Cross-sectional relationship between glycaemic control, hyperglycaemic symptoms and quality of life in type 2 diabetes (ZODIAC-2)

BACKGROUND: To describe the relationship between glycaemic control, hyperglycaemic symptoms and quality of life (HRQOL) in type 2 diabetic patients. METHODS: In a shared-care diabetes project HRQOL was assessed. A total of 1664 patients with type 2 diabetes were identified in 32 primary healthcare practices. Of these patients, 1149 were included. HRQOL was measured using a generic questionnaire (Rand-36), completed by 1006 of the 1149 participants. RESULTS: The number of hyperglycaemic symptoms was higher in women (1.88) compared with men (1.64), without differences in mean haemoglobin A1c (HbA1c) (7.5%)-Univariate analyses showed negative relationships between all dimensions of the Rand-36 and hyperglycaemic symptoms (p<0.001), but between only one dimension and HbA1c (p=0.005). Multivariate analyses showed no association between any of the dimensions of the Rand-36 and HbA1c, but the relationship between hyperglycaemic symptoms persisted in all dimensions (p<0.001). Notwithstanding these results, the presence of hyperglycaemic symptoms was related to higher HbA1c. CONCLUSION: In type 2 diabetic patients, as assessed by a generic questionnaire, there is an evident relationship between hyperglycaemic symptoms and HRQOL and not between HbA1c and HRQOL. Subjective hyperglycaemic symptoms are, independent of HbA1c, important for HRQOL in type 2 diabetic patients, and should therefore not be neglected in the management of diabetes.     

Health-related quality of life in patients with inflammatory bowel disease measured with the short form-36: psychometric assessments and a comparison with general population norms

BACKGROUND: We compared health-related quality of life (HRQOL) in a population-based cohort of Norwegian patients with inflammatory bowel disease (IBD) with a normal reference population by means of the short form-36 (SF-36) questionnaire, including the effect of age, sex, educational status, and symptom severity and the psychometric properties of the questionnaire. METHODS: The SF-36 was self-administered and was answered by the patients at the hospital at 2 occasions that were 6 months apart. RESULTS: Five hundred fourteen patients with IBD were eligible for analysis: 348 with ulcerative colitis (UC) and 166 with Crohn's disease (CD). The comparison group consisted of 2323 Norwegian people. The dimension scores for SF-36 were significantly lower in 6 of 8 dimensions for patients with UC and in 7 of 8 dimensions for patients with CD than for the reference population. In both patients with UC and patients with CD, we found lower scores in elderly patients, which also was found in the background population. Women scored lower than men in all dimension scores. In both patients with UC and patients with CD, there was a statistically significant reduction in HRQOL score with increasing symptoms. The SF-36 has satisfactory reliability and discriminant ability for scores for all dimensions in both patients with UC and patients with CD. However, when measuring responsiveness, the figures were generally low. This finding, together with the high ceiling effects, may indicate that the SF-36 has limitations regarding detecting deterioration or improvement over time. CONCLUSION: We have shown that HRQOL in a Norwegian population-based cohort of patients with IBD, measured with the SF-36, is lower than that of a Norwegian reference population. In general, the SF-36 was found to have satisfactory psychometric properties in this IBD population.     

Health-related quality of life in Italian patients with systemic lupus erythematosus. I. Relationship between physical and mental dimension and impact of age

OBJECTIVE: To examine health-related quality of life (HRQOL) in Italian patients with systemic lupus erythematosus (SLE) and compare it with that of healthy people, and to investigate relationships among different dimensions and subscales of a generic health status measure. METHODS: The Medical Outcomes Study Short Form-36 (SF-36) was applied in a cohort of 126 consecutive SLE patients and 96 healthy controls. At the time of HRQOL testing, all patients underwent clinical and laboratory evaluation. RESULTS: Both physical (PCS) and mental (MCS) component summary scores of the SF-36 were reduced in patients compared with controls. In SLE great variability in all the subscales was observed. Significant correlations between PCS and MCS and between many different subscales were observed in patients but not in controls. The PCS was higher than MCS more frequently in controls than in SLE patients (81 vs 48.4%, P<0.00001). In SLE, HRQOL tended to worsen with age. CONCLUSION: Both PCS and MCS contribute to the decrease in HRQOL in SLE patients. In SLE the mutual interaction between these two dimensions seems to be more relevant than in healthy people.     

