Health-related Quality Of Life In Individuals Research Articles

Estimation of the relationship between body mass index and EQ-5D health utilities in individuals with type 2 diabetes: Evidence from the population-based KORA studies

ObjectivesObesity is known to be an important risk factor for type 2 diabetes and its related comorbid conditions; however, its specific impact on generic health-related quality of life (HRQL) is less clear. The objective of this study was to estimate the association between body mass index (BMI) and HRQL in individuals with type 2 diabetes. MethodsThe EQ-5D quality of life questionnaire was administered in a follow-up of 10,385 participants aged 33–94 of the population-based German MONICA/KORA surveys. 1033 participants with type 2 diabetes were identified by self-report combined with validated physician diagnoses. Semiparametric additive regression models were used to estimate the effect of BMI on EQ-5D health utilities adjusted for age, sex, education and comorbidities. ResultsBMI was significantly associated with EQ-5D health utilities even after adjustment for macro- and microvascular complications. The functional relationship between BMI and utilities was nonlinear, reflecting optimal health around 26kg/m2 and significantly decreasing health utilities with increasing levels of overweight and obesity (−0.09 points between BMI values 26 and 40). Among the diabetic complications, the history of a stroke (−0.13) and neuropathy (−0.10) were the strongest predictors of reduced health utility scores. ConclusionsBMI is strongly associated with health utilities in persons with type 2 diabetes. This suggests that lifestyle measures to reduce obesity can markedly improve patients' health-related quality of life and that the negative effect of potential weight gain should be taken into account when determining patient preferences for different type 2 diabetes treatment options.

The impact of individual quality of life assessment on psychosocial attention in patients with chest malignancies: a randomized study

The aims of this study were to investigate the impact of individual health-related quality of life (HRQL) evaluation on the attention towards symptom control and psychosocial function in advanced cancer patients. Patients with advanced lung cancer or mesothelioma who attended a pulmonary oncology outpatient clinic were randomized to either of two strategies for HRQL assessment. The experimental group (EG) answered the EORTC QLQ-C30 + LC13 questionnaire using a digital table interface, with outprint of aggregated scale scores presented to the consulting physician as a support for evaluation. The control group (CG) answered a paper version of the same questionnaire, which was stored for later analysis. Consultations were audio-recorded. Outcome measures were a quantitative content analysis of audio-recorded consultations and medical and psychosocial interventions abstracted from clinical records. One hundred seventy-one patients were randomized and participated in the study. Issues regarding emotional function were more frequently discussed during consultations in the EG (p < 0.05). Similarly, interventions directed to emotional and social concerns were more frequent in the EG (p = 0.013 and p = 0.0036, respectively). HRQL measures over time were similar across the groups. Individual HRQL assessment increased the attention to psychosocial functioning in patients with chest malignancies.

Effects of Structured Follow-Up and of More Effective Acid Inhibitory Treatment in the Management of GORD Patients in a Swedish Primary-Care Setting

Despite the high prevalence of gastro-oesophageal reflux disease (GORD) and the documented impact of GORD symptoms on individual health-related quality of life (HR-QOL) and on socioeconomic factors, structured management of GORD has had a low priority in Swedish routine primary health care. The primary objective of this study (IMPROVE) was to evaluate the effects of a structured follow-up and management regimen for primary-care GORD patients with symptomatic breakthrough despite standard proton pump inhibitor (PPI) treatment. Patients received either an increased dose of current PPI treatment or were switched to the more effective acid inhibitor esomeprazole. GORD patients with symptomatic breakthrough despite standard PPI treatment were identified through medical records and by a postal survey using the GERD Impact Scale (GIS) questionnaire. Patients rated the severity and frequency of GORD symptoms, general health status (EuroQol Group 5-Dimension Self-Report Questionnaire) and the impact of GORD symptoms on work productivity (Work Productivity and Activity Impairment) before and 4 weeks following randomization to open-label treatment with either increased acid suppressive therapy or an adjusted, higher dosage of the PPI previously used. The patients' valuation, in monetary terms, of the treatment they received pre-study versus the treatment given during the study was documented through willingness-to-pay (WTP) questions. Following more effective acid suppression, 66.3% of the study population experienced complete relief of heartburn, with no difference between the groups; HR-QOL was restored to a level comparable to that of a normal Swedish population and ability to work efficiently was significantly improved. Access to a better acid suppressive treatment was highly valuable to the patients in terms of WTP. An improved GORD management strategy including structured follow-up of treatment given and initiation of more effective acid inhibitor therapy when symptoms persist will be of great benefit to GORD patients. [ClinicalTrials.gov Identifier: NCT00272701].

