Predicting EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L) Utilities from Older People's Quality of Life Brief Questionnaire (OPQoL-Brief) Scores

Individualized Care in Nursing Homes Before and After the COVID-19 Pandemic

Background: Individualizing care is the essence of nursing, and its benefits have been extensively proven in older people. The changes arisen during the COVID-19 pandemic may have affected it. The aim of this study is to analyze the changes produced in the perceptions about the individualization of care, quality of life, and care environment of elderly people living in long-term care centers before and after the pandemic. Methods: A prospective cross-sectional observational study was carried out. For data collection, the Individualized Care Scale-patient, the EuroQol-5D scale, and a reduced version of the Sheffield Care Environment Assessment Matrix test were used, and a statistical analysis was performed. Results: A total of 177 people participated in the study, with 87 pre-COVID-19 and 90 post-COVID-19, 62.7% of whom were women. The average age was 83.3 years. General activities of the individualized care obtained medians of 4, 2.5, and 3 (out of 5) in clinical situation, personal life situation, and decisional control dimensions, respectively, and no substantial change was observed pre- and post-pandemic. Nevertheless, 10 out of 17 items related with the maintenance of individuality in the last shift were higher rated after COVID-19. They are mainly related to the feelings and needs of care, daily life activities, and the expression of opinions. The median of all items was 3 despite the improvement observed after the pandemic. Residents scored an average of 6.47 points (out of 10) in the life quality self-evaluation and were satisfied with the care environment (94%). Patients with higher life quality and adherence to their environment perceived better care. Conclusions: Although slight improvements were observed in the individualized care after the pandemic, the obtained results revealed that there is still room for improvement. Particularly, it is necessary to develop strategies aimed at motivating the family participation or providing individual spaces in the residences.

Effects of a mobile health intervention based on a multitheoretical model of health behavior change on anxiety and depression, fear of cancer progression, and quality of life in patients with differentiated thyroid cancer: A randomized controlled trial

BACKGROUND

Despite the high cure rate of differentiated thyroid cancer (DTC), patients endure side effects from treatment and psychological distress, impacting their quality of life. The potential of mobile health (mHealth) interventions to address these issues remains unexplored. The purpose of this study is to develop an mHealth intervention based on the Multi-Theoretical Model of Health Behavior Change (MTM) and evaluate its impact on reducing anxiety, depression, fear of cancer progression, and enhancing quality of life in DTC patients.

METHODS

A single-blind, single-center, prospective, randomized controlled trial was conducted. One hundred and eleven consecutive DTC patients from Harbin Medical University's Fourth Hospital were enrolled from March 2023 to March 2024. Participants were randomized into a control group and an intervention group that received a 3-month mHealth intervention based on MTM theory. Outcomes were assessed using web-based questionnaires at baseline and conclusion.

RESULTS

One hundred four patients with DTC completed the study, with 7 lost to follow-up (6.3%). The intervention group experienced a significant drop in PHQ-4 scores post-MTM-mHealth intervention (P < .026), with no change in the control group, demonstrating a significant difference. The intervention group also had significantly lower anxiety (P < .015) and depression (P < .032) scores compared to controls. All PHQ-4 scores improved in the intervention group except for "Little interest or pleasure in doing things." Anxiety levels were significantly lower in the intervention group (P < .026) but remained unchanged in controls. The control group exhibited a significant increase in FCR-4 scores at follow-up, differing from the intervention group (P < 0.001). Quality of life scores did not differ at baseline but saw a significant improvement in the intervention group, while the control group experienced no significant change. The intervention group had higher VAS scores (P < .030) and greater health education satisfaction across all dimensions (P < .019).

CONCLUSIONS

The MTM-based mHealth intervention significantly benefits DTC patients by reducing anxiety, fear of cancer recurrence, and improving quality of life, though its effect on depression requires further investigation.

TRIAL REGISTRATION

China Clinical Trial Registry ChiCTR2200064321.

Impact of a mobile health intervention based on multi-theory model of health behavior change on self-management in patients with differentiated thyroid cancer: protocol for a randomized controlled trial

Introduction

Theoretical models of health behavior are important guides for disease prevention and detection, treatment and rehabilitation, and promotion and maintenance of physical and mental health, but there are no intervention studies related to differentiated thyroid cancer (DTC) that use theoretical models of health as a guide. In this study, we used a microblogging platform as an intervention vehicle and mobile patient-doctor interactive health education as a means of intervention, with the aim of improving the health behaviors of DTC patients as well as the corresponding clinical outcomes.

