Disease-specific Quality Of Life Instrument Research Articles

The Skin Cancer Index: Clinical Responsiveness and Predictors of Quality of Life

To establish the clinical responsiveness of the Skin Cancer Index (SCI), a new disease-specific quality of life (QOL) instrument, and to assess demographic and clinical factors which impact QOL in patients with nonmelanoma skin cancer (NMSC). Prospective study of 183 patients with NMSC of the face and neck referred to a tertiary care Mohs surgery clinic. The SCI is a 15 item, validated, disease-specific QOL instrument with 3 distinct subscales, Emotion, Social, and Appearance. Higher scores reflect better QOL. The SCI and the Dermatology Life Quality Index (DLQI), a general dermatology instrument, was administered at initial consultation and 4 months after surgical treatment. Multivariate analysis was conducted to assess demographic and clinical factors predictive of QOL for both instruments. The SCI total score and all three subscale scores increased with treatment, demonstrating strong evidence of responsiveness over time (P < .001) in contrast with the DLQI (P = .46). Predictors of poorer QOL for the SCI included female sex and cancers located on the lip. Patients who demonstrated greatest improvement in QOL with treatment included those who were younger (<50 yr) and had lower reported household income. Also, first time NMSC patients and those patients who underwent less extensive reconstructions demonstrated greater improvements in QOL. The SCI is a sensitive and responsive QOL instrument for patients with NMSC. Distinct demographic and clinical variables that impact QOL have been demonstrated using this multidimensional, disease-specific instrument.

Difference in Quality of Life According to the Severity of Malocclusion in Japanese Orthodontic Patients

Although quality of life (QOL) assessment is important in dentistry, it has not been fully investigated in orthodontic patients. We investigated the health-related generic QOL (entire body health) and disease specific QOL (oral health) in adult patients with malocclusions at the first visit. One hundred and twenty-seven orthodontic patients and 66 persons with normal occlusion were recruited for the study. The subjects were divided into the three following groups based on their treatment: 61 patients in need of surgical correction (SURG), 66 patients in need of non-surgical correction (NONS), and 66 control subjects with normal occlusion. Their dentofacial morphology was assessed using a specific Severity Score (SS), which was set up originally based on their cephalometric radiographs and their plaster models of arrangement of their teeth. The subjects also completed a generic QOL assessment questionnaire, the SF-36, and two disease-specific QOL instruments. The patients with malocclusions, especially SURG, had lower disease-specific QOL, although the generic QOL was equal to that of control subjects. Furthermore, in patients with the same severity of dentofacial deformities, especially SS 4 and SS 5, the borderline cases of surgical correction and non-surgical correction, there were differences between SURG and NONS in some items of the QOL. The severity of malocclusion evidently plays an important role in patients' choice of treatment, but also QOL appeared to play a significant role. The QOL assessment may contribute to the selection of the best treatment for improving QOL, especially for borderline cases with moderate degrees of orthodontic abnormality.

Comparison of three disease-specific quality-of-life questionnaires (Bristol Female Lower Urinary Tract Symptoms, Incontinence Quality of Life and King's Health Questionnaire) in women with stress urinary incontinence

To examine the impact of stress urinary incontinence (UI) on quality of life (QOL) using three disease-specific QOL instruments and compare the results obtained with these instruments. A total of 28 women (age range 36-74 years) with stress UI were included in the study. To obtain QOL assessments, patients were asked to complete the Bristol Female Lower Urinary Tract Symptoms (BFLUTS), Incontinence Quality of Life (I-QoL) and King's Health Questionnaire (KHQ) instruments. One domain in the BFLUTS (Incontinence symptoms) and one in the KHQ (Severity measures) correlated inversely with the Valsalva leak point pressure and the cough leak point pressure, respectively; however, other domains in the three questionnaires did not correlate with objective data. Two BFLUTS domains (Incontinence symptoms and QOL) correlated weakly or moderately with six KHQ domains; however, other BFLUTS domains did not correlate with most KHQ domains. Significant negative correlations were noted between two BFLUTS domains (Incontinence symptoms and QOL) and most I-QoL domains; however, other BFLUTS domains did not correlate with the I-QoL. Role limitations, Emotional problems and Severity measures in the KHQ correlated weakly or moderately with the I-QoL; however, General health and Personal relationships did not correlate significantly with the I-QoL. Subjective QOL results of stress UI using condition-specific QOL questionnaires may differ because there are a plethora of measurement instruments that vary in terms of their scope and content. Our findings suggest that, before deciding on an instrument, its contents should be thoroughly reviewed to ensure that a particular aspect of QOL does not need additional assessment.

Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence

A significant proportion of patients with primary biliary cirrhosis (PBC) suffer from severe fatigue. The aim of this study was to characterize patterns of daytime sleep in patients with PBC (using both objective and subjective assessment approaches) and to study the association between sleep abnormality and fatigue severity. Fatigue severity was assessed in 48 female subjects with PBC (using a disease-specific quality of life instrument (the PBC-40) and a generic fatigue measure (Fatigue Impact Scale [FIS]) as well as 48 case-matched normal controls. All participants also completed the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS, which assesses daytime hypersomnolence). Objective sleep assessment was performed using accelerometry over 7 days. Global sleep quality assessed by the PSQI was significantly lower in the PBC group compared to controls (P < .0001). ESS scores were significantly higher in patients with PBC than controls (P = .0001), suggesting significantly greater daytime somnolence in the patients with PBC. Objective sleep assessment confirmed that subjects with PBC were sleeping on average almost twice as long as controls during the daytime. Both degree of daytime somnolence (ESS) and actual daytime sleep activity (accelerometry) correlated strongly with fatigue severity in the patient group (r2 = 0.5, P < .0001 and r2 = 0.2, P < .01, respectively). In conclusion, Sleep abnormality, in the form of excessive daytime somnolence, is present in a significant proportion of patients with PBC, with the degree of daytime somnolence correlating strongly with the degree of fatigue. Existing agents effective at reducing daytime somnolence (such as modafinil) hold potential for the treatment of fatigue in PBC.

Improved quality of life after sympathetic block for upper limb hyperhidrosis

The aim of the study was to assess two disease-specific quality of life (QoL) instruments after limited endoscopic thoracic sympathetic block (TS) at T4 for upper limb hyperhidrosis. : Between 2001 and 2005, 112 patients underwent 223 TS procedures in a prospective study. Some 103 patients (92.0 per cent) had palmar, 87 (77.7 per cent) had axillary and 75 (67.0 per cent) had combined hyperhidrosis. QoL questionnaires devised by Keller et al. and Milanez de Campos et al. were employed before and after treatment. Mean(s.d.) follow-up was 21.9(10.1) months. A total of 106 patients (94.6 per cent) were evaluated. All patients with palmar hyperhidrosis were completely or almost dry after surgery. Side-effects of compensatory sweating and gustatory sweating were observed in 17.0 and 28.3 per cent of patients respectively. QoL improved after TS in 100 per cent (Keller) and 97.3 per cent (Milanez de Campos) of patients illustrated by ameliorated scores of 78.7 and 67.8 per cent, respectively (both P < 0.001). Both questionnaires showed that compensatory sweating resulted in reduced postoperative QoL (P = 0.011, Keller; P = 0.032, Milanez de Campos). Endoscopic sympathetic block at T4 leads to improved QoL. Both current questionnaires fulfilled validation criteria for disease-specific QoL instruments in upper limb hyperhidrosis.

