Responsiveness and Minimal Clinically Important Differences after Cholecystectomy: GIQLI Versus SF-36

Introduction  To compare responsiveness and minimal clinically important differences (MCID) between the Gastrointestinal Quality of Life (GIQLI) and the Short Form 36 (SF-36), we prospectively analyze 159 patients undergoing cholecystectomy at two tertiary academic hospitals. Patients and Methods  All patients completed the disease-specific GIQLI and the generic SF-36 before and 3 months after surgery. Scores using these instruments were interpreted by generalized estimating equation before and after cholecystectomy. The bootstrap estimation was used to derive 95% confidence intervals for differences in the responsiveness estimates. Results and Discussion  Mean changes in all GIQLI and the SF-36 subscales were statistically significant (p < 0.05). Comparisons of effect size (ES), standardized response means (SRM), and relative efficiency (>1) indicated that the responsiveness of the GIQLI was superior to that of the SF-36. In the equivalence test, all lower or upper confidence limits presented no equivalence (>5), indicating good MCID. The ES and SRM for emotions and physical function in the GIQLI significantly differed from those of the SF-36 (p < 0.05). Conclusion  The data in this study indicate that clinicians and health researchers should weight disease-specific measures more heavily than generic measures when evaluating treatment outcomes.     

Preoperative Binge Eating Status and Gastric Bypass Surgery: A Long-Term Outcome Study

Background  The primary purpose of the study was to evaluate the effect of preoperative binge status on long-term weight loss outcomes. Methods  IRB approval was obtained. This prospective study was initiated in 1997 at a large teaching hospital. Adult patients who participated in the study and attended post-surgery clinic visits for at least 12 months were included. Patients completed the gormally binge eating scale (BES), the beck depression inventory (BDI), and the SF-36 at baseline prior to surgery. All data are expressed as mean ± SD. Data were analyzed using a Student’s t test, pairwise correlation and regression analysis as appropriate. Results  A total of 157 patients (135 women) aged 45 ± 10  years were recruited. Their preoperative BMI was 50.7 ± 8.0  kg/m². Thirty-seven patients were classified as severe binge eaters (BES ≥ 27) prior to surgery. There was no significant difference in their weight loss compared to the rest of the group at any time point up to 6 years after surgery. Patients with significant depressive symptoms (BDI >13) had no significant difference in their weight loss outcomes compared to the rest of the group. Pre-surgery SF-36 scores did not predict differences in weight loss outcome. Conclusion  Pre-surgical binge status, incidence of depressive symptoms and health related quality of life were not predictive of poor weight loss outcomes in patients up to 6 years after gastric bypass surgery, who were able to make lifestyle changes in preparation for surgery and who adhered to scheduled post surgery clinic visits.     

Assessing patient-reported outcomes of cholecystectomy in short-stay surgery

Background  The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy. Methods  In two centers for short-stay surgery, patients referred for laparoscopic cholecystectomy were surveyed between Aug 1999 and Jan 2002. Patients reported on health-related quality of life (SF-36), symptoms (gallstone symptom checklist, GSCL) and other indicators preoperatively (T0), 14 days (T1) and 6 months postoperatively (T2). The SF-36 subscales physical functioning, bodily pain, and role physical as well as the GSCL and treatment satisfaction at T2 were considered as main outcomes. The main outcomes were analyzed by generalized linear models with regard to predictors. Results  At T0 a total of 205 patients were included. The response rate at T2 was 63.4% (74.6% females, 53.6 years of age). The GSCL score at T0 (29.4% preoperatively) fell slightly to 27.9% at T1 and decreased to 14.8% at T2 (T0–T2: p < 0.001). The SF-36 subscales showed a different course over time (decrease of health-related quality of life at T1 and large increase at T2). The level of satisfaction with the outcome of cholecystectomy was 82.3%. The patient-reported outcomes were mainly influenced by the preoperative level, age and self-reported postoperative complaints. Conclusion  The low response rate was mainly due to nondelivery of questionnaires at T1 during the regular postoperative visit by the operating physician. Though nonresponse occurs under conditions of routine care, meaningful information was gained, which should be used for quality improvement activities. Because the preoperative level is a major determinant of the postoperative health outcomes, the prospective pre–post measurement should be preferred if institutional comparisons are intended.     

