Generic versus Disease-specific Instruments in Quality-of-life Assessment of Chronic Obstructive Pulmonary Disease

Association between isolated or combined malnutrition and sarcopenia and quality of life in heart failure outpatients: A cross-sectional study

BACKGROUND

Heart failure (HF) is a chronic condition with symptoms linked to worse quality of life. Malnutrition and sarcopenia are conditions frequently found in patients with HF. This study aims to evaluate the association between isolated or combined malnutrition and sarcopenia and quality of life in outpatients with HF.

METHODS

This is a cross-sectional study with a sample of outpatients with HF aged ≥18 years. Malnutrition was assessed according to the criteria of the Global Leadership Initiative on Malnutrition, and sarcopenia was evaluated by the European Working Group on Sarcopenia in Older People. Quality of life was assessed using the Minnesota Living with HF questionnaire (MLHFQ). Clinical and sociodemographic data were collected.

RESULTS

One hundred and fifty-one patients were included in this study, with a median (interquartile range) age of 58 (48-65) years, 58.9% were adults, and 68.9% were male. A total of 29.5% of the patients were malnourished, and 28.5% and 2.6% were identified with probable sarcopenia and sarcopenia, respectively. Of the total, 15.9% of patients were identified with both conditions. Sarcopenia was associated with higher odds of increase in the MLHFQ total score, indicating worse quality of life (odds ratio [OR] = 3.61; 95% CI, 1.65-7.89). The same was found in the presence of two conditions (OR 3.97; 95% CI, 1.32-11.54), whereas isolated malnutrition was not related to life quality (OR = 1.62; 95% CI, 0.73-3.60).

CONCLUSION

The presence of malnutrition and sarcopenia simultaneously were associated with worse quality of life scores when compared with these isolated conditions.

Development and psychometric testing of the Self-Care of Stroke Inventory

PURPOSE

To develop and evaluate the psychometric properties of the Self-Care of Stroke Inventory (SCSI).

MATERIALS AND METHODS

A cross-sectional, instrument development and the psychometric testing study was conducted. A 23-item self-report Self-Care of Stroke Inventory with 3 separate scales was developed. This study involved three stages: (a) Initial items generation; (b) Content and face validation; (c) Psychometric properties evaluation. The SCSI was validated by content validity, construct validity, convergent validity, internal consistency, and test-retest reliability.

RESULTS

From the initial 80-item pool, 24 items of 3 scales in the SCSI were retained by the expert consultation and item analysis. The scale's content validity was 0.976, 0.966, and 0.973. The EFA showed the total variance explained by the 3 scales of the SCSI were 73.417%, 74.281%, and 80.207%, respectively. The models of the 3 scales identified by EFA were all confirmed by the CFA. The SCSI scale shows evidence of good convergent validity. Cronbach's αs were 0.830, 0.930, and 0.831. Test-retest reliability of the SCSI was excellent, with an intraclass correlation coefficient of 0.945, 0.907, and 0.837.

CONCLUSIONS

The final 23-item SCSI presents good psychometric properties and can be used to explore the self-care of stroke in community settings.IMPLICATIONS FOR REHABILITATIONThis study developed and validated the Self-Care of Stroke Inventory (SCSI).The SCSI contains the following 3 scales: the Self-care Maintenance of Stroke scale, the Self-care Monitoring of Stroke scale, and the Self-care Management of Stroke scaleThe 23-item SCSI demonstrated strong psychometric properties.The SCSI may be used to develop future programmes to promote self-care for stroke survivors and improve their rehabilitation outcomes.

Mapping the Food Allergy Quality of Life Questionnaire Parent Form onto the Short-Form Six-Dimensions version 2

BACKGROUND

The Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) is the most widely used quality of life questionnaire in food allergy. The objective of this study was to develop a mapping algorithm to convert FAQLQ-PF scores into health state utilities.

METHODS

The Short-Form Six-Dimensions version 2 (SF-6Dv2) and FAQLQ-PF questionnaires were collected from an academic center oral immunotherapy referral cohort. Utility estimates were derived from the SF-6Dv2 using the food allergy preference set. Candidate mapping algorithm models were developed using seven regression methods starting from either the total average score, the average scores of each of the three domains or the individual item scores of FAQLQ-PF. The process was repeated twice, including only section A, common to all age groups, or including all age-applicable sections of the FAQLQ-PF. The mean absolute error (MAE) and root mean squared error (RMSE) were used to select the best fitting model. An independent cohort from a previous national online survey was used for external validation.

