Background
It is important to understand the interaction of various predictors with oral health‐related quality of life (OHRQoL) to better design effective interventions to improve OHRQoL.
Aim
The ...aim of this study was to develop and validate a conceptual model evaluating the factors affecting the OHRQoL in children.
Design
The study group consisted of 754 parent‐child dyads. The data collection tools were a socio‐demographic data form, the Early Childhood Oral Health Impact Scale (ECOHIS), Corah Dental Anxiety Scale (C‐DAS), Children's Fear Survey Schedule‐Dental Subscale (CFSS‐DS), and an oral and dental health examination form. A conceptual model was developed to examine the factors affecting OHRQoL in children consisting of four endogenous and four exogenous variables. Path analysis was used to test the compatibility of the conceptual model.
Results
OHRQoL was associated with parental socio‐economic status (β = −0.12; P < .001), dental anxiety (β = −0.15; P < .001), and oral health behaviours (β = −0.13; P < .001). Although parental dental anxiety had the strongest direct effect on OHRQoL, children's oral health behaviours had the strongest indirect effect.
Conclusions
This study revealed a valid demonstrable path of association between parental socio‐economic status, dental anxiety, childhood dental anxiety, oral health behaviours, and OHRQoL.
Aims and objectives
To test whether the revised Wilson and Cleary model could identify which factors contribute to health‐related quality of life in chronic kidney disease.
Background
Chronic kidney ...disease affects a person's health‐related quality of life detrimentally although nursing practice informed by theory is only beginning to emerge.
Design
A cross‐sectional study reported using the STROBE guidelines.
Methods
About 886 participants with chronic kidney disease (varying grades) completed validated measures of symptoms (renal version of the Integrated Palliative care Outcome Scale), and general health perceptions and health‐related quality of life (European Quality of Life five‐dimension three‐level). Socio‐demographic and renal characteristics were also collected. Data were analysed using descriptive statistics and structural equation modelling.
Results
Biological function (decreased kidney function and haemoglobin and greater number of comorbidities), directly contributed to increased symptom burden. Symptoms demonstrated strong negative relationships with both general health perceptions and health‐related quality of life. General health perceptions had a direct positive relationship with health‐related quality of life. As age increased, health‐related quality of life decreased. The only environmental characteristic of significance was the distance between home and hospital although it was not directly associated with health‐related quality of life. Overall, the model explained approximately half of the deterioration in health‐related quality of life.
Conclusions
The model demonstrated how various factors influence alteration of health‐related quality of life in people with chronic kidney disease. Early identification of these factors could assist nurses to introduce effective management strategies into patient care plans proactively.
Relevance to clinical practice
Comprehensive symptom assessment needs to occur not only in kidney failure but in earlier chronic kidney disease grades to enable timely interventions targeted at improving people's wellbeing.
Patient or public contribution
Validated interviewer administered questionnaires were completed by participants with chronic kidney disease in this study.
Traditionally seen as a sudden, brutal event with short-term impairment, traumatic brain injury (TBI) may cause persistent, sometimes life-long, consequences. While mortality after TBI has been ...reduced, a high proportion of severe TBI survivors require prolonged rehabilitation and may suffer long-term physical, cognitive, and psychological disorders. Additionally, chronic consequences have been identified not only after severe TBI but also in a proportion of cases previously classified as moderate or mild. This burden affects the daily life of survivors and their families; it also has relevant social and economic costs.Outcome evaluation is difficult for several reasons: co-existing extra-cranial injuries (spinal cord damage, for instance) may affect independence and quality of life outside the pure TBI effects; scales may not capture subtle, but important, changes; co-operation from patients may be impossible in the most severe cases. Several instruments have been developed for capturing specific aspects, from generic health status to specific cognitive functions. Even simple instruments, however, have demonstrated variable inter-rater agreement.The possible links between structural traumatic brain damage and functional impairment have been explored both experimentally and in the clinical setting with advanced neuro-imaging techniques. We briefly report on some fundamental findings, which may also offer potential targets for future therapies.Better understanding of damage mechanisms and new approaches to neuroprotection-restoration may offer better outcomes for the millions of survivors of TBI.
