Changes In Disease-specific Quality Research Articles

Intranasal antihistamines in the treatment of idiopathic non-allergic rhinitis: a systematic review and meta-analysis.

Idiopathic rhinitis (IR), previously known as vasomotor rhinitis (VMR), is the most common type of non-allergic rhinitis (NAR) which affects around 100 million people worldwide. The treatment of patients with IR is not standardized. Intranasal antihistamines (INAH) are potent drugs in the treatment of allergic rhinitis but are frequently prescribed in the treatment of IR. This systematic review of the literature and meta-analysis aims to assess the effects of INAH on IR. A comprehensive review of the literature was conducted on Medline, Embase and Cochrane library. Randomized, controlled trials and non-randomized comparative parallel group trials comparing INAH to placebo or different INAHs were included. The primary outcome was the change in disease specific quality of life questionnaires, total nasal symptom score (TNSS). The secondary outcomes were other reported nasal symptom scores, individual symptom scores and adverse events. Six trials out of 987 assessing a total of 675 participants were deemed relevant for inclusion. Compared to placebo, INAH decreased total nasal symptom scores. One study also reported reduction of symptoms recorded on a visual analogue scale. There was no difference between the INAHs in terms of efficacy. Bitter taste sensation was the most frequently reported adverse event. INAHs seem to have benefit over placebo on nasal symptoms improvement in the treatment of NAR. No superiority between INAHs was identified.

Development and implementation of a nurse-led allergy clinic model in primary care: feasibility trial protocol

In the United Kingdom, there are acknowledged short comings in allergy care provision for patients seen in primary care. There is a lack of allergy training for healthcare professionals and this leads to inappropriate referrals to the limited number of allergy specialists. The primary aims of this study are to assess the feasibility of delivering and evaluating a new nurse-led allergy service in primary care, measured by recruitment, retention and quality of life. This is a single arm feasibility trial in which up to 250 participants referred to the nurse-led allergy clinic will receive the intervention and complete 6–12 weeks follow-up before being referred back to their usual care. Primary outcomes for this study will be establishment of clinics, recruitment and retention rates, and estimates of change in disease-specific quality of life measures. Secondary outcomes will be acceptability of the new service to participants/carers and healthcare professionals. A sample of participants and professional stakeholders will take part in more in-depth semi-structured qualitative interviews. Data from this feasibility trial will be used to inform plans for a pilot randomised controlled trial of nurse-led allergy clinics.

Quality of life after thyroidectomy in patients with nontoxic nodular goiter: A prospective cohort study.

Using the thoroughly validated Thyroid-Related Quality-of-Life Patient-Reported Outcome (ThyPRO) questionnaire, the purpose of this study was to investigate changes in disease-specific quality of life (QOL) after surgical treatment in patients with benign nontoxic multinodular goiters. Patients with goiters scheduled for thyroid surgery (n = 106) and individuals from the general population (n = 739) were studied. The ThyPRO data before, 3 months, and 6 months after surgery were compared with normative scores from the general population using a linear mixed model and t tests. Before surgery, patients with goiters experienced poorer scores on all scales compared to the general population. After surgery, moderate to large improvements were seen in goiter symptoms, tiredness, anxiety, and overall QOL. After surgery, all scales returned to values equal to the general population. The degree of anxiety was, in fact, lower than in the general population. Thyroid surgery leads to significant benefit among patients with benign nontoxic goiters by restoring QOL equal to that in the general population.

Outcomes of surgical stabilization in patients with combined ACL deficiency and patellofemoral instability — A case series

BackgroundThe purpose of this study was to assess the disease-specific quality of life, and the objective clinical and functional outcomes of patients with symptomatic ACL deficiency and patellofemoral instability following surgical stabilization of both ligaments. MethodsBetween February 2010 and August 2013, 22 subjects underwent a combined ACL reconstruction and patellofemoral stabilization. The anterior cruciate ligament quality of life questionnaire (ACL-QOL) was completed pre-operatively and two-years post-operatively. Clinical and functional assessments were performed two-years post-operatively. A paired t-test assessed the difference between the pre- and post-operative ACL-QOL scores. Effect size was calculated manually using the Eta squared formula. A Pearson r correlation coefficient assessed for a relationship between the post-operative ACL-QOL scores and functional tests. ResultsTwenty patients completed the 24-month ACL-QOL, 17/20 completed clinical assessment, and 14/20 completed functional testing. The mean pre-operative ACL-QOL score was 21.20 (SD=7.25, range 5.8 to 31.7) and two-years post-operative it was 65.24 (SD=21.38, range 34.5 to 99.1). The paired t-test demonstrated a statistically significant improvement in ACL-QOL scores; t (19)=9.119, p<.001 (two-tailed). The Eta squared statistic (0.81) indicated a very large effect size. Statistically significant correlations (p<.05) were evident between post-operative ACL-QOL scores and all the operative limb single-leg hop tests. ConclusionsCombined ACL reconstruction and patellofemoral stabilization surgery leads to good results. This patient cohort with chronic ACL–MPFL injuries demonstrated a statistically significant change in disease-specific quality of life following surgery. In addition, the patient-reported outcomes and objective functional testing results correlated. Level of evidenceCase series — IV.

Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease.

How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD). In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4weeks, and 130 at 4months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George's Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed. At 4weeks and 4months, changes in disease-specific QOL (st. β=-0.35, p<0.001, partial (p) R (2)=11-12%), depression (st. β=-0.32 to -0.36, p<0.001, pR (2)=9-12%), and anxiety (st. β=-0.21 to -0.40, p<0.02-0.001, pR (2)=4-15%) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4months (st. β=0.21, p=0.02, pR (2)=4%), but not with changes in depression. Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.

Evaluation of Improvement in Nasal Obstruction Following Nasal Valve Correction in Patients With a History of Failed Septoplasty.

Patients with a septal deviation and concerns about nasal obstruction often undergo septoplasty to improve nasal airflow. Following primary septoplasty, however, some patients have persistent symptoms due to nasal valve dysfunction and may require nasal valve surgery. To evaluate the change in disease-specific quality of life for patients who undergo nasal valve correction after failed septoplasty using the Nasal Obstruction Symptom Evaluation (NOSE) survey and to determine whether identifiable anatomical risk factors are more common in patients with a history of failed septoplasty. Prospective observational outcomes study conducted at a tertiary care medical center. Forty patients who underwent nasal valve correction through an open approach from January 1, 2012, through December 31, 2014, with a history of septoplasty for nasal obstruction were included. Data analysis was conducted from January 1, 2013, through May 1, 2015. [corrected]. Demographic information, a standardized nasal examination, and preoperative and postoperative NOSE scores were collected and reviewed. Comparison between preoperative and postoperative NOSE scores at 2, 4, and more than 6 months after surgery. Forty patients were included in the study; 23 (57%) were male and 17 (43%) were female. The mean age was 39.3 years. Findings from preoperative nasal examination demonstrated moderate or severe internal nasal valve narrowing in 38 (95%) patients, internal nasal valve collapse in 19 (48%), external nasal valve narrowing in 18 (45%), or external nasal valve collapse in 16 (40%). The most common anatomical cause of obstruction was internal nasal valve narrowing in 38 (95%) patients, dorsal septum deflection in 26 (65%), and narrowed middle vault in 16 (40%). The mean (SD) preoperative NOSE score was 75.7 (20.1). Mean (SD) postoperative NOSE scores at 2, 4, and greater than 6 months were 31.4 (27.2), 34.0 (19.8), and 22.1 (18.8), respectively, with significantly improved NOSE scores at each time point compared with before surgery (P < .001). Nasal valve dysfunction remains an underdiagnosed entity and should be considered in all patients with septal deviation before septoplasty, especially in patients with a severe dorsal deflection and a narrow middle vault. In this study, surgical nasal valve correction demonstrated a significant reduction in nasal obstruction, as measured by a validated outcome measure, in patients for whom a previous septoplasty had failed. 4.

Multicentre prospective clinical application of the T14 paediatric outcome tool.

This study aimed to measure changes in disease-specific quality of life in children following tonsillectomy or adenotonsillectomy. A multicentre prospective cohort study was performed involving seven ENT departments in England. A total of 276 children entered the study over a 2-month period: 107 underwent tonsillectomy and 128 adenotonsillectomy. Forty-one children referred with throat problems initially managed by watchful waiting were also recruited. The follow-up period was 12 months. Outcome measures were the T14, parental impressions of their child's quality of life and the number of days absent from school. One-year follow-up data were obtained from 150 patients (52 per cent). The mean baseline T14 score in the non-surgical group was significantly lower (T14 = 23) than in the tonsillectomy group (T14 = 31) or the adenotonsillectomy group (T14 = 35; p < 0.001). There was a significant improvement in the T14 scores of responders in all groups at follow up. The effect size was 1.3 standard deviations (SD) for the non-surgical group, 2.1 SD for the tonsillectomy group and 1.9 SD for the adenotonsillectomy group. Between-group differences did not reach statistical significance. A third of children in the non-surgical group underwent surgery during the follow-up period. Children who underwent surgical intervention achieved a significant improvement in disease-specific quality of life. Less severely affected children were managed conservatively and also improved over 12 months, but 1 in 3 crossed over to surgical intervention.

