EQ-5D Questionnaire Research Articles

The results of the assessment of burnout syndrome in outpatient clinic staff for the development of personalized rehabilitation

In conditions of increased workload on the medical staff of outpatient clinics, the need to preserve their physical and mental health, reduce the socially significant consequences of emotional burnout comes first, which makes it necessary to search for new directions of prevention, correction and rehabilitation using personalized medicine methods. The study aims to assess the state of health and the syndrome of emotional burnout in medical workers of the outpatient clinic. Specialists have examined 100 medical workers of outpatient and inpatient departments of the medical institution in equal numbers. The average age of outpatient medical staff was 49 [46;59] years, and inpatient — 43 [33;53] years. The average work experience of the examined medical personnel was the same both in outpatient settings (20 [16;28] years) and in hospital (20 [13;31] years). The authors have performed general clinical, laboratory and instrumental examinations. In addition to the standard examination scheme, the scientists assessed emotional burnout using the V.V. Boyko method and the quality of life according to the EQ-5D questionnaire in modification 3L and the hospital anxiety and depression scale HADS, and also conducted a questionnaire on a new coronavirus infection and the detection of post-COVID syndrome. As a result of the study, the authors proved a decrease in the psychological and physical components of the quality of life of medical workers, which are associated with both work experience and a new coronavirus infection. It was confirmed that according to the results of the Boyko questionnaire, employees of the outpatient clinic, compared with their colleagues from the hospital, often have a higher unfavorable total score. According to the results of the survey, we observe an improvement in the psychological and physical components of the quality of life of medical personnel after individual rehabilitation. This study showed the importance of assessing the state of health and emotional burnout syndrome in medical workers, high scores were revealed according to the Boyko questionnaire. Limitations. This study is limited to a sex-and-age sample of medical staff at a medical institution. Ethics. The study was conducted in accordance with the Helsinki Declaration "Recommendations for Doctors on Biomedical research in Humans" (2013), the World Association "Ethical Principles of Scientific Medical Research with Human Participation" as amended in 2000 and the "Rules of Clinical Practice in the Russian Federation", approved by Order of the Ministry of Health and Social Development of the Russian Federation No. 266 dated 06/19/2003, according to the developed protocol.

Quality of life of inflammatory bowel diseases patients in france with EQ-5D-5L: the QALY-MICI study.

This study aimed to document utility values and the Visual Analog Scale (VAS) with the 5-level version of the EQ-5D questionnaire in a large sample of patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). QALY-MICI was a cross-sectional survey across three sources in France. Data were collected between 2019 and 2022 for patients 18 and over. The EQ-5D-5L, the EQ-VAS, the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), the Harvey-Bradshaw Index (HBI) for CD, and the Walmsley Index for UC (SCCAI) were collected. A total of 2,841 patients aged over 18 were recruited (1785 with CD, 1056 with UC). The mean age was 40.2 (SD 14.3). The time since diagnosis was 6 years and over for 61.9% of patients. The most impacted dimensions were usual activities, anxiety/ depression, and pain/ discomfort. The mean utility value was 0.863 (SD 0.172) versus 0.905 (SD 0.158) in the French population (p = 0.007). The mean VAS value was 68 (SD 19.2) versus 73.4 (SD 22.2) in the general population (p = 0.016). Utility values and VAS were similar for CD and UC and higher for men. There was a strong positive correlation between utility values, the VAS, and the SIBDQ score, and a negative correlation between the HBI and the SCCAI. The SIBDQ score and disease activity were the main predictors of utility and VAS. The QALY-MICI is, to our knowledge, the first study documenting utility values and VAS using the EQ-5D-5L questionnaire on a large sample, with a comparison to the general population.

The validity and reliability of the Arabic version of the EQ-5D in atrial fibrillation patients in a conflict country: a study from Syria

BackgroundThe EQ-5D is one of the most commonly used tools to establish health-related quality of life (QoL). EQ-5D data in atrial fibrillation (AF) patients in the Middle East are lacking.ObjectivesThis study aims to evaluate the reliability and validity of the Arabic version of the EQ-5D in AF inpatients in Syria.MethodsThe study involved patients admitted to the emergency department of Tishreen’s University Hospital in Latakia with AF as the primary diagnosis between the 1st of June 2021 and the 1st of June 2023. Arabic versions of the EQ-5D, EQ-VAS and SF36 questionnaires were administered to patients. Validation was done using convergent, discriminant, and known-groups validity, while reliability was conducted using EQ-5D retesting within 2–4 weeks.Results432 participants were included in the study with a mean ± standard deviation of 63 ± 15. Males represented 242 (56%) of the participants. All hypotheses relating EQ-5D responses to external variables were satisfied. All three validation hypotheses demonstrated that the EQ-5D had the convergent, discriminant and known group validity to assess QoL in this cohort. The intraclass correlation coefficient (ICC) for test-retest reliability ranged between 0.74 and 0.88, while Cohen’s κ ranged between 0.72 and 0.86. Cronbach’s α value for internal consistency was 0.73.ConclusionThe Arabic version of EQ-5D was valid and reliable in measuring QoL in AF inpatients in Syria. This validation opens the door for more widespread use of the EQ-5D in Arabic-speaking regions, facilitating better-informed healthcare decisions and improving patient care strategies in Syria and other Middle Eastern countries.

