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Muigg F, Zelger P, Rossi S, Kühn H, Schmutzhard J, Graf S, Weichbold V. Health-related quality of life in vibrant soundbridge patients: generic and specific measures, short-term and long-term outcomes. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08889-2. [PMID: 39179912 DOI: 10.1007/s00405-024-08889-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/31/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE The goal of the study was to determine the short- and long-term outcome of health-related quality of life (HRQoL) in adults implanted with a Vibrant Soundbridge (VSB). METHODS Twenty-one adults (8 females, 13 males; mean age at implantation: 57 ±10 years) who received a unilateral VSB for combined or conductive hearing loss, were administered two questionnaires: the Nijmegen Cochlear Implant Questionnaire (NCIQ) as a measure of hearing-specific HRQoL, and the Health Utility Index 3 (HUI 3) as a measure of generic HRQoL. The questionnaires were administered before implantation and three, six, 12 and 24 months after processor activation. RESULTS The NCIQ total score raised significantly from 62 points before implantation to 76 points at three months after processor activation (p < 0.005). Thereafter, no significant increases occurred anymore. The HUI 3 multi-attribute score (MAUS) increased from 0.59 before implantation to 0.70 at three months and at six months after processor activation and then declined slightly to 0.68 at 24 months after processor activation. Similar values were observed with the HUI 3 single-attribute score (SAUS) of Hearing. The increases of the HUI 3 scores were not statistically significant, but all pre-post-implantation differences were clinically relevant. DISCUSSION VSB recipients experienced a quick improvement of their HRQoL. After just three months of device use, a significant improvement of hearing-specific HRQoL and a clinically relevant improvement of generic HRQoL were seen. After three months, no essential changes of HRQoL occurred in our sample, suggesting that the achieved level of HRQoL may remain stable in the long term.
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Affiliation(s)
- Franz Muigg
- Speech & Voice Disorders, University Hospital for Hearing, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Zelger
- Speech & Voice Disorders, University Hospital for Hearing, Medical University of Innsbruck, Innsbruck, Austria.
- ICONE - Innsbruck Cognitive Neuroscience, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sonja Rossi
- Speech & Voice Disorders, University Hospital for Hearing, Medical University of Innsbruck, Innsbruck, Austria
- ICONE - Innsbruck Cognitive Neuroscience, Medical University of Innsbruck, Innsbruck, Austria
| | - Heike Kühn
- Comprehensive Hearing Center Würzburg, University-ENT-Hospital, Würzburg, Germany
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Simone Graf
- Speech & Voice Disorders, University Hospital for Hearing, Medical University of Innsbruck, Innsbruck, Austria
| | - Viktor Weichbold
- Speech & Voice Disorders, University Hospital for Hearing, Medical University of Innsbruck, Innsbruck, Austria
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Watson B, Amin GR. An examination of health care efficiency in Canada: a two-stage semi-parametric approach. HEALTH ECONOMICS, POLICY, AND LAW 2024:1-20. [PMID: 38825866 DOI: 10.1017/s1744133124000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Using data envelopment analysis, we examine the efficiency of Canada's universal health care system by considering a set of labour (physicians) and capital (beds) inputs, which produce a level of care (measured in terms of health quality and quantity) in a given region. Data from 2013-2015 were collected from the Canadian Institute for Health Information regarding inputs and from the Canadian Community Health Survey and Statistics Canada regarding our output variables, health utility (quality) and life expectancy (quantity). We posit that variation in efficiency scores across Canada is the result of regional heterogeneity regarding socioeconomic and demographic disparities. Regressing efficiency scores on such covariates suggests that regional unemployment and an older population are quite impactful and associated with less efficient health care production. Moreover, regional variation indicates the Atlantic provinces (Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick) are quite inefficient, have poorer economic prospects, and tend to have an older population than the rest of Canada. Oaxaca-Blinder decompositions suggest that the latter two factors explain about one-third of this efficiency gap. Based on our two-stage semi-parametric analysis, we recommend Canada adjust their transfer payments to reflect these disparities, thereby potentially reducing inequality in regional efficiency.
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Affiliation(s)
- Barry Watson
- Faculty of Business, University of New Brunswick, 100 Tucker Park Road, PO Box 5050, Saint John, New Brunswick, E2L 4L5, Canada
| | - Gholam R Amin
- Faculty of Business, University of New Brunswick, 100 Tucker Park Road, PO Box 5050, Saint John, New Brunswick, E2L 4L5, Canada
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Ullah MN, Cevallos A, Shen S, Carver C, Dunham R, Marsiglia D, Yeagle J, Della Santina CC, Bowditch S, Sun DQ. Cochlear implantation in unilateral hearing loss: impact of short- to medium-term auditory deprivation. Front Neurosci 2023; 17:1247269. [PMID: 37877013 PMCID: PMC10591100 DOI: 10.3389/fnins.2023.1247269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Single sided deafness (SSD) results in profound cortical reorganization that presents clinically with a significant impact on sound localization and speech comprehension. Cochlear implantation (CI) has been approved for two manufacturers' devices in the United States to restore bilateral function in SSD patients with up to 10 years of auditory deprivation. However, there is great variability in auditory performance and it remains unclear how auditory deprivation affects CI benefits within this 10-year window. This prospective study explores how measured auditory performance relates to real-world experience and device use in a cohort of SSD-CI subjects who have between 0 and 10 years of auditory deprivation. Methods Subjects were assessed before implantation and 3-, 6-, and 12-months post-CI activation via Consonant-Nucleus-Consonant (CNC) word recognition and Arizona Biomedical Institute (AzBio) sentence recognition in varying spatial speech and noise presentations that simulate head shadow, squelch, and summation effects (S0N0, SSSDNNH, SNHNSSD; 0 = front, SSD = impacted ear, NH = normal hearing ear). Patient-centered assessments were performed using Tinnitus Handicap Inventory (THI), Spatial Hearing Questionnaire (SHQ), and Health Utility Index Mark 3 (HUI3). Device use data was acquired from manufacturer software. Further subgroup analysis was performed on data stratified by <5 years and 5-10 years duration of deafness. Results In the SSD ear, median (IQR) CNC word scores pre-implant and at 3-, 6-, and 12-months post-implant were 0% (0-0%), 24% (8-44%), 28% (4-44%), and 18% (7-33%), respectively. At 6 months post-activation, AzBio scores in S0N0 and SSSDNNH configurations (n = 25) demonstrated statistically significant increases in performance by 5% (p = 0.03) and 20% (p = 0.005), respectively. The median HUI3 score was 0.56 pre-implant, lower than scores for common conditions such as anxiety (0.68) and diabetes (0.77), and comparable to stroke (0.58). Scores improved to 0.83 (0.71-0.91) by 3 months post-activation. These audiologic and subjective benefits were observed even in patients with longer durations of deafness. Discussion By merging CI-associated changes in objective and patient-centered measures of auditory function, our findings implicate central mechanisms of auditory compensation and adaptation critical in auditory performance after SSD-CI and quantify the extent to which they affect the real-world experience reported by individuals.
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Affiliation(s)
- Mohammed N. Ullah
- Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Ashley Cevallos
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Sarek Shen
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Courtney Carver
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Rachel Dunham
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Dawn Marsiglia
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Jennifer Yeagle
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Charles C. Della Santina
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Steve Bowditch
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Daniel Q. Sun
- Department of Otolaryngology – Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Khan N, Lewis AT. Influence of Bone Conduction Hearing Device Implantation on Health-Related Quality of Life for Patients with and without Tinnitus. Audiol Res 2023; 13:573-585. [PMID: 37622926 PMCID: PMC10451704 DOI: 10.3390/audiolres13040050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Tinnitus, often related to hearing loss, is an addressable public health concern affecting health-related quality of life (HRQoL). This study aimed to explore the influence of bone conduction hearing aid (BCHA) implantation on HRQoL and hearing disability in patients with hearing loss suffering from tinnitus. (2) Methods: Data were collected from an international hearing implant registry. Health Utilities Index Mark 3 (HUI-3), Spatial and Qualities of Hearing- 49 Questionnaire (SSQ) and self-reported tinnitus burden data for adult patients implanted with a BCHA (n = 42) who provided baseline as well as follow-up data 1-year post-implantation were extracted from the registry. Wilcoxon signed rank tests and paired samples t-tests were used to analyse outcomes data. (3) Results: Patients, with or without tinnitus, demonstrated clinically important mean improvements in HUI-3 multi-attribute utility scores, HUI-3 hearing attribute and SSQ scores. Hearing loss patients with tinnitus presented with a lower HRQoL than patients without tinnitus. (4) Conclusions: These findings demonstrate the importance of hearing rehabilitation in improving the quality of life and hearing disability of patients with or without tinnitus and in providing tinnitus relief in some patients with hearing loss and tinnitus.
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Affiliation(s)
- Nasrene Khan
- School of Public Health and Community Medicine, University of Gothenburg, 40530 Gothenburg, Sweden;
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Thompson NR, Lapin BR, Katzan IL. Utilities Estimated from PROMIS Scales for Cost-Effectiveness Analyses in Stroke. Med Decis Making 2023; 43:704-718. [PMID: 37401739 DOI: 10.1177/0272989x231182446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND The EQ-5D and Health Utilities Index Mark 3 (HUI-3) are preference-based measures used in cost-effectiveness studies. The Patient Reported Outcomes Measurement Information System (PROMIS) Preference scoring system (PROPr) is a new preference-based measure. In addition, algorithms were previously developed to map PROMIS Global Health (PROMIS-GH) items to HUI-3 using linear equating (HUILE) and 3-level EQ-5D using linear (EQ5DLE). We sought to evaluate and compare estimated utilities based on PROPr and PROMIS-GH in adult stroke survivors. METHODS We performed a retrospective cohort study of adults diagnosed with 1 of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage seen in an outpatient clinic between 2015 and 2019. Patients completed PROMIS scales and other measures. We computed a modified version of PROPr (mPROPr) and compared the distributional characteristics and correlations with stroke outcomes for mPROPr, HUILE, and EQ5DLE. RESULTS T toal of 4,159 stroke survivors (average age 62.7 ± 14.7 y, 48.4% female, 77.6% ischemic stroke) were included. Mean utility estimates for mPROPr, EQ5DLE, and HUILE were 0.333 ± 0.244, 0.739 ± 0.201, and 0.544 ± 0.301, respectively. Correlations between the modified Rankin Scale and each of mPROPr and HUILE were both -0.48 and -0.43 for EQ5DLE. Regression analyses indicated that mPROPr scores may be too low for stroke patients in good health and that EQ5DLE scores may be too high for stroke patients in poor health. CONCLUSIONS All 3 PROMIS-based utilities were associated with measures of stroke disability and severity, but the distributions of utilities were very different. Our study highlights the problem cost-effectiveness researchers face of valuing health states with certainty. For researchers using utilities estimated from PROMIS scales, our study indicates that mapping PROMIS-GH item scores to HUI-3 via linear equating may be most appropriate in stroke patients. HIGHLIGHTS A new preference-based measure has been developed from the Patient Reported Outcomes Measurement Information System (PROMIS), known as the PROMIS-Preference (PROPr) scoring system, and published equations mapping PROMIS Global Health (PROMIS-GH) items to the Health Utilities Index Mark 3 (HUI-3) and EQ-5D-3L are available for use in cost-effectiveness studies.Our study provides distributional characteristics and comparisons of utilities estimated using a modified version of PROPr and equations mapping PROMIS-GH items to EQ-5D-3L and HUI-3 in a sample of stroke survivors.The results of our study show large differences in the distributions of utilities estimated using the different health state measures, and these differences highlight the ongoing difficulty researchers face in valuing health states with certainty.
