Change in perceived health and functioning over time in patients with type I diabetes mellitus

Objective: The objective of this study was to investigate perceived health and functioning (PHF) of patients with type I diabetes mellitus (DMT1) over time and to compare change in perceived PHF with that of a sample of the general population. Methods: In a Dutch cohort of 234 patients with DMT1 we assessed PHF over time with two generic instruments: RAND-36 and EuroQol. We applied multilevel modelling to estimate change in PHF over the years 1995–2001. We compared change in PHF with change estimated from a comparably aged sample from the general population using a one-sample t-test. Results: Patients reported a significant decrease in PHF for most RAND-36 subscales. Mean changes in RAND–36 scores ranged from −0.09 (mental health) to −1.18 per year (bodily pain). EQ scores decreased significantly as well. Patients in the cohort had a faster decrease in three RAND-36 subscales and EQ-VAS over time than the estimated decrease in the general population. Conclusion: This study showed that patients with DMT1 have a faster decrease in PHF over time than comparably aged persons from the general population. The generic instruments used in our study were sensitive enough to measure changes in PHF over time in an adult diabetes population.     

Factors that predicted change in health-related quality of life were identified in a cohort of diabetes mellitus type 1 patients

OBJECTIVE: The aim of this study was to investigate whether sociodemographic and diabetes-specific characteristics can predict the rate of change in health-related quality of life (HRQOL) over time in patients with diabetes mellitus type I (DMT1). STUDY DESIGN AND SETTING: A Dutch cohort of 234 patients with DMT1 was followed for 6 years (1995-2001). HRQOL (RAND-36 and EuroQol) and several demographic and clinical patient characteristics were recorded annually during the study period. Baseline characteristics associated with rate of change in HRQOL were identified using an individual linear growth model. RESULTS: Patients showed a statistically significant decrease over time in most HRQOL scales. Higher baseline diastolic blood pressure was predictive of a faster decrease in RAND-36 PCS score (-0.025, P = .02). Patients with nephropathy showed a faster decrease in PCS (-0.749, P = .003), and those with intermittent claudication a faster decrease in EQ-5D (-0.049, P = .008). CONCLUSION: In this cohort of patients with DMT1, it was possible to identify factors predicting change in HRQOL. Late complications and risk factors for the development and progression of these complications are predictive of a lower HRQOL in the coming years.     

The validity and reliability of the Diabetes Health Profile (DHP) in NIDDM patients referred for insulin therapy

Recently, a new diabetes-specific questionnaire, the Diabetes Health Profile (DHP), has been developed to identify psychosocial dysfunctioning of insulin-requiring (NIDDM) and insulin-dependent diabetes mellitus (IDDM) patients. The DHP comprises three dimensions: psychological distress (PSY: 14 items), barriers to activity (BAR: 12 items) and disinhibited eating (EAT: five items). This study investigates the psychometric properties of the DHP in Dutch noninsulin-dependent diabetes mellitus (NIDDM) patients referred for insulin therapy. In addition, the relation-ship between patient characteristics and the DHP outcome was examined. The factor structure found was similar but not identical to former studies, but construct validity was supported by high correlations of our factor structure and the original factor outcome and Cronbach's . The three factors explained 32% of the variance, supporting earlier findings. It was shown that Cronbach's was satisfactory (0.72, 0.72 and 0.79). Convergent validity showed strong and significant correlations between the PSY/BAR dimensions and predicted corresponding scales of the RAND-36. However, the PSY/BAR dimensions also showed, although less strong, significant correlations with the non-corresponding RAND-36 scales. The EAT dimension showed only correlations with two of the RAND-36 dimensions, thus measuring a different trait. Regression analysis showed that older patients had less problems with items of the EAT dimension and that no difference was found between men and women, supporting earlier findings. The hyperglycaemic complaint fatigue gave a significantly lower score (more problems) on the PSY and BAR dimensions. Younger age, the presence of hypertension and retinopathy resulted in a significantly lower score on the EAT dimension. DHP outcome was not significantly influenced by duration of diabetes, HbA_1c (indicator of glycemic control), serum total cholesterol, body mass index, chronic diabetes complications and comorbidity. Overall, the psychometric properties were good considering the small and diverse sample, suggesting that the DHP is promising for use in NIDDM patients, although more study is necessary in a larger sample.     

