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.     

Multimorbidity and Health-Related Quality of Life in Old Age: Role of Functional Dependence and Depressive Symptoms

ObjectivesTo examine the associations of multimorbidity patterns with health-related quality of life (HRQL) in rural-dwelling older adults in China, and to explore to what extent their associations were mediated by functional dependence and depressive symptoms.DesignPopulation-based cross-sectional study.Setting and participants1497 participants (age ≥60 years; 66.4% women) in the 2014-2016 examination of the Confucius Hometown Aging Project who were living in a rural community near Qufu, Shandong, China.MeasuresData on demographics, lifestyles, chronic health conditions, and use of medications were collected through interviews, clinical examinations, and laboratory tests. Multimorbidity was defined as co-occurrence of ≥2 chronic diseases in the same person. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, and EQ-5D-3L was used to assess HRQL.ResultsMultimorbidity was present in 83.8% of the participants (women vs men: 85.5% vs 80.6%, P = .015). Exploratory factor analysis identified 4 patterns of multimorbidity, that is, patterns of cardiovascular-degenerative, respiratory, neurologic-thyroid, and metabolic-cognitive-cerebrovascular diseases. The neurologic-thyroid disease pattern did not show a significant association with HRQL. The 3 other patterns were associated with poor HRQL and had a diverse impact on different dimensions of HRQL. Mediation analysis suggested that functional dependence and the presence of depressive symptoms could mediate 24.8% and 21.8%, respectively, of the association between the number of chronic diseases and poor HRQL.Conclusions/ImplicationsMultimorbidity is associated with poor HRQL in older adults, in which functional dependence and depressive symptoms partly mediate their associations. Prevention and proper management of dependence and depressive symptoms in older people with multimorbidity may help maintain and improve quality of life.     

The Relationship between Asthma Severity,Family Functioning and the Health-Related Quality of Life of Children with Asthma

This study compared the health-related quality of life (HRQL) of 236 children with mild or moderate/severe asthma with that of a large representative sample of children in the general community. The study also examined the relationship between the HRQL of children with asthma and their demographic characteristics, asthma severity and family functioning. Children with asthma had a significantly poorer HRQL than other children in the community. Amongst the children with asthma, parents reported that children living in single-parent families had poorer physical health, mental health and social functioning than children in two-parent families. There was a significant relationship between the mental health of children with asthma and family functioning but no significant relationship between their physical health and family functioning. These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. A better understanding of these relationships will facilitate the development of new interventions to help children with asthma. This revised version was published online in June 2006 with corrections to the Cover Date.     

上海居民慢性病与生命质量关系的研究

目的研究上海居民慢性病患病情况及其对生命质量的影响,分析慢性病与生命质量的关系。方法采用随机、分层、多阶段抽样的方法抽取调查对象,运用自填式问卷调查方式对919名居民进行调查,问卷包括调查对象基本情况问卷及SF-36健康调查量表。结果上海居民慢性病患病率达25.14%,其中高血压患病率最高。有慢性病者的SF-36量表各维度得分均比无慢性病者低,而且慢性病数量影响生命质量,慢性病越多生命质量越差。结论慢性病已经成为一个重要的公共卫生问题,严重损害人们的生命质量。     

Health-Related Quality of Life Measured with EQ-5D in Patients Treated for Depression in Primary Care

OBJECTIVE: The objective of the present study was to assess the impact of depression on patients' health-related quality of life (HRQL) with the EQ-5D instrument over 6 months while on antidepressant treatment. METHODS: A total of 447 patients were recruited at 56 primary care centers to this naturalistic longitudinal observational study. Patients older than 18 years with depressive symptoms, and who initiated an antidepressant therapy because of depression were included in the study. Data on patients' sociodemographics, daily activity, and quality of life (EQ-5D) were collected using questionnaires completed during outpatient general practitioner visits for a follow-up period of 6 months. RESULTS: The mean EQ-5D utility score at baseline was 0.47 (0.44-0.49). Milder cases of depression reported a health utility of 0.60, whereas moderately and severely depressed patients reported utility values of 0.46 and 0.27, respectively (P < 0.01). At end of follow up the average utility was 0.69 (0.67-0.72), corresponding to an increase of 0.23 over 6 months (P < 0.01). Regression analyses showed that, all else equal, patients who were on sick leave were associated with 10% lower utility. CONCLUSIONS: Depression has a substantial impact on HRQL. Our results indicate that treatments for depression are associated with significant improvement in EQ-5D index score over a course of 6 months. Self-reported patient valuations are important outcomes for cost-utility analysis of new treatments for depression and the present study provides important evidence for future economic evaluations.     