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Affiliation(s)
- Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Brittany R Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Irene L Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Weichbold V, Zelger P, Galvan O, Muigg F. 5-Year Observation Period of Quality of Life After Cochlear Implantation. Otol Neurotol 2023; 44:e155-e159. [PMID: 36649486 DOI: 10.1097/mao.0000000000003809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Only few studies assessed health-related quality of life (HRQoL) in cochlear implant (CI) patients for a period of more than 2 years. Some of these studies indicated that HRQoL might decrease after that period. The goal of our study was to see whether HRQoL indeed decreases or remains stable beyond 2 years after implant activation. METHODS Twenty-five adults (11 women, 14 men; mean age at implantation: 60 ± 19 yr) with a unilateral CI for profound hearing loss were administered two questionnaires: the Nimjegen Cochlear Implant Questionnaire and the Health Utility Index 3 (HUI 3). The Nimjegen Cochlear Implant Questionnaire total score and the HUI single-attribute utility score of Hearing are measures of hearing-specific HRQoL, whereas the HUI multiattribute utility score is a measure of generic HRQoL. The questionnaires were administered before cochlear implantation and 1, 2, and 5 years after implant activation. RESULTS Hearing-specific HRQoL was significantly improved at 1 year after implant activation and did not significantly change thereafter. Generic HRQoL also showed significant improvement at 1 year after implant activation, but deteriorated to a clinically relevant degree thereafter. CONCLUSIONS The significant improvement of hearing-specific HRQoL obtained from cochlear implantation was fully maintained for up to 5 years after implantation. Generic HRQoL of our CI patients, however, fluctuated over time. The decrease of generic HRQoL is supposed to reflect general age-associated health declines.
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Affiliation(s)
- Viktor Weichbold
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Zelger
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Franz Muigg
- Department for Hearing, Speech and Voice Disorders, Tirol Kliniken GmbH, Innsbruck, Austria
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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Impairment in Health-Related Quality of Life among Community-Dwelling Stroke Survivors. Can J Neurol Sci 2021; 49:373-380. [PMID: 34075863 DOI: 10.1017/cjn.2021.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Health utility instruments are increasingly being used to measure impairment in health-related quality of life (HRQoL) after stroke. Population-based studies of HRQoL after stroke and assessment of differences by age and functional domain are needed. METHODS We used the Canadian Community Health Survey linked with administrative databases to determine HRQoL using the Health Utilities Index Mark 3 (HUI3) among those with prior hospitalization or emergency department visit for stroke and compared to controls without stroke. We used multivariable linear regression to determine the difference in HUI3 between those with stroke and controls for the global index and individual attributes, with assessment for modification by age (<60, 60-74, and 75+ years) and sex, and we combined estimates across survey years using random effects meta-analysis. RESULTS Our cohort contained 1240 stroke survivors and 123,765 controls and was weighted to be representative of the Canadian household population. Mean health utility was 0.63 (95% confidence interval [CI] 0.58, 0.68) for those with stroke and 0.83 (95% CI 0.82, 0.84) for controls. There was significant modification by age, but not sex, with the greatest adjusted reduction in HUI3 among stroke respondents aged 60-74 years. Individual HUI3 attributes with the largest reductions in utility among stroke survivors compared to controls were mobility, cognition, emotion, and pain. CONCLUSIONS In this population-based study, the reduction in HUI3 among stroke survivors compared to controls was greatest among respondents aged 60-74, and in attributes of mobility, cognition, emotion, and pain. These results highlight the persistent impairment of HRQoL in the chronic phase of stroke and potential targets for community support.
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Whang KA, Le TK, Khanna R, Williams KA, Roh YS, Sutaria N, Choi J, Gabriel S, Chavda R, Semenov Y, Kwatra SG. Health-related quality of life and economic burden of prurigo nodularis. J Am Acad Dermatol 2021; 86:573-580. [PMID: 34058278 DOI: 10.1016/j.jaad.2021.05.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is an understudied, pruritic inflammatory skin disease. Little is known about the effect of PN on quality of life and its associated economic burden. OBJECTIVE To quantify the impact of PN on quality of life and its economic implications. METHODS A cohort study of PN patients (n = 36) was conducted using the Health Utilities Index Mark 3 questionnaire. Control data from US adults (n = 4187) were obtained from the 2002-2003 Joint Canada/United States Survey of Health. Quality-adjusted life year loss and economic costs were estimated by comparing the Health Utilities Index Mark 3 scores of the PN patients with those of the controls. RESULTS The PN patients had lower overall health performance compared to the controls, (mean ± SE, 0.52 ± 0.06 vs 0.86 ± 0.003, respectively, P < .001). In multivariable regression, PN was found to be associated with worse health performance (coefficient -0.34, 95% CI [-0.46 to -0.23]), most prominent in the pain subdomain (coefficient -0.24, 95% CI [-0.35 to -0.13]). This correlated to an average of 6.5 lifetime quality-adjusted life years lost per patient, translating to an individual lifetime economic burden of $323,292 and a societal burden of $38.8 billion. CONCLUSION These results demonstrate that PN is associated with significant quality-of-life impairment, similar to the level of other chronic systemic conditions. PN is also associated with a substantial individual economic burden, emphasizing the necessity of research on effective treatment options.
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Affiliation(s)
- Katherine A Whang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas K Le
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Youkyung Sophie Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sylvie Gabriel
- Galderma Prescription Global Business Unit, Rue d'Entre-deux-Villes, La Tour-de-Peilz, Switzerland
| | - Rajeev Chavda
- Galderma Prescription Global Business Unit, Rue d'Entre-deux-Villes, La Tour-de-Peilz, Switzerland
| | - Yevgeniy Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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An Assessment of the Validity and Reliability of the Pediatric Child Health Utility 9D in Children with Inflammatory Bowel Disease. CHILDREN-BASEL 2021; 8:children8050343. [PMID: 33925356 PMCID: PMC8146594 DOI: 10.3390/children8050343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 12/03/2022]
Abstract
Health utilities relevant to children are lacking, compromising health funding and policy decisions for children. The Child Health Utility 9D (CHU9D) is a recently developed preference-based health utility instrument designed for use in children. The objective was to examine the validity of the CHU9D in a cohort of 285 Canadian children aged 6.5 to 18 years of age with Crohn’s disease (CD) and ulcerative colitis (UC), (collectively inflammatory bowel disease (IBD)). The correlation and agreement between paired CHU9D and Health Utility Index (HUI) assessments were determined with Spearman coefficients and Bland–Altman levels of agreement. Total and domain utilities were calculated for the CHU9D using Australian adult and youth tariffs. Algorithms for HUI2 and HUI3 were used. Domain correlations were determined between domains with expected overlap between instruments. In CD and in UC, correlations between CHU9D, HUI2, and HUI3 utilities ranged between 0.62 to 0.67 and 0.67 to 0.69, respectively (p < 0.05). CHU9D utilities were lower using youth tariffs compared to adult tariffs. A large range in health utilities suggested a heterogeneous quality of life. The CHU9D is a good option for preference-based utility measurement in pediatric IBD. Additional research is required to derive pediatric tariffs to conduct economic evaluation in children.
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Whang KA, Khanna R, Williams KA, Mahadevan V, Semenov Y, Kwatra SG. Health-Related QOL and Economic Burden of Chronic Pruritus. J Invest Dermatol 2020; 141:754-760.e1. [PMID: 32941916 DOI: 10.1016/j.jid.2020.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
Chronic pruritus (CP) has considerable implications for QOL. However, its impact on health-related QOL and economic burden is not fully characterized. We administered a cross-sectional survey on 132 patients with CP using the Health Utilities Index Mark 3 instrument. Normative data from healthy adults (n = 4,187) were obtained from the Joint Canada/US Survey of Health. Quality-adjusted life-year loss and economic costs were estimated on the basis of Health Utilities Index Mark 3 scores of patients with CP versus controls. Patients with CP had lower overall health performance than the control (0.56 ± 0.03 vs. 0.86 ± 0.003, P < 0.001). In multivariable regression, CP was associated with worse overall health performance (coefficient = -0.30, 95% confidence interval = -0.33 to -0.27), most accentuated in the domains of pain (coefficient = -0.24, confidence interval = -0.28 to -0.21) and emotion (coefficient = -0.11, confidence interval = -0.13 to -0.10). The reduced Health Utilities Index Mark 3 score correlated with 5.5 average lifetime quality-adjusted life-years lost per patient. Using conservative estimates for willingness to pay, the quality-adjusted life-year loss translated to an individual lifetime economic burden of $274,921 and a societal burden of $88.8 billion. CP is associated with significant QOL impairment. The economic burden of CP highlights the necessity for further research into management options.
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Affiliation(s)
- Katherine A Whang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Varun Mahadevan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yevgeniy Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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Loftus TJ, Filiberto AC, Li Y, Balch J, Cook AC, Tighe PJ, Efron PA, Upchurch GR, Rashidi P, Li X, Bihorac A. Decision analysis and reinforcement learning in surgical decision-making. Surgery 2020; 168:253-266. [PMID: 32540036 PMCID: PMC7390703 DOI: 10.1016/j.surg.2020.04.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/18/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgical patients incur preventable harm from cognitive and judgment errors made under time constraints and uncertainty regarding patients' diagnoses and predicted response to treatment. Decision analysis and techniques of reinforcement learning theoretically can mitigate these challenges but are poorly understood and rarely used clinically. This review seeks to promote an understanding of decision analysis and reinforcement learning by describing their use in the context of surgical decision-making. METHODS Cochrane, EMBASE, and PubMed databases were searched from their inception to June 2019. Included were 41 articles about cognitive and diagnostic errors, decision-making, decision analysis, and machine-learning. The articles were assimilated into relevant categories according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS Requirements for time-consuming manual data entry and crude representations of individual patients and clinical context compromise many traditional decision-support tools. Decision analysis methods for calculating probability thresholds can inform population-based recommendations that jointly consider risks, benefits, costs, and patient values but lack precision for individual patient-centered decisions. Reinforcement learning, a machine-learning method that mimics human learning, can use a large set of patient-specific input data to identify actions yielding the greatest probability of achieving a goal. This methodology follows a sequence of events with uncertain conditions, offering potential advantages for personalized, patient-centered decision-making. Clinical application would require secure integration of multiple data sources and attention to ethical considerations regarding liability for errors and individual patient preferences. CONCLUSION Traditional decision-support tools are ill-equipped to accommodate time constraints and uncertainty regarding diagnoses and the predicted response to treatment, both of which often impair surgical decision-making. Decision analysis and reinforcement learning have the potential to play complementary roles in delivering high-value surgical care through sound judgment and optimal decision-making.
