Showing papers on "Quality of life published in 2006"
TL;DR: Exercise is an effective intervention to improve quality of life, cardiorespiratory fitness, physical functioning and fatigue in breast cancer patients and survivors and larger trials that examine the long-term benefits of exercise are needed for this patient group.
Abstract: Background: Physical exercise has been identified as a potential intervention to improve quality of life in women with breast cancer. We sought to summarize the available evidence concerning the effects of exercise on breast cancer patients and survivors. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsychINFO, CancerLit, PEDro and SportDiscus as well as conference proceedings, clinical practice guidelines and other unpublished literature resources. We included only randomized controlled trials that examined exercise interventions for breast cancer patients or survivors with quality of life, cardiorespiratory fitness or physical functioning as primary outcomes. We also extracted data on symptoms of fatigue, body composition and adverse effects. Results: Of 136 studies identified, 14 met all the inclusion criteria. Despite significant heterogeneity and relatively small samples, the point estimates in terms of the benefits of exercise for all outcomes were positive even when statistical significance was not achieved. Exercise led to statistically significant improvements in quality of life as assessed by the Functional Assessment of Cancer Therapy–General (weighted mean difference [WMD] 4.58, 95% confidence interval [CI] 0.35 to 8.80) and Functional Assessment of Cancer Therapy–Breast (WMD 6.62, 95% CI 1.21 to 12.03). Exercise also led to significant improvements in physical functioning and peak oxygen consumption and in reducing symptoms of fatigue. Interpretation: Exercise is an effective intervention to improve quality of life, cardiorespiratory fitness, physical functioning and fatigue in breast cancer patients and survivors. Larger trials that have a greater focus on study quality and adverse effects and that examine the long-term benefits of exercise are needed for this patient group.
1,017 citations
TL;DR: CBT is related to short-term effects on depression and anxiety and both short and long term effects on QOL and individual interventions were more effective than group.
Abstract: Objective: The purpose of this meta-analysis was to investigate the effects of cognitive behavioral therapy (CBT) and patient education (PE) on commonly reported problems (depression, anxiety, pain, physical functioning, and quality of life (QOL)) in adult cancer survivors. Methods: Meta analyses of randomized controlled trials of CBT and PE were conducted. MEDLINE, PSYCHINFO and the Cochrane Database were searched from 1993-2004. The effects of individual versus group interventions and short ( 8 months) term follow up are also reported. Results: Fifteen studies met quality criteria. The sample size was 1,492 adult cancer survivors with an age range of 18-84. 790 were randomly assigned to intervention groups and 702 to control groups. CBT varied in duration from 4 weekly one-hour sessions to 55 weekly two-hour sessions. PE ranged from a single 20-minute session to 6 weekly one-hour sessions. Follow up ranged from 1 week to 14 months. CBT was effective for depression (ES = 1.2; 95% CI = 0.22-2.19), anxiety (ES = 1.99; 95% CI = 0.69-3.31), and QOL
574 citations
TL;DR: QoL in "general" patients with AF as well as the effects that rate and/or rhythm-control interventions have on QoL are examined, suggesting that patients with atrial fibrillation have impaired QoO, and that QOL can be significantly improved through rate or rhythm- control strategies.
536 citations
TL;DR: Physical more than mental health deteriorated with increasing multimorbidity, and perceived social support and self-perception of economic status were significantly related to all scales of the SF-36, which adversely affected HRQOL in primary-care adult patients.
Abstract: Previous studies about the association of multimorbidity and the health-related quality of life (HRQOL) in primary-care patients are limited because of their reliance on simple counts of diseases from a limited list of diseases and their failure to assess the severity of disease. We evaluated the association while taking into account the severity of the medical conditions based on the Cumulative Illness Rating Scale (CIRS) score, and controlling for potential confounders (age, sex, household income, education, self-perception of economic status, number of people living in the same dwelling, and perceived social support). We randomly selected 238 patients to construct quintiles of increasing multimorbidity (CIRS). Patients completed the 36-item Medical Outcomes study questionnaire (SF-36) to evaluate their HRQOL. Applying bivariate and multivariate linear regression analyses, we used the CIRS as either a continuous or a categorical (quintiles) variable. Use of the CIRS revealed a stronger association of HRQOL with multimorbidity than using a simple count of chronic conditions. Physical more than mental health deteriorated with increasing multimorbidity. Perceived social support and self-perception of economic status were significantly related to all scales of the SF-36 (p < 0.05). Increased multimorbidity adversely affected HRQOL in primary-care adult patients, even when confounding variables were controlled for.
