Life Research

Health-related quality of life in injury patients: the added value of extending the EQ-5D-3L with a cognitive dimension Abstract Introduction The EQ-5D is frequently used to understand the development of health-related quality of life (HRQL) following injury. However, the lack of a cognition dimension is generally felt as disadvantageous as many injuries involve cognitive effects. We aimed to assess the added value of a cognitive dimension in a cohort of injury patients. Methods We analyzed EQ-5D-3L extended with cognition (EQ-5D + C) dimension responses of 5346 adult injury patients. We studied dimension dependency, assessed the additional effect of the cognitive dimension on the EQ-VAS, and, using the EQ-VAS as a dependent variable, determined the impact of EQ-5D and EQ-5D + C attributes in multivariate regression analyses. Results Extreme cognitive problems combined with no problems on other dimensions are uncommon, whereas severe problems on other dimensions frequently occur without cognitive problems. The EQ-VAS significantly decreased when cognitive problems emerged. Univariate regression analyses indicated that all EQ-5D + C dimensions were significantly associated with the EQ-VAS. Exploratory analyses showed that using any set of five of the six EQ-5D + C dimensions resulted in almost identical explained variance, and adding the remaining 6th dimension resulted in a similar additional impact. Conclusions The addition of the cognition dimension increased the explanatory power of the EQ-5D-3L. Although the increase in explanatory power was relatively small after the cognition dimension was added, the decrease of HRQoL (measured with the EQ-VAS) resulting from cognitive problems was comparable to the decreases resulting from other EQ-5D dimensions.

Do 8- to 18-year-old children/adolescents with chronic physical health conditions have worse health-related quality of life than their healthy peers? a meta-analysis of studies using the KIDSCREEN questionnaires Abstract Purpose This meta-analytic review aimed to estimate the magnitude of health-related quality of life (HrQoL) impairments, as assessed by the KIDSCREEN questionnaires, both self- and parent-reported, in 8- to 18-years-old children/adolescents with chronic health conditions. Methods To identify studies using the KIDSCREEN questionnaires, three electronic databases (PubMed, PsycINFO, EBSCOhost Psychology & Behavioral Sciences) were searched. The final search (February 14–15, 2018) revealed 528 non-duplicated articles, of which 23 papers (21 studies) directly compared the HrQoL of pediatric patients to community/healthy controls and were included in the meta-analysis. Pooled mean differences (MD) with 95% CIs were estimated using the inverse-variance random-effects method. Results Of the 21 studies, 16 used self-reports, one used parent-reports and four adopted a multi-informant approach. Self-reported data were retrieved from 20 studies (4852 cases/28,578 controls), and parent-reported data were retrieved from four studies (511 cases/433 controls). Pediatric patients presented significant HrQoL impairments in the domains of physical well-being (MD = − 4.84, 95% CI − 6.44/− 3.24 for self-reports; MD = − 6.86, 95% CI − 10.42/− 3.29 for parent-reports) and peers and social support (MD = − 1.29, 95% CI − 2.25/− 0.34 for self-reports; MD = − 3.90, 95% CI − 5.28/− 2.52 for parent-reports), compared to community/healthy peers. Between-studies heterogeneity was explained by diagnostic categories, instrument version and informants. Conclusions The identification of significant HrQoL impairments among pediatric patients, specifically in the physical and social domains, highlights the importance of routine psychosocial assessment and intervention in primary pediatric healthcare services. Specific recommendations include the use of profile measures, both self- and parent-reports, and the prioritization of oncology, endocrinology and neurology services.

