TY  - JOUR
AB  - BACKGROUND: While total hip and knee replacement (THR/TKR) surgery are effective measures to restore functioning and reduce pain in patients with severe osteoarthritis (OA), long-term treatment effects vary among patients. Following behavioral economic theory, these differences may be partially attributed to the impact of personality traits on individual strategies to approach post-surgical challenges. This study explored the associations between self-efficacy, willingness to take risk regarding health (H-WTTR), and future orientation, and the 3-month course of health-related quality of life (HRQoL) and OA-specific health status. METHODS: As part of the prospective and observational MobilE-TRA 2 cohort study, 147 patients aged 60 years and older were assessed by self-administered questionnaires before and three months after THR/TKR at a single German hospital. As indicators for the surgical outcome, HRQoL was assessed by the EuroQol Five-Dimensional Five-Level Questionnaire (EQ-5D-5L), including the visual analogue scale (EQ-VAS), and functioning was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) using the global score, function score, and pain score. All WOMAC scores were transformed into scales with 0 = worst health and 100 = best health. Self-efficacy was measured using the General Self-Efficacy Short Scale. H-WTTR and future orientation were assessed by single-item questions on 11-point Likert scales. The associations between these personality traits and the 3-month change in the outcome scores were analyzed using linear regression models for THR and TKR respectively. RESULTS: In THR patients a one-point-increase in self-efficacy was associated with improvements in EQ-5D-5L (β=0.0704; p=0.0099), WOMAC global (β=6.6337; p=0.0139), WOMAC function (β=8.2557; p=0.0046), and WOMAC pain (β=5.9994; p=0.0232). For TKR, only the association of self-efficacy with the EQ-VAS change-score was significant (β=5.8252; p=0.0482). Self-efficacy demonstrated weak positive, but not significant associations with all WOMAC scores and a negative association close to zero with the EQ-Index. H-WTTR and future orientation showed no significant associations to changes of the outcome scores. CONCLUSIONS: Self-efficacy appears to be a prognostic factor for better THR/TKR outcomes after three months. If these findings can be confirmed in further research, strategies to improve self-efficacy should be considered in prehabilitation programs. TRIAL REGISTRATION: Not applicable.
AU  - Fuchs, S.*
AU  - Schwettmann, L.
AU  - Katzenberger, B.*
AU  - Paulus, A.*
AU  - Holzapfel, B.M.*
AU  - Biebl, J.T.*
AU  - Weigl, M.*
C1  - 74194
C2  - 57373
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Association of self-efficacy, risk attitudes, and time preferences with health-related quality of life and functioning after total hip or knee replacement - Results of the MobilE-TRA 2 cohort.
JO  - Health Qual. Life Outcomes
VL  - 23
IS  - 1
PB  - Bmc
PY  - 2025
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: The amount of empirical research on whether people in fact include health-related changes in leisure time into health state valuations is limited and the results are inconclusive. In this exploratory study, we analyse whether time aspects of diabetes self-care might explain the ratings of the health state (HSR) in addition to the effects of physical and mental health-related quality of life. METHODS: Using the data from participants with diagnosed type 2 diabetes in the population-based KORA FF4 study (n = 190, 60% Male, mean age 69 ± 10 years), multiple logistic regression models were fitted to explain HSR (good vs. poor) in terms of the SF-12 physical and mental component summary (PCS and MCS) scores, time spent on diabetes self-care and a number of background variables. RESULTS: There was no significant association between time spent on diabetes self-care and HSR in models without interaction. Significant interaction term was found between the SF-12 PCS score and time spent on self-care. In models with interaction self-care time has a small, but significant impact on the HSR. In particular, for a PCS score under 40, more time increases the chance to rate the health state as "good", while for a PCS score above 40 there is a reverse effect. CONCLUSIONS: The additional impact of self-care time on HSR in our sample is small and seems to interact with physical health-related quality of life. More research is needed on whether inclusion of health-related leisure time changes in the denominator of cost-effectiveness analysis is sufficient.
AU  - Icks, A.*
AU  - Stöbel, S.*
AU  - Thorand, B.
AU  - Holle, R.*
AU  - Laxy, M.*
AU  - Schunk, M.*
AU  - Neumann, A.*
AU  - Wasem, J.*
AU  - Gontscharuk, V.*
AU  - Chernyak, N.*
C1  - 66989
C2  - 53397
TI  - Self-care time and rating of health state in persons with diabetes: Results from the population-based KORA survey in Germany.
