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Makarawung DJS, Dijkhorst PJ, de Vries CEE, Monpellier VM, Wiezer MJ, van Veen RN, Geenen R, Mink van der Molen AB. Body Image and Weight Loss Outcome After Bariatric Metabolic Surgery: a Mixed Model Analysis. Obes Surg 2023; 33:2396-2404. [PMID: 37354307 DOI: 10.1007/s11695-023-06690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE As in nonsurgical weight loss populations, body image may partly explain differences in weight loss outcomes after surgery. The aim of this study was to determine the prospective association between body image and weight loss in a longitudinal cohort of patients up to 3 years after bariatric metabolic surgery. MATERIALS AND METHODS The BODY-Q self-report questionnaire was used to assess body image. Linear mixed models evaluated associations of baseline body image with weight loss in the first year as well as associations of body image at 12 months and first-year change in body image with weight loss 12 to 36 months after surgery. RESULTS Available body image data included 400 (100%), 371 (93%), 306 (77%), 289 (72%), and 218 (55%) patients at baseline and 4, 12, 24, and 36 months, respectively. Body image scores improved significantly until 12 months, followed by a gradual decline. Scores remained improved in comparison to baseline (β = 31.49, 95% CI [27.8, 35.2], p < .001). Higher baseline body image was associated with less weight loss during the first year, and the effect size was trivial (ß = -0.05, 95% CI [-0.09, -0.01], p = .009). Body image and change in body image were not associated with weight loss 12 to 36 months after surgery. CONCLUSION Body image improved after bariatric metabolic surgery. Although no clinically relevant associations of body image with weight loss were demonstrated, the gradual decline in body image scores underlines the importance of long-term follow-up with regular assessment of this aspect of quality of life.
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Affiliation(s)
- Dennis J S Makarawung
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands.
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
| | - Phillip J Dijkhorst
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Claire E E de Vries
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Valerie M Monpellier
- Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), Amersfoortseweg 43, 3712 BA, Huis ter Heide, the Netherlands
| | - M J Wiezer
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
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Dijkhorst PJ, Makarawung DJS, Vanhommerig JW, Kleipool SC, Dalaei F, de Vries CEE, van der Molen AB, Poulsen L, Sorensen JA, Bonjer HJ, de Castro SMM, van Veen RN. Predictors of improved psychological function after bariatric surgery. Surg Obes Relat Dis 2023; 19:872-881. [PMID: 36842930 DOI: 10.1016/j.soard.2023.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Negative psychological sequelae have been reported after bariatric surgery. It is unclear which factors affect psychological function in the first postoperative years. OBJECTIVE Evaluation of significant predictors of improved psychological function following bariatric surgery by analyzing data from the BODY-Q questionnaire. SETTING Multicenter prospective cohort in 3 centers located in The Netherlands and Denmark. METHODS The BODY-Q questionnaire was used to assess 6 domains of health-related quality of life. The domain of interest, psychological function, consists of 10 questions from which a converted score of 0 (low) to 100 (high) can be calculated. Linear mixed models were used to analyze which patient characteristics were most predictive of the psychological function score. Secondary outcomes of interest were cross-sectional scores of psychological function and the impact of weight loss, and the effect of major short-term complications on psychological function. RESULTS Data were analyzed from 836 patients who underwent bariatric surgery from 2015 to 2020. Patients with lower expectations concerning weight loss (<40% desired total weight loss), higher educational level, no history of psychiatric illness, and employment before bariatric surgery demonstrated the highest psychological function scores after bariatric surgery. At 1 and 2 years after bariatric surgery, more weight loss was associated with significantly higher psychological function scores. Experiencing a major short-term complication did not significantly impact psychological function. CONCLUSIONS Several relevant predictors of improved postoperative psychological function have been identified. This knowledge can be used to enhance patient education preoperatively and identify patients at risk for poor psychological functioning postoperatively.
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Affiliation(s)
- Phillip J Dijkhorst
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands.
