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Brands MR, Janssen EAM, Cnossen MH, Smit C, van Vulpen LFD, van der Valk PR, Eikenboom J, Heubel-Moenen FCJI, Hooimeijer L, Ypma P, Nieuwenhuizen L, Coppens M, Schols SEM, Laros-van Gorkom BAP, Leebeek FWG, Driessens MHE, Rosendaal FR, van der Bom JG, Fijnvandraat K, Gouw SC. Transition readiness among adolescents and young adults with haemophilia in the Netherlands: Nationwide questionnaire study. Haemophilia 2023; 29:1191-1201. [PMID: 37602825 DOI: 10.1111/hae.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Care for adolescents with haemophilia is transferred from paediatric to adult care around the age of 18 years. Transition programs help to prepare adolescents for this transfer and prevent declining treatment adherence. Evaluating transition readiness may identify areas for improvement. OBJECTIVE Assess transition readiness among Dutch adolescents and young adults with haemophilia, determine factors associated with transition readiness, and identify areas of improvement in transition programs. METHODS All Dutch adolescents and young adults aged 12-25 years with haemophilia were invited to participate in a nationwide questionnaire study. Transition readiness was assessed using multiple-choice questions and was defined as being ready or almost ready for transition. Potential factors associated with transition readiness were investigated, including: socio-demographic and disease-related factors, treatment adherence, health-related quality of life, and self-efficacy. RESULTS Data of 45 adolescents and 84 young adults with haemophilia (47% with severe haemophilia) were analyzed. Transition readiness increased with age, from 39% in 12-14 year-olds to 63% in 15-17 year-olds. Nearly all post-transition young adults (92%, 77/84) reported they were ready for transition. Transition readiness was associated with treatment adherence, as median VERITAS-Pro treatment adherence scores were worse in patients who were not ready (17, IQR 9-29), compared to those ready for transition (11, IQR 9-16). Potential improvements were identified: getting better acquainted with the adult treatment team prior to transition and information on managing healthcare costs. CONCLUSIONS Nearly all post-transition young adults reported they were ready for transition. Improvements were identified regarding team acquaintance and preparation for managing healthcare costs.
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Affiliation(s)
- Martijn R Brands
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Ebony A M Janssen
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Cees Smit
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lize F D van Vulpen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul R van der Valk
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Louise Hooimeijer
- Department of Pediatrics, University Medical Center Groningen, Groningen, the Netherlands
| | - Paula Ypma
- Department of Hematology, HagaZiekenhuis, The Hague, the Netherlands
| | | | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Nijmegen, the Netherlands
| | - Britta A P Laros-van Gorkom
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Nijmegen, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Kuijlaars IAR, van der Net J, van Vulpen LFD, Driessens MHE, Schols SEM, Tan M, Gouw SC, Fischer K. Validation of the pedHAL short and HAL short in Dutch children and adults with haemophilia. Haemophilia 2022; 28:1007-1015. [PMID: 35905309 PMCID: PMC9796045 DOI: 10.1111/hae.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The Haemophilia Activities List (HAL) and paediatric HAL assess self-reported limitations in various daily activities. To reduce patient burden, shorter versions of the pedHAL (22 items) and HAL (18 items) have been developed. AIM This study aimed to determine the agreement between the pedHAL/HALfull and pedHAL/HALshort and construct validity and internal consistency of the pedHAL/ HALshort in persons with haemophilia (PWH). METHODS A cross-sectional secondary analysis of the Hemophilia in the Netherlands-6 national survey was performed. Adult and paediatric PWH completed the original pedHAL/HALfull , from which pedHAL/ HALshort were derived. Score differences between the original and short versions were calculated. Construct validity was studied by testing hypotheses regarding the relationship of the pedHAL/HALshort with the pedHAL/HALfull , Haemophilia & Exercise Project Test-Questionnaire (HEP-Test-Q), Canadian Haemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) and RAND 36-item Health Survey (RAND-36) (convergent/discriminant validity) as well as its ability to discriminate between subgroups (known-group validity). Internal consistency was assessed with Cronbach's α. RESULTS We included 113 children (median 10y [range 4-17], 53% severe haemophilia) and 691 adults (median 51y [range 18-88], 35% severe). Scores of the pedHAL/HALfull and pedHAL/HALshort were similar with high correlations (>0.9). Construct validity was confirmed for the pedHAL/HALshort . The HALshort was able to discriminate between different disease severities and ages. Cronbach's α of the pedHAL/HALshort was 0.95-0.97. CONCLUSION This study confirmed the agreement between the pedHAL/HALfull and the pedHAL/HALshort and the construct validity of the pedHAL/HALshort . The next step is to study construct validity of the pedHAL/HALshort when administered as short forms.
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Affiliation(s)
- Isolde A. R. Kuijlaars
- Center for Benign HaematologyThrombosis and HaemostasisVan CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Janjaap van der Net
- Center for Child DevelopmentExercise and Physical LiteracyUniversity Medical Center UtrechtUtrecht UniversityUniversity Children's HospitalUtrechtthe Netherlands
| | - Lize F. D. van Vulpen
- Center for Benign HaematologyThrombosis and HaemostasisVan CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | | | - Saskia E. M. Schols
- Department of HaematologyRadboud University Medical CenterNijmegenthe Netherlands,Haemophilia Treatment Center Nijmegen‐Eindhoven‐MaastrichtRadboud University Medical CenterNijmegenthe Netherlands
| | - Melanie Tan
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamthe Netherlands
| | - Samantha C. Gouw
- Emma Children's HospitalAmsterdam UMCUniversity of AmsterdamPediatric HematologyAmsterdamthe Netherlands,Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Kathelijn Fischer
- Center for Benign HaematologyThrombosis and HaemostasisVan CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
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Qolami M, Mirzajani A, Ronda-Pérez E, Cantó-Sancho N, Seguí-Crespo M. Translation, cross-cultural adaptation and validation of the Computer Vision Syndrome Questionnaire into Persian (CVS-Q FA ©). Int Ophthalmol 2022; 42:3407-3420. [PMID: 35543851 PMCID: PMC9092937 DOI: 10.1007/s10792-022-02340-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
Purpose To translate, cross-culturally adapt and validate the Computer Vision Syndrome Questionnaire (CVS-Q©) into Persian. Methods This study was carried out in 2 phases: (1) the CVS-Q© was translated and cross-culturally adapted into Persian and (2) the validity and reliability of CVS-Q FA© were assessed in a cross-sectional validation study. An expert committee composed of 15 optometrists evaluated content validity (item-level (I-CVI) and scale-level (S-CVI) content validity index were calculated). A pretest was performed (n = 20 participants) to verify the comprehensibility of the questionnaire. A total of 102 computer users completed the final questionnaire. Criterion validity and diagnostic performance of the CVS-Q FA© were assessed by calculating sensitivity, specificity and receiver characteristic operator curve. Cronbach's alpha was calculated for the assessment of internal consistency and 46 participants refilled the questionnaire for the second time and the interclass correlation coefficient (ICC) and Cohen's kappa (κ) were evaluated for test–retest reliability. Results The translation and cross-cultural adaptation process was performed successfully according to accepted scientific recommendations without any major difficulties. The I-CVI was above 0.80 for all items (symptoms) except item 15 (feeling that sight is worsening) and the S-CVI was 0.92. The CVS-Q FA© showed good sensitivity (81.1%) and acceptable specificity (69.2%). Also, it achieved good internal consistency (Cronbach's alpha = 0.80) and test–retest reliability (ICC = 0.81 and κ = 0.65). Conclusion The CVS-Q FA© was successfully translated, cross-culturally adapted, and validated into Persian. This study provides a valid and reliable tool for the assessment of computer vision syndrome among the Iranian working population. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-022-02340-3.