JO  - Health Qual. Life Outcomes
VL  - 20
IS  - 1
PY  - 2022
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - Background The role of artisanal and small-scale gold mining (ASGM) as a source of income is rapidly gaining importance in the economically difficult times in Zimbabwe. Besides limited epidemiological data, no data about the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners exist. The aim of the project was to access HRQoL of ASGM workers to improve the data base and compare the data to the urban Zimbabwean population. Methods Data from 83 artisanal and small-scale gold miners in Kadoma, Zimbabwe was analysed. The HRQoL was assessed using the EuroQol dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) accompanied by the cognition add-on questionnaire (EQ-5D-3L+C) and associated visual analogue scale (VAS). We described the EQ-5D dimensions and VAS values and computed health utility (HU) values using the Zimbabwean tariff. The proportions of miners reporting no problem in each EQ-5D dimension were compared with corresponding proportions reporting any problem (moderate or severe), and mean HU and VAS values were analysed across subgroups of the sample. To test differences between subgroups, Fisher's exact test was used and between urban and mining population, Student's t-test was used. Results The reported health states of miners were homogenous, with a large amount (42%) reporting 'full health'. Mean (SD) VAS and HU values were 81.0 (17.5) and 0.896 (0.13), respectively. Subgroup analysis showed that miners with a lower education reported significantly more problems in the dimension of daily activities and miners with mercury contact had more problems in the dimensions of pain/discomfort and cognition. Comparison between mining and urban population showed that in the oldest age group, self-rated VAS values of miners were significantly higher than of their urban counterparts. Conclusions There were no significant differences in the HRQoL of mining and urban populations. However, the reason might be adverse health effects faced by the urban population that do not apply to rural mining areas. A higher education level of miners can improve the HRQoL, which is especially impaired by problems in the cognition dimension.
AU  - Becker, J.
AU  - Bose-O'Reilly, S.*
AU  - Shoko, D.*
AU  - Singo, J.*
AU  - Steckling-Muschack, N.*
C1  - 59825
C2  - 49060
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Comparing the self-reported health-related quality of life (HRQoL) of artisanal and small-scale gold miners and the urban population in Zimbabwe using the EuroQol (EQ-5D-3L+C) questionnaire: A cross-sectional study.
JO  - Health Qual. Life Outcomes
VL  - 18
IS  - 1
PB  - Bmc
PY  - 2020
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BackgroundObesity can significantly reduce health-related quality of life (HRQoL) and may lead to numerous health problems even in youths. This study aimed to investigate whether HRQoL varies among youths with obesity depending on grade of obesity and other factors.MethodsFor the Youths with Extreme obesity Study (YES) (2012-2014), a prospective multicenter cohort study, a baseline sample of 431 obese and extremely obese adolescents and young adults (age 14 to 24years, BMI >= 30kg/m(2)) was recruited at four German university medical centers and one job center. Obesity grade groups (OGG) were defined according to BMI (OGG I: 30-34.9kg/m(2), OGG II: 35-39.9kg/m(2), OGG III (extreme obesity): >= 40kg/m(2)). HRQoL was measured with the Euroqol-5D-3L (EQ-5D-3L), DISABKIDS chronic generic (DCGM-31) and the KINDLR obesity module. Differences between OGGs were assessed with logistic and linear regression models, adjusting for age, sex, and study center in the base model. In a second regression analysis, we included other characteristics to identify possible determinants of HRQoL.ResultsThree hundred fifty-two adolescents (mean age: 16.6 (2.4), mean BMI: 39.1 (7.5) kg/ m(2)) with available HRQoL data were analysed. HRQoL of youths in all OGGs was markedly lower than reference values of non-obese adolescents. Adjusting for age and sex, HRQoL of youths in OGG III significantly impaired compared to OGG I. Youths in OGG III were 2.15 times more likely to report problems with mobility in the EQ-5D-3L than youths in OGG I. A mean difference of 9.7 and 6.6 points between OGG III and I were found for DCGM-31 and KINDL respectively and 5.1 points between OGG II and I for DCGM-31. Including further variables into the regression models, showed that HRQoL measured by DCGM-31 was significantly different between OGGs. Otherwise, female sex and having more than 4h of daily screen time were also associated with lower HRQoL measured by DCGM-31 and KINDL.Conclusion HRQoL of adolescents with obesity is reduced, but HRQoL of adolescents with extreme obesity is particularly affected. Larger and longitudinal studies are necessary to understand the relation of extreme obesity and HRQoL, and the impact of other lifestyle or socioeconomic factors.
