Reproducibility and Reliability of the Quality of Life Questionnaire in Patients With Atrial Fibrillation

Background

Studies have shown the impact of atrial fibrillation (AF) on the patients'' quality of life. Specific questionnaires enable the evaluation of relevant events. We previously developed a questionnaire to assess the quality of life of patients with AF (AFQLQ version 1), which was reviewed in this study, and new domains were added.

Objective

To demonstrate the reproducibility of the AFQLQ version 2 (AFQLQ v.2), which included the domains of fatigue, illness perception and well-being.

Methods

We applied 160 questionnaires (AFQLQ v.2 and SF-36) to 40 patients, at baseline and 15 days after, to measure inter- and intraobserver reproducibility. The analysis of quality of life stability was determined by test-retest, applying the Bartko intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach''s alpha test.

Results

The total score of the test-retest (n = 40) had an ICC of 0.98 in the AFQLQ v.2, and of 0.94 in the SF36. In assessing the intra- and interobserver reproducibility of the AFQLQ v.2, the ICC reliability was 0.98 and 0.97, respectively. The internal consistency had a Cronbach''s alpha coefficient of 0.82, compatible with good agreement of the AFQLQ v.2.

Conclusion

The AFQLQ v.2 performed better than its previous version. Similarly, the domains added contributed to make it more comprehensive and robust to assess the quality of life of patients with AF.     

Depression as a Clinical Determinant of Dependence and Low Quality of Life in Elderly Patients with Cardiovascular Disease

Background

The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists.

Objective

Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life.

Methods

This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State.

Results

The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p < 0.001), lack of physical activity (p = 0.016), osteoarthritis (p < 0.001), cognitive impairment (p < 0.001), and major depression (p < 0.001). Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36.

Conclusion

Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.     

Association Between Hemodynamic Profile,Physical Capacity and Quality of Life in Pulmonary Hypertension

Background

No studies have described and evaluated the association between hemodynamics, physical limitations and quality of life in patients with pulmonary hypertension (PH) without concomitant cardiovascular or respiratory disease.

Objective

To describe the hemodynamic profile, quality of life and physical capacity of patients with PH from groups I and IV and to study the association between these outcomes.

Methods

Cross-sectional study of patients with PH from clinical groups I and IV and functional classes II and III undergoing the following assessments: hemodynamics, exercise tolerance and quality of life.

Results

This study assessed 20 patients with a mean age of 46.8 ± 14.3 years. They had pulmonary capillary wedge pressure of 10.5 ± 3.7 mm Hg, 6-minute walk distance test (6MWDT) of 463 ± 78 m, oxygen consumption at peak exercise of 12.9 ± 4.3 mLO2.kg-1.min-1 and scores of quality of life domains < 60%. There were associations between cardiac index (CI) and ventilatory equivalent for CO2 (r=-0.59, p <0.01), IC and ventilatory equivalent for oxygen (r=-0.49, p<0.05), right atrial pressure (RAP) and ''general health perception'' domain (r=-0.61, p<0.01), RAP and 6MWTD (r=-0.49, p<0.05), pulmonary vascular resistance (PVR) and ''physical functioning'' domain (r=-0.56, p<0.01), PVR and 6MWTD (r=-0.49, p<0.05) and PVR index and physical capacity (r=-0.51, p<0.01).

Conclusion

Patients with PH from groups I and IV and functional classes II and III exhibit a reduction in physical capacity and in the physical and mental components of quality of life. The hemodynamic variables CI, diastolic pulmonary arterial pressure, RAP, PVR and PVR index are associated with exercise tolerance and quality of life domains.     

贲门失弛缓症患者的精神心理因素和生活质量调查

背景：贲门失弛缓症患者的症状常受情绪影响，但情绪因素在贲门失弛缓症发病中的作用尚不清楚。目的：了解贲门失弛缓症患者的生活质量以及精神心理因素在其发病中的作用。方法：对近10年在北京协和医院确诊并完成扩张治疗的347例贲门失弛缓症患者，通过发信以问卷形式进行调查，内容包括患者一般资料、发病诱因和症状加重原因、症状以及汉化版简明健康调查量表SF-36。结果：共收回问卷166份，应答率为47．8％。发病有明显诱因者占63．9％．其中受情绪影响51．2％，过度劳累21.1％，工作压力15．7％，应激事件15．7％；症状加重有明显原因者占62．0％．其中受情绪影响48．8％，过度劳累27．7％，应激事件15．7％，工作压力12．7％。扩张治疗后，患者8项症状均显著改善（P〈0．05），但各维度生活质量仍显著低于健康对照组（P〈0．05）。结论：精神心理因素可诱发、加重贲门失弛缓症患者的症状。扩张治疗可使患者的食管、气道等症状明显改善，并有维持疗效的作用。但患者在生理和心理两方面的生活质量仍明显低于健康人。     

Portuguese-language version of the COPD Assessment Test: validation for use in Brazil

OBJECTIVE:

To validate a Portuguese-language version of the COPD assessment test (CAT) for use in Brazil and to assess the reproducibility of this version.

