Health-related Quality Of Life In Persons Research Articles

Self-efficacy and health status improve after a wellness program in persons with multiple sclerosis

Purpose: To determine if an intensive wellness program for persons with MS results in improved self-efficacy, quality of life (QOL), or physical activity outcomes. Methods: 129 subjects participated in one of seven 4-day interdisciplinary educational wellness programs throughout the United States. This intervention was based on the philosophy that health management is important to disease management. The program consisted of psychological and physiological evaluations, lectures and workshops. Before the intervention and after at 1, 3 and 6 months, self-efficacy (MS Self-Efficacy Scale, MSSE, control), health related QOL (SF-36) and physical activity (Physical Activity Scale for Persons with Physical Disabilities, PASAID) was assessed. Results: Improvements were noted at 1, 3 and 6 months post-intervention. Those present at 6 months included, MSSE, role physical, vitality and mental health scales of the SF-36. PASAID did not change. Improvements were independent of disability (EDSS). Conclusion: A 4-day multidisciplinary educational wellness program can result in improvement in self-efficacy and health-related QOL in persons with MS and can be stable up to at least 6 months. Improvements do not depend on degree of disability.Implications for RehabilitationMultiple sclerosis is a neurologic disease that can have a significant negative impact on self-efficacy and quality of life.Some wellness based programs have been shown to be effective in improving self-efficacy and quality of life (QOL) in persons with MS.Distance or time could be barriers to access effective wellness programs.An intensive “traveling” 4-day interdisciplinary educational wellness program can result in improvements in self-efficacy and health-related quality of life in persons with MS.Improvements were not dependent on a person’s level of disability (i.e. EDSS).

Influence of Social Support and Personal Barriers on Physical Activity and Health-Related Quality of Life in Persons with Multiple Sclerosis

The model of functioning and disability is a multi-dimensional model that includes interrelated factors such as body functions and structures, activities, participation, environmental factors, and personal factors. All these components are hypothesized to influence health conditions and quality of life (WHO, 2001). This conceptual model, however, has rarely been applied to examine the relationship between physical activity (PA) behavior and health-related quality of life (HQOL) in persons with disabilities. PURPOSE: To determine the role of PA behavior and its behavioral antecedents on HQOL in persons with Multiple Sclerosis (MS). METHODS: 77 participants with MS (12 males & 65 females, 47.66±10.37 yrs, & BMI 28.15±6.55) completed previously validated questionnaires measuring PA (PASIPD), HQOL (MS QOL-54; mental health only), self-efficacy (Marcus et al., 1992), social support (Sallis et al., 1987), and PA barriers (Zhu et al., 2001). Descriptive and path analysis were conducted using SPSS17 and AMOS16, respectively. RESULTS: The initial model included (1) a direct path from PA to HQOL and (2) indirect path from environmental factors (environmental PA barriers; BAen & social support) and personal factors (self-efficacy & personal PA barriers; BApsn) to HQOL through PA. Even though the model was well-fit (chi-square(4)=5.07 with p=.28, NFI=.96, CFI=.99, & RMSEA=.06), BAen and self-efficacy were not statistically significant (BAen=.19 with p=.33 & SE= -.049 with p=.65). Therefore, BAen and self-efficacy were excluded from the model and social support and BApsn represented the environmental and personal factors. The model fit was slightly decreased but sill acceptable (chi-square(2) =3.86 with p=.15, NFI=.90, CFI=.94, & RMSEA=.08). All variables were statistically significant with p<.05. Standardized path coefficient (beta) of social support and BApsn to PA were.33 and -.37, respectively, and it accounted for 33% of the variance in PA. PA (beta=.28) accounted for 8% of variance in HQOL. CONCLUSION: For individuals with MS, social support and BApsn are critical factors in PA participation and factors that indirectly affect on HQOL through PA. Acknowledgement: This study was supported by College of Health and Human Sciences at Oregon State University.