Influence of Activity on Quality of Life Scores After RYGBP

Gastric bypass is one of the medically acceptable interventions for weight loss for the obese. Quality of life greatly improves after surgery. Most improvements in quality of life (QOL) after these surgeries are attributed to the weight loss. Few studies have demonstrated any contribution of other variables to positive outcomes in QOL. The purpose of this study was to suggest variables that improve QOL in this post-surgical population. The Arizona Activity Frequency Questionnaire, the Arizona Food Frequency Questionnaire, and the SF-36 survey were sent to all of the Roux-en-Y gastric bypass procedure (RYGBP) patients who had surgery 1–5 years prior to the study and performed through the same bariatric surgery center (n = 805; respondents = 265; 33%). Analysis was performed through ANOVA testing to determine relationships between selected behaviors and the SF-36 of the respondents. Comparisons of differences in SF-36 scores were analyzed using the variables of hours of activity/day (HOAD) and energy in activity/day (EEAD). Patients with more EEAD and HOAD demonstrated significantly better SF-36 scores in both mental component and physical component scores (p = 0.05) when compared to those with less EEAD or HOAD. Outcomes measured by the SF-36 tool were improved after RYGBP, if the patient expended more energy/day or was active more hours/day. The post-bariatric surgery populations will have improved QOL if the patients expend more energy and are active more hours as demonstrated in activity/day after their surgery.     

Recurrence and Quality of Life Following Perineal Proctectomy for Rectal Prolapse

Background  Surgical outcome and quality of life (QOL) following perineal proctectomy for rectal prolapse remain poorly documented. Methods  From 1994 to 2004, patients with full-thickness rectal prolapse were treated exclusively with perineal proctectomy independent of age or comorbidities. Subjective patient assessments and recurrences were determined retrospectively from hospital and clinic records. Consenting patients completed the gastrointestinal quality of life index (GIQLI). Results  Perineal proctectomy was performed in 103 consecutive patients with a median age of 75 years (range 30–94). Most patients underwent concurrent levatorplasty (anterior 85.8%, posterior 67.9%). Durable results were obtained in all patients; the recurrence rate was 8.5% over a mean follow-up of 36 months. Preoperatively, 75.5% of patients reported fecal incontinence, and 32.1% had obstructed defecation. Incontinence significantly improved post-proctectomy (41.5%, p < 0.001), as did constipation (10.4%, p < 0.001). GIQLI respondents reported satisfaction following proctectomy with 63% scoring within one standard deviation of healthy controls. Patients with recurrent prolapse reported a lower QOL. Risk factors for recurrence included duration of prolapse, need for posterior levatorplasty, and prior anorectal surgery. Conclusions  Perineal proctectomy provides significant relief from fecal incontinence and obstructive symptoms caused by rectal prolapse, with an acceptable recurrence rate and low morbidity. This study was supported exclusively using institutional funding.     

Health-related quality of life after total hip replacement: a Taiwan study

This study applied the generalised estimating equations (GEE) in a large-scale prospective cohort study of predictors of health-related quality of life (HRQoL) in a Taiwan population. The study population included all patients who had undergone primary total hip replacement (THR) performed between March 1998 and December 2002 by either of two orthopaedic surgeons in two hospitals. The SF-36 was used in pre- and postoperative assessments of 335 patients. Young age, male gender, minimal comorbidity, use of epidural anaesthesia, lack of readmission within the previous 30 days, and higher preoperative functional status were positively associated with HRQoL (P < 0.05). Patients should be advised that their postoperative HRQoL may depend not only on their postoperative health care but also on their preoperative functional status. These analytical results should be applicable to other Taiwan hospitals and to other countries with similar social and cultural practices.     

Changes in Quality of Life After Balloon Treatment Followed by Gastric Banding in Severely Obese Patients—The Use of Two Different Quality of Life Questionnaires

Background  Improvements in quality of life (QOL) obtained by weight loss have mainly been reported after bariatric surgery. QOL has not been investigated in surgical patients first losing weight by nonsurgical means followed by a surgical intervention and never simultaneously by two QOL—a generic and a disease-specific—questionnaires. Methods  Prospective data were obtained from 40 consecutive patients (mean age 36.6 years, body weight 142.4 kg, body mass index (BMI) 46.5 kg/m²). Two different QOL questionnaires, the generic Medical Outcomes Study Short Form-36 (SF-36) and the disease-specific Health-Related Quality of Life (HRQL) questionnaire, were evaluated at three points in time: at the start, 3 months after the placement of an intragastric balloon that remained in situ for 6 months, and 3 months after subsequent gastric banding. Results  QOL scores revealed a significant improvement in many health domains, with an earlier improvement with the disease-specific HRQL, whereas the generic QOL questionnaire lagged behind. However, in the end, the SF-36 caught up completely to normal-weight levels, whereas some scales of the HRQL remained below these levels. Work productivity and involvement in sports improved significantly. BMI declined significantly over time, but no correlation with SF-36 and HRQL score changes was found. Conclusion  The QOL improved substantially independent of changes in BMI. Because of the divergent outcomes of generic and disease-specific QOL questionnaires, prospective studies should examine the sensitivity to changes of both kinds of QOL questionnaires.     