| | | | | | - Suzanne C Kleipool
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
| | - Farima Dalaei
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Odense Explorative Patient Network (OPEN), Odense, Denmark
| | - Claire E E de Vries
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
| | | | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Odense Explorative Patient Network (OPEN), Odense, Denmark
| | - Jens A Sorensen
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Odense Explorative Patient Network (OPEN), Odense, Denmark
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam Medical University Center, Amsterdam, The Netherlands
| | - Steve M M de Castro
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
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Dijkhorst PJ, de Vries CEE, Mou D, Poulsen L, Sørensen JA, Hoogbergen MM, van Veen RN, Klassen AF, Pusic AL. Quantifying patients' expectations prior to bariatric surgery with the BODY-Q in an international multicentre cohort. Clin Obes 2023; 13:e12555. [PMID: 36181294 DOI: 10.1111/cob.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/19/2023]
Abstract
Many people living with obesity may have unrealistic expectations prior to undergoing bariatric surgery. These expectations can lead to frustration, regret and even worse psychological outcomes after surgery. Prior to undergoing bariatric surgery, patients completed the BODY-Q Expectations scale. This 15-item scale asks patients to imagine what their life will be like when 2 years have passed since bariatric surgery. Scores for expectations range from 0 (low) to 100 (high). Linear regression models were used to assess which of the patient characteristics could predict patients' expectations. From 2019 to 2020, a total of 333 patients were recruited from three different countries. The mean score on the BODY-Q Expectations scale was 73.1, ±20. Out of the 15 items on the Expectation scale, people living with obesity found it most likely that bariatric surgery would make them feel better and improve their energy, while it was reported least likely that they would look good without clothes on. Younger age (p = <.01) and race (non-white) (p = .046) were found to be significant predictors for higher scores on the Expectations scale. Participants who identified as non-white from the Netherlands and United States, and those aged under 40 years reported higher expectations compared with participants who identified as white race and were 40 years of age or older. Prior to bariatric surgery, patients aged under 40 years and those who identified as non-white for race had higher expectations that their life would change after bariatric surgery. These relevant findings should be considered when giving pre-operative counselling.
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Affiliation(s)
| | | | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, Massachusetts, USA
| | - Lotte Poulsen
- Research Unit of Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- OPEN, Odense Explorative Patient Network, Odense, Denmark
| | - Jens A Sørensen
- Research Unit of Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- OPEN, Odense Explorative Patient Network, Odense, Denmark
| | | | | | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Massachusetts, USA
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de Vries CEE, Tsangaris E, Makarawung DJS, Mink van der Molen AB, van Veen RN, Hoogbergen MM, Ziekenhuis C, Pusic AL, Terwee CB, Cano S, Klassen AF. Validation of the Dutch Version of the BODY-Q Measuring Appearance, Health-related Quality of Life, and Experience of Healthcare in Patients Undergoing Bariatric and Body Contouring Surgery. Aesthet Surg J 2022; 43:569-579. [PMID: 36478151 PMCID: PMC10085541 DOI: 10.1093/asj/sjac311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
The BODY-Q is a patient-reported outcome measure (PROM) developed for use in bariatric and body contouring surgery.
Objectives
The objective of this study was to examine the validity and reliability of the Dutch version of the BODY-Q.
Methods
The BODY-Q consists of 163 items in 21 independently functioning scales that measure appearance, health-related quality of life (HRQL) and experience of care. The data used to validate the Dutch BODY-Q were provided by two prospective multicenter cohort studies across three hospitals in the Netherlands. The BODY-Q was administered before and after surgery at 3 or 4 months and 12 months. Rasch Measurement Theory (RMT) analysis was used to evaluate the BODY-Q for targeting, category threshold order, Rasch model fit, Person Separation Index (PSI), and differential item functioning (DIF) by language (original English data versus Dutch data).
Results
Data were collected between January 2016 and May 2019. A total of 876 participants were included in the study who provided 1614 assessments. Validity was supported by three RMT findings: most scales showed good targeting, 160/163 (98.2%) items evidenced ordered thresholds, and 142/163 (87.1%) items fit to the RMT model. Reliability was high with PSI values >0.70 for 19/21 scales. There was negligible influence of DIF by language on person item locations and the scales scoring.
Conclusions
This study provides evidence for the reliability and validity of the Dutch BODY-Q for use in bariatric and body contouring patients in the Netherlands. The Dutch BODY-Q can be used in (inter)national research and clinical practice.
