Predictors Of HRQoL Research Articles

Ocular Damage Index, Ocular Pain and Subjective Visual Rating in Patients with Behçet’s Uveitis: A Study of Impact on Health-Related Quality of Life

ABSTRACT Purpose The aim of our study is to assess subjective disease burden parameters (SVR and OP) as well as objective ones (BCVA and ODI) as predictors of HRQoL in Egyptian patients with BD uveitis. Methods Ninety-six patients with BD uveitis were recruited in this cross-sectional study from the Rheumatology Department, Cairo University Hospital. HRQoL was assessed using RAND-36 item health survey 1.0, subjective visual rating (SVR) was measured on a 6-point Likert scale. Ocular pain (OP) was rated on a numeric rating scale. The Ocular Damage Index (ODI) was calculated using the ocular domain of the BD damage index. Linear regression was performed to determine predictors of HRQoL metrics. Results SVR predicted Vitality (β = 0.15, p = 0.004), Emotional Well-being (EW) (β = 0.13, p = 0.005), General Health (β = 0.18, p = 0.012) and Mental Component Summary (β = 0.22, p = 0.002). OP predicted Social Function (β = -3.18 p < 0.001), General Health (β = −1.55, p = 0.004), Physical Component Summary (β = -2.00, p = 0.007) and Mental Component Summary (β = -1.53, p = 0.005). BCVA predicted Physical Function (β = 31.1, p = 0.02) and Emotional Well-being (β = 7.94, p = 0.01). ODI failed to predict any HRQoL metrics. ODI was independent predictor of legal blindness adjusted for uveitis duration and severity. Legally blind patients had worse HRQoL metrics than patients with better vision. Conclusion In BD uveitis patients, subjective disease burden parameters were more informative about HRQoL metrics than objective ones. Longitudinal studies are needed to elucidate the utility of ODI as an outcome measure in BD uveitis. Precis In Behcet’s uveitis patients, health-related quality of life was related to visual outcome, ocular pain, and subjective visual rating. Ocular damage was an independent predictor of legal blindness, adjusted for uveitis duration and severity.

Neuropsychiatric drugs and a neurophysiological marker as predictors of health-related quality of life in patients with phantom limb pain.

To explore the relationship between sociodemographic, clinical, and neurophysiological variables and health-related quality of life (HR-QOL) of patients with phantom limb pain. This is a cross-sectional analysis of a previous clinical trial. Univariate and multivariate linear and logistic regression analyses were used to model the predictors of HR-QOL. We utilized a sequential modeling approach with increasing adjustment levels, controlling for age and sex, and other relevant clinical variables (time since amputation, level of amputation, and pain). HR-QOL was assessed by the SF-36 Health Survey and its eight subdomains. We analyzed baseline data from 92 patients with lower-limb amputations. They were mostly male (63%), 45.2 ± 15.6 years, with a mean time since amputation of 82.7 ± 122.4 months, and an overall SF-36 score of 55.9 ± 21.5. We found an association between intracortical facilitation in the affected hemisphere (ICF), gabapentin usage, and HR-QOL. ICF is a predictor of better HRQOL, whereas gabapentin usage was associated with a poorer HR-QOL, with the main model explaining 13.4% of the variance in the outcome. For the SF-36 subdomains, ICF was also a positive predictor for social functioning, bodily pain, and vitality, while medication usage was associated with lower scores in mental health, general health perception, bodily pain, and vitality. We found firsthand two new independent predictors of HR-QOL in individuals with PLP, namely, the neurophysiological metric ICF and gabapentin usage. These results highlight the role of the motor cortex excitability in the HR-QOL and stress the need for treatments that favor the neuroplastic adaptation after amputation, for which ICF may be used as a possible marker.

Preoperative state anxiety predicts postoperative health-related quality of life: A prospective observational study on patients undergoing lung cancer surgery.