Methods

This research project is a quantitative methodological study, and the trial will be a single-blind, single-center randomized controlled trial conducted at the Fourth Hospital of Harbin Medical University in Harbin, Heilongjiang Province. The study subjects are patients over 18 years of age with differentiated thyroid cancer who were given radioactive iodine-131 therapy as well as endocrine therapy after radical surgery for thyroid cancer. The intervention group will receive MTM-mhealth, and the realization of health education will rely on the smart terminal WeChat platform. Routine discharge education will be given to the control group at discharge. The primary outcome will be change in thyroid-stimulating hormone (TSH) from baseline and at 3 and 6 months of follow-up, and secondary outcomes will include change in self-management behavior, social cognitive and psychological, and metabolic control.

Discussion

This study will explore a feasible mHealth intervention program applied to a population of DTC patients using the Multi-theory model of health behavior change (MTM) as a guide, with the aim of evaluating the MTM-based intervention program for clinical outcome improvement in DTC patients, as well as determining the effectiveness of the MTM-based intervention program in improving self-management skills in DTC patients. The results of this study will indicate the feasibility as well as the effectiveness of the application of health theoretical modeling combined with mHealth applications in disease prognostic health management models, and provide policy recommendations and technological translations for the development of mobility-based health management applications in the field of health management.

Mapping Studies to Estimate Health-State Utilities From Nonpreference-Based Outcome Measures: A Systematic Review on How Repeated Measurements are Taken Into Account

OBJECTIVES

Mapping algorithms are developed using data sets containing patient responses to a preference-based questionnaire and another health-related quality-of-life questionnaire. When data sets include repeated measurements from the same individuals over time, the assumption of observations' independence, required by standard models, is violated, and standard errors are underestimated. This review aimed to identify how studies deal with methodological challenges of repeated measurements, provide an overview of practice to date, and potential implications for future work.

METHODS

We conducted a systematic literature search of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, specialized databases, and previous systematic reviews. A data template was used to extract, among others, start and target instruments if the data set(s) used for estimation and validation had repeated measurements per patient, used regression techniques, and which (if any) adjustments were made for repeated measurements.

RESULTS

We identified 278 publications developing at least 1 mapping algorithm. Of the 278 publications, 121 used a data set with repeated measurements, among which 92 used multiple time points for estimation, and 39 selected specific time points to have 1 observation per participant. A total of 36 studies did not account for repeated measurements. An adjustment was conducted using cluster-robust standard errors (21), random-effects models (30), generalized estimating equations (7), and other methods (7).

CONCLUSIONS

The inconsistent use of methods to account for interdependent observations in the literature indicates that mapping guidelines should include recommendations on how to deal with repeated measurements, and journals should update their guidelines accordingly.

Convergent and Discriminant Validity of the Barthel Index and the EQ-5D-3L When Used on Older People in a Rehabilitation Setting

This study compares the empirical performance of a commonly used functional-status measure, the Barthel Index (BI), to that of a widely used generic preference-based instrument, the EuroQoL-5-Dimensions 3 Level (EQ-5D-3L), in older people. Data from older people receiving rehabilitation services were used to test the validity of the BI and EQ-5D-3L. Convergent validity was investigated using Spearman’s correlation, exploratory factor analysis (EFA), scatter plots, Krippendorff’s alpha and modified Bland-Altman plots. Discriminant validity was examined using Kruskal Wallis tests, ceiling effects and EFA. A total of 1690 participants were included in the analysis. The BI total and EQ-5D-3L utility scores showed moderate correlation (r = 0.51; Krippendorff’s alpha = 0.52). Kendall’s Tau-B correlations between BI items and EQ-5D-3L dimensions measuring the same construct were weak to moderate (0.05 ≤ absolute r ≤ 0.54). In the EFA, some BI items cross-loaded onto the same factors as EQ-5D-3L dimensions, suggesting that the instruments were interrelated. The BI, however, focuses more on physical functioning, while the EQ-5D-3L measures broader wellbeing concepts. Both instruments showed good discriminant validity and would therefore be equally valuable for measuring subgroup differences. Researchers should consider using the BI in rehabilitation to capture more physical functioning-specific constructs not measured by the EQ-5D-3L.

