Study Of Health-related Quality Research Articles

Abstract 10749: A Prospective Study of Health-Related Quality of Life Outcomes in Thoracic Aortopathy Patients

Introduction: Health-related quality of life (QOL) outcomes in thoracic aortopathy (TA) patients who have not yet met the surgical threshold, but need significant lifestyle/weightlifting restrictions, are not well understood. We prospectively studied a newly developed QOL instrument to examine the associations between patient characteristics and self-reported QOL scores in TAA patients not anticipated to undergo aortic intervention for at least 6 months. Methods: All 128 adult TA patients (57±10 years, mean thoracic aortic diameter = 4.4±0.3cm, 77% male) were recruited prospectively as a single center and completed a baseline QOL instrument. The 70-item QOL instrument was adapted from validated QOL questionnaires. All patients signed informed consent. Results: Mean QOL scores for the eight scales of the instrument (range, 0 to 5, with 5 reflecting best function/QOL) were self-reported and as follows: physical function (4.2±0.8), depression (3.9±0.8), anxiety (3.8±0.9), post-traumatic stress disorder (PTSD) (4.1±0.9), social function (4.4±0.6), spiritual acceptance of diagnosis (3.6±0.7), self-efficacy (4.2±0.7), and resilience (4.1±0.6). Higher physical function score was associated with higher emotional (β=0.67, p<0.001) and social function (β=0.52, p<0.001) scores. Higher physical function (β=0.535), less depression (β=0.47), less anxiety (β=0.45), less PTSD (β =0.43), and higher social function (β=0.281) scores were all significant predictors of higher perceived overall health (all p<0.001). The degree of TA dilatations had no significant association with lower social function (β=-0.89, p=0.65), lower self-efficacy (β=-2.73, p=0.21), or lower resilience. Conclusion: In TA patients not requiring aortic surgery, higher physical, emotional, and social function scores were significantly associated with self-perceived overall health. However, the actual size had no significant association with these metrics. Further research is needed to elucidate trends of patient-reported QOL and their correlation to clinical/imaging changes.

Impact of sofosbuvir and daclastavir on health-related quality of life in patients co-infected with hepatitis C and human immunodeficiency virus

BackgroundWe conducted a real-life study of health-related quality of life (HRQoL) transformation before and 12 weeks after sofosbuvir and daclatasvir therapy in HCV/HIV co-infected patients. Factors related to the significant changes of each HRQoL domain/item were also evaluated.MethodsA prospective study was performed in the HIV integrated clinic at Cipto Mangunkusumo Hospital, Jakarta. HCV/HIV co-infected patients who started sofosbuvir and daclatasvir from government free DAA program in 2017–2019. WHOQoL-HIV BREF and RAND SF-36 questionnaires were recorded at baseline and post-treatment week 12.Results145 patients with mean age of 37.8 years (SD = 4.2) were included in the analysis. Most of patients were male (89%), previous IVDU (89%), active smoker (50.4%) and non-cirrhosis (80%). SVR12 was achieved in 95.5% of patients. Sofosbuvir and daclatasvir treatments showed positive impacts on 2 domains and 2 other items of WHOQoL-HIV BREF and 2 domains and 1 item of SF-36. Predicting factors of significant increase in each domain/item were: male and normal body mass index (BMI) for level of independence (RR 4.01,95% CI 1.09–14.74 and 4.80,95% CI 1.79–12.81); higher HCV-RNA for overall perception of QoL (RR 0.42,95% CI 0.18–0.94); non-smoking status for overall perception of health (RR 0.32,95% CI 0.15–0.66); male and fibrosis stage 0–1 for general health (RR 6.21,95% CI 1.69–22.88 and 2.86,95% CI 1.16–7.00); and the use of NNRTI-based ART (RR 5.23, 95% CI 1.16–23.65). Spiritual/personal belief decline was predicted by non-smoking status (RR 0.46, 95% CI 0.23–0.95). Treatment success was not associated with any changes of HR-QoL domain/item.ConclusionsHCV/HIV co-infected patients were successfully treated with sofosbuvir and daclatasvir and experienced improvement of HRQoL 12 weeks after treatment completion.

