中国结直肠癌患者生活质量研究系统评价

目的系统了解我国2006-2015年结直肠癌患者生活质量(quality of life,Qo L)研究现状,为后期研究提供方向参考。方法基于Pub Med、中国知网和万方开展系统文献检索,摘录基本情况(包括发表文献、研究对象、内容和方法等),概括涉及量表并汇总分析不同类型量表的评价结果。结果最终纳入76项研究,44项发表于近3年,涉及全国24个省份;以横断面(36项)或临床试验(33项)的设计最多,调查时机多为治疗结束后(60项)。文献共涉及11种量表,包括7种特异性量表[最常用的为生活质量核心调查问卷(QLQ-C30),共41项]和4种通用性量表[最常用的为健康相关生命质量量表(SF-36),共12项];几乎所有量表均有关注躯体、生理和社会关系维度,但具体维度内容和数量不同。所有Qo L量化指标均为量表或维度得分,未见健康效用值数据。以特异性量表QLQ-C30为例,采用不同国家模型映射所得结果差异明显,韩国和英国模型映射所得效用值中位数值分别为0.867和0.165。此外,SF-36量表8个维度间得分差值较小(仅为3.5~9.9分),提示特定通用性量表分维度敏感性可能欠佳。结论我国结直肠癌生活质量研究数量增长较快,但相关效用值数据仍匮乏。基于国外映射模型的分析及结果解释应谨慎,后期工作可优先选择已有我国人群健康效用值积分体系的量表进行评价。     

心理护理对艾滋病患者生活质量影响的Meta分析

目的 评价心理护理干预对艾滋病患者生活质量的影响。方法 系统检索PubMed、Web of Science、Cochrane Library、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方数据库和维普中文科技期刊数据库（VIP）,纳入心理护理干预对艾滋病患者生活质量影响的实验性研究,采用Review Manager 5.3对SF-36量表8个维度得分进行合并,求其效应合并值的加权均数差（WMD）及其95%CI。结果 除生理功能维度外,SF-36量表其余7个维度得分的加权均数差均具有统计学意义,其中生理功能维度平均得分提高最少为6.48,情感职能维度平均得分提高最多为19.90,因此可认为除生理功能维度外,经心理护理干预后其余维度的得分均有所提高,敏感性分析结果显示,SF-36量表8个维度得分的加权均数差均具有统计学意义,即观察组的生活质量高于对照组。结论 心理护理干预可提高艾滋病患者的生活质量,可作为有效的辅助治疗手段在临床护理中进行推广应用。     

SF-36量表在江苏省晚期血吸虫病患者中的应用

目的 使用SF-36量表评价江苏省晚期血吸虫病患者的生命质量,以评估该量表的信度和效度。方法 使用自行改编设计的调查问卷（江苏省晚期血吸虫病患者生命质量调查表）,采用整群抽样方法,抽取江苏省内登记在册的部分晚期血吸虫病患者,进行面对面访谈调查。结果 量表的分半信度Spearman-Brown系数为0.92（P＜0.001）。内部一致性信度Cronbach''a系数为0.90,各维度的α系数为0.69~0.98。主成分分析法提取2个因子,累计贡献率达67.37%。SF-36量表评价不同地区、不同收入水平患者生命质量的差异有统计学意义,表明有一定判别效度。与杭州常模和四川常模比较,江苏省晚期血吸虫病患者生命质量各维度得分普遍低于常模。结论 SF-36量表用于评价晚期血吸虫病患者的生命质量有较好的信度和一定的判别效度,但结构效度较差。江苏省晚期血吸虫病患者由于受长期患病影响,生命质量有待改善。     