AU  - Felix, J.
AU  - Stark, R.G.
AU  - Teuner, C.M.
AU  - Leidl, R.
AU  - Lennerz, B.*
AU  - Brandt, S.*
AU  - von Schnurbein, J.*
AU  - Moss, A.*
AU  - Bollow, E.*
AU  - Sergeyev, E.*
AU  - Mühlig, Y.*
AU  - Wiegand, S.*
AU  - Holl, R.W.*
AU  - Reinehr, T.*
AU  - Kiess, W.*
AU  - Scherag, A.*
AU  - Hebebrand, J.*
AU  - Wabitsch, M.*
AU  - Holle, R.
C1  - 58603
C2  - 48251
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Health related quality of life associated with extreme obesity in adolescents - results from the baseline evaluation of the YES-study.
JO  - Health Qual. Life Outcomes
VL  - 18
IS  - 1
PB  - Bmc
PY  - 2020
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BackgroundHealth-related quality of life (HRQL) in interstitial lung disease (ILD) patients is impaired. We aimed to identify baseline predictors for HRQL decline within a 12-month observation period. MethodsWe analyzed 194 ILD patients from two German ILD-centers in the observational HILDA study. We employed the disease-specific King's Brief Interstitial Lung Disease questionnaire (K-BILD) with the subdomains 'psychological impact', 'chest symptoms' and 'breathlessness and activities', and the generic EQ-5D Visual Analog Scale (VAS). We evaluated how many patients experienced a clinically meaningful decline in HRQL. Subsequently, we investigated medical and sociodemographic factors as potential predictors of HRQL deterioration.ResultsWithin the study population (34.0% male, O age 61.7) mean HRQL scores hardly changed between baseline and follow up (K-BILD: 52.8 vs. 52.5 | VAS: 60.0 vs. 57.3). On the intra-individual level, 30.4% (n=59) experienced a clinically relevant deterioration in K-BILD total score and 35.4% (n=68) in VAS. Lower baseline forced vital capacity (FVC) % predicted determined HRQL decline in K-BILD total score (ss -coefficient: - 0.02, p=0.007), VAS (ss -coefficient: - 0.03, p<0.0001), and in the subdomain 'psychological impact' (-coefficient: - 0.02, p=0.014). Lower baseline diffusing capacity of carbon monoxide (DLCO) % predicted determined deterioration in 'breathlessness and activities' (ss -coefficient: - 0.04, p=0.003) and 'chest symptoms' (ss -coefficient: - 0.04, p=0.002). Additionally, increasing age predicted decline in 'psychological impact' (ss -coefficient: 0.06, p<0.007).ConclusionAround a third of ILD patients experienced a clinically relevant HRQL deterioration in a 12-month period, which was associated with baseline lung function values in all K-BILD domains. As lung function values are time-dependent variables with possible improvements, in contrast to age and ILD subtype, it, thus, seems important to improve lung function and prevent its decline in order to maintain HRQL on the possibly highest level.
AU  - Maqhuzu, P.N.
AU  - Szentes, B.L.
AU  - Kreuter, M.*
AU  - Bahmer, T.*
AU  - Kahn, N.*
AU  - Claussen, M.*
AU  - Holle, R.
AU  - Schwarzkopf, L.
C1  - 60313
C2  - 49261
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Determinants of health-related quality of life decline in interstitial lung disease.