RESULTS

In the index cohort, 1000 of 1257 respondents had completed both questionnaires. The lowest MAE (0.0791) and RMSE (0.1020) were recorded when entering individual item scores in a categorical regression model. The model including only FAQLQ-PF section A was found to be most consistent when tested in the external validation cohort (n = 248) (MAE of 0.0898).

CONCLUSION

The FAQLQ-PF was mapped onto SF-6Dv2 utilities with good predictive accuracy in two independent cohorts. This will enable calculation of health utility for cost-effectiveness analyses in food allergy.

Development and preliminary validation of the chronic obstructive pulmonary disease scale quality of life instruments for chronic diseases-chronic obstructive pulmonary disease based on classical test theory and generalizability theory

Quality of life (QOL) in patients with Chronic obstructive pulmonary disease (COPD) is a major global concern in respiratory care with the specific instruments used rarely being developed using a modular approach. This paper is aimed to develop the COPD scale of the system of QOL Instruments for Chronic Diseases (QLICD-COPD) by the modular approach based on Classical Test Theory and Generalizability Theory (GT). 114 inpatients with COPD were used to provide the data measuring QOL three times before and after treatments. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation analysis, factor analyses, multi-trait scaling analysis, and also GT analysis. The Results showed that Multi-trait scaling analysis, correlation and factor analyses confirmed good construct validity and criterion-related validity with almost all correlation coefficients or factor loadings being above 0.40. The internal consistency α and test-retest reliability coefficients (Pearson r and Intra-class correlations ICC) for all domains except for the social domain were larger than 0.70, ranging between 0.70–0.86 with r = 0.85 for the overall. The overall score and scores for physical and the specific domains had statistically significant changes after treatments with moderate effect size SRM (standardized response mean) ranging from 0.32 to 0.44. All G-coefficients and index of dependability were all greater than 0.80 exception of social domain (0.546 and 0.500 respectively), confirming the reliability of the scale further. It concluded that the QLICD-COPD has good validity, reliability, and moderate responsiveness, and can be used as the QOL instrument for patients with COPD.

Development and validation of a revised trauma-specific quality of life instrument

BACKGROUND

The National Academies of Science has called for routine collection of long-term outcomes after injury. One of the main barriers for this is the lack of practical trauma-specific tools to collect such outcomes. The only trauma-specific long-term outcomes measure that applies a biopsychosocial view of patient care, the Trauma Quality-of-Life (T-QoL), has not been adopted because of its length, lack of composite scores, and unknown validity. Our objective was to develop a shorter version of the T-QoL measure that is reliable, valid, specific, and generalizable to all trauma populations.

METHODS

We used two random samples selected from a prospective registry developed to follow long-term outcomes of adult trauma survivors (Injury Severity Score ≥9) admitted to three level I trauma centers. First, we validated the original T-QoL instrument using the 12-Item Short-Form Health Survey (SF-12) version 2.0 and Breslau post-traumatic stress disorder screening (B-PTSD) tools. Second, we conducted a confirmatory factor analysis to reduce the length of the original T-QoL instrument, and using a different sample, we scored and performed internal consistency and validity assessments of the revised T-QoL (RT-QoL) components.

RESULTS

All components of the original T-QoL were significantly correlated negatively with the B-PTSD and positively with the SF-12 mental and physical composite scores. After confirmatory factor analysis, a three-component structure using 18 items (six items/component) most appropriately represented the data. Each component in the revised instrument demonstrated a high level of internal consistency (Cronbach's α ≥0.8) and correlated negatively with the B-PTSD and positively with the SF-12, demonstrating concurrent validity. In addition, each of the RT-QoL components was able to distinguish between individuals based on their work status, with those who have returned to work reporting better health.

CONCLUSION

This more practical RT-QoL measure greatly increases the ability to evaluate long-term outcomes in trauma more efficiently and meaningfully, without sacrificing the validity and psychometric properties of the original instrument.

