Health-related quality of life. A guide for the health professional

The effect of a pay-for-performance program on health-related quality of life for patients with hepatitis in Taiwan

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.

Death anxiety, self-esteem, and health-related quality of life among geriatric caregivers during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has influenced all social spaces and older adults are susceptible to COVID-19. Geriatric caregivers in nursing homes might experience death anxiety when faced with infected older adults and a closed working environment. Death anxiety is a negative and formidable affective state. Yet, little is currently known about the relationships among death anxiety, self-esteem, and health-related quality of life among geriatric caregivers during the COVID-19 pandemic. This study aimed to examine whether self-esteem could moderate the association between death anxiety and health-related quality of life during the pandemic.

METHODS

A cross-sectional study was conducted in Jinan and Heze cities, Shandong Province, from November 2020 to January 2021. Participants comprised a convenience sample of 236 geriatric caregivers in nursing homes. Data on sociodemographic variables, death anxiety, self-esteem, and health-related quality of life were collected. Descriptive analysis, Pearson correlation, and moderated analysis were used for statistical analysis.

RESULTS

Self-esteem moderated the association between death anxiety and health-related quality of life (death anxiety × self-esteem: B = -0.113, 95% CI: -0.143, -0.018).

CONCLUSION

This study revealed that self-esteem played a moderating role between death anxiety and health-related quality of life during the pandemic, which implies that mental health should be given more attention, and that interventions for improving self-esteem need to be carried out.

Refining items for a preference-based, amyotrophic lateral sclerosis specific, health-related quality of life scale

Objective: The aim of this study was to refine the items of a preference-based amyotrophic lateral sclerosis health-related quality of life scale (PB-ALS HRQL scale) based on domains generated in a previous study. Methods: Survey methodology was used to assess item importance rating (IR) and independence. Median importance was calculated for each item and a rating of "very important" was required for the item to remain. Correlations were used to examine item independence. Highly correlated items (r_s > 0.7) were considered for removal. Cognitive debriefing (CD) interviews, conducted by Zoom, telephone, or email based on participant preference and communication needs, were used to identify potential issues. Participants provided feedback about wording, clarity, response options, and recall period on randomly selected items. Items were considered finalized when three sequential CD participants approved the item with no revisions. Results: Thirty-four people with ALS (PALS, n = 16 females; age range 44-78 years; ALS Functional Rating Scale-Revised [ALSFRS-R] range 0-48) in Canada completed the survey; a subset of 18 PALS completed CD interviews (n = 8 female; age range 44-71 years; ALSFRS-R range 0-48). Four items were highly correlated with one or more items, were not rated as very important, or were not approved via CD and were removed. Conclusions: The final four-response option PB-ALS Scale includes eight items: recreation and leisure, mobility, interpersonal interactions and relationships, eating and swallowing, handling objects, communicating, routine activities, and mood. The next step is to translate the PB-ALS Scale into French and develop a scoring algorithm based on PALS' preferences.

The association between nonrestorative sleep and health-related quality of life in Chinese adults: a cross-sectional study

PURPOSE

Sleep problems are prevalent among the general population and can cause various health problems, which may lead to decreased quality of life. However, little is known about nonrestorative sleep and its implications. This study aimed to examine the association between nonrestorative sleep and health-related quality of life (HRQL) in Chinese adults.

METHODS

Data were collected through a cross-sectional study of 500 adults in Hong Kong (66.4% female, average age of 39 years). The Short-Form-12 Health Survey version 2 (SF-12v2), Nonrestorative Sleep Scale (NRSS), Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered. Objective sleep parameters were based on participants' sleep condition over 1 week, as measured using an ActiGraph GT9X Link.

RESULTS

Mean standardized scores for the physical component summary (PCS) and mental component summary (MCS) of the SF-12v2 and the NRSS were 50.33 ± 6.50, 49.00 ± 9.03, and 64.77 ± 12.75, respectively. After adjusting for sociodemographic and lifestyle characteristics, sleep quality, objective sleep parameters, social support, somatic symptoms, stress, anxiety, and depression, NRSS scores were associated with PCS (b = 0.12, 95%CI: 0.06 to 0.18, p < 0.001) and MCS (b = 0.08, 95%CI: 0.02 to 0.15, p = 0.013) scores. Furthermore, associations of NRSS score with PCS as well as MCS scores were stronger in women than in men.

CONCLUSION

Nonrestorative sleep is a potentially modifiable risk factor for poor HRQL. Thus, interventions to relieve or decrease nonrestorative sleep could be beneficial for improving HRQL.

Health-related quality of life of middle-aged and elderly people with hypertension: A cross-sectional survey from a rural area in China

OBJECTIVE

To evaluate health-related quality of life (HRQoL) of middle-aged and elderly people with hypertension in Enshi, China, and to explore the important correlates defining HRQoL.

METHODS

From April through July 2018, a self-monitoring intervention program for hypertension control was implemented in a remote area of central China. Participants completed a cross-sectional survey which included demographic characteristics, the Health-related Quality of Life Survey, and the Pittsburgh Sleep Quality Index Survey. Univariate analysis was performed by analysis of variance, and multiple linear regression analysis was used to analyze the influencing factors of HRQoL in middle-aged and elderly hypertensive patients. In the multivariate analysis, the variables with P≤0.05 in the single factor analysis were combined with the professional significance to establish a multiple linear regression model.

RESULTS

Information from 500 participants was available for analysis. Among them, the scores of PCS and MCS was 31.66 ± 9.50 and 41.38 ± 10.69, respectively. Multivariable regression analyses showed that higher education and sleep quality, and moderate physical activity (30 minutes for at least five days a week) had a positive influence on PCS scores. Higher monthly family income (3,000-5,000 ¥) and sleep quality, regular tea-drinking, having 30 minutes of moderate physical activity at least five days a week were positively associated with MCS scores.