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Affiliation(s)
- Milad Qolami
- Department of Optometry, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mirzajani
- Department of Optometry, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, San Vicente del Raspeig, Alicante, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Natalia Cantó-Sancho
- Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, Alicante, Spain.
| | - Mar Seguí-Crespo
- Public Health Research Group, University of Alicante, San Vicente del Raspeig, Alicante, Spain
- Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, Alicante, Spain
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Smyth M, Jacobson K. Pediatric Quality of Life Inventory TM version 4.0 short form generic core scale across pediatric populations review data. Data Brief 2021; 39:107599. [PMID: 34901340 PMCID: PMC8639391 DOI: 10.1016/j.dib.2021.107599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
The Pediatric Quality of Life InventoryTM Version 4.0 Short Form Generic Core Scale (PedsQLTM) is a validated and widely used tool assessing the quality of life (QoL) of children and youth. It has been used extensively across healthy populations as well as those with chronic and acute illnesses, allowing for comparison of the psychosocial impact of chronic illness between pediatric disease cohorts. As part of the QoL initiative undertaken at the British Columbia Children's Hospital (BCCH) Inflammatory Bowel Disease (IBD) program and published in the Journal of Pediatrics titled “Cross-Sectional Analysis of Quality of Life in Pediatric Patients with IBD in British Columbia, Canada,” a limited literature review was conducted using Embasse and Ovid. Studies using the English version of the PedsQLTM short form generic scale (not a disease specific scale) were identified. Studies with populations greater than 50 patients with robust subgroup sample size were included, with an emphasis on studies with well-defined patients with chronic disease. These data were compared to the BCCH population, as discussed in the aforementioned journal article. Analysis within the BCCH cohort is described separately. Comparison between different populations from the existing literature was qualitative only, with no statistical analysis done given the heterogeneity of populations and studies. In a study of patients from the emergency department at BCCH (n=178), the mean (SD) QoL scores of the healthy patients was 89.2 (10.3). In a group of self-identified healthy patients in California (n=5079), their mean QoL score was 83.9 (12.5). Separating the BCCH IBD population by disease activity, those in remission (n=220, 84.4 (12.8)) have similar QoL scores to these healthy cohorts, though their scores remain slightly below the previously published BCCH cohort. For children with any degree of active IBD (n=98, 75.6 (15.8)), their QoL scores are below the healthy means and are lower than other groups with self-identified “chronic illnesses” (n=367, 77.2 (15.5)), diabetes (n=418, 82.3 (13.5)), mild asthma (n=281, 85.5 (13.3)), or Canadian patients 4 weeks post-concussion (n=1157, 80.3). BCCH IBD patients with moderately to severely active disease have QoL scores well below the other disease groups (n=33, 63.1 (18.8)); lower than oncology patients on induction chemotherapy regimens (n=105, 68.9 (16.0)), acute inpatients (n=359, 63.9 (20.3)), and asthmatics with moderate-severe, persistent asthma (n=86, 67.1 (18.6)). This data is useful for clinicians treating pediatric patients looking at how QoL is influenced by chronic illness and by factors such as disease type and severity.
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Affiliation(s)
- Matthew Smyth
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital, University of British Columbia, British Columbia, Canada.,British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kevan Jacobson
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital, University of British Columbia, British Columbia, Canada.,British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Cross-Sectional Analysis of Quality of Life in Pediatric Patients with Inflammatory Bowel Disease in British Columbia, Canada. J Pediatr 2021; 238:57-65.e2. [PMID: 34293367 DOI: 10.1016/j.jpeds.2021.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate quality of life (QoL) in a large cohort of pediatric patients with inflammatory bowel disease (IBD) and to identify the clinical factors that influence QoL. STUDY DESIGN This cross-sectional study analyzes a quality improvement initiative in 351 pediatric patients with IBD in British Columbia, Canada using the self-reported Pediatric Quality of Life Inventory (PedsQL) 4.0 generic scale. The questionnaire was completed at outpatient clinic and biologic infusion appointments. Statistical analysis included the t test, ANOVA, and multilinear regressions to evaluate the relationships between clinical factors and QoL. RESULTS Mean (SE) QoL scores (79.95 [0.84]) fell between previously described healthy and chronically ill populations. Disease activity was the most significant predictor of QoL, with patients in remission scoring similar (84.42 [0.87]) to well established healthy norms, and those with moderately or severely active disease having some of the lowest published PedsQL scores (63.13 [3.27]), lower than most other chronic pediatric conditions. Twenty-five patients with moderately or severely active disease at the time of survey completion had follow-up surveys identified 1 year later and had a significant improvement of both their disease activity (P < .005) and their PedsQL scores (follow-up survey mean 76.13 [3.11]). Additional clinical factors independently associated with poor QoL were school nonattendance (15.5% decrease in QoL, P < .001), immune-modulator selection (methotrexate conferring a 9.5% lower mean QoL score than azathioprine, P = .005), and female gender (P = .031). CONCLUSION Pediatric patients with IBD experience a QoL significantly impacted by multiple clinical factors including current severity of IBD symptoms.
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Xu RH, Dong D, Luo N, Wong ELY, Wu Y, Yu S, Yang R, Liu J, Yuan H, Zhang S. Evaluating the psychometric properties of the EQ-5D-5L and SF-6D among patients with haemophilia. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:547-557. [PMID: 33761029 DOI: 10.1007/s10198-021-01273-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the psychometric properties of the EQ-5D-5L and SF-6D, and to compare their performance among patients living with haemophilia in China. METHODS A total of 875 Chinese patients completed the EQ-5D-5L, SF-6D, and Haem-A-QoL questionnaires. Construct validity of the EQ-5D-5L and SF-6D dimensions and indices was assessed by testing hypotheses relating these measures to Haem-A-QoL and clinical measures. The Spearman correlation coefficient was used to assess convergent validity, and one-way analysis of variance (F statistic) was used to assess the known-groups validity (discriminatory power). The agreement between EQ-5D-5L and SF-6D indices was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. RESULTS Both the EQ-5D-5L and SF-6D indices showed acceptable ceiling and floor effects. As hypothesised, both EQ-5D-5L and SF-6D were significantly correlated with Haem-A-QoL (both dimensions and overall score). EQ-5D-5L and SF-6D indices as well as EQ-VAS differentiated patients are known to differ in severity of haemophilia, bleeding status, disabling levels, and comorbidity. The F statistics in the known-groups comparisons suggested that the EQ-5D-5L was slightly more discriminative than the SF-6D. ICC (0.41) and Bland-Altman plot confirmed that the agreement between the EQ-5D-5L and SF-6D indices was poor. CONCLUSION Both EQ-5D-5L and SF-6D showed satisfactory construct validity in the measurement of the HRQoL among patients with haemophilia. However, the two instruments may not be used interchangeably in this patient population due to their poor agreement and differing discriminatory power.
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Affiliation(s)
- Richard Huan Xu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Dong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yushan Wu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siyue Yu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Renchi Yang
- Thrombosis and Hemostasis Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Junshuai Liu
- Beijing Society of Rare Disease Clinical Care and Accessibility, Beijing, China
| | - Huiqin Yuan
- Beijing Society of Rare Disease Clinical Care and Accessibility, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Kinahan JY, Graham JMI, Hébert YV, Sampson M, O'Hearn K, Klaassen RJ. Patient-reported Outcome Measures in Pediatric Non-Malignant Hematology: A Systematic Review. J Pediatr Hematol Oncol 2021; 43:121-134. [PMID: 33136776 DOI: 10.1097/mph.0000000000001984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Patient-reported outcome measures (PROMs) are questionnaires completed by patients or caregivers without influence by health care professionals. As such, PROMs show subjective health experiences, enhance the clinical information available to providers, and inform clinical action. The objective of this systematic review is to identify and list which validated PROMs have been used to monitor health-related quality of life in pediatric patients with nonmalignant hematology (hemophilia, immune thrombocytopenia, sickle cell disease, and thalassemia). Databases (MEDLINE, Embase, HaPI, CINAHL, and PsycTESTS) were searched to identify publications that validated or used PROMs as an outcome measure in the 4 disease groups. Overall, 209 articles met the inclusion criteria, identifying 113 PROMs. Of the 113 identified PROMs, 95 are generic and can be used in multiple disease groups. The Pediatric Quality of Life Generic Core Scales was the most frequently used generic PROM (68 studies). The 18 remaining PROMs were disease specific. The results of this review, together with the COSMIN tool for selecting outcome measures, will allow clinicians to evaluate the PROMs that are best suited to their patient population. In addition, the focus groups are currently being conducted with patients, parents, and clinicians to determine the optimal use of PROMs in the clinical environment.
