Health-related Quality Of Life Subdomains Research Articles

Global health status and fatigue score in isocitrate dehydrogenase-mutant diffuse glioma grades 2 and 3: A longitudinal population-based study from surgery to 12-month follow-up.

At the group level, health-related quality of life (HRQoL) in patients with IDH-mutant diffuse glioma grades 2 and 3 seems to remain stable over time. However, clinical experience indicates that there are patients with unfavorable outcomes on key HRQoL subdomains. The aim of this longitudinal population-based study, following patients over a period of 12 months from surgery, was to describe individual-level data on global health status and fatigue score and explore possible predictors of deterioration. All patients undergoing surgery for presumed glioma grades 2 or 3 at the Sahlgrenska University Hospital during 2017-2022, were screened for the study. Patients were invited to complete the European Organization of Research and Treatment of Cancer core questionnaires and brain module at baseline, 3 and 12 months postoperatively. Data is reported with respect to minimal clinical important difference (MCID). We included 51 patients with IDH-mutant diffuse glioma grades 2 or 3. There was no difference in group-level data of either global health status or fatigue score from baseline to the 12-month follow-up (P-value > .05). Unfavorable individual changes (beyond MCID) in global health status and fatigue score were observed in 12 and in 17 patients, respectively (23.5% and 33.3%). A lower proportion of proton radiotherapy was found in patients with unfavorable changes in fatigue (10/15, 66.7%) compared to all other patients undergoing radiotherapy (22/23, 95.7%, P-value .03). Deterioration beyond MCID was seen in approximately one-third of patients. Changes in global health status could not be predicted, but changes in fatigue may be influenced by tumor-targeted and symptomatic treatment.

Impact of Covid-19 lockdown on health-related quality of life, mental well-being, and daily routines among high school children of Udupi District, Karnataka, India: A cross-sectional study

BackgroundCovid-19 lockdown had a multidimensional impact on the health and well-being among children. The present study aimed to determine the impact of COVID-19 lockdown on Health-Related Quality of Life (HRQOL), mental well-being, and daily routines among high school children, and find the relationship between them. MethodsThis cross-sectional study was conducted among 420 high school students between 13 and 17 years of age from selected High Schools of Udupi District. The data collection instruments included: Background Proforma, KIDSCREEN-27 Index, Stirling Children's Wellbeing Scale, and Daily Routines Questionnaire. ResultsOut of 420 participants, 51.7% were males. Mean age was 14.35 ± 0.96. Around 91.2% participants experienced average HRQOL. Mean HRQOL score was 47.5 ± 5.98. HRQOL subdomains showed average levels of physical well-being, autonomy and parent relations, social support and peers, and school environment. Around 60.2% experienced average mental well-being, and 35.7% experienced poor mental well-being. Mean mental well-being was 48.8 ± 6.62. Daily routines analysis showed that 49.7% were engaged in physical activities, 36.9% used phones for one to 2 h a day, 75.7% had adequate nighttime sleep and 43.3% were mentally stressed due to online classes. A significant correlation was found between HRQOL and mental well-being (r = 0.615, p < 0.001). ConclusionChildren experienced average HRQOL and mental well-being during lockdown. Higher the HRQOL of children, better the mental well-being. Health promotion strategies and good support system from the school is needed to enhance HRQOL and improve mental well-being of children, thus contributing to Sustainable development goal (SDG) 3.

Association between symptoms and health-related quality of life in patients with cancer with prior or ongoing immune checkpoint inhibitor therapy exposure.

e24085 Background: There is a growing appreciation that patients exposed to immune checkpoint inhibitors (ICI) may experience long-term symptoms that impact health-related quality of life (HRQoL). We conducted an app-based, electronic patient reported outcomes (ePRO) study to explore the relationship between the symptom experience and HRQoL in a population of patients with cancer exposed to ICI therapy. Methods: Eligible patients had a history of advanced skin cancer or kidney cancer treated with ICI (adjuvant or metastatic) with ongoing, clinician-assessed disease control. Patients may have completed a course of ICI or continued on therapy if ≥ 6 months had passed since initiation. We conducted a single-center, observational, prospective cohort study where participants completed ePRO assessments via smartphone (ImmunoWave) measuring eleven symptoms (PRO-CTCAE) and HRQoL (PROMIS-29) weekly for 12 weeks. We used generalized estimating equations to assess the changes in PROMIS scores over study and to test the association of PRO-CTCAE symptoms with PROMIS scores and subdomains. Results: Forty-seven patients (77% melanoma, 15% renal cell carcinoma, 8% non-melanoma skin cancer) consented to the study. 70% were on active therapy while 30% had completed therapy. Most (62%) were treated in the metastatic setting. 43 patients who completed questionnaires were included in the analysis. Among subdomains of HRQoL at the study population level, social function was observed to have a significant linear trend (p = 0.013) and potentially meaningful (3.9 points overall) increase over the 12 weeks. Other subdomains were felt to have no clinically meaningful change at the population level over the 12 wk study period. Several PRO-CTCAE symptoms were significantly associated with health-related quality of life (PROMIS) subdomains (Table). Joint pain was significantly associated with fatigue (B = 1.006, p = 0.045), pain interference (B = 2.579, p = 0.002) and physical function (B = -1.532, p = 0.042). Itch was associated with anxiety (B = 1.017, p = 0.007) and social function (B = -1.136, p = 0.030). Numbness and tingling was associated with fatigue (B = 0.891, p = 0.027) and sleep disturbance (B = 1.436, p &lt; 0.001). Conclusions: We observed high concordance between patient symptom report by PRO-CTCAE and corresponding PROMIS HRQoL subdomains. Addressing specific symptoms such as itch, numbness/tingling and joint pain in patients with current or prior ICI exposure could improve HRQoL. [Table: see text]