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Affiliation(s)
- Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL
| | | | - Yanjun Li
- NSF Center for Big Learning, University of Florida, Gainesville, FL
| | - Jeremy Balch
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Allyson C Cook
- Department of Medicine, University of California, San Francisco, CA
| | - Patrick J Tighe
- Departments of Anesthesiology, Orthopedics, and Information Systems/Operations Management, University of Florida Health, Gainesville, FL
| | - Philip A Efron
- Department of Surgery, University of Florida Health, Gainesville, FL
| | | | - Parisa Rashidi
- Departments of Biomedical Engineering, Computer and Information Science and Engineering, and Electrical and Computer Engineering, University of Florida, Gainesville, FL; Precision and Intelligence in Medicine, Department of Medicine, University of Florida Health, Gainesville, FL
| | - Xiaolin Li
- NSF Center for Big Learning, University of Florida, Gainesville, FL
| | - Azra Bihorac
- Department of Medicine, University of California, San Francisco, CA; Precision and Intelligence in Medicine, Department of Medicine, University of Florida Health, Gainesville, FL.
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Noto S, Uemura T. Japanese health utilities index mark 3 (HUI3): measurement properties in a community sample. J Patient Rep Outcomes 2020; 4:9. [PMID: 31997027 PMCID: PMC6987883 DOI: 10.1186/s41687-020-0175-5] [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: 04/17/2019] [Accepted: 01/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background The McMaster Health Utilities Index Mark 3 (HUI3) is a generic multi-attribute, preference-based system for assessing health-related quality of life (HRQOL). This study describes the translation procedures and cultural adaptation of the Japanese HUI3 and its measurement properties in a community sample. Methods The Japanese HUI3 was developed through forward and back translations in cooperation with the developers of the HUI. Acceptability, comprehensibility of questionnaires, and test-retest reliability were assessed. In a community survey of a total of 3860 people (age: 41 ± 14.3, male/female: 2651/1209), the Canadian scoring function was used to calculate utility scores. Construct validity was assessed by examining the relationship between 20 personal characteristics and utility scores. Results Linear regression estimates demonstrated a significant negative relation between HUI3 utility score and low education, male gender, poor interpersonal relationships, older age, and a higher number of chronic diseases. Single-attribute utility scores were associated with chronic conditions in the manner expected. The community samples were relatively healthy. More than 90% of the respondents were distributed in levels 1 and 2 in all attributes except cognition. Interpretability of utility score was assessed by estimation of the relationship between visual analogue scale (VAS) and the self-rated health and utility score. Independence of attributes was assessed. For only 3 of the 28 possible cross-comparisons among the 8 attributes were correlations coefficients greater than 0.25. Conclusion Translation and adaptation of the HUI3 questionnaire into Japanese was successful, but the sample size and selection bias limit the interpretation of our study conclusions.
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Affiliation(s)
- Shinichi Noto
- Department of Rehabilitation, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata city, Niigata, Japan.
| | - Takamoto Uemura
- A Corporate Juridical Person, Life Science Promotion Association, Tokyo, Japan.,School of Medicine, Udayana University, Bali, Indonesia
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Cochlear implantation in adults with single-sided deafness: generic and disease-specific long-term quality of life. Eur Arch Otorhinolaryngol 2019; 277:695-704. [DOI: 10.1007/s00405-019-05737-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/16/2019] [Indexed: 12/17/2022]
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Chen A, Nowrouzi-Kia B, Usuba K. Health-related quality of life in Canadians with asthma: A case-control study using census data. Respir Med 2018; 140:82-86. [PMID: 29957286 DOI: 10.1016/j.rmed.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/19/2018] [Accepted: 06/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Asthma is a common medical condition that impacts the lives of many Canadians; yet the health-related quality of life (HRQoL) in persons with asthma relative to the general population (GP) is poorly studied. In this study, data from the Canadian Community Health Survey (CCHS) 2013 was used to quantify and compare the HRQoL of the asthmatic population (AP) and the GP. METHODS A representative survey sample of Canadians was taken from the CCHS to compare the Health Utilities Index Mark 3 (HUI3) scores, a generic HRQoL measure, between the AP (n = 572) and the GP (n = 6518). The HUI3 multi-attribute utility (MAU) and the single-attribute utility (SAU) scores between the two sample groups were studied. The CCHS 2013 dataset was explored as the primary analysis, while the 2012 dataset was used as the confirmatory analysis to verify the consistency of the results. RESULTS Clinically important difference was found in the MAU score between the AP and GP (p < 0.001, Effect size = 0.30). MANOVA on the eight SAU scores with post-hoc test revealed that the AP had a lower mean score of vision (p < 0.001, Effect size = 0.36) and pain/disconfort (p < 0.001, Effect size = 0.29). Those findings were consistent with the CCHS 2012 dataset result. CONCLUSIONS These results provided evidence that in Canada, having asthma significantly worsens asthma patients' overall HRQoL and imposes significant impacts on the patients' vision and pain/discomfort. Therefore, there is room for improvement in the currently available asthma therapies so patients could achieve better HRQoL; particular focus should be given to the pain/discomfort and vision health domains.
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Affiliation(s)
- Amy Chen
- School of Health Science, Hibernia College, Dublin, Ireland
| | - Behdin Nowrouzi-Kia
- Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, Ontario, Canada; School of Rural and Northern Health, Laurentian University, Canada; Department of Occupational Therapy and Occupational Science, University of Toronto, Ontario, Canada
| | - Koyo Usuba
- Research Centre for Evaluating Children's Health Outcomes (ECHO), Laurentian University, Sudbury, Ontario, Canada; Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.
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Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3. Qual Life Res 2018; 27:1295-1309. [PMID: 29435802 PMCID: PMC5891555 DOI: 10.1007/s11136-018-1800-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/24/2022]
Abstract
Background Health-related quality of life (HRQoL) measures are of interest because they can be used to describe health of populations and represent a broader health outcome for population health analyses than mortality rates or life expectancy. The most widely used measure of HRQoL for deriving estimates of health-adjusted life expectancy is the Health Utilities Index Mark 3 (HUI3). The HUI3 is available in most national surveys administered by Statistics Canada, and has been used as part of a microsimulation model to examine the impact of neurological conditions over the life course. Persons receiving home care and nursing home services are often not well-represented in these surveys; however, interRAI assessment instruments are now used as part of normal clinical practice in these settings for nine Canadian provinces/territories. Building on previous research that developed a HUI2 crosswalk for the interRAI assessments, the present study examined a new interRAI HRQoL index crosswalked to the HUI3. Methods interRAI and survey data were used to examine the distributional properties of global and domain-specific interRAI HRQoL and HUI3 index scores, respectively. Three populations were considered: well-elderly persons not receiving home care, home care clients and nursing home residents. Results The mean HUI3 and interRAI HRQoL index global scores declined from independent healthy older persons to home care clients, followed by nursing home residents. For the home care and nursing home populations, the interRAI HRQoL global estimates tended to be lower than HUI3 global scores obtained from survey respondents. While there were some statistically significant age, sex and diagnostic group differences in global scores and within attributes, the most notable differences were between populations from different care settings. Discussion The present study provides strong evidence for the validity of the interRAI HRQoL based on comparisons of distributional properties with those obtained with survey data based on the HUI3. The results demonstrate the importance of admission criteria for home care and nursing home settings, where function plays a more important role than demographic or diagnostic criteria. The interRAI HRQoL has a distinct advantage because it is gathered as part of normal clinical practice in care settings where interRAI instruments are mandatory and are used to assess all eligible persons in those sectors. In particular, those with severe cognitive and functional impairments (who tend to be under-represented in survey data) will be evaluated using the interRAI tools. Future research should build on this work by providing direct, person-level comparisons of interRAI HRQoL index and HUI3 scores, as well as longitudinal analyses to examine responsiveness to change.
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Dickerson JF, Feeny DH, Clarke GN, MacMillan AL, Lynch FL. Evidence on the longitudinal construct validity of major generic and utility measures of health-related quality of life in teens with depression. Qual Life Res 2018; 27:447-454. [PMID: 29149441 DOI: 10.1007/s11136-017-1728-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine the longitudinal construct validity in the assessment of changes in depressive symptoms of widely used utility and generic HRQL instruments in teens. METHODS 392 teens enrolled in the study and completed HRQL and diagnostic measures as part of the baseline interview. HRQL measures included EuroQol (EQ-5D-3L), Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3), Quality of Well-Being Scale (QWB), Pediatric Quality of Life Inventory (PEDS-QL), RAND-36 (SF-6D), and Quality of Life in Depression Scale (QLDS). Youth completed follow-up interviews 12 weeks after baseline. Sixteen youth (4.1%) were lost to follow-up. We examined correlations between changes in HRQL instruments and the Children's Depression Rating Scale-Revised (CDRS-R) and assessed clinically meaningful change in multi-attribute utility HRQL measures using mean change (MC) and standardized response mean (SRM) among youth showing at least moderate (20%) improvement in depression symptomology. RESULTS Spearman's correlation coefficients demonstrated moderate correlation between changes in CDRS-R and the HUI2 (r = 0.38), HUI3 (r = 0.42), EQ-5D-3L (r = 0.36), SF-6D (r = 0.39), and PEDS-QL (r = 0.39) and strong correlation between changes in CDRS-R and QWB (r = 0.52) and QLDS (r = - 0.71). Effect size results are also reported. Among multi-attribute utility measures, all showed clinically meaningful improvements in the sample of youth with depression improvement (HUI2, MC = 0.20, SRM = 0.97; HUI3, MC = 0.32, SRM = 1.17; EQ-5D-3L, MC = 0.08, SRM = 0.51; QWB, MC = 0.11, SRM = 0.86; and SF-6D, MC = 0.12, SRM = 1.02). CONCLUSIONS Findings support the longitudinal construct validity of included HRQL instruments for the assessment of change in depression outcomes in teens. Results of this study can help inform researchers about viable instruments to include in economic evaluations for this population.
