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Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire
Abstract
There is an interest in the consequences of deriving a single index measure of health for validity and sensitivity. This paper presents the results of testing a recent example of a general health measure designed to derive a single index, the Euroqol (EQ), and presents a comparison with a new, influential profile measure, the Short Form 36 (SF-36) Health Survey Instrument. The EQ and an anglicised version of the SF-36 health survey, both designed for self-completion, were included in a postal survey of a random sample of 1980 patients from two practice lists in Sheffield, UK. The response rate for the EQ questionnaire was 83%, and the rate of completion over 95%. Evidence was found for the construct validity of the EQ dimension responses and the derived total EQ health score in terms of distinguishing between groups with expected health differences. Considerable agreement was found between EQ responses and the total EQ score, and the UK SF-36 profile scores. There was substantial evidence of EQ being less sensitive at the ceiling (i.e. low levels of perceived ill-health) and throughout the range of health states. A recent restructuring of the EQ, may help overcome some of the problems with the physical dimensions by reducing their skewness.
... We developed a new scale to measure health issues in everyday life and the workplace, based on the framework established by Brazier, Jones [36]. To ensure the scientific integrity of the scale development process, the tool was designed collaboratively by the authors, three researchers in related fields, and four workers exposed to noisy environments. ...
... For example, the European Quality of Life was included as an orthopaedic assessment. This assessment, however, has been validated in neurologic [55,56] and general populations [57] as well. Similarly, the 10 meter walk test, which is used to calculate gait speed, was included as a neurologic assessment; ...
Background
High-value care aims to enhance meaningful patient outcomes while reducing costs. Curating data across healthcare systems with common data models (CDMs) would help these systems move towards high-value healthcare. However, meaningful patient outcomes, such as function, must be represented in commonly used CDMs, such as Observational Medical Outcomes Partnership Model (OMOP). Yet the extent that functional assessments are included in the OMOP CDM is unclear.
Objective
Examine the extent that functional assessments used in neurologic and orthopaedic conditions are included in the OMOP CDM.
Methods
After identifying functional assessments from clinical practice guideline, two reviewer teams independently mapped the neurologic and orthopaedic assessments into the OMOP CDM. After this mapping, we measured agreement with the reviewer team with the number of assessments mapped by both reviewers, one reviewer but not the other, or neither reviewer. The reviewer teams then reconciled disagreements, after which we again examined agreement and the average number of concept ID numbers per assessment.
Results
Of the 81 neurologic assessments, 48.1% were initially mapped by both reviewers, 9.9% were mapped by one reviewer but not the other, and 42% were unmapped. After reconciliation, 46.9% of neurologic assessments were mapped by both reviewers and 53.1% were unmapped. Of the 79 orthopaedic assessments, 46.8% were initially mapped by both reviewers, 12.7% were mapped by one reviewer but not the other, and 48.1% were unmapped. After reconciliation, 48.1% of orthopaedic assessments were mapped by both reviewers and 51.9% were unmapped. Most assessments that were mapped had more than one concept ID number (neurologic assessments: 2.2±1.3; orthopaedic assessments: 4.3±4.4).
Conclusions
The OMOP CDM includes a portion of functional assessments recommended for use in neurologic and orthopaedic conditions. Many assessments did not have any term in the OMOP CDM. Thus, expanding the OMOP CDM to include recommended functional assessments and creating guidelines for mapping functional assessments would improve our ability to harmonize these data across healthcare systems.
... 34 For instance, although SF-36 was capable of identifying more fine variations concerning HRQoL due to its granular nature, EQ-5D could determine differences influencing participants' lives. 35 Last, a report clearly stated that EQ-5D can be used to measure and monitor altering health status in the context of chronic liver disease. 36 Zoe et al showed the EQ-5D utility index remained static during a follow-up of 12 months following diagnosis. ...
Purpose
The utility of the EuroQol Group 5 Dimension (EQ-5D) measuring health-related quality of life (HRQoL) has been verified; however, knowledge gaps remain concerning predictive performance in cirrhosis. We aimed to identify the optimal threshold for risk stratification and the pronounced domain in the EQ-5D linked to inferior outcomes.
Patients and Methods
The X-tile project was used to obtain a threshold, considering the composite outcome of 1-year all-cause mortality or readmission. A restricted cubic spline (RCS) was performed to test the non-linear relationship between the EQ-5D utility value and the primary outcome. Six multivariate Cox regression models incorporating EQ-5D utility value and each of the five domains were constructed.
Setting/Participants
Totally, 420 patients with cirrhosis were recruited.
Results
The median utility value of the study population was 0.77 and 59.8% reported impairment in minimal one EQ-5D domain. RCS indicated a linear relationship between the utility value and composite inferior outcome. X-tile pinpointed a utility value of 0.59 stratifying populations into high- and low-risk groups based on the outcome. Inpatients with cirrhosis and deteriorated HRQoL (utility value ≤0.59) were at higher risk of death or readmission (adjusted HR: 2.18, P < 0.001). Furthermore, mobility and usual activities were the most pronounced domains associated with composite inferior outcome.
Conclusion
A utility value ≤0.59 can identify cirrhotic inpatients exhibiting compromised HRQoL and mortality/readmission risk. It is tempting to reverse the decreased HRQoL by applying longitudinal measurements and keeping surveillance on utility value, while interventions appear to mainly focus on improving mobility and usual activities.
... The remaining patients refused to participate or could not be contacted ( Figure 1 PRISMA flow diagram). The clinical reevaluation included the patient-oriented questionnaires surveys of the Majeed score [27], Iowa Pelvic Score (IPS) [28,29], Work Ability Index (WAI) [30][31][32], Study Short-Form 36-item Health Survey (SF-36) [33] and European Quality of Life 5 Dimensions-5 Level (EQ5D-5L) [34,35]. These scores are established for analyzing functional outcome after pelvic ring injuries and have been used frequently for more than 20 years in similar studies (Table 1) [18,[29][30][31][36][37][38][39][40][41][42][43][44][45]. ...
(1) Background: High-energy injuries of the pelvic ring are rare. The wide application of iliosacral screw fixation of the posterior pelvic ring is relatively new. The aim of the present study was to evaluate the long-term quality of life. (2) Methods: All patients treated with an iliosacral screw for a posterior pelvic ring stabilization after high-energy trauma at a level 1 trauma center between 2005 and 2015 were included. Pelvic ring injuries were classified according to the Tile classification adapted by AO/ASIF. The clinical evaluation included the patient-oriented questionnaires surveys of the Majeed Score, Iowa Pelvic Score (IPS), Work Ability Index (WAI), SF-36, EQ5D-5L. (3) Results: A total of 84 patients were included with a median follow-up of 130.1 months (IQR 95.0–162.0 months). The median ISS was 22.5 (IQR 16.0–29.0), mean Majeed Score 83.32 (SD ± 19.26), IPS 77.88 (SD ± 13.96), WAI 32.71 (SD ± 11.31), SF-36 PF 71.25 (SD ± 29.61) and EQ5D-5L 0.83 (SD ± 0.21). There was a notably difference between uni- and bilateral pelvic fractures (p = 0.033) as well as a correlation with the ISS (p = 0.043) with inferior functional outcome measured by IPS. (4) Conclusions: Long-term follow-up of iliosacral screw fixation of unstable pelvic ring fractures showed a good quality of life and functional outcome with equal EQ5D-5L results and inferior SF-36 physical functioning compared to the German population.
... At each ILD clinic visit, patients completed a cough visual analog scale, the University of California San Diego shortness of breath questionnaire, 19,20 and the EQ-5D visual analog scale for quality of life. [21][22][23] Dates of death and lung transplantation were recorded. ...
... The outcome of interest for this study was HRQoL as estimated using the EQ-5D-5L instrument. The EQ-5D-5L instrument has been widely used and tested for validity, reliability, and generalisability [34,35] in many different diseases and conditions, [8,36] and the general populations of several countries. [36] The instrument comprises five domains: mobility, self-care, usual activities, pain or discomfort and anxiety or depression. ...
... On the contrary, the disadvantages of EQ-5D are the reduced sensitivity and the strong ceiling effect. [24][25][26][27][28][29] Finally, the EQ-5D has undergone the process of cultural adaptation to the Greek language. 29 In a recent study, in which both the analog scale and the York A1 tariff index were also used, the instrument demonstrated good validity and reliability with a representative sample of Greek general population. ...
Background: Acute myocardial infarction is one of the leading causes of death in the developed world. The purpose of this research is to study the biopsychosocial rehabilitation of patients with myocardial infarction six months after their release from the heart attack unit. Method and Material: The population of the study consisted of patients who had suffered a myocardial infarction and had been hospitalized in the heart attack unit of a University General Hospital six months ago. The study sample was 100 patients. The sampling method is simple randomization. Results: Problems of anxiety and sadness with a percentage of 50% are in first place, followed by problems of pain and discomfort at a percentage of 24%, problems in performing usual daily activities at a percentage of 22%, mobility problems at a percentage of 16 % and finally the problems of self-care at a rate of 12%. There is a statistically significant difference between genders, with men being more affected with mobility problems (p-value= 0.014) and with performing usual activities (/p-value= 0.003). Patients who are ≤65 years of age appeared to be more affected compared to those >65 years of age in terms of mobility problems (/p-value= 0.009). Conclusions: Quality of life improves for most patients after myocardial infarction. Whether or not patients have problems on one or more dimensions of the EQ-5D is highly related to the patient's profile. Fewest problems are observed in the self-care dimension and most problems are reported in the anxiety or sadness dimension.
... HRQoL was based on the Euro-QoL five dimensional visual analogue scale (EQ-5D-vas) which is a numerical scale between 0 (worst HRQoL imaginable) and 100 (best HRQoL imaginable). 24 The EQ-5D is valid, comparable to other quality of life tools 25,26 and is widely used in HF clinical trials. 27 Based on the cut-offs for similar 0-100 HRQoL scales in prior studies, 28,29 the EQ5D-vas scores are classified into four baseline categories: "best" (76-100), "good" (51-75), "bad" (26-50), and "worst" (0-25). ...
Background
There are calls to integrate serial recordings of health related quality of life (HRQoL) into routine care, clinical trials and prognosis. Little is known about the relationship between change in HRQoL and outcomes in heart failure (HF) patients by age, sex and HF subtype.