Correlation of Patient-reported Symptom Outcomes and Treadmill Test Outcomes after Treatment for Aortoiliac Claudication

PurposeTo examine the relationship between objective treadmill test outcomes and subjective symptom outcomes among patients with claudication treated with stent revascularization (ST) compared with supervised exercise (SE). Materials and MethodsFive scales of the Peripheral Artery Questionnaire and Walking Impairment Questionnaire were correlated with peak walking time and treadmill claudication onset time. ResultsThe correlation between change in disease-specific quality of life (QOL) and change in peak walking time differed according to treatment group, with statistically significant correlations for all five scales for the ST group and weaker trends for the SE group, only one of which was statistically significant. In contrast, improvements in disease-specific QOL correlated well with increases in claudication onset time, with no significant interaction with treatment group for any of the five scales. ConclusionsDisease-specific QOL results at 6 months in the Claudication: Exercise Vs. Endoluminal Revascularization (CLEVER) study show that improved maximal treadmill walking in patients with claudication treated with SE correlated poorly with self-reported symptom relief. Conversely, patients treated with ST showed good correlation between improved maximal treadmill walking and self-reported symptom improvement. The correlation between claudication onset time and self-reported symptom relief was good across treatment groups. This finding indicates that traditional objective treadmill test outcomes may not correlate well with symptom relief in patients with claudication. Future studies should investigate these data and improve understanding of patient relevance of traditional objective treadmill-based treatment outcomes.

Clinical Long-term Outcome after Uterine Artery Embolization: Sustained Symptom Control and Improvement of Quality of Life

To evaluate long-term clinical efficacy of uterine artery embolization (UAE) for uterine fibroids with respect to symptom control and improvement in quality of life. Between October 2000 and October 2007, 380 consecutive women underwent UAE. To determine long-term efficacy, the rate of reinterventions (ie, repeat UAE, hysterectomy, myomectomy) and the clinical response regarding symptoms related to bleeding and bulk were documented. Persistence, worsening, or recurrence of symptoms and reinterventions were classified as treatment failure (TF). The cumulative rate of freedom from TF was determined by Kaplan-Meier analysis. Cox regression was used to identify possible clinical or morphologic predictors of outcome. Secondary outcome measures were changes in disease-specific quality of life and onset of menopause. Follow-up was available for a median of 5.7 years (range, 3.1-10.1 y) after treatment in 304 of 380 (80%) patients. There were 54 TFs with subsequent reintervention in 46 women. Kaplan-Meier analysis revealed a cumulative TF rate of 23.3% after 10 years. Cox regression demonstrated a significantly higher likelihood of TF in patients<40 years old compared with patients>45 years old (hazard ratio, 2.28; P = .049). Women without TF showed sustained normalization of disease-specific quality of life (P <.001). Cessation of menstruation at a median age of 51 years was reported by 57 (22.8%) of 250 women. UAE leads to long-term control of fibroid-related symptoms and normalization of quality of life in approximately 75% of patients. Younger women seem to have a higher risk of TF than older women closer to menopause.

Association of change in depression and anxiety symptoms with functional outcomes in pulmonary rehabilitation patients