中文版抑郁量表信效度研究的系统综述

目的 通过对以中国成年人为研究对象的中文版抑郁量表的信效度研究进行系统综述,评价适用于不同人群的抑郁量表的信效度。方法 基于万方、中国知网、PubMed和Embase四个数据库,检索2016年5月6日前发表的对中文版抑郁量表进行信效度评估的文献,评价量表的整体信效度,并采用诊断试验准确性Meta分析的HSROC模型对病人健康问卷抑郁量表（PHQ-9）的灵敏度和特异度进行分析。结果 共纳入文献44篇,结果表明常见中文版抑郁量表如贝克抑郁量表、汉密顿抑郁量表、流调中心抑郁量表、病人健康问卷、老年抑郁量表等信效度均较高。多数量表的Cronbach系数 > 0.8,重测信度和分半信度 > 0.7,内部一致性和稳定性较好。不同研究者对量表结构的评价不一,但量表的效标效度、聚合效度、区分效度及筛查效度良好。对PHQ-9的筛查指标进行诊断试验准确性Meta分析的结果显示：合并后灵敏度为0.88（95% CI：0.85～0.91）,特异度为0.89（95% CI：0.82～0.94）,表明PHQ-9可作为筛查工具进行抑郁的初筛。结论 适用于不同人群的中文版抑郁量表的信效度均较高,可作为筛查工具进行研究对象抑郁状态的评估。同时建议在选择量表时应考虑不同量表的适用人群特点。     

广东省慢性病患者生存质量及健康调整期望寿命分析

目的 分析广东省慢性病患者生存质量及健康调整期望寿命。方法 基于广东省第五次全国卫生服务调查数据,通过欧洲五维度三水平健康量表对人群生存质量进行评价。运用多重线性回归和等级logistic回归评价慢性病对人群生存质量的影响,并用期望寿命和健康调整期望寿命指标评价慢性病对人群健康的综合影响。结果 共纳入68 550名居民数据进行分析,等级logistic回归显示在校正了社会人口学特征后,慢性病对生存质量各个维度的影响均有统计学意义,其中对疼痛/不舒服维度的影响最大[OR=4.48（95% CI：4.20~4.77）],其余依次为焦虑/抑郁[OR=3.95（95% CI：3.62~4.31）]、日常活动[OR=3.69（95% CI：3.37~4.04）]、行动[OR=3.63（95% CI：3.34~3.94）]和自我照顾[OR=3.30（95% CI：2.98~3.66）]。慢性病患者期望寿命比非慢性病人群平均少12.7年,健康调整寿命平均减少14.6年（男性减少17.8年,女性减少9.7年）。人群去慢性病健康调整期望寿命收益为3.8年（男性为5.1年,女性为2.0年）。结论 慢性病会影响患者生存质量的各维度,从而减少患者的健康调整期望寿命,给人群和社会带来沉重的健康负担。从卫生政策和卫生资源优化配置的角度看,需为慢性病患者尤其是为老年患者提供更全面可及的医疗照护,照护需不仅关注生理健康也要注重心理健康。     

SF-36量表应用于城市化居民生命质量评价的信度和效度分析

目的 评价SF-36量表用于城市化居民生命质量评价的信度和效度,为选择合适的健康测量工具提供参考。方法 采用多阶段整群系统抽样方法,使用SF-36量表进行入户调查,利用Spearman-Brown系数和Cronbach''s α 系数评价量表分半信度和内部一致性信度,集合效度实验和区分效度实验成功率评价量表集合效度和区分效度,采用相关分析和非参数检验以自评健康状况为标准进行标准关联效度分析,结构效度评价采用基于结构方程模型的验证性因子分析。结果 SF-36量表应用于城市化居民生命质量评价具有良好的分半信度(R=0.94)和内部一致性信度(除"躯体疼痛"和"精力"维度外,Cronbach''s α 系数为0.70~0.91),量表集合效度(定标成功率为88.57%)、区分效度(定标成功率为90.61%)和准则效度(γ_s=0.56,评分与自评健康状况相一致)良好,二阶验证性因子分析模型对数据拟合度较差(拟合优度指数为0.721,调整拟合优度指数为0.682,比较拟合指数为0.731,残差均方和平方根为0.084,近似误差均方为0.098),提示结构效度欠佳。结论 SF-36量表用于城市化居民生存质量评价具有良好的信度、集合效度、区分效度和标准关联效度,但结构效度欠佳,建议在实际应用中对相应条目进行调整。     