505 citations
TL;DR: The data from this randomised study support the use of SNB in patients with clinically node negative breast cancer.
Abstract: This study is the first large prospective RCT of sentinel node biopsy (SNB) compared with standard axillary treatment (level I-III axillary lymph node dissection or four node sampling), which includes comprehensive and repeated quality of life (QOL) assessments over 18 months. Patients (n = 829) completed the Functional Assessment of Cancer Therapy - Breast (FACT-B+4) and the Spielberger State/Trait Anxiety Inventory (STAI) at baseline (pre-surgery) and at 1, 3, 6, 12, and 18 months post-surgery. There were significant differences between treatment groups favouring the SNB group throughout the 18 months assessment. Patients in the standard treatment group showed a greater decline in Trial Outcome Index (TOI) scores (physical well-being, functional well-being and breast cancer concerns subscales in FACT-B+4) and recovered more slowly than patients in the SNB group (p 0.05). For 6 months post-surgery younger patients reported less favourable QOL scores (p < 0.001) and greater levels of anxiety (p < 0.01). In view of the benefits regarding arm functioning and quality of life, the data from this randomised study support the use of SNB in patients with clinically node negative breast cancer.
468 citations
TL;DR: Female patients appear to be more exposed to psychological impairment, which correlates well with some specific symptomatic aspects of the disease, such as dyspnea, which is more strongly correlated with depression in women than in men.
434 citations
TL;DR: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood if these factors are controlled.
Abstract: Objectives: To investigate whether longstanding illnesses, social context, and current socioeconomic circumstances predict quality of life. Design: Secondary analysis of wave 1 of the English longitudinal study of aging. Missing data were imputed and multiple regression analyses conducted. Setting: England, 2002 Participants: Nationally representative sample of non-institutionalised adults living in England (n = 11 234, 54.5% women, age 65.1 (SD 10.2) years). Main outcome measure: Quality of life as measured by CASP-19, a 19 item Likert scaled index. Results: The quality of life was reduced by depression (β −0.265), poor perceived financial situation (β −0.157), limitations in mobility (β −0.124), difficulties with everyday activities (β −0.112), and limiting longstanding illness (β −0.112). The quality of life was improved by trusting relationships with family (β 0.105) and friends (β 0.078), frequent contacts with friends (β 0.059), living in good neighbourhoods (β 0.103), and having two cars (β 0.066). The regression models explained 48% variation in CASP-19 scores. There were slight differences between age groups and between men and women. Conclusions: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood. There is the potential for improved quality of life in early old age (the third age) if these factors are controlled.
430 citations
TL;DR: A meta-analysis on published QOL articles on response shift finds that a definitive conclusion on the clinical significance of response shift cannot currently be drawn from existing studies, and recommends a standardized approach for reporting results of future response shift research to advance the field and to facilitate interpretation and comparisons across studies.
Abstract: When individuals experience changes in their health states, they may alter their internal standards, values, or conceptualization of quality of life (QOL). Such ‘response shifts’ can affect or distort QOL outcome measurement, which is of particular concern when evaluating medical or psychosocial interventions. Although clinicians and researchers acknowledge the occurrence of response shifts, little is known about the magnitude and clinical significance of those effects. To fill this gap in knowledge about response shift phenomena, we performed a meta-analysis on published QOL articles on response shift. Extensive literature searches and multiple contacts with researchers yielded a collection of 494 articles for potential reviewing. We retained only published longitudinal studies that measured response shift, resulting in 26, of which 19 reported the requisite data for computing an effect size (ES). We calculated and compared the ESs for each study with regard to potential moderator variables: the QOL domains measured, disease group investigated, sample size, and response shift method used. We rated studies for quality to allow ES weighting. When we examined ES absolute values, we found that ES magnitude was small, with the largest ESs detected for fatigue, followed by global QOL, physical role limitation, psychological well-being, and pain (mean |ESweighted| = 0.32, 0.30, 0.24, 0.12, and 0.08, respectively). ESs varied considerably in direction. Aggregating raw ES scores over all studies led to positive and negative values canceling each other out (mean directional ESweighted = 0.17, 0.02, −0.01, 0.06, and 0.02, respectively). We found little evidence of an effect for the moderator variables examined. A definitive conclusion on the clinical significance of response shift cannot currently be drawn from existing studies. For a number of reasons, ES estimates were primarily based on then-test results, a method that is not without criticism, such as its susceptibility to recall bias. We recommend a standardized approach for reporting results of future response shift research to advance the field and to facilitate interpretation and comparisons across studies.