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Affiliation(s)
- Claire E E de Vries
- Plastic surgery resident, Patient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital , Boston, MA
| | - Elena Tsangaris
- Researcher, Patient-Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital , Boston, MA
| | - Dennis J S Makarawung
- PhD student, Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Aebele B Mink van der Molen
- Plastic surgeon, Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht , Utrecht , the Netherlands
| | - Ruben N van Veen
- Surgeon, Department of Surgery , OLVG, Amsterdam , the Netherlands
| | - Maarten M Hoogbergen
- Plastic surgeon, Department of Plastic and Reconstructive Surgery , Eindhoven , The Netherlands
| | | | - Andrea L Pusic
- Plastic surgeon, Division of Plastic Surgery, Brigham and Women’s Hospital , Boston, MA
| | - Caroline B Terwee
- Professor, Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit , Amsterdam , the Netherlands
| | - Stefan Cano
- Chief scientific officer, Modus Outcomes , Letchworth Garden City , UK
| | - Anne F Klassen
- Professor, Faculty of Health Sciences, McMaster University , Hamilton, Ontario , Canada
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5
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de Vries CEE, Terwee CB, Al Nawas M, van Wagensveld BA, Janssen IMC, Liem RSL, Nienhuijs SW, Cohen RV, van Rossum EFC, Brown WA, Ghaferi AA, Ottosson J, Coulman KD, Petry TBZ, Sogg S, West-Smith L, Halford JCG, Salas XR, Dixon JB, Al-Sabah S, Lee WJ, Andersen JR, Flint SW, Hoogbergen MM, Backman B, Govers E, Isack N, Clay C, Birney S, Gunn M, Masterson P, Roberts A, Nesbitt J, Meloni R, le Brocq S, de Blaeij S, Kraaijveld C, van der Steen F, Visser B, Hamers P, Monpellier VM. Outcomes of the first global multidisciplinary consensus meeting including persons living with obesity to standardize patient-reported outcome measurement in obesity treatment research. Obes Rev 2022; 23:e13452. [PMID: 35644939 PMCID: PMC9539945 DOI: 10.1111/obr.13452] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
Quality of life is a key outcome that is not rigorously measured in obesity treatment research due to the lack of standardization of patient-reported outcomes (PROs) and PRO measures (PROMs). The S.Q.O.T. initiative was founded to Standardize Quality of life measurement in Obesity Treatment. A first face-to-face, international, multidisciplinary consensus meeting was conducted to identify the key PROs and preferred PROMs for obesity treatment research. It comprised of 35 people living with obesity (PLWO) and healthcare providers (HCPs). Formal presentations, nominal group techniques, and modified Delphi exercises were used to develop consensus-based recommendations. The following eight PROs were considered important: self-esteem, physical health/functioning, mental/psychological health, social health, eating, stigma, body image, and excess skin. Self-esteem was considered the most important PRO, particularly for PLWO, while physical health was perceived to be the most important among HCPs. For each PRO, one or more PROMs were selected, except for stigma. This consensus meeting was a first step toward standardizing PROs (what to measure) and PROMs (how to measure) in obesity treatment research. It provides an overview of the key PROs and a first selection of the PROMs that can be used to evaluate these PROs.
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Affiliation(s)
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - May Al Nawas
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis Ter Heide, The Netherlands
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.,Dutch Obesity Clinic, The Hague, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Elisabeth F C van Rossum
- Obesity Centre CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karen D Coulman
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, North Bristol NHS Trust, Bristol, UK
| | - Tarissa B Z Petry
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Stephanie Sogg
- Massachusetts General Hospital Weight Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa West-Smith
- Department of Surgery, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Ximena Ramos Salas
- Obesity Canada, Edmonton, Alberta, Canada.,European Association for the Study of Obesity, Teddington, UK
| | - John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Salman Al-Sabah
- Department of Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - John Roger Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre of Health Research, Førde Hospital Trust, Førde, Norway
| | - Stuart W Flint
- School of Psychology, University of Leeds, Leeds, UK.,Scales Insights, Nexus, University of Leeds, Leeds, UK
| | | | - Brooke Backman
- Bariatric Surgery Registry, Monash University, Melbourne, Victoria, Australia
| | - Ellen Govers
- Amstelring and Dutch Knowledge Centre of Dietitians on Obesity (KDOO), Amsterdam, The Netherlands
| | | | | | - Susie Birney
- European Coalition for People Living with Obesity, Dublin, Ireland
| | - Maureen Gunn
- European Coalition for People Living with Obesity, Dublin, Ireland
| | - Paul Masterson
- European Coalition for People Living with Obesity, Dublin, Ireland
| | - Audrey Roberts
- European Coalition for People Living with Obesity, Dublin, Ireland
| | - Jacky Nesbitt
- European Coalition for People Living with Obesity, Dublin, Ireland
| | - Riccardo Meloni
- People Living with Obesity Representatives of the S.Q.O.T. Initiative, Amsterdam, The Netherlands
| | | | | | - Christina Kraaijveld
- People Living with Obesity Representatives of the S.Q.O.T. Initiative, Amsterdam, The Netherlands
| | - Floor van der Steen
