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Mackenzie RM, Ali A, Bruce D, Bruce J, Ford I, Greenlaw N, Grieve E, Lean M, Lindsay RS, O'Donnell J, Sattar N, Stewart S, Logue J. Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study. Health Technol Assess 2024; 28:1-115. [PMID: 38343107 PMCID: PMC11017628 DOI: 10.3310/unaw6331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a United Kingdom setting. Objective To establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life and the effect on comorbidities. Design Prospective observational cohort study. Setting National Health Service secondary care and private practice in Scotland, United Kingdom. Participants Adults (age >16 years) undergoing their first bariatric surgery procedure. Main outcome measures Change in weight, hospital length of stay, readmission and reoperation rate, mortality, diabetes outcomes (HbA1c, medications), quality of life, anxiety, depression. Data sources Patient-reported outcome measures, hospital records, national electronic health records (Scottish Morbidity Record 01, Scottish Care Information Diabetes, National Records Scotland, Prescription Information System). Results Between December 2013 and February 2017, 548 eligible patients were approached and 445 participants were enrolled in the study. Of those, 335 had bariatric surgery and 1 withdrew from the study. Mean age was 46.0 (9.2) years, 74.7% were female and the median body mass index was 46.4 (42.4; 52.0) kg/m2. Weight was available for 128 participants at 3 years: mean change was -19.0% (±14.1) from the operation and -24.2% (±12.8) from the start of the preoperative weight-management programme. One hundred and thirty-nine (41.4%) participants were readmitted to hospital in the same or subsequent 35 months post surgery, 18 (5.4% of the operated cohort) had a reoperation or procedure considered to be related to bariatric surgery gastrointestinal complications or revisions. Fewer than five participants (<2%) died during follow-up. HbA1c was available for 93/182 and diabetes medications for 139/182 participants who had type 2 diabetes prior to surgery; HbA1c mean change was -5.72 (±16.71) (p = 0.001) mmol/mol and 65.5% required no diabetes medications (p < 0.001) at 3 years post surgery. Physical quality of life, available for 101/335 participants, improved in the 3 years post surgery, mean change in Rand 12-item Short Form Survey physical component score 8.32 (±8.95) (p < 0.001); however, there was no change in the prevalence of anxiety or depression. Limitations Due to low numbers of bariatric surgery procedures in Scotland, recruitment was stopped before achieving the intended 2000 participants and follow-up was reduced from 10 years to 3 years. Conclusions Bariatric surgery is a safe and effective treatment for obesity. Patients in Scotland, UK, appear to be older and have higher body mass than international comparators, which may be due to the small number of procedures performed. Future work Intervention studies are required to identify the optimal pre- and post surgery pathway to maximise safety and cost-effectiveness. Study registration This study is registered as ISRCTN47072588. Funding details This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ruth M Mackenzie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Abdulmajid Ali
- University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK
| | | | - Julie Bruce
- Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Lean
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Joanne O'Donnell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sally Stewart
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
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Pérez Pico AM, Gómez González MÁ, Alarcón González MI, Villar Rodríguez J, Mayordomo Acevedo R. Quality of Life, Pedobarographic Parameters, and Foot Disorders in Patients with Extreme Obesity: Preliminary Results on Changes After Bariatric Surgery with Gastric Bypass. Obes Surg 2023; 33:3829-3840. [PMID: 37816972 PMCID: PMC10687121 DOI: 10.1007/s11695-023-06843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Obesity is a growing health problem that affects a high percentage of the population. In podiatry context, few studies have addressed obesity because most pedobarographic systems are unable to bear the weight of patients with obesity, making it difficult to examine and manage these patients. The objective of this study was analyzed the sociodemographic characteristics, quality of life, foot disorders, and pedobarographic parameters of patients with extreme obesity who are candidates for bariatric surgery and determine the changes after weight loss post-surgery. MATERIALS AND METHODS We conducted a foot examination, a pedobarographic study using a Podoprint® pressure platform, and a quality of life questionnaire (EQ-5D) on 23 patients with extreme obesity and analyzed the changes 12-18 months after surgery in 11 of them. RESULTS We observed foot disorders, high plantar pressure, greater rearfoot contact, flat footprint, asymmetries, and alterations in toe contact. Almost 73.9% of participants said they had foot pain, 56.5% said they had impaired mobility, and more than 40% said they had limitations in carrying out daily activities and suffered from anxiety. After weight loss, we observed improved quality of life; more foot disorders; changes in total contact area, plantar pressures, barycenter, contact time, and footprint; decreased pain perception, walking problems and anxiety situations. Moreover, medication decreased, but they need to take more vitamins and calcium. CONCLUSION Weight loss improved the quality of life of the participating patients but altered their foot disorders. All parameters need regular reassessment to detect changes and modify initially prescribed treatments.
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Affiliation(s)
- Ana María Pérez Pico
- DEDAP Research Group, Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain
| | - María Ángeles Gómez González
- DEDAP Research Group, Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain
- DEDAP Research Group, Department of Nursing, Centro Universitario de Plasencia, Universidad de Extremadura. Prevention Unit, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain
| | | | - Julia Villar Rodríguez
- DEDAP Research Group, Department of Anatomy, Cell Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain
| | - Raquel Mayordomo Acevedo
- DEDAP Research Group, Department of Anatomy, Cell Biology and Zoology, Centro Universitario de Plasencia, Universidad de Extremadura, Plasencia, Cáceres, Spain.
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of intermittent fasting for adults with overweight or obesity.
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Roux-en-Y gastric bypass, gastric banding, or sleeve gastrectomy for severe obesity: Baseline data from the By-Band-Sleeve randomized controlled trial. Obesity (Silver Spring) 2023; 31:1290-1299. [PMID: 37140395 DOI: 10.1002/oby.23746] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/01/2023] [Accepted: 01/22/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This paper reports the study design, participant characteristics, and recruitment results of By-Band-Sleeve, which investigated the clinical and cost-effectiveness of gastric bypass, gastric banding, and sleeve gastrectomy in adults with severe obesity in the UK. METHODS A pragmatic open adaptive noninferiority trial with 3-year follow-up was conducted. Participants were randomly assigned to bypass or band initially and to sleeve after the adaptation. Co-primary end points are weight loss and health-related quality of life assessed using the EQ-5D utility index. RESULTS Between December 2012 and August 2015, the study recruited into two groups and, after the adaptation, into three groups until September 2019. The study screened 6960 patients; 4732 (68%) were eligible and 1351 (29%) were randomized; 5 subsequently withdrew consent to use data, leaving 462, 464, and 420 assigned to bypass, band, and sleeve, respectively. Baseline data showed high levels of obesity (mean BMI = 46.4 kg/m2; SD: 6.9) and comorbidities (e.g., 31% diabetes), low scores for health-related quality of life, and high levels of anxiety and depression (e.g., 25% abnormal scores). Nutritional parameters were poor, and the average equivalized household income was low (£16,667). CONCLUSIONS By-Band-Sleeve fully recruited. Participant characteristics are consistent with contemporary patients having bariatric surgery, and therefore the results will be generalizable.