Improving quality of life (QOL) after surgery is very important. Recently, preoperative anxiety has been suggested to predict postoperative health-related (HR) QOL, however the accuracy of anxiety measurement remains problematic. We examined the relationship between preoperative anxiety level and postoperative HRQOL using qualitative and quantitative assessment of anxiety. We used a detailed anxiety assessment to quantitatively investigate preoperative anxiety as a predictor of postoperative HRQOL in lung cancer patients. Fifty one patients who underwent surgery for lung cancer were included. They were assessed four times: on admission, on discharge, 1 month after surgery, and 3 months after surgery. Anxiety was measured separately as "state anxiety" and "trait anxiety" using the State-Trait Anxiety Inventory, and HRQOL was measured using the EuroQol 5 dimension 5-level. The HRQOL decreased at discharge and gradually recovered over time, reaching the same level at 3 months after surgery as at admission. HRQOL score was lower at discharge than at pre-surgery and 3 months after the surgery (p < 0.0001 each), and the score at 1 month after the surgery was lower than at pre-surgery (p = 0.007). In addition, multiple regression analysis showed that HRQOL at discharge was associated with "state anxiety" rather than "trait anxiety" at admission (p = 0.004). This study identifies the types of anxiety that affect postoperative HRQOL. We suggest that postoperative HRQOL on discharge may be improved by interventions such as psychological or medication treatment for preoperative state anxiety if identified preoperative state anxiety can be managed appropriately.

Neighborhood disadvantage and health-related quality of life in pediatric epilepsy

IntroductionWhile several demographic and epilepsy-specific characteristics are associated with diminished HRQoL in children and adolescents with epilepsy, prior investigations have failed to incorporate and address the influence of broader social contextual factors on functional outcomes. To address this gap, the purpose of the current study was to investigate the role of neighborhood disadvantage on HRQoL, including the extent to which familial and seizure-specific risk factors are impacted. MethodsData included parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 135 children and adolescents with epilepsy, and the Area Deprivation Index (ADI) to measure neighborhood disadvantage. Bivariate correlations were conducted to identify significant associations with neighborhood disadvantage, followed by a three-stage hierarchical multiple regression to predict HRQoL. Follow-up binary logistic regressions were used to determine the risk conferred by neighborhood disadvantage on sociodemographic, seizure-specific, and HRQoL factors. ResultsModerate associations between neighborhood disadvantage and familial factors, including parental psychiatric history and Medicaid insurance, were identified, while disadvantage and greater seizure frequency were marginally associated. Neighborhood disadvantage independently predicted HRQoL, and was the sole significant predictor of HRQoL when familial factors were incorporated. Children with epilepsy living in disadvantaged areas were four times more likely to have diminished HRQoL, five times more likely to live with a parent with a significant psychiatric history, and four times more likely to reside with a family receiving Medicaid insurance. ConclusionsThese results highlight the importance of identifying high-risk groups, as the cumulative burden of social context, familial factors, and seizure-specific characteristics contribute to lower HRQoL in pediatric epilepsy which disproportionately affects patients from lower-resourced backgrounds. Potentially modifiable factors such as parental psychiatric status exist within the child’s environment, emphasizing the importance of a whole-child approach to patient care. Further exploration of disadvantage in this population is needed to better understand these relationships over time.

Health-Related Quality of Life in pre-dialysis patients with chronic kidney disease: the role of Big-Five personality traits and illness denial

Health-Related Quality of Life (HRQoL) in patients with chronic kidney disease (CKD) is significantly affected, regardless of the stage of the disease, as regards the physical, psychological and social functioning dimension. Big-Five personality traits can affect patients' HRQoL and willingness to take treatment options. Illness denial consists of denial of negative emotions, resistance to change and conscious avoidance. Poorer HRQoL can predict a higher risk of hospitalization and mortality, and broadly a worse adjustment to the dialytic therapy. Thus, a clearer knowledge of the psychological variables associated with a worse HRQoL in the predialysis stage might improve the interventionplanning. No study investigated illness denial and personality traits simultaneously. We investigated the role of illness denial and Big-Five personality traits in the domains of HRQoL in predialysis patients with CKD. One hundred adults (mean age: 75.87years) with CKD participated. The Kidney Disease Quality of Life Short form, the Italian version of Ten Item Personality Inventory Revised, the Illness Denial Questionnaire, and the State-Trait Anxiety Inventory Form-Y were administered. Illness denial was associated with increased HRQoL relatedto symptoms/problems, effectand burden of CKD and cognitive functions domains, and it was a predictor of higher HRQoL in the last three domains mentioned above. Extraversion was related to better work status and sexual function; agreeableness was linked to elevated cognitive function, quality of social interaction and sexual function; conscientiousness was related to better sexual function; neuroticism was linked to improved cognitive and sexual functions; in the end, openness to experience was related to fewer symptoms and problems. This is the first study which simultaneously assessed Big-Five personality traits and illness denial in different domains of HRQoL of CKD patients. Personalised psychological interventions aimed at improving HRQoL in this population might focus on specific illness denial processes and personality traits.

