Validation of the Polish version of Diabetes Quality of Life - Brief Clinical Inventory (DQL-BCI) among patients with type 2 diabetes

Cross-cultural adaptation and validation of Diabetes Quality of Life Brief Clinical Inventory in Turkish patients with type 2 diabetes mellitus

PURPOSE

To translate and culturally adapt the Diabetes Quality of Life Brief Clinical Inventory (DQoL-BCI) into Turkish and assess the psychometric properties of the translated version.

METHODS

A forward-backward translation process was conducted in conformity with international guidelines. A total of 150 patients with type 2 diabetes mellitus (T2DM) completed the Turkish version of DQoL-BCI (DQoL-BCI-Tr). The factor structure, test-retest reliability, and construct validity were evaluated.

RESULTS

In the DQoL-BCI-Tr, the three-factor structure was found optimal and explained 68.7% of the variance. The DQoL-BCI-Tr showed excellent internal consistency (Cronbach's alpha = 0.90) and test-retest reliability (ICC = 0.98). Cronbach's alpha values ranged from 0.85 to 0.91 for subscales (satisfaction, worry, impact). A negative correlation was found between the total scores of the DQoL-BCI-Tr and the EuroQoL-5 dimensions (EQ-5D) indexes (r= -0.22, p < 0.01). The DQoL-BCI-Tr total score and satisfaction and worry subscale scores differentiated between groups defined by glycated hemoglobin (HbA1c>9%) and the use of insulin.

CONCLUSIONS

The study results showed that the DQoL-BCI-Tr can be served as a reliable and valid instrument to obtain information from Turkish patients with T2DM diagnosis, including satisfaction with treatment, the impact of the disease, and worry about the social/vocational issues.Implications for rehabilitationThe Turkish version of the Diabetes Quality of Life Brief Clinical Inventory (DQoL-BCI) is a valid and reliable instrument.The DQoL-BCI Questionnaire in Turkish (DQoL-BCI-Tr) is an easy and quick way to determine satisfaction with treatment, impact of disease, and worry about the social/vocational issues.The DQoL-BCI-Tr is a reliable instrument for assessing disease-specific effects, emotional loads, and satisfaction of Turkish patients with type 2 diabetes in clinical and research settings.

Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review

Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .

EQ-5D-5L-based quality of life normative data for patients with self-reported diabetes in Poland

INTRODUCTION

The new, five-level EQ-5D generic questionnaire (EQ-5D-5L) has never been used among diabetes patients in Poland.

OBJECTIVES

To develop health-related quality of life (HRQoL) norms for patients with self-reported diabetes, based on a large representative sample of the general Polish population, using the EQ-5D-5L.

MATERIALS AND METHODS

Members of the general public, selected via multistage stratified sampling, filled in the EQ-5D-5L questionnaire and answered a question about the presence of diabetes. We estimated three types of EQ-5D-5L outcomes: limitations within domains, EQ VAS and EQ-5D-5L index. Multiple linear regression was used to examine the relationship between sociodemographic characteristics and HRQoL, both in patients with diabetes and the general population sample.

RESULTS

Among 2,973 respondents having complete EQ-5D-5L data, 255 subjects (8.6%) self-reported diabetes. Treatment with insulin, other drugs, combination therapy or lack of drug treatment was declared by 22.0%, 48.6%, 5.1% and 24.3% of patients, respectively. Respondents with diabetes had a lower EQ VAS score (18.5 points difference on a 100-points scale) and a lower EQ-5D-5L index score (0.135 difference; scale range: 1.59). The multivariate analysis showed that the factors independently improving the HRQoL in the general population were secondary or higher education, and factors reducing HRQoL were female sex, belonging to an older age group, being treated because of diabetes with insulin, other drugs or combination treatment. Respondents diagnosed with diabetes but not treated with drugs showed a decrease in EQ VAS scores, but not in the EQ-5D-5L index.

CONCLUSIONS

Diabetes leads to HRQoL deterioration in all age groups when compared to matched general population respondents without diabetes. The most significant HRQoL reduction experience older patients with a basic level of education. Obtained EQ-5D-5L normative data may be used in the clinical care of patients with diabetes and health technology assessment of new anti-diabetic drugs.

Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review

BACKGROUND

The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs.

OBJECTIVE

Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed.

METHODS

This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines.

RESULTS

A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use.

CONCLUSIONS

This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.

The assessment and management of quality of life of older adults with diabetes mellitus

Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.

Type 1 Diabetes Mellitus in Pediatric Patients and Its Impact on Relationships in the Family Environment

PURPOSE

The aim of this study is to assess the impact of type 1 diabetes mellitus on family environment relationships, as well as the management and approach to this disease.