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Soley N, Song S, Flaks-Manov N, Overby Taylor C. Risk for Poor Post-Operative Quality of Life Among Wearable Use Subgroups in an All of Us Research Cohort. PACIFIC SYMPOSIUM ON BIOCOMPUTING. PACIFIC SYMPOSIUM ON BIOCOMPUTING 2023; 28:31-42. [PMID: 36540962 PMCID: PMC9798526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this research was to build and assess the performance of a prediction model for post-operative recovery status measured by quality of life among individuals experiencing a variety of surgery types. In addition, we assessed the performance of the model for two subgroups (high and moderately consistent wearable device users). Study variables were derived from the electronic health records, questionnaires, and wearable devices of a cohort of individuals with one of 8 surgery types and that were part of the NIH All of Us research program. Through multivariable analysis, high frailty index (OR 1.69, 95% 1.05-7.22, p<0.006), and older age (OR 1.76, 95% 1.55-4.08, p<0.024) were found to be the driving risk factors of poor recovery post-surgery. Our logistic regression model included 15 variables, 5 of which included wearable device data. In wearable use subgroups, the model had better accuracy for high wearable users (81%). Findings demonstrate the potential for models that use wearable measures to assess frailty to inform clinicians of patients at risk for poor surgical outcomes. Our model performed with high accuracy across multiple surgery types and were robust to variable consistency in wearable use.
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Affiliation(s)
- Nidhi Soley
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shanshan Song
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA,Division of General Internal Medicine, Department of
Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
USA,Biomedical Informatics & Data Science Section, The
Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Natalie Flaks-Manov
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Casey Overby Taylor
- Institute for Computational Medicine, Whiting School of
Engineering, Johns Hopkins University, Baltimore, Maryland, USA,Department of Biomedical Engineering, Johns Hopkins
University, Baltimore, Maryland, USA,Division of General Internal Medicine, Department of
Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,
USA,Biomedical Informatics & Data Science Section, The
Johns Hopkins University School of Medicine, Baltimore, Maryland
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Sousa MS, Martin P, Johnson MJ, Lind M, Maddocks M, Bullock A, Agar M, Chang S, Kochovska S, Kinchin I, Morgan D, Fazekas B, Razmovski-Naumovski V, Lee JT, Itchins M, Bray V, Currow DC. Phase II, double blind, placebo controlled, multi-site study to evaluate the safety, feasibility and desirability of conducting a phase III study of anamorelin for anorexia in people with small cell lung cancer: A study protocol (LUANA trial). PLoS One 2023; 18:e0285850. [PMID: 37195996 DOI: 10.1371/journal.pone.0285850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
Anorexia is experienced by most people with lung cancer during the course of their disease and treatment. Anorexia reduces response to chemotherapy and the ability of patients to cope with, and complete their treatment leading to greater morbidity, poorer prognosis and outcomes. Despite the significant importance of cancer-related anorexia, current therapies are limited, have marginal benefits and unwarranted side effects. In this multi-site, randomised, double blind, placebo controlled, phase II trial, participants will be randomly assigned (1:1) to receive once-daily oral dosing of 100mg of anamorelin HCl or matched placebo for 12 weeks. Participants can then opt into an extension phase to receive blinded intervention for another 12 weeks (weeks 13-24) at the same dose and frequency. Adults (≥18 years) with small cell lung cancer (SCLC); newly diagnosed with planned systemic therapy OR with first recurrence of disease following a documented disease-free interval ≥6 months, AND with anorexia (i.e., ≤ 37 points on the 12-item Functional Assessment of Anorexia Cachexia Treatment (FAACT A/CS) scale) will be invited to participate. Primary outcomes are safety, desirability and feasibility outcomes related to participant recruitment, adherence to interventions, and completion of study tools to inform the design of a robust Phase III effectiveness trial. Secondary outcomes are the effects of study interventions on body weight and composition, functional status, nutritional intake, biochemistry, fatigue, harms, survival and quality of life. Primary and secondary efficacy analysis will be conducted at 12 weeks. Additional exploratory efficacy and safety analyses will also be conducted at 24 weeks to collect data over longer treatment duration. The feasibility of economic evaluations in Phase III trial will be assessed, including the indicative costs and benefits of anamorelin for SCLC to the healthcare system and society, the choice of methods for data collection and the future evaluation design. Trial registration. The trial has been registered with the Australian New Zealand Clinical Trials Registry [ACTRN12622000129785] and approved by the South Western Sydney Local Health District Human Research Ethics Committee [2021/ETH11339]. https://clin.larvol.com/trial-detail/ACTRN12622000129785.
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Affiliation(s)
- Mariana S Sousa
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Peter Martin
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England
| | - Michael Lind
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Denmark Hill, London, United Kingdom
| | - Alex Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, England
| | - Meera Agar
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Department of Medical Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
- South West Sydney Clinical Campuses, University of New South Wales Sydney, Kensington, Australia
| | - Sungwon Chang
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Slavica Kochovska
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Irina Kinchin
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Deidre Morgan
- RePaDD, Flinders University, Adelaide, South Australia, Australia
| | - Belinda Fazekas
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Valentina Razmovski-Naumovski
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- South West Sydney Clinical Campuses, University of New South Wales Sydney, Kensington, Australia
| | - Jessica T Lee
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Concord Centre for Palliative Care, Concord Repatriation General Hospital, Concord West, New South Wales, Australia
- Concord Clinical school, University of Sydney, Camperdown, New South Wales, Australia
| | - Malinda Itchins
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Victoria Bray
- Department of Medical Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - David C Currow
- Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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7
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Daza JF, Cuthbertson BH, Myles PS, Shulman MA, Wijeysundera DN, Wijeysundera DN, Pearse RM, Myles PS, Abbott TEF, Shulman MA, Torres E, Ambosta A, Melo M, Mamdani M, Thorpe KE, Wallace S, Farrington C, Croal BL, Granton JT, Oh P, Thompson B, Hillis G, Beattie WS, Wijeysundera HC, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Kirabiyik Y, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Day L, Pazmino-Canizares J, Belliard R, Lee L, Dobson K, Stanbrook M, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, McAllister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G. Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian H Cuthbertson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Mejaddam A, Krantz E, Höskuldsdóttir G, Fändriks L, Mossberg K, Eliasson B, Trimpou P, Landin-Wilhelmsen K. Comorbidity and quality of life in obesity-a comparative study with the general population in Gothenburg, Sweden. PLoS One 2022; 17:e0273553. [PMID: 36194568 PMCID: PMC9531784 DOI: 10.1371/journal.pone.0273553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/11/2022] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Obesity is considered to have a detrimental impact on health-related quality of life (HRQoL). OBJECTIVE To compare HRQoL in a well-defined group of people with obesity with a population-based control group from the general public. DESIGN Observational cross-sectional cohort study with a reference population. SETTING The Regional Obesity Center at the Department of Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS People with obesity (n = 1122) eligible for surgical and non-surgical obesity treatment in routine care were included consecutively between 2015 and 2017 into the BASUN study. Men and women from the WHO-MONICA-GOT project were used as a reference population (n = 414). MAIN OUTCOME MEASURES HRQoL was measured with the RAND-36/Short Form-36 questionnaire (SF-36) and a Visual Analogue Scale (VAS) for self-related health (SRH). Prescription drugs for hypertension, diabetes mellitus, depression, and anxiety were taken as a proxy for these conditions. RESULTS People with obesity rated their overall HRQoL lower than the reference population according to the SRH-VAS. Lower scores were reported on physical and social functioning, vitality, general and mental health after adjustment for age and use of prescription drugs (considered a proxy for burden of disease, or comorbidities) using the RAND-36/SF-36 questionnaire. Use of some psychopharmacological agents was more common in patients with obesity. CONCLUSION People with obesity seeking help with weight reduction are more likely to have lower physical and mental self-reported HRQoL than the general population.