- People Living with Obesity Representatives of the S.Q.O.T. Initiative, Amsterdam, The Netherlands
| | - Bibian Visser
- People Living with Obesity Representatives of the S.Q.O.T. Initiative, Amsterdam, The Netherlands
| | - Petra Hamers
- People Living with Obesity Representatives of the S.Q.O.T. Initiative, Amsterdam, The Netherlands
| | - Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis Ter Heide, The Netherlands
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Dalaei F, de Vries CEE, Poulsen L, Kaur MN, Pfob A, Mou D, Jacobsen AL, Repo JP, Salzillo R, Opyrchal J, Klassen AF, Sørensen JA, Pusic AL. General population normative scores for interpreting the BODY-Q. Clin Obes 2022; 12:e12528. [PMID: 35611607 PMCID: PMC9541838 DOI: 10.1111/cob.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
The BODY-Q is a patient-reported outcome measure used to assess outcomes in patients undergoing weight loss and/or body contouring surgery (BC) following massive weight loss. Normative values for the BODY-Q are needed to improve data interpretation and enable comparison. Thus, the aim of this study was to determine normative values for the BODY-Q. Participants were recruited internationally through two crowdsourcing platforms. The participants were invited to complete the BODY-Q scales through an URL link provided within the crowdsourcing platforms. General linear analyses were performed to compare normative means between countries and continents adjusted for relevant covariates. Normative reference values were stratified by age, body mass index (BMI), and gender. The BODY-Q was completed by 4051 (2052 North American and 1999 European) participants. The mean age was 36 years (±14.7 SD) and ranged from 17 to 76 years, the mean BMI was 26.4 (±6.7 SD) kg/m2 , and the sample consisted of 1996 (49.3%) females and 2023 (49.9%) males. Younger age and higher BMI were negatively associated with all BODY-Q scales (p < .001). This study provides normative values for the BODY-Q scales to aid in the interpretation of BODY-Q scores in research and clinical practise. These values enable us to understand the impact of weight loss and BC on patients' lives.
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Affiliation(s)
- Farima Dalaei
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
- OPEN, Odense Explorative Patient NetworkOdenseDenmark
| | - Claire E. E. de Vries
- Department of Surgery, OLVGAmsterdamNetherlands
- Department of Surgery, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
| | - Lotte Poulsen
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Manraj N. Kaur
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - André Pfob
- University Breast Unit, Department of Obstetrics and GynecologyHeidelberg University HospitalHeidelbergBaden‐WürttembergGermany
| | - Danny Mou
- Department of General SurgeryBrigham and Women's Hospital, Harvard UniversityBostonMassachusettsUSA
| | - Amalie L. Jacobsen
- Department of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Jussi P. Repo
- Unit of Musculoskeletal Surgery, Department of Orthopedics and TraumatologyTampere University Hospital and University of TampereTampereFinland
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of RomeRomeItaly
| | - Jakub Opyrchal
- Department of Plastic SurgeryT. Marciniaka Specialized HospitalWroclawPoland
| | - Anne F. Klassen
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Jens Ahm Sørensen
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Andrea L. Pusic
- Department of Surgery, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
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Makarawung DJS, de Vries CEE, List EB, Monpellier VM, Mou D, Klassen AF, Pusic AL, van Veen RN, Mink van der Molen AB. Patient-Level Factors Associated with Health-Related Quality of Life and Satisfaction with Body After Bariatric Surgery: a Multicenter, Cross-Sectional Study. Obes Surg 2022; 32:3079-3087. [PMID: 35859022 DOI: 10.1007/s11695-022-06214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Health-Related Quality of Life (HRQL) is a key outcome of success after bariatric surgery. Not all patients report improved HRQL scores postoperatively, which may be due to patient-level factors. It is unknown which factors influence HRQL after surgery. Our objective was to assess patient-level factors associated with HRQL after surgery. METHODS This international cross-sectional study included 730 patients who had bariatric surgery. Participants completed BODY-Q scales pertaining to HRQL and satisfaction with body, and demographic characteristics were obtained. The sample was divided into three groups based on time since surgery: 0 - 1 year, 1 - 3 years and more than 3 years. Uni- and multivariable linear regression analyses were conducted to identify variables associated with the BODY-Q scales per group. RESULTS The 0 - 1 year postoperative group included 377 patients (50.9%), the 1 - 3 years postoperative group 218 (29.4%) and the more than 3 years postoperative group 135 patients (18.2%). Lower current body-mass index (BMI), more weight loss (%TWL), being employed, having no comorbidities, higher age and shorter time since surgery were significantly associated with improved HRQL outcomes postoperatively. None of these factors influenced all BODY-Q scales. The effect of current BMI increased with longer time since surgery. CONCLUSION Factors including current BMI, %TWL, employment status, presence of comorbidities, age and time since surgery were associated with HRQL postoperatively. This information may be used to optimize patient-tailored care, improve patient education and underline the importance of long-term follow-up with special attention to weight regain to ensure lasting improvement in HRQL.
