Editorial: Health-related quality of life in health care

Association Between High Blood Pressure-Specific Health Literacy and Health-Related Quality of Life Among Patients With Hypertension in Urban-Rural Fringe Communities in China: A Mediation Analysis of Social Support and Self-management

BACKGROUND

Despite rapid urbanization, no researchers have focused on patients with hypertension in urban-rural fringe areas, where rural characteristics are retained but the influences of urbanization are typically found.

OBJECTIVE

In this study, we aimed to reduce health inequities by examining the status quo of health-related quality of life (HRQOL), high blood pressure-specific health literacy (HBP-HL), and social support and self-management and to explore how HBP-HL influences HRQOL among patients with hypertension in urban-rural fringe communities.

METHODS

Four hundred six patients with hypertension completed physical examinations and HBP-HL, HRQOL, self-management, and social support assessments via in-person interviews. Bootstrap multiple mediating effect analysis was used to explore associations between HBP-HL and HRQOL.

RESULTS

Only 24.2% of participants had a high HRQOL. None of the participants had adequate HBP-HL, only 23.2% had limited HBP-HL, and 76.8% had moderate HBP-HL. The HBP-HL score was directly correlated with HRQOL (β = 0.802; 95% confidence interval, 0.344-1.259) and indirectly correlated with HRQOL via social support (β = 0.368; 95% confidence interval, 0.202-0.568) and self-management (β = 0.314; 95% confidence interval, 0.102-0.560). The total contribution rate of the mediating effect was 41.4%.

CONCLUSIONS

The HRQOL and HBP-HL scores of patients with hypertension were intermediate and inadequate, respectively. In addition, HBP-HL directly and indirectly influenced HRQOL through social support and self-management. Health providers should screen for inadequate HBP-HL in patients with hypertension before intervention. Health-promoting interventions involving HBP-HL as a breakthrough point should be tailored to control blood pressure and improve HRQOL.

Validation and adaptation of the Arabic version of health-related quality of life with six domains (HRQ-6D): A factor and Rasch analyses study

BACKGROUND

Health-related quality of life (HRQOL) provides a complete picture of patients' overall health status and should be evaluated in all patients encountered. To accurately assess patients' HRQOL a comprehensive validated tool is necessary. Therefore, the present study aimed to validate the Arabic version of the Health-Related Quality of Life with Six Domains (Ar-HRQ-6D) scale.

METHODS

This cross-sectional study utilized an online questionnaire targeting adult Jordanians and implemented several validation steps to ensure the adequacy of the Ar-HRQ-6D. These steps included the application of the forward-backward translation technique, assessment of the content and face validity of the questionnaire, evaluation of internal consistency, validation of the construct through confirmatory factor analysis (CFA) and Rasch analysis, and assessment of the questionnaire's predictive capabilities.

RESULTS

A total of 808 participants (63% female) completed the Ar-HRQ-6D. Confirmatory Factor Analysis (CFA) supported the suitability of the original three-factor model for the present study data, yielding acceptable model fit indices (χ²/df = 4.1, SRMR = 0.03, RMSEA = 0.06, CFI = 0.99, GFI = 0.96, CIF = 0.98, and TLI = 0.97) and factor loadings ranging from 0.63 to 0.86. Cronbach's alpha for the three factors ranged from 0.81 to 0.90, confirming the high reliability of the questionnaire. Rasch analysis further validated the person and item separation reliability for the three factors. Additionally, all items of the Ar-HRQ-6D fell within the acceptable infit and outfit ranges. All thresholds were appropriately ordered, ranging from -5.27 to 2.86. Significant differences were observed in the median Ar-HRQ-6D scores across the various health status categories (p < 0.001), with the healthy category showing significantly higher median scores than the other categories. These findings confirm the predictive validity of the Ar-HRQ-6D.

CONCLUSION

The study confirmed the reliability, validity, and predictive accuracy of the Arabic version of the Ar-HRQ-6D. This tool is suitable for assessing patients' HRQOL across various medical settings.

The Effect of Muscle Cramps During Hemodialysis on Quality of Life and Habitual Physical Activity

Background and Objectives: This study aimed to evaluate the association between QoL, self-assessed physical activity, and the presence and severity of muscle spasms in chronic hemodialysis patients. Patients undergoing regular in-center hemodialysis (HD) have much lower quality of life (QoL) than healthy individuals. However, there is limited knowledge about the impact of specific common complications of hemodialysis, particularly muscle spasms on the overall well-being of patients. Materials and Methods: In this prospective, single-center study, 67 chronic HD patients were surveyed regarding the prevalence of muscle spasms using a validated 9-multiple-choice-question survey, alongside the Physical Activity Questionnaire (IPAQ) and The Short Form (36) Health Survey (SF-36). Based on the muscle spasms survey answers, patients were divided into two subgroups: with (n = 39) and without muscle spasms (n = 28). Results: The findings revealed that patients with muscle spasms had a higher body mass index (BMI) (p = 0.005), a shorter dialysis vintage (p = 0.063), and significantly longer sitting times (p = 0.017). Multivariate analysis identified BMI (p = 0.034), sitting time (p = 0.009), physical functioning scores (p = 0.032), and dialysis vintage (p = 0.040) as significant predictors of muscle spasms. Conclusions: This study concluded that muscle spasms are associated with lower QoL among HD patients. The contributing factors to this dependance are BMI, dialysis vintage, physical functioning, and sitting time.

