Importance of factors determining the low health-related quality of life in people presenting with a diabetic foot ulcer: the Eurodiale study

AIM

To identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors.

METHODS

A total of 1232 patients with a new foot ulcer, who presented at one of the 14 centres in 10 European countries participating in the Eurodiale study, were included in this cross-sectional study. Patient and ulcer characteristics were obtained as well as results from the Euro-Qol-5D questionnaire, a health-related quality of life instrument with five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). To analyse the relative importance of comorbidities and ulcer- and patient-related factors for health-related quality of life, linear regression models were used to calculate the relative contributions of each factor to the fit (R(2) ) of the model.

RESULTS

Patients reported poor overall health-related quality of life, with problems primarily in the mobility and pain/discomfort domains. Among the comorbidities, the inability to stand or walk without help was the most important determinant of decreased health-related quality of life in all five domains. Among ulcer-related factors, ulcer size, limb-threatening ischaemia and elevated C-reactive protein concentration also had high importance in all domains. The clinical diagnosis of infection, peripheral arterial disease and polyneuropathy were only important in the pain/discomfort domain.

CONCLUSIONS

The factors that determine health-related quality of life are diverse and to an extent not disease-specific. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important.

Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial

The aim of this randomized controlled trial was to evaluate the effect of a 3-month course of exercises on mobility, balance, disease-specific, and generic health-related quality of life (HRQOL) for women with osteoporosis and a history of vertebral fractures. Our results showed that exercises improved their mobility, balance, and HRQOL.

INTRODUCTION

The aim was to evaluate the effect of a 3-month course of circuit exercises plus a 3-h lesson on how to cope with osteoporosis on mobility, balance, and the HRQOL for postmenopausal women (60-84 years) with osteoporosis and a history of vertebral fracture. Our hypothesis was that a 3-month course would have a significantly positive effect on the women's mobility and balance as well as on their HRQOL.

METHODS

The participants (89) were randomized to an intervention group (IT) or a control group (CT) and assessed at baseline at 3 months and at 12 months with measurement of maximum walking speed (MWS), Timed Up and GO (TUG), Functional Reach (FR), the Quality of Life Questionnaire issued by the European Foundation for Osteoporosis ('QUALEFFO-41') and the General Health Questionnaire (GHQ-20). The sample size was calculated with reference to walking speed (primary outcome), and the statistical approaches used were Student's t test or the chi-square test.

RESULTS

At 3 months, better results were registered on the primary outcome, MWS as well as TUG, FR, sum score of GHQ-20, and "QUALEFFO-41: mental function" in the IT compared with the CT. At 12 months, those in the IT had a better result on the primary outcome, MWS as well as TUG, "QUALEFFO-41: total score" "QUALEFFO-41: mental function", "QUALEFFO-41: physical function", and "QULEFFO-41: pain" compared with CT.

CONCLUSION

Circuit exercises will improve mobility and health-related quality of life of elderly women with osteoporosis and a history of vertebral fractures.

Nottingham health profile scores predict the outcome and support aggressive revascularisation for critical ischaemia

AIMS

to assess changes in health related quality of life (HRQoL) following peripheral arterial reconstruction for critical limb ischaemia (CLI).

METHODS

sixty patients with CLI were prospectively evaluated with the Nottingham Health Profile (NHP) before and 3 and 12 months after arterial reconstruction. In addition, at 12 months, patients were asked if their expectations of the revascularisation had been met and whether they considered the surgical treatment had been worthwhile.

RESULTS

primary amputations and mortality were 5% and 3% and after 12 months 12% and 12% respectively. Three months after surgery scores on the pain and sleep sections of the NHP had improved significantly (p < 0.05). These improvements were maintained at 12 months.

CONCLUSION

revascularisation for CLI improves HRQoL and pre-operative health perceptions are related to surgical outcome.

The purpose of the general practice consultation from the patient's perspective--theoretical aspects

BACKGROUND

Medical practice and research are paying increasing attention to what patients want, as reflected by the growth of routine surveys of patients' satisfaction and more formal studies of patients' views of medical care. However, the field lacks conceptual clarity.

OBJECTIVES

The aim of this study was to propose a theoretical clarification of the concept of the patients' purpose of a consultation by presenting a patient-centred definition, applicable for clinical work and research in general practice.

METHODS

An extensive literature review was conducted to explore presumptions and definitions reported by previous studies. Most authors failed to define or distinguish the concept under investigation. We took these shortcomings as our starting point, added some significant dimensions drawn from a few selected authors who had discussed relevant perspectives in their work and arrived at a proposed working definition of the 'purpose' concept.