Health-related quality of life in older adults with symptomatic hip and knee osteoarthritis: a comparison with matched healthy controls

BACKGROUND AND AIMS: Health-related quality of life (HRQOL) assessment is receiving increasing attention as an outcome measure in osteoarthritis (OA). The aims of this study were to compare HRQOL among older adults aged 55 to 78 years with hip and/or knee OA with those without OA, and to assess the influence of selected variables (sex, body mass index, radiographic OA severity, educational level, comorbidities) on HRQOL. METHODS: The generic Medical Outcome Study Short Form-36 item health status questionnaire (SF-36) was administered to a cohort of 264 OA patients (105 with hip OA alone, 108 with knee OA alone, and 51 with both hip and knee OA) and 112 healthy controls. RESULTS: Compared with the healthy controls, OA of the lower extremities has a detrimental effect on the eight-scale profile score, as well as on physical and mental summary measures of the SF-36. The most striking impact was seen in the physical measures "physical functioning", "physical role" and "pain" (p<0.0001). No statistically significant differences in SF-36 scores were found among the three groups of OA patients. The physical and mental summary scales of the SF-36 were closely correlated (p<0.0001). One hundred and forty-five patients (54.9%) reported at least one chronic coexisting disease. There was a significant inverse association with measures of comorbidity (number of comorbidities and comorbidity index score) and both physical and mental summary scores of the SF-36 questionnaire. In patients with OA of the knee alone (but not in hip OA alone or hip and knee OA), the SF-36 pain score was inversely correlated with years of formal education (p=0.016). In addition, the impact of hip and knee SF-36 dimensions was not influenced by the degree of radiographic severity. CONCLUSIONS: Older adults with OA of the lower extremities undergo a significant impact on multiple dimensions of HRQOL, compared with healthy controls. The use of a generic measure of HRQOL such as the SF-36, in studies of OA where comorbidity is common, should be useful in characterizing the global burden of this disease.     

Minimal clinically important difference for the UCSD Shortness of Breath Questionnaire

PURPOSE: A minimal clinically important difference (MCID) is important in evaluating clinical measures such as health-related quality of life (HRQOL) instruments. The purpose of this analysis is to evaluate MCID for the UCSD Shortness of Breath Questionnaire (SOBQ). METHODS: We examined measures of disease-specific and generic HRQOL in 164 subjects with chronic lung disease before and after pulmonary rehabilitation. Subjects completed 2 disease-specific [SOBQ, Chronic Respiratory Questionnaire (CRQ)], and 2 generic HRQOL measures [RAND-36 and Quality of Well-Being Scale (QWB)]. The MCID was calculated using 3 methods: effect size, standard error of the measurement (SEM), and comparison between the SOBQ and CRQ Dyspnea scores. RESULTS: HRQOL measures correlated moderately with measures of maximum exercise tolerance but not with lung function (FEV1, FVC). HRQOL and exercise capacity improved significantly after pulmonary rehabilitation. A change of 5 units for the SOBQ appears to be a reasonable MCID for this instrument. The calculated MCIDs for the CRQ (0.47/item) and QWB (0.031) were consistent with established change scores. CONCLUSIONS: The MCID calculated using an SEM approach for the SOBQ, CRQ, and QWB meets clinical expectations for these instruments. HRQOL measures provide information that is complementary and distinct from physiological measures.     

