A comparative review of generic quality-of-life instruments

Secondary Analysis of Helplessness, Depressive Symptoms, and Sleep Quality on Health Status: A Moderated Mediation Analysis

Purpose

The objective of the study was to determine whether depressive symptoms mediated the association between helplessness and health status, and to assess whether sleep quality moderated this relationship for people with fibromyalgia (FM) in a moderated mediation model.

Patients and Methods

The participants were 600 members of a health maintenance organization. The Arthritis Helplessness Index (AHI) was used to assess helplessness. The Center for Epidemiological Studies Depression Scale (CES-D) was used to measure symptoms of depression. Sleep quality was assessed using The Pittsburgh Sleep Quality Index (PSQI). Health Status was measured using the Quality of Well-Being Scale (QWB).

Results

Depressive symptoms partially mediated the relationship between helplessness and health status. Sleep quality fully moderated the association between depressive symptoms and health status. However, worse sleep quality was associated with a weaker relationship between depressive symptoms and health status.

Conclusion

The findings extend the literature by explaining the impact of helplessness on health status via depressive symptoms, and emphasize the importance of reducing feelings of helplessness and depression in people with FM. The results suggest that depressive symptoms may be more critical than addressing sleep quality problems in interventions designed for people with FM.

Health measurement instruments and their applicability to military veterans: a systematic review

INTRODUCTION

Accurate measurement of health status is essential to assess veterans' needs and the effects of interventions directed at improving veterans' well-being. We conducted a systematic review to identify instruments that measure subjective health status, considering four components (ie, physical, mental, social or spiritual well-being).

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, JSTOR, ERIC, Social Sciences Abstracts and ProQuest in June 2021 for studies reporting on the development or evaluation of instruments measuring subjective health among outpatient populations. We assessed risk of bias with the Consensus-based Standards for the Selection of Health Measurement Instruments tool and engaged three veteran partners to independently assess the clarity and applicability of identified instruments.

RESULTS

Of 5863 abstracts screened, we identified 45 eligible articles that reported health-related instruments in the following categories: general health (n=19), mental health (n=7), physical health (n=8), social health (n=3) and spiritual health (n=8). We found evidence for adequate internal consistency for 39 instruments (87%) and good test-retest reliability for 24 (53%) instruments. Of these, our veteran partners identified five instruments for the measurement of subjective health (Military to Civilian Questionnaire (M2C-Q), Veterans RAND 36-Item Health Survey (VR-36), Short Form 36, Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Sleep Health Scale) as clear and very applicable to veterans. Of the two instruments developed and validated among veterans, the 16-item M2C-Q considered most components of health (mental, social and spiritual). Of the three instruments not validated among veterans, only the 26-item WHOQOL-BREF considered all four components of health.

CONCLUSION

We identified 45 health measurement instruments of which, among those reporting adequate psychometric properties and endorsed by our veteran partners, 2 instruments showed the most promise for measurement of subjective health. The M2C-Q, which requires augmentation to capture physical health (eg, the physical component score of the VR-36), and the WHOQOL-BREF, which requires validation among veterans.

Quality of Life, Wellbeing and Participation in Adults Born With Congenital Diaphragmatic Hernia

BACKGROUND

As more neonates born with congenital diaphragmatic hernia (CDH) survive, interest in long-term morbidities and their health-related quality of life (HRQoL) is growing. For adolescents and young adults with CDH, information on HRQoL is anecdotal. Therefore, our aim was to evaluate HRQoL and its determinants in a recently studied cohort of adult CDH survivors.

METHODS

We conducted a prospective, nationwide observational cohort study in CDH patients born 1989 to 2001. Demographic and clinical characteristics were collected, and participants completed questionnaires assessing HRQoL, participation and autonomy, fatigue, and emotional and behavioral wellbeing. Descriptive and inferential statistical analyses were performed.

RESULTS

Sixty-one CDH patients aged 19-31 years were included. Overall, participants experienced normal HRQoL for both physical (mean (SD) z-score: 0.03 (1.01); p = 0.088) and mental (z-score -0.23 (1.05); p = 0.316) components. Their participation and autonomy exceeded that of a reference population with one chronic disorder (p < 0.001), but they experienced significantly more fatigue (z-score: -0.46 (1.24); p = 0.006); which was severe in 16 %. Patients reported significantly more frequent internalizing problems, particularly within the 'somatic complaints' domain (p = 0.004). Among positive determinants of physical HRQoL were attendance of regular education, a higher exercise capacity, and better outdoors autonomy. Positive determinants of mental HRQoL included undergoing primary diaphragmatic repair and having fewer internalizing problems.

CONCLUSIONS

CDH patients perceive their HRQoL to be comparable to that of the general population, achieving similar participation and autonomy. However, fatigue warrants attention during long-term follow-up, and psychological counseling in childhood and adolescence may be beneficial for addressing emotional problems.

LEVEL OF EVIDENCE

Not applicable.

Measuring health-related quality of life among university students: a scoping review protocol

BACKGROUND

Understanding university students' health-related quality of life (HRQoL) can help propose strategies that support targeted care for this population and identify issues affecting these individuals. Therefore, it is necessary to identify the commonly used instruments and possible study designs for the university population, enabling the standardization of interventions and instruments to evaluate the HRQoL of university students. We aim to conduct a scoping review to identify the main measurement instruments and key characteristics in studies using HRQoL measures among university students. It is also aimed at identifying the foundations for guiding future research priorities.

METHODS

This review will consider original peer-reviewed articles that used any generic HRQoL measurement instruments exclusively used with university students aged 18-59. Validation, qualitative, language translation, or adaptation studies will be excluded. This review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research will be conducted in five electronic databases (PubMed, Embase, Web of Science, Scopus, and SPORTDiscus). Two reviewers will independently screen records using predefined eligibility criteria and extract data using tables. The extracted data will include specific details about the title, authors, year of publication, HRQoL instrument utilized, participants, intervention design, and critical findings. The results will be presented in a narrative summary with data displayed in tabular and diagrammatic formats.

DISCUSSION

This proposed scoping review aims to provide a comprehensive overview of the existing methods for assessing health-related quality of life in university students. The results will help identify gaps in the literature and establish a foundation for guiding future research priorities.

SCOPING REVIEW REGISTRATION

Registration with Open Science Framework can be found under registration number https://doi.org/10.17605/OSF.IO/FY9GU .

Resilience as a mediator of quality of life in cancer patients in healthcare services

Quality of life is a critical outcome in oncology, influencing treatment adherence and patient satisfaction. Haematology patients face psychological challenges, including emotional distress, depression and PTSD, which can affect their quality of life. Resilience and social support are protective factors that help patients cope with these challenges. This study aimed to assess the psychological adjustment of haematology patients by examining psychological outcomes (PTSD and depression), psychological resources (resilience and perceived social support), and quality of life. It also examined correlations between demographic variables, psychological outcomes and resources to identify predictors of quality of life and whether resilience mediates these effects. A sample of 110 haematology patients from three hospital centers in central/southern Italy participated. Data were collected using self-report questionnaires measuring PTSD, depression, resilience, social support and quality of life. Correlational analyses and hierarchical multiple regression were used to explore the relationships between variables, followed by a mediation analysis to examine the role of resilience. Results indicated that QOL was negatively associated with gender, age, PTSD and depression, but positively associated with resilience. Regression analyses showed that quality of life was significantly predicted by resilience, age, depressive symptoms and gender. The mediation model showed that resilience partially mediated the effects of age, gender and depression on QoL. These findings highlight the protective role of resilience in improving quality of life in haematology patients. Despite limitations related to sample size and the use of self-report questionnaires, this study provides valuable insights into the psychological adjustment of haematology patients and highlights the importance of considering psychological resources in oncology care.

Health-Related Quality of Life in a Slovak Representative Sample: A Validation Study of the Short Form-8 Scale

OBJECTIVES

The Short Form-8 (SF-8) is a widely used 8-item tool for health-related quality of life assessment. This study aimed to evaluate the psychometric properties of the Slovak version of the SF-8 in a population sample.

METHODS

A cross-sectional survey on a Slovak representative sample (n = 1018; mean age 46.24 ± 16.56 years; 51.3% women) monitoring health and well-being was performed in 2019. Exploratory network analysis and confirmatory factor analysis were used to assess the construct validity of the scale. Reliability and sociodemographic differences were evaluated.

RESULTS

A 2-factor model had an adequate fit to the data [χ2(19) = 186.2, P < .001, comparative fit index = 0.998, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.093, standardized root mean of residuals = 0.039], with high reliability (α = 0.93, ω = 0.95). The physical component score and mental component score (MCS) were negatively associated with the presence of chronic health conditions. Lower physical component score and MCS were associated with higher age (P < .001), and lower MCS were associated with female gender (P < .001).

CONCLUSIONS

The Slovak version of the SF-8 represents a valuable tool for measuring health-related quality of life in the Slovak population in both practice and research.

Health-related quality of life and its association with disease activity/functional status in rheumatoid arthritis: A cross-sectional study from South India

BACKGROUND

Rheumatoid arthritis (RA) is an autoimmune disease with chronic pain that gradually becomes incapacitating and negatively influences the health-related quality of life (HRQoL). This study estimates HRQoL in RA using the EuroQol five dimensions (EQ-5D) tool and its association with functional status and disease activity.