PATIENTS AND METHODS

One hundred one children, 52.47% male and 47.52% female, with an average age of 8.55 ± 4.01 years, diagnosis of type 1 diabetes mellitus. Quantitative cross-sectional descriptive study was conducted using the validated questionnaires "Modified Diabetes Quality of Life" and "Questionnaire for the assessment of psychological impact in parents/guardians of diabetic children".

RESULTS

Most of the children (70.3% versus 29.7%) identified diabetes as unpleasant or not fun. The ≤5-year-olds expressed that they felt concerned about the consequences of being diabetic (8.1% by age group), as opposed to the 10-year-olds who did not feel concerned (85.1% by age group), P <0.001. The family environment was affected in 98.1% (n=99) of the cases.

CONCLUSION

Self-care of type 1 diabetes mellitus in pediatric patients is a complex process that impacts the family environment and their relationship with their peers, especially for children under the age of 5. Fear, concern and insecurity were prevalent feelings in children suffering type 1 diabetes mellitus.

Pain, acceptance of illness, adjustment to life with cancer and coping strategies in prostate cancer patients

INTRODUCTION

Prostate cancer is the second most common type of carcinoma in men. The rate of prostate cancer has increased approximately fivefold lover the last 30 years. The purpose of the study was to evaluate coping strategies, pain management, illness acceptance, and adjustment to cancer in patients diagnosed with prostate carcinoma and the effect of socioeconomic variables on the above-mentioned issues.

MATERIAL AND METHODS

The study included 228 patients diagnosed with prostate cancer. The questionnaire interview consisted of demographic questions and four psychometric tests: BPCQ, measuring the influence of factors affecting pain management, CSQ, designed to evaluate pain coping strategies, the AIS questionnaire, measuring disease acceptance, and the Mini-Mac.

RESULTS

Pain locus of control scores in prostate cancer patients are distributed evenly across all three BPCQ subscales. The top mean score was observed in the area of beliefs that powerful others (doctors) control pain. Increased behavioral activity was the most frequently selected coping strategy (mean score = 18.27). The average level of disease acceptance in study patients was 30.39, with a standard deviation of 8.07. The results were differentiated by education (p = 0.08) and income (p = 0.012). The most frequently indicated coping strategies were fighting spirit (mean score = 22.46) and positive re-evaluation (mean score = 22.04).

CONCLUSIONS

The main belief about pain control in prostate cancer patients is that powerful others (doctors) control pain. The study patients cope with disease constructively. The main socioeconomic variables which differentiate the scores obtained across all tests are income and education.

Quality of life of patients from rural and urban areas in Poland with head and neck cancer treated with radiotherapy. A study of the influence of selected socio-demographic factors

INTRODUCTION

The quality of life (QoL) experienced by cancer patients depends both on their state of health and on sociodemographic factors. Tumours in the head and neck region have a particularly adverse effect on patients psychologically and on their social functioning.

MATERIAL AND METHODS

The study involved 121 patients receiving radiotherapy treatment for head and neck cancers. They included 72 urban and 49 rural residents. QoL was assessed using the questionnaires EORTC-QLQ-C30 and QLQ-H&N35. The data were analysed using statistical methods: a χ² test for independence and a multinomial logit model.

RESULTS

The evaluation of QoL showed a strong, statistically significant, positive dependence on state of health, and a weak dependence on sociodemographic factors and place of residence. Evaluations of financial situation and living conditions were similar for rural and urban residents. Patients from urban areas had the greatest anxiety about deterioration of their state of health. Rural respondents were more often anxious about a worsening of their financial situation, and expressed a fear of loneliness.

CONCLUSIONS

Studying the QoL of patients with head and neck cancer provides information concerning the areas in which the disease inhibits their lives, and the extent to which it does so. It indicates conditions for the adaptation of treatment and care methods in the healthcare system which might improve the QoL of such patients. A multinomial logit model identifies the factors determining the patients' health assessment and defines the probable values of such assessment.

EQ-5D-5L Polish population norms

INTRODUCTION

The new, five-level version of the EQ-5D (EQ-5D-5L) questionnaire has better psychometric properties than the standard three-level version (EQ-5D-3L), including a reduced ceiling effect. Currently, there are few existing population norms for the EQ-5D-5L. The aims of this study were to provide population norms for the EQ-5D-5L in Poland, based on a representative sample of adults, and to compare those with norms from other countries.

MATERIAL AND METHODS

Members of the general public, selected through multistage stratified sampling, filled in paper-and-pencil EQ-5D-5L questionnaires in the presence of an interviewer. EQ-5D-5L index values were estimated using an interim value set, based on a crosswalk methodology. Descriptive statistics were calculated for the EQ-5D-5L index. The distribution of answers was obtained for the descriptive part of the EQ-5D-5L.