Use of an Australian Quality of Life Tool in Patients with COPD

Abstract

COPD is a leading chronic disease, increasing globally. Given this condition's irreversible and progressive nature, health-related quality of life (HRQOL) is increasingly a primary end-point in COPD management. We evaluated several HRQOL tools with a primary goals of (1) investigating how the generic Assessment Quality of Life (AQOL) functions compared to the Medical Outcomes Study 36-item Short Form Health Survey (SF36) and the St. Georges Respiratory Questionnaire (SGRQ); and (2) considering the extent to which clinical disease severity, as measured by the BODE index, predicts variation in HRQOL reports. Methods: 134 consecutive patients entering a pulmonary rehabilitation program were recruited. Participants completed two generic measures of HRQOL (SF36 and AQOL) and one disease specific measure (SGRQ). The clinical severity of COPD was assessed using a composite global COPD severity score, BODE. Results: Significant associations were demonstrated between AQOL and both the SF36 (r = .68) and SGRQ (r = –.60). BODE significantly predicted AQOL scores (R = –.31); mMRC (R = –.36) and 6MWD (R = .39) were stronger contributors to these predictions than were FEV₁ or BMI. Conclusions: This study establishes convergent validity between AQOL, and the SF36 and SGRQ in patients with COPD. For future studies wishing to examine HRQOL from a generic perspective, we have shown that during cross-sectional analyses AQOL performs similarly to the SF36. In addition we identified that the clinical severity of COPD, as assessed by BODE, significantly influences reports of quality of life made using AQOL. The components of BODE that most strongly contributed to predicting HRQOL were dsypnea and exercise tolerance.     

Development and evaluation of the Liver Disease Quality of Life instrument in persons with advanced, chronic liver disease--the LDQOL 1.0

OBJECTIVES: Assessment of health-related quality of life (HRQOL) outcomes in studies of liver disease and liver transplantation is necessary. Reliable and valid disease-targeted HRQOL measures are thus needed. The objective of this study was to develop a reliable and valid self-report HRQOL instrument for ambulatory adults with chronic liver disease. METHODS: The Liver Disease Quality of Life instrument, LDQOL 1.0 (an HRQOL measure that uses the SF-36 as a generic core and 12 disease-targeted multi-item scales) was administered in a multicenter, cross-sectional field test to 221 ambulatory adults with advanced, chronic liver disease referred for primary liver transplantation evaluation. Disease-targeted scales included liver disease-related symptoms, liver disease-related effects on activities of daily living, concentration, memory, sexual functioning, sexual problems, sleep, loneliness, hopelessness, quality of social interaction, health distress, and self-perceived stigma of liver disease. We estimated the internal consistency reliability (Cronbach's alpha) for multi-item scales and construct validity. RESULTS: Interial consistency reliability coefficients were excellent, ranging from 0.62 to 0.95, with 19 of 20 scales >0.70. Multitrait scaling analysis provided strong support for item discrimination across scales, and exploratory factor analysis demonstrated distinguishable physical, mental, and social health dimensions. Significant associations were found between worse HRQOL and worse Child-Pugh class, worse self-rated liver disease severity, and increased number of disability days. CONCLUSIONS: The results of this multicenter field test provide support for the reliability and validity of the LDQOL 1.0 as an HRQOL outcome measure for individuals with chronic liver disease.     

Alcohol Use Disorders, Consumption Patterns, and Health-Related Quality of Life of Primary Care Patients

This study examined the association of alcohol use disorders and consumption patterns with various dimensions of Health-Related Quality of Life (HRQOL) in primary care patients, as measured by the SF-36 Health Survey. A probability sample of 1333 primary care patients completed the Alcohol Use Disorder and Associated Disabilities Interview Schedule to determine the presence of alcohol abuse or dependence disorders, and answered questions about patterns of alcohol consumption. Physical and Mental Health Component Summaries and primary scales of the SF-36 were used as measures of HRQOL. Patients meeting criteria for alcohol dependence scored lower (poorer HRQOL) on the Mental Health Component Summary and each primary scale of the SF-36, whereas no differences were observed for alcohol abusers compared with patients not meeting criteria for a disorder. The association of alcohol dependence with diminished mental health functioning was mediated by its co-occurrence with mood and anxiety disorders. Patients who drank in a Frequent, Low-Quantity pattern generally had better overall HRQOL than patients from other consumption groups. Binge drinkers and Frequent, High-Quantity Drinkers showed markedly lower scores in the areas of Role Functioning and Mental Health. In contrast to recent studies of mental health problems in primary care, alcohol use disorders and consumption patterns seem to have a modest impact on patients' HRQOL. These effects, though, vary by dimension of functioning, the presence of alcohol dependence rather than abuse, and pattern of alcohol consumption. Global measures of HRQOL such as the SF-36 Health Survey may provide important indicators of treatment effectiveness in primary care intervention studies for patients with drinking problems.     