Exercise Training in Patients with Pulmonary Arterial Hypertension: A Case Report

To describe the benefits of a feasible, outpatient exercise training program on exercise tolerance and health-related quality of life (HRQL) in individuals with pulmonary arterial hypertension (PAH). Case report on two subjects recruited from a tertiary care pulmonary hypertension clinic. Subject 1 was a 50-year-old male with idiopathic PAH. Subject 2 was a 54-year-old female with a 20+ year history of scleroderma and 6-year history of PAH. Both subjects underwent exercise training 3 times per week for 6 weeks using a cycle ergometer at workloads progressing from 50% to 80% of peak workload. Outcomes were assessed using cardiopulmonary exercise testing, six-minute walk test (6MWT), and HRQL using the Chronic Respiratory Disease Questionnaire (CRQ) and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR). Both subjects made substantial improvements in oxygen consumption and workload at anaerobic threshold (improvements of 3.8 and 4.2 mL.kg(-1).min,(-1) 26 and 18 W, respectively) and 6MWT distance (from 496 to 586m and 416 to 517m, respectively). Only Subject 1 made substantial improvements in peak oxygen consumption (from 16.0 to 18.3 mL.kg(-1).min(-1)and from 15.0 to 15.6 mL.kg(-1).min,(-1) respectively) and peak work rate (from 112 to 130W and 66 to 69W, respectively). Both subjects demonstrated improved HRQL. No adverse events were noted. A short and practical exercise training program can improve measures of workload, aerobic capacity, and HRQL in individuals with PAH with no adverse effects shown in these two case studies.

Health Limitations and Quality of Life Associated With Cancer and Other Chronic Diseases by Phase of Care

To estimate health limitations and health-related quality of life (HRQL) associated with cancer and other chronic conditions in a nationally representative sample within a phase-of-care framework. We used a nested case-control design to assess health limitations and HRQL in individuals reporting a breast, colorectal, prostate, or lung cancer diagnosis, or a diagnosis of arthritis, diabetes, heart disease, or hypertension compared with similar controls without these conditions. All subjects were selected from the 1986-1994 National Health Interview Surveys linked to mortality files in 1995, and classified into the initial, continuing, or last year of life phase of care. Health limitations and HRQL were compared for cases and controls for each condition with 2-sided statistical tests. Across all conditions, individuals in the last year of life phase of care reported greater health limitations and lower HRQL, as measured by the Health Activities and Limitations Index (HALex), than did individuals in the initial and continuing phases of care. Compared with their matched controls, individuals with cancer or other chronic conditions were more likely to report health limitations and lower mean HALex values in the initial, continuing, and last year of life phases of care (P < 0.05). We observed greater health limitations and lower HRQL associated with cancer and other chronic diseases compared with similar individuals without these conditions. The phase-of-care framework used in this study seems to be applicable to the assessment of HRQL for cancer and other chronic diseases.

