Domains Of Health-related Quality Research Articles

Stroke: patient characteristics and quality of life of caregivers.

to investigate the association between the domains of health-related quality of life of family caregivers and sociodemographic characteristics of individuals with stroke sequelae. descriptive, cross-sectional, quantitative research, conducted with 136 family caregivers of individuals with stroke sequelae by means of home interviews from April to June 2013. we found that caregivers of individuals aged under 65 years, married, with 10 to 12 years of formal education, presented higher scores, respectively, in the domains 'Social aspects', 'Emotional aspects', and 'Mental health'. However, caregivers of patients with higher degree of disability obtained lower score in the 'Mental Health' domain. the results foster reflection on the need of including the family caregivers of individuals with stroke sequelae in the planning of care provided by health professionals.

Issue Highlights

Issue Highlights

Health-related quality of life among osteoarthritis patients attending primary care clinics of Mangalore city

Introduction: Osteoarthritis (OA) of the knee is the most common type of arthritis of the elderly among Asians. Reports suggest that it affects the quality of life. Hence, this study was undertaken with the objective to know the impact of OA of the knee on 8 domains of health related quality of life (HRQoL) which include: (1) Physical functioning (PF), (2) role limitation due to physical health (RP). (3) Emotional well-being/mental health (MH), (4) role limitation due to emotional problems (RE), (5) energy/vitality, (6) social well-being (short form [SF]), (7) body pain, (8) general health. Materials and Methods: This cross-sectional study was conducted in primary care rural clinics situated on peripheral areas of Mangalore city. Total sample size was calculated to be 77. Patients who met the criteria of modified American Rheumatologic Association Classification for OA of knee were administered a SF-36 questionnaire to measure the HRQoL in the local language version. Mean scores (with its standard deviation) across each domain was calculated. Results: Of 80 patients, 38 were males. OA affected HRQoL. Four out 8 factors had more impact on HRQoL (they are PF, RP, MH, RE). Duration of OA is an important determinant on HRQoL. Patients with newer onset of OA ( 4 years) of OA (Domain, Mean), the emotional impact (MH, 44.67; RE, 45.67) reduced but the physical impact (PF, 47.83; RP, 19.75) persisted/got worse. Conclusion: Osteoarthritis had impact on HRQoL. Duration of OA determines the kind of impact. With the onset of OA emotional/mental support would be needed in addition to the medical treatment. As the disease progresses, they tend to cope with emotional/mental problems even as the physical problems persist/increase.

Treatment of low back pain: randomized clinical trial comparing a multidisciplinary group‐based rehabilitation program with oral drug treatment up to 12 months

This study aimed to examine the effects of a multidisciplinary treatment program on health-related quality of life of Iranian patients living with chronic low back, at 12months follow-up. This study is an extended follow-up of an original randomized, controlled trial with registration number NCT00600197. In the present study 87 patients in an intervention group and 91 patients in a control group were assessed at 12months follow-up. The intervention was a group-based multidisciplinary rehabilitation program which continued by monthly motivational consultation by telephone from 6 to 12months after intervention. Data from three standard measures, Short Form 36 (SF-36), QDS and RDQ were collected at 3, 6 and 12months follow-up and analyzed through repeated measures analysis of variance. Despite the similarity between the two groups who completed the 6month follow-up in terms of all baseline variables, there were significant differences between the two groups in all domains of the SF-36 scale, as well as QDS and RDQ scales (P<0.05). Also, there were differences within each group over time in the SF-36 domains and disability measurements (P<0.05). The physical function mean score differed significantly when the interaction between groups and time points was examined (P=0.02). This study indicates that the multidisciplinary program could improve the domains of health related quality of life and disability in chronic low back pain patients up to 12months.

Sexuality and breast cancer: prime time for young patients.

Sexuality and sexual functioning is a cardinal domain of health-related quality of life in breast cancer patients, namely in the younger population. Young women below 40 years of age go through a time in their lives where sexual self-identity has recently matured, their professional obligations are demanding and they bear interpersonal and childbearing expectations, all of which can suffer a devastating turnaround with cancer diagnosis and its physical and psychological aftermath. Although these women's sexuality and directed interventions have remained largely unaddressed so far, concepts are evolving and treatment options are becoming diversified, chiefly on the field of non-hormonal pharmacological therapy of sexual dysfunction. This review will examine the definitions of female sexual dysfunction, the etiology of the disorders in young breast cancer patients, the assessment methods, the non-pharmacological and pharmacological treatment options and the challenges that lie ahead.