A longitudinal study of health related quality of life and functioning in severely injured Dutch service members

BackgroundOptimal health is demanded for service members in military operations. However, the strains of deployment can result in a deterioration, moreover when combat-related injuries are sustained, affecting level of participation and health related quality of life (HRQOL). Secondary health conditions may occur in time, however existing studies measure coping, level of activity and participation and HRQOL at one point in time. AimTo assess the change over time concerning coping, mobility, level of participation and HRQOL in Dutch service members with combat-related injuries sustained during operation Task Force Uruzgan (TFU). MethodsThe lower extremity functional scale (LEFS), the cognitive emotion regulation questionnaire (CERQ), the assessment of life habits short version (LIFE-H) and the EuroQol-5D (EQ-5D), measuring HRQOL, were administered in 2010 and 2014. Change of scores between the two time points was tested with the Wilcoxon signed rank test. ResultsThe response rate was 53% (28/53). The score on the coping strategy self-blame showed a significant increase over time with low scores on both occasions. The coping strategies positive reappraisal and acceptance showed the highest scores. No significant change is shown in mobility, the level of participation or HRQOL. Conclusionservice members with combat-related injuries remain stable in level of activity and participation and HRQOL in time and they use adaptive coping strategies.

An observational descriptive cross sectional multicenter study of health related quality of life among Iraqi patients after total hip replacement.

BackgroundHip replacement is highly effective procedure to decrease pain and disability in patients with hip arthritis and accordingly can affect health related quality of life (HRQOL). Globally, limited studies have reported impact of total hip replacement (THR) on HRQOL and there is no previous reports of HRQOL among Iraqi patients after THR.ObjectiveTo evaluate HRQOL in patients after THR and to assess impact of sociodemographic characteristics on it if present.Patients and methodsA multicenter cross sectional study was conducted on 96 patients with THR in Iraq. Sociodemographic characteristics were measured. HRQOL after THR was evaluated using Harris hip score (HHS).ResultsThe mean age of patients was 56.76, (13.88) years with a range of 23–90 years. Most of patients were females (52 patients (54.2%). Mean BMI was 44.87(8.07) kg/m2 with a range of 28.1–56.7 kg/m2. The mean(SD) of HHS was 84.39 (7.25) with minimum score of 61.7 and maximum score 93.8. Sociodemographic characteristics had no statistically significant effect on HRQOL measured by HHS except BMI. For each 1 unit increase in BMI, there is significantly and independently decrease in HHS by −0.276.ConclusionsTHR improved HRQOL. BMI was the only significant independent factor that was negatively correlated with HRQOL.

Association of Patient Age and Gender with Kidney Stone Related Quality of Life.

Kidney stone formers have lower health related quality of life than nonstone formers. The North American Stone Quality of Life Consortium is a multicenter, longitudinal, prospective study of health related quality of life in patients with kidney stones using the WISQOL (Wisconsin Stone Quality of Life Questionnaire) with data on 2,052 patients from a total of 11 centers. This study is a subanalysis of cross-sectional data looking at the association of age, gender and race on health related quality of life of stone formers. We performed multivariable analyses of ordinal logistic regression analyses to determine the impact of age, gender and race on health related quality of life, adjusting for other baseline covariates. The proportional odds assumption of ordinal logistic regression was checked. Total score and scores on 4 subdomains (social functioning, emotional functioning, stone related impact and vitality) were included. Median total score for all patients was 80.4. On multivariable analysis older patients had a significantly higher total health related quality of life score than younger patients (per 10-year increase OR 1.25, p <0.0001). Male patients had higher scores than females (OR 1.56, p = 0.0003) and nonCaucasian patients had lower health related quality of life than nonLatino Caucasian patients (OR 0.63, p = 0.0045). Younger and female patients with kidney stones have lower health related quality of life than older and male patients, respectively. NonCaucasian patients with stones also have lower health related quality of life. The clinical impact of these findings might include future implications for patient counseling, including dietary and medical management of stone disease, and potential changes to the paradigm of the surgical management of stones.

Hermeneutics of concepts of the existential-psychological healing model

The article describes an interdisciplinary research project on the management of health-related quality of life of cancer patients. The project involves theoretical and applied studies of health-related quality of life of breast cancer patients, their existential and psychological characteristics. A comparative analysis of the diagnosis of quality of life in medical (objective) and psychological (subjective) assessments was carried out. The key concepts of the existential-psychological model of healing - pain, the existential meaning of pain, illness, fear – were revealed. The possibility and effectiveness of complementation of the medical and existential-psychological models of healing using key concepts - the existential-psychological model of managing health related quality of life, existential meanings of pain, illness, fear – were analyzed. The existential-psychological model of healing is psychometric tools used for describing, explaining and generalizing psychological and existential data on a cancer patient. New psycho-diagnostic tools are used in medical professional practice taking into account requirements of personalized medicine and problems of maintaining health-related quality of life of cancer patients; adjustment of the behavior of cancer patients using existential experiences, reflexivity, trust, responsibility, and health-related quality of life.

