Maternal quality of life in routine labor epidural analgesia versus labor analgesia on request: results of a randomized trial

Introduction

The purpose of this study was to evaluate the changes in maternal quality of life (QOL) from pregnancy to 6 weeks after delivery between routine labor epidural analgesia (EA) and pain relief on maternal request only.

Methods

\Women delivering of a singleton in cephalic presentation beyond 36?+?0 weeks’ gestation were randomly allocated to EA as a routine during labor (routine EA group), or to any kind of analgesia on request only (control group). The Short Form health survey (SF-36) was used to assess women’s QOL before randomization, and 6 weeks postpartum. Data were analyzed according to the intention to treat principle.

Results

A total of 488 women were included, and antepartum as well as postpartum SF-36 questionnaires were filled in by 356 (73.0%) women, 176 (49.4%) in the routine EA group, and 180 (50.6%) in the control group. Changes from the QOL antepartum to the QOL 6 weeks postpartum were comparable between both groups, also in the subgroup of women in the control group who gave birth without any pain medication (n?=?41, 22.8%). Maternal age and the incidence of adverse events related to EA, which were both higher in the routine EA group, had no influence on the changes in QOL. Differences in request for pain relief were comparable with other studies.

Conclusion

Routine administration of EA during labor and pain relief on maternal request only are associated with comparable changes of women’s QOL antepartum to 6 weeks postpartum.

     

Change in quality of life and one-year mortality risk in maintenance dialysis patients

Background

Quality of life (QOL) is an important metric of high-quality dialysis care. QOL is commonly measured by the Short Form 36 Questionnaire (SF-36), which provides two summary scores: a mental component score (MCS) and a physical component score (PCS). Poor QOL is associated with mortality in dialysis patients. Small studies show that changes in QOL also predicts mortality. We investigated whether changes in QOL over time are associated with mortality in a large cohort of maintenance hemodialysis patients.

Methods

This retrospective study was conducted in 1017 outpatient dialysis facilities. Over 10,000 hemodialysis patients completed two SF-36 surveys. We compared 1-year morality rates in those whose MCS or PCS increased or decreased ±5 vs. those whose did not.

Results

For those who completed two surveys, mean score for PCS was unchanged, whereas MCS increased slightly (48.6 vs. 48.9, p = 0.05). Individual patients, however, showed marked variation. On the second survey, more than half of patients demonstrated a ± 5 point change in the PCS and/or MCS. After multivariate adjustment, a ≥ 5 decrease in MCS was associated with an increase in mortality (HR = 1.33, 95 % CI 1.18, 1.50).

Conclusions

Clinicians should be aware that many patients experience a significant change in both the MCS and PCS on dialysis. A MCS decrease of ≥5 was associated with increased mortality. More study is needed to determine whether this is a causal relationship. Physicians should evaluate root causes and seek to mitigate declines in QOL whenever possible.

     

Comparison of quality of life among community-dwelling older adults with the frailty phenotype

Purpose

To compare the perception of the quality of life (QOL) of community-dwelling older adults with the phenotype of frailty.

Methods

Cross-sectional analysis of baseline data of the “Cohort of Obesity, Sarcopenia and Frailty of Mexican Older Adults” (COSFOMA). Operationalization of frailty was carried out using the phenotype as follows: weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness. QOL was measured using two scales: World Health Organization Quality of Life of Older Adults (WHOQOL-OLD), which is a specific instrument for the elderly population, and Short Form-36 Health Survey (SF-36), a generic instrument to evaluate the QOL related to health. One-way analyses of variance were conducted to assess the differences among the three phenotypes of frailty and QOL perception.

Results

There were 1252 older adult participants who were analyzed; 11.2% (n = 140) had frailty, 50.3% (n = 630) pre-frailty and 38.5% (n = 482) were not frail. The mean (±SD) total score of the WHOQOL-OLD according to the phenotype of frailty was 60.3 (13.9) for those with frailty, 67.4 (12.7) pre-frailty and 72.4 (11.2) not frail (ANOVA, p < 0.001). The mean (±SD) of the SF-36 of the physical and mental component measures the sum, 38.9 (9.9) and 41.9 (11.3) with frailty, 45.7 (9.1) and 46.6 (9.8) pre-frailty, and 49.6 (7.3) and 49.4 (7.9) not frail, respectively (ANOVA, p < 0.001).