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Affiliation(s)
- Ala Mejaddam
- Department of Internal Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- * E-mail:
| | - Emily Krantz
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudrún Höskuldsdóttir
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Fändriks
- Department of Surgery, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Mossberg
- Department of Public Health and Community Medicine Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Penelope Trimpou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
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9
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Boye KS, Matza LS, Stewart KD, Andrews H, Howell TA, Stefanski A, Malley KG, Ishak KJ, Fernández Landó L. Health state utilities associated with weight loss in type 2 diabetes and obesity. J Med Econ 2022; 25:14-25. [PMID: 34734554 DOI: 10.1080/13696998.2021.2002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Health state utilities associated with weight change are needed as inputs for cost-utility analyses (CUAs) examining the value of treatments for obesity and type 2 diabetes (T2D). Although some pharmaceutical treatments currently in development are associated with substantial weight loss, little is known about the utility impact of weight decreases greater than 10%. The purpose of this study was to estimate utilities associated with body weight decreases up to 20% based on preferences of individuals with obesity, with and without T2D. METHODS Health state vignettes were developed to represent respondents' own current weight and weight decreases of 2.5, 5, 10, 15, and 20%. Health state utilities were elicited in time trade-off interviews in two UK locations (Edinburgh and London) with a sample of participants with obesity, with and without T2D. Mean utility increases associated with each amount of weight decrease were calculated. Regression analyses were performed to derive a method for estimating utility change associated with weight decreases. RESULTS Analyses were conducted with data from 405 individuals with obesity (202 with T2D, 203 without T2D). Utility increases associated with various levels of weight decrease ranged from 0.011 to 0.060 in the subgroup with T2D and 0.015 to 0.077 in the subgroup without T2D. All regression models found that the percentage of weight decrease was a highly significant predictor of change in utility (p < .0001). The relationship between weight change and utility change did not appear to be linear. Equations are recommended for estimating utility change based on the natural logarithm of percentage of weight decrease. DISCUSSION Results of this study may be used to provide inputs for CUAs examining and comparing the value of treatments that are associated with substantial amounts of weight loss in patients with obesity, with or without T2D.
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Affiliation(s)
| | - Louis S Matza
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | | | - Haylee Andrews
- Formerly of Patient-Centered Research, Evidera, Bethesda, MD, USA
| | | | | | | | - K Jack Ishak
- Patient-Centered Research, Evidera, Bethesda, MD, USA
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10
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Korrel M, Roelofs A, van Hilst J, Busch OR, Daams F, Festen S, Groot Koerkamp B, Klaase J, Luyer MD, van Oijen MG, Verdonck-de Leeuw IM, Besselink MG. Long-Term Quality of Life after Minimally Invasive vs Open Distal Pancreatectomy in the LEOPARD Randomized Trial. J Am Coll Surg 2021; 233:730-739.e9. [PMID: 34530127 DOI: 10.1016/j.jamcollsurg.2021.08.687] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP) shortens time to functional recovery and improves 30-day quality of life (QoL), as compared with open distal pancreatectomy (ODP) for nonmalignant disease. The impact of MIDP on QoL, cosmetic satisfaction, and overall major complications beyond 1-year follow-up is currently unknown. STUDY DESIGN The Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD) trial randomized 108 patients to MIDP (laparoscopic or robotic) or ODP in 14 Dutch centers (April 2015 to March 2017). The primary outcome measure of this study was quality-adjusted life years (QALYs), as assessed with the EQ-5D. QoL was assessed using subscales of the EORTC QLQ-C30, PAN-26, and a body image questionnaire. The latter included a cosmetic satisfaction score (range 3-24), and a body image score (range 5-20). Differences between MIDP and ODP for QALYs, generic, and disease-specific QoL and body image were analyzed. Missing QoL data were imputed using multiple imputation. RESULTS In total, 84 patients were alive, with a median follow-up of 44 months; 62 of these patients (74%) completed the questionnaires (27 MIDP, 35 ODP). There was no significant difference in QALYs between the 2 groups (mean score 2.34 vs 2.46 years, p = 0.63), nor on the QoL subscales. Significant overall change in EQ-5D health utilities were found for both groups over time (p < 0.001). Patients in the MIDP group scored higher on cosmetic satisfaction (21 vs 14, p = 0.049). No differences between the 2 groups were observed for clinical outcomes such as major complications, readmissions, and incisional hernias. CONCLUSIONS More than 3 years after distal pancreatectomy, no improvement in QALYs and overall QoL was seen after MIDP, whereas cosmetic satisfaction was higher after MIDP as compared with ODP.
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Affiliation(s)
- Maarten Korrel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Anne Roelofs
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Jony van Hilst
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands; Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | | | | | - Joost Klaase
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Martijn G van Oijen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands; Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands.
