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Younossi ZM, Stepanova M, Younossi I, Racila A. Validation of a Primary Biliary Cholangitis-Specific Version of Chronic Liver Disease Questionnaire: CLDQ-PBC. Clin Transl Gastroenterol 2024; 15:e1. [PMID: 38738764 PMCID: PMC11421712 DOI: 10.14309/ctg.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Primary biliary cholangitis (PBC) is a chronic liver disease, leading to cirrhosis and impairment of patient-reported outcomes. We aimed to develop a PBC-specific version of the Chronic Liver Disease Questionnaire (CLDQ) instrument to assess health-related quality of life of patients with PBC. METHODS From our Liver Database, we included patients with PBC who had CLDQ, clinicolaboratory data, and completed Short Form-36 and The Functional Assessment of Chronic Illness Therapy-Fatigue. The 29 items of CLDQ were subjected to item reduction, exploratory factor analysis, and fed into a standard instrument validation pipeline. RESULTS Data were available for 108 patients with PBC: 57 ± 11 years, 7% male, 58% cirrhosis, and 24% decompensated cirrhosis (Child B and C). Of 29 CLDQ items, none met the exclusion criteria. Exploratory factor analysis (95% of variance) returned 7 factors. Based on evaluation of factor loadings and face validity, those factors yielded 7 domains (Diet, Emotion, Fatigue, Itch, Symptoms, Sleep, and Worry). Good to excellent internal consistency (Cronbach's α 0.85-0.93) was observed for 5/7 domains. For the remaining 2 domains (Diet and Itch), additional items obtained from patients, experts, and review of the literature were included. For 5 domains, known-group validity tests discriminated between patients with PBC with and without cirrhosis, advanced cirrhosis, and depression ( P < 0.05 for 3-5 domains). The CLDQ-PBC domains were correlated with relevant domains of Short Form-36, CLDQ-PBC Fatigue correlated with Fatigue Scale of Functional Assessment of Chronic Illness Therapy-Fatigue (rho = +0.85), and CLDQ-PBC Worry domain negatively correlated with alkaline phosphatase (rho = -0.38, P = 0.0082). DISCUSSION The CLDQ-PBC has been developed based on the original CLDQ. The new instrument has evidence for internal consistency and validity and is being fully validated using an external cohort.
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Affiliation(s)
- Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA.
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA.
| | - Issah Younossi
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA.
| | - Andrei Racila
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA.
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Su WC, Chen TT, Yang SS, Shih LN, Liu CK, Wang CC, Wu CH. The effect of a pay-for-performance program on health-related quality of life for patients with hepatitis in Taiwan. Health Qual Life Outcomes 2022; 20:130. [PMID: 36064530 PMCID: PMC9446742 DOI: 10.1186/s12955-022-02038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 06/13/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Chronic viral hepatitis is a major global public health problem. The guidelines suggest the long-term performance of regular ongoing liver examinations to monitor liver inflammation and screen for hepatocellular carcinoma. However, the effects of regular liver examinations on health-related quality of life (HRQoL) have not been adequately evaluated. Therefore, this study evaluated the effects of regular ongoing examinations on the quality of life of patients with hepatitis.
Methods A cross-sectional study was conducted from October to December 2016 in four hospitals in northern Taiwan. A hepatitis pay-for-performance (P4P) program was launched in 2010 to ensure that hepatitis patients have regular ongoing liver examinations. The study group consisted of patients who joined and stayed in the program for more than one year. The study assessed HRQoL utilizing the five-level version of the EuroQol-5 Dimension (EQ-5D-5L) and the EuroQoL visual analog scale (EQ-VAS). The responses for the EQ-5D-5L in hepatitis patients were transformed into the EQ-5D index according to the Taiwanese population’s value set. Sociodemographic and clinical characteristics were collected by questionnaire, and descriptive statistics were presented. A two-part model and generalized linear model with a Poisson distribution and a log link function, respectively, were used to examine the associations of the EQ-5D index and EQ-VAS score with participation in the hepatitis P4P program. We applied propensity score weighting with inverse probability weighting to control for selection bias. Results In all, 508 patients (aged 57.6 ± 11.6 years; 60.8% male) were enrolled in this study. The mean (standard deviation, SD) reported EQ-5D index and EQ-VAS scores were 0.93 (0.12) and 75.1 (13.8), and the median (interquartile range, IQR) values were 1 (0.108) and 80 (15), respectively. The study group had a moderately significantly higher EQ-VAS score (mean ratio = 1.029, P < 0.001). However, the differences in the EQ-5D index scores between the study and control groups were not significant. Conclusion Patients with hepatitis partially benefited from receiving hepatitis P4P in Taiwan, which featured regular ongoing liver examinations, in that their EQ-VAS scores were enhanced but not their EQ-5D index scores.
