Do we know what global ratings of health-related quality of life measure?

Quality of Life in European Older Adults of SHARE Wave 7: Comparing the Old and the Oldest-Old

CASP-12 (Control, Autonomy, Self-realization, and Pleasure scale) is one of the most common internationally used measures for quality of life in older adults, although its structure is not clearly established. Current research aims to test the factor structure of the CASP-12, so as to provide evidence on reliability and external validity, and to test for measurement invariance across age groups. Data from 61,355 Europeans (≥60 years old) from the Survey of Health, Ageing and Retirement in Europe wave 7 were used. CASP-12, EURO-D (European depression scale), self-perceived health, and life satisfaction measurements were included. Reliability and validity coefficients, competing confirmatory factor models, and standard measurement invariance routine were estimated. A second-order factor model with the original factor structure was retained. The scale showed adequate reliability coefficients except for the autonomy dimension. The correlation coefficients for external validity were all statistically significant. Finally, CASP-12 is scalar invariant across age. We conclude that the best-fitting factor structure retained allows using CASP-12 either by factors, or as an overall score, depending on the research interests. Findings related to CASP-12 measurement invariance encourage its use in the oldest-old too. When comparing the dimensions across age groups, as people age, autonomy slightly increases and the rest of the dimensions decline.

The minimal perceived change: a formal model of the responder definition according to the patient's meaning of change for patient-reported outcome data analysis and interpretation

Background

Patient-Reported Outcomes (PROs) are standardized questionnaires used to measure subjective outcomes such as quality of life in healthcare. They are considered paramount to assess the results of therapeutic interventions. However, because their calibration is relative to internal standards in people’s mind, changes in PRO scores are difficult to interpret.

Knowing the smallest value in the score that the patient perceives as change can help. An estimator linking the answers to a Patient Global Rating of Change (PGRC: a question measuring the overall feeling of change) with change in PRO scores is frequently used to obtain this value. In the last 30 years, a plethora of methods have been used to obtain these estimates, but there is no consensus on the appropriate method and no formal definition of this value.

Methods

We propose a model to explain changes in PRO scores and PGRC answers.

Results

A PGRC measures a construct called the Perceived Change (PC), whose determinants are elicited. Answering a PGRC requires discretizing a continuous PC into a category using threshold values that are random variables. Therefore, the populational value of the Minimal Perceived Change (MPC) is the location parameter value of the threshold on the PC continuum defining the switch from the absence of change to change.

Conclusions

We show how this model can help to hypothesize what are the appropriate methods to estimate the MPC and its potential to be a rigorous theoretical basis for future work on the interpretation of change in PRO scores.

Health-related quality of life in French adolescents and adults: norms for the DUKE Health Profile

BACKGROUND

The continual monitoring of population health-related quality of life (HRQoL) with validated instruments helps public health agencies assess, protect, and promote population health. This study aimed to determine norms for the French adolescent and adult general population for the Duke Health Profile (DUKE) questionnaire in a large representative community sample.

METHODS

We randomly selected 17,733 French people aged 12 to 75 years old in 2 steps, by households and individuals, from the National Health Barometer 2005, a periodic population study by the French National Institute for Prevention and Health Education. Quality of life and other data were collected by computer-assisted telephone interview.

RESULTS

Normative data for the French population were analyzed by age, gender and self-reported chronic disease. Globally, function scores (best HRQoL=100) for physical, mental, social, and general health, as well as perceived health and self-esteem, were 72.3 (SEM 0.2), 74.6 (0.2), 66.8 (0.1), 71.3 (0.1), 71.3 (0.3), 76.5 (0.1), respectively. Dysfunction scores (worst HRQoL=100) for anxiety, depression, pain and disability domains were 30.9 (0.1), 27.6 (0.2), 34.3 (0.3), 3.1 (0.1), respectively.

CONCLUSION

The French norms for adolescents and adults for the DUKE could be used as a reference for other studies assessing HRQoL, for specific illnesses, in France and for international comparisons.