Impact of stress urinary incontinence and overactive bladder on micturition patterns and health-related quality of life

We examined the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on micturition habits and health-related quality of life (QOL). A total of 250 Korean women were included in the study. The Medical Outcomes Study Short Form (SF-36) and the King's Health Questionnaire (KHQ) were used to assess QOL in the patient (SUI, n=158 and OAB, n=92) and control (n=70) groups. A control group was recruited at the Health Promotion Center of our hospital. Each of the dimension scores in the SF-36 represents better health, while that of the KHQ does worse health perception. On the frequency-volume charts, patients with OAB had more nighttime voids than those with SUI (P=0.001). Of the eight domains in the SF-36 questionnaire, four domains were significantly different between the control and OAB groups. Patients with SUI had a significantly lower score on one domain than the controls. Between the SUI and OAB groups, only one domain showed a significant difference. Regarding the KHQ, all domain scores in control subjects were significantly lower than those in the SUI and OAB groups. Between the SUI and OAB groups, the OAB group had higher scores on 'general health perception' and 'sleep/energy disturbances', while the scores of 'physical limitations' and 'severity measures' were higher in the SUI group. Women with OAB have a higher number of nocturic episodes than those with SUI, but the QOL is not less affected by SUI than by OAB. Furthermore, simultaneous disease-specific QOL instruments should be used in the evaluation of urinary incontinence because the generic QOL instrument is not a sensitive tool for measuring QOL in this population.

Long-term quality of life after total laryngectomy

There is a perception that a total laryngectomy has a devastating effect on patients and their families, but only a few studies have addressed long-term quality of life (QOL) after laryngectomy. A cross-sectional study of 49 patients more than 2 years since laryngectomy was performed with a general health status instrument (Short Form-12, version 2 [SF-12 v2.]) and a disease-specific QOL instrument (University of Washington Quality of Life questionnaire, version 4 [UW-QOL v4.]) in a national meeting of laryngectomy survivors. As measured by the UW-QOL, patients identified speech, appearance, and activity as the most important problems after total laryngectomy, but surprisingly, no correlation was seen between speech and overall QOL. Age was a predictor of appearance and anxiety, women were more likely to report difficulties swallowing, irradiated patients reported more difficulties with speech and anxiety, and patients who received chemotherapy were more likely to report difficulties with mood. The SF-12 captured no differences between normal subjects and laryngectomees in the physical summary domain (p = .21); however, laryngectomees scored better in the mental domain (p = .004). Laryngectomees had lower scores in physical function (p = .005) and role physical (p = .036). Long-term QOL is not decreased after total laryngectomy when it is measured with general health instruments and compared with the normal population, but impairment in physical scales is found when disease-specific questionnaires or subscale scores are included. Age, sex, radiation therapy, and chemotherapy are independent predictors of UW-QOL subscales. Voice handicap is identified as a problem but is not predictive of overall QOL. A strong relationship exists between UW-QOL and SF-12.

Quality of Life in Patients Undergoing Thyroid Surgery

The extent of thyroidectomy in the management of low-risk, well-differentiated thyroid carcinoma (WDTC) has been debated extensively. Our objective was to determine if hemithyroidectomy has a less detrimental effect on quality of life (QOL) than total thyroidectomy. Prospective, nonblinded, nonrandomized, cohort study. Tertiary care academic otolaryngology-head and neck surgery practice. Using both disease-specific and global QOL instruments, patients treated with either hemi- or total thyroidectomy were prospectively followed. QOL was assessed preoperatively and for 12 months postoperatively. Scores on the two QOL instruments throughout a 12-month postoperative period. Patients with cancer experienced a greater drop in QOL during the first 6 months following surgery when compared with patients with benign disease (p < .03). Additionally, patients treated with total thyroidectomy did not have a significantly different QOL than patients treated with hemithyroidectomy (p > .2). These results suggest that QOL is not significantly impacted by the extent of surgery and that QOL should not be a factor in the decision-making process for the treatment of low-risk WDTC.

