A Longitudinal Analysis of the Efficacy of Environmental Interventions on Asthma-Related Quality of Life and Symptoms Among Children in Urban Public Housing

In an environmental intervention study in public housing, we examined monthly Juniper Paediatric Asthma Quality of Life (QOL) Questionnaires for 51 children. Longitudinal analysis and spline models were used to identify time periods with significant improvements in QOL to inform judgments about causality. We found significant improvements in QOL, with moderate improvements before environmental interventions, increased rates of improvement immediately after, and reduced rates more than 5 months post-intervention. Effect modification analyses identified high-risk subpopulations and emphasized the importance of environmental, social, and economic conditions. Our results demonstrate the value of longitudinal techniques in evaluating the benefits of environmental interventions for asthma.     

Quality of life in elderly heart failure patients

Quality of life(QOL),as a relevant area of research in the understanding of heart failure(HF)patient outcomes,has been increasingly studied during the last two decades.The purposes of this review article are to (1)describe QOL in older adults with HF,(2) identify and critique research designed to test interventions to improve QOL,(3)identify gaps in the literature,and (4)provide recommendations for future research.Seventeen studies describing QOL in older adults with HF were identified.Elderly HF patient QOL has been reported to be fair to poor and is worse as compared to a healthy control group.Furthermore,there is some evidence that suggests that QOL is better in older adults than younger adults and worse in women(both older and younger)than in men,although these findings are not consistent across studies.Predictors of QOL and its dimensions in older HF patients included demographic,clinical,and psychosocial variables.Sixteen interventional studies were identified that reported QOL as an outcome in older adults.Findings among randomized clinical trials(RCTs)to improve QOL outcomes in elderly HF patients do not allow strong conclusions about the benefits of the interventions.It must be noted,though,that while not all studies reported improvements in QOL(either significant or as a trend), no studies reported deterioration in QOL with randomization to an intervention versus control.These studies were limited by several methodological issues.While there has been some research of QOL in this elderly cohort,it is paramount that we address methodological issues and thereby improve the scientific rigor of our research,continue to explore QOL in elderly HF patients,and design intervention trials for elders at risk for poor QOL.     

Clinical outcome after radiofrequency catheter ablation of focal atrial fibrillation triggers

INTRODUCTION: Ablative therapy for atrial fibrillation (AF) by targeting initiating triggers, usually in or around the pulmonary veins, has been reported by several centers. Evidence for an overall improvement in quality of life (QOL) and amelioration of symptoms is lacking. METHODS AND RESULTS: Seventy-one patients undergoing attempted ablation of focal AF were followed for 60+/-33 weeks. QOL and symptom questionnaires were completed 1 month before and 6 months after electrophysiologic study. Twenty-three patients (32%) underwent electrophysiologic mapping but no ablation because of either insufficient or multifocal ectopy; the other 48 patients (68%) underwent attempted ablation. Sixteen of 48 patients (33%) undergoing ablation, or 16 (23%) of 71 on an intention-to-treat basis, were found at last follow-up to have persistent sinus rhythm without antiarrhythmic drugs. Patients who underwent mapping without ablation reported no improvements in any QOL or symptom score, whereas patients who had long-term successful ablation had significant improvements in all six QOL measures. Interestingly, patients who developed AF recurrence after ablation still reported significant improvements in 4 of 6 QOL measures. Four of 48 patients (8.3%) undergoing ablation developed pulmonary vein stenosis. CONCLUSION: Paroxysmal AF can be treated successfully in some patients by ablating initiating triggers in the pulmonary veins; however, in our experience the recurrence rate (32/48 [68%]) and risk of pulmonary vein stenosis (8%) after ablation are high. Patients with recurrent AF after ablation of focal AF triggers have significant improvement in QOL and symptoms compared with before ablation. Patients and their physicians should carefully balance the risks and benefits before considering ablation.     