Association of unmet basic resource needs with frailty and quality of life among older adults with cancer-Results from the CARE registry.

Basic resource needs related to transportation, housing, food, and medications are important social determinants of health and modifiable indicators of poverty, but their role in modifying the risk of frailty and health-related quality of life (HRQoL) remains unknown. The goal of our study was to examine the prevalence of unmet basic needs and their association with frailty and HRQoL in a cohort of older adults with cancer. The CARE registry prospectively enrolls older adults (≥60 years) with cancer. Assessments of transportation, housing, and material hardship were added to the CARE tool in 8/2020. The 44-item CARE Frailty Index was used to define frailty, and subdomains of physical and mental HRQoL were assessed using the PROMIS® 10-global. Multivariable analysis examined the association between unmet needs with frailty and HRQoL subdomains, adjusting for covariates. The cohort included 494 participants. Median age of 69 years, 63.6% were male and 20.2% were Non-Hispanic (NH) Black. Unmet basic needs were reported in 17.8% (transportation 11.5%, housing 2.8%, and material hardship 7.5%). Those with unmet needs were more often NH Black (33.0% vs. 17.8%, p = 0.006) and less educated (<high school: 19.5% vs. 9.7%, p = 0.023). Compared to those without unmet needs, unmet needs were associated with higher odds of frailty (adjusted odds ratio [aOR] 3.3, 95% CI 1.8-5.9), low physical (aOR = 2.1, 95% CI 1.2-3.8) and low mental (aOR = 2.5, 95% CI 1.4-4.4) HRQoL. Unmet basic needs represent a novel exposure that is independently associated with frailty and low HRQoL and warrants the development of targeted interventions.

Quality of life in children with cochlear implants in Kazakhstan

BackgroundAlthough cochlear implantation (CI) has been performed in Kazakhstan since 2007 little is known about quality of life of patients after CI. The aim of this study was to assess the health-related quality of life (HRQoL) of Kazakhstani children after CI.MethodsAltogether, 53 families with a child using a cochlear implant for at least 1 year participated in the study between July 20, 2019 and February 20, 2020 at the Audiological Сenter of Almaty, Kazakhstan. The parents/caregivers completed the “Children with Cochlear Implants: Parental Perspectives (CCIPP)” questionnaire.Results‘Well-being and happiness’ subdomain of the HRQoL yielded the highest ratings. ‘Communication’, ‘general functioning’, ‘self-reliance’, and ‘supporting the child’ subdomains each achieved significant (p < 0.01) associations with all HRQoL subdomains. There were positive correlations between language used by the parent who completed the questionnaire (Kazakh or Russian) and three HRQoL subdomains, including ‘well-being and happiness’, ‘supporting the child’ and ‘social relations’.ConclusionParents/caregivers reported high quality of life in all HRQoL subdomains. Further research in this area with more detailed socio-demographic and medical history data is required to identify quality of life predictors in children after cochlear implantation.