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.     

Determinants of Health-Related Quality of Life in Long-Term Survivors of Hodgkin's Lymphoma

In this study health-related quality of life (HRQL) in long-term survivors of Hodgkin's lymphoma (HL) was evaluated and the findings were analyzed using a conceptual model developed by Wilson and Cleary. A better understanding of the relationships between the variables explaining HRQL may improve care and rehabilitation of HL patients. The populations were long-term survivors of HL (n = 121) and a control group (n = 236). Participants were approached with one semi-structured interview, an extended version of the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) and three standardized questionnaires: Hospital Anxiety and Depression (HAD) scale, Short Form 12 health survey questionnaire (SF-12) and Sense of Coherence (SOC) scale. No differences regarding the mean scores were found between the HL survivors and the controls except for the SF-12, where the patients considered themselves to be in poorer physical health than the controls (p < 0.01). Even though physical health was diminished, patients did not evaluate overall QoL worse compared to the controls. The major determinants of perception of general QoL were self-rated physical and mental health as well as SOC. The HRQL of persons who have survived a median of 14 years with HL is similar to that of controls.     

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.     

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 in Adolescents With Chronic Illness in Jamaica: Adolescent and Parent Reports

PurposeThe aim of this study is to assess the level of agreement between adolescents’ self-assessment and parent-proxy reports on health-related quality of life (HRQOL) in Jamaican adolescents with chronic illness.MethodsA cross-sectional study was conducted, recruiting adolescents living with a chronic illness (ALCIs)—asthma, human immunodeficiency virus, insulin-dependent diabetes mellitus, or sickle cell disease and age/sex-matched healthy adolescents. Data were collected on HRQOL from adolescents and parents using the Pediatric Quality of Life Scale. Parent-adolescent agreement was determined at group level (Wilcoxon signed-rank test) and individual level (intraclass correlation coefficient).ResultsTwo hundred twenty-six (226) parent/adolescent pairs participated: 130 ALCIs and 96 healthy peers; mean age 14.9 ± 2.8 years; 58% females. Adolescents with and without chronic illness reported similar HRQOL; parent-proxies reported better HRQOL for healthy adolescents compared to ALCIs. Intraclass correlation demonstrated higher levels of parent-adolescent correlation for ALCIs than healthy adolescents (ALCIs: 0.11–0.34; healthy adolescents: 0.01–0.10). At group level, analyses demonstrated better parent-proxy rating of QOL in all of the scores with the exception of the general health score. Parent-proxies overestimated QOL for asthma and insulin-dependent diabetes mellitus but not for sickle cell disease and human immunodeficiency virus. Linear regression modeling revealed that female sex and living with chronic illness were significant predictors of agreement.DiscussionParent-proxies overestimated adolescents’ QOL compared to adolescents’ report regardless of whether the adolescent was living with a chronic illness or not. As such, health care providers should elicit feedback from the adolescent wherever possible and proxy reports should be used as complementary information rather than primary source.     

Assessing the Quality of Life of Adults with Chronic Respiratory Diseases in Routine Primary Care: Construction and First Validation of the 10-Item Respiratory Illness Questionnaire-Monitoring 10 (RIQ-MON10)