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Affiliation(s)
- Julia Y Kinahan
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | - Johann M I Graham
- Children's Hospital of Eastern Ontario Research Institute
- Regional Hospital Center of Lanaudiere, Saint-Charles-Borromée
- Laval University, Quebec City, QC, Canada
| | - Yamilée V Hébert
- Children's Hospital of Eastern Ontario Research Institute
- University of Ottawa, Ottawa, ON
| | | | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute
| | - Robert J Klaassen
- Children's Hospital of Eastern Ontario Research Institute
- Division of Hematology/Oncology, Department of Pediatrics
- University of Ottawa, Ottawa, ON
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Price VE, Dover S, Blanchette VS, Klaassen RJ, Belletrutti M, Bruce AAK, Chan AK, Wakefield C, Carcao M, Bouskill V, Young NL. Updating the Canadian Hemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) in the era of extended half-life clotting factor concentrates. Res Pract Thromb Haemost 2021; 5:403-411. [PMID: 33870026 PMCID: PMC8035800 DOI: 10.1002/rth2.12498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The purpose of this study was to review and update the content of the Canadian Hemophilia Outcomes-Kids' Life Assessment Tool version 2.0 (CHO-KLAT), in the context of extended half-life (EHL) factor concentrates (FCs) and to establish the validity and reliability of the updated CHO-KLAT. METHODS Focus groups were conducted with boys with hemophilia, their parents, and health care providers across Canada to review the CHO-KLAT v2.0 and determine if any modifications were required. The validity of the revised CHO-KLAT (version 3.0) was then determined in a sample of boys with hemophilia and their parents by calculating its correlation with the Pediatric Quality of Life Core Module (PedsQL-Core). Test-retest reliability was assessed using an intraclass correlation coefficient (ICC). RESULTS Thirteen focus groups at 5 pediatric hemophilia treatment centers (HTCs) (n = 71) resulted in 19 changes to the CHO-KLAT v2.0, generating a revised 40-item CHO-KLAT, the CHO-KLAT v3.0. Thirty-five boys with hemophilia (median age, 14; range, 7-17 years) and 47 parents participated in the validation of the CHO-KLAT v3.0. There was a moderate correlation between the CHO-KLAT v3.0 child self-report and PedsQL-Core (r = 0.56, P = .01), and a strong correlation between the CHO-KLAT v3.0 parent-proxy and PedsQL-Core (r = .79, P = .0007). The test-retest reliability ICC was 0.90 for the child self-report CHO-KLAT v3.0 and 0.68 for the parent-proxy CHO-KLAT v3.0. CONCLUSION The CHO-KLAT v3.0 is a reliable and valid child-centric tool that effectively measures health-related quality of life in boys with hemophilia who are receiving standard half-life or EHL FCs.
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Affiliation(s)
- Victoria E. Price
- Department of PediatricsDivision of Pediatric Hematology/OncologyIWK Health CentreDalhousie UniversityHalifaxNSCanada
| | - Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
| | - Robert J. Klaassen
- Division of Pediatric Hematology/OncologyUniversity of OttawaChildren’s Hospital of Eastern OntarioOttawaONCanada
| | - Mark Belletrutti
- Department of PediatricsPediatric HematologyUniversity of AlbertaEdmontonABCanada
| | - Aisha A. K. Bruce
- Department of PediatricsPediatric HematologyUniversity of AlbertaEdmontonABCanada
| | - Anthony K. Chan
- Department of PediatricsMcMaster Children’s HospitalMcMaster UniversityHamiltonONCanada
| | - Cindy Wakefield
- Department of NursingThe Hospital for Sick ChildrenTorontoONCanada
| | - Manuel Carcao
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
| | - Vanessa Bouskill
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of NursingThe Hospital for Sick ChildrenTorontoONCanada
| | - Nancy L. Young
- Child Health Evaluative SciencesThe Hospital for Sick Children Research InstituteTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- School of Rural and Northern HealthLaurentian UniversitySudburyONCanada
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Zhao Y, Hu Y, Jin J, Zhao X, Wang X, Wu R, Wu D, Yang R, Yang F, Hu Q, Wang J, Fang H, Engl W. Phase 4 Safety and Efficacy Study of Antihemophilic Factor (Recombinant) in Previously Treated Chinese Patients With Severe/Moderately Severe Hemophilia A. Clin Appl Thromb Hemost 2021; 27:1076029621989811. [PMID: 33587652 PMCID: PMC7890741 DOI: 10.1177/1076029621989811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Antihemophilic factor (recombinant) (rAHF; ADVATE®; Baxalta US Inc., a Takeda company, Lexington, MA, USA) is indicated for the treatment and prevention of bleeding in patients with hemophilia A. We aimed to assess the safety and efficacy of standard prophylaxis versus on-demand treatment with rAHF in previously treated Chinese patients with severe/moderately severe hemophilia A. This open-label, sequential, interventional, postapproval study (NCT02170402) conducted in China included patients of any age with hemophilia A with factor VIII (FVIII) level ≤2%. Patients received 6 months’ on-demand rAHF then 6 months’ rAHF prophylaxis (20-40 IU/kg every 48 ± 6 hours). The primary objective was percentage reduction in annualized bleeding rate (ABR) in the per-protocol analysis set (PPAS); secondary objectives included ABR by bleeding subtype, hemostatic efficacy, immunogenicity, and safety. Of 72 patients who received ≥1 rAHF dose, 61 were included in the PPAS. Total ABR was lower during prophylaxis (mean 2.5, 95% CI 1.5-3.7; median 0) versus on-demand treatment (mean 58.3, 95% CI 52.5-64.7; median 53.9), representing a 95.9% risk reduction. Similar findings in favor of prophylaxis were observed for all types of bleeding event by cause and location. rAHF hemostatic efficacy was rated as “excellent”/“good” in 96.1% of treated bleeding events. Transient FVIII inhibitors (0.6-1.7 BU) in 4 patients resolved before study end; no unexpected safety issues were observed. rAHF prophylaxis in this study of previously treated Chinese patients with severe/moderately severe hemophilia A resulted in a clear reduction in bleeding events versus rAHF on-demand treatment, with no change in safety profile.
