Assessment of factors influencing health‐related quality of life in HIV‐infected patients

Objectives

Health‐related quality of life (HRQL) is used in the assessment of chronic illness. Regarding HIV infection, HRQL assessment is an objective for physicians and institutions since antiretroviral treatment delays HIV clinical progression. The aim of this study was to determine the factors with the most influence on HRQL in HIV‐infected people and to create a predictive model.

Methods

We conducted a cross‐sectional study in 150 patients in a tertiary hospital. HRQL data were collected using the Medical Outcomes Study HIV Health Survey (MOS‐HIV) questionnaire. The research team created a specific template with which to gather clinical and sociodemographic data. Adherence was assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and depression data were obtained using the Beck Depression Inventory, Second Edition (BDI‐II) inventory. Logistic regression models were used to identify determinants of HRQL.

Results

HIV‐related symptoms and presence of depression were found to be negatively associated with all the MOS‐HIV domains, the Physical Health summary score and the Mental Health summary score. Patients receiving protease inhibitor (PI)‐based treatment had lower scores in four of the 11 domains of the MOS‐HIV questionnaire. Gender, hospitalization in the year before enrolment, depression and parenthood were independently related to the Physical Health Score; depression and hepatitis C virus coinfection were related to the Mental Health Score.

Conclusions

Optimization of HRQL is particularly important now that HIV infection can be considered a chronic disease with the prospect of long‐term survival. Quality of life should be monitored in follow‐up of HIV‐infected patients. The assessment of HRQL in this population can help us to detect problems that may influence the progression of the disease. This investigation highlights the importance of a multidisciplinary approach to HIV infection.     

The impact of joint range of motion limitations on health‐related quality of life in patients with haemophilia A: a prospective study

In patients with haemophilia A, repeated occurrences of haemarthrosis and synovitis lead to limitations in range of motion (ROM) of major joints. However, the effect of limitations in joint ROM on health‐related quality of life (HRQOL) in these patients has not been studied previously. The aim of this study was to assess the impact of ROM limitations of 10 major joints (bilateral shoulders, elbows, hips, knees and ankles), combined with other possibly influential factors, on HRQOL in patients with haemophilia A. The ROM limitations in 13 movements and pain intensity of the 10 major joints were measured. The socio‐demographic and clinical data were recorded. Short‐Form 36 was used as the HRQOL measurement. Eighteen patients (mean age: 36.9 years) were included. Hip ROM limitations, knee ROM limitations and hip pain intensity predicted physical functioning scale (P < 0.001; adjusted R² = 0.553). Shoulder ROM limitations and age predicted role limitation were due to emotional problems scale (P < 0.001; adjusted R² = 0.373). Elbow ROM limitations and haemophilia severity predicted mental health scale (P = 0.001; adjusted R² = 0.320). Hip ROM limitations predicted social functioning scale (P = 0.041; adjusted R² = 0.091). Educational level and elbow ROM limitations predicted vitality scale (P < 0.001; adjusted R² = 0.416). The ROM limitations of hip, knee, shoulder and elbow could be predictors for HRQOL in patients with haemophilia A. Improving ROM of major joints could be an appropriate treatment strategy to enhance HRQOL in these patients.     

Proxy‐reported health‐related quality of life of patients with juvenile idiopathic arthritis: The pediatric rheumatology international trials organization multinational quality of life cohort study

Objective

To investigate the proxy‐reported health‐related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA).

Methods

In this multinational, multicenter, cross‐sectional study, HRQOL of patients with JIA was assessed through the Child Health Questionnaire (CHQ) and was compared with that of healthy children of similar age from the same geographic area. Potential determinants of HRQOL included demographic data, physician's and parent's global assessments, measures of joint inflammation, Childhood Health Assessment Questionnaire (CHAQ), and erythrocyte sedimentation rate.

Results

A total of 6,639 participants (3,324 with JIA and 3,315 healthy) were enrolled from 32 countries. The mean ± SD physical and psychosocial summary scores of the CHQ were significantly lower in patients with JIA than in healthy children (physical: 44.5 ± 10.6 versus 54.6 ± 4.0, P < 0.0001; psychosocial: 47.6 ± 8.7 versus 51.9 ± 7.5, P < 0.0001), with the physical well‐being domain being most impaired. Patients with persistent oligoarthritis had better HRQOL compared with other subtypes, whereas HRQOL was similar across patients with systemic arthritis, polyarthritis, and extended oligoarthritis. A CHAQ score >1 and a pain intensity rating >3.4 cm on a 10‐cm visual analog scale were the strongest determinants of poorer HRQOL in the physical and psychosocial domains, respectively.