METHODS

RA patients (n = 320) aged above 18 years, visiting outpatient clinic at a tertiary care multispecialty hospital in south India were the study participants. Sociodemographic, clinical, and laboratory data were collected from them. EQ-5D-5L questionnaire and the EQ Global Health Visual Analogue Scale (EQ-VAS) were used to measure HRQoL. Disease activity was measured using Disease Activity Score-28 (DAS-28), and the Health Assessment Questionnaire (HAQ) was used to assess functional status. Pearson's correlation and multiple linear regression were used to measure association, and statistical significance was considered at p < 0.05.

RESULTS

The EQ-5D utility score was 0.54 ± 0.36, pain and anxiety were the most affected domains, and the mean EQ-VAS was 63.05 ± 18.54%. A moderate to high disease activity was present in 85% (DAS-28 > 3.2), and a severe functional disability in 32.8% (HAQ > 1.5) of study participants. The mean EQ-5D scores for RA patients were 0.78 (0.65-0.90) for no disease activity, 0.73 (0.65-0.80) for mild, 0.53 (0.32-0.74) for moderate and 0.47 (0.32-0.62) for high disease activity. In multiple linear regression analysis, HAQ and age independently predicted EQ-5D.

CONCLUSION

RA significantly impacts HRQoL, and interventions focussing on pain and anxiety management are essential. The study's EQ-5D values could help estimate Quality Adjusted Life Years (QALY) while conducting economic evaluation studies in RA within an Indian context.

Prevalence of mistreatment in veterinary medical education; a survey of 3rd year veterinary students at a single university

BACKGROUND

Improving quality of life in veterinary medicine has emerged as an important topic. One factor which may influence quality of life in medical education is mistreatment (verbal abuse, power abuse, and physical abuse to establish and maintain a power hierarchy). Although it has been documented in medical education, its occurrence in veterinary education is not yet known.

METHODS

Third year veterinary students were invited to participate in an anonymous and voluntary survey on mistreatment during the preclinical and clinical education. Students were asked if they witnessed and/or experienced a mistreatment, the type of mistreatment, and the person responsible for administering the mistreatment. Quality of life scores were obtained using the Medical Outcomes Trust short form questionnaire (SF-36). An analysis of variance (ANOVA) model followed by pairwise Least Significant Difference post hoc comparison was used to investigate the relationship variables.

RESULTS

Fifty-five of 60 students (91.7%) that completed the questions on mistreatment indicated that they experienced and/or witnessed a mistreatment during veterinary education. 92% of students that experienced a mistreatment said that it interfered with the learning environment but only 29% of students reported the mistreatment at the time that it occurred. The most common mistreatment was public humiliation (78.3%) followed by special treatment based on gender (63.3%) and racially or ethnically offensive remarks (28.3%). Only racially or ethnically insensitive remarks were associated with a lower quality of life score in the social functioning category (p = 0.0131).

CONCLUSIONS

Mistreatment frequently occurred during the preclinical and clinical education of veterinary students in this population and interfered with the learning environment. The only mistreatment associated with a lower quality of life score was racially insensitive remarks. Programs to educate students and clinicians/staff about mistreatment and how to handle education in a stressful clinical and a preclinical setting may be of benefit in the future.

CLINICAL TRIAL NUMBER

Not applicable.

Quality of life trajectories for different dialysis modalities-a nationwide study

Background

Few contemporary studies have investigated the changes in quality of life across dialysis modalities. Our aim was to compare longitudinal changes in health-related physical and mental quality of life between patients on institutional hemodialysis (IHD), peritoneal dialysis (PD) and home hemodialysis (HHD).

Methods

Patients on dialysis with registered Research and Development 36 (RAND-36) questionnaires between 2017-2021 in the Swedish Renal Registry (SRR) were eligible for inclusion. Information on dialysis, patient characteristics and medication were collected from SRR and other registries. Patients were followed up to 39 months. Changes in physical (PCS) and mental (MCS) component summary scores were analyzed in adjusted linear mixed models and joint models.

Results

We included 930 patients (IHD 714, PD 128, HHD 88) with a median follow-up of 1.8 years (interquartile range 1.0-2.1). At baseline, the mean unadjusted PCS was lower in IHD (30.7; 95% CI 29.9, 31.4) compared with HHD (35.3; 95% CI 33.0, 37.5) and PD (33.2; 95% CI 31.3, 35.1). PCS declined over time in all modalities, but faster for PD compared with IHD (-1.2; 95% CI -2.1, -0.3 per year) and HHD (-1.5, 95% CI -2.9, -0.04). MCS was similar at baseline. HHD had improving MCS trajectory compared to IHD (-1.5, 95% CI -2.8, 0.2) and PD (-2.3, 95% CI -3.9, 0.7), largely resulting from improvement in role limitations caused by mental health (6.2, 95% CI 0.9, 11.5).

Conclusion

Insights about the variation in quality-of-life trajectories for different dialysis modalities are important for patients to make informed choices.

Post-stroke Cognition is Associated with Stroke Survivor Quality of Life and Caregiver Outcomes: A Systematic Review and Meta-analysis

Disability arising from post-stroke cognitive impairment is a likely contributor to the poor quality of life (QoL) stroke survivors and their carers frequently experience, but this has not been summarily quantified. A systematic literature review and meta-analysis was completed examining the association between general and domain-specific post-stroke cognitive functioning and adult stroke survivor QoL, caregiver QoL, and caregiver burden. Five databases were systematically searched, and eligibility for inclusion, data extraction, and study quality were evaluated by two reviewers using a standardised protocol. Effects sizes (r) were estimated using a random effects model. Thirty-eight studies were identified, generating a sample of 7365 stroke survivors (median age 63.02 years, range 25-93) followed for 3 to 132 months post-stroke. Overall cognition (all domains combined) demonstrated a significant small to medium association with QoL, r = 0.23 (95% CI 0.18-0.28), p < 0.001. The cognitive domains of speed, attention, visuospatial, memory, and executive skills, but not language, also demonstrated a significant relationship with QoL. Regarding caregiver outcomes, 15 studies were identified resulting in a sample of 2421 caregivers (median age 58.12 years, range 18-82) followed for 3 to 84 months post-stroke. Stroke survivor overall cognitive ability again demonstrated a significant small to medium association with caregiver outcomes (QoL and burden combined), r = 0.17 (95% CI 0.10-0.24), p < 0.001. In conclusion, lower post-stroke cognitive performance is associated with significant reductions in stroke survivor QoL and poorer caregiver outcomes. Cognitive assessment is recommended early to identify those at risk and implement timely interventions to support both stroke survivors and their caregivers.

Quality of Life Among Kurdish Patients With Knee Osteoarthritis in Duhok Governorate

BACKGROUND

Osteoarthritis (OA) is a chronic disease and a leading cause for pain, stiffness, functional dependence, and diminished quality of life (QoL). The assessment of the latter in OA is becoming increasingly common in both research and clinical settings.

OBJECTIVES

The study aimed to examine OA among Kurdish patients with unilateral or bilateral OA.

METHODS

A cross-sectional study was conducted at the Duhok Centre of Rheumatology and Medical Rehabilitation in the Kurdistan Region of Iraq, involving 262 patients aged 40-70 who have unilateral or bilateral OA.

RESULTS

The study subjects had the lowest mean QoL score in the domain of role limitations due to physical health problems (14.22±34.124). The highest mean QoL score was in the social functioning domain (86.78±20.878). Females had a statistically significant lower QoL mean score across most domains, except for emotional role functioning. Older patients (over 50) had lower scores in several domains, such as physical function, physical role functioning, energy/fatigue, social functioning, and bodily pain. Longer disease duration is correlated with lower QoL scores in most domains, except emotional well-being. Obesity negatively impacted QoL in terms of physical function and pain dimensions. Finally, the severity of osteoarthritis is positively correlated with a lower QoL score in the domains of physical functioning, physical role functioning, energy/fatigue, social functioning, and the pain component.

CONCLUSION

QoL is diminished in Kurdish patients with unilateral or bilateral knee OA and is influenced by age, gender, obesity, disease duration, and OA severity.

Effectiveness of the active communication education program in improving the general quality of life of older adults who use hearing aids: a randomized clinical trial

BACKGROUND

Hearing loss in older adults affects general, generic health-related and disease-specific quality of life (QoL). The conventional strategy to address it is through hearing aids, which have been shown to improve disease-specific QoL. However, the long-term results regarding general quality of life are unknown, and communication problems and stigma associated with hearing loss may persist. An effective intervention strategy to address these problems is group communication programs, most notably Active Communication Education (ACE). This program has been shown to increase communication strategies and reduce communication activity limitations and participation restrictions. These precedents allow us to hypothesize that this program could improve general QoL.

METHODS

A randomized clinical trial was conducted on 114 older adult hearing aid users. Fifty-four subjects composed the intervention group that received the ACE program, while 60 subjects composed the control group that received an informational-lectures type intervention. The WHOQOL-BREF questionnaire was used to measure general QoL. Measurements were taken before and right after the intervention, with follow-ups at 6 and 12 months. Multilevel linear mixed models were estimated, considering the WHOQOL-BREF dimension scores and total score as the outcomes, and an interaction term between time since intervention and group as the predictor. Within- and between-group comparisons were made.