Assessing the Validity and Responsiveness of Disease-specific Quality of Life Instruments in Intermittent Claudication

Purpose To recommend a suitable disease-specific quality of life (QOL) instrument for use in intermittent claudication (IC) based on validity and responsiveness. Methods Seventy claudicants completed two generic (SF36 and EUROQOL) and three disease-specific (CLAUS, VASCUQOL and SIP IC) QOL instruments prior to and 6 months after treatment (angioplasty or conservative therapy). Ankle brachial pressure indices and treadmill walking distances were measured at each assessment and International Society of Cardiovascular Surgery (ISCVS) recommended outcome measures were used to stratify the results. Construct and convergent-divergent validity was assessed for the three disease-specific QOL instruments. Responsiveness was assessed using effect sizes (effect size >0.5 is clinically significant). Results All clinical indicators improved significantly following treatment. All five domains of CLAUS, the VASCUQOL and SIP IC showed highly significant spearman correlation with intermittent claudication distance (ICD) and maximum walking distance (MWD) (0.267–0.697, p=0.01), suggesting good construct validity. There was greater correlation between like domains of CLAUS and SF36 than non-like domains suggesting good convergent-divergent validity. Pain domain of CLAUS and VASCUQOL could detect mild clinical improvement significantly (effect sizes 0.55 and 0.67). Pain and everyday life domain of CLAUS and the VASCUQOL could detect moderate clinical improvement significantly (effect sizes 0.7, 0.74 and 0.56, respectively). Conclusion The three disease-specific QOL instruments (CLAUS, VASCUQOL, SIP IC) showed a high degree of construct and convergent-divergent validity. Amongst the three disease-specific QOL instruments, the VASCUQOL was most responsive and we would recommend its use in clinical practice.

Creation of a Quality of Life Instrument for Nonmelanoma Skin Cancer Patients

Malignancies of the skin are the most common cancers among humans. The cervicofacial region is most affected by cutaneous malignancies, with approximately 80% of nonmelanoma skin cancers (NMSC) occurring in the head and neck. Treatment of cervicofacial skin cancers also is more likely to result in significant patient morbidity, because of the functional and cosmetic importance of this region. Unlike other malignancies, skin cancer has not been well investigated in terms of patient quality of life (QOL) assessment. Furthermore, no validated disease-specific QOL instrument currently exists for skin cancer. The aim of this study was to construct a new QOL instrument, The Facial Skin Cancer Index (FSCI), that captures the relevant QOL issues for NMSC patients. Cross-sectional study of patients presenting to a dermatologic surgery clinic with NMSC of the head and neck. For stage I, item generation, a sample of 20 patients with cervicofacial NMSC and six health care providers specializing in the care of NMSC patients completed semistructured interviews. For stage II, item reduction, a second sample (n = 52) of NMSC patients rated the items in terms of their importance for QOL among skin cancer patients. Domains of the FSCI were evaluated in terms of data quality, item variability, internal consistency, and range and skewness of scale score on aggregation and floor and ceiling effects. A total of 71 distinct items were generated in stage I. After using the outlined item reduction techniques in stage II, the FSCI was reduced from 71 to 36 items, representing 6 domains. With the exception of Physical Functioning (alpha = 0.63) that suggested adequate reliability, all subscale scores showed excellent reliability coefficients, with Cronbach's alpha ranging from 0.78 (Lifestyle) to 0.87 (Social/Family). A new disease-specific QOL instrument for patients with NMSC of the head and neck has been created. Validation studies are currently underway. Future directions will include sensitivity analysis to determine whether the FSCI is sensitive to change over time among patients undergoing treatment for NMSC.

Methodological issues and the measurement of fatigue in primary biliary cirrhosis

Methodological issues and the measurement of fatigue in primary biliary cirrhosis

Development and Pilot testing of a Disease-Specific Quality of Life Questionnaire for Adult Patients with Haemophilia (Haem-A-QoL).