Determinants of health-related quality of life in recently detoxified patients with severe alcohol use disorder

BackgroundHealth-related quality of life (HRQoL) is an important clinical outcome in Alcohol Use Disorder (AUD) and is considered as a relevant indicator of treatment success. While a better understanding of the factors affecting HRQoL would enable to adjust patients’ care to favour treatment outcome, the determinants of HRQoL in AUD remain unclear. This study aims at describing HRQoL in AUD patients and at identifying its best predictors.Methods53 recently detoxified patients with severe AUD (sAUD) underwent a cognitive assessment and filled in a HRQoL questionnaire dedicated to AUD patients (Alcohol Quality of Life Scale; AQoLS), as well as questionnaires concerning socio-demographics, alcohol history, sleep quality, depression, anxiety and impulsivity. 38 healthy controls (HC) underwent the same assessment (except AQoLS) in order to identify the altered cognitive and clinical variables that could potentially be determinants of HRQoL in sAUD.ResultssAUD patients reported that alcohol affects their HRQoL mainly in the “negative emotions”, “control”, “relationships”, and “sleep” domains. Compared to HC, they were impaired on episodic memory, working memory, executive functions, and processing speed tasks. They also reported lower sleep quality, higher depression, anxiety and impulsivity. No association was found between AQoLS total score and socio-demographics, cognitive performance, or sleep quality in patients. We found a significant correlation between HRQoL and depression/anxiety as well as impulsivity. Anxiety and impulsivity were indeed the only significant predictors of HRQoL, explaining 47.7% of the variance.ConclusionAnxiety and impulsivity are crucial determinants of HRQoL in recently detoxified sAUD patients. Since anxiety and impulsivity are frequent issues in addiction and especially in AUD, they should be particularly considered by clinicians to favour treatment outcomes.

Healthcare, Clinical Factors and Rehabilitation Predicting Quality of Life in First-time Stroke Patients: A 12-month Longitudinal Study

ObjectivesOne of the long-term rehabilitation goals in stroke survivors is to achieve the best health-related quality of life (HRQoL). This study analyzes the evolution of HRQoL one-year post-stroke to establish the main pre-stroke, clinical, health care and rehabilitation predictors. Materials and methodsThis study uses patient-level data from a one-year single-center prospective cohort study of first stroke patients, assessed at baseline, 3, 6 and 12 months. A generalized linear model with a linear response determined independent predictors of HRQol with EQ-5D-3L and SF-6D. The model included age, gender, scholarity, monthly income, residence, occupation, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index (BI), Mini-Mental State Examination (MMSE), length of stay, door-to-neurological examination time, access, frequency, and satisfaction with rehabilitation care. ResultsA total of 391 acute stroke patients, with a mean disability of 3.7 and severity of 11.7 participated. A decline of HRQoL was observed from baseline to the first three months in both indexes, with an increase in HRQoL at 3 months until 12 months. Scores were significantly lower compared to corresponding population norms throughout follow-up, mostly affected by stroke severity, disability, rehabilitation access and frequency. Higher HRQoL was associated with lower mRS, NIHSS, age, length of stay, and with higher BI, MMSE, scholarity, occupation, and rehabilitation care. ConclusionClinical measures and rehabilitation care were the strongest HRQoL predictors of stroke survivors regardless of severity levels. These findings may contribute to the development of future health policies that focus on post-stroke recovery.

Predictors of Health-related Quality of Life among Warfarin Patients

Objective: Warfarin is amongst the most frequently used oral anticoagulant, that is often prescribed to control and prevent various thromboembolic diseases like venous thromboembolism, stroke, atrial fibrillation, and valvular heart disease. This study aimed to determine various predictors and their impact on overall HRQoL among warfarin patients.&#x0D; Methods: A cross-sectional study using WHOQOL-BREF research tool was conducted among warfarin patients. Data was collected by convenience sampling method. Descriptive, comparative, and inferential statistics were used by Statistical Package for the Social Sciences (SPSS) ver. 24 to determine the predictors of HRQoL among warfarin patients.&#x0D; Results: The majority of the studied warfarin patients were females than males (n=221, 69.3%, and n=98, 30.7% respectively). In univariate analysis, statistically non-significant differences (p &gt;0.05) were observed in gender, age, marital status and work. In multivariate analysis, significant differences (p &lt;0.05) were observed in education, warfarin usage, and warfarin therapy duration.&#x0D; Conclusion: These results indicated that education, warfarin usage, and warfarin therapy duration were the pure predictors of HRQoL among the studied cohort of the warfarin patients.