The association between health literacy and quality of life of patients with type 2 diabetes mellitus: A cross-sectional study

BACKGROUND

Health literacy-driven interventions in patients with type 2 diabetes have been found to play an important role in achieving glycemic control and enhancing diabetic self-management outcomes. The present study aimed to examine the role of health literacy as a predictor of quality of life among diabetic patients in Jordan.

METHODS

This cross-sectional study enrolled 400 Type 2 diabetic patients visiting the endocrinology department at the outpatient clinic at Al Basheer Hospital in Amman, Jordan. The data were collected between 1st of August and 28th of December 2023, using the validated Jordanian Diabetic Health Literacy Questionnaire and the EuroQol-5D tool. A quantile regression analysis was conducted to explore the factors associated with health-related quality of life among the study participants.

RESULT

This study included 68.8% females, with a median age of 58 (50-64) years. The median EQ5-D index score was 0.66 (0.41-0.78). Findings from regression analysis indicated as patients' age increased, their quality of life scores significantly decreased (-0.004, 95%CI (-0.006, -0.001), p = 0.002). Additionally, higher JDHLQ scores were significantly associated with higher EQ5-D scores (0.012, 95% CI (0.006-0.018), p<0.001). Moreover, patients with only an elementary education had significantly lower EQ5-D scores compared to those with a postgraduate education (-0.106, 95%CI (-0.190, -0.023), p = 0.013).

CONCLUSION

The findings of the present study emphasize the importance of including health literacy assessments and interventions in the diabetes care plans of patients in Jordan.

Health-related quality of life assessed by EQ-5D-5L and its determinants among Chinese adults

Background

Due to the rising standard of living and advances in public health and medical care in recent years in China, the health-related quality of life (HRQoL) has been increasingly acknowledged as an important part of health management of adults. This study aimed to analyze the HRQoL of Chinese adults and identify the influencing factors, proposing specific recommendations for improvement.

Methods

A cross-sectional study was conducted among 1,291 selected adults from four provinces spanning different regions in China aged ≥18 years from July 2021 and January 2022. The EuroQol-5D-5L (EQ-5D-5L) was used to conduct the HRQoL survey, and a general questionnaire was administered to collect demographic characteristics, general information, and health behaviors of participants. The health utility value was measured, and one-way analysis of variance was performed. The Tobit regression model was employed to analyze the factors influencing the HRQoL of Chinese adults.

Results

The mean health utility values and visual analog scale scores for adults were 0.9400 ± 0.1197 and 84.09 ± 14.392, respectively. Notably, 60.3% of respondents reported no difficulties in any of the five dimensions of EQ-5D. However, a substantial proportion faced challenges in anxiety/depression (27%) and pain/discomfort (26.2%). Tobit regression model revealed that age, marital status, educational level, diet, sleep, mental state, mood, and chronic diseases significantly impact the HRQoL of Chinese adults.

Conclusion

The HRQoL among Chinese adults is generally satisfactory, but pay particular attention on areas such as pain, psychological anxiety, chronic diseases, and negative emotions is needed. The factors such as stress associated with marriage and the demands of high-skilled occupations might influence the overall health of the population. According to our findings, public health strategies to improve HRQoL should be developed to promote relatively healthy environments and lifestyles for older adults. Moreover, proactive measures are crucial for mitigating the potential health impacts associated with marital stress and high-skilled employment.

Integrating the assessment of quality of life in care and research in pulmonary fibrosis

PURPOSE OF REVIEW

Pulmonary fibrosis (PF) negatively influences health-related quality of life (HRQOL). Patients living with PF have voiced the desire for a focus on symptoms and HRQOL in both disease monitoring and treatment decisions.

RECENT FINDINGS

Currently available disease modifying treatments do little to impact HRQOL. Newer studies evaluating pharmacologic and nonpharmacologic therapies targeting symptoms and HRQOL in PF have been conducted with some promising results. There is increasing recognition of the importance of incorporating HRQOL as a higher tier endpoint in clinical trials. Disease-specific measure of HRQOL have been developed for those living with PF, and there is ongoing work to better understand the validity and reliability characteristics of these tools. In addition to research, there is recognition of the potential benefits of measuring HRQOL and symptoms in clinical practice in facilitate integrating patient perspective into care and allow for more personalized treatment approaches.

SUMMARY

There is increased momentum to discover treatments that impact HRQOL in PF. More work is desperately needed to identify better treatment targets, and to incorporate HRQOL and symptoms as higher tier endpoints in clinical trials. Further work is also needed to address the practicalities of integrating HRQOL measurement into clinical care.

Prior Engagement in Physical Activity Correlates with Enhanced Quality of Life Perceptions among Older Adults during COVID-19 Lockdown

BACKGROUND

This longitudinal study aimed to evaluate whether prior engagement in a physical exercise program correlated with enhanced perceptions of quality-of-life components among older adults during the COVID-19 lockdown period.