LEVEL OF EVIDENCE

Prognostic and epidemiological, level III.

Factors Associated With Long-term Outcomes After Injury: Results of the Functional Outcomes and Recovery After Trauma Emergencies (FORTE) Multicenter Cohort Study

OBJECTIVE

The aim of this study was to determine factors associated with patient-reported outcomes, 6 to 12 months after moderate to severe injury.

SUMMARY OF BACKGROUND DATA

Due to limitations of trauma registries, we have an incomplete understanding of factors that impact long-term patient-reported outcomes after injury. As 96% of patients survive their injuries, several entities including the National Academies of Science, Engineering and Medicine have called for a mechanism to routinely follow trauma patients and determine factors associated with survival, patient-reported outcomes, and reintegration into society after trauma.

METHODS

Over 30 months, major trauma patients [Injury Severity Score (ISS) ≥9] admitted to 3 Level-I trauma centers in Boston were assessed via telephone between 6 and 12 months after injury. Outcome measures evaluated long-term functional, physical, and mental-health outcomes. Multiple regression models were utilized to identify patient and injury factors associated with outcomes.

RESULTS

We successfully followed 1736 patients (65% of patients contacted). More than half (62%) reported current physical limitations, 37% needed help for at least 1 activity of daily living, 20% screened positive for posttraumatic stress disorder (PTSD), all SF-12 physical health subdomain scores were significantly below US norms, and 41% of patients who were working previously were unable to return to work. Age, sex, and education were associated with long-term outcomes, while almost none of the traditional measures of injury severity were.

CONCLUSION

The long-term sequelae of trauma are more significant than previously expected. Collection of postdischarge outcomes identified patient factors, such as female sex and low education, associated with worse recovery. This suggests that social support systems are potentially at the core of recovery rather than traditional measures of injury severity.

Mapping the Minnesota living with heart failure questionnaire (MLHFQ) to EQ-5D-5L in patients with heart failure

BACKGROUND

Mapping algorithms can be used to convert scores from a non-preference based instrument to health state utilities. The objective of this study was to develop mapping algorithms which will enable the Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores to be converted into EQ-5D-5L utility scores that can be used in heart failure related cost utility studies.

METHOD

Patients diagnosed with heart failure were recruited from Australia. Mapping algorithms were developed using both direct and indirect response mapping approach. Three model specifications were considered to predict the EQ-5D-5 L utility score using MLHFQ total score (Model 1), MLHFQ domain scores (Model 2), or MLHFQ item scores (Model 3). Six regression techniques, each of which has the capability to cope with either skewness, heteroscedasticity, ceiling effects and/or the potential presence of outliers in the data set were used to identify the optimal mapping functions for each of the three models. Goodness-of-fit of the models were assessed using six indicators. In the absence of an external validation dataset, predictive performance of was assessed using three-fold cross validation method. In the indirect response mapping, EQ. 5D 5 L responses were predicted separately using the MLHFQ item scores using ordered logit model.

RESULTS

A total of 141 patients participated in the study. The lowest mean absolute error (MAE) was recorded from the multivariable fractional polynomials (MFP) model in all three-model specifications. Regarding the indirect response mapping, results showed that the performance was comparable with the direct mapping approach based on root mean squared error (RMSE) but was worse based on MAE.

CONCLUSION

The MLHFQ can be mapped onto EQ-5D-5 L utilities with good predictive accuracy using both direct and indirect response mapping techniques. The reported mapping algorithms would facilitate calculation of health utility for economic evaluations related to heart failure.

Patient and observer reported outcome measures to evaluate health-related quality of life in inherited metabolic diseases: a scoping review

Background

Health-related Quality of Life (HrQoL) is a multidimensional measure, which has gained clinical and social relevance. Implementation of a patient-centred approach to both clinical research and care settings, has increased the recognition of patient and/or observer reported outcome measures (PROMs or ObsROMs) as informative and reliable tools for HrQoL assessment. Inherited Metabolic Diseases (IMDs) are a group of heterogeneous conditions with phenotypes ranging from mild to severe and mostly lacking effective therapies. Consequently, HrQoL evaluation is particularly relevant.

