Factors Influencing Quality of Life and Predictors of Low Quality of Life Scores in Patients on Treatment for Pulmonary Tuberculosis: A Cross Sectional Study

Health-related quality of life among adults newly diagnosed with pulmonary tuberculosis in Lagos State, Nigeria: a prospective study

PURPOSE

Tuberculosis (TB) has far-reaching effects on the social, mental, and emotional well-being of patients and consequently, their health-related quality of life (HRQOL). Few studies in Nigeria have examined changes in quality of life over the course of treatment. changes in (PTB) and factors associated with HRQOL.

METHODS

A prospective cohort study was conducted with patients recruited from health facilities in Lagos State. The World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF) was used to assess HRQOL. A semi-structured questionnaire was also administered to elicit information on socio-demographic characteristics and the medical and social history of the respondents. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23. A repeated measures analysis of variance (ANOVA) test with polynomial contrasts was used to assess how domain scores varied over time. Multivariable analysis was conducted using generalized estimating equations (GEE) to assess change in HRQOL and its predictors.

RESULTS

Two hundred and ten patients, predominantly male [108 (63.3%)] were recruited. The mean age was 36.7 ± 12.3 years. The HRQOL was impaired in all four domains at baseline. However, HRQOL scores increased over the treatment period with the largest improvement being in the 'environment' domain, where mean scores increased from 45.27 ± 14.59 to 61.28 ± 15.86. The proportion of respondents that expressed satisfaction with their health increased from 13.5% at baseline to 55.7% at the end of treatment. Low socio-economic status, delay in presentation, and an HIV-positive status were found to be significantly associated with reduced HRQOL at baseline (p < 0.05). In the multivariable longitudinal analysis, patients who were employed had higher HRQOL scores while persistent symptoms and a delay in presentation (≥ 4 weeks) were negatively associated with change in HRQOL scores over the course of treatment.

CONCLUSION

The HRQOL of respondents progressively improved over the six-month treatment period. However, change in HRQOL was influenced by a delay in presentation and persistence of symptoms. The study also highlights the need for increased recognition of patient-reported outcomes as an adjunct outcome measure.

Effects of Dynamic Stretching Combined with Manual Therapy on Pain, ROM, Function, and Quality of Life of Adhesive Capsulitis

This study was conducted to evaluate the effects of dynamic stretching combined with manual therapy on pain, range of motion, function, and quality of life in patients with adhesive capsulitis. The participants were randomly divided into two groups: the dynamic stretching combined with manual therapy (DSMT) group (n = 17) and the static stretching combined with manual therapy (SSMT) group (n = 17). Both groups received manual therapy for 10 min and two sessions per week for 4 weeks. The DSMT group also performed additional dynamic stretching for 20 min per session, two sessions per week for 4 weeks. The SSMT group practiced additional static stretching for 20 min per session, two sessions per week for 4 weeks. The pain, ROM, function, and quality of life were measured and evaluated before and after treatment. There were significant improvements in the outcomes of pain, flexion and abduction of shoulder ROM, Shoulder Pain and Disability Index (SPADI), and the physical component score and mental component score of the Short Form-36 (SF-36) in both groups. Additionally, the external and internal rotation of the shoulder ROM and the SF-36 general health factor increased significantly more in the A group (DSMT group) compared to the B group (SSMT). In conclusion, dynamic stretching plus manual therapy offers the same results as static stretching plus manual therapy, but with additional improvement in internal and external rotation.

Short-term effects of high-resolution (1-km) ambient PM2.5 and PM10 on hospital admission for pulmonary tuberculosis: a case-crossover study in Hainan, China

Introduction

There is limited evidence regarding particulate matter (PM)'s short-term effects on pulmonary tuberculosis (PTB) hospital admission. Our study aimed to determine the short-term associations of the exposure to ambient PM with aerodynamic diameters <2.5 μm (PM2.5) and < 10 μm (PM10) with hospital admission for PTB in Hainan, a tropical province in China.

