What do measures of ‘oral health-related quality of life’ measure?
01 Dec 2007-Community Dentistry and Oral Epidemiology (Community Dent Oral Epidemiol)-Vol. 35, Iss: 6, pp 401-411
TL;DR: The main conclusion is that while all document the frequency of the functional and psychosocial impacts that emanate from oral disorders they do not unequivocally establish the meaning and significance of those impacts.
Abstract: The terms 'health-related quality of life' and 'quality of life' are now in common use to describe the outcomes of oral health conditions and therapy for those conditions. In addition, there has been a proliferation of measures designed to quantify those outcomes. These measures, which were initially designated as socio-dental indicators or subjective oral health indicators are now more usually referred to as measures of oral health-related quality of life (OH-QoL). This is based on the assumption that the functional and psychosocial impacts they document must, of necessity, affect the quality of life. While this assumption has been subject to critical scrutiny in medicine, this is not the case with dentistry. Consequently, exactly what is being measured by indexes of OH-QoL is somewhat unclear. Based on the debate between Gill and Feinstein and Guyatt and Cook, we outline a number of criteria by means of which the construct addressed by measures of OH-QoL may be assessed. These are concerned with how the measures were developed and validated. These criteria are then used to appraise five of the many measures that have been developed over the past 20 years--the GOHAI, OHIP, OIDP, COHQoL and OH-QoL. The main conclusion is that while all document the frequency of the functional and psychosocial impacts that emanate from oral disorders they do not unequivocally establish the meaning and significance of those impacts. Consequently, the claim that oral disorders affect the quality of life has yet to be clearly demonstrated. Verifying this claim requires further qualitative studies of the outcomes of oral disorders as perceived by patients and persons, and the concurrent use of measures that more explicitly address the issue of quality of life.
Citations
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TL;DR: The authors discuss the importance of evaluating the oral health of the geriatric population in a comprehensive manner, beyond simple clinical assessments, in this nonsystematic review of oral health among the elderly.
Abstract: Data on the oral health of the elderly depict a worrying situation, with an elevated prevalence of caries and moderate periodontal disease, frequent edentulism, and numerous cases of dry mouth and oral cancer. There is wide evidence that periodontitis is a risk factor for certain systemic diseases, and impaired oral health has been associated with mastication and nutritional problems, especially among the elderly, with highly negative effects on their quality of life. In this nonsystematic review, the authors discuss the importance of evaluating the oral health of the geriatric population in a comprehensive manner, beyond simple clinical assessments.
291 citations
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TL;DR: The results indicate that periodontal disease may exert an impact on quality of life of individuals, with greater severity of the disease related to greater impact.
Abstract: The diagnosis of periodontal disease is commonly based on objective evaluations of the patient's medical/dental history as well as clinical and radiographic examinations. However, periodontal disease should also be evaluated subjectively through measures that quantify its impact on oral health-related quality of life. The aim of this study was to evaluate the impact of periodontal disease on quality of life among adolescents, adults and older adults. A systematic search of the literature was performed for scientific articles published up to July 2015 using electronic databases and a manual search. Two independent reviewers performed the selection of the studies, extracted the data and assessed the methodological quality. Thirty-four cross-sectional studies involving any age group, except children, and the use of questionnaires for the assessment of the impact of periodontal disease on quality of life were included. Twenty-five studies demonstrated that periodontal disease was associated with a negative impact on quality of life, with severe periodontitis exerting the most significant impact by compromising aspects related to function and esthetics. Unlike periodontitis, gingivitis was associated with pain as well as difficulties performing oral hygiene and wearing dentures. Gingivitis was also negatively correlated with comfort. The results indicate that periodontal disease may exert an impact on quality of life of individuals, with greater severity of the disease related to greater impact. Longitudinal studies with representative samples are needed to ensure validity of the findings.
201 citations
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TL;DR: Despite the different definitions and measures of tooth loss and dental caries, the majority of the available evidence reported a negative impact of these conditions on HRQoL.
Abstract: The objective of this study was to verify whether oral conditions (tooth loss, periodontal disease, dental caries) are negatively associated with health-related quality of life (HRQoL) in adults. A search was carried out on PubMed, EMBASE, Web of Science, Scopus, SciELO, and LILACS databases until the end of July 2016 with no date restrictions. Quantitative observational studies written in English were included and data extraction was performed independently by 2 reviewers. HRQoL was investigated as the outcome, and tooth loss, periodontal diseases, and dental caries were exposures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used and the quality of the selected studies was assessed by using the Joanna Briggs Institute Meta-Analysis of Statistics assessment and review instrument (JBI-MAStARI). Twenty-one studies were included. The sample sizes ranged from 88 to 15,501 subjects; 20 studies were cross-sectional designs, while 1 was a case-control study. Case definitions of the exposures were different across the studies, mainly for tooth loss, which was defined according to 11 different criteria. Fifteen studies were of "high" and 6 of "medium" quality. Eight HRQoL instruments were identified, and the most frequent was the EuroQol ( n = 8). Ten of 16 studies reported a negative impact of tooth loss on HRQoL. Four of 7 studies reported that periodontal disease impairs HRQoL, and 1 study showed that periodontal disease is positively associated with HRQoL. All studies that assessed dental caries reported a negative association between this condition and HRQoL. Despite the different definitions and measures of tooth loss and dental caries, the majority of the available evidence reported a negative impact of these conditions on HRQoL. Mixed and inconclusive findings were observed for the association between periodontal disease and HRQoL. Longitudinal prospective studies are suggested to improve the strength of the findings.
191 citations
Cites background from "What do measures of ‘oral health-re..."
...Although these measures were developed to evaluate the subjective oral health status, they are commonly used as measures of oral healthrelated quality of life (OHRQoL) (Locker and Allen 2007)....