RESULTS

Compared to the baseline time-point, the ACE group showed significant improvements right after the intervention, and at the 6-month and 12-month follow-ups for the dimensions of psychological health, social relationships, environment, and total score. Compared to the control group, the ACE group exhibited significantly greater improvements in the social dimension at all postintervention assessments, as well as in the environment dimension and total score at the 12-month follow-up.

CONCLUSIONS

The ACE program improved general QoL in terms of social relationships and environment dimensions, which lasted up to 12 months after the intervention. Therefore, ACE is positioned as an effective complement for HA users, enhancing and delivering new benefits related to broader aspects of QoL not necessarily tied to health.

TRIAL REGISTRATION

ISRCTN54021189 (retrospectively registered on 18/07/2023).

Pain Assessment for Patients with Dementia and Communication Impairment: Feasibility Study of the Usage of Artificial Intelligence-Enabled Wearables

BACKGROUND

Recent studies on machine learning have shown the potential to provide new methods with which to assess pain through the measurement of signals associated with physiologic responses to pain detected by wearables. We conducted a prospective pilot study to evaluate the real-world feasibility of using an AI-enabled wearable system for pain assessment with elderly patients with dementia and impaired communication.

METHODS

Sensor data were collected from the wearables, as well as observational data-based conventional everyday interventions. We measured the adherence, completeness, and quality of the collected data. Thereafter, we evaluated the most appropriate classification model for assessing the detectability and predictability of pain.

RESULTS

A total of 18 patients completed the trial period, and 10 of them had complete sensor and observational datasets. We extracted 206 matched records containing a 180 min long data segment from the sensor's dataset. The final dataset comprised 153 subsets labelled as moderate pain and 53 labelled as severe pain. After noise reduction, we compared the recall and precision performances of 14 common classification algorithms. The light gradient-boosting machine (LGBM) classifier presented optimal values for both performances.

CONCLUSIONS

Our findings tended to show that electrodermal activity (EDA), skin temperature, and mobility data are the most appropriate for pain detection.

Tools for Assessing Quality of Life in People with Stroke-Induced Aphasia: A Literature Review

BACKGROUND

The quality of life (QOL) of individuals with stroke-induced aphasia is significantly impacted by the condition. Clinicians and researchers are increasingly focusing on QOL assessments for people with aphasia (PWA) to gauge the effects of aphasia and the effectiveness of interventions. While several QOL assessment tools are utilized for PWA, there is limited literature comparing and evaluating their suitability for this population. This review aimed to explore the QOL measurement tools used with PWA, their aphasia-friendly characteristics, their applicability to severe aphasia, and the technical aspects of these questionnaires.

SUMMARY

The review process involved two stages. Initially, a search was conducted to identify the tools used for assessing the QOL of PWA in studies published between 1975 and 2022. Various databases such as Google Scholar, PubMed, Scopus, and Web of Science were searched using specific keywords related to stroke, aphasia, QOL, questionnaires, outcome measurements, tools, scales, and instruments. Subsequently, hand searching was employed to gather additional information on the identified tools, including technical properties, communication and language domains, and crucial factors for QOL assessment in PWA. Results revealed that 28 articles met the inclusion criteria, identifying 26 tools for QOL assessment in PWA, comprising 11 generic, 9 stroke-specific, and 6 aphasia-specific tools. Technical details such as research country distribution, publication years (ranging from 1972 to 2015), completion time, administration methods (self-reporting), item formats (question or statement), response types (all tools, except SIP-136, NHP, and SA-SIP30 used Likert type scale for ratings), scoring methods (sum of score or using an algorithm), translation/adaptation status (EQ-5D-3L among generic tools, SIS-16 among stroke-specific questionnaires, and SAQOL-39 among aphasia-specific instruments received the most amount of translation/adaptation), respondent characteristics (almost all the tools except aphasia-specific tests excluded people with severe aphasia), number of dimensions (ranged 1-12), item numbers [6-136], and coverage of communication/language domains (BOSS, CDP, ALA, AIQ-21 covered all language domains) were analyzed. Notably, ALA emerged as the most suitable tool for assessing QOL in PWA due to its alignment with the desired features.

KEY MESSAGES

Based on the review findings, clinicians and researchers are advised to prioritize the following features when selecting a QOL questionnaire for PWA: aphasia-specific and aphasia-friendly design, comprehensive coverage of QOL dimensions, inclusion of all language domains, and provision of self-reporting opportunities for PWA across all severity levels. ALA stands out as the preferred tool for QOL assessment in PWA based on its adherence to these criteria.

Tools and Strategies to Integrate Multi-Domain Information for Personalized Decision-Making in Oncological Care Pathways: A Scoping Review

Introduction

There is a growing interest in personalized decision-making in oncology. According to the Integrated Oncological Decision-Making Model (IODM), decisions should be based on information from three domains: (1) medical technical information, (2) patients' general health status and (3) patients' preferences and goals. Little is known about what kind of tool/strategy is used to collect the information, by whom this is collected (nurse, clinician) when this is collected (moment in the care pathway), and how this information should be collected and integrated within decision-making in oncological care pathways, and what its impact is.

Methods

We searched PUBMED, Embase and Web of Science in October 2023 for studies looking at tools to collect and integrate information from the three domains of the IODM. We extracted data on the content and implementation of these tools, and on decision and patient outcomes.

Results

The search yielded 2576 publications, of which only seven studies described collection of information from all three domains (inclusion criteria). In the seven included studies, information on the three domains was collected through dialogue, questionnaires, and assessments (what) by a nurse (2 out of 7 studies) or by other members of the Multi-Disciplinary Team (by whom) (5 out of 7 studies). Members of the Multi-Disciplinary Team subsequently integrated the information (5 out 7 studies) during their meeting (when), with patients and family attending this meeting in 2 studies (how). In terms of decision outcomes, 5 out of 7 studies compared the treatment recommendations before and after implementation of the tools, showing a modification of the treatment plan in 3% to 53% of cases. The limited data on patient outcomes suggest positive effects on well-being and fewer complications (3 out of 7 studies).

Conclusion

The seven studies identified that integrated information from the three IODM domains into treatment decision-making lacked comprehensive information regarding the strategies, process, timing and individuals involved in implementing the tools. Nevertheless, the few studies that looked at patient outcomes showed promising findings.

Quality of life in persons with mild cognitive impairment: a systematic review and meta-analysis

The global increase in the aging population has raised concerns over various age-related conditions like dementia and mild cognitive impairment (MCI) and their consequences on the affected persons. People with MCI exhibit cognitive deficits more significantly than expected for their age and literacy level. Though the nature of this condition is considered "mild", studies have reported that even more subtle deficits can influence the quality of life (QOL).

Objective

The present work aimed at exploring and comparing QOL in older adults with and without MCI through a systematic review and meta-analysis.

Methods

After a detailed search of articles till May 2021 in the relevant electronic databases (PubMed Central, PubMed, Scopus, CINAHL Plus, Web of Science, ProQuest, and Cochrane) using the keywords "mild cognitive impairment", "quality of life", "old", "old aged", "aged", "older adult", "geriatrics", "healthy controls", "healthy participants", and "normal controls", we included 23 articles in the systematic review and 12 in the meta-analysis.

Results

The quality of all the included articles were assessed using the Modified Downs and Black tool. Most of the studies in the systematic review demonstrated differences in QOL scores in older adults with MCI compared to healthy older adults. However, meta-analysis findings suggest that older adults with MCI had statistically non-significant yet lower differences in QOL compared to their healthy counterparts.

Conclusion

Future research should focus on developing QOL assessment tools specifically for older adults with MCI and follow-up studies that could provide better knowledge of their changing cognitive profile and life quality.

Efficacy of Daily Walking as a Potential Predictor of Improved Health-Related Quality of Life in Patients with Type 2 Diabetes in Korea

This study examines whether health-related quality of life (HRQoL) scores differ due to the frequency of walking or physical activity (PA) throughout a week in diabetic patients in Korea. This population-based cross-sectional study used data from the 2018-2021 Korea National Health and Nutrition Examination Survey. The dependent variable was HRQoL scores as measured with EuroQol-5D (EQ-5D). The independent variables were defined as three types of PA: (1) walking; (2) moderate; and (3) vigorous. An estimated population size of 2,376,066 was included in this study. The mean (95% confidence interval (CI)) age of patients was 60.12 years (59.23, 60.81), and 53.0% were female. The mean (95% CI) of EQ-5D was 0.867 (0.857, 0.877). The majority of diabetic patients reported walking daily (39.05%, 95% CI; 36.28-41.81%), while a significant proportion did not engage in moderate (65.45%, 95% CI; 62.79-68.11%) or vigorous (78.38%, 95% CI; 73.02-77.73%) PA at all. After controlling for covariates, EQ-5D scores significantly increased when patients had walked once per week for at least 10 min in the Tobit regression model. The frequency of walking was the most significant predicting factor for better HRQoL in patients with type 2 diabetes.