Electronic collection of health-related quality of life data: Validity,time benefits,and patient preference

This study sought to validate World Wide Web-compliant software tools used to collect health-related quality of life (HRQOL) data, relative to pencil-and-paper collection. The RAND-36 general health survey and the Seattle Angina questionnaire (SAQ), a disease-specific functional status measure for patients with coronary artery disease, were each administered in paper and electronic format to 55 consecutive patients visiting the cardiology outpatient clinic of a public hospital. All eight sub-scale scores of the RAND-36 (interclass correlation coefficient range = 0.54-0.75, p < 0.01) and all five domains of the SAQ (interclass correlation coefficient range = 0.84-0.90, p < 0.01) collected using the software were significantly correlated with those collected using the paper version of questionnaires. Computer literacy, educational level, age, sex, and race were not significantly associated with the ability to successfully complete the computer-assisted questionnaire. Eighty-two percent of patients preferred the computer-assisted administration to paper, and 89% reported that they would feel comfortable using the software in the future without any technical assistance. This pilot study suggests that HRQOL measures can be reliably collected using software operating over the World Wide Web. Data collected in this manner are valid and of comparable quality to self-reported, HRQOL data obtained via paper survey.     

An integrated psychological strategy for advanced colorectal cancer patients

Background

Interpretations of profile and preference based measure scores can differ. Profile measures often use a norm-based scoring algorithm where each scale is scored to have a standardized mean and standard deviation, relative to the general population scores/norms (i.e., norm-based). Preference-based index measures generate an overall scores on the conventional scale in which 0.00 is assigned to dead and 1.00 is assigned to perfect health. Our objective was to investigate the interpretation of norm-based scoring of generic health status measures in a population of adults with type 1 diabetes by comparing norm-based health status scores and preference-based health-related quality of life (HRQL) scores.

Methods

Data were collected through self-complete questionnaires sent to patients with type 1 diabetes. The RAND-36 and the Health Utilities Index Mark 3 (HUI3) were included.

Results

A total of 216 (61%) questionnaires were returned. The respondent sample was predominantly female (58.8%); had a mean (SD) age of 37.1 (14.3) years and a mean duration of diabetes of 20.9 (12.4) years. Mean (SD) health status scores were: RAND-36 PHC 47.9 (9.4), RAND-36 MHC 47.2 (11.8), and HUI3 0.78 (0.23). Histograms of these scores show substantial left skew. HUI3 scores were similar to those previously reported for diabetes in the general Canadian population. Physical and mental health summary scores of the RAND-36 suggest that this population is as healthy as the general adult population.

Conclusion

In this sample, a preference-based measure indicated poorer health, consistent with clinical evidence, whereas a norm-based measure indicated health similar to the average for the general population. Norm-based scoring measure may provide misleading interpretations in populations when health status is not normally distributed.     

Quality of life in patients with colo-rectal cancers at a Tunisian hospital center. A case control study of a population unhurt by cancer

The aim of our study is to value the quality of life (QOL) in patients with colo-rectal cancers in the region of tunisian center and to compare it to the QOL in a healthy population unhurt of cancer. METHODS: Our population is made by 80 patients treated for coloractal cancers. The population witness includes 80 healthy individuals unhurt of cancers. The assessment of the QOL in patients is achieved with the specific colo-rectal cancer questionnaire: the FACT-C. The comparison of the QOL in the 2 populations is made by the general questionnaire of quality of life of Spitzer. RESULTS: The QOL in patients is good in 55% of cases, average in 44% of cases and bad in 11% of cases. The QOL is better in case of favourable socioeconomic conditions (p < 0,05), colic localization (p < 0.015), absence of metastases (p< 0.05), not mutilating surgery (p < 0.01) especially the absence of stoma (p < 0.001) and the restoring of the continuity (p < 0.002), absence of pain (p < 0.0001), absence of current treatment (p < 0.01). The comparison of the different domains of QOL between the 2 groups (patients and healthy) finds a better QOL in healthy group, in all domains except for the relational ship domain witch turned to be comparable for the 2 samples.     