Conclusions

Frailty is observed in 1/10 community-dwelling older adults. Those with frailty and pre-frailty had a lower perception of QOL compared with those who were not frail.

     

Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study

Background

Deep infiltrating endometriosis (DIE) can affect importantly patients' quality of life (QOL). The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment.

Methods

It is a prospective cohort study. In a tertiary care university hospital, between April 2008 and December 2009, 100 patients underwent laparoscopic management of DIE and completed preoperatively and 6-months postoperatively a QOL questionnaire, the short form 36 (SF-36).Quality of life was measured through the SF-36 scores. Intra-operative details of disease site, number of lesions, type of intervention, period of hospital stay and peri-operative complications were noted.

Results

Six months postoperatively all the women had a significant improvement in every scale of the SF-36 (p < 0,0005). Among patients with intestinal DIE, significant differences in postoperative scores of SF-36 were not detected between patients submitted to nodule shaving and segmental resection (p > 0.05). There was no significant difference in the SF-36 scores at 6 months from surgery between patients who received postoperative medical treatment and patients who did not (p > 0.05).

Conclusions

Laparoscopic excision of DIE lesions significantly improves general health and psycho-emotional status at six months from surgery without differences between patients submitted to intestinal segmental resection or intestinal nodule shaving.

     

Trajectories and associated factors of quality of life,global outcome,and post-concussion symptoms in the first year following mild traumatic brain injury

Purpose

To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI).

Methods

This was a prospective longitudinal study of 100 participants with mTBI from neurosurgical outpatient departments in Chiayi County District Hospitals in Taiwan. The checklist of post-concussion syndromes (CPCS) was used to assess PCS at enrollment and at 1, 3, and 12 months after mTBI; the glasgow outcome scale extended (GOSE), the quality of life after brain injured (QOLIBRI), Chinese version, and the Short Form 36 Health Survey (SF-36), Taiwan version, were used to assess mTBI global outcome and QoL at 1, 3, and 12 months after mTBI.

Results

Latent class growth models (LCGMs) indicated the change trajectories of QOLIBRI, PCS SF-36, MCS SF-36, GOSE, and PCS. Classes of trajectory were associated with age ≥40 years, unemployment at 1 month after injury, and educational level ≤12 years. Univariate analysis revealed that employment status at 1 month post-injury was correlated with the trajectories of QOLIBRI, PCS SF-36, MCS SF-36, and GOSE, but not PCS.

Conclusions

Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI.

     

Psychometric validation of the SF-36<Superscript>®</Superscript> Health Survey in ulcerative colitis: results from a systematic literature review

Purpose

To conduct a systematic literature review of the reliability, construct validity, and responsiveness of the SF-36^® Health Survey (SF-36) in patients with ulcerative colitis (UC).

Methods

We performed a systematic search of electronic medical databases to identify published peer-reviewed studies which reported scores from the eight scales and/or two summary measures of the SF-36 collected from adult patients with UC. Study findings relevant to reliability, construct validity, and responsiveness were reviewed.

Results

Data were extracted and summarized from 43 articles meeting inclusion criteria. Convergent validity was supported by findings that 83% (197/236) of correlations between SF-36 scales and measures of disease symptoms, disease activity, and functioning exceeded the prespecified threshold (r ≥ |0.40|). Known-groups validity was supported by findings of clinically meaningful differences in SF-36 scores between subgroups of patients when classified by disease activity (i.e., active versus inactive), symptom status, and comorbidity status. Responsiveness was supported by findings of clinically meaningful changes in SF-36 scores following treatment in non-comparative trials, and by meaningfully larger improvements in SF-36 scores in treatment arms relative to controls in randomized controlled trials. The sole study of SF-36 reliability found evidence supporting internal consistency (Cronbach’s α ≥ 0.70) for all SF-36 scales and test–retest reliability (intraclass correlation coefficient ≥0.70) for six of eight scales.

Conclusions

Evidence from this systematic literature review indicates that the SF-36 is reliable, valid, and responsive when used with UC patients, supporting the inclusion of the SF-36 as an endpoint in clinical trials for this patient population.

     

Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease

Purpose

How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD).

Methods

In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4 weeks, and 130 at 4 months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George’s Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed.