Objectives

We aimed to: (1) identify patient and/or caregiver-reported HrQoL instruments used among IMDs; (2) identify the main results of the application of each HrQoL tool and (3) evaluate the main limitations of HrQoL instruments and study design/methodology in IMDs.

Methods

A scoping review was conducted using methods outlined by Arksey and O’Malley. Additionally, we critically analysed each article to identify the HrQoL study drawbacks.

Results

Of the 1954 studies identified, 131 addressed HrQoL of IMDs patients using PROMs and/or ObsROMs, both in observational or interventional studies. In total, we identified 32 HrQoL instruments destined to self- or proxy-completion; only 2% were disease-specific. Multiple tools (both generic and disease-specific) proved to be responsive to changes in HrQoL; the SF-36 and PedsQL questionnaires were the most frequently used in the adult and pediatric populations, respectively. Furthermore, proxy data often demonstrated to be a reliable approach complementing self-reported HrQoL scores. Nevertheless, numerous limitations were identified especially due to the rarity of these conditions.

Conclusions

HrQoL is still not frequently assessed in IMDs. However, our results show successful examples of the use of patient-reported HrQoL instruments in this field. The importance of HrQoL measurement for clinical research and therapy development, incites to further research in HrQoL PROMs’ and ObsROMs’ creation and validation in IMDs.

Electronic supplementary material

The online version of this article (10.1186/s13023-018-0953-9) contains supplementary material, which is available to authorized users.

UceWeb: a Web-based Collaborative Tool for Collecting and Sharing Quality of Life Data

Objectives: This work aims at building a platform where quality-of-life data, namely utility coefficients, can be elicited not only for immediate use, but also systematically stored together with patient profiles to build a public repository to be further exploited in studies on specific target populations (e.g. cost/utility analyses).

Methods: We capitalized on utility theory and previous experience to define a set of desirable features such a tool should show to facilitate sound elicitation of quality of life. A set of visualization tools and algorithms has been developed to this purpose. To make it easily accessible for potential users, the software has been designed as a web application. A pilot validation study has been performed on 20 atrial fibrillation patients.

Results: A collaborative platform, UceWeb, has been developed and tested. It implements the standard gamble, time trade-off and rating-scale utility elicitation methods. It allows doctors and patients to choose the mode of interaction to maximize patients’ comfort in answering difficult questions. Every utility elicitation may contribute to the growth of the repository.

Conclusion: UceWeb can become a unique source of data allowing researchers both to perform more reliable comparisons among healthcare interventions and build statistical models to gain deeper insight into quality of life data.

Minimally Clinically Important Change in the Activity Measure for Post-Acute Care (AM-PAC), a Generic Patient-Reported Outcome Tool, in People With Low Back Pain

BACKGROUND

The Activity Measure for Post-Acute Care (AM-PAC) is a generic metric of patient-reported functional status. The minimal clinically important difference (MCID) in the AM-PAC score has not been determined.

OBJECTIVE

The study objective was to determine the MCID for AM-PAC in people with low back pain.

DESIGN

This was a retrospective cohort study.

METHODS

Anchor-based and distribution-based methods were used to estimate the MCID. The Modified Low Back Pain Disability Questionnaire was used as the anchor. Adults who had a primary ICD-9 code for low back pain in at least 1 outpatient physical therapist visit during an episode of care and who completed both the AM-PAC and the Modified Low Back Pain Disability Questionnaire in at least 2 visits during the care episode were included. The MCID was calculated for the AM-PAC basic mobility version as well its adapted version, which the Cleveland Clinic uses for patients 65 years old or older.

RESULTS

A total of 1,271 participants were eligible for study. For the AM-PAC basic mobility version, anchor-based methods yielded MCID estimates of between 3.4 and 5.1, whereas distribution-based methods yielded estimates of 1.7 to 4.2. The minimal detectable change (MDC) for the AM-PAC basic mobility version was 3.3. For the adapted AM-PAC basic mobility version, the MCID was estimated to be between 2.9 and 4.0 via anchor-based methods and between 1.2 to 3.5 via distribution-based methods. The MDC for the adapted AM-PAC basic mobility version was 3.5.

LIMITATIONS

The estimated MCID was designed for people with low back pain only.