Methods

We collected individual data on patients hospitalized with PTB, PM2.5, PM10, and meteorological data from 2016 to 2019 in Hainan Province, China. Conditional logistic regression models with a time-stratified case-crossover design were used to assess the short-term effects of PM2.5 and PM10 on hospital admission for PTB at a spatial resolution of 1 km  ×  1 km. Stratified analyses were performed according to age at admission, sex, marital status, administrative division, and season of admission.

Results

Each interquartile range (IQR) increases in the concentrations of PM2.5 and PM10 were associated with 1.155 (95% confidence interval [CI]: 1.041-1.282) and 1.142 (95% CI: 1.033-1.263) hospital admission risks for PTB at lag 0-8 days, respectively. The stratified analyses showed that the effects of PM2.5 and PM10 were statistically significant for patients aged ≥65 years, males, married, and those residing in prefecture-level cities. Regarding seasonal differences, the associations between PM and hospital admission for PTB were statistically significant in the warm season but not in the cold season. The effect of PM2.5 was consistently stronger than that of PM10 in most subgroups.

Conclusion

Short-term exposure to PM increases the risk of hospital admission for PTB. The potential impact of PM with smaller aerodynamic diameter is more detrimental. Our findings highlight the importance of reducing ambient PM level to alleviate the burden of PTB.

The Impact of Chronic Pulmonary Aspergillosis Co-infection on the Health-Related Quality of Life of Patients with Pulmonary Tuberculosis in Uganda

Background Both pulmonary tuberculosis (PTB) and chronic pulmonary aspergillosis (CPA) significantly affect health-related quality of life (HR-QoL). We aimed to determine the impact of CPA co-infection on the HR-QoL of Ugandans with PTB. Methods We conducted a prospective study among participants with PTB with persistent pulmonary symptoms after 2 months of anti-TB treatment at Mulago Hospital, Kampala, Uganda between July 2020 and June 2021. HR-QoL was assessed using St. George Respiratory Questionnaire (SGRQ) at enrollment and at the end of PTB treatment (4 months apart). SGRQ scores range from 0 to 100, with higher score representing a poorer HR-QoL. Results Of the 162 participants enrolled, 32 (19.8%) had CPA + PTB and 130 (80.2%) had PTB only. The baseline characteristics of the two groups were comparable. Regarding overall health, a higher proportion of the PTB only group rated their HR-QoL as "very good" compared to those who had both TB and CPA (68 (54.0%) versus 8 (25.8%)). At enrollment, both groups had comparable median SGRQ scores. However, at follow up, the PTB only group had statistically significantly better SGRQ scores (interquartile range); symptoms (0 (0 - 12.4) versus 14.4 (0 - 42.9), p < 0.001), activity ((0 (0 - 17.1) versus 12.2 (0 - 35.5), p = .03), impact (0 (0 - 4.0) versus 3.1 (0 - 22.5), p = 0.004), and total scores ((0 (0 - 8.5) versus 7.6 (0 - 27.4), p = 0.005). Conclusion CPA co-infection impairs HR-QoL of people with PTB. Active screening and management of CPA in patients with PTB is recommended to improve HR-QoL of these individuals.

Correlates of quality of life among persons living with tuberculosis: A cross-sectional study

Introduction

The correlates of quality of life originating from the demographic characteristics, comorbidities and sources of social support among persons living with tuberculosis remain underreported. The aim of this study was to examine the correlates of quality of life among persons living with tuberculosis within Greater Accra, Ghana.

Methods

A cross-sectional survey design was used to assess the correlates of quality of life among 250 randomly sampled persons living with tuberculosis. Quality of life was assessed with the Quality of Life Brief Version (WHOQOL-BREF) questionnaire and correlates were derived using Spearman rho correlations. Chi-square analyses assessed associations among respondent characteristics.

Results

All four quality of life domains (physical, psychological, social relationship and environmental) of persons living with tuberculosis were positively correlated. Furthermore, receiving social support from family or friends correlated positively with respondents’ quality of life. Human Immunodeficiency Virus (HIV) infection and receiving social support mainly from work colleagues or religious institutions correlated negatively with respondents’ quality of life domains. Other correlates of quality of life included age, pleuritis with pleural effusion, number of dependants and distance to tuberculosis treatment centres. Social support from family and friends corresponded with better quality of life among persons living with tuberculosis.