Personality traits and health-related quality of life: the mediator role of coping strategies and psychological distress

BackgroundThe study of health-related quality of life (HRQOL) is an important topic in mental health around the globe. However, there is the need for more evidence about the cumulative influence of psychological variables on HRQOL. The main aim of the study was to evaluate how specific personality traits might explain scores in HRQOL and to explore how this relationship might be mediated by coping styles and psychological distress.MethodsYoung Colombian subjects (N = 274) were included (mean age: 21.3; SD = 3.8). The Short-Form Health Survey was used to measure HRQOL. For assessment of psychological variables, the Hospital Anxiety and Depression Scale, the Zung Self-Rating Anxiety Scale, The Coping Inventory for Stressful Situations and the short version of Big Five Inventory were used.ResultsThe personality trait that was the best predictor of HRQOL was openness to experience, forming an explanatory model for HRQOL, along with emotional coping style and depressive and anxious symptoms. Emotional coping style and psychological distress were significant mediators of the relationship between openness and HRQOL.ConclusionsOur findings provide additional data about the cumulative influence of specific psychological variables on HRQOL, in a mostly young female Latin American sample.

The Impact of Peripheral Artery Disease on Health Related Quality of Life: Comparison with the Impact of Coronary Artery Disease

Introduction: Peripheral artery disease is a common cardiovascular disease with high morbidity and mortality. The traditional objective parameters used to assess and guide the therapeutic interventions, poorly reflect the real effects from patients’ perspectives and their experience of living with peripheral artery disease. The importance of evaluating and improving quality of life has been recognized in several studies. Coronary artery disease is a more life-threatening cardiovascular disease. However, comparing coronary and peripheral artery disease, as to their impact on health related quality of life, has been controversial. The aim of this study was the assessment of health related quality of life in patients with peripheral artery disease and the investigation of relations and correlations with the objective criteria of illness. Moreover, the group of patients with peripheral arterial disease who were scheduled for surgical intervention was compared with the corresponding group of patients with coronary artery disease, as for the quality of life. Methods: Symptomatic patients with peripheral artery disease (n=125) referred to the Vascular surgery service during a six month period were enrolled in this observational study of health related quality of life. Patients completed the short form-36 (SF-36) questionnaire and ankle-brachial index was measured at presentation. During the same period, patients with coronary artery disease who were scheduled for bypass surgery (n=43) were also enrolled in the study and health related quality of life was assessed using the same questionnaire. Results: Patients with peripheral artery disease had significantly impaired health related quality of life, reporting low scores in all SF-36 domains. Markedly low they scored on the domain’s physical functioning, bodily pain, role limitations by physical problems and role limitations by emotional problems. The mean anklebrachial index was 0.57 (range, 0.30-0.90) exhibiting modest correlation with SF- 36 scores. Patients with peripheral artery disease who were scheduled for bypass surgery scored significantly (p<0.001) lower than relevant patients with coronary artery disease on the domains physical functioning, bodily pain and vitality. Conclusions: Peripheral artery disease has negative impact on health related quality of life. Objective measures, as the ankle-brachial index, only partially reflect the quality of life of these patients. Compared with patients with coronary artery disease who are scheduled for surgery, patients with peripheral artery disease have similar or even greater negative impact on health related quality of life.

A Descriptive, Longitudinal Study of Quality of Life and Perceived Health Needs in Patients With Head and Neck Cancer.