AB0700 The reliability, validity and responsiveness of the thai version of systemic lupus erythematosus quality of life (SLEQOL-TH) instrument

BackgroundThe English version of the Systemic Lupus Erythematosus Quality of Life Questionnaire (SLEQOL) is a validated disease-specific quality of life instrument. According to the domains of health related quality of...

Life satisfaction and health related quality of life among low-income medical patients: The mediating influence of self-esteem

This study investigated the relationship between life satisfaction, self-esteem, and perceived health for an ethnically diverse, low SES sample of primary care patients. Results indicated that several specific domains of health-related quality of life (HRQL), including health perception, social functioning, mental health, and energy/fatigue, significantly predicted life satisfaction in this sample of 60 patients. Self-esteem mediated this relationship, partially with health perception and fully with the remaining three domains. The results of this study underscore the importance of healthcare interventions that consider the bidirectional relationship between physical and emotional well-being.

The Role of Self-Efficacy in Quality of Life for Disadvantaged Men With Prostate Cancer

Self-efficacy is associated with increased participation in treatment decision making and improved health related quality of life. We examined the influence of perceived efficacy in patient-physician interactions on health related quality of life among low income, uninsured men with prostate cancer during a 2-year period. We analyzed data derived on participants enrolled in a state funded program providing free prostate cancer treatment and care to indigent men. We used validated instruments to measure patient self-efficacy (confidence in interacting with physicians), and the general and prostate specific health related quality of life outcomes of urinary, sexual and bowel bother, symptom distress, psychological well-being and vitality. We performed repeated measures analysis with general linear mixed modeling to estimate the association of sociodemographic and clinical covariates with health related quality of life. Our cohort included a total of 472 observations in 99 men. Self-efficacy had a measurable effect on subjective measurements of general and disease specific health related quality of life. Men with the lowest self-efficacy had inferior mean health related quality of life scores across all outcomes. Low self-efficacy was significantly associated with worse bowel bother and general symptom distress during the 2-year study period. Similar health related quality of life outcomes trajectories were observed across self-efficacy categories. Of disadvantaged men with clinically localized prostate cancer those with the lowest self-efficacy in physician interactions fared worst across all measured domains of health related quality of life. Interventions to improve patient-physician communication in this population may provide physicians with a supplemental method by which to address health perceptions, mitigate symptom experience and improve health outcomes.

Which measures of physical function and motor impairment best predict quality of life in Parkinson’s disease?

IntroductionOur objective was to compare the relative value of elements of the motor system in predicting the physical mobility domain of health related quality of life in patients with Parkinson’s disease in order to specify targets for intervention. MethodsIn this cross-sectional study, the Parkinson’s disease questionnaire-39 was administered to 263 subjects with Parkinson’s disease to assess health related quality of life. Demographics, motor impairments and physical function were assessed using the Unified Parkinson disease rating scale, 10-m walk test, 6-min walk test, Freezing of gait questionnaire, Timed up & go, functional gait assessment, Berg balance test, functional reach and 9-hole peg test. ResultsThe results revealed that demographic factors accounted for 19.7% of the variance in Parkinson disease questionnaire-39 mobility score. When motor impairments were added to the model, the bradykinesia composite score contributed a significant portion of the variance (R2 change = 0.12, p < 0.001). The tremor and rigidity composite scores did not contribute significantly. The Freezing of gait questionnaire was the strongest predictor (R2 change = 0.23, p < 0.001) of the physical function tests followed by Functional gait assessment (R2 change = 0.06, p < 0.001) and 6-min walk test (R2 change = 0.01, p = 0.01). Collectively, 61% of the variance in Parkinson disease questionnaire-39 mobility score and 41.5% of the Parkinson disease questionnaire-39total score was accounted for. DiscussionThese results suggest greater value of physical function tests, and not tests of motor impairments, in predicting health related quality of life.

Developing a model of participation post-stroke: a mixed-methods approach.

PurposeTo develop and verify a model of participation post stroke, as a domain of health related quality of life.MethodsAn explanatory sequential mixed-methods design was selected. The quantitative phase developed a participation model with data from an observational study of 453 participants at 12 months post-stroke, using structural equation modeling. The qualitative phase followed to verify the model from the perspective of individuals post-stroke. Data was collected from two groups of eight stroke survivors involved in a multicentre trial about participation in the community. Individuals took photographs to describe participation; discussion of photographs was conducted over the course of three focus groups, and analysis identified emergent categories related to the model.ResultsThe 12-month post stroke participation model consisted of latent variables: accomplishment, restricted roles, and health efficacy. The model fit was reasonable: normed χ2 = 2.95, RMSEA = 0.066(0.052; 0.079). The qualitative data verified the model; participants initiated photo-taking and discussion of all aspects of the model. Concepts of social support, environment, and cognitive difficulties were also discussed in relation to participation.ConclusionsThe participation model was developed and verified. Additions to future models are suggested. Theoretical, clinical, and research implications are discussed.