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Affiliation(s)
| | - Yu Hu
- Union Hospital, 66375Tongji Medical College of Huazhong, Wuhan, China
| | - Jie Jin
- The First Affiliated Hospital of College of Medicine, 12377Zhejiang University, Hangzhou, China
| | - Xielan Zhao
- 159374Xiangya Hospital, Central South University, Changsha, China
| | - Xuefeng Wang
- 162762Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runhui Wu
- 117984Beijing Children's Hospital, Capital University of Medical Sciences, Beijing, China
| | - Depei Wu
- 74566The First Affiliated Hospital of Soochow University, Soochow, China
| | - Renchi Yang
- Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Feng'e Yang
- 117890Fujian Medical University Union Hospital, Fuzhou, China
| | - Qun Hu
- 66375Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Juan Wang
- Cangzhou Central Hospital, Cangzhou, China
| | - Hai Fang
- Shire BioScience (Shanghai) Co., Ltd., a Takeda Company, Shanghai, China
| | - Werner Engl
- Baxalta Innovations GmbH, a Takeda Company, Vienna, Austria
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10
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Rayment R, Chalmers E, Forsyth K, Gooding R, Kelly AM, Shapiro S, Talks K, Tunstall O, Biss T. Guidelines on the use of prophylactic factor replacement for children and adults with Haemophilia A and B. Br J Haematol 2020; 190:684-695. [PMID: 32390158 DOI: 10.1111/bjh.16704] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | - Anne M Kelly
- Cambridge University Hospitals NHS foundation Trust, Cambridge, UK
| | - Susan Shapiro
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Talks
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Oliver Tunstall
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tina Biss
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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11
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Gulshan S, Mandal PK, Phukan A, Baul S, De R, Dolai TK, Chakrabarti P. Is Low Dose a New Dose to Initiate Hemophilia A Prophylaxis? - A Systematic Study in Eastern India. Indian J Pediatr 2020; 87:345-352. [PMID: 32048222 DOI: 10.1007/s12098-019-03179-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the effectiveness of low dose secondary/tertiary prophylaxis in severe Hemophilia A children and determine improvements in their daily life. METHODS Thirty Hemophilia A children (≤ 12 y) with factor VIII <2% and less than two joint bleeds without inhibitors, were given prophylaxis with recombinant Fc fusion long acting factor VIII (ELOCTATE) at 10 IU.kg-1 twice weekly for 1 y. Earlier, patients received on-demand FVIII for a minimum of six months. Outcome was measured in terms of annual bleeding rate, Hemophilia Joint Health Score (HJHS) and child activity/participation was measured in terms of school absenteeism, School Activity Participation Score and Daily Activity Score according to Beijing Children Hospital assessment scale. RESULTS A total of 30 children were included in the study. There was reduction in annual joint bleeds by 85.76% (14.5 to 2.2) and school absenteeism (days/month) by 86% (17.38 to 2.42) before and after prophylaxis respectively. Majority (43%) showed moderate improvement in daily activity score. Mean HJHS score was 8.3. There was mild improvement in School Activity Participation Score in 57%. Mean annual hospitalization rate reduced from 8.7 to 1.1 with improvement in joint scores. Mean annual factor consumption decreased from 1944.2 IU.kg-1 to 1560.3 IU.kg-1. CONCLUSIONS With low dose secondary/tertiary prophylaxis, there is significant reduction in the annual joint bleed rate with improvement in joint health and child activity. As factor consumption is reduced, this has a positive effect on cost benefit; and is a very feasible option in developing countries.
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Affiliation(s)
- Shazia Gulshan
- Department of Hematology, NRS Medical College, Kolkata, 700014, India
| | | | - Abhijit Phukan
- Department of Hematology, NRS Medical College, Kolkata, 700014, India
| | - Shuvraneel Baul
- Department of Hematology, NRS Medical College, Kolkata, 700014, India
| | - Rajib De
- Department of Hematology, NRS Medical College, Kolkata, 700014, India
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12
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Lambert C, Meité ND, Sanogo I, Lobet S, Hermans C, Henrard S, Blanchette V, Young NL. Cross-cultural adaptation and validation of the Canadian Haemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) in Côte d'Ivoire (the Ivory Coast). Health Qual Life Outcomes 2020; 18:76. [PMID: 32188477 PMCID: PMC7079424 DOI: 10.1186/s12955-020-01327-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/12/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction Health-related quality of life evaluation is recognized as an important outcome in the assessment of boys with haemophilia. In fact, reliable health-related quality of life data are even more critical in developing countries to advocate for government agencies to develop national haemophilia care programmes. However, validated tools are not yet available in sub-Saharan African countries. Aims The purpose of this study was to complete the cultural adaptation and validation of the Canadian Haemophilia Outcomes-Kids’ Life Assessment Tool version2.0 (CHO-KLAT2.0) in Côte d’Ivoire. Methods The process included four steps: a linguistic adaptation, cognitive debriefing interviews with children and their parents, a validity assessment with the Pediatric Quality of Life Inventory (PedsQL) as a comparator, and a test-retest reliability assessment. Results The initial Ivoirian version of the CHO-KLAT2.0 was developed through a linguistic adaptation performed in close collaboration with members of the local medical team and haemophilia community. Cognitive debriefings were completed with five boys and their parents, with the final Ivoirian version of the CHO-KLAT2.0 developed in September 2017. The validation process included 37 boys with haemophilia (mean age: 11.4 years; 34 with severe and three with moderate forms of haemophilia, all treated on demand) and their parents. Among the child-reported population (n = 20), we observed a mean CHO-KLAT2.0 score of 51.3 ± 9.2; there was a moderate correlation between the CHO-KLAT2.0 and PedsQL scores (r = 0.581; p = 0.007) and an inverse correlation of the CHO-KLAT2.0 and PedsQL scores with the global rating of the degree to which the boys were bothered by their haemophilia. The mean parent proxy CHO-KLAT2.0 score (n = 17) was 53.5 ± 9.8. Among the parents, we found no significant correlation between the Ivoirian CHO-KLAT2.0 and PedsQL scores or between the parent-reported scores and the parent global ratings of bother. The test-retest intraclass correlation coefficient was 0.879 (95% CI: 0.673; 0.954) for the child-reported questionnaires and 0.880 (95% CI: 0.694; 0.955) for the proxy-reported questionnaires. Conclusions A cross-culturally adapted and validated version of the CHO-KLAT2.0 for Côte d’Ivoire is now available that enables baseline values to be obtained and intervention outcomes (namely, prophylaxis) to be measured in Ivoirian boys with haemophilia.
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Affiliation(s)
- Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
| | - N' Dogomo Meité
- Division of Clinical Hematology, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Ibrahima Sanogo
- Division of Clinical Hematology, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Division of Physical Medicine and Rehabilitation, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Université catholique de Louvain (UCLouvain), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab, 1200, Brussels, Belgium
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain (UCLouvain), Brussels, Belgium.,Institute of Health and Society (IRSS), Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Victor Blanchette
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Nancy L Young
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
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13
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Usuba K, Price VE, Blanchette V, Abad A, Altisent C, Buchner‐Daley L, Carneiro JDA, Feldman BM, Fischer K, Grainger J, Holzhauer S, Luke K, Meunier S, Ozelo M, Tang L, Antunes SV, Villaça P, Wakefield C, Wharfe G, Wu R, Young NL. Impact of prophylaxis on health-related quality of life of boys with hemophilia: An analysis of pooled data from 9 countries. Res Pract Thromb Haemost 2019; 3:397-404. [PMID: 31294327 PMCID: PMC6611476 DOI: 10.1002/rth2.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prophylaxis reduces the frequency of bleeds in boys with severe hemophilia and is the standard care for their management in resource-abundant countries. The effect of prophylaxis on Health-Related Quality of Life (HRQoL) has not been established, because the sample sizes of most studies are too small to explore the relationship of multiple factors that influence HRQoL. METHODS The aim of this study was to assess the impact of hemophilia severity and treatment regimen on HRQoL and to establish the minimum important difference (MID) using the international level of score distributions. HRQoL data were pooled from 7 studies across 9 countries. HRQoL was measured using the Canadian Hemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT). A mixed-effect linear regression analysis was employed to assess the impact of prophylaxis on the CHO-KLAT score. RESULTS Data from 401 boys with hemophilia were analyzed (57.6% severe hemophilia and 57.6% receiving prophylaxis). The model revealed that receiving prophylaxis was significantly associated with higher HRQoL (regression coefficient 8.5, 95% confidence interval [CI] 3.9-13.1). Boys with severe hemophilia had a significantly lower HRQoL as compared to boys with moderate and mild hemophilia whose CHO-KLAT scores were 7.0 and 6.6 points higher, respectively. There was a significant interaction between treatment and disease severity (P = 0.023), indicating prophylaxis has the most significant impact in boys with severe hemophilia. Based on these pooled data, the MID of the CHO-KLAT was established at 6.5. CONCLUSIONS This study confirms the positive effect of prophylaxis on HRQoL in boys with hemophilia in a real-world setting and provides initial benchmarks for interpreting HRQoL scores based on use of the CHO-KLAT instrument.