CONCLUSION

The overall HRQoL for rural middle-aged and elderly hypertensive patients in Xuan'en county of Hubei province was poor. Effective relevant measures for the above factors were urgently needed to improve the quality of life for the elderly in rural areas. Awareness of these relevant factors could help health care professionals provide better supportive care.

Spirituality and outcomes in caregivers of persons with traumatic brain injury (TBI)

PURPOSE/OBJECTIVE

Spiritual well-being has been associated with better quality of life outcomes in caregivers, but the associations among the care recipient's functional status, the caregiver's spiritual well-being, and the caregiver's health-related quality of life (HRQOL) is unknown. Research Method/Design: The study examined the Spiritual Well-Being Scale in caregivers of persons with traumatic brain injury (TBI; n = 335). Participants completed measures from the Patient-Reported Outcomes Measurement Information System, the Quality of Life in Caregivers of TBI, and the Caregiver Appraisal Scale. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) measured care recipient's functional status. The association between religious well-being and existential well-being and HRQOL were examined with Pearson correlation coefficients. Multiple linear regressions examined the interaction between caregiver well-being and care recipient functional status on HRQOL outcomes accounting for demographic variables.

RESULTS

Less favorable caregiver HRQOL was associated with military affiliation, male status, spousal caregiver relationship, and White race. MPAI-4 was moderately associated with all HRQOL subdomains. For spiritual well-being, existential well-being was moderately correlated with 9 of 16 HRQOL subdomains in comparison to religious well-being that demonstrated small correlations with 3 of 16 subdomains. MPAI-4 had negative effects on HRQOL regardless of spiritual well-being with higher existential well-being reducing the negative impact of the care recipient's functional impairment on HRQOL for significant HRQOL interactions.

CONCLUSIONS/IMPLICATIONS

Interventions that encourage development and maintenance of life purpose and meaning in caregivers of persons with TBI, and less so, spirituality, might have beneficial effects on HRQOL when the person with injury has more functional limitations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sleep impairment is related to health-related quality of life among caregivers of lower-functioning traumatic brain injury survivors

Objective: The purpose of this study was to examine perceived sleep-related impairment in caregivers of individuals with traumatic brain injury (TBI). Specifically, we examined the relationship between caregiver-perceived sleep-related impairment and different aspects of health-related quality of life (HRQOL) and explored whether these relationships were moderated by the perceived level of everyday function in the person with TBI. Method: Three hundred forty-one caregivers of individuals with TBI completed surveys to determine whether the association between sleep-related impairment and HRQOL was moderated by caregiver-perceived functional impairment of the person with injury. Participants completed measures from the Patient-Reported Outcomes Measurement Information System and the TBI-CareQOL. These measures were used to examine different aspects of HRQOL: caregiver-specific HRQOL, mental HRQOL, social HRQOL, and fatigue. The Mayo-Portland Adaptability Inventory-4 was used to measure caregiver perceptions of the level of everyday function in the person with injury. Results: Results indicated that caregiver-perceived sleep-related impairment was associated with each of the four HRQOL scores. This relationship was moderated by the caregiver-reported level of everyday function in the person with TBI for both caregiver-specific HRQOL and fatigue but not mental or social HRQOL. For caregiver-specific HRQOL and fatigue, caregiver-perceived sleep-related impairment was associated with worse HRQOL for those caring for individuals with lower perceived levels of everyday function, but not for those caring for individuals with higher levels of everyday function. Conclusions: Interventions to improve caregiver sleep and HRQOL should consider both psychosocial and environmental factors (i.e., factors related to the person with the TBI). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Depressive symptoms mediate the association between insomnia symptoms and health-related quality of life and synergistically interact with insomnia symptoms in older adults in nursing homes

AIMS

The aim of this study was to elucidate whether depressive symptoms mediate the association between insomnia symptoms and health-related quality of life (HRQOL) and to explore whether insomnia symptoms and depressive symptoms synergistically interact to affect HRQOL among older adults in nursing homes.

METHODS

Older adults living in nursing homes (n = 323) completed Athens Insomnia Scale, the 15-item Geriatric Depression Scale, and the 36-item Short Form Health Survey. PROCESS for SPSS was used in the mediation model. Logistic regression analysis was conducted to obtain odds ratios (OR) for insomnia symptoms, depressive symptoms, and HRQOL. The relative excess risk due to interaction, the attributable proportion due to interaction, and the synergy index were assessed.

RESULTS

Insomnia symptoms and depressive symptoms were negatively related to HRQOL. Depressive symptoms mediated the relationship between insomnia symptoms and HRQOL. Compared with the older adults without insomnia symptoms or depressive symptoms, those with only depressive symptoms (OR = 8.36, 95% confidence interval (CI): 3.46-20.18) or insomnia symptoms (OR = 2.24, 95%CI: 1.04-4.83) had a lower HRQOL. Also, the co-presence of insomnia symptoms and depressive symptoms significantly increased the risk of lowering HRQOL (OR = 25.79; 95%CI: 12.72-52.28). The relative excess risk due to interaction, attributable proportion due to interaction, and synergy index were 16.19, 0.63, and 2.88, respectively.

CONCLUSIONS

Depressive symptoms may play a mediating role between insomnia symptoms and HRQOL. Comorbid insomnia symptoms and depressive symptoms synergistically interact to affect HRQOL. It is vital to focus on elderly nursing home residents with insomnia symptoms and/or depressive symptoms and to adopt interventions.