Results

At 4 weeks and 4 months, changes in disease-specific QOL (st. β = –0.35, p < 0.001, partial (p) R ² = 11–12 %), depression (st. β = –0.32 to –0.36, p < 0.001, pR ² = 9–12 %), and anxiety (st. β = –0.21 to –0.40, p < 0.02–0.001, pR ² = 4–15 %) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4 months (st. β = 0.21, p = 0.02, pR ² = 4 %), but not with changes in depression.

Conclusions

Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.

     

Distilling the essence of appraisal: a mixed methods study of people with multiple sclerosis

Background

This study aimed to identify the essential parts of the Quality of Life (QOL) Appraisal Profile that capture the most important differences in the ways that people with multiple sclerosis respond to patient-reported outcome (PRO) measures. This process will enable the eventual development of a more practical, less resource-intensive version of the QOL Appraisal Profile to facilitate its use in clinical research and practice.

Methods

This is a secondary analysis of longitudinal PRO data (n = 859) of participants in the North American Research Committee on Multiple Sclerosis registry. Following the Rapkin and Schwartz (Health Qual Life Outcomes 2(1):14, 2004) model, we computed a “standard QOL model,” and then multivariate analysis of variance (MANOVA) and discriminant function (DF) analysis to identify patterns of appraisal measures associated with group differences in response to each QOL outcome.

Results

The “standard QOL model” explains a moderate amount of variance (i.e., 15–17 %) in physical functioning and disease-specific disability, and very little variance in mental health functioning. The MANOVAs identified the appraisal variables that mattered by PRO, and the DF analysis included 10–16 of the 83 potential appraisal variables in two DFs per outcome that distinguished groups with better, average, and worse expected scores, as well as groups with better-than-expected, as-expected, and worse-than-expected scores. The dominant appraisal parameters were more similar between the generic and disease-specific measure of physical functioning and disability, respectively, than between the mental health measure and the former two measures.

Conclusions

The practical implications of this work all revolve around a fundamental recommendation: Whenever one measures QOL, one should measure appraisal.

     

Trajectories of quality of life in patients with traumatic limb injury: a 2-year follow-up study

Purpose

Traumatic limb injury (TLI) can have a negative impact on a patient’s quality of life (QOL), and the patient’s QOL may fluctuate over time. However, the longitudinal change patterns of QOL in patients with TLI are largely unknown. The aim of this study was to investigate the QOL trajectories in patients with TLI in 4 QOL domains: physical capacity, psychological well-being, social relationships, and environment.

Methods

The patients’ QOL was assessed within 14 days and at 1, 3, 6, 12, and 24 months after injury. In each QOL domain, 4 latent growth curve models (LGMs, including non-growth, linear growth, quadratic growth, and cubic LGM) were adopted to examine the QOL trajectories across the 6 time points.

Results

A total of 499 patients completed the 6 assessments. For all 4 QOL domains, the cubic LGM had the best model fitting (root-mean-square error of approximation < 0.01) revealing that the patients’ 4 QOL domains changed with cubic trajectories: QOL improved in the first 6 months, deteriorated in the second 6 months, and improved smoothly at 12–24 months after injury.

Conclusions

This study found that the trajectories in the 4 QOL domains were cubic trajectories in patients with TLI. These findings indicate that clinicians should pay additional attention to improve the patients’ QOL in the first 6 months after injury and to prevent or reduce QOL deterioration at 6–12 months.

     

Comparison of quality of life among long-term melanoma survivors and non-melanoma controls: a cross-sectional study

Purpose

Little is known about specific concerns facing long-term melanoma survivors. The goal of this study was to compare quality of life (QOL) and mental health between long-term melanoma survivors and population controls.

Methods

Participants from a previously conducted case-control study of risk factors for melanoma were recruited for a cross-sectional survey. Generic QOL and emotional health were measured using the SF-36 and Hospital Anxiety and Depression Scale questionnaires. A total of 724 melanoma survivors and 660 controls participated. Most melanoma survivors had stage I disease (85.6%); mean time from diagnosis was 9.6?±?1.0 years. Comparisons of QOL measures between melanoma survivors and controls were conducted using regression models, adjusting for potential confounders.

Results

Melanoma survivors, compared to controls, reported statistically significant but only slightly higher physical functioning and bodily pain QOL subscale scores than controls and otherwise similar QOL as measured by the remaining six SF-36 subscale scores. Prevalence of anxiety (18.1% vs. 19.3%, adjusted OR?=?1.00 (0.74, 1.36); p?=?1.00) and depression (7.2% vs. 9.8%, adjusted OR?=?0.74 (0.48, 1.16); p?=?1.00) were similar between melanoma survivors and controls.