An evaluation of quality of life of mothers of children with enuresis nocturna

The aim of this study was to evaluate the impact of enuresis nocturna on quality of life of the mothers. Mothers who have a child with monosymptomatic nocturnal enuresis (n = 28) and mothers who have a child without any health problems (n = 38) were enrolled in the study. Groups were in balance for background variables (child’s age, gender, and number of siblings; mother’s age, marital status, highest year of education completed, and occupation; presence of health insurance; and type of residence). Short-Form Health Survey (SF-36) Questionnaire, the Beck Depression Inventory (BDI), and Spielberg’s State-Trait Anxiety Inventory (STAI) were applied to all mothers. The mothers of children with enuresis had significantly lower quality-of-life scores in the SF-36 for the bodily pain (p = 0.015) and role emotional (p = 0.014) subscales. We observed significant difference between groups according to BDI; mean score was higher in mothers who have a child with enuresis nocturna (p = 0.017). There was no significant difference between groups according to the STAI. Significant differences according to bodily pain and role emotional subscales of SF-36, and the BDI scores, show that the mothers were negatively affected by having a child with monosymptomatic nocturnal enuresis.     

Prospective 6 Weeks Follow-up Post-cholecystectomy: The Predictive Value of Pre-Operative Symptoms

Objective  Many patients with symptomatic cholelithiasis report persisting symptoms after elective cholecystectomy. The current prospective follow-up study aims at the identification and valuation of risk factors for negative symptomatic outcome at 6 weeks. Methods  Consecutive patients (n = 183), age 18–65 years, indicated for elective cholecystectomy due to symptomatic cholelithiasis, completed a self-report questionnaire. At 6 weeks post-operatively, the same self-report questionnaires were completed (n = 129). Predictors of the persistence and emergence of biliary and dyspeptic symptoms at 6 weeks post-cholecystectomy were investigated using univariate and multivariate logistic regression. Results  At 6 weeks post-operatively, the report of post-operative biliary symptoms was independently predicted by pre-operative dyspeptic symptoms (OR = 6.60) and bad taste (OR = 3.55). Pre-operative flatulence was an independent predictor of the report of biliary and dyspeptic symptoms ((OR = 3.33) and (OR = 3.27), respectively) and persisting biliary symptoms (OR = 4.21). Predictors of symptomatic outcome were only identified in women, not in men. Conclusion  Patients with pre-operative dyspeptic symptoms, notably bad taste and flatulence, have an increased risk of negative post-cholecystectomy outcomes at 6 weeks. A symptom-specific approach should lead to optimalization of the indication of cholecystectomy and information of patients. Known risk factors for long-term outcomes might be valuable in female patients only.     

Bone health and deterioration in quality of life among participants from the Hertfordshire cohort study

Summary  

We utilised the Hertfordshire cohort study to examine relationships between bone density at baseline and SF-36 status 4 years later. We found deterioration in the mental health domain over follow-up in osteoporotic men (but not women) compared with other groups (relative rate ratio = 5.78, 95% confidence interval (CI) 1.78–19.2).     

Laparoscopic versus small-incision cholecystectomy: Health status in a blind randomised trial

