Quality of life and depression among older patients waiting for joint replacement surgery

Purpose: Older patients waiting for joint replacement surgery in many western countries experience lengthy waits for their surgery. Although these patients suffer with mobility problems the nature of the disability associated with waiting for surgery is unclear. The purpose of this study was to determine health-related quality of life and symptoms of depression in persons waiting for their initial orthopaedic consultation following referral for total knee or total hip replacement surgery.

Methods: All patients who were waiting for an initial orthopaedic consultation for lower-limb joint replacement as at 25 August 2005 were surveyed. Participants were mailed questionnaires concerning demographic information, medical history, health-related quality of life (the Assessment of Quality of Life (AQoL) instrument), and symptoms of depression (Center for Epidemiologic Studies – Depression (CES-D) Scale).

Results: The 84 respondents (response rate 64%) had a mean age of 68.3 (SD 11.5 years), and 60% or respondents were women. Respondents reported an average of 1.6 (SD 0.9) medical conditions, and 85% reported osteoarthritis.} The average health-related quality of life was low (mean AQoL 0.38; SD 0.27), and near death-equivalent or worse than death-equivalent health-related quality of life (AQoL<0.1 of a maximum possible 1.0) was reported by 23% of the participants.The mean depression scale score was 16.5 (SD 11.1), and symptoms of depression (CES-D>16 of a maximum possible 60) were reported by 35% of the sample. There was a strong correlation between health-related quality of life and depression (r=–0.6).

Conclusions: Almost a third of patients waiting to see an orthopaedic surgeon about joint replacement surgery for their hip or knee had symptoms of depression. Geriatric rehabilitation services often provide interventions to these patients. The very poor quality of life reported suggests that more than exercise and strengthening will be needed to reduce disability.

Population norms and meaningful differences for the Assessment of Quality of Life (AQoL) measure

Objective: The Assessment of Quality of Life (AQoL) instrument is widely used in Australian health research. To assist researchers interpret and report their work, this paper reports population and health status norms, general minimal important differences (MIDs) and effect sizes.

Method: Data from the 1998 South Australian Health Omnibus Survey (n=3,010 population-based respondents) were analysed by gender, age group and health status. Data from four other longitudinal studies were analysed to obtain estimated MIDs.

Results: The mean (SD) AQoL utility score was 0.83 (0.20). Gender and age subgroup differences were apparent; the mean scores for women were consistent until their 50s, when scores declined. Greater variability was observed for males whose scores declined more slowly but consistently between 40–80 years. For both genders, those aged 80+ years had the lowest scores When assessed by health status, those reporting excellent health obtained the highest utility scores; progressive declines were observed with decreasing health status. Effect sizes of 0.13 or greater may reflect important differences between groups A difference in AQoL scores of 0.06 utility points over time suggests a general MID.

Conclusions: AQoL population norms, MIDs and effect sizes can be used as reference points for the interpretation of AQoL data. These findings add to the growing evidence that the AQoL is a robust and sensitive measure that has wide applicability.

Implications: The availability of population norms will assist researchers using the AQoL to more easily interpret and report their work.

Quality of life assessment in the community-dwelling elderly : validation of the Assessment of Quality of Life (AQoL) instrument and comparison with the SF-36

Measurement of Health-Related Quality of Life (HRQoL) of the elderly requires instruments with demonstrated sensitivity, reliability, and validity, particularly with the increasing proportion of older people entering the health care system. This article reports the psychometric properties of the 12-item Assessment of Quality of Life (AQoL) instrument in chronically ill community-dwelling elderly people with an 18-month follow-up. Comparator instruments included the SF-36 and the OARS. Construct validity of the AQoL was strong when examined via factor analysis and convergent and divergent validity against other scales. Receiver Operator Characteristic (ROC) curve analyses and relative efficiency estimates indicated the AQoL is sensitive, responsive, and had the strongest predicative validity for nursing home entry. It was also sensitive to economic prediction over the follow-up. Given these robust psychometric properties and the brevity of the scale, AQoL appears to be a suitable instrument for epidemiologic studies where HRQoL and utility data are required from elderly populations.

Does obesity affect the quality of life of adolescents?

Abstract located in Obesity Facts: the European journal of obesity : Vol. 2 : Suppl. 2 : Abstract number :T2:PO.09

Measuring quality of life in alcohol and other drug users - the need for improvement

Objective : The use of Quality of Life (QoL) -related measures in Alcohol and Other Drug-related research has increased dramatically over the past decade. However, there remains a great deal of confusion about which type of QoL measure is most valid, what each constrict actually measures and the ethicality of the process of QoL measurement and its subsequent transfer to monetary value. This is particularly important in regard to subsequent resource allocation on the basis of Quality Adjusted Life Years (QALYs). We aim to review the logic of current QoL -related measurement and determine the most conceptually valid way of measuring QoL.

Methods : This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQoL) and the measurement of subjective well-being.

Results : We argue that there are serious logical and methodological issues concerning HRQoL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood.

Conclusions : It is recommended that HRQoL measurement be abandoned in favour of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

Subjective quality of life of people with MS and their partners

The findings of this thesis supported a model proposed to explain the influence of psychological factors on subjective quality of life. In comparison with their partners, and with a control group, people with MS reported a lowered subjective quality of life and self-esteem, an increased need for social support, and maladaptive use of control. Recommendations for interventions were made based on these findings.