国人生活质量普适量表的编制与评价

目的编制适合中国一般人群的生活质量普适量表并评价该量表的信度和效度。方法参照世界卫生组织生活质量量表（WHO-100）和美国医学结局健康状况调查问卷（SF-36），并结合中国人群社会文化特点编制生活质量普适量表（QOL-35），包括35个条目，分别属于总体健康和生活质量、生理功能、独立生活能力、心理功能、社会功能、生活条件6个领域和1个反应生活质量变化的条目。对127名社区成人的生活质量进行间隔24—72h的重复调查，评价量表的重测信度。对135名门诊或社区人群同时应用WHO-100、SF-36和QOL-35，比较QOL-35与国外标准量表的内部一致性信度和结构效度。在1356名社区人群中评价QOL-35的稳定性和适用性。结果（1）重测信度：QOL-35量表各条目2次测量之间权重一致性（Kappa值）范围为0．86～1．00，各领域和整个量表在2次测量之间的组内相关系数范围为0．68～0．94。（2）内部一致性信度：QOL-35、WHO-100和SF-36量表的克隆巴赫a分别为0．93、0．97和0．89。（3）结构效度：三个量表经因子分析选出的前7个因子方差累计贡献率分别为66．5％、50．3％和65．3％。（4）标准效度：QOL-35总分与WHO-100总分和SF-36的总分Spearman相关系数分别为0．805和0．745。（5）判别效度：各种慢性病总患病率在QOL-35总分第一到第四分位人群中分别为53．1％、33．1％、26．4％和25．1％（P〈0．05）。（6）QOL-35在1356名一般人群的初步应用显示出近似的克隆巴赫α。结论QOL-35具有较好的重测信度，与WHO-100和SF-36相比以较少的条目获得较好的结构效度、内部一致性和判别效度，在较大人群的初步应用显示出较为稳定的测量特性，QOL-35是评价中国一般人群生活质量较理想的工具。     

Distinguishing between quality of life and health status in quality of life research: A meta-analysis

Despite the increasing acceptance of quality of life (QOL) as a critical endpoint in medical research, there is little consensus regarding the definition of this construct or how it differs from perceived health status. The objective of this analysis was to understand how patients make determinations of QOL and whether QOL can be differentiated from health status. We conducted a meta-analysis of the relationships among two constructs (QOL and perceived health status) and three functioning domains (mental, physical, and social functioning) in 12 chronic disease studies. Instruments used in these studies included the RAND-36, MOS SF-20, EORTC QLQ-30, MILQ and MQOL-HIV. A single, synthesized correlation matrix combining the data from all 12 studies was estimated by generalized least squares. The synthesized matrix was then used to estimate structural equation models. The meta-analysis results indicate that, from the perspective of patients, QOL and health status are distinct constructs. When rating QOL, patients give greater emphasis to mental health than to physical functioning. This pattern is reversed for appraisals of health status, for which physical functioning is more important than mental health. Social functioning did not have a major impact on either construct. We conclude that quality of life and health status are distinct constructs, and that the two terms should not be used interchangeably. Many prominent health status instruments, including utility-based questionnaires and health perception indexes, may be inappropriate for measuring QOL. Evaluations of the effectiveness of medical treatment may differ depending on whether QOL or health status is the study outcome.     

Subjective quality of life in severely mentally ill patients: A comparison of two instruments

Although many quality of life (QOL) scales have been developed, comparison of specific QOL instruments is lacking. We compared the psychometric properties of two QOL measures in parallel samples of mentally disturbed and non-patient subjects. We simultaneously administered the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and self-report items of the Lancashire Quality of Life Profile (LQOLP) to 199 patients with severe mental disorders and 175 non-patients. The patients were evaluated with psychiatric rating scales. We identified five concordant domains, and five instrument-specific domains for the LQOLP and four for the Q-LES-Q. The Q-LES-Q provides better psychometric properties than the LQOLP in both samples. Both instruments show a good capacity to evaluate QOL and discriminate between the patients and non-patient controls. Within the patient sample, both QOL measures showed similarly negative correlations with severity of depression, but not mania, positive, negative, and general symptomatology. Both instruments proved to be mental health related, but neither was mental-disorder specific. Despite the acceptable psychometric properties and correlation of general QOL indices, similar QOL domains proved to be instrument specific and not sufficiently compatible. These discrepancies should be considered when comparing evaluations from similar domains in these QOL scales.     

四川部分地区阿片类药物依赖人群生命质量及其影响因素的研究

目的调查四川地区三城市阿片类药物依赖人群生命质量,找出影响生命质量的因素。方法用SF-36量表和PSSS量表来评估阿片类药物依赖人群的生命质量和社会支持,同时用自编量表调查该人群的一般特征及其与药物依赖相关的因素。用t检验、相关分析、方差分析和多元线形逐步回归等统计分析对资料进行分析。结果①阿片类药物依赖人群的生命质量显著性低于正常对照人群(P<0.001);该人群的社会支持在PSSS量表所测的不同领域均低于对照人群(P<0.001)。②单因素分析时,年龄、婚姻状况、文化程度、职业、收入、吸烟、患有慢性病、社会支持的3个维度、吸毒方式、共用针管、家庭成员吸毒、吸毒时间、吸毒剂量、戒毒方式及复吸次数等17种因素与研究人群生命质量的各领域或部分领域均有关系。③多因素分析后发现,对研究人群生命质量的主要影响因素是吸毒时间、吸毒剂量、家庭外源性社会支持、全部社会支持、共用针管和收入。婚姻状况、家庭内源性社会支持、吸毒方式、患有慢性病、吸烟、家庭成员吸毒、戒毒方式及复吸次数等因素则对个别领域有影响。结论四川地区三城市阿片类药物依赖人群生命质量较低,且缺乏足够的社会支持。     