384 citations
TL;DR: Findings show that religious coping plays an important role for the QOL of patients and the types of religious coping strategies used are related to better or poorer QOL.
Abstract: Background: For patients confronting a life-threatening illness such as advanced cancer, religious coping can be an important factor influencing their quality of life (QOL). Objective: The study's main purpose was to examine the association between religious coping and QOL among 170 patients with advanced cancer. Both positive religious coping (e.g., benevolent religious appraisals) and negative religious coping (e.g., anger at God) and multiple dimensions of QOL (physical, physical symptom, psychological, existential, and support) were studied. Design: Structured interviews were conducted with 170 patients recruited as part of an ongoing multi-institutional longitudinal evaluation of the prevalence of mental illness and patterns of mental health service utilization in advanced cancer patients and their primary informal caregivers. Measurements: Patients completed measures of QOL (McGill QOL questionnaire), religious coping (Brief Measure of Religious Coping [RCOPE] and Multidimensional Measure of Religio...
367 citations
TL;DR: Findings indicate that all aspects of QOL are markedly affected in individuals with OCD and are associated with OCD severity (particularly obsessional severity) and depression severity.
349 citations
TL;DR: A structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment, and control participants experienced a significant decrease in their QOL.
Abstract: Purpose The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. Patients and Methods Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. Results Of the 103 participants, overall QOL at week 4 was ...
TL;DR: This study examines HRQOL and its association with depressive symptoms and perceived social support in African‐American and white youth pursuing weight management treatment.
Abstract: ZELLER, MEG H. AND AVANI C. MODI. Predictors of health-related quality of life in obese youth. Obesity. 2006; 14:122-130. Objective: Recent literature has documented the psychosocial consequences of pediatric obesity, including poor health-related quality of life (HRQOL). The present study examines HRQOL and its association with depressive symptoms and perceived social support in African-American and white youth pursuing weight management treatment. Research Methods and Procedures: Study participants were 166 obese youth (mean = 12.7 years, 70% females, 57% African American, mean BMI = 37.0) referred to a pediatric weight management program. Parents of participants completed a demographics form and the parent-proxy Pediatric Quality of Life Inventory (PedsQL). Youth completed the Children's Depression Inventory, PedsQL, and Perceived Social Support Scale for Children. Results: HRQOL scores were quite impaired relative to published norms on healthy youth (p < 0.001). Approximately 11 % of the sample met criteria for clinically significant depressive symptoms. Simultaneous regression analyses revealed that depressive symptoms, perceived social support from classmates, degree of overweight, and socioeconomic status seem to be strong predictors of HRQOL. Discussion: Obesity has a clear impact on HRQOL regardless of respondent (e.g., parent, youth) or racial group. It is likely that assessing and treating depressive symptoms and fostering social support in the context of pediatric intervention have implications for both improved HRQOL and weight management outcomes.
TL;DR: Eerrlotinib not only improves survival in previously treated patients with NSCLC, but also improves tumor-related symptoms and important aspects of QOL.