Vision-Specific Tools for the Assessment of Health-Related Quality of Life (HR-QoL) in Children and Adolescents with Visual Impairment: A Scoping Review

Vision-related quality-of-life (QoL) measures offer a comprehensive evaluation of the impact of eye conditions and the effectiveness of treatment on important aspects of QoL. A substantial number of tools for assessing health-related quality of life (HR-QoL) in adults have been reviewed. However, despite the high prevalence of uncorrected refractive errors causing visual impairment (VI) in children, there is a notable lack of similar tools for this vulnerable population. This review aimed to systemically map evidence on the availability and use of vision-specific instruments for assessing HR-QoL in children and adolescents with VI. This review follows the Joanna Briggs Institute (JBI) guidelines (2020) and the framework by Arksey and O'Malley and Levac et al. (2010). We conducted systematic searches through databases PubMed, Science Direct, and Scopus and search platforms Web of Science and EBSCOhost to source reviews published in English from the date of their inception to December 2023. The findings are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). We reviewed twenty tools, nine of which were developed for children in the United States and three of which were developed for children in developing countries; no tools specifically developed for children in Africa were found. In the reviewed papers, the tools were presented to children, parents, or proxies in an interview or questionnaire format. For most of the tools, reliability was assessed using internal consistency (n = 12) and test-retest reliability (n = 12). The most dominant measures of validity were construct (n = 16), content (n = 8), internal (n = 4), and criterion (n = 4). There appears to be a need for more tools developed for children in middle-low-income countries, especially for African children.

Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements

Objectives

Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life.

Design

We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis.

Participants

The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression.

Variables

The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems.

Statistical methods

We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping.

Results

After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up.

Conclusion

Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.

Health-related quality of life measured using the EQ-5D-3L: iranian population norms

BACKGROUND

Normative values are valuable for comparing a specific population with the general population, making them particularly useful in disease burden studies and cost-effectiveness analysis. The objective of this study was to estimate HRQoL normative values for the EQ-5D measure in Iran.

METHODS

The analysis was performed using a sample (n = 27,704) of the Iranian adult population, which was extracted from a nationwide survey conducted in 2021. Participants assessed their health-related quality of life using the EQ-5D-3 L instrument and a visual analogue scale (EQ VAS). Multivariable regression analyses were performed to examine the relationships between utility scores, EQ VAS scores, and various socio-demographic factors.

RESULTS

The mean utility and EQ VAS scores of the total sample were 0.87 (95% CI: 0.86, 0.88) and 72.9 (95% CI: 72.7, 73.1), respectively. Almost half of the respondents (46.8%) reported a health state without any problems. The most prevalent problems were pain/discomfort (38.3%) and anxiety/depression (35.2%). Furthermore, EQ-5D values and EQ VAS scores were associated with gender, age, employment status, education level, marital status, and chronic illness.

CONCLUSIONS

This study provided normative values for the general population in Iran. Policymakers and researchers can use these values as a reference for population norms in economic assessments and studies focusing on the population's health.

The normativist-naturalist puzzle: Functions and assumptions of health assessment tools

While there is no shortage in discussions of health assessment tools, little is known about health professionals' experience of their practical uses. However, these tools rely on assumptions that have significant impacts on the practice of health assessment. In this study, we explore health professionals' experiences with health assessment tools, that is, how they define, use, and understand these tools, and whether they take them to measure health and wellbeing. We combine a qualitative, interview-based study of the uses and understandings of health assessment tools among Danish health professionals with a philosophical analysis of these applications and perceptions. Our study shows that contrary assumptions are involved in the use of the tools, to the extent that one can speak of a normativist-naturalist puzzle: health professionals generally apply a normativist conception of health, find health assessment useful and valuable for their clinical practice, but believe that what the tools measure is basically not health proper but some proximal entity of a more naturalist kind. This result demonstrates the complexity of health assessment tools and suggests that they are used with care to ensure both that particular tools are used for the kinds of tasks they are most apt for, and that they are put to use in awareness of their limitations.

Navigating Life Post-emergency Laparotomy: A Narrative Review on Quality-of-Life Outcomes

An emergency laparotomy is a life-saving surgical procedure performed to address acute abdominal conditions. While crucial for immediate survival, this procedure can have significant long-term implications for patients' quality of life. This comprehensive review examines the physical, psychological, and social outcomes following emergency laparotomy, highlighting the importance of addressing quality-of-life concerns in this patient population. Key findings reveal that patients may experience complications, psychological distress, and challenges in social functioning post-procedure. Age, gender, and access to support networks influence outcomes. Recommendations for clinical practice include routine assessment of quality of life, multidisciplinary care, and patient education. Further research is needed to understand predictors of poor outcomes and evaluate interventions to improve quality of life post-emergency laparotomy. Healthcare providers can enhance patient care and outcomes in this vulnerable population by addressing these issues.

Different Frameworks, Similar Results? Head-to-Head Comparison of the Generic Preference-Based Health-Outcome Measures CS-Base and EQ-5D-5L

OBJECTIVE

We compared two generic, preference-based health-outcome measures: the novel patient-centered Château-Santé Base (CS-Base), entailing a multi-attribute preference response framework, and the widely used EQ-5D-5L, regarding effects of different measurement frameworks and different descriptive systems.

METHODS

We conducted a cross-sectional study using a random sample of patients (3019 reached, 1988 included) in the USA with various health conditions. The CS-Base (12 attributes, each with four levels), EQ-5D-5L and the 5D-4L (an ad hoc, multi-attribute preference response-based measure that includes five attributes similar to the EQ-5D-5L, but with four levels) were used as health-outcome measures. We compared the proportions of problems reported on health attributes, statistical robustness and face validity of coefficients, attribute importance, differentiation between health states based on health-state values obtained with these measures, and user experience.

RESULTS

All the CS-Base and 5D-4L coefficients had logical orders and significant differences from the reference level (p < 0.001). Substantial differences were observed in the CS-Base and 5D-4L coefficients between all levels on all attributes, while subtle differences were seen in those of the EQ-5D-5L. Attribute importance of usual (daily) activities were lowest or second lowest in all the three health-outcome measures. Attributes with the highest importance in the CS-Base, 5D-4L, and EQ-5D-5L were respectively mobility, anxiety/depression, and pain/discomfort. Four attributes are similar between the CS-Base and EQ-5D-5L, eight are exclusive to CS-Base. Of the eight, vision and hearing had the highest importance. Health-state values showed a smoother distribution with minimal discontinuity in the CS-Base and EQ-5D-5L than in the 5D-4L. In user experience evaluation, both CS-Base and the 5D-4L showed mean scores above 50 (indicating positive evaluation) in terms of the description of health and ease of understanding.

CONCLUSIONS

This study demonstrated that CS-Base and 5D-4L, which are grounded in the multi-attribute preference response framework, produced statistically robust coefficients, with better face validity than those for the EQ-5D-5L. CS-Base and the EQ-5D-5L outperformed the 5D-4L in differentiating between health states. Notwithstanding differences in content, measurement frameworks, and estimated coefficients, the computed health-state values were similar between CS-Base and EQ-5D-5L.

Quality of life in young patients with acute type a aortic dissection in China: comparison with Marfan syndrome and non-Marfan syndrome

BACKGROUND

There is a paucity of Chinese studies evaluating the quality of life (QoL) in young acute type A aortic dissection (AAAD) patients with Marfan syndrome.

METHODS

Young adult AAAD patients (younger than 45 years old) underwent surgical treatment at our institution from January 2017 to December 2020 were consecutive enrolled. The hospital survivors completed 1 year of follow up. Patients were divided into two groups according to the presence or absence of Marfan syndrome (MFS). A 1:1 propensity score matching (PSM) with a caliper 0.2 was conducted to balance potential bias in baseline. The follow-up data were analyzed primarily for change in quality of life and anxiety status.

RESULTS

After PSM, 32 comparable pairs were matched. The baseline data were comparable and postoperative complications were similar between groups. In terms of SF-36 scale, the role physical, bodily pain, role emotional and mental health subscales were no significantly improved in MFS patients over time. At 1 year after discharged, the subscale of mental health and bodily pain were significantly lower in the MFS group than in the non-MFS group. In terms of HADS assessments, the level of anxiety in MFS patients was significantly higher than in non-MFS patients at 1 year after discharged.

CONCLUSIONS

The QoL in young AAAD patients with MFS is lower than those without MFS after surgery. This may be associated with the uncontrollable persistent chronic pain and the uncertainty and concerns for the disease's progression.

Health-related quality of life after hip fracture: effects of a 12-month home-based exercise intervention-secondary analyses of an RCT

PURPOSE

In this randomized controlled trial, we analyzed the effects of a 12-month home-based exercise intervention on the health-related quality of life (HRQoL) of patients with a hip fracture.

METHODS

Participants (n = 121) aged ≥ 60 years, with a Mini-Mental State Examination (MMSE) score of ≥ 12 and an operated hip fracture, were placed into Exercise (n = 61) or Usual care (n = 60) groups. Physiotherapist-supervised, home-based training was given twice a week over 12 months. HRQoL was assessed using the 15D instrument at baseline and at 3, 6, and 12 months. The total 15D scores and dimension scores were analyzed and compared to national age- and sex-matched reference data.