Predictive value of sagittal craniocervical roentgenographic parameters for HRQOL after craniocervical fusion.

Loss of "physiological" sagittal alignment following craniocervical fusion (CCF) for degenerative disease may be associated with loss of horizontal gaze, dysphagia and poor HRQOL. This study reports on sagittal craniocervical roentgenographic predictors of HRQOL (SF-36) in patients following uncomplicated CCF for fresh upper cervical traumatic (UCT) injuries. Twenty-two consecutive adult patients (group P) aged 50 ± 16years, who had undergone CCF for fresh unstable C1 and C2AO/type UCT injuries, were evaluated 39 ± 12months postoperatively with upright lateral cervical roentgenograms and SF-36as HRQOL measure. Physiological data for cervical sagittal alignment and SF-36 were taken from an age-matched control group (C) of 30 individuals aged 52 ± 12years. Several commonly used sagittal cervical roentgenographic parameters were tested as potential predictors of the SF-36 domains in both groups. Roentgenographic predictors for each of the nine SF-domains were calculated using stepwise multilinear regression analysis (MLRA). The roentgenographic predictors in patients included (1) the angle created by McGregor's line and the inferior surface of the axis (OC2a) for physical function (PF, P = 0.049), role limitations due to physical health (RLPH, P = 0.004),role limitation due to emotional problems (RLEP, P = 0.004), emotional functioning (EF) (P = 0.012), social functioning (SF) (P = 0.028) and general health (GH, P = 0.041). (2) The angle formed between a horizontal line and the superior endplate of T1-vertebra (T1-slope) was predictor for SF (P = 0.017) and pain (P = 0.021), and (3) the angle between McGregor's line and the line that links the center of the C1 anterior arch and the apex of cervical sagittal curvature (PIA) was predictor for health change (HC, P = 0.002). This study showed that postoperative OC2a, PIA and T1-slope safely predict HRQOL outcomes (SF-36) following CCF for fresh trauma. It seems theoretically that the adequate restoration of the upper cervical alignment including C1-C2 upper cervical lordosis (OC2a) and PIA, in interaction with T1-slope, is important for postoperative HRQOL scores close to physiological values. The authors speculate that C0-C4 fusion restores horizontal gaze and allows for painful regain of pre-trauma quality of life. Spine surgeons should realign and stabilize the craniocervical junction taking in consideration these roentgenographic predictors.

PND59 Determining the Relationship of Seizures, Seizure-Free Days (SFDS) and Other Predictors of Health-Related Quality of Life (HRQOL) in Patients with Dravet Syndrome (DS) and Their Carers

DS is a rare, early onset, lifelong epileptic encephalopathy characterised by frequent and severe seizures. High seizure frequency is associated with behavioral and physical developmental comorbidities with a substantial burden to patients’ and carers’ HR-QoL. Reducing convulsive seizure frequency and increasing SFDs is a primary treatment goal for patients. This study explored the impact of increasing SFDs on patients’ and carers’ HR-QoL. In fenfluramine registration studies, patients (or proxies) completed the Pediatric Quality of Life Inventory. These patient HR-QoL data were mapped to EQ-5D-Y to provide patient utilities. Carer utilities were collected directly (EQ-5D) and mapped to EQ-5D-3L. A linear mixed effects regression model was developed to explore relationships between patient EQ-5D-Y, and clinically relevant variables: age group, frequency of SFDs per 28-days, motor impairment(s) and treatment dose. A linear panel regression model examined the relationship between SFDs and carer HR-QoL. Adjusting for age and underlying comorbidities, results from the patient regression model showed “frequency of SFDs per 28-days” was a significant predictor of HR-QoL (gain in EQ-5D utility of 0.005 per additional SFD, p<0.001). The carer linear panel model also showed “frequency of SFDs per 28-days” as a significant predictor of HR-QoL (gain in EQ-5D-3L utility of 0.014 per additional SFD, p<0.001). For example, a typical patient aged <6 years with 2 co-morbidities and 10 SFDs per 28-days would have an EQ-5D utility of 0.48. If on fenfluramine, SFDs increased to 20 or 28 (“seizure-free”) per 28 days, patient utility would rise 11.4% and 20.5%, and their carer’s utility by 27.7% and 49.8%, respectively. This regression framework provides a useful method in determining the HR-QoL impact that frequent seizures have on DS patients and their carers; highlighting that effective antiseizure treatments that durably increase SFDs, also improve patients’ and carers’ QoL in a directly quantifiable manner.