RESULTS

The proposed definition allows for multiple purposes for the consultation. We incorporate what the patient hopes to gain from the consultation, as opposed to their 'expectations of the most likely outcome'. Our working definition aims to identify patients' a priori wishes and hopes for a specific process and outcome, while acknowledging that these may not be voiced and may be modified by the patient during the consultation. General characteristics of the doctor, such as being considerate or professionally skillful, are not included.

Adaptation into Danish of the Stanford Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Scale (RAQoL)

OBJECTIVES

The study was designed to adapt the Stanford Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) for use in Denmark.

METHOD

The instruments were translated into Danish and then field-tested with 10 RA patients for relevance, and face and content validity. Reliability and validity were assessed by administering the new measures and a comparator instrument (the Danish Nottingham Health Profile) to 80 RA patients on two occasions.

RESULTS

Patients found both measures acceptable and easy to complete. They had good test-retest reliability (>0.90) and internal consistency and were both able to discriminate between groups with different levels of functional status and self-perceived severity. When compared with the NHP sections, both measures showed expected convergence and divergence.

CONCLUSION

Given the excellent psychometric properties of the Danish versions of the RAQoL and HAQ, both are recommended for inclusion in clinical trials and studies.

International development of the Quality of Life in Depression Scale (QLDS)

BACKGROUND

The Quality of Life in Depression Scale (QLDS) employs the needs-based model of quality of life (QoL) and was developed in the UK and The Netherlands as an outcome measure for clinical trials. This paper describes the production and psychometric assessment of nine new language versions for Canada (French and English), Denmark, France, Germany, Italy, Morocco, Spain and the US.

METHODS

Three adaptation stages were employed; production of conceptually equivalent translations, field-test interviews and assessment of reliability and construct validity by survey of patients with major depression.

RESULTS

Few problems were experienced with producing conceptually equivalent translations, except in Morocco. Patients in the field-test interviews found the instrument to have appropriate content and to be easy to complete. Internal consistency and test-retest reliability were excellent for all language versions and scores were found to relate appropriately to measures of depression severity and health status.

LIMITATIONS

Further investigation is required of the ability of the measure to assess individuals at the extremes of the QoL continuum. Data collected with the Arabic QLDS should not be combined with those from other countries.

CONCLUSIONS

The QLDS is the first instrument designed to assess QoL in depression based on a coherent model of the construct. Each language version has been shown to be well accepted by respondents and to have excellent psychometric properties. As the instrument is now available in a large number of languages, the QLDS is the QoL instrument of choice for inclusion in clinical trials of interventions for depression.

[Individual registration of children in the national health service. New possibilities for epidemiological research in primary health care]

Since January 1st 1996 all Danish citizens, children included, have been recorded individually in The National Health Service Register (SSR). Services rendered to children are no longer registered with an adult person. This article describes the implementation of this new arrangement. The part of health services to children recorded under an adult personal identification number is getting asymptotically closer to a minimum of about four percent, which is determined by the average time of naming of children. After the introduction of individual registration of children the SSR has improved considerably as a basis for epidemiological studies in Danish primary care.

Influence of follow-up on health-related quality of life after radical surgery for colorectal cancer

BACKGROUND

The possible benefit for patients of follow-up examinations after curative surgery for colorectal cancer is at present not proven. The purpose of this study was to evaluate the influence of follow-up examinations on health-related quality of life and to assess the attitude of the patients to check-ups.

METHODS

A total of 350 patients who had had curative surgery for colorectal cancer and who had been subsequently randomized to either frequent follow-up or virtually no follow-up completed the Nottingham Health Profile and a second questionnaire assessing their attitude to the follow-up visits.

RESULTS

The patients who were receiving more frequent follow-up had greater confidence in the check-ups, but the improvement in the health-related quality of life was only marginally better than that of those receiving few follow-up visits.

CONCLUSION

The relatively small benefit for health-related quality of life does not justify expensive frequent routine examinations after surgery for colorectal cancer. The Nottingham Health Profile proved to be a reliable instrument within this patient group.

The international development of the RGHQoL: a quality of life measure for recurrent genital herpes

This paper describes the international development and psychometric testing of the Recurrent Genital Herpes Quality of Life Questionnaire (RGHQoL), a condition-specific quality of life (QoL) instrument. The theoretical foundation for the measure is the needs-based model of QoL and the content of the instrument was derived from in-depth qualitative interviews with relevant patients in the UK. Versions of the RGHQoL were required for the UK, USA, Italy, Germany, France and Denmark for use in international clinical trials. The results indicate that the final 20 item measure has good reliability, internal consistency and validity for all language versions. A small responsiveness study in Denmark suggested that the measure is sensitive to changes in QoL associated with the initiation of suppression treatment for recurrent genital herpes (RGH). It is concluded that the RGHQoL is a valuable instrument for inclusion in clinical trials. The psychometric properties of the instrument are such that it may also be used to monitor the progress of individual patients.