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Affiliation(s)
- Koyo Usuba
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
- Evaluating Children's Health Outcomes Research CentreLaurentian UniversitySudburyOntarioCanada
| | - Victoria E. Price
- Division of Pediatric Hematology/OncologyDepartment of PediatricsIWK Health CentreDalhousie UniversityHalifaxNova ScotiaCanada
| | - Victor Blanchette
- Division of Hematology/OncologyDepartment of PediatricsThe Hospital for Sick Children (SickKids)University of TorontoTorontoOntarioCanada
| | - Audrey Abad
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
| | | | | | - Jorge D. A. Carneiro
- Centro de Hemofilia e Instituto da CriançaHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Brian M. Feldman
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Institute of Health PolicyManagement & Evaluation, the Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Susanne Holzhauer
- Department of Pediatric Hematology and OncologyCharité University MedicineBerlinGermany
| | - Koon‐Hung Luke
- Department of PediatricsLaboratory Medicine and PathologyUniversity of OttawaOttawaOntarioCanada
| | - Sandrine Meunier
- Hemostase CliniqueGroupement Hospitalier Universitaire EstHospices Civils de LyonBronFrance
| | - Margareth Ozelo
- Unit of Hemophilia IHTCCláudio L.P. CorreaHemocentro UnicampINCT do SangueUniversity of CampinasCampinasBrazil
| | - Ling Tang
- Hematology/Oncology CenterBeijing Children's Hospital, Capital Medical UniversityBeijingChina
| | - Sandra V. Antunes
- Department of HematologyUniversidade Federal de São Paulo (UNIFESP)São PauloBrazil
| | - Paula Villaça
- Service of HematologyHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Cindy Wakefield
- Department of NursingThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
| | - Gilian Wharfe
- Department of PathologyUniversity of the West Indies (UWI)MonaJamaica
| | - Runhui Wu
- Hematology/Oncology CenterBeijing Children's Hospital, Capital Medical UniversityBeijingChina
| | - Nancy L. Young
- Child Health Evaluative Sciences Program, Research InstituteThe Hospital for Sick Children (SickKids)TorontoOntarioCanada
- Evaluating Children's Health Outcomes Research CentreLaurentian UniversitySudburyOntarioCanada
- School of Rural and Northern HealthLaurentian UniversitySudburyOntarioCanada
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14
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Zhang H, Huang J, Kong X, Ma G, Fang Y. Health-related quality of life in children with haemophilia in China: a 4-year follow-up prospective cohort study. Health Qual Life Outcomes 2019; 17:28. [PMID: 30728017 PMCID: PMC6366014 DOI: 10.1186/s12955-019-1083-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 01/07/2019] [Indexed: 11/29/2022] Open
Abstract
Background Health-related quality of life (HRQoL) has been brought up for decades in haemophilia patients. However, no data to date are available about HRQoL in children with haemophilia using long-term follow up data. This nearly 4-year follow-up study aimed to assess the long-term HRQoL of haemophilia children. Methods A prospective cohort study among 42 children with haemophilia and their parents was conducted in August 2014 in a children’s hospital; follow-up was completed in January 2018. Primary endpoint was the change in patient HRQoL evaluated by Canadian Haemophilia Outcomes–Kids’ Life Assessment Tool (CHO-KLAT) from baseline to year 4; secondary endpoint was the impact of bleeding rates, physical activity restriction, financial burden and treatment (prophylaxis vs on-demand treatment) on HRQoL, as well as the impact of treatment on event-free survival. Results Totally 42 patients (mean age, 5.48[SD, 4.63] years) and 42 parents were included. 38 families completed 4-year follow up. Patients reported a small increase in HRQoL from baseline to year 4. The mean scores of child self-report and parent proxy report of CHO-KLAT at baseline were 60.69 (SD = 20.28) and 61.01 (SD = 12.14), respectively. Scores at follow-up were 64.69 (SD = 13.71) and 65.33 (SD = 15.78), respectively. Haemophilia patients without physical activity restriction, living in urban areas, and receiving prophylactic treatment and home injection, had higher average values for HRQoL scores than the others. Bleeding rates were proportionally negatively correlated with HRQoL. Patients who had received prophylactic treatment had better event-free survival. Conclusions Haemophilia decreased HRQoL of patients, but this effect weakened after 4 years. HRQoL of children is influenced by severity of haemophilia, bleeding rates, physical activity restriction, financial burden and treatment. Prophylactic treatment is a key factor contributing to event-free survivor prognosis and the optimal form of therapy for childhood haemophilia.
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Affiliation(s)
- Heng Zhang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Jie Huang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xiaoyan Kong
- Department of anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Gaoxiang Ma
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, China
| | - Yongjun Fang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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15
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Lee Mortensen G, Strand AM, Almén L. Adherence to prophylactic haemophilic treatment in young patients transitioning to adult care: A qualitative review. Haemophilia 2019; 24:862-872. [PMID: 30485633 DOI: 10.1111/hae.13621] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
Abstract
Recombinant prophylactic treatment (PTX) has greatly improved morbidity, mortality and health-related quality of life (HRQoL) in patients with severe haemophilia. Yet, treatment adherence appears suboptimal in adolescents and young adults with haemophilia (YWH). Young patients experience major biopsychosocial changes challenging their adherence through the transition from parental to self-care, from paediatric to adult care. In clinical practice, a systematic approach to transition is rarely used and there is little evidence on best practices. This qualitative review was based on a systematic literature search including quantitative as well as qualitative research reports to examine all relevant factors influencing adherence to PTX in YWH. We aimed to gain comprehensive insight into main drivers and barriers to adherence by exploring them in the context of YWH's disease perceptions, characteristics, HRQoL and needs. The outcome is an overview of the latest published recommendations to support treatment adherence in YWH during the transition from family-oriented care to self-care and from paediatric to adult care. The literature suggests that adherence to PTX is best supported when individual patient needs and preferences are taken into consideration when planning treatment. Preserving normality is a main priority in young patients making it crucial to support patients from early childhood in considering PTX as enabling rather than hindering a normal social and physically active life. Education in self-management should include psychosocial support of patients as well as caregivers. This requires systematic transition planning including milestone assessments and ongoing multidisciplinary support until full self-management is secured.
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16
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Seuser A, Djambas Khayat C, Negrier C, Sabbour A, Heijnen L. Evaluation of early musculoskeletal disease in patients with haemophilia: results from an expert consensus. Blood Coagul Fibrinolysis 2018; 29:509-520. [PMID: 30020119 PMCID: PMC6125749 DOI: 10.1097/mbc.0000000000000767] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 11/25/2022]
Abstract
: Early joint damage in patients with haemarthrosis often escapes diagnosis because of insufficient investigation of biomechanical changes. Arthropathy in haemophilia requires complex assessment with several tools. Considering the increased emphasis on an integrated approach to musculoskeletal (MSK) outcomes, re-evaluation of MSK assessment to address individual patient needs is warranted. To advise on the optimal use of current assessment tools and strategies for tailored MSK evaluation in patients with haemophilia. A panel of experts in haemophilic arthropathy evaluated internationally recognized assessment tools through published literature and personal expertise. Each tool was considered, scored and ranked for their utility in the clinical assessment of MSK damage. Subsequently, a patient evaluation table detailing advice on type and frequency of assessments for different patient populations was constructed. To obtain a complete MSK assessment, multiple tools must be used to ensure each criterion is evaluated. For patients with haemophilia, clinical examination of the joint, disease-specific structure/function scores, and activity/participation scores including quality of life are important, and should be performed on a regular basis according to age and clinical condition. Joint imaging is recommended in the prevention, diagnosis and follow-up of haemophilic arthropathy and should be used in conjunction with joint structure and function scores. An integrated approach to MSK assessment using combinations of tools will allow earlier management of dysfunction and may improve long-term outcomes. This approach could be used in long-term follow-up of all patients independent of age and disease stage, especially in children to prevent arthropathy.