Method
From the Swedish Heart Failure Registry (SwedeHF; 2008–2019), patients were categorised by reduced (<40%, HFrEF), mildly-reduced (40–49%, HFmrEF) and preserved (≥50%, HFpEF) ejection fraction. HRQoL was measured using Euro-QoL-5D visual analogue scale (EQ5D-vas), collected at baseline and 1-year. Baseline EQ5D-vas scores were categorised by: “best” (76–100), “good” (51–75), “bad” (26–50), and “worst” (0–25). Change in EQ5D-vas was categorised as ‘no significant change’ (<5 points increase/decrease); some worsening (5–9 points decrease); considerable worsening (≥10 points decrease); some improvement (5–9 points increase); considerable improvement (≥10 points increase). Associations with admission and death were estimated and interactions with patient sub-groups tested.
Findings
Among 23,553 patients (median age 74 [66–81] years, 8000 [34%] female), baseline EQ5D-vas was worse in older patients, women, and those with HFpEF compared to their respective counterparts. Compared to patients with the “best” EQ5D-vas, the adjusted associations for admission for those with “good”, “bad” and “worst” EQ5D-vas were, respectively: HR 1.09 (1.04, 1.14), 1.27 (1.21, 1.33) and 1.39 (1.28, 1.51). Compared to no significant change in EQ5D-vas, the adjusted estimates for admission following some improvement, considerable improvement, some worsening and considerable worsening were, respectively: HR 0.91 (0.82, 1.01), 0.75 (0.70, 0.81), 1.04 (0.92, 1.16) and 1.25 (1.16, 1.35). Results were similar amongst groups and for HF admission and death.
Interpretation
Change in HRQoL was an independent indicator of risk of admission and death in people with all HF subtypes, irrespective of age and sex.
Funding
10.13039/501100000272NIHR.
... Health-related quality of life was assessed using the RAND-36 test, which is also validated in the Finnish population [26,27]. ...
Introduction:
Sarcopenia is common in people 70+ years of age, and its prevalence increases with further aging. Insufficient energy and protein intake accelerates muscle loss, whereas sufficient protein intake and milk fat globule membrane (MFGM) may suppress age-associated deterioration of muscle mass and strength. Our objective was to test whether a snack product high in MFGM and protein would improve physical performance in older women.
Methods:
In this 12-week randomized controlled trial, women ≥ 70 years, with protein intake < 1.2 g/body weight (BW) kg/day (d), were randomized into intervention (n = 51) and control (n = 50) groups. The intervention group received a daily snack product containing ≥ 23 g of milk protein and 3.6-3.9 g of MFGM. Both groups were advised to perform a five-movement exercise routine. The primary outcome was the change in the five-time-sit-to-stand test between the groups. Secondary outcomes included changes in physical performance, cognition, hand grip strength, and health-related quality of life.
Results:
The change in the five-time-sit-to-stand test did not differ between the intervention and the control groups. The change in the total Short Physical Performance Battery score differed significantly, favoring the intervention group (p = 0.020), and the balance test showed the largest difference. Protein intake increased significantly in the intervention group (+14 g) compared to the control group (+2 g). No other significant changes were observed.
Conclusions:
Our results indicate that the combination of MFGM and protein may improve the physical performance-related balance of older women.
... Finally, the SF-36 was developed as a set of generic, coherent, and easily administered quality-of-life (QOL) measures. These measures rely upon participant self-reporting, provide a direct quantitative indication of an individual's health status, and is widely used as a QOL evaluation tool [38,39]. ...
Background
Effective antiretroviral therapy (ART) in people living with HIV (PLWH) has improved life expectancy and increased risk of age-associated cardiometabolic comorbidities. At-risk alcohol use is more frequent among PLWH and increases the risk of health challenges. PLWH with at-risk alcohol use are more likely to meet criteria for prediabetes/diabetes and this is associated with impaired whole-body glucose-insulin dynamics.
Methods
The Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions Study (ALIVE-Ex Study, NCT03299205) is a longitudinal, prospective, interventional study to determine the effects of an aerobic exercise protocol on improving dysglycemia among PLWH with at-risk alcohol use. The intervention is a moderate intensity aerobic exercise protocol implemented 3 days per week for 10 weeks at the Louisiana State University Health Sciences Center-New Orleans. Participants who have a fasting blood glucose level between 94 and 125 mg/dl will be enrolled in the study. Oral glucose tolerance tests, fitness assessments, and skeletal muscle biopsies will be performed pre- and post-exercise intervention. The primary outcome is to determine whether the exercise protocol improves measures of whole-body glucose-insulin dynamics, cardiorespiratory fitness, and skeletal muscle metabolic and bioenergetic function. Secondary outcomes are to determine whether the exercise intervention improves cognitive function and overall quality of life. Results generated will demonstrate the effect of exercise on glycemic measures in PLWH with subclinical dysglycemia and at-risk alcohol use.
Conclusions
The proposed intervention will also have the potential to be scalable to promote lifestyle changes among PLWH, particularly in underserved communities.
... The respondent chooses the closest description to their state, resulting in a five-digit profile indicating the score on the dimensions. The second section allows for self-evaluation of the overall health status on a 20 cm analogue scale, anchored from 0 (worst state) to 100 (best health state), and patients are required to indicate the score that best represents their current health status [25,26]. ...
Introduction. Schizophrenia is a severe mental health disorder affecting almost 0.5% of the global population. Despite decades of research, it remains a debilitating condition that significantly impacts individuals' quality of life (QoL) in aspects such as physical health, psychological well-being, independence, social relationships, beliefs, and environment. Current pharmacological treatment for schizophrenia consists of typical and atypical antipsychotics. Objective and methods. We conducted a cross-sectional study on a population of 109 patients who met the DSM-IV-TR or ICD-10 criteria for schizophrenia, aiming to assess their QoL, depending on the type of antipsychotic used (typical or atypical). Descriptive statistics were used to characterize the sample, and simple linear regression was used to evaluate the impact of the type of antipsychotic on the QoL. In addition, educational level, pathology, and previous treatment were considered as controlling factors. QoL was assessed using the EuroQol EQ-5D Quality of Life Scale (EQ-5D-3L) and the abbreviated version of the World Health Organization Quality-of-Life (WHO-QOL-BREF) Scale. Results. Patients treated with atypical antipsychotics (AA) presented higher overall scores on the EQ-5D-3L, indicating better QoL. In addition, there were significant associations between treatment type and gender, as well as employment status. However, no significant differences were observed in treatment history, marital status, educational level, or Positive And Negative Syndrome Scale (PANSS) results between the two groups. Conclusion. These findings highlight the need for individualized considerations of QoL when selecting the most suitable treatment approach for patients with schizophrenia. Further studies are warranted to provide precise guidance in tailoring treatments for these patients. Additionally, it is essential to conduct studies focusing on specific antipsychotic medications rather than broad categories to understand their distinct impacts on QoL and explore the complex relationships between antipsychotics and various influential factors in schizophrenia treatment..
... This measure has been used extensively among various medical populations, yielding rich normative data [42][43][44][45]. The psychometric properties of the measure are well-established [46][47][48][49][50], and it has been used to demonstrate validate several QoL instruments [51]. ...
Purpose
To determine to what extent head and neck cancer (HNC) survivors participate in health behaviors (HBs) recommended by the National Cancer Center Network (NCCN®).
Methods
Participants identified through the tumor registries at the Abramson Cancer Center (ACC), University of Pennsylvania and affiliated sites. Eligibility: (a) diagnosis and treatment HNC; (b) aged 18 to 70 years; (c) ≥ 1-year post-diagnosis; (d) human papillomavirus (HPV) status confirmed; (e) ability to understand written English. Potential participants received an explanation of the study, informed consent, self-reported questionnaire, and self-addressed stamped envelope.
Results
451 individuals eligible, 102 (23%) agreed to participate, HPV positive (74%). Current smoking rare (7%), historical use common (48%). Current alcohol use common (65%), average 2.1 drinks/day, 12 days/month. 22% binge drank with an average of 3.5 binge-drinking sessions per month. Nutritional behavior mean 7.1 (range 0–16), lower scores indicating better nutrition. Body mass index (BMI) 59% overweight/obese. Adequate aerobic exercise 59%, adequate strength and flexibility 64%. Leisure time activity, 18% sedentary, 19% moderately active, 64% active. All participants reported having a primary care physician, 92% seen in the previous 12 months.
Conclusions
Most HNC survivors participated in some HBs. Current smoking rarely reported, binge drinking and high BMI most common negative HBs. Opportunities remain to improve dietary and exercise behaviors.
Implications for cancer survivors
The NCCN® has outlined HBs that decrease likelihood of cancer survivors developing comorbidities that could impact overall survival. It is incumbent on healthcare providers to educate and encourage cancer survivors to participate in these HBs.
... Various questionnaires have been developed to assess health-related QOL. However, to calculate QALYs, one of the outcomes of cost-utility analysis, it is necessary to measure utility values using preference-based measures (PBMs) including EuroQol five-dimensions (EQ-5D), Short Form six-dimensions (SF-6D), and health utilities index (HUI) (12)(13)(14). In particular, the EQ-5D questionnaire method of asking specific patients to provide their QOL values is widely and commonly used. ...
Quality-of-life (QOL) is important for cancer patients with poor prognosis. However, QOL survey is difficult using patients. We created cancer scenarios and investigated QOL utility values among the general public using vignette-based methods. On the other hand, some scenarios may have been difficult for the general public to image and understand. Therefore, we conducted a QOL survey among physicians. This survey was conducted by interviewing physicians adminis-tering chemotherapy to patients for recurrent/metastatic pancreatic cancer. Responses were eval-uated using Composite Time Trade-Off (cTTO) and Visual Analog Scale (VAS) for 11 pancreatic cancer status scenarios to be evaluated (survey scenarios). Survey scenarios consisted of health state, type and Grade of adverse events. Health status was classified into two categories: Stable disease (SD) and Progressive disease (PD). Twenty responders answered in this survey, however two responses were excluded because of inconsistent responses. The stable disease had the highest QOL value for both assessment method. Whereas progression disease (PD) had the lowest QOL value. The physicians scored higher QOL values on VAS and cTTO than the general public in all survey scenarios. The QOL values obtained by physicians were consistent with the degree of sta-tus in any assessment scenarios.