BACKGROUND: As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ). METHODS: Secondary analyses of the data of 3 controlled studies (n = 328, 502 and 555). PROCEDURES: inter-item correlations, scale distributions, Cronbach's alpha and factor analysis. Dyspnoea, forced expiratory volume in 1 s (FEV1), COOP/WONCA charts, the Medical Research Council-ECCS symptoms questionnaire and the MOS-SF 36 served as criteria to test validity and responsiveness. RESULTS: Item-reduction resulted in a 10-item short form (alpha's 0.87-0.90), consisting of 2 5-item factors: (1) physical and emotional complaints and (2) physical and social limitations. The correlations of the short form with dyspnoea (r from 0.57 to 0.60), the generic health status instruments (r from 0.39 to 0.59) and lung function (r from 0.10 to 0.15) fulfilled the criteria. FURTHER RESULTS: a clinical relevant score difference (> 0.5) between upper and lower quartiles of the convergent instruments, an intraclass correlation between repeated scores in a stable group of 0.82 and a standardised response mean of 0.86 in an improved group of patients. CONCLUSIONS: The short form (RIQ-MON10) maintained the psychometric properties of the original instrument and is promising for assessing quality of life (QoL) during routine primary care visits.     

A Longitudinal Evaluation of Health-Related Quality of Life of Patients with Parkinson's Disease

Objectives:  Few longitudinal studies have evaluated health-related quality of life (HRQoL) in Parkinson's disease (PD) and these studies have not evaluated all potentially relevant domains of PD. Our objective was to identify domains at baseline that predict change in HRQoL, and to evaluate the relation between change in HRQoL and change in particular domains of PD.
Methods:  A total of 336 patients who participated in the longitudinal SCOPA-PROPARK cohort study and had data from the first and third annual evaluation were included in this study. The Scales for Outcomes in Parkinson's disease (SCOPA) evaluation was used to assess impairments and disabilities. HRQoL was assessed with the EuroQol-5D visual analogue scale. Multiple linear regression analysis with "change in HRQoL" as dependent variable was used to identify factors that influence the change in HRQoL.
Results:  Health-related quality of life as well as most impairment and disability domains decreased significantly from baseline to follow-up. The two regression models of "change in HRQoL," adjusted for baseline HRQoL, included 1) the baseline domains autonomic dysfunction, nighttime sleep problems, and cognitive function, and 2) "change in psychosocial problems,""change in depressive symptoms," and "change in cognitive function."
Conclusions:  Patients who have autonomic dysfunction, nighttime sleep problems, and cognitive dysfunction are at risk for deterioration in HRQoL. Deterioration in HRQoL over 2-year time was associated with worsening in psychosocial well-being, mood, and cognitive function. Interventions aiming to improve these domains are important and would likely contribute to improvement in HRQoL, although more research is necessary.     

肝癌患者TACE术后的抑郁与生活质量的调查及相关性分析

目的探讨肝癌患者TACE术后的抑郁与生活质量之间的关系,为临床护理工作提供重要参考依据。方法采用问卷调查法对130名TACE术后的肝癌患者展开调查,应用抑郁自评量表(SDS)及肝癌患者生活质量测定量表QOL-LC V2.0对患者的抑郁和生活质量进行测评。结果 TACE术后的肝癌患者53.6%存在抑郁;肝癌患者TACE术后的生活质量总均分为128.21±29.72,抑郁与生活质量总分及各维度呈负相关。结论 TACE术后肝癌患者的抑郁发生率较高;患者的抑郁越严重其生活质量越低;TACE术后肝癌患者的生活质量有待提高。     

DDQ-15 Health-Related Quality of Life Instrument for Patients with Digestive Disorders