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TL;DR: In the United States, the impact of oral disease disproportionately affected disadvantaged groups, a finding that supports application of the US Healthy People 2010 major goals of improved quality of life and reduced health disparities.
Abstract: The US National Health and Nutrition Examination Survey (NHANES 2003–2004) evaluated oral health quality of life for the first time using a previously untested subset of seven Oral Health Impact Profile (OHIP) questions, i.e. the NHANES-OHIP.
Objectives
(i) To describe the impact of dental conditions on quality of life in the US adult population; (ii) to evaluate construct validity and adequacy of the NHANES-OHIP in NHANES 2003–2004 and a comparable Australian survey.
166 citations
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TL;DR: Different approaches (distribution-based and anchor-based) and specific methods for assessing the minimally important difference in both longitudinal and cross-sectional studies are discussed, and minimum standards for reporting and interpreting PBO measures in an oral health context are suggested.
Abstract: The most common way of presenting data from studies using quality of life or patient-based outcome (PBO) measures is in terms of mean scores along with testing the statistical significance of differences in means. We argue that this is insufficient in and of itself and call for a more comprehensive and thoughtful approach to the reporting and interpretation of data. PBO scores (and their means for that matter) are intrinsically meaningless, and differences in means between groups mask important and potentially different patterns in response within groups. More importantly, they are difficult to interpret because of the absence of a meaningful benchmark. The minimally important difference (MID) provides that benchmark to assist interpretability. This commentary discusses different approaches (distribution-based and anchor-based) and specific methods for assessing the MID in both longitudinal and cross-sectional studies, and suggests minimum standards for reporting and interpreting PBO measures in an oral health context.
150 citations
References
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Willem Kuyken, John Orley, Mick Power, Helen Herrman, Hilary Schofield, B. Murphy, Željko Metelko, Silvija Szabo, Mirjana Pibernik-Okanović, N. Quemada, A. Caria, S. Rajkumar, S. Kumar, Shekhar Saxena, Dan Bar-On, M. Amir, M. Tazaki, A. Noji, G. Vanheck, J. Devries, J.A. Sucre, L. Picardami, M. Kabanov, A. Lomachenkov, G. Burkovsky
TL;DR: The World Health Organization's project to develop a quality of life instrument (the WHOQOL) is described, the reasons that the project was undertaken, the thinking that underlies the project, the method that has been followed in its development and the current status of the project.
5,273 citations
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TL;DR: To evaluate how well quality of life is being measured in the medical literature and to offer a new approach to the measurement, original English-language articles having the term "quality of life" in their titles were identified.
Abstract: Objective. —To evaluate how well quality of life is being measured in the medical literature and to offer a new approach to the measurement. Data Sources. —Original English-language articles having the term "quality of life" in their titles were identified from a recent Quality-of-Life Bibliography and from two MEDLINE searches. Articles were eligible for review only if they described or used one or more "quality-of-life" instruments. Study Selection. —Twenty-five articles were randomly selected from each of the three data sources. Data Extraction. —Each article was reviewed for its compliance with two sets of criteria having several components, which are cited under "Data Synthesis." Data Synthesis. —(1) Investigators conceptually defined quality of life in only 11 (15%) of the 75 articles; identified the targeted domains in only 35 (47%); gave reasons for selecting the chosen quality-of-life instruments in only 27 (36%); and aggregated their results into a composite quality-of-life score in only 27 (38%) of 71 eligible articles. (2) No article distinguished "overall" quality of life from health-related quality of life; patients were invited to give their own separate rating for quality of life in only 13 articles (17%); and among 71 eligible articles, patients were asked to supplement the stipulated items with personal responses in only nine (13%) and to rate the importance of individual items in only six (8.5%). Conclusions. —Because quality of life is a uniquely personal perception, denoting the way that individual patients feel about their health status and/or nonmedical aspects of their lives, most measurements of quality of life in the medical literature seem to aim at the wrong target. Quality of life can be suitably measured only by determining the opinions of patients and by supplementing (or replacing) the instruments developed by "experts." (JAMA. 1994;272:619-626)
2,192 citations
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TL;DR: The Oral Health Impact Profile offers a reliable and valid instrument for detailed measurement of the social impact of oral disorders and has potential benefits for clinical decision-making and research.
Abstract: The capacity of dental clinicians and researchers to assess oral health and to advocate for dental care has been hampered by limitations in measurements of the levels of dysfunction, discomfort and disability associated with oral disorders The purpose of this research was to develop and test the Oral Health Impact Profile (OHIP), a scaled index of the social impact of oral disorders which draws on a theoretical hierarchy of oral health outcomes Forty nine unique statements describing the consequences of oral disorders were initially derived from 535 statements obtained in interviews with 64 dental patients The relative importance of statements within each of seven conceptual subscales was assessed by 328 persons using Thurstone's method of paired comparisons The consistency of their judgements was confirmed (Kendall's mu, P < 005) The reliability of the instrument was evaluated in a cohort of 122 persons aged 60 years and over Internal reliability of six subscales was high (Cronbach's alpha, 070-083) and test-retest reliability (intraclass correlation coefficient, 042-077) demonstrated stability Validity was examined using longitudinal data from the 60 years and over cohort where the OHIP's capacity to detect previously observed associations with perceived need for a dental visit (ANOVA, p < 005 in five subscales) provided evidence of its construct validity The Oral Health Impact Profile offers a reliable and valid instrument for detailed measurement of the social impact of oral disorders and has potential benefits for clinical decision-making and research
2,001 citations
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TL;DR: Quality of life is dependent upon finding a balance between body, mind and spirit in the self and on establishing and maintaining an harmonious set of relationships within the person's social context and external environment.
1,593 citations
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