Background: Haemophilia and its treatment influence the every-day-life of patients and impact on their quality of life. For the adequate assessment of quality of life validated instruments are necessary. While haemophilia-specific questionnaires for children are existing (v. Mackensen et al., 2004; Young et al., 2004), up to now no validated instrument for adults is available. Currently some developmental works are on-going in order to develop such an instrument as well for adults. In a multi-centre validation study a health-related quality of life questionnaire for adults with haemophilia was developed and pilot tested in Italy.Aim: This study was designed to develop and validate a haemophilia-specific quality of life measurement for adults (Haem-A-QoL) in Italy.Methods: The study consisted of three phases: a) a qualitative study including focus groups (with patients and physicians), item formulation and expert ratings of a catalogue of items by patients and physicians, b) a psychometric study including cognitive debriefing, and feasibility testing and c) data analysis. The qualitative study has been performed by the University of Hamburg in cooperation with the University of Milan.Results: Focus groups with semi-structured interviews were performed in 32 patients from 6 Italian haemophilia centres (Milan, Perugia, Genova, Bari, Castelfranco, Parma). 14 physicians and 8 nurses were asked the same questions. Patients and physicians/nurses consider similar dimensions important for quality of life. But the order of importance is different for patients (physical health, social interaction, dependence, future, work) and physicians/nurses (dependence, work, social interaction, treatment, physical health). Based on the focus group results a draft version of the questionnaire was formulated and given to patients and physicians in order to evaluate the items concerning importance for haemophilia and comprehensibility. The draft version consisted of 159 items. After expert evaluation the questionnaire was revised: several items could be eliminated and some were reworded. The revised version of the Haem-A-QoL consisting of 50 items and was psychometrically tested in 10 Italian centres. The pilot testing showed excellent psychometric characteristics in terms of reliability and validity (convergent, discriminant).Conclusions: The development of a disease-specific quality of life instrument requires multiple steps and the involvement of different experts (patients, physicians, nurses) in order to have a standardised and valid questionnaire. The Haem-A-QoL is well-accepted by adult haemophiliacs and proved to be a valid and reliable disease-specific self-report measurement for the assessment of quality of life in haemophiliacs. In a next step the Haem-A-QoL will be applied in clinical trials to evaluate patient perceptions of different treatment regimens in haemophilia.

Colorectal Cancer Screening and Treatment: Review of Outcomes Research

Colorectal cancer is the second leading cause of cancer deaths in the United States each year. Screening is effective in reducing colorectal cancer mortality; however, compliance with screening is poor, and factors associated with its compliance are poorly understood. The outcomes of treatment of colorectal cancer (surgery, radiation therapy, and chemotherapy) may have profound effects on quality of life (QOL). Furthermore, colorectal cancer screening and treatment may be expensive, and the costs are important from a policy perspective. This review examines patient-centered outcomes research related to colorectal cancer screening and treatment and outlines the work that has been done in several areas, including patient preferences, QOL, and economic analysis. The literature on the health outcomes associated with colorectal cancer screening and treatment was reviewed. A MEDLINE search of English language articles published from January 1, 1990 through February 2001, was conducted and was supplemented by a review of references of obtained articles. Criteria for study inclusion were identified a priori. A standardized data abstraction form was developed. Summary statistical analyses were performed on the results. Six hundred eighty-six articles were selected for review. In total, 530 articles were excluded because they either did not include patient-centered outcomes, were duplicate articles, or could not be obtained. There were 156 articles included in the analysis; 67 addressed screening, 18 examined surveillance of high-risk groups, 22 concerned treatment of local disease, 10 examined treatment of local and metastatic disease, and 19 considered treatment of metastatic disease only. One study examined end-of-life care. In 19 studies, the phase of care was unspecified. Standardized, disease-specific QOL instruments should be applied in clinical trials so that the results may be compared across different types of interventions. Valid and reliable methods that accurately capture patient preferences regarding screening and treatment should be developed.

Comorbidities affect the impact of urinary incontinence as measured by disease-specific quality of life instruments.

The aim of this study was to determine if the impact of urinary incontinence on activities of daily living, as measured by a disease-specific quality of life instrument, is dependent on comorbid conditions. Incontinent kidney transplant recipients participated in a survey to determine the impact of urinary incontinence on activities of daily living using the Incontinence Impact Questionnaire (IIQ-7). Similar information was collected from the charts of nontransplant incontinent women. Participants were matched for age, incontinence severity, pads per day, and leaks per day noted in a 3-day 24-h bladder diary. IIQ-7 scores from participants were compared using Mann-Whitney U tests. Nontransplant incontinent women reported a 200% greater affect of incontinence on activities of daily living than incontinent renal transplant recipients (35.5+/-26.5 vs 12.9+/-15.4, p<0.0001) despite similarities in incontinence severity measures. Urinary incontinence has less of an impact on activities of daily living for renal transplant recipients than nontransplant incontinent women with similar incontinence severity measures because the disease-specific quality of life instrument used in this study was sensitive to their comorbid condition (transplant status).