RESULTS

The sample was representative of the Polish population in terms of age, gender, geographical region, education, and socio-professional group. Population norms were developed based on 3963 questionnaires with no missing data. At least one slight, moderate, severe, and extreme health limitation was reported by 61.5%, 31.1%, 12.4%, and 1.6% of the respondents, respectively. Polish society is characterized by poorer health, as compared to its direct neighbor, Germany, especially with regard to the individuals' perception of pain, as well as anxiety and depression.

CONCLUSIONS

Polish population norms for the EQ-5D-5L should encourage clinicians, economists, and policymakers in Poland to use this questionnaire on a broader scale.

Linguistic and psychometric validation of the Malaysian version of Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI)

BACKGROUND

Quality of life (QoL) assessment provides valuable outcome to support clinical decision-making, particularly for patients with chronic diseases that are incurable. A brief, 15-item diabetes-specific tool [i.e. Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI)] is known to be developed in English and validated for use in clinical practice. This simplified tool, however, is not readily available for use in the Malaysian setting.

OBJECTIVE

To translate the DQoL-BCI into a Malaysian version and to assess its construct validity (factorial validity, convergent validity and discriminant validity), reliability (internal consistency) and floor and ceiling effects among the Malaysian diabetic population.

MATERIAL AND METHODS

A forward-backward translation, involving professional translators and experts with vast experience in translation of patient reported outcome measures, was conducted. A total of 202 patients with Type 2 diabetes mellitus (T2DM) who fulfilled the inclusion criteria were invited to complete the translated DQoL-BCI. Data were analysed using SPSS for exploratory factor analysis (EFA), convergent and discriminant validity, reliability and test-retest, and AMOS software for confirmatory factor analysis (CFA).

RESULTS

Findings from EFA indicated that the 4-factor structure of the Malaysian version of DQoL-BCI was optimal and explained 50.9% of the variance; CFA confirmed the 4-factor model fit. There was negative, moderate correlation between the scores of DQoL-BCI (Malaysian version) and EQ-5D-3L utility score (r = -0.329, p = 0.003). Patients with higher glycated haemoglobin levels (p = 0.008), diabetes macrovascular (p = 0.017) and microvascular (p = 0.013) complications reported poorer QoL. Cronbach's alpha coefficient and intraclass coefficient correlations (range) obtained were 0.703 and 0.86 (0.734-0.934), indicating good reliability and stability of the translated DQoL-BCI.

CONCLUSION

This study had validated the linguistic and psychometric properties of DQoL-BCI (Malaysian version), thus providing a valid and reliable brief tool for assessing the QoL of Malaysian T2DM patients.

Evaluation of medical and psychological parameters of quality of life in supraventricular tachyarrhythmia children. A comparison with healthy children

INTRODUCTION

There are only a few available studies evaluating quality of life (QoL) in pediatric patients with cardiac arrhythmia. The aim of the study was to evaluate medical and psychological parameters of the QoL in children with a diagnosed supraventricular tachyarrhythmia (SVT) and to compare the obtained data with a group of healthy children (HC).

MATERIAL AND METHODS

Inclusion criteria: children aged 7-18 with SVT, treated at Poznan University of Medical Sciences, Department of Pediatric Cardiology. The evaluation tools were the WHOQOL-BREF instrument and a questionnaire related to the patient's feelings and observations concerning arrhythmia (Pediatric Arrhythmia Related Score - PARS), developed by the authors and adjusted to the group of arrhythmia patients.

RESULTS

The study included 180 SVT children and 83 HC. On the basis of WHOQOL-BREF the SVT group was found to have lower assessment values of QoL within the physical domain (Phd) (mean ± SD: 65.7 ±15.8 vs. 81.6 ±12.8; p < 0.0001) and psychological domain (Psd) (mean ± SD: 75.8 ±15.2 vs. 81.3 ±14.1; p < 0.005). No significant differences were found within the social relationships domain or the environment domain. On the basis of PARS in the SVT group the patients reported significantly increased symptoms within Phd (mean ± SD: 2.3 ±0.7 vs. 1.6 ± 0.3; p < 0.0001) as well as increased negative feelings within Psd (mean ± SD: 2.3 ±0.7 vs. 2.1 ± 0.6; p < 0.005).

CONCLUSIONS

Medical and psychological parameters of the QoL in SVT children are significantly lower in comparison with HC. A diagnosis of SVT has no influence on the social and environmental areas of QoL. The PARS appears to be a useful tool to supplement the generic questionnaire for QoL evaluation in SVT children.