Patients with head and neck cancer have numerous concerns and symptoms in the first year of posttreatment survivorship and are especially vulnerable at the end of treatment and 1 month posttreatment. This article shares the findings of a descriptive, longitudinal study of health-related quality of life (HRQOL) in patients with head and neck cancer from the beginning of treatment through 12 months posttreatment. The primary objective of this study was to describe the symptom experience and health needs of patients receiving radiation for head and neck cancer to support the establishment of an advanced practitioner (AP) clinic for head and neck cancer survivors. Significant findings in this study showed HRQOL at the end of treatment was significantly lower than baseline (p < .001). Low scores persisted through 1 month, with gradual recovery by 12 months. Fatigue and anxiety had the highest mean scores, yet anxiety improved with time, whereas fatigue did not. Positive human papillomavirus status was statistically associated with higher anxiety. Socioeconomic status negatively impacted HRQOL. Themes of perceived health needs were managing oral symptoms, returning to a normal life, and regaining energy. The AP in oncology can play a pivotal role in providing comprehensive assessment, symptom management, health education, and supportive counseling in this population throughout treatment and survivorship.

Prospective study of health-related quality of life in men with high- and intermediate-risk prostate cancer who received secondary therapy.

5054Background: Men with high risk (HR) and intermediate risk (IR) prostate cancer (CaP) require definitive therapy and may require secondary therapy (2*T) after primary treatment (1*T). Study aims...

Refined comorbidity index based on dimensionality of comorbidity for use in studies of health-related quality of life.

To refine two subscales of the health-related quality of life comorbidity index (HRQoL-CI) into a single index measure. The 2010 and 2012 Medical Expenditure Panel Surveys were utilized as development and validation datasets, respectively. The least absolute shrinkage and selection operator was applied to select important comorbidity candidates associated with HRQoL. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess dimensionality in comorbidity. Statistical weights were derived based on standardized factor loadings from CFA and regression coefficients from the model predicting HRQoL. Prediction errors and model R(2) values were compared between HRQoL-CI and Charlson CI (CCI). Eighteen comorbid conditions were identified. CFA models indicated that the second-order multidimensional comorbidity structure had a better fit to the data than did the first-order unidimensional structure. The predictive performance of the refined scale under a multidimensional structure utilizing statistical weights outperformed the original scale and CCI in terms of average prediction error and R(2) in the prediction models (R(2) values from refined scale model are 0.25, 0.30, and 0.28 versus those from CCI of 0.10, 0.09, and 0.06 for general health, SF-6D, and EQ-5D, respectively). The dimensionality of comorbidity and the weight scheme significantly improved the performance of the refined HRQoL-CI. The refined single HRQoL-CI measure appears to be an appropriate and valid instrument specific for risk adjustment in studies of HRQoL. Future research that validates the refined scales for different cultures, age groups, and healthcare settings is warranted.

フルーツグラノーラ摂取が女性のQOLに与える影響

女性のQOLを網羅的に把握し，フルーツグラノーラ摂取がQOLに及ぼす効果について検討した．方法は，インターネットを介したアンケート調査（株式会社LSTT製・女性のためのQOL調査票）により，3,460名の身体的・精神的なQOLを調査した．また，便秘気味108名，そうでない者57名の合計165名に対し，フルーツグラノーラを自由に摂取させ，試食前後のQOLの比較を行った． スクリーニング調査の結果，非便秘気味の者は便秘気味の者と比べ，全てのカテゴリーで有意に満足度が高かった．また，フルーツグラノーラの摂取習慣がある者は，精神的側面のQOLスコアが有意に高かった． さらに，フルーツグラノーラを摂取することで，全体的なQOLスコアの上昇が見られた．このことから，フルーツグラノーラの摂取は女性のQOL向上に有効である可能性が示唆された．

252 A comparative international study of health related quality of life in Eastern Europe

252 A comparative international study of health related quality of life in Eastern Europe

A prospective longitudinal multicentre study of health related quality of life in ICU survivors with COPD

IntroductionMortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.MethodsFifty-one COPD patients (COPD-ICU group) with an ICU stay longer than 24 hours received a questionnaire at 6, 12 and 24 months after discharge from ICU. HRQL was measured using two generic instruments: the EuroQoL instrument (EQ-5D and EQ-VAS) and the Short Form 36 Health Survey (SF-36). The results were compared to HRQL of two reference groups from the general population; an age- and sex-adjusted reference population (Non-COPD reference) and a reference group with COPD (COPD reference).ResultsHRQL of the COPD-ICU group at 6 months after discharge from ICU was lower compared to the COPD reference group: Median EQ-5D was 0.66 vs. 0.73, P = 0.08 and median EQ-VAS was 50 vs.55, P < 0.05. There were no significant differences in the SF-36 dimensions between the COPD-ICU and COPD-reference groups, although the difference in physical functioning (PF) approached statistical significance (P = 0.059). Patients in the COPD-ICU group who were lost to follow-up after 6 months had low HRQL scores at 6 months. Scores for patients who died were generally lower compared to patients who failed to respond to the questionnaire. The PF and social functioning (SF) scores in those who died were significantly lower compared to patients with a complete follow up. HRQL of patients in the COPD-ICU group that survived a complete 24 months follow up was low but stable with no statistically significant decline from 6 to 24 months after ICU discharge. Their HRQL at 24 months was not significantly different from HRQL in the COPD reference group.ConclusionsHRQL in COPD survivors after intensive care was low but did not decline from 6 to 24 months after discharge from ICU. Furthermore, HRQL at 24 months was similar to patients with COPD who had not received ICU treatment.