Conclusion

The quality of life domains of persons living with tuberculosis are interrelated and can be enhanced by social support. Healthcare providers should involve the significant others of persons living with tuberculosis, human immunodeficiency virus and pleuritis with pleural effusion in their care to promote patients’ quality of life.

Health-Related Quality of Life (HRQoL) of Patients with Tuberculosis: A Review

Tuberculosis (TB) is a major killer and cause of human suffering worldwide and imposes a substantial reduction in patients’ health-related quality of life (HRQoL). HRQoL indicates the consciousness of patients regarding their physical and mental health. It is, therefore, very relevant in comprehending and measuring the exact impact of the disease state. Therefore, we undertook this review to summarize the available evidence on the impact of TB and its treatment on HRQoL. An in-depth understanding of HRQoL in TB patients can identify the existing management gaps. We undertook a systematic search through PubMed and CENTRAL. Data were extracted and tabulated for study design, targeted population, QoL instrument used, QoL domain assessed, and key findings. We included studies that assessed the effect of TB on the QoL both during and after treatment. There are no specific HRQoL assessment tools for utilization among TB patients. HRQoL is markedly impaired in patients with TB. The factors affecting HRQoL differ with active and latent TB, socio-demographics, socio-economic status, presence of co-infections, etc. This review’s findings can help to frame appropriate policies for tackling HRQoL issues in TB patients.

Prospective Evaluation of Positivity Rates of Aspergillus-Specific IgG and Quality of Life in HIV-Negative Tuberculosis Patients in Lagos, Nigeria

Background

Pulmonary tuberculosis (PTB) often results in residual anatomical and functional changes despite microbiological cure and may be complicated by chronic pulmonary aspergillosis (CPA). In this study, we determined the perceived health-related quality of life (HRQoL) of patients during and after PTB therapy and compared it with their quantitative Aspergillus-specific IgG positivity rates.

Methodology

We conducted a longitudinal study among TB patients attending two directly observed therapy short-course (DOTS) clinics in Lagos, Nigeria. Two hundred and four confirmed TB patients were recruited over 9 months, with five visits at baseline and 3, 6, 9, and 12 months. They were all acid-fast bacilli smear, GeneXpert, or culture positive for Mycobacterium tuberculosis. Two HRQoL questionnaires translated into Yoruba were self-administered. Chest X-ray and Aspergillus IgG were collected at each visit.

Results

A total of 204 participants were recruited into this study. Most (70.6%) were age 18–39 years, and only 3.9% were above 60 years; 66.7% of all participants were males. A total of 189 (92.6%) participated in the 3-month assessment, 174 (85.3%) at 6 months, 139 (68.1%) at 9 months, and 99 (48.5%) at 12 months. At baseline, only 60.9% scored “good” or “very good” QoL and health on the WHOQOL-Bref, which improved to 77% at 6 months. At baseline, 10.4% had positive Aspergillus IgG levels, 15.1% at 3 months, 11.5% at 6 months, 16.7% at 9 months, and 19.3% at 12 months. Those with a positive Aspergillus IgG at 6 months had worse physical health (p = 0.001), psychological state (p = 0.002), social relationships (p = 0.006), and environmental QoL (p = 0.001) domains of the WHOQOL-Bref. Probable CPA was 10.4% at baseline and 19.3% at 6 months post-PTB therapy. Thirty-eight (18.6%) relocated after 6 months of treatment, 16 (7.8%) were lost to follow-up, and 11 (5.4%) died.

Conclusion

Our findings reveal a significant relationship between the QoL and Aspergillus IgG levels of TB patients. Further follow-up studies and additional imaging are required to determine when patients develop CPA and its clinical impact.

Health-Related Quality of Life in Tuberculosis Patients in Eritrea: Comparison Among Drug-Susceptible and Rifampicin/Multidrug-Resistant Tuberculosis Patients

Background

Despite the negative impact of tuberculosis (TB) on patients’ quality of life, TB control programs focus on biological and clinical parameters to manage and monitor TB patients. In our setting, patients’ perception of their experience with TB and the impacts of TB on patients’ physical, mental, and social wellbeing remain unknown.