中文版酒精使用障碍筛查量表信度和效度评价

目的 评价中文版酒精使用障碍筛查量表（AUDIT）的信度和效度,为该量表在中国医学生中的推广使用提供科学依据。方法 使用电子问卷,将问卷发给5所医学院校学生,让其按意愿自行填写。了解Cronbach''s α和分半信度评价量表的信度,了解内容效度、结构效度、会聚效度和区别效度评价量表的效度。结果 中文版AUDIT量表总的Cronbach''s α为0.782,分半信度为0.711;危险饮酒、酒精依赖、有害饮酒3个维度的Cronbach''s α分别为0.796、0.561、0.647,分半信度分别为0.794、0.623、0.640。条目水平的内容效度指数（item-level CVI,I-CVI）为0.83~1.00,平均量表水平的内容效度指数S-CVI（S-CVI/Ave）为0.99,全体一致S-CVI（S-CVI/UA）为0.90,内容效度比为0.80~1.00。探索性因子分析结果显示,中文版AUDIT量表符合预设的3个维度结构,累计方差贡献率为61.175%;量表的会聚效度与区别效度定标试验成功率均为100%。结论 中文版AUDIT量表在中国医学生中具有较好的信度和效度,值得推广使用。     

我国乳腺癌筛查卫生经济学研究的系统评价

目的 了解我国大陆地区乳腺癌筛查的卫生经济学评价进展。方法 系统检索PubMed、中国知网、万方数据知识服务平台和维普网1995年1月至2015年12月收录文献,对纳入研究基本信息、人群项目参与率及检出率、模型研究方法学、经济学评价方法及结果等信息进行摘录和比较,采用卫生经济学评价报告规范（CHEERS）评价报告质量（总分24分）。结果 共检索356篇文献,最终纳入13篇,均发表于近4年（2012-2015年）,其中11篇基于人群、3篇基于模型研究。筛查起始年龄为18～45岁,终止年龄均≥59岁;筛查技术包括临床检查、超声和钼靶单一或联合筛查。有7篇报道了研究角度,其中为政府等服务提供方5篇,社会角度2篇;仅有5篇研究进行了成本和（或）效果贴现。11篇成本-效果分析中,有9篇提供了评价指标检出1例乳腺癌的成本,为5.0～229.3（M=14.5）万元。以质量调整生命年（QALY）或伤残调整生命年（DALY）为指标的成本-效用分析仅4篇,相应增量成本效果比（ICER）为0.3万元～27.1万元（2015年我国人均GDP为4.9万元）。13篇文献平均得分14.5（9.5～21.0）分,总分24分,其中研究角度、贴现率、ICER及不确定性等维度得分较低。结论 我国大陆地区乳腺癌筛查的经济学研究尚处于起步阶段,尤其是模型研究;各研究间方法及结果可比性一般,报告质量有待加强。应从社会角度全面核算成本后对筛查项目开展以QALY或DALY为指标的成本-效用分析。     

50岁及以上人群生活质量与体力活动的关联研究

目的 探讨上海市≥50岁人群体力活动水平和生活质量之间的关系。方法 2009年10月至2010年6月使用多阶段随机整群抽样方法抽取上海市5个区8 872名≥50岁的中老年人,使用全球体力活动问卷和WHO生活质量量表8项版（WHOQoL-8）评估体力活动水平和生活质量,并获取社会人口学及健康、社会参与等信息,采用两水平（个体层面和社区层面）线性模型分析不同年龄段的中老年人群其体力活动水平与幸福感的关系。结果 共纳入有效样本8 454份,年龄为（63.16±9.74）岁,体力活动水平较低的人群占59.95%,中等体力活动水平的人群比例为28.00%,高体力活动水平者仅占12.05%。WHOQoL-8生活质量得分为43.91±0.69,体力活动水平越高,WHOQoL-8得分越低,生活质量越好（P=0.00）。在控制社会经济因素和健康状况、社会参与等混杂因素后,对<80岁各个年龄段的中老年人群而言,体力活动水平的增高对提高生活质量具有显著作用（P<0.05）,然而对≥80岁的高龄人群,和低水平体力活动相比,中水平和高水平的体力活动对提升生活质量不具备有意义的影响,P值分别为0.06及0.47。结论 上海市≥50岁且<80岁的人群中,较高的体力活动水平与较好的生活质量相关。     

