Related Quality Of Life Measures Research Articles

Extensor Mechanism Disruption after Total Knee Arthroplasty

Extensor mechanism disruption after total knee arthroplasty is a challenging complication for orthopaedic surgeons. The treatment options for repair include observation, direct primary repair, direct primary repair with synthetic ligament or autogenous tissue augmentation, or reconstruction with allograft tissue. A computerized systemic review and literature search was performed to identify the relevant literature on extensor mechanism disruptions associated with total knee arthroplasty. A comprehensive review of the literature and description of relevant treatment options and outcomes were performed using the information gained with the literature review. A multi-center prospective study on a consecutive series of patients recruited from the North American Knee Arthroplasty Revision (NAKAR) study was performed and data collected pre-operatively, intra-operatively, and post-operatively on patients that had a failed total knee arthroplasty using validated health related quality of life measures was analyzed. Six out of 290 patients in the study had extensor mechanism disruption and this group of patients had overall worse functional outcomes. The results of the study have solidified our knowledge that patients with extensor mechanism disruptions have worse functional outcomes and will need intensive management and rehabilitation. Economic and decision analyses, level III (systematic review of level III studies). See Guide for Authors for a complete description of levels of evidence.

Health related quality of life in people with hereditary neuromuscular diseases: An investigation of test–retest agreement with comparison between two generic questionnaires, the Nottingham health profile and the short form-36 items

The present work attempts to define reproducibility, test–retest and internal consistencies of two standardised tools that measure health related quality of life (HRQoL), specifically as they apply to hereditary neuromuscular disease (HNMD): the Nottingham health profile (NHP) and the medical outcome study 36-item short-form questionnaire (MOS SF-36). A cross sectional survey of 108 hereditary neuromuscular disease patients completed the questionnaires consecutively in the course of multidisciplinary consultations in Reims between April 2002 and February 2005. The results of the study confirm the acceptability of using generic questionnaires such as the Nottingham health profile and the SF-36, and show good reliability for these instruments. For both instruments, reproducibility (test–retest) appears excellent for the physical dimensions explored, and satisfactory for the mental dimensions. There is nonetheless a need for health related quality of life measures validated for neuromuscular disease patients. Health related quality-of-life (HRQoL) measures provide information on how patients assess their health and the care provision they are offered.

Combination of tizanidine and amitriptyline in the prophylaxis of chronic tension–type headache: evaluation of efficacy and impact on quality of life

Chronic tension type headache (CTTH) has a strong impact on the Quality Of Life (QOL). We carried out an open–label randomized clinical trial on 18 patients with CTTH in order to compare two different regimens of pharmacological prophylaxis: the first provided for the use of amitriptyline 20 mg/d during 3 months, while in the second we combined amitriptyline with tizanidine (4 mg/d) in the first 3 weeks of treatment.Our hypothesis is that the combination therapy may guarantee an improvement of QOL even in the early stages of treatment. In fact, it's as well–known, there is a delay of 2–3 weeks in the prophylactic effect of amitriptyline, with a consequent persistence, in the first phases of therapy, of the headache and its negative impact.We assessed the following outcome measures: frequency, pain intensity, duration of headache and the Headache Impact Test (HIT) score, used as headache–related QOL measure. The combination therapy was effective since the first month of treatment, with a significant reduction of the headache, greater than one obtained with amitriptyline alone, in terms of frequency (–52,3% vs. –40,7%), intensity (–59,51% vs. –20,39%) and duration (–53,17% vs. –36,16%).This trend was confirmed by the HIT. Our data suggest that the combination of tizanidine with amitriptyline is faster than the amitriptyline alone in providing an improvement in the headache pattern and correlated QOL.

PedsQL™ and EuroQol Most Responsive Measures To Change in Health-Related Quality of Life in Children with Hodgkin's Disease.