The Effect of Diabetes on Health-Related Quality of Life in Emirati Patients

Background: Diabetes mellitus (DM) is known to negatively affect quality of life (QoL), yet very few studies have been done on QoL of patients with diabetes in the United Arab Emirates population. Objectives: The aim of this study was to assess the impact of DM on health-related QoL (HRQoL) of patients with diabetes of Emirati nationality. Methods: Two hundred and forty Emirati patients with diabetes, treated at the Dubai Diabetes Center, were randomly selected and interviewed using the Short Form-36 questionnaire to assess HRQoL domains. Appropriate statistical measures were performed to associate HRQoL domains with diabetes-related factors. Results: HRQoL satisfaction scores for physical and mental health domains were very high for the majority of participants. Male participants ranked significantly higher median scores in all HRQoL domains than females (77.36 vs. 65.28, p = 0.004). There was a significant (p < 0.001) negative correlation between diabetes duration and the total averaged score for all sub-domains, and significant (p < 0.001) negative correlations between glycated hemoglobin percentage (HBA1c%) and all sub-domains of HRQoL. Patients without complications had significantly better scores in all HRQoL sub-domains than patients suffering from any complications. Median total HRQoL score for those with neuropathy compared to those without neuropathy was 63.9 versus 82.6 (p < 0.001), for nephropathy was 43.6 versus 72.5 (p < 0.001), for retinopathy 50.7 versus 76.0 (p < 0.001), for ischemic heart disease 54.1 versus 77.3 (p < 0.001), and for cerebrovascular disease 36.7 versus 72.4 (p < 0.001). Multiple regression showed 3 significant predictors for the total averaged score from all HRQoL sub-domains; these were age (p = 0.007), HbA1c% (p < 0.001), and the number of complications related to DM (p = 0.001). Conclusion: HRQoL in Emirati patients with diabetes was significantly associated with the presence of diabetes-related complications, glycemic control, and age of the patient. The assessment of QoL in patients with diabetes can be a valuable measure for the healthcare providers to assess patient’s well-being.

"Moving Fourth": Introduction of a practical toolkit for shared decision-making to facilitate healthy living beyond HIV viral suppression.

An extension of the UNAIDS 90-90-90 target proposes >90% of people living with HIV (PLHIV) should have good health-related quality of life (HrQoL); however, limited guidance exists. The "Health Goals for Me" framework, an individualized approach to HIV care, provides a framework to assess HrQoL. We analyzed several patient-reported outcome measures (PROMs) to develop a practical toolkit to facilitate shared physician-patient decision-making. HrQoL subdomains, actionable in the clinical setting and measurable as PROMs, were selected. PROMs were collated through systematic literature searches, scored by the authors on usability, validation, and availability, after which practical recommendations were made. Nine subdomains were selected across physical, psychological, social, and environmental domains; 46 validated PROMs were identified. After pre-screening, from 39 evaluated PROMs, we recommended PROMs in the following subdomains: fatigue/energy loss, frailty/resilience, sleep disturbance, substance use, anxiety/depression, cognition, sexual function and desire, and stigma. Using this toolkit, healthcare professionals and PLHIV can collaborate and mutually agree on individual care objectives. Following the "Health Goals for Me" framework, appropriate care interventions can be implemented and reviewed in a continuous cycle. We discussed how eHealth interventions, which will have increasing importance in the post-COVID era, can facilitate improved HrQoL for PLHIV by utilizing toolkits such as the one described here. Implementation of this practical framework and the PROMs toolkit could provide a useful approach to assessing HrQoL in PLHIV and could enhance the physician's ability to gain valuable insights into the patient's daily life across a broad range of HrQoL issues.

Salvage cystectomy and ileal conduit urinary diversion as a last-line option for benign diseases-perioperative safety and postoperative health-related quality of life.

Radical cystectomy and urinary diversion impact various dimensions of patients' health-related-quality-of-life (HRQOL). Yet, less is known about salvage cystectomy as a last-line option for treatment-refractory benign diseases. Therefore, our aim is to provide HRQOL data from a contemporary cohort of open salvage cystectomies for benign conditions. Fifty-four consecutive patients were enrolled in one single tertiary referral center. Analysis was limited to patients undergoing urinary diversion via ileal conduit (IC). Complications were assessed via Clavien-Dindo-scale. HRQOL was measured using the validated European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BLM30 questionnaire. HRQOL QLQ-C30 domains were measured preoperatively and up to 3 years postoperatively. Longitudinal changes were analyzed using Friedman's rank test. Primary endpoint was good general HRQOL based on QLQ-C30 global health status (GHS). Multivariate analysis was performed using logistic regression models with a step-wise backward selection procedure. Longitudinal analysis of HRQOL subdomains revealed significantly improved pain (p = .005) and fatigue (p = .002) scores as well as improved social functioning (p = .038). Furthermore, general HRQOL (GHS scores) improved significantly during the follow-up period (28.0 vs. 50.6 [36 months], p = .045). In multivariate analysis, the indication for salvage cystectomy could not be identified as an independent predictor for good general HRQOL. We observed a total number of 10 (41.7%) high-grade (Clavien ≥III) 90 day-complications. Limitations include limited follow-up rates at respective time-points. Salvage cystectomy and IC can be safely performed as a last-line treatment for benign conditions and increases general HRQOL in the long-term follow-up. Thus, it can play a role in a holistic approach for a challenging clinical setting.

