Health and Quality of Life Outcomes - Most viewed articles

The Hospital Anxiety And Depression Scale

R Philip Snaith — 2003-08-01

There is a need to assess the contribution of mood disorder, especially anxiety and depression, in order to understand the experience of suffering in the setting of medical practice.Most physicians are aware of this aspect of the illness of their patients but many feel incompetent to provide the patient with reliable information. The Hospital Anxiety And Depression Scale, or HADS, was designed to provide a simple yet reliable tool for use in medical practice. The term 'hospital' in its title suggests that it is only valid in such a setting but many studies conducted throughout the world have confirmed that it is valid when used in community settings and primary care medical practice.It should be emphasised that self-assessment scales are only valid for screening purposes; definitive diagnosis must rest on the process of clinical examination.

The Stanford Health Assessment Questionnaire: Dimensions and Practical Applications

Bonnie Bruce and James F Fries — 2003-06-09

The ability to effectively measure health-related quality-of-life longitudinally is central to describing the impacts of disease, treatment, or other insults, including normal aging, upon the patient. Over the last two decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements, such as erythrocyte sedimentation rate, lipid profiles, or radiographs, to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on generic, patient-centered dimensions. The HAQ was designed to represent a model of patient-oriented outcome assessment and has played a major role in many diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of NSAID gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA.Evidenced by its use over the past two decades in diverse settings, the HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It is available in more than 60 languages and is supported by a bibliography of more than 500 references. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. In this article, information regarding the HAQ's development, content, dissemination and reference sources for its uses, translations, and validations are provided.

The 12-item General Health Questionnaire (GHQ-12): translation and validation study of the Iranian version

2003-11-13

Background: The objective of this study was to translate and to test the reliability and validity of the 12-item General Health Questionnaire (GHQ-12) in Iran. Methods: Using a standard 'forward-backward' translation procedure, the English language version of the questionnaire was translated into Persian (Iranian language). Then a sample of young people aged 18 to 25 years old completed the questionnaire. In addition, a short questionnaire containing demographic questions and a single measure of global quality of life was administered. To test reliability the internal consistency was assessed by Cronbach's alpha coefficient. Validity was performed using convergent validity. Finally, the factor structure of the questionnaire was extracted by performing principal component analysis using oblique factor solution. Results: In all 748 young people entered into the study. The mean age of respondents was 21.1 (SD = 2.1) years. Employing the recommended method of scoring (ranging from 0 to 12), the mean GHQ score was 3.7 (SD = 3.5). Reliability analysis showed satisfactory result (Cronbach's alpha coefficient = 0.87). Convergent validity indicated a significant negative correlation between the GHQ-12 and global quality of life scores as expected (r = -0.56, P < 0.0001). The principal component analysis with oblique rotation solution showed that the GHQ-12 was a measure of psychological morbidity with two-factor structure that jointly accounted for 51% of the variance. Conclusion: The study findings showed that the Iranian version of the GHQ-12 has a good structural characteristic and is a reliable and valid instrument that can be used for measuring psychological well being in Iran.

Thai SF-36 health survey: tests of data quality, scaling assumptions, reliability and validity in healthy men and women

Lynette L Lim, Sam-ang Seubsman and Adrian Sleigh — 2008-07-18

Background: Since its translation to Thai in 2000, the SF-36 Health Survey has been used extensively in many different clinical settings in Thailand. Its popularity has increased despite the absence of evidence that the translated instrument satisfies the psychometric properties required for valid interpretation of the SF-36 summated ratings scales. The purpose of this paper was to examine these properties and to report on the reliability and validity of the Thai SF-36 in a non-clinical general population. Methods: 1345 distance-education university students who live in all areas of Thailand completed a questionnaire comprising the Thai SF-36 (Version 1). Median age was 31 years. Psychometric tests recommended by the International Quality of Life Assessment Project were used. Results: Data quality was satisfactory: questionnaire completion rate was high (97.5%) and missing data rates were low (<1.5% for all items). The ordering of item means within scales generally were clustered as hypothesized and scaling assumptions were satisfied. Known groups analysis showed good discriminant validity between subgroups of healthy persons with differing health states. However, some areas of concern were revealed. Possible translation problems of the Physical Functioning (PF) items were indicated by the comparatively low ceiling effects. High ceiling and floor effects were seen in both role functioning scales, possibly due to the dichotomous format of their response choices. The Social Functioning scale had a low reliability of 0.55, which may be due to cultural differences in the concept of social functioning. The Vitality scale correlated better with the Mental Health scale than with itself, possibly because a healthy mental state is central to the concept of vitality in Thailand. Conclusions: The summated ratings method can be used for scoring the Thai SF-36. The instrument was found to be reliable and valid for use in a general non-clinical population. Version 2 of the SF-36 could improve ceiling and floor effects in the role functioning scales. Further work is warranted to refine items that measure the concepts of physical functioning, social functioning, vitality and mental health to improve the reliability and discriminant validity of these scales.