Abstract: Purpose This report describes the quality of life (QOL) findings of a randomized placebo controlled study of erlotinib, an epidermal growth factor receptor inhibitor, in patients with non‐small-cell lung cancer (NSCLC). Patients and Methods This double-blind phase III trial randomly assigned 731 patients with NSCLC who had progressed after prior chemotherapy to erlotinib 150 mg daily or placebo, with survival as the primary study outcome. QOL was assessed by European Organisation for Research and Treatment of Cancer QLQ-C30 and the lung cancer module QLQ-LC13. The primary end points for QOL analysis were time to deterioration of three common lung cancer symptoms: cough, dyspnea, and pain. Results Survival was significantly longer (hazard ratio, 0.70; P .0001) in the erlotinib arm. Compliance with QOL was 87% at baseline and more than 70% during treatment. Patients receiving erlotinib had significantly longer median time to deterioration for all three symptoms (4.9 v 3.7 months for cough [P .04]; 4.7 v 2.9 months for dyspnea [P .04], and 2.8 v 1.9 months for pain [P .03]). QOL response analyses showed that 44%, 34%, and 42% of patients receiving erlotinib had improvement in these three symptoms, respectively. This was accompanied by a significant improvement in the physical function (31% erlotinib v 19% placebo, P .01), and global QOL (35% v 26%, P .0001). Patients with complete or partial response were more likely to have improvement in the QOL response than patients with stable or progressive disease (P .01).
TL;DR: Four relatively distinct patient subgroups were identified based on patients experiences with four highly prevalent and related symptoms; the subgroup of patients who reported low levels of all four symptoms reported the best functional status and QOL.
Abstract: PURPOSE/OBJECTIVES: To identify subgroups of outpatients with cancer based on their experiences with the symptoms of fatigue, sleep disturbance, depression, and pain; to explore whether patients in the subgroups differed on selected demographic, disease, and treatment characteristics; and to determine whether patients in the subgroups differed on two important patient outcomes: functional status and quality of life (QOL). DESIGN: Descriptive, correlational study. SETTING: Four outpatient oncology practices in northern California. SAMPLE: 191 outpatients with cancer receiving active treatment. METHODS: Patients completed a demographic questionnaire, Karnofsky Performance Status scale, Lee Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies Depression Scale, Multidimensional Quality-of-Life Scale Cancer, and a numeric rating scale of worst pain intensity. Medical records were reviewed for disease and treatment information. Cluster analysis was used to identify patient subgroups based on patients symptom experiences. Differences in demographic, disease, and treatment characteristics as well as in outcomes were evaluated using analysis of variance and chi square analysis. MAIN RESEARCH VARIABLES: Subgroup membership, fatigue, sleep disturbance, depression, pain, functional status, and QOL. FINDINGS: Four relatively distinct patient subgroups were identified based on patients experiences with four highly prevalent and related symptoms. CONCLUSIONS: The subgroup of patients who reported low levels of all four symptoms reported the best functional status and QOL. IMPLICATIONS FOR NURSING: The findings from this study need to be replicated before definitive clinical practice recommendations can be made. Until that time, clinicians need to assess patients for the occurrence of multiple symptoms that may place them at increased risk for poorer outcomes.
TL;DR: ARDS survivors in different clinical settings experience similar decrements in QOL, and the precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.
Abstract: To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors.
A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results. Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15–26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than ± 9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge. ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.
TL;DR: The findings support a social cognitives model of physical activity’s relationship with QOL, which influenced self-efficacy and QOL through physical and mental health status, which in turn influenced global QOL.
Abstract: Background: Physical activity has been positively linked to quality of life (QOL) in older adults. Measures of health status and global well-being represent common methods of assessing QOL outcomes, yet little has been done to determine the nature of the relationship of these outcomes with physical activity.Purpose: We examined the roles played by physical activity, health status, and self-efficacy in global QOL (satisfaction with life) in a sample of older Black and White women.Method: Participants (N = 249, M age = 68.12 years) completed multiple indicators of physical activity, self-efficacy, health status, and QOL at baseline of a 24-month prospective trial. Structural equation modeling examined the fit of 3 models of the physical activity and QOL relationship.Results: Analyses indicated that relationships between physical activity and QOL, self-efficacy and QOL were all indirect. Specifically, physical activity influenced self-efficacy and QOL through physical and mental health status, which in turn influenced global QOL.Conclusions: Our findings support a social cognitives model of physical activity’s relationship with QOL. Subsequent tests of hypothesized relationships across time are recommended.
TL;DR: Poor glycemic control in peridatric T1DM is associated with lower SES and depression, and the probability of depression increases as gly glucose control worsens.