Treatment of Lupus: Impact on Quality of Life

Systemic lupus erythematosus (SLE) is an autoimmune disease that disproportionately affects women of childbearing age during their most productive years. Current therapeutic measures have improved patient survival; however, the impact of interventions on general and specific domains of health-related quality of life requires further study. Medical Outcomes Survey Short Form 36 (SF-36), the most commonly used measure, has been included in some SLE randomized controlled trials, but the observed effect sizes were generally small and in some cases negligible. An SLE patient's quality of life is known to be significantly worse than that of someone in the general population and perhaps worse than those with most other common chronic diseases. SF-36, although useful as a general measure, may not be the most sensitive way to gauge changes perceived by patients with SLE. Ongoing trials and observational longitudinal studies using lupus-specific health-related quality-of-life measures may help better determine health-related quality-of-life responses and determine the domains most amenable to interventions.

M1381 Use and Helpfulness of Mechanism-Targeted Medical Pain Therapies in Chronic Pancreatitis

AIM: SF-36 Health Survey is a generic questionnaire designed as an assessment method of health status, using 36 questions that are grouped in eight scales: physical functioning (PF), role physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional functioning (RE), and mental health (MH). This study was designed to examine the quality of life (QOL) in patients with chronic pancreatitis (CP) of varying severity, and to determine the factors associated with poor physical and mental health. Material and method: We studied 104 pacients, (93.2% male and 6.8% female) from a tertiary care gastroenterology clinic. The diagnosis of chronic pancreatitis was made by a combination of morphologic, functional, and clinical findings. Data were obtained either by face-to-face interview (31%) or by telephone (69%). Results: The scale scores of PF, RP, BP, GH, VT, SF, RE, and MH were as follows: 58.7, 65.1, 77.6, 65.7, 54.4, 53.6, 69.4, and 66.9. When compared to the general population (values of mean SF-36 scores published 8 years ago by The National Institute of Statistics), all domains of health-related quality of life were reduced in CP, mainly in witch concernes PF (p=0.08), symptoms' severity (p=0.005) and the cognitive function impairment (p=0.004). Furthermore, regarding the severity of CP assessed by imagistic (CT, EUS and ERCP) and functional means (fecal elastase test), the 64 (61,7%) patiens meeting the stage III Cambridge criteria scored significantly worse then those in stage II (n=28, 27.1%); or I (n=12,11.1%) (p<0.005). Out of the various variables that we considered as possible factors related to CP (pancreatic calcifications, Wirsung duct dilatation, pseudocysts, pancreatic insufficiency, diabetes), only pain significantly impaired all eight domains (ANOVA, p< 0.0005 for all scales). Regarding the changes in pancreatic morphology, main pancreatic duct dilatation was the element that influenced the most QOL in CP. Patients presenting Between clinical variables patients presenting diabetes mellitus, pancreatic insufficiency and BMI < 19 scored worse mainly for physical domains Conclusion: Patients with CP presented an impaired QOLwitch wasmore important in the physical component than in the mental component. In our study, pain was the clinical element that impaired all 8 domain of SF-36, whereas pancreatic morphological changes, and other clinical elements influenced only some of these domains.

M1382 Nutritional Assessment of Patients With Chronic Pancreatitis and Impact of Dietary Advice

