IMAGINE…

Aneesa A., Gay W.Y.E, Chua Q.Y.F, Ng W.Y.K, Seet Z.T., Sim H.Z.T

What is the Relationship between Quality of Life and Physical

Functions of Patients Undergoing Palliative Care?

ContentIntroduction & Literature Reviews

Our HypothesesMethodResults & DiscussionLimitationsSuggestions for Future StudiesConclusion

Introduction and Literature Reviews

Introduction

Cancer

• 1 out of 4 Singaporeans will die of cancer (Hock 2002)

• Early screening and treatment

Palliative Care

• Singapore Hospice to increase beds by 20% in 5 to 7 years (Ministry of Health, Channel Newsasia, 14th Oct 2008,)

• Improve QOL (Granda-Cameron et al., 2008)

QOL

• Multi-factorial (World Health Organisation, 2002)

• Measured by QOL questionnaire

Quality of Life

Social Relations

hip

Physical Function

ing

Level of Independ

ence

Environmental

Factors

Psychological State

Personal Beliefs

(World Health Organisation, 1997)

Physical Function

ing

AgilityFlexibili

ty

Balance

Strength

Endurance

(Reuben et al., 2003)

Correlation of QOL to Physical Objective

MeasuresPhysical Component score SF-36 correlated

strongly (r=0.766) with distance walked in 6-minute walk test in liver transplant patients.

(Hsieh et al., 2010)

Strong correlations (r>0.7) between 6-minute walk distance and Dyspnoea, Fatigue, Emotion and Total QOL scores of Chronic Heart Failure Questionnaire.

(O'Keeffe et al., 1998)

SF-36 physical scores has a strong relationship with 6-minute walk distance in bronchiectasis patients (r=0.71, p < 0.001).

(Lee et al., 2009)

EORTC QLQ-C30 physical functioning strongly correlates with 6-minute walk distance in palliative patients (r2=0.70).

(Nicklasson et al., 2007)

Correlation of QOL to Physical Objective

Measures

AIM:Determine the

correlation of physical objective measures and

questionnaire scores for the overall wellness of patients undergoing

palliative care

QOL

Patient

Caregiver

Caregiver’s Rating of Patient’s QOL

Moderate levels (r=0.68) of correlation in patient-caregiver mental health scores of SF12 and CES-D (depression questionnaire)

(Fleming et al., 2006)

Fair to moderate levels of agreement in patient-caregiver QOL scores of older adults with cognitive impairments.

(Logsdon et al., 2002)

Caregiver’s Rating of Patient’s QOL

AIM:To determine the correlation of the

ratings of palliative patient’s QOL by

themselves and their caregivers.

Primary HypothesisHo: There is NO relationship between

Quality of Life Questionnaire Score and Physical Objective Measures among terminally ill cancer patients undergoing palliative care.

Ha: There is A relationship between Quality of Life Questionnaire Score and Physical Objective Measures among terminally ill cancer patients undergoing palliative care.

Secondary Hypothesis

Ho: There is NO agreement between the Quality of Life Questionnaire answers of the caregivers and the patients.

Ha: There is AN agreement between the Quality of Life Questionnaire answers of the caregivers and the patients.

Method

EORTC QLQ – C15 PAL

Derived from EORTC QLQ – C30EORTC QLQ-C30 is a reliable and well-

validated tool of measuring QOL. (Nicklasson et al., 2007)

Similar trend observed between overseas and local population (Luo et al., 2005)

EORTC QLQ - C30 questions are not relevant to palliative care setting (Fredheim et al., 2007)

EORTC QLQ – C15 PAL

Shows good content validity for palliative care (Groenvold et al., 2006)

EORTC QLQ – C15 PAL

Global Quality of Life

Physical functionEmotional functionFatigueDypsnoeaConstipationPainNauseaInsomniaLoss of appetite

EORTC QLQ – C15 PAL

* Questions are directly plucked out from C30

Physical Objective Measures - Endurance

The six-minute walk test, which has been found to reflect activities of daily living better than other walk tests, measures of walking capacity (Solway et

al., 2001).

Physical Objective Measures – Upper Limb Strength

Handheld dynamometer test has been shown to correlate with gold standard methods of strength testing, such as repetition maximum testing (Lippincott et al., 2006).

Physical Objective Measures – Lower Limb Strength

5 times Sit-To-Stand Test measures the ability to stand from a chair by testing lower-extremity strength and balance (Lord et al., 2002).

Physical Objective Measures - Balance

Functional reach, a well-known clinical measure of balance, has shown to correlate with activities of daily living (Duncan et al., 1990).

Physical Objective Measures - Agility

The Timed Up and Go Test is a measure of the subject’s mobility and balance which are crucial for those who are home or community ambulant. The test is also used to assess fall risk (Overcash et al., 2008).