A comparison of objective biomarkers with a subjective health status measure among children in the Philippines

Large health surveys use subjective (self-reported) and objective (biomarkers) measures to assess heath status. However, the linkage or disparity of these measures has not been systematically studied in developing countries.

METHOD

Using data from the Philippine Quality Improvement Demonstration Study, QIDS, this study evaluated the associations between General Self-Reported Health Status (GSRH) and height, weight, hemoglobin, red blood cell folate, C-reactive protein, and blood lead levels. The authors modeled each biomarker as a function of GSRH controlling for socioeconomic status and selection effects. Changes in biomarkers and GSRH in children who had previously been hospitalized were also examined.

RESULTS

GSRH independently predicted hemoglobin, C-reactive protein, stunting, and wasting. GSRH did not vary significantly with folate deficiency and blood lead levels.

CONCLUSIONS

In addition to being a measure of overall child health status, GSRH may be a useful and inexpensive screening tool for identifying children that need further health testing.

Validation and calibration of the SF-36 health transition question against an external criterion of clinical change in health status

PURPOSE

Cross-sectional surveys depend on retrospective health transition questions (HTQ) to estimate recent changes in health status. This paper assesses the validity of the SF-36 HTQ and calibrates its categories against change assessed prospectively on the SF-36 domain scales in a sub-group known to have experienced clinically important changes in health status.

METHODS

Adults (n = 9,649) from a longitudinal population survey completed the SF-36 in 2001 and 2002. Prospective measures were calculated as mean changes in SF-36 scale scores adjusted for age and gender, and also expressed as standardised response means. Comparison groups were those who had developed a long-term health condition since the last interview and the HTQ response categories for those who had not developed any new conditions.

RESULTS

Those with a new condition and those without a new condition but who described their health as "somewhat worse" than a year ago had comparable declines in health status on all domain scales except role physical, where those with a new condition experienced a greater decline.

CONCLUSIONS

This analysis demonstrates the validity and limitations of the HTQ as a measure of change in population studies. The calibration is useful for interpreting the meaning of the HTQ categories at the group level but not at the individual level.

Correspondence between EQ-5D health state classifications and EQ VAS scores

BACKGROUND

The EQ-5D health-related quality of life instrument comprises a health state classification followed by a health evaluation using a visual analogue scale (VAS). The EQ-5D has been employed frequently in economic evaluations, yet the relationship between the two parts of the instrument remains ill-understood. In this paper, we examine the correspondence between VAS scores and health state classifications for a large sample, and identify variables which contribute to determining the VAS scores independently of the health states as classified.

METHODS

A UK trial of management of low-grade abnormalities detected on screening for cervical pre-cancer (TOMBOLA) provided EQ-5D data for over 3,000 women. Information on distress and multi-dimensional health locus of control had been collected using other instruments. A linear regression model was fitted, with VAS score as the dependent variable. Independent variables comprised EQ-5D health state classifications, distress, locus of control, and socio-demographic characteristics. Equivalent EQ-5D and distress data, collected at twelve months, were available for over 2,000 of the women, enabling us to predict changes in VAS score over time from changes in EQ-5D classification and distress.

RESULTS

In addition to EQ-5D health state classification, VAS score was influenced by the subject's perceived locus of control, and by her age, educational attainment, ethnic origin and smoking behaviour. Although the EQ-5D classification includes a distress dimension, the independent measure of distress was an additional determinant of VAS score. Changes in VAS score over time were explained by changes in both EQ-5D severities and distress. Women allocated to the experimental management arm of the trial reported an increase in VAS score, independently of any changes in health state and distress.

CONCLUSION

In this sample, EQ VAS scores were predictable from the EQ-5D health state classification, although there also existed other group variables which contributed systematically and independently towards determining such scores. These variables comprised psychological disposition, socio-demographic factors such as age and education, clinically-important distress, and the clinical intervention itself.