JO  - Health Qual. Life Outcomes
VL  - 18
IS  - 1
PB  - Bmc
PY  - 2020
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - Background: Evaluation of variations in pre- and postoperative patient reported outcomes (PRO) and the association between preoperative patient characteristics and health and satisfaction outcomes after total knee arthroplasty (TKA) may support shared decision-making in Germany. Since previous research on TKA health outcomes indicated valuation differences in longitudinal data, experienced-based population weights were used for the first time as an external valuation system to measure discrepancies between patient and average population valuation of HRQoL.Methods: Baseline data (n = 203) included sociodemographic and clinical characteristics and PROs, measured by the EQ-5D-3 L and WOMAC. Six-month follow-up data (n = 161) included medical changes since hospital discharge, PROs and satisfaction. A multivariate linear regression analysis was performed to evaluate the relationship between preoperative patient characteristics and PRO scores. Patient acceptable symptom state (PASS) was calculated to provide a satisfaction threshold. Patient-reported health-related quality of life (HRQoL) valuations were compared with average experienced-based population values to detect changes in valuation.Results: One hundred thirty-seven subjects met inclusion criteria. All PRO measures improved significantly. Preoperative WOMAC and EQ-5D VAS, housing situation, marital status, age and asthma were found to be predictors of postoperative outcomes. 73% of study participants valued their preoperative HRQoL higher than the general population valuation, indicating response shift. Preoperatively, patient-reported EQ-5D VAS was substantially higher than average experienced-based population values. Postoperatively, this difference declined sharply. Approximately 61% of the patients reported satisfactory postoperative health, being mainly satisfied with results if postoperative WOMAC was >= 82.49 (change >= 20.25) and postoperative EQ-5D VAS was >= 75 (change >= 6).Conclusion: On average, patients benefited from TKA. Preoperative WOMAC and EQ-5D VAS were predictors of postoperative outcomes after TKA. Particularly patients with high absolute preoperative PRO scores were more likely to remain unsatisfied. Therefore, outcome prediction can contribute to shared-decision making. Using general population valuations as a reference, this study underlined a discrepancy between population and patient valuation of HRQoL before, but not after surgery, thus indicating a potential temporary response shift before surgery.
AU  - Felix, J.
AU  - Becker, C.
AU  - Vogl, M.
AU  - Buschner, P.*
AU  - Plötz, W.*
AU  - Leidl, R.
C1  - 57589
C2  - 47837
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty results from a German prospective cohort study.
JO  - Health Qual. Life Outcomes
VL  - 17
IS  - 1
PB  - Bmc
PY  - 2019
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: Value assessment of vaccination programs against serogroup B invasive meningococcal disease (IMD) is on the agenda of public health authorities. Current evidence on the burden due to IMD is unfit for pinning down the nature and magnitude of the full social and economic costs of IMD for two reasons. First, the concepts and components that need to be studied are not agreed, and second, measures of the concepts that have been studied are weak and inconsistent. Thus, the economic evaluation of the available serogroup B meningococcal (MenB) vaccines is difficult. The aims of this DELPHI study are to: (1) agree on the concepts and components determining the burden of MenB diseases that need to be studied; and (2) seek consensus on appropriate methods and study designs to measure quality of life (QoL) associated with MenB induced long-term sequelae in future studies. METHODS: We designed a DELPHI questionnaire based on the findings of a recent systematic review on the QoL associated with IMD-induced long-term sequelae, and iteratively interviewed a panel of international experts, including physicians, health economists, and patient representatives. Experts were provided with a controlled feedback based on the results of the previous round. RESULTS: Experts reached consensus on all questions after two DELPHI rounds. Major gaps in the literature relate (i) to the classification of sequelae, which allows differentiation of severity levels, (ii) to the choice of QoL measures, and (iii) to appropriate data sources to examine long-term changes and deficits in patients' QoL. CONCLUSIONS: Better conceptualisation of the structure of IMD-specific sequelae and of how their diverse forms of severity might impact the QoL of survivors of IMD as well as their family network and care-providers is needed to generate relevant, reliable and generalisable data on QoL in the future. The results of this DELPHI panel provide useful guidance on how to choose the study design, target population and appropriate QoL measures for future research and hence, help promote the appropriateness and consistency in study methodology and sample characteristics.
AU  - Marten, O.*
AU  - Koerber, F.
AU  - Bloom, D.*
AU  - Bullinger, M.*
AU  - Buysse, C.*
AU  - Christensen, H.*
AU  - De Wals, P.*
AU  - Dohna-Schwake, C.*
AU  - Henneke, P.*
AU  - Kirchner, M.*
AU  - Knuf, M.*
AU  - Lawrenz, B.*
AU  - Monteiro, A.L.*
AU  - Sevilla, J.P.*
AU  - Van de Velde, N.*
AU  - Welte, R.*
AU  - Wright, C.*
AU  - Greiner, W.*
C1  - 56139
C2  - 46853
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - A DELPHI study on aspects of study design to overcome knowledge gaps on the burden of disease caused by serogroup B invasive meningococcal disease.