CONCLUSIONS

The MCID ranged from 3.3 to 5.1 for the AM-PAC basic mobility version and 3.5 to 4 for the adapted version, with the MDC as the lower limit. Changes in the AM-PAC for people with low back pain may be interpreted using the estimated MCID. Future studies are needed to determine the AM-PAC MCID for populations other than those with low back pain.

Mental Health Status and Quality of Life in Undiagnosed Glaucoma Patients: A Nationwide Population-Based Study

Glaucoma is a leading cause of irreversible vision loss. Mental health and quality of life (QoL) are important issues for patients with glaucoma because visual impairment can be related to those. Analysis of mental health status or QoL in undiagnosed glaucoma patients can be free of the bias caused by awareness of the disease itself. In this study, the association between mental health status or QoL and undiagnosed glaucoma, along with the effects of visual acuity or visual field damage was investigated. Among individuals in the Korea National Health and Nutrition Examination Survey (KNHANES) V (2010-2012), subjects 40 years or older were included. KNHANES is a cross-sectional study using a stratified, multistage, probability sampling survey. The KNHANES includes questionnaires to assess psychological health, including depression, sleep duration, psychological stress, and suicidal ideations. To evaluate QoL, the KNHANES includes the EuroQoL, which is composed of a health-status descriptive system (EuroQol 5-dimension, EQ-5D) and the EQ visual analog scale (EQ-VAS). The proportion of people reporting symptoms of "some or severe problems" in all 5 dimensions of the EuroQoL-5 instrument, including anxiety/depression, was higher in the glaucoma group than in the nonglaucoma group. The subjective health status reported by the EQ-VAS was lower in the subjects with glaucoma than in those without glaucoma. Suicidal ideation was greater in subjects with glaucoma than in those without glaucoma (P = 0.005). After adjustment for demographic factors, glaucoma subjects were more likely than those without glaucoma to have some or severe problems with anxiety/depression (odds ratio 1.77; 95% confidence interval, 1.26-2.49). Worse best corrected visual acuity was associated with more problems with a lower EQ-5D score in glaucoma subjects. Individuals who had undiagnosed glaucoma were more depressed than those without glaucoma. QoL can be affected by glaucoma, especially in patients with worse visual acuity.

Effect of routine diagnostic imaging for patients with musculoskeletal disorders: A meta-analysis

PURPOSE

The increasing use of diagnostic imaging has led to high expenditures, unnecessary invasive procedures and/or false-positive diagnoses, without certainty that the patients actually benefit from these imaging procedures. This review explores whether diagnostic imaging leads to better patient-reported outcomes in individuals with musculoskeletal disorders.

METHOD

Databases were searched from inception to September 2013, together with scrutiny of selected bibliographies. Trials were eligible when: 1) a diagnostic imaging procedure was compared with any control group not getting or not receiving the results of imaging; 2) the population included individuals suffering from musculoskeletal disorders, and 3) if patient-reported outcomes were available. Primary outcome measures were pain and function. Secondary outcome measures were satisfaction and quality of life. Subgroup analysis was done for different musculoskeletal complaints and high technological medical imaging (MRI/CT).

RESULTS

Eleven trials were eligible. The effects of diagnostic imaging were only evaluated in patients with low back pain (n=7) and knee complaints (n=4). Overall, there was a moderate level of evidence for no benefit of diagnostic imaging on all outcomes compared with controls. A significant but clinically irrelevant effect was found in favor of no (routine) imaging in low back pain patients in terms of pain severity at short [SMD 0.17 (0.04-0.31)] and long-term follow-up [SMD 0.13 (0.02-0.24)], and for overall improvement [RR 1.15 (1.03-1.28)]. Subgroup analysis did not significantly change these results.

CONCLUSION

These results strengthen the available evidence that routine referral to diagnostic imaging by general practitioners for patients with knee and low back pain yields little to no benefit.

Socioeconomic Characteristics Are Major Contributors to Ethnic Differences in Health Status in Obstructive Lung Disease: An Analysis of the National Health and Nutrition Examination Survey 2007-2010

BACKGROUND

Understanding ethnic differences in health status (HS) could help in designing culturally appropriate interventions. We hypothesized that racial and ethnic differences exist in HS between non-Hispanic whites and Mexican Americans with obstructive lung disease (OLD) and that these differences are mediated by socioeconomic factors.

