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QUALITY OF LIFE MEASURING INSTRUMENTS IN CHRONIC VENOUS DISEASE What’s the best option? Class 05 Introdução à Medicina II - 2010/2011.

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Presentation on theme: "QUALITY OF LIFE MEASURING INSTRUMENTS IN CHRONIC VENOUS DISEASE What’s the best option? Class 05 Introdução à Medicina II - 2010/2011."— Presentation transcript:

1 QUALITY OF LIFE MEASURING INSTRUMENTS IN CHRONIC VENOUS DISEASE What’s the best option? Class 05 Introdução à Medicina II - 2010/2011

2 Chronic Venous Disease Definition “Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.” Source: http://www.ncbi.nlm.nih.gov/meshhttp://www.ncbi.nlm.nih.gov/mesh

3 Video ricardo

4 Etiology Congenit Primary Secondary (post thrombotic) Anatomy Superficial veins Deep veins Perforating veins Physiopathology Reflux Obstruction Reflux and obstruction

5 C3 Edema C2 Varicose veins C1 Reticular veins C4 Trophic skin alterations C5 Healed ulcers C0 No visible or touchable symptoms C6 Skin ulceration

6 “It is a generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment; the overall condition of a human life.” Source: http://www.ncbi.nlm.nih.gov/mesh?term=life%20quality http://www.ncbi.nlm.nih.gov/mesh?term=life%20quality

7 Mortality, Morbidity, or Cure Health-related quality of life (HRQOL) Mortality, Morbidity, or Cure

8 … a multidimensional concept… Physical Domain Psychological Domain Social Domain

9  Which are the most used instruments to measure QOL in CVD?  Which is the best instrument used to measure QOL in CVD?

10 Quality of Life in CVD Identify the instruments used currently to measure QOL in CVD Find the instrument most used to measure QOL in CVD Characterize the main instruments used to measure QOL in CVD

11 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

12 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

13 Type of study Synthesis study Systematic Review and Meta-Analysis Bibliographic Review

14 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

15 Pubmed’s Query: measuring[All Fields] AND ("quality of life"[MeSH Terms] OR ("quality"[All Fields] AND "life"[All Fields]) OR "quality of life"[All Fields]) AND chronic[All Fields] AND ("veins"[MeSH Terms] OR "veins"[All Fields] OR "venous"[All Fields]) AND ("disease"[MeSH Terms] OR "disease"[All Fields]) AND insufficiency[All Fields]

16 measuring quality of life in chronic venous insufficiency measuring measurement evaluating evaluation

17 Isi, Cochrane and Scopus’ Query: Topic=((evaluating OR measuring OR assessing)) AND Topic=(quality of life) AND Topic=((chronic venous insufficiency OR chronic venous disease))

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19 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

20 Search in: PubMed, Google Scholar, Isi, Cochrane, Scopus

21 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

22 Stage 2: First Selection Stage 1: Search in Pubmed U GoogleScholar U Isi U Cochrane U Scopus 821 Selected Articles 82 Articles -Title - Abstract -Title - Abstract Stage 3: Second Selection -Full Text -Abstract (if Full Text was not available) -Full Text -Abstract (if Full Text was not available) 27 Articles

23 700 articles 35 articles 158 articles 42 articles 22 articles 4 articles 22 articles 0 articles 0 articles CochraneScoopus ISI Web of Knowledge Google Schoolar 0 articles 17 articles 10 articles 1 article Pubmed

24 Article Article Reader nº1 / Reader nº 2 Reader nº1 / Reader nº 2 Discussion Data Extraction Reader nº. 3 if there is no consensus

25 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

26 Extracted Data About the Measuring Instrument Articles Identification Authors/Country Publication date Study design Impact Factor (of the journal) Number of Quotes Instrument used to measure QoL Questionnaires Language About the Study

27 IdentificationAuthorsPublication Date Study Design InstrumentCountryIFCitations Languages Quality of life of people with venous leg ulcers: A comparison of the discriminative and responsive characteristics of two generic and a disease specific instruments Cynthia P. lglesias, Yvonne Birks, Elizabeth A. Nelson, Elizabeth Scanlon & Nicky A. Cullum 18 February 2005 Clinical Trial SF-12, EQ-5D, Hyland United Kingdom 2.37628English (…) Measuring instruments found in the selected article Impact Factor, used as a proxy for the relative importance of the article

28 QuestionnaireValidated? Available in portuguese? Languages Generic or Specific? Domains Targeted Population VEINES-QoLYesNo Italian French English Specific Venous thrombosis Venous insufficiency Adults NHPYesNo English (UK and US), Dutch, French, Generic patient's perceived emotional social and physical health problems Adults (16+years) (...)