MethodExperimental Procedure

5 subjects recruited by judgment sampling from Assisi Hospice

EORTC QLQ C15-PAL(VERBAL) administered to subjects and caregivers

5 Physical Objective Measures performed on subjects

Inclusion Criteria:• Palliative care cancer patient with <1 year prognosis• 21 years and above• understands or have a caregiver who understands conversational English or Chinese• home ambulant with or without walking aid• meet PAR-Q standards or recommended by hospice healthcare professionals

Exclusion Crieria:•Inability to follow simple instructions

•Other conditions which limit physical ability and function (blindness, deafness, etc)

MethodPhysical Objective measures

Questionnaire

Functional reach EORTC QLQ-C15 PAL (subjects)

EORTC QLQ-C15 PAL (caregivers)

Hand grip dynamometer

5 times sit to stand

Timed up and go

6 minute walk test

Pearson’s correlation (r)

Scores generated from EORTC Scoring Formula

Results & Discussion

EORTC QLQ – C15 vs Physical Objective

Measures

Physical functioni

ng

6 minute walk test 0.749 0.145

Dyspnoea

Functional reach 0.750 0.144

Handheld dynamom

eter0.860 0.061

Global QOL

Correlation

Significance

Domains of EORTC QLQ - C15

Physical objective measures

Handheld dynamome

ter-0.826 0.085

Functional reach -0.950 0.013

Negative Correlation for Global QOL

Global QOL

EORTC-

QLQ-C15-PAL

Emotional

Function

Physical Functio

n

Fatigue

Nausea

Pain

Dypsnoea

Insomnia

Appetite Loss

Constipation

“How would you rate your overall quality of life during the past week?”

“How would you rate your overall quality of life during the past week?”

Quality of Life

Social Relations

hip

Physical Functioni

ng

Level of Independ

ence

Environmental

Factors

Psychological State

Personal Beliefs

(World Health Organisation, 1997)

Recall…

Caregiver Questionnaire vs

Subjects Questionnaire

SubjectCaregive

r

Pearson’s

Correlation

Sig.Fig

Physical Physical FunctioninFunctionin

gg

Physical Physical FunctioninFunctionin

gg0.9520.952 0.0130.013

FatigueFatigue FatigueFatigue 1.0001.000 0.0000.000

Inability to compute results

5 out of 10 domains in correlation of EORTC QLQ – C15 scores and physical objective measures

7 out of 10 domains in correlation of caregivers’ and subjects’ responses

Questions are not discriminative enough

Inability to compute results

LimitationsJudgement sampling of higher

functioning subjects Frail patients undergoing palliative care may

not be willing to participate in the physical objective measures

Homogenous population therefore not representative of entire palliative care population

Suggestions for Future Studies

Include subjects of various physical functioning status

Source for suitable subjects who are not involved in centre activities

Conclusion

ConclusionOnly 3 consistent, strong correlation found:

Subjects’ Physical functioning scores and 6 minute walk test

Caregivers’ and subjects’ physical functioning scores of the EORTC QLQ C15 PAL

Caregivers’ and subjects’ fatigue scores of the EORTC QLQ C15 PAL

ConclusionPhysiotherapists have to encourage

patients to maintain active lifestyle despite medical condition

There is still a need establish patient’s physical functions through physical objective measures

Quality of Life of patients has to be determined by patients themselves

Special Thanks!Mr Abdul Rashid

Jailani for his guidance and

advice

Mr Andy Ongfor his statistical

expertise

Mr Patrick Tanfor his technical and

logistical support throughout out project

Dr Bala S. Rajaratnam for providing us with

all the necessary resources needed

Ms Grace Simfor her enthusiasm in

assisting us

Staff and Patients of Assisi Homefor bringing us much

joy during our visits

ReferencesBartlett D, Birmingham T. (2003) Validity and reliability of a pediatric reach test. Pediatr Phys Ther.;15(2):84-92.

Bennie S, Bruner K, Dizon A, Fritz H, Goodman B, Peterson S. (2003). Measurements of balance: comparison between the timed up and go test and Functional Reach test with the Berg Balance Scale. J Phys Ther Sci;15:93-7.

 

Brusse KJ, Zimdars S, Zalewski KR, Steffen TM. (2005). Testing functional performance in people with Parkinson disease. Phys Ther.;85:134 –141.

Duncan, P.W., Weiner, D.K., Chandler, J., Studenski, S. (1990) Functional reach: a new clinical measure of balance. J Gerontol ,45, M192–M197.

Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149-1160

Fialka-Moser V, Crevenna R, Korpan M, Quittan M. (2003) Cancer rehabilitation: Particularly with aspects on physical impairments. Journal of Rehabilitation Medicine, 35(4):153-162.

Fleming DA, Sheppard VB, Mangan PA, Taylor KL, Tallarico M, Adams I, Ingham J. (2006). Caregiving at the End of Life: Perceptions of Health Care Quality and Quality of Life Among Patients and Caregiver. Journal of Pain and Symptom Management. 31(5):407-420.