The effect of a psychosocial intervention and quality of life after acute myocardial infarction: the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial

PURPOSE: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) clinical trial was designed to test whether intervening on depression or low perceived social support reduces mortality and reinfarction in patients with acute myocardial infarction (MI). This report analyzes the effect of the intervention on quality of life (QOL), which was an important secondary outcome. METHODS: ENRICHD was a randomized controlled clinical trial comparing a psychosocial intervention based on cognitive behavioral therapy to usual medical care in 2,481 patients from 8 clinical centers. Patients with acute MI were included if they met criteria for depression, low perceived social support, or both. QOL was assessed at the 6-month clinic visit in the first 1,296 patients. QOL measures included the Medical Outcomes Study Short Form summary measures of physical functioning (SF12-PCS) and mental functioning (SF12-MCS), a Life Satisfaction Scale (LSS), and a measure of overall QOL based on the ladder of life (LOL) technique. RESULTS: There were significant treatment differences on the SF12-MCS (difference 2.2, 95% confidence interval [CI] 1.2-3.2), the LSS (difference 1.0, 95% CI 0.5-1.5), and the LOL (difference 0.3, 95% CI 0.1-0.6), but not on the SF12-PCS (difference 0.8; 95% CI = -0.5-2.0). Effect sizes for the intervention on QOL outcomes were modest. CONCLUSIONS: Psychosocial interventions of limited duration confer modest QOL benefits in post-MI patients who are depressed or have low perceived social support. Interventions of longer duration or greater intensity may be required to produce more substantial improvements in QOL in these patients.     

The effect of ethnicity and sexual preference on prostate-cancer-related quality of life

In general, patients with prostate cancer are able to maintain a relatively high quality of life (QOL), commonly reporting improvements in physical, emotional, and social functioning within 1 year of treatment. However, certain subpopulations of patients are susceptible to significant reductions in QOL during the course of their treatment. Data suggest that ethnic background and sexual preference both have significant effects on QOL for patients with prostate cancer. These parameters are often poorly documented and addressed by medical practitioners. Greater attention is needed to identify patients who are at increased risk of QOL reduction as a result of these factors.     

A randomized, controlled trial of fall prevention programs and quality of life in older fallers

OBJECTIVES: To compare the effects of three fall-prevention programs (education (ED), home safety assessment and modification (HSAM), and exercise training (ET)) on quality of life (QOL), functional balance and gait, activities of daily living (ADLs), fear of falling, and depression in adults aged 65 and older. DESIGN: A 4-month randomized trial. SETTING: Randomized, controlled trial. PARTICIPANTS: One hundred fifty participants who had experienced a recent fall. MEASUREMENTS: QOL was assessed according to the brief version of the World Health Organization Quality of Life instrument (WHOQOL-BREF), functional balance and gait according to functional reach and Tinetti balance and gait, ADLs according to the Older Americans Resources and Services questionnaire, fear of falling according to a visual analog scale, and depression level according to the Geriatric Depression Scale. RESULTS: The score changes for the ET group were 2.1 points greater on the physical domain (95% confidence interval (CI)=-1.2-5.3), 3.8 points greater on the psychological domain (95% CI=0.7-7.0), and for the WHOQOL-BREF, 3.4 points greater on the social domain (95% CI=0.7-6.1) and 3.2 points greater on the environmental domain (95% CI=0.6-5.7) than for the ED group. The score change for each domain of the WHOQOL-BREF for the HSAM group was greater than that for the ED group, although these results were not statistically significant. The ET group also had greater improvements in functional reach, Tinetti balance and gait, and fear of falling than the ED group. CONCLUSION: The QOL outcome supports the superiority of ET over the other two interventions in older people who have recently fallen. This finding also parallels those gathered from the functional measures.     

Correlates of quality of life in symptomatic HIV patients living in Hong Kong

This cross-sectional study assessed quality of life (QOL), coping styles, mood and uncertainty in illness in a non-random sample of 46 (out of 91 eligible) symptomatic HIV patients living in Hong Kong. QOL was moderate and the main concerns were related to the environmental aspects of QOL, spirituality and social relationships. Considerable mood disturbance was demonstrated in the sample, especially with regards to depression, fatigue and tension/anxiety. High levels of uncertainty in illness were also reported. A median split of the uncertainty score demonstrated that high uncertainty was related to lower levels of overall QOL (p = 0.04), higher psychological dysfunction (p = 0.05), worse adjustment with the environment (p < 0.001) and higher mood disturbance (p = 0.008). The sample predominantly used internal coping, which also correlated well with higher QOL scores. Through regression analysis it was shown that QOL could be predicted with the combined effects of uncertainty in illness and fatigue (adjusted R2 = 0.51, p < 0.001). Findings indicate that efforts should be directed towards improving QOL issues in the Chinese HIV patients and interventions could be introduced to alleviate those factors that were found to affect QOL. It is suggested that such interventions may include group or individual psychological therapies, management of fatigue and teaching patients more effective coping techniques.     