TRIAL REGISTRATION

ISRCTN34841617.

Validity of single-item parental ratings of child oral health

OBJECTIVE

The aim of this study was to assess the validity of single-item parental ratings of child oral heath.

METHODS

Data were collected during a study to assess the impacts of dental injury. Clinical examinations of children aged 11-14 years were undertaken that included measures of trauma, decay, treatment needs, and fluorosis. Children with trauma and a group of trauma-free children were followed-up. Parents were mailed a questionnaire along with a questionnaire for the child that contained a short form of the Child Perceptions Questionnaire 11-14 (CPQ11-14). Bivariate analyses examined associations between parents' ratings of their child's oral health, measures of dental disease, clinically defined treatment needs, and scores on the CPQ11-14. Logistic regression was used to see if the associations observed remained after controlling for access to dental care variables.

RESULTS

Complete data were collected from 370 children and their parents. Parental ratings showed significant associations with most of the clinical indicators used and CPQ11-14 scores. Similar results were obtained when the data were analysed for subgroups defined by household income and mother's education. These associations remained after controlling for access to dental services.

CONCLUSION

The data suggest that single-item parental ratings of child oral health have adequate construct validity.

Validity of patient-reported health-related quality of life global ratings of change using structural equation modeling

BACKGROUND

Patient-perceived global ratings of change are often used as anchors of health-related quality of life (HRQoL) since they are easy for clinicians to interpret and incorporate the patient's perception of change as a means to capture clinical significance. Although this approach may be preferred, the validity of the anchor-based approach is currently under scrutiny.

OBJECTIVE

To estimate the explained variation in single-item domain-specific global ratings of change (GRCs) that is accounted for by time 1 (T1) and time 2 (T2) domain-specific summary change scores from the Short-Form 36, V2 (SF-36) Health Survey in asthma primary care patients.

METHODS

The baseline and first follow-up enrollment data to be evaluated in this investigation were part of a larger longitudinal HRQoL study conducted from August 2000-December 2002, in which the 356 asthma patients from Midwestern primary care facilities completed telephone interviews for every two consecutive months for a year on multiple HRQoL measures, including the SF-36 and domain-specific GRCs. A structural equation modeling technique was employed to ascertain the explained variability in patient-reported GRCs for each SF-36 domain that is accounted for by the summary change scores at the two time-points for four SF-36 domains (bodily pain, general health perception, mental health, and physical functioning). The model was estimated by the maximum likelihood method with the Satorra-Bentler correction for ordinal variables using equal threshold asymptotic covariance matrices.

RESULTS

Multicollinearity between T1 and T2 latent constructs clouded interpretation of the standardized structural coefficients leading to GRCs. Correlations, however, revealed that all four domain-specific GRCs were more strongly related to T2- than T1-domain summary scores, indicating that patients were not equally relying on T1 and T2 to generate the GRCs. Furthermore, T1-domain summary scores were not of equal magnitude and opposite sign as compared to T2 scores.

CONCLUSIONS

In this study, there is insufficient evidence to establish SF-36 domain-specific GRC validity in asthma primary care patients. Therefore, it is recommended to reassess validity before using domain-specific SF-36 GRCs to classify clinically important change over time.

What Do Older Adults' Global Self-ratings of Oral Health Measure?

OBJECTIVE

Although global self-ratings of oral health are widely used in oral health research, the frames of reference on which older people's ratings are based are not known. This study used a quantitative approach in order to identify these referents.

METHODS

Data were collected from 498 dentate subjects aged 53 years and over who took part in the second stage of a three-phase longitudinal epidemiological and sociodental study. Data were obtained by means of a personal interview and clinical oral examination and a self-complete version of the 49-item Oral Health Impact Profile (OHIP). These data were used to construct measures of oral disorders, oral symptoms, the functional and psychosocial impacts of oral disorders, health behaviours and contextual variables such as general health status, socioeconomic status and sociodemographic characteristics. Bivariate and linear regression analyses were used to identify which of these variables predicted self-ratings of oral health.