The Danish National Health Service Register. A tool for primary health care research

The purpose of the article is to describe the Danish National Health Service Register and its value in primary health care research, using mainly general practice as an example. The Danish National Health Service Register is a data system available for counties and municipalities to manage the National Health Insurance covering primary health care providers. The counties use the register for administrative purposes, especially for the settling of accounts with providers. The register contains data on all citizens, providers, and health care services reimbursed by the health authorities, but holds no data regarding health status. The accuracy and degree of completeness of persons and variables in the National Health Service Register rests on the fact that most primary health care services in Denmark are reimbursed and, therefore, included in the data base. This tie to the economy of both health care authorities and providers is supposed to confer the final register with a high degree of completeness. It is a clear advantage that almost all citizens in Denmark are assigned to only one general practice, and that the attitude towards research is positive among Danish patients and doctors. The register has so far only been used occasionally for research purposes. To take advantage of the register for research purposes within clinical and health services research, however, one must possess not only a detailed knowledge of the Danish society, including the structure of the Danish health care system, but also an intimate acquaintance with rather complex agreement system and the actual interpretation of this.

Perceived health in three groups of elderly people. A validity study of the Danish version of the Nottingham Health Profile

The Nottingham Health Profile (NHP) is a measure of physical, emotional and social distress. It was developed in the United Kingdom and has been adapted and translated into Danish. The Danish version of the NHP has been shown to be reliable. In order to establish the validity of the measure it was administered to three groups of people, all over the age of 60, who were expected to differ in health status. These groups consisted of 120 persons attending fitness classes on a regular basis, 64 patients with low back pain and/or pain in the lower extremities referred by their general practitioner for treatment at an out-patient clinic and 72 patients with osteoarthrosis of the hip awaiting hip replacement operation. As predicted, the patients awaiting hip replacement surgery scored higher (indicating greater distress) on all six sections of the measure than did the patients attending the out-patient clinic. Both these groups scored higher on all sections of the NHP than the fitness class members. It is concluded that the Danish version of the NHP has been found valid insofar as it shows expected differences between three groups of elderly people.

The Danish version of the Nottingham Health Profile: its adaptation and reliability

OBJECTIVE

To test the reliability of the Danish version of the Nottingham Health Profile.

DESIGN

Test-retest reliability with an interval of four weeks between administrations of the measure.

SETTING

Copenhagen.

PARTICIPANTS

Seventy patients suffering from osteoarthrosis, living at home and awaiting hip-replacement operation. The patients' ages ranged from 37 to 90 years, with a median of 72 years.

OUTCOME MEASURE

The Danish version of the Nottingham Health Profile, a measure of perceived health status, widely used in Europe. The measure consists of six sections; pain, physical mobility, energy level, sleep, social isolation, and emotional reactions.

RESULTS

The respondents scored highly on the measure, particularly on the pain, physical mobility, and energy sections. No major differences in scores associated with age or sex were found. The test-retest correlation coefficients obtained for the six sections were high (ranging from 0.76 to 0.86) and comparable with those found in Sweden and the UK. The test-retest correlation for the whole measure was 0.93.

CONCLUSION

The Danish version of the Nottingham Health Profile has been shown to be reliable and to be acceptable and relevant to patients with chronic disability. Should the formal tests of validity currently in progress prove satisfactory, Danish clinicians and researchers will have a valuable tool available for gaining insight into the impact of illness and its treatment on patients.

Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study

In a controlled, cross-over study the effect of low level laser therapy (LLLT) was evaluated. During a five weeks period forty-seven female laboratory technicians received six laser and six placebo treatments to tender points in the neck and shoulder girdle. Subjects rated the placebo treatment significantly more beneficial than LLLT (p = .04). There was no reduction in consumption of analgesics associated with either laser or placebo treatment. The results indicate no beneficial effect of LLLT for myofascial pain.

[Low energy laser treatment--effect in localized fibromyalgia in the neck and shoulder regions]

The effect of low-level laser therapy (GaAlAs, 830 nm, continuous) for chronic myofascial pain in the neck and shoulder girdle was assessed in a double-blind randomized study with 36 female participants. Treatments were given six times during two weeks with a total effect of 4.5-22.5 J per treatment depending on the number of tender points. No significant effect was found, neither in pain relief nor in tablet intake between the laser and the placebo group. None of the participants reported any side-effects.