КАЧЕСТВО ЖИЗНИ И КОГНИТИВНЫЕ НАРУШЕНИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Abstract. Вackground. Chronic heart failure (CHF) has a high prevalence in the Russian population. It is one of the main causes of reduced quality of life in cardiology patients due to the gradual progression of the disease and the development of complications, as well as the development of cognitive impairment. Early recognition of these disorders will optimize the management of patients with CHF. Purpose of the study. To evaluate the quality of life and cognitive functions in patients with different severity of chronic heart failure. Characterization of patients and methods of the study. 105 patients with confirmed diagnosis of CHF with different functional classes according to NYHA were included in the open cross-sectional non-randomized cohort study. Cognitive screening was performed using the Montreal Cognitive Assessment (MoCA), and quality of life was assessed by the Quality of Life Questionnaire (EQ-5D). Statistical Analysis Methods. Excel data analysis package and SPSS 23.0 data analysis package were used. Results and Conclusion. A pilot study was conducted to detect mild or severe cognitive impairment using the Montreal Cognitive Scale and quality of life using the EQ-5D questionnaire in patients with different functional classes of CHF. A significant correlation was found between cognitive function and left ventricular ejection fraction. Quality of life did not depend on the severity of CHF, sex, age, concomitant pathology. The obtained data should be taken into account in personalized management of patients with CHF.

Comparison of the quality of life in peritoneal dialysis and hemodialysis patients

Chronic kidney disease (CKD) has a profound impact on patients' health-related quality of life (QoL). Particular problems are caused by the end-stage disease, which leads to the need for renal replacement therapy (RRT). Physicians and patients face the challenge of choosing a type of RRT. In this case, it is necessary to take into account not only survival rates but also the quality of life of patients who undergo the therapy, because the ability to function and maintain well-being is one of the treatment goals recommended by the World Health Organization. Therefore, assessing QoL and identifying factors influencing it becomes increasingly important in terms of therapy effectiveness and measures aimed at improving outcomes. The purpose of this work was to review recent scientific studies assessing the quality of life among peritoneal dialysis (PD) and hemodialysis (HD) patients, as well as identifying the better RRT type and risk factors that affect the quality of life. In order to identify the most relevant RRT type, the general questionnaires SF-36 and EQ-5D were used. A search for scientific studies was carried out in the international PubMed/MEDLINE database in April 2024 using the keywords: chronic kidney disease, quality of life, SF-36, EQ-5D, hemodialysis, and peritoneal dialysis. We selected papers published from 2018 to 2024 where the quality of life of patients with CKD receiving such RRT types as hemodialysis and peritoneal dialysis was studied. The results showed that PD is more preferable than HD. To achieve a high quality of life, it is also necessary to carefully treat disorders of calcium and phosphate metabolism and anemia, adequately manage concomitant diseases, assist patients with medical care provided at home, organize educational programs to increase patients’ self-efficacy and self-management, and provide psychological assistance if necessary.

Évaluation préliminaire de l'intérêt d'une cellule d'optimisation thérapeutique sur la titration des traitements de l'insuffisance cardiaque à fraction d’éjection ventriculaire gauche réduite et la qualité de vie des patients

IntroductionA multidisciplinary therapeutic optimization unit (COT) was created in January 2023 at Versailles Hospital, aimed at therapeutic optimisation of patients with chronic heart failure with reduced left ventricular ejection fraction. The objective of the study was to assess the impact of the first year of COT activity on the sequential implementation and titration of heart failure treatments, the clinical evolution, and improvement of patients’ quality of life. MethodsThis prospective study included consecutive patients treated by the COT after hospitalisation for acute heart failure, from January to December 2023. Clinical, biological, titration, and tolerance data were analysed. Quality of life was assessed at baseline and at the end of the follow-up by COT, using standardized SF-12 and EQ-5D questionnaires. ResultsWe included 90 patients (men 73%, mean age 67 years). The mean left ventricular ejection fraction was 34 ± 10 %. At final visit (median number of visits 4 ; median follow-up duration 156 days), 76.7% of patients achieved optimisation with respect to maximum individually tolerated doses, but only 13.3% with respect to theoretical maximum doses for the four therapeutic classes. At 1-year follow up, total mortality was 4.4% (4/90), and 9 patients (10%) were rehospitalised unplanned for acute heart failure. COT monitoring was associated with significant improvement in NYHA class, left ventricular ejection fraction, and SF-12 and EQ-5D-5L quality of life scores. ConclusionAlthough titration of heart failure treatments remained suboptimal, significant improvement was observed for NYHA class, left ventricular ejection fraction, and patient quality of life parameters.

Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial

None of the spironolactone trials in heart failure (HF) assessed the blood pressure (BP) responses to exercise, while conflicting results were reported for exercise capacity. In the HOMAGE trial, 527 patients at increased HF risk were randomized to usual treatment with or without spironolactone (25–50 mg/day). The current substudy included 113 controls and 114 patients assigned spironolactone, who all completed the incremental shuttle walk test at baseline and months 1 and 9. Quality of life (QoL) was assessed by EQ5D questionnaire. Between-group differences (spironolactone minus control [Δs]) were analyzed by repeated measures ANOVA with adjustment for baseline and, if appropriate, additionally for sex, age and body mass index. Δs in the pre-exercise systolic/diastolic BP were −8.00 mm Hg (95% CI, −11.6 to −4.43)/−0.85 mm Hg (−2.96 to 1.26) at month 1 and −9.58 mm Hg (−14.0 to −5.19)/−3.84 mm Hg (−6.22 to −1.47) at month 9. Δs in the post-exercise systolic/diastolic BP were −8.08 mm Hg (−14.2 to −2.01)/−2.07 mm Hg (−5.79 to 1.65) and −13.3 mm Hg (−19.9 to −6.75)/−4.62 mm Hg (−8.07 to −1.17), respectively. For completed shuttles, Δs at months 1 and 9 were 2.15 (−0.10 to 4.40) and 2.49 (−0.79 to 5.67), respectively. Δs in QoL were not significant. The correlations between the exercise-induced BP increases and the number of completed shuttles were similar in both groups. In conclusion, in patients at increased risk of developing HF, spironolactone reduced the pre- and post-exercise BP, but did not improve exercise capacity or QoL.

Accelerometer-Based Physical Activity and Health-Related Quality of Life in Korean Adults: Observational Study Using the Korea National Health and Nutrition Examination Survey.

Health-related quality of life (HRQoL) reflects an individual's perception of their physical and mental health over time. Despite numerous studies linking physical activity to improved HRQoL, most rely on self-reported data, limiting the accuracy and generalizability of findings. This study leverages objective accelerometer data to explore the association between physical activity and HRQoL in Korean adults. The objective of this study is to analyze the relationship between objectively measured physical activity using accelerometers and HRQoL among Korean adults, aiming to inform targeted interventions for enhancing HRQoL through physical activity. This observational study included 1298 participants aged 19-64 years from the Korea National Health and Nutrition Examination Survey (KNHANES) VI, who wore an accelerometer for 7 consecutive days. HRQoL was assessed using the EQ-5D questionnaire, and physical activity was quantified as moderate-to-vigorous physical activity accelerometer-total (MVPA-AT) and accelerometer-bout (MVPA-AB). Data were analyzed using logistic regression to determine the odds ratio (ORs) for low HRQoL, adjusting for socioeconomic variables and mental health factors. Participants with higher HRQoL were younger, more likely to be male, single, highly educated, employed in white-collar jobs, and had higher household incomes. They also reported less stress and better subjective health status. The high HRQoL group had significantly more participants meeting MVPA-AB ≥600 metabolic equivalents (P<.01). Logistic regression showed that participants meeting MVPA-AB ≥600 metabolic equivalents had higher odds of high HRQoL (OR 1.55, 95% CI 1.11-2.17). Adjusted models showed consistent results, although the association weakened when adjusting for mental health factors (OR 1.45, 95% CI 1.01-2.09). The study demonstrates a significant association between HRQoL and moderate to vigorous physical activity sustained for at least 10 minutes, as measured by accelerometer. These findings support promoting physical activity, particularly sustained moderate to vigorous activity, to enhance HRQoL. Further interventional studies focusing on specific physical activity domains such as occupational, leisure-time, and commuting activities are warranted.

Developing an 8-Week, Tele-Education Weight Control and Exercise Programme, and Evaluating Its Effects on Weight and Pain Reduction in Patients With Obesity and Knee Osteoarthritis: A Double-Blinded Randomised Clinical Trial.