RESULTS

The participants' mean age was 81 years (SD 7), 75% were women, and 61% had a femoral neck fracture. The mean within-group change in total 15D score over 12 months was 0.023 (95% CI: -0.003 to 0.048) in the Usual care group, and 0.028 (CI: 0.003 to 0.054) in the Exercise group (between-group p = 0.76). We found a statistically significant change in total 15D score in the Exercise group, as well as in the dimension scores of mobility and usual activities in both groups. All 15D scores remained below the general population reference level.

CONCLUSION

Exercise training for 12 months did not enhance the HRQoL of home-dwelling patients with hip fractures any more than usual care. In addition, HRQoL remained below the population level in both groups.

Predictive Role of Physical Activity and Health-Related Quality of Life in Police Officers' Work Assessment

Police officers (POs) frequently encounter high stress and burnout risks in their demanding professional environment. This study delves into the relationship between physical activity (PA), health-related quality of life (HRQoL), and job performance among POs. A cross-sectional survey was conducted involving 1175 POs, with 691 providing complete responses. The survey included questions on biosocial and professional characteristics; the International Physical Activity Questionnaire-short form; the Short Form Health Survey version 2.0; and a qualitative job performance evaluation. The key findings highlight that vigorous PA significantly enhances job performance. About 46.2% of POs engage in vigorous PA, with a notable 73.7% participating in some form of PA weekly. This study also found that age and gender considerably impact the HRQoL, especially in mental health aspects like vitality and social functioning. Vigorous PA is linked to higher job performance ratings, especially when practised consistently. In conclusion, this research underscores the importance of vigorous PA in improving job performance among POs. We suggest that institutions prioritise facilitating environments that encourage regular PA, recognising its substantial benefits in both professional effectiveness and the overall health of POs. This study contributes to understanding the critical role of physical fitness in enhancing the occupational well-being of law enforcement personnel.

Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment

BACKGROUND

Postpartum quality of life (QoL) in women with heart disease has been neglected.

AIM

To improve clinical communication and treatment, we integrated medical data and subjective characteristics to study postpartum QoL concerns.

METHODS

The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey. The Edinburgh Postnatal Depression Scale, Cardiac Anxiety Questionnaire, European Heart Failure Self-Care Behavior Scale, and a self-designed questionnaire based on earlier research were also used to assess patient characteristics. Patient data were collected. Prediction models were created using multiple linear regression.

RESULTS

This retrospective study examined postpartum QoL in 105 cardiac patients. Postpartum QoL scores were lower (90.69 ± 13.82) than those of women without heart disease, with physical component scores (41.09 ± 9.91) lower than mental component scores (49.60 ± 14.87). Postpartum depression (33.3%), moderate anxiety (37.14%), pregnancy concerns (57.14%), offspring heart problems (57.14%), and life expectancy worries (48.6%) were all prevalent. No previous cardiac surgery, multiparity, higher sadness and cardiac anxiety, and fear of unfavorable pregnancy outcomes were strongly related to lower QoL (R2 = 0.525).

CONCLUSION

Postpartum QoL is linked to physical and mental health in women with heart disease. Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.

Factors Affecting and Promoting Health-related Quality of Life in Patients With Liver Cirrhosis: An Underestimated Domain in Patient Care

Cirrhosis patients have poor health-related quality of life (HRQoL). To enhance medical care and therapeutic approaches, it is crucial to identify factors that alter HRQoL in patients with cirrhosis. The present study aims to identify the potential factors affecting and promoting HRQoL in patients with liver cirrhosis. Four databases were extensively searched, including PubMed, Scopus, Embase, and Google Scholar. All original articles with liver cirrhosis and factor-altering HRQoL were included. The present study showed that elderly age, female gender, low family income, low body mass index (BMI), presence of anxiety and depression, presence of cirrhosis complications including ascites, hepatic encephalopathy (HE), and abnormal endoscopic findings, high disease severity score, presence of sarcopenia, disturbed sleep pattern, muscle cramps, poor sexual health, and increased levels of bilirubin, prothrombin time, and albumin-bilirubin ratio were the significant factors associated with lower HRQoL scores. Meanwhile, physical exercise, liver transplant, stem cell therapy, mindfulness, and the use of probiotics, rifaximin, and lactulose were associated with increased HRQoL scores. The present study recommends more prospective or randomized control trials with interventions including health education, yoga, psychotherapy, and other potential factors promoting HRQoL in patients with liver cirrhosis. The present study also emphasizes that the treating physician should consider taking HRQoL into account when prescribing medical therapy.

Impact of different surgical and non-surgical interventions on health-related quality of life after thoracolumbar burst fractures without neurological deficit: protocol for a comprehensive systematic review with network meta-analysis

INTRODUCTION

There is no international consensus on how to treat thoracolumbar burst fractures (TLBFs) without neurological deficits. The planned systematic review with network meta-analyses (NMA) aims to compare the effects on treatment outcomes, focusing on midterm health-related quality of life (HRQoL).

METHODS AND ANALYSIS

We will conduct a comprehensive and systematic literature search, identifying studies comparing two or more treatment modalities. We will search MEDLINE, EMBASE, Google Scholar, Scopus and Web of Science from January 2000 until July 2023 for publications. We will include (randomised and non-randomised) controlled clinical trials assessing surgical and non-surgical treatment methods for adults with TLBF. Screening of references, data extraction and risk of bias (RoB) assessment will be done independently by two reviewers. We will extract relevant studies, participants and intervention characteristics. The RoB will be assessed using the revised Cochrane RoB V.2.0 tool for randomised trials and the Newcastle-Ottawa Scale for controlled trials. The OR for dichotomous data and standardised mean differences for continuous data will be presented with their respective 95% CIs. We will conduct a random-effects NMA to assess the treatments and determine the superiority of the therapeutic approaches. Our primary outcomes will be midterm (6 months to 2 years after injury) overall HRQoL and pain. Secondary outcomes will include radiological or clinical findings. We will present network graphs, forest plots and relative rankings on plotted rankograms corresponding to the treatment rank probabilities. The ranking results will be represented by the area under the cumulative ranking curve. Analyses will be performed in Stata V.16.1 and R. The quality of the evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluations framework.

ETHICS AND DISSEMINATION

Ethical approval is not required. The research will be published in a peer-reviewed journal.

Psychometrics and validation of the EQ-5D-5L instrument in individuals with ischemic stroke in Lithuania

Background

Experiencing stroke is associated with deterioration in health-related quality of life (HRQL). One of the generic tools used for HRQL assessment is the EuroQol instrument of five dimensions and five levels (EQ-5D-5L), which has not yet been validated in Lithuania. This study aimed to evaluate validity, reliability, and factor structure of the EQ-5D-5L instrument in a sample of Lithuanian individuals at the end of the first week after experiencing ischemic stroke (IS).

Methods

The study had a cross-sectional design, including 134 individuals [61.9% men and 38.1% women; median (IQR) age was 66 years (59-73) years, in the final analysis]. Alongside the EQ-5D-5L, psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Assessment-7 (GAD-7); neurological impairment with the National Institutes of Health Stroke Scale (NIHSS); and functional independence with the Barthel index (BI). Confirmatory factor analysis (CFA) was performed for validation of the factor structure.

Results

The internal consistency of the EQ-5D-5L instrument was 0.81. A significant ceiling effect (17.2%) of the descriptive part of the EQ-5D-5L was detected. The convergent validity of the EQ-5D-5L descriptive system was confirmed, with significant correlations with the other scales used, except for the visual analog scale. The two-factor ("physical" and "emotional") model was confirmed by CFA, with acceptable fit [root mean square error of approximation (RMSEA) = 0.045, RMSEA 90% CI = 0.000-0.145; comparative fit indices (CFI) = 0.996; non-normal fit index (NFI) = 0.983; Tucker-Lewis Index (TLI) = 0.936; χ2/df = 1.27)].

Conclusion

This study provides information on the psychometric properties of the EQ-5D-5L instrument in Lithuanian individuals, showing that the EQ-5D-5L descriptive system is a reliable and valid tool for HRQL assessment. The Lithuanian version of the descriptive part of the EQ-5D-5L instrument is best expressed as a two-factor model, estimating the physical and emotional dimensions of HRQL in individuals who have experienced IS.

Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease

The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.

Health-related quality of life and willingness to pay measurement among patients on warfarin in Thailand

BACKGROUND

Complex dosage regimens and the high incidence of adverse events associated with warfarin therapy can affect the health-related quality of life (HRQoL) and willingness to pay (WTP) among patients on warfarin. No such previous study has been conducted to assess the HRQoL and WTP among Thai patients on warfarin; therefore, this study aimed to measure these parameters and identify some sociodemographic factors associated with those aspects among patients on warfarin in Thailand.

METHODS

This cross-sectional survey study involving 260 patients on warfarin between June 2022 and June 2023 used a quantitative method for data collection. Face-to-face interviews with well-trained interviewers were conducted and patients were required to complete the questionnaires of both World Health Organization Quality of Life-BREF (WHOQOL-BREF) and EQ-5D-5L to assess and measure their HRQoL levels. WTP was assessed using a bidding game technique. Descriptive statistics with mean and standard deviations were used to report HRQoL scores and WTP, whereas a generalized linear model was employed to identify factors associated with both HRQoL and WTP.