METHODS:

This was multicenter study involving patients with stable COPD at two teaching hospitals in the city of Fortaleza, Brazil. Two independent observers (twice in one day) administered the Portuguese-language version of the CAT to 50 patients with COPD. One of those observers again administered the scale to the same patients one week later. At baseline, the patients were submitted to pulmonary function testing and the six-minute walk test (6MWT), as well as completing the previously validated Portuguese-language versions of the Saint George''s Respiratory Questionnaire (SGRQ), modified Medical Research Council (MMRC) dyspnea scale, and hospital anxiety and depression scale (HADS).

RESULTS:

Inter-rater and intra-rater reliability was excellent (intraclass correlation coefficient [ICC] = 0.96; 95% CI: 0.93-0.97; p < 0.001; and ICC = 0.98; 95% CI: 0.96-0.98; p < 0.001, respectively). Bland Altman plots showed good test-retest reliability. The CAT total score correlated significantly with spirometry results, 6MWT distance, SGRQ scores, MMRC dyspnea scale scores, and HADS-depression scores.

CONCLUSIONS:

The Portuguese-language version of the CAT is a valid, reproducible, and reliable instrument for evaluating patients with COPD in Brazil.     

Quality of Life in the Management of Hypertension

Results from long term trials suggest that first line treatment with the diuretic chlorthalidone is not associated with any adverse effects on quality of life including cognitive performance. Similar findings may be true for other diuretics but there is less evidence. However chlorthalidone and other diuretics do produce erectile problems in around 10% to 15% of middle aged men while the proportion of older men affected is not known. Beta blockers have mixed effects but recent drugs of this class have minor, if any adverse impacts. Calcium channel blockers, especially dihydropyridines, are associated with higher discontinuation rates. ACE inhibitors appear to cause minimal impairment to QoL; they do not interfere with cognitive function or sexual performance and are associated with a low withdrawal rate. Greater control of blood pressure is associated with improved quality of life as are strategies such as weight loss and increased physical exercise.     

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Background

The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD.

Objectives

To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD.

Methods

The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI.

Results

The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach''s α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO₂max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient.

Conclusions

The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.     

Efficacy and Influence on Quality of Life of Enalapril as a First Step Treatment of Hypertension

205 patients with mild to moderate uncomplicated hypertension participated in a six-month double-blind parallel study performed in a unique center. After a two-week single-blind placebo period, the patients were randomly allocated to receive either Enalapril 20 mg once-a-day or placebo as the first step treatment. They were then followed-up every two weeks and successive doses of hydrochlorothiazide, oxprenolol, and dihydralazine were added until the diastolic pressure was lower than 90 mmHg. After six months, the systolic and diastolic blood pressures were lower in the Enalapril than in the control group (129/82+12/6 mmHg versus 136/86 ± 10/5 mmHg; p < 0.001). Drug withdrawal was necessary for 8 patients in the Enalapril group and for 16 patients in the control group (p < 0.05). The number of daily tablets was 2.7+1.8 in the Enalapril group and 4.4±2.4 in the control group (p < 0.01). Therefore, a stepped-care program based on Enalapril appears significantly more effective than a stepped-care program based on a diuretic.     

Quality of life in chronic pancreatitis

INTRODUCTIONIn the present era, there is a high demand for health services with the associated pressure of controllingspending, health care organizations are concerned with the cost-effectiveness of quality improvement interventions. On the other hand, th…     