AIM: SF-36 Health Survey is a generic questionnaire designed as an assessment method of health status, using 36 questions that are grouped in eight scales: physical functioning (PF), role physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional functioning (RE), and mental health (MH). This study was designed to examine the quality of life (QOL) in patients with chronic pancreatitis (CP) of varying severity, and to determine the factors associated with poor physical and mental health. Material and method: We studied 104 pacients, (93.2% male and 6.8% female) from a tertiary care gastroenterology clinic. The diagnosis of chronic pancreatitis was made by a combination of morphologic, functional, and clinical findings. Data were obtained either by face-to-face interview (31%) or by telephone (69%). Results: The scale scores of PF, RP, BP, GH, VT, SF, RE, and MH were as follows: 58.7, 65.1, 77.6, 65.7, 54.4, 53.6, 69.4, and 66.9. When compared to the general population (values of mean SF-36 scores published 8 years ago by The National Institute of Statistics), all domains of health-related quality of life were reduced in CP, mainly in witch concernes PF (p=0.08), symptoms' severity (p=0.005) and the cognitive function impairment (p=0.004). Furthermore, regarding the severity of CP assessed by imagistic (CT, EUS and ERCP) and functional means (fecal elastase test), the 64 (61,7%) patiens meeting the stage III Cambridge criteria scored significantly worse then those in stage II (n=28, 27.1%); or I (n=12,11.1%) (p<0.005). Out of the various variables that we considered as possible factors related to CP (pancreatic calcifications, Wirsung duct dilatation, pseudocysts, pancreatic insufficiency, diabetes), only pain significantly impaired all eight domains (ANOVA, p< 0.0005 for all scales). Regarding the changes in pancreatic morphology, main pancreatic duct dilatation was the element that influenced the most QOL in CP. Patients presenting Between clinical variables patients presenting diabetes mellitus, pancreatic insufficiency and BMI < 19 scored worse mainly for physical domains Conclusion: Patients with CP presented an impaired QOLwitch wasmore important in the physical component than in the mental component. In our study, pain was the clinical element that impaired all 8 domain of SF-36, whereas pancreatic morphological changes, and other clinical elements influenced only some of these domains.

Health-Related Quality of Life in Adults With Hodgkin's Disease

Hodgkin's disease (HD) affects younger and older adults and can disrupt developmental tasks and cause multiple medical sequelae. Since long-term survival is excellent, understanding issues related to all domains of health-related quality of life (HRQOL)-physical, psychological, social/functional, and spiritual-after completion of treatment is a critical step in designing and testing interventions to improve survivors' adjustment and return to their previous level of functioning. This article is an integrative review of empirical studies of HRQOL in HD survivors. Following Ganong's guidelines, 35 studies were identified and reviewed. Commonly reported physical consequences of HD include fatigue, anticipatory nausea and vomiting, and cognitive problems that lasted several years after treatment completion, as well as long-term life-threatening adverse effects including secondary cancers and cardiovascular and respiratory complications. Psychological consequences include emotional distress, especially depression and anxiety, and social/functional difficulty, including inability to return to work and adjustment to the workplace environment secondary to diminished capacity to complete work tasks. Within the spiritual domain, survivors reported that they had a greater appreciation for life after treatment. Development of appropriate theory-guided interventions to improve the HRQOL for HD survivors can be achieved through more rigorous study designs and standardization of HRQOL measurements.

New treatment options in the management of fibromyalgia: role of pregabalin

Fibromyalgia (FM) is a common, chronic pain disorder with unknown etiology, characterized by widespread musculoskeletal pain and tenderness, and accompanied by several other symptoms such as sleep disturbance, fatigue, and mood disorders. Pregabalin is the first drug approved for the treatment of FM. Pregabalin has analgesic, anticonvulsant, and anxiolytic activity and has earlier demonstrated efficacy in the management of neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, and as adjuvant therapy for adult patients with partial onset seizures. Pregabalin, a lipophilic gamma-aminobutyric acid (GABA) analog, is alpha(2)delta-1 ligand that binds to, and modulates, voltage-gated calcium channels. This modulation is characterized by a reduction of the excessive neurotransmitter release that is observed in certain neurological and psychotic disorders. Several randomized, double-blind, placebo-controlled studies have demonstrated that pregabalin has been effective in pain management, improving sleep quality and fatigue, as well as in several domains of health related quality of life. Because of mild to moderate adverse effects it can be considered a well-tolerated therapy for FM.

Health-Related Quality of Life in Patients with Trachomatous Trichiasis or Entropion

Purpose: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. Methods: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision ≥ 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. Results: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision ≥ 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. Conclusions: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.

Depression and health-related quality of life in patients with rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory musculoskeletal disease with a prevalence rate of 1–3% in Western countries. In addition to limited physical function, rheumatoid arthritis patients also suffer from psychologic comorbidities. Depression in rheumatoid arthritis patients has been linked to disease outcomes such as increased healthcare service utilization and poor adherence to medication. This review focuses on the impact of depression on rheumatoid arthritis patient’s quality of life and how quality of life can be improved through the management of depression. Both generic and disease-specific instruments have been used to assess health-related quality of life in rheumatoid arthritis research. Commonly used instruments include the generic Short Form-36, the Nottingham Health Profile, the disease-specific Arthritis Impact Measurement Scale and the Rheumatoid Arthritis Quality of Life. Studies have shown that depression in rheumatoid arthritis patients may exert an important impact on multiple domains of health-related quality of life. Currently, depression in rheumatoid arthritis has been managed by both psychoeducation and antidepressant treatment. They are generally effective in improving clinical outcomes. However, future studies are needed to clarify whether they can improve patient reported quality of life. As depression is a prevalent comorbidity in rheumatoid arthritis, clinicians should pay more attention to the rheumatoid arthritis patient’s psychologic wellbeing. Screening for depression and other psychologic distress should be recognized as an important process in the routine clinical care of patients with rheumatoid arthritis.