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Affiliation(s)
- Dennis J S Makarawung
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
- Department of Plastic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
| | - Claire E E de Vries
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Emile B List
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Valerie M Monpellier
- Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), Amersfoortseweg 43, 3712 BA, Huis Ter Heide, the Netherlands
| | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Ruben N van Veen
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
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Mou D, de Vries CEE, Pater N, Poulsen L, Makarawung DJS, Wiezer MJ, van Veen RN, Hoogbergen MM, Sorensen JA, Klassen AF, Pusic AL, Tavakkoli A. Correction to: BODY-Q patient-reported outcomes measure (PROM) to assess sleeve gastrectomy vs. Roux-en-Y gastric bypass: eating behavior, eating-related distress, and eating-related symptoms. Surg Endosc 2022; 36:2721. [PMID: 35194668 DOI: 10.1007/s00464-022-09077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA.
| | - Claire E E de Vries
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA
| | - Nena Pater
- Maastricht University Medical School, Maastricht, The Netherlands
| | - Lotte Poulsen
- Department of Plastic Surgery, University of Southern Denmark, Odense, Denmark
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA
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de Vries CEE, Makarawung DJS, Monpellier VM, Janssen IMC, de Castro SMM, van Veen RN. Is the RAND-36 an Adequate Patient-reported Outcome Measure to Assess Health-related Quality of Life in Patients Undergoing Bariatric Surgery? Obes Surg 2021; 32:48-54. [PMID: 34729711 PMCID: PMC8752557 DOI: 10.1007/s11695-021-05736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/06/2022]
Abstract
Purpose The RAND-36 is the most frequently used patient-reported outcome measure (PROM) to evaluate health-related quality of life (HRQoL) in bariatric surgery. However, the RAND-36 has never been adequately validated in bariatric surgery. The purpose of this study was to validate the RAND-36 in Dutch patients undergoing bariatric surgery. Material and Methods To validate the RAND-36, the following measurement properties were assessed in bariatric surgery patients: validity (the degree to which the RAND-36 measures what it purports to measure (HRQoL)), reliability (the extent to which the scores of the RAND-36 are the same for repeated measurement for patients who have not changed in HRQoL), responsiveness (the ability of the RAND-36 to detect changes in HRQoL over time). Results Two thousand one hundred thirty-seven patients were included. Validity was not adequate due to the irrelevance of some items and response options, the lack of items relevant to patients undergoing bariatric surgery, and the RAND-36 did not actually measure what it was intended to measure in this study (HRQoL in bariatric surgery patients). Reliability was insufficient for the majority of the scales (the scores of patients who had not changed in HRQoL were different when the RAND was completed a second time (intraclass correlation coefficient (ICC) values 0.10–0.69)). Responsiveness was insufficient. Conclusion The RAND-36 was not supported by sufficient validation evidence in patients undergoing bariatric surgery, which means that the RAND-36 does not adequately measure HRQoL in this patient population. Future research studies should use PROMs that are specifically designed for assessing HRQoL in patients undergoing bariatric surgery. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05736-9.
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Affiliation(s)
- Claire E E de Vries
- Department of Surgery, Obesity Center Amsterdam, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands.
| | - Dennis J S Makarawung
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712, Huis Ter Heide, the Netherlands
| | - Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712, Huis Ter Heide, the Netherlands
| | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712, Huis Ter Heide, the Netherlands
| | - Steve M M de Castro
- Department of Surgery, Obesity Center Amsterdam, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Ruben N van Veen
- Department of Surgery, Obesity Center Amsterdam, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
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10