Predictors of HRQOL among U.S. Hispanic Population with Hyperlipidemia and Co-Morbidities: A Race-Based Study

Cardiovascular disease (CVD) is reported to cause one in three deaths each year in the United States (U.S.) with approximately half of Americans having at least one of the major clinical risk factors...

Nutritional Status and Health-Related Quality of Life in Men with Advanced Castrate-Resistant Prostate Cancer

Background Despite professional recommendations malnutrition is not adequately addressed in cancer patients. Here, we explored whether nutritional status (NS) is associated with HRQoL in men with metastatic castrate-resistant prostate cancer (mCRPC). Methods: Men with mCRPC enrolled into this prospective observational study were allocated to one of the four NS categories based on clinical, laboratory, and patient self-reported criteria: well-nourished (WN), nutritional risk without criteria for cachexia/sarcopenia (NR), sarcopenia, and cachexia. The HRQoL was evaluated by the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. Association between NS and self-reported HRQoL was sought by the linear regression model, which was adjusted for known prognostic variables and body mass index. Results: Over the period of two years, 141 patients were enrolled. Their median age was 74.1 years (IQR 68.6–79.4 years) and majority of them were minimally symptomatic. Fifty-nine patients (41.8%) were WN, followed by 24 (17%), 42 (29.8%), and 16 (11.4%) patients with NR, sarcopenia, and cachexia, respectively. As compared to WN patients, all three other NS categories were significant negative predictors of HRQoL (P < 0.04). Conclusions: Abnormal NS is highly prevalent in men with mCRPC and is negatively associated with their HRQoL, which supports the recommendation for management of malnutrition in these patients.

Quality of life among advanced cancer patients in Vietnam: a multicenter cross-sectional study

PurposeCancer is a leading cause of death in Vietnam. To maximize quality of life (QOL) at the end of life, valid and clinically useful instruments are needed to assess palliative care needs and the effectiveness of palliative care interventions.MethodsWe aimed to (i) determine psychometric properties of the Vietnamese version of the WHO abbreviated quality of life scale (WHOQOL-BREFVN) among advanced cancer patients, (ii) measure HR-QOL, and (iii) identify predictors of HR-QOL. We collected demographic, clinical, and HR-QOL data from stage III/IV adult cancer patients at two major Vietnamese cancer centers. We determined the internal consistency (Cronbach’s alpha), construct validity (confirmatory factor analysis (CFA)), and discriminant validity (known-groups comparison) of the Vietnamese instrument. HR-QOL was analyzed descriptively. Multinomial logistic regressions identified predictors of HR-QOL.ResultsA total of 825 patients participated. Missing data were completely at random (MCAR) (chi-square = 14.270, df = 14, p = 0.430). Cronbach’s alpha for all items was 0.904. CFA loadings of physical, psychological, social relationship, and environment domains onto HR-QOL were 0.81, 0.82, 0.34, and 0.75, respectively. Prediction of scores differed significantly by functional status (Wilks’ lambda = 0.784, chi-square = 197.546, df = 4, p < 0.01, correct prediction = 74.6%). HR-QOL was reported as very bad/bad by n = 188 patients (22.8%) and general health as very bad/bad by n = 430 (52.1%). Multinomial logistic regression (likelihood ratio test: chi-square = 35.494, df = 24, p = 0.061, correct prediction = 62.2%) and the Pearson correlations revealed worse HR-QOL was associated with inpatient status, high ECOG score, and having dependent children.ConclusionThe Vietnamese version of the WHOQOL-BREF has excellent internal consistency reliability and sound construct and discriminant validity in advanced cancer patients. Advanced cancer inpatients, those with dependent children, and those with poorer physical function appear to have the greatest palliative care needs.

Factors affecting health-related quality of life among prostate cancer patients: A systematic review.

