QUALITY OF LIFE MEASURING INSTRUMENTS IN CHRONIC VENOUS DISEASE What’s the best option?
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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
Chronic Venous DiseaseDefinition
“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/mesh
Video ricardo
CEAP Classification
Etiology
• Congenit• Primary• Secondary
(post thrombotic)
Anatomy
• Superficial veins
• Deep veins• Perforating
veins
Physiopathology
• Reflux• Obstruction• Reflux and
obstruction
Clinical signs (CEAP)
C3 Edema
C2 Varicose veins
C1 Reticular veins
C4 Trophic skin alterations
C5Healed ulcers
C0 No visible or touchable symptoms
C6 Skin
ulceration
Quality of LifeChronic Venous Disease
Quality of Life
“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
Quality of Life
Before… Now…
Mortality, Morbidity, or
Cure
Health-related
quality of life (HRQOL)
Mortality,
Morbidity, or Cure
Health-Related Quality of Life
… a multidimensional concept…
Physical Domain
Psychological Domain
Social Domain
Questions
Which are the most used instruments to measure QOL in CVD?
Which is the best instrument used to measure QOL in CVD?
Aims of the work
Quality of Life in CVDIdentify
the instruments
used currently to
measure QOL in CVD
Find the
instrument most used to measure QOL
in CVDCharacteriz
e the main
instruments used to
measure QOL in CVD
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Type of Study
Type of
study
Synthesis study
Systematic Review and
Meta-Analysis
Bibliographic Review
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Query SelectionPubmed’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]
Query Selectionmeasuring quality of life
in chronic venous insufficiency
measuring measurement
evaluating evaluation
Query SelectionIsi, Cochrane and Scopus’ Query:Topic=((evaluating OR measuring OR assessing)) AND Topic=(quality of life) AND Topic=((chronic venous insufficiency OR chronic venous disease))
Query Selection
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Selection Criteria•Date
•Articles published before 1990•Type of Studie
•Essay, Synthesis studies, Comentaries.EXCLUSION
criteria
•Studies that mention quality of life and CVD
•Presence of information relating to, at least one QoL instrument;INCLUSIO
Ncriteria
Search in: PubMed, Google Scholar, Isi, Cochrane, Scopus
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Articles Selection
Stage 2: First
Selection
Stage 1: Search in Pubmed U GoogleScholar U Isi U Cochrane
U Scopus 821 Selected
Articles
82 Articles
-Title- Abstract
Stage 3: Second
Selection-Full Text-Abstract (if Full Text was not available)27 Articles
Articles Selection
700 article
s35
articles
158 article
s42
articles
22 article
s4
articles
22 article
s
19 article
s0
articles
Cochrane
ScoopusISI Web of KnowledgeGoogle
Schoolar
0 articl
es
0 articl
es
0 articl
es
17 articl
es
10 articl
es
1 article
Pubmed
Articles Selection (stage 3)
Article
Reader nº1 / Reader nº 2
Discussion
Data Extraction
Reader nº. 3 if there is no consensus
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Data Extraction
Extracted DataAbout the Measuring
Instrument Articles IdentificationAuthors/CountryPublication dateStudy designImpact Factor (of the journal)
Number of Quotes
Instrument used to measure QoLQuestionnaires Language
****
About the Study
**
**
Identification
Authors
Publication Date
Study Desig
n
Instrument
Country
IF Citations
Languages
Quality of life of people with
venous leg ulcers: A
comparisonof the
discriminative and
responsive characteristics of two genericand a disease
specific instruments
Cynthia P.
lglesias, Yvonne Birks,
Elizabeth A.
Nelson, Elizabet
h Scanlon & Nicky
A. Cullum
18 February 2005
Clinical Trial
SF-12, EQ-5D, Hyland
United Kingdom
2.376
28 English
(…)
Measuring instruments found
in the selected article
Impact Factor, used as a proxy for the
relative importance of the article
Data Extraction
Data Extraction
Questionnaire
Validated?
Available in
portuguese?
Languages Generic or Specific? Domains
Targeted Populatio
n
VEINES-QoL Yes No ItalianFrenchEnglish
SpecificVenous thrombosis
Venous insufficiency
Adults
NHP Yes No English (UK and US), Dutch, French, Generic
patient's perceived
emotional social and physical
health problems
Adults(16+years)
(...)
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Data Management
SPSS v.19 was used to… Data Analysis
Data Storage
Our database...
Our database...
Our database...
Methodology
1. Type of study
2. Query selection
3. Selection criteria
4. Articles’ selection
5. Data extraction
6. Data management
7. Data analysis
Data AnalysisInstruments with the highest frequecies will be described and analysed in terms of:
Specificity
Validation
Practicabilit
y
Reliability
Graphic 1– Frequency of use of QoL measurements
Results
Results
Graphic 2– Frequency of use of QoL measurements
GenericSpecific
p= 0,756
Results
Graphic 3– Impact factor by QoL measurement
Generic
Specific
Results
Graphic 4– Mean of the number of quotes by measurement of QoL
GenericSpecific
Results
Graphic 5– Comparison between the mean of the impact factor and the mean of the number of quotes
Spearman’s correlation coeficient= 0,667
Results
Graphic 6– Number of years published of de QoL measurements
GenericSpecific
Results
Graphic 7– Percentage (%) of Validated Questionnaires
Not Val-idated22%
Validated 78%
Available in Por-
tuguese; 28%
Not Avail-able in Por-
tuguese; 72%Graphic 8– Percentage (%) of Questionnaires
available in portuguese
Results
Table 1– Basic Requirements of Measuring Instruments
Basic requirements
Measuring instruments
Practicability Validation Reliability Specificity
SF-36 ++ validated ++ +
EQ-5D +++ validated ++ +
CIVIQ ++ validated +++ +
VEINES-QOL ++ validated +++ +++
SF-12 +++ validated ++ +++
AVVQ ++ validated ++ ++
Results
Table 2– Most frequent generic measuring instruments
Name Frequency Validation Number of languages
Years since
publication
SF-36 13 Yes 52 7SF-12 4 Yes 4 5EQ-5D 6 Yes 5 5
Table 3– Most frequent specific measuring instruments
Results
Name Frequency Validation Number of languages
Years since
publication
CIVIQ 5 Yes 11 4VEINES Qol 5 Yes 3 6Aberdeen 2 Yes 2 5
Results
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)
ResultsCIVIQ- 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.
Conclusion
OurRecommendation...
References 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
References 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.
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Nelson, EA, Bell-Syer, SE, Cullum, NA. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev . 2000. CD002303.
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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
Class 05:ANA RAFAELA SOUSA
ANA SOFIA PINTO ANDREIA MACHADO
FRANCISCO GONÇALVESGASTÃO FONTESINÊS GOUVEIA
INÊS GONÇALVES JOANA INÊS SILVA
JOÃO CORREIA LAURA COSTA
RICARDO SOARES SARA PEREIRA
Email: [email protected] The End!!