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Affiliation(s)
- Wei-Chih Su
- Department of Gastroenterology, Buddhist Tzu Chi Medical Foundation, Taipei Tzu-Chi Hospital, New Taipei City, Taiwan.,Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Sien-Sing Yang
- Liver Unit, Cathay General Hospital Medical Center, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Ling-Na Shih
- Lo-Sheng Sanatorium Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chih-Kuang Liu
- Department of Urology, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan.,Graduate Institute of Business Administration and College of Medicine, Fu-Jen, Catholic University, New Taipei City, Taiwan
| | - Chia-Chi Wang
- Department of Gastroenterology, Buddhist Tzu Chi Medical Foundation, Taipei Tzu-Chi Hospital, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Hsien Wu
- Lo-Sheng Sanatorium Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan. .,Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
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Chang PE, Tan HK, Lee Y, Fook-Chong S, Chia PY, Shaik-Hussain N, Lee HL, Aloweni F. Clinical validation of the chronic liver disease questionnaire for the Chinese population in Singapore. JGH OPEN 2020; 4:191-197. [PMID: 32280764 PMCID: PMC7144794 DOI: 10.1002/jgh3.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
Background and Aim Assessment of health‐related quality‐of‐life (HRQOL) in patients with chronic liver disease (CLD) requires the use of validated instruments that are understood by patients in their native language. We previously translated the Chronic Liver Disease Questionnaire into the Singapore‐Mandarin version (CLDQ‐SG). This study aims to examine the internal consistency and validity of the CLDQ‐SG in patients with CLD. Methods We conducted a cross‐sectional study of adult patients with CLD seen in a tertiary center in Singapore who completed both the CLDQ‐SG and Short Form Health Survey 36 version 2 (SF‐36v2) questionnaires. Internal consistency of the CLDQ‐SG was assessed using Cronbach's alpha coefficient. Convergent and divergent validity of the SF‐36v2 was assessed using the Spearman correlation coefficient, while discriminant validity was assessed using the Jonckheere‐Terpstra test for trend. Exploratory factor analysis was performed to evaluate the factor structure of the CLDQ‐SG. Results We enrolled 242 subjects (68.2% males, median age 67 years). Predominant etiology of CLD was chronic hepatitis B. Severity of CLD was divided into noncirrhotic (67.3%), compensated cirrhosis (24.0%), and decompensated cirrhosis (8.7%). Item convergent and discriminant validity of the CLDQ‐SG was excellent, with 100% scaling success in all six domains. All domains exhibited good internal consistency, with Cronbach's α > 0.70. We observed a consistent trend of a reduction in mean CLDQ‐SG score in the three groups reflecting the discriminant validity of the CLDQ‐SG to assess changes in HRQOL in different severities of CLD. Factor analysis of the CLDQ‐SG demonstrated an independent factor assessing sleep. Conclusion The Singapore‐Mandarin version of CLDQ‐SG is a valid and reliable instrument to measure HRQOL in patients with CLD.
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Affiliation(s)
- Pik-Eu Chang
- Department of Gastroenterology and Hepatology Singapore General Hospital Singapore.,Duke-NUS Medical School Singapore
| | - Hiang-Keat Tan
- Department of Gastroenterology and Hepatology Singapore General Hospital Singapore.,Duke-NUS Medical School Singapore
| | - Yean Lee
- Nursing Division Singapore General Hospital Singapore
| | - Stephanie Fook-Chong
- Health Services Research Unit, Division of Medicine Singapore General Hospital Singapore
| | - Pei-Yuh Chia
- Nursing Division Singapore General Hospital Singapore
| | | | - Hwei-Ling Lee
- Nursing Division Singapore General Hospital Singapore
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Valery PC, Bernardes CM, Stuart KA, Hartel GF, McPhail SM, Skoien R, Rahman T, Clark PJ, Horsfall LU, Hayward KL, Gupta R, Powell EE. Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC). Patient Prefer Adherence 2020; 14:599-611. [PMID: 32256051 PMCID: PMC7094148 DOI: 10.2147/ppa.s236818] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/18/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We report the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC). METHODS The 50-item SNAC was administered to patients (n=465) diagnosed with cirrhosis recruited from five metropolitan hospitals in Queensland, Australia. Items were assessed for ceiling and floor effects, and exploratory factor analysis was used to assess the factor structure. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. RESULTS Exploratory factor analysis identified 4 factors (39 items), which together accounted for 49.2% of the total variance. The 39-item SNAC met the requirements of a needs assessment tool and identified a range of needs important to patients with cirrhosis that were grouped in four subscales: "Psychosocial issues", "Practical and physical needs", "Information needs", and "Lifestyle changes". Cronbach's alpha values for the four subscales ranged from 0.64 to 0.92. Convergent validity was supported by a strong correlation between the total SNAC score and that of the Chronic Liver Disease Questionnaire (CLDQ; Spearman rho -0.68; p<0.001), and moderate correlations with the Distress Thermometer (Spearman rho 0.53; p<0.001) and seven subscales of a generic health-related quality of life instrument (Short Form 36; Spearman rho ranged from -0.48 to -0.57; p<0.001). The SNAC discriminated patient groups with respect to sex (p=0.013), age group (p<0.001), and hospital admission status (admitted vs not; p<0.001). CONCLUSION These data provide initial evidence for the validity and reliability of the SNAC, an instrument designed to measure type and amount of perceived unmet practical and psychological needs of people diagnosed with cirrhosis.
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Affiliation(s)
- Patricia C Valery
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gunter F Hartel
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Queensland Health and the School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Richard Skoien
- Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Tony Rahman
- Gastroenterology & Hepatology Department, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia
| | - Leigh U Horsfall
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rohit Gupta
- Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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