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Affiliation(s)
- John F Dickerson
- Center for Health Research - Kaiser Permanente, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - David H Feeny
- Department of Economics, McMaster University, Hamilton, ON, Canada
- Health Utilities Incorporated, Dundas, ON, Canada
| | - Gregory N Clarke
- Center for Health Research - Kaiser Permanente, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Alex L MacMillan
- ThinkShout, Inc, 433 NW 4th Ave, Suite 100, Portland, OR, 97209, USA
| | - Frances L Lynch
- Center for Health Research - Kaiser Permanente, 3800 N. Interstate Ave., Portland, OR, 97227, USA
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Harvie HS, Lee DD, Andy UU, Shea JA, Arya LA. Validity of utility measures for women with pelvic organ prolapse. Am J Obstet Gynecol 2018; 218:119.e1-119.e8. [PMID: 28988907 DOI: 10.1016/j.ajog.2017.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/11/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pelvic organ prolapse is a common condition that frequently coexists with urinary and fecal incontinence. The impact of prolapse on quality of life is typically measured through condition-specific quality-of-life instruments. Utility preference scores are a standardized generic health-related quality-of-life measure that summarizes morbidity on a scale from 0 (death) to 1 (optimum health). Utility preference scores quantify disease severity and burden and are widely used in cost-effectiveness research. The validity of utility preference instruments in women with pelvic organ prolapse has not been established. OBJECTIVE The objective of this study was to evaluate the construct validity of generic quality-of-life instruments for measuring utility scores in women with pelvic organ prolapse. Our hypothesis was that women with multiple pelvic floor disorders would have worse (lower) utility scores than women with pelvic organ prolapse only and that women with all 3 pelvic floor disorders would have the worst (lowest) utility scores. STUDY DESIGN This was a prospective observational study of 286 women with pelvic floor disorders from a referral female pelvic medicine and reconstructive surgery practice. All women completed the following general health-related quality-of-life questionnaires: Health Utilities Index Mark 3, EuroQol, and Short Form 6D, as well as a visual analog scale. Pelvic floor symptom severity and condition-specific quality of life were measured using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, respectively. We measured the relationship between utility scores and condition-specific quality-of-life scores and compared utility scores among 4 groups of women: (1) pelvic organ prolapse only, (2) pelvic organ prolapse and stress urinary incontinence, (3) pelvic organ prolapse and urgency urinary incontinence, and (4) pelvic organ prolapse, urinary incontinence, and fecal incontinence. RESULTS Of 286 women enrolled, 191 (67%) had pelvic organ prolapse; mean age was 59 years and 73% were Caucasian. Among women with prolapse, 30 (16%) also had stress urinary incontinence, 39 (20%) had urgency urinary incontinence, and 42 (22%) had fecal incontinence. For the Health Utilities Index Mark 3, EuroQol, and Short Form 6D, the pattern in utility scores was noted to be lowest (worst) in the prolapse + urinary incontinence + fecal incontinence group (0.73-0.76), followed by the prolapse + urgency urinary incontinence group (0.77-0.85) and utility scores were the highest (best) for the prolapse only group (0.80-0.86). Utility scores from all generic instruments except the visual analog scale were significantly correlated with the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire total scores (r values -0.26 to -0.57), and prolapse, bladder, and bowel subscales (r values -0.16 to -0.50). Utility scores from all instruments except the visual analog scale were highly correlated with each other (r = 0.53-0.69, P < .0001). CONCLUSION The Health Utilities Index Mark 3, EuroQol, and Short Form 6D, but not the visual analog scale, provide valid measurements for utility scores in women with pelvic organ prolapse and associated pelvic floor disorders and could potentially be used for cost-effectiveness research.
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Affiliation(s)
- Heidi S Harvie
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel D Lee
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Uduak U Andy
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lily A Arya
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Agrawal Y, Pineault KG, Semenov YR. Health-related quality of life and economic burden of vestibular loss in older adults. Laryngoscope Investig Otolaryngol 2017; 3:8-15. [PMID: 29492463 PMCID: PMC5824117 DOI: 10.1002/lio2.129] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/12/2017] [Accepted: 11/10/2017] [Indexed: 01/05/2023] Open
Abstract
Objectives Vestibular loss is a debilitating condition, and despite its high prevalence in older adults, the quality of life (QoL) burden of vestibular loss in older individuals has not been well-studied. This report quantifies the impact on overall QoL and identifies domains of health most affected. We hypothesize vestibular loss will be associated with impairment in diverse domains of health-related QoL. Study Design Prospective, case-control study. Methods A convenience sample of 27 patients age ≥60 years with vestibular physiologic loss was recruited from an academic neurotology clinic. The patients did not have any identifiable cause of their vestibular loss other than aging. The convenience sample was compared to an age-matched cross-sectional sample of the general US population (n = 1266). The main outcome was QoL measured by the Ontario Health Utilities Index Mark III (HUI3). Results Compared to the general population, patients with vestibular loss had significantly lower overall unadjusted HUI3 scores (-0.32, p < 0.001). Multivariate regression analysis showed vestibular loss was significantly associated with poorer performance in vision (-0.11 p < 0.0001), speech (-0.15, p < 0.0001), dexterity (-0.13, p < 0.0001), and emotion (-0.07, p = 0.0065). Adjusted aggregate HUI3 was also significantly lower for vestibular loss (-0.15, p = 0.0105). These QoL decrements resulted in an average loss of 1.30 Quality-Adjusted Life Years (QALYs). When using a $50,000/QALY willingness-to-pay threshold, vestibular loss was associated with a $64,929 lifetime economic burden per affected older adult, resulting in a total lifetime societal burden of $227 billion for the US population ≥60 years of age. Conclusions Loss of vestibular function with aging significantly decreases quality of life across multiple domains of well-being. These QoL reductions are responsible for heavy societal economic burdens of vestibular loss, which reveal potential benefits of prompt diagnosis and treatment of this condition. Level of Evidence 3.
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Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD U.S.A
| | - Kevin G Pineault
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD U.S.A
| | - Yevgeniy R Semenov
- Division of Dermatology Washington University School of Medicine Saint Louis MO U.S.A
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Kwon J, Kim SW, Ungar WJ, Tsiplova K, Madan J, Petrou S. A Systematic Review and Meta-analysis of Childhood Health Utilities. Med Decis Making 2017; 38:277-305. [PMID: 28990449 DOI: 10.1177/0272989x17732990] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A common feature of most reviews or catalogues of health utilities has been their focus on adult health states or derivation of values from adult populations. More generally, utility measurement in or on behalf of children has been constrained by several methodological concerns. The objective of this study was to conduct the first comprehensive systematic review and meta-analysis of primary utility data for childhood conditions and descriptors, and to determine the effects of methodological factors on childhood utilities. METHODS The review followed PRISMA guidelines. PubMed, Embase, Web of Science, PsycINFO, EconLit, CINAHL and Cochrane Library were searched for primary studies reporting health utilities for childhood conditions or descriptors using direct or indirect valuation methods. The Paediatric Economic Database Evaluation (PEDE) Porject was also searched for cost-utility analyses with primary utility values. Mean or median utilities for each of the main samples were catalogued, and weighted averages of utilities for each health condition were estimated, by valuation method. Mixed-effects meta-regression using hierarchical linear modeling was conducted for the most common valuation methods to estimate the utility decrement for each health condition category relative to general childhood population health, as well as the independent effects of methodological factors. RESULTS The literature searches resulted in 272 eligible studies. These yielded 3,414 utilities when all sub-groups were considered, covering all ICD-10 chapters relevant to childhood health, 19 valuation methods, 12 respondent types, 8 modes of administration, and data from 36 countries. A total of 1,191 utility values were obtained when only main study samples were considered, and these were catalogued by health condition or descriptor, and methodological characteristics. 1,073 mean utilities for main samples were used for fixed-effects meta-analysis by health condition and valuation method. Mixed-effects meta-regressions estimated that 53 of 76 ICD-10 delineated health conditions, valued using the HUI3, were associated with statistically significant utility decrements relative to general population health, whereas 38 of 57 valued using a visual analog scale (VAS) were associated with statistically significant VAS decrements. For both methods, parental proxy assessment was associated with overestimation of values, whereas adolescents reported lower values than children under 12 y. VAS responses were more heavily influenced by mode of administration than the HUI3. CONCLUSION Utilities and their associated distributions, as well as the independent contributions of methodological factors, revealed by this systematic review and meta-analysis can inform future economic evaluations within the childhood context.
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Affiliation(s)
- Joseph Kwon
- Department of Economics, University of Warwick, Coventry, UK
| | - Sung Wook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Kate Tsiplova
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
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Mohammad S. Budesonide as first-line therapy for non-cirrhotic autoimmune hepatitis in children: a decision analysis. Scand J Gastroenterol 2016; 51:753-62. [PMID: 26762679 DOI: 10.3109/00365521.2015.1130166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Therapy for autoimmune hepatitis has been prednisone based for decades; however, budesonide may be equally effective with fewer side effects. Our aim was to evaluate quality-adjusted life years and health care costs of three different treatment regimens. MATERIALS AND METHODS Treatment using prednisone, budesonide or a combination of both over a three-year period in newly diagnosed children with type I autoimmune hepatitis were simulated with a Markov model. Transition probabilities were calculated over consecutive three-month period. Costs were determined from a hospital database and health utilities were estimated from the literature. A Monte Carlo probabilistic sensitivity analysis was used to simulate the outcomes of 5000 patients in each treatment arm. RESULTS Compared to standard therapy, budesonide leads to a gain of 0.09 quality-adjusted life years, costing $17,722 per QALY over a three-year period. Standard therapy led to significantly lower QALY's compared to other strategies (p < 0.001). Health utilities of patients in remission in each treatment group had the greatest impact on the model. Budesonide remained the treatment of choice if the probability of inducing remission was 55% or greater. CONCLUSIONS Budesonide therapy in non-cirrhotic, treatment naïve patients with type I autoimmune hepatitis yielded greater QALY's compared to the current standard therapy with an acceptable increase in costs.
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Affiliation(s)
- Saeed Mohammad
- a Department of Pediatrics , Feinberg School of Medicine, Northwestern University , 225 E Chicago Ave , Chicago , IL , USA
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Sullivan PW, Ghushchyan VH, Globe G, Sucher B. Health-related quality of life associated with systemic corticosteroids. Qual Life Res 2016; 26:1037-1058. [PMID: 27757775 DOI: 10.1007/s11136-016-1435-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Systemic corticosteroids (SCS) are commonly used but are associated with adverse effects. Given their prevalent use, the potential impact of SCS use on health-related quality of life (HRQoL) is important to characterize. OBJECTIVE To assess the HRQoL of patients taking SCS. METHODS The 2000-2003 Medical Expenditure Panel Survey was used to examine EQ-5D and SF-6D scores associated with SCS use in adults. The study sample was restricted to those with a condition for which SCS are prescribed. SCS use was categorized into three levels: none; 1-3; and ≥4 prescriptions per year. HRQoL scores were regressed on SCS use (1-3 or ≥4 annual prescriptions) controlling for age, gender, race, ethnicity, education, income category, geographic region, number of ER visits, number of outpatient visits, total number of chronic conditions (for which SCS are not used) and conditions for which SCS are clinically indicated. RESULTS There were 54,856 individuals with no SCS exposure, 2245 with 1-3 and 624 with ≥4 annual SCS prescriptions. In adjusted analyses, use of ≥4 annual SCS prescriptions appeared to be associated with significantly lower EQ-5D (US), EQ-5D (UK), SF-6D and EQ-5D VAS scores compared to no exposure: -0.032, -0.047, -0.036, and -7.58. CONCLUSION While SCS are efficacious and widely used for numerous conditions, results suggest that their use may be associated with a substantial deleterious impact on HRQoL. This potential negative effect should be considered in balance with the cost and efficacy of comparable treatments.