We evaluated four different health related quality of life measures to determine their ability to detect change over time. The four measures included the Health Utilities Index Mark 2 and 3 (HUI 2/3), the PedsQLTM 4.0 Generic Core and Cancer Module, the EuroQol and the Lansky Play - Performance Scale. Children with Hodgkin's disease, their parents and the clinic nurse were all asked to complete the four measures at four time points: 2 weeks after the 1st course of chemotherapy, on the 3rd day of the 2nd course of chemotherapy, during the 3rd week of radiation and 1 year after diagnosis. At each follow up time point the respondents were asked to indicate whether the child's HRQL had improved, stayed the same or became worse since the last measurement. 51 adolescents from 12 centres across Canada were enrolled in the study between May 1, 2002 and March 31, 2005. Two patients were excluded: one patient died shortly after the first time point, and the other patient failed to complete any of the questionnaires. The 49 patients included in the analysis had an average age of 14.7 years (8.9 - 17.9), with the two most common stages being IIA (39%) and IVA (18%). Complete data was available on 92% of patients at time 2, 89% at time 3 and 76% at time 4. Four of the 36 patients with complete follow up had relapsed (11%). The summary scores from the patients responses can be seen in the graph below. [Display omitted] All measures showed a significant change between time 1 and time 4 (<0.05). When the change in child scores was analysed between the time points using the child's self-reported change in HRQL, the PedsQL and the EuroQol showed significant change at all time points.Change in Measures According to Reported Global Rating of Change by PatientTime PeriodHUI2HUI3PedsQLPedsQL cancerEuroQolLanskyImproved1 to 2, n = 70.0220.0110.0150.0460.001NS2 to 3, n = 15NSNS0.0280.0390.017NS3 to 4, n = 20NSNS0.011NS<0.001<0.001Same1 to 2, n = 16NSNS0.033NSNSNS2 to 3, n = 9NSNS0.0390.006NS0.0283 to 4, n = 1NSNSNSNSNSNSWorse1 to 2, n = 6NSNSNSNS0.033NS2 to 3, n = 0NSNSNSNSNSNS3 to 4, n = 1NSNSNSNSNSNSAll of the measures were able to detect change in a diverse group of children with Hodgkin's Disease. The PedsQL and the EuroQol appeared to be the most sensitive to change.

The sensitivity and responsiveness of an oral health related quality of life measure to tooth whitening

To assess the sensitivity and responsiveness of an oral health related quality of life measure to tooth whitening. Following screening at a clinic, 87 subjects were given an array of tooth whitening products to use at home and reviewed 8 weeks later. Subjects self-completed the 49-item Oral Health Impact Profile (OHIP) at baseline and follow-up, and rated their satisfaction with the whiteness of their teeth compared to baseline on a global transition scale. In terms of sensitivity, observed changes were apparent in overall OHIP scores (P<0.05) and across several domains, notably functional limitation (P<0.01). However, the magnitude of change (effect size) was generally small except for the functional domain. There was an observed gradient in observed change in OHIP scores and in the magnitude of such changes (effect sizes) in relation to global rating of satisfaction with the outcome, supporting the responsiveness of the measure. The OHIP scale is sensitive and responsive to the effects of tooth whitening. Greatest sensitivity and responsiveness was in relation to functional limitations. These findings have implications for the use of oral health related quality of life measures as an outcome measure of interventions aimed at improving dental aesthetics through tooth whitening.

A cross sectional study on determinants of quality of life in ALS

Background: Understanding the determinants of quality of life (QoL) in amyotrophic lateral sclerosis (ALS) has become increasingly important with the recent emphasis on the comprehensive management of patients. Objective: To...

Patients at the centre: in our practice, and in our use of language

In a formerly widespread approach to medical decision making, physicians made a diagnosis, considered the management alternatives, and informed patients what would be done to help them. Decision making rested...

Development of the Korean version of Short-Form 36-Item Health Survey: health related QOL of healthy elderly people and elderly patients in Korea.

The health-related QOL (HRQOL) has been used extensively in clinical and epidemiological research and health service studies. Especially, the Medical Outcome Study Short-form 36-Item Health Survey (SF-36) is a widely used health status measure. However, a Korean version has not been developed and tested yet. The purpose of this study was to develop a Korean version of the Short-form Health Survey (SF-36) for use in health related quality of life measurements for Korean elderly people. SF-36 data from 90 healthy elderly people using Social Education Service and 120 elderly patients using a day care service in Seoul, Korea, were examined. We translated SF-36 version 2.0 into Korean and assessed its reliability and validity. In the results, the content validity and discriminant validity were found to be satisfactory. Cronbach's alpha coefficients ranged from 0.9298 to 0.9383. The test-retest reliability coefficients ranged from 0.710 to 0.895. In addition, the utility was examined by testing the correlation between the health-related QOL and related factors (sex, age, motor function, ability of daily life) among the elderly people. The present findings suggested that the Korean version of SF-36 would be useful as a measure of the health related QOL in Korean elderly people.