Spirituality and outcomes in caregivers of persons with traumatic brain injury (TBI).

Spiritual well-being has been associated with better quality of life outcomes in caregivers, but the associations among the care recipient's functional status, the caregiver's spiritual well-being, and the caregiver's health-related quality of life (HRQOL) is unknown. Research Method/Design: The study examined the Spiritual Well-Being Scale in caregivers of persons with traumatic brain injury (TBI; n = 335). Participants completed measures from the Patient-Reported Outcomes Measurement Information System, the Quality of Life in Caregivers of TBI, and the Caregiver Appraisal Scale. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) measured care recipient's functional status. The association between religious well-being and existential well-being and HRQOL were examined with Pearson correlation coefficients. Multiple linear regressions examined the interaction between caregiver well-being and care recipient functional status on HRQOL outcomes accounting for demographic variables. Less favorable caregiver HRQOL was associated with military affiliation, male status, spousal caregiver relationship, and White race. MPAI-4 was moderately associated with all HRQOL subdomains. For spiritual well-being, existential well-being was moderately correlated with 9 of 16 HRQOL subdomains in comparison to religious well-being that demonstrated small correlations with 3 of 16 subdomains. MPAI-4 had negative effects on HRQOL regardless of spiritual well-being with higher existential well-being reducing the negative impact of the care recipient's functional impairment on HRQOL for significant HRQOL interactions. Interventions that encourage development and maintenance of life purpose and meaning in caregivers of persons with TBI, and less so, spirituality, might have beneficial effects on HRQOL when the person with injury has more functional limitations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Exploring the Health-Related Quality of Life of Patients Treated With Immune Checkpoint Inhibitors: Social Media Study.

BackgroundImmune checkpoint inhibitors (ICIs) are increasingly used to treat several types of tumors. Impact of this emerging therapy on patients’ health-related quality of life (HRQoL) is usually collected in clinical trials through standard questionnaires. However, this might not fully reflect HRQoL of patients under real-world conditions. In parallel, users’ narratives from social media represent a potential new source of research concerning HRQoL.ObjectiveThe aim of this study is to assess and compare coverage of ICI-treated patients’ HRQoL domains and subdomains in standard questionnaires from clinical trials and in real-world setting from social media posts.MethodsA retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experiences with ICIs between January 2011 and August 2018. Automatic and manual extractions were implemented to create a corpus where domains and subdomains of HRQoL were classified. These annotations were compared with domains covered by 2 standard HRQoL questionnaires, the EORTC QLQ-C30 and the FACT-G.ResultsWe identified 150 users who described their own experience with ICI (89/150, 59.3%) or that of their relative (61/150, 40.7%), with 137 users (91.3%) reporting at least one HRQoL domain in their social media posts. A total of 8 domains and 42 subdomains of HRQoL were identified: Global health (1 subdomain; 115 patients), Symptoms (13; 76), Emotional state (10; 49), Role (7; 22), Physical activity (4; 13), Professional situation (3; 9), Cognitive state (2; 2), and Social state (2; 2). The QLQ-C30 showed a wider global coverage of social media HRQoL subdomains than the FACT-G, 45% (19/42) and 29% (12/42), respectively. For both QLQ-C30 and FACT-G questionnaires, coverage rates were particularly suboptimal for Symptoms (68/123, 55.3% and 72/123, 58.5%, respectively), Emotional state (7/49, 14% and 24/49, 49%, respectively), and Role (17/22, 77% and 15/22, 68%, respectively).ConclusionsMany patients with cancer are using social media to share their experiences with immunotherapy. Collecting and analyzing their spontaneous narratives are helpful to capture and understand their HRQoL in real-world setting. New measures of HRQoL are needed to provide more in-depth evaluation of Symptoms, Emotional state, and Role among patients with cancer treated with immunotherapy.