Conclusion

Long-term early stage melanoma survivors report similar general QOL and mental health compared to population controls. Further research is needed to identify concerns more specific to melanoma.

     

Frailty predicts trajectories of quality of life over time among British community-dwelling older people

Purpose

To investigate associations between baseline frailty status and subsequent changes in QOL over time among community-dwelling older people.

Methods

Among 363 community-dwelling older people ≥65 years, frailty was measured using Frailty Index (FI) constructed from 40 deficits at baseline. QOL was measured using Older People’s Quality of Life Questionnaire (OPQOL) six times over 2.5 years. Two-level hierarchical linear models were employed to predict QOL changes over time according to baseline frailty.

Results

At baseline, mean age was 73.1 (range 65–90) and 62.0 % were women. Mean FI was 0.17 (range 0.00–0.66), and mean OPQOL was 130.80 (range 93–163). The hierarchical linear model adjusted for age, gender, ethnicity, education, and enrollment site predicted that those with higher FI at baseline have lower QOL than those with lower FI (regression coefficient = ?47.64, p < 0.0001) and that QOL changes linearly over time with slopes ranging from 0.80 (FI = 0.00) to ?1.15 (FI = 0.66) as the FI increases. A FI of 0.27 is the cutoff point at which improvements in QOL over time change to declines in QOL.

Conclusions

Frailty was associated with lower QOL among British community-dwelling older people. While less frail participants had higher QOL at baseline and QOL improved over time, QOL of frailer participants was lower at baseline and declined.

     

Quality of life of patients with gastrointestinal cancers undergoing chemotherapy

Purpose

Findings regarding changes in the quality of life (QOL) of patients with gastrointestinal cancers (GI) undergoing chemotherapy (CTX) are inconclusive. Purpose was to evaluate for changes in QOL scores of patients with GI cancers over two cycles of CTX.

Methods

Patients (n?=?397) completed disease-specific [i.e., Quality of Life-Scale-Patient Version (QOL-PV)] and generic [12-item Medical Outcomes Study Short Form Survey (SF-12)] measures of QOL a total of six times over two cycles of CTX. Changes in these QOL scores were evaluated using bootstrapped multilevel regression with full information maximum likelihood estimation. Treatment group (i.e., with or without targeted therapy), age, number of metastatic sites, time from cancer diagnosis, number of prior cancer treatments, GI cancer diagnosis (i.e., colon/rectum/anal vs. other), and CTX regimen were evaluated as covariates in the conditional models for each of the QOL scores.

Results

During the second cycle of CTX, QOL-PV scores decreased in the week following CTX administration, and then increased the following week. For both cycles of CTX, the physical component summary and mental component summary scores of the SF-12 decreased in the week following CTX administration and then increased the following week. Increased time from cancer diagnosis and a higher number of prior cancer treatments resulted in worse QOL-PV and SF-12 scores at enrollment.

Conclusions

While changes in QOL scores over the two CTX cycles were statistically significant, the differences were not clinically meaningful. Future studies need to determine the optimal timing of QOL assessments to assess changes associated with cancer treatments.

     

Health-related quality of life in patients with chronic rheumatic disease after a multidisciplinary rehabilitation regimen

Introduction

Multidisciplinary rehabilitation has beneficial effects on health-related quality of life (HRQoL) in patients with chronic rheumatic diseases. However, whether this intervention benefits different age groups in women or men is largely unknown.

Purpose

To investigate HRQoL in patients with chronic rheumatic disease after completion of a 3-week multidisciplinary treatment, with special focus on differences in effect between age and gender groups.

Method

HRQoL was measured with SF-36. Mean scores for all SF-36 domains were compared before and after the 3-week regimen and again at 3-, 6-, and 12-month follow-ups. Multivariable linear regression models using generalized estimating equations to account for repeated measurement were employed. A weighting procedure to account for differential dropouts was applied.

Results

Three hundred fifty-six women and 74 men with chronic rheumatic disease were included. There were short-term improvements in all SF-36 domains irrespective of age or gender. These effects persisted for up to 1 year in the psychological, social, and energy domains for women under 50. We found no lasting effects for men; however, young men showed similar trends.