Objective

The objective of this study was to evaluate the health-related quality of life (HRQOL) among rifampicin/multidrug-resistant TB (RR/MDR-TB) in comparison to drug-susceptible TB (DS-TB) patients in Eritrea.

Methods

A cross-sectional study was conducted in RR/MDR-TB and DS-TB patients under treatment. Anonymized data collected using the WHOQOL-BREF questionnaire were analyzed using SPSS version 23. Frequency, mean and standard deviation were used to describe the data. Mean group score comparison and relationship between variables were assessed using t-test. Domain score was calculated with a mean score of items within each domain and scaled positively, a higher (increasing) score denoting a higher quality of life. Internal consistency was measured using Cronbach’s alpha and statistical significance was set at p < 0.05.

Results

A total of 92 patients (46 RR/MDR-TB and 46 DS-TB) participated in the study. Environmental (40.63 ± 10.72) and physical domains (61.80 ±17.18) were the two most affected domains in RR/MDR-TB and DS-TB patients, respectively. The psychological domain was the least affected domain in RR/MDR-TB (48.28 ± 20.83) and DS-TB patients (76.63 ±15.32). RR/MDR-TB patients had statistically lower mean scores in all domains than DS-TB patients.

Conclusion

HRQOL was impaired in both groups, but RR/MDR-TB patients had a worse health-related quality of life.

Health related quality of life and associated factors with medication adherence among tuberculosis patients in selected districts of Gandaki Province of Nepal

Background

Tuberculosis is one of the significant public health problems of Nepal. Adherence to medication is very important for improving quality of life and preventing complication. Adherence to tuberculosis medications has significant economic and therapeutic consequences as non-adherence patients are at greater risk of developing complications which affect their health status and overall quality of life. The study aims to determine the factors associated with medication adherence and its effect on health related quality of life among tuberculosis patients in selected districts of Gandaki Province.

Methods

A health facility based cross-sectional study was carried out among 180 tuberculosis patients registered under DOTS and receiving treatment more than or equal to 60 days. WHOQOL-BREF tools to assess quality of life and Morisky medication adherence scale (MMAS-8) was adopt to assess medication adherence. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science (SPSS). The odds ratio with a 95% CI was calculated and p-value of <0.05 was considered as cutoff for statistical significance.

Results

A total 180 TB patients were participated in this study. Overall quality of life ranges from 10.75 to 89.25 with Mean ± SD as 55.96 ± 14.65. More than three-fourth (79.4%) respondents were adhere to medication. Medication adherence and health related quality of life was found statistically significant with relationship with health workers, favourable time at DOTS centre, absence of co-infection. Participants who were highly adhered to medication had good quality of life.

Conclusion

Majority of tuberculosis patients adhering to medication had good quality of life. Especial emphasis should be given to tuberculosis patients with co-infection, health workers should behave friendly and provide appropriate counselling in order to maintain the medication adherence and quality of life.

Factors Affecting Tuberculosis Patients' Quality of Life in Surabaya, Indonesia

PURPOSE

Patients with tuberculosis need to religiously take medication daily. However, they experience several side effects from these medications. The main reason for measuring the quality of life is to explain closely related factors that affect the patient's daily life that have been compromised with illness, while considering a patients' well-being that has associations with individual characteristics.

PATIENTS AND METHODS

This study included 157 patients with tuberculosis at 5 primary health-care centers and 2 hospitals in Surabaya. Quality of life is determined based on eight domains: general health, pain, social functioning, physical functioning, role limitation due to physical health, role limitation due to emotional problems, energy, and emotional well-being. The research instrument used to measure the quality of life is the RAND-36 Item Health Survey, whereas that used to measure mental distress is the Self-Reporting Questionnaire.

RESULTS

Our study results show that, of the eight domains measuring the quality of life, only age exhibited a significant effect on general health (P = 0.018); sex did not significantly affect the quality of life in all domains. The level of education exhibited a significant effect only on role limitation due to emotional problems (P = 0.014). Mental distress demonstrated a significant effect on the quality of life in all domains.