Conclusion

We found that patients with JIA have a significant impairment of their HRQOL compared with healthy peers, particularly in the physical domain. Physical well‐being was mostly affected by the level of functional impairment, whereas the intensity of pain had the greatest influence on psychosocial health.     

Health‐related quality of life in subjects with HCV/HIV coinfection: results from ACTG 5178 study

Summary. Although health‐related quality of life (HRQOL) is diminished in HCV/HIV, the relationship between virologic response and maintenance therapy with HRQOL in this population is unknown. ACTG 5178 was a phase 2, randomized trial, with three steps – Step 1: all subjects received pegylated interferon (PEG‐IFN)/ribavirin (P/R) for 12 weeks. Step 2: subjects who failed to achieve early viral response (EVR) were randomized to PEG‐IFN or observational control for an additional 72 weeks. Step 3: subjects with EVR from step 1 continued on P/R for a total of 72 weeks with 24 weeks follow‐up off‐therapy. HRQOL, symptom distress and depression levels were measured at multiple time points. In step 1 (n = 329), there was a significant decline in HRQOL in all dimensions. In step 3 (n = 169), the overall HRQOL and three of its eight dimensions (general health, role function and pain score) were increased, and achievement of sustained virologic response was associated with increased general health and cognitive function. In step 2 (n = 85), there was no significant change in HRQOL and no significant difference between groups (PEG‐IFN vs observational control). There was a significant decline in HRQOL during the initial 12 weeks of therapy. Thereafter, the HRQOL profile differed for subjects with EVR vs without EVR. Maintenance therapy with PEG‐IFN had no impact on the HRQOL.     

Bone density and health‐related quality of life in adult patients with severe haemophilia

Summary. Severe haemophilia and reduced bone density can negatively influence perception of patient’s health‐related quality of life (HRQoL), especially considering future aspects, the risk of losing independence or pain suffering. The aim of this study was to assess levels of HRQoL in severe haemophilia patients and to compare HRQoL to those of the general population as well as to determine whether reduced bone density is correlated to the perceived HRQoL. Patients were divided into two groups based on timing of being treated with prophylaxis: Group A (started prophylaxis at age of ≤3 years; n = 22); Group B (at age of >3 years; n = 15). The bone mineral density (BMD g cm^?2) of different measured sites was measured by dual energy X‐ray absorptiometry (DXA). HRQoL was assessed using SF‐36 questionnaire. Group A have mean BMD T‐score >?1.0 (i.e. normal score) at all measured sites, and have almost similar scores in the SF‐36 domains compared with the reference population. Group B have mean BMD T‐score ?1.0 at lumbar spine and total body, and their scores in the SF‐36 domains were lower compared with the reference population. Moreover, significant correlations were found between BMD at femoral neck and total body with physical domains. With adequate long‐term prophylaxis since early childhood, adult patients with haemophilia report a comparable BMD and HRQoL to the Swedish reference population. Reduced BMD in group B correlated with impaired physical health, which underscores the importance of early onset of adequate prophylactic treatment.     

Minimal hepatic encephalopathy does not impair health‐related quality of life in patients with cirrhosis: a prospective study

Background: Minimal hepatic encephalopathy (HE) is a serious complication of cirrhosis; however, the impact of minimal HE on health‐related quality of life (HRQoL) remains controversial. The Psychometric Hepatic Encephalopathy Score (PHES) remains a ‘gold standard’ for the assessment of minimal HE, but its results clearly differ between studied populations. Aim: We studied the effect of minimal HE on patient HRQoL. Methods: Eighty‐seven consecutive cirrhotic patients were included. All patients underwent clinical and psychometric evaluation at the same day. Ten subjects with overt HE confirmed with West Haven criteria were excluded from the study, thus 77 patients were finally analysed. Patients with minimal HE were identified on the grounds of altered PHES. HRQoL was assessed by the Medical Outcomes Study 36‐Item Short Form Health Survey (SF‐36) and the Chronic Liver Disease Questionnaire (CLDQ). Normative reference data for PHES were established from a cohort of 305 healthy Polish subjects. Results: Twenty‐nine (37.7%) patients were diagnosed with minimal HE. When patients with and without minimal HE were compared, HRQoL was not significantly different in none of the SF‐36 and CLDQ domains. Conclusion: Minimal HE does not affect HRQoL.     