Objective Pulmonary rehabilitation (PR) has emerged over the last decade as an essential component of an integrated approach to managing patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). We sought to examine how depression and anxiety symptom changes relate to disease-specific quality of life outcomes following PR. Methods We performed a cohort study of 81 patients with COPD who completed PR at a Veterans Administration Medical Center. Pulmonary rehabilitation consisted of supervised exercise training and education twice weekly for 8 weeks. Beck Depression and Anxiety Inventories (BDI and BAI) assessed symptom burden at baseline and completion of PR. We measured change in disease-specific quality of life using the dyspnea, mastery, emotion and fatigue domains of the Chronic Respiratory Questionnaire Self-Reported (CRQ-SR) from baseline to completion of PR. Results Participants were 69.8±9.1 years old and all male. Forced expiratory volume in 1 s (FEV1) was 1.23±0.39 L. The CRQ-SR scores improved significantly: dyspnea ( P<.0001), mastery ( P=.015) and fatigue ( P=.017). The BDI scores improved significantly (13.1±10.5 to 10.8±9.9, P=.003; BAI: 13.1±10.1 to 12.1±11.7). Multivariate regression models controlling for age, FEV1, depression treatment and anxiety treatment showed that improvement in depressive symptoms were associated with improvement in fatigue ( P=.003), emotion ( P=.003) and mastery ( P=.01). Anxiety symptom change was not significantly associated with change in disease-specific quality of life domains. Conclusion Addressing anxiety symptoms in PR patients may be indicated because disease-specific quality of life improvement appears to be associated with mood.

Influence of Body Mass Index on Changes in Disease-Specific Quality of Life of Veterans Completing Pulmonary Rehabilitation

Body mass index (BMI) has prognostic value in patients with chronic lung disease. Pulmonary rehabilitation improves quality of life. This study investigated whether BMI predicts change in disease-specific quality of life following pulmonary rehabilitation. Subjects (N = 61), who completed pulmonary rehabilitation, were classified by BMI as low (<23 kg/m), middle (> or =23 and <33 kg/m), or high (> or =33 kg/m). Outcomes were changes in disease- specific quality of life measured by the following domains of the Chronic Respiratory Questionnaire Self-Reported (CRQ-SR): dyspnea, mastery, emotion, and fatigue. Subjects completed CRQ-SR at the start and end of pulmonary rehabilitation. Multivariable regression was used to compare change in CRQ-SR scores of each domain by BMI group controlling for forced expiratory volume in 1 second. Subjects were 68.9 +/- 9.0 years old and were all white men. At baseline, the low-BMI group had lower mean forced expiratory volume in 1 second (0.96 +/- 0.28) than the middle (1.29 +/- 0.48, P = .02) and high (1.37 +/- 0.38, P = .01) BMI groups. Collectively, subjects improved on CRQ-SR dyspnea (P < .004), mastery (P < .008), emotion (P < .03), and fatigue (P < .005). In multivariable models, the high-BMI group had greater improvement on the CRQ-SR domains for fatigue (beta = 3.5 +/- 1.0, P = .0008) and mastery (beta = 4.8 +/- 1.6, P = .003) than the middle-BMI group. Pulmonary rehabilitation results in improved disease-specific quality of life. BMI influences this improvement and should be considered in the assessment, plan of care, and outcomes in response to pulmonary rehabilitation for patients with chronic respiratory disease.

Energy Delivery During 810 nm Endovenous Laser Ablation of Varicose Veins and Post-procedural Morbidity

Aim The durability of occlusion post endovenous laser therapy (EVLT) for varicose veins is linked to the magnitude of energy delivered to the vein and consequently increasing amounts of energy are employed. The aim of this study is to establish whether increasing the energy results in greater periprocedural morbidity or complications. Methods Linear and logistic regression models were built to study the effect of energy delivery on outcome. The models controlled for age, gender, BMI, pre-operative quality of life and vein dimension. The outcomes were pain and analgesia requirement in week 1, change in disease specific quality of life (Aberdeen varicose vein questionnaire (AVVQ), change in generic quality of life (Short Form-36 (SF-36) and Euroqol (EQ5D)at week 1 and 6 and complication rates. The sample size calculation established that 115 patients would be required to detect any significant relationship. Results 232 patients were included. The mean (range) age was 50 (18–83) years. 63% were women. The mean (range) energy delivery was 89.8 (44.5–158.4) J/cm. There was no significant effect on any outcome related to increasing energy delivery. Conclusion Up to 160J/cm, increasing energy delivery has no significant effect upon the morbidity or complications of EVLT for superficial venous insufficiency.