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11
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Mackenzie RM, Greenlaw N, Ali A, Bruce D, Bruce J, Grieve E, Lean M, Lindsay R, Sattar N, Stewart S, Ford I, Logue J. SurgiCal Obesity Treatment Study (SCOTS): a prospective, observational cohort study on health and socioeconomic burden in treatment-seeking individuals with severe obesity in Scotland, UK. BMJ Open 2021; 11:e046441. [PMID: 34446484 PMCID: PMC8395268 DOI: 10.1136/bmjopen-2020-046441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES There is a lack of evidence to inform the delivery and follow-up of bariatric surgery for people with severe obesity. The SurgiCal Obesity Treatment Study (SCOTS) is a national longitudinal cohort of people undergoing bariatric surgery. Here, we describe characteristics of the recruited SCOTS cohort, and the relationship between health and socioeconomic status with body mass index (BMI) and age. PARTICIPANTS/METHODS 445 participants scheduled for bariatric surgery at any of 14 centres in Scotland, UK, were recruited between 2013 and 2016 for this longitudinal cohort study (1 withdrawal); 249 completed health-related preoperative patient-reported outcome measures. Regression models were used to estimate the effect of a 10-unit increase in age or BMI, adjusting for sex, smoking and socioeconomic status. RESULTS Mean age was 46 years and median BMI was 47 kg/m2. For each 10 kg/m2 higher BMI, there was a change of -5.2 (95% CI -6.9 to -3.5; p<0.0001) in Rand 12-item Short Form Survey Physical Component Summary (SF-12 PCS), -0.1 (95% CI -0.2 to -0.1; p<0.0001) in EuroQoL 5-level EQ-5D version index score and 14.2 (95% CI 10.7 to 17.7; p<0.0001) in Impact of Weight on Quality of Life-Lite Physical Function Score. We observed a 3.1 times higher use of specialist aids and equipment at home (OR: 3.1, 95% CI 1.9 to 5.0; p<0.0001). Broadly, similar results were seen for each 10-year higher age, including a change of -2.1 (95% CI -3.7 to -0.5; p<0.01) in SF-12 PCS. CONCLUSIONS A higher BMI combined with older age is associated with poor physical functioning and quality of life in people seeking bariatric surgery treatment. Policy-makers must consider the health and care needs of these individuals and invest to provide increased access to effective weight management. TRIAL REGISTRATION NUMBER ISRCTN47072588.
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Affiliation(s)
- Ruth M Mackenzie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | | | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Eleanor Grieve
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Robert Lindsay
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sally Stewart
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
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12
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Ageing, Health-Related Quality of Life and Physical Activity – Evidence Based on the EQ-5D-5L. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Naeem Z, Nie L, Drakos P, Yang J, Gan TJ, Pryor AD, Spaniolas K. The Relationship Between Postoperative Nausea and Vomiting and Early Self-Rated Quality of Life Following Laparoscopic Sleeve Gastrectomy. J Gastrointest Surg 2021; 25:2107-2109. [PMID: 33528788 DOI: 10.1007/s11605-021-04923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/13/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Zaina Naeem
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center T18-040, Stony Brook Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA.
| | - Lizhou Nie
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Panagiotis Drakos
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center T18-040, Stony Brook Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Tong J Gan
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Aurora D Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center T18-040, Stony Brook Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center T18-040, Stony Brook Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, 11794-8191, USA
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14
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Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res 2021; 30:647-673. [PMID: 33284428 PMCID: PMC7952346 DOI: 10.1007/s11136-020-02688-y] [Citation(s) in RCA: 291] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L. METHODS Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models. RESULTS Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health. CONCLUSIONS The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.
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Affiliation(s)
- You-Shan Feng
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany.
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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15
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Herhaus B, Kersting A, Brähler E, Petrowski K. Depression, anxiety and health status across different BMI classes: A representative study in Germany. J Affect Disord 2020; 276:45-52. [PMID: 32697715 DOI: 10.1016/j.jad.2020.07.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Changes in body mass index (BMI) over the course of one's lifetime are related to the development of mental disorders. In the current study we compared symptoms of depression, generalized anxiety as well as general health status in the four BMI-classes: underweight, normal weight, overweight and obesity. Furthermore, mediator role of general health status on the relationship between BMI and depression and generalized anxiety was analyzed. METHODS A representative sample (random-route sampling) of the German population (N = 2350) was investigated in a cross-sectional survey by measuring the three questionnaires PHQ-9, GAD-7 and EQ-5D-5L. RESULTS The results showed significant differences between the four BMI-classes in all three questionnaires. Individuals with obesity demonstrated higher values in depression, anxiety and general health compared to the three other BMI-classes. However, there was no U-shaped association between BMI and depression, anxiety and health-related quality of life. Regarding to the mediation analysis, general health status fully mediated the association between BMI, depressive symptoms as well as generalized anxiety symptoms. LIMITATIONS The assessment of the three factors depression, anxiety and general health status were measured by questionnaires, but no clinical diagnoses can be provided. CONCLUSIONS Evidence supports that individuals with obesity have an increased risk for depression and anxiety as well as lower general health. Further research on potential intervention and strategies in public health policies is needed to be able to target the developing of mental disorders in individuals with obesity. Taking their general health status into account is also of great importance.
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Affiliation(s)
- Benedict Herhaus
- Medical Psychology & Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128 Mainz, Germany.
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Katja Petrowski
- Medical Psychology & Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128 Mainz, Germany
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16
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Hu X, Jing M, Zhang M, Yang P, Yan X. Responsiveness and minimal clinically important difference of the EQ-5D-5L in cervical intraepithelial neoplasia: a longitudinal study. Health Qual Life Outcomes 2020; 18:324. [PMID: 33008423 PMCID: PMC7531135 DOI: 10.1186/s12955-020-01578-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022] Open
Abstract
Background With the widespread clinical application of the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L), whether the questionnaire scores are responsive to changes in patients’ health and how much changes in questionnaire scores represent patients’ real health changes require consideration. Consequently, we assessed responsiveness and estimated the minimal clinically important difference (MCID) of the EQ-5D-5L in surgically treated patients with cervical intraepithelial neoplasia (CIN) to determine the relationship between MCID and minimal detectable change (MDC). Methods We conducted a longitudinal, observational study. Participants were patients with CIN from the gynecology inpatient department of a grade-A tertiary hospital in Shihezi, Xinjiang, China. Participants completed the EQ-5D-5L and the Global Rating of Change Questionnaire (GRCQ) at baseline and one month post-surgery. The Wilcoxon signed-rank test was used to compare EQ-5D-5L scores pre- and post-treatment. We calculated the effect size (ES) and the standardized response mean (SRM) to quantitatively assess responsiveness. Distribution-based, anchor-based, and instrument-defined methods were used to estimate MCID. MCID to MDC ratios at individual- and group-levels were also calculated. Results Fifty patients with CIN completed the follow-up investigation (mean age 44.76 ± 8.72 years; mean follow-up time 32.28 ± 1.43 days). The index value and EQ visual analogue scale (EQ VAS) of the EQ-5D-5L improved by 0.025 and 6.92 (all p < 0.05) at follow-up as compared to baseline respectively. The ES and the SRM of the index value were 0.47 and 0.42 respectively, indicating small responsiveness; while the ES and the SRM of EQ VAS were 0.50 and 0.49 respectively, indicating small to moderate responsiveness. The average (range) of MCIDs for index value and EQ VAS were 0.039 (0.023–0.064) and 5.35 (3.12–6.99) respectively. These values can only be used to determine whether patients have experienced clinically meaningful health improvements at the group level. Conclusions The EQ-5D-5L has only small to moderate responsiveness in post-surgical patients with CIN, and the MCIDs developed in this study can be used for group-level health assessment. However, further study is needed concerning health changes at the individual level.