Knee osteoarthritis (OA) is a leading cause of disability among the elderly and is often exacerbated by obesity. Research supports weight loss and exercise therapy as key strategies for managing knee OA-related disability. Concurrently, telemedicine is becoming a popular healthcare approach. This study aimed to develop and evaluate an 8-week tele-education programme's impact on weight control and knee OA outcomes. Participants with knee OA and obesity were included. Baseline data on pain (VAS index), physical activity (GPAQ questionnaire), and quality of life (EQ5D and KOOS questionnaires) were collected. Performance tests, including the 30-second Chair Stand test (30CST) and the Timed Up-and-Go test (TUG), were recorded. Participants were randomly divided into two groups: a control group receiving oral advice on diet and exercise, and an intervention group receiving educational videos on nutrition, lifestyle changes, physical activity, individualised exercises, and psychosocial support. Evaluations were repeated after 8weeks. Data from 25 of 30 participants were analysed. In the intervention group, body composition, waist, and abdominal circumference decreased significantly (p<0.05). The KOOS questionnaire showed significant improvements in pain, activity, and daily tasks (p=0.00). The EQ5D questionnaire and health satisfaction also showed positive results within the intervention group (p=0.00) and between groups (p=0.008). The pain index improved significantly within (p=0.00) and between groups (p=0.02). Functional test results were significant within the intervention group (p=0.00) and between groups (p=0.017 for 30CST and p=0.004 for TUG). An 8-week tele-education programme for weight control and exercise therapy in knee OA patients significantly improved body composition, quality of life, and functional performance. Given the costs of obesity and knee OA on both people and the health system, tele-education can be a cost-effective treatment strategy.

Effects of beta-blockers on quality of life and well-being in patients with myocardial infarction and preserved left ventricular function-a prespecified substudy from REDUCE-AMI.

In the Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction (REDUCE-AMI) study, long-term beta-blocker use in patients after acute myocardial infarction (AMI) with preserved left ventricular ejection fraction demonstrated no effect on death or cardiovascular outcomes. The aim of this prespecified substudy was to investigate effects of beta-blockers on self-reported quality of life and well-being. From this parallel-group, open-label, registry-based randomized clinical trial, EQ-5D, and World Health Organization well-being index-5 (WHO-5) questionnaires were obtained at 6-10 weeks and 11-13 months after AMI in 4080 and 806 patients, respectively. We report results from intention-to-treat and on-treatment analyses for the overall population and relevant subgroups using Wilcoxon rank sum test and adjusted ordinal regression analyses. Of the 4080 individuals reporting EQ-5D (median age 64 years, 22% female), 2023 were randomized to beta-blockers. The main outcome, median EQ-5D index score, was 0.94 [interquartile range (IQR) 0.88, 0.97] in the beta-blocker group, and 0.94 (IQR 0.88, 0.97) in the no-beta-blocker group 6-10 weeks after AMI, OR 1.00 [95% CI 0.89-1.13; P>0.9]. After 11-13 months, results remained unchanged. Findings were robust in on-treatment analyses and across relevant subgroups. Secondary outcomes, EQ-VAS and WHO-5 index score, confirmed these results. Among patients after AMI with preserved left ventricular ejection fraction, self-reported quality of life and well-being was not significantly different in individuals randomized to routine long-term beta-blocker therapy as compared to individuals with no beta-blocker use. These results appear consistent regardless of adherence to randomized treatment and across subgroups which emphasizes the need for a careful individual risk-benefit evaluation prior to initiation of beta-blocker treatment.

Quality of Life is an Independent Predictor of Mortality in Patients with Heart Failure: A Prospective Cohort Study from the Colombian Heart Failure Registry (RECOLFACA).

Patients with Heart Failure (HF) commonly have poor quality of life (QoL), secondary to the persistence and severity of HF symptoms. We aimed to evaluate the prognostic value of QoL measures on all-cause mortality in patients with HF from the Colombian registry of heart failure (RECOLFACA). We analyzed data from patients registered in RECOLFACA during 2017-2019. QoL was measured using the EuroQol-5D questionnaire (EQ-5D). From the questionnaire, two independent predictors of mortality were obtained, the visual analogue scale (VAS) and the utility score (US). Primary outcome was all-cause mortality, and secondary variables evaluated were demographic factors, comorbidities, NYHA classification, medications used and laboratory test results. To analyze survival among patients, the Kaplan-Meier method and the hierarchical Cox proportional-hazards regression model were used. This study included 2514 patients from RECOLFACA. Most patients were male (57.6%), and mean age was 67.8 years. Mean value and standard deviation (SD) of the VAS score was 78.8 ± 20.1 points, while the mean and SD of the US score was 0.81 ± 0.20. As the Kaplan-Meier curve illustrated, patients in the lower quartiles of both VAS and US scores had a significantly higher probability of mortality (log-rank test: p<0.001 for both scores). QoL, as calculated by the EQ-5D questionnaire, served as an independent predictor of mortality in patients from RECOLFACA. Further studies may be needed to evaluate whether provision of optimizing therapies and follow-up care based on patients' perceived QoL reduces short- and long-term mortality rates in this population.