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Haal S, Guman MSS, Boerlage TCC, Acherman YIZ, de Brauw LM, Bruin S, de Castro SMM, van Hooft JE, van de Laar AWJM, Moes DE, Schouten M, Schouten R, van Soest EJ, van Veen RN, de Vries CEE, Fockens P, Dijkgraaf MGW, Gerdes VEA, Voermans RP. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial. Lancet Gastroenterol Hepatol 2021; 6:993-1001. [PMID: 34715031 DOI: 10.1016/s2468-1253(21)00301-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rapid weight loss is a major risk factor for the formation of cholesterol gallstones. Consequently, patients with morbid obesity undergoing bariatric surgery frequently develop symptomatic gallstone disease. This trial assessed the efficacy of ursodeoxycholic acid versus placebo for the prevention of symptomatic gallstone disease after bariatric surgery. METHODS This multicentre, double-blind, randomised, placebo-controlled superiority trial enrolled patients with an intact gallbladder scheduled for laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy in three hospitals in the Netherlands. Patients were randomly assigned (1:1) by a web-based randomisation module to receive 900 mg ursodeoxycholic acid daily for 6 months or matched placebo. Randomisation was stratified by the presence of asymptomatic gallstones at baseline and type of surgery. Patients, clinicians, and study staff were masked to treatment allocation. The primary endpoint was symptomatic gallstone disease within 24 months, assessed in the modified intention-to-treat population (all randomly assigned eligible patients with any post-randomisation measurement). Prespecified subgroup analyses were done based on the stratification groups. Safety was assessed in all patients who took at least one dose of the study drug. This trial is registered with the Netherlands Trial Register, NL5954. FINDINGS Between Jan 11, 2017, and Oct 22, 2018, 985 patients were randomly assigned to receive either ursodeoxycholic acid (n=492) or placebo (n=493). 967 patients were included in the modified intention-to-treat population, of whom 959 had data available for primary endpoint assessment. 189 (20%) patients had asymptomatic gallstones at baseline and 78 (8%) received a sleeve gastrectomy. Symptomatic gallstone disease occurred in 31 (6·5%) of 475 patients in the ursodeoxycholic acid group and in 47 (9·7%) of 484 patients in the placebo group (relative risk 0·67, 95% CI 0·43-1·04, p=0·071). Logistic regression showed a significant interaction between ursodeoxycholic acid and the presence of asymptomatic gallstones at baseline (p=0·046), with an effect of ursodeoxycholic acid in patients without (0·47, 0·27-0·84, p=0·0081), and no effect in patients with asymptomatic gallstones at baseline (1·22, 0·61-2·47, p=0·57). The effect was stronger in patients without gallstones at baseline undergoing RYGB (0·37, 0·20-0·71, p=0·0016), whereas the subgroup of patients undergoing sleeve gastrectomy was too small to draw clear conclusions. Adverse events were rare. In the ursodeoxycholic acid group, diarrhoea occurred in four (0·9%) of 444 patients and skin rash in two (0·5%) patients. In the placebo group, diarrhoea occurred in two (0·4%) of 453 patients and skin rash in two (0·4%) patients. The total number of serious adverse events did not significantly differ between the trial groups (75 [17%] in 444 patients in the ursodeoxycholic acid group and 102 [23%] in 453 patients in the placebo group). The most common serious adverse events were abdominal pain and internal hernia. No serious adverse event was attributed to the study drug. INTERPRETATION Ursodeoxycholic acid prophylaxis did not significantly reduce the occurrence of symptomatic gallstone disease in all patients after bariatric surgery. In patients without gallstones before RYGB surgery, ursodeoxycholic acid treatment reduced the occurrence of symptomatic gallstone disease compared with placebo. Further research is needed to assess the efficacy of ursodeoxycholic acid after sleeve gastrectomy. FUNDING The Netherlands Organization for Health Research and Development, Zambon Netherlands BV, Foundation for Clinical Research of the Slotervaart Hospital, the Spaarne Gasthuis Academy, and Amsterdam Gastroenterology Endocrinology Metabolism.
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Affiliation(s)
- Sylke Haal
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Maimoena S S Guman
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Thomas C C Boerlage
- Department of Gastroenterology and Hepatology, UMC Utrecht, Utrecht, Netherlands
| | | | | | - Sjoerd Bruin
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Daan E Moes
- Department of Surgery, Dijklander Hospital, Hoorn, Netherlands
| | - Manon Schouten
- Department of Surgery, Flevohospital, Almere, Netherlands
| | - Ruben Schouten
- Department of Surgery, Flevohospital, Almere, Netherlands
| | - Ellert J van Soest
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Hoofddorp, Netherlands
| | | | | | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands
| | - Victor E A Gerdes
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands; Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands.