METHODS

The cohort comprised elderly individuals (aged ≥ 65 years) who had previously partaken in a 12-week randomized controlled trial investigating the effects of a mixed aerobic-anaerobic, moderate-intensity exercise program. Participants' health-related quality of life was assessed using the Short Form Health Survey-12 item (SF-12) at the beginning of the initial trial and, again, one year later during the COVID-19 lockdown. In the exercise group, 44 participants were included, while the control group consisted of 49 participants, with computer-based, double-blind randomization conducted in Cagliari, Italy. The differences in scores for each SF-12 item between the two groups from T0 to T1 were compared using one-way ANOVA with Bonferroni corrections. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 27.

RESULTS

No statistically significant differences were observed on average by age (exercise group vs. control group 72.20 ± 4.78 vs. 72.91 ± 4.77; F = 0.513, p = 0.476). A decrease from T0 to T1 towards a better score on the SF-12 was observed in the exercise group compared to the control group in item 1 (F = 67.463, p < 0.0001); in item 5 (F = 4.319, p = 0.041); item 8 (F = 4.269, p = 0.041); item 9 (F = 10.761, p = 0.001); item 10 (F = 170.433, p < 0.001); and item 11 (F = 4.075, p = 0.046).

CONCLUSIONS

The results suggest that participation in a moderate physical exercise program one year prior may have equipped older adults with better coping mechanisms to navigate the stress and isolation imposed by the COVID-19 lockdown, as reflected by their enhanced scores on quality-of-life components pertaining to mental well-being. Exercise may confer a protective effect against the adverse psychological impacts of stressful events like the pandemic, even among older adults with chronic conditions. This study underscores the potential benefits of exercise interventions for promoting quality of life and preventing mood disorders in the elderly population.

Validation of the arabic version of the EuroQol-5-dimension 5-level (EQ-5D-5 L) in patients with spinal degenerative diseases

OBJECTIVE

This study aims to test the reliability and validity of the translated Arabic version of EQ-5D-5 L.

METHODS

The study was conducted on 100 patients operated upon for degenerative spine diseases coming for follow up in the outpatient clinic of a Tertiary care hospital. Test-retest reliability was assessed by completing the self-administered tool in two follow up visits, one week apart, by 50 patients. Internal consistency was evaluated by Cronbach's alpha. Intra-class correlation coefficients and kappa statistics were performed to test for the agreement between the two ratings. Criterion validity was assessed by comparing the responses of 100 patients to the EQ-5D-5 L with scores of two validated questionnaires; the Arabic version of the Oswestry disability index and the Arabic version of short-form health survey-36. The construct validity was assessed using known-groups comparison to test for hypothesized differences concerning demographic and clinical variables.

RESULTS

The Arabic version of EQ-5D-5 L questionnaire had a high reliability with high observed internal consistency (Cronbach's alpha = 0.816, CI: 0.719-0.886). It showed strong temporal stability, with ICCs of the EQ-5D-5 L score, index and EQ-visual analog scale (EQ-VAS) of 0.852, 0.801, and 0.839 respectively. Agreement by kappa was moderate; above 0.4, for all domains, except for the "Usual activities" domain. EQ-5D-5 L domains, VAS and index had moderate to strong significant correlations with SF-36 and ODI subscales and total scores in the correct direction indicating a good criterion validity of the instrument.

CONCLUSION

The Arabic version of EQ-5D-5 L is reliable and valid for assessment of HRQoL of Arabic speaking patients.

Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review

Mild cognitive impairment (MCI), representing the 'transitional zone' between normal cognition and dementia, has become a novel topic in clinical research. Although early detection is crucial, it remains logistically challenging at the same time. While traditional pen-and-paper tests require in-depth training to ensure standardized administration and accurate interpretation of findings, significant technological advancements are leading to the development of procedures for the early detection of Alzheimer's disease (AD) and facilitating the diagnostic process. Some of the diagnostic protocols, however, show significant limitations that hamper their widespread adoption. Concerns about the social and economic implications of the increasing incidence of AD underline the need for reliable, non-invasive, cost-effective, and timely cognitive scoring methodologies. For instance, modern clinical studies report significant oculomotor impairments among patients with MCI, who perform poorly in visual paired-comparison tasks by ascribing less attentional resources to novel stimuli. To accelerate the Global Action Plan on the Public Health Response to Dementia 2017-2025, this work provides an overview of research on saccadic and exploratory eye-movement deficits among older adults with MCI. The review protocol was drafted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were systematically searched to identify peer-reviewed articles published between 2017 and 2022 that examined visual processing in older adults with MCI and reported gaze parameters as potential biomarkers. Moreover, following the contemporary trend for remote healthcare technologies, we reviewed studies that implemented non-commercial eye-tracking instrumentation in order to detect information processing impairments among the MCI population. Based on the gathered literature, eye-tracking-based paradigms may ameliorate the screening limitations of traditional cognitive assessments and contribute to early AD detection. However, in order to translate the findings pertaining to abnormal gaze behavior into clinical applications, it is imperative to conduct longitudinal investigations in both laboratory-based and ecologically valid settings.