... The EQ5D includes overall index and a VAS with a range from 0 to 100, with a higher score indicating better health and 5 separate questions covering mobility, self care, usual activities, pain or discomfort and anxiety/depression. EQ5D has been used in many patient populations including CKD [9,10]. The KD-QoL is a valid measure of generic but disease-specific health-related QoL scoring system which is separated into 5 subscales consisting of 2 general component summary measures (physical health composite scores (physical functioning (PF) + role physical (RP) + bodily pain (BP) + general health (GH)) and mental health composite scores (vitality (VT) + social functioning (SF) + role emotional (RE) + mental health (MH)). ...
Background:
Impaired quality of life is common in patients with end-stage kidney disease. We report the baseline quality of life measures in participants from the PIVOTAL randomized controlled trial and the potential relationship with the primary outcome (all-cause mortality, myocardial infarction, stroke, and heart failure hospitalisation), and associations with key baseline characteristics.
Methods:
This was a post hoc analysis of 2141 patients enrolled in the PIVOTAL trial. Quality of life was measured using EQ5D index, Visual Analogue Scale, and the KD-QoL [Physical Component Score and Mental Component Score].
Results:
Mean baseline EQ5D index and visual analogue scale scores were 0.68 and 60.7 and 33.7 (Physical Component Score) and 46.0 (Mental Component Score), respectively. Female sex, higher Body Mass Index, diabetes mellitus, history of myocardial infarction, stroke or heart failure were associated with significantly worse EQ5D index and visual analogue scale. Higher C-reactive protein levels and lower transferrin saturation were associated with worse quality of life. Haemoglobin was not an independent predictor of quality of life. A lower transferrin saturation was an independent predictor of worse physical component score. A higher C-reactive protein level was associated with most aspects of worse quality of life. Impaired functional status was associated with mortality.
Conclusion:
Quality of life was impaired in patients starting haemodialysis. A higher C-reactive protein level level was a consistent independent predictor of the majority of worse quality of life. Transferrin saturation ≤ 20% was associated with worse physical component score of quality of life. Baseline quality of life was predictive of all-cause mortality and the primary outcome measure.
Eudract registration number:
2013-002267-25.
... Scores for depression, anxiety and stress are calculated by summing the scores for the relevant items. Health related quality of life will be measured using the EuroQol-5 Dimensions questionnaire including five items of different health domains; mobility, self-care, activities of daily living, pain and anxiety/depression, which is scored on 5-point Likert scale ("no problems" to "extreme problems") and a visual analogue scale (0-100) where the endpoints are labelled "The best health you can imagine" and "The worst health you can imagine" [55]. ...
Background
Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND– Let’s get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden.
Methods
One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments.
Discussion
We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA.
Trial registration
ClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.
... Examples for non-PBMs include the Medical Outcomes Study (MOS) short form-36 (SF-36) for patients with mild symptoms, and European Organization for Research and Treatment of Cancer Quality of Life (EORTC-QLQ) for cancer patients [21,22]. PBMs can indirectly measure utility using a specific questionnaire including the EuroQol 5 dimensions 5-level (EQ-5D-5L), short form 6 dimensions (SF-6D), and health utilities index (HUI) [23][24][25]. Because indirect utility measurement applies to various diseases, quality-adjusted life years (QALYs) can be calculated from the target disease utility and survival time and used as effectiveness for cost-utility analysis in health technology assessment. ...
Backgrounds
Limited information is available on the utility values of metastatic pancreatic cancer, focusing on different health statuses, selected chemotherapy, and related grades 1/2 and 3/4 adverse events (AEs). We evaluated Japanese societal-based health-related utility values for metastatic pancreatic cancer by considering different grade toxicities commonly associated with chemotherapy using the vignette-based method.
Methods
We developed health status scenarios for patients with metastatic pancreatic cancer undergoing chemotherapy and conducted utility research using the developed scenarios in four steps: ‘literature review,’ ‘exploratory interview,’ ‘content validation’, and ‘utility research’. In the development process, to consider the impact of AEs of chemotherapy for metastatic pancreatic cancer on health state utility values, we selected neutropenia, febrile neutropenia, diarrhea, nausea and vomiting, and neuropathy as representative AEs. Each AE was classified as either grade 1/2 or 3/4. We confirmed our created scenarios through cognitive interviews with the general population and clinical experts to validate the content. Finally, we developed 11 scenarios for using ‘utility research,’ evaluated in a societal-based valuation study using the face-to-face method. Participants for ‘utility research’ were the general population, and they evaluated these scenarios in the composite time trade-off (cTTO) and visual analog scale (VAS) of the European quality of life (EuroQol) valuation technology to derive health state utility scores.
Results
Of 220 responders who completed this survey, 201 were adapted into the analysis population. Stable disease with no AEs (reference state) had a mean utility value of 0.653 using cTTO. The lowest mean utility score in the stable state was 0.242 (stable disease + grade 3/4 vomiting). VAS results ranged from 0.189 to 0.468, depending on the various grades of AEs in stable disease. In addition, grade 3/4 AEs and grade 1/2 nausea/vomiting were associated with significantly greater disutility. Utility values were also strongly influenced by the direct impact of AE on physical symptoms, severity and their experience. In addition, 95.9% of the respondents agreed that they understood the questions in the post-response questionnaire.
Conclusions
We clarified the health state utility values of patients with metastatic pancreatic cancer based on the general population in Japan. The effect on utilities should be considered not only for serious AEs, but also for minor AEs.
... 38 Also, in the anxiety/depression dimension, the differences regarding median of values for SF-36v2 MH dimension (32.0 points) and SF (25.0 points) are higher than the difference for PF (15.0 points), in agreement with hypothesis H 5 and already observed. 39 The difference in points for the median of the SF-36v2 PR dimension, between those referring in EQ-5D that do not have any pain and those referring problems regarding pain is of 39.0 points (hypotheses H 6 ), also previously demonstrated. 40 In order to answer hypothesis H 7 , the relationship between responses to EQ-5D dimensions, age and the presence of pathology are presented in Table 8. ...
Introduction: The EQ-5D allows the achievement of two essential components of any measure of health-related quality of life to be used in cost-utility economic evaluations: (i) a profile describing the health status in terms of domains or dimensions; and (ii) a numeric value associated with the health status described.Aim: The Portuguese version of the EQ-5D questionnaire was completed in 1998, based on guidelines set by the EuroQol Group, including translation and back translation procedures. Despite its wide use in Portugal, until now it had not yet been published studies that initially led to the Portuguese version and the guarantee of acceptability, reliability and validity. The purpose of this article is to document these first values relating to the Portuguese version of the EQ-5D.Material and Methods: We used three different samples: a first one with 1,500 individuals representative of the Portuguese population; a second with 140 individuals just intended for the reliability test; and a third sample with 643 individual patients with cataracts, asthma, chronic obstructive pulmonary disease, or rheumatoid arthritis.Results: The acceptability was assessed by the number of missing responses. It was also found a marked ceiling effect, with a large part of the sample not reporting any problems in the dimensions of the EQ-5D.Discussion: The construct validity was tested by examining the degree to which low values of EQ-5D were positively associated with increasing age, being female, and the sick, as well as the values of dimensions of the SF-36v2 scale. Convergent validity was based on correlations between EQ-5D values and other specific measures. The EQ-5D showed moderate to high correlations with other diseasespecific measures of health status and health related quality of life.Conclusion: We can state that the Portuguese version of the EQ-5D has a good accessibility, reliability and validity in measuringhealth.
... Patients completed self-report HRQOL questionnaires: the EuroQol ( EuroQol 5-dimension 3 L questionnaire [EQ-5D-3L]), 28 and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), 29 , and other assessments (Table S1). Minimal clinically important differences for the KCCQ-12 29 and EQ-5D visual analog scale (VAS) 8,30 are 5 and 10 points, respectively. ...
Background:
Restoring health-related quality of life (HRQOL) is a therapeutic goal for older patients with advanced heart failure. We aimed to describe change in HRQOL in older patients (60-80 years) awaiting heart transplantation (HT) with or without pretransplant mechanical circulatory support (MCS) or scheduled for long-term MCS, if ineligible for HT, from before to 6 months after these surgeries and identify factors associated with change.
Methods:
Patients from 13 US sites completed the EuroQol 5-dimension 3L questionnaire and Kansas City Cardiomyopathy Questionnaire-12 at baseline and 3 and 6 months after HT or long-term MCS. Analyses included univariate comparisons and multivariable linear regression.
Results:
Among 305 participants (cohort mean age=66.2±4.7 years, 78% male, 84% White, 55% New York Heart Association class IV), 161 underwent HT (n=68 with and n=93 without pretransplant MCS), and 144 received long-term MCS. From baseline to 3 months, EuroQol 5-dimension visual analog scale scores improved in HT patients without pretransplant MCS (54.5±24.3 versus 75.9±16.0, P<0.001) and long-term MCS patients (45.7±22.9 versus 66.2± 20.9, P <0.001); while Kansas City Cardiomyopathy Questionnaire-12 overall summary scores improved in all 3 groups (HT without pretransplant MCS: 47.2±20.9 versus 77.4±20.1, P <0.001; long-term MCS: 35.3±20.2 versus 58.6±22.0, P <0.001; and HT with pretransplant MCS: 58.3±23.6 versus 72.1±23.5, P=0.002). No further HRQOL improvement was found from 3 to 6 months. Factors most significantly associated with change in HRQOL, baseline 3 months, were right heart failure and 3-month New York Heart Association class, and 3 to 6 months, were 6-month New York Heart Association class and major bleeding.
Conclusions:
In older heart failure patients, HRQOL improved from before to early after HT and long-term MCS. At 6 postoperative months, HRQOL of long-term MCS patients was lower than one or both HT groups. Understanding change in HRQOL from before to early after these surgeries may enhance decision-making and guide patient care.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT02568930.
... We include here several widely used clinical screening tools that may be used by the clinician to measure patient-reported outcomes in patients with cancer (Table 3) [117][118][119][120][121][122][123][124][125][126][127][128]. Patient-reported outcome measures should be selected carefully, based on their purpose, context, and the issue/symptom to be investigated. ...
