Development and Validation of a New Spanish Instrument to Measure Health-Related Quality of Life in Patients with Allergic Rhinitis: The ESPRINT Questionnaire

ObjectivesTo develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations.MethodsAn initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test–retest (2–4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).ResultsThe new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score.ConclusionsThis new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.     

The Relationship Between Patient Knowledge of Hemoglobin Levels and Health-Related Quality of Life

Background: An anti-anemia drug may improve self-reported quality of life (QOL) partly because patients know their hemoglobin level is rising. In the absence of any published studies on this topic, the authors investigated the association between knowledge of hemoglobin levels and self-reported QOL.Methods: The study analyzed health-related QOL (HRQOL) data from five randomized clinical trials of erythropoietic therapy in patients with cancer-related anemia. Patients were asked whether they knew their hemoglobin level and, if so, to report its value. Patients (n = 1007) were grouped into three categories depending on the extent and accuracy of hemoglobin level knowledge. HRQOL scale scores were compared between categories.Results: Only 23.2% of patients reported knowing their hemoglobin level at the end of the study; however, the value was accurate (within 1 g/dl) in 88.0% of these patients. On five of the 11 HRQOL scales studied, there was a significant association between knowledge of hemoglobin level and HRQOL score. However, the magnitude of the mean difference between those who knew vs. those who did not know their hemoglobin was generally below scale thresholds for minimally important differences. Conclusions: Patient knowledge of hemoglobin level has a modest association with some aspects of self-reported HRQOL. The magnitude of this association, where it exists, would be unlikely to explain large group differences in HRQOL reports over time, even for patients who know their hemoglobin level.     

Assessing Health-Related Quality of Life in Cataract Patients: The Relationship between utility and Health-Related Quality of Life Measurement

The relationship between health-related quality of life (HQL) measures and patient preference for their health status was studied. Study subjects consisted of 132 patients at four hospitals who were scheduled for cataract surgery. Generic and disease-specific health status measures were determined in study subjects. The Medical Outcomes Study Short-form 36 (SF-36) item health status instrument was used to measure generic health status and the Visual Function 14 (VF-14) item visual health status instrument was used as the disease-specific health measure. Preference for general health and visual health was measured by assessing utilities assigned by patients to certain health states. Utilities assigned for general health were correlated with all categories of the SF-36 and VF-14 scores. Utilities assigned for visual health were correlated with four categories of the SF-36 (role limitation due to emotional health, general health, physical functioning, and vitality) and VF-14 scores. Utilities assigned for visual health were more strongly correlated with VF-14 scores than generic measures of health. Verbal ratings for visual health were correlated with Snellen visual acuity (SVA) (r=0.20), utilities assigned for visual health (r=0.58), VF-14 scores (r=0.74), all categories of the SF-36 (r values ranging from 0.21 to 0.28), utilities assigned for general health (r=0.19), and verbal ratings for general health (r=0.29). Utility measures and verbal ratings for general and visual health were shown to be appropriate HQL measures. These measures were strongly correlated with other established generic and disease-specific health measures and should be included in the array of health status measures. This revised version was published online in June 2006 with corrections to the Cover Date.     

Psychosocial Factors and Health-Related Quality of Life in Hemodialysis Patients

Several sociodemographic and clinical variables are known to influence the health-related quality of life (HRQOL) of patients with kidney disease, yet the relationship between psychological factors and the HRQOL measured by the Kidney Disease Quality of Life Short-Form (KDQOL-SF) is incompletely understood. The objective of this study was to examine the relationship between psychosocial status (depressive symptoms, trait anxiety, and social support) and KDQOL-SF scales in hemodialysis (HD) patients by controlling the effects of sociodemographic and clinical variables. The HRQOL of 194 patients from 43 dialysis centers in Spain was assessed by completing the KDQOL-SF, and evaluating depressive symptoms (Cognitive Depression Index), trait anxiety (Trait Anxiety Inventory) and degree of social support (Scale of Perceived Social Support). We also recorded several sociodemographic and clinical variables. Two regression models were estimated for each of the 19 scales in the KDQOL-SF. In the first model, we only included sociodemographic and clinical-factors, while the second model also took into consideration psychosocial variables. These last factors (trait anxiety and depressive symptoms, not social support) were found to increase the proportion of explained variability, with highest standardized regression coefficients observed for most KDQOL-SF scales. Depressive symptoms were related to a poor HRQOL when there was a strong physical component, while trait anxiety was mainly related to emotional upset and social relationships. We were able to conclude that trait anxiety and depressive symptoms are strongly associated with the HRQOL assessed by the KDQOL-SF in HD patients. The effects of these factors should therefore be considered when evaluating the quality of life of this type of patient.     

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.     

Associations between Cardiorespiratory Fitness and Health-Related Quality of Life

Background  

There is limited data examining the association between cardiorespiratory fitness (CRF) and health related quality of life (HRQOL) in healthy young adults. We examined the association between CRF and the HRQOL Physical Component Summary (PCS) and Mental Component Summary (MCS) scores in apparently healthy males in the United States Navy.     

