Quality of life and objective disease criteria in patients with intermittent claudication in general practice

BACKGROUND: The quality of life (QoL) of patients with chronic diseases is an important decision criterion for medical treatment, especially in primary care settings. It is known that subjective sickness feelings often cannot be correlated with objective disease criteria. OBJECTIVE: The aim of the study was to determine the QoL of patients with intermittent claudication with the arterial morphology, haemodynamic parameters and functional disability of peripheral arterial occlusive disease (PAOD). METHODS: In 150 patients with stable intermittent claudication, the health-related QoL was compared with the angiogram score, the resting Doppler pressure values, and the initial claudication distance (ICD) and absolute claudication distance (ACD) with treadmill exercise. RESULTS: The QoL did not correlate significantly with either the angiogram score or the ankle systolic blood pressure and ankle brachial index. ICD and ACD correlated significantly with the QoL activity subscales of pain, complaints and functional status (P < 0.001). In a multiple regression analysis, ACD and body mass index were the most predictive variables for the QoL. CONCLUSION: The QoL of PAOD patients is independent of the peripheral Doppler pressure and the angiographic severity of the disease. The most important criterion for the QoL is the patient's functional disability.     

Modified Dermatology Life Quality Index as a measure of quality of life in patients with filarial lymphoedema

The quality of life (QoL) and correlates of the QoL of lymphoedema patients attending filariasis clinics and a hospital outpatient department were studied using a Life Quality Index (LQI) in a region endemic for Bancroftian filariasis in Sri Lanka. The index was derived by modifying a previously validated Dermatology Life Quality Index (DLQI) to focus on the oedematous limb rather than the skin. The index was scored from 0 (normal) to 30 (severely affects QoL). Lymphoedema was graded using criteria recommended by the WHO. Another semi-structured questionnaire was used to assess the patient's socioeconomic status, frequency of acute adenolymphangitis attacks (ADLA) and measures practiced for morbidity control. Ninety-one patients (62 females, 29 males; mean age 50.4 years) were studied. A single lower limb, both lower limbs or a single upper limb were affected in 78 (85.7%), 10 (11.0%) and 3 (3.3%) patients, respectively. The severity of lymphoedema ranged from stage 1 (mild) to stage 6 (severe). The mean LQI was 8.2 (SD 5.2, range 0-20). The modified DLQI scores showed a significant positive correlation with severity of lymphoedema and a negative correlation with age (R=0.59 and R=-0.1, respectively). The frequency of ADLAs correlated with an increased modified DLQI score. Local pain, embarrassment and limitations of physical activities were the most distressing aspects of lymphoedema. Disease severity and early onset lymphoedema were found to be significantly associated with poorer QoL in filarial lymphoedema.     

Plasma endothelin-1 levels in patients with peripheral arterial occlusive disease at different Fontaine's stages

Endothelin-1 (ET-1) is a potent vasoconstrictor and mitogenic peptide produced and secreted by endothelial cells, which can play a potential role in the development of atherosclerosis and in the pathophysiology of extreme vasoconstriction of various diseases. METHODS: To assess plasma endothelin-1 (ET-1) concentrations in patients with peripheral arterial occlusive disease (PAOD) at different Fontaine's stages, we measured plasma ET-1 by radioimmunoassay in 14 stage II PAOD patients (12 men, 2 women; mean age 59.5 +/- 3.4 years) and in 10 stage III-IV PAOD patients (8 men, 2 women, mean age 61.2 +/- 3.3 years). Ten normal subjects (8 men, 2 women, mean age 58.1 +/- 7.2 years) were considered as controls. RESULTS: Mean (+/- SD) plasma ET-1 levels, as measured by radioimmunoassay, were significantly greater in stage II and stage III-IV PAOD patients than in control subjects (4 +/- 0.4 and 5 +/- 0.4 pmol/L vs 2.5 +/- 0.6 pmol/L, respectively, p < 0.001). Furthermore, plasma levels of ET-1 in stage III-IV patients were significantly higher than in stage II patients (p < 0.01). A significant correlation was found between plasma ET-1 levels and number of the arterial obstructive lesions in PAOD patients (r = 0.698; p < 0.0001). No significant correlation was found between plasma ET-1 concentrations and pain-free walking distance (r = -0.279, p = 0.333, in stage II patients; r = 0.137, p = 0.705, in stage III-IV patients), and between plasma ET-1 levels and ankle/arm pressor index (r = 0.032, p = 0.913, in stage II patients; r = 0.149, p = 0.681, in stage III-IV patients) in the PAOD patients. CONCLUSIONS: Raised plasma ET-1 could be a sensible marker both of endothelial damage and disease extension. It could also promote the progression of atherosclerotic plaques and enhance the microvascular resistance in these patients.     