Measurement of health-related quality of life in the national emphysema treatment trial

PURPOSES: To evaluate two generic and two disease-specific measures of health-related quality of life (QOL) using prerandomization data from the National Emphysema Treatment Trial (NETT). METHOD: The analyses used data collected from the 1,218 subjects who were randomized in the NETT. Patients completed evaluations before and after completion of the prerandomization phase of the NETT pulmonary rehabilitation program. Using data obtained prior to participation in the rehabilitation program, QOL measures were evaluated against physiologic and functional criteria using correlational analysis. The physiologic criteria included estimates of emphysema severity based on FEV(1) and measures of Pao(2) obtained with the subject at rest and breathing room air. Functional measures included the 6-min walk distance (6MWD), maximum work, and hospitalizations in the prior 3 months. RESULTS: Correlation coefficients between QOL measures ranged from -0.31 to 0.70. In comparison to normative samples, scores on general QOL measures were low, suggesting that the NETT participants were quite ill. All QOL measures were modestly but significantly correlated with FEV(1), maximum work, and 6MWD. Patients who had stayed overnight in a hospital in the prior 3 months reported lower QOL on average than those who had not been hospitalized. There were significant improvements for all QOL measures following the rehabilitation program, and improvements in QOL were correlated with improvements in 6MWD.Comment: The disease-specific and general QOL measures used in the NETT were correlated. Analyses suggested that these measures improved significantly following the rehabilitation phase of the NETT.     

The benefits of yoga for rheumatoid arthritis: results of a preliminary, structured 8-week program

The aim of this study was to measure the effects of a bi-weekly Raj yoga program on rheumatoid arthritis (RA) disease activity. Subjects were recruited from among RA patients in Dubai, United Arab Emirates by email invitations of the RA database. Demographic data, disease activity indices, health assessment questionnaire (HAQ), and quality of life (QOL) by SF-36 were documented at enrollment and after completion of 12 sessions of Raj yoga. A total of 47 patients were enrolled: 26 yoga and 21 controls. Baseline demographics were similar in both groups. Patients who underwent yoga had statistically significant improvements in DAS28 and HAQ, but not QOL. Our pilot study of 12 sessions of yoga for RA was able to demonstrate statistically significant improvements in RA disease parameters. We believe that a longer duration of treatment could result in more significant improvements.     

Exercise training improves overall physical fitness and quality of life in older women with coronary artery disease

BACKGROUND: Older women with coronary artery disease (CAD) have reduced peak aerobic power (Vo(2)peak), muscle strength, and quality of life (QOL). Exercise interventions that can improve Vo(2)peak and muscle strength may also result in an improvement in QOL. This study compared the effect of aerobic training (AT) or combined aerobic and strength training (COMT) on Vo(2)peak, distance walked in 6 min, upper- and lower-extremity maximal strength, and QOL in 18 women (age range, 60 to 80 years) with documented CAD. METHODS: After baseline testing, subjects were randomly assigned to AT (treadmill and cycle exercise, n = 9) or COMT (treadmill and cycle exercise plus upper- and lower-extremity strength training, n = 9), and each group exercised 3 d/wk for 8 weeks. RESULTS: Both AT and COMT resulted in a similar increase in Vo(2)peak, distance walked in 6 min, lower-extremity strength, and emotional and global QOL. COMT improved upper-extremity strength, and physical and social QOL, which was unchanged after AT. CONCLUSIONS: Older women with CAD should perform aerobic and strength training to attain optimal improvements in overall physical fitness and QOL.     