TL;DR: Multivariate regression showed that those with active IBD had higher levels of distress, health anxiety, and perceived stress, lower social support, well-being and mastery, and poorer disease-specific QOL, relative to those with inactive disease.
TL;DR: QOL’s relationship with disability is complex, displaying non-linearity and interacting with patient characteristics, which has implication for QOL research methodology and provides insight into factors affecting patients’ perceptions of well-being.
Abstract: Objectives: (1) Evaluate the impact of the patient charateristics of disability, gender and employment status on health-related quality of life (HRQOL) in multiple sclerosis (MS) and (2) Characterize the functional relationship between HRQOL and disability overall, and by gender and employment status. Methods: We assessed the HRQOL of 215 MS outpatients in our clinic using the MSQOL-54 and Fatigue Severity Scale (FSS), and that of 172 healthy controls, using the SF-36 (a subset of MSQOL-54). We compared QOL between MS subgroups defined by disability, gender and employment, and computed the linear and non-linear relationships between disability level measured by the Expanded Disability Status Scale (EDSS) and MSQOL-54 dimensions. Results: QOL of MS patients measured by SF-36 is lower than controls, varying by QOL dimension with the greatest difference emerging for physical aspects of the disease. The relationship of physical disability, measured by EDSS, and all 14 MSQOL-54 dimensions and FSS is negative; for 12 of the 14 dimensions and FSS it is also non-linear. Non-linearity is most pronounced among women, who show a weak EDSS/QOL relatioship at higher levels of physical disability, suggesting women better able to “psychologically buffer” the debilitating aspects of MS. While employed have higher QOL than unemployed, the former are more affected by physical disability. Conclusions: Multiple attributes, including disability, gender and employment status, affect QOL. QOL’s relationship with disability is complex, displaying non-linearity and interacting with patient characteristics. This has implication for QOL research methodology and provides insight into factors affecting patients’ perceptions of well-being.
TL;DR: Treatment of IBD‐associated anemia with iron may lead to improvement in patients' QOL, and increases in Hb improved QOL scores in IBD patients independent of change in disease activity.
Abstract: Background: Anemia commonly complicates inflammatory bowel disease (IBD). In patients with chronic renal failure, the treatment of anemia with iron ± erythropoietin improves both quality of life (QOL) and cognitive function (CF). The same drugs are effective in treating severe anemia in IBD, but there is no evidence to direct the treatment of mild anemia. Concern exists that the use of iron may exacerbate inflammation in patients with IBD. The present study examined the association between changes in hemoglobin (Hb) in a population of IBD patients and changes in QOL and CF independent of change in disease activity (DA). Subsidiary aims were to assess whether the use of iron was associated with worsening DA.
Methods: A cohort of 50 patients with IBD (29 Crohn's disease and 21 ulcerative colitis) took part. Iron replacement was given to 21 patients with low Hb. Measures of QOL, CF, DA, and Hb were recorded at baseline and at 6 months.
Results: The iron-treated group had lower Hb and higher DA scores compared with the non-iron-treated group at baseline. In a hierarchical regression model, changes in DA accounted for 13% (P = 0.17) and changes in Hb accounted for 18% (P = 0.005) of the variance in change in SF-36 and 12% (P = 0.23) and 17% (P = 0.009) in the Inflammatory Bowel Disease Questionnaire. In this pilot study, although no associations were identified between changes in Hb or DA and CF, increases in Hb improved QOL scores in IBD patients independent of changes in DA. We found no similar effect with CF, but again, the sample size was small. We found no evidence that iron therapy causes worsening of DA.
Conclusions: Treatment of IBD-associated anemia with iron may lead to improvement in patients' QOL.
TL;DR: Parents' perceptions of QoL for children with FAP were lower than their children's self-reported scores, highlighting the clinical significance of FAP and providing insight into one facet of the disease's biopsychosocial etiology.