The effect of nature exposure on the mental health of patients: a systematic review Abstract Background The effect of nature-based interventions on self-reported mental well-being in patients with physical disease is gaining increasing attention. However, there is a lack of randomized controlled trials investigating this area. Due to the massive costs in health care systems, there is a need for new strategies to address these issues and an urgent need for attention to this field. Nature-based interventions are low cost, easy to implement, and should get attention within the health care field. Therefore, the objective was to find the impact of nature interventions on mental well-being in humans with a physical disease. Methods In four major databases (PubMed, Cinahl, PsycINFO, and Cochrane Library), a systematic review of quantitative studies of nature's impact on self-reported mental health in patients with physical disease was performed. A total of 1909 articles were retrieved but only five met the inclusion criteria and were summarized. Results All five studies were quantitative, with a control group and a nature-based intervention. A source of heterogeneity was identified: the patients in one of the five studies were psychosomatic. In the four studies with somatic patients, significant benefit of nature on self-reported mental health outcomes was found; the only study that failed to show a significant benefit was the one with psychosomatic patients. Conclusion A significant effect of nature on mental well-being of patients with somatic disease was found. The result in patients with psychosomatic disease is inconclusive, and more studies in this category are needed. Further research on the effect of nature on mental health is merited, with special attention to standardizing intervention type and dose as well as outcome measures within each medical discipline.

The added value of the EQ-5D with a cognition dimension in injury patients with and without traumatic brain injury Abstract Purpose This study investigated the psychometric gain, if any, from the extension of the EQ-5D with a cognition bolt-on (EQ-5D + C) in a large cohort injury patients with and without traumatic brain injury (TBI). Methods Hospitalized adult injury patients filled out a survey 1 month after initial admission. The survey included the EQ-5D-3L, the cognition bolt-on item in EQ-5D format, and the visual analogue scale (EQ-VAS). We compared ceiling and other distributional effects between EQ-5D and EQ-5D + C and TBI and non-TBI group, and assessed convergent validity using the predictive association with EQ-VAS. Also, we assessed explanatory power using regression analysis, and classification efficiency using Shannon indices. Results In total, 715 TBI patients and 1978 non-TBI patients filled out the EQ-5D + C and EQ-VAS. Perfect health was reported by 7.9% (N = 214) on the EQ-5D, and 7.3% (N = 197) on the EQ-5D + C. Convergent validity was highest for EQ-5D + C in the TBI group (Spearman's rank correlation coefficient = − 0.736) and lowest for EQ-5D in the non-TBI group (Spearman's rank correlation coefficient = − 0.652). For both TBI and non-TBI groups, the explanatory power of EQ-5D + C was slightly higher than of EQ-5D (R2 = 0.56 vs. 0.53 for TBI; R2 = 0.47 vs. 0.45 for non-TBI). Absolute classification efficiency was higher for EQ-5D + C than for EQ-5D in both TBI groups, whereas relative classification efficiency was similar. Conclusions Psychometric performance in general of both the EQ-5D and EQ-5D + C was better in TBI patients. Adding a cognitive bolt-on slightly improved the psychometric performance of the EQ-5D-3L.

Longitudinal validity of the hemophilia caregiver impact measure Abstract Introduction The hemophilia caregiver impact (HCI) measure is a 36-item self-report tool that has documented reliability and validity in a large cross-sectional study, but its longitudinal construct validity is unknown. This study's objective was to evaluate the responsiveness of the HCI to clinically important change, and to provide interpretation guidelines. Methods This web-based study invited 458 hemophilia caregivers involved in the HCI's validation study to provide follow-up data. Measures included the HCI, and a Likert item querying Global Assessment of Change (GAC) for caregiver burden. Responsiveness was estimated using anchor- and distribution-based methods. The anchor-based method computed the minimally important difference (MID) by computing the mean change separately for those who reported lesser or more caregiver burden on the GAC. The distribution-based method computed the Modified Standardized Response Mean (MSRM) separately for people who reporting reduced or increased burden as compared to the 'same' groups. Results The study sample included 323 caregivers (71% response rate), with mean follow-up of 21.9 months. The HCI Burden Summary score and all negative-burden subscales but not the Positive Emotions subscale evidenced responsiveness to clinically important differences, showing statistically significant differences by transition group. The MIDs were relatively small mean changes over time (e.g., Burden Summary MID ranged from − 2.2 to 2.6, for reduced versus increased burden), and the MSRMs were small effect sizes. The Burden Summary score was equally sensitive to reduced versus increased burden (MSRM of − 0.32 and 0.35, respectively). Conclusions The HCI demonstrated longitudinal construct validity. The HCI shows promise for clinical hemophilia studies as a caregiver-based tool for evaluating treatments.