CONCLUSION

There are several factors affecting TB patients' quality of life. The study found that age, level of education, and comorbidity affect quality of life in several domains. However, mental distress affects quality of life in all domains.

Associations of chronic illnesses and socio-demographic factors with health-related quality of life of older adults in Nigeria: A cross-sectional study

BACKGROUND

The increase in life expectancy has brought about a higher prevalence of chronic illnesses among older people.

OBJECTIVES

To identify common chronic illnesses among older adults, to examine the influence of such conditions on their Health-Related Quality of Life (HRQoL), and to determine factors predicting their HRQoL.

METHOD

A population-based cross-sectional study was conducted involving 377 individuals aged 60 years and above who were selected using multi-stage sampling techniques in Olorunda Local Government, Osun State, Nigeria. Data were collected using an interviewer-administered questionnaire comprising socio-demographic characteristics, chronic illnesses, and the World Health Organization quality of life instrument (WHOQOL-BREF) containing physical health, psychological, social relationships, and environmental domains.

RESULTS

About half (51.5%) of the respondents reported at least one chronic illness which has lasted for 1-5 years (43.3%). The prevalence of hypertension was 36.1%, diabetes 13.9% and arthritis 13.4%. Respondents with chronic illness had significantly lower HRQoL overall and in the physical health, social relationships and the environmental domains (all p<0.05) compared to those without a chronic illness. Factors that predicted HRQoL include age, marital status, level of education, the presence of chronic illness and prognosis of the condition.

CONCLUSION

This study concluded that chronic illness is prevalent in Nigerian older people and significantly influence their HRQoL. Age, marital status, and level of education were associated with HRQoL in this group.

FUNDING

Postdoctoral fellowship from Consortium for Advanced Research Training in Afric.

Quality of life and its effective factors in tuberculosis patients receiving directly observed treatment short-course (DOTS)

Background

Quality of life in patients affected with chronic diseases has developed into a therapeutic objective as the best tool to evaluate response to treatment and medical care. The purpose of this study was to evaluate quality of life and its related factors in tuberculosis patients receiving directly observed treatment short-course in Iran.

Methods

This was a cross-sectional research with a descriptive-analytic design. Sample size included 71 patients affected with tuberculosis based on census method; so that, at the time of the study, all the tuberculosis patients were recruited in this research. The data collection instrument was a questionnaire comprised of two parts including demographic characteristics information and standard 36-Item Short Form Health Survey (SF-36). The data were also analyzed using SPSS Statistics along with descriptive and analytic statistics and independent t-tests, analysis of variance (ANOVA), and Chi-square test.

Results

The lowest mean score was 63.58 ± 10.16 and 62.82 ± 15.2 related to limited physical activity following mental problems and social functioning, respectively. Furthermore, the findings of the independent t-test demonstrated that the mean scores of quality of life among men and women, those with pulmonic and non-pulmonic tuberculosis, patient's place of residence and the stage of treatment were statistically and significantly different.

Conclusion

According to the above results, tuberculosis and its treatment have impact on the social function, mental, and emotional aspects of the quality of life of patients, Attention to and monitoring of the quality of life as a follow up of the treatment and care intervention in these patients is necessary.

Assessment of Health-Related Quality of Life among Tuberculosis Patients in a Public Primary Care Facility in Indonesia

Background and Objectives:

Evaluation of health-related quality of life (HRQoL) among tuberculosis (TB) patients could improve understanding about the burden associated with the diseases. There is a paucity of research regarding evaluation of HRQoL among TB population in Indonesia. This study aimed to investigate HRQoL among TB patients in Ciamis, Indonesia.

Methods:

This was a cross-sectional study conducted at one primary health-care facility in Ciamis, Indonesia. HRQoL was measured using the World Health Organization (WHO) QoL-BREF instrument which covers assessment on physical, psychological, social relationship, and environmental health domains. Multiple regression analysis was used to investigate the association between domain scores with demographic factors of the participants such as age, sex, education years, and types of treatment. Statistical analysis was conducted using SPSS software version 21.