Abstract: OBJECTIVE. Children with chronic abdominal pain of nonorganic origin, termed functional abdominal pain (FAP), experience school absences and social withdrawal and report impaired physical ability. The aim of this study was to assess patients9 and parents9 perceptions of health-related quality of life (QoL) for children with FAP. METHODS. Between October 2002 and November 2003, 209 children (including 125 girls; age: 11.2 ± 3.5 years) and 209 parents were recruited from a pediatric referral center. At the time of their initial evaluations, participants completed a validated, health-related QoL instrument (Pediatric Quality of Life Inventory), which was scored on a scale of 0 (poor) through 100 (best). Children with FAP (n = 65) and their families were compared with control groups of healthy children (n = 46) and children with histologically proven inflammatory bowel disease (IBD) (n = 42) or gastroesophageal reflux disease (GERD) (n = 56). RESULTS. Children with FAP had self-reported QoL scores (score: 78) that were similar to those for children with GERD (score: 80) or IBD (score: 84). Children with FAP had lower QoL scores than did healthy children (score: 88). Parents of children with FAP reported lower QoL scores, compared with their children9s scores (scores: 70 vs 78). CONCLUSIONS. Children with FAP reported lower QoL, compared with their healthy peers, and had the same QoL scores as did children with IBD or GERD. Parents9 perceptions of QoL for children with FAP were lower than their children9s self-reported scores. These findings highlight the clinical significance of FAP and may provide insight into one facet of the disease9s biopsychosocial etiology.
TL;DR: A comparison of the mean OHIP-14S scores of the healthy/low and the high/severe periodontal attachment loss groups revealed significant differences in respect of the subscales of functional limitation, physical pain, psychological discomfort, physical and psychological disabilities.
Abstract: Background As patient-centered approaches become more popular, increasing attention is being given to assess the effects of various human health situations on an individual's overall quality of life (QoL). Measures have been used in dentistry to study the effects of orthodontic treatment and oral surgery, but so far little has been reported about the effects of periodontal disease. Objective This study assessed the impact of periodontal health status on QoL. Methods A subsample of 767 subjects were selected from a community study (n=1000) which investigated the association between psychological factors and clinical periodontal attachment level (CAL). The sample included subjects with full-mouth mean CAL 3 mm (high/severe periodontal attachment loss group). The subjects were requested to complete the Chinese short-form version of Oral Health Impact Profile (OHIP-14S) and a checklist of self-reported periodontal symptoms during the previous 12 months. Results A total of 727 subjects (95%) completed the questionnaire. The OHIP-14S and subscale scores were significantly associated with six of seven of the self-reported periodontal symptoms. A comparison of the mean OHIP-14S scores of the healthy/low and the high/severe periodontal attachment loss groups revealed significant differences in respect of the subscales of functional limitation, physical pain, psychological discomfort, physical and psychological disabilities. Conclusion This study demonstrates a significant association between oral health-related QoL and periodontal disease.
TL;DR: A symptom-based score for neurogenic bowel dysfunction (NBD) is developed and validated based on valid and reproducible questions and constructed a score for NBD that is correlated to impact on QOL.
Abstract: Cross-sectional questionnaire study. To develop and validate a symptom-based score for neurogenic bowel dysfunction (NBD): NBD score. University Hospital of Aarhus, Denmark. A questionnaire including questions about background parameters (n=8), faecal incontinence (n=10), constipation (n=10), obstructed defecation (n=8), and impact on quality of life (QOL) (n=3) was sent to 589 Danish spinal cord injured (SCI) patients. The reproducibility and validity of each item was tested in 20 and 18 patients, respectively. Associations between items and impact on QOL were determined by logistic regression analysis. The NBD score was constructed from items with acceptable reproducibility and validity that were significantly associated with impact on QOL. Based on odds ratios for associations between items and impact on QOL, each item was given a corresponding number of points in the NBD score. A total of 424 SCI patients responded. The following 10 items met the criteria above: frequency of bowel movements (0–6 points), headache, perspiration or discomfort before or during defecation (0–2 points), tablets and drops against constipation (0–2 points each), time used for each defecation (0–7 points), frequency of digital stimulation or evacuation (0–6 points), frequency of faecal incontinence (0–13 points), medication against faecal incontinence (0–4 points), flatus incontinence (0–2 points) and perianal skin problems (0–3 points). Differences in NBD score among patients reporting no, little, some or major impact on QOL were statistically significant (all P<0.001). Based on valid and reproducible questions, we have constructed a score for NBD that is correlated to impact on QOL.