Nationwide cost-effectiveness and quality of life analysis of minimally invasive distal pancreatectomy

BackgroundThis study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP).MethodsConsecutive patients submitted to LDP or RDP from 2010 to 2020 in four high-volume Italian centers were included, with a minimum of 12 months of postoperative follow-up were included. QoL was evaluated using the EORTC QLQ-C30 and EQ-5D questionnaires, self-reported by patients. After a propensity score matching, which included BMI, gender, operation time, multiorgan and vascular resections, splenic preservation, and pancreatic stump management, the mean differential cost and Quality-Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane.ResultsThe study population consisted of 564 patients. Among these, 271 (49%) patients were submitted to LDP, while 293 (51%) patients to RDP. After propensity score matching, the study population was composed of 159 patients in each group, with a median follow-up of 59 months. As regards the QoL analysis, global health and emotional functioning domains showed better results in the RDP group (p = 0.037 and p = 0.026, respectively), whereas the other did not differ. As expected, the median crude costs analysis confirmed that RDP was more expensive than LDP (16,041 Euros vs. 10,335 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay more than 5697 Euros/QALY was accepted.ConclusionRDP was associated with better QoL as explored by specific domains. Crude costs were higher for RDP, and the cost-effectiveness threshold was set at 5697 euros/QALY.

Development and implementation of a digital health intervention (DHI) electronic patient-reported outcome measure (ePROM) platform to monitor patients with cancer.

163 Background: Cancer is heterogeneous diseases associated with a significant burden of symptoms and treatment-related adverse events. Digital Health Interventions (DHIs) emerge as promising tools for active/continuous monitoring of patients (pts). Evidence suggests that DHIs may enhance healthcare delivery and improve clinical outcomes by facilitating symptom detection and enabling more effective real-time informed decisions. We aim to develop and implement an electronic Patient-reported Outcome Measure (ePROM) platform to monitor pts undergoing cancer treatment. Methods: We developed ThummiOnco, a DHI ePROM platform designed for monitoring of pts during cancer treatment. It allows pts to report their symptoms (reported and graded according to the CTCAE), quality-of-life (QoL) (EORTC EQ-5D questionnaire), emotional state, treatment adherence (Morisky-Green questionnaire), Emergency Room (ER) visits and hospitalizations through a mobile application. Upon registration, pts consent to share their data with their medical team and provide essential demographic information such as age, sex, cancer type, and treatment regimen. A medical algorithm analyzes the collected data to generate instant personalized recommendations and guidance, including indicating the need of seeking emergency care in the case of serious high-grade or worrisome complaints. Patients also have the option to engage in real-time conversations with the medical team through an online chat feature. Treating physicians and the medical team can continuously access pts data real-time, through an online dashboard, enabling them to visualize information and statistics, address symptom alerts, and make informed management decisions. ThummiOnco is available at no cost to pts at htt ps://thummi.global . Results: Between August 2021 and March 2024, ThummiOnco monitored 925 pts across 7 institutions in Brazil, encompassing both private and public health systems. The majority of pts (72%) were female, with 28% being male. The most frequently monitored cancer types were Breast Cancer (39%), Lung Cancer (7%) and Colon Cancer (6%). During this period, a total of 71.373 interactions were recorded, including 36.175 (51%) chat messages, 21.644 (30%) symptom reports, 10.597 (15%) emotional state reflections, 2.819 (4%) QoL assessments, and 138 (0.2%) ER registries. A total of 23 different symptoms were reported, with the most frequent being: fatigue (16%), joint pain (8%), and nausea (7%). 13.187 (61%) grade 1, 6.545 (30%) grade 2, and 1.912 (9%) grade 3 symptoms were registered. In total, the medical algorithm generated 1.921 recommendations for seeking emergency care. Conclusions: ThummiOnco's capacity to detect a wide range of symptoms and enable real-time informed decisions underscores its potential to enhance patient outcomes and healthcare service delivery.

Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial

Long-term data showing the benefits of endovascular thrombectomy for stroke with large infarct are scarce. The TENSION trial showed the safety and efficacy of endovascular thrombectomy in patients with ischaemic stroke and large infarct at 90 days. We aimed to investigate the safety and efficacy at 12 months of endovascular thrombectomy in patients who were enrolled in the TENSION trial. TENSION was an open-label, blinded endpoint, randomised trial done at 40 hospitals across Europe and one hospital in Canada. We included patients (aged ≥18 years) with acute ischaemic stroke due to large vessel occlusion in the anterior circulation and who had a large infarct, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) of 3-5 on standard-of-care stroke imaging. We randomly assigned patients (1:1) to receive either endovascular thrombectomy with medical treatment or medical treatment only up to 12 h from stroke onset. The primary outcome was functional outcome across the entire range of the modified Rankin Scale at 90 days. Here, we report the prespecified 12-month follow-up analyses for functional outcome (using the simplified modified Rankin Scale questionnaire), quality of life (using the Patient-Reported Outcomes Measurement Information System 10-item [PROMIS-10] and EQ-5D questionnaires), post-stroke anxiety and depression (using the Patient Health Questionnaire-4 [PHQ-4]), and overall survival. Outcomes (except survival) were assessed in the intention-to-treat population; the survival analysis was based on treatment received. This trial is registered with ClinicalTrials.gov, NCT03094715, and is completed. We enrolled patients between July 17, 2018, and Feb 21, 2023, when the trial was stopped early for efficacy. 253 patients were randomly assigned, 125 (49%) to endovascular thrombectomy and 128 (51%) to medical treatment only. Median follow-up was 8·36 months (IQR 0·02-12·00). Endovascular thrombectomy was associated with a shift in the distribution of scores on the modified Rankin Scale towards better functional outcome at 12 months (adjusted common odds ratio 2·39 [95% CI 1·47-3·90]). Endovascular thrombectomy was also associated with a better quality of life compared with medical treatment only, as reflected by median scores on the EQ-5D questionnaire index (0·7 [IQR 0·4-0·9] vs 0·4 [0·2-0·7]), median scores for health status on the EQ-5D questionnaire visual analogue scale (50 [IQR 35-70] vs 30 [5-60]), and median global physical health scores on the PROMIS-10 questionnaire (T-score 39·8 [IQR 37·4-50·8] vs 37·4 [32·4-44·9]); although there was not enough evidence to suggest a difference between groups in global mental health scores on PROMIS-10 (41·1 [IQR 36·3-48·3] vs 38·8 [31·3-44·7]) or the numbers of patients reporting anxiety (13 [22%] of 58 vs 15 [42%] of 36) and depression (18 [31%] vs 18 [50%]) on PHQ-4. Overall survival was slightly better in the endovascular thrombectomy group compared with medical treatment only (adjusted hazard ratio 0·70 [95% CI 0·50-0·99]). In patients with acute ischaemic stroke from large vessel occlusion with established large infarct, compared with medical treatment only, endovascular thrombectomy was associated at 12 months after stroke with better functional outcome, quality of life, and overall survival. These findings suggest that the benefits of endovascular thrombectomy in patients with an ischaemic stroke and a large infarct are sustained in the long term and support the use of endovascular thrombectomy in these patients. European Union Horizon 2020 Research and Innovation Programme.

Development and validation of a new questionnaire for the assessment of patients with diabetic foot disease: The Diabetic Foot Questionnaire (DiaFootQ)

BackgroundThe epidemiology data and global burden of diabetic foot disease underscores the need for effective prevention strategies, which requires an early diagnosis. Patient-reported outcome measures are instruments based on a simple format, which favours their application. Currently, there is an absence of instruments with a broad enough scope to capture the diverse aspects involved in diabetic foot disease. ObjectivesTo develop a questionnaire for the assessment of patients with diabetic foot disease and carry out an analysis of its validity and reliability. MethodsThe study was developed in two stages. Stage 1: the Delphi Panel was composed of 22 experts. The questionnaire is made up of 25 questions selected, after three rounds, from an initial sample of 68 questions. Stage 2: A validation study was performed. With a sample of 273 subjects, an exploratory factor analysis and an analysis of internal consistency, items response, and validity were carried out using the Diabetes Quality of Life, SF-12v2, Foot Function Index and EuroQol EQ5D questionnaires. Measurements of error and sensitivity to change were also analyzed. ResultsA 25-item questionnaire (DiaFootQ) was developed. It comprised two dimensions: 1) lifestyle and function; and 2) footwear and foot self-care. Sample (n=273) mean age was 69.77 years (±11.08). The internal consistency of DiafootQ was α=0.916, and item response values were ICC=0.862–0.998. External validity correlation levels ranged from r=0.386 to r=0.888. ConclusionDiaFootQ was developed. Integrating the main aspects involved in diabetic foot disease could help to detect more accurately the risk or severity of these patients. DiaFootQ is a well-structured, valid, and reliable tool whose use should be promoted in clinical and research settings.

