Which instrument is more suitable to assess health-related quality of life: Nottingham Health Profile or Short-Form-36?

The association between pregnancy, pelvic girdle pain and health-related quality of life - a comparison of two instruments

Background

The main purposes in this cross-sectional study were to study the impact of pregnancy and pelvic girdle pain (PGP) on health related quality of life (HRQoL), by comparing the scores on different domains of two HRQoL instruments in pregnant women with population norms as well as in women with severe and less severe PGP. Further, to explore the association between PGP and HRQoL and whether the two instruments differ in the way they assess the influence of PGP on HRQoL.

Methods

Pregnant women in gestation week 30 completed questionnaires containing the Short Form Health Survey (SF-36) and the Nottingham Health Profile (NHP). Additional variables, self-reported PGP, pain location in the pelvis and response on clinical tests were also collected. HRQoL scores were compared with expected age adjusted mean scores and comparisons between groups with different severity of PGP were made, using Mann-Whitney U, t-tests and Hodges-Lehman method.

Results

Two hundred eighty-three pregnant women, mean age 31.3 (SD 4.2) years, participated. We found statistical significant differences in all domains of both HRQoL instruments in late pregnancy compared to the expected age-adjusted means of the reference populations (p ≤ 0.003) except for Social isolation (p = 0.775). Women with PGP had lower HRQoL than women without, and the most affected women scored lowest. SF-36 detected a deficit in Social Function compared to norms whereas the NHP showed no evidence of Social Isolation.

Conclusions

Both instruments revealed changes in HRQoL in pregnant women compared with population norms. Pregnancy itself influences HRQoL and having PGP gave an additional impact. The consistency of the correlations between SF-36 and NHP domains across the sub-groups found in this study suggests convergent validity across levels of impairment. The results in social domains vary between SF-36 and NHP in pregnant women and might be due to the basic design (construction) of the tools.

A telephone questionnaire in order to assess functional outcome after post-traumatic limb salvage surgery: Development and preliminary validation

BACKGROUND

Post-traumatic limb salvage surgery is challenging and evaluation of the results remains arduous. No questionnaire specifically assessing functional outcome after post-traumatic limb salvage surgery of the lower extremity exists. Due to regionalization of specialized care, the patients' travel time to the hospital increases. To overcome a higher patients' travel burden, patients' follow up by telephone is an option. We aimed to develop a telephone questionnaire in order to assess functional outcome after post-traumatic limb salvage surgery of the lower extremity.

METHODS

From a review of scores of functional assessment of the lower limb surgery, we have developed a telephone questionnaire. A prospective study was performed to validate this telephone questionnaire. Twenty patients were included. The participants were called to complete the telephone questionnaire twice with an interval of a week. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was completed during the second telephone call. The internal consistency was analyzed by the Cronbach's alpha (α). With the outcome scores of both completions, the test-retest reliability was analyzed by the interclass correlation coefficient (ICC) 2,k with a 95% confidence interval (95% CI). The outcome scores of the second telephone questionnaire and the WOMAC questionnaire were used for the construct validity analysis by the Spearman's rank correlation coefficient (r(s)) with a 95% CI.

RESULTS

The internal consistency analysis revealed a α=0.62 which improved to α=0.92 after removing one question from the telephone questionnaire. The final version of the telephone questionnaire comprises 32 questions, divided in 3 subscales: function, daily life and psychology. The total score varies between 0 and 86 points. The test-retest reliability was ICC 2,k=0.93 (95% CI: 0.82-0.97) and the construct validity was r(s)=0.92 (95% CI: 0.81-0.97).

CONCLUSIONS

We present a specific telephone questionnaire in order to assess functional outcomes after posttraumatic limb salvage surgery of the lower extremity. Further research on a large number of patients will be necessary to validate this newly developed questionnaire.

Assessment of quality of life in haemodialysis patients: a comparison of the Nottingham Health Profile and the Short Form 36

This study aimed to compare the psychometric properties of the Nottingham Health Profile (NHP) and the Medical Outcomes Study Short Form Health Survey (SF-36), which evaluates health-related quality of life in haemodialysis patients. Data were gathered using the NHP and the SF-36. Quality of life scores obtained from the NHP and the SF-36 were compared according to sociodemographic characteristics. It was found that the internal consistency values of the NHP and the SF-36 were similar. The floor effect of the two NHP subscales and the ceiling effect of all the NHP subscales were higher than those pertaining to the. It was observed that the NHP mean subscale scores were higher than those of the SF-36, except for one subscale of the SF-36. There was a significant positive correlation between the similar subscales of the NHP and the SF-36 and between the total scores. These results seem to support the utility of the NHP and the SF-36 in evaluating quality of life in haemodialysis patients.

