Patient-centered measures for achalasia |
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| Authors: | Julie L Harnish Gail E Darling Nicholas E Diamant Paul P Kortan George A Tomlinson Wayne Deitel Audrey Laporte David R Urbach |
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| Institution: | (1) Division of Clinical Decision Making, Toronto General Hospital Research Institute, 200 Elizabeth Street, 13-EN-232B, M5G 2C4 Toronto, Ontario, Canada;(2) Department of Surgery, University Health Network, Toronto, Ontario, Canada;(3) Department of Medicine, University Health Network, Toronto, Ontario, Canada;(4) Division of Gastroenterology, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada;(5) Department of Medical Imaging, St. Michael’s Hospital, Toronto, Ontario, Canada;(6) Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada |
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| Abstract: | Background Various instruments may be used to measure health-related quality of life in patients with achalasia.
Methods We administered four patient-centered measures used for evaluation of achalasia severity an achalasia severity questionnaire
we developed previously, an achalasia symptom checklist, the Gastrointestinal Quality-of-Life Index (GIQLI), and the Medical
Outcomes Study 36-item Short-Form survey (SF-36)] to 25 subjects enrolled in a randomized controlled trial comparing pneumatic
dilatation and laparoscopic Heller myotomy. We estimated correlations between the different measures.
Results Twenty-five patients (13 male, 12 female) were studied; 12 were treated by pneumatic dilatation and 13 by laparoscopic myotomy.
The average age of patients was 48.5 range 25–69, standard deviation (SD) 13.7] years. Baseline scores demonstrated a substantial
burden of impairment. The mean (SD) score on the achalasia severity measure ranges from 0 (best) to 100 (worst)] was 62.3
(13.4). The mean (SD) symptom checklist score ranges from 0 (best) to 36 (worst)] was 23.2 (6.6). The mean (SD) GIQLI ranges
from 0 (worst) to 144 (best)] was 77.04 (19.4). The SF-36 mean (SD) for the physical component score (PCS) was 45.29 (9.21)
and the mean for the mental component score (MCS) was 37.61 (14.97). The achalasia severity measure correlated highly with
the GIQLI (r = −0.57, p = 0.01), and the symptom checklist (r = 0.65, p = 0.004). The achalasia severity measure correlated well with the SF-36 PCS (r = −0.42, p = 0.039), but not with the MCS (r = −0.14, p = 0.501).
Conclusion Subjects recruited to a randomized controlled trial of achalasia treatment demonstrated impairment in both generic quality-of-life
and disease-specific measures. Scores on achalasia-specific measures correlated well with each other, but less well with measures
of generic quality-of-life and mental health scales. Because of the multidimensional nature of achalasia, disease-specific
measures should be combined with generic health measures for the best assessment of patient outcome. |
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| Keywords: | Achalasia Quality of life |
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