Prostate cancer is recognized as the leading cause of malignancy-related incidence and mortality in the male population. The treatment regimens have long-term effects detrimental to the patient's quality of life. Hence, this review was aimed to determine the overall HRQOL and its associated among prostate cancer patients. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases searched were PubMed, Embase, Google Scholar and Cumulative Index to the Nursing and Allied Literature (CINAHL), which provided articles that were critically examined, yielding 52 studies that met the inclusion criteria for the systematic review. Out of 52 studies, 30 studies reported poor overall HRQOL in various domains after prostate cancer treatment. Contrastingly, 15 studies reported good overall quality of life after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer. Nonetheless, seven studies showed that the absence of a significant change in the overall quality of life after treatment. According to the studies, older age, comorbidities, higher clinical stage, higher Gleason score, greater cancer severity, African American race, impaired mental health, neoadjuvant hormonal therapy and lower level of education were the major poor predictors of HRQOL among prostate cancer patients. The overall HRQOL in prostate cancer patients was generally poor in various functional domains after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer.

P1474IMPACT OF MALNUTRITION ON HEALTH-RELATED QUALITY OF LIFE IN DIALYSIS PATIENTS: A PROSPECTIVE STUDY

Abstract Background and Aims Health-related quality of life (HRQoL) is severely impaired in dialysis patients compared to the general population. Previous studies have shown that malnutrition, a frequent complication and independent risk factor for mortality in the dialysis population, is associated with poor HRQoL. However, there is no published evidence regarding the impact of malnutrition on change in HRQoL over time. We sought to determine the most important predictors of poor HRQoL as well as the determinants of change in HRQoL over time in dialysis patients, with a particular focus on malnutrition. Method We enrolled 119 haemodialysis and 31 peritoneal dialysis patients in a 1-year single-centre prospective observational study. HRQoL was assessed using the physical and mental component scores (PCS and MCS, respectively) from the 36-Item Short Form Health Survey and the health state and visual analogue scores from the European Quality of Life 5-Dimensions (EQ5D) questionnaire. The 7-point scale Subjective Global Assessment (SGA) was performed to evaluate nutritional status. Energy, protein and fat intake, biochemical variables, anthropometric measurements and handgrip strength (HGS) were also measured. All study assessments were performed at baseline, 6 and 12 months. Results Mean age was 64±14 years. Malnutrition was present in 37% of the population (as determined by 7-point SGA). Patients with malnutrition and diabetes had significantly lower MCS, PCS and EQ5D scores compared to well-nourished and non-diabetic patients, respectively. At baseline, chronological age, serum albumin, energy and protein intake, and HGS correlated positively with PCS and EQ5D health state score. Multivariable analysis at baseline identified malnutrition as the strongest independent predictor of decreased HRQoL, after adjusting for confounders (Table 1). Patients who stayed or became malnourished during one year showed a significant decrease in MCS, PCS and EQ5D health state score at 12 months compared to baseline. This same group of patients had significantly lower MCS, PCS and EQ5D scores at baseline and 12 months compared to those who stayed or became well-nourished during one year. Prevalent/development of malnutrition was independently and significantly associated with the 1-year decrease in MCS and EQ5D health state score. In addition, a decrease in serum total protein and dietary protein intake (markers of malnutrition) were identified as independent determinants of 1-year decrease in MCS, PCS and EQ5D health state score. Conclusion We observed in this prospective observational study that presence of malnutrition was the most important and strongest independent predictor of decreased HRQoL in this dialysis population. Furthermore, prevalence/development of malnutrition and a decrease in markers of nutritional status were independently associated with a decrease in some HRQoL scores over 1 year. These findings strengthen the importance of undertaking screening to identify malnutrition, and providing specialised, individualised nutritional advice to all dialysis patients in order to prevent and/or improve nutritional status. Future studies with larger sample sizes, longer follow-up, and which include evaluation of barriers to effective nutritional interventions are needed to evaluate the impact of nutritional interventions on HRQoL and other long-term outcomes.