Comparing health status in Belarus between 2001-10: a novel method using surveys with different response categories

BACKGROUND

Two population surveys were conducted in Belarus: The Living Conditions, Lifestyle and Health (LLH) in 2001 (n = 2000) and The Health in Times of Transition (HITT) in 2010 (n = 1800). Each survey included a question on health status. The LLH questionnaire provided a 4-point Verbal Response Scale, but the HITT questionnaire used a 5-point scale. When translated into Russian, only two response categories of these scales had identical wording. These differences made a direct comparison of self-reported health status between 2001 and 2010 difficult.

METHODS

We conducted a Health Category Response Scale (HCRS) survey in 2010 (n = 570) using a 100ths graduated Visual Analogue Scale (VAS) to understand how the response categories of different scales are perceived by Russian speakers. We implemented the HCRS survey's data to calculate the weighted health status (WHS) for each of the original surveys and to compare health status in Belarus between 2001and 2010.

RESULTS

The WHS in Belarus showed a small, but statistically significant, improvement of 2.9 points on a 0-100 scale between 2001 and 2010 (56.2 vs. 59.1). Identical response categories were perceived differently on a 4-point and 5-point VAS. The category 'good' ('Хорошее') measured ∼12 points higher, and the category 'bad/poor' ('Плохое') measured ∼16 points lower, on the 4-point compared with the 5-point VAS.

CONCLUSION

Our HCRS survey and novel method enabled a direct comparison of questions with different response options. When applied to the LLH and HITT projects, we concluded that health status in Belarus has improved between 2001 and 2010.

Lower-Limb Lymphedema and Vulval Cancer: Feasibility of Prophylactic Compression Garments and Validation of Leg Volume Measurement

Objectives:

Leg lymphedema remains a significant health problem after treatment of vulval cancer. This pilot study explored the feasibility of conducting a larger trial to investigate whether the early use of compression stockings is effective in preventing leg lymphedema.

Methods:

Fourteen patients undergoing inguinofemoral lymphadenectomy for vulval cancer were randomized to either best supportive care or best supportive care plus the use of graduated compression stockings for 6 months.

Results:

Six of 7 patients in the treatment group complied with the study protocol. The incidence of clinically significant lymphedema was not different between both groups; however, there was a greater increase in mean leg volume in the control group (953 vs 607 mL, P = 0.010). Furthermore, patients in the treatment group showed better performance as judged by leg symptoms (P = 0.031, at 3 months) and clinical examination (P = 0.039 at 4 weeks and P = 0.004 at 6 months). There was no difference in the incidence of groin wound dehiscence, infection, or lymphocyst formation. We detected no difference between both groups' scores when using a validated quality-of-life questionnaire. Intraobserver and interobserver variabilities of leg-volume measurement technique were investigated using the principles of repeatability and reproducibility statistics. Intraobserver variability was estimated at 270 mL, whereas interobserver variability was 1000 mL.

Conclusions:

The prophylactic use of stockings in this population is feasible, and further larger studies are justified to investigate its role in reducing the incidence of leg lymphedema. The design of these studies should take into account the observer-related variability in measuring leg volume or consider alternative methods.

Quality of life in patients receiving opioid maintenance therapy. A comparative study of slow-release morphine versus methadone treatment

BACKGROUND/AIMS

In recent years, quality of life (QoL) assessments have proved useful for evaluating and comparing drug treatment programs. To compare QoL of patients maintained on methadone versus slow-release morphine, a prospective, randomized, double-blind, double-dummy, cross-over study was conducted.

METHODS

Over two 7-week study phases, participants received either oral slow-release morphine capsules followed by methadone oral solution or vice versa. QoL status was assessed at baseline, week 7, and week 14 using the German version of the Lancashire Quality of Life Profile.

RESULTS

No statistically significant difference was found between methadone and slow-release morphine in any QoL domain. A significant time effect for nearly all QoL domains was observed after 14 weeks of opioid medication, independent of the chosen drug (general well-being, p < 0.001; mental health, p = 0.001; general state of health, p = 0.018; leisure time at home, p = 0.034; leisure time out of the home, p = 0.008). Furthermore, this study revealed that even short-term maintenance yields significantly higher QoL scores in the important domain of general well-being.

CONCLUSION

These results indicate that slow-release morphine has effects comparable to methadone on patient-reported QoL data and is thus a promising option for treatment of opioid-dependent subjects.

Rehabilitation des chronisch unspezifischen Kreuzschmerzes

In this study we documented the effectiveness of a 3-week multidisciplinary rehabilitative intervention in patients with chronic nonspecific low back pain. We compared the therapy group (136 patients: 91 female, 45 male) with a waiting list control group (34 patients: 25 female, 9 male). The patients showed chronic pain grades 1 and 2 (according to the Mainz Pain Staging System) and mild restriction of activity. Pain intensity, activity, participation, and health-related quality of life improved significantly in the intervention group (VAS from 46.34 to 25.91; FFbH-R from 19.79 to 18; PDI from 21.02 to 14.57; NHP from 161.83 to 120.97); the waiting list control group remained unchanged. The improvement was independent of age, gender, duration of disease, work status, or workplace satisfaction.