RESULTS

One quarter of subjects stated that their oral health was only fair or poor. At the bivariate level most variables were associated with self-ratings of oral health. The regression model for all subjects indicated that the most important predictor of these self-ratings was the OHIP functional limitations sub-scale score. This explained 23% of the variation in the self-ratings. Six other variables entered the model and increased the R2 value to 0.36. There was some variation in the models and the influence of various factors by age and educational attainment.

CONCLUSIONS

The results suggest that the referents that inform older adults' ratings of oral health are broadly similar to those that have been reported to inform their ratings of general health and differ across groups.

A comparison of traditional and Rasch cut points for assessing clinically important change in health-related quality of life among patients with asthma

BACKGROUND

Patient-perceived change in health-related quality of life (HRQoL) domains has often been classified using a 15-point patient transition rating scale. However, traditional change levels of trivial ( - 1, 0, or 1), minimal (2, 3 or - 2, - 3), moderate (4, 5 or - 4, - 5) and large (6, 7 or - 6, - 7) on this scale have been arbitrarily defined and originally assumed that change related to an improvement was the same as that for a decline.

OBJECTIVE

To compare traditional and Rasch partial credit model-derived cut points and the mean changes for each change categorization when assessing clinically important change in asthma-specific HRQoL.

METHODS

Our sample included 396 asthmatic outpatients who completed bimonthly telephone interviews on the Asthma Quality of Life Questionnaire and transition rating items over 1 year of participation. We employed item response theory in a novel approach to identify cut points on domain-specific HRQoL change data and transition ratings. After determining natural cut points for minimal, moderate, and large differences on the transition rating anchor, we calculated mean changes under change categorizations for both improvements and declines for the two transition rating classification approaches.

RESULTS

Although traditional and Rasch categorizations for small, moderate, and large changes slightly differed and displayed a lack of symmetry between improvements and declines, nearly all mean changes between classification approaches were comparable.

CONCLUSIONS

In this study, traditional transition rating cut points remain suitable to assess HRQoL clinical significance in outpatients with asthma.

The concept of positive health: a review and commentary on its application in oral health research

Although the concept of positive health has been around for more than 60 years, acceptable measures of this construct have yet to emerge. Potential explanations are that there is no consensus on how it is to be defined and its ambiguous status with respect to medical and socioenvironmental models of health. In this paper we review definitions of positive health, the origins of these definitions, the way the concept of positive outcomes has been used in research on the outcomes of oral and orofacial conditions and assess whether the concept of positive health has any merit in terms of applied oral health research. This literature reveals many competing and imprecise definitions, many of which are similar to other constructs, such as well-being. Most are lacking empirical referents or indicators. In examining the literature on oral health we found five distinct, although overlapping, ways in which the concept of positive health has been framed: (i) positive health as the absence of negative health states; (ii) positive health as positively worded items; (iii) the positive outcomes of oral health; (iv) positive oral health as a set of psychological and social attributes, and (v) the positive outcomes of chronic conditions such as oro- and craniofacial differences. Each of these ways can be challenged on conceptual or methodological grounds. For example, the states that comprise the upper end of the negative-positive health continuum have not been defined and health states and determinants of health are often confused. Moreover, the meaning of responses to health status questionnaires and the interpretation of accounts of the illness experience is often unclear. Nevertheless, the notion of positive health, irrespective of its merits and public policy implications, provides a context for methodological and theoretical debate that can only serve to enrich theory and practice with respect to measures of health and quality of life and therapeutic interventions at the individual and population.