BACKGROUND: Gallstones are a major cause of morbidity, and cholecystectomy is a commonly performed procedure. Minimal invasive procedures, laparoscopic cholecystectomy (LC) and small-incision cholecystectomy (SIC), have replaced the classical open cholecystectomy. No differences have been found in primary outcome measures between LC and SIC, therefore secondary outcome measures have to be considered to determine preferences. The aim of our study was to examine health status applying evidence-based guidelines in LC and SIC in a randomised trial. METHODS: Patients with symptomatic cholecystolithiasis were included in a blind randomised trial. Operative procedures, anaesthesia, analgesics and postoperative care were standardised in order to limit bias. Questionnaires were filled in preoperatively, the first day postoperatively, and at outpatients follow-up at 2, 6 and 12 weeks. In accordance with evidence-based guidelines, the generic short form (SF-36) and the disease-specific gastrointestinal quality-of-life index (GIQLI) questionnaires were used in addition to the body image questionnaire (BIQ). RESULTS: A total of 257 patients were randomised between LC (120) and SIC (137). Analyses were performed according to intention-to-treat (converted procedures included) and also distinguishing converted from minimal invasive (nonconverted) procedures. Questionnaires were obtained with a response rate varying from 87.5% preoperatively to 77.4% three months postoperatively. Except for two time-specific measurements in one SF-36 subscale, there were no differences between LC and SIC. There were significant differences in several subscales in all three questionnaires comparing minimal invasive versus converted procedures. CONCLUSIONS: Applying adequate methodological quality and evidence-based guidelines (by using SF-36 and GIQLI), there are no significant differences in health status between LC and SIC.     

Five-Year Survival in a Cohort of Hip Fracture Patients: The Predictive Role of Pre-fracture Health Status

The aim was to assess the outcome of surgery at 5 years after hip fracture. In this prospective study, we analyzed 5-year survival of a cohort of 105 hip fracture patients as a function of preoperative health. The main outcome measurements were the status of the patient, dead or alive, and the SF-36 of their pre-fracture status as recalled during their hospital stay. In the fifth year post-hospitalization 58 patients were alive. There was a significant association between the recall SF-36 general health score and being alive in the fifth year (P = 0.0004) and with survival in general (P = 0.0001). This and prior studies support the concept of stratifying hip fracture patients according to pre-fracture health status when assessing outcomes of fracture repair or other interventions. This study further demonstrates the utility of the SF-36 for this purpose.     

Mapping the Gastrointestinal Quality of Life Index to Short-Form 6D utility scores

Purpose

The Gastrointestinal Quality of Life Index (GIQLI) is a disease-specific quality of life instrument that is commonly used in gastrointestinal disorders. However, no preference weights, which are used to calculate quality-adjusted life years for cost-effectiveness analyses, for this instrument have been assigned. Therefore, the objective of this study was to develop a mapping function to derive utility scores for the GIQLI.

Methods

Patients undergoing elective laparoscopic cholecystectomy completed the short-form 6D (SF-6D), a preference-weighted utility measure, and the GIQLI at baseline and at 1 wk and 1 mo postoperatively. The responsiveness of the SF-6D to expected postoperative changes as well as the correlation between the SF-6D and the GIQLI was investigated. Ordinary least squares regression was performed to derive a mapping function using the baseline values, which was then validated using postoperative values. Adjusted r², mean absolute error, and root mean square error was used to determine model performance.

Results

A total of 50 patients were included in the study (mean age 51.1 [standard deviation 16.8], 28% male). The SF-6D and GIQLI domains were responsive to expected postoperative changes, and there was high correlation between the SF-6D and four of the five GIQLI domains (excluding treatment effects). The final mapping function explained 63% of the variance in the derivation sample but had relatively high mean absolute error (0.075 and 0.067 in the 1-wk and 1-mo samples, respectively) and adjusted root mean square error (13.1% and 12.0% in the 1-wk and 1-mo samples, respectively).

Conclusions

The GIQLI can be accurately mapped to SF-6D preference weights at the group level but may be too inexact at the individual level.     

Prospective analysis of health-related quality of life and clinical evaluations in patients with anterior cruciate ligament injury undergoing reconstruction

Introduction

This study aimed to evaluate the treatment outcome of patients with anterior cruciate ligament (ACL) injury using the patient-based quality of life (QOL) survey SF-36, and investigate the correlation with conventional objective assessment methods. Our hypothesis that SF-36 is a useful assessment method for QOL in patients with ACL injury, and this assessment clarifies the concord and the discord between doctor-based objective assessment.

Patients and methods

A prospective study was conducted on patients who underwent ligament reconstruction. Eighty-one patients with a mean age of 27.4?years were analyzed. Clinical evaluations comprising SF-36 survey, Lysholm scoring, and anterior tibial translation measurement were conducted before as well as after surgery. The changes over time and the correlation between these evaluation methods were analyzed.

Results

All SF-36 subscales were significantly improved after surgery. Regarding QOL of patients with ACL injury, the preoperative scores of all the subscales except vitality and mental health were lower than the national standard values, while the postoperative scores of all subclasses were not different from the national standards. A correlation was found between Lysholm score and all SF-36 subscale scores except general health before surgery, but a correlation was observed only with physical functioning, bodily pain and role emotional at 6?months after surgery, and with physical functioning, role physical, bodily pain and vitality at 12?months. No correlation between SF-36 scores and distance of anterior tibial translation was observed both before and after surgery.