Quality of life of cancer patients living in Trinidad and Tobago Abstract Purpose To determine quality of life (QoL) of cancer patients in The Republic of Trinidad and Tobago using the European Organization for Research and Treatment of Cancer Care Quality of Life Instrument (EORTC QLQ-C30) and examine relationships between QoL and socioeconomic and medical variables. Method A cross-sectional study, consisting of 480 cancer patients being managed at the National Radiotherapy Centre, was conducted. One-way, multiple analysis of variance (MANOVA) with post hoc testing was used to analyze relationships between socioeconomic and medical variables and scales on the EORTC QLQ-C30. Stepwise linear regression was used to evaluate which independent variables contributed to the global QoL and function scores. Results Participants were of mean age 64.1 ± 12.1 years (males) and 56.7 ± 16.6 years (females). Mean values for global QoL and function scales were below 75. Persons in younger age groups had significantly better physical and cognitive function scores (p < 0.05). Males had higher emotional function scores than females (p < 0.05). Persons with higher income and education had better scores on all function scales, except social, and less symptoms (p < 0.05). Persons receiving chemotherapy had more nausea/vomiting, appetite loss, and constipation (p < 0.05). Conclusion Age, income, education, and cancer treatment were factors most associated with scores on the EORTC QLQ-C30. Further research is required in this population to examine these variables in more depth and explore methods to improve QoL of cancer patients in this population.

Comparison between the EQ-5D-3L and the SF-6D quality of life (QOL) questionnaires in patients with chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS) Abstract Purpose Lung volume reduction surgery (LVRS) has been shown to improve lung function, but also improve the overall quality of life (QOL). The aim of this study is to compare two QOL questionnaires-EuroQol Questionnaire (EQ-5D-3L) and 36-item Short Form Health Survey (SF-36) in patients post-LVRS. Methods All patients undergoing LVRS for severe chronic obstructive pulmonary disease (COPD) at a single center of excellence were analyzed (n = 94). Baseline demographic and clinical outcomes were characterized. Both EQ-5D-3L and SF-36 questionnaires were administered to all patients at baseline (n = 94) and at the end of 1 year (n = 89) post-surgery. SF-36 was converted to Short Form six-dimensions (SF-6D) using standard algorithm. Correlation, discrimination, responsiveness and differences across the two questionnaires were examined. Results The mean age of patients enrolled in the cohort was 66 years. There was significant increase in forced expiratory volume (FEV1, 43%), forced vital capacity (FVC 46%), diffusion capacity (DLCO 15%), 6 min walk distance test (6MWD 21%) and a significant decrease in residual volume (RV 23%) at the end of 1-year follow-up. The overall mean utility index significantly improved for both SF-6D and EQ-5D-3L questionnaires at the end of follow-up (p = 0.0001). However, the magnitude of percentage increase was higher with EQ-5D-3L compared to SF-6D (32% vs. 13%). Stronger correlations confirmed convergent validity at the end of 1-year follow-up between similar domains. Both questionnaires failed to discriminate between different levels of disease severity post-LVRS in patients with severe COPD. Conclusions Both questionnaires responded similarly in patients with COPD post-LVRS. Combining results from QOL questionnaire(s) along with symptoms of disease and history of exacerbation may be a possible solution for identifying disease severity in old and sick patients unwilling/unable to come to hospital for a pulmonary function test post-LVRS.