Quality of life: questionnaires and questions

Quality of life (QoL) is a phrase often used in health care settings at policy and administration levels, in clinical assessments of therapies, and in clinical management of individual cases. While QoL is a broad concept that covers such areas as social, environmental, economic, and health satisfaction, health-related quality of life (HRQL) is less wide ranging, including mental and physical health and their consequences. First, I question the singularity of HRQL, suggesting there are at least two distinct meanings of HRQL. Second, questionnaires designed to assess individual patients' HRQL allow a limited range of ways for patients to express their state of being. The Medical Outcomes Study Short Form (SF-36), which operationalises HRQL for a traditional clinical setting, is used to show in detail the restricted options that are available for patient respondents. The communications limitations of utility-based measures, designed as cost-effectiveness measures but often used as though they were HRQL instruments, are also discussed. For assessing the HRQL of individuals in a health setting, such questionnaires can provide only a starting point, which should be supplemented with good interaction and communication.

Assessing Measurement Properties of Two Single-item General Health Measures

BACKGROUND

Multi-item health status measures can be lengthy, expensive, and burdensome to collect. Single-item measures may be an alternative. We compared measurement properties of two single-item, general self-rated health (GSRH) questions to assess how well they captured information in a validated, multi-item instrument.

METHODS

We administered a general health survey (SF-12V) that included "standard" and "comparative" forms of a GSRH. We repeated the survey two weeks later to the same 75 medically stable outpatients to test for GSRH reproducibility, reliability, and validity using SF-12V Physical Functioning and Emotional Health subscales as a reference.

RESULTS

At each survey administration, the two GSRH questions demonstrated good alternate forms reliability (first administration: r = 0.74, p < 0.001; second administration: r = 0.74, p < 0.001) and good reproducibility ("standard": ICC 0.69; "comparative": ICC 0.85). Both GSRH items correlated with physical functioning ("standard": r = 0.66; "comparative": r = 0.56) and emotional health measures ("standard": r = 0.65; "comparative": r = 0.59). Mean subscale measures associated with responses in each GSRH category were significantly different (ANOVA, p < 0.001), indicating strong discriminant scale performance.

CONCLUSIONS

Our single-item, GSRH questions demonstrated good reproducibility, reliability, and strong concurrent and discriminant scale performance with an established health status measure.

Discrepancies between self-ratings of and satisfaction with oral health in two older adult populations

OBJECTIVES

General health perceptions, usually measured by means of single-item indicators, are commonly included in health and oral health surveys. The aim of the study reported here was to assess the relationship between self-rated oral health and satisfaction with oral health in two studies of older adult populations.

METHODS

Participants in Study 1 were aged 50 years and over, the majority of whom had multiple chronic medical conditions and disabilities and lived within a multi-level geriatric care setting. They were recruited when attending a clinic in that setting for their annual dental screening. Participants in Study 2 were somewhat healthier community dwelling individuals, also aged 50 years and older, who took part. They were originally recruited by means of a telephone survey based on random-digit dialing. For Study 1, data were collected by means of personal interviews and a review of dental clinic charts, while for Study 2 personal interviews, clinical examination and self-completed questionnaires were used. Measures included self-rated oral health, satisfaction with oral health, oral health-related quality of life (OHRQoL) and tooth loss.

RESULTS

Data were obtained from 225 persons in Study 1 and 541 in Study 2. In both studies there was a significant association between self-ratings of oral health and satisfaction with oral health. However, also in both studies there was a discrepancy between the measures: approximately 10% of those with favourable oral health ratings were dissatisfied while approximately half of those with unfavourable ratings were satisfied. Those with apparently discordant responses had significantly higher scores on OHRQoL measures such as the GOHAI and the OHIP-14 than those with concordant responses. In Study 2, a similar discrepancy between self-rated general health and satisfaction with general health was also observed.

CONCLUSIONS

There is degree of discordance between self-ratings of and satisfaction with both oral and general health status in the older adult populations studied here. This may be because of the expectations concerning health in later life. More needs to be known about the frames of reference people use in constructing their responses to questions designed to assess health perceptions.

What do children's global ratings of oral health and well-being measure?