Prospective randomized trial of direct endomyocardial implantation of bone marrow cells for treatment of severe coronary artery diseases (PROTECT-CAD trial).

AIMS: Experimental studies have demonstrated that bone marrow (BM) cells can induce angiogenesis in ischaemic myocardium. Recently, several non-randomized pilot studies have also suggested that direct BM cells implantation appears to be feasible and safe in patients with severe coronary artery diseases (CAD). METHODS AND RESULTS: We performed a randomized, blinded, and placebo-controlled trial in 28 CAD patients. After BM harvesting, we assigned patients to receive low dose (1 x 10(6) cells/0.1 mL, n = 9), high dose (2 x 10(6) cells/0.1 mL, n = 10) autologous BM cells or control (0.1 mL autologous plasma/injection, n = 9) catheter-based direct endomyocardial injection as guided by electromechanical mapping. Our primary endpoint was the increase in exercise treadmill time and our secondary endpoints were changes in Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) class, and myocardial perfusion and left ventricular ejection fraction (LVEF) assessed by single-photon emission computed tomography and magnetic resonance imaging, respectively. A total 422 injections (mean 14.6 +/- 0.7 per patient) were successfully performed at 41 targeted ischaemic regions without any acute complication. Baseline exercise treadmill time was 439 +/- 182 s in controls and 393 +/- 136 s in BM-treated patients, and changed after 6 months to 383 +/- 223s and 464 +/- 196 s [BM treatment effect +0.43 log seconds (+53%), 95% CI 0.11-0.74, P = 0.014]. Compared with placebo injection, BM implantation was associated with a significant increase in LVEF (BM treatment effect +5.4%, 95% CI 0.4-10.3, P = 0.044) and a lower NYHA class (odds ratio for treatment effect 0.12, 95% CI 0.02-0.73, P = 0.021) after 6 months, but CCS reduced similarly in both groups. We observed no acute or long-term complications, including ventricular arrhythmia, myocardial damage, or development of intramyocardial tumour or calcification associated with BM implantation. CONCLUSION: Direct endomyocardial implantation of autologous BM cells significantly improved exercise time, LVEF, and NYHA functional class in patients with severe CAD who failed conventional therapy.     