A disease-specific quality of life instrument for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: CLDQ-NAFLD

BACKGROUND

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are the most common causes of chronic liver disease with known negative impact on patients' health-related quality of life. Our aim was to validate a disease-specific health-related quality of life instrument useful for efficacy trials involving patients with non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.

METHODS

From a long item selection questionnaire, we selected relevant items which, by factor analysis, were grouped into domains constituting Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease version. The developed instrument was subjected to internal validity, test-retest reliability and construct validity assessment using standard methods.

RESULTS

For development of the Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease version instrument, a 75-item-long item selection questionnaire was administered to 25 patients with non-alcoholic fatty liver disease. After item reduction, factor analysis found that 98.7% of variance in the remaining items would be explained by six factors. Thus, the resulting Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease version instrument had 36 items grouped into six domains: Abdominal Symptoms, Activity, Emotional, Fatigue, Systemic Symptoms, and Worry. The independent validation group included another 104 patients with non-alcoholic fatty liver disease. The Cronbach's alphas of 0.74-0.90 suggested good to excellent internal consistency of the domains. Furthermore, the presence of obesity and history of depression were discriminated best by Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease version scores (P<.05). The domains' correlations with the most relevant domains of Short Form-36 exceeded 0.70. Test-retest reliability in a subgroup of patients (N=27) demonstrated no significant within-patient variability with multiple administrations (all median differences were zero, all P>.15, intraclass correlations .76-.88).

CONCLUSION

The Chronic Liver Disease Questionnaire-Non-Alcoholic Fatty Liver Disease version is a disease-specific health-related quality of life instrument developed and validated using an established methodology and useful for clinical trials of non-alcoholic fatty liver disease.

The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study

Background

Hypertension is a common and frequently occurring chronic disease of the cardiovascular system. Besides the pathological factors, the occurrence and exacerbation of hypertension are also associated with many factors of lifestyle and behaviors. Thus hypertensive patients’ Health-related quality of life (HRQL) is not only influenced by the disease itself but also by many subjective factors such as health literacy and self-management efficacy, especially in the deeper part of southwestern China and thus is less developed compared to the other places. The purpose of this study was to examine the association between the HRQL of hypertensive patients and health literacy and self-management efficacy as well as how they affect the HRQL, so as to provide a theoretical reference for improving the HRQL of patients with hypertension in less developed areas.

Methods

This was a cross-sectional study of baseline data from a clustered randomized controlled trial. The study design had passed a cross-national peer review and accepted grants by the China Medical Board. It was also registered in the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).

A standardized questionnaire adapted from a previous validated WHO questionnaire was used for the survey which included detailed questions about patient’s socio-demographic characteristics and self-reported information.

Patients’ HRQL was measured by the Mandarin version of the 36-item Short Form. We used the validated Mandarin version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale to assess patients’ self-management efficacy. The validated three-item Brief Health Literacy Screening (BHLS) was used to measure the patients’ health literacy.

A structural equation model was constructed, and p ≤ 0.05 was taken as significant.

Results

Demographic characteristics, health literacy and self-management efficacy have all significant effects on HRQL. Age, education level, self-management efficacy and health literacy were significantly related to the HRQL. The constructed model had a good fit for the data according to the model fit indices. Based on the model, health literacy (r = 0.604, p = 0.029) and Self-management efficacy (r = 0.714, p = 0.018) have a significant impact on HRQL. Demographic characteristics were inversely related to HRQL (r = −0.419, p = 0.007), but have a significant impact on health literacy (r = 0.675, p = 0.029) and self-management efficacy (r = 0.379, p = 0.029). At the same time, self-management efficacy was positively correlated to health literacy (r = 0.413, p < 0.01).

Conclusions

Age, education level, self-management efficacy and health literacy were all related to the HRQL of patient with hypertension, which means that patients who are more elderly and have lower education level, low self-management efficacy and poor health literacy get worse HRQL. This may imply the necessary to introduce routine assessment of health literacy and self-management efficacy into assessment procedures for hypertensive patients’ health management. Such assessment can help professionals to identify the population at greatest risk for poor health outcomes and low well-being in the future. In clinical practice, effective interventions such as direct guidance and education to raise the self-management efficacy and enhance health literacy might improve the HRQL of patients with hypertension.

Trial registration

Retrospectively registered Chinese Clinical Trial Registry (ChiCTR-OOR-14005563).

Name of registry: Effects of the integrated delivery system and payment system of community-based intervention on rural patients of chronic diseases in Qianjiang District, China

Date of registration: Retrospectively registered 23 November 2014.

Date of enrolment of the first participant to the trial: 5 July 2012

Validation of the psychometrics properties of a French quality of life questionnaire among a cohort of renal transplant recipients less than one year

BACKGROUND

Renal transplantation is considered as the treatment of choice for patients with end-stage renal disease. Health-related quality of life (HRQoL) of renal transplant recipients (RTR) is very important to assess, especially during the first year after transplantation. To provide new evidence about the suitability of HRQoL measures in RTR during the first post-transplant year, we explored the internal structure, reliability and external validity of a French specific HRQoL instrument, the Renal Transplant Quality of life Questionnaire Second Version (RTQ V2).

METHODS

The data were issued from the French multicenter cohort of renal transplant patients followed during 4 years (EPIGREN). The HRQoL of RTR was assessed five times (at 1, 3, 6, 9 and 12 months after transplantation) with the RTQ V2, a specific instrument consisting of 32 items describing five dimensions. Socio-demographic information, clinical characteristics and HRQoL (i.e., RTQ V2 and SF-36) were collected. For the five times, psychometric properties of the RTQ V2 were compared to those reported from the reference population assessed in the validation study.

