Health-related Quality Of Life Scores In Patients Research Articles

Coping style and health-related quality of life in caregivers of epilepsy patients.

Epilepsy has a significant impact on health-related quality of life (HRQOL) of patients and personal coping style is an important determinant. Less is known about home caregivers. This study investigates HRQOL and coping style of both patients and caregivers and their interaction. Epilepsy patients attending the outpatient clinic of the University Medical Centre in Utrecht and their caregivers were sent EQ5D and RAND-36 questionnaires. The Utrecht Coping List was used to chart personal coping styles. HRQOL scores of patients and caregivers were compared to the general Dutch population. The association between patient and caregiver HRQOL scores was calculated. A stepwise backward multivariate linear regression analysis was used to explain variances in caregiver HRQOL. Eighty-six couples (49%) returned all questionnaires. Caregiver HRQOL scores were comparable to the general Dutch population (EQ5D: 0.88–0.88; p = 0.90, RAND-36 MCS: −2 points; p = 0.16), while patients HRQOL scores were lower (EQ5D: 0.79; p < 0.01, RAND-36 MCS −10 points; p < 0.01). However, on several specific domains, associations between patient and caregiver HRQOL scores within couples were found. Passive coping style explained 50% of variation in HRQOL scores of caregivers. As a group, caregivers of epilepsy patients have normal HRQOL, but there are significant associations between patient and caregiver HRQOL scores. Improving caregiver HRQOL through interventions on coping style might benefit patients as well. Recognizing personal coping styles of both patient and caregiver should be part of a patient-oriented approach in treatment.

Health-related quality of life in chronic liver disease: the impact of type and severity of disease.

The type and severity of chronic liver disease may have different effects on health-related quality of life (HRQL). The aim of our study was to determine whether HRQL in patients with chronic liver disease differs by type and severity of disease and to identify which clinical and physiological factors affect this impairment. In this study, HRQL was measured with a generic (Short Form 36) and a liver disease-specific (Chronic Liver Disease Questionnaire) questionnaire. Clinical, demographic, and laboratory data were collected at office visits. Patient's HRQL scores were compared with the published norms and to the chronically ill populations. A total of 353 patients (mean age 50 yr, 51% men) with chronic liver disease, either viral disease (hepatitis B and C), cholestatic disease (primary biliary cirrhosis or primary sclerosing cholangitis), or hepatocellular disease were enrolled in the study. In general, HRQL in patients with chronic liver disease was lower than the normal population and was similar to that of patients with chronic obstructive pulmonary disease or congestive heart failure. In cirrhotic patients, some dimensions of HRQL were less impaired in patients with cholestatic disease than in those with hepatocellular diseases. More severe disease (higher Child's class) was associated with a lower Chronic Liver Disease Questionnaire score and the Short Form 36's physical component summary scores. Older age had a weak negative association with the physical aspects of HRQL. We conclude that chronic liver disease substantially reduces HRQL, and this impact does not differ markedly by type of disease. Older age and measures of disease severity were associated with poorer HRQL.

Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C

OBJECTIVES: Patients with chronic hepatitis C (HCV) consistently report a reduction in multiple domains of health-related quality of life (HRQOL) that does not correlate with liver disease severity. This may in part be due to the use of insensitive HRQOL instruments or extrahepatic factors that independently influence HRQOL. We hypothesized that a past history of substance abuse or active medical and psychiatric comorbidities would correlate with HRQOL scores. METHODS: In 107 patients who had failed previous interferon therapy, HRQOL was measured by using the modified SF-36, a disease-specific instrument, and the Health Utilities Index (HUI) Mark III, a generic instrument. RESULTS: Multiple SF-36 subscale and summary scores as well as the HUI Mark III attributes of emotion and pain were significantly reduced in the study population compared with healthy controls ( p < 0.001). Serum alanine aminotransferase and HCV RNA levels, HCV genotype, liver histology, and HCV risk factors as well as demographic variables did not correlate with modified SF-36 and HUI scores. In addition, a history of alcohol abuse or dependency and intravenous drug use or dependency, identified in 52 and 51% of participants, respectively, did not correlate with HRQOL scores. However, the presence of one or more active medical comorbidities, defined as a chronic medical condition requiring treatment and monitoring, was significantly associated with both the modified SF-36 scores and HUI attribute deficits ( p < 0.001). In particular, painful medical comorbidities or depressed mood requiring treatment were significantly associated with modified SF-36 scores and with HUI attribute deficits and utility scores ( p < 0.001). CONCLUSIONS: Active medical and psychiatric comorbidities may account for some of the reduction and variability in HRQOL scores in patients with chronic HCV who have failed previous interferon therapy. Future studies that control for the presence of active comorbidities in large groups of treatment naı̈ve patients with varying severity of chronic HCV are needed to confirm these findings.

Health-related quality-of-life and service utilization in Alzheimer's disease: A cross-sectional study

The objective of this study was to explore the relationships between the severity of Alzheimer's disease (AD) in different care settings, health-related quality-of-life (HQoL), service utilization, and caregiver time and burden. Data were from a 1996 cross-sectional study of 679 AD patient/caregiver pairs. Patients met NINCDS/ADRDA criteria for probable Alzheimer's, were staged with the Clinical Dementia Rating Scale, and recruited from managed care plans, academic medical centers, nursing homes, and assisted living facilities. Patient data included: demographics, MMSE, co-morbidities, health-related quality-of-life, health status, and service utilization. Family caregiver data included demographics, caregiver time and burden. Significant findings included: patient HQoL scores were better for community patients, but worsened with disease severity; regardless of setting, patient SF-36 scores showed worse physical functioning and better mental health scores as disease severity increased; inpatient stays and ER visits were rare regardless of severity or setting, and for community patients, day care and in-home services use increased with AD severity. Family caregivers spent 18 hours per month on ADLs and 32 hours on IADLs. Hours increased for community patients and those with greater disease severity. Caregiver burden levels were higher for those serving community patients and increased with disease severity. Burden was lowest for mild and moderate patients in assisted living. Greater patient AD severity was related to increased morbidity, poorer health status, lower health-related quality-of-life, greater family caregiver time and burden, and greater service use regardless of setting. Findings reinforce the need for an AD continuum of care.