MP74-14 HEALTH-RELATED QUALITY OF LIFE AFTER OPEN AND ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHED ANALYSIS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (MP74)1 Apr 2020MP74-14 HEALTH-RELATED QUALITY OF LIFE AFTER OPEN AND ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE MATCHED ANALYSIS Alexander Kretschmer*, Robert Bischoff, Alexander Buchner, Michael Chaloupka, Philipp Weinhold, Thilo Westhofen, Friedrich Jokisch, Frank Strittmatter, Armin Becker, and Christian G. Stief Alexander Kretschmer*Alexander Kretschmer* More articles by this author , Robert BischoffRobert Bischoff More articles by this author , Alexander BuchnerAlexander Buchner More articles by this author , Michael ChaloupkaMichael Chaloupka More articles by this author , Philipp WeinholdPhilipp Weinhold More articles by this author , Thilo WesthofenThilo Westhofen More articles by this author , Friedrich JokischFriedrich Jokisch More articles by this author , Frank StrittmatterFrank Strittmatter More articles by this author , Armin BeckerArmin Becker More articles by this author , and Christian G. StiefChristian G. Stief More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000960.014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Introduction of robot-assisted radical prostatectomy (RARP) has revolutionized the therapeutic landscape of organ confined prostate cancer (PCa) over the last two decades. However, comparative analyses focused on health-related quality of life (HRQOL) after RARP and open retropubic prostatectomy (ORP) are rare. In the current. Study, we analyse differences in preoperative and postoperative HRQOL after ORP and RARP in a propensity score matched patient cohort with favourable preoperative patient characteristics. METHODS: In the current retrospective analysis, inclusion criteria encompassed PSA ≤10ng/ml, ≤pT2c, ISUP ≤3, age ≤65yrs, as well as preoperative continence. A propensity score matched patient cohort [n=418 (ORP: 209, RARP: 209)] was created and HRQOL was assessed based on validated questionnaires preoperatively, 3mo, 12mo, or 24mo postoperatively. Primary endpoint was good general HRQOL based on previously published cut-off values. Secondary endpoints encompassed the respective HRQOL subdomains as well as functional outcomes at different timepoints. Erectile function was measured via IIEF-5, urinary continence via ICIQ-SF questionnaire. Multivariable analysis included binary logistic regression models (p<0.05). RESULTS: ORP and RARP cohorts were well-balanced. After 3mo, continence results based on mean ICIQ-SF scores were superior for ORP compared to RARP (3.9 vs. 5.3; p=0.003) with no differences at the remaining time points. After 24mo, 64.3 (ORP) vs 73.8% (RARP) of the preoperatively potent patients had regained IIEF-5 scores of 18 or more (p=0.190). Mean QLQ-C30 global health status was significantly higher for ORP compared to RARP after 3mo (70.1 vs. 61.6, p=0.001), but not after the remaining follow-up periods. There were no significant differences regarding the remaining QLQ-C30 functioning and symptom scores in the longer-term follow-up. In multivariable analysis stratified for IIEF-5 and ICIQ-SF scores and surgeon experience, RARP could be confirmed as an marginally independent predictor for lower ratios of good general HRQOL after 3mo (OR 0.464, 95% CI 0.215 – 0.999; p=0.050) without any differences at the remaining time points. CONCLUSIONS: The current study addresses various HRQOL outcomes over an postoperative period of up to 2 years in a homogenous propensity score matched contemporary cohort. Marginally better general HRQOL outcomes could be detected for ORP compared to RARP 3mo postoperatively. Functional outcomes were comparable between both surgical techniques. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1137-e1137 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kretschmer* More articles by this author Robert Bischoff More articles by this author Alexander Buchner More articles by this author Michael Chaloupka More articles by this author Philipp Weinhold More articles by this author Thilo Westhofen More articles by this author Friedrich Jokisch More articles by this author Frank Strittmatter More articles by this author Armin Becker More articles by this author Christian G. Stief More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery.

Achieving high patient satisfaction with management is often one of the goals after adult spinal deformity (ASD) surgery. However, literature on associated factors and their correlations with patient satisfaction is limited. The aim of this study was to determine the clinical and radiographic factors independently correlated with patient satisfaction in terms of management at 2 years after surgery. A multicenter prospective database of ASD surgery was retrospectively reviewed. The demographics, complications, health-related quality of life (HRQOL) subdomains, and radiographic parameters were examined to determine their correlation coefficients with the Scoliosis Research Society-22 questionnaire (SRS-22R) satisfaction scores at 2 years (Sat-2y score). Subsequently, factors determined to be independently associated with low satisfaction (Sat-2y score ≤ 4.0) were used to construct 2 types of multivariate models: one with 2-year data and the other with improvement (score at 2 years - score at baseline) data. A total of 422 patients who underwent ASD surgery (mean age 53.1 years) were enrolled. All HRQOL subdomains and several coronal and sagittal radiographic parameters had significantly improved 2 years after surgery. The Sat-2y score was strongly correlated with the SRS-22R self-image (SI)/appearance subdomain (r = 0.64), followed by moderate correlation with subdomains related to standing (r = 0.53), body pain (r = 0.49-0.55), and function (r = 0.41-0.55) at 2 years. Conversely, the correlation between radiographic or demographic parameters with Sat-2y score was weak (r < 0.4). Multivariate analysis to eliminate confounding factors revealed that a worse Oswestry Disability Index (ODI) score for standing (≥ 2 points; OR 4.48) and pain intensity (≥ 2 points; OR 2.07), SRS-22R SI/appearance subdomain (< 3 points; OR 2.70) at 2 years, and a greater sagittal vertical axis (SVA) (> 5 cm; OR 2.68) at 2 years were independent related factors for low satisfaction. According to the other model, a lower improvement in ODI for standing (< 30%; OR 2.68), SRS-22R pain (< 50%; OR 3.25) and SI/appearance (< 50%; OR 2.18) subdomains, and an inadequate restoration of the SVA from baseline (< 2 cm; OR 3.16) were associated with low satisfaction. Self-image, pain, standing difficulty, and sagittal alignment restoration may be useful goals in improving patient satisfaction with management at 2 years after ASD surgery. Surgeons and other medical providers have to take care of these factors to prevent low satisfaction.