29 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

30 SPSS v.19 was used to… Data Analysis Data Storage

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34 1. Type of study 2. Query selection 3. Selection criteria 4. Articles’ selection 5. Data extraction 6. Data management 7. Data analysis

35 Instruments with the highest frequecies will be described and analysed in terms of: Specificity Validation Practicability Reliability

36 Graphic 1– Frequency of use of QoL measurements

37 Graphic 2– Frequency of use of QoL measurements Generic Specific p= 0,756

38 Graphic 3– Impact factor by QoL measurement Generic Specific

39 Graphic 4– Mean of the number of quotes by measurement of QoL Generic Specific

40 Graphic 5– Comparison between the mean of the impact factor and the mean of the number of quotes Spearman’s correlation coeficient= 0,667

41 Graphic 6– Number of years published of de QoL measurements Generic Specific

42 Graphic 7– Percentage (%) of Validated Questionnaires Graphic 8– Percentage (%) of Questionnaires available in portuguese

43 Table 1– Basic Requirements of Measuring Instruments Table 1– Basic Requirements of Measuring Instruments Basic requirements Measuring instruments PracticabilityValidationReliabilitySpecificity SF-36++validated+++ EQ-5D+++validated+++ CIVIQ++validated++++ VEINES-QOL++validated+++ SF-12+++validated+++++ AVVQ++validated++

44 Table 2– Most frequent generic measuring instruments Table 2– Most frequent generic measuring instruments NameFrequencyValidation Number of languages Years since publication SF-3613Yes527 SF-124Yes45 EQ-5D6Yes55

45 Table 3– Most frequent specific measuring instruments Table 3– Most frequent specific measuring instruments NameFrequencyValidation Number of languages Years since publication CIVIQ5Yes114 VEINES Qol5Yes36 Aberdeen2Yes25

46 SF-36 -Developed by Ware & Sherbourne 1992 -translated into various languages -all health conditions -physical functioning and social functioning -easy to administer (only requires 5-10 minutes)

47 CIVIQ - initially developed by Launois et al. - 20-item questionnaire - 4 different dimensions: physical, psichological, social e pain sensitive to QoL dimensions, mainly the ones that are related to CVD.

48 Our Recommendation...

49  Mirjam A. G. Sprangers, Carolyn E. Schwartz. Integrating response shift into health-related quality of life research: a theoretical model. Social Science & Medicine. Volume 48, Issue 11, June 1999. Pages 1507-1515  R. D. Hays, R. Anderson and D. Revicki Psychometric considerations in evaluating health- related quality of life measures. Quality of Life Research. Volume 2, Number 6. Pages 441- 449, DOI: 10.1007/BF00422218.  Susan R Kahn, Cyr E M'lan, Donna L Lamping, Xavier Kurz, Anick Bérard, Lucien A Abenhaim. Relationship between clinical classification of chronic venous disease and patient-reported quality of life: results from an international cohort study. Journal of Vascular Surgery. VEINES Study Group. Volume 39, Issue 4, 2004 April. Pages 823-828, DOI: 10.1016/j.jvs.2003.12.007).  Donna L. Lamping.Donna L. Lamping. Measuring Health-Related Quality of Life in Venous Disease: Practical and Scientific Considerations. Angiology. January 1997. Pages 48: 51-57.  Kahn SR, Milan CE, Lamping DL, Kurz X, Bérard A, Abenhaim. Relationship between clinical classification of chronic venous disease and patient-reported quality of life: results from an international cohort study. J Vasc Surg. LAVEINES Study Group. 2004. Pages 39:823–828.  Kahn SR, M’Lan CE, Lamping DL, Kurz X, Berard A, Abenhaim L. The influence of venous thromboembolism on quality of life and severity of chronic venous disease. J Thromb Haemost. 2004. Pages 2: 2146–51.  Callam, MJ. Epidemiology of varicose veins. Br J Surg. 1994. Pages 81-167.  http://www.ncbi.nlm.nih.gov/mesh

50  Douglas, WS, Simpson, NB. Guidelines for the management of chronic venous leg ulceration. Report of a multidisciplinary workshop. British Association of Dermatologists and the Research Unit of the Royal College of Physicians. Br J Dermatol.1995. Pages 132- 446.  Santos Raymundo, Porfírio Gustavo, Pitta Guilherme. Differences in the quality of life of patients with mild and severe chronic venous disease. J Vasc Bras. 2009. Pages 8(2): 143- 147.  G M Andreozzi, R Córdova, M A Scomparin, R Martini, A D’Eri, F Andreozzi. Quality of Life in Chronic Venous Insufficiency. Int Angiol. 2005. Pages 24: 272-7.  Nelson, EA, Bell-Syer, SE, Cullum, NA. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2000. CD002303.  Mani, R, Vowden, K, Nelson, EA. Intermittent pneumatic compression for treating venous leg ulcers (Coochrane Review). Cochrane Database Syst Rev.2001. 4:CD001899.  Jeffrey L. Ballard and John J. Bergan. Chronic venous insufficiency: diagnosis and treatment. 2nd ed.Springer-Verlag London Limited. 2000.  Kathleenn. Lohr. Rating the strength of scientific evidence: relevance for quality improvement programs. International Journal for Quality in Health Care.2004. Volume 16. Number 1. Pages 9–18. 10.1093/intqhc/mzh005  C. Rutishauser; S.M. Sawyer; L. Bond; C. Coffey; G. Bowes. Development and validation of the Adolescent Asthma Quality of Life Questionnaire (AAQOL). ERS Journals Ltd. Available from http://erj.ersjournals.com/content/17/1/52.full.  http://www.ncbi.nlm.nih.gov/mesh?term=life%20quality

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