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Affiliation(s)
- Xin Hu
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Mingxia Jing
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China.
| | - Mei Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Ping Yang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Xiaolong Yan
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
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17
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Xia Q, Campbell JA, Ahmad H, Si L, de Graaff B, Otahal P, Palmer AJ. Health state utilities for economic evaluation of bariatric surgery: A comprehensive systematic review and meta-analysis. Obes Rev 2020; 21:e13028. [PMID: 32497417 DOI: 10.1111/obr.13028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
Health state utilities (HSUs) are health economic metrics that capture and assess health-related quality of life (HRQoL). They are essential in health-economic evaluations when calculating quality-adjusted life years. We investigated published studies reporting bariatric surgery-related HSUs elicited through direct or indirect (multiattribute utility instrument [MAUI]) patient-reported methods (PROSPERO registration number: CRD42019131725). Mean HSUs for different time points and HSU changes over time (where feasible) were meta-analysed using random-effects models. Of the 950 potentially relevant identified studies, n = 28 (2004-2018) qualified for data extraction, with n = 85 unique HSUs elicited mainly from the EQ-5D (88%). Most (75%) studies were published after 2013. The follow-up duration varied between studies and was often limited to 12 months. The pooled mean HSU was 0.72 (0.67-0.76) at baseline/presurgery (n = 18) and 0.84 (0.79-0.89) one-year postsurgery (n = 11), indicating a 0.11 (0.09-0.14) utility unit increment. EQ-5D showed the similar results. This positive difference can be partially explained by BMI and/or co-morbidities status improvement. This study provides a valuable summary of HSUs to future bariatric surgery-related cost-utility models. However, more well-designed higher-quality bariatric-related HSU studies are expected for future reviews to improve the available evidence. We suggest that researchers select an MAUI that is preferentially sensitive to the study population.
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Affiliation(s)
- Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Centre for Health Economics, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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18
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Donnan J, Gao Z, Adey T, Walsh K, Pace D, Twells L. Prioritization for bariatric surgery: capturing Canadian patient preference weights using a discrete choice experiment. Surg Obes Relat Dis 2020; 16:751-759. [DOI: 10.1016/j.soard.2020.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 01/18/2023]
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Tahiri M, Goudie E, Jouquan A, Martin J, Ferraro P, Liberman M. Enhanced recovery after video-assisted thoracoscopic surgery lobectomy: a prospective, historically controlled, propensity-matched clinical study. Can J Surg 2020; 63:E233-E240. [PMID: 32386474 DOI: 10.1503/cjs.001919] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Enhanced recovery pathways or fast-tracking following surgery can decrease the rate of postoperative complications and hospital length of stay. The objectives of this study were to implement an enhanced recovery after surgery (ERAS) pathway for patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy, to assess the safety and efficiency of this protocol by measuring associated postoperative outcomes, and to compare the outcomes for patients in the ERAS group with the outcomes for patients in a propensity-matched control group. Methods The study was a prospective clinical trial. Patients who were scheduled to undergo VATS lobectomy at the Centre hospitalier de l'Université de Montréal in Montréal, Quebec, Canada, were enrolled between November 2015 and October 2016. The ERAS pathway was used for all enrolled patients. The primary outcome was the number and severity of complications measured by the Comprehensive Complication Index. Secondary outcomes included length of stay, readmission and recovery. Recovery of patients was measured using EQ-5D-5L preoperatively and at 1 week, 1 month and 4 months after surgery. Prospectively enrolled patients were propensity matched to historical controls. Results Ninety-eight patients (36 men and 62 women) in the ERAS group and 98 patients in the control group (29 men and 69 women) were included in the analysis. The mean age was 65.2 ± 9.3 years, the mean body mass index (BMI) was 26.9 ± 5.9 kg/m2 and the median Charlson Comorbidity Index score was 2 (interquartile range [IQR] 2-3) in the ERAS group. In the control group, the mean age was 66.2 ± 9.4 years, the mean BMI was 27.4 ± 5.6 kg/m2 and the median Charlson Comorbidity Index score was 3 (IQR 2-3). A total of 23 patients (23.4%) in the ERAS group and 28 (28.6%) in the control group experienced 1 or more postoperative complications. The mean Comprehensive Complication Index score was 7.4 ± 16.8 in the ERAS group compared with 8.0 ± 14.3 in the control group (p = 0.79). The median postoperative length of stay was 3 days in the ERAS group and 5 days in the control group (p < 0.001). Five patients in the ERAS group and 4 patients in the control group were readmitted. The protocol adherence rate was 64.3%. Conclusion It is feasible to implement an enhanced recovery protocol after VATS lobectomy. Although the pathway is still early in its development in Canada, implementation of an ERAS pathway after VATS lobectomy was associated with decreased length of stay, with no observable increase in complication or readmission rates.