Do Men and Women with HIV Differ in Their Quality of Life? A Study from South India

This paper examined gender differences in Quality of Life (QOL) among people living with HIV/AIDS in South India using the locally validated version of the WHO Quality of Life Instrument for HIV (WHOQOL-HIV 120). Participants (N = 109) were men and women with HIV1 Clade C infection participating in a cohort study. There was no gender difference in CD4 counts or use of antiretroviral therapy. Of the 29 facets of QOL, men reported significantly higher QOL in the following facets-positive feeling, sexual activity, financial resources and transport, while women reported significantly higher QOL on the forgiveness and blame facet. Of the six domains of QOL, men reported better quality of life in the environmental domain while women had higher scores on the spirituality/religion and personal beliefs domain. Understanding these gender differences may provide potentially useful information for tailoring interventions to enhance QOL among people infected with HIV/AIDS.     

Improved treatment satisfaction and weight‐related quality of life with exenatide once weekly or twice daily1

Aims To assess treatment satisfaction and weight‐related quality of life (QOL) in subjects with Type 2 diabetes treated with exenatide once weekly (QW) or twice daily (BID). Methods In this 52‐week randomized, multi‐centre, open‐label study, 295 subjects managed with diet and exercise and/or oral glucose‐lowering medications received either exenatide QW or BID during weeks 1–30; thereafter, subjects receiving exenatide BID were switched to exenatide QW, with 258 total subjects receiving exenatide QW during weeks 30–52. Diabetes Treatment Satisfaction Questionnaire—status (DTSQ‐s) and Impact of Weight on Quality of Life—Lite (IWQOL‐Lite) were assessed at baseline and weeks 30 and 52. Mean group changes from baseline to week 30 were estimated by ancova ; changes from week 30 to week 52 were assessed by Student’s t‐test. Results Statistically significant improvements from baseline to week 30 were observed in both treatment groups for DTSQ‐s and IWQOL‐Lite measures, with significantly greater reduction in perceived frequency of hyperglycaemia and greater satisfaction with continuing treatment in the QW group compared with the BID group. Effect sizes for change in DTSQ‐s total scores were 0.84 QW, 0.64 BID; for IWQOL‐Lite: 0.96 QW, 0.82 BID. Treatment satisfaction and QOL improved significantly between weeks 30 and 52 for those switching from BID to QW. Occurrence of adverse events did not affect patients’ improvements in treatment satisfaction and QOL. Conclusions Patients treated with exenatide QW or BID experienced significant and clinically meaningful improvements in treatment satisfaction and QOL. Patients who switched from exenatide BID to exenatide QW administration reported further significant improvements.     

The relationship between disease activity and quality of life in systemic lupus erythematosus

OBJECTIVE: To determine the quality of life (QOL) in SLE patients and correlate it with disease activity. METHODS: Lupus patients fulfilling the ACR 1997 criteria for SLE were included in this cross-sectional study. Patients were administered the World Health Organization Quality of Life-Bref (WHOQOL-Bref) to assess their quality of life. Disease activity was measured using Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI). RESULTS: The study group comprised 73 lupus patients (70 females and three males) with mean age 35.22 +/- 11.15 yr and mean disease duration 5.62 +/- 5.14 yr. Mean Mex-SLEDAI score was 3.31 +/- 3.19. Higher disease activity scores were associated with lower QOL scores in the physical (P = 0.001) and psychological domains (P = 0.01) but showed no significant correlation with the domains of social and environmental QOL. Patients with clearly active and probably active disease showed significantly lower scores in the physical (P = 0.01) and psychological (P = 0.02) domains than patients with inactive disease. However, no significant difference was found in the domains of social and environmental QOL. Age or disease duration did not affect the QOL in any of the domains. CONCLUSIONS: Physical and psychological QOL are impaired to a larger extent in active lupus. However, social and environmental QOL do not correlate with the disease activity status in lupus patients.     