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Affiliation(s)
- Axel Seuser
- Private Practice for Prevention, Rehabilitation and Orthopaedics, Bonn, Germany
| | | | - Claude Negrier
- Centre Régional de Traitement de l’Hémophilie, Louis Pradel, University Claude Bernard, Lyon, France
| | - Adly Sabbour
- Physiotherapy Department, Cairo University, Egypt
| | - Lily Heijnen
- Van Creveldkliniek, UMC, Utrecht, the Netherlands
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17
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Wharfe G, Buchner-Daley L, Gibson T, Hilliard P, Usuba K, Abad A, Boma-Fischer L, Bouskill V, Floros G, Lillicrap D, Lowe Y, Lowe D, Palmer-Mitchell N, Rand ML, Teitel J, Tuttle A, Watson A, White R, Young NL, Blanchette VS. The Jamaican Haemophilia Registry: Describing the burden of disease. Haemophilia 2018; 24:e179-e186. [PMID: 29855125 DOI: 10.1111/hae.13517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Jamaica has an estimated 200 persons with haemophilia (PWH), who face significant constraints in access to specialized haemophilia care, including access to clotting factor concentrates. AIM The aim of this paper is to establish the current burden of disease in PWH in Jamaica. METHODS PWH were enrolled through the University Hospital of the West Indies, Jamaica. The impact of haemophilia was assessed using a comprehensive battery of heath outcome measures that included the following: laboratory, clinical information and validated outcome measures of joint structure and function, activity, and health-related quality of life (HRQoL) to provide a health profile of the Jamaican haemophilia population. RESULTS In all, 45 PWH were registered (mean age: 29, range: 0.17-69 years), including 13 children (<18 years of age) and 32 adults. In this sample, 41 had haemophilia A (30 severe) and 4 had haemophilia B (3 severe); 10 patients with haemophilia A were inhibitor positive. The results indicate that adults with haemophilia in Jamaica have significant joint damage: mean Haemophilia Joint Health Score (HJHS) = 42.1 (SD = 17.3); moderate activity levels - mean Haemophilia Activities List (HAL) score = 64.8 (SD = 17.8); and low HRQoL scores - mean Haemo-QoL-A score = 62.3 (SD = 19.4). Results for children are also reported but should be interpreted with caution due to the small sample size. CONCLUSIONS There is a very high burden of disease in PWH in Jamaica. The health profiles reported in this paper are an essential first step in advocating for a multidisciplinary Comprehensive Care Program for assessment and care of PWH in Jamaica.
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Affiliation(s)
- G Wharfe
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - L Buchner-Daley
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - T Gibson
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - P Hilliard
- Department of Rehabilitation, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Usuba
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,School of Rural and Northern Health and ECHO Research Centre, Laurentian University, Sudbury, ON, Canada
| | - A Abad
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - L Boma-Fischer
- Department of Hematology, Comprehensive Care Hemophilia Program, St. Michael's Hospital, Toronto, ON, Canada
| | - V Bouskill
- Department of Nursing, The Hospital for Sick Children, Toronto, ON, Canada
| | - G Floros
- Department of Hematology, Comprehensive Care Hemophilia Program, St. Michael's Hospital, Toronto, ON, Canada
| | - D Lillicrap
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Y Lowe
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - D Lowe
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - N Palmer-Mitchell
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - M L Rand
- Departments of Laboratory Medicine & Pathobiology, Biochemistry and Paediatrics, University of Toronto, Toronto, ON, Canada.,Translational Medicine Program, Research Institute, The Hospital for Sick Children, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Teitel
- Department of Hematology, Comprehensive Care Hemophilia Program, St. Michael's Hospital, Toronto, ON, Canada
| | - A Tuttle
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - A Watson
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - R White
- University Hospital, University of the West Indies (UWI), Mona, Kingston, Jamaica
| | - N L Young
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,School of Rural and Northern Health and ECHO Research Centre, Laurentian University, Sudbury, ON, Canada
| | - V S Blanchette
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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18
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Feldman BM, Rivard GE, Babyn P, Wu JKM, Steele M, Poon MC, Card RT, Israels SJ, Laferriere N, Gill K, Chan AK, Carcao M, Klaassen RJ, Cloutier S, Price VE, Dover S, Blanchette VS. Tailored frequency-escalated primary prophylaxis for severe haemophilia A: results of the 16-year Canadian Hemophilia Prophylaxis Study longitudinal cohort. LANCET HAEMATOLOGY 2018; 5:e252-e260. [PMID: 29731369 DOI: 10.1016/s2352-3026(18)30048-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe haemophilia A has high morbidity, and treatment, while effective, is very expensive. We report the 16-year follow-up of the Canadian Hemophilia Prophylaxis Study, which examined the effectiveness of tailored frequency-escalated primary prophylaxis with a focus on health outcomes within the domains of body structures and functions, and activities and participation (according to the WHO International Classification of Functioning, Disability and Health [WHO-ICF] framework) and a view to reducing consumption of costly clotting factor, which accounts for more than 90% of the cost of care of severe haemophilia. METHODS In this longitudinal study, boys with severe haemophilia A from 12 Canadian centres were enrolled at age 1·0-2·5 years. They were treated with standard half-life recombinant factor VIII (SHL-rFVIII), beginning as once-weekly prophylaxis with 50 IU/kg and escalating in frequency (with accompanying dose adjustments) in response to breakthrough bleeding as determined by the protocol. The primary endpoint for this analysis was joint health, as measured by the modified Colorado Child Physical Examination Scores (CCPES) at study end. All analyses were done by intention to treat. The trial is complete, and is registered with ClinicalTrials.gov, number NCT01085344. FINDINGS Between June 26, 1997, and Jan 30, 2007, 56 boys were enrolled. They were followed for a median of 10·2 years (to a maximum of 16·1 years). Median rFVIII usage was about 3600 IU/kg per year. The median end-of-study CCPES physical examination score was 1 (IQR 1-3; range 0-12) for the left ankle and 1 (1-2; 0-12) for the right ankle, with all other joints having a median score of 0. No treatment-related safety events occurred over the duration of the study, including central venous catheter infections. The median annualised index joint bleeding rate was 0·95 per year (IQR 0·44-1·35; range 0·00-13·43), but 17 (30%) patients had protocol-defined unacceptable breakthrough bleeding at some point during the study. INTERPRETATION Tailored frequency-escalated prophylaxis leads to very little arthropathy and very good health outcomes within the WHO-ICF domains, and only uses a moderate amount of expensive clotting factor as compared with standard prophylaxis protocols. Some sequelae of bleeding were observed in our cohort, and future studies should consider a more stringent protocol of escalation. FUNDING This study was initially funded by grants from the Medical Research Council of Canada/Pharmaceutical Manufacturers Association of Canada Partnership Fund and the Bayer/Canadian Blood Services/Hema-Quebec Partnership Fund. Subsequent renewals were funded by Bayer.