Health-Related Quality of Life Measurement in Type 2 Diabetes

Type 2 diabetes has significant adverse effects on health-related quality of life (HRQoL). A vast array of questionnaires has been used to measure HRQoL in diabetes patients, contributing to the difficulty of selecting instruments for future research. To systematically evaluate these measures, a literature search was undertaken to identify relevant publications. This paper summarizes the generic, diabetes-specific, and psychological measures utilized to evaluate persons with type 2 diabetes, and highlights related findings. Generic instruments demonstrate significant reductions in health status compared with other chronic disease populations and healthy controls. Multiple diabetes-specific measures are available to assess domains affected by the disease, including symptoms, worries, self-care, locus of control, functional ability, social support, and sexual functioning. Psychological measures show that type 2 diabetes is frequently associated with adverse psychological effects, particularly depression. Since much of this research has been cross-sectional in nature, little is known about responsiveness of many of the HRQoL measures to clinical change and treatment effects. It is clear that HRQoL results are influenced by multiple patient and disease factors, particularly age, gender, and the presence and severity of disease complications and comorbid conditions. These factors should be considered in the design and analysis of HRQoL evaluations in type 2 diabetes patients. Selection of instruments for future research will therefore require careful evaluation of study design and objectives, population characteristics, the presence of disease-related factors, and outcomes of interest.     

Impact of Untreated Psychosis on Quality of Life in Patients with First-episode Schizophrenia

Despite increasing interest in the quality of life (QOL) of psychiatric patients in recent years, few studies have focused on the potential adverse effects of the illness on QOL during the period of untreated psychosis. Our study compares the QOL of patients with first-episode schizophrenia when they first presented to the psychiatric service with that of the normal population, and identifies possible relationships with various clinical parameters. One hundred and seventeen patients with schizophrenia (aged 14–28 years) who entered the Early Assessment Services for Young People with Psychosis (EASY) programme in Hong Kong from June 2001 to January 2004 were assessed with the MOS 36 item Short Form Health Survey (SF-36) and the World Health Organization Quality of Life Measure, abbreviated Hong Kong version (WHOQOL-BREF(HK)). We compared their SF-36 scores with controls from the normal population matched by age, sex, marital status and educational level. We assessed clinical parameters including positive, negative and depressive symptoms by the Positive and Negative Syndrome Scale (PANSS), the Scale for Assessment of Negative Symptoms (SANS), and the Montgomery and Asberg Depression Rating Scale (MADRS). When compared with matched controls from the normal population, significantly lower scores in all of the eight scales of the SF-36 were found in our patient group (p < 0.005). Various QOL domain scores had significant inverse correlations with the total MADRS score. However, there was no significant correlation with other clinical parameters. Young patients with first-episode schizophrenia have poorer QOL in the period of untreated psychosis than their counterparts in the community. Amongst various clinical parameters, the severity of depressive symptoms correlates most with QOL.     

Impact of laparoscopic colorectal segment resection on quality of life in women with deep endometriosis: one year follow-up

Purpose

To evaluate the changes in quality of life (QOL) over a 1-year follow-up period in patients submitted to laparoscopic colorectal resection for the treatment of deep endometriosis.

Methods

A prospective observational cohort study (Canadian Task Force Design Classification II) involving 40 women with intestinal deep endometriosis was conducted between June 2007 and September 2008 at the Department of Obstetrics and Gynecology, Santa Casa Medical School, Sao Paulo, Brazil. Prior to the surgical procedure, all patients received magnetic resonance studies of the pelvis and rectal echoendoscopy, which suggested intestinal involvement of the disease in all cases. The patients received laparoscopic colorectal resections and treatment for other endometriotic lesions. The subjects completed the QOL SF-36 at 3 time points (T0 pre-operatively; T1 6 months post-operatively; and T2 1 year post-operatively).

Results

The physical functioning, role physical, social functioning and role emotional subscales evidenced the most substantial median increases for T0, T1 and T2. The pain, general health, vitality and mental health domains showed slight changes and increases in medians but did not increase to the same extent as the previous group. Significant improvements were observed in all domains of the SF-36 throughout the study period (p < 0.05). Physical health-related QOL domains showed greater improvement than mental health domains. Analyses of age, parity and body mass index as potential factors influencing the impact of surgery on QOL revealed no differences. Therefore, these factors were not used as prognostic indicators for the surgical procedure or for patient follow-up. In addition, we noted that the patients with poorest results on the initial QOL questionnaire showed the greatest improvements at the end point.