JO  - Health Qual. Life Outcomes
VL  - 17
IS  - 1
PB  - Bmc
PY  - 2019
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - Background: Population-based value sets are widely used to transform health states into utilities, but may deviate from actual patient experience. Whether this occurs in a systematic way can be analyzed, in a first step, for respondents who do not report problems on the five domains of the EQ-5D-5L instrument in population studies.Methods: EQ-5D-5L results from three annual cross-sectional surveys (2012, 2013, and 2014) were filtered for participants who reported being problem-free. Continuous visual analog scale (VAS) scores, ranging from 0 (worst imaginable health) to 100 (best imaginable health) were then used to measure their actual health perception and to compare results with the proposed EQ-5D-5L value. A multiple linear regression model was used to identify possible risk factors for low VAS scores.Results: Some 3739 (615%) participants reported being problem-free. Their mean age was 41.1 years and mean VAS score was 91.9. Age and BMI were significantly associated with lower VAS scores. Age groups from 50 years onwards reported VAS means of 90.0 and below. Female gender and low education also had small but significant negative effects on patient experience. The presence of BMI class III as well as diabetes had the greatest negative effect on VAS results (- 9.0 and - 8.4) and reached the range of minimally important differences. Heart disease (- 6.2) and musculoskeletal disease (- 3.4) also had strong negative effects. The 25th percentile of VAS scores in our sample was 90.0, and the 50th percentile was 95.0.Conclusions: For some groups in population studies, especially older people with high BMI and those affected by specific diseases, no problems on all five domains of the EQ-5D-5L fails to reflect the respondents' health perception as measured by the VAS.
AU  - Huber, M.B.
AU  - Vogelmann, M.*
AU  - Leidl, R.
C1  - 54081
C2  - 45294
CY  - Campus, 4 Crinan St, London N1 9xw, England
TI  - Valuing health-related quality of life: Systematic variation in health perception.
JO  - Health Qual. Life Outcomes
VL  - 16
IS  - 1
PB  - Bmc
PY  - 2018
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: Decision makers need to know whether health state values, an important component of summary measures of health, are valid for their target population. A key outcome is the individuals' valuation of their current health. This experience-based perspective is increasingly used to derive health state values. This study is the first to compare such experience-based valuations at the population level across countries. METHODS: We examined the relationship between respondents' self-rated health as measured by the EQ-VAS, and the different dimensions and levels of the EQ-5D-3 L. The dataset included almost 32,000 survey respondents from 15 countries. We estimated generalized linear models with logit link function, including country-specific models and pooled-data models with country effects. RESULTS: The results showed significant and meaningful differences in the valuation of health states and individual health dimensions between countries, even though similarities were present too. Between countries, coefficients correlated positively for the values of mobility, self-care and usual activities, but not for the values of pain and anxiety, thus underlining structural differences. CONCLUSIONS: The findings indicate that, ideally, population-specific experience-based value sets are developed and used for the calculation of health outcomes. Otherwise, sensitivity analyses are needed. Furthermore, transferring the results of foreign studies into the national context should be performed with caution. We recommend future studies to investigate the causes of differences in experience-based health state values through a single international study possibly complemented with qualitative research on the determinants of valuation.
AU  - Heijink, R.*
AU  - Reitmeir, P.
AU  - Leidl, R.
C1  - 51491
C2  - 43094
CY  - London
TI  - International comparison of experience-based health state values at the population level.
JO  - Health Qual. Life Outcomes
VL  - 15
IS  - 1
PB  - Biomed Central Ltd
PY  - 2017
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: Quality of life as an endpoint in a clinical study may be sensitive to the value set used to derive a single score. Focusing on patients' actual valuations in a clinical study, we compare different value sets for the EQ-5D-3L and assess how well they reproduce patients' reported results. METHODS: A clinical study comparing inpatient (n = 98) and outpatient (n = 47) rehabilitation of patients after an acute coronary event is re-analyzed. Value sets include: 1. Given health states and time-trade-off valuation (GHS-TTO) rendering economic utilities; 2. Experienced health states and valuation by visual analog scale (EHS-VAS). Valuations are compared with patient-reported VAS rating. Accuracy is assessed by mean absolute error (MAE) and by Pearson's correlation ρ. External validity is tested by correlation with established MacNew global scores. Drivers of differences between value sets and VAS are analyzed using repeated measures regression. RESULTS: EHS-VAS had smaller MAEs and higher ρ in all patients and in the inpatient group, and correlated best with MacNew global score. Quality-adjusted survival was more accurately reflected by EHS-VAS. Younger, better educated patients reported lower VAS at admission than the EHS-based value set. EHS-based estimates were mostly able to reproduce patient-reported valuation. Economic utility measurement is conceptually different, produced results less strongly related to patients' reports, and resulted in about 20 % longer quality-adjusted survival. CONCLUSION: Decision makers should take into account the impact of choosing value sets on effectiveness results. For transferring the results of heart rehabilitation patients from another country or from another valuation method, the EHS-based value set offers a promising estimation option for those decision makers who prioritize patient-reported valuation. Yet, EHS-based estimates may not fully reflect patient-reported VAS in all situations.
