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 Life

Chronic 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 CVD

Identify the instruments used to measure

QOL in CVD

Find the instrument most used to

measure QOL in CVDCharacterize

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 Selection

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]

Query Selectionmeasuring quality of life

in chronic venous insufficiency

measuring measurement

evaluating evaluation

Query Selection

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))

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;

INCLUSION

criteria

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 ou

4articl

es

Cochrane

ScoopusISI Web of Knowledge

Google Schoolar

Pubmed

0 articl

es

0 articl

es

0 articl

es

17 articl

es

10 articl

es

1 article

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 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

**

**

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?

LanguagesGeneric or Specific?

DomainsTargeted Populatio

n

VEINES-QoL Yes No ItalianFrenchEnglish

SpecificVenous thrombosis

Venous insufficiency

Adults

NHP Yes NoEnglish (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...

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 Analysis

Instruments 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

Generic

Specific

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

Generic

Specific

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

Generic

Specific

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

- evaluate QoL independently of any condition or disease

- measure QoL in patients with a specific condition

- try to establish an eventual connection between the disease and the QoL level.

Generic Specific

Questionnaires

Results

Table 2– Most frequent generic measuring instruments

Name Frequency ValidationNumber of languages

Years since

publication

SF-36 13 Yes 52 2

SF-12 4 Yes 4 5

EQ-5D 6 Yes 5 5

Table 3– Most frequent specific measuring instruments

Results

Name Frequency ValidationNumber of languages

Years since

publication

CIVIQ 5 Yes 11 4

VEINES Qol 5 Yes 3 6

Aberdeen 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)

Results

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.

Conclusion

Our Recomendation

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.

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

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: turma05fmup@gmail.com The End!!