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Affiliation(s)
- Mehdi Tahiri
- From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman)
| | - Eric Goudie
- From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman)
| | - Adeline Jouquan
- From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman)
| | - Jocelyne Martin
- From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman)
| | - Pasquale Ferraro
- From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman)
| | - Moishe Liberman
- From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman)
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Health related quality of life associated with extreme obesity in adolescents - results from the baseline evaluation of the YES-study. Health Qual Life Outcomes 2020; 18:58. [PMID: 32138734 PMCID: PMC7059717 DOI: 10.1186/s12955-020-01309-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 02/26/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obesity can significantly reduce health-related quality of life (HRQoL) and may lead to numerous health problems even in youths. This study aimed to investigate whether HRQoL varies among youths with obesity depending on grade of obesity and other factors. METHODS For the Youths with Extreme obesity Study (YES) (2012-2014), a prospective multicenter cohort study, a baseline sample of 431 obese and extremely obese adolescents and young adults (age 14 to 24 years, BMI ≥30 kg/m2) was recruited at four German university medical centers and one job center. Obesity grade groups (OGG) were defined according to BMI (OGG I: 30-34.9 kg/m2, OGG II: 35-39.9 kg/m2, OGG III (extreme obesity): ≥40 kg/m2). HRQoL was measured with the Euroqol-5D-3 L (EQ-5D-3 L), DISABKIDS chronic generic (DCGM-31) and the KINDLR obesity module. Differences between OGGs were assessed with logistic and linear regression models, adjusting for age, sex, and study center in the base model. In a second regression analysis, we included other characteristics to identify possible determinants of HRQoL. RESULTS Three hundred fifty-two adolescents (mean age: 16.6 (±2.4), mean BMI: 39.1 (±7.5) kg/ m2) with available HRQoL data were analysed. HRQoL of youths in all OGGs was markedly lower than reference values of non-obese adolescents. Adjusting for age and sex, HRQoL of youths in OGG III significantly impaired compared to OGG I. Youths in OGG III were 2.15 times more likely to report problems with mobility in the EQ-5D-3 L than youths in OGG I. A mean difference of 9.7 and 6.6 points between OGG III and I were found for DCGM-31 and KINDL respectively and 5.1 points between OGG II and I for DCGM-31. Including further variables into the regression models, showed that HRQoL measured by DCGM-31 was significantly different between OGGs. Otherwise, female sex and having more than 4 h of daily screen time were also associated with lower HRQoL measured by DCGM-31 and KINDL. CONCLUSION HRQoL of adolescents with obesity is reduced, but HRQoL of adolescents with extreme obesity is particularly affected. Larger and longitudinal studies are necessary to understand the relation of extreme obesity and HRQoL, and the impact of other lifestyle or socioeconomic factors. TRIAL REGISTRATION Clinicaltrials.gov NCT01625325; German Clinical Trials Register (DRKS) DRKS00004172.
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Alligier M, Barrès R, Blaak EE, Boirie Y, Bouwman J, Brunault P, Campbell K, Clément K, Farooqi IS, Farpour-Lambert NJ, Frühbeck G, Goossens GH, Hager J, Halford JCG, Hauner H, Jacobi D, Julia C, Langin D, Natali A, Neovius M, Oppert JM, Pagotto U, Palmeira AL, Roche H, Rydén M, Scheen AJ, Simon C, Sorensen TIA, Tappy L, Yki-Järvinen H, Ziegler O, Laville M. OBEDIS Core Variables Project: European Expert Guidelines on a Minimal Core Set of Variables to Include in Randomized, Controlled Clinical Trials of Obesity Interventions. Obes Facts 2020; 13:1-28. [PMID: 31945762 PMCID: PMC7098277 DOI: 10.1159/000505342] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022] Open
Abstract
Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes.
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Affiliation(s)
- Maud Alligier
- FCRIN/FORCE Network, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Lyon, France
| | - Romain Barrès
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ellen E Blaak
- Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Yves Boirie
- University Clermont Auvergne, CHU Clermont-Ferrand, Clinical Nutrition Department, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Jildau Bouwman
- TNO (Netherlands Organization for Applied Scientific Research), Microbiology and Systems Biology, Zeist, The Netherlands
| | - Paul Brunault
- Equipe de Liaison et de Soins en Addictologie, CHRU de Tours, and UMR 1253, iBrain, Université de Tours, Inserm, and Qualipsy EE 1901, Université de Tours, Tours, France
| | - Kristina Campbell
- KC Microbiome Communications Group, Victoria, British Columbia, Canada
| | - Karine Clément
- Sorbonne University/INSERM, Nutrition and Obesities, Systemic Approaches Research Unit, and Assistance Publique Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
| | - I Sadaf Farooqi
- Wellcome-MRC Institute of Metabolic Science and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Nathalie J Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Health, Primary Care and Emergency, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra & CIBEROBN, IdiSNA, Pamplona, Spain
| | - Gijs H Goossens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jorg Hager
- Metabolic Phenotyping, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Jason C G Halford
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hans Hauner
- Institute of Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - David Jacobi
- L'Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center (CRESS), Inra, Cnam, Paris 13 University and Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Dominique Langin
- Institute of Metabolic and Cardiovascular Diseases, I2MC, Inserm, Paul Sabatier University, and Department of Medical Biochemistry, Toulouse University Hospitals, Toulouse, France
| | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martin Neovius
- Department of Medicine (Solna), Karolinska Institute, Stockholm, Sweden
| | - Jean Michel Oppert
- Department of Nutrition, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Uberto Pagotto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Policlinic S. Orsola, Endocrinology Unit, Bologna, Italy
| | - Antonio L Palmeira
- CIPER, PANO-SR, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Helen Roche
- Nutrigenomics Research Group, UCD Institute of Food & Health, University College Dublin, Dublin, Ireland
| | - Mikael Rydén
- Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - André J Scheen
- Liège University, Division of Diabetes, Nutrition and Metabolic Disorders, CHU Liège, Liège, Belgium
| | - Chantal Simon
- CarMen Laboratory, INSERM 1060, INRA 1397, University of Lyon, Oullins, France
| | - Thorkild I A Sorensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Luc Tappy
- Physiology Department, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Hannele Yki-Järvinen
- University of Helsinki, Helsinki University Hospital, and Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Olivier Ziegler
- Department of Endocrinology, Diabetes and Nutrition, Hôpital Brabois Adultes, CHRU de Nancy, Vandoeuvre Lès Nancy, France
| | - Martine Laville
- FCRIN/FORCE Network, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Université de Lyon, Hospices Civils de Lyon, Lyon, France,
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Brown A, Dornhorst A, McGowan B, Omar O, Leeds AR, Taheri S, Frost GS. Low-energy total diet replacement intervention in patients with type 2 diabetes mellitus and obesity treated with insulin: a randomized trial. BMJ Open Diabetes Res Care 2020; 8:e001012. [PMID: 32049634 PMCID: PMC7039597 DOI: 10.1136/bmjdrc-2019-001012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The management of patients with long-standing type 2 diabetes and obesity receiving insulin therapy (IT) is a substantial clinical challenge. Our objective was to examine the effect of a low-energy total diet replacement (TDR) intervention versus standardized dietetic care in patients with long-standing type 2 diabetes and obesity receiving IT. RESEARCH DESIGN AND METHODS In a prospective randomized controlled trial, 90 participants with type 2 diabetes and obesity receiving IT were assigned to either a low-energy TDR (intervention) or standardized dietetic care (control) in an outpatient setting. The primary outcome was weight loss at 12 months with secondary outcomes including glycemic control, insulin burden and quality of life (QoL). RESULTS Mean weight loss at 12 months was 9.8 kg (SD 4.9) in the intervention and 5.6 kg (SD 6.1) in the control group (adjusted mean difference -4.3 kg, 95% CI -6.3 to 2.3, p<0.001). IT was discontinued in 39.4% of the intervention group compared with 5.6% of the control group among completers. Insulin requirements fell by 47.3 units (SD 36.4) in the intervention compared with 33.3 units (SD 52.9) in the control (-18.6 units, 95% CI -29.2 to -7.9, p=0.001). Glycated Hemoglobin (HbA1c) fell significantly in the intervention group (4.7 mmol/mol; p=0.02). QoL improved in the intervention group of 11.1 points (SD 21.8) compared with 0.71 points (SD 19.4) in the control (8.6 points, 95% CI 2.0 to 15.2, p=0.01). CONCLUSIONS Patients with advanced type 2 diabetes and obesity receiving IT achieved greater weight loss using a TDR intervention while also reducing or stopping IT and improving glycemic control and QoL. The TDR approach is a safe treatment option in this challenging patient group but requires maintenance support for long-term success. TRIAL REGISTRATION NUMBER ISRCTN21335883.