中国1～12岁健康儿童接种1剂水痘减毒活疫苗保护效果的系统评价与证据质量分析

目的 系统评价1～12岁健康儿童接种1剂水痘减毒活疫苗保护效果（VE）,探索运用GRADE（Grades of Recommendation, Assessment, Development, and Evaluation）证据质量评级方法评价疫苗效果观察性研究。方法 检索2019年以前关于中国1～12岁健康儿童1剂水痘减毒活疫苗VE的文献,采用纽卡斯尔-渥太华量表进行文献质量评价,采用Meta分析计算水痘疫苗VE,对研究类型、是否为暴发疫情、文献质量、年龄分亚组计算VE。采用GRADE方法评价整合证据质量。结果 共纳入32篇文献,合并后VE值为75%（95% CI：68%～80%）,亚组分析暴发疫情VE（66%,95% CI：57%～73%）低于非暴发疫情［85%（95% CI：78%～89%）］,<6岁儿童VE［84%（95% CI：77%～89%）］高于≥6岁儿童VE［60%（95% CI：51%～68%）］,不同研究类型、不同文献质量的VE差异无统计学意义。整合证据评级VE证据质量为“极低”,分别在偏倚风险和不一致性方面降一级,在间接性、不精确性和发表偏倚方面未降级。结论 中国1～12岁健康儿童1剂次水痘减毒活疫苗可提供中等水平保护,但≥6岁儿童VE明显降低,建议对<6岁儿童开展2剂次水痘疫苗接种。GRADE的证据质量评级方法可用于疫苗效果的观察性研究,建议制定观察性研究技术指南,提高证据体的整体质量。     

A prospective comparison of quality of life measures for patients with esophageal cancer

Among the most widely used instruments to assess quality of life (QOL) in patients with cancer are the European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30) and the Functional Assessment of Chronic Illness Therapy, cancer instrument (FACT-G). This study compared these approaches in patients who had undergone esophagectomy for cancer. The EORTC core questionnaire and esophageal module and the FACT-G and esophageal scale were completed by 57 patients. Missing data, relationships between QOL scales and analyses of patients preferences were examined. There were 14/2736 (0.5%) missing items from EORTC questionnaires and 45/2565 (1.8%) from FACT instruments (p < 0.01). Relationships between corresponding generic EORTC and FACT scales were average to good (r 0.57) except for the social function scale (r = 0.01). EORTC symptom scores were moderately correlated with the FACT general scale, but poorly related to the FACT esophageal scale (r < 0.28). EORTC swallowing scores were moderately correlated with all FACT scales. The FACT-E and EORTC QLQ-C30 measure assess similar generic aspects of QOL (except social function). EORTC esophageal symptom scores relate poorly to FACT esophageal scales, except for swallowing. Choice of QOL measure after esophagectomy for cancer depends upon outcomes of interest. Future studies will determine which instruments are appropriate in each context.     

Normative Estimates and Agreement Between 2 Measures of Health-Related Quality of Life in Older People With Frailty: Findings From the Community Ageing Research 75+ Cohort

BackgroundPrevious studies have summarized evidence on health-related quality of life for older people, identifying a range of measures that have been validated, but have not sought to present results by degree of frailty. Furthermore, previous studies did not typically use quality-of-life measures that generate an overall health utility score. Health utility scores are a necessary component of quality-adjusted life-year calculations used to estimate the cost-effectiveness of interventions.MethodsWe calculated normative estimates in mean and standard deviation for EQ-5D-5L, short-form 36-item health questionnaire in frailty (SF-36), and short-form 6-dimension (SF-6D) for a range of established frailty models. We compared response distributions across dimensions of the measures and investigated agreement using Bland-Altman and interclass correlation techniques.ResultsThe EQ-5D-5L, SF-36, and SF-6D scores decrease and their variability increases with advancing frailty. There is strong agreement between the EQ-5D-5L and SF-6D across the spectrum of frailty. Agreement is lower for people who are most frail, indicating that different components of the 2 instruments may have greater relevance for people with advancing frailty in later life. There is a greater risk of ceiling effects using the EQ-5D-5L rather than the SF-6D.ConclusionsWe recommend the SF-36/SF-6D as an appropriate measure of health-related quality of life for clinical trials if fit older people are the planned target. In trials of interventions involving older people with increasing frailty, we recommend that both the EQ-5D-5L and SF36/SF6D are included, and are used in sensitivity analyses as part of cost-effectiveness evaluation.     