Conclusion

Inpatient multidisciplinary rehabilitation improves short-term HRQoL in all patients. Younger women maintain these beneficial effects for up to 1 year. Additional intervention should be considered for elderly women and for men in order to sustain rehabilitation effects.

     

Reduction of quality-adjusted life years (QALYs) in patients with premenstrual dysphoric disorder (PMDD)

Purpose

Premenstrual dysphoric disorder (PMDD) refers to the depression that occurs during the premenstrual phase and remits soon after the onset of menses. It affects the quality of life (QOL) of patients with PMDD. Therefore, this preliminary survey from chart recordings aimed to understand the symptom appearance and QOL reduction patterns in patients with PMDD, and to examine the extent of the loss of their quality-adjusted life years (QALYs).

Methods

Participants were 66 untreated female patients with PMDD. Data on symptom appearance and QOL reduction during the menstrual cycle, and the EuroQoL-5D (EQ-5D) scores during the premenstrual phase and immediately after the completion of a menstrual period were collected.

Results

The mean EQ-5D score of the 66 patients with PMDD was 0.795 ± 0.120 (range 0.362–0.949), indicating that their expected mean loss of QALYs was about 0.14 years.

Conclusions

If untreated, PMDD is expected to cause a mean loss of QALYs of about 0.14 years. However, on accounting for the period from disease development to menopause, and subtracting the menstruation-free periods such as pregnancy and breastfeeding, patients with untreated PMDD are expected to experience a QALY loss of about 3 years during their lifetime.

     

Measuring quality of life in children with spinal muscular atrophy: a systematic literature review

Objectives

Spinal muscular atrophy (SMA) is a rare, hereditary, autosomal recessive neuromuscular disorder that, in its most severe forms, impacts infants and children. Once symptomatic, it is characterized clinically by a distinct inability to achieve motor milestones, such as the ability to lift the head, sit, stand, or walk. Quality of life (QOL) measurement in very young infants presents a particular challenge. Therefore, this review aims to highlight commonly used measurement tools and identifies future research opportunities for QOL measurement in SMA.

Methods

A systematic literature review was carried out focusing on the various tools used to measure QOL in children?<?18 years of age with formally diagnosed SMA type I, II, or III. Although the disease area of interest was SMA, data on Duchenne’s muscular dystrophy were also included because of the rare nature of SMA.

Results

The Pediatric Quality of Life Inventory was the most commonly utilized tool to measure QOL in children; this included the generic and neuromuscular modules. No disease-specific tool to capture QOL in children with SMA was identified. Additionally, no measurement tools exist for very young infants (i.e., under 12 months) with SMA Type 1.

Conclusions

Evolving standards of care will lead to increased interest by stakeholders, on the methods used to measure QOL in infants and children across all types of SMA. Generic tools may not adequately capture QOL changes in SMA, especially given the age group affected by the disease. Further research is required to explore the scope for a disease-focused approach.

     

An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire

Background

Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL) measure, the deep venous thrombosis quality of life questionnaire (DVTQOL), for patients with recent exposition and treatment of proximal deep venous thrombosis.

Methods

A total of 121 consecutive outpatients (50 % males; mean age 61.2 ± 14 years) treated with warfarin (Waran^®) for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL.

Results

Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising); limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93). The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity.

Conclusions

The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored.

     

Physical training following gastric bypass: effects on physical activity and quality of life—a randomized controlled trial

Background

Obesity is associated with physical inactivity and impaired health-related quality of life (HRQoL). We aim to test the hypothesis that Roux-en-Y gastric bypass (RYGB) followed by supervised physical training improves physical activity (PA) levels and HRQoL.

Methods

Sixty patients, qualified for RYGB, were at 6 months post-surgery randomized to 26 weeks of a supervised physical training intervention (INT) or to a control (CON) group. PA was assessed by accelerometry and using the questionnaire RPAQ. HRQoL was measured by the SF-36 questionnaire. All assessments were performed pre-surgery and 6, 12, and 24 months post-surgery.

Results

RYGB did not improve objectively or self-reported PA, but improved all domains of SF-36 (all p?<?0.01). Objectively measured light PA, moderate to vigorous PA, and step counts tended to increase in INT compared to CON 12 months after RYGB (0.05?<?p?<?0.09), but the effects failed to persist. The SF-36 domain “general health” increased in INT compared to CON 24 months after RYGB (p?=?0.041).