功能性消化不良患者生活事件、生活质量与症状关系的研究

背景：目前有关功能性消化不良（FD）患者生活事件状况的研究结论不一，国内这方面的研究不多，对两者之间的关系尚不明了。目的：调查FD患者经历的生活事件和生活质量状况，探讨两者以及FD症状程度之间的关系。方法：对114例FD患者和100名健康对照者进行问卷调查，调查内容包括生活事件量表（LES）、简明健康状况调查表（SF-36）和症状评分表，并进行分析比较。结果：FD患者经历的生活事件总值（P=-0．014）和负性生活事件值（P〈0．001）显著高于健康对照组，正性生活事件值则低于健康对照组（P=0．001）。FD患者的生活质量在8个健康概念维度上均显著较健康对照组差（P〈0．001）。FD患者的症状评分与各生活事件值均无相关性；生活事件总值和负性生活事件值分别与生活质量8个健康概念维度中的6个和7个呈负相关（P〈0．05），正性生活事件值与生活质量无关；症状评分与生活质量中的活力、躯体疼痛无明显相关性，与其余6个健康概念维度均呈负相关（P〈0．05）。结论：经历更多负性生活事件是FD的特征和诱因之一，负性生活事件影响患者生活质量的作用明显。     

Leicester Cough Questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil

Objective:

To translate the Leicester Cough Questionnaire (LCQ) to Portuguese and adapt it for use in Brazil.

Methods:

Cross-cultural adaptation of a quality of life questionnaire requires a translated version that is conceptually equivalent to the original version and culturally acceptable in the target country. The protocol used consisted of the translation of the LCQ to Portuguese by three Brazilian translators who were fluent in English and its back-translation to English by another translator who was a native speaker of English and fluent in Portuguese. The back-translated version was evaluated by one of the authors of the original questionnaire in order to verify its equivalence. Later in the process, a provisional Portuguese-language version was thoroughly reviewed by an expert committee. In 10 patients with chronic cough, cognitive debriefing was carried out in order to test the understandability, clarity, and acceptability of the translated questionnaire in the target population. On that basis, the final Portuguese-language version of the LCQ was produced and approved by the committee.

Results:

Few items were questioned by the source author and revised by the committee of experts. During the cognitive debriefing phase, the Portuguese-language version of the LCQ proved to be well accepted and understood by all of the respondents, which demonstrates the robustness of the process of translation and cross-cultural adaptation.

Conclusions:

The final version of the LCQ adapted for use in Brazil was found to be easy to understand and easily applied.     

老年胃食管反流病患者临床症状、心理状况和生活质量调查

背景:近年来,胃食管反流病(GERD)的患病率呈增高趋势,且其患病率随年龄的增长而增加。目的:分析GERD患者,尤其是老年GERD患者的胃食管反流症状、食管外症状、精神心理和生活质量状况,为GERD的诊治提供依据。方法:于2007年1月～2009年7月连续纳入GERD患者296例(老年组160例,非老年组136例),同期纳入正常对照者60例。以反流性疾病问卷(RDQ)和食管外症状调查问卷评价患者的胃食管反流症状和食管外症状,Zung焦虑自评量表(SAS)和Zung抑郁自评量表(SDS)调查患者的精神心理状况,SF-36健康凋查量表评价患者的生活质量情况。结果:GERD患者的胃食管反流症状和食管外症状较正常对照组更常见且更严重,SAS评分和SDS评分明显高于正常对照组,SF-36评分明显低于正常对照组,差异均有统计学意义(P0.05)。GERD组老年患者与非老年患者间的胃食管反流症状差异无统计学意义;老年GERD患者的食管外症状发生率较高,SAS和SDS评分明显高于非老年患者,SF-36评分明显低于非老年患者,差异均有统计学意义(P0.05)。结论:GERD患者常伴有精神心理异常和生活质量下降。老年人更易罹患GERD,老年GERD患者食管外症状较常见,心理健康水平更易受到影响,生活质量下降更为明显。     

舒血宁对老年缺血性脑卒中疗效及生活质量的影响

目的 探讨舒血宁对老年缺血性脑卒中患者临床疗效和生活质量的影响.方法 212例老年缺血性脑卒中患者随机分为治疗组和对照组各106例,两组均予常规治疗,治疗组加用舒血宁,对照组加用安慰剂,2周为一疗程.进行神经功能缺损评分,采用SS-QOL量表对患者进行生活质量问卷评价,检测血中内皮素1和降钙素基因相关肽.结果 治疗组总有效率为86.8％,明显高于对照组的76.5％(P＜0.05);治疗后,治疗组SS-QOL量袁评分明显提高,内皮素1含量下降,降钙素基因相关肽含量上升,与对照组差异有显著性(P ＜0.05或P＜0.01).结论 舒血宁结合常规治疗可明显改善老年缺血性脑卒中患者神经功能缺损评分,提高患者生活质量.     