Assessment of quality of life in lung cancer patients

Objetives: The aim of this study was to describe lung cancer patients' quality of life, measuring physical, psychological and social parameters, and general and specific symptoms of the disease using different questionnaires.Methods: 103 primary lung cancer patients who were between 20 and 80 years old and recruited during one year were included. All patients fulfilled the generic health related quality of life (HRQoL) questionnaire SF-36 and the specific EORTC-C30. Also sociodemographic and clinical important data were collected. Differences in aspects of perceived quality of life by diagnostic group and stage were analysed.Results: The results indicate that the patients with a higher disease stage had worse perception of their quality of life in comparison with patients in a lower stage of the disease. Likewise, small cell lung cancer patients, overall, showed a worse perception of their quality of life than non-small cell lung cancer patients. These differences were shown either by generic and the specific questionnaire scores.Conclusions: The results obtained in the study show that the SF-36 and EORTC capture the differences in the perceived quality of life in patients by diagnosis and evolution stage of the disease. All quality of life areas were already affected at the moment of the diagnosis of the disease. The scores of both questionnaires are coherent with clinical evaluation, based on the clinical stage, which support the discriminative validity of those instruments.     

Predicting SF-6D from the European Organization for Treatment and Research of Cancer Quality of Life Questionnaire Scores in Patients with Colorectal Cancer

ObjectivesTo develop a mapping model for estimating six-dimensional health state short form (SF-6D) utility scores from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (QLQ-C30 and QLQ-CR29) scores in patients with colorectal cancer (CRC), with and without adjustment for clinical and demographic characteristics.MethodsOrdinary least squares regression models were applied to a cross-sectional data set of 216 patients with CRC collected from a regional hospital in Hong Kong. Item responses or scale scores of cancer-specific (QLQ-C30) and colorectal-specific health-related quality-of-life (QLQ-CR38/CR29) data and selected demographic and clinical characteristics of patients were used to predict the SF-6D scores. Model goodness of fit was examined by using exploratory power (R² and adjusted R²), Akaike information criterion, and Bayesian information criterion, and predictive performance was evaluated by using root mean square error, mean absolute error, and Spearman’s correlation coefficients between predicted and observed SF-6D scores. Models were validated by using an independent data set of 56 patients with CRC.ResultsBoth scale and item response models explained more than 67% of the variation in SF-6D scores. The best-performing model based on goodness of fit (R² = 75.02%), predictive ability in the estimation (root mean square error = 0.080, mean absolute error = 0.065), and validation data set prediction (root mean square error = 0.103, mean absolute error = 0.081) included variables of main and interaction effects of the QLQ-C30 supplemented by QLQ-CR29 subset scale responses and a demographic (sex) variable.ConclusionsSF-6D scores can be predicted from QLQ-C30 and QLQ-CR38/CR29 scores with satisfactory precision in patients with CRC. The mapping model can be applied to QLQ-C30 and QLQ-CR38/CR29 data sets to produce utility scores for the appraisal of clinical interventions targeting patients with CRC using economic evaluation.     

