The Suitability of Measuring Patient-Reported Outcomes in Older Adults Following a Hip Fracture Using the Short-Form 36 Questionnaire: A Qualitative Description Approach

Hip-fractures (HF) in older adults are associated with poor outcomes and high costs. Measuring quality-of-care of HF patients has focused on clinical definitions rather than on measuring outcomes that are meaningful to the patient. Healthcare systems worldwide are increasingly interested in patient-reported outcome measures (PROs). The Short-form (SF36) questionnaire is a recommended measure among older adults however it's comprehensiveness and uniqueness for specific patients after a HF is not clear. The aims of this study were to: understand the perspective of the older adults experience following HF, to assess the suitability of the SF36 as a PRO for HF and to determine the best timing for questioning. A qualitative description approach was used. This took place in 2 large academic medical-centers in Israel. The inquiry was done in 2 parts by semi-structured interview. A total 15 HF patients were interviewed. Categories and themes emerging from their responses were similar to the 8 domains of the SF36 questionnaire, but the participants added clarity regarding their own needs for setting goals. In the second part, participants agreed that the SF36 reflected common issues and served as an adequate measure for personal-goal setting. The study encourages patient-centered care in older adults recovering from HF, providing evidence that the SF36 is a suitable tool for measuring PROs in HF patients. Healthcare systems focus on clinical-outcome indicators and do not reflect how the patient views his outcomes. This study provides evidence that care should be customized for each person.

Do They Feel the Same Way? Health-Related Quality of Life and Satisfaction With Life in Jewish Immigrants From the Former Soviet Union in Germany and Israel

There is consensus that experiences gained during immigration have an impact on health status. However, studies comparing health-related outcomes in homogeneous groups of immigrants living in different host countries are rare. In a sample of Jewish immigrants from the Former Soviet Union (FSU) in two different host countries, Germany and Israel, possible predictors of health-related quality of life (HRQoL) and satisfaction with life (SWL) were examined. In total, 359 Jewish immigrants from the FSU living in Germany ( n = 180) and Israel ( n = 179) completed the questionnaire measuring immigration-related and sociodemographic characteristics. HRQoL was assessed via Short Form Health Survey Version 2 (SF-12v2), and SWL via Satisfaction With Life Scale (SWLS). Hierarchical linear regression models were applied for analyzing immigration-related and sociodemographic predictors of HRQoL and SWL. Participants living in Israel scored higher on HRQoL, and no differences were found concerning SWL ratings. However, no direct influences of the host country were detected by predicting HRQoL and SWL scores. In both subgroups, immigration-related factors such as perceived discrimination or level of integration were found as significant predictors. In the face of different immigration waves in the host countries, Germany and Israel, the results display similarities rather than differences between the groups concerning the sociodemographic and immigration-related predictors on HRQoL and SWL. The findings using cross-cultural analysis level underscore the need of much more detailed future research on this issue.

Health-related quality of life in multiple sclerosis: psychometric analysis of inventories

Objective: Measuring health-related quality of life (HRQoL) enables attainment of a comprehensive picture of chronic patients’ conditions. The aim was to gain insight into HRQoL as viewed by Israeli multiple sclerosis (MS) patients, with an eye to its cross-cultural applicability, using psychometric analysis and a regression-based procedure. Methods: The reliability and validity of the MSQoL-54 was assessed in 215 Israeli MS patients. Subsequently, a novel method in QoL research for assessing the relative importance to patients of different aspects of the construct, comparing these between males and females, was applied. Using factor analysis, the degree to which the MSQoL-54 dimensions are applicable in our population and the existence of a separate dimension of Fatigue were tested. Finally, structural equation modelling (SEM) was used to examine relationships between QoL dimensions. Results: The MSQoL-54 showed reliabilities and validities comparable to those found in other populations. Females attach importance to emotional aspects of QoL, while males are more concerned with physical aspects. The distinction between Emotional and Physical dimensions emerged from SEM, as did a distinction between Fatigue and Energy, the former being primarily Physical, and the latter Emotional. SEM indicated a reciprocal causality between Physical and Emotional dimensions. Conclusions: Based on internal structure, reliability and validity, the MSQoL-54 is applicable to Israeli MS patients. However, the scale’s Social Function dimension is indecisively defined, which requires further study. QoL research in MS should distinguish between emotional and physical Fatigue. Assessing importance of QoL dimensions should inform clinicians in tailoring treatment to the individual patient.