The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

Lymphedema is a chronic disorder which can adversely affect quality of life (QOL). The purpose of this study was 1) to evaluate whether QOL was improved in patients with lymphedema following Complete Decongestive Therapy (CDT), and 2) whether limb volume change as a result of treatment correlated with change in QOL. Thirty-six patients with peripheral lymphedema from varying causes were enrolled in the study. The QOL of each participant, with regard to physical, functional, and psychosocial concerns, was measured by pre- and post-treatment questionnaires. Percent edema volume reduction was calculated for each patient with only one affected limb. QOL pre- and post-treatment scores were assessed by multivariate repeated measures analysis. QOL scores differed significantly (p<0.05) between pre- and posttreatment in all areas of inquiry. Patients with lower extremity lymphedema had significantly greater mean improvement in QOL scores compared with patients with upper extremity lymphedema (p=0.02). There was no correlation between percent edema volume reduction and post-treatment QOL improvement. This study suggests that significant improvements are made in the QOL of patients exhibiting peripheral lymphedema following CDT, which is not necessarily correlated with limb volume reduction.     

Quality of life in older patients with atrial fibrillation

This review summarizes what is known about quality of life (QOL) in older patients with atrial fibrillation (AF). The studies reviewed in this paper represent an increasingly broad repertoire of therapies for the treatment of AF and suggest that QOL in older patients does improve with treatment. The most dramatic improvements in QOL are noted in patients who are highly symptomatic and have poorer QOL at baseline. The data from studies where ablation and pacing therapy is used for treatment in patients with refractory AF vividly demonstrate this statement. There is also evidence of improvement in QOL in those with less severe symptoms, though it is extremely challenging to measure improvements in older patients who are asymptomatic (e.g., silent AF) or mildly symptomatic. Recommendations about new knowledge needed to optimize outcomes, particularly QOL, in patients with AF are based on these findings and the gaps in existing knowledge.     

Quality of life after liver transplantation. A systematic review

BACKGROUND/AIMS: Although many studies have reported significant improvements in quality of life (QOL) after liver transplantation (LT), consistent data on areas of improvement are lacking. To perform a systematic review on medical literature of QOL after LT paying particular attention to studies that utilized the most commonly adopted study instrument, Short Form-36 (SF-36). METHODS: To collect studies focused on QOL in adult LT recipients, from 1963 to 2007, cited in Pub Med, Embase or Cochrane databases. From an initial identification of 613 articles, we selected 44 longitudinal studies with pre- and post-LT data that we assessed using a sign test, and 19 used SF-36, which we analyzed separately. RESULTS: Longitudinal data showed remarkable improvement of common domains of QOL comparing pre- and post-transplant items. However, analysis of 16 SF-36 cross-sectional studies comparing post-LT patient domains with control population showed significantly higher ratings for controls in six while no differences were found in two. CONCLUSIONS: This review suggests that whereas general QOL improves after LT, when compared with healthy controls, LT recipients have significant deficits in QOL. Consequently, the previously reported QOL benefits after LT may have been overstated.     

The impact of contingency management on quality of life among cocaine abusers with and without alcohol dependence

The use of quality of life (QOL) measures in substance abuse treatment research is important because it may lead to a broader understanding of patients’ health status and effects of interventions. Despite the high rates of comorbid cocaine and alcohol use disorders, little is known about the QOL of this population, and even less about the impact of an efficacious behavioral treatment, contingency management (CM), on QOL. In this study, data from three clinical trials were retrospectively analyzed to examine QOL in outpatient cocaine abusers with and without alcohol dependence (AD) and the impact of CM on QOL over time as a function of AD status. Patients were randomized to standard care (n = 115) or standard care plus CM (n = 278) for 12 weeks. QOL was assessed at baseline and Months 1, 3, 6, and 9. At treatment initiation, AD patients had lower QOL total scores and they scored lower on several subscale scores than those without AD. CM treatment was associated with improvement in QOL regardless of AD status. These data suggest that CM produces benefits that go beyond substance abuse outcomes, and they support the use of QOL indexes to capture information related to treatment outcomes. (Am J Addict 2011;21:47–54)     

Improvements in quality of life and functional status in patients with psoriatic arthritis receiving anti–tumor necrosis factor therapies

Objective

To evaluate the impact of anti–tumor necrosis factor (anti‐TNF) therapies on quality of life (QOL) and functional status in psoriatic arthritis (PsA) patients and study potential predictors for QOL improvements.