Quality of Life – a tool to guide decision making in neuroendocrinology – development of AcroQoL

With the current medical and surgical treatments available for acromegaly, biochemical disease control and restoration of morbidity and mortality to normal can be achieved in most cases, but patient's preferences and features relevant to individual Health-Related Quality of Life (HRQoL) are often not considered. AcroQoL is a disease-generated, simple questionnaire designed to assess HRQoL in acromegaly. It contains 22 questions that evaluate physical and psychological dimensions (the latter divided into 2 sub-dimensions on appearance and personal relationships) on a 5 possible answer Likert scale which considers the frequency of occurrence (always, most of the time, sometimes, rarely, never) and the degree of agreement with the statement (completely agree, moderately agree, neither agree nor disagree, moderately disagree, completely disagree) as response choices. Answers are transformed to a percentage value, where 100 is the maximal (best) and 0 the minimum (worse) score depicting self-perceived QoL related to acromegaly. Translations into 12 languages are available up to date. Cross-sectional evaluation of HRQoL in patients with acromegaly using generic questionnaires and AcroQoL have shown severe impairment. Active disease, female gender, older age, disease duration, joint symptoms and prior radiotherapy are associated with worse HRQoL. The most affected dimension is appearance and the least personal relations; comparable results have been observed in Spanish, German, Dutch, British and Turkish speaking patients. Patients with active acromegaly show worse score (mean range: 43 to 56) than those in remission (mean range: 65 to 71). In longitudinal studies, we have shown that in patients with controlled, stable acromegaly, no change was observed on retesting at 1 month (65 + 18 versus 66 + 19), demonstrating good test-retest reliability. In patients with active acromegaly, after 6 months of treatment, an improvement in AcroQoL score was observed (56 + 20 to 66 + 18; p<0.01), demonstrating good sensitivity to change. Internal consistency of AcroQoL was good (Cronbach's α >0.7) and we observed a near significant trend between AcroQoL scores and IGF-I SDS (p=0.051), but not with GH levels. However, in 118 controlled Dutch acromegalic patients, a weakly significant correlation with GH (not with IGF-I) was found. Despite biochemical cure, acromegalic patients have a reduced HRQoL when compared to general population, even in patients with biochemically controlled disease, worse than in other chronic conditions like asthma or angina and similar to that observed in osteoarthritis, suggesting that these patients would benefit from an earlier diagnosis, before irreversible signs and symptoms of the disease impair their HRQoL. No large comparative studies are yet available including HRQoL as an outcome measure, although it is currently being evaluated with AcroQoL in clinical practice and several randomised controlled clinical trials for the evaluation of different medical therapy regimes in acromegaly. Thus, it is conceivable that not only biochemical and radiological parameters, but also dimensions that reflect HRQoL deserve to be considered as necessary tools to optimise management strategies in acromegaly.

Does it really matter where you live? A panel data multilevel analysis of Swedish municipality-level social capital on individual health-related quality of life

We test whether individual health status is related to area-level social capital measured by rates of voting participation in municipal political elections, controlling for personal characteristics, where health status is measured by mapping responses to interview survey questions into the generic health-related quality of life measure (HRQoL) the EQ-5D in order to derive the health state scores. The analysis is based on unbalanced panel data from Statistic Sweden's Survey of Living Conditions (the ULF survey) and a 3-level multilevel regression analysis, where level 1 consists of a total of 31,585 observations for 24,419 individuals at level 2 nested within 275 Swedish municipalities at level 3. We find that the health state scores increase significantly with municipality election rates. This result is robust to a number of measurement and specification issues explored in a sensitivity analysis. However, almost all variation in health status exists across individuals (more than 98%), which demonstrates that even if social capital (and other contextual variables) may be significant it is of less importance, at least at the municipality level in Sweden.

How to ‘count the cost’ and measure burden? A review of health-related quality of life in people with eating disorders

Background: Health-related quality of life (HRQOL) estimates are important for accurately estimating the individual and community burden from eating disorders and cost-utility of treatments.Aims: The aim was to conduct a systematic review in order to evaluate and compare attempts to estimate HRQOL in eating disorders (EDs).Method: A MEDLINE database and Quality of Life Research Journal search was conducted for relevant English-language papers that used validated measures of HRQOL and ED diagnostic symptoms.Results: Fifteen papers were identified which all supported EDs having a substantial impact on individual's HRQOL, in the mental health domain, that in some studies remained when controlling for body weight. Some studies indicated that presence of psychiatric co-morbidity increases the impact of the ED. In one study, when accounting for prevalence, community burden estimates were for EDs low relative to mood disorders. Findings were mixed for participants with AN, possibly reflecting its ego-syntonic nature.Conclusions: An important gap identified was the paucity of large scale community-based studies. In order to better estimate the “true” costs of EDs there is an urgent need for such research, and studies that include psychiatric control groups as well as medically ill and well groups.Declaration of interest: none.