Preservation of cognitive function is an important outcome in oncology. Optimal patient management requires an understanding of cognitive effects of the disease and its treatment and an efficacious approach to assessment and management of cognitive dysfunction, including selection of treatments to minimize the risk of cognitive impairment. Awareness is increasing of the potentially detrimental effects of cancer-related cognitive dysfunction on functional independence and quality of life. Prostate cancer occurs most often in older men, who are more likely to develop cognitive dysfunction than younger individuals; this population may be particularly vulnerable to treatment-related cognitive disorders. Prompt identification of treatment-induced cognitive dysfunction is a crucial aspect of effective cancer management. We review the potential etiologies of cognitive decline in patients with prostate cancer, including the potential role of androgen receptor pathway inhibitors; commonly used tools for assessing cognitive function validated in metastatic castration-resistant prostate cancer and adopted in non-metastatic castration-resistant prostate cancer trials; and strategies for management of cognitive symptoms. Many methods are currently used to assess cognitive function. The prevalence and severity of cognitive dysfunction vary according to the instruments and criteria applied. Consensus on the definition of cognitive dysfunction and on the most appropriate approaches to quantify its extent and progression in patients treated for prostate cancer is lacking. Evidence-based guidance on the appropriate tools and time to assess cognitive function in patients with prostate cancer is required.
... Caregivers completed paper-and-pencil self-report instruments (described in detail in Supplementary Table 1), including the following: EuroQol-5D(EQ-5D-3L), a 6-item generic health profile including 5 questions about dimensions of HRQOL and a visual analog scale (VAS) 22 ; two measures of the mental health domain of HRQOL: the Personal Health Questionnaire-8 (PHQ-8), an 8-item screen for symptoms of depression 23,24 and the State-Trait Anxiety Inventory À state form (STAI-state) encompassing 20 items measuring state anxiety 25 ; and a measure of burden: the Oberst Caregiving Burden Scale (OCBS), a 15-item instrument with 2 subscales: perceived time and difficulty completing caregiving tasks. 26À28 Caregivers also completed an 11-item Health History which included demographics, medical/surgical history, and whether caregivers perceived that their health would be affected by their role as a caregiver. ...
BACKGROUND
: We compared HRQOL, depressive symptoms, anxiety and burden among caregivers of older HF patients based on intended patient therapy goal: awaiting heart transplantation (HT) with or without mechanical circulatory support (MCS); and prior to long-term MCS; and identified factors associated with HRQOL.
METHODS
: Caregivers (n=281) recruited from 13 U.S. HT and MCS programs, completed measures of HRQOL (EQ-5D-3L), depressive symptoms (PHQ-8), anxiety (STAI-state), and burden (Oberst Caregiving Burden Scale). Analyses included ANOVA, Kruskal-Wallis tests, chi-square tests, and linear regression.
RESULTS
: The majority of caregivers were female, white, spouses with ≤2 co-morbidities, median[Q1,Q3] age=62[57.8,67.0] years. Caregivers (HT with MCS=87, HT without MCS=98, long-term MCS=96) reported similarly high baseline HRQOL (EQ-5D-3L visual analog scale median score=90, p=0.67, for all groups) and low levels of depressive symptoms. STAI-state median scores were higher in the long-term MCS group versus the HT groups with and without MCS, (38 versus 32 versus 31, p<0.001), respectively. Burden (task: time spent/difficulty) differed significantly among groups. Caregiver factors (number of comorbidities, diabetes, and higher anxiety levels) were significantly associated with worse caregiver HRQOL, R²=26%.
CONCLUSIONS
: Recognizing caregiver-specific factors, including comorbidities and anxiety, associated with HRQOL of caregivers of these older advanced HF patients may guide support strategies.
... The procedure consisted of applying the same measurement at two different times where change is assumed to not have occurred [20]. We attributed change in scores over this period to random error [21,22]. A two-way mixed-effects model, absolute ICC [23] was used to estimate the stability of the EQ-5D-5L and EQ-VAS scores. ...
Background
The EQ-5D is a validated and widely used generic measure of health-related quality of life (HRQoL) in both healthy individuals and those with various medical conditions. The objective of this study was to test whether EQ-5D-5L is reliable and valid for use among school sample adolescents and those with major mental health disorders in Ethiopia.Methods
Participants were recruited from ten sub-districts comprising the Butajira Rural Health Programme (BRHP) and Butajira major mental health disorders center. Data were collected using an Amharic (Ethiopia) EQ-5D-5L self-complete-paper and the questionnaire was administered 10 days after the first completion for test–retest procedures. Two-way mixed-effects models absolute intraclass correlation coefficient (ICC) was used to test reliability of the instrument while Kruskal–Wallis rank test with pairwise comparison was used to assess the known group validity of the instrument.ResultsThere were 501 (201 school sample and 300 adolescents with major mental health disorders) participants recruited and 497 were included in the sample for analysis. The ICC was high (ICC > 0.7, p < 0.001) for all EQ-5D-5L dimensions, EQ-5D-5L utility index and EQ-VAS scores. The findings revealed that the Amharic EQ-5D-5L has significant known group validity as shown by the difference in scores among various disease group (depression, schizophrenia, and bipolar) and experience of chronic illness.Conclusions
The results shows that the Amharic EQ-5D-5L is reliable and valid instrument for the measurement of HRQoL among adolescent populations in Ethiopia.
... The EQ-5D-5L is a standardized self-report measure tool that was selected for its ease of administration and has been shown to be sensitive to low levels of health. 30 Participating patients were asked to complete the EQ-5D-5L at enrollment and approximately 3 months following their individual enrollment date. ...
Background:
There is growing evidence demonstrating the benefits of intradialytic cycling. However, there are relatively few centers where this practice has been adopted with no reports from hemodialysis units in rural, remote, and northern locations. Maintaining mobility and quality of life for patients on kidney replacement therapy living in remote northern communities is inhibited by inclement weather and lack of access to resources and infrastructure that support physical activity. The integration of intradialytic cycling during hemodialysis offers patients a form of safe physical activity year-round.
Objective:
This study focuses on better understanding the feasibility and acceptability of implementing intradialytic cycling in a remote northern geographical context.
Design:
A feasibility study using a mixed-methods explanatory design was adopted for this study.
Setting:
The research is conducted in Prince George, British Columbia.
Participants:
The participants are patients attending a community-based dialysis unit in remote northern British Columbia and health professionals working in the same facility.
Methods:
Quantitative measures were captured through cycling logbooks and quality of life measure, and qualitative data were obtained through semi-structured interviews and analyzed using thematic analysis.
Results:
Six (43%) eligible patients used leg ergometers more than once for a median of 2.5 (interquartile range: 1-4) months and 87% of hemodialysis sessions. Participants cycled for a median of 65 (interquartile range: 39-76) minutes per session, with frequent variability noted between participants and different hemodialysis sessions for the same participant. Nine patients completed the European Quality of Life Health Questionnaire prestudy, with 5 (56%) also completing it poststudy. Interviews with 9 patients, 4 nurses, and 1 physiotherapist led to the identification of themes instrumental to implementation: a supportive community dialysis unit, shared responsibility, knowledge of patients/providers, and benefits associated with engagement. Themes that were identified as being key to acceptability in this remote dialysis unit were trust, connection, and engagement through common values.
Limitations:
Due to dialysis unit size, we had a small number of participants.
Conclusions:
This study demonstrates the feasibility of implementing best practice in a remote community and provides insight into the elements of context and participation that contribute to acceptability in the implementation of intradialytic cycling.
... Storch et al. [125,126] developed another scale to measure functional impairment in group of children with tics, the Mini-Child Tourette Syndrome Impairment Scale. Also more general quality of life scales can be implemented, including for example the Short Form Health Survey [36item from (SF-36) or 12-item version (SF-12)] and Euro-Qol-5 Dimension [171,172] which are validated in general and psychiatric populations. An overview and suggestions are given in Tables 4 and 5. ...
In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills.
... Caring for an individual with CRC can take a drastic toll on the physical as well as mental health of the family caregivers (FCs) (3,4). Some hitherto research studies have adopted generic tools, for instance the SF-36 Health Survey Instrument, for evaluating the health-related quality of life (HRQoL) of the FCs (5). Although these investigations documented that FCs of individuals with cancer have remarkably worst psychological and social influences in contrast with others, they cannot be transformed into a single health utility score. ...
Objective: To compare the EuroQol-5D-3L (EQ-5D-3L) and the Short Form-6D (SF-6D) utility scores in family caregivers (FCs) of colorectal cancer (CRC) patients.
Method: This study was performed on FCs of CRC patients from three primary cancer centers in the capital city of the Heilongjiang province. The participants (FCs) who were enrolled, filled the EQ-5D-3L, along with the SF-6D questionnaire. Two tools were compared for their distribution, discriminant validity, agreement, and convergent validity along with known-groups validity.
Result: Two hundred ninety-two FCs of CRC patients were enrolled. The score distribution of the SF-6D along with the EQ-5D-3L were not normal. A ceiling impact was seen in 31.8% of the FCs for EQ-5D-3L; however, none for the SF-6D. Good associations (Spearman’s rho = 0.622, p < 0.01) and intraclass correlation coefficient (ICC 0.637 and average ICC 0.778) between the two scores were observed. The EQ-5D-3L yielded higher utility scores in contrast with the SF-6D in the better health subclass. The SF-6D distinguished better between excellent and good health statuses, with better effect size and relative efficiency statistics. Both tools showed good known-groups validity.
Conclusion: The utility scores of SF-6D were remarkably lower relative to that of the EQ-5D-3L, but the difference may be clinically insignificant. However, the SF-6D may be superior because of the lack of ceiling impact. SF-6D exhibited a better convergent validity along with discrimination validity of excellent health condition and improved known-groups validity efficiency.
... Finally, we elected to use EQ-5D rather than other generic or disease-specific questionnaires, because it is readily available and short enough to be applied as an addition to other routine measurements, such as clinical and treatment data, while preserving the nature of a validated and standardized instrument. (32) This is particularly relevant in daily practice with a remarkable work load on critical patients, such as patients with decompensated cirrhosis in this study. Actually, Ufere et al. clearly stated that 91% of cirrhosis providers noted competing demands for time as a marked barrier to engaging in palliative care. ...