Multivariate models of determinants of health-related quality of life in severe chronic obstructive pulmonary disease

Persons with severe chronic obstructive pulmonary disease (COPD) and similar levels of forced expiratory volume in 1 second (FEV(1)), exercise capacity, and dyspnea have a wide range of health-related quality of life (HRQL). We identified the independent determinants of HRQL in persons with COPD. Comprehensive assessments of physiological, psychosocial, and clinical variables from the National Emphysema Treatment Trial were used. HRQL was assessed by the Medical Outcomes Study 36-Item Short Form Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and the St. George's Respiratory Questionnaire total score (SGRQ-TS). In multivariate linear regression models, exercise capacity, dyspnea, age, single-breath diffusing capacity of the lung for carbon monoxide percent predicted, and self-report of being disabled were significant determinants of PCS score. Dyspnea, depression, antidepressant use, daytime sleepiness, and education were significant determinants of MCS score. Prior participation in pulmonary rehabilitation, supplemental oxygen use, and oral corticosteroid use were significant determinants of SGRQ-TS. Although FEV(1), 6-minute walk test distance, and dyspnea significantly correlated with HRQL, their effects on HRQL were reduced when other variables were considered. Greater exercise capacity, prior participation in pulmonary rehabilitation, and use of supplemental oxygen were significantly associated with better HRQL. Self-perception of being disabled, (Abstract continued) depression, dyspnea, oral corticosteroid use, and daytime sleepiness were associated with worse HRQL. To optimize HRQL, clinicians should pay attention to a number of clinical and physiological factors.

Use of the WHOQOL-BREF for Evaluating Persons with Traumatic Brain Injury

This study examined psychometric properties of a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) among persons with traumatic brain injury (TBI) and the relations of the WHOQOL-BREF domains, including physical capacity, psychological wellbeing, social relationships, and environment, to different indicators of TBI severity. Of the 354 eligible and available subjects from 22 hospitals in northern Taiwan over a 6-month period, 199 completed telephone interviews during data collection. Three indicators of TBI severity were used: the Glasgow Coma Scale, the presence of post-traumatic amnesia, and the abbreviated injury scale to the head. All domain scores of the WHOQOL-BREF had nearly symmetrical distributions: low percentages of ceiling and floor values (0-3%), low missing rates (0-0.5%) for all but one item (43.2%), and very good internal consistency (0.75-0.89) and test-retest reliability (0.74-0.95). The WHOQOL-BREF also exhibited excellent known-groups validity, as well as very good responsiveness and convergent validity with regard to employment, independence in daily life activities, social support, and depression. After adjustment for potential confounders, almost none of the domain scores of the WHOQOL-BREF significantly differed in the severity levels of the three severity indicators. In conclusion, the WHOQOL-BREF is an appropriate health-related quality of life (HRQL) instrument for persons with TBI. Furthermore, the initial severity of the TBI might not be suitable for predicting levels of HRQL in persons with TBI.

Determinants of Health-Related Quality of Life in Long-Term Survivors of Hodgkin's Lymphoma

In this study health-related quality of life (HRQL) in long-term survivors of Hodgkin's lymphoma (HL) was evaluated and the findings were analyzed using a conceptual model developed by Wilson and Cleary. A better understanding of the relationships between the variables explaining HRQL may improve care and rehabilitation of HL patients. The populations were long-term survivors of HL (n = 121) and a control group (n = 236). Participants were approached with one semi-structured interview, an extended version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) and three standardized questionnaires: Hospital Anxiety and Depression (HAD) scale, Short Form 12 health survey questionnaire (SF-12) and Sense of Coherence (SOC) scale. No differences regarding the mean scores were found between the HL survivors and the controls except for the SF-12, where the patients considered themselves to be in poorer physical health than the controls (p < 0.01). Even though physical health was diminished, patients did not evaluate overall QoL worse compared to the controls. The major determinants of perception of general QoL were self-rated physical and mental health as well as SOC. The HRQL of persons who have survived a median of 14 years with HL is similar to that of controls.