RESULTS

The mean EQ-5D index and mean EQ-VAS score were 0.89 ± 0.15 and 76.92 ± 15.95, respectively, whereas the mean WHOQOL-BREF domain scores were 59.18 ± 14.13, 68.56 ± 15.47, 59.13 ± 19.64, and 65.23 ± 14.04 for the physical, psychological, social, and environmental domains, respectively. Elderly participants (age > 60 years) and those with comorbidities had lower HRQoL scores than their counterparts. The mean WTP was 22.25 ± 32.19 USD for one patient's visit. The presence of comorbidities was the only factor significantly associated with WTP values.

CONCLUSIONS

Thai patients on warfarin have lower mean EQ-5D indexes and EQ-VAS scores than members of the general Thai population. Patients on warfarin with comorbidities have diminished HRQoL and WTP values. Therefore, all healthcare professionals should pay more attention to this group of patients on warfarin to achieve better outcomes.

Relationship between three dietary indices and health-related quality of life among rural elderly in China: a cross-sectional study

Purpose

This study aimed to explore the association between health-related quality of life (HRQOL) and diet quality using three evidence-based dietary indices among older people in rural China.

Methods

This cross-sectional study included 1,258 rural older people (mean age 72.32 years; 55.6% female). HRQOL was assessed using the European Five Dimension Health Scale (EQ-5D), and dietary intake was assessed using a Food Frequency Questionnaire. Three dietary scoring indices, including the Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension, and Dietary Diversity Score (DDS), were calculated to assess and analyze the relationship between these dietary indices and quality of life.

Results

The EQ-5D score was 0.95 ± 0.10, and the EQ-Visual Analog Scale (VAS) score was 76.76 ± 14.44. All three groups with higher dietary indices had higher quality of life scores. After controlling for covariates in multivariate adjusted binary logistic regression analyzes, participants in the top tertile of DDS had higher quality of life scores than those in the bottom tertile. DDS was consistently associated with EQ-5D (Model 2: OR = 1.567, p = 0.001; Model3: OR = 1.351, p = 0.044) and EQ-VAS (Model 2: OR = 1.830, p < 0.001; Model 3: OR = 1.383, p = 0.047), significantly different from the other groups.

Conclusion

Older people in rural China who adhere to various foods experience a better quality of healthy life.

Anterolateral versus posterior minimally invasive lumbar interbody fusion surgery for spondylolisthesis: comparison of outcomes from a global, multicenter study at 12-months follow-up

BACKGROUND CONTEXT

Several minimally invasive lumbar interbody fusion techniques may be used as a treatment for spondylolisthesis to alleviate back and leg pain, improve function and provide stability to the spine. Surgeons may choose an anterolateral or posterior approach for the surgery however, there remains a lack of real-world evidence from comparative, prospective studies on effectiveness and safety with relatively large, geographically diverse samples and involving multiple surgical approaches.

PURPOSE

To test the hypothesis that anterolateral and posterior minimally invasive approaches are equally effective in treating patients with spondylolisthesis affecting one or two segments at 3-months follow-up and to report and compare patient reported outcomes and safety profiles between patients at 12-months post-surgery.

DESIGN

Prospective, multicenter, international, observational cohort study.

PATIENT SAMPLE

Patients with degenerative or isthmic spondylolisthesis who underwent 1- or 2-level minimally invasive lumbar interbody fusion.

OUTCOME MEASURES

Patient reported outcomes assessing disability (ODI), back pain (VAS), leg pain (VAS) and quality of life (EuroQol 5D-3L) at 4-weeks, 3-months and 12-months follow-up; adverse events up to 12-months; and fusion status at 12-months post-surgery using X-ray and/or CT-scan. The primary study outcome is improvement in ODI score at 3-months.

METHODS

Eligible patients from 26 sites across Europe, Latin America and Asia were consecutively enrolled. Surgeons with experience in minimally invasive lumbar interbody fusion procedures used, according to clinical judgement, either an anterolateral (ie, ALIF, DLIF, OLIF) or posterior (MIDLF, PLIF, TLIF) approach. Mean improvement in disability (ODI) was compared between groups using ANCOVA with baseline ODI score used as a covariate. Paired t-tests were used to examine change from baseline in PRO for both surgical approaches at each timepoint after surgery. A secondary ANCOVA using a propensity score as a covariate was used to test the robustness of conclusions drawn from the between group comparison.

RESULTS

Participants receiving an anterolateral approach (n=114) compared to those receiving a posterior approach (n=112) were younger (56.9 vs 62.0 years, p <.001), more likely to be employed (49.1% vs 25.0%, p<.001), have isthmic spondylolisthesis (38.6% vs 16.1%, p<.001) and less likely to only have central or lateral recess stenosis (44.9% vs 68.4%, p=.004). There were no statistically significant differences between the groups for gender, BMI, tobacco use, duration of conservative care, grade of spondylolisthesis, or the presence of stenosis. At 3-months follow-up there was no difference in the amount of improvement in ODI between the anterolateral and posterior groups (23.2 ± 21.3 vs 25.8 ± 19.5, p=.521). There were no clinically meaningful differences between the groups on mean improvement for back- and leg-pain, disability, or quality of life until the 12-months follow-up. Fusion rates of those assessed (n=158; 70% of the sample), were equivalent between groups (anterolateral, 72/88 [81.8%] fused vs posterior, 61/70 [87.1%] fused; p=.390).

CONCLUSIONS

Patients with degenerative lumbar disease and spondylolisthesis who underwent minimally invasive lumbar interbody fusion presented statistically significant and clinically meaningful improvements from baseline up to 12-months follow-up. There were no clinically relevant differences between patients operated on using an anterolateral or posterior approach.

The effect of post-traumatic long bone non-unions on health-related quality of life

BACKGROUND

Fracture non-unions have a detrimental effect on patients due to reduced mobility and severe pain. Current literature on the quality of life in non-unions is limited, hence the purpose of this study, to quantify the health-related quality of life (HRQoL) among patients with post-traumatic long bone non-unions. It was hypothesized that the HRQoL of these patients is lower than the Dutch population standard as well as for multiple chronic diseases and musculoskeletal disorders.

PATIENTS AND METHODS

From January 2020 to December 2021, this study included consecutive patients who were referred to a multidisciplinary (trauma, orthopedic and plastic surgery), non-union clinic at the Maastricht UMC+. All non-unions were evaluated using the Non-Union Scoring System (NUSS) questionnaire. Patient reported HRQoL outcomes were acquired using the EQ-5D-5L questionnaire and the Lower Extremity Functional Scale (LEFS).

RESULTS

50 patients were included, 18 females and 32 males, with a mean age of 55 years (± 15.5 SD). Eighteen patients presented with an open fracture, nine non-unions were infected and 39 patients had a lower extremity non-union. The mean NUSS score was 39.61 (± 14.6 SD). The mean EQ-5D-5L index score was 0.490 (± 0.261 SD), where patients experienced most problems with mobility. The mean EQ-5D-5L VAS was 61.4 (± 19.6 SD). The patients had a mean LEFS score of 28.7 (± 16.4 SD). The health-related quality of life was well below the age-corrected normative score of the Dutch population (EQ-5D-5L 0.857(p < 0.001); LEFS 77(p < 0.001)). This cohort's HRQoL was significantly lower than the HRQoL of multiple chronic and musculoskeletal disorders, including different forms of cancer and osteoarthritis.

CONCLUSIONS

This study has quantified the detrimental effect of post-traumatic long bone non-unions on patient's health-related quality of life, being significantly lower than the HRQoL of the Dutch population as well as for multiple chronic and musculoskeletal medical conditions. This cohort demonstrates a patient population in need of more specialized care with a low health-related quality of life.

Impact of major age-related eye disorders on health-related quality of life assessed by EQ-5D: a systematic review and meta-analysis

PURPOSE

This study is to quantitatively estimate the health-related quality of life (HRQOL) impact of major age-related eye diseases (AREDs) including cataract, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR) assessed by the EuroQoL Five-Dimensional Questionnaire (EQ-5D).

METHODS

PubMed, Embase, Cochrane Library, and CINAHL were searched until October 20, 2022. Studies were included if they reported the EQ-5D health utility score (HUS) or visual analogue scale (VAS) score of both AREDs patients and healthy controls. The mean difference (MD) in HUS or VAS score between cases and controls and its 95% confidence interval (95%CI) were pooled using the random-effects model. We also performed sensitivity analysis using the leaving-one-out method and subgroup analyses by sample size and race. The prevalence in reporting any problems in the five EQ-5D dimensions was summarized and compared between cases and controls using the Chi-square test.

RESULTS

Fifteen articles involving 30,491 participants were included in this review. Pooled estimates indicated reduced HUS in AMD patients (MD = - 0.04, 95%CI - 0.07, - 0.01; P = 0.009), DR patients (MD = - 0.03, 95%CI - 0.05, - 0.01; P = 0.01), and glaucoma patients (MD = - 0.06, 95%CI - 0.10, - 0.01; P = 0.01), compared with the controls. Significantly lower EQ-5D VAS score was also observed in cataract patients (MD = - 11.33, 95%CI - 13.47, - 9.18; P < 0.001) and DR patients (MD = - 6.41, 95%CI - 10.64, - 2.18; P = 0.003). AREDs patients reported usual activities and anxiety/depression problems more frequently than the control group.

