health perception scale.

METHODS

To assess psychometric characteristics of the CFQ-14+, cross-sectional (homogeneity, discriminative and construct validity) and test-retest designs were used. Eighty-four adolescents and adults with CF (mean age: 21.4 years, range 14.0-46.5 years) and a wide range of lung function (mean FEV1: 59.9% predicted, range 15-121%) completed the questionnaire during a routine visit.

RESULTS

Internal consistency was acceptable for most domains of the CFQ-14+ (alpha = 0.43-0.92) and test-retest reliability was high for all domain scores (0.72-0.98). Several domains of the CFQ-14+ were able to differentiate between individuals with varying disease severity and between nourished and malnourished patients. Construct validity of the questionnaire was fair, with moderate to strong correlation between physically orientated domains and pulmonary function (rs = 0.36-0.62).

CONCLUSION

The results demonstrate that the CFQ-14+ questionnaire is a well-validated measure of HRQOL assessment in adolescents and adults with CF.

Translating clinical tools in nursing practice

BACKGROUND

The widespread use of clinical tools in nursing practice reflects their usefulness in guiding patient care, evaluating treatment effectiveness and conducting audit. Cultural awareness and the provision of culturally competent care is a high priority for nurses in the United Kingdom (UK), given patterns of increasing ethnic diversity. However, meeting the individual needs of patients can be difficult when language barriers hinder communication. One way to address these difficulties is to translate existing clinical tools.

AIM

The aim of this paper is to appraise the potential for, and limitations of, translating clinical tools for use in nursing practice.

DISCUSSION

Drawing on a range of studies from the disciplines of health and social science, this review describes and discusses some key considerations relevant to translating clinical tools in nursing. These considerations include the need to ensure cultural equivalence, lack of familiarity with clinical tool formats in some cultures and its impact on responses, and low literacy levels in some populations.

CONCLUSION

Clinical tools provide benefits in identifying patients' problems, guiding patient care, and evaluating treatments and interventions. Translating these tools can help to bridge the language gap that hinders good communication between nurses and patients. Translated clinical tools can be of acceptable cultural equivalence and validity if high quality translation methodologies are employed, together with an awareness of culturally relevant issues when interpreting the information gained from the tools.

Quality of life in children and adolescents with cystic fibrosis: implications for optimizing treatments and clinical trial design

Health related quality of life (QOL) as an outcome measure in clinical trials is becoming increasingly important. Trials should not only be able to demonstrate the pharmacologic activity of a therapy, but of equal importance, they should demonstrate clinical effectiveness that is of significant benefit to the patient. QOL measurement provides a way of incorporating the child/parent's perspective of how cystic fibrosis (CF) and its therapies impact on their lives. Several validated generic instruments have been employed to measure QOL in adolescents and adults. QOL assessment is more difficult in children and, therefore, has been employed less often in children with CF. Difficulties arise with the issue of whether children can report their own experiences directly, or whether a parent or clinician should report on behalf of the child. A child-centered approach is imperative since the literature indicates that children are able to report on their own QOL. An additional complication has been the use of adult measures with children. These are often inappropriate in their complexity, use of language, response scales, and time frame. The evaluation of pharmacologic therapies can profit from QOL measurement. The effectiveness of a drug and any adverse effects that impact on daily life can be assessed from the child/parent's viewpoint. Home therapy versus hospital therapy and drug delivery systems, are additional areas where QOL as an outcome measure is valuable. There have been relatively few appropriately powered trials in CF, and only a minority of these have evaluated QOL as an outcome measure. This review highlights areas where QOL measurement is appropriate. It focuses on the pharmacologic trials that have employed QOL assessment for antibiotic, mucociliary clearance, anti-inflammatory, and nutritional therapies. Methodological issues of incorporating QOL assessment into trials center on cross-cultural and data interpretation issues. QOL measurement in CF has been patchy and largely unreliable. The notion that improved symptoms equate with improved QOL is erroneous. Measurement of how symptoms impact on QOL is essential. Currently, the development and validation of CF specific measures (across the CF age range) provides optimism for appropriate QOL measurement in clinical trials, and for future meta-analysis and systematic reviews.