It is essential to determine contributors around impairment in health-related quality of life (HRQoL) in patients with cirrhosis aiming at improving health care and therapeutic strategy. Studies simultaneously incorporating disease severity based on biochemical parameters and other physical/psychological effects (i.e., sleep disturbance and frailty) are heterogeneous and the subject of the present study. We analyzed and compared HRQoL, using the EuroQol Group 5 Dimension (EQ-5D) questionnaire and the utility index retrieved, in patients with cirrhosis and across groups stratified by sleep disturbance or frailty phenotype. Sleep disturbance and frailty were determined by the Pittsburgh Sleep Quality Index (PSQI) and Frailty Index, respectively. Multiple linear regression was implemented to clarify contributors of poor HRQoL. In this cohort of 227 patients with mean age of 61.7 years and 47.2% male, more than half of the study population represented impairment in HRQoL in at least one domain, according to EQ-5D. Furthermore, sleep disturbance and frailty have proved to be independently associated with poor HRQoL in two separate regression models, whereas conventional scoring systems such as Child-Pugh classification and Model for End-Stage Liver Disease are not closely relevant. Intriguingly, not all health domains within EQ-5D correlated well with PSQI and Frailty Index, with the exception of usual activities. Pain and anxiety/depression were the most frequently affected HRQoL domains even in patients without sleep disturbance or frailty. Conclusion: Impaired HRQoL is prevalent in patients with decompensated cirrhosis. Sleep disturbance and frailty are independently associated with poor HRQoL. It is imperative to timely intervene with these symptoms and deliver tailored health care.
... There is a separate Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12), each with its own scale scores. The SF-12 is the abridged version of the 36-Item Short-Form Health Survey (SF-36) and retains the validity, reliability, and responsiveness of the longer version (Brazier, Jones, & Kind, 1993;McHorney, Kosinski, & Ware Jr., 1994). The PCS-12 and the MCS-12 are scored using norm-based methods. ...
Psychological resources can help individuals adjust to changes associated with aging. In this study, we examined the effect of demographic, health, and psychological resource variables in explaining driving status among adults 55 years and older. A convenience sample of 222 adults between the ages of 55 and 91 years (mean = 72.20 years) completed questionnaires that included measures of driving status, self-rated health, and psychological resources (e.g., life control, life purpose, and locus of control). Multiple logistic regression models that controlled for confounders were constructed with driver status (i.e., current driver or former driver) as the outcome. Former drivers were older, reported being in poorer health, and reported more depression symptoms. After controlling for age and health, current drivers reported higher levels of life control and life purpose and a more internal locus of control. Results highlight the importance of considering psychological resources when examining driving cessation.
... Compared with other life quality evaluating scale questionnaire such as SF-36, it focuses more on clinical relevance. 46,47 By restoring vertebral height and improving kyphosis, PVP could be associated with improving life quality. However, considering that the number of trials reporting EQ-5D is relatively small, researches on life quality should be further performed. ...
Study design:
Meta-analysis.
Objective:
To systematically compare the effectiveness and safety of vertebral augmentation procedure (VAP) with non-surgical management (NSM) for the treatment of osteoporotic vertebrate compression fractures (OVCFs).
Methods:
Systematic reviews and meta-analyses with the comparison between VAP and NSM were identified to extract randomized controlled trials from electronic database. Additionally, recently published RCTs were identified. Two researchers independently extracted the data. The primary outcome of this meta-analysis was pain relief evaluated by visual analogue scale (VAS).
Results:
Twenty RCTs involving 2566 patients with painful OVCFs were included. Significant differences were found between percutaneous vertebroplasty (PVP) and conservative treatment (CT) in VAS at each time point during follow-up period. The differences of VAS were not significant between PVP and sham procedure at most time points during follow-up period. In subgroup analysis based on fracture type and fracture location, significant differences of VAS were found between PVP and CT and were not found between PVP and sham procedure. In subgroup analysis of duration of back pain, significant differences were found between PVP and CT in VAS at 1 week, 3 month and 1 year. And the differences of VAS were not significant between PVP and CT at 1 month and 6 month.
Conclusion:
BKP is considered sufficient to achieve good clinical outcomes. PVP is associated with on beneficial effect on treatment of painful OVCFs compared with sham procedure. The indication and timing of VAP need further research. More independently high-quality RCTs with sufficiently large sample sizes reporting cost-effectiveness are needed.
Background:
Generic and heart failure-specific measures do not capture unique aspects of living with a VAD. Using state-of-the-science psychometric measurement methods, we developed a measurement system to assess post-ventricular assist device (VAD) adjustment and HRQOL.
Methods:
Patients were recruited from 10/26/16-2/29/20 from 12 U.S. VAD programs. We created a dataset of participants (n=620) enrolled before left (L)VAD implantation, with data at 3- or 6- months post-implantation (Group1 [n=154]), and participants enrolled after LVAD implantation, with data at one timepoint (Group 2 [n=466]). We constructed five item banks: three modified from existing measures and two new measures. Analyses included item response theory (IRT) modeling, differential item functioning tests for systematic measurement bias, and indicators of reliability and validity.
Results:
Of 620 participants, 56% (n=345) were implanted as destination therapy, 51% (n=316) were <12 months post-implantation, mean age=57.3 years, 78% (n=485) male, 70% (n=433) White, 58% (n=353) married/partnered, and 58% (n=357) with >high school education. We developed five new VAD item banks/measures: 6-item VAD Team Communication; 12-item Self-efficacy Regarding VAD Self-care; 11-item Being Bothered by VAD Self-care and Limitations; 7-item Satisfaction with Treatment; and 11-item Stigma. Cronbach's alpha reliability ranged from good (≥0.80) to excellent (≥0.90) for item banks/measures. All measures, except VAD Team Communication, demonstrated at least moderate correlations (≥0.30) with construct validity indicators.
Conclusions:
These measures meet IRT modeling assumptions and requirements; scores demonstrate reliability and validity. Use of these measures may assist VAD clinicians to inform patients about VADs as a treatment option and guide post-VAD interventions.
Background:
Information about health-related quality of life (HRQOL) among caregivers of older patients with heart failure who receive heart transplantation (HT) and mechanical circulatory support (MCS) is sparse. We describe differences and factors associated with change in HRQOL before and early post-surgery among caregivers of older heart failure patients who underwent 3 surgical therapies: HT with pretransplant MCS (HT MCS), HT without pretransplant MCS (HT non-MCS), and long-term MCS.
Methods:
Caregivers of older patients (60-80 years) from 13 US sites completed the EQ-5D-3 L visual analog scale (0 [worst]-100 [best] imaginable health state) and dimensions before and 3 and 6 months post-surgery. Analyses included linear regression, t tests, and nonparametric tests.
Results:
Among 227 caregivers (HT MCS=54, HT non-MCS=76, long-term MCS=97; median age 62.7 years, 30% male, 84% White, 83% spouse/partner), EQ-5D visual analog scale scores were high before (84.8±14.1) and at 3 (84.7±13.0) and 6 (83.9±14.7) months post-surgery, without significant differences among groups or changes over time. Patient pulmonary hypertension presurgery (β=-13.72 [95% CI, -21.07 to -6.36]; P<0.001) and arrhythmia from 3 to 6 months post-operatively (β=-14.22 [95% CI, -27.41 to -1.02]; P=0.035) were associated with the largest decrements in caregiver HRQOL; patient marital/partner status (β=6.21 [95% CI, 1.34-11.08]; P=0.013) and presurgery coronary disease (β=8.98 [95% CI, 4.07-13.89]; P<0.001) were associated with the largest improvements.
Conclusions:
Caregivers of older patients undergoing heart failure surgeries reported overall high HRQOL before and early post-surgery. Understanding factors associated with caregiver HRQOL may inform decision-making and support needs.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT02568930.
This study attempted to assess the relationship between short and medium term public sector ART and both physical and emotional health outcomes in the Free State province of South Africa. The first model examined the effects of less than six months of ART on both physical and emotional QoL and of physical QoL on emotional QoL, while controlling for the possibly perturbing influences of inequitable ART distribution. The second model assessed the effects of the next six months of ART by comparing the physical en emotional QoL of patients at baseline and follow-up. First, the findings demonstrate the positive physical and emotional health outcomes of the first six months of ART in the Free State, South Africa. The study suggests that the poorest of the poor are not the first beneficiaries of the public programme. Second, the results show no additional positive effect of the subsequent six months of ART on the emotional and physical QoL of patients.
Background:
Caregiving for heart failure (HF) patients is burdensome. We examined differences in caregiver burden for three groups of older advanced HF patients: (1) supported with mechanical circulatory support (MCS) before heart transplantation (HT MCS), (2) awaiting transplant without MCS (HT non-MCS), and (3) prior to long-term MCS and factors associated with burden.
Methods:
From 10/1/15-12/31/18, we enrolled 276 caregivers for HF patients from 13 U.S. sites: 85 HT MCS, 96 HT non-MCS, and 95 prior to long-term MCS. At enrollment, caregivers completed the Oberst Caregiving Burden Scale (15 items, 2 subscales: time (range=1-5; higher score=more time spent on task) and difficulty (range=1-5; higher score=higher difficulty of task) and other measures. Statistical analyses included descriptive statistics, ANOVA, chi-square tests, and linear regression.
Results:
Overall, caregivers were aged 60.8±9.8 years and predominantly white, female, spouses, well educated, and reported ≥1 comorbidities. Caregivers overall reported a moderate amount of time spent on tasks and slight task difficulty. Caregivers for HT non-MCS candidates reported significantly less perceived time spent on tasks than caregivers for HT MCS candidates and caregivers for patients prior to long-term MCS (2.2±0.74 vs 2.4±0.74 vs 2.5±0.71, respectively, p=0.02) and less perceived difficulty of tasks (1.2±0.33 vs 1.4±0.53 vs 1.4±0.54, respectively, p=0.01). Caregiver and patient factors were associated with caregiver burden.
Conclusions:
Prior to HT and long-term MCS, caregiver burden was low to moderate. Caregiver factors were predominantly associated with caregiver burden. Understanding caregiver burden and factors affecting caregiver burden may enhance preoperative advanced therapies discussions and guide caregiver support.
Objective:
This systematic review aimed to examine the effects of motivational interviewing-based interventions on hypertension management.
Methods:
Six databases were searched from inception to 25 July, 2022 for randomized controlled trials involving adults diagnosed with hypertension and including motivational interviewing in the treatment interventions.