RESULTS

Three hundred and thirty-four patients were enrolled. The proportions of well-projected items, item-internal consistency, item-discriminant validity, floor and ceiling effects, Cronbach's alpha coefficients and item goodness-of-fit statistics were satisfactory for each dimension at the five times of the study. The suitability indices of construct validity were higher than 90 % for each time (minimum-maximum: 90.8-97.4 %). The external validity was less satisfactory, with a suitability indices ranged from 46.7 % at M1 to 66.7 % at M12. However, the discrepancies with the reference population (mainly for the gender) appeared logical considering the scientific literature on HRQoL of RTR during the first post-transplant year and may not compromise the external validity.

CONCLUSION

These results support the validity and reliability of the RTQ V2 for evaluating HRQoL in RTR during the first post-transplant year, and confirm that the RTQ V2 is a useful tool to assess the HRQoL precociously after transplant.

Mental Health and Health-Related Quality of Life in Multiple Sclerosis Caregivers in Mexico

BACKGROUND

Multiple sclerosis (MS) rates are increasing in Latin America, and caregiving for an individual with MS is associated with poorer mental and physical health outcomes. No existing research has examined the relation between mental health and health-related quality of life (HRQOL) in MS caregivers in Latin America.

METHODS

The present study examined the association between mental health (Patient Health Questionnaire-9, Satisfaction with Life Scale, Rosenberg Self-esteem Scale, State-Trait Anxiety Inventory) and HRQOL (36-item Short Form Health Status Survey) in 81 Mexican MS caregivers.

RESULTS

A canonical correlation analysis uncovered a large, significant overall association between mental health and HRQOL, with 52.7% of the variance shared between the two sets of constructs. When individual canonical loadings were examined in this analysis, the most substantial pattern that emerged was between depression and general health. Four regressions controlling for demographic variables found that HRQOL uniquely accounted for 19.0% of the variance in caregiver anxiety, 32.5% in depression, 13.5% in satisfaction with life, and 14.3% in self-esteem.

CONCLUSIONS

These findings demonstrated a strong association between HRQOL and mental health, which points to directions for future studies on interventions for MS caregivers, particularly in Mexican and other Latino populations.

Social networks and health-related quality of life among Chinese old adults in urban areas: results from 4th National Household Health Survey

OBJECTIVE

To examine the associations between components of social networks and health-related quality of life (HRQoL) in community-dwelling old adults in urban areas in China.

STUDY DESIGN

Data from the 4th National Household Health Survey (NHHS) in China, conducted in 2008, were used. HRQoL of respondents aged ≥15 years was assessed using EQ-5D in the NHHS.

METHODS

The sample for the current analysis included 9833 old adults aged ≥60 years. Multiple linear and logistic regression models were used to assess the associations between indicators of social network and HRQoL.

RESULTS

Approximately 6% of the respondents saw their children once a year or less, and approximately 1% reported that they had no children. Thirteen percent of the sample seldom contacted their neighbours and seldom met with relatives or friends; approximately 62% seldom attended social gatherings. The five dimensions of HRQoL (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) were reported to be moderate or severe in 14.5%, 9.4%, 12.6%, 18.3% and 9.3% of the sample, respectively. The mean visual analogue scale (VAS) score and EQ-5D index using the time trade-off method was 70.96 [standard deviation (SD) 14.79] and 0.869 (SD 0.163), respectively. After adjusting for potential confounding variables, old adults with weaker social networks were more likely to report problems on EQ-5D dimensions, lower VAS scores and lower EQ-5D indexes.

CONCLUSIONS

For old adults living in urban communities in China, increased social participation has a positive effect on various dimensions of HRQoL. There is a need for policy considerations that will improve integration of community-level public resources in order to encourage frequent social interaction among old adults, and promote health and social care as a whole.

Cross Sectional Assessment of Health Related Quality of Life (HRQoL) among patients with cancer in Malaysia

BACKGROUND

Health Related Quality of Life (HRQoL) is an important aspect in identifying cancer patients' perceptions of being diagnosed with cancer and the assessment of treatment outcomes. The present study aimedto assess the profile and predicators of HRQoL of Malaysian oncology patients.

MATERIALS AND METHODS

A cross sectional study adopting the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was conducted. All cancer patients attending Penang General Hospital between August-November 2011 were approached. Descriptive statistics were used to assess demographic and disease related characteristics of the patients. All analyses were performed using SPSS v 16.0.

RESULTS

Three hundred and ninety three cancer patients met the inclusion criteria and were enrolled in the study. The mean age was 53.9 (SD±13) years. The cohort was dominated by females (n=260, 66.2%). Nearly half (n=190, 48.3%) of the participants were of Malay ethnicity, practicing Islam as their religion (n=194, 49.4%). Two hundred and ninety six (n=296, 75.3%) had beene diagnosed with cancer within six months to 3 years previously. The most common primary cancer site was breast (n=143, 36.4%). The mean Global Health Status (GHS) score was 60.7 (SD=21.3). Females (mean GHS score of 62.3, p=0.035) with Malay ethnicity (mean GHS score of 63.8, p=0.047), practicing Islam as their religion (mean GHS score of 63.0, p=0.011) had better GHS scores. Patients having medical insurance had good scores (mean 65.6, p=0.021). Marital status was significantly associated with GHS scores (p=0.022). Bone cancer patientshad the lowest mean GHS score of 49.2 (p=0.044). Patients at very advanced stages of cancer featured a low GHS mean score of 52.2 (p<0.001).