Identifying women with severe angiographic coronary disease

Abstract. Kreatsoulas C, Natarajan MK, Khatun R, Velianou JL, Anand SS (McMaster University; CARING Network, McMaster University; Population Health Research Institute, McMaster University and Hamilton Health Sciences; Interventional Cardiology, Hamilton Health Sciences; Eli Lilly Canada–May Cohen Chair in Women's Health, McMaster University; Michael G. DeGroote‐Heart and Stroke Foundation of Ontario Chair in Population Health Research, McMaster University; Population Genomics Program, McMaster University; McMaster University, Hamilton, ON, Canada). Identifying women with severe angiographic coronary disease. J Intern Med 2010; 268 :66–74. Objectives. To determine sex/gender differences in the distribution of risk factors according to age and identify factors associated with the presence of severe coronary artery disease (CAD). Design. We analysed 23 771 consecutive patients referred for coronary angiography from 2000 to 2006. Subjects. Patients did not have previously diagnosed CAD and were referred for first diagnostic angiography. Outcome measures. Patients were classified according to angiographic disease severity. Severe CAD was defined as left main stenosis ≥50%, three‐vessel disease with ≥70% stenosis or two‐vessel disease including proximal left anterior descending stenosis of ≥70%. Univariate and multivariate logistic regression was used to assess the association between risk factors and angina symptoms with severe CAD. Results. Women were less likely to have severe CAD (22.3% vs. 36.5%) compared with men. Women were also significantly older (69.8 ± 10.6 vs. 66.3 ± 10.7 years), had higher rates of diabetes (35.0% vs. 26.6%), hypertension (74.8% vs. 63.3%) and Canadian Cardiovascular Society (CCS) class IV angina symptoms (56.7% vs. 47.8%). Men were more likely to be smokers (56.9% vs. 37.9%). Factors independently associated with severe CAD included age (OR = 1.05; 95% CI 1.05–1.05, P < 0.01), male sex (OR = 2.43; CI 2.26–2.62, P < 0.01), diabetes (OR = 2.00; CI 1.86–2.18, P < 0.01), hyperlipidaemia (OR = 1.50; CI 1.39–1.61, P < 0.01), smoking (OR = 1.10; CI 1.03–1.18, P = 0.06) and CCS class IV symptoms (OR = 1.43; CI 1.34–1.53, P < 0.01). CCS Class IV angina was a stronger predictor of severe CAD amongst women compared with men (women OR = 1.82; CI 1.61–2.04 vs. men OR = 1.28; CI 1.18–1.39, P < 0.01). Conclusions. Women referred for first diagnostic angiography have lower rates of severe CAD compared with men across all ages. Whilst conventional risk factors, age, sex, diabetes, smoking and hyperlipidaemia are primary determinants of CAD amongst women and men, CCS Class IV angina is more likely to be associated with severe CAD in women than men.     

Physical and psychosocial contributors to quality of life in veterans with hepatitis C not on antiviral therapy

BACKGROUND AND AIMS: Treatment-naive hepatitis C virus (HCV)-infected patients report impaired health-related quality of life (HRQOL), although causes are unclear. Psychosocial factors may be major determinants of HRQOL. METHODS: We administered a general (Short Form-36; SF-36) and a liver-specific (Chronic Liver Disease Questionnaire; CLDQ) HRQOL measure to 62 HCV-infected veterans being considered for antiviral therapy. Psychosocial assessment included the Structured Clinical Interview for DSM-IV Axis I Disorders/Non-Patient (SCID-I/NP), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Abbreviated Cook-Medley (ACM) anger measure, and Medical Outcomes Study Social Support Measure (SSM). We examined the potential determinants of HRQOL, including psychosocial measures, demographic measures (age, sex, race/ethnicity), clinical measures (presence of cirrhosis, comorbid medical conditions), and viral data (quantitative PCR). RESULTS: SF-36 scores were significantly lower in HCV-infected patients than published U.S. population norms but similar to those reported by previous studies of HCV-infected samples. CLDQ scores were very similar to those reported by previous studies. Demographic, clinical, and viral indicators were not statistically associated with HRQOL, and neither was the presence of a substance abuse or psychotic disorder. Lower BDI-II and BAI scores were associated with better general and disease-specific HRQOL. Lower SSM scores were associated with lower scores on SF-36 but not CLDQ; however, this effect did not persist in multiple linear regression analyses. In these, BDI-II was the strongest independent predictor of both SF-36 and CLDQ. CONCLUSIONS: Psychosocial factors, especially depression, are strong indicators of impaired HRQOL for HCV-infected veterans not receiving antiviral therapy. Screening and treatment of psychosocial factors is recommended.     

Sexual problems in male vs. female non-Hodgkin lymphoma survivors: prevalence,correlates, and associations with health-related quality of life

The objective of this study was to examine the prevalence and factors associated with sexual problems and their relationship to health-related quality of life (HRQOL) in male and female non-Hodgkin lymphoma (NHL) survivors. In this cross-sectional study, 738 NHL survivors (425 men and 313 women; mean time since diagnosis, 6.2 years) in South Korea completed the six-item instrument of adult sexual behavior used by the National Health and Social Life Survey in the United States. HRQOL was measured by two subscales of the EORTC QLQ-C30. Sexual problems were reported by a greater proportion of women (range, 31.9 to 64.4%) than men (range, 23.3 to 49.1%). Among four items common to both sexes, three (lacking interest in sex, unable to achieve orgasm, sex not pleasurable) were significantly more prevalent in women. Significant factors associated with multiple sexual problems in men were older age and being unemployed; in women, they were marital status and comorbidity. Lastly, more significant associations between sexual problems and HRQOL were observed in men than in women. Male and female NHL survivors differ in the prevalence of sexual problems and the factors associated with them as well as their associations with HRQOL. These findings can be used to develop sex-specific interventions to improve sexual function in this population.     

Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography.

OBJECTIVES: This study was designed to address, in patients with severe ischemic left ventricular dysfunction, whether dobutamine stress echocardiography (DSE) can predict improvement of left ventricular ejection fraction (LVEF), functional status and long-term prognosis after revascularization. BACKGROUND: Dobutamine stress echocardiography can predict improvement of wall motion after revascularization. The relation between viability, improvement of function, improvement of heart failure symptoms and long-term prognosis has not been studied. METHODS: We studied 68 patients with DSE before revascularization; 62 patients underwent resting echocardiography/radionuclide ventriculography before and three months after revascularization. Long-term follow-up data (New York Heart Association [NYHA] functional class, Canadian Cardiovascular Society [CCS] classification and events) were acquired up to two years. RESULTS: Patients with > or =4 viable segments on DSE (group A, n = 22) improved in LVEF at three months (from 27+/-6% to 33+/-7%, p < 0.01), in NYHA functional class (from 3.2+/-0.7 to 1.6+/-0.5, p < 0.01) and in CCS classification (from 2.9+/-0.3 to 1.2+/-0.4, p < 0.01); in patients with <4 viable segments (group B, n = 40) LVEF and NYHA functional class did not improve, whereas CCS classification improved significantly (from 3.0+/-0.8 to 1.3+/-0.5, p < 0.01). A higher event rate was observed at long-term follow-up in group B versus group A (47% vs. 17%, p < 0.05). CONCLUSIONS: Patients with substantial viability on DSE demonstrated improvement in LVEF and NYHA functional class after revascularization; viability was also associated with a favorable prognosis after revascularization.     

Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL)

AIMS: To assess the impact of irritable bowel syndrome (IBS) on patient-reported health-related quality of life (HRQOL). METHODS: Two HRQOL instruments were administered by telephone interviews to a sample of 253 IBS French patients recruited from the general population. IBS was diagnosed according to the Manning, Rome I and Rome II criteria. Patients with organic diseases were excluded from the study. A generic instrument, the Short Form 36 (SF-36), and an IBS disease-specific instrument, the IBSQOL, were used. RESULTS: Patients with IBS had statistically significant (P<0.05) lower scores for all SF-36 QOL domains compared with the general French population. Women (N=192) reported significantly (P<0.05) poorer HRQOL on both the SF-36 and the IBSQOL scores than men (N=61) for all domains except energy on the SF36 and the sleep on the IBSQOL. HRQOL deteriorated with time since onset of IBS symptoms for some domains such as diet. For both instruments, a positive correlation was observed between low scores and intensity of pain and discomfort. IBS patients with a predominance of diarrhea (N=72) exhibited significantly greater impairment of HRQOL in the emotional domain than IBS persons with constipation predominance (N=65) (P相似文献   

Vitamin B-12 treatment has limited effect on health-related quality of life among individuals with elevated plasma methylmalonic acid: a randomized placebo-controlled study