CONCLUSIONS

Our findings confirmed the HRQOL impairment caused by major AREDs including AMD, cataract, DR, and glaucoma. High-quality studies with large sample sizes are warranted to further verify our results.

Population norms for the EQ-5D-3L and EQ-5D-5L in Romania

BACKGROUND

The majority of patient reported outcome measures (PROMs) don't have population norms in Romania. This is the case with the EQ-5D as well. Therefore, we aimed to estimate population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ-VAS.

METHODS

A cross-sectional survey was conducted in all regions of Romania from November 2018 to November 2019. A three-stage probability sampling procedure stratified by region and settlement size was used to select a representative sample. Interviews were computer-assisted and conducted in respondents' homes by trained interviewers. Health status was assessed with the EQ-5D-5L, the EQ-5D-3L and the EQ VAS. Descriptive statistics were used to estimate population norms by age groups and sex for the EQ-5D-5L, the EQ-5D-3L, their indexes and the EQ VAS. Population norms were weighted using survey weights. Indexes for the EQ-5D questionnaires were estimated using the recently developed Romanian value sets.

RESULTS

Data from 1,649 interviews was analysed in the present study. Survey weights were used so that sex and place of residence ratios for the weighted sample matched the Romanian general population distribution. Participants' mean age was 47.4 years (SE = 1.157) and 50.3% of them reported being in good health. The dimension for which people reported the highest number of problems for both questionnaires was the pain/discomfort dimension. Men aged 35 plus reported fewer problems with pain/discomfort than women for both the EQ-5D-5L and EQ-5D-3L. Health decreased with age as shown by the decrease from age group 18-24 to age group 75 plus in the indexes of both questionnaires: from 0.977 (SE = 0.005) to 0.765 (SE = 0.017) for EQ-5D-5L and from 0.981 (SE = 0.005) to 0.784 (SE = 0.019) for EQ-5D-3L. There was 29.9 points drop in the EQ VAS score between the youngest and oldest group.

CONCLUSIONS

Population norms for the Romanian versions of the EQ-5D-5L, EQ-5D-3L, their indexes, and the EQ VAS are now available. These can now be used as reference values by healthcare professionals, researchers and decision-makers leading to a further development of health-related quality of life research in Romania.

Quality of Life Measures in Aortic Stenosis Research: A Narrative Review

BACKGROUND

Elderly patients with aortic stenosis (AS) not only have a reduced life expectancy but also a reduced quality of life (QoL). The benefits of an AS intervention may be considered a balance between a good QoL and a reasonably extended life. However, the different questionnaires being used to determine the QoL were generally not developed for the specific situation of patients with AS and come with strengths and considerable weaknesses. The objective of this article was to provide an overview of the available QoL instruments in AS research, describe their strengths and weaknesses, and provide our assessment of the utility of the available scoring instruments for QoL measurements in AS.

SUMMARY

We identified and reviewed the following instruments that are used in AS research: Short Form Health Survey (SF-36/SF-12), EuroQol-5D (EQ-5D), the Illness Intrusiveness Rating Scale (IIRS), the HeartQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHF), the MacNew Questionnaire, and the Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ).

KEY MESSAGES

There is no standardized assessment of QoL in patients with AS. Many different questionnaires are being used, but they are rarely specific for AS. There is a need for AS-specific research into the QoL of patients as life prolongation may compete for an improved QoL in this elderly patient group.

Patient-Reported Outcomes in Colorectal Surgery

Given the increased life expectancy and improvements in the treatment of colorectal patients, the success of a treatment course can no longer be determined only by objective outcomes. Health care providers ought to take into consideration the impact an intervention will have on the quality of life of patients. Endpoints that take into account the patient's perspective are defined as patient-reported outcomes (PROs). PROs are assessed through patient-reported outcome measures (PROMs), usually in the form of questionnaires. PROs are especially important in colorectal surgery, whose procedures can often be associated with some degree of postoperative functional impairment. Several PROMs are available for colorectal surgery patients. However, while some scientific societies have offered recommendations, there is no standardization in the field and PROMs are seldom implemented in clinical practice. The routine use of validated PROMs can guarantee that functional outcomes are followed over time; this way, they can be addressed in case of worsening. This review will provide an overview of the most commonly used PROMs in colorectal surgery, both generic and disease specific, as well as a summary of the available evidence in support of their routine utilization.

Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes

The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: "fit/resilient", "fit/non-resilient", "frail/resilient" and "frail/non-resilient". Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Predictors for SF-36 score < 61.60 were the phenotypes "frail/non-resilient" (OR = 4.69, CI 2.08-10.55), "fit/non-resilient" (OR = 2.79, CI 1.00-7.73). Predictors for EQ-5D-5L < 89.7% were the phenotypes "frail/non-resilient" (OR = 5.93, CI 2.64-13.33) and "frail/resilient" (OR = 5.66, CI 1.93-16.54). Predictors of impaired IC (below the mean score value) were "frail/non-resilient" (OR = 7.39, CI 3.20-17.07), and "fit/non-resilient" (OR = 4.34, CI 2.16-8.71) phenotypes. Resilience and frailty phenotypes may have a different impact on wellness and QoL and may be evaluated in people with PACS to identify vulnerable individuals that require suitable interventions.

Sense of vitality is associated with cardiovascular events in type 2 diabetes independently of traditional risk factors and arterial stiffness

AIMS

The aim of this study was to determine if single items in the quality of life questionnaire short form 36 (SF36) were associated with cardiovascular events in patients with type 2 diabetes mellitus (T2DM).

METHODS

In 756 T2DM patients (260 women) from the CARDIPP study, nine questions from the domains vitality and well-being in SF36 were analysed. Patients, 55-66 years, were recruited in 2005-2008 and followed up until 31 December 2018 for the incidence of major adverse cardiovascular events (MACE), that is, myocardial infarction, stroke or cardiovascular death.

RESULTS

Median follow-up time: 11.6 years, during which 119 (16%) MACE occurred. The SF36 items: 'seldom full of pep' (HR 1.2, 95% CI: 1.1-1.4, p = 0.006), 'seldom a lot of energy' (HR 1.3, 95%CI: 1.1-1.5, p < 0.001), 'worn out' (HR 1.2, 95%CI: 1.0-1.4, p = 0.020) and 'seldom happy' (HR 1.2, 95%CI: 1.0-1.4, p = 0.012) were independent risk factors for MACE in separate models, as well as male sex, diabetes duration, HbA1c , sagittal abdominal diameter and aortic pulse wave velocity. The variables 'seldom full of pep' and 'seldom a lot of energy' remained associated with MACE when conducting separate analyses for sexes. Only 'seldom a lot of energy' remained associated with MACE when all items from SF-36 were comprised in the same model.

CONCLUSIONS

One single question regarding energy levels from SF36 may be used as an independent risk factor for cardiovascular events in T2DM patients in primary care, for both men and women. This item may be included in future risk assessment for use in clinical practice for cardiovascular risk stratification of T2DM patients.

TRIAL REGISTRATION

The study was registered in clinicaltrial.gov (NCT01049737) in 14 January 2010.

Using a generic quality of life measure to determine adherence thresholds: a cross-sectional study on older adults with neurological disorders in Germany

OBJECTIVES

Measuring the degree of adherence to medication is essential in healthcare However, the cut-offs provided for adherence scales are often arbitrary and disease-specific, and need to be validated against a clinical outcome. Here, we used health-related quality of life (QoL) to determine cut-offs for a self-report adherence questionnaire in patients with neurological diagnoses.

DESIGN

Cross-sectional study.

PARTICIPANTS

910 patients (age 70±8.6 years) with neurological disorders were recruited from the wards of neurology at a local university hospital. All patients received a comprehensive geriatric assessment, including assessments of adherence (Stendal Adherence to Medication Score, SAMS) and QoL (Short Form Survey SF-36).

OUTCOME MEASURES

The main aim of the study was to define a cut-off for non-adherence at which QoL is significantly impaired. Thus, we used Spearman's rank correlation, multivariate and univariate analyses of variance to test the impact of different adherence levels on QoL. Receiver operating characteristics and area under curve measures were then used to determine cut-off scores for adherence based on significant differences in QoL.

RESULTS

Correlations between SAMS and SF-36 domains were weak (ranging between r=-0.205 for emotional well-being and r=-0.094 for pain) and the effect of non-adherence on QoL disappeared in the multivariate analysis of variance (p=0.522) after adjusting for demographical and clinical factors. SAMS cut-offs in terms of SF-36 domains varied greatly, so that an overall SAMS cut-off for this cohort could not be defined.

CONCLUSIONS

QoL as measured by the SF-36 is not suitable as a single outcome parameter to study the impact of non-adherence on QoL in a mixed neurological cohort. Since both QoL and adherence are heterogeneous, multifaceted constructs, it is unlikely to find an overarching cut-off applicable for all patients. Thus, it may be necessary to use disease or cohort-specific external outcome parameters to measure the indirect effect of interventions to enhance adherence.

TRIAL REGISTRATION NUMBER

DRKS00016774.