CONCLUSIONS

The present study identified many demographic and disease related factors which may contribute to the HRQoL of cancer patients, pointing to the necessity for improved management of disease symptoms and provision of psychological and financial support.

Challenges in measuring outcomes following digital replantation

In the early period of replantation surgery, the emphasis was on digit survival. Subsequently, with better microsurgical techniques and instrumentation, the focus has shifted to function and in recent years to consideration of cost-effectiveness. Despite over 40 years of effort in refining digital replantation surgery, a rigorous evaluation of the outcomes of digital replantation has not been performed. This is because of the many confounding variables that influence outcome comparisons. These variables include the mechanism of injury (guillotine, crush, avulsion), the injury itself (total, near total, subtotal, partial amputation), and the surgical procedure (replantation, revascularization). In addition, the traditional outcome measures (two-point discrimination, range of motion, grip strength, or the ability to return to work) are reported inconsistently and vary widely among publications. All these factors make meaningful comparison of outcomes difficult. The recent emphasis on outcome research and cost-effectiveness necessitates a rethinking in the way we report outcomes of digital replantation. In this article, the authors summarize the challenges in assessing outcomes of digital replantation and explain the need to measure outcomes using rigorous clinical research designs that incorporate cost-effectiveness studies in the research protocol.

A cross sectional assessment of health related quality of life among patients with Hepatitis-B in Pakistan

OBJECTIVE

The study aims to assess Health Related Quality of Life (HRQoL) among Hepatitis B (HB) patients and to identify significant predictors of the HRQoL in HB patients of Quetta, Pakistan.

METHODS

A cross sectional study by adopting European Quality of Life scale (EQ-5D) for the assessment of HRQoL was conducted. All registered HB patients attending two public hospitals in Quetta, Pakistan were approached for study. Descriptive statistics were used to describe demographic and disease related characteristics of the patients. HRQoL was scored using values adapted from the United Kingdom general population survey. EQ-5D scale scores were compared with Mann-Whitney and Kruskal-Wallis test. Standard multiple regression analysis was performed to identify predictors of HRQoL. All analyses were performed using SPSS v 16.0.

RESULTS

Three hundred and ninety HB patients were enrolled in the study. Majority of the participants (n = 126, 32.3%) were categorized in the age group of 18-27 years (36.07 ± 9.23). HRQoL was measured as poor in the current study patients (0.3498 ± 0.31785). The multivariate analysis revealed a significant model (F(10, 380) = 40.04, P < 0.001, adjusted r(2) = 0.401). Educational level (β = 0.399, p = 0.025) emerged as a positive predictor of HRQoL. Age, gender, occupation, income and locality were not predictive of better quality of life in HB patients.

CONCLUSIONS

Hepatitis B has an adverse affect on patients' well-being and over all HRQoL. The study findings implicate the need of health promotion among HB patients. Improving the educational status and imparting disease related information for the local population can results in better control and management of HB.

Level of oral health impacts among patients participating in PEARL: a dental practice-based research network

OBJECTIVES

To determine whether participants of a dental practice-based research network (PBRN) differ in their level of oral health impact as measured by the Oral Health Impact Profile (OHIP) questionnaire.

METHODS

A total of 2410 patients contributed 2432 OHIP measurements (median age = 43 years; interquartile range = 28) were enrolled in four dental studies. All participants completed the Oral Health Impact Profile (OHIP-14) during a baseline visit. The main outcome of this study was the level of oral health impact, defined as follows: no impact ('Never' reported on all items); low ('Occasionally' or 'Hardly ever' as the greatest frequency score reported on any item); and high ('Fairly often' or 'Very often' as the greatest frequency reported on any item). Polychotomous logistic regression was used to develop a predictive model for the level of oral health impact considering the following predictors: patient's age, gender, race, practice location, type of dentist, and number of years the enrolling dentist has been practicing.

RESULTS

A high level of oral health impacts was reported in 8% of the sample; almost a third (29%) of the sample reported a low level of impacts, and 63% had no oral health impacts. The prevalence of impacts differed significantly across protocols (P < 0.001). Women were more likely to be in the high oral impact group than in the no impact group compared to men (OR = 1.46; 95% CI = 1.06-1.99). African Americans were more likely to report high oral impacts when compared to other racial/ethnic groups (OR = 2.11; 95% CI = 1.26-3.55). Protective effects for being in the high or in the low-impact groups were observed among patients enrolled by a solo practice (P < 0.001) or by more experienced dentists (P = 0.01). A small but highly significant statistical association was obtained for patient age (P < 0.001). In the multivariate model, patient's age, practice size, and gender were found to jointly be significant predictors of oral health impact level.

CONCLUSIONS

Patients' subjective report of oral health impact in the clinical setting is of importance for their health. In the context of a dental PBRN, the report of oral health-related quality of life (OHRQoL) was different across four dental studies. The observed findings validate the differential impact that oral health has on the patients' perception of OHRQoL particularly among specific groups. Similar investigations to elucidate the factors associated with patient's report of quality of life are warranted.

Psychometric properties of the Specific Thalassemia Quality of Life Instrument for adults

BACKGROUND

No specific questionnaire has been developed to assess the health-related quality of life of thalassemia patients. Thus, the main objective of this study was to develop, according to psychometric standards, a self-administered Specific Thalassemia Quality of Life Instrument (STQOLI) for adult patients.