OBJECTIVE: To examine the hypothesis that treatment with vitamin B-12 improves health-related quality of life (HRQOL) in individuals with biochemical signs of vitamin B-12 deficiency. DESIGN: A randomized placebo-controlled study. SETTING: Municipality of Aarhus, Denmark. SUBJECTS: Nonhospitalized individuals (n = 140) with a modest increase in plasma methylmalonic acid (0.40-2.00 micromol L-1) not previously treated with vitamin B-12. INTERVENTION: The participants were randomized to vitamin B-12 injection treatment or placebo weekly for 4 weeks and re-examined 3 months later. The investigator and the participants were blinded to the intervention. MAIN OUTCOME MEASURE: Change in HRQOL assessed by the SF-36 questionnaire from baseline to follow-up examination 3 months later. RESULTS: The participants reported a significantly worser HRQOL than the age- and sex-matched Danish general population (P < 0.001). However, no change was observed after treatment with vitamin B-12 for seven of eight health dimensions. A significant improvement was found only in general health when compared with the placebo group (P = 0.03). CONCLUSIONS: Vitamin B-12 treatment influenced only one of eight dimensions of HRQOL amongst participants with biochemical signs of vitamin B-12 deficiency. We therefore question the benefit of vitamin B-12 treatment amongst elderly with a modestly increased plasma methylmalonic acid as the only sign of vitamin B-12 deficiency.     

Clear associations between demographic and psychosocial factors and health-related quality of life in patients with early inflammatory joint complaints

OBJECTIVE: Objective. To identify demographic and psychosocial characteristics associated with health-related quality of life (HRQOL) in patients with early inflammatory joint complaints. METHODS: In this cross-sectional study, patients had inflammatory joint complaints for less than 12 months. Data were collected on clinical characteristics, demographics, lifestyle, behavioral coping, perceived health control, and social support. HRQOL was assessed by 8 dimensions of the Medical Outcome Study Short Form-36 Health Survey. Multiple regression analysis was used to determine the associations between clinical, demographic, lifestyle, and psychosocial characteristics with HRQOL. RESULTS: In total, 359 patients were included, of which 24% were classified as RA, 34% as mono- or oligo-poly arthritis, and 42% as inflammatory joint complaints without clinical synovitis. Among all patients, the health dimensions physical function, physical role functioning, and bodily pain were most affected. The diagnostic group, erythrocyte sedimentation rate, disease duration, and comorbidity explained 4%-9% of the variance in HRQOL dimensions, whereas the combined demographic and psychosocial characteristics explained an additional 21%-29% of HRQOL. HRQOL was negatively associated with younger age, lower education, non-Dutch origin, passive behavioral coping with pain, lower perceived health control, and low social support. Passive behavioral coping with pain had the strongest association with HRQOL. CONCLUSION: In patients with early inflammatory joint complaints, HRQOL was associated more strongly with personal characteristics than with clinical characteristics. From the time of onset of complaints onwards, physicians should take psychosocial factors and demographics into account to obtain an optimal disease outcome.     

Improvement and longterm maintenance of quality of life during treatment with adalimumab in severe rheumatoid arthritis

OBJECTIVE: In patients with longstanding severe rheumatoid arthritis (RA) receiving chronic treatment with adalimumab, health related quality of life (HRQOL) was assessed using new instruments [Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-Fatigue) and Health Utilities Index Mark 3 (HUI3)] and a more conventional instrument [Medical Outcomes Study Short Form-36 Health Survey (SF-36)].METHODS: Different measures for collecting patient-reported outcomes were applied simultaneously during the 3-year study period. Sociodemographic and medical history data were assessed at the baseline visit. Clinical examinations (e.g., joint examination and morning stiffness), disease assessments, and HRQOL data were recorded every 8 weeks. For dichotomous and categorical variables, absolute and relative frequencies were calculated. Metric measures were described using mean and standard deviation and/or standard error of the mean. HRQOL data were analyzed using observed cases. RESULTS: All assessed measures (FACIT-Fatigue, HUI3, SF-36) showed a rapid and statistically significant improvement from baseline following initiation of adalimumab therapy. This effect was maintained over the study period for a mean of 1.6 years in all applied measures. HRQOL data from all tested instruments were significantly correlated with each other. CONCLUSION: Chronic therapy with adalimumab improved measures of fatigue and HRQOL in patients with longstanding RA.     