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Affiliation(s)
- Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Georges E Rivard
- Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada
| | - John K M Wu
- Division of Hematology/Oncology/BMT, Department of Pediatrics, UBC & BC Children's Hospital, Vancouver, BC, Canada
| | - MacGregor Steele
- Section of Pediatric Hematology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Man-Chiu Poon
- Department of Medicine, Division of Hematology and Hematologic Malignancies, Foothills Hospital, Calgary, AB, Canada
| | - Robert T Card
- Department of Hematology, Division of Oncology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara J Israels
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Laferriere
- Division of Hematology/Oncology, Thunder Bay Regional Cancer Care, Thunder Bay, ON, Canada
| | - Kulwant Gill
- Hemophilia Program, Laurentian Hospital, Sudbury, ON, Canada
| | - Anthony K Chan
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Manuel Carcao
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert J Klaassen
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Stephanie Cloutier
- Centre de l'hémophilie de l'est du Québec de Québec-Hôpital de l'Enfant-Jésus, Université Laval, Quebec, QC, Canada
| | - Victoria E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Saunya Dover
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Victor S Blanchette
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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19
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Tang L, Xu W, Li CG, Hou F, Feng XQ, Wang H, Li XJ, Li WL, Liu JP, Sun LR, Wang SH, Jin J, Fang Q, Luke KH, Poon MC, Blanchette VS, Usuba K, Young NL, Wu R. Describing the quality of life of boys with haemophilia in China: Results of a multicentre study using the CHO-KLAT. Haemophilia 2017; 24:113-119. [PMID: 28922525 DOI: 10.1111/hae.13349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The treatment of haemophilia varies across countries and across regions within some countries. Similar variation has been observed in health-related quality of life (HR-QoL). Relatively little is known about the HR-QoL of boys with haemophilia in China. AIM The aim of this study was to describe the HR-QoL of boys with haemophilia in China using the Canadian Haemophilia Outcomes-Kids Life Assessment Tool (CHO-KLAT). METHODS Boys (4-18 years of age) with haemophilia and their parents were enroled in a cross-sectional study. All parents/guardians of study subjects were requested to complete a CHO-KLAT questionnaire during a clinic visit, and report on several other clinical and socioeconomic factors in the past year. Boys who were > 7 years also completed the CHO-KLAT. RESULTS A total of 269 parents of boys with haemophilia, from 13 hospitals in 12 provinces, were enroled during 2014. The boys ranged from 4.0 to 17.9 years of age; 91% had haemophilia A, most had moderate (52%) or severe (36%) disease, and most were receiving sub-optimal on-demand therapy or low-dose prophylactic therapy. Child self-report CHO-KLAT scores were available for 171 boys ≥7 years of age and ranged from 24.2 to 85.3 with a mean of 57.6 (n = 171). Parent proxy-reported CHO-KLAT scores ranged from 25.0 to 88.7 with a mean of 55.1 (n = 269). CONCLUSION HR-QoL scores in boys with haemophilia in China were substantially lower than reported from Canadian and European boys with haemophilia. Longer term prospective studies are required to examine the factors impacting the HR-QoL for boys with haemophilia in China.
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Affiliation(s)
- L Tang
- Hematology and Oncology Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - W Xu
- Hematology Department, School of Medicine, Children's Hospital of Zhejiang University, Hangzhou, China
| | - C G Li
- Hematology& Oncology Department, Shenzhen Children's Hospital, Shenzhen, China
| | - F Hou
- Hematology Department, Shanxi Children's Hospital, Taiyuan, China
| | - X Q Feng
- Pediatric Department, Southern Medical University, Nanfang Hospital, Guangzhou, China
| | - H Wang
- Pediatric Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - X J Li
- Pediatric Hematology and Oncology Department, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - W L Li
- Hematology Department, Hunan Children's Hospital, Changsha, China
| | - J P Liu
- Pediatric Hematology Department, Inner Mongolia People's Hospital, Huhehaote, China
| | - L R Sun
- Pediatric Department, Shandong Province Hospital, Jinan, China
| | - S H Wang
- Hematology Department, Wulumuqi Children's Hospital, Wulumuqi, China
| | - J Jin
- Pediatric Department, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Q Fang
- Hematology Department, Hebei Children's Hospital, Shijiazhuang, China
| | - K H Luke
- Department of Hematology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - M C Poon
- Department of Hematology, University of Calgary, Calgary, Alberta, Canada
| | - V S Blanchette
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - K Usuba
- ECHO Research Centre, Laurentian University, Sudbury, Ontario, Canada
| | - N L Young
- School of Rural and Northern Health and ECHO Research Centre, Laurentian University, Sudbury, Ontario, Canada
| | - R Wu
- Hematology and Oncology Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
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20
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Limperg P, Terwee C, Young N, Price V, Gouw S, Peters M, Grootenhuis M, Blanchette V, Haverman L. Health-related quality of life questionnaires in individuals with haemophilia: a systematic review of their measurement properties. Haemophilia 2017; 23:497-510. [DOI: 10.1111/hae.13197] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 01/29/2023]
Affiliation(s)
- P.F. Limperg
- Psychosocial Department; Emma Children's Hospital; AMC; Amsterdam the Netherlands
| | - C.B. Terwee
- Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
| | - N.L. Young
- School of Rural and Northern Health; Laurentian University; Sudbury Ontario Canada
| | - V.E. Price
- Division of Pediatric Hematology/Oncology; Department of Pediatrics; IWK Health Centre; Dalhousie University; Halifax Nova Scotia Canada
| | - S.C. Gouw
- Department of Pediatric-Hematology; Emma Children's Hospital and Hemophilia Comprehensive Care Treatment Center; AMC; Amsterdam the Netherlands
| | - M. Peters
- Department of Pediatric-Hematology; Emma Children's Hospital and Hemophilia Comprehensive Care Treatment Center; AMC; Amsterdam the Netherlands
| | - M.A. Grootenhuis
- Psychosocial Department; Emma Children's Hospital; AMC; Amsterdam the Netherlands
| | - V. Blanchette
- Department of Pediatrics; University of Toronto; Division of Hematology/Oncology; The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - L. Haverman
- Psychosocial Department; Emma Children's Hospital; AMC; Amsterdam the Netherlands
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21
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Wu R, Sun J, Xiao J, Liu Y, Xue F, Wang H, Tang L, Zhao Y, Li K, Yang R, Hu Y, Luke KH, Poon MC, Blanchette VS, Usuba K, Young NL. A prospective study of health-related quality of life of boys with severe haemophilia A in China: comparing on-demand to prophylaxis treatment. Haemophilia 2017; 23:430-436. [PMID: 28345299 DOI: 10.1111/hae.13198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Treatment for boys with haemophilia in China is rapidly improving; however, comprehensive outcomes have not been examined prospectively. AIM The aim of this study was to evaluate the effect of short-term full-dose prophylaxis compared to on-demand treatment, on the Health-Related Quality of Life (HR-QoL) of boys with severe haemophilia A (HA) in China. METHODS Boys with severe HA (FVIII<1%) completed 3 months of on-demand treatment and 3 months of full-dose prophylaxis (25 FVIII IU per kg 3x per week). The primary outcomes were child- and parent-reported Canadian Hemophilia Outcomes - Kids Life Assessment Tool (CHO-KLAT) scores. The number and type of bleeds and Activities Scale for Kids (ASK) scores were also recorded. RESULTS Analyses included 23 boys between 4 and 15.9 years of age. The number of bleeds decreased by 94% on prophylaxis (P < 0.0001, Wilcoxon Signed-Rank test). The mean child-reported CHO-KLAT scores for boys ≥7 years (n = 20) was 61.4 (±10.9) during on-demand treatment and 61.9 (±11.4) following short-term prophylaxis (P = 0.72, paired t-test). The mean parent-reported CHO-KLAT score during the on-demand phase was 54.4 (±10.5) with an increase of 3.8 points (±8.1; P = 0.04, paired t-test) following prophylaxis. CONCLUSIONS Child-reported CHO-KLAT scores were lower in boys with severe HA in China than reported in countries with access to full-dose prophylaxis. Boys reported higher HR-QoL scores than their parents. Small improvements in ASK scores were noted following the prophylaxis phase. These changes were only significant in the parent-reported CHO-KLAT scores. Longer term prospective clinical trials are needed in China to determine the impact of prophylaxis on HR-QoL in boys with severe HA.