Health-Related Quality of Life,Quality-Adjusted Life Years,and Quality-Adjusted Life Expectancy in New York City from 1995 to 2006

We applied our previously developed estimation equation to predict EQ-5D index scores from the Centers for Disease Control and Prevention’s Healthy Days measures for the New York City (NYC) adult population from 1995 to 2006 and compared these trends over time with the US general population. Such scores enabled us to examine the burden of disease attributable to smoking and overweight/obesity at both the local and national levels. We employed the estimation equation to the 1993–2007 Behavioral Risk Factor Surveillance System (BRFSS) data to obtain EQ-5D index scores for all survey respondents based on their age, self-rated health status, and overall number of unhealthy days. With the combination of mortality data, we calculated trends of quality-adjusted life years (QALYs), life expectancy (LE), and quality-adjusted life expectancy (QALE) as well as the percent of QALYs and QALE lost contributed by smoking and overweight/obesity. Mean EQ-5D index scores for NYC adults decreased from 0.874 to 0.852 but, more recently, have increased to 0.869. The LE of an 18-year-old living in NYC increased 4.7 years and QALE increased 2.6 years. The contribution of smoking to the proportion of QALYs lost decreased from 6.7% to 3.5%, while the contribution of overweight/obesity to the proportion of QALYs lost increased from 4.5% to 16.9%. The proportion of QALEs lost due to smoking decreased from 5.5% to 4.5%, while the proportion of QALEs lost due to overweight/obesity increased from 3.5% to 11.8%. Because the Healthy Days measures have been included in the BRFSS since 1993, translating Healthy Days Measures to a preference-based measure is a useful method for longitudinal tracking of population health at the local, state, and national level.     

Health-Related Quality of Life and Associated Factors Among Oldest-Old in China

The oldest old population has become the fastest growing segment with excess need of care and social support, it is crucial to improve the health-related quality of life (HRQoL) of these populations. This study seeks to evaluate the health status and to investigate modifiable factors associated with health-related quality of life for oldest old adults in China. A cross-sectional population-based study. Hainan Province in the south of China. 1,278 adults aged 80 years or older. HRQoL was assessed by three-level EuroQol-5D scale (EQ-5D-3L) and a visual analogue scale (VAS). Demographic and health-related variables were analysed by estimating mean values and standard deviations for continuous variables, percentages and standard deviations for categorical variables. Tobit regressions, ordinary least Squared (OLS) regressions and ordered probit regressions were adopted to determine the associated factors for overall HRQoL and for each health dimension. Anxiety/depression was the least reported problem while mobility was the most frequently reported with problem. Female respondents had lower EQ-5D score (0.76 vs. 0.86) and VAS score (66.55 vs. 69.84) than male respondents. Better health-related quality of life was significantly associated with higher BMI, no drinking habit, more leisure activities, living with family members, good sleeping quality, closer social and family connections, fewer numbers of drugs consumed per day, without having hearing or visual impairment, and fewer chronic conditions, after controlling for potential confounders. Findings from this study suggested that quality of life was not only associated with age-related diseases, but also correlated with a range of health-related lifestyles, and factors indicating social and family support.     

Health-Related Quality of Life in Spanish Women with Eating Disorders

People with eating disorders show impaired health-related quality of life (HRQoL). We aimed to investigate the relative role of physical and mental factors and stage of change as possible predictors of HRQoL in a group of Spanish women (n = 124) with eating disorders. For this purpose, initial and follow-up data were obtained after 6 months from patients attending an outpatient treatment unit for eating disorders. The determinants of the physical and mental domains of the Medical Outcomes Survey Short-form Health Survey (SF-36) questionnaire were investigated in the total sample and separately based on the eating disorder diagnosis by multiple linear regression. Lower scores in the physical component of the SF-36 questionnaire were associated with the presence of a higher body mass index (BMI) at follow-up as well as a higher score in the “action” component of the Attitudes towards Change in Eating Disorders Questionnaire (ACTA). Conversely, a higher index in the EuroQoL-5D overall quality of life questionnaire (EQ-5D) and the presence of obsessive compulsive disorder were associated with a higher score in the physical dimension. The instrument used demonstrated the ability to assess changes associated with the physical component of these patients over the period studied, and the analysis provided more information and specific data on different aspects of HRQoL, thus allowing a more detailed analysis of the information.     

Measuring Health-Related Quality of Life Among Primary School Children in Ahwaz, Iran

It has been claimed that health-related quality of life (HRQL) assessments should provide information about capabilities and well-being and their relevance to the individual concerned. No attempt has been made before to measure children's HRQL in Iran. The purpose of this study was to describe reports of parents in a random sample of 3,800 Iranian primary school children (ages 6–12 years old) on domains of the TNO AZL Child Quality of Life (TACQOL) parent form, in the winter of 2001. It was a cross-sectional design, and 56 items taken from seven domains of TACQOL were employed. The parents' questionnaire included demographic questions and seven eight-item scales: physical complaints, motor functioning, autonomy, cognitive (such as concentration, or understanding what others say) and social functioning, and positive and negative emotions. All scales were scored from 56 to 280 (8–40 for each scale), with higher scores indicating better HRQL. Scale reliability was assessed with Cronbach's alpha. The mean score for all domains was 35.3 (ranged from 32.5 for positive emotions to 37.7 for motor functioning). Significant differences were found between the HRQL of children and mothers' job and child's birth order (p<;0.01). However, no significant differences were found by child's sex, child's age, and mothers' educational attainment. There are some limitations and difficulties for Iranian children's HRQL. Children's quality-of-life measurements should be considered by researchers in less economically developed countries as a routine part of health and medical visits. Health policy-makers may also consider HRQL measurements in their national data capture system to recognize children's well-being status.     