Methods

The study was based on a cohort of 596 PsA patients receiving anti‐TNF therapies. Changes in functional status and QOL were assessed using the Health Assessment Questionnaire (HAQ) and Short Form 36 (SF‐36) questionnaire on a 6‐month basis. The Short Form 6D (SF‐6D) was calculated as a utility score. Univariate and multivariate linear regression models were developed to examine potential predictors of QOL improvements at 6 months, using a range of demographic, baseline disease‐specific, and therapeutic variables.

Results

At 6 months, significant improvements in all SF‐36 subscale scores were found, with the greatest percentage improvement from baseline related to physical role (113.8%; 95% confidence interval [95% CI] 102.6, 125.0). The percent improvement for the physical component scale was 53.2% (95% CI 44.5, 61.9) at 6 months, whereas that for the mental component scale was 16.9% (95% CI 14.7, 19.2). The mean ± SD SF‐6D score was 0.58 ± 0.07 at baseline, and this improved to 0.63 ± 0.06 at 6 months. The median HAQ score at baseline was 1.88 (interquartile range [IQR] 1.38–2.25) for the entire cohort, and this improved to 1.25 (IQR 0.63–1.88) at 6 months. Improvements in Disease Activity Score in 28 joints at 6 months were found to be significantly associated with QOL improvements at the same time point.

Conclusion

Anti‐TNF therapy is associated with improvement in both physical and mental status in PsA patients. These improvements were most substantial in patients who also had improvements in their disease activity.     

Changes over time in older dialysis patients' self-assessed quality of life

Followup interviews were conducted after three years with 127 older dialysis patients whose treatment modality was unchanged. The mean age of black patients was 70; the mean age of white patients was 72. A significant race difference in reported change in quality of life (QOL) was found for only one variable; white patients, but not black patients, felt they were not taking care of their health as well at Time 2 as at Time 1. For the total sample of patients who were reinterviewed, significant change in QOL responses was found for 9 measures. Vascular access problems were reported significantly less often at Time 2 by hemodialysis patients. Physical complaints related to ESRD and dialysis, use of assist devices, functional impairment, exercise involvement, number of leisure activities, perceived control over future health, depressive symptoms, and mood state responses at Time 2 indicated decline in QOL self-assessments. For the majority of QOL measures that were investigated, including overall life satisfaction, no significant change was found. A clinical challenge is to identify interventions that effectively target areas in which older dialysis patients are at risk for declining QOL over time.     

A national interactive web-based physical activity intervention in women, evaluation of the american heart association choose to move program 2006-2007

Increased physical activity (PA) is associated with improvement of cardiac risk factors and prevention of cardiovascular disease, yet many women remain sedentary. With rising Internet use, Web-based interventions provide an alternative to improve PA, but their effectiveness for change in PA and quality of life (QOL) in a real-world setting is unknown. Participants were United States women ≥18 years old who received 12 weekly PA modules and completed surveys on PA, QOL, and readiness for PA at registration (registration cohort, n = 3,796) or registration and 12 weeks (evaluation cohort, n = 892). QOL was assessed with a modified Short Form-36 with subscores for energy and well-being. Participants showed significant (p <0.001) favorable changes in PA (baseline, median 240 kcal/week, interquartile range 62 to 667; 12 weeks, 343 kcal/week, 131 to 828), stage of readiness for PA, and body mass index (baseline, 29.3 kg/m(2), 24.9 to 34.7; 12 weeks, 28.9 kg/m(2), 24.6 to 34.2). Significant improvements (p <0.0001) were also found in composite scores for energy and well-being. Compliance with PA guideline recommendations increased from 15.8% to 21.4%. Program weeks completed (p = 0.03), energy (p = 0.04), and well-being (p = 0.002) were significantly associated with achieving guideline compliance. In women reporting no PA at baseline (n = 88), program participation resulted in 54.6% achieving some PA and another 9.1% achieving total compliance with recommendations. In conclusion, in this national cohort of women, a 12-week Web-based intervention improved PA and QOL measurements, resulting in higher short-term PA guideline compliance and better QOL. Increasing use of this simple Web-based tool could improve PA and promote disease prevention.