528 Clinical correlates and prognostic value of health related quality of life measurement in chronic hearth failure

528 Clinical correlates and prognostic value of health related quality of life measurement in chronic hearth failure

Progressive resistance strength training for physical disability in older people

Background Muscle weakness in old age, is associated with physical disability and an increased risk of falls. Progressive resistance strength (PRT) training exercises (i.e. movements performed against a specific external force that is regularly increased during training) are designed to increase strength in older people. Objectives To assess the effect of PRT on measures of physical disability, functional limitation and impairment in older people, and identify adverse events. Search strategy We searched the Cochrane Bone, Joint and Muscle Trauma Group specialized register (to August 2002), CENTRAL/CCTR (The Cochrane Library Issue 2, 2002), MEDLINE (1966 to February 1, 2002), EMBASE (1980 to February 1, 2002), CINAHL (1982 to February 1, 2002), Sports Discus (1948 to February 1, 2002), PEDro - The Physiotherapy Evidence Database (accessed February 1, 2002) and Digital Dissertations (accessed February 1, 2002) . We also searched reference lists of articles, reviewed conference abstracts and contacted authors. Selection criteria Randomised trials of PRT alone for older people (i.e. mean age of 60 or over) were included. Data collection and analysis Two reviewers independently assessed trial quality and extracted data. Weighted mean differences (WMD) were obtained using fixed or random effect models as appropriate. When measures with different units were pooled, standardised mean differences (SMD) were calculated. Relative risks were calculated for dichotomous outcomes. Main results Sixty-six trials with 3783 participants were included. Most studies were small and of poor quality. PRT had a large positive effect on strength (41 trials, 1955 participants), but there was statistical heterogeneity that was not explained by differences in study quality, participant characteristics or the exercise program. Some functional limitation measures showed modest improvements (i.e. gait speed, 14 trials, 798 participants, WMD 0.07 m/s, 95% CI 0.04 to 0.09). However, there was no evidence that PRT had an effect on physical disability when activity measures or health related quality of life measures (HRQOL) were assessed (10 trials, 798 participants, SMD 0.01, 95% CI -0.14 to 0.16 ). Adverse events were poorly recorded, but musculoskeletal injuries were detected in most of the studies that prospectively defined and monitored these events. Authors' conclusions PRT appears to be an effective intervention to increase strength in older people and has a positive effect on some functional limitations. However, the effect of this intervention on more substantive outcomes such as measures of disability or HRQOL remains unclear. It is difficult to determine the balance of risks and benefits of PRT because adverse events have generally been poorly collected and recorded.

Progressive resistance strength training for physical disability in older people.

Muscle weakness in old age, is associated with physical disability and an increased risk of falls. Progressive resistance strength (PRT) training exercises (i.e. movements performed against a specific external force that is regularly increased during training) are designed to increase strength in older people. To assess the effect of PRT on measures of physical disability, functional limitation and impairment in older people, and identify adverse events. We searched the Cochrane Musculoskeletal Injuries Group specialized register (to August 2002), CENTRAL/CCTR (The Cochrane Library Issue 2, 2002), MEDLINE (1966 to February 1, 2002), EMBASE (1980 to February 1, 2002), CINAHL (1982 to February 1, 2002), Sports Discus (1948 to February 1, 2002), PEDro - The Physiotherapy Evidence Database (accessed February 1, 2002) and Digital Dissertations (accessed February 1, 2002). We also searched reference lists of articles, reviewed conference abstracts and contacted authors. Randomised trials of PRT alone for older people (i.e. mean age of 60 or over) were included. Two reviewers independently assessed trial quality and extracted data. Weighted mean differences (WMD) were obtained using fixed or random effect models as appropriate. When measures with different units were pooled, standardised mean differences (SMD) were calculated. Relative risks were calculated for dichotomous outcomes. Sixty-six trials with 3783 participants were included. Most studies were small and of poor quality. PRT had a large positive effect on strength (41 trials, 1955 participants), but there was statistical heterogeneity that was not explained by differences in study quality, participant characteristics or the exercise program. Some functional limitation measures showed modest improvements (i.e. gait speed, 14 trials, 798 participants, WMD 0.07 m/s, 95% CI 0.04 to 0.09). However, there was no evidence that PRT had an effect on physical disability when activity measures or health related quality of life measures (HRQOL) were assessed (10 trials, 798 participants, SMD 0.01, 95% CI -0.14 to 0.16 ). Adverse events were poorly recorded, but musculoskeletal injuries were detected in most of the studies that prospectively defined and monitored these events. PRT appears to be an effective intervention to increase strength in older people and has a positive effect on some functional limitations. However, the effect of this intervention on more substantive outcomes such as measures of disability or HRQOL remains unclear. It is difficult to determine the balance of risks and benefits of PRT because adverse events have generally been poorly collected and recorded.