Objective: This study assessed the reproducibility, reliability, and validity of the DDQ-15, a 15-item quality of life questionnaire for patients with digestive disorders (Phases I and II). It also assessed the reliability of two modes of administration of the instrument: paper versus computer (Phase III). Data Sources/Study Setting: Digestive Disease Center (DDC) patients at the Medical University of South Carolina participated in the study. These patients were attending the DDC on an outpatient basis for a pancreatobiliary disorder, GI cancer, a luminal GI disorder, or liver disorder. Study Design: Over 200 patients participated in the validation study (Phase II) of the DDQ-15. They completed the instrument three times: within one week before a scheduled clinic visit, at the clinic visit, and approximately two months after the clinic visit. The patients also completed the SF-36 and Gastrointestinal Quality of Life Index during the clinic visit. For Phase III, 150 participants were randomized to take the DDQ-15 on computer first or on paper fist. All participants took both versions during the same clinic visit and prior to being seen by a physician. Data Collection Methods: Patients responded to the DDQ-15 items directly on the personal computer for the computer version. The paper version was self-administered by the patients, or if they could not read, the responses on the paper version required manual data entry by the study staff. Principal Findings: For the validation study (Phase II) Cronbach's alpha for the DDQ-15 was 0.92 indicating high internal consistency of the instrument. The intraclass correlation coefficient between pre-clinic and clinic visit scores was 0.97. Pearson's correlation coefficient between the clinic visit DDQ-15 and the Gastrointestinal Quality of Life Index was 0.84, and the coefficients between DDQ-15 and the subscales of SF-36 ranged from 0.55 to 0.79. For Phase III, high internal consistency was observed for both versions, and reproducibility analysis yielded excellent agreement between the two. Intraclass correlation scores indicated high concordance of DDQ-15 scores. Education level and the order in which the two versions were completed were significant factors affecting the concordance of responses. Conclusions: DDQ-15 was shown to be a reliable, reproducible, and valid instrument for assessing QOL in patients with digestive diseases. The simplicity of the instrument should facilitate its use in an ordinary clinical setting. The study also showed that agreement between computer and paper DDQ-15 versions was excellent, indicating that mode of administration minimally affected response to QOL items. This study showed the computer interface to be a reliable alternative to the conventional paper questionnaire.     

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.     

Health-related Quality of Life, Depression and Anxiety in Thyroid Cancer Patients

Objectives: We examined the relationships among physical complaints, health-related quality of life (HRQL), anxiety and depression in differentiated thyroid cancer (DTC) patients under short-term hypothyroidism. Methods: We conducted a cross-sectional study in 136 patients hypothyroid on thyroid hormone withdrawal (THW) hospitalized for radioiodine administration. Patients were assessed using Short Form SF-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Beck Depression Inventory (BDI), and physical complaints. Results: Compared to the German general population, hypothyroid patients had significantly impaired HRQL. Surprisingly, the prevalence of anxiety (62.5%), but not depression (17.9%) was much higher in hypothyroid DTC patients than in the general population. In multivariate analysis, depression and age were independently associated with the physical health score (R² = 0.21), but only psychological variables (depression, mood disturbance, and anxiety) were associated with the mental health score (R² = 0.43), on the SF-36 HRQL instrument. Conclusions: HRQL is severely impaired in DTC patients under short-term hypothyroidism. As potential predictors of generic HRQL impairment, depression, anxiety, and mood disturbance could be used to preselect the patients most needing psychiatric care. The high frequency of anxiety should be considered in the aftercare of thyroid cancer patients.     

Longitudinal Study of Depressive Symptoms and Health-Related Quality of Life During Pregnancy and After Delivery: The Health Status in Pregnancy (HIP) Study

Objective Depressive symptoms are known to affect functioning in early pregnancy. We estimated the effect of a change in depressive symptoms status on health-related quality of life (HRQoL) throughout pregnancy and after delivery. Methods Longitudinal study of 200 women. The independent variable was depressive symptoms, defined as a Center for Epidemiologic Studies Depression (CES-D) score of ≥16. The dependent variable was HRQoL from 8 domains of the Medical Outcomes Study (SF-36) Short Form. Women were categorized based on the change in CES-D score: (1) never depressed, (2) became well, (3) became depressed and (4) always depressed. A random effects model was used to (1) estimate the effect of a change in depressive symptomatology from the first to the second trimester on HRQOL in the second trimester and (2) estimate the change in depressive symptomatology from the second to the third trimester on HRQoL in the third trimester and after delivery, adjusting for covariates. Intra-individual correlations were accounted for using generalized estimating equations (GEE). Results The proportion of women with depressive symptoms was 15%, 14%, and 30% in the first, second and third trimesters, respectively, and 9% after delivery. Women who became depressed had scores in the social domains that were 10–23 points and 19–31 points lower in the second and third trimesters, respectively, compared to women with no depressive symptoms. Women who became well had scores that were 3–31 points lower, compared to women with no depressive symptoms. Conclusions Alterations in depressive symptomatology have a substantial effect on functioning during pregnancy and after delivery. This paper was presented, in part, at the 134th Annual Meeting of the American Public Health Association, Boston, MA on November 8, 2006.     

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.