Telaah Faktor Risiko dan Pemeriksaan Osteoartritis terhadap Kualitas Hidup Masyarakat Desa Kendalpayak Malang

Osteoarthritis is a degenerative disease characterized by loss of synovial fluid and articular cartilage in the joints, causing pain and difficulty moving which harms people's quality of life. This community service activity aims to examine the risk factors and results of osteoarthritis examinations on the quality of life of the community. The activity was carried out by collecting data on risk factors and quality of life of the community from 10 elderly integrated health service centers in Kendalpayak. Osteoarthritis examination is carried out based on a clinical examination by a Bone Specialist at Saiful Anwar Hospital. The results obtained were 94 women and 19 men, aged 40-45 years 12 people, 46-60 years 43 people, and 54 people aged &gt;60 years. The Body Mass Index categories of underweight, normal, overweight, and obesity were 4.4%; 45.1%; 30.1%; and 20.4%, respectively. Menopause status ≤10 and &gt;10 years were 22.3% and 29.9%. The data collection on light, moderate, and heavy exercise patterns were 68.2%; 27.4%; 4.4%. The physical activity data collected from light, moderate, and heavy respectively were as follows: 39%; 52.2%; 8.8%. There were 5.3% who had a history of bone trauma. Based on clinical examination, 7.2% were positive for osteoarthritis. Measuring quality of life using the EQ-5D questionnaire in osteoarthritis sufferers shows the severity of the dimensions Mobility (56.1%), Self-Care (24.2%), Usual Activities (41.5%), Pain/Discomfort (92.7%), and Anxiety/Depression (61%). In conclusion, risk factors that influence the quality of life of osteoarthritis sufferers in Kendalpayak Village, Malang include being elderly, female, and menopausal.

A randomized controlled trial to assess if changing sleep timing can improve glucose metabolism in people with prediabetes and type 2 diabetes

BackgroundSocial jetlag is a chronic disruption of sleep timing that is characterized by different sleep timing during workdays and free days. Social jetlag has been associated with disturbed glucose metabolism, insulin resistance, and increased risk of metabolic syndrome and type 2 diabetes. In this study, we aim to investigate whether a combination of bright light therapy in the morning, bright light reduction in the evening and sleep advance instructions for 3 weeks reduces social jetlag and if this results in improvement of glycemic and metabolic control, sleep, mood and quality of life after 3 and 12 weeks in people with prediabetes and type 2 diabetes and to assess possible mediators, compared to regular sleep habits.MethodsIn this randomized controlled trial, 60 people with prediabetes or type 2 diabetes with > 1 h social jetlag will be recruited. The intervention consists of bright light therapy (5000 lx) emitted by Vitamine-L (Lumie, UK) for 30 min each morning, combined with the advice to follow sleep advance instructions and to wear bright light-dimming goggles every evening for a period of 3 weeks. The control group adheres to their regular sleep habits and conditions. The primary outcome is glycated hemoglobin (HbA1c) after 12 weeks comparing the intervention and control in an intention-to-treat analysis. Secondary outcomes at 3 and 12 weeks are (1) social jetlag; (2) insulin sensitivity, fasting blood glucose, glucose-lowering medication use, and frequency of perceived hypoglycemia; (3) metabolic outcomes, including body mass index (BMI), waist circumference, body fat percentage, and blood pressure; (4) mood, including depression, fatigue and anxiety (measured with questionnaires); and (5) quality of life measured using EQ5D questionnaire. To assess other factors that might play a role as possible mediators, we will measure (para)sympathetic nervous system activity assessed with ECGs and electrochemical skin conductance tests, sleep quality and sleep phase distribution assessed with a sleep measuring headband (ZMax), the Dim Light Melatonin Onset in saliva samples (in a subgroup) at 3 and 12 weeks, the feeling of satiety and satiation with a 10-cm visual analog scale (VAS), diet using a food frequency questionnaire, and physical activity using an accelerometer (ActiGraph).DiscussionSocial jetlag can contribute to poorer glycemic control and metabolic control in those with type 2 diabetes. With this intervention, we aim to reduce social jetlag and thereby improve glycemic and metabolic control. This could offer a way to improve overall population health and to reduce the disease burden of type 2 diabetes.Trial registrationISRCTN registry ISRCTN11967109. Registered on 9 May 2024.

Spectrum of cutaneous lesions in a cohort of patients with neurofibromatosis type 2.