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Affiliation(s)
| | - Vahram H Ghushchyan
- Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes Research, University of Colorado Aurora, Aurora, CO, USA.,American University of Armenia, Yerevan, Armenia
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Naeim A, Keeler EB, Mangione CM. Options for Handling Missing Data in the Health Utilities Index Mark 3. Med Decis Making 2016; 25:186-98. [PMID: 15800303 DOI: 10.1177/0272989x05275153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The Health Utilities Index Mark 3 (HUI3) is a tool composed of 41 questions, covering 8 attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Responses to these questions can define more than 972,000 health situations. This tool allows respondents to answer “Don’t Know,” for which there is no scoring instruction, to any given question. This situation creates a break in the scoring algorithm and leads to considerable amounts of missing data. The goal of this study is to develop strategies to deal with HUI3 scores for participants who have missing data. Methods. The authors used data from 248 individuals enrolled in the Cataract Management Trial, focusing on the HUI3 vision and ambulation attributes, which had 19% and 10% of attribute levels missing, respectively. Inspection and deduction were used to fill in values independent of the value of the missing data, then alternative analytic techniques were compared, including mean substitution, model scoring, hot deck, multiple imputation, and regression imputation. Results. Inspection and logical deduction reduced the percentage of missing information in the HUI3 by 49% to 87%. A comparison of analytic techniques used for the remaining HUI3 vision data missing demonstrated the value of building models based on internal response patterns and that simple analytic techniques fare as well as more complicated ones when the number of missing cases is small. Conclusion .Analyzing the pattern of responses in cases where the attribute level score is missing reduces the amount of missing data and can simplify the analytic process for the remaining missing data.
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Affiliation(s)
- Arash Naeim
- Division of Hematology-Oncology, UCLA Department of Medicine, Los Angeles, CA 90095-1687, USA.
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Wang C, Li Q, Sweetman A, Hurley J. Mandatory universal drug plan, access to health care and health: Evidence from Canada. JOURNAL OF HEALTH ECONOMICS 2015; 44:80-96. [PMID: 26410422 DOI: 10.1016/j.jhealeco.2015.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 05/12/2015] [Accepted: 08/11/2015] [Indexed: 06/05/2023]
Abstract
This paper examines the impacts of a mandatory, universal prescription drug insurance program on health care utilization and health outcomes in a public health care system with free physician and hospital services. Using the Canadian National Population Health Survey from 1994 to 2003 and implementing a difference-in-differences estimation strategy, we find that the mandatory program substantially increased drug coverage among the general population. The program also increased medication use and general practitioner visits but had little effect on specialist visits and hospitalization. Findings from quantile regressions suggest that there was a large improvement in the health status of less healthy individuals. Further analysis by pre-policy drug insurance status and the presence of chronic conditions reveals a marked increase in the probability of taking medication and visiting a general practitioner among the previously uninsured and those with a chronic condition.
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Affiliation(s)
- Chao Wang
- International School of Economics and Management, Capital University of Economics and Business, Beijing 100070, PR China.
| | - Qing Li
- International School of Economics and Management, Capital University of Economics and Business, Beijing 100070, PR China.
| | - Arthur Sweetman
- Department of Economics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4M4; Centre for Health Economics and Policy (CHEPA), McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1.
| | - Jeremiah Hurley
- Department of Economics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4M4; Centre for Health Economics and Policy (CHEPA), McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1.
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Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA. Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study. J Physiother 2014; 60:217-23. [PMID: 25443651 DOI: 10.1016/j.jphys.2014.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/12/2014] [Accepted: 09/05/2014] [Indexed: 11/30/2022] Open
Abstract
QUESTION In the 6 months after total knee arthroplasty (TKA), what is the pattern of pain resolution and functional recovery in people without diabetes, with diabetes that does not impact on routine activities, and with diabetes that does impact on routine activities? Is diabetes that impacts on routine activities an independent predictor of slower resolution of pain and functional recovery after TKA? DESIGN Community-based prospective observational study. PARTICIPANTS A consecutive cohort of 405 people undergoing primary TKA, of whom 60 (15%) had diabetes. PARTICIPANTS with diabetes were also asked preoperatively whether diabetes impacted on their routine activities. PARTICIPANTS were categorised into three groups: no diabetes (n=345), diabetes with no impact on activities (n=41), and diabetes that impacted activities (n=19). OUTCOME MEASURES Pain and function were measured using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index within the month before surgery and 1, 3 and 6 months after surgery. Demographic, medical and surgical factors were also measured, along with depression, social support and health-related quality of life. RESULTS No baseline differences in pain and function were seen among the three groups (p > 0.05). Adjusting for age, gender and contralateral joint involvement across the 6 postoperative months, participants with diabetes that impacted on routine activities had pain scores that were 8.3 points higher (indicating greater pain) and function scores that were 5.4 points higher (indicating lower function) than participants without diabetes. PARTICIPANTS with diabetes that doesn't impact on routine activities had similar recovery to those without diabetes. CONCLUSION People undergoing TKA who report preoperatively that diabetes impacts on their routine activities have less recovery over 6 months than those without diabetes or those with diabetes that does not impact on routine activities. Physiotherapists could institute closer monitoring within the hospital and community settings for people undergoing TKA who perceive that diabetes impacts on their routine activities. [Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA (2014) Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study.Journal of Physiotherapy60: 217-223].
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Affiliation(s)
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta; Orthopedic Research, Capital Health
| | | | - Sheri L Pohar
- Canadian Agency for Drugs and Technologies in Health, Ottawa
| | - Scot Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - Sharon Warren
- Faculty of Rehabilitation Medicine, University of Alberta
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta
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Changes in Gross Motor Function and Health-Related Quality of Life in Adults With Cerebral Palsy: An 8-Year Follow-Up Study. Arch Phys Med Rehabil 2014; 95:2071-2077.e1. [DOI: 10.1016/j.apmr.2014.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 05/01/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022]
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Mok WKY, Wong WHS, Mok GTK, Chu YWY, Ho FKW, Chow CB, Ip P, Chung BHY. Validation and application of health utilities index in Chinese subjects with down syndrome. Health Qual Life Outcomes 2014; 12:144. [PMID: 25311245 PMCID: PMC4207901 DOI: 10.1186/s12955-014-0144-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/12/2014] [Indexed: 01/31/2023] Open
Abstract
Objectives The objectives of the study were (1) to validate the Chinese version of Health Utilities Index (HUI-Ch); (2) to examine the Health-related Quality of Life (HRQoL) of Chinese subjects with Down syndrome (DS); and (3) to study the impact of chronic health conditions on HRQoL of Chinese with DS. Methods The multiple choice questionnaire for scoring Health Utilities Index Mark 2 (HUI2) and Health Utilities Index Mark 3 (HUI3) was translated and validated. In addition to the HRQoL scores from HUI2 and HUI3, proxy-data on socio-demographics, and 10 common chronic health conditions for people with DS were collected and analyzed. Data analysis involves multiple imputation and multiple regression analysis to predict variations in HRQoL in relation to different factors. Lastly, a gradient interval was constructed on the number of chronic health conditions in relation to HRQoL. Results HUI-Ch was validated according to standard guidelines. People with DS were found to have a lower HRQoL as compared to the general population, with the majority categorized as moderate or severe on the scale. Behavioral and hearing problems on HUI2, and hearing problems on HUI3 were found to be statistically significant predictors of a lower HRQoL score. A significant gradient relationship existed showing when the number of health problems increased, the HRQoL scores decreased. Conclusions HUI-Ch is a valid instrument to assess HRQoL. It can have broad application in Chinese subjects with DS including the study of the impact of different chronic health conditions on their quality of life. The quantifiable nature of HUI-Ch will facilitate longitudinal study on the well-being of subjects with DS and evaluation of effectiveness of intervention programs in the near future. Electronic supplementary material The online version of this article (doi:10.1186/s12955-014-0144-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Winnie Ka Yan Mok
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Gary Tsz Kin Mok
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Yoyo Wing Yiu Chu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Frederick Ka Wing Ho
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Chun Bong Chow
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| | - Brian Hon-Yin Chung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
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Feeny D, Garner R, Bernier J, Thompson A, McFarland BH, Huguet N, Kaplan MS, Ross NA, Blanchard CM. Physical activity matters: associations among body mass index, physical activity, and health-related quality of life trajectories over 10 years. J Phys Act Health 2014; 11:1265-75. [PMID: 24176861 PMCID: PMC4358805 DOI: 10.1123/jpah.2012-0268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of this study was to assess the associations among body mass index (BMI), leisure time physical activity (LTPA) and health-related quality of life (HRQL) trajectories among adults. METHODS Self-reported data were drawn from the Canadian National Population Health Survey, with respondents being interviewed every 2 years between 1996-97 and 2006-07. Using growth curve modeling, HRQL trajectories for individuals aged 18 and over were associated with measures of BMI and LTPA. Growth models were constructed separately for males and females. RESULTS Findings suggested that, for males, BMI categories had little impact on baseline HRQL, and no impact on the rate of change in HRQL. Among women, higher BMI categories were associated with significantly lower baseline HRQL. However, BMI had no impact on the rate of change of HRQL. Conversely, for both men and women and regardless of BMI category, LTPA had significant impacts on baseline HRQL, as well as the rate of change in HRQL. Individuals who were inactive or sedentary had much steeper declines in HRQL as they aged, as compared with individuals who were active in their leisure time. CONCLUSIONS The results underscore the importance of LTPA in shaping trajectories of HRQL.
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Affiliation(s)
- David Feeny
- Dept of Economics, McMaster University, Canada
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Withdrawal of immunosuppression following pediatric liver transplantation: a Markov analysis. J Pediatr Gastroenterol Nutr 2014; 59:182-9. [PMID: 24813534 DOI: 10.1097/mpg.0000000000000413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Survivors of pediatric liver transplantation are at risk for developing complications related to posttransplant immunosuppressive medications. Withdrawal is possible in selected patients but carries the risk of graft rejection and loss. We modeled the effect of withdrawing immunosuppressive medications on survival, cost, and quality-adjusted life-years (QALYs) in a hypothetical cohort of pediatric patients who received transplantation for biliary atresia with stable liver enzymes and no recent episodes of rejection, and who were free from immunosuppression-related adverse effects. METHODS A decision analysis tree was developed, and Monte Carlo simulations were used to track patients through the model during a 10-year time course with 1-year cycles. Data from the literature were used to assign probabilities to major clinical events and preference-based utility scores to the values of health outcomes. One-way and probabilistic sensitivity analyses were used to evaluate the impact of uncertainty. RESULTS Patients following the withdrawal strategy had a 10-year survival rate of 95.8% and experienced 8.61 QALYs versus 88.6% survival and 8.01 QALYs for those taking immunosuppressive medications. Each additional QALY is attained at a cost of -$18,992.41 and was therefore cost saving. CONCLUSIONS Patients in our model who had their immunosuppression withdrawn had improved survival and QALYs with lower costs. Although every effort was made to validate the model, it is limited by the accuracy of the underlying assumptions. Therefore, clinical trials are needed to determine predictors of successful immunosuppression withdrawal to allow for personalization of medication regimens.