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Affiliation(s)
- Adrian Brown
- Nutrition and Dietetic Research Group, Imperial College London, London, UK
- Centre for Obesity Research, Department of Medicine, University College London, London, UK
| | - Anne Dornhorst
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Barbara McGowan
- Institute of Diabetes, Endocrinology and Obesity, Guy's and St Thomas' Hospital, London, UK
| | - Omar Omar
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine-Qatar, Qatar-Foundation Education City, Doha, Qatar
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Anthony R Leeds
- Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Unit, Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark
| | - Shahrad Taheri
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine-Qatar, Qatar-Foundation Education City, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Gary S Frost
- Nutrition and Dietetic Research Group, Imperial College London, London, UK
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Davies A, Waylen A, Leary S, Thomas S, Pring M, Janssen B, Beynon R, Lang S, Schimansky S, Hurley K, Ness A. Assessing the validity of EQ-5D-5L in people with head & neck cancer: Does a generic quality of life measure perform as well as a disease-specific measure in a patient population? Oral Oncol 2019; 101:104504. [PMID: 31835074 DOI: 10.1016/j.oraloncology.2019.104504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) is an important cause of morbidity and mortality globally. Radical treatment methods may result in facial disfigurement and/or functional difficulties with subsequent adverse impacts on health-related quality of life (HRQoL). Guidelines suggest that HRQoL should be measured repeatedly throughout treatment to enable refined treatment protocols and tailored follow-up support but questionnaires are often long and burdensome. We compared condition-specific and generic metrics to assess HRQoL for people with this condition. METHODS We used data from the prospective Head and Neck 5000 clinical cohort study - 5511 participants with a new diagnosis of HNC between 2011 and 2014. HRQoL data were collected at baseline from 2065 people who completed both the condition-specific EORTC-QLQ-C30 and the shorter, generic EQ-5D-5L questionnaires. RESULTS There was strong evidence of association between comparable scales on each questionnaire at baseline: higher levels of functioning and lower levels of reported symptoms assessed with EQ-5D-5L were associated with lower EORTC-QLQ-C30 symptom scores. A moderate relationship (0.61) was found between overall QoL in the EQ-5D-5L index and self-perceived health (EQ VAS). CONCLUSIONS HRQoL data collected from the generic EQ-5D-5L and cancer-specific EORTC-QLQ-C30 questionnaires are comparable at baseline for people diagnosed with HNC. This would allow a reduced burden of data collection but the EQ-5D-5L may not be sensitive to some condition-specific symptoms. Clinicians and researchers must clarify their aims and outcomes of interest before choosing their HRQoL measures. Further work is required to examine the ability to detect change in these measures over time.
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Affiliation(s)
- A Davies
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - A Waylen
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - S Leary
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - S Thomas
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - M Pring
- Bristol Dental School, Lower Maudlin Street, Bristol BS1 2LY, UK
| | - B Janssen
- EuroQoL Research Foundation, Marten Meesweg 107, 3068 AV Rotterdam, the Netherlands
| | - R Beynon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - S Lang
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - S Schimansky
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - K Hurley
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
| | - A Ness
- NIHR Bristol Biomedical Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK; Bristol Medical School, 1(st) Floor, 5 Tyndall Ave, Bristol BS8 1UD, UK
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Aloweni F, Doshi K, Fook-Chong S, Malhotra R, Østbye T. The types of caregiving reactions experienced by the older spouse caregivers. J Clin Nurs 2019; 28:4538-4548. [PMID: 31466133 DOI: 10.1111/jocn.15044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/30/2019] [Accepted: 08/18/2019] [Indexed: 01/07/2023]
Abstract
AIMS To examine factors associated with the four types of caregiver reactions according to the modified Caregiver Reaction Assessment (mCRA) and assess the differences in the narrative assessment from spouse caregivers between the high-positive and high-negative caregiver reactions. BACKGROUND There is a limited understanding of the factors contributing to positive and negative reactions among older spouse caregivers with chronic illnesses. Narrative assessment from spouse caregivers has not been studied before. DESIGN The study design was a paired-sample, mixed-method survey design. Data were collected from spouse caregivers (≥55 years old) and care-recipients in one medical institute from February 2017-December 2017. This manuscript used STROBE checklist to ensure complete reporting. METHODS Demographic, socioeconomic, Frailty Index, perceived stress, and quality of life data were gathered from caregiver dyads. mCRA, relationship, and life satisfaction data were collected from caregivers. mCRA identified the four types of caregiver reactions: (a) high-positive, low-negative; (b) high-positive, high-negative; (c) low-positive, high-negative; and (d) low-positive, low-negative. A qualitative interview was conducted to understand the differences in the narrative and choice of words used to describe caregiving experience. RESULTS Seventy-five caregiver dyads were recruited. Total perceived stress was found to be negatively associated with high-positive, low-negative caregiver reaction (baseline category: low-positive, high-negative) by multinomial logistic regression. Content analyses showed that low-positive and high-negative caregivers used words that implied a lack of volition. Caregivers with positive experience viewed caregiving as a responsibility; the opposite viewed it as having 'no choice'. CONCLUSIONS Perceived stress is an important indicator of caregiver reactions. Words used when describing caregiving experiences can potentially depict the spouse caregivers' current state of being as a caregiver. RELEVANCE TO CLINICAL PRACTICE Spouse caregiver's narrative of their caregiving experience may provide easy and quick insights if interventions are needed. Early identification of negative reactions will allow for prompt interventions in mitigating caregivers' stress.