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Affiliation(s)
- R Wu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
| | - J Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - J Xiao
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Y Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - F Xue
- Thrombosis & Hemostasis center, Institute of Hematology, Blood Diseases Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Tianjin, China
| | - H Wang
- Department of Hematology, Wuhan Union Medical College Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - L Tang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Beijing, China
| | - Y Zhao
- Department of Hematology, Hemophilia clinic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - K Li
- Department of Hematology, Hemophilia clinic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - R Yang
- Thrombosis & Hemostasis center, Institute of Hematology, Blood Diseases Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Tianjin, China
| | - Y Hu
- Department of Hematology, Wuhan Union Medical College Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - K-H Luke
- Department of Pediatrics, Laboratory Medicine and Pathology, Division of Hematology and Oncology, Children Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - M-C Poon
- Departments of Medicine, Pediatrics and Oncology, Foothills Hospital, Alberta Health Services, University of Calgary and Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, AB, Canada
| | - V S Blanchette
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - K Usuba
- School of Rural and Northern Health and the Research Centre for Evaluating Children's Health Outcomes (ECHO), Laurentian University, Sudbury, ON, Canada
| | - N L Young
- School of Rural and Northern Health and the Research Centre for Evaluating Children's Health Outcomes (ECHO), Laurentian University, Sudbury, ON, Canada
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22
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St-Louis J, Urajnik DJ, Ménard F, Cloutier S, Klaassen RJ, Ritchie B, Rivard GE, Warner M, Blanchette V, Young NL. Generic and disease-specific quality of life among youth and young men with Hemophilia in Canada. BMC HEMATOLOGY 2016; 16:13. [PMID: 27158500 PMCID: PMC4858890 DOI: 10.1186/s12878-016-0052-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/27/2016] [Indexed: 11/20/2022]
Abstract
Background This study was undertaken to explore the longitudinal patterns of health-related quality of life (HRQoL) among youth and young adults with Hemophilia A (HA) over a 3-year period. This report presents the baseline characteristics of the study cohort. Methods Males, 14 to 29 years of age, with predominantly severe HA were recruited from six treatment centres in Canada. Subjects completed a comprehensive survey. HRQoL was measured using: the CHO-KLAT2.0 (youth), Haemo-QoL-A (young adults) and the SF-36v2 (all). Results 13 youth (mean age = 15.7, range = 12.9-17.9 years) and 33 young adults (mean age = 23.6; range = 18.4 -28.7 years) with moderate (7 %) and severe (93 %) HA were enrolled. All were on a prophylactic regimen with antihemophilic factor (Helixate FS®) during the study. The youth had minimal joint damage (mean HJHS = 5.2) compared to young adults (mean HJHS = 13.3). The mean HRQoL scores for youth were: 79.2 (SD = 11.9) for the CHO-KLAT, and 53.0 (5.5) and 52.3 (6.8) for the SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores respectively. The mean HRQoL scores for young adults were: 85.8 (9.5) for the Haemo-Qol-A, and 50.8 (6.4) and 50.9 (8.8) for PCS and MCS respectively. PCS and MCS scores were comparable to published Canadian norms, however significant differences were found for the domains of Physical Functioning and Bodily Pain. The disease-specific HRQoL scores were weakly correlated with the PCS for youth (CHO-KLAT vs. PCS r = 0.28, p = 0.35); and moderately correlated for the MCS (r = 0.39, p = 0.19). Haemo-QoL-A scores for young adults were strongly correlated with the PCS (r = 0.53, p = 0.001); and weakly correlated with the MCS (r = 0.26, p = 0.13). Joint status as assessed by HJHS was correlated with PCS scores. A history of lifelong prophylaxis resulted in better PCS but worse MCS scores. Conclusion Despite having hemophilia, the youth in this cohort have minimal joint disease and good HRQoL. The young adults demonstrated more joint disease and slightly worse HRQoL in the domains of physical functioning and pain. The data presented here provide new information to inform the selection of Health Related Quality of Life (HRQoL) instruments for use in future clinical trials involving persons with hemophilia. Trial registration ClinicalTrials.gov : NCT01034904. Study funded by CSL Behring Canada. Electronic supplementary material The online version of this article (doi:10.1186/s12878-016-0052-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J St-Louis
- CHU Sainte-Justine, Montréal, Canada ; Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | | | - F Ménard
- CHU Sainte-Justine, Montréal, Canada
| | - S Cloutier
- Hôpital de l'Enfant-Jésus, Quebec city, Canada
| | - R J Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - B Ritchie
- University of Alberta, Edmonton, Canada
| | | | - M Warner
- McGill University Health Centre, Montréal, Canada
| | - V Blanchette
- University of Toronto, Toronto, Canada ; Hospital for Sick Children, Toronto, Canada
| | - N L Young
- Laurentian University, Sudbury, Canada ; Hospital for Sick Children, Toronto, Canada
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23
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Price VE, Hawes SA, Bouchard A, Vaughan A, Jarock C, Kuhle S. Unmeasured costs of haemophilia: the economic burden on families with children with haemophilia. Haemophilia 2015; 21:e294-9. [PMID: 25955276 DOI: 10.1111/hae.12715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although economic evaluations of haemophilia-related care have highlighted both the health care payer and societal perspectives, the costs to families with children with haemophilia have not been examined. This study determined the costs incurred by families of children with haemophilia, attending a haemophilia treatment centre (HTC), servicing a large geographical area in Eastern Canada. METHODS Families recorded all direct and indirect costs associated with haemophilia-related care for a year. Costs incurred to receive care at the HTC and local health care centres were compared. The relationship between distance to the HTC and costs was modelled using linear regression. RESULTS Participants included 31/45 children (68%) from 27 families attending the HTC. Median age was 12 years (range: 0.5-17 years); 24/31 (77%) had severe haemophilia. The median distance to the HTC and local health care facility was 230 km (range: 7-600 km) and 33.5 km (range: 2-400 km) respectively. Due to this difference in distance, 23/31 (74%) children do not attend the HTC for management of acute haemorrhage. The median annual total cost per family to attend the HTC is $775.93 (range: $200.00-$5741.00). The total cost to attend the HTC increases by $2.16 (95% CI 1.24-3.9) per kilometer from the HTC. The median total annual cost of haemophilia-related care per family is $1222.50 (range: $396.00-$8037.00). CONCLUSION Families incur high costs related to haemophilia care. The distance to the HTC is a barrier to care. Improving access to HTCs is paramount in improving haemophilia-related outcomes.
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Affiliation(s)
- V E Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - S A Hawes
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - A Bouchard
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - A Vaughan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - C Jarock
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - S Kuhle
- Perinatal Epidemiology Research Unit, Departments of Pediatrics and Obstetrics & Gynaecology, IWK Health Centre, Halifax, NS, Canada
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24
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McCusker PJ, Fischer K, Holzhauer S, Meunier S, Altisent C, Grainger JD, Blanchette VS, Burke TA, Wakefield C, Young NL. International cross-cultural validation study of the Canadian haemophilia outcomes: kids' life assessment tool. Haemophilia 2014; 21:351-357. [PMID: 25471939 DOI: 10.1111/hae.12597] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/30/2022]
Abstract
Health-related quality of life (HRQoL) assessment is recognized as an important outcome in the evaluation of different therapeutic regimens for persons with haemophilia. The Canadian Haemophilia Outcomes-Kids' Life Assessment Tool (CHO-KLAT) is a disease-specific measure of HRQoL for 4 to 18-year-old boys with haemophilia. The purpose of this study was to extend this disease-specific, child-centric, outcome measure for use in international clinical trials. We adapted the North American English CHO-KLAT version for use in five countries: France, Germany, the Netherlands, Spain and the United Kingdom (UK). The process included four stages: (i) translation; (ii) cognitive debriefing; (iii) validity assessment relative to the PedsQL (generic) and the Haemo-QoL (disease-specific) and (iv) assessment of inter and intra-rater reliability. Cognitive debriefing was performed in 57 boys (mean age 11.4 years), validation was performed in 144 boys (mean age 11.0 years) and reliability was assessed for a subgroup of 64 boys (mean age 12.0 years). Parents also participated. The mean scores reported by the boys were high: CHO-KLAT 77.0 (SD = 11.2); PedsQL 83.8 (SD = 11.9) and Haemo-QoL 79.6 (SD = 11.5). Correlations between the CHO-KLAT and PedsQL ranged from 0.63 in Germany to 0.39 in the Netherlands and Spain. Test-retest reliability (concordance) for child self-report was 0.67. Child-parent concordance was slightly lower at 0.57. The CHO-KLAT has been fully culturally adapted and validated for use in five different languages and cultures (in England, the Netherlands, France, Germany and Spain) where treatment is readily available either on demand or as prophylaxis.
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