Quality of life instruments in studies of chronic pelvic pain: a systematic review

The use of quality of life (QoL) instruments in chronic pelvic pain (CPP) will allow a more objective assessment of patient-centred clinical outcomes. However, there is concern that not enough emphasis is placed on clinical face validity (i.e. issues which are of importance to patients and reflect their experiences and concerns). To explore this issue, we performed a systematic review of published research. Relevant papers were identified through electronic scanning of six electronic databases and by manual searching of bibliographies of known primary and review articles. Studies were selected if they assessed women with CPP for life quality, either developing QoL instruments or applying them as an outcome measure. Selected studies were assessed for the quality of their QoL instruments using a 17-item checklist, including 10 items for clinical face validity and seven items for measurement (psychometric) properties. A total of 19 articles were eligible for inclusion in the review. The generic Short Form 36 Health Survey Questionnaire (SF-36) was used most frequently, being employed in 10/19 (53%) of the studies. Three studies developed disease-specific QoL instruments for CPP complying with 59 - 77% of the quality criteria. Overall, quality assessment showed that only 4/18 (22.2%) studies complied with more than half the criteria for face validity, whereas 12/18 (66.6%) studies complied with more than half of the criteria for measurement properties (P = 0.0001). Among existing QoL instruments, compliance with the quality criteria for measurement properties is higher than for clinical face validity. There is a need to develop disease specific QoL instruments for CPP with face validity in addition to sound measurement properties.

Quality of life in relation to symptoms in patients with gastro‐oesophageal reflux disease — an analysis based on the ProGERD initiative

To determine the impact of gastro-oesophageal reflux disease (GERD) on the quality of life, to assess changes in the quality of life during treatment with esomeprazole and to define factors that can predict these changes. Patients with GERD (n=6215) were included in a prospective cohort study (ProGERD). All patients underwent endoscopy and received esomeprazole. At baseline and after 2 weeks of treatment, symptoms and quality of life were assessed. Factors that influenced changes in the quality of life were determined by multiple regression analyses. At baseline, the quality of life in GERD patients was lower than that in the general population, and was similar to that in patients after acute coronary events. No differences in symptoms or quality of life were observed between the subgroups of patients with non-erosive GERD, erosive GERD and Barrett's oesophagus. After treatment with esomeprazole, the symptoms and quality of life were improved in all subscales within 2 weeks (P<0.001). The mean score of the disease-specific quality of life instrument (Quality of Life in Reflux and Dyspepsia Patients) increased from 4.6 to 6.2 points, representing a highly relevant clinical improvement. The generic quality of life (SF-36) reached levels similar to those in the general population, but, again, no difference was found between the three different subgroups of GERD patients. The main factors associated with an improvement in the quality of life after treatment were symptom relief, severe erosive reflux disease, absence of extra-oesophageal disorders, avoidance of non-steroidal anti-inflammatory drug intake and positive Helicobacter pylori status. GERD causes a significant impairment in the quality of life that can be attenuated or normalized within a time period as short as 2 weeks by treatment with esomeprazole. These findings were similar across the whole GERD patient spectrum.

Health-related quality of life in patients with progressive supranuclear palsy.