Prescribed Exercise: A Prospective Study of Health-Related Quality of Life and Physical Fitness Among Participants in an Officially Sponsored Municipal Physical Training Program

Participants who completed a 3-month prescribed individualized exercise program in groups were followed-up prospectively. The aims were to describe the characteristics of the participants, their health-related quality of life (HRQoL) and physical fitness at baseline, at completion and at 12-month follow-up, and to identify predictors of HRQoL and physical fitness at completion and at 12-month follow-up. A 1-group follow-up design was used. Data were collected from records of 163 attendees at a municipality-sponsored health center in Norway. HRQoL was measured by self-report using the COOP/WONCA questionnaire. Physical fitness was estimated from the results of a 2-km walk test. Of the 163 participants referred to the clinic, 130 (79.8%) were women and 33 were (20.2%) men. Participants who completed were older than those who dropped out. The participants showed clinical improvement in physical fitness and all health-related quality life domains (d > 0.53) at the completion of the program and in physical functioning, mental health, performance of daily activities, overall health, and perceived improved health after 12 months (d > 0.36). Participation in group-based prescribed exercise program for 3 months may improve physical fitness and HRQoL significantly in short and long terms.

Contralateral prophylactic mastectomy in breast cancer patients with a family history: A prospective 2-years follow-up study of health related quality of life, sexuality and body image

IntroductionContralateral prophylactic mastectomy (CPM) is the most effective option to prevent the occurrence of a second breast cancer in hereditary breast cancer patients. This study aimed to prospectively evaluate health-related quality of life (HRQoL), anxiety and depression, sexuality and body image in breast cancer patients with a family history undergoing CPM with immediate breast reconstruction. Patients and methodsIn total, 60 of 69 eligible patients agreed to participate in the study. Four validated questionnaires were used: the SF-36, the Hospital Anxiety and Depression Scale (HAD), the Body Image Scale (BIS), and the Sexual Activity Questionnaire (SAQ). Forty-five patients (75%) responded before CPM, 49 (82%) at 6months, and 45 (75%) at 2years after CPM. ResultsOverall, the patients showed a satisfactory HRQoL 2years after CPM, similar to women in the general population. There were no differences in HRQoL, anxiety, depression or sexuality before and after CPM. However, more than half of the women reported at least one body image problem 2years postoperatively. ConclusionNo adverse effects on HRQoL, anxiety, depression or sexuality were observed. However, some aspects of body image were negatively affected after CPM. These findings could be used in preoperative counselling of breast cancer patients opting for CPM.

Community-based study of health-related quality of life in spinal cord injury, muscular dystrophy, multiple sclerosis, and cerebral palsy

Purpose: To assess health-related quality of life (HRQOL) in adults with spinal cord injury (SCI), muscular dystrophy (MD), multiple sclerosis (MS), and cerebral palsy (CP). Methods: This is a multicenter, community-based, cross-sectional study of adults diagnosed with CP (94), MD (99), MS (98), SCI (99), and healthy adults (105). The WHOQOL-BREF and WHOQOL-DIS questionnaire were used. Results: Significant differences in physical functioning between adults with CP and SCI and adults with MS (p = 0.003 and p < 0.001, respectively), as well as between adults with SCI and MD (p = 0.001) were found. Univariate tests revealed significant psychological functioning differences between adults with SCI and MD (p = 0.02) and SCI and MS (p = 0.001). There was a significant difference in physical functioning between controls and adults with SCI (p = 0.049) and a significant difference in psychological functioning between controls and adults with MS (p = 0.039). No statistically significant differences were found between the groups in social and environmental domains. Conclusions: Physical and physiological functioning were affected to various degrees in the studied neurodisabilities, while all groups reported similar levels of functioning and well-being in social and environmental domains.Implications for RehabilitationHealth-related quality of life (HRQOL) in adults with neurodisabilities living in a community differs from HRQOL in these individuals sampled in clinical and/or rehabilitation settings.Psychosocial aspects of HRQOL relevant to physical disability were similarly affected across those groups.Physical and physiological domains in HRQOL were affected to various degrees among adults with neurodisabilities living in a community.Levels of functioning and well-being in social and environment domains of HRQOL are similar among adults with neurodisabilities living in a community.Community-based study of health-related quality of life in spinal cord injury, muscular dystrophy, multiple sclerosis, and cerebral palsy.