Is Quality if Life Different for Men with Erectile Dysfunction and Prostate Cancer Compared to Men with Erectile Dysfunction Due to Other Causes? Results from the ExCEED Data Base

To our knowledge the relationship between the underlying etiology of erectile dysfunction and its impact on health related quality of life has not been studied. Such a study is important for men with prostate cancer, as the potential negative quality of life impact of erectile dysfunction may affect clinical decision making in newly diagnosed disease. We compare health related quality of life in impotent men with prostate cancer to that of impotent men without prostate cancer using the Exploratory and Comprehensive Evaluation of Erectile Dysfunction (ExCEED, TAP Pharmaceutical Products, Inc., Lake Forest, Illinois) data base, which is a multicenter, observational disease registry of men with erectile dysfunction. The cohort included 168 men in ExCEED who had baseline health related quality of life measurement. Of these men 47 reported a history of prostate cancer while 121 did not. Appropriate univariate and multivariate analyses were performed comparing health related quality of life outcomes between impotent men with and without prostate cancer. Men with erectile dysfunction and prostate cancer had worse sexual self-efficacy, erectile function, intercourse satisfaction and orgasmic function than those with erectile dysfunction without prostate cancer (all p <0.001). However, men with erectile dysfunction and prostate cancer experienced less psychological impact of erectile dysfunction on sexual experience (p = 0.05) and emotional life (p = 0.03) than those with erectile dysfunction without prostate cancer. The findings regarding the psychological impact of erectile dysfunction persisted in multivariate linear regression models. Men with erectile dysfunction and prostate cancer appear to have better disease specific health related quality of life than those with erectile dysfunction and no history of prostate cancer. This finding has important ramifications for clinicians when counseling patients newly diagnosed with prostate cancer and also when treating patients who present with erectile dysfunction of various etiologies.

Changes in life quality following third molar surgery – the immediate postoperative period

This study describes patients' perceptions of changes in oral health related quality of life (OHQOL) in the early postoperative period following third molar surgery. One hundred patients were enrolled in a prospective cohort study of the surgical removal of lower third molars under local anaesthetic. Two specific oral health related quality of life measures, OHIP-14 and OHQoLUK, were administered to the study group prior to surgery. Standardized surgical and analgesic protocols were followed. Patients kept a diary of changes in life quality each postoperative day (POD) for 7 days, completing both OHIP-14 and OHQoLUK daily. Both oral health related quality of life measures identified a significant deterioration in quality of life on POD1 (P<0.01) and this remained evident on POD2 (P<0.01), POD3 (P<0.01), POD4 (P<0.01) and POD5 (P<0.05). By POD6 and POD7 there was no significant difference in quality of life compared with preoperative status (P>0.05). Deterioration in life quality over the study period was associated with postoperative clinical findings (P<0.05): swelling and trismus. The study concludes that there is a significant deterioration in oral health related quality of life in the immediate postoperative period following third molar surgery; particularly during the first five days. This is associated with postoperative clinical findings. This has implication for patients deciding on third molar surgery and informed consent.

Third molar surgery and postoperative pain relief

Objectives This study describes patients' perceptions of changes in oral health related quality of life (OHQOL) in the early postoperative period following third molar surgery. Methods One hundred patients were enrolled in a prospective cohort study of the surgical removal of lower third molars under local anaesthetic. Two specific oral health related quality of life measures, OHIP-14 and OHQoLUK Results Both oral health related quality of life measures identified a significant deterioration in quality of life on POD1 (P 0.05). Deterioration in life quality over the study period was associated with postoperative clinical findings (P<0.05): swelling and trismus. Conclusion The study concludes that there is a significant deterioration in oral health related quality of life in the immediate postoperative period following third molar surgery; particularly during the first five days. This is associated with postoperative clinical findings. This has implication for patients deciding on third molar surgery and informed consent.

Patient-centred outcome measures in oral surgery: validity and sensitivity

The performances of patient-centred outcome measures after oral surgery were evaluated in a prospective cohort study of 100 patients who had third molar extractions. Participants self-completed a questionnaire incorporating a general health (12-item short form health survey: SF-12 ®) and two specific outcome scales to oral health (oral health impact profile: OHIP-14, and The United Kingdom Oral Health related Quality of Life measure: OHQoL-UK ©) preoperatively, daily during the immediate postoperative period, and at the review appointment (7-days later). Ninety-seven completed the study. History of ‘taking time off’ work/study because of pericoronitis during the past year was significantly associated with preoperative OHIP-14 and OHQoL-UK © scores. There were significant differences in SF-12, OHIP-14, OHQoL-UK © scores during the immediate postoperative period compared with preoperatively, when postoperative symptoms were prevalent. At the review appointment, OHIP-14 and OHQoL-UK © scores were associated with clinical findings. The measures were valid and sensate in relation to oral surgery. However, those specific to oral health were more discerning than the general scale.