WW17: SELECTING HEALTH-RELATED QUALITY-OF-LIFE MEASURES: FIRST PRINCIPLES

WORKSHOP OBJECTIVE: The purpose of this workshop is to develop skills for evaluating alternative measurement strategies for assessing health outcomes and health-related quality of life in clinical trials and pharmacoeconomic studies. A key to having an assessment strategy that leads to meaningful results is the selection of instruments that measure domains of health-related quality of life that are relevant for the purpose of study and target population. We will present and discuss an approach for systematically evaluating questionnaires, rating scales and classification systems for use, singly or in combination, in different types of studies. PARTICIPANTS WHO WOULD BENEFIT: Pharmacoeconomic and health outcomes researchers who want to increase their understanding of the issues involved in selecting meaningful and responsive quality of life instruments for use in clinical trials and other evaluative studies. Health outcomes and quality-of-life assessment is becoming increasingly important in the evaluation of pharmaceutical products, in terms of labeling claims and product promotion as well as in terms of formulary decisions. Each of these applications requires an assessment strategy that provides information relevant for decision-making. How is a successful assessment strategy developed? What criteria, including reliability, validity and responsiveness, should be used when evaluating instruments for use in a clinical trial or pharmacoeconomic study? This workshop will address these questions and introduce an analytic framework that participants can apply in their daily experience.

The effect of individually assessed preference weights on the relationship between holistic utilities and nonpreference-based assessment.

In the assessment of health-related quality of life, nonpreference-based methods usually show only moderate correlations with utility-based measures. One cause may be that patients assign different weights to the various domains of health-related quality of life, for which nonpreference-based methods usually do not allow. Utilities reflect a weighted sum of these domains. The aim of this study is to assess whether the relationship between utility-based methods and nonpreference-based measures improves through the use of individual importance weights for the various domains of health-related quality of life. For this purpose, weights were obtained from 41 early-stage breast cancer patients, both before and during treatment, for seven pre-selected health status attributes representing important domains of health-related quality of life during chemotherapy. The importance weights were combined with the level of functioning on the attributes. These scores were regressed against patients' utilities for their actually experienced health state during chemotherapy, measured by means of a visual analog scale (VAS), a time trade-off (TTO), and a standard gamble (SG). Before weighting, the seven attribute scores were more strongly related to TTO and SG utilities than the nonpreference-based questionnaires. However, when they were combined with the importance weights, only the correlation with the SG utilities improved, and only so with the importance weights obtained before chemotherapy. In this study, assigning individually assessed preference weights to self-reported level of functioning did not result in stronger relationships with utilities.

Effects of ACE inhibitor therapy on quality of life in patients with heart failure.

In addition to effects on survival, hemodynamics, and exercise capacity, quality of life has become an important outcome of therapy for chronic heart failure. A large clinical trial of the angiotensin-converting enzyme (ACE) inhibitor enalapril reports that certain domains of health-related quality of life (HRQL) have a long-term impact on survival in patients with reduced left ventricular systolic function, regardless of symptoms of heart failure at diagnosis. Results of large-scale clinical trials that measured the impact of several different ACE inhibitors on quality of life in these patients suggest benefits of the drugs, but data are confounded by a definite placebo effect. Studies are further confounded by high noncompletion rates for sicker patients, particularly beyond 1 year. Because measurement tools varied and different quality of life domains were evaluated, direct comparison of studies is problematic. Typically, HRQL measurements in patients receiving ACE inhibitors showed small improvement or did not differ significantly from those in placebo-treated patients with long-term follow-up, although short-term trials (< 6 mo) showed some benefit. Moreover, multicenter trials such as SOLVD, V-HeFT II, and ramipril studies indicated that ACE inhibitors do not compromise and may actually improve certain components of quality of life in a large number of patients with chronic heart failure secondary to reduced left ventricular systolic function while having favorable effects on survival, exercise capacity, hemodynamics, or symptoms.