METHODS

First, a qualitative phase was conducted to generate items and identify domains using the critical analysis incident technique and a literature review. A list of easily comprehensible, non-redundant items was defined using the Delphi technique and a pilot study on ten thalassemia patients. This phase involved both patients and experts. The second step was a quantitative validation phase comprising a study of 128 thalassemia patients in a single hospital. It was designed to select items, identify dimensions, and measure reliability and internal and concurrent validity. The psychometric and scaling properties of the proposed 41-item Specific Thalassemia Quality of Life Instrument were then assessed among patients recruited from the Thalassemia Unit at the General Hospital of Nikaia, Greece.

RESULTS

The final questionnaire had 41 items comprising four main domains and one global item about general health. The factorial structure was satisfactory (loading > 0.40 on each factor of the four domains for all items). Interscale correlations ranged from 0.06 to 0.78, Cronbach's α-coefficients were 0.78 for the psychosocial domain, 0.77 for the chelation domain, 0.72 for the transfusion domain, 0.81 for the disease and symptoms domain, and 0.840 for the total score of the questionnaire.

CONCLUSION

The 41-item Specific Thalassemia Quality of Life Instrument seems to be a valid tool for assessing health-related quality of life for patients with thalassemia. More research is needed to explore the universal properties of the questionnaire.

A cross-sectional assessment of health-related quality of life (HRQoL) among hypertensive patients in Pakistan

OBJECTIVE

To describe the health-related quality of life (HRQoL) profile of hypertensive population in Pakistan.

METHODS

A cross-sectional descriptive study was undertaken with a cohort of 385 hypertensive patients attending two public hospitals in Quetta city, Pakistan. The EuroQoL EQ-5D scale was used for the assessment of HRQoL. EQ-5D is a standardized instrument for use as a measure of health outcome and is used in the clinical and economic evaluation of health care as well as population health surveys. The HRQoL was scored using values derived from the UK general population survey. P ≤ 0.05 was taken as significant.

RESULTS

Two hundred and sixty-five (68.85%) respondents were men with 3.01 ± 0.939 years of history of hypertension. Majority (n = 186, 48.3%) were categorized in age group of 28-37 years with mean age of 39.02 ± 6.596. Education, income and locality had significant relation with HRQoL score. HRQoL was measured poor in our study patients (0.4674 ± 0.2844).

CONCLUSION

Hypertension has an adverse effect on patients' well-being and HRQoL. Results from this study could be useful in clinical practice, particularly in early treatment of hypertension, at point where improving HRQoL is still possible.

Reflecting on whiplash associated disorder through a QoL lens: an option to advance practice and research

PURPOSE

To examine the constructs of quality of life (QoL) as applied to whiplash associated disorder (WAD), its current state of measurement and suggestions for future application.

METHOD

Narrative literature review.

RESULTS

The burden of WAD on the healthcare system is substantive. Assessment of QoL issues for people with WAD may provide a broader understanding of the patient experience. No consistent framework for QoL in WAD has been adopted, nor has preference for any QoL instrument been established. Inconsistent use of terminology for what is being measured, and the measures themselves hamper clarity on the issue. Options for assessing QoL currently include a meaningful condition-specific scale that has not undergone sufficient psychometric evaluation (Whiplash Disability Questionnaire (WDQ), or generic scales with strong psychometric properties that have not undergone sufficient relevancy evaluation (e.g. SF-36, WHOQOL BREF). Generic measures can measure overlapping constructs including heath status, utility, health-related quality of life or generic QoL. The inter-relationships between these in WAD have not been defined.

CONCLUSIONS

Given the impact of WAD on QoL, additional clarity on tools and approaches are needed. There is a need for research on the relevance and clinical measurement properties of available condition-specific and generic tools to define a preferred measurement approach in WAD.

Cautionary tales in the clinical interpretation of trials assessing therapy-induced changes in health status

Trials assessing the effects of therapies on symptoms, functional capacity, health-related quality of life and other aspects of health status are becoming more common in an era of chronic disease management. Such trials involve instruments for measuring health status whose reliability, validity and responsiveness need to be understood by clinicians and policy-makers in interpreting trial results. Deciding whether a treatment is clinically efficacious requires prior determination, based on empirical evidence, of what constitutes a minimal important difference (MID) between active treatment and control groups in the change in health status between study start and end. This MID should be used to calculate the sample size that will confer adequate power to detect a treatment effect if it truly exists. Many trials assessing health status have major methodological flaws: use of inappropriate or psychometrically unsound measurement instruments, lack of specification of MID, assumption that statistically significant results represent clinically significant treatment effects, and statement of conclusions inconsistent with observed results. This article provides guidance to clinicians in interpreting results of such trials in regard to clinical decision-making.

Outcomes in microsurgery

The reporting of microsurgical outcomes has been variable. Historically, emphasis has been placed on flap and digit survival or failure in the case of free-tissue transfer or digit replantation, respectively. Outcomes have also been measured with indices such as range of motion or grip strength for digital replantations, the ability to eat or talk for head and neck microsurgery, and the ability to walk or return to work for lower extremity microsurgery. Although relevant, this type of reporting of outcomes may fail to capture the effectiveness of microsurgical intervention from the patient's, the third-party payer's, or society's perspective. Significant events have arisen in the past two decades, including the emphasis on outcomes research, recent recommendations to adopt evidence-based microsurgery, and the inclusion in academic training programs of the competency "manager" to the health care system. This necessitates rethinking the way we report outcomes in microsurgery. This article explains the need to (1) use health-related quality-of-life scales to measure the benefits of microsurgical interventions, (2) measure outcomes with high-quality clinical research designs, and (3) incorporate proper cost-effectiveness studies in our clinical research before adopting new technologies such as new free flaps or techniques.