Effect of order of administration of health-related quality of life interview instruments on responses

Purpose: To determine the effect on patient responses from the order in which the generic health-related and vision-targeted instruments are administered in a set of randomized clinical trials of intraocular surgery. Patients and methods: Patients who agreed to enroll in the Submacular Surgery Trials (SST) completed baseline quality of life interviews prior to random assignment to surgery or observation. Interviews were conducted by trained interviewers located at the SST Coordinating Center, via a computer-assisted telephone interview system that randomly assigned the order of instrument administration. Either the generic health-related instruments were administered first, the SF-36 Health Survey (SF-36) followed by the Hospital Anxiety and Depression Scale (HADS), followed by the vision-targeted instruments, National Eye Institute-Vision Function Questionnaire (NEI-VFQ) followed by the SST-Vision Preference Value Scale, or the vision-targeted questions were asked first, followed by the generic health instruments. The four instruments have 25 subscales total. Results: Of the 1015 patients enrolled in the SST, 992 patients had all four instruments administered in random order: 483 (49%) patients responded to the generic instruments first and 509 (51%) patients responded to the vision-targeted instruments first. Order of administration produced significantly different scores for three health status subscales: SF-36 mental health, HADS depression and HADS anxiety (p0.05, Wilcoxon rank sum test). Conclusions: Overall, the order of administration did not have a large effect on responses to the baseline interviews in this study. However, three mental health subscales were affected by order, though the order effect was small in magnitude. When the generic health instruments followed the vision-targeted instrument the HADS depression and anxiety scores were higher and the SF-36 mental health scores were lower, both suggesting poorer mental health status. Thus, the order of administration in other settings in which both a generic health-related instrument and a condition-targeted instrument are used may be decided based on individual study goals and priorities but order of administration should be consistent throughout the study.The Submacular Surgery Trials Research Group - Members of the SST Patient-Centered Outcomes Subcommittee who take responsibility for the content of this report, SST Report No. 3, on behalf of the SST Research Group are listed in Appendix A. The reference for the SST Research Group is in Appendix A.     

Minimal clinically important differences in the EORTC QLQ-C30 and brief pain inventory in patients undergoing re-irradiation for painful bone metastases

Purpose

The EORTC QLQ-C30 and the Brief Pain Inventory (BPI) are validated tools for measuring quality of life (QOL) and the impact of pain in patients with advanced cancer. Interpretation of these instrument scores can be challenging and it is difficult to know what numerical changes translate to clinically significant impact in patients’ lives. To address this issue, our study sought to establish the minimal clinically important differences (MCID) for these two instruments in a prospective cohort of patients with advanced cancer and painful bone metastases.

Methods

Both anchor-based and distribution-based methods were used to estimate the MCID scores from patients enrolled in a randomized phase III trial evaluating two different re-irradiation treatment schedules. For the anchor-based method, the global QOL item from the QLQ-C30 was chosen as the anchor. Spearman correlation coefficients were calculated for all items and only those items with moderate or better correlation (|r| ≥ 0.30) with the anchor were used for subsequent analysis. A 10-point difference in the global QOL score was used to classify improvement and deterioration, and the MCID scores were calculated for each of these categories. These results were compared with scores obtained by the distribution-method, which estimates the MCID purely from the statistical characteristics of the sample population.

Results

A total of 375 patients were included in this study with documented pain responses and completed QOL questionnaires at 2 months. 9/14 items in the QLQ-C30 and 6/10 items in the BPI were found to have moderate or better correlation with the anchor. For deterioration, statistically significant MCID scores were found in all items of the QLQ-C30 and BPI. For improvement, statistically significant MCID scores were found in 7/9 items of the QLQ-C30 and 2/6 items of the BPI. The MCID scores for deterioration were uniformly higher than the MCIDs for improvement. Using the distribution-based method, there was good agreement between the 0.5 standard deviation (SD) values and anchor-based scores for deterioration. For improvement, there was less agreement and the anchor-based scores were lower than the 0.5 SD values obtained from the distribution-based method.

Conclusion

We present MCID scores for the QLQ-C30 and BPI instruments obtained from a large cohort of patients with advanced cancer undergoing re-irradiation for painful bone metastases. The results from this study were compared to other similar studies which showed larger MCID scores for improvement compared to deterioration. We hypothesize that disease trajectory and patient expectations are important factors in understanding the contrasting results. The results of this study can guide clinicians and researchers in the interpretation of these instruments.