SAT-220 QUALITY of LIFE and HEALTH RELATED QUALITY OF LIFE in PATIENTS with END STAGE KIDNEY DISEASE

End-stage kidney disease (ESKD) is a serious and irreversible condition. Understanding the impact of ESKD and its treatment on an individual's quality of life (QoL) is important. There are limited studies found that assess QoL and Health-related QoL in middle east region, and Oman in particular. End-stage kidney disease (ESKD) is a serious and irreversible condition. Understanding the impact of ESKD and its treatment on an individual's quality of life (QoL) is important. There are limited studies found that assess QoL and Health-related QoL in middle east region, and Oman in particular. A cross-sectional, correlational study was conducted in four phases. Phase One explored the conceptual basis of QoL and how that has been assessed in ESKD patients. Phase Two explored the understanding and acceptability of the concepts within Omani patients using cognitive interviewing and individualized QoL instrument. Phase Three tested the feasibility of the main study design. Phase Four assessed the level and predictors of QoL/HRQoL from 13 hemodialysis units across Oman; and tested psychometric adequacy of key measures using exploratory and confirmatory factor analysis. Phase 1: showed inconsistencies and inappropriate us of the terms QoL and HRQoL in literature. A range of measures used to examine QoL/HRQoL. Phase 2: revealed some cultural sensitivities in two items of the SF36v2 and QoLI-D measures but generally were accepted. The SEIQoL-DW instrument supported the finding that QoL is a meaningful concept but one significant difference was the importance and universality of religion/spirituality as a key aspect of QoL. Phase 3: showed that chosen study approach was feasible and acceptable. Six nurses were identified and trained to support in patient recruitment and data collection. Phase 4: participants were 445 with mean age 46.59. Majority were male (56.3%), married (62.5%), and employed (37.5%). Significant impairment in HRQoL was found for most of SF36v2 scales: PF 52.24, RP 54.24, BP 56.72, GH 53.18, VT 52.90, SF 60.50, RE 56.25, MH 63.75, respectively. Anxiety and depression symptoms were the most significant predictors and fatigue and pruritus were next. Also Muslims patients with ESKD encounter difficulties in performing their religion obligations due to the disease. Psychometric testing revealed that SF-36 is a three-factor structure with the inclusion of a separate role functioning component; and HADS one and two factor solutions were supported. Patients reported relatively moderate levels of HRQoL, considering that they were suffering from the burden of disease symptoms, lower functional status and reasonable general health perceptions. Emotional symptoms, including anxiety and depression, had the greatest impact on reducing their HRQoL. This may suggest that psychological factors may be better predictors of HRQoL than physiological factors. Thus, consistent clinical assessment of anxiety and depression symptoms is essential for these patients. Introducing interventions to rebalance patients’ moods and incorporate psycho-social support into routine care may help them to experience a higher HRQoL future studies should continue to identify factors that influence quality of life and determine interventions that enhance a person’s sense of wellbeing.

The prevalence of sleep impairments and predictors of sleep quality among patients with asthma

Background Sleep is a significant dimension of daily life. However, only a few studies have examined the sleep quality of asthmatics in a real-world clinical settings. Objective This study is aimed to estimate the prevalence of sleep impairments among asthmatic patients and examine the relationship between sleep quality, asthma control, rhinitis symptoms, and sociodemographic characteristics. Methods The present study adopted the observational cross-sectional research design that has been designed by the Italian Respiratory Society and used valid assessments to measure the study variables. Results Data from 1150 asthmatic patients (mean age 51.01 years ± 16.03) were subjected to analysis. 58.3% of the patients had impaired sleep quality (Pittsburgh Sleep Quality Index [PSQI] total scores > 5), and their mean PSQI score was 5.68 (SD = 3.4). A significant correlation emerged between sleep quality and asthma control (p = 0.0001) and a significant albeit weak correlation emerged between PSQI total scores and Total 5 Symptoms Score (r = 0.24, p = 0.0001). Sleep quality was significantly associated health-related quality of life [HRQoL]. (r = 0.50, p < 0.001). After exclusion of patients at risk for Obstructive Sleep Apnea Syndrome (OSAS) and Gastro Esophageal Reflux Disease (GERD), the most important determinants of PSQI score were HRQoL, In the entire sample asthma control is the strongest predictor of both sleep quality and HRQoL. Conclusions The results of this real-world study highlight the prevalence, impact and predictors of sleep disturbances in asthmatic patients and suggest the need for physicians to detect poor sleep quality

Prospective Study of Psychological Morbidity and Illness Perceptions in Young People With Inflammatory Bowel Disease.