AU  - Leidl, R.
AU  - Schweikert, B.*
AU  - Hahmann, H.*
AU  - Steinacker, J.M.*
AU  - Reitmeir, P.
C1  - 48186
C2  - 39976
CY  - London
TI  - Assessing quality of life in a clinical study on heart rehabilitation patients: How well do value sets based on given or experienced health states reflect patients' valuations?
JO  - Health Qual. Life Outcomes
VL  - 14
IS  - 1
PB  - Biomed Central Ltd
PY  - 2016
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - Background: Little is known about the association between diabetes and health related quality of life (HRQL) in lower-middle income countries. This study aimed to investigate HRQL among individuals with and without diabetes in Bangladesh. Methods: The analysis is based on data of a case-control study, including 591 patients with type 2 diabetes (cases) who attended an outpatient unit of a hospital in Dhaka and 591 age -and sex-matched individuals without diabetes (controls). Information about socio-demographic characteristics, health conditions, and HRQL were assessed in a structured interview. HRQL was measured with the EuroQol (EQ) visual analogue scale (VAS) and the EQ five-dimensional (5D) descriptive system. The association between diabetes status and quality of life was examined using multiple linear and logistic regression models. Results: Mean EQ-VAS score of patients with diabetes was 11.5 points lower (95 %-CI: -13.5, -9.6) compared to controls without diabetes. Patients with diabetes were more likely to report problems in all EQ-5D dimensions than controls, with the largest effect observed in the dimensions 'self-care' (OR = 5.9; 95 %-CI: 2.9, 11.8) and 'mobility' (OR = 4. 5; 95 %-CI: 3.0, -6.6). In patients with diabetes, male gender, high education, and high-income were associated with higher VAS score and diabetes duration and foot ulcer associated with lower VAS scores. Other diabetes-related complications were not significantly associated with HRQL. Conclusions: Our findings suggest that the impact of diabetes on HRQL in the Bangladeshi population is much higher than what is known from western populations and that unlike in western populations comorbidities/complications are not the driving factor for this effect.
AU  - Safita, N.
AU  - Islam, S.M.S.*
AU  - Chow, C.K.*
AU  - Niessen, L.W.*
AU  - Lechner, A.
AU  - Holle, R.
AU  - Laxy, M.
C1  - 49818
C2  - 40969
CY  - London
TI  - The impact of type 2 diabetes on health related quality of life in Bangladesh: Results from a matched study comparing treated cases with non-diabetic controls.
JO  - Health Qual. Life Outcomes
VL  - 14
PB  - Biomed Central Ltd
PY  - 2016
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - Background: A number of studies have shown an association between health-related quality of life (HRQL) and socioeconomic status (SES). Indicators of SES usually serve as potential confounders; associations between SES and HRQL are rarely discussed in their own right. Also, few studies assess the association between HRQL and SES among those with a chronic disease. The study focuses on the question of whether people with the same state of health judge their HRQL differently according to their SES, and whether a bias could be introduced by ignoring these differences.Methods: The analyses were based on a representative sample of the adult population in Germany (n = 11,177). HRQL was assessed by the EQ-5D-3 L, i.e. the five domains (e.g. 'moderate or severe problems' concerning mobility) and the Visual Analog Scale (VAS). SES was primarily assessed by educational level; age, sex and family status were included as potential confounders. Six chronic diseases were selected, each having a prevalence of at least 1% (e.g. diabetes mellitus). Multivariate analyses were conducted by logistic and linear regression.Results: Among adults with a chronic disease, most 'moderate or severe problems' are reported more often in the low (compared with the high) educational group. The same social differences are seen for VAS values, also in subgroups characterized by 'moderate or severe problems'. Gender-specific analyses show that for women the associations with VAS values can just be seen in the total sample. For men, however, they are also present in subgroups defined by 'moderate or severe problems' or by the presence of a chronic disease; some of these differences exceed 10 points on the VAS scale.Conclusions: Low SES groups seem to be faced with a double burden: first, increased levels of health impairments and, second, lower levels of valuated HRQL once health is impaired. These associations should be analysed and discussed in their own right, based on interdisciplinary co-operation. Social epidemiologists could include measures of HRQL in their studies more often, for example, and health economists could consider assessing whether recommendations based on HRQL scales might include a social bias.