     

Comparing the Discriminative Validity of Two Generic and One Disease-Specific Health-Related Quality of Life Measures in a Sample of Patients with Dry Eye

OBJECTIVE: The purpose of this study was to compare the discriminative properties of two generic health-related quality of life (QoL) instruments (SF-36 and EQ-5D) and a newly developed disease-specific patient-reported outcomes instrument (Impact of Dry Eye on Everyday Life (IDEEL)) to distinguish between different levels of dry eye severity. METHODS: Assessment of 210 people: 130 with non-Sjogren's Keratoconjunctivitis Sicca (non-SS KCS), 32 with Sj?gren's Syndrome (SS) and 48 controls; comparison of SF-36, EQ-5D, and IDEEL age-adjusted data by dry eye severity levels. Severity was assessed based on diagnosis (non-SS KCS, SS, control), patient-report (none, very mild, mild, moderate, severe, extremely severe) and clinician-report (none, mild, moderate, severe). RESULTS: Discriminative validity results were consistent for all instruments. Significant differences between severity levels were found with most SF-36 scales (P < 0.05), all EQ-5D scales (P < 0.05), and all IDEEL scales (P < 0.0001), except for Treatment Satisfaction. IDEEL scales consistently outperformed the generic QoL measures regardless of the severity criterion used. Most SF-36 scales outperformed the EQ-5D QoL scale, but the EQ-5D visual analog scale outperformed the SF-36 scales, except for General Health Perceptions. CONCLUSIONS: The disease-specific IDEEL scales are better able to discriminate between severity levels than the majority of the generic QoL scales. Preliminary evidence demonstrates that the IDEEL will be sensitive to QoL changes over time, although further testing in controlled longitudinal studies is needed.     

The MOS SF-36 health survey questionnaire in severe chronic airflow limitation: Comparison with the Nottingham health profile

This study documents the cross-sectional, health-related quality of life (HRQOL) measures obtained at baseline for patients with severe chronic airways limitation (CAL) being assessed for home oxygen therapy (HOT) at the Flinders Medical Centre, Adelaide, South Australia. Two generic quality of life instruments, the Nottingham Health Profile (NHP) and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF-36), were administered by interview to the same patients to permit comparisons to be made between the two instruments. SF-36 mean scores were also compared with scores obtained in separate studies of a South Australian elderly general population and of groups of Australian subjects with various medical and psychiatric conditions. NHP mean scores were compared with scores from an elderly group of Adelaide residents from a household survey. HRQOL measures were obtained for 60 patients, 32 males and 28 females. At assessment for HOT, patients with severe CAL were experiencing severe impairment in their quality of life in comparison to age-matched South Australian norms, with physical disability the major limitation. There were several significant correlations between the domains of the SF-36 and the NHP which were predominantly gender-specific. Only small decrements in mental health were found with the SF-36 questionnaire. The SF-36 and the NHP appear to provide discrepant information for severely disabled CAL patients for the subjective domains of emotional and mental health.     

Condition-specific measure was more responsive than generic measure in colorectal cancer: all but social domains

ObjectiveTo examine the responsiveness of generic and condition-specific instruments based on the anchor of self-reported level of global change in patients with colorectal cancer (CRC).Study Design and SettingThree hundred thirty-three patients with CRC were surveyed at two assessments at baseline and follow-up at 6 months from September 2009 to July 2010 using the Short Form-12 Health Survey version 2 (SF-12v2) and Functional Assessment of Cancer Therapy-Colorectal (FACT-C) measures. The responsiveness of the two measures was evaluated using standardized effect size, standardized response mean, responsiveness statistic, and receiver operating characteristic (ROC) curve analysis.ResultsIn worsened group, internal responsiveness of detecting negative changes was satisfactory for most subscales of FACT-C and SF-12v2. The FACT-C subscales were significantly more responsive to positive changes detection than the SF-12v2 subscales in improved group. Physical well-being subscale, Trial Outcome Index (TOI), and total score of FACT-C were more externally responsive to ROC curve analysis. The FACT-C measure was generally more responsive to changes in health status compared with SF-12v2 measure.ConclusionTOI and total score of FACT-C were the most responsive among subscales of condition-specific measure, which were more responsive than all generic subscales with the exception of social domain. Complementary use of condition-specific and generic instruments to evaluate the health-related quality of life of CRC patients is encouraged.