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Klassen AF, Kaur MN, Tsangaris E, de Vries CEE, Bordeleau L, Zhong T, Cano SJ, Breitkopf T, Pusic AL. ASO Visual Abstract: Development and Psychometric Validation of BREAST-Q Scales Measuring Cancer Worry, Fatigue, and Impact on Work. Ann Surg Oncol 2021. [PMID: 34046773 DOI: 10.1245/s10434-021-10128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Anne F Klassen
- McMaster University, 3N27, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
| | - Manraj N Kaur
- McMaster University, 3N27, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Elena Tsangaris
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Toni Zhong
- Toronto General Hospital, Toronto, ON, Canada
| | - Stefan J Cano
- Modus Outcomes, Spirella Building, Letchworth Garden City, UK
| | - Trisia Breitkopf
- McMaster University, 3N27, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Andrea L Pusic
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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de Vries CEE, Mou D, Poulsen L, Breitkopf T, Makarawung DJS, Wiezer MJ, van Veen RN, Hoogbergen MM, Sorensen JA, Liem RSL, Nienhuijs SW, Tavakkoli A, Pusic AL, Klassen AF. Development and Validation of New BODY-Q Scales Measuring Expectations, Eating Behavior, Distress, Symptoms, and Work Life in 4004 Adults From 4 Countries. Obes Surg 2021; 31:3637-3645. [PMID: 34041700 DOI: 10.1007/s11695-021-05462-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The BODY-Q is a rigorously developed patient-reported outcome measure (PROM) for patients seeking treatment for obesity and body contouring surgery. A limitation of the uptake of the BODY-Q in weight management treatments is the absence of scales designed to measure eating-specific concerns. We aimed to develop and validate 5 new BODY-Q scales measuring weight loss expectations, eating behaviors, distress, symptoms, and work life. MATERIAL AND METHODS In phase 1 (qualitative), patient and expert input was used to develop and refine the new BODY-Q scales. In phase 2 (quantitative), the scales were field-tested in bariatric and weight management clinics in the United States (US), The Netherlands, and Denmark between June 2019 and January 2020. Data were also collected in the US and Canada in September 2019 through a crowdworking platform. Rasch measurement theory (RMT) analysis was used for item reduction and to examine reliability and validity. RESULTS The new BODY-Q scales were refined through qualitative input from 17 patients and 20 experts (phase 1) and field-tested in 4004 participants (phase 2). All items showed ordered thresholds and good fit to the Rasch model. The RMT analysis provided evidence of reliability, with PSI values ≥0.72, Cronbach alpha values ≥0.83, and test-retest values ≥0.79. Better scores on 4 scales (exception expectations scale) correlated with lower BMI, with the strongest correlation between the eating-related distress scale scores and BMI (r= -0.249, P < 0.001). CONCLUSION The new BODY-Q scales can be used in research and clinical practice to assess weight loss treatments from the patient perspective.
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Affiliation(s)
- Claire E E de Vries
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. .,Department of Surgery, OLVG, Amsterdam, The Netherlands.
| | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Trisia Breitkopf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.,Dutch Obesity Clinic, The Hague, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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13
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Klassen AF, Kaur MN, Tsangaris E, de Vries CEE, Bordeleau L, Zhong T, Cano SJ, Breitkopf T, Pusic AL. Development and Psychometric Validation of BREAST-Q Scales Measuring Cancer Worry, Fatigue, and Impact on Work. Ann Surg Oncol 2021; 28:7410-7420. [PMID: 34028633 DOI: 10.1245/s10434-021-10090-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The BREAST-Q is a patient-reported outcome measure for women with breast cancer. The aim of this study was to develop new BREAST-Q scales to measure Cancer Worry, Fatigue and Impact on Work. METHODS Data were collected between January 2017 and November 2019. Phase 1 (qualitative) included participants from Canada and the USA, pre/post any type of breast cancer treatment (surgery, adjuvant, neoadjuvant). Interviews were audio-recorded, transcribed verbatim and coded line-by-line. New scales were drafted and refined through cognitive interviews and expert input. Phase 2 (field-test study) involved USA members of the Love Research Army (LRA). Rasch measurement theory analysis was used to examine reliability and validity. RESULTS In phase 1, 57 women were interviewed. Three concepts were identified as important to the breast cancer experience that are not currently covered in the BREAST-Q and developed into scales, i.e., Cancer Worry, Fatigue and Impact on Work. Feedback from nine women and 23 experts was used to establish content validity. The scales were field-tested in the LRA sample (n = 1680), of whom 1006 completed a test-retest. Reliability was > 0.81 for the person separation index, > 0.89 for Cronbach's alpha and > 0.83 for interclass correlation coefficients. Lower scores on all three scales were significantly associated with being closer in time to diagnosis and having a higher cancer stage at diagnosis (p < 0.001 on ANOVA). CONCLUSION These new scales expand the BREAST-Q measurement system and provide a means to evaluate additional important outcomes for breast cancer patients in clinical care and research.