Assessing health-related quality-of-life in individuals with haemophilia in China.

Haemophilia is a group of inherited, congenital diseases present all through the life. Those disorders are associated with a chronic burden of morbidity punctuated by episodes of acute deterioration in health-related quality-of-life (HR-QL). The significances of assessing HR-QL in individuals with haemophilia as an important component of the clinical database have gained increasing recognition in recent years. To the best of our knowledge, reports on the HR-QL of Chinese patients with haemophilia are not available. The purpose of this paper was to assess the HR-QL of patients with haemophilia in China. In order to do this, 179 patients with haemophilia (age 16-70) were mailed China quality-of-life questionnaire, which was designed specially for this study taking into account the culture characters of Chinese. Compared with the normal male general population, individuals with haemophilia experienced significantly lower levels of HR-QL and within the subgroups of patients, there was a gradation of HR-QL from mild < moderate < severe haemophilia patients. Age, clinical severity, degree of arthropathy, hepatitis status, salary and mean annual expenditure for replacement therapy were predictors of HR-QL. Clinical severity of the disease manifestation rather than the severity of the disease based on molecular classification was a factor that negatively influenced the HR-QL of patients with haemophilia. Arthropathies of patients with haemophilia in China were more severe than that in western countries because of the poorer medical care and were associated with their lower income and therapy cost. A large number of patients never had hepatitis or HIV serological examination. The exact prevalence of hepatitis and HIV was difficult to obtain and the HR-QL of hepatitis and HIV positive patients required further study.

Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases.

Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases.This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000–01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (≤ 0.5 and 0.06–1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases.

Stress and Health-related Quality of Life Individuals Undergoing Cardiac Transplantation and their Spouses

Levels of stress in individuals who have undergone heart transplantation and their spouses, and their combined effects on health-related quality of life (HRQL) were examined prospectively in 34 couples pre and post transplantation. Both members of the couple reported normative stress levels pre and post transplantation. Spousal stress levels, as well as candidate stress levels predicted Psychosocial HRQL functioning in the candidate member of the couple atone month pre transplantation, accounting for 58% of the variance. Stress levels of the recipient continued to be associated with psychosocial functioning post transplantation. Our results confirmed the importance of assessing stress levels in both members of the marital system when considering HRQL in individuals undergoing heart transplantation, particularly during the pre transplantation phase. Clinical implications for the rehabilitation counselor are discussed.

The problem of measuring change in individual health-related quality of life by postal questionnaire: use of the patient-generated index in a disabled population.

The Patient-generated Index (PGI) is a health-related quality of life (HRQoL) measure which asks respondents to nominate the areas of their lives which are most affected by their health condition, so that they can then rate the severity of the effects and weight their relative importance. It is unusual amongst such measures in that it is designed for postal administration. This study assessed the ability of the revised PGI to measure change in HRQoL in a population of 161 people who had previously been identified as having limiting long-term illness. A questionnaire, including a revised version of the PGI and the developmental version of the SF-36, was mailed at two time points (T1 and T2), 4.5 months apart. The PGI was subsequently assessed in terms of practicality, validity, reliability and responsiveness. At T1, 62% of those who felt that they still had a health problem affecting their life completed the PGI correctly. These people were significantly younger and had spent longer in education than the remaining 38%. Only 19 respondents completed the PGI correctly on both occasions, rendering reliability and responsiveness testing inconclusive. The value of the PGI is significantly diminished by the fact that many people cannot complete it correctly. Future development of the instrument is appraised in the context of related measurement methods.