Current Status of Research on the Mapping Function of Health Utility Values in the Asia Pacific Region: A Systematic Review

OBJECTIVES

This systematic review aimed to analyze the published studies on the use of the mapping method between generic scales and disease-specific scales as well as between 2 universal scales.

METHODS

A systematic literature search was conducted using PubMed, ScienceDirect, Web of Science, CNKI, Weipa Database, Wanfang Database, and HERC Database to collect articles about the application of the mapping method to the measurement of health utility value from January 2000 to December 2019.

RESULTS

Overall, 59 articles met the inclusion requirements, and most of them were a mapping study between a disease-specific scale and a generic scale. Then all these articles were classified by the following study types: a clear functional relationship; unclear functional relationship; disease-specific scale and universality; mapping between generic scales and disease-specific scales, and mapping between universal scales. Most studies derived the best mapping model from the ordinary least squares regression, and fewer studies chose to use new regression methods. Sample sizes in the retrieved studies generally affected the reliability of the study results.

CONCLUSIONS

In recent years, as more attention has been paid to the research of the mapping method, a large number of problems have followed, such as the selection of scale types, the coverage of the study sample, and the selection of evaluation index of model performance and sample size. It is hoped that these problems can be properly solved in the future research.

Persian version of the brief Older People's Quality of Life questionnaire (OPQOL-brief): the evaluation of the psychometric properties

BACKGROUND AND OBJECTIVE

Quality of life (QoL) is a multi-dimensional concept and its assessment is one of important themes of care for older people. Assessing QoL in older people needs specific scales. The aim of this study was to culturally adapt and investigate the psychometric properties of the Persian version of brief Older People's Quality of Life questionnaire (OPQOL-brief) in an Iranian older population.

METHODS

This methodological cross-sectional study was conducted among 525 Persian-speaking older people (aged 60 and over), living in Isfahan, Iran. Translation of the OPQOL-brief questionnaire was performed using forward-backward method. Test-retest reliability was evaluated through Intra Class Correlation (ICC) coefficient and internal consistency by using Cronbach's α. Construct validity was investigated by using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Latent class analysis (LCA). Criterion, convergent and discriminant validities were also assessed.

RESULTS

Persian version of the OPQOL-brief showed good test-retest reliability (ICC = 0.842, 95% CI = 0.73-0.91; P < 0.001). Persian OPQOL-brief scale demonstrated high internal consistency (Cronbach's α = 0.83). It showed good discriminant validity and differentiated old patients from healthy older individuals (P < 0.001). Construct validity based on EFA led to extraction of three dimensions ("socioeconomic", "emotional", and "physical" well-being) and the CFA confirmed the adequacy of extracted construct from EFA (CFI = 0.909, PCFI = 0.52, PNFI = 0.5, CMIN/DF = 3.012, and RMSEA = 0.08). LCA classified participants into three classes in terms of QoL level (low (16%), middle (67%), and high (17%)). Criterion validity and convergent validity revealed significant positive correlations between OPQOL-brief and physical and psychological dimensions of the SF-36.

CONCLUSION

The Persian version of the OPQOL-brief is a reliable and valid instrument for assessing QoL with applicability in a broad range of older Persian language population.

Effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery

Background

To investigate the effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery

Methods

A total of 120 patients with lung cancer were randomly allocated into three groups: general anesthesia group (GAL group), thoracic paravertebral nerve block (TPVB) combined with general anesthesia (TPL group), and TPVB (with paravertebral dexmedetomidine) combined with general anesthesia group (TDL group); 120 patients with esophageal cancer were randomly allocated into three groups: general anesthesia group (GAE group), TPVB combined with general anesthesia group (TPE group), and thoracic epidural block combined with general anesthesia group (TEE group). Lung injury and immune function were evaluated. Hemodynamic changes, early recovery in post‐anesthesia care unit, pain, 6‐min walking test (6MWT), drug consumption, and life quality were also observed. The duration in the PACU of patients was retrospectively analyzed. The effect of dexmedetomidine on lung injury was established in vitro.