Discussion

The QOL of patients with ACL injury as assessed by SF-36 improved significantly after reconstruction surgery. The mental health subscales of SF-36 correlate with Lysholm score before surgery suggesting that apart from the physical impairment, lowered mental health is also an important clinical issue in patients with ACL injury.     

Relief of Dysphagia after Laparoscopic Heller Myotomy Improves Long-Term Quality of Life

Background and Objective  Quality of life (QoL) is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect on the QoL along with their direct effect on the diseases they are targeting. The aim of the study was to assess the impact of residual dysphagia on QoL after laparoscopic Heller myotomy for achalasia. Methods  QoL was evaluated using the short-form-36 (SF-36) and postoperative dysphagia was assessed using a dysphagia score. The score (range 0–10) was calculated by combining the frequency of dysphagia (0=never, 1 = < 1 day/wk, 2 = 1 day/wk, 3 = 2–3 days/wk, 4 = 4–6 days/wk, 5=daily) with the severity (0=none, 1=very mild, 2=mild, 3=moderate, 4=moderately severe, 5=severe). Patients were classified in the Nonresponder group when their dysphagia score was in the upper quartile. Results  Questionnaires were mailed to 110 patients. The overall response rate was 91% with 100 patients (54 female) returning the questionnaires. The average follow-up was 3.3 years. There was a significative inverse correlation between dysphagia score and mental component (P = 0.0001) and total SF-36 (P = 0.001) scores. According to their postoperative dysphagia scores, 77 patients were assigned to the Responder Group and 23 patients to the Nonresponder Group. The two groups were similar in terms of age, gender, rate of fundoplication, and length of follow-up. Mental component and total SF-36 scores were significantly (P < 0.05) higher in the Responder group. Successful relief of dysphagia after Heller myotomy was associated with health-related quality of life scores that were 13 higher in Vitality (P < 0.05), 11 points higher in mental health (P < 0.05), and 12 points higher in General Health (P < 0.05). Overall patient satisfaction with surgical outcome was 92%, with only eight patients not satisfied with the surgery. Conclusion  Laparoscopic Heller myotomy offers excellent long-term relief of achalasia-related symptoms, namely dysphagia, and this was projected on a significant improvement in quality of life and patient satisfaction. Presented at the 47th annual meeting at Digestive Disease Week 2006     

Gastrointestinal symptoms in relation to quality of life after metabolic surgery in adolescents

BackgroundAdolescent obesity is associated with significant co-morbidities, including decreased quality of life (QOL). QOL improves after metabolic and bariatric surgery (MBS), but recent studies have demonstrated that certain gastrointestinal symptoms (GIS) worsen after surgery, including reflux symptoms, nausea, bloating, and diarrhea.ObjectiveThe aim of this study was to evaluate QOL and the effect of these symptoms on QOL after bariatric surgery.SettingFive academic centers that perform adolescent MBS in the United States.MethodsWe prospectively studied 228 adolescents undergoing MBS using the Teen-Longitudinal Assessment of Bariatric Surgery cohort. GIS and QOL scores were assessed before surgery, at 6 months, and yearly to 5 years after surgery. Analysis involved linear models examining QOL and the association between GIS and QOL adjusting for a priori determined covariates.ResultsAdjusting for body mass index change over time, the physical component score (PCS) of the Short Form-36 (SF-36) increased after surgery from 44.2 at baseline to 54.4 at 5 years (P < .0001). The mental component score did not significantly change over time. The SF-36 domains that showed the biggest increase after surgery were physical functioning, physical role functioning, and general health. The SF-36 PCS decreased significantly over time post surgery in those with GIS of reflux, nausea, and diarrhea but remained higher than baseline SF-36 PCS. There was no statistically significant change in mental component score or impact of weight on quality of life-KIDS scores in those with or without GIS.ConclusionQOL, specifically the SF-36 PCS, increases after MBS. Reflux symptoms, nausea, and diarrhea reduce the degree of improvement in QOL in adolescents after MBS. Patients should be monitored and treated for these symptoms to address this decreased QOL.     

Clinical impact of tamsulosin on generic and symptom-specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36-item Health Survey

AIM: To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. METHODS: A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. RESULTS: After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. CONCLUSIONS: Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.     

Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy

BACKGROUND: Few studies have assessed health-related quality of life (HRQoL) among patients undergoing cholecystectomy. This study aimed to determine clinical variables that predict changes in HRQoL following cholecystectomy. METHODS: This was a prospective study of consecutive patients undergoing elective cholecystectomy for gallstones in six hospitals. Patients were asked to complete two questionnaires-the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)-before and 3 months after cholecystectomy. Multivariate linear regression models were used to examine factors potentially contributing to changes in HRQoL. RESULTS: Patients with symptomatic cholelithiasis and low surgical risk experienced the highest HRQoL gains in several SF-36 and GIQLI domains, with significant improvements in physical function detected by both instruments, compared with asymptomatic individuals at high surgical risk. Patients with asymptomatic cholelithiasis or high surgical risk experienced least improvement. CONCLUSION: These data indicate that cholecystectomy is appropriate for patients with symptomatic cholelithiasis and low surgical risk. In terms of HRQoL, the risk to benefit ratio seems poor for patients with asymptomatic gallstones.     

The impact of lumbar scoliosis on pain, function and health-related quality of life in postmenopausal women

The impact of adult scoliosis on pain, function and health-related quality of life (QOL) has not been clearly defined. A population-based study using widely applied screening tools could better reflect the impact of adult scoliosis. In this study, a visual analog pain scale assessment (VAS) for lumbar and leg pain, an Oswestry disability index (ODI) and a standard version of the Medical Outcome Study Short Form-36 (SF-36) questionnaire were sent by mail to 261 women of age 50 years and older, consecutively evaluated with dual-energy radiograph absorptiometry (DXA) scan images. 138 patients (32 with lumbar curves 10° or bigger) returned the questionnaires. Differences in lumbar VAS, leg VAS, ODI and SF-36 values between groups of patients with curves <10°, 10°–19° and ≥20° were evaluated. Correlation analyses of the Cobb angle, age and body mass index (BMI) with VAS, ODI and SF-36 values, and multivariate regression analysis were performed. Patients with curves <10°, 10°–19° and ≥20° had no significant differences in lumbar or leg VAS, ODI or SF-36 values. ODI values correlated with age and BMI; SF-36 values correlated with BMI only; lumbar and leg VAS values did not correlate with lumbar curvature, age or BMI. Regression disclosed that Cobb angle values did not influence ODI, SF-36 or VAS values. In postmenopausal women with mild and moderate lumbar curves, Cobb angle had no influence on pain, function and QOL; age and BMI had small effect.     

Measurement of Health-related Quality of Life with the Dutch Translated Aberdeen Varicose Vein Questionnaire before and after Treatment

ObjectiveThis clinical trial evaluated the use of the Dutch translated Aberdeen Varicose Vein Questionnaire (AVVQ) and SF-36 before and after treatment in patients with clinical-severity classes 1–6 venous disease of the lower limb.MethodsA total of 145 patients with symptomatic venous disease of the leg were included. Numbers of patients were evenly distributed among the six clinical-severity classes 1–6 (clinical, aetiology, anatomy and pathophysiology; CEAP). Patients completed two preoperative AVVQ questionnaires and one short-form health survey with 36 items (SF-36) questionnaire to evaluate test–re-test reliability of the AVVQ. Patients completed one postoperative AVVQ and SF-36 to evaluate the effect of treatment.ResultsThe test (99%) and re-test responses (97%) of the AVVQ were sufficient. Internal consistency of the Dutch translated AVVQ showed a Cronbach's α of 0.76. Correlation of test and re-test of the AVVQ was high (ρ = 0.86, P < 0.001). A significant negative association, by Spearman's correlation coefficient, was found between the preoperative baseline Dutch translated AVVQ score and all eight domains of the preoperative SF-36 (P < 0.001). These significant associations were also found in the postoperative scores.The mean preoperative AVVQ score of 19.5 (SD 11.8) and mean postoperative AVVQ score of 16.1 (SD 12.0) differed significantly (P < 0.01). Analysis of three subgroups of clinical-severity classes (C1–2, C3–4 and C5–6) showed significant score changes before and after surgery (P < 0.01). Preoperative and postoperative SF-36 scores were not significantly different.ConclusionsThis study established the use of the Dutch translated AVVQ as a valid, health-related quality of life (QOL) questionnaire for measuring QOL before and after treatment in patients with clinical-severity classes 1–6 venous disease of the leg.