Adaptación al español del cuestionario Vecú et Sante Perçue de l'Adolescent (VSP-A): una medida genérica de calidad de vida para adolescentes

Different measures of health related quality of life for use exclusively in children and adolescents have been developed over the last ten years. However, few instruments of this type have been adapted in Spain. The VSP-A is a generic health related quality of life measure for adolescents aged 11-17 developed in France. The objective of this study was to adapt the VSP-A into Spanish as a first step towards obtaining this questionnaire. The version of the VSP-A including 39 questions was adapted following the forward-backward translation methodology, including two translations into Spanish, scoring of difficulty (0 min-10 max.) and classification of semantic and conceptual equivalence, two panel discussions with adolescents, as well as meetings of consensus with the original authors. Finally, a backward translation (translation back into the original language) was carried out into French, and the final pre-test version was administered in a pilot test. Most of the questions were classified as equivalent (24/39). Following the meetings with adolescents, changes were made in some questions. After the back-translation into French, three questions required some minor changes. The Spanish version of the VSP-A seems to be semantically and culturally equivalent to the original version and suitable for adolescents in Spain. The inclusion of easy statements in the original version, the comments of the adolescents and the involvement in the adaptation process of the original authors has offered the possibility of achieving a suitable pre-test version. The next phase of the study will involve the questionnaire's reliability and validity testing. The VSP-A is expected to be useful for measuring the health-related quality of life in health surveys or as a screening tool in schools and primary care centers in Spain.

Population based norming of the UK oral health related quality of life measure (OHQoL-UK).

The aims of this study were to establish normative age-gender values for the UK oral health related quality of life measure (OHQoL-UK) in Britain and to provide a local reference for its interpretation. In addition, to identify key factors associated with oral health related quality of life in the UK. A national survey conducted with the assistance of the Office for National Statistics involving a random probability sample of 2,718 households. Participants were interviewed about their oral health status. The impact of oral health on quality of life was measured using the 16 item OHQoL-UK measure. The response rate was 68% (1,838/2,718). The majority (75%, 1,378/1,838) perceived their oral health as affecting their life quality and did so across a wide range of domains. Age-gender norm values are presented. Variations in OHQoL-UK scores were apparent in relation to socio-demographics: age (P<0.05), social class (P<0.01), and self-reported oral health status: number of teeth possessed (P<0.01). The impact of oral health on the life quality of Britons was substantial, in both positive and negative ways and associated with socio-demographic and oral health (self-reported) factors. National norm values presented should provide a reference source for meaningful interpretation of similar data and local studies.

Public conceptions of the impact of oral health on quality of life

Objectives The aims of this study were to establish normative age-gender values for the UK oral health related quality of life measure (OHQoL-UK©) in Britain and to provide a local reference for its interpretation. In addition, to identify key factors associated with oral health related quality of life in the UK. Materials and methods A national survey conducted with the assistance of the Office for National Statistics involving a random probability sample of 2,718 households. Participants were interviewed about their oral health status. The impact of oral health on quality of life was measured using the 16 item OHQoL-UK measure. Results The response rate was 68% (1,838/2,718). The majority (75%, 1,378/1,838) perceived their oral health as affecting their life quality and did so across a wide range of domains. Age-gender norm values are presented. Variations in OHQoL-UK scores were apparent in relation to socio-demographics: age (P < 0.05), social class (P < 0.01), and self-reported oral health status: number of teeth possessed (P < 0.01). Conclusions The impact of oral health on the life quality of Britons was substantial, in both positive and negative ways and associated with socio-demographic and oral health (self-reported) factors. National norm values presented should provide a reference source for meaningful interpretation of similar data and local studies.

Nottingham Health Profile: reliability in a sample of 542 subjects with major amputation of one or several limbs.

The reliability of a generic health-related quality of life measure was assessed for subjects with major amputation of one or several limbs. The Nottingham Health Profile was sent a first time to 1011 limb amputees, and a second time to the 542 respondents to the first inquiry. The intraclass correlation coefficient (ICC) between the answers to each survey was highest for the categories of distress caused by pain (ICC = 0.83), emotional reactions (ICC = 0.83) and mobility (ICC = 0.81). It was found satisfactory for energy level (ICC = 0.75), sleep (ICC = 0.75) and social isolation (ICC = 0.64). It is concluded that the NHP is a reliable health related quality of life measure for amputees.

A randomised controlled crossover trial of nurse practitioner versus doctor led outpatient care in a bronchiectasis clinic

Background: With the decrease in junior doctor hours, the advent of specialist registrars, and the availability of highly trained and experienced nursing personnel, the service needs of patients with chronic...