Prospective evaluation of preferences and quality of life in women with hip fractures

OBJECTIVE: Hip fractures are a major cause of morbidity for older women, which result in impaired health related quality of life (HRQOL). Few studies have prospectively evaluated the effect of hip fractures in women on HRQOL with different health state preference measures. We compared how 4 different preference measures change in women post-hip fracture and evaluated the responsiveness of the preference measures. We also compared HRQOL in women with recent hip fractures to a control sample at baseline and to normative Canadian data at followup. METHODS: Health status measures [the Medical Outcomes Study Short Form-36 (SF-36)] and preferences (direct and indirect) of women over age 50 years with hip fractures were measured at baseline and at 3 and 9 months. Baseline preferences [Health Utilities Index (HUI), Feeling Thermometer, Standard Gamble, and SF-36] were obtained from women without hip fractures for comparison. Independent sample t tests were used to compare baseline scores of fracture and nonfracture controls. Correlations between preference and health status measures were assessed and repeated measures ANOVA was used to assess change in health status and preferences over time. RESULTS: Health status and preference measures were lower in women with hip fractures in comparison to nonfracture controls. After 9 months, the SF-36, HUI, Feeling Thermometer, and SF-6D scores improved significantly. Values for the SF-36 remained lower than an age-matched normative sample. The HUI and SF-6D were sensitive to change over time, but the Standard Gamble was not. CONCLUSION: HRQOL and preference measures improve over time in women with recent hip fractures, with the majority of the change occurring in the initial 3 months. Our results suggest that the HUI and SF-6D are valid measures to assess change over time post-hip fracture.     

The impact of Fibromyalgia on health-related quality of life in patients according to age

Previous studies show controversial results regarding the influence of age on health-related quality of life (HRQOL) in patients with Fibromyalgia (FM). While some studies suggest that elderly patients have a worse HRQOL when compared with younger patients, others did not find differences according to age. The aim of the study was to analyse the impact of FM on HRQOL as far as patients’ age is concerned. A cross-sectional study was conducted with 76 adult Portuguese women with FM between 22 and 75 years ( $ \bar{x} = 4 9. 6 1 $ ; SD = 10.07). The HRQOL was assessed through the generic questionnaire Short-Form 36 Health Survey (SF-36). To this study, we considered the direct scores on each dimension that encompasses the SF-36, and standardized scores of each dimension by age and gender, using Portuguese normative data. Data regarding clinical and psychological variables (anxiety, depression and social support) were also collected. Of the total sample, 11 patients (14.5 %) had <39 years, 54 patients (71 %) had between 40 and 59 years and 11 subjects (14.5 %) had 60 years or more. There were no differences between the three patient groups in any of the clinical and psychological variables considered, and the same lack of differences was observed in the SF-36 direct scores. Nevertheless, when the analysis was made using the SF-36 standardized scores, the patients over 60 years presented a significantly lower deterioration on physical (Physical Function, Role Physical and General Health) and social dimensions when compared with patients under 59 years, on Vitality when compared with patients under 39 years, and on Body Pain when compared to patients with age between 40 and 59 years. Regarding mental dimensions, no differences were found in the three age groups. In conclusion, it is important to control age effect on HRQOL to determine the specific impact of FM. Controlling the age effect on the HRQOL with standardized scores, elderly women with FM (≥60 years) have less impact of the disease on the physical and social dimensions of the HRQOL than younger patients.     

Impact of fatigue on health-related quality of life in rheumatoid arthritis

OBJECTIVE: To multidimensionally assess fatigue in rheumatoid arthritis (RA) and to evaluate the impact of fatigue on health-related quality of life (HRQOL). METHODS: The study was conducted in 1999 among 490 RA patients with varying disease duration. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) and HRQOL with a validated Dutch version of the RAND 36-Item Health Survey. We evaluated the impact of fatigue on HRQOL by multiple linear regression analyses taking into account RA-related pain and depressive symptoms. RESULTS: Different aspects of fatigue selectively explained different dimensions of HRQOL. The MFI-20 was entered last to the linear regression models, resulting in an additional increase of explained variance of 1% (mental health) to 14% (vitality). CONCLUSION: The multidimensional portrayal of RA-related fatigue can be used to develop intervention strategies targeted to specific aspects of fatigue. Fatigue, supplementary to RA-related pain and depressive symptoms, appears to be a feasible and treatable target in the clinical management of RA to increase HRQOL.