OBJECTIVES

To explore the constructs children incorporate in the responses to global ratings of their oral health (OH) and OH-related overall well-being (OWB).

METHODS

Data were collected as part of a project to validate the Child Perceptions Questionnaire for ages 11-14 (CPQ11-14), a self-report measure of OH-related quality of life. Its 37 questions are organized in the symptoms, functional limitations, emotional and social well-being domains. Children were recruited from paediatric dentistry, orthodontic and orofacial dental clinics. To identify the CPQ11-14 domain scores and questions predicting the global ratings, correlation and multiple regression analyses were used.

RESULTS

Of the 123 children, 22.8% rated their OH as 'Fair/Poor' and 30.1% reported that their OWB was affected by their oral/orofacial condition. Positive significant correlations were observed between the OH ratings and the CPQ11-14 oral symptoms and emotional well-being domains, and between the OWB ratings and all four CPQ11-14 domains. The number of the CPQ11-14 questions significantly correlated with the OH and OWB ratings were 8 and 19, respectively. Only the symptoms domain entered the model for the OH (R2=0.05), while age, functional limitations and emotional well-being domains predicted the OWB (R2=0.18). The OH model included three questions (R2=0.13) and the OWB model included age and six questions (R2=0.25). In both models all but one of the questions came from the emotional and social well-being domains.

CONCLUSIONS

These findings suggest that children view OH and its impact on well-being as multidimensional concepts. Further research, including qualitative studies, is needed to better understand the referents children use when responding to global ratings and the factors that determine their responses.

Health related quality of life of adolescents in Vietnam: cross-cultural adaptation and validation of the Adolescent Duke Health Profile

Quality of life (QOL) of adolescents has been scarcely documented in a general population sample. The study was aimed at translating and adapting the Adolescent Duke Health Profile to Vietnamese, validating the questionnaire, determining reference value, and identifying determinants of poor QOL. Following a cross-cultural methodology, the Adolescent Duke Health Profile (ADHP) had content adapted to Vietnamese by alteration of 2 out of 17 items. Test-retest validity was checked in 408 adolescents. Construct validity and internal consistency were assessed in a 1408 probability sample of adolescents in Vietnam, and determinants were analysed by multiple linear regression. The ADHP showed satisfactory internal consistency (Cronbach's alpha=0.87-0.92) and satisfactory construct validity in relation with drug abuse or not, or with parent situation living in couple or alone. Test-retest reliability was acceptable (ICC=0.7-0.8) and major determinants were age, sex, education, chronic disease, alcohol and drug use. This works provide a validated, simple health related QOL scale suited to adolescent population with reference values. Taking into account determinants identified will help program prevention and intervention health policy and to evaluate the effect of these actions.

Defining clinically meaningful change in health-related quality of life

This article reviews current approaches to defining clinically meaningful change in health-related quality of life (HRQOL) and provides guidelines for their use. Definitions of clinically meaningful change are discussed. Two broad methods for identifying clinically meaningful change are contrasted: anchor-based methods and distribution-based methods. Anchor-based methods include cross-sectional approaches and longitudinal approaches. Distribution-based methods include those based on statistical significance, sample variability, and measurement precision. Anchor-based and distribution-based methods have advantages and limitations, and neither seems to be superior to the other. An integrated system for defining clinically meaningful change is recommended that combines anchor-based and distribution-based methods. We propose a new terminology for describing meaningful change derived from anchor-based and distribution-based methods.

Activity, participation, and quality of life 6 months poststroke

OBJECTIVES

To estimate the extent of activity and participation of individuals 6 months poststroke and their influence on health-related quality of life (QOL) and overall QOL, information that would be useful in identifying services that stroke patients would need in the community.

DESIGN

Inception cohort study.

SETTING

Ten acute care hospitals in metropolitan areas of the province of Quebec.