METHODS

We analyzed 826 US adults aged ≥ 30 years self-identified as Mexican American or non-Hispanic white with spirometry-confirmed OLD (FEV₁/FVC < 0.7) who participated in the National Health and Nutrition Examination Survey 2007-2010. We assessed associations between Mexican American ethnicity and self-reported HS using logistic regression models adjusted for demographics, smoking status, number of comorbidities, limitations for work, and lung function and tested the contribution of education and health-care access to ethnic differences in HS.

RESULTS

Among Mexican Americans with OLD, worse (fair or poor) HS was more prevalent than among non-Hispanic whites (weighted percentage [SE], 46.6% [5.0] vs 15.2% [1.6]; P < .001). In bivariate analysis, socioeconomic characteristics were associated with lower odds of reporting poor HS (high school graduation: OR, 0.24 [95% CI, 0.10-0.40]; access to health care: OR, 0.50 [95% CI, 0.30-0.80]). In fully adjusted models, a strong association was found between Mexican American ethnicity (vs non-Hispanic white) and fair or poor HS (OR, 7.52; 95% CI, 4.43-12.78; P < .001). Higher education and access to health care contributed to lowering the Mexican American ethnicity odds of fair or poor HS by 47% and 16%, respectively, and together, they contributed 55% to reducing the differences in HS with non-Hispanic whites.

CONCLUSIONS

Mexican Americans with OLD report poorer overall HS than non-Hispanic whites, and education and access to health care are large contributors to the difference.

A randomised controlled trial on the effectiveness of a home-based self-management programme for community-dwelling patients with myocardial infarction

AIM

To examine the effectiveness of a four-week home-based self-management rehabilitation programme on health-related quality of life, anxiety and depression levels, cardiac risks and unplanned visits to the health services among community-dwelling patients with myocardial infarction.

METHODS

A randomised controlled trial with repeated measurements was used. A convenience sample of 128 patients with myocardial infarction was recruited from outpatient cardiology clinics at a tertiary hospital in Singapore. Participants were randomly assigned to the intervention group or control group. The outcomes were measured using Short Form 12-item Health Survey Version 2, Myocardial Infarction Dimensional Assessment Scale, and Hospital Anxiety and Depression Scale. The cardiac physiological risk parameters and number of unplanned health service use were also assessed. Data were collected at baseline, and at four weeks and 16 weeks from the baseline.

RESULTS

Over the 16 weeks, the two groups reported significant differences in physical activity (F = 4.23, p = 0.02), dependency (F = 5.16, p = 0.01), concerns over medication (F = 3.47, p = 0.04) on MIDAS, anxiety level (F = 3.41, p = 0.04) and body mass index (F = 3.12, p = 0.04). A significant difference was also found in unplanned cardiac-related emergency room visits (χ(2) = 6.64, p = 0.036) and medical consultation (χ(2) = 9.67, p = 0.046) at the 16-week study point.

CONCLUSION

The study may provide a useful tool to help health care professionals to meet the cardiac rehabilitative care needs of community-dwelling patients with myocardial infarction in Singapore.

Health-related quality of life and its associated factors in Chinese myocardial infarction patients

BACKGROUND

Healthcare providers are called on to assess and improve the health-related quality of life (HRQL) of patients with myocardial infarction (MI). However, there is lack of empirical data on HRQL of such individuals in mainland China. The purpose of this study is to assess HRQL and identify associated factors in hospitalized Chinese MI patients.

METHODS

A single group, cross-sectional design was adopted with a sample of 192 hospitalized MI patients at two teaching hospitals in Xi'an, People's Republic of China. HRQL was assessed using the Chinese Mandarin versions of the Short Form 36 health survey (SF-36), the Myocardial Infarction Dimensional Assessment Scale (MIDAS), and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Chinese MI patients reported poor HRQL as measured by both the generic (SF-36) and disease-specific (MIDAS) instruments. Advancing age and the presence of heart failure, anxiety, and depression were significant predictors of overall HRQL. Smoking and hypertension were significant predictors of the physical aspects of HRQL.