Mental health implications of migration: a review of mental health community studies on Russian-speaking immigrants in Israel

INTRODUCTION

Since late 1980s, 1,001,726 immigrants arrived in Israel from the former Soviet Union (FSU). A review of community studies on the mental health of these immigrants is presented.

METHOD

Israeli studies from the past two decades were reviewed. Presented are findings on the prevalence of psychological distress and psychiatric disorders as well as on a number of risk factors among FSU immigrants.

RESULTS

Higher psychological distress and psychiatric morbidity were consistently found among FSU immigrants compared to the Israel-born. Social support was identified as a major stress-mitigating factor in migration. Most studies reveal the persistence of psychological distress among FSU immigrants during the first 5 years following migration, with a risk period around the second and third years following migration.

DISCUSSION

Findings from Israel corroborate some findings on immigrants in other countries but as they are limited to a single immigrant population, replication of these studies is necessary.

Health-related Quality of Life in Multiple Sclerosis: The Impact of Disability, Gender and Employment Status

OBJECTIVES

(1) Evaluate the impact of the patient characteristics of disability, gender and employment status on health-related quality of life (HRQOL) in multiple sclerosis (MS) and (2) Characterize the functional relationship between HRQOL and disability overall, and by gender and employment status.

METHODS

We assessed the HRQOL of 215 MS outpatients in our clinic using the MSQOL-54 and Fatigue Severity Scale (FSS), and that of 172 healthy controls, using the SF-36 (a subset of MSQOL-54). We compared QOL between MS subgroups defined by disability, gender and employment, and computed the linear and non-linear relationships between disability level measured by the Expanded Disability Status Scale (EDSS) and MSQOL-54 dimensions.

RESULTS

QOL of MS patients measured by SF-36 is lower than controls, varying by QOL dimension with the greatest difference emerging for physical aspects of the disease. The relationship of physical disability, measured by EDSS, and all 14 MSQOL-54 dimensions and FSS is negative; for 12 of the 14 dimensions and FSS it is also non-linear. Non-linearity is most pronounced among women, who show a weak EDSS/QOL relationship at higher levels of physical disability, suggesting women better able to "psychologically buffer" the debilitating aspects of MS. While employed have higher QOL than unemployed, the former are more affected by physical disability.

CONCLUSIONS

Multiple attributes, including disability, gender and employment status, affect QOL. QOL's relationship with disability is complex, displaying non-linearity and interacting with patient characteristics. This has implication for QOL research methodology and provides insight into factors affecting patients' perceptions of well-being.

Quality of life of patients with end-stage renal disease at various stages of the illness

This study aimed to examine the quality of life of patients undergoing different types of treatment for End Stage Renal Disease at various points in the course of the disease. The theoretical model that guided the study was based on the work of Rolland (1987) and Wilson and Clearly (1995). Subjects were 72 patients at the largest nephrology center in Israel. Instruments included the SF-36 Health Survey (version 1.0) and Parfrey's health questionnaire for End Stage Renal Disease. The findings indicate that the negative effects of the disease on quality of life can be observed in the pre-dialysis stage, and that the strongest predictor of quality of life were patients' symptom reports, independent of objective indicators of their health state. Social workers play a key role in aiding patients and their families to adjust to the disease and its treatment prior to starting dialysis, and in bringing the importance of patients' subjective assessments to the attention of the treatment team.