Effect of long‐term late‐evening snack on health‐related quality of life in cirrhotic patients

Aim: In patients with liver cirrhosis, abnormal energy metabolism induces low health‐related quality of life (HRQOL) scores. However, late‐evening snack (LES) prevents morning starvation in cirrhotic patients. Our aim is to assess the effect of long‐term LES on HRQOL in cirrhotic patients, using the 36‐item Short Form (SF‐36) health survey. Methods: Thirty‐nine cirrhotic patients classified as Child–Pugh grade A were recruited. The patients were randomly divided into two groups: 24 were assigned to the non‐LES group and 15 to the LES group. SF‐36 scores, anthropometric data and serum biochemical parameters were examined in the non‐LES and LES groups at 0, 6 and 12 months. Results: Neither anthropometric data nor laboratory data showed significant differences between the non‐LES and the LES groups at 0, 6 and 12 months. The role–emotional (RE) HRQOL scores at 6 months and mental health (MH) scores at 6 and 12 months were significantly reduced from the baseline level in the non‐LES group. In contrast, these scores remained unchanged in the LES group. General health perception (GH) scores at 12 months, RE at 6 months and MH at 6 and 12 months in the LES group were significantly higher than those of the non‐LES group. Conclusion: Long‐term LES administration may be helpful in maintaining higher HRQOL in patients with cirrhosis.     

The association between depression and health‐related quality of life in people with type 2 diabetes: a systematic literature review

The relationships between co‐morbid depression in people with diabetes and adverse outcomes including poor HbA_1c control, adherence to medication and mortality have been examined and confirmed. However, as the awareness of the decrement to health‐related quality of life (HRQOL) in people with diabetes and its clinical consequences grows, investigators have become increasingly interested in measuring HRQOL in clinical trials. Given that the psychological factors such as depression may contribute to diminished HRQOL, the present review sought to summarize the association between these variables in people with type 2 diabetes. Articles for a systematic review were obtained via a search performed using MEDLINE, EMBASE and PsycINFO (1980–2007). Fourteen articles fulfilled the inclusion criteria. Studies indicated that self‐reported depressive symptoms markedly impaired HRQOL on several domains. However, depression was not related to all sub‐domains of HRQOL in all studies, suggesting that the effects of depression on certain aspects of HRQOL may vary between clinical and demographic subgroups. Although a number of shortcomings identified in the current literature should be taken into account for future research, the importance of this review lies in the possibility it raises that the improvements in HRQOL and clinical practice may potentially be achieved by placing greater attention on the identification and management of depression. Copyright © 2010 John Wiley & Sons, Ltd.     

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.

     

Cross‐cultural development and psychometric evaluation of a patient‐reported health‐related quality of life questionnaire for adults with haemophilia

Summary. Co‐morbidities of haemophilia, such as arthropathy and blood‐borne infections, can adversely affect the quality of life of adult patients with haemophilia. The purpose of this study was to develop and validate a haemophilia‐specific health‐related quality of life questionnaire for adults (HAEMO‐QoL‐A). Subjects with varying severities of haemophilia completed the HAEMO‐QoL‐A at baseline and 4 weeks. Other assessments included the SF‐36 and Health Assessment Questionnaire – Functional Disability Index (HAQ‐FDI). Two‐hundred and twenty‐one participants completed the 41‐item HAEMO‐QoL‐A covering six domains (Physical Functioning, Role Functioning, Worry, Consequences of Bleeding, Emotional Impact and Treatment Concerns) and four independent items. Internal consistency was good‐to‐excellent (Cronbach’s α‐range: 0.75–0.95). Test–retest reproducibility was good, with intraclass correlation coefficients >0.80 except for the Emotional Impact domain (0.79). Concurrent validity between the HAEMO‐QoL‐A total and subscale scores and all SF‐36 subscale scores were generally good (correlations range: 0.13–0.87). Significant correlations between the HAEMO‐QoL‐A and the HAQ‐FDI ranged from ?0.14 to ?0.69. There were non‐significant correlations with the Treatment Concerns subscale and with the Worry subscale. The HAEMO‐QoL‐A discriminated significantly between adults with haemophilia by severity and HIV status. The Physical Functioning subscale discriminated between patients receiving prophylactic or on‐demand therapy. The HAEMO‐QoL‐A is a valid and reliable instrument for assessing quality of life in haemophilia patients.