Conclusion

The study results showed that laparoscopic colorectal segment resection for endometriosis had a positive impact on QOL in this patient group. The positive effects persisted 1 year after surgery.     

Assessment of quality of life among HIV-infected persons in Pune,India

Objective: To study dimensions of Quality of Life (QOL) amongst HIV infected persons, their relationship with socio-demographic characteristics and disease progression.Design: Cross-sectional study with one time assessment of QOL.Methods: Modified Medical Outcome Study (MOS) core instrument [The Medical Outcome Study 116 core set of Measures of functioning and well being, Appendix A, core survey instrument (internet)] was interview -administered to 100 HIV infected individuals.Results: The instrument showed significant positive inter-domain correlations and desired linear association between QOL scores and the CD4 counts. The scale had a Cronbach α value of 0.75. QOL was markedly affected in the domains of physical health, work and earnings, routine activities and appetite and food intake. Women had significantly lower QOL scores than men despite having less advanced disease. The QOL scores were significantly lower among persons with lower CD4 counts mainly in different domains of physical health.Conclusions: The modified MOS scale had the desired reliability and validity for evaluation of QOL in the HIV-infected persons in India. Low scores in the domains of physical health compared to other domains suggest a strategy to focus on medical intervention. A need for psychosocial intervention for women was perceived. Longitudinal studies must be done to assess the impact of anti-retroviral therapy being rolled out through the national programme on QOL.Source of Funding: National AIDS Research Institute, Intra-mural funds Indian Council Of Medical Research, New Delhi, India.     

How should we evaluate health status? A comparison of three methods in patients presenting with obstructive sleep apnoea

The purpose of this paper is to compare three approaches to the measurement of patient-reported health status which produce summary scales of health status: the Patient-generated Index (PGI) is a measure of individual quality of life (QoL), the EuroQol is a measure of QoL the results of which are weighted by utility values gained from community surveys and the SF-36 which produces two summary scales of health status (the physical component summary (PCS) and the mental component summary (MCS) scores). A follow-up interview survey of patients with obstructive sleep apnoea (OSA) was conducted. The patients received continuous positive airways pressure therapy (CPAP) between the two administrations of the questionnaires. One hundred patients presenting with OSA and who were suitable for CPAP therapy were asked if they would take part in the study. The results on the PGI, EuroQol EQ-5D utility weighted scores and thermometer scores and SF-36 physical and mental summary scores were measured. Eighty-nine respondents provided sufficient data to calculate PGI and EuroQol scores and 86 patients provided sufficient data to calculate SF-36 summary scores. The PGI indicated substantial improvement after CPAP treatment whereas the EuroQol indicated little or no improvement on either utility weighted or thermometer scores. The SF-36 PCS and MCS scores were lower than those of the general population at baseline, but had improved to the normative levels after treatment. The EuroQol provided a substantially different picture of change to either of the ones gained from the SF-36 or PGI. It is suggested that the EuroQol does not contain questions which relate to important aspects of health and well-being and may not accurately reflect the health state of individuals. Consequently, caution must be exercised to assure that an appropriate instrument has been employed when using health outcomes data to assess or prioritize available health care treatments.     

Treatment compliance and subjective well-being among post-stroke patients]

The quality of life (QOL) and the factors that influenced it were studied in patients suffering from stroke. QOL was studied at 2 separate levels: 1) compliance with the advice of a physician, 2) subjective well-being. A patient with high QOL was defined as a person with both high compliance to the advice of a physician and high subjective well-being. Subjects were selected from persons who participated in rehabilitation at health centers and welfare centers, and members of a stroke patient. The following results were obtained. 1) When compared to results obtained from other research for the general population, subjective well-being in stroke patients was lower among men and those 69 years of age or under. Compliance with advice of a physician was higher for either sex and all age groups in the interviewees than in the general population. 2) Factors which were related to compliance differed from those related to subjective well-being. Compliance with the advice of a physician was higher among those interviewees having the shortest time elapsing since the occurrence of stroke, high social support and low psychological adaptation to the stroke experience. Among social support network members, relatives figured prominently among factors related to compliance. Among interviewees, subjective well-being decreased with depression, high degree of impairment in activity of daily living, and when three years or greater had elapsed since the stroke. Among these factors the relationship between depression and subjective well-being was the strongest.