[Assessment instruments for a Health-Related Quality of Life in diabetes mellitus]

The assessment of Health-Related Quality of Life (HRQoL) has been increasingly used to measure the overall impact of diseases in people's life. Diabetes mellitus (DM) is a chronic disease associated with high morbidity, mortality, and HRQoL impairment in patients. In longitudinal studies, the psychosocial impact of DM predicts mortality. The objective of this review is to describe and to analyze the main instruments used for the HRQoL evaluation in patients with DM. Generic instruments such, as the Quality of Well-Being Scale (QWB), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), EuroQol (EQ-5D) and specific instruments as the Diabetes Care Profile (DCP), Diabetes Quality of Life Measure (DQOL), Diabetes Impact Measurement Scales (DIMS), Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1 and DHP-18), Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R), Well-Being Enquiry goes Diabetics (WED), Diabetes-Specific Quality-of-life Scale (DSQOLS), Diabetes 39 (D-39) Problems Areas in Diabetes (PAID) were analyzed. PAID is the only translated and validated instrument available in Brazil. The generic and specific instruments have their stregths and shortcomings for evaluation of HRQL in patients with DM. The combined use of both generic (such as the SF-36) and specific (such as the PAID) appears to be a consistent way to evaluate HRQoL as a construct in Brazilian patients with DM. The present article reviews a variety of instruments and emphasizes the urgent need for validation studies of such instruments to be used in Brazilian subjects with DM.

Critique on the conceptualisation of quality of life: a review and evaluation of different conceptual approaches

Over the past decades, the concept of quality of life has been of paramount importance for evaluating the quality and outcome of health care. Despite its importance, there is still no consensus on the definition or proper measurement of quality of life. Several concept analyses of quality of life have been published. However, they appear to have had a rather limited impact on how empirical studies are conducted. Therefore, we present an overview and critique of different conceptualisations of quality of life, with the ultimate goal of making quality of life a less ambiguous concept. We also describe six conceptual problems. These problems were used as criteria to evaluate the appropriateness of different conceptualisations. This evaluation suggests that defining quality of life in terms of life satisfaction is most appropriate, because this definition successfully deals with all the conceptual problems discussed. The result of our concept evaluation was not surprising for it corroborated the results of several concept analyses and the findings of a structural equation modelling study. Based on the findings revealed by our review, we propose that the scientific community should revitalise the conceptual discussion on quality of life. Furthermore, our findings can assist researchers in developing more rigourous quality-of-life research.

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.

Why call it health-related quality of life when you mean perceived health status?

Health-related quality of life is a term frequently used in health services and nursing research. However, when using this term, researchers often refer to the self-perceived health status or the functional abilities of the patients. Since there is increasing evidence that quality of life and health status are distinct concepts, the appropriateness of the term 'health-related quality of life' is questionable. Therefore, researchers should consider whether health-related quality of life is actually measured if a health-status instrument is used. The scientific community should take up this conceptual discussion in order to make the concept of quality of life less ambiguous.

Health-related quality of life predicts emergency department utilization for patients with asthma

STUDY OBJECTIVE

The objective of this study is to evaluate health-related quality of life as a risk factor for subsequent emergency department (ED) utilization in a cohort of patients with asthma.

METHODS

We conducted a 1-year prospective cohort study of 1,406 adult asthma patients. Baseline physical and mental health status were measured using the Physical Component Summary and Mental Component Summary scores from the Short Form-12 health status survey. Asthma-specific health-related quality of life was measured with the mini-Asthma Quality of Life Questionnaire. Multivariable regression was used to assess the independent association between baseline Physical Component Summary, Mental Component Summary, and Asthma Quality of Life Questionnaire scores and asthma-related ED visits during the subsequent year.

RESULTS

During the 1-year follow-up period, 116 patients made at least 1 asthma-related ED visit. After adjustment for multiple sociodemographic and clinical factors, both the Physical Component Summary score (odds ratio [OR] 1.72; 95% confidence interval [CI] 1.46 to 2.02) and the Asthma Quality of Life Questionnaire score (OR 1.34; 95% CI 1.18 to 1.52) were associated with subsequent asthma-related ED utilization. In contrast, overall mental health status was not associated with subsequent asthma-related ED utilization (OR 1.17; 95% CI 0.96 to 1.44).

CONCLUSION

Overall physical health status and asthma-specific quality of life predict subsequent ED utilization. Health-related quality of life may be useful in identifying patients at increased risk for asthma exacerbation requiring emergency care.

Standards for Clinical Trials in Sexual Dysfunctions of Women: Research Designs and Outcomes Assessment

INTRODUCTION

Clinical trials on sexual dysfunctions in women are limited in spite of the fact that sexual dysfunctions are likely more common in women than in men. Currently there are no medications approved for treatment in women, and limited data on drug efficacy or psychological efficacy in well-controlled studies.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for the research design and outcome assessment standards for clinical trials in women's sexual dysfunctions.

METHODS

An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Standards for Clinical Trials in Women's Sexual Dysfunctions Committee, there were seven experts from two countries.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

A comprehensive update was created which included references and recommended guidelines for rationale and design of clinical trials, study populations, outcome assessments, protocol design and implementation, data analysis and reporting, as well as ethical and clinical issues related to sexual dysfunction research.

CONCLUSIONS

There is a need for more research in developing standards to be used when performing clinical trials and outcomes assessment research in sexual dysfunctions of women.