Effect of Intracapsular Tonsillectomy on Quality of Life for Children With Obstructive Sleep-Disordered Breathing

To assess the change in disease-specific quality of life (QOL) in pediatric patients with obstructive sleep-disordered breathing (OSDB) secondary to adenotonsillar hypertrophy after powered intracapsular tonsillectomy and adenoidectomy. Prospective outcomes study. Hospital-based pediatric otolaryngology practice. Fifty children with a mean age of 4.5 years who had a clinical diagnosis of OSDB. A caregiver of qualifying patients completed a validated QOL survey of pediatric obstructive sleep apnea, the OSA-18 (Obstructive Sleep Apnea-18), preoperatively and 3 months and 1 year postoperatively. The OSA-18 mean change scores. The mean (SD) total OSA-18 change score at the 3-month follow-up visit was 2.3 (1.2) and at the 1 year follow-up visit was 2.2 (1.3). The total and individual domain change scores were significantly improved at both postoperative intervals (P<.001 for all). There were no significant changes in the total or domain change scores between the intervals. The total change score was not significantly associated with either tonsil size or tonsil position. The OSDB-related QOL is significantly improved after powered intracapsular tonsillectomy and adenoidectomy, and this improvement remains stable even after 1 year.

Improvement in Quality of Life Following Surgery for Adolescent Idiopathic Scoliosis

We used the Climent Quality of Life for Spinal Deformities Scale prospectively in a nonrandomized prospective comparative cohort of operative versus observational management of adolescent idiopathic scoliosis. To compare the change in disease-specific quality of life associated with operating on adolescents with idiopathic scoliosis, to the change in disease-specific quality of life among observed scoliosis patients with a similar 2-year follow-up period. The immediate effect of scoliosis surgery on quality of life from a patient perspective has not been properly documented but should play a role in the patient's decision to operate. At a single tertiary referral children's hospital spinal clinic, 119 patients undergoing scoliosis surgery and 42 patients undergoing observation only for scoliosis were enrolled in a prospective study, including preoperative and postoperative spine-specific quality of life. Change in quality of life after 2 years of follow-up among operated versus observed patients (adjusted for baseline quality of life) was used to estimate the short-term benefit of scoliosis surgery. The operated group experienced an increase in quality of life of 4.3 points (95% confidence interval, 0.69-7.88) on the 115-point Climent scale. Although statistically significant, this increase was lower than the 5.5-point cutoff we had defined a priori as clinically significant. Scoliosis surgery results in a small increase in spine-related quality of life at 2 years. This increase is of questionable clinical significance. Decisions to operate on adolescents with scoliosis should acknowledge modest expectations about short-term gains in quality of life.

A new measure of placebo response and patient satisfaction in office encounters

Objectives Placebo response is defined as a change in health status resulting from the symbolic significance attributed by the patient or proxy to the physician encounter. Our goals were to validate the PR12 survey as a measure of placebo response and to analyze the placebo response as a discrete and measurable component of everyday office encounters with the otolaryngologist. Study design This was a prospective, before-and-after clinical outcomes study of 95 children aged 6 months to 12 years conducted in an academic metropolitan pediatric otolaryngology practice. Caregivers completed the PR-12 survey at entry and at least 4 weeks later. The survey included 3 domains (4 questions each) reflecting the main components of the placebo response: meaningful explanation, care and concern, and mastery and control. PR-12 was correlated with longitudinal change in health status at least 1 to 2 months after the baseline visit. Outcome measures included direct and indirect measures of change in disease-specific quality of life and satisfaction with change. Results Test-retest reliability was fair for most PR-12 survey items (R = 0.41 to 0.76) but was higher for domains (0.60 to 0.66) and the overall survey score (0.66). PR-12 had excellent internal consistency (Cronbach's alpha 0.91) and appropriate construct validity. Caregiver satisfaction change at follow-up correlated with the PR-12 (r = −.25, P = 0.036). Conversely, no correlation was seen between the PR-12 and direct and indirect measures of change in disease specific quality of life. Conclusion Placebo response is an important and potentially measurable aspect of clinical encounters. PR-12 is a promising first step at creating a brief, reliable, and valid instrument to assess the placebo response. Significance Reemphasizing the therapeutic potential of the doctor-patient relationship may improve quality of care and disease outcomes.

The Canadian Optimal Therapy of COPD Trial: Design, Organization and Patient Recruitment