Eating Together and Health-Related Quality of Life Among Korean Adults

ObjectiveTo investigate the association between frequency of eating together and health-related quality of life (HRQoL).DesignPopulation-based cross-sectional study.Participants and SettingA total of 13,920 adults (≥19 years). Data obtained from the Korea National Health and Nutrition Examination Survey conducted from 2014 to 2016. The European Quality of Life-5 Dimensions index was used to assess the HRQoL.Main Outcome MeasuresRelation between the frequency of eating together (eating alone, 1 time/d, and ≥2 times/d) and HRQoL.AnalysisANOVA, correlations, and multivariable logistic regression.ResultsA significantly positive association was observed between the frequency of eating together and the European Quality of Life-5 Dimensions index (P < .001). An increase in the frequency of eating together was associated with decreased odds ratios of having problems in subdimensions (self-care, usual activities, and anxiety or depression; P for trend <.005).Conclusions and ImplicationsA decreased frequency of eating together is associated with low HRQoL. Additional work is warranted to confirm the association between the frequency of eating together and HRQoL in young adults, aged 19–64 years. Further studies are required to identify whether an intervention to increase the frequency of eating together would improve HRQoL in individuals who usually eat alone.     

Impact of weight loss on Health-Related Quality of Life

To examine the effect of treatment-induced weight loss on Health-Related Quality of Life (HRQL), 38 mildly-to-moderately overweight persons recruited to participate in a study to examine the efficacy of a lifestyle modification treatment program completed a sociodemographic questionnaire, the Beck Depression Inventory (BDI), the Medical Outcomes Study Short-Form Health Survey (SF-36, as an assessment of HRQL), and underwent a series of clinical evaluations prior to treatment. After baseline evaluations, participants were randomly assigned to either a program of lifestyle physical activity or a program of traditional aerobic activity. Participants again completed the SF-36 and BDI after the 13-week treatment program had ended. Weight loss averaged 8.6 ± 2.8 kg over the 13-week study. We found that weight loss was associated with significantly higher scores (enhanced HRQL), relative to baseline, on the physical functioning, role-physical, general health, vitality and mental health domains of the SF-36. The largest improvements were with respect to the vitality, general health perception and role-physical domains. There were no significant differences between the lifestyle and aerobic activity groups on any of the study measures. These data indicate that, at least in the short-term, weight loss appears to profoundly enhance HRQL.     

Validation of Gastrointestinal Quality of Life Index in Swedish for Assessing the Impact of Gallstones on Health-Related Quality of Life

Objective:  The aim of the present study was to validate a Swedish translation of the Gastrointestinal Quality of Life Index (GIQLI) questionnaire in patients with gallstone disease.
Methods:  Sensitivity to change, internal consistency, and test–retest stability were tested in 187 consecutive patients who underwent planned cholecystectomy. Construct validity was assessed by comparing the GIQLI score with the bodily pain scale of SF-36 and four single-item questions in a separate group of 104 patients.
Results:  A significant increase in all five domains as well as in the overall GIQLI score 6 months after surgery (all P  < 0.05) was seen. All five domains correlated significantly with other measures of gallstone-related symptoms except one single-item question. Intraclass correlations ranged from 0.62 to 0.87. Cronbach's alpha ranged from 0.77 to 0.89.
Conclusion:  The Swedish translation of GIQLI has a high validity and reliability for assessing the impact of gallstones on quality of life.     

Musculoskeletal Injury,Functional Disability,and Health-Related Quality of Life in Aging Mexican Immigrant Farmworkers

Migrant and seasonal farmworkers are at high risk for musculoskeletal and other occupational injuries. Although persons aged 40–80 years account for 40 % of all US farmworkers and as many as 50 % in certain regions, little is known about their occupational health issues. The current study examined work-related persistent musculoskeletal injuries (PMIs) and their association with clinical and functional indicators of disability and health-related quality of life (HRQOL) in 177 middle-aged and elderly US–Mexico border farmworkers. At interview, 68 % reported current PMI pain; 51 % had pain at multiple sites. PMI pain was associated with increased shoulder, knee, and lower extremity dysfunction and reduced HRQOL scores. However, fewer than 25 % of injured participants received any conventional medical treatment. The study results indicated that work-related PMIs, especially multiple PMIs, caused significant functional impairment, disability, and poorer HRQOL, adversely affecting the ability of the aging farmworkers to perform work, self-care, and other daily activities.