 

Fredheim, O.M., Borchgrevink, P.C., Saltnes, T., Kaasa, S. (2007). Validation & Comparison of the Health-Related Quality-of-Life Instruments EORTC QLQ-C30 & SF-36 in Assessment of Patients with Chronic Nonmalignant Pain. Journal of Pain and Symptom Management, 34(6):657-665

Garman K.S., Cohen H.J. (2002). Functional status and the elderly cancer patient. Critical Reviews in Oncology/Hematology, 43;191-208

Giorgetti MM, Harris BA, Jette A . (1998). Reliability of clinical balance outcome measures in the elderly. Physical therapy ressaech international; 3; 274-283 

Granda-Cameron, C., Viola, S.R., Lynch, M.P., Polomano, R.C. (2008). Measuring Patient-Oriented Outcomes in Palliative Care: Functionality and Quality of Life. Clinical Journal of Oncology Nursing, 12(1):65-77  

Groenvold, M., Petersen, M.A., Aaronson, N.K., Arraras, J.I., Blazeby, J.M., Bottomley, A., Fayers, P.M., de Graeff, A., Hammerlid, E., Kaasa, S., Sprangers, M.A., Bjorner, JB. (2006). EORTC QLQ-C15-PAL the new standard in the assessment of health-related quality of life in advanced cancer? Palliative Medicine, 20(1):1-2

 

Helbostad, J.L., Hølen, J.C., Jordhøy, M.S., Ringdal, G.I., Oldervoll, L., Kaasa, S. (2009). A First Step in the Development of an International Self-Report Instrument for Physical Functioning in Palliative Cancer Care: a systematic literature review and an expert opinion evaluation study. Journal of Pain and Symptom Management, 37(2):196-205

 

Hsieh CB, Tsai CS, Chen TW, Chu HC, Yu JC, Chen DR. (2010). Correlation Between SF-26 and Six-Minute Walk Distance in Liver Donors. Transplantation Proceedings. 42(9):3597-3599.

Hock LC. (2002). An overview of the cancer control programme in Singapore. Japanese Journal of Clinical Oncology, 32:S62–S65

 

Jones, CJ, Rikli RE, Beam WC.(1999) A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport.70:113-119.

 

Kazumi N (2007). Relationships between the 30-second chair-stand test given to elderly people and the maximum strength of the lower limbs as well as the functioning of daily living. Rigakuryoho Kagaku. 22:225-228

Langley FA., Mackintosh SFH. (2007). Functional balance assessment of the older community dwelling adults; A systematic review of the literature. The Internal Journal of Allied Health Sciences and Practice; 5, 1-11

Logsdon RG, Gibbons LE, McCurry SM, Teri L. (2002). Assessing Quality of Life in Older Adults With Cognitive Impairment. Psychosomatic Medicine. 64:510-519.

Lord, S.R., Murray, S.M., Chapman, K (2002). Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Am Geriatr Soc. 57, 539–543.

Luo, N., Fones, C.S.L., Lim, S.E., Xie, F., Thumboo, J., Li, S.C. (2005). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): Validation of English version in Singapore. Quality of Life Research, 14:1181-1186 McCarthy EK, Horvat MA, Holtsberg PA, Wisenbaker JM. (2008) Reliability of performance-based measures in people awaiting joint replacement surgery of the hip or knee. Physiotherapy Research International.13:141-152.

Mong Y, Teo TW, Ng SS. (2010). 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity. Arch Phys Med Rehabil. 91(3):407-13. Nicklasson, M., Bergman, B. (2007). Validity, reliability and clinical relevance of EORTC QLQ-C30 and LC13 in patients with chest malignancies in a palliative setting. Quality of Life Research, 16(6):1019-1028 O'Keeffe ST, Lye M, Donnellan C, Carmichael DN. (1998). Reproducibility and responsiveness of quality of life assessment and six minute walk test in elderly heart failure patients. Heart. 80:377-382.

Oldervoll, L.M., Loge, J.H., Paltiel, H., Asp, M.B., Vidvei, U., Wiken, A.N., Hjermstad, M.J., Kaasa, S. (2006). The Effect of a Physical Exercise Program in Palliative Care: A phase II study. Journal of Pain and Symptom Management, 31(5):421-430 Overcash, J.A., Rivera Jr. H.R., (2008). Physical performance evaluation of older cancer patients: A preliminary study. Critical Reviews in Oncology/Hematology 68, 233–241. Pearce, N.J.M., Sanson-Fisher, R., Campbell, H.S. (2007). Measuring quality of life in cancer survivors: a methodological review of existing scales. Psycho-Oncology, 17(7):629-640

Sneeuw KCA, Aaronson NK, Sprangers MAG, Detmar SB, Wever LDV, Schornagel JH. (1998). Comparison Of Patient And Proxy EORTC QLQ-C30 Ratings In Assessing The Quality Of Life Of Cancer Patients. Journal Of Clinical Epidermiology. 7:617-631.

World Health Organisation (1997). Measuring Quality of Life. WHO (MNH/PSF/97.4)

Whitney SL, Wrisley DM, Marchetti GF, et al. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the 5-Times-Sit-to-Stand Test. Phys Ther. 2005;85:1034-1045. Zhao, H., Kanda, K. (2000). Translation and validation of the Standard Chinese Version of the EORTC QLQ-C30. Quality of Life Research, 9(2):129-137