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Affiliation(s)
- Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Kinjal Doshi
- Department of Psychology, Singapore General Hospital, Singapore, Singapore
| | | | - Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Truls Østbye
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Community and Family Medicine, Duke University, Durham, NC, USA
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Goh KKK, Lai PSM, Lim SK. Cross cultural adaptation and validation of the Malay Kidney Disease Quality of Life (KDQOL-36™). BMC Nephrol 2019; 20:226. [PMID: 31221116 PMCID: PMC6585031 DOI: 10.1186/s12882-019-1397-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background In Malaysia, the prevalence of chronic kidney disease is high (9.1%). To date, no questionnaire that specifically assesses the health-related quality of life of patients with chronic kidney disease has been validated in Malaysia. Malay is the national language of Malaysia and spoken by the majority of its citizens. Therefore, the aim of our study was to cross-culturally adapt and validate the Malay Kidney Disease Quality of Life-36 (KDQOL-36) among patients with chronic kidney disease. Methods The English version of the KDQOL-36 was translated according to international guidelines to Malay. Content validity was verified by an expert panel and piloted in five patients. Our instrument was then administered to patients with chronic kidney disease stage 1-3A and patients on hemodialysis at baseline and 4 weeks later. Results A total of 181/232 patients agreed to participate (response rate = 78.0%). The majority were male (69.6%) with a median age of 51.0 years. Exploratory factor analysis found that the KDQOL-36 had three domains. All three domains showed low to moderate correlation (Spearman’s Rho = 0.297–0.610) with the Europe Quality of Life Five Dimension questionnaire. Patients on hemodialysis (physical component summary = 39.8; mental component summary = 53.1;burden of disease = 37.5; symptoms/burden list = 75.0; effects of kidney disease on daily life = 68.8) had significantly worse quality of life than patients with chronic kidney disease stage 1-3A (physical component summary = 49.9; mental component summary = 52.9; burden of disease = 75.0; symptoms/burden list = 85.4; effects of kidney disease on daily life = 93.8, p < 0.001) except for the mental component summary. This indicates that the Malay KDQOL-36 has achieved adequate known-groups validity. Cronbach alpha ranged from 0.872–0.901, indicating adequate internal consistency. At retest, intraclass correlation coefficient ranged from 0.584–0.902, indicating moderate to good correlation. Conclusion The Malay Kidney Disease Quality of Life-36 was found to be a valid and reliable tool to assess the quality of life in patients with chronic kidney disease. This tool can now be used to assess the health-related quality of life (HRQOL) in patients with chronic kidney disease, as HRQOL is an important independent predictor of patient outcome. Electronic supplementary material The online version of this article (10.1186/s12882-019-1397-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kent Ka Kian Goh
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Soo Kun Lim
- Department of Medicine (Nephrology) Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Sakakibara BM, Chakrabarti S, Krahn A, Mackay MH, Sedlak T, Singer J, Whitehurst DG, Lear SA. Delivery of Peer Support Through a Self-Management mHealth Intervention (Healing Circles) in Patients With Cardiovascular Disease: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12322. [PMID: 30635261 PMCID: PMC6330197 DOI: 10.2196/12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 01/29/2023] Open
Abstract
Background Cardiovascular disease (CVD) is a leading cause of hospitalization and death around the world. The prevalence of CVD is increasing and, therefore, development and investigation of effective programs to help people better self-manage their CVD and prevent secondary complications are needed. Objective In this paper, we report on a protocol to evaluate Healing Circles—an evidence-based and patient-informed peer support mobile health program designed to facilitate self-management and support patients in their recovery from and management of CVD. We hypothesize that individuals with CVD who use Healing Circles will experience greater improvements to their self-management ability than individuals receiving usual care. Methods In this single-blinded (assessor) randomized controlled trial, 250 community-living individuals with CVD will be randomized on a 1:1 basis to either Healing Circles or Usual Care. The primary outcome of self-management will be measured using the Health Education Impact Questionnaire version 3.0. Secondary outcomes include self-efficacy with chronic disease management, health-related quality of life, health resource use and costs, and electronic health literacy. Measurements will be taken at the baseline and every 6 months for 24 months. Results The study started recruitment in September 2017. Individuals are currently being recruited for participation, and existing participants are currently on follow-up. Measurements will be taken every 6 months until the study end, which is anticipated in December 2019. Conclusions Healing Circles is a novel program aimed toward improving self-management through peer support. Given our real-world study design, our findings will be readily translatable into practice. If the results support our hypothesis, it will indicate that Healing Circles is an effective intervention for improving self-management and reducing health care use. Trial Registration ClinicalTrials.gov NCT03159325; https://clinicaltrials.gov/ct2/show/NCT03159325 (Archived by WebCite at http://www.webcitation.org/74DvxVKUd) International Registered Report Identifier (IRRID) DERR1-10.2196/12322
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Affiliation(s)
| | | | - Andrew Krahn
- Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
| | - Martha H Mackay
- Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
| | - Tara Sedlak
- Division of Cardiology, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Joel Singer
- School of Public and Population Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.,Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
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27
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de Vries CEE, Kalff MC, Prinsen CAC, Coulman KD, den Haan C, Welbourn R, Blazeby JM, Morton JM, van Wagensveld BA. Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review. Obes Rev 2018; 19:1395-1411. [PMID: 29883059 DOI: 10.1111/obr.12710] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study is to systematically assess the quality of existing patient-reported outcome measures developed and/or validated for Quality of Life measurement in bariatric surgery (BS) and body contouring surgery (BCS). METHODS We conducted a systematic literature search in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Database Systematic Reviews and CENTRAL identifying studies on measurement properties of BS and BCS Quality of Life instruments. For all eligible studies, we evaluated the methodological quality of the studies by using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and the quality of the measurement instruments by applying quality criteria. Four degrees of recommendation were assigned to validated instruments (A-D). RESULTS Out of 4,354 articles, a total of 26 articles describing 24 instruments were included. No instrument met all requirements (category A). Seven instruments have the potential to be recommended depending on further validation studies (category B). Of these seven, the BODY-Q has the strongest evidence for content validity in BS and BCS. Two instruments had poor quality in at least one required quality criterion (category C). Fifteen instruments were minimally validated (category D). CONCLUSION The BODY-Q, developed for BS and BCS, possessed the strongest evidence for quality of measurement properties and has the potential to be recommended in future clinical trials.
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Affiliation(s)
- C E E de Vries
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - M C Kalff
- Department of Surgery, OLVG West, Amsterdam, The Netherlands
| | - C A C Prinsen
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - K D Coulman
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C den Haan
- Medical Library, OLVG, Amsterdam, The Netherlands
| | - R Welbourn
- Department of Bariatric and Upper GI Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
| | - J M Morton
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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