Quality of Life in Oporto and South of Douro Region – Comparison of EQ-5D and SF-36 Introdução...

Quality of Life in Oporto and South of Douro Region –

Comparison of EQ-5D and SF-36

Introdução à MedicinaTurma 6 – 2006/2007

• Difficult to define.• Multidimensional – integrates a lot of concepts

that are all interrelated. A possible division is: Subjective Objective

• Not a static definition – varies with time and from person to person.

“An uniquely personal perception, denoting the way individual patients feel about their health

status and/or non-medical aspects of their lives.” Gill and Feinstein

What is Quality of Life (QOL)?

Jenney M, Campbell S. Measuring quality of life. Arch. Dis. Child. 1997; 77:347-350McKevitt C, Redfern J, La-Placa V, Wolfe CDA. Definig and using quality of life: a survey of health care professionals: Clinical Rehabilitation, 2003; 17: 865-870Felce D, Jonathan P. Quality of Life: Its Definition and Measurement: Research in Developmental Disabilities. 1995, 16 (1); 51-74.


McKevitt C, Redfern J, La-Placa V, Wolfe CDA. Definig and using quality of life: a survey of health care professionals: Clinical Rehabilitation, 2003; 17: 865-870


Felce D, Jonathan P. Quality of Life: Its Definition and Measurement: Research in Developmental Disabilities. 1995, 16 (1); 51-74.


The need to quantify/measure Quality of Life is increasing every day.

But why?

In order to improve a population’s well being it is necessary to understand its problems and needs – easily perceived through QOL studies.

Jenney M, Campbell S. Measuring quality of life. Arch. Dis. Child. 1997; 77:347-350McKevitt C, Redfern J, La-Placa V, Wolfe CDA. Definig and using quality of life: a survey of health care professionals: Clinical Rehabilitation, 2003; 17: 865-870Felce D, Jonathan P. Quality of Life: Its Definition and Measurement: Research in Developmental Disabilities. 1995, 16 (1); 51-74.

Taxonomy of QOL instruments

• Generic instruments– Health Profiles (eg: SF-36)– Utility measures (eg: EQ-5D)

• Specific instruments– Disease-specific (eg: diabetes)– Population-specific (eg: trail elderly)– Function-specific (eg: sexual functioning)– Condition-specific (eg: pain)

Joel C, Sumati R, Keininger Dorothy L, Hays Ron D. Comparative Reviem of Generic Quality-of-Life Instruments. USA: Pharmacoeconomics. 2000; 17 (1): 13-35 Coons Stephen Joel, Rao Sumati, Keininger Dorothy L, Hays Ron D. Comparative Reviem of Generic Quality-of-Life Instruments. USA: Pharmacoeconomics. 2000; 17 (1): 13-35

• Questionnaire designed by EuroQol group

• Multidimensional, simple and brief

• Two parts:1. EQ-5D – 5 item questionnaire (1, 2 e 3)

2. EQ-VAS – visual analogue scale (0-100)

Badia X, Schiaffino A, Alonso J, Herdman M. Using the EuroQol 5-D in the catalan general population: feasibility and construct validity . Barcelona: Quality of Life Research, 1998; 7: 311-322Coons Stephen Joel, Rao Sumati, Keininger Dorothy L, Hays Ron D. Comparative Reviem of Generic Quality-of-Life Instruments. USA: Pharmacoeconomics. 2000; 17 (1): 13-35Jenkinson C, Gray A, Doll H, Lawrence K, Keoghane S, Layte R. Evaluation of Index and Profile Measures of Health Status in a Randomized Controlled Trial: Comparison of the Medical Outcomes Study 36-Item Short Form Health Survey, EuroQol, and Disease Specific Measures : Medical Care, November 1997; 35(11): 1109-1118, Brooks R, Jendteg S, Lindgren B, Persson U, Björk S. EuroQol: health-related quality of life measurement. Results of the Swedish questionnaire exercise : Health Policy, 1991; 18: 37-48

What is EuroQol instrument?

• Designed to be used in clinical activities, evaluative programmes, the health policy arena and general populations monitoring

• Kinds of data:• Indicates the extent of problems on the 5 dimensions• Self-rated assessment of health status based on the VAS• Population-weighted health index

What is 36-Item Short Form (SF-36)?

• Widely used questionnaire• Multi-purpose 36-item survey

Joel C, Sumati R, Keininger Dorothy L, Hays Ron D. Comparative Reviem of Generic Quality-of-Life Instruments. USA: Pharmacoeconomics. 2000; 17 (1): 13-35Jenkinson C, Gray A, Doll H, Lawrence K, Keoghane S, Layte R. Evaluation of Index and Profile Measures of Health Status in a Randomized Controlled Trial: Comparison of the Medical Outcomes Study 36-Item Short Form Health Survey, EuroQol, and Disease Specific Measures : Medical Care, November 1997; 35(11): 1109-1118Myers C, Wilks D. Comparison of Euroqol EQ-5D and SF-36 in patients with chronic fatigue syndrome: Quality of Life Research, March 1999; 8: 9-16Ware J. SF-36 Health Survey Update: SPINE, 2000; 25: 3130-3139

• Designed to be used in clinical practice, research, health policy evaluations and general populations monitoring

• Kinds of data:• Profile – assesses health concepts in 8 dimensions• 2 summary measures of health status:

– Physical component– Mental component

Ware J. SF-36 Health Survey Update: SPINE, 2000; 25: 3130-3139

EQ-5D versus SF-36

Joel C, Sumati R, Keininger Dorothy L, Hays Ron D. Comparative Reviem of Generic Quality-of-Life Instruments. USA: Pharmacoeconomics. 2000; 17 (1): 13-35Jenkinson C, Gray A, Doll H, Lawrence K, Keoghane S, Layte R. Evaluation of Index and Profile Measures of Health Status in a Randomized Controlled Trial: Comparison of the Medical Outcomes Study 36-Item Short Form Health Survey, EuroQol, and Disease Specific Measures : Medical Care, November 1997; 35(11): 1109-1118Myers C, Wilks D. Comparison of Euroqol EQ-5D and SF-36 in patients with chronic fatigue syndrome: Quality of Life Research, March 1999; 8: 9-16Ware J. SF-36 Health Survey Update: SPINE, 2000; 25: 3130-3139

E Q -5 D S F -3 6 5 q u e s tio n + V A S 3 6 q u e s tio n s ~ 1 m in u te to fill 5 -1 0 m in u te s to fill S e lf -a d m in is t e re d S e lf- a d m in is te re d

D iffic u lt to a d m in is te r b y p h o n e (V A S ); e a s ily a d m in is tra te d in p e rso n

E a s ily a d m in is tra te d b y p h o n e a n d in p e rso n

M o re m iss in g d a ta L e ss m iss in g d a ta U tility m e a su re su b ty p e H e a lth p ro file su b ty p e

S c o re s a s in g le n u m b e r w h ic h re la te s to a n h e a lth in d e x .

U se fu l in c o s t -u tility a n a ly s is

M u ltip le o u tc o m e sc o re s w h ic h c a n b e u se fu l to m e a su re d iffe re n tia l e ffe c ts o f a c o n d itio n o r its tre a tm e n t o n v a rio u s H R -

Q O L d o m a i n s In c o m p a ra t iv e s tu d ie s E Q -5 D a n d S F- 3 6 sc o re s a re u su a lly s tro n g ly c o rre la te d

Personal interviews Household drop-off

Mail

DIFFERENT TYPES OF METHODS

Telephone interviews

Group administered

Gordon H. Guyatt, David H. Feeny, Donal L. Patrick. Measuring Health-related Quality of Life: Annals of Internal Medicine, 1993; 118: 622-629

How to apply the QOL instrument?

How to apply the QOL instrument?


ADVANTAGES DISADVANTAGES

• Are relatively inexpensive to administer• Can be sent to a wide number of people• Respondents can answer at their own convenience• No influence uppon respondents

• The response rates are often low• Some groups are more reluctant to respond to this kind of questionnaires (bias)• People might be unable to answer some questions

Mail Questionnaire


Why?

Mainly because of VAS

Protocol• Primary objective

– Quantify the health related quality of life (HR-QOL) of the adult population in Oporto and South of Douro region.

– Compare measurement scales and subscales and analyse the agreement between two broadly used HR-QOL generic instruments – EQ-5D and SF-36.

• Secondary objectives– Compare results between typical groups:

• Age• Sex

– Compare the results of our study with the results of pre-existing studies.

Protocol

• Study design

– Cross-Sectional Survey

1.Cheap2.Quick3.No follow up, less resources4.(Prevalence)

Protocol

• Selection criteria:

– General adult population (aged 18 or above) within the Oporto and South of Douro region, living in a household with phone.

– Listed telephone numbers.

Limitations

Protocol• Sampling design:

Protocol• Sampling design:

– Random choice of phone numbers from the “Oporto and South of Douro” phonelist using SuperCool Random Number Generator - software which randomly creates a combination of three numbers:

• Page• Column • Line

Limitations

Protocol

• Sampling design:

– According to two studies(1) the overall response rates were 59% and 65.5%

– We believe that we will not be able to achieve such level, therefore we will consider 40% of response rate

Number of letters=

19140% = 478

(1) Lubetkin E, Jia H, Franks P, Gold M. Relationship among sociodemographic factors, clinical conditions, and health-related quality of life: Examinig the EQ-5D in the U.S. general population: Quality of Life Research, 2005; 14: 2187-2196 and Norlund A, Ekberg K, Kristenson M, Linquest Group. EQ-5D in a general population survey – A description of the most commonly reported EQ-5D health states using SF-36: Quality of Life Research, 2005; 14: 1099-1109

Protocol

• Limitations:

– Inhabitants without telephone, or whose phone number is not listed will not be contemplated.

• This will lead to some bias since there is probably a higher rate of missing contacts among poorer inhabitants.

– The phonebook may be outdated or even have lack of address information.

• This may cause letters not to be delivered.

Protocol• Limitations:

– In the phonebook there are numbers that do not correspond to households (enterprises, hospitals,…).

• In this cases we will select the next household contact.

– Some addresses have more lines than others.• More probable to be chosen – bias.

– Not all pages of the phonebook have the same number of lines.

• When the line number generated by the software exceeds the number of lines of a column the count will proceed on the following column.

Protocol• Data collection:

– EQ-5D questionnaire– SF-36 questionnaire

• Contact method:– 2 stages:

1. Mail the questionnaire2. If inquiries do not answer in 2/3 weeks-time: send

another questionnaire3. 2/3 weeks afterwards, if here is still no answer:

contacted by phone

• Data processing and analysis– Creation of a database in SPSS to analyse our data

Quality of Life in Oporto and South of Douro Region – Comparison of EQ-5D and SF-36 Introdução...

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