CONCLUSIONS

Assessing HRQL of hospitalized Chinese MI patients and identifying associated factors may help health professionals in the design and delivery of appropriately tailored and culturally relevant interventions to this group of patients.

Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation

AIMS

This study aimed to evaluate the short- and long-term effects of 4-week inpatient rehabilitation on health-related quality of life (HRQL), anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and investigate the influence of clinical and socio-demographical factors on unaltered or improved HRQL after discharge.

METHODS

A total of 111 consecutive cases with mild-to-very severe COPD were recruited from three rehabilitation centres and measured at baseline (t1), 4 weeks (t2) and 6-month follow-up (t3). Disease severity was assessed by spirometric tests, HRQL by The St. George's Respiratory Questionnaire (SGRQ) and anxiety and depression by The Hospital Anxiety and Depression Scale (HADS). Socio-demography and co-morbidity was also reported. Changes in SGRQ and HADS scores from baseline to follow-up were analysed by paired-sample t-test, and logistic regression was used to investigate the influence of different factors on HRQL after discharge.

RESULTS

Health-related quality of life and depression improved between t1 and t2: a change of -3.6 for the SGRQ impact score (p = 0.009), -2.8 for the SGRQ total score (p = 0.012), a clinical relevant change of -4.0 for the SGRQ symptom score (p = 0.012) and a reduction of -0.7 for the HADS depression score (p = 0.011). Between t2 and t3, all SGRQ and HADS scores deteriorated with enhancement of SGRQ impact score (+3.5, p = 0.016), SGRQ total score (+2.5, p = 0.029), HADS anxiety score (+1.1, p = 0.000), HADS depression score (+0.6, p = 0.022) and HADS total score (+1.7, p = 0.000). No significant differences between t1 and t3 were found, except for HADS anxiety score (+0.9, p = 0.003). Patients living alone were 2.9 times more likely to maintain or improve HRQL 6 months after rehabilitation than patients living with someone (95% CI 1.1-7.8, p = 0.039).

CONCLUSION

Short-term benefits on HRQL and depression after rehabilitation relapsed at 6-month follow-up, but without any further deterioration from baseline. Living alone may be beneficial to maintain or improve HRQL after discharge.

Pulmonary rehabilitation reduces depression and enhances health-related quality of life in COPD patients--especially in patients with mild or moderate disease

The first objective of the study was to evaluate a 4-week inpatient pulmonary rehabilitation program on exercise capacity, health-related quality of life (HRQL) and psychological distress in patients with COPD. The second objective was to investigate the influence of gender, age, disease severity, co-morbidity, anxiety and depression on improved HRQL after rehabilitation. The study comprised 136 consecutive patients from baseline to follow-up with mild-to-severe COPD. Exercise capacity was measured by the 6-min walking distance test, disease severity by spirometric tests, HRQL by The St. George's Respiratory Questionnaire and psychological distress by the The Hospital Anxiety and Depression Scale. Variables on socio-demography and co-morbidity were self-reported. Exercise capacity was improved from baseline to follow-up with a score difference of +44 metres (p = 000). Except for the activity score, HRQL was significantly improved: a change of -3.5 for the symptom score (p = 014), -3.1 for the total score (p = 003) and a clinical significant change of - 4.0 for the impact score (p = 002). The anxiety score did not change significantly after rehabilitation (-0.1, p = 545), though there was a significant reduction of the depression score (-0.8, p = 002) and a 10.4% reduction in the prevalence of possible depression cases (p = 017). Patients with forced expiratory volume in 1 second ≥50% predicted were 4.2 times more likely to achieve a clinical significant improved HRQL after rehabilitation than patients with forced expiratory volume in 1 second <50% predicted (95% confidence interval [CI] 1.7-10.3, p = 002). A 4-week inpatient rehabilitation program improves HRQL and exercise capacity and reduces depression in COPD patients. Patients with mild or moderate disease are more likely to achieve an improved HRQL after rehabilitation than patients with severe or very severe disease.

Falls in people with chronic obstructive pulmonary disease: an observational cohort study

STUDY OBJECTIVE

To investigate incidence, risk factors and impact of falls on health related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD).

DESIGN

Observational cohort study.