Health-Related Quality of Life Subdomains in Patients with Parkinson's Disease: The Role of Gender.

The most frequently used instrument to assess health-related quality of life (HrQoL) in Parkinson's disease (PD) is the Parkinson's Disease Questionnaire 39 (PDQ-39). However, both the dimensionality of the eight PDQ-39 subscales and their summary score recently faced criticism. Furthermore, data on disease-related and neuropsychological determinants and the role of gender on HrQoL in PD are inconclusive yet. Therefore, our aim was to reevaluate the PDQ-39 structure and to further explore determinants of HrQoL in PD. 245 PD patients (age: M = 69.64, SD = 8.43; 62.9% male; H&Y: Md = 3.00; cognitive assessment with PANDA: M = 24.82, SD = 3.57) from the baseline database of the Cologne Parkinson Network were used to reevaluate the dimensionality of the PDQ-39 with a principal component analysis (PCA). Multiple regression analyses were conducted to clarify general and domain-specific relationships between clinical, (neuro)psychological, and sociodemographic variables, gender in particular, and HrQoL. The PCA identified three HrQoL domains: physical-functioning, cognition, and socioemotional HrQoL. Depressive symptoms were identified as the most important determinant of HrQoL across all models. Disease-related HrQoL determinants (UPDRS-III, H&Y stage, and LEDD) were less strong and consistent HrQoL determinants than nonmotor symptoms. Analyses did not reveal a global gender effect; however, female gender was a negative predictor for physical-functioning and socioemotional HrQoL, whereas male gender was a negative predictor for cognition HrQoL. Our analyses suggest the consideration of a reevaluation of the PDQ-39. Only the full understanding of HrQoL, its determinants, and their interrelationships will allow the development of PD intervention strategies focusing on what matters the most for patients' HrQoL. Gender is one relevant variable that should be considered in this context.

Health-related quality of life after pediatric liver transplantation: A systematic review.

With improved survival rates after pediatric liver transplantation (LT), attention is targeting improving the health-related quality of life (HRQOL) as an outcome metric. We conducted a systematic review of the literature to examine HRQOL after pediatric LT, focusing on assessment tools and factors associated with HRQOL. A literature search was conducted through PubMed, Web of Science, Ovid, and Google Scholar for all studies matching the eligibility criteria between January 2004 and September 2016. Titles and abstracts were screened independently by 2 authors and consensus for included studies was achieved through discussion. A total of 25 (2 longitudinal, 23 cross-sectional) studies were reviewed. HRQOL in pediatric LT recipients is lower than healthy controls, but it is comparable to children with chronic diseases or other pediatric solid organ transplant recipients. Domain scores were lowest in school functioning on the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale 4.0 and general health perception on the Child Health Questionnaire, the 2 most commonly used generic HRQOL instruments. Identified predictors of poor HRQOL include sleep disturbances, medication adherence, and older age at transplantation. Two recently validated disease-specific HRQOL tools, Pediatric Liver Transplant Quality of Life tool and the Pediatric Quality of Life Inventory 3.0 Transplant Module, have enabled enhanced representation of patient HRQOL, when used in conjugation with generic tools. Heterogeneity in study design and instruments prevented a quantitative, meta-analysis of the data. In conclusion, continued optimization of durable outcomes for this population mandates prioritization of research focusing on the gap of targeted intervention studies aimed at specific HRQOL subdomains and longitudinal studies to predict the trajectory of HRQOL over time. Liver Transplantation 23 361-374 2017 AASLD.

Prospective evaluation of health-related quality of life after radical cystectomy: focus on peri- and postoperative complications.