Conclusion

RYGB improves HRQoL, but does not increase PA. Supervised physical training intervention improves general health 24 months after RYGB and tends to improve certain domains of PA right after the intervention period, but fails to increase the patients’ overall PA level over time. Clinical Trial Registration Registered at ClinicalTrials.gov—no. NCT01690728.

     

The relationship between hypertension and health-related quality of life: adjusted by chronic pain,chronic diseases,and life habits in the general middle-aged population in Japan

Objectives

The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan.

Methods

This study is a population-based cross-sectional study. In this study, 1117 participants aged 40–65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation).

Results

In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = ?8.84, 95 % confidence interval (95 % CI) = ?13.3 to ?4.34, standardized coefficients; β = ?0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30–10.0, β = 0.149, p < 0.05) after adjusting by chronic pain and life habits.

Conclusions

These results may be due to the sex difference in the light of the perception for health.

     

Maternal health-related quality of life after induction of labor or expectant monitoring in pregnancy complicated by intrauterine growth retardation beyond 36 weeks

Objective

Pregnancies complicated by intrauterine growth retardation (IUGR) beyond 36 weeks of gestation are at increased risk of neonatal morbidity and mortality. Optimal treatment in IUGR at term is highly debated. Results from the multicenter DIGITAT (Disproportionate Intrauterine Growth Intervention Trial At Term) trial show that induction of labor and expectant monitoring result in equal neonatal and maternal outcomes for comparable cesarean section rates. We report the maternal health-related quality of life (HR-QoL) that was measured alongside the trial at several points in time.

Methods

Both randomized and non-randomized women were asked to participate in the HR-QoL study. Women were asked to fill out written validated questionnaires, covering background characteristics, condition-specific issues and the Short Form (SF-36), European Quality of Life (EuroQoL 6D3L), Hospital Anxiety and Depression scale (HADS), and Symptom Check List (SCL-90) at baseline, 6 weeks postpartum and 6 months postpartum. We compared the difference scores of all summary measures between the two management strategies by ANOVA. A repeated measures multivariate mixed model was defined to assess the effect of the management strategies on the physical (PCS) and mental (MCS) components of the SF-36. Analysis was by intention to treat.

Results

We analyzed data of 361 randomized and 198 non-randomized patients. There were no clinically relevant differences between the treatments at 6 weeks or 6 months postpartum on any summary measures; e.g., on the SF-36 (PCS: P = .09; MCS: P = .48). The PCS and the MCS were below norm values at inclusion. The PCS improved over time but stayed below norm values at 6 months, while the MCS did not improve.

Conclusion

In pregnancies complicated by IUGR beyond 36 weeks, induction of labor does not affect the long-term maternal quality of life.

     

Testing whether patients with diabetes and healthy people perceive the meaning of the items in the Persian version of the SF-36 questionnaire similarly: a differential item functioning analysis

Purpose

It has been rarely studied whether observed disparity in health-related quality-of-life (HRQoL) scores between patients with diabetes and healthy individuals is due to differential item functioning (DIF) or a true difference in the underlying construct. This study aimed to examine DIF in the SF-36 questionnaire and its effect on comparing HRQoL scores between patients with diabetes and healthy people.

Methods

The sample consisted of 230 patients with type 2 diabetes and 642 healthy individuals who filled out the Persian version of the SF-36 questionnaire. To detect DIF across patients with diabetes and healthy individuals, multiple-group multiple-indicator multiple-causes model was used. In addition, item calibration strategy was used to determine whether the effect of item-level DIF was transferred to the scale level.

Results

Nine out of thirty-six (25 %) items were detected as DIF, of which one item (11 %) was flagged as uniform and eight items (89 %) as non-uniform DIF. Most of the DIF items were detected in the mental health component which includes vitality, perceived mental health and social functioning subscales rather than in physical health component. Moreover, nonsignificant latent mean differences for general health perception and social functioning subscales became significant after DIF calibration.

Conclusion

The findings of the present study show that patients with diabetes and healthy individuals perceived some items in the SF-36 questionnaire differently. More importantly, in some subscales, the effect of item-level DIF was transferred to the scale level. Consequently, considerable caution should be taken in comparing HRQoL scores between patients with diabetes and healthy individuals.