Results

The lung injury, including injury scores, apoptosis, and inflammation, were decreased in the TDL group compared with the GAL group and TPL group. The ratio of CD4⁺/CD8⁺ cells at the end of surgery was higher in the TPE group than in the GAE group. More stable hemodynamic was found in TPL group and TPE group. Acute pain was alleviated and the 6MWT was enhanced by TPVB with or without dexmedetomidine. Anesthetic consumption was decreased by thoracic nerve block.

Conclusions

Thoracic nerve block, especially TPVB with or without paravertebral dexmedetomidine, can enhance recovery after thoracic surgery. Protection against independent lung injury and cellular immune dysfunction may be a potential mechanism.

Mapping the Chinese Version of the EORTC QLQ-BR53 Onto the EQ-5D-5L and SF-6D Utility Scores

OBJECTIVE

This study aimed to develop mapping algorithms from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-BR53, including EORTC QLQ-C30 and QLQ-BR23) onto the 5-level EQ-5D (EQ-5D-5L) and Short Form 6D (SF-6D) utility scores.

METHODS

The data were taken from 607 breast cancer patients in mainland China. The EQ-5D-5L and SF-6D instruments were scored using Chinese-specific tariffs. Three model specifications and seven statistical techniques were used to derive mapping algorithms, including ordinary least squares (OLS), Tobit, censored least absolute deviation (CLAD) model, generalized linear model (GLM), robust MM-estimator, finite mixtures of beta regression model for directly estimating health utility, and using ordered logit regression (OLOGIT) to predict response levels. A five-fold cross-validation approach was conducted to test the generalizability of each model. Two key goodness-of-fit statistics (mean absolute error and mean squared error) and three secondary statistics were employed to choose the optimal models.

RESULTS

Participants had a mean ± standard deviation (SD) age of 49.0 ± 9.8 years. The mean ± SD health state utility scores were 0.828 ± 0.184 (EQ-5D-5L) and 0.646 ± 0.125 (SF-6D). Mapping performance was better when both the QLQ-C30 and QLQ-BR23 dimensions were considered rather than when either of these dimensions were used alone. The mapping functions from the optimal direct mapping and indirect mapping approaches were reported.

CONCLUSIONS

The algorithms reported in this paper enable EORTC QLQ-BR53 breast cancer data to be mapped into utilities predicted from the EQ-5D-5L and SF-6D. The algorithms allow for the calculation of quality-adjusted life years for use in breast cancer cost-effectiveness analyses studies.

An Updated Systematic Review of Studies Mapping (or Cross-Walking) Measures of Health-Related Quality of Life to Generic Preference-Based Measures to Generate Utility Values

BACKGROUND

Mapping is an increasingly common method used to predict instrument-specific preference-based health-state utility values (HSUVs) from data obtained from another health-related quality of life (HRQoL) measure. There have been several methodological developments in this area since a previous review up to 2007.

OBJECTIVE

To provide an updated review of all mapping studies that map from HRQoL measures to target generic preference-based measures (EQ-5D measures, SF-6D, HUI measures, QWB, AQoL measures, 15D/16D/17D, CHU-9D) published from January 2007 to October 2018.

DATA SOURCES

A systematic review of English language articles using a variety of approaches: searching electronic and utilities databases, citation searching, targeted journal and website searches.

STUDY SELECTION

Full papers of studies that mapped from one health measure to a target preference-based measure using formal statistical regression techniques.

DATA EXTRACTION

Undertaken by four authors using predefined data fields including measures, data used, econometric models and assessment of predictive ability.

RESULTS

There were 180 papers with 233 mapping functions in total. Mapping functions were generated to obtain EQ-5D-3L/EQ-5D-5L-EQ-5D-Y (n = 147), SF-6D (n = 45), AQoL-4D/AQoL-8D (n = 12), HUI2/HUI3 (n = 13), 15D (n = 8) CHU-9D (n = 4) and QWB-SA (n = 4) HSUVs. A large number of different regression methods were used with ordinary least squares (OLS) still being the most common approach (used ≥ 75% times within each preference-based measure). The majority of studies assessed the predictive ability of the mapping functions using mean absolute or root mean squared errors (n = 192, 82%), but this was lower when considering errors across different categories of severity (n = 92, 39%) and plots of predictions (n = 120, 52%).

CONCLUSIONS

The last 10 years has seen a substantial increase in the number of mapping studies and some evidence of advancement in methods with consideration of models beyond OLS and greater reporting of predictive ability of mapping functions.