Liver Transplant Recipients Quality of Life Instrument: Development and Psychometric Testing

Background

Liver transplantation is a life-saving intervention for many patients with end-stage liver disease. In the past, evaluation of successful liver transplantation was based on patients’ survival rate. However, in recent years this evaluation has been based on patients’ quality of life. Various instruments have been developed to evaluate patients’ quality of life. Nonetheless, scholars still believe that it is crucial to develop a standardized and disease specific instrument for evaluating the quality of life in liver transplant recipients.

Objectives

The aim of this paper was to describe the development and psychometric testing process of a quality of life instrument specific to liver transplant recipients.

Materials and Methods

Initial items of this instrument were extracted from a conventional content analysis study, and then were completed with findings of related international literature. The face validity was assessed by interviewing with four liver transplant recipients, and the content validity was evaluated by eleven experts in the field of transplantation. The construct validity was achieved by involving 250 liver transplant recipients through exploratory factor analysis method, and reliability was calculated by Cronbach''s alpha.

Results

Three main factors with 40 items were extracted from the exploratory factor analysis: Health Satisfaction, Concerns, and Complications. Reliability of the instrument was confirmed (alpha = 0.922).

Conclusions

Given the special considerations regarding liver transplant recipients, this questionnaire is more accurate in evaluating the success of liver transplantation.     

The use of rheumatoid arthritis health‐related quality of life patient questionnaires in clinical practice: Lessons learned

Objective

The utilization of health‐related quality of life (HRQOL) patient questionnaires by clinical rheumatologists is limited. Yet, considerable literature exists defining the value of such data. In an effort to understand this apparent paradox, we performed a literature review and conducted a survey to describe what has been learned over the past 2 decades concerning the use of these measures in clinical care and explore the reasons for their underutilization.

Methods

A panel of rheumatologists with extensive clinical experience was convened to review the relevant literature pertaining to the use of HRQOL patient instruments in clinical practice. Additionally, a survey of all American College of Rheumatology practicing clinicians was conducted to assess the use of and beliefs about these measures.

Results

The literature provided evidence to support the use of HRQOL patient measures in clinical practice. Forty‐seven percent of the responding rheumatologists stated that none of their patients complete HRQOL patient questionnaires. The majority of respondents (63%) reported that such information is “somewhat valuable.” The most frequently reported reason for the underutilization was that such instruments “require too much staff time.”

Conclusions

The literature supports the potential value of HRQOL patient questionnaires in clinical practice. Few rheumatologists routinely gather such information as part of patient care. Reasons for this discrepancy between utility and use are given along with recommendations intended to help increase their utilization in clinical care.

     

Development and validation of Cedars‐Sinai Health‐Related Quality of Life in Rheumatoid Arthritis (CSHQ‐RA) short form instrument

Objective

To develop an abridged version of the 33‐item Cedars‐Sinai Health‐Related Quality of Life in Rheumatoid Arthritis instrument (CSHQ‐RA) and test the validity and reliability of the abridged instrument.

Methods

Items from the original 33‐item, 5‐domain CSHQ‐RA were assessed using psychometric and regression analyses of survey responses from 274 patients with rheumatoid arthritis. Items were retained in the final instrument based on statistical analysis and evaluation by an expert panel. Test‐retest reliability, internal consistency, convergent and discriminant validity, and ceiling and floor effects were examined for the shortened CSHQ‐RA.

Results

Statistical analysis and expert assessment yielded an 11‐item instrument including questions in 4 domains. Test‐retest reliability and internal consistency were high and the instrument showed good convergent and discriminant validity.

Conclusion

The abridged CSHQ‐RA short form is a valid and reliable instrument that can be used to examine the impact of RA on patients' health‐related quality of life. Prospective validation in clinical trial settings is warranted.

     

Cross-Cultural Validation of Irritable Bowel Syndrome Quality of Life in Korea

Patients’ responses to quality-of-life questionnaires are dependent on the cultural milieu. The aims of this study were to translate the Irritable Bowel Syndrome Quality of Life questionnaire, which was developed in the West, into Korean and to validate the translated questionnaire in patients with irritable bowel syndrome. Translation of the original questionnaire was performed according to accepted linguistic validation guidelines. Korean patients had no difficulty understanding the questions. Data from the translated questionnaire were well correlated with results from the SF-36 questionnaire and reflected the stress status of the patients as measured on the Perceived Stress Scale. Some questionnaire items seemed, on first analysis, to be problematic in this subset of patients, but these results may relate, in part, to cultural differences between Korea and the West. We conclude that the translated questionnaire is reliable and offers an accurate measure of quality of life for Korean patients with irritable bowel syndrome.