METHODS

Patients completed these questionnaires at baseline and at 6-months: Medical Outcomes Study Short Form 36 (SF-36), Chronic Respiratory Questionnaire (CRQ), Activities Balance Confidence (ABC) Scale and a form to record demographic data, medications, co-morbidities, oxygen use, acute exacerbations, fall history and assistive device use. Physical activity was measured with the Physical Activity Scale for the Elderly (PASE) only at baseline. Fall incidence was monitored through monthly fall diaries. Patients were categorized as non-fallers (0 falls) or fallers (≥ 1 falls).

RESULTS

Data from 101 patients with a forced expiratory volume in 1 s of 46.4 ± 21.6% predicted were analyzed. Thirty-two patients (31.7%) reported at least one fall during the 6-months. Fall incidence rate was 0.1 (95% CI: 0.06-0.14) falls per person-month. Fallers tended to be older (p = 0.04), female (p = 0.04) and oxygen dependent (p = 0.02), have a history of previous falls (p < 0.001), more co-morbidities (p = 0.007) and take more medications (p = 0.001). Previous falls (OR = 7.36; 95% CI: 2.39-22.69) and diagnosis of coronary heart disease (OR = 7.07; 95% CI: 2.14-23.36) were the most important predictors of falls. The Dyspnea Domain of the CRQ declined significantly more (p = 0.02) in the fallers group at 6-months.

CONCLUSIONS

Patients with COPD have a high susceptibility to falls, which is associated with a worsening of dyspnea perception as related to HRQoL. Fall prevention programs in COPD are recommended.

Comparative study of two quality of life questionnaires in patients with COPD

OBJECTIVE

To compare two quality of life questionnaires-the Saint George's Respiratory Questionnaire (SGRQ) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36)-in patients with COPD, focusing on the discriminative properties of the questionnaires and correlating their domains with the following variables: Modified Medical Research Council Dyspnea Scale score; Beck Depression Inventory score; visual analog scale general health perception; Mini-Mental State Examination score; and a COPD clinical score developed specifically for the study.

METHODS

We interviewed 30 COPD patients between May and September of 2006. For the SF-36 and SGRQ, scores (total and domain) were compared and correlated.

RESULTS

With the exception of the pain domain, all of the SF-36 domains correlated significantly with the SGRQ total score (r = -0.5 to -0.69; p < 0.01). Of the SGQR domains, only the symptoms domain correlated significantly with all of the variables studied (p < 0.05).

CONCLUSIONS

The majority of the expected correlations between the SGRQ and the SF-36 were observed, as were those expected between the two questionnaires and the other variables studied. The SGRQ, notably the symptoms domain, presented better discriminative properties than did the generic SF-36 questionnaire. The SF-36 is not an appropriate instrument for determining the affective state of COPD patients.

Intervention by phone calls raises domiciliary activity and exercise capacity in patients with severe COPD

BACKGROUND

Patients with severe COPD suffer from impairments of exercise capacity which affects daily activity. Conversely, activity might exert effects on the functional state. We studied whether a short-term intervention by regular phone calls caused an increase in activity at home and whether this resulted in a gain in exercise capacity.

METHODS

Over a 2-week period (P1) normal daily activity was assessed in 21 patients with stable severe COPD (GOLD III/IV). After this, the individual setting was explored in a short home visit. The subsequent 2-week period (P2) involved phone calls every other day to raise home-based activity (target: 3x15 min daily at 75% of maximum dyspnea). During the study, patients wore an actograph plus pedometer and kept a diary. Before P1 and after P2, 6-min walking distance (6MWD), lung function, the Borg score and quality of life (SF-36, SGRQ) were determined.

RESULTS

Compared to P1, actograph counts (p<0.05) were higher in P2. There was also an increase in 6MWD (p<0.05) and quality of life scores (SF-36, p<0.05) between initial and final visit, whereby improvements in 6MWD correlated with changes in activity (p<0.01). Conversely, four patients who experienced an exacerbation in P2 showed no increase in activity or 6MWD.

CONCLUSIONS

In patients with stable severe COPD, it was possible to increase activity by regular phone calls without performing previous rehabilitation. Increased activity resulted in increased exercise capacity and quality of life within 2 weeks, underlining the effectiveness of continued motivational support in patients with severe COPD.