Development of the Knee Quality of Life (KQoL-26) 26-item questionnaire: data quality, reliability, validity and responsiveness

2008-07-10

Background: This article describes the development and validation of a self-reported questionnaire, the KQoL-26, that is based on the views of patients with a suspected ligamentous or meniscal injury of the knee that assesses the impact of their knee problem on the quality of their lives. Methods: Patient interviews and focus groups were used to derive questionnaire content. The instrument was assessed for data quality, reliability, validity, and responsiveness using data from a randomised trial and patient survey about general practitioners' use of Magnetic Resonance Imaging for patients with a suspected ligamentous or meniscal injury. Results: Interview and focus group data produced a 40-item questionnaire designed for self-completion. 559 trial patients and 323 survey patients responded to the questionnaire. Following principal components analysis and Rasch analysis, 26 items were found to contribute to three scales of knee-related quality of life: physical functioning, activity limitations, and emotional functioning. Item-total correlations ranged from 0.60–0.82. Cronbach's alpha and test retest reliability estimates were 0.91–0.94 and 0.80–0.93 respectively. Hypothesised correlations with the Lysholm Knee Scale, EQ-5D, SF-36 and knee symptom questions were evidence for construct validity. The instrument produced highly significant change scores for 65 trial patients indicating that their knee was a little or somewhat better at six months. The new instrument had higher effect sizes (range 0.86–1.13) and responsiveness statistics (range 1.50–2.13) than the EQ-5D and SF-36. Conclusion: The KQoL-26 has good evidence for internal reliability, test-retest reliability, validity and responsiveness, and is recommended for use in randomised trials and other evaluative studies of patients with a suspected ligamentous or meniscal injury.

Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity

Christina C Wee, Roger B Davis and Mary Beth Hamel — 2008-01-30

ObjectiveTo assess how well the SF-36, a well-validated generic quality of life (QOL) instrument, compares with its shorter adaptation, the SF-12, in capturing differences in QOL among patients with and without obesity. Methods: We compared the correlation between the physical (PCS) and mental (MCS) component summary measures of the SF-12 and SF-36 among 356 primary care patients using Pearson coefficients (r) and conducted linear regression models to see how these summary measures captures the variation across BMI. We used model R2 to assess qualitatively how well each measure explained the variation across BMI. Results: Correlations between SF-12 and SF-36 were higher for the PCS in obese (r = 0.89) compared to overweight (r = 0.73) and normal weight patients (r = 0.75), p < 0.001, but were similar for the MCS across BMI. Compared to normal weight patients, obese patients scored 8.8 points lower on the PCS-12 and 5.7 points lower on the PCS-36 after adjustment for age, sex, and race; the model R2 was higher with PCS-12 (R2 = 0.22) than with PCS-36 (R2 = 0.16). BMI was not significantly associated with either the MCS-12 or MCS-36. Conclusion: The SF-12 correlated highly with SF-36 in obese and non-obese patients and appeared to be a better measure of differences in QOL associated with BMI.

Patterns of health-related quality of life and patterns associated with health risks among Rhode Island adults

Yongwen Jiang and Jana Earl Hesser — 2008-07-11

Background: Health-related quality of life (HRQOL) has become an important consideration in assessing the impact of chronic disease on individuals as well as in populations. HRQOL is often assessed using multiple indicators. The authors sought to determine if multiple indicators of HRQOL could be used to characterize patterns of HRQOL in a population, and if so, to examine the association between such patterns and demographic, health risk and health condition covariates. Methods: Data from Rhode Island's 2004 Behavioral Risk Factor Surveillance System (BRFSS) were used for this analysis. The BRFSS is a population-based random-digit-dialed telephone survey of adults ages 18 and older. In 2004 RI's BRFSS interviewed 3,999 respondents. A latent class regression (LCR) model, using 9 BRFSS HRQOL indicators, was used to determine latent classes of HRQOL for RI adults and to model the relationship between latent class membership and covariates. Results: RI adults were categorized into four latent classes of HRQOL. Class 1 (76%) was characterized by good physical and mental HRQOL; Class 2 (9%) was characterized as having physically related poor HRQOL; Class 3 (11%) was characterized as having mentally related poor HRQOL; and Class 4 (4%) as having both physically and mentally related poor HRQOL. Class 2 was associated with older age, being female, unable to work, disabled, or unemployed, no participation in leisure time physical activity, or with having asthma or diabetes. Class 3 was associated with being female, current smoking, or having asthma or disability. Class 4 was associated with almost all the same predictors of Classes 2 and 3, i.e. older age, being female, unable to work, disabled, or unemployed, no participation in leisure time physical activity, current smoking, with having asthma or diabetes, or with low income. Conclusion: Using a LCR model, the authors found 4 distinct patterns of HRQOL among RI adults. The largest class was associated with good HRQOL; three smaller classes were associated with poor HRQOL. We identified the characteristics of subgroups at higher-risk for each of the three classes of poor HRQOL. Focusing interventions on the high-risk populations may be one approach to improving HRQOL in RI.