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Affiliation(s)
| | | | - Elena Tsangaris
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Toni Zhong
- Toronto General Hospital, 8N-871, Norman Urquhart Wing, Toronto, ON, Canada
| | - Stefan J Cano
- CPsychol, AFBPsS, Modus Outcomes, Letchworth Garden City, UK
| | | | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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14
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Klassen AF, Kaur MN, de Vries CEE, Poulsen L, Breitkopf T, Pusic A. The BODY-Q Cellulite Scale: A Development and Validation Study. Aesthet Surg J 2021; 41:206-217. [PMID: 32303735 DOI: 10.1093/asj/sjaa100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cellulite is a localized metabolic disorder of the subcutaneous tissue. To measure the impact of cellulite and its treatment(s) on patients' health-related quality of life, a psychometrically sound patient-reported outcome measure is needed. OBJECTIVES The authors sought to develop and field test a new BODY-Q cellulite scale to measure the appearance of cellulite. METHODS Appearance-related codes from the original BODY-Q qualitative interviews were reexamined, and a set of cellulite-specific items was developed and refined through cognitive patient interviews (n = 10) and expert input (n = 17). This scale was field-tested in adults with cellulite through 2 crowdworking platforms. Rasch Measurement Theory analysis was employed to refine the scale and examine its psychometric properties. RESULTS The field-test sample included 2129 participants. The 15-item scale was reduced in length to 11 items. Data from the sample fit the Rasch model (X2 [99] = 21.32, P = 0.06). All items had ordered thresholds and mapped out a targeted clinical hierarchy. The reliability statistics for the person separation index was 0.94 and for Cronbach's alpha was 0.97. In terms of validity, worse scores on the cellulite scale were associated with being more bothered by how the cellulite looked overall, having more severe cellulite on the Patient-Reported Photo-numeric Cellulite Severity Scale, and having more self-reported cellulite and more areas of the body with cellulite. CONCLUSIONS The BODY-Q cellulite scale can be utilized to measure appearance of cellulite and provides a solid basis for future studies evaluating the impact of cellulite and its treatment.
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Affiliation(s)
| | | | - Claire E E de Vries
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Andrea Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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15
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Boerlage TCC, Haal S, Maurits de Brauw L, Acherman YIZ, Bruin S, van de Laar AWJM, Moes DE, van Wagensveld BA, de Vries CEE, van Veen R, Schouten R, Dijkgraaf MG, Fockens P, Gerdes VEA, Voermans RP. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery: study protocol for a randomized controlled trial (UPGRADE trial). BMC Gastroenterol 2017; 17:164. [PMID: 29262795 PMCID: PMC5738131 DOI: 10.1186/s12876-017-0674-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/10/2017] [Indexed: 02/08/2023] Open
Abstract
Background The number of bariatric interventions for morbid obesity is increasing worldwide. Rapid weight loss is a major risk factor for gallstone development. Approximately 11 % of patients who underwent Roux-en-Y gastric bypass develop symptomatic gallstone disease. Gallstone disease can lead to severe complications and often requires hospitalization and surgery. Ursodeoxycholic acid (UDCA) prevents the formation of gallstones after bariatric surgery. However, randomized controlled trials with symptomatic gallstone disease as primary endpoint have not been conducted. Currently, major guidelines make no definite statement about postoperative UDCA prophylaxis and most bariatric centers do not prescribe UDCA. Methods A randomized, placebo-controlled, double-blind multicenter trial will be performed for which 980 patients will be included. The study population consists of consecutive patients scheduled to undergo Roux-en-Y gastric bypass or sleeve gastrectomy in three bariatric centers in the Netherlands. Patients will undergo a preoperative ultrasound and randomization will be stratified for pre-existing gallstones and for type of surgery. The intervention group will receive UDCA 900 mg once daily for six months. The placebo group will receive similar-looking placebo tablets. The primary endpoint is symptomatic gallstone disease after 24 months, defined as admission or hospital visit for symptomatic gallstone disease. Secondary endpoints consist of the development of gallstones on ultrasound at 24 months, number of cholecystectomies, side-effects of UDCA and quality of life. Furthermore, cost-effectiveness, cost-utility and budget impact analyses will be performed. Discussion The UPGRADE trial will answer the question whether UDCA reduces the incidence of symptomatic gallstone disease after Roux-en-Y gastric bypass or sleeve gastrectomy. Furthermore it will determine if treatment with UDCA is cost-effective. Trial registration Netherlands Trial Register (trialregister.nl) 6135. Date registered: 21-Nov-2016.
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Affiliation(s)
- Thomas C C Boerlage
- Department of internal medicine, MC Slotervaart, Amsterdam, the Netherlands.,Department of gastroenterology & hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Sylke Haal
- Department of internal medicine, MC Slotervaart, Amsterdam, the Netherlands.,Department of gastroenterology & hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | | | | | - Sjoerd Bruin
- Department of surgery, MC Slotervaart, Amsterdam, the Netherlands
| | | | - Daan E Moes
- Department of surgery, MC Slotervaart, Amsterdam, the Netherlands
| | | | | | | | - Ruben Schouten
- Department of surgery, MC Zuiderzee, Lelystad, the Netherlands
| | - Marcel G Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of gastroenterology & hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Victor E A Gerdes
- Department of internal medicine, MC Slotervaart, Amsterdam, the Netherlands.,Department of vascular medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rogier P Voermans
- Department of gastroenterology & hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. .,Department of gastroenterology, MC Slotervaart, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
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