TL;DR: There is considerable evidence for the major damage done to QoL by MD which is underestimated by health status and utility measures, and difficulties associated with inappropriate use of health status measures and misinterpretation of utility values asQoL measures are considered.
Abstract: The Age-related Macular Degeneration Alliance International commissioned a review of the literature on quality of life (QoL) in macular degeneration (MD) with a view to increasing awareness of MD, reducing its impact and improving services for people with MD worldwide. A systematic review was conducted using electronic databases, conference proceedings and key journal hand search checks. The resulting 'White Paper' was posted on the AMD Alliance website and is reproduced here. MD is a chronic, largely untreatable eye condition which leads to loss of central vision needed for tasks such as reading, watching TV, driving, recognising faces. It is the most common cause of blindness in the Western world. Shock of diagnosis, coupled with lack of information and support are a common experience. Incidence of depression is twice that found in the community-dwelling elderly, fuelled by functional decline and loss of leisure activities. Some people feel suicidal. MD threatens independence, especially when comorbidity exacerbates functional limitations. Rehabilitation, including low vision aid (LVA) provision and training, peer support and education, can improve functional and psychological outcomes but many people do not receive services likely to benefit them. Medical treatments, suitable for only a small minority of people with MD, can improve vision but most limit progress of MD, at least for a time, rather than cure. The White Paper considers difficulties associated with inappropriate use of health status measures and misinterpretation of utility values as QoL measures: evidence suggests they have poor validity in MD. There is considerable evidence for the major damage done to QoL by MD which is underestimated by health status and utility measures. Medical treatments are limited to a small proportion of people. However, much can be done to improve QoL by early diagnosis of MD with good communication of prognosis and continuing support. Support could include provision of LVAs, peer support, education and effective help in adjusting to MD. It is vital that appropriate measures of visual function and QoL be used in building a sound evidence base for the effectiveness of rehabilitation and treatment.
TL;DR: The findings highlight the diversity that is apparent in the conceptualization of paediatric QOL and draw attention to the lack of empirical evidence for many of the fundamental assumptions.
Abstract: With an increasing number of paediatric quality of life (QOL) instruments being developed, it is becoming difficult for researchers and clinicians to select the most appropriate instrument. Reviews of QOL instruments tend to report only basic properties of the instruments such as domains and psychometric properties. This paper seeks to appraise critically the conceptual underpinnings of paediatric QOL instruments. A systematic review was conducted to identify QOL instruments for children aged 0 to 12 years, and to examine and compare their conceptual frameworks, definitions employed, and structure. Both generic and condition-specific measures were reviewed. Fourteen generic and 25 condition-specific QOL instruments were identified. Eleven types of definition of QOL and health-related QOL and three theories of QOL were identified. QOL was measured by a variety of domains including emotional, social and physical health, and well-being. Items commonly assessed difficulties, or intensity/frequency of feelings/symptoms, in contrast to positive aspects of life and happiness. The findings highlight the diversity that is apparent in the conceptualization of paediatric QOL and draw attention to the lack of empirical evidence for many of the fundamental assumptions. The impact of the conceptual underpinnings of the instruments on the resulting QOL scores is discussed.
TL;DR: The present findings suggest that oral health status could affect health-related QOL in some settings; however, further evidence is needed to support this interpretation.
Abstract: This study was conducted in order to identify the literature on oral health status and health-related QOL, review the findings systematically, and assess the association between them. We performed a literature search of reports published between January 1973 and June 2004, using five databases including MEDLINE. Only studies that used validated generic health-related QOL instruments were selected. The reviewers evaluated selected articles independently and resolved disagreements by consensus. A total of 1,726 articles were retrieved and seven were selected for the review; five observational studies and two intervention studies. Four studies showed significant associations between oral health status and health-related QOL. Temporomandibular disorders were highly associated with reduced health-related QOL. Poor oral status linked to both craniomandibular and cervical spinal pain was associated with increased impairment of health-related QOL. Dissatisfaction with the teeth and mouth, and a sensation of dry mouth contributed to reduce health-related QOL. Providing edentulous patients with implant-supported full dentures contributed to improve health-related QOL. Assessment of health-related QOL in relation to oral health with validated instruments remains insufficient. The present findings suggest that oral health status could affect health-related QOL in some settings; however, further evidence is needed to support this interpretation.