老年周围动脉硬化闭塞病与血浆纤维蛋白原、血小板集聚率关系的研究

目的　探讨血浆纤维蛋白原、血小板聚集对老年周围动脉硬化闭塞病 (PAOD)的影响。方法　在北京市万寿路地区 2 0 4 11名老年居民中 ,以家委会为单位整群随机抽样 2 12 1人 ,男 94 1人 ,女 1180人 ,最大年龄 89岁 ,最小年龄 6 0岁 ,平均年龄 6 8.5 1岁± 4 .83岁。以踝动脉指数 <0 .9为PAOD诊断标准。以此诊断分成PAOD与非PAOD人群。在PAOD人群中抽取病例组 2 32例 ,其中男 73例、女 15 9例 ,平均年龄 70 .97岁± 6 .4 6岁 ;在非PAOD人群中按完全随机方式抽取对照组 4 6 4人 ,其中男 2 17人、女 2 4 7人 ,平均年龄 6 8.6 3岁± 5 .2 9岁。病例组与对照组均化验血浆纤维蛋白原浓度 ,血小板最大聚集率及 3min血小板聚集率。同时在两组中对PAOD患病有影响的因素进行多元logistic逐步回归分析。 结果　PAOD病例组血浆纤维蛋白原 (435 .4 5mg/dl±115 .2 5mg/dl)高于对照组 (36 0 .96mg/dl±93.5 2mg/dl) ,P =0 .0 0 1;3min血小板聚集率 (48.76 %± 2 3.90 % )高于对照组(43.5 0 %± 2 6 .76 % ) ,P =0 .0 12。logistic回归结果也显示血浆纤维蛋白原 (OR =0 .994 ,95 %CI :0 .992～ 0 .994 )及 3min血小板聚集率 (OR =0 .5 78,95 %CI:0 .4 0 3～ 0 .82 9)为对PAOD患病有显著影响意义的因素。结论　PAOD患者中     

Relief of symptoms and improvement of quality of life five years after coronary artery bypass grafting in relation to preoperative ejection fraction

Aim: To describe the relief of symptoms and improvement in Quality of Life (QoL) 5 years after coronary artery bypass grafting (CABG) in relation to preoperative ejection fraction (EF). Methods: Patients who underwent CABG between 1988 and 1991 in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. Quality of Life was estimated with three different instruments: Physical activity score, Nottingham Health Profile and Psychological General Well-being Index. Results: Among all patients who underwent CABG (n = 1904) the 5-year mortality rate was 27% in those with EF < 0.40 and 12% in those with EF 0.40 (p < 0.0001). In all, 849 patients, of whom 58 (7%) had EF < 0.40 participated in the evaluation. Neither physical activity, symptoms of chest pain, dyspnea nor any indices of QoL were significantly associated with preoperative EF. Improvement in physical activity, symptoms of chest pain and dyspnea and various estimates of QoL appeared similar and marked regardless of preoperative EF. Conclusion: Among survivors there was no association between preoperative EF and symptoms or various estimates of QoL 5 years after CABG. Improvement in symptoms and QoL were not dependent on preoperative EF.     

Disease-specific quality of life: is it one construct?

The objective of this study was to examine the structure of disease-specific quality of life (QoL). Models of QoL with either one overall construct or more constructs were tested and the relationships (factor loadings) between the constructs and dimensions were established, using structural equation modelling. The models were tested over time to assess the stability of the structure. To generalize the results further, disease-specific questionnaires of two very different chronic diseases have been compared: inflammatory bowel disease (IBD) and Parkinson's disease (PD).Questionnaires were mailed in 1994 and a repeated measurement was conducted in 1995. Data were obtained from 222 IBD patients and 235 PD patients. The results show that for both diseases, disease-specific QoL can be considered as one construct. The stability over time of the structure of the QoL models was satisfactory. In PD the factor loadings between the dimensions and QoL were within a small range and remained the same over time, while in IBD, the factor loadings had a larger range and fluctuated more. These results imply that one meaningful sum score can be obtained from these questionnaires.     