Purpose Reference values for patient-reported outcome measures are useful for interpretation of results from clinical trials. The study aims were to collect Norwegian SF-36 reference values and ...compare with data from 1996 to 2002. Methods In 2015, SF-36 was sent by mail to a representative sample of the population (N = 6165). Time trends and associations between background variables and SF-36 scale scores were compared by linear regression models. Results The 2015 response rate was 36% (N = 2118) versus 67% (N = 2323) in 1996 and 56% (N = 5241) in 2002. Only 5% of the youngest (18-29 years) and 27% of the oldest (>70 years) responded in 2015. Age and educational level were significantly higher in 2015 relative to 1996/2002 (p < .001). The oldest age group in 2015 reported better scores on five of eight scales (p < 0.01), the exceptions being bodily pain, vitality, and mental health compared to 1996/2002 (NS). Overall, the SF-36 scores were relatively stable across surveys, controlled for background variables. In general, the most pronounced changes in 2015 were better scores on the role limitations emotional scale (7.4 points, p < .001) and lower scores on the bodily pain scale (4.6 points, p < .001) than in the 1996/2002 survey. Conclusions The low response rate in 2015 suggests that the results, especially among the youngest, should be interpreted with caution. The high response rate among the oldest indicates good representativity for those >70 years. Despite societal changes in Norway the past two decades, HRQoL has remained relatively stable.
Purpose
The aims of this cross-sectional study were to explore reliability and validity of the Norwegian version of the Patient-Reported Outcome Measurement System
®
—Profile 57 (PROMIS-57) ...questionnaire in a general population sample,
n
= 408, and to examine Item Response properties and factor structure.
Methods
Reliability measures were obtained from factor analysis and item response theory (IRT) methods. Correlations between PROMIS-57 and RAND-36-item health survey (RAND36) were examined for concurrent and discriminant validity. Factor structure and IRT assumptions were examined with factor analysis methods. IRT Item and model fit and graphic plots were inspected, and differential item functioning (DIF) for language, age, gender, and education level were examined.
Results
PROMIS-57 demonstrated excellent reliability and satisfactory concurrent and discriminant validity. Factor structure of seven domains was supported. IRT assumptions were met for unidimensionality, local independence, monotonicity, and invariance with no DIF of consequence for language or age groups. Estimated common variance (ECV) per domain and confirmatory factor analysis (CFA) model fit supported unidimensionality for all seven domains. The GRM IRT Model demonstrates acceptable model fit.
Conclusions
The psychometric properties and factor structure of Norwegian PROMIS-57 were satisfactory. Hence, the 57-item questionnaire along with PROMIS-29, and the corresponding 8 and 4 item short forms for physical function, anxiety, depression, fatigue, sleep disturbance, social participation ability and pain interference, are considered suitable for use in research and clinical care in Norwegian populations. Further studies on longitudinal reliability and sensitivity in patient populations and for Norwegian item calibration and/or reference scores are needed.
The coronavirus disease 2019 (COVID-19) epidemic affects people's health and health-related quality of life (HRQoL), especially in those who have suspected COVID-19 symptoms (S-COVID-19-S). We ...examined the effect of modifications of health literacy (HL) on depression and HRQoL. A cross-sectional study was conducted from 14 February to 2 March 2020. 3947 participants were recruited from outpatient departments of nine hospitals and health centers across Vietnam. The interviews were conducted using printed questionnaires including participants' characteristics, clinical parameters, health behaviors, HL, depression, and HRQoL. People with S-COVID-19-S had a higher depression likelihood (OR, 2.88;
< 0.001), lower HRQoL-score (B, -7.92;
< 0.001). In comparison to people without S-COVID-19-S and low HL, those with S-COVID-19-S and low HL had 9.70 times higher depression likelihood (
< 0.001), 20.62 lower HRQoL-score (
< 0.001), for the people without S-COVID-19-S, 1 score increment of HL resulted in 5% lower depression likelihood (
< 0.001) and 0.45 higher HRQoL-score (
< 0.001), while for those people with S-COVID-19-S, 1 score increment of HL resulted in a 4% lower depression likelihood (
= 0.004) and 0.43 higher HRQoL-score (
< 0.001). People with S-COVID-19-S had a higher depression likelihood and lower HRQoL than those without. HL shows a protective effect on depression and HRQoL during the epidemic.
Summary
Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an ...underlying higher‐order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health‐Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four‐factor model and a bifactor model that included one general factor and four group factors. Using model‐fit criteria and factor interpretability as guides, the four‐factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0·05, CFI = 0·99) and interpretability. These results corroborate our previous findings that four highly correlated factors – which we have named Oral Function, Oro‐facial Pain, Oro‐facial Appearance and Psychosocial Impact – can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four‐factor solution suggest that OHRQoL can also be sufficiently described with one score.
Background
Young adult cancer survivors experience frailty and decreased muscle mass at rates equivalent to much older noncancer populations, which indicate accelerated aging. Although frailty and ...low muscle mass can be identified in survivors, their implications for health‐related quality of life are not well understood.