TL;DR: The QoL-AD could be used as an effective measure of the quality of life of people with dementia in residential homes and was strongly linked with dependency, whereas mood was the main predictor of residents' own assessment of theirquality of life.
Abstract: Background Many people with dementia live in residential homes, but little is known about their quality of life.
Aims To compare the views of residents with dementia with the views of staff as to their quality of life, and to look at factors associated withthese ratings.
Method The Quality of Life in Alzheimer’s Disease (QoL–AD) scale was used to rate residents’and staff’s perceptions of the quality of life of 238 residents of 24 residential homes in the UK.
Results There were 119 QoL–AD scales completed by both residents and staff. For the residents, high QoL–AD scores strongly correlated with lower scores for depression (ρ=-0.53, P <0.0001) and anxiety (ρ=-0.50, P <0.001). In contrast, better quality of life as rated by staff correlated most strongly with increased dependency (ρ=-0.53, P <0.001) and behaviour problems (ρ=-0.40, P <0.001).
Conclusions The QoL–AD could be used as an effective measure of the quality of life of people with dementia in residential homes. Whereas mood was the main predictor of residents’own assessment of their quality of life, staff ratings were strongly linked with dependency. Staff should be aware that mood rather than level of dependency has a greater impacton residents’ quality of life.
TL;DR: Results indicated that cancer survivors reported significantly higher quality of life, less fear of cancer recurrence, and more support than their family caregivers, and the importance of including both survivors and family caregivers in programs of care.
Abstract: Although survival rates for all cancers continue to increase, few studies have examined the quality of life of both cancer survivors and family caregivers during the survivorship period after treatment has ended. Information is lacking on the stressors, resources, meaning, and quality of life reported by survivors and family caregivers and the interrelationship between survivors' and family caregivers' quality of life. A stratified, random sample of 123 cancer survivors and 123 family caregivers (N = 246) were interviewed in an exploratory, cross-sectional design 1-6 years after cancer treatment had ended. Approximately half (N = 62) of the dyads were white and half (N = 61) were African American. Results indicated that cancer survivors reported significantly higher quality of life, less fear of cancer recurrence, and more support than their family caregivers. The strongest predictors for cancer survivors' quality of life were family stressors, social support, meaning of the illness, and employment status, whereas the strongest predictors for family caregivers' quality of life were fear of recurrence and social support. Both the survivor's and family caregiver's quality of life independently contributed to the other's quality of life. Findings from this study suggest the importance of including both survivors and family caregivers in programs of care.
TL;DR: Health-related quality of life (HRQoL) is reduced in SLE patients; HRZoL is not correlated to disease activity or damage; age appears to have a negative impact on HRQeL especially physical health but the effect of disease duration is unclear.
Abstract: Health-related quality of life (HRQoL) is an important outcome measure in patients with systemic lupus erythematosus (SLE). A review was undertaken of the literature relating to HRQoL in SLE. MEDLINE, EMBASE, CINAHL, Allied and Complimentary Medicine were searched to locate full papers in the English language reporting on HRQoL in adult SLE patients published between 1990 and 2005. In total 53 papers were included and the review was subdivided into: 1) description of HRQoL in SLE patients; 2) HRQoL and disease activity and/or damage; 3) the impact of other variables on HRQoL; and 4) HRQoL measures used in clinical trials in SLE patients. The findings were as follows: HRQoL is reduced in SLE patients; HRQoL is not correlated to disease activity or damage; age appears to have a negative impact on HRQoL especially physical health but the effect of disease duration is unclear; other potentially modifiable variables such as fatigue and psychosocial factors impact on HRQoL in a complex manner; and HRQoL measures which are sensitive to change should be an essential outcome measure in all clinical trials on SLE patients.
TL;DR: Results suggest that DDs and ADs are associated with worse asthma-related quality of life, but only DDs are responsible for worse asthma control, and physicians may want to consider the differential impact of negative mood states when assessing levels of asthma control andquality of life.