To analyse the impact of perioperative complications and complex treatment courses on postoperative health-related quality of life (HRQOL) after radical cystectomy (RC) and continent (ONB) or incontinent (IC) urinary diversion at multiple prospective time points. A total of 121 consecutive patients underwent RC with curative intent between 2013 and 2014. HRQOL was prospectively assessed preoperatively, after 3 and 12months, using the QLQ-C30 questionnaire. The impact of complex perioperative treatment courses including cases requiring surgical re-interventions was retrospectively assessed using Martin criteria and the Clavien-Dindo scale. Urinary continence was determined using the validated ICIQ-SF questionnaire. Statistical analysis included Kruskal-Wallis ANOVA, Spearman's rank correlation, and ordinal regression models (p<0.05). A total of 100 patients underwent further analysis. Physical functioning (PF), role functioning (RF), and global health status (GHS) scores were higher in the ONB subgroup both preoperatively (p<0.001, 0.010, 0.048) and 3months after RC (p=0.003, 0.048, 0.019). Clavien complications ≥III led to reduced PF levels after 3months (p=0.050) without effect on GHS (p=0.825). Operating time and length of critical care monitoring correlated with 3months pain scores in the ONB subgroup (p=0.003, 0.009) without affecting GHS (p=0.603, 0.653). Continent urinary diversion was an independent predictor of increased HRQOL after 3months (p=0.021), however, not after 12months (p=0.803). Patients receiving an IC have lower PF, RF, and GHS scores than those receiving ONB. Perioperative complications and complicated treatment courses can affect HRQOL subdomains but do not significantly impact the GHS. ONB is an independent predictor for better overall HRQOL 3months, but not 12months after RC.

Insomnia is associated with quality of life impairment in medical-surgical intensive care unit survivors

ObjectivesTo examine the prevalence of insomnia and its relationship to health-related quality of life (HRQOL) post-intensive care unit (ICU). BackgroundThe burden of post-ICU insomnia is unknown. MethodsThis cross-sectional study examined data from 120 patients with an ICU stay >24 h. Pre-hospital health was assessed in-hospital. Insomnia, HRQOL and post-ICU psychiatric symptoms were assessed at 12 months post-ICU. ResultsOver one-quarter (28%) of subjects met insomnia criteria at 12 months post-ICU. Post-ICU insomnia was independently associated with worse mental HRQOL (P < 0.01), as well as worse scores on the HRQOL sub-domains of bodily pain (P < 0.001), vitality (P < 0.05) and physical function (P < 0.05). However, these associations were no longer significant after adjusting for post-ICU psychiatric symptoms (P = 0.33). ConclusionsInsomnia is common among ICU survivors. Post-ICU insomnia is significantly associated with mental HRQOL and could identify ICU survivors who may benefit from further psychiatric evaluation.

Low impact of congenital hand differences on health-related quality of life

Abstract Ardon MS, Janssen WG, Hovius SE, Stam HJ, Selles RW. Low impact of congenital hand differences on health-related quality of life. Objective To evaluate health-related quality of life (HRQoL) and its determinants in children with congenital hand differences (CHDs). Design Survey. Setting Outpatient clinic of a university hospital. Participants Children (N=116; age range, 10–14y) with CHDs. Interventions Not applicable. Main Outcome Measures HRQoL evaluated by child self-reports of the Pediatric Quality of Life Inventory and compared with reference values of healthy peers. Multivariable regression analysis was performed to investigate determinants of HRQoL. Results All children with CHDs had scores similar to those of healthy peers, except for a lower score on social functioning in children aged 13 to 14 years. Higher ease of activity performance was related to higher HRQoL scores, and presence of comorbidity was related to lower scores on all HRQoL subdomains except for school functioning. Additionally, physical health was influenced by ethnicity, bilateral involvement, and previous surgery; emotional functioning by the number of affected digits; school functioning by age; and total HRQoL by bilateral involvement. Conclusions Children with CHDs report similar HRQoL as healthy peers. HRQoL decreased in the presence of comorbidity but increased with higher ease of activity performance. Scores on some subdomains were improved by the number of affected digits, but were reduced by age, ethnicity, bilateral involvement, and surgery. Although HRQoL is an important health outcome, it may not be sensitive to detect changes over time or changes after treatment in children with CHDs.