Neurofibromatosis type 2 (NF2) is a rare autosomal dominant syndrome with a predisposition to the development of central nervous system tumors, ophthalmic manifestations, and dermatological lesions. The latter are present in 70-95% of patients and can precede the evolution of other tumors. However, they are not included in the diagnostic criteria and are frequently undervalued during follow-up. An observational cross-sectional study characterizing cutaneous lesions in a cohort of NF2 patients was carried out. Dermatological examinations were performed, and lesions were classified into neural cutaneous tumors (superficial, SNCT, and deep, DNCT), hyperpigmented patches (HyperP), and hypopigmented patches (HypoP). The Dermatology Life Quality Index (DLQI) and EQ-5D questionnaires were applied to evaluate the impact on quality of life. Nineteen patients with a mean age of 36 years were included. Sixteen (84%) patients had cutaneous lesions, mostly developed 10 or more years before the diagnosis. SNCT, DNCT, and HyperP showed similar frequencies (58%). HypoP were observed in only one patient. HyperP developed, on average, earlier than NCT (9.6 vs. 16.5 SNCT, 17.0 DNCT; years). The excised lesions had different histological patterns, including neurofibromas, schwannomas, and a hybrid tumor. Most patients reported a low impact of cutaneous manifestations on the quality of life (DLQI 0 or 1). Cutaneous lesions are frequent in NF2 and may precede the diagnosis by several years. Their identification is important to establish the diagnosis earlier and potentially reduce morbidity and mortality.

Valuation of Multi-Dimensional Health States With a Bolt-On: Is There a Shortcut?

ObjectivesTo use the EQ-5D questionnaire with bolt-on dimensions in economic evaluation studies, new value sets are needed. In this study, we explored the feasibility of a new approach called the scaling factor model, which estimates bolt-on value sets using estimated EQ-5D dimensional weights. MethodsWe designed a 2-arm study, inviting university students to value health states with and without bolt-on items using the composite time trade-off method. We selected 25 health states from an orthogonal array and added the 5 mildest EQ-5D states in the design. In arm 1, EQ-5D without self-care and standard EQ-5D states were valued, and in arm 2, standard EQ-5D states and EQ-5D with vision were valued. By arm, we compared the mean observed values of health states with and without bolt-on item. Next, by arm, we estimated value sets for the EQ-5D with bolt-on states using both standard model and scaling factor model. Model performances were compared in terms of prediction accuracy and correlation with likelihood-based mean values. ResultsAdding a five-level bolt-on to EQ-5D resulted in statistically lower values. This effect was consistent across 2 arms and bolt-on items. The scaling factor models outperformed the standard models in all statistics. ConclusionsThe scaling factor model offers a methodologically viable and low-cost option for producing value sets for EQ-5D supplemented with bolt-on items. Future studies should further test this method using other bolt-on items and more relevant study populations.

Resilience After High-Grade Subarachnoid Hemorrhage: A Prospective Cohort Study on Quality of Life.

Treatment of patients who present with poor clinical condition is often postponed until neurological improvement is observed. Despite previous studies, it is still unclear how survivors perceive their quality of life (QoL). This study aimed to evaluate self-perceived QoL in patients with aneurysmal subarachnoid hemorrhage who present with poor clinical condition, as defined by World Federation of Neurosurgical Societies (WFNS) grades 4 to 5, compared with those who present in more favorable clinical condition (WFNS 1-3). Between 2011 and 2021, 1160 patients with aneurysmal subarachnoid hemorrhage were admitted to the Amsterdam UMC. Among the 845 patients who survived, 537 participated in the QoL questionnaires. Patient characteristics, complications, EQ-5D questionnaires, modified Rankin Scale, and Hospital Anxiety and Depression Scale were analyzed using the nonparametric Mann-Whitney U test for continuous variables or the Pearson χ2 test for categorical variables. Of the 537 responders, 452 (84%) presented with low grade (WFNS 1-3) and 85 (16%) presented with high grade (WFNS 4-5). The high-grade group reported a self-perceived QoL score of 70 (of 100), while the low-grade group reported a score of 75 (P = .12). The mean EQ-5D index value was 0.74 for the high-grade group and 0.81 for the low-grade group (P < .01). In the high-grade group, 61 patients (72%) had a favorable outcome (modified Rankin Scale 0-3) compared with 419 (94%) in the low-grade group (P < .001). High-grade WFNS patients rated their QoL as satisfactory, with only a marginal 5-point difference on a 100-point scale compared with low-grade WFNS patients. In addition, almost three-quarters of high-grade WFNS survivors achieved a favorable outcome. Given that a subset of patients, despite presenting with a poor clinical condition, still achieve a favorable outcome, these findings reinforce our perspective advocating for early and comprehensive treatment.