Mapping of the World Health Organization Quality of Life Brief (WHOQOL-BREF) to the EQ-5D-5L in the General Thai Population

PURPOSE

This study aimed at mapping the World Health Organization Quality of Life Brief (WHOQOL-BREF) and the EQ-5D-5L in the general Thai population and to determine the impact on the incremental cost-utility ratio (ICUR) through five hypothetical scenarios.

METHODS

A total of 1,200 Thai participants were randomly allocated into the 'estimation' and 'validation' groups. A curve estimation with nine regression models was performed to identify the best-fit regression model of significant WHOQOL-BREF dimension scores for the EQ-5D-5L index score predictions in the estimation group. The identified model was then used for the calculation of the predicted EQ-5D-5L index scores in the validation group. The percentage change from the hypothetical base-case scenario with predefined parameters was used to determine the impact on the ICUR.

RESULTS

An inverse model was the best-fit regression model to predict the EQ-5D-5L index scores. The absolute difference between the predicted and observed index scores was 0.064, and the percentage of the sample that was mispredicted by ≥ 0.05 and ≥ 0.1 was 43.8% and 16.8%, respectively. Moreover, the percentage change in ICUR ranged between 0.13 and 1.84% from the hypothetical base-case scenario.

CONCLUSIONS

An inverse relationship between the studied scores was identified. The minimal impact on the ICUR suggests that the Health Utility Index of the mapped equation can be applied to economic analyses.

Health-Related Quality of Life and Associated Factors Among Covid-19 Survivors. Experience from Ethiopian Treatment Centers

Background

The pandemic of the novel coronavirus (Covid-19), which is extremely stressful and has an adverse effect on people's health-related quality of life (HRQoL), poses a serious threat to global public health. As a result, this study evaluated the health-related quality of life and associated factors among Covid-19 patients who were discharged from Ethiopian treatment centers.

Methods

We conducted a multi-center, cross-sectional study among 493 Covid-19 survivors who had been discharged from treatment centers between 1st January 2020, and 20th October 2021. We collected respondents' data using validated Amharic version EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients. Differences in HRQOL scores between patient subgroups were tested by Mann-Whitney U or Kruskal-Wallis test, and the multivariable betaMix regression was used to investigate factors associated with HRQOL scores.

Results

The EQ-5D and VAS median score for Covid-19 survivors was 0.940 (IQR: 0.783-0.966) and 87 (IQR: 70-91) respectively. Overall, married individuals, old-aged, individuals who had low educational status, high monthly income, comorbidities, admitted to the Intensive care Unit, received intranasal oxygen care, and prolonged hospitalization had lower utility scores and EQ-VAS scores compared to their counterparts. In multivariate betaMix regression, respondents' health status at admission, old age, chronic obstructive pulmonary disease, asthma, and hospital length of stay were significantly associated with the lower EQ-5D-Index value and EQ-VAS score.

Conclusion

We found that Covid-19 infection had a persisting impact on the physical and psychosocial health of Covid-19 survivors. Age, having asthma and chronic obstructive pulmonary disease, having a worsening health state upon admission, and a prolonged hospital length of stay were significantly associated with the lower EQ-5D and EQ-VAS score. Therefore, the cost-effective psychological treatment such as cognitive behaviour therapy should be encouraged after hospitalization to improve the post-Covid-19 depression and fatigue.

Parent-Reported Health-Related Quality of Life of Pediatric Burn Patients 5 to 7 Years after Burn Injuries: A Multicenter Study

BACKGROUND

 Pediatric burns significantly impact the short-term health-related quality of life (HRQL) of children. Knowledge regarding the long-term impact is scarce. We therefore evaluated the parent-reported HRQL in pediatric burn patients 5 to 7 years after burns.

METHODS

 We invited parents of eligible children admitted to a Dutch Burn Center between August 2011 and September 2012. This sample was enriched with children with severe burns (> 10% of total body surface area [TBSA] burned) admitted between January 2010 and March 2013. The EQ-5D was completed by parents 5 to 7 years postburn. Outcomes and predictive factors were studied and compared between children with minor/moderate and severe burns.

RESULTS

 We included 130 children (mean TBSA burned 7%): 102 children with mild/intermediate burns and 28 with severe burns. Mean EQ-5D summary was 0.96 and EQ visual analogue scale (VAS) 93.1. These outcomes were significantly better in children with minor/moderate burns (0.97; 94.4) compared with children with severe burns (0.93; 88.3) (p < 0.05). Nineteen percent of the children with minor/moderate burns and 43% of those with severe burns reported any problems. The most frequently reported problem was anxiety/depression for both groups. Pain/discomfort (p = 0.012) and cognition (p = 0.035) were statistically significantly worse in children with severe burns compared with those with minor/moderate burns. Full thickness burns and number of surgeries were found to predict long-term HRQL impairment.

CONCLUSION

 Five to seven years postburn, the majority of children in our study (76%) did not experience long-term problems with HRQL. In a minority of the children, burns showed to have a prolonged negative impact, especially in those being severely burned and who had to undergo surgery for their burns. Most experienced problems were related to anxiety/depression. These important insights could be used to inform children and their parents about the expected long-term HRQL after pediatric burns.

Body dysmorphia in common skin diseases: results of an observational, cross-sectional multicentre study among dermatological outpatients in 17 European countries

BACKGROUND

Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective, interventions. BDD symptoms are more prevalent in patients with dermatological conditions than in the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls.

OBJECTIVES

To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition.

METHODS

This observational, cross-sectional, comparative multicentre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological outpatients at 22 clinics in 17 European countries, and 2808 healthy skin controls (66% female). BDD symptoms were assessed by the Dysmorphic Concern Questionnaire. Sociodemographic data and information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. The study was registered with number DRKS00012745.

RESULTS

The average participation rate of invited dermatological patients was 82.4% across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than 11-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared with healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than sixfold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatization.

CONCLUSIONS

Clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.

Quality of Life and Anorectal Malformations: A Single-Center Experience

PURPOSE

The treatment and long term clinical outcomes of anorectal malformations (ARM) in children have always been the focus of pediatric surgeons. This study aimed at reporting our experience as far as long-term follow-up of ARM in children is concern.

METHODS

We enrolled patients treated between 1999 and 2019, and established selection criteria to choose appropriate subjects. A validated questionnaire was used to determine long-term quality of life outcomes.

RESULTS

Out of a total of 48 patients treated within the study period, 28 were enrolled in this study. Among the latter, more than 35% had at least one long-time complication, and more than 90% had a good lifestyle. Urinary and fecal continence was achieved in more than 95% of the patients using medical devices.

CONCLUSION

This study aimed to bring up new concepts; taking into consideration all aspects of life in patients with ARM, from school life to sexuality, while evaluating fecal and urinary continence. This is essential for the improvement of the skills of the different specialists involved in the management of these patients, and for the implementation of strategies that can improve postoperative function. Most especially, it will also help improve communication between doctors to ensure an adequate transition of these children into adult life.

Use of quality-of-life instruments for people living with HIV: a global systematic review and meta-analysis

Introduction

Due to the effectiveness of combined antiretroviral therapy and its growing availability worldwide, most people living with HIV (PLHIV) have a near‐normal life expectancy. However, PLHIV continue to face various health and social challenges that severely impact their health‐related quality‐of‐life (HRQoL). The UNAIDS Global AIDS Strategy discusses the need to optimize quality‐of‐life, but no guidance was given regarding which instruments were appropriate measures of HRQoL. This study aimed to review and assess the use of HRQoL instruments for PLHIV.

Methods

We conducted a global systematic review and meta‐analysis, searching five databases for studies published between January 2010 and February 2021 that assessed HRQoL among PLHIV aged 16 years and over. Multivariable regression analyses were performed to identify factors associated with the choice of HRQoL instruments. We examined the domains covered by each instrument. Random‐effects meta‐analysis was conducted to explore the average completion rates of HRQoL instruments.

Results and discussion

From 714 publications, we identified 65 different HRQoL instruments. The most commonly used instruments were the World Health Organization Quality‐of‐Life‐ HIV Bref (WHOQOL‐HIV BREF)—19%, Medical Outcome Survey‐HIV (MOS‐HIV)—17%, Short Form‐36 (SF‐36)—12%, European Quality‐of‐Life Instrument‐5 Dimension (EQ‐5D)—10%, World Health Organization Quality‐of‐Life Bref (WHOQOL BREF)—8%, Short Form‐12 (SF‐12)—7% and HIV/AIDS Targeted Quality‐of‐Life (HAT‐QOL)—6%. There were greater odds of using HIV‐specific instruments for middle‐ and low‐income countries (than high‐income countries), studies in the Americas and Europe (than Africa) and target population of PLHIV only (than both PLHIV and people without HIV). Domains unique to the HIV‐specific instruments were worries about death, stigma and HIV disclosure. There were no significant differences in completion rates between different HRQoL instruments. The overall pooled completion rate was 95.9% (95% CI: 94.7−97.0, I² = 99.2%, p < 0.01); some heterogeneity was explained by country‐income level and study type.

Conclusions

A wide range of instruments have been used to assess HRQoL in PLHIV, and the choice of instrument might be based on their different characteristics and reason for application. Although completion rates were high, future studies should explore the feasibility of implementing these instruments and the appropriateness of domains covered by each instrument.