Cost-Effectiveness of Surgical Treatment for Adult Spinal Deformity: A Comparison of Dollars per Quality of Life Improvement Across Health Domains

DesignRetrospective, single-center analysis of consecutive patients undergoing surgical treatment for adult spinal deformity (ASD). ObjectiveAssess the value of surgical treatment for ASD across different health domains. Summary of Background DataThe cost of improvement in health-related quality of life (HRQOL) is an important consideration for resource allocation. There is also growing concern among policy makers regarding the incorporation of patient-specific preferences in the appropriate definition and assessment health care value. MethodsSingle-center, retrospective study of consecutive ASD patients undergoing primary surgery with principal diagnosis code 737.0–737.9 from 2005 through May 2010. Patients less than 18 years of age were excluded. The HRQOL measures were based on the Short Form–36, the Oswestry Disability Index (ODI), and the Scoliosis Research Society (SRS)–22 questionnaire after at least 2 years after surgery. The SRS scores were translated to a 100-point scale. Costs were collected from hospital data on the total costs incurred for the episode of surgical care. Confidence intervals were calculated using nonparametric bootstrap methods. ResultsBaseline and minimum 2-year HR follow-up data were available for 164 patients, with an average follow-up of 3.2 years and a range of 2 to 7.4 years. Patients were predominantly female (14; 88%) and ranged from 18 to 82 years of age at index surgery (average of 51 years of age). The cost-effectiveness (CE) ratios varied across different HRQOL outcomes, ranging from an average cost of $5,658 per 1-point improvement in SRS Self-image to an average cost of $25,918 per 1-point improvement in SF-36 Physical Component Score (PCS). Results revealed statistically significant differences (p < .05) in CE ratios across different HRQOL outcomes. ConclusionsStatistically significant differences were found in CE ratios across HRQOL sub-domains. This has important implications in the assessment of patient-specific value of health care services, and illustrates that surgical treatment for ASD may be more cost-effective for some purposes (eg, pain reduction) and less cost-effective for others (eg, improved functional activity).

Physical activity and screen-based media use: cross-sectional associations with health-related quality of life and the role of body satisfaction in a representative sample of German adolescents

Purpose: Although it is widely accepted that physical activity (PA) positively, and screen-based media use (SBM) negatively, affects well-being, there is a lack of studies relating PA and SBM to health-related quality of life (HRQoL) in adolescents. We examined these associations in German adolescents for different HRQoL subdomains and explored the role of body satisfaction as a possible mediator. Methods: The 11–17-year-old subsample of the German Health Interview and Examination Survey (2003–2006) was analysed (N = 6813; 51.3% male). Cross-sectional associations of self-reported PA frequency and amount of daily SBM with HRQoL subscale scores (according to KINDL-R) were examined by hierarchical linear regression models, adjusting for the clustering of the sample and for a variety of possible confounders. The size and significance of indirect effects via body (dis)satisfaction (BDS) were examined by mediation analyses. Results: Higher PA frequency was significantly associated with higher HRQoL on nearly all subscales and dose–response-relationships were observable. Variations were greatest in terms of social well-being in boys (effect size d = 0.59) and physical well-being in girls (d = 0.43). Higher SBM was related to lower HRQoL on all subscales in girls and on some subscales in boys, with the largest effects for school functioning in both genders (d = 0.31 and 0.37, respectively). The mediated effects for PA and SBM were significant in both genders, but the sizes and the proportions of total effects mediated by body satisfaction were rather small. Conclusions: Higher PA frequency was associated with higher self-reported HRQoL, and higher SBM was associated with lower self-reported HRQoL in both genders, even after adjusting for relevant covariates. The results support the assumption of independent health impacts of both behaviours, although no causal relationship can be confirmed with these cross-sectional data. Mechanisms other than body satisfaction must largely account for the effects of PA and SBM on well-being.

Low Impact of Congenital Hand Differences on Health-Related Quality of Life

Ardon MS, Janssen WG, Hovius SE, Stam HJ, Selles RW. Low impact of congenital hand differences on health-related quality of life. ObjectiveTo evaluate health-related quality of life (HRQoL) and its determinants in children with congenital hand differences (CHDs). DesignSurvey. SettingOutpatient clinic of a university hospital. ParticipantsChildren (N=116; age range, 10–14y) with CHDs. InterventionsNot applicable. Main Outcome MeasuresHRQoL evaluated by child self-reports of the Pediatric Quality of Life Inventory and compared with reference values of healthy peers. Multivariable regression analysis was performed to investigate determinants of HRQoL. ResultsAll children with CHDs had scores similar to those of healthy peers, except for a lower score on social functioning in children aged 13 to 14 years. Higher ease of activity performance was related to higher HRQoL scores, and presence of comorbidity was related to lower scores on all HRQoL subdomains except for school functioning. Additionally, physical health was influenced by ethnicity, bilateral involvement, and previous surgery; emotional functioning by the number of affected digits; school functioning by age; and total HRQoL by bilateral involvement. ConclusionsChildren with CHDs report similar HRQoL as healthy peers. HRQoL decreased in the presence of comorbidity but increased with higher ease of activity performance. Scores on some subdomains were improved by the number of affected digits, but were reduced by age, ethnicity, bilateral involvement, and surgery. Although HRQoL is an important health outcome, it may not be sensitive to detect changes over time or changes after treatment in children with CHDs.