The Relative Contribution of Domains of Quality of Life to Overall Quality of Life for Different Chronic Diseases

This study examined the contribution of the quality of life (QoL) domains physical, social and psychological functioning to the explanation of overall QoL. Various disorders may differentially affect QoL domains due to disease-specific factors and, consequently, the relationship between QoL domains and overall QoL may vary between diseases. We therefore studied this relationship for several diseases as well as the differential impact of these diseases on QoL. The present study had a cross-sectional design. We selected patients (aged 57 years and older) with one of the following eight chronic medical conditions: lung disorder, heart condition, hypertension, diabetes mellitus, back problems, rheumatoid arthritis, migraine, or dermatological disorders. The total group of respondents included 1457 patients and 1851 healthy subjects. Regression analyses showed that the domain of psychological functioning contributed to overall QoL for all disorders, whereas physical and social functioning contributed to overall QoL for some disorders. Differences were found between most patient groups and healthy subjects with respect to physical functioning; with respect to social and psychological functioning some groups differed from the healthy group. Explanations for the findings and implications for clinical practice are discussed.     

Impact of comorbid diabetes on quality of life and perception of angina pain in people with angina registered with general practitioners in the UK

AIMS: To investigate the impact of comorbid diabetes on general and angina-related quality of life (QoL) in people with angina. METHODS: We analysed data for a subset of patients with angina, from a randomised controlled trial conducted in UK primary care. SF36 scores and Seattle Angina Questionnaire scores were compared for people with and without diabetes. We adopted a robust statistical approach, using nonparametric quantile regression to adjust for the influence of potential confounders. RESULTS: Data were available for 904 cases of whom 181 (20%) had diabetes. Presence of comorbid diabetes was significantly associated with reduced generic QoL for all SF36 domains and Seattle Angina Questionnaire physical limitation scores (estimated regression coefficient -12.33), but not for the other angina-related scores. Greater frequency of perceived angina was strongly correlated with reduced QoL (P<0.001) and angina frequency was similar in people with and without diabetes (P=0.576). CONCLUSIONS: Our results confirm the cumulative impact of having multiple chronic diseases on QoL. Though limited by the data available, our finding of similar angina frequency in patients with and without diabetes contributes to the debate regarding the influence of autonomic neuropathy on perception of angina in people with diabetes.     

Development of a Pain and Discomfort Module for Use with the WHOQOL-100

Clinicians and researchers have become increasingly interested in the impact of chronic pain (CP) on quality of life (QoL). This report describes the qualitative stages of developing a pain and discomfort module for persons with CP to be used with the UK World Health Organisation generic measure of quality of life (WHOQOL). The aims were to investigate patients' perceptions of CP and its effect on QoL, and to generate items to be used in the development of a module appended to the UK WHOQOL-100. At the first stage (study 1), six focus groups of patients were invited to discuss how living with pain and discomfort affected QoL. At the second stage (study 2), an international web survey was conducted with English-speaking respondents. Ten new facets of QoL were identified by the focus groups: flare-ups, pain relief, anger and frustration, vulnerability/fear/worry, uncertainty, loss/loneliness/feeling alone, positive strategies, communication, guilt and burdening others, and relationship with health care providers. The web-survey confirmed and validated these new facets. Although the WHOQOL-100 is a reliable and valid measure of QoL for use in CP, this study shows that additional areas must be assessed when measuring the impact of CP on QoL.     

The Significance of Importance: An Evaluation of Ferrans and Powers’ Quality of Life Index

Ferrans and Powers’ Quality of Life Index (QLI) defines and assesses quality of life (QoL) in terms of importance-weighted life satisfaction. This study assessed the value of such weights and explored the relationship between weighted and unweighted (satisfaction only) scores and single-item rated overall life satisfaction (LS) and QoL. Data were collected by a postal survey to 81 Parkinson’s disease patients (88% response rate). Correlations between weighted and unweighted QLI scores were ≥0.96, except for one subscale (r_s = 0.85). Item non-response rates ranged between 4.2 and 45.1% and 1.4 and 38% for the weighted and unweighted QLI, respectively. Cronbach’s α exceeded 0.7 for weighted and unweighted versions of two out of the four subscales and the total score. Scaling success rates were similar for weighted and unweighted scores and did not support the current subscale structure. Unexpectedly, weighted total scores correlated stronger with LS than with QoL, and unweighted scores displayed the opposite pattern. This study found no advantages by using importance-weighted satisfaction scores. The correlational pattern with overall LS and QoL challenges the QLI approach to QoL, although these observations may relate to the use of multiplicative item weights. This study has implications also beyond the QLI regarding, e.g., the use of multiplicative weights and the relationship between life satisfaction and QoL.