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Friedman HS, Navaratnam P, Reardon G, High KP, Strauss ME. A retrospective analysis of clinical characteristics, hospitalization, and functional outcomes in residents with and without Clostridium difficile infection in US long-term care facilities. Curr Med Res Opin 2014; 30:1121-30. [PMID: 24552133 DOI: 10.1185/03007995.2014.895311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Patients in long-term care (LTC) are at increased risk for acquiring Clostridium difficile infection (CDI). We compared the characteristics and outcomes of matched cohorts with and without CDI in the LTC setting. METHODS Using a retrospective cohort design, demographic characteristics, Minimum Data Set (MDS 2.0) assessments (years 2007-2010), and pharmacy records of residents were analyzed. Residents were required to have a CDI diagnosis, ≥1 MDS 2.0 assessment ≤120 days pre- and post-index event, and receipt of metronidazole (MET) or vancomycin (VAN) within ±7 days of index date. Baseline characteristics were compared between cases and controls matched 1:3 on age, gender, and index year. Cox regression (CR) analysis evaluated the relationship between CDI status, and post-index mortality and hospitalization. RESULTS A total of 1145 CDI residents were matched with 3488 non-CDI residents. A second sample used propensity score methods. CDI vs. non-CDI residents had a higher baseline comorbidity burden (Charlson score: 3.0 ± 1.9 vs. 2.2 ± 1.8, respectively), and were more likely to have had a recent hospitalization (63% vs. 9%, respectively) and shorter mean pre-index continuous length of stay (cLOS) in the LTC (386.4 d ± 536.3 d vs. 568.3 d ± 567.4 d, respectively), all P < 0.0001. CR analyses of both samples indicated that CDI was strongly associated with shorter times to hospitalization and mortality (hazard ratio (HR) = 1.3, P = 0.023 and 2.2, P < 0.0001, respectively; propensity-matched group). Pre-index LTC cLOS also remained an important variable in the CR analysis and was the strongest predictor of post-index hospitalization and mortality (HR = 0.999 and 0.996, respectively, P < 0.0001), indicating that residents with longer pre-index LTC cLOS had longer times to post-index hospitalization and mortality. Our reliance on the MDS records for case identification was our chief limitation; misclassification was mitigated by our requirement to include CDI treatment as part of our inclusion criteria. CONCLUSIONS Understanding factors that put LTC patients at risk for CDI can help guide better management and improvement of patient outcomes.
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Thoma A, Kaur MN, Ignacy TA, Levis C, Martin S, Duku E, Haines T. Psychometric properties of health-related quality of life instruments in patients undergoing palmar fasciectomy for dupuytren's disease: a prospective study. Hand (N Y) 2014; 9:166-74. [PMID: 24839417 PMCID: PMC4022949 DOI: 10.1007/s11552-013-9597-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The traditional outcome measured following treatment of Dupuytren's Disease (DD) has been digital range of motion; specifically the gain in digital extension. The outcomes research movement in the last three decades however has been advocating the measurement of outcomes from the patient's perspective using Health-Related Quality of Life questionnaires (HRQOL). Although several generic and region-specific HRQOL questionnaires exist, there is no guidance as to which one is the most appropriate for this population. The objective of this study is to evaluate the psychometric properties of three self-reported HRQOL outcome measures in patients with DD. METHODS Patients with DD were enrolled from the practices of three plastic surgeons. Test-retest reliability, concurrent validity and responsiveness of three HRQOL questionnaires were compared in a prospective study design. The HRQOL measures included Health Utilities Index Mark 3 (HUI3), Short Form-36 (SF-36), and the Michigan Hand Questionnaire (MHQ). RESULTS All three measures demonstrated good test-retest reliability (ICC = 0.77-0.85). Concurrent validity was found between the HUI3 pain and dexterity attributes and SF-36 physical summary score. The sensitivity of the MHQ to detect changes in the status of the patient was found to be high (effect size = 1.14) whereas that of the SF-36 was trivial. CONCLUSIONS The HUI3 and the MHQ seem to be reliable and valid tools to assess the HRQOL in patients with Dupuytren's Disease.
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Affiliation(s)
- Achilleas Thoma
- />Division of Plastic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON Canada
- />Surgical Outcomes Research Centre, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON Canada
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON Canada
- />Suite 101, 206 James Street South, Hamilton, ON Canada L8P 3A9
| | - Manraj Nirmal Kaur
- />Division of Plastic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON Canada
- />Surgical Outcomes Research Centre, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON Canada
| | - Teegan Aili Ignacy
- />Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON Canada
| | - Carolyn Levis
- />Division of Plastic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON Canada
| | - Stuart Martin
- />Division of Plastic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON Canada
| | - Eric Duku
- />Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON Canada
| | - Ted Haines
- />Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON Canada
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Lloyd A, Wild D, Gallop K, Cowell W. Reimbursement agency requirements for health related quality-of-life data: a case study. Expert Rev Pharmacoecon Outcomes Res 2014; 9:527-37. [DOI: 10.1586/erp.09.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Harvie HS, Shea JA, Andy UU, Propert K, Schwartz JS, Arya LA. Validity of utility measures for women with urge, stress, and mixed urinary incontinence. Am J Obstet Gynecol 2014; 210:85.e1-6. [PMID: 24055585 DOI: 10.1016/j.ajog.2013.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/28/2013] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to evaluate the construct validity of 3 health status classification system instruments-Health Utilities Index Mark 3 (HUI-3), EuroQol (EQ-5D), and Short Form 6D (SF-6D)-and a visual analog scale (VAS) for measuring utility scores in women with urge, stress, and mixed urinary incontinence. STUDY DESIGN Utility scores were measured in 202 women with urinary incontinence. Pelvic floor symptom severity and quality of life were measured using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire, respectively. Construct, discriminant, and concurrent validity were evaluated. RESULTS Significant correlations were noted between utility scores and the Pelvic Floor Distress Inventory (r = -0.22 to -0.42, P < .05) and the Pelvic Floor Impact Questionnaire (r = -0.32 to -0.50, P < .05). Mean utility scores were significantly lower for women with urge or mixed incontinence compared to stress incontinence for the EQ-5D (0.71 ± 0.23, 0.73 ± 0.26, and 0.81 ± 0.16, respectively, P = .02) and the SF-6D (0.76 ± 0.12, 0.74 ± 0.12, and 0.81 ± 0.11, respectively, P = .02) but not the HUI-3 or the VAS. There was a clinically important difference in utility scores (>0.03) between women with urge or mixed incontinence as compared to stress incontinence for the HUI-3, EQ-5D, and SF-6D but not the VAS. Utility preference scores were significantly lower for women with combined urinary and fecal incontinence (0.69-0.73) than urinary incontinence alone (0.77-0.84, P < .01). CONCLUSION The HUI-3, EQ-5D, and SF-6D, but not the VAS, provide valid measurements for utility scores in women with stress, urge, and mixed urinary incontinence.
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Edfeldt L, Strömbäck K, Grendin J, Bunne M, Harder H, Peebo M, Eeg-Olofsson M, Petersson CM, Konradsson K. Evaluation of cost-utility in middle ear implantation in the 'Nordic School': a multicenter study in Sweden and Norway. Acta Otolaryngol 2014; 134:19-25. [PMID: 24256038 DOI: 10.3109/00016489.2013.834459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Hearing restoration using an active middle ear implant (AMEI) is a highly cost-effective treatment for a selected group of patients with no other possibilities for auditory rehabilitation. OBJECTIVES To evaluate the cost-utility of using an AMEI for hearing rehabilitation. METHODS This was a prospective, multicenter, single-subject repeated study in six tertiary referral centers. Twenty-four patients with sensorineural (SNHL), conductive (CHL), and mixed hearing loss (MHL) were implanted with the AMEI Vibrant Soundbridge® (VSB) for medical reasons. All patients were previously rehabilitated with conventional hearing aids. Multiple validated quality of life patient questionnaires, Health Utilities Index (HUI 2 and 3), and Glasgow Hearing Aid Benefit Profile (GHABP) were used to determine the utility gain and quality adjusted life years (QALY). Directly related treatment costs for the implantation were calculated and related to utility gain and QALY. RESULTS The cost/QALY for patients with SNHL was estimated at €7260/QALY, and for patients with C/MHL at €12 503/QALY.
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Affiliation(s)
- Lennart Edfeldt
- Department of Surgical Sciences, Section of Otolaryngology, Uppsala University Hospital , Uppsala , Sweden
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Luo N, Seng BK, Thumboo J, Feeny D, Li SC. A Study of the Construct Validity of the Health Utilities Index Mark 3 (HUI3) in Patients with Schizophrenia. Qual Life Res 2013; 15:889-98. [PMID: 16721648 DOI: 10.1007/s11136-005-5745-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2005] [Indexed: 10/24/2022]
Abstract
This study assessed the construct validity of the Health Utilities Index Mark 3 (HUI3) in patients with schizophrenia. Patients with schizophrenia recruited from a tertiary mental hospital in Singapore completed the HUI3, the Short-Form 36 Health Survey (SF-36) and the Schizophrenia Quality of Life Scale (SQLS). Patients were assessed for presence and absence of 22 common psychiatric symptoms. Construct validity was assessed using 6 a priori hypotheses. Two hundred and two patients (mean age: 37.8 years, female: 52%) completed the survey. As hypothesized, overall HUI3 utility scores were correlated with SF-36 measures (Spearman's rho: 0.19 to 0.51), SQLS scales (Spearman's rho: -0.56 to -0.36), and the number of psychiatric symptoms (Spearman's rho: -0.49). The HUI3 emotion attribute was moderately correlated with SF-36 mental health (Spearman's rho: 0.45) and SQLS psychosocial scales (Spearman's rho: -0.43), and HUI3 pain attribute was strongly correlated with SF-36 bodily pain scale (Spearman's rho: 0.58). The mean HUI3 overall, emotion, cognition, and speech scores for patients with schizophrenia were 0.07, 0.09, 0.04 and 0.04 points lower than respective age-, sex- and ethnicity-adjusted population norms (p<0.001 for all, ANCOVA). This study provides evidence for the construct validity of the HUI3 in patients with schizophrenia.
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Affiliation(s)
- Nan Luo
- Health Services Research Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Davis EM, Lynd LD, Grubisic M, Kopec JA, Sayre EC, Cibere J, Esdaile J, Marra CA. Responsiveness of health state utility values in knee osteoarthritis. J Rheumatol 2013; 40:2075-82. [PMID: 24187098 DOI: 10.3899/jrheum.130176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Adaptive tests are increasingly being used to assess health-related quality of life in patients with a variety of medical conditions, including osteoarthritis (OA) of the knee. This approach has recently been used to assess health state utility valuations (HSUV) for use in quality-adjusted life-year calculations. To accurately assess incremental value for money, these tools must be responsive. Therefore, we examined the responsiveness of the Health Utilities Index mark 3 (HUI3) and Paper Adaptive Test-5D (PAT-5DQOL) in a group of patients with knee OA. METHODS We used patient-level data from a randomized controlled trial evaluating a pharmacist-initiated multidisciplinary intervention in newly diagnosed patients with knee OA. The mean change for utility scores from baseline to 6 months was calculated, as well as effect size (ES) and standardized response mean (SRM) for the HUI3 and PAT-5DQOL, and generalized additive model plots, using the Western Ontario and McMaster Osteoarthritis index as a reference standard. RESULTS When patients were assessed based on whether their condition had improved, remained unchanged, or worsened over time, the PAT-5DQOL showed greater responsiveness in patients whose condition had either improved or worsened. ES and SRM were generally small for both instruments. CONCLUSION The PAT-5DQOL is more responsive to change over time than the HUI3 in patients with knee OA.