Psychological morbidity is increased in young people with inflammatory bowel disease [IBD]. Illness perceptions may be an important factor. This study aimed to describe the prevalence and severity of psychological morbidity and to examine relationships between baseline illness perceptions and anxiety, depression, and health-related quality of life [HRQoL], at baseline and 12 months later, in 16-21 year olds with IBD. IBD patients [n = 121] completed measures of anxiety, depression, HRQoL, and illness perceptions [IPQ-R] at baseline and follow-up [n = 100, 83%]. Among the 121 patients at baseline [median age 19.3 years, 40% female, 62% Crohn's disease, 73% in clinical remission], 55% reported elevated symptoms of anxiety/depression and 83% reported low HRQoL. Negative illness perceptions at baseline were significantly correlated with greater anxiety, depression, and lower HRQoL at baseline and follow-up. In regression analysis at baseline, the IPQ-R domain of greater perception of a cyclical nature of IBD was an independent predictor of anxiety, and a greater perceived emotional impact of IBD was an independent predictor of anxiety, depression, and HRQoL. Female gender and clinical relapse were also independent predictors of lower HRQoL. After controlling for baseline measures, clinical risk factors and illness perceptions did not explain additional variance in psychological morbidity at follow-up. A high prevalence of psychological morbidity, stable over 1 year, was demonstrated in young people with IBD. Having negative illness perceptions, being female, and having active disease predicted those at greatest risk of psychological morbidity. Illness perceptions may be an appropriate target for psychological interventions.

Correlates and Predictors of Health-Related Quality of Life among Patients with COPD: An Integrative Review

Background: Health-related quality of life is an important outcome variable with COPD patients. Impaired health-related quality of life among COPD patients is closely related to various factors. There are many factors that predict the HRQoL and the correlation with other important variables. Predictors of health-related quality of life were debatable in the literature. Aim: This review aimed to describe the correlation with HRQoL and to explore the predictors of HRQoL among patients with COPD. Methods: An integrative review method was conducted. A search protocol was conducted using EBSCO, Pubmed, CINAHL, Ovid, ProQuest, Cochrane, and Google Scholar databases up to October 1, 2019. Results: The review results out of 30 articles that discuss the predictors of HRQoL and 22 articles that discuss the HRQoL correlations with other important variables. The HRQoL predictors are classified according to sociodemographic factors and clinical factors, and also, the correlation and prediction of HRQoL with anxiety, fatigue, and uncertainty. The results of this review showed controversies in predictors between the studies. The most retrieved predictors were age, educational level, comorbidities, socioeconomic status, FEV1% predicted, GOLD stages, and the number of hospitalizations. The variables of anxiety and fatigue were strongly correlated and predicted HRQoL. While uncertainty was not reported as a significant HRQoL predictor. Conclusion: This review provides support about reliable predictors than unreliable one although some predictors still need further research in different races and cultures. Future research is needed to explore whether uncertainty can predict HRQoL among patients with COPD.

Can acute clinical outcomes predict health-related quality of life after stroke: a one-year prospective study of stroke survivors

BackgroundHealth-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients’ perspective. Yet HRQoL is not readily measured in clinical practice. This study aims to investigate the extent to which clinical outcomes during admission predict HRQoL at 3 months and 1 year post-stroke.MethodsStroke patients admitted to five tertiary hospitals in Singapore were assessed with Shah-modified Barthel Index (Shah-mBI), National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), and Frontal Assessment Battery (FAB) before discharge, and the EQ-5D questionnaire at 3 months and 12 months post-stroke. Association of clinical measures with the EQ index at both time points was examined using multiple linear regression models. Forward stepwise selection was applied and consistently significant clinical measures were analyzed for their association with individual dimensions of EQ-5D in multiple logistic regressions.ResultsAll five clinical measures at baseline were significant predictors of the EQ index at 3 months and 12 months, except that MMSE was not significantly associated with the EQ index at 12 months. NIHSS (3-month standardized β = − 0.111; 12-month standardized β = − 0.109) and mRS (3-month standardized β = − 0.122; 12-month standardized β = − 0.080) were shown to have a larger effect size than other measures. The contribution of NIHSS and mRS as significant predictors of HRQoL was mostly explained by their association with the mobility, self-care, and usual activities dimensions of EQ-5D.ConclusionsHRQoL at 3 months and 12 months post-stroke can be predicted by clinical outcomes in the acute phase. NIHSS and mRS are better predictors than BI, MMSE, and FAB.