The association of age, literacy, and race on completing patient-reported outcome measures in pediatric oncology Abstract Purpose Age is often used to determine when children can begin completing patient-reported outcome (PRO) instruments or transition to adult instruments. This study's purpose was to determine relationships between literacy, age, and race and their influence on a child's ability to understand and complete a PRO instrument. Methods The Wide Range Achievement Test was used to evaluate literacy in children and young adults with cancer, participating in a cognitive interview for the Pediatric PRO-CTCAE instrument. 140 participants (7–20 years) were recruited from 8 sites. Logistic regression and multivariable liner regression were used to examine relationships among key variables. Results Higher literacy scores were significantly associated with fewer PRO-CTCAE items being identified as "hard to understand" (p = 0.017). Literacy scores increased with age, but older participants were more likely to fall behind expected reading levels compared with US norms. A 1-year increase in age was associated with a 19% increase in the likelihood for being below the expected WRAT word reading score (OR 1.19; 95% CI 1.06–1.33, p = 0.003). No associations were found between race and literacy. Conclusions Wide variations in literacy were noted across age groups. All participants were able to complete the Pediatric PRO-CTCAE, although most 7 year olds (63%) required reading assistance. Those with lower literacy skills were able to understand items suggesting that multiple factors may be involved in comprehension (developmental stage, concentration, vocabulary, or prior health experiences). Risk for falling below expected literacy levels increased with age implying a need for literacy consideration for cancer patients.

Comparison of EQ-5D-5L and SPVU-5D for measuring quality of life in patients with venous leg ulcers in an Australian setting Abstract Purpose Given the importance of measuring health-related quality of life (HRQoL) for cost–utility studies, this study aimed to determine the validity and responsiveness of two preference-based HRQoL instruments, the EuroQol-five dimensions-five levels questionnaire (EQ-5D-5L) and the Sheffield Preference-based Venous Ulcer questionnaire (SPVU-5D) in patients with venous leg ulcers (VLUs) in an Australian setting. Methods This study analysed de-identified data collected from 80 patients with VLUs recruited by a prospective study in Brisbane, Queensland, Australia. Patients were asked to complete EQ-5D-5L and SPVU-5D surveys at baseline, 1-month, 3-month and 6-month follow-up as part of the prospective study. Baseline data and follow-up data were pooled to test the construct validity and level of agreement of the two instruments. Follow-up data were used to test the responsiveness. Results The ceiling effects were negligible for EQ-5D-5L and SPVU-5D utility scores. Both instruments were able to discriminate between healed VLU and unhealed VLU and showed great responsiveness when healing status changed over time. Weak to strong correlations were found between dimensions of EQ-5D-5L and SPVU-5D. The utility scores produced from EQ-5D-5L were generally lower. Conclusions This study found that both EQ-5D-5L and SPVU-5D were valid and responsive in detecting change of VLU healing status among a small Australian population. Both instruments may be used in economic evaluation studies that involve patients with healed or unhealed VLUs. However, given the limitations presented in this study, further research is necessary to make sound recommendations on the preferred instrument in economic evaluation of VLU-related interventions.

Ethnic background and children's oral health-related quality of life Abstract Purpose Ethnic background is known to be related to oral health and socioeconomic position (SEP). In the context of patient-centered oral health care, and the growing number of migrant children, it is important to understand the influence of ethnic background on oral health-related quality of life (OHRQoL). Therefore, we aimed to identify the differences in children's OHRQoL between ethnic groups, and the contribution of oral health status, SEP, and immigration characteristics. Methods This study was part of the Generation R Study, a prospective cohort study conducted in Rotterdam, the Netherlands. In total, 3121 9-year-old children with a native Dutch (n = 2510), Indonesian (n = 143), Moroccan (n = 104), Surinamese (n = 195), or Turkish (n = 169) background participated in the present study. These ethnicities comprise the most common ethnic groups in the Netherlands. OHRQoL was assessed using a validated short form of the child oral health impact profile. Several regression models were used to study an association between ethnic background and OHRQoL, and to identify potential mediating factors. Results Turkish and Surinamese ethnic background were significantly associated with lower OHRQoL. After adjusting for mediating factors, only Surinamese children had a significantly lower OHRQoL than Dutch children (β:− 0.61; 95% CI− 1.18 to –0.04). Conclusions Our results show that Turkish and Surinamese children have a significantly lower OHRQoL than native Dutch children. The association was partly explained by oral health status and SEP, and future studies are needed to understand (cultural) the determinants of ethnic disparities in OHRQoL, in order to develop effective oral health programs targeting children of different ethnic groups.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com