Results:
In total, 11 studies with 2121 participants were included. Compared with no or minimal additional intervention, motivational interviewing-based intervention showed greater reduction in systolic blood pressure (MD: -6.56, 95 % CI: -10.51, -2.62, P = 0.001) and diastolic blood pressure (MD: -3.75, 95 % CI: -4.92, -2.58, P < 0.001). Compared with the lower intensity intervention, motivational interviewing-based intervention produced statistically significant effect on reducing systolic blood pressure (MD: -2.72, 95 % CI: -5.34, -0.10, P = 0.040); while there was no significant effect on reducing diastolic blood pressure (MD: -0.47, 95 % CI: -2.21, 1.28, P = 0.600). Four out of six studies demonstrated medication adherence significantly improved following motivational interviewing-based intervention. Two studies included self-efficacy and quality of life, and inconsistent findings were observed.
Conclusion:
Motivational interviewing could be effective in improving blood pressure control among patients with hypertension. Future studies with more rigorous study designs should be conducted to confirm the effects of motivational interviewing on medication adherence and psychological well-being.
Practice implications:
Motivational interviewing could be applied as a promising intervention strategy among patients with hypertension.
Background:
We sought to quantify the impact of pre- and post-operative variables on health-related quality of life (HRQOL) after left ventricular assist device (LVAD) implantation.
Methods:
Primary durable LVAD implants between 2012-2019 in the Interagency Registry for Mechanically Assisted Circulatory Support were identified. Multivariable modeling using general linear models assessed the impact of baseline characteristics and post-implant adverse events (AEs) on HRQOL as assessed by the EQ-5D Visual Analog Scale (VAS) [0 (worst) to 100 (best) health state] at 6 months and 3 years.
Results:
Of 22,230 LVAD implants, 9,888 patients had complete VAS data at 6 months, and 2,170 patients at 3 years post-implant. VAS improved from a mean of 38.2±28.3 to 70.7±22.9 at 6 months and from 40.1±27.8 to 70.3±23.1 at 3 years. KCCQ improved from a mean of 28.2±23.9 to 64.3±23.2 at 6 months and from 29.8 ± 23.7 to 63.0 ±23.7 at 3 years. Pre-implant variables, including baseline VAS, had small effect sizes on HRQOL while post-implant AEs had large negative effect sizes. Recent stroke, respiratory failure, and renal dysfunction had the largest negative effect on HRQOL at 6 months, while recent renal dysfunction, respiratory failure, and infection had the largest negative effect at 3 years.
Conclusion:
AEs following LVAD implantation have large negative effects on HRQOL in early and late follow-up. Understanding the impact of AEs on HRQOL may assist shared decision-making regarding LVAD eligibility. Continued efforts to reduce post-LVAD AEs are warranted to improve HRQOL in addition to survival.
Introduction
Accurate measurement of health status is essential to assess veterans’ needs and the effects of interventions directed at improving veterans’ well-being. We conducted a systematic review to identify instruments that measure subjective health status, considering four components (ie, physical, mental, social or spiritual well-being).
Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, JSTOR, ERIC, Social Sciences Abstracts and ProQuest in June 2021 for studies reporting on the development or evaluation of instruments measuring subjective health among outpatient populations. We assessed risk of bias with the Consensus-based Standards for the Selection of Health Measurement Instruments tool and engaged three veteran partners to independently assess the clarity and applicability of identified instruments.
Results
Of 5863 abstracts screened, we identified 45 eligible articles that reported health-related instruments in the following categories: general health (n=19), mental health (n=7), physical health (n=8), social health (n=3) and spiritual health (n=8). We found evidence for adequate internal consistency for 39 instruments (87%) and good test–retest reliability for 24 (53%) instruments. Of these, our veteran partners identified five instruments for the measurement of subjective health (Military to Civilian Questionnaire (M2C-Q), Veterans RAND 36-Item Health Survey (VR-36), Short Form 36, Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Sleep Health Scale) as clear and very applicable to veterans. Of the two instruments developed and validated among veterans, the 16-item M2C-Q considered most components of health (mental, social and spiritual). Of the three instruments not validated among veterans, only the 26-item WHOQOL-BREF considered all four components of health.
Conclusion
We identified 45 health measurement instruments of which, among those reporting adequate psychometric properties and endorsed by our veteran partners, 2 instruments showed the most promise for measurement of subjective health. The M2C-Q, which requires augmentation to capture physical health (eg, the physical component score of the VR-36), and the WHOQOL-BREF, which requires validation among veterans.
Importance:
There is a need to better assess the cumulative effect on morbidity and mortality in patients undergoing durable left ventricular assist device (LVAD) implantation. This study evaluates a patient-centered performance metric (days alive and out of hospital [DAOH]) for durable LVAD therapy.
Objective:
To determine the incidence of percent of DAOH before and after LVAD implantation and (2) explore its association with established quality metrics (death, adverse events [AEs], quality of life).
Design, settings, and participants:
This was a retrospective national cohort study of Medicare beneficiaries implanted with a durable continuous-flow LVAD between April 2012 and December 2016. The data were analyzed from December 2021 to May 2022. Follow-up was 100% complete at 1 year. Data from The Society of Thoracic Surgeons Intermacs registry were linked to Medicare claims.
Main outcomes and measures:
The number of DAOH 180 days before and 365 days after LVAD implantation and daily patient location (home, index hospital, nonindex hospital, skilled nursing facility, rehabilitation center, hospice) were calculated. Percent of DAOH was indexed to each beneficiary's pre- (percent DAOH-BF) and postimplantation (percentage of DAOH-AF) follow-up time. The cohort was stratified by terciles of percentage of DAOH-AF.
Results:
Among the 3387 patients included (median [IQR] age: 66.3 [57.9-70.9] years), 80.9% were male, 33.6% and 37.1% were Interfaces Patient Profile 2 and 3, respectively, and 61.1% received implants as destination therapy. Median (IQR) percent of DAOH-BF was 88.8% (82.7%-93.8%) and 84.6% (62.1-91.5%) for percent of DAOH-AF. While DAOH-BF was not associated with post-LVAD outcomes, patients in the low tercile of percentage of DAOH-AF had a longer index hospitalization stay (mean, 44 days; 95% CI, 16-77), were less likely to be discharged home (mean. -46.4 days; 95% CI, 44.2-49.1), and spent more time in a skilled nursing facility (mean, 27 days; 95% CI, 24-29), rehabilitation center (mean, 10 days; 95% CI, 8-12), or hospice (mean, 6 days; 95% CI, 4-8). Increasing percentage of DAOH-AF was associated with patient risk, AEs, and indices of HRQoL. Patients experiencing non-LVAD-related AEs had the lowest percentage of DAOH-AF.
Conclusions and relevance:
Significant variability existed in the percentage of DAOH within a 1-year time horizon and was associated with the cumulative AEs burden. This patient-centered measure may assist clinicians in informing patients about expectations after durable LVAD implantation. Validation of percentage DAOH as a quality metric for LVAD therapy across centers should be explored.
This study presents the cultural and linguistic adaptation and psychometric properties of the Argentine version of the Quality of Life in Epilepsy Inventory (QOLIE-31P) scale.
An instrumental study was carried out. A version of QOLIE-31P translated into Spanish was provided by the original authors. To assess the content validity, evaluation of expert judges was requested, and the degree of agreement was determined. The instrument was administered to 212 people with epilepsy (PWE) of Argentina, together with the BDI-II, B-IPQ and a sociodemographic questionnaire. A descriptive analysis of the sample was carried out. Discriminative capacity of the items was performed. Cronbach's alpha was calculated to assess reliability. To study the dimensional structure of the instrument, a confirmatory factorial analysis (CFA) was performed. Convergent and discriminant validity was tested through mean difference tests, linear correlation, and regression analysis.
Aiken's V coefficients ranged between .90 and 1 (acceptable), which allows to state that a conceptually and linguistically equivalent version of the QOLIE-31P was reached. Cronbach's Alpha of 0.94 was obtained for the Total Scale (optimal). As a result of CFA, 7 factors were obtained, being the dimensional structure similar to the original version. Also, unemployed PWE reported significant lower scores than employed PWE. Finally, QOLIE-31P scores negatively correlated with depression symptom severity and negative illness perception.
The Argentine version of the QOLIE-31P is a valid and reliable instrument, presenting good psychometric properties, such as high internal consistency and a dimensional structure similar to that of the original version.
Background:
Geriatric syndromes, which are multi-factorial conditions common in older adults, predict health-related quality of life (HRQOL). Although chronic kidney disease (CKD) is associated with lower HRQOL, whether geriatric syndromes contribute to HRQOL in CKD is unknown. Our objective was to compare associations of geriatric syndromes and medical conditions with HRQOL in older adults with CKD.
Methods:
This was a secondary analysis of a parallel-group randomized controlled clinical trial evaluating a 12- month exercise intervention in persons ≥55 years with CKD Stage 3b-4. Participants were assessed for baseline geriatric syndromes (cognitive impairment, poor appetite, dizziness, fatigue, and chronic pain), and medical conditions (diabetes, hypertension, coronary artery disease, cancer, or chronic obstructive pulmonary disease). Participants' HRQOL was assessed with the Short Form Health Survey-36 (SF-36), EuroQol 5 Dimensions-5 Level, and the EuroQol Visual Analogue Scale. We examined the cross-sectional and longitudinal associations of geriatric syndromes and medical conditions with HRQOL using multiple linear regression.
Results:
Among 99 participants, the mean age was 68.0 years, 25% were female, and 62% were Black. Participants had a baseline mean of 2.0 geriatric syndromes and 2.1 medical conditions; 49% had ≥ two geriatric syndromes and ≥ two medical conditions concurrently. Sixty-seven participants (68%) underwent 12-month assessments. In models using geriatric syndromes and medical conditions as concurrent exposures, the number of geriatric syndromes was cross-sectionally associated with SF-36 scores for general health (β = -0.385), role limitations due to physical health (β=-0.374), physical functioning (β= -0.300, all p < 0.05). The number of medical conditions was only associated with SF-36 score for role limitations due to physical health (β = -0.205).
Conclusions:
In older adults with CKD Stage 3b-4, geriatric syndromes are common and are associated with lower HRQOL. Addressing geriatric conditions is a potential approach to improve HRQOL for older adults with CKD.
Study design:
Secondary analysis of a randomized controlled trial.
Objective:
To assess how baseline treatment with opioids is associated with pain and function in older adults with lumbar spinal stenosis who receive epidural injections.
Summary of background data:
Data were obtained from the Lumbar Epidural Steroid injections for Spinal Stenosis (LESS) trial, a double-blind, multisite, randomized controlled trial.