Results:

Eighty-one participants were recruited in the present study. The total mean score for all domains was 45.35 (±23.3). The mean scores for physical, physiological, social relationship, and environmental health domains were 20.5 (±9.9), 76.4 (±11.9), 36.9 (±9.2), and 46.9 (±10.4), respectively. Education years were significantly associated with improved HRQoL in environmental health domain (P < 0.05).

Conclusion:

TB had remarkable negative impacts on patients HRQoL, with physical domain was the most affected. This finding calls upon strategies addressing HRQoL problems in the management of TB patients.

Health-related quality of life in South African patients with pulmonary tuberculosis

Background

The evaluation of patient-reported health-related quality of life (HRQOL) in pulmonary tuberculosis (TB) contributes to a comprehensive understanding of the burden associated with this disease. The aim of this study was to assess the overall impact of TB on the health status and on single health domains identified in the WHO definition of health, including physical, mental and social health aspects.

Methods

Four instruments for HRQOL evaluation were applied in a longitudinal multicentre study during six-month standard TB treatment in South Africa. These included the generic SF-12 and EQ-5D-5L, the disease-specific St. George´s Respiratory Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression Scale (HADS). Statistical analysis included significance testing, univariable and multivariable analysis, and repeated measures ANOVA. Change over time in the physical component score (PCS) of SF-12 was defined as primary endpoint. A target sample size of 96 patients was estimated.

Results

HRQOL of the study participants was impaired in all physical, mental and psycho-social health domains at treatment start. HRQOL improved significantly and in a clinically meaningful manner during the course of standard TB treatment, over the period of the study. The greatest improvement (95%) was observed in mental health. Younger patients with higher education and who were employed had a better HRQOL.

Discussion

This study demonstrates the need for an integrative understanding of TB with HRQOL as core element to inform gaps in current TB management. Improvements in the management of TB following an integrative patient-centred approach will contribute towards meeting the United Nations Sustainable Development Goal 3 (SDG3) target and will support the End TB strategy of the WHO.

Health-related quality of life and its association with medication adherence in active pulmonary tuberculosis- a systematic review of global literature with focus on South Africa

INTRODUCTION

Tuberculosis (TB) is a leading cause of morbidity and mortality in South Africa. Clinical parameters are important objective outcomes in TB; however they often are not directly correlated with subjective well-being of the patient, but can be assessed using patient-reported outcome (PRO) measures. Health-related quality of life (HRQOL) is a specific PRO generally multi-dimensional in nature and includes physical, mental and social health domains. The inclusion of HRQOL PROs in trials and clinical practice can provide additional information beyondclinical and microbiological parameters. Furthermore, HRQOL may be associated with medication adherence. This review focuses on patient-reported HRQOL and its association with medication adherence in TB patients in South Africa.

METHODS

A comprehensive search strategy was developed focusing on the impact of TB on patient-reported HRQOL,the existence of a conceptual framework of TB-specific HRQOL, determinants of medication adherence and the association of HRQOL with medication adherence. Data were extracted from all identified articles and additionaldata extraction was performed by two independent reviewers with special focus on longitudinal studies in order to understand changes of HRQOL and adherence over time. Research gaps were identified with regard to patient-reported HRQOL and medication adherence.

RESULTS

A total of 66 articles met the eligibility criteria. Ten HRQOL studies and one adherence study used a longitudinal design, none of these in South Africa. A variety of different generic and disease-specific HRQOL measures were identified in the articles. In South Africa four HRQOL and five adherence studies (non-longitudinal) were published. Similar factors (socio-demographic, socio-economic, disease-related, therapy-related and psycho-social aspects) affect HRQOL and adherence. Although standard TB treatment improved all health domains, psychological well-being and social functioning remained impaired in microbiologically cured patients after treatment.

CONCLUSION

While evidence of TB impact on HRQOL and medication adherence and their association exists, it is verylimited for the South African situation. No valid and reliable TB-specific HRQOL measures were identified in this systematicreview. An assessment of HRQOL in TB patients in South Africa is required as this may assist with improving current disease management programmes, medication adherence and national treatment guidelines.