AU  - Mielck, A.
AU  - Vogelmann, M.*
AU  - Leidl, R.
C1  - 31356
C2  - 34451
CY  - London
TI  - Health-related quality of life and socioeconomic status: Inequalities among adults with a chronic disease.
JO  - Health Qual. Life Outcomes
VL  - 12
IS  - 1
PB  - Biomed Central Ltd
PY  - 2014
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - Background The aim of the study was to analyze the effect of preoperative patient characteristics on health outcomes 6 months after total hip replacement (THR), to support patient’s decision making in daily practice with predicted health states and satisfaction thresholds. By giving incremental effects for different patient subgroups, we support comparative effectiveness research (CER) on osteoarthritis interventions. Methods In 2012, 321 patients participated in health state evaluation before and 6 months after THR. Health-related quality of life (HRQoL) was measured with the EQ-5D questionnaire. Hip-specific pain, function, and mobility were measured with the WOMAC in a prospective observation of a cohort. The predictive capability of preoperative patient characteristics – classified according to socio-demographic factors, medical factors, and health state variables – for changes in health outcomes is tested by correlation analysis and multivariate linear regressions. Related satisfaction thresholds were calculated with the patient acceptable symptom state (PASS) concept. Results The mean WOMAC and EQ-5D scores before operation were 52 and 60 respectively (0 worst, 100 best). At the 6-month follow-up, scores improved by 35 and 19 units. On average, patients reported satisfaction with the operation if postoperative (change) WOMAC scores were higher than 85 (32) and postoperative (change) EQ-5D scores were higher than 79 (14). Conclusions Changes in WOMAC and EQ-5D scores can mainly be explained by preoperative scores. The lower the preoperative WOMAC or EQ-5D scores, the higher the change in the scores. Very good or very poor preoperative scores lower the probability of patient satisfaction with THR. Shared decision making using a personalized risk assessment approach provides predicted health states and satisfaction thresholds.  
AU  - Vogl, M.
AU  - Wilkesmann, R.*
AU  - Lausmann, C.*
AU  - Hunger, M.
AU  - Ploetz, W.*
C1  - 32448
C2  - 35038
TI  - The impact of preoperative patient characteristics on health states after total hip replacement and related satisfaction thresholds: A cohort study.
JO  - Health Qual. Life Outcomes
VL  - 12
IS  - 1
PY  - 2014
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: To assess associations of obesity with health-related quality of life (HRQL) in postmenopausal women, and whether depressed mood and diabetes moderate these associations. METHODS: Survey of 983 postmenopausal women aged 35-74, general population, Augsburg region/Germany, 2004/2005. Body weight/height and waist/hip circumference were assessed anthropometrically and classified via BMI ≥ 30 as obese, and WHR ≥ 0.85 as abdominally obese (vs. not). Depressed mood was assessed by the Depression and Exhaustion-(DEEX-)scale, diabetes and postmenopausal status by self-report/medication, and HRQL by the SF-12. RESULTS: General linear models revealed negative associations of obesity and abdominal obesity with physical but not mental HRQL. Both forms of excess weight were associated with diabetes but not depressed mood. Moderation depended on the HRQL-domain in question. In non-diabetic women, depressed mood was found to amplify obesity-associated impairment in physical HRQL (mean "obese"-"non-obese" difference given depressed mood: -6.4, p < .001; among those without depressed mood: -2.5, p = .003). Reduced mental HRQL tended to be associated with obesity in diabetic women (mean "obese"-"non-obese" difference: -4.5, p = .073), independent of depressed mood. No interactions pertained to abdominal obesity. CONCLUSIONS: In postmenopausal women, depressed mood may amplify the negative impact of obesity on physical HRQL, while diabetes may be a precondition for some degree of obesity-related impairments in mental HRQL.
AU  - Heidelberg, D.A.*
AU  - Holle, R.
AU  - Lacruz, M.E.
AU  - Ladwig, K.-H.
AU  - von Lengerke, T.
C1  - 5631
C2  - 29383
TI  - Do diabetes and depressed mood affect associations between obesity and quality of life in postmenopause? Results of the KORA-F3 Augsburg population study.
JO  - Health Qual. Life Outcomes
VL  - 9
PB  - BioMed Central Ltd.