PARTICIPANTS

Persons with first-ever stroke, either ischemic or hemorrhagic. In parallel, a population-based sample of community-dwelling individuals without stroke, frequency matched in age and city district, were also recruited.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Stroke subjects were interviewed by telephone at 6-month intervals for 2 years of follow-up. The community-dwelling individuals without stroke were also followed.

RESULTS

A total of 434 persons were interviewed approximately 6 months poststroke. Their average age +/- standard deviation was 68.4+/-12.5 years; the average age of the 486 controls was 61.7+/-12.4 years. The stroke group scored on average 90.6/100 on the Barthel Index; 39% reported a limitation in functional activities, 54% reported limitations with higher-level activities of daily living such as housework and shopping, and 65% reported restrictions in reintegration into community activities. By using the Medical Outcomes 36-Item Short-Form Health Survey (SF-36), persons with stroke rated their physical health 7 points lower than healthy peers; also, 7 of the 8 subscales of the SF-36 were affected by stroke.

CONCLUSION

Almost 50% of the community-dwelling stroke population lived with sequelae of stroke such that, unless there was a full-time and able-bodied caregiver at home, they needed some form of home help. A large proportion also reported lack of meaningful activity, indicating a need for organized support groups for people with stroke; otherwise, boredom will lead to depression and worsening of function, affect, health status, and QOL.

Quality of life in dependent older adults living at home

The purpose of medical interventions today is to favor the duration of life and to assure its quality. For a proper evaluation of the quality of life (QoL) of the elderly, it is important to assess not only the health status, but also psychological, functional and existential domains. Up to now, QoL of the dependent older living at home does not seem to have received sufficient attention. This study is a population based, cross-sectional health survey, and tries to give a picture of the QoL conditions of a group of dependent elderly living at home, using a specifically designed structured interview. In addition to this interview the Activities of Daily Living (ADL) Index and the Zung rating scale for Anxiety and Depression (AD) were administered to a total of 167 elderly (60 males and 107 females). The most interesting results of the study are the following: (1) the definition of dependence is often worsen by cultural prejudices; (2) psychopathological factors show a deep negative effect on 'attitudes towards life' of the dependent elderly; (3) QoL of the dependent elderly people in this sample is mainly negatively influenced by the degree of depression. We believe that the 'QoL-oriented' therapeutic strategy should consider more articulated and multidisciplinary geriatric and psychosocial interventions in this population.

The cancer patient and quality of life

Over the last decade, clinicians have accepted that while survival and disease-free survival are critical factors for cancer patients, overall quality-of-life is fundamental. This review considers recent developments in the field of quality of life, oncological challenges and future directions.

A comparison of the SF-36 and Nottingham Health Profile in patients with chronic neuropathic pain

The aim of this study was to evaluate and compare the psychometric properties of two generic health-related quality of life (HRQoL) instruments, the Short Form Health Survey (SF-36) and the Nottingham Health Profile (NHP) in a group of patients with chronic peripheral neuropathic pain (PNP). The sample consisted of 126 adults (56 men and 70 women) with PNP following a lesion of a peripheral nerve, spinal nerve or nerve root or patients with post-herpetic neuralgia. The battery of tests included visual analogue scales (VASs) for pain assessment and global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors. The SF-36 had higher internal consistency reliability coefficients (alpha=0.79, range 0.70-0.90) than the NHP (alpha=0.68, range 0.49-0.79). Correlations between comparable dimensions of the two instruments were significant (range from -0.79 for the physical and mental dimensions to -0.29 for the social dimension) indicating a moderate degree of convergent validity. The study population had significantly worse scores on all dimensions of the two instruments when compared with the general population. Subjects with high VAS scores for pain on movement and those with low global health ratings had poorer scores on the both instruments. Overall, the SF-36 performed somewhat better on psychometric testing than did the NHP. However, the NHP contains dimensions such as sleep and more pain items which might be of particular importance in the PNP population. Since the instruments are short, both could be retained for continued testing in outcome studies of this population.