Methods
Through a cross‐sectional analysis of young adult cancer survivors, frailty was assessed with the Fried frailty phenotype and skeletal muscle mass in relation to functional and quality of life outcomes measured by the Medical Outcomes Survey Short‐Form 36 (SF‐36). z tests compared survivors with US population means, and multivariable linear regression models estimated mean SF‐36 scores by frailty and muscle mass with adjustments made for comorbidities, sex, and time from treatment.
Results
Sixty survivors (median age, 21 years; range, 18‐29) participated in the study. Twenty‐five (42%) had low muscle mass, and 25 were either frail or prefrail. Compared with US population means, survivors reported worse health and functional impairments across SF‐36 domains that were more common among survivors with (pre)frailty or low muscle mass. In multivariable linear modeling, (pre)frail survivors (vs nonfrail) exhibited lower mean scores for general health (−9.1; P = .05), physical function (−14.9; P < .01), and overall physical health (−5.6; P = .02) independent of comorbid conditions.
Conclusions
Measures of frailty and skeletal muscle mass identify subgroups of young adult cancer survivors with significantly impaired health, functional status, and quality of life independent of medical comorbidities. Identifying survivors with frailty or low muscle mass may provide opportunities for interventions to prevent functional and health declines or to reverse this process.
Lay Summary
Young adult cancer survivors age more quickly than peers without cancer, which is evidenced by a syndrome of decreased resilience known as frailty.
The relationship between frailty (and one of its common components, decreased muscle mass) and quality of life among young adult cancer survivors was examined.
Measuring decreased muscle mass and frailty identifies young survivors with poor quality of life, including worse general health, fatigue, physical function, and overall physical health, compared with nonfrail survivors.
Interventions to address components of frailty (low muscle mass and weakness) may improve function and quality of life among young adult cancer survivors.
Measuring decreased muscle mass and frailty identifies young adult cancer survivors with poor quality of life, including worse general health, fatigue, physical function, and overall physical health, compared with nonfrail survivors. Interventions to address components of frailty (low muscle mass and weakness) may improve function and quality of life among young adult cancer survivors.
German Value Set for the EQ-5D-5L Ludwig, Kristina; Graf von der Schulenburg, J.-Matthias; Greiner, Wolfgang
PharmacoEconomics,
06/2018, Letnik:
36, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objectives
The objective of this study was to develop a value set for EQ-5D-5L based on the societal preferences of the German population. As the first country to do so, the study design used the ...improved EQ-5D-5L valuation protocol 2.0 developed by the EuroQol Group, including a feedback module as internal validation and a quality control process that was missing in the first wave of EQ-5D-5L valuation studies.
Methods
A representative sample of the general German population (
n
= 1158) was interviewed using a composite time trade-off and a discrete choice experiment under close quality control. Econometric modeling was used to estimate values for all 3125 possible health states described by EQ-5D-5L. The value set was based on a hybrid model including all available information from the composite time trade-off and discrete choice experiment valuations without any exclusions due to data issues.
Results
The final German value set was constructed from a combination of a conditional logit model for the discrete choice experiment data and a censored at −1 Tobit model for the composite time trade-off data, correcting for heteroskedasticity. The value set had logically consistent parameter estimates (
p
< 0.001 for all coefficients). The predicted EQ-5D-5L index values ranged from −0.661 to 1.
Conclusions
This study provided values for the health states of the German version of EQ-5D-5L representing the preferences of the German population. The study successfully employed for the first time worldwide the improved protocol 2.0. The value set enables the use of the EQ-5D-5L instrument in economic evaluations and in clinical studies.
To compare stroke-specific health related quality of life in two country-regions with organisational differences in subacute rehabilitation services, and to reveal whether organisational factors or ...individual factors impact outcome.
A prospective multicentre study with one-year follow-up of 369 first-ever stroke survivors with ischaemic or haemorrhagic stroke, recruited from stroke units in North Norway (n = 208) and Central Denmark (n = 161). The 12-domain Stroke-Specific Quality of Life scale was the primary outcome-measure.
The Norwegian participants were older than the Danish (M
age
= 69.8 vs. 66.7 years, respectively), had higher initial stroke severity, and longer stroke unit stays. Both cohorts reported more problems with cognitive, social, and emotional functioning compared to physical functioning. Two scale components were revealed. Between-country differences in the cognitive-social-mental component showed slightly better function in the Norwegian participants. Depression, anxiety, pre-stroke dependency, initial stroke severity, and older age were substantially associated to scale scores.
Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services.
IMPLICATIONS FOR REHABILITATION
The stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services.
The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services.
For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning.
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