Low Quality of Life Prior to Screening for Abdominal Aortic Aneurysm: A Possible Risk Factor for Negative Mental Effects

The objective of this study was to evaluate the effect on quality of life (QOL) of screening for abdominal aortic aneurysm (AAA) in a population-based AAA screening program. Twenty-four patients with screening-detected AAA and 45 controls with normal aortic diameter were studied in a prospective, controlled, population-based study. Prior to and 12 months after the ultrasonography examination, all participants completed Short-Form 36 and at 12 months, 10 AAA-specific questions were added. Comparisons were made between the two groups (AAA patients and controls), within each group, and between the groups and norms for the general Swedish population in the same age interval. Our results showed that screening for AAA results in impairment of QOL among those who have the disease and who suffered a low QOL prior to screening. Among those who had an age-adjusted normal QOL prior to screening and who were found to have the disease, and among those who were found to have normal aortas, no negative effect on QOL was observed. Thus, low QOL before screening is a possible risk factor for negative mental effects of diagnosing an AAA by screening.

Hormone replacement therapy and the risk of incident congestive heart failure: the Cardiovascular Health Study

BACKGROUND

The development of congestive heart failure (CHF) in older persons is related to a variety of mechanisms. Hormone replacement therapy (HRT) affects several of the pathways that may be important in the development of CHF. We hypothesized that HRT would be associated with a decreased risk of incident CHF.

METHODS

Using Cox proportional-hazards regression, we assessed the risk of incident CHF (n = 304) associated with time-dependent past and current use of HRT compared to never use. The Cardiovascular Health Study is a prospective cohort study of community-dwelling adults aged 65 years and older. This analysis included female participants without a history of CHF at baseline (n = 3223).

RESULTS

At baseline, 62% were never users, 26% were past users, and 12% were current users of HRT. Compared with never users, the multivariable relative risk (RR) of CHF was 1.01 (95% confidence interval [95% CI] 0.76,1.34) for past users and 1.34 (0.93,1.94) for current users. Results were similar among most treatment and clinical subgroups, except that the association of current HRT with CHF appeared to depend on body mass index (BMI) or osteoporosis status. The RR was 0.82 (0.43,1.60) for normal weight women, 1.65 (0.95,2.88) for overweight women, and 2.22 (1.06,4.67) for obese women (p = 0.01 for interaction). Similarly, the RR was 0.15 (0.04,0.65) for women with osteoporosis and 1.82 (1.25,2.65) for women without osteoporosis (p = 0.001 for interaction).

CONCLUSIONS

Overall, HRT was not associated with the risk of incident CHF, although BMI and osteoporosis appeared to modify the association of HRT with CHF. The risk of CHF was lower in patients with lower BMI or osteoporosis.

Health-related quality of life outcomes measures

OBJECTIVE

To review critically the features of measures of generic health-related quality of life (HRQOL) for disability outcomes research.

DATA SOURCES

A search of electronic databases, summary reviews, books, and government documents was performed. Comment and experiences from participants of a conference on outcomes research were also incorporated.

STUDY SELECTION

English language literature from scientists from a broad range of disciplines and research settings, including medicine, nursing, social science, and public health, and health services research and practice.

DATA EXTRACTION

A critical review of measures that have been or might be used to measure disability outcomes.

DATA SYNTHESIS

Commonly used generic measures of HRQOL can be applied to disability outcomes research with some caveats. Three common tools are the Medical Outcomes Study Short-Form Health Survey (SF-36), Sickness Impact Profile (SIP), and Quality of Well-Being (QWB) scale. The SF-36 and SIP have been used with some success in research with people with disability. The QWB scale has been used less frequently.

CONCLUSION

Most studies using generic HRQOL tools are of groups with specific impairments rather than heterogeneous groups of people with disability. None of the tools appears to measure HRQOL without some potential biases (eg, inappropriate wording) for people with disability, but more specific testing of these problems is needed. Also needed are studies to determine whether these tools can measure meaningful longitudinal changes.

Selecting a measure of health related quality of life

Quality of life is becoming recognized increasingly as an important outcome measure which needs to be considered by social workers. However, there does not appear to be a clear consensus about the definition of quality of life. In addition, social workers are likely to experience difficulties choosing and applying an appropriate instrument with which to measure quality of life because of the many available instruments purporting to assess quality of life. This paper discusses the definition of health-related quality of life and explains the main measurement properties of an instrument that must be appraised when considering whether or not an instrument is appropriate. The paper will assist social workers to make an informed choice about measures of health-related quality of life.

Performance of health-related quality-of-life instruments in a spinal cord injured population

OBJECTIVE

General health-related quality-of-life (HRQoL) surveys have not been well tested in populations with spinal cord injury (SCI). This study evaluated the performance of 5 such instruments.

DESIGN

A cross-sectional survey with instruments administered in random order during computer-assisted interviews.

SETTING

A midwestern US veteran SCI program.

SUBJECTS

One hundred eighty-three veterans with SCI ranging in age from 21 to 81 yrs (mean = 50.5).

MEASURES

The Behavioral Risk Factor Surveillance System (BRFSS) HRQoL modules, the Quality of Well-Being scale (QWB), the Medical Outcomes Study Short-Form 36 and Short-Form 12 (SF-36, SF-12), and instrumental activities of daily living (IADL).

RESULTS

Construct validity was supported by scores from the QWB, IADL, and physical health measures of the BRFSS and SF-36 showing greater impairment for quadriplegia than paraplegia. Similar constructs on the SF-36 and BRFSS were more strongly correlated than between the IADL and QWB; eg, correlation between the SF-36 Vitality scale and the BRFSS "Days full of energy" question was r = .789 (p < .01), whereas correlation between the IADL and QWB was r = -.454 (p < .01). Longer surveys (SF-36, QWB) were rated lower in subject acceptability.

CONCLUSIONS

These instruments have potential for research use among patients with SCI. More studies are needed to explore the best use of instruments with apparently different domains.