EQ-5D visual analog scale and utility index values in individuals with diabetes and at risk for diabetes: Findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD)

Susan Grandy and Kathleen M Fox — 2008-02-27

Background: The EQ-5D was used to compare burden experienced by respondents with diabetes and those at risk for diabetes. Methods: A survey including the EQ-5D was mailed to individuals with self-reported diabetes, as well as those without diabetes but with the following risk factors (RFs): (1) abdominal obesity, (2) body mass index ≥ 28 kg/m2, (3) dyslipidemia, (4) hypertension, and (5) cardiovascular disease. Non-diabetes respondents were combined into 0–2 RFs and 3–5 RFs. Mean EQ-5D scores were compared across groups using analysis of variance. Multivariable linear regression modeling identified factors affecting respondents' EQ-5D scores. Results: Complete responses were available from >75% of each cohort. Mean EQ-5D index scores were significantly lower for respondents with type 2 diabetes and 3–5 RFs (0.778 and 0.792, respectively) than for those with 0–2 RFs (0.870, p < 0.001 for each); score for respondents with type 2 diabetes was also significantly lower than for those with 3–5 RFs (p < 0.001). Similar patterns were seen for visual analog scale (VAS). For both VAS and index scores, after adjusting for other characteristics, respondents reported decreasing EQ-5D scores as status moved from low to high risk (-6.49 for VAS score and -0.045 for index score) to a diagnosis of type 2 diabetes (-9.75 for VAS score and -0.054 for index score; p < 0.001 vs. 0–2 RFs for all). Conclusion: High-risk and type 2 diabetes groups had similar EQ-5D scores, and both were substantially lower than in low-risk respondents.

Do estimates of cost-utility based on the EQ-5D differ from those based on the mapping of utility scores?

2008-07-14

Background: Mapping has been used to convert scores from condition-specific measures into utility scores, and to produce estimates of cost-effectiveness. We sought to compare the QALY gains, and incremental cost per QALY estimates, predicted on the basis of mapping to those based on actual EQ-5D scores. Methods: In order to compare 4 different interventions 389 individuals were asked to complete both the EQ-5D and the Western Ontartio and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, 6, 12, and 24 months post-intervention. Using baseline data various mapping models were developed, where WOMAC scores were used to predict the EQ-5D scores. The performance of these models was tested by predicting the EQ-5D post-intervention scores. The preferred model (that with the lowest mean absolute error (MAE)) was used to predict the EQ-5D scores, at all time points, for individuals who had complete WOMAC and EQ-5D data. The mean QALY gain associated with each intervention was calculated, using both actual and predicted EQ-5D scores. These QALY gains, along with previously estimated changes in cost, were also used to estimate the actual and predicted incremental cost per QALY associated with each of the four interventions. Results: The EQ-5D and the WOMAC were completed at baseline by 348 individuals, and at all time points by 259 individuals. The MAE in the preferred model was 0.129, and the mean QALY gains for each of the four interventions was predicted to be 0.006, 0.058, 0.058, and 0.136 respectively, compared to the actual mean QALY gains of 0.087, 0.081, 0.120, and 0.149. The most effective intervention was estimated to be associated with an incremental cost per QALY of £6,068, according to our preferred model, compared to £13,154 when actual data was used. Conclusion: We found that actual QALY gains, and incremental cost per QALY estimates, differed from those predicted on the basis of mapping. This suggests that though mapping may be of value in predicting the cost-effectiveness of interventions which have not been evaluated using a utility measure, future studies should be encouraged to include a method of actual utility measurement.Trial registrationCurrent Controlled Trials ISRCTN93206785

Enhancing quality of life in older adults: A comparison of muscular strength and power training

Jeffrey A Katula, W Jack Rejeski and Anthony P Marsh — 2008-06-13

Background: Although progressive resistance strength training (ST) has been found to improve various measures of physical functioning in older adults, the benefit to quality of life is unclear. Additionally, recent evidence suggests that high velocity power training (PT) may be more beneficial for physical functioning than ST, but it is not known whether this type of training impacts quality of life. The purpose of this study was to compare changes in multiple measures of quality of life resulting from ST vs. PT in older adults. A no exercise group was also included as control comparison condition. Methods: Forty-five older adults (M age = 74.8 years; SD = 5.7) were randomly assigned to either a) PT, b) ST, or c) control group (no exercise). Measures of self-efficacy (SE), satisfaction with physical function (SPF), and the Satisfaction with Life Scale (SWL) were assessed at baseline and following training. The resistance training conditions met 3 times per week for 12 weeks at an intensity of 70% 1 repetition maximum. Results: A series of ANCOVA's comparing between group differences in change and controlling for baseline values revealed significant group differences in all three measures: SE (F(2,31) = 9.77; p < .001); SPF (F(2,32) = 3.36; p = .047); SWL (F(2,31) = 4.76; p = .016). Follow up analyses indicated that the PT group reported significantly more change in SE, SPF, and SWL than the control group whereas the ST group reported greater change than the control group only in SE. Conclusion: These pilot data indicate that high velocity power training may influence multiple levels of quality of life over and above the benefits gained through traditional strength training.