We assessed health-related quality of life (QoL) of patients with progressive supranuclear palsy (PSP), identified the most important QoL issues in patients with this disorder, and assessed the usefulness of existing QoL measures in patients with PSP. Twenty-seven patients in all stages of PSP and their carers underwent a semistructured in-depth interview on the impact of PSP and a neurological examination. They were also asked to complete existing measures of QoL and depression. An item-pool of issues relevant to QoL of patients with PSP was created from the patient and carer interviews. Carers and patients largely agreed on issues relevant for patients' QoL but more carers than patients considered symptoms of frontal lobe dysfunction as problematic for the patients. There was no association of QoL with age and gender, as assessed in interviews and on two QoL instruments. QoL deteriorated with increasing disease duration and severity and greater cognitive impairment and was associated with worse depression scores. While the generic SF-36 was not found to be useful to assess QoL in PSP, feasibility and validity for the PDQ-39 and the EQ-5D were acceptable in this study. However, additional issues relevant to patients with PSP that were not addressed in these instruments included visual disturbances, dysarthria, dysphagia, muddled thinking, confusion, and apathy. The generic EQ-5D and the Parkinson's disease-specific PDQ-39 are useful instruments to assess QoL in patients with PSP. However, they lack questions on important aspects of QoL in PSP that were reported by patients and carers in semistructured interviews. The item pool created in these interviews provides the basis for the development of disease-specific QoL instruments for patients with PSP.

The psychometric properties of four quality of life instruments used in cardiovascular populations.

The psychometric properties of four quality of life instruments used in cardiovascular populations.

Disease-specific quality of life assessment in intermittent claudication: Review

Objectives: intermittent claudication (IC) is a common condition that has a major impact on the patients' quality of life (QoL). Generic QoL instruments often lack sensitivity to detect small but clinically significant variation in QoL. Disease-specific instruments may overcome this problem. This study aims to review various disease-specific QoL instruments available for use in IC and make recommendations for clinical utilization based on validity, reliability and responsiveness. Methods: a detailed literature search and extensive bibliography review of all papers relating to disease-specific QoL and IC. Results: several disease-specific QoL instruments are available for use in patients with IC. The most notable of these are the Claudication Scale (CLAU-S), Sickness Impact Profile—Intermittent Claudication (SIPIC) and the VascuQoL. The Walking Impairment Questionnaire (WIQ) is an objective measure of the patient's walking ability and not a QoL instrument. Conclusion: many of the questionnaires are new and have undergone only a limited validation process. More work is required in this field before any one disease-specific QoL instrument can be recommended for use in patients with IC.Eur J Vasc Endovasc Surg 25, 202–208 (2003)

Gastrointestinal Quality of Life Before and After Laparoscopic Heller Myotomy With Partial Posterior Fundoplication

To assess the outcome of laparoscopic Heller myotomy for achalasia using a specific quality of life (QoL) instrument for gastrointestinal disorders. Current therapies for achalasia do not restore normal esophageal motility but aim at palliating dysphagia. However, many other symptoms may persist that cannot be assessed objectively by currently available symptom scores. Although generic QoL instruments have shown improvement in QoL after myotomy, disease-specific QoL instruments may be more responsive to change and therefore more reliable for comparing outcomes of therapeutic options for achalasia. The Gastrointestinal Quality of Life Index (GIQLI) was studied before and after laparoscopic Heller myotomy associated with posterior partial fundoplication. Starting in January 1991, 73 consecutive patients were operated on laparoscopically for various clinical stages of achalasia. Since 1996, 40 patients completed a GIQLI questionnaire both preoperatively and after a minimum postoperative follow-up of 1 year. Median preoperative GIQLI score was 84 (range 34-129) out of a theoretical maximum score of 144. At a median follow-up of 31 months (range 12-54), the score had significantly improved to 119 (range 77-143), close to the range for the normal French population. Not only items assessing gastrointestinal symptoms but also the domains of physical, social, and emotional function were significantly improved. The most marked improvements were achieved in patients with the lowest preoperative scores. The GIQLI allows us to objectify the impact of achalasia symptoms on health-related QoL. At medium-term follow-up, laparoscopic Heller myotomy, performed either as primary treatment or after endoscopic dilation, significantly improves most health-related QoL aspects. Short of randomized comparisons between the different therapeutic options available for achalasia, reported series could be made more comparable if validated QoL instruments specific for gastrointestinal disorders were used routinely for outcome evaluation.