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Affiliation(s)
- Erin M Davis
- From the School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador; Collaboration for Outcomes Research and Evaluation (CORE), and School of Population and Public Health, University of British Columbia, Arthritis Research Centre, and Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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An assessment of the effects of Iyengar yoga practice on the health-related quality of life of patients with chronic respiratory diseases: a pilot study. Can Respir J 2013; 20:e17-23. [PMID: 23616973 DOI: 10.1155/2013/265406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the effects of an Iyengar yoga program (IYP) on patients with chronic respiratory diseases. METHODS Patients attending lung transplant clinics in a tertiary institution were invited to participate in a two-phase, 12-week IYP that included 2 h biweekly classes. Doctors completed a formal physical and clinical assessment on candidates before enrollment. Patients with New York Association Class III or IV, or dyspnea grade IV were excluded. At baseline and at the end of 12-weeks, patients completed the Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Questionnaire (CRQ) and Health Utilities Index (HUI). Medication(s), 6 min walk test results and other clinical parameters were also recorded. Patients recorded the effects of the IYP on their daily living in journals. Nonparametric and qualitative methods were used to analyze the data. RESULTS Twenty-five patients diagnosed with pulmonary arterial hypertension and chronic obstructive pulmonary disease (mean age 60 years) were invited to participate. At the end of the 12-week period, changes in HADS anxiety and CRQ fatigue scores were statistically significant (P<0.05) and changes in HUI ambulation, pain, emotion and overall score were clinically important. The content of the journals revealed patients' improvement in breathing capacity, mobility, energy, sleep and included positive feedback such as: "increased tidal volume with slowing expiration", "I have an overall feeling of wellbeing" and "excellent amount of energy". CONCLUSIONS The findings suggest that yoga has significant potential to produce benefits. Potential benefits will be further explored in a national multisite study.
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Jones CA, Pohar SL, Feeny DH, Eng K. Longitudinal construct validity of the Health Utilities Indices Mark 2 and Mark 3 in hip fracture. Qual Life Res 2013; 23:805-13. [DOI: 10.1007/s11136-013-0531-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/28/2022]
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Adibe MO, Ukwe CV, Aguwa CN. The Impact of Pharmaceutical Care Intervention on the Quality of Life of Nigerian Patients Receiving Treatment for Type 2 Diabetes. Value Health Reg Issues 2013; 2:240-247. [PMID: 29702871 DOI: 10.1016/j.vhri.2013.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the impact of pharmaceutical care (PC) intervention on health-related quality of life (HRQOL) of patients with type 2 diabetes. METHODS This study was a randomized, controlled study with a 12-month patient follow-up. The study protocol was approved by the Research Ethical Committees of the institutions in which this study was conducted. A total of 110 patients were randomly assigned to each of the "intervention" (PC) and "control" (usual care [UC]) groups. Patients in the UC group received the usual/conventional care offered by the hospitals. Patients in the PC group received UC and additional PC for 12 months. The HUI23S4EN.40Q (developed by HUInc - Mark index 2&3) questionnaire was used to assess the HRQOL of the patients at baseline, 6 months, and 12 months. Two-sample comparisons were made by using Student's t tests for normally distributed variables or Mann-Whitney U tests for nonnormally distributed data at baseline, 6 months, and 12 months. Comparisons of proportions were done by using the chi-square test. RESULTS The overall HRQOL (0.86 ± 0.12 vs. 0.64 ± 0.10; P < 0.0001) and single attributes except "hearing" functioning of the patients were significantly improved at 12 months in the PC intervention arm when compared with the UC arm. The HRQOL utility score was highly negatively (deficit ≥10%) associated with increasing age (≥52 years), diabetes duration (>4 years), emergency room visits, comorbidity of hypertension, and stroke in both PC and UC groups. CONCLUSION Addition of PC to UC improved the quality of life in patients with type 2 diabetes.
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Affiliation(s)
- Maxwell O Adibe
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu, Nigeria; Pharmacotherapeutic Group, Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu, Nigeria.
| | - Chinwe V Ukwe
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu, Nigeria; Pharmacotherapeutic Group, Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Cletus N Aguwa
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu, Nigeria; Pharmacotherapeutic Group, Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu, Nigeria
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Dukes JL, Seelam S, Lentine KL, Schnitzler MA, Neri L. Health-related quality of life in kidney transplant patients with diabetes. Clin Transplant 2013; 27:E554-62. [PMID: 23902276 DOI: 10.1111/ctr.12198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to assess the disutility associated with diabetes in the kidney transplant population. METHODS We enrolled 233 kidney transplant recipients age 18-74 from a Midwestern hospital outpatient department. Recipients with multiple or multi-organ transplants, those with laboratory evidence that suggests acute cellular damage (creatinine-kinase > 200 U/L), or a diagnosis of acute renal failure or acute rejection were excluded from the analysis (n = 33). Participants health-related quality of life (HRQOL) were evaluated using the Euro-QoL-5 Dimension (EQ-5D), Health Utility Index Mark III (HUI-III), and the Short Form-6D (SF-6D), which was calculated from the generic section (SF-12) of the Kidney Disease Quality of Life 36 (KDQOL-36). We estimated health utilities associated with diabetes using general linear modeling after adjusting for demographic, socioeconomic, and clinical characteristics. RESULTS The adjusted health disutilities associated with diabetes were clinically and statistically significant: EQ-5D (Δ = 0.05; p < 0.01), HUI-III (Δ = 0.09; p < 0.01), and SF-6D (Δ = 0.04, p < 0.01). There was no difference between diabetic patients with good glycemic control (mean serum glucose <126 mg/dL in the three months prior to enrollment) and patients with poor glycemic control. CONCLUSIONS Among kidney transplant patients between the ages of 18-74, non-diabetics have significantly higher HRQOL scores on the EQ-5D, HUI-III, and SF-6D compared with patients with diabetes.
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Affiliation(s)
- Jonathan L Dukes
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA; Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Bello AK, Stenvinkel P, Lin M, Hemmelgarn B, Thadhani R, Klarenbach S, Chan C, Zimmerman D, Cembrowski G, Strippoli G, Carrero JJ, Tonelli M. Serum testosterone levels and clinical outcomes in male hemodialysis patients. Am J Kidney Dis 2013; 63:268-75. [PMID: 23896484 DOI: 10.1053/j.ajkd.2013.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 06/13/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies linking low serum testosterone concentration to adverse clinical outcomes in hemodialysis patients have been relatively small. We investigated the role of testosterone in adverse outcomes and quality of life in an incident cohort of male Canadian hemodialysis patients. STUDY DESIGN A prospectively designed multicenter observational study using data from the Canadian Kidney Disease Cohort Study (CKDCS). SETTING & PARTICIPANTS Male patients initiating hemodialysis therapy since February 14, 2005, in 3 Canadian centers serving ethnically diverse populations were studied (N = 623). PREDICTOR Serum testosterone levels using the International Society of Andrology, International Society for the Study of the Aging Male, and European Association of Urology cutoffs (low, <231 ng/dL; borderline, 231-346 ng/dL; normal, >346 ng/dL). OUTCOMES All-cause mortality, fatal and nonfatal cardiovascular (CV) events, and Health Utility Index (HUI)-assessed health-related quality of life. MEASUREMENTS Participants completed a structured interview on demographics and medical history and an HUI questionnaire (version 3). Routine laboratory test results captured into the study database, and serum testosterone measured within 3 months after initiation of the baseline hemodialysis session. RESULTS During a median follow-up of 20 (range, 1-81) months, 166 (27%) died and 98 (20%) had a CV event. Mean serum testosterone level was 234.1 ± 146.1 (SD) ng/dL. Higher serum testosterone levels were associated with significantly decreased unadjusted risk of death (HR per 10-ng/dL increase, 0.58; 95% CI, 0.37-0.90). There was a statistically significant trend for higher all-cause mortality with low serum testosterone levels in adjusted analyses (P < 0.001). Higher levels of log-transformed testosterone were associated with significantly higher HUI scores (P for trend <0.001), and low levels of serum testosterone were associated significantly with lower HUI scores (P for trend <0.001). Although there was a significant trend in the unadjusted risk of CV events among participants with low serum testosterone levels (P < 0.001), the risk was no longer significant after adjustment for age. There was no significant interaction with age and serum testosterone level tested as continuous variables (P = 0.07). LIMITATIONS A short follow-up period and serum testosterone measured on a single occasion. CONCLUSIONS Low serum testosterone concentration may be a modifiable risk factor for adverse outcomes and poor quality of life in male hemodialysis patients. This hypothesis should be tested in randomized controlled trials.
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Affiliation(s)
| | | | - Meng Lin
- University of Alberta, Edmonton, Alberta, Canada
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Sullivan PW, Smith KL, Ghushchyan VH, Globe DR, Lin SL, Globe G. Asthma in USA: its impact on health-related quality of life. J Asthma 2013; 50:891-9. [PMID: 23815682 DOI: 10.3109/02770903.2013.813035] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Given the growing prevalence of asthma in USA, it is important to understand its national burden from the patient's perspective. The objective of this research is to examine the national burden of asthma and poor asthma control on health function, health perception and preference-based health-related quality of life (HRQL). METHODS The Medical Expenditure Panel Survey (MEPS), a nationally representative survey, was used to estimate the impact of asthma and indicators of poor asthma control on health function, self-rated health perception and preference-based HRQL using multivariate regression methods controlling for socioeconomic, clinical and demographic characteristics. Two HRQL instruments were used: SF-12v2 Physical Component Scale (PCS-12) and Mental Component Scale (MCS-12); EQ-5D-3L index and visual analogue scale (VAS). Two multivariate regression methods were used, Censored Least Absolute Deviation [EQ-5D-3L and VAS (due to censoring)] and Ordinary Least Squares (OLS) (PCS-12 and MCS-12). RESULTS After controlling for covariates, asthma resulted in a statistically significant reduction in preference-based HRQL, health perception and physical and mental function (EQ-5D -0.023; VAS -2.21; PCS-12 -2.36; MCS-12 -0.96). Likewise, experiencing an exacerbation in the previous year and using more than three canisters of quick-relief medication in the previous 3 months were both associated with a statistically significant and clinically meaningful reduction in all four measures. CONCLUSIONS Asthma itself and especially indicators of poor asthma control were associated with a deleterious effect on health function, preference-based HRQL and self-perceived health status. Given the prevalence of asthma, poorly controlled asthma constitutes a significant national burden in USA.