Methods:
Baseline treatment with opioids was assessed from electronic medical record prescription pharmacy data or from health utilization records collected from patients. We calculated adjusted changes in back pain numerical rating scale (NRS), leg pain NRS, and back-related disability (Roland Morris Disability Questionnaire (RMDQ) scores) from baseline to 3 weeks and to 6 weeks among patients treated and not treated with opioids at baseline using generalized linear regression.
Results:
Baseline treatment with opioids was not significantly associated with back pain intensity (adjusted difference in means at 3 weeks of follow-up between patients treated with opioids at baseline versus not (±95% confidence interval) 0.1 (-0.7, 0.7)), leg pain intensity (-0.2 (-0.9, 0.4)), or back-related function (-0.8 (-2.1, 0.4)). We found similar results at 6-weeks of follow-up.
Conclusion:
Among older adults with lumbar spinal stenosis who are receiving epidural injections, those treated with opioids at baseline had similar outcomes to those who were not.
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
As more patients with peripheral arteriopathy present to vascular specialists for medical attention, the necessity and timing of intervention(s) have become a topic of important inquiry. Lower extremity revascularization is often a temporizing measure because established goals include symptom improvement or resolution, wound healing, and limb preservation; however, there are no curative medical or surgical therapies available to date. Given the significant morbidity associated with vascular interventions and sequelae of potentially poor outcomes, vascular specialists are faced with even more complex decisions when formulating a plan of care for patients with peripheral arteriopathy.Whether or not to intervene on a patient with significant lower extremity peripheral arteriopathy can be a difficult decision to make. Traditionally, outcomes such as revascularization patency, readmission, limb loss, and mortality are frequently reported after lower extremity revascularization. Although these outcomes are critical metrics to evaluate after operative intervention, for the interventionalist and healthcare system, they do not always embody what the individual patient values most. Therefore, providers have begun to incorporate patient-reported outcome measures (PROMS), including quality of life (QoL) assessments, as part of their decision-making algorithm.KeywordsQuality of lifePatient-reported outcomesPeripheral artery diseaseIntermittent claudicationChronic limb-threatening ischemiaInfrainguinal bypassAngioplasty
Purpose
The aim of this study was the comparative assessment of long-term clinical (subjective and objective), functional and quality of life outcome data between primary and revision THA.
Methods
122 patients (130 hips) who underwent cementless revision THA of both components (TMT cup, Wagner SL stem, Zimmer Biomet) for aseptic loosening only (Group A) were compared to a matched group of 100 patients (100 hips) who underwent cementless primary THA for osteoarthritis (Synergy stem, R3 cup, Smith & Nephew) (Group B). Outcomes were evaluated with survival analysis curves, Harris Hip Score (HHS), WOMAC, Oxford Hip Score (OHS), Short-Form Health Survey (SF-12) and EQ-5D-5L scales. Mobility was assessed with walking speed, Timed Up And Go Test (TUG), Parker Mobility Score, Lower Extremity Functional Scale (LEFS) and UCLA scores.
Results
At a mean follow-up of 11.1 (8–17) years a cumulative success rate of 96% (95% CI, 96–99%) in Group A and 98% (95% CI, 97–99%) in Group B with operation for any reason as an endpoint was recorded. Statistically significant differences between groups were developed for WOMAC (Mann-Whitney U-test, p = 0.014), OHS (Mann-Whitney U-test, p = 0.020) and physical component of SF-12 scores (Mann-Whitney U-test, p = 0.029) only. Group A had less improvement in function as compared with group B. In Group A, in multiple regression analysis, patients’ cognition ( p = 0.001), BMI ( p = 0.007) and pain ( p = 0.022) were found to be independent factors influencing functional recovery (WOMAC). Similarly, pain ( p = 0.03) was found to influence quality of life (EQ-5D-5).
Conclusions
In the long term, revision THA shows satisfactory but inferior clinical, functional, and quality of life outcomes when compared to primary THA. Residual pain, BMI and cognitive impairment independently affect functional outcomes.
Background
There is a paucity of research describing health‐related quality of life (HRQOL) in older adults considered for advanced heart failure surgical therapies. Using data from our SUSTAIN‐IT (Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support) study, we aimed to compare HRQOL among 3 groups of older (60–80 years) patients with heart failure before heart transplantation (HT) or long‐term mechanical circulatory support (MCS) and identify factors associated with HRQOL: (1) HT candidates with MCS, (2) HT candidates without MCS, or (3) candidates ineligible for HT and scheduled for long‐term MCS.
Methods and Results
Patients from 13 US sites completed assessments, including self‐reported measures of HRQOL (EuroQol‐5 Dimension Questionnaire, Kansas City Cardiomyopathy Questionnaire–12), depressive symptoms (Personal Health Questionnaire–8), anxiety (State‐Trait Anxiety Inventory–state form), cognitive status (Montreal Cognitive Assessment), and performance‐based measures (6‐minute walk test and 5‐m gait speed). Analyses included ANOVA, χ ² tests, Fisher’s exact tests, and linear regression. The sample included 393 patients; the majority of patients were White men and married. Long‐term MCS candidates (n=154) were significantly older and had more comorbidities and a higher New York Heart Association class than HT candidates with MCS (n=118) and HT candidates without MCS (n=121). Long‐term MCS candidates had worse HRQOL than HT candidates with and without MCS (EQ‐5D visual analog scale scores, 46±23 versus 68±18 versus 54±23 [ P <0.001] and Kansas City Cardiomyopathy Questionnaire–12 overall summary scores, 35±21 versus 60±21 versus 49±22 [ P <0.001], respectively). In multivariable analyses, lower 6‐minute walk distance, higher New York Heart Association class, depressive symptoms, and not being an HT candidate with MCS were significantly associated with worse overall HRQOL.
Conclusions
Our findings demonstrate important differences in overall and domain‐specific HRQOL of older patients with heart failure before HT or long‐term MCS. Understanding HRQOL differences may guide decisions toward more appropriate and personalized advanced heart failure therapies.
Background: Autonomic symptoms are common in older adults, and a large body of literature focusing on age-related diseases shows that autonomic symptoms in these diseases constrain Health-Related Quality of Life (HRQoL). To our best knowledge, the association between autonomic symptoms in older adults, independent of specific diseases, and HRQoL has not yet been assessed.
Aim: To assess the frequency and the effect of autonomic symptoms in general, as well as orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms, on HRQoL in older adults.
Methods: Cross-sectional data of the fourth visit of the Tübinger evaluation of Risk factors for Early detection of Neurodegeneration (TREND) study were included. Autonomic symptoms, as assessed with the Composite Autonomic Symptom Score 31 (COMPASS 31), were quantified and compared with HRQoL, as assessed with the EuroQol five-level version (EQ-5D-5L). Statistical analyses included Spearman's rank correlation and multiple linear regression analysis.
Results: The analysis included 928 participants with a median of 68 years; 47% were women. Of those, 85% reported at least one autonomic symptom. Gastrointestinal and secretomotor symptoms were most common. The COMPASS 31 total score and all subdomains were significantly associated with reduced HRQoL. Among the subdomains, the strongest correlations with HRQoL were found for gastrointestinal and bladder symptoms. Overall, autonomic symptoms alone explained 20% of the variance of HRQoL; when depressive mood was added, the model explained 32%.
Conclusion: Autonomic symptoms are associated with HRQoL and depressive symptoms in older adults.
Background:
We sought to compare change over time (baseline to 2 y) in health-related quality of life (HRQOL) between older (60-80 y) patients awaiting heart transplantation (HT) with mechanical circulatory support (MCS) versus without MCS and their caregivers and caregiver burden.
Methods:
This study was conducted at 13 United States sites. Patient HRQOL was examined using the EuroQol 5-dimensional questionnaire (EQ-5D-3L) and Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Caregiver measures included the EQ-5D-3L and Oberst Caregiving Burden Scale, measuring time on task and difficulty. Analyses included analysis of variance, χ2, and linear regression.
Results:
We enrolled 239 HT candidates (n = 118 with MCS and n = 121 without MCS) and 193 caregivers (n = 92 for candidates with MCS and n = 101 for candidates without MCS). Baseline differences in HRQOL were observed between HT candidates with and without MCS: EQ-5D-3L visual analog scale (VAS) score (67.7 ± 17.6 versus 54.1 ± 23.3, P < 0.001) and KCCQ-12 overall summary score (59.9 ± 21.0 versus 48.9 ± 21.6, P < 0.001), respectively. HT candidates with MCS had significantly higher EQ-5D-3L VAS scores and KCCQ-12 overall summary score across time versus without MCS. Baseline EQ-5D-3L VAS scores did not differ significantly between caregivers of HT candidates with and without MCS (84.6 ± 12.9 versus 84.3 ± 14.4, P = 0.9), respectively, nor were there significant between-group differences over time. Caregivers for HT candidates with MCS reported more task difficulty (range: 1 = not difficult to 5 = extremely difficult) versus caregivers for those without MCS at baseline (1.4 ± 0.5 versus 1.2 ± 0.3, P = 0.004) and over time.
Conclusions:
Understanding differences in HRQOL and caregiver burden among older HT candidates with and without MCS and their caregivers may inform strategies to enhance HRQOL and reduce burden.
Purpose
To evaluate the QOL and vision-related QOL in patients suffering from coexisting glaucoma and cataract.
Methods
This cross-sectional-analytical study was carried out on 222 cases including 163 patients suffering from coexisting glaucoma and cataract as patients’ group and 59 healthy individuals as the control group. Data were gathered via the use of EuroQol five-dimensional (EQ-5D) and National Eye Institute-Visual Functioning Questionnaire 39 (NEI-VFQ 39(. Then, the obtained results were compared before and one month after cataract surgery in patients and control groups.
Results
The mean and 95% confidence interval of overall vision-related QOL score in healthy individuals and patients during pre- and post-operation phases were 86.65 (69.3 – 104.0), 48.7 (9.4 – 88.1) and 56.1 (12.2 – 100.0), respectively. There were significant differences among the three compared groups in terms of all NEI-VFQ 39 items (P<0.05). The mean and confidence interval of EQ-5D score during pre- and post-operation phases were 0.42 (0.21-0.64) and 0.58 (0.39-0.78), respectively (P=0.017) and for healthy individuals, it was 0.70(0.59-0.80). After surgery, all QOL items significantly increased among patients (P<0.05). Also, there were significant differences in the scores compared to healthy individuals (P<0.05). One month after surgery, all vision-related QOL items` scores obtained by NEI-VFQ 39 and all QOL items` scores obtained by EQ-5D were significantly lower in the treated patients than healthy individuals (P<0.05).