There are no published studies that have assessed whether adding long-acting beta 2-agonist bronchodilators and/or inhaled steroids to chronic therapy with tiotropium would provide additional clinical benefit to patients with moderate to severe chronic obstructive pulmonary disease (COPD). The Canadian Optimal Therapy of COPD Trial is a randomized, prospective, double-blind, placebo-controlled, multicentre trial funded by the Canadian Institutes of Health Research that has been designed to determine which combination of inhaled medications will most effectively prevent exacerbations and optimize disease-specific quality of life in patients with COPD. The trial is the first to evolve from the Canadian Thoracic Society Clinical Trials Group. The study will randomize 432 patients with moderate to severe COPD to one of three parallel treatment arms for 52 weeks: tiotropium and fluticasone/salmeterol; tiotropium and salmeterol; or tiotropium and placebo inhaler. The participants will be allowed to use salbutamol as required throughout the trial period. The primary outcome measure is the proportion of patients in the three treatment groups who experienced a respiratory exacerbation within 52 weeks of randomization. Other outcomes that will be assessed over the 52-week trial period will include: changes in disease-specific quality of life and changes in dyspnea, health care use and changes in lung function. A pharmacoeconomic analysis will also be performed to evaluate the cost of these therapies. The study commenced recruitment in October 2003. It is currently operating at 22 centres across Canada and has randomized 137 patients during the first four months of recruitment. Recruitment is scheduled to continue until April 2005 or until 432 patients have been randomized. The present randomized, placebo-controlled trial offers a unique opportunity to answer the question, what is the best combination of inhaled medications to use for COPD patients? It is hoped that optimal use of inhaled medications will improve patient health and quality of life, reduce patient respiratory exacerbations, and ultimately, reduce health care resource use.

Evaluation of sleep-disordered breathing in children.

We evaluated changes in disease-specific quality of life (QOL) for children with sleep-disordered breathing (SDB). We conducted a cohort study in 69 children (age range, 6 months to 13 years; median age, 6.1 years) from a hospital-based pediatric otolaryngology practice in a metropolitan area. We used the OSA-18, an 18-item QOL survey with known test-retest reliability, internal consistency, and construct validity. Survey domains included sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns. Tonsillectomy or adenoidectomy was performed as part of routine clinical care. The OSA-18 was completed at entry by the child's caregiver and again at least 4 weeks after surgery. The validity of the OSA-18 change score was assessed by comparison with multiple external constructs, including a validated measure of longitudinal change (OSD-6 survey). Responsiveness was assessed by the standardized response mean (SRM). The mean baseline OSA-18 survey score was 3.1 (SD, 0.9) of a maximum 7.0, with higher values indicating poorer QOL. Change scores were available for all children, with a mean interval between preoperative and postoperative surveys of 61 days (range, 42 to 92 days). The mean OSA-18 change score of 1.14 (SD, 0.71) showed significant correlation with tonsil size (r = 0.40), adenoid size (r = 0.31), OSD-6 change scores (r = 0.71), and the direct caregiver estimates of change (r = 0.34). OSA-18 change scores showed large responsiveness to change (SRM 1.44; 95% confidence interval, 1.16 to 69), with the most responsive domains being sleep disturbance, physical suffering, and caregiver concerns. Significant responsiveness was also demonstrated for the domains of daytime problems and emotional distress. The OSA-18 is a valid, reliable, and responsive QOL measure that combines the advantages of a discriminative and evaluative survey in a single instrument. The OSA-18 is a useful measure of patient-based outcomes for clinical trials, health services research, and routine clinical care.

Quality-of-life outcomes after surgical intervention for otitis media.

To assess the change in disease-specific quality of life in children with recurrent acute otitis media and/or chronic otitis media with effusion treated with surgical intervention. Prospective questionnaire-based outcome study. An academic pediatric otolaryngology practice. Consecutive series of 123 children referred for surgical treatment of recurrent acute otitis media and/or chronic otitis media with effusion. Surgery included bilateral myringotomy and tympanostomy tube placement either alone or with adenoidectomy. An otitis media disease-specific questionnaire was administered before and after surgical intervention. Comparison of the mean percentage change in total ear symptom score between presurgery and postsurgery scores at 1 and 6 months after surgery. The mean percentage change in total ear symptom score was a 74.5% improvement (P<.001) at the 1-month follow-up and a 59.8% improvement (P<.001) at the 6-month follow-up. Parental worry related to the child's ear problems was also significantly decreased, with a mean otitis media disease-specific questionnaire score of 3.43 (P<.001) at 1 month and 2.64 (P<.001) at 6 months after surgery. When caregivers were asked if they would have their child undergo tympanostomy tube placement if they had to make the decision again, 91% and 84% responded yes at the 1- and 6-month follow-up, respectively. The disease-specific quality of life of children with recurrent acute otitis media and/or chronic otitis media with effusion with appropriate surgical indications significantly improved after surgical intervention. The amount of parental worry concerning their children's ear problems also significantly improved following surgery, and most caregivers would opt again for tube placement.