A comparative study of health related quality of life, psychological well-being, impact of illness and stigma in epilepsy and migraine

This study aimed to show the difference of epilepsy from another chronic neurological disorder with episodic manifestations (CDEM): migraine. Seventy persons with epilepsy (PWE), 56 persons with migraine (PWM) and 45 healthy control participants (HCs) were included. The groups were compared in terms of demographics, quality of life, depression and self-esteem. The PWE and PWM were also compared with regard to stigma, impact of the illness, disclosure, application of spiritual/traditional healing methods, limitations, most affected life areas, and restrictions. Results showed that the PWM had lower quality of life values than the PWE and the HCs, while there was no difference among the groups in depression and self-esteem. Results also show higher unemployment levels and lower marriage rates for the PWE, where education levels were equal. Although the PWM had higher impact of illness values, the PWE were shown to have higher stigma, more concealment behavior, and higher traditional/spiritual healing application ratios. Also, the PWM emphasized the importance of being “able to fulfil daily living, social and work activities”, while the PWE emphasized the need for “independence” constantly. These results indicate that, although both migraine and epilepsy are CDEMs, they have different levels of impact on patients’ lives. The impacts are socially greater in epilepsy and extend beyond the neurological condition itself.

P01-218 - An indian study of health related quality of life in bipolar disorder patients and their caregivers

IntroductionThere are major health care implications of quality of life (QOL) in longstanding disorders such as Bipolar affective disorder (BD) for the patients and their caregivers.ObjectivesThe aim of the present study is to compare quality of life among bipolar disorder patients, their caregivers and to assess whether the level of depression correlates with the scores of quality of life in Bipolar Disorder patients.MethodWe compared bipolar disorder (N = 40), their caregivers (N = 40) and no psychiatric illnesses (N = 150) on health related quality of life (HRQOL) which was assessed using the 26-item World Health Organization QOL instrument (WHOQOL-BREF Hindi version). All patients were diagnosed using the Structured Clinical Interview for DSM IV. Within the group with bipolar disorder, we examined the relationship between HRQOL using WHOQOL BREF Hindi version and depression assessed using the 17-item Hamilton Depression Rating Scale (HDRS).ResultsPatients in bipolar disorder group had lower QOL on all the four domains compared to healthy controls, caregivers. The four domains of the WHOQOL scale correlated negatively with the HDRS.ConclusionsOur findings suggest that bipolar depression and residual symptoms of depression are negatively correlated with QOL in BD patients.

Participation in Valued Roles Post-Liver Transplant

Purpose: The purpose of the study was to identify the participation patterns of liver transplant (LT) recipients in valued roles following LT and the relationship of these to quality of life. Design: This was a cross-sectional study of health-related quality of life and role participation in 161 LT recipients, conducted between 27 August 2008 and 1 December 2008. The participants were a mean of 5.25, ±2.5, years post-LT, 75% male, and had a mean age of 59 years, range 37–77 years. Main outcome measures: These were the Role Checklist and the National Institute of Diabetes and Digestive and Kidney Diseases — Quality of Life instrument. Results: Analysis revealed that LT recipients showed a wide disparity in the number of roles currently occupied, range 1–10, mean = 4.9 and SD = 1.8, and normal distribution. There was a significant relationship (p&lt;0.001) between participation in a greater number of valued roles and all five quality of life scales. Conclusion: People who are participating in a smaller number of valued roles have lower levels of life satisfaction. The problem is believed to be related to difficulties in forming new habits. Habit training and monitoring of role return to determine when intervention is needed are required to enable all LT recipients to return to the highest quality of life possible.