PY  - 2011
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D. METHODS: The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method. RESULTS: The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2. CONCLUSIONS: There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status.
AU  - Hunger, M.
AU  - Thorand, B.
AU  - Schunk, M.
AU  - Döring, A.
AU  - Menn, P.
AU  - Peters, A.
AU  - Holle, R.
C1  - 4832
C2  - 28795
TI  - Multimorbidity and health-related quality of life in the older population: Results from the German KORA-Age study.
JO  - Health Qual. Life Outcomes
VL  - 9
PB  - BIOMED CENTRAL LTD
PY  - 2011
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: The aim of this study was to measure HrQoL during acute exacerbations of COPD using generic and disease-specific instruments, and to assess completeness, proportion with best or worst health state, sensitivity to change and discriminative ability for each instrument. METHODS: EQ-5D, SF-12 and SGRQ were obtained from COPD patients with GOLD stage III and IV hospitalized for an acute exacerbation both at admission and discharge. To assess the instruments' properties, utility values were calculated for EQ-5D and SF-12, and a total score was derived from the SGRQ. RESULTS: Mean utilities ranged from 0.54 (SF-12, stage IV) to 0.62 (EQ-5D, stage III) at admission, and from 0.58 (SF-12, stage IV) to 0.84 (EQ-5D, stage III) at discharge. Completeness was best for EQ-5D and SGRQ, while no utility value for the SF-12 could be calculated for more than 30%. For SGRQ subscales, the minimal score occurred in up to 11% at admission, while full health was observed for the EQ-5D at discharge in 13%. Sensitivity to change was generally good, whereas discrimination between COPD stages was low for the EQ-5D. CONCLUSIONS: Acute exacerbations seriously impair health status and quality of life. The EQ-5D is generally suitable to measure HrQoL in exacerbations of severe COPD, although the high proportion of patients reporting full health at discharge poses a problem. The main issue with the SF-12 is the high proportion of missing values in a self-assessed setting. Properties of the SGRQ were satisfactory. However, since no utility values can be derived from this disease-specific instrument, it is not suitable for cost-utility analyses in health-economic evaluations.
AU  - Menn, P.
AU  - Weber, N.*
AU  - Holle, R.
C1  - 1131
C2  - 27335
TI  - Health-related quality of life in patients with severe COPD hospitalized for exacerbations - comparing EQ-5D, SF-12 and SGRQ.
JO  - Health Qual. Life Outcomes
VL  - 8
PB  - BioMed Central Ltd.
PY  - 2010
SN  - 1477-7525
ER  - 

TY  - JOUR
AB  - BACKGROUND: To explore the concept of the Minimum Clinically Important Difference (MID) of the Worry Scale of the Hypoglycaemia Fear Survey (HFS-II) and to quantify the clinical importance of different types of patient-reported hypoglycaemia. METHODS: An observational study was conducted in Germany with 392 patients with type 2 diabetes mellitus treated with combinations of oral anti-hyperglycaemic agents. Patients completed the HFS-II, the Treatment Satisfaction Questionnaire for Medication (TSQM), and reported on severity of hypoglycaemia. Distribution- and anchor-based methods were used to determine MID. In turn, MID was used to determine if hypoglycaemia with or without need for assistance was clinically meaningful compared to having had no hypoglycaemia. RESULTS: 112 patients (28.6%) reported hypoglycaemic episodes, with 15 patients (3.8%) reporting episodes that required assistance from others. Distribution- and anchor-based methods resulted in MID between 2.0 and 5.8 and 3.6 and 3.9 for the HFS-II, respectively. Patients who reported hypoglycaemia with (21.6) and without (12.1) need for assistance scored higher on the HFS-II (range 0 to 72) than patients who did not report hypoglycaemia (6.0). CONCLUSION: We provide MID for HFS-II. Our findings indicate that the differences between having reported no hypoglycaemia, hypoglycaemia without need for assistance, and hypoglycaemia with need for assistance appear to be clinically important in patients with type 2 diabetes mellitus treated with oral anti-hyperglycaemic agents.
AU  - Stargardt, T.
AU  - Gonder-Frederick, L.*
AU  - Krobot, K.J.*
AU  - Alexander, C.M.*
C1  - 773
C2  - 26677
TI  - Fear of hypoglycaemia: Defining a minimum clinically important difference in patients with type 2 diabetes.
JO  - Health Qual. Life Outcomes
VL  - 7
PB  - Biomed Central Ltd
PY  - 2009
SN  - 1477-7525
ER  -