Conclusion
In patients suffering from coexisting glaucoma and cataract, the overall QOL and vision-related QOL scores were improved after cataract surgery. However, there was a significant difference between them and healthy individuals.
Background
Little information exists on properties of EQ-5D-5L (the 5L hereafter) compared to the EQ-5D-3L (the 3L hereafter) measures in the context of Iran. This study aims to compare the measurement properties of the two versions of the EQ-5D (the 3L vs. the 5L) using data obtained from general population in Iran.
Methods
A total of 886 adults aged 18 years and above from September to November 2020 participated in this cross-sectional analysis. The required data collected using self-administered and—standard questionnaire and multistage sampling method was used to select the samples. The 3L and 5L measures compared in terms of celling effect, distribution and redistribution pattern, feasibility, convergent validity, know-groups validity and informativity.
Results
From September to November 2020, 886 adults (mean aged = 44.6 years; 55% male and 87.1% married) included in the study. The study indicated that the 5L had lower celling effects compared to the 3L (45% vs. 46%). A better convergent validity and known-groups validity was found for the 5L version compared to the 3L and significantly stronger association found between the 5L measure with both the Visual Analogue Scale and the 5-point health status scale. The 5L index score showed higher relative efficiency (RE) in 9 of 11 condition (mean RE = 1.36). Compared to the 3L, the 5L classification system had higher Shannon index (H′) in all dimensions: mobility (0.52 vs. 0.40), self-care (0.23 vs. 0.20), usual activities (0.61 vs. 0.47), pain/discomfort (1.19 vs. 0.89) and anxiety/depression (1.22 vs. 0.47).
Conclusion
The study demonstrated that the measurement properties of 5L version in terms of celling effects, convergent validity, known-groups validity, RE and informativity similar or better than the 3L among general population; suggesting the use of 5L in the context of Iran. Hence, we suggested the use of the 5L in economic evaluation, clinical and public health studies in Iran.
Introduction:
In this era of cost-conscious health systems, it is of utmost importance to identify and establish the most cost-effective treatment option. However, in case of peripheral entrapment mononeuropathies there is a lack of data regarding economically effective treatment strategies. Therefore, the objective was to conduct an economic evaluation including both costs and benefits of various treatment strategies applied for peripheral entrapment mononeuropathies to estimate the relative cost-effective treatment regimens.
Areas covered:
Over the 19 years, 7 excellent-high quality economic evaluations of three types of peripheral entrapment mononeuropathies were identified in four countries. Our findings showed that surgery was the most cost-effective therapy followed by same cost efficacy of infiltrative therapy and conservative therapy for peripheral entrapment mononeuropathies. However, the fact that surgery was the most common comparator (n = 6) in our selected studies cannot be neglected.
Expert opinion:
Due to huge methodological variability, the finding of surgery as the cost-effective treatment strategy remains tentative and the decision about the most suitable clinical and cost-effective therapy should be individualized from case to case. Moreover, the economic evaluation of all possible treatment strategies for peripheral entrapment mononeuropathies for a longer period of analysis is required in future studies.
The International Quality of Life Assesment (IQOLA) Project is a 4-year project to translate and adapt the widely used MOS SF-36 Health Survey Questionnaire in up to 15 countries and validate, norm, and document the new translations as required for their use in international studies of health outcomes. In addition to the eight-scale SF-36 health profile, the project will also validate psychometrically based physical and mental health summary scores, as well as health utility indexes incorporating SF-36 scales for use in cost-utility studies.
To test the acceptability, validity, and reliability of the short form 36 health survey questionnaire (SF-36) and to compare it with the Nottingham health profile.
Postal survey using a questionnaire booklet together with a letter from the general practitioner. Non-respondents received two reminders at two week intervals. The SF-36 questionnaire was retested on a subsample of respondents two weeks after the first mailing.
Two general practices in Sheffield.
1980 patients aged 16-74 years randomly selected from the two practice lists.
Scores for each health dimension on the SF-36 questionnaire and the Nottingham health profile. Response to questions on recent use of health services and sociodemographic characteristics.
The response rate for the SF-36 questionnaire was high (83%) and the rate of completion for each dimension was over 95%. Considerable evidence was found for the reliability of the SF-36 (Cronbach's alpha greater than 0.85, reliability coefficient greater than 0.75 for all dimensions except social functioning) and for construct validity in terms of distinguishing between groups with expected health differences. The SF-36 was able to detect low levels of ill health in patients who had scored 0 (good health) on the Nottingham health profile.
The SF-36 is a promising new instrument for measuring health perception in a general population. It is easy to use, acceptable to patients, and fulfils stringent criteria of reliability and validity. Its use in other contexts and with different disease groups requires further research.
There is inconsistency in the literature on the relationship between age and depressive symptoms. Although a careful review shows that some of this inconsistency can be reconciled by recognizing the nonlinear relationship (Newmann, 1989), 2 additional issues remain unclear. One is that most previous studies used depression screening scales that contain somatic items that could introduce an age bias. The other is that most previous studies combined samples of men and women even though there is evidence that the sex difference in depressive symptoms varies with age. These 2 issues are addressed in this article, using analyzed data from 2 large national surveys. There is a consistent, but quite modest, nonlinear association between age, somatic, and nonsomatic depressive symptoms in both surveys. There is no significant sex difference in the age curves.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
Despite growing interest in the measurement of health-related quality of life, no single means of achieving such measurement has so far emerged as a standard. Researchers from 5 European and Scandinavian countries have jointly developed a common generic measure. The Euroqol questionnaire was designed as a self-administered instrument to complement other forms of quality of life measurement. A postal survey of some 1300 patients in General Practice was carried out to check the feasibility of collecting valuations for health states using the Euroqol questionnaire. This paper describes the results of that survey which revealed significant differences in values for more severe health states, particularly associated with respondents’ level of educational achievement.
Tavistock Press was established as a co-operative venture between the Tavistock Institute and Routledge & Kegan Paul (RKP) in the 1950s to produce a series of major contributions across the social sciences. This volume is part of a 2001 reissue of a selection of those important works which have since gone out of print, or are difficult to locate. Published by Routledge, 112 volumes in total are being brought together under the name The International Behavioural and Social Sciences Library: Classics from the Tavistock Press. Reproduced here in facsimile, this volume was originally published in 1980 and is available individually. The collection is also available in a number of themed mini-sets of between 5 and 13 volumes, or as a complete collection.
Reliability, the ratio of the variance attributable to true differences among subjects to the total variance, is an important attribute of psychometric measures. However, it is possible for instruments to be reliable, but unresponsive to change; conversely, they may show poor reliability but excellent responsiveness. This is especially true for instruments in which items are tailored to the individual respondent. Therefore, we suggest a new index of responsiveness to assess the usefulness of instruments designed to measure change over time. This statistic, which relates the minimal clinically important difference to the variability in stable subjects, has direct sample size implications. Responsiveness should join reliability and validity as necessary requirements for instruments designed primarily to measure change over time.
In the course of developing a standardised, non-disease-specific instrument for describing and valuing health states (based on the items in Table 1), the EuroQol Group (whose members are listed In the Appendix) conducted postal surveys in England, The Netherlands and Sweden which indicate a striking similarity in the relative valuations attached to 14 different health states (see Table 3). The data were collected using a visual analogue scale similar to a thermometer (see Table 2). The EuroQol Instrument Is Intended to complement other quality-of-life measures and to facilitate the collection of a common data set for reference purposes. Others interested in participating in the extension of this work are invited to contact the EuroQol Group.
Reliability, the ratio of the variance attributable to true differences among subjects to the total variance, is an important attribute of psychometric measures. However, it is possible for instruments to be reliable, but unresponsive to change: conversely, they may show poor reliability but excellent responsiveness. This is especially true for instruments in which items are tailored to the individual respondent.Therefore, we suggest a new index of responsiveness to assess the usefulness of instruments designed to measure change over time. This statistic, which relates the minimal clinically important difference to the variability in stable subjects, has direct sample size implications. Responsiveness should join reliability and validity as necessary requirements for instruments designed primarily to measure change over time.
This study examined age differences in the quality of self-report data in patients with chronic disease conditions (hypertension, diabetes, heart disease, depression). Data are from 2,304 patients in three health care systems in Los Angeles, Chicago, and Boston. Results support the idea that self-report health data can be gathered from older and younger patients without significant decrements in data quality. Specifically, results showed: (1) small decreases in the reliability of multi-item measures with age, primarily occurring in balanced scales; (2) little evidence of differences among age groups in response set or the tendency to respond "don't know" or "uncertain," although older patients had a greater tendency to respond in a socially desirable manner; (3) higher item nonresponse in older patients; (4) little variation in item nonresponse by type of question or question placement; (5) generally high panel retention in all age groups, supporting the value of repeated follow-up; and (6) similar known-groups validity across age groups.
The interest in measuring health status with survey instruments has not been matched with an analysis of their performance characteristics in the field. We used the Medical Outcome Study Short Form (MOS-20) to assess health outcomes among patients who were hospitalized in one of two public hospitals. We mailed the MOS-20 and a series of transition questions, which asked about changes in health, to patients admitted in the previous year. We received 414 completed surveys from 480 patients at baseline and follow-up data on 90% of these patients six months later. Baseline MOS-20 scores for study patients were significantly lower, corresponding to worse health, than previously reported outpatient and general population cohorts. While the direction of change on serial applications of the MOS-20 paralleled the patients' perception of change reported on transition questions, many patients who reported their health had become worse also recorded the lowest possible score on the MOS-20 at baseline. These low baseline MOS-20 scores prohibited the recognition of larger declines in function during the follow-up period. This floor in the response range creates an instrument bias against documenting a decline in health among severely ill patients, the group in which it may be most important to detect such a change.
Measuring functioning and well-being. The medical outcomes study approach
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- Review
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Measuring keulfk, a reuiew of quality of l$e measurement s&es
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Current practice in obtaining
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Measures of need and outcome for primary health care
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Measuring functioning and well-being. The medical outcomes study approach
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Health Measurement Scales: a practical guide to their development and use
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Measuring health changes among severely ill patients: The floor phenomenon
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