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Treviño RP, Pham TH, Edelstein SL. Obesity and preference-weighted quality of life of ethnically diverse middle school children: the HEALTHY study. J Obes 2013; 2013:206074. [PMID: 23853717 PMCID: PMC3703726 DOI: 10.1155/2013/206074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/17/2013] [Indexed: 01/01/2023] Open
Abstract
To date, studies examining the relation between body mass index percentile (BMI%) categories and health-related quality of life (QOL) measurements have not reported preference-weighted scores among ethnically diverse children. We report the associations between BMI% categories and preference-weighted scores among a large cohort of ethnically diverse sixth grade children who participated in the HEALTHY school-based type 2 diabetes risk factor prevention study. Health Utility Index 2 (HUI2) and Health Utility Index 3 (HUI3) and the feeling thermometer (FT) were the preference-weighted QOL instruments used to measure student's preference scores. Of 6358 consented students, 4979 (78.3%) had complete QOL, height, weight, and covariate data. Mean (SD) preference scores were 0.846 (0.160), 0.796 (0.237), and 0.806 (0.161) for the HUI2, HUI3, and FT, respectively. After adjusting for age, sex, blood glucose and insulin, Tanner stage, race/ethnicity, family history of diabetes, and educational attainment, children with severe obesity (>99%) had significantly lower preference scores compared to normal weight on all three instruments (HUI2 P = 0.013; HUI3 P = 0.025; and FT P < 0.001). Obese and severe obese categories were significantly associated with lower HUI2 functional ratings in the mobility domain and with lower HUI3 functional ratings in the speech domain.
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Affiliation(s)
- R P Treviño
- Social and Health Research Center, San Antonio, TX 78210, USA.
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Bailey RA, Reardon G, Wasserman MR, McKenzie RS, Hord RS. Association of anemia with worsened activities of daily living and health-related quality of life scores derived from the Minimum Data Set in long-term care residents. Health Qual Life Outcomes 2012; 10:129. [PMID: 23083314 PMCID: PMC3541079 DOI: 10.1186/1477-7525-10-129] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Among long-term care (LTC) residents, we explored the association between anemia status and hemoglobin (Hb) level with Activities of Daily Living (ADL) functioning and health-related quality of life (HRQOL). Methods Data were derived from the AnalytiCare database, containing laboratory and Minimum Data Set (MDS) reports for 27 LTC facilities in Colorado. Study timeframe was 1/1/07-9/15/08. Patients were selected based on: residence in LTC >90 days, Hb and serum creatinine value within 90 days of the earliest non-admission (index) MDS. From the index MDS, the method of 1) Carpenter et al. [BMC Geriatrics 6:7(2006)] was used to derive a summary measure of ADL performance (the MDS-ADL score) and 2) Wodchis et al. [IJTAHC 19:3(2003)] was used to assign HRQOL scores (MDS items were mapped to the Health Utilities Index Mark 2 (HUI2) scoring function to create the MDS-HSI score). Anemia was defined as Hb <12 g/dL females and <13 g/dL males. Adjusted linear regression was used to evaluate the independent association of anemia and hemoglobin level on MDS-ADL and MDS-HSI scores. Results 838 residents met all inclusion criteria; 46% of residents were anemic. Mean (SD) MDS-ADL score was 14.9 (7.5) [0–28 scale, where higher score indicates worse functioning]. In the adjusted model, anemia was associated with a significantly worse MDS-ADL score (+1.62 points, P=.001). Residents with Hb levels 10 to <11 g/dL had significantly worse ADL score (+2.06 points, P=.005) than the >13 g/dL reference. The mean MDS-HSI score was 0.431 (0.169) [range, where 0=dead to 1=perfect health]. Compared with non-anemic residents, in this adjusted model, residents with anemia had significantly worse MDS-HSI scores (−0.034 points, P=.005). Residents with hemoglobin levels <10 g/dL had significantly worse MDS-HSI scores (−0.058 points, P=.016) than the >13 g/dL reference. Conclusions After adjusting for several covariates, LTC residents with anemia, and many of those with moderate to severe declines in Hb level, had significantly poorer outcomes in both ADL functioning and HRQOL. The association between Hb level and the HRQOL measure of MDS-HSI appears to be largely explained by the mobility domain of the HRQOL measure.
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Rae C, Furlong W, Horsman J, Pullenayegum E, Demers C, St-Louis J, Lillicrap D, Barr R. Bleeding disorders, menorrhagia and iron deficiency: impacts on health-related quality of life. Haemophilia 2012; 19:385-91. [PMID: 22994803 DOI: 10.1111/hae.12014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 12/20/2022]
Abstract
von Willebrand disease (VWD) is a bleeding disorder that occurs in up to 1% of the general population. The great majority of females with VWD experience menorrhagia. The morbidity burden in females with VWD may relate to iron deficiency resulting from menorrhagia. To explore relationships between bleeding disorders, menorrhagia, iron deficiency and the outcomes of health-related quality of life (HRQL) and educational attainment. All subjects with VWD, and females with other bleeding disorders, in the Canadian national registry who were more than 12 years of age were eligible for survey. Survey measures included the HEALTH UTILITIES INDEX(®); abridged Clinical History Assessment Tool; socio-demographic questions and serum ferritin. Statistical analyses included testing differences among groups of means using analysis of variance and of proportions using chi-squared test. Significant size differences in mean HRQL scores were detected between VWD females and both females with other bleeding disorders [diff = (-0.08); P = 0.017] and VWD males [diff = (-0.07); P = 0.039]. Mean HRQL scores differed between females with and without menorrhagia (P < 0.001). Mean HRQL scores were not significantly different between females with and without iron deficiency. Educational attainment was not associated with disease group, menorrhagia status or iron status. Females with VWD have a greater morbidity burden than females in the general population, females with other bleeding disorders and males with VWD. Menorrhagia is associated with low HRQL scores in females with bleeding disorders, including VWD. Further investigation should assess how menorrhagia impacts HRQL in females with bleeding disorders.
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Affiliation(s)
- C Rae
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Swan IRC, Guy FH, Akeroyd MA. Health-related quality of life before and after management in adults referred to otolaryngology: a prospective national study. Clin Otolaryngol 2012; 37:35-43. [PMID: 22212609 PMCID: PMC3380566 DOI: 10.1111/j.1749-4486.2011.02433.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objective An assessment of the effect of otolaryngological management on the health-related quality of life of patients. Design Application of the Health Utilities Index mark 3 (HUI-3) before and after treatment; application of the Glasgow Benefit Inventory (GBI) after treatment. Setting Six otolaryngological departments around Scotland. Participants A 9005 adult patients referred to outpatient clinics. Main outcome measures Complete HUI-3 data was collected from 4422 patients; complete GBI data from 4235; complete HUI-3 and GBI data from 3884. Results The overall change in health related quality of life from before to after management was just +0.02. In the majority of subgroups of data (classified by type of management) there was essentially no change in HUI-3 score. The major exceptions were those patients provided with a hearing aid (mean change 0.08) and those whose problem was managed surgically (mean change 0.04). The mean GBI score was 5.3 which is low. Those managed surgically reported a higher GBI score of 13.0. Conclusion We found that patients treated surgically or given a hearing aid reported a significant improvement in their health related quality of life after treatment in otolaryngology departments. In general, patients treated in other ways reported no significant improvement. We argue that future research should look carefully at patient groups where there is unexpectedly little benefit from current treatment methods and consider more effective methods of management.
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Affiliation(s)
- I R C Swan
- MRC Institute of Hearing Research (Scottish Section), Glasgow Royal Infirmary, Alexandra Parade, UK.
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Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH. Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S383-412. [PMID: 22588759 DOI: 10.1002/acr.20541] [Citation(s) in RCA: 253] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Lucy Busija
- University of Melbourne, Melbourne, Victoria, Australia.
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Kaplan MS, Huguet N, Feeny D, McFarland BH, Caetano R, Bernier J, Giesbrecht N, Oliver L, Ross N. Alcohol use patterns and trajectories of health-related quality of life in middle-aged and older adults: a 14-year population-based study. J Stud Alcohol Drugs 2012; 73:581-90. [PMID: 22630796 PMCID: PMC3364324 DOI: 10.15288/jsad.2012.73.581] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 03/23/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A 14-year multiwave panel design was used to examine relationships between longitudinal alcohol-consumption patterns, especially persistent moderate use, and change in health-related quality of life among middle-aged and older adults. METHOD A nationally representative sample of 5,404 community-dwelling Canadians ages 50 and older at baseline (1994/1995) was obtained from the longitudinal National Population Health Survey. Alcohol-consumption patterns were developed based on the quantity and frequency of use in the 12 months before the interview. Health-related quality of life was assessed with the Health Utilities Index Mark 3 (HUI3). Latent growth curve modeling was used to estimate the change in HUI3 for each alcohol pattern after adjusting for covariates measured at baseline. RESULTS Most participants showed stable alcohol-consumption patterns over 6 years. Persistent non-users, persistent former users, those decreasing their consumption levels, and those with unstable patterns (i.e., U shaped and inverted U shaped) had lower HUI3 scores at baseline compared with persistent moderate drinkers. A more rapid decline in HUI3 scores than that observed for persistent moderate users was seen only in those with decreasing consumption (p < .001). In a subgroup identified as consistently healthy before follow-up, longitudinal drinking patterns were associated with initial HUI3 scores but not rates of change. CONCLUSIONS Persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, U-shaped users, and inverted U-shaped users. However, rates of decline over time were similar for all groups except those decreasing their consumption, who had a greater decline in their level of health-related quality of life than persistent moderate users.
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Garner RE, Feeny DH, Thompson A, Bernier J, McFarland BH, Huguet N, Kaplan MS, Orpana H, Ross NA, Blanchard C. Bodyweight, gender, and quality of life: a population-based longitudinal study. Qual Life Res 2012; 21:813-25. [PMID: 21842378 PMCID: PMC3258331 DOI: 10.1007/s11136-011-9989-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2011] [Indexed: 12/24/2022]
Abstract
PURPOSE The objective of the paper is to describe trajectories of health-related quality of life (HRQL) associated with categories of body mass index (BMI): underweight, normal weight, overweight, obese class I, and obese classes II and III. METHODS Data come from the longitudinal Canadian National Population Health Survey. Analyses are based on data for 3,864 men and 4,745 women who were 40+ in 1998/1999 and followed through 2006/2007. HRQL was measured with the Health Utilities Index Mark 3. Multi-level growth modeling was used. RESULTS HRQL declined with age. For men, there was a large HRQL decrement for being underweight; trajectories for all other BMI categories were very similar. For women being underweight was associated with higher HRQL at younger ages but lower at older ages. Otherwise, for women, HRQL was ordered from highest to lowest: normal, overweight, obese class I, and obese classes II and III. CONCLUSIONS Given that excess weight is a risk factor for mortality and the development of chronic conditions, the HRQL results for men are surprising. The HRQL results for women may reflect both the importance of body image on mental health and the health effects of excess weight.
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van Bloemendaal M, van de Water ATM, van de Port IGL. Walking tests for stroke survivors: a systematic review of their measurement properties. Disabil Rehabil 2012; 34:2207-21. [PMID: 22583082 DOI: 10.3109/09638288.2012.680649] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.
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