Berrie Middel

Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q)

Objective:To evaluate the psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q) in patients with atrial fibrillation. Design: A prospective study of the patients who underwent DC electrical cardioversion. Setting: Clinics of cardiology and thoracic surgery of the University Hospital in Groningen, the Netherlands. Main outcome measures: The disease-specific MLHF-Q and generic measures of quality of life were administered. The sensitivity to change over time was tested with effect sizes (ES). Internal consistency of MLHF-Q scales was estimated with Cronbachs alpha. To evaluate the construct validity multitrait–multimethod analysis was applied. The ‘known group validity’ was evaluated by the comparison of mean scores and effect sizes between two groups of the New York Heart Association (NYHA) classification (NYHA I versus II–III). Stability of MLHF-Q scales was estimated in a subgroup of patients who remained stable. Perfect congruence analysis and factor analysis were applied to confirm the a priori determined structure. Results: Cronbachs alpha was ≥0.80 of the MLHF-Q scales. Perfect congruence analysis (PCA) showed that the results resemble quite well the a priori assumed factor structure. Multitrait–multimethod analysis showed convergent validity coefficients ranging from 0.59 to 0.73 (physical impairment dimension) and 0.39 to 0.69 (emotional dimension). The magnitude of change can be interpreted as medium (ES = 0.50). The results of a ‘test–retest’ analysis in a stable group can be valued as satisfactory for the MLHF-Q scales (Pearsons r > 0.60). The physical dimension and the overall score of the MLHF-Q discriminated significantly between the NYHA I and II–III groups (p < 0.001) with large effect sizes (ES > 1.0). Conclusions: The MLHF-Q has solid psychometric properties and the outcome of the current study indicates that the MLHF-Q is an effective and efficient instrument.

Effect of intrathecal baclofen delivered by an implanted programmable pump on health related quality of life in patients with severe spasticity

OBJECTIVES To compare clinical effectiveness and health related quality of life in patients with severe spasticity who received intrathecal baclofen or a placebo. METHODS In a double blind, randomised, multicentre trial 22 patients were followed up during 13 weeks and subsequently included in a 52 week observational longitudinal study. Patients were those with chronic, disabling spasticity who did not respond to maximum doses of oral baclofen, dantrolene, and tizanidine. After implantation of a programmable pump patients were randomly assigned to placebo or baclofen infusion for 13 weeks. After 13 weeks all patients received baclofen. Clinical efficacy was assessed by the Ashworth scale, spasm score, and self reported pain, and health related quality of life by the sickness impact profile (SIP) and the Hopkins symptom checklist (HSCL). RESULTS At three months the scores of the placebo and baclofen group differed slightly for the spasm score (effect size=0.20) and substantially for the Ashworth scale (effect size=1.40) and pain score (effect size=0.94); health related quality of life showed no significant differences. Three months after implantation the baclofen group showed a significant, substantial improvement on the SIP “physical health”, “mental health”, “mobility”, and “sleep and rest” subscales and on the HSCL mental health scale; patients receiving placebo showed no change. After one year of baclofen treatment significant (P<0.05) improvement was found on the SIP dimensions “mobility” and “body care and movement” with moderate effect sizes. Improvement on the SIP subscale “physical health” (P<0.05; effect size 0.86), the SIP overall score (without “ambulation”), and the “physical health” and overall scale of the HSCL was also significant, with effect sizes >0.80. Changes in health related behaviour were noted for “sleep and rest” and “recreation and pastimes” (P<0.01, P<0.05; effect size 0.95 and 0.63, respectively). Psychosocial behaviour showed no improvement. CONCLUSIONS Intrathecal baclofen delivered by an implanted, programmable pump resulted in improved self reported quality of life as assessed by the SIP, and HSCL physical health dimensions also suggest improvement.

Social support as a predictor of perceived health status in patients with multiple sclerosis

OBJECTIVE The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients. METHODS Two hundred and seven MS patients (38.4+/-10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzkes expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis. RESULTS Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS from family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36. CONCLUSION PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients. PRACTICE IMPLICATIONS The results show the importance of supporting social ties and relationships between MS patients and others.

The Impact of Type D Personality on Health-Related Quality of Life in Tinnitus Patients Is Mainly Mediated by Anxiety and Depression

Objective: To evaluate the impact of Type D personality on health-related quality of life (HRQoL) and self-reported tinnitus-related distress in chronic tinnitus patients and whether this relationship is mediated by indicators of psychological distress (i.e., vital exhaustion, anxiety, and depression). Materials and Methods: Using a cross-sectional study design, 265 consecutive tinnitus patients were asked to complete the Hospital Anxiety and Depression Scale, the Maastricht Questionnaire, the Type D Scale (DS14), the Short-Form Health Survey 36, and the Tinnitus Reaction Questionnaire. Results: The prevalence of Type D was 35.5%. Type D patients were significantly more anxious, depressed, and vitally exhausted, and experienced more impaired HRQoL and increased tinnitus-related distress compared with non-Type D patients. Structural equation modeling showed that Type D personality directly increased symptoms of depression and anxiety, but not vital exhaustion. Type D was also a direct predictor of poor mental and physical HRQoL and increased tinnitus-related distress, although this influence was mainly mediated by symptoms of depression and anxiety. Anxiety, depression, and vital exhaustion had a direct influence on HRQoL and self-reported tinnitus-related distress, with a higher impact on mental HRQoL (R2 = 0.74) compared with physical HRQoL (R2 = 0.33). Vital exhaustion was a predictor of HRQoL and self-reported tinnitus-related distress; however, its influence was moderated by enhanced levels of anxiety and depression. Conclusion: Tinnitus patients with a Type D personality were more likely to be anxious and depressed and to experience poor HRQoL and increased self-reported tinnitus-related distress, with the impact of Type D mainly being mediated by symptoms of anxiety and depression, although Type D also exerted a direct influence on these outcomes. These findings underline that to reduce the impact of tinnitus on HRQoL and self-reported tinnitus-related distress, treatment should be directed toward reducing anxiety and depression, especially in patients with a Type D personality.

The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review

ObjectivesThis systematic review focuses on the role of the intensity of fear in patient’s delay in cancer and in myocardial infarction.MethodsIn a search of literature published between 1990 and June 2009, 161 articles were found. After the use of inclusion and exclusion criteria, 11 articles in cancer and 4 articles in myocardial infarction remained.ResultsHigh levels of fear are associated with earlier help-seeking in both diseases; for low levels of fear, the picture is unclear.ConclusionThe level of fear is an important factor, which should be taken into account when facilitating help-seeking by patients.

Fatigue in Parkinson's disease is not related to excessive sleepiness or quality of sleep

OBJECTIVES Many patients with Parkinsons disease (PD) suffer from non-motor symptoms like sleep disturbances, excessive daytime sleepiness and fatigue. The aim of our research was to explore whether fatigue is related to sleepiness and sleep problems, depression and functional status, controlled for age, gender and disease duration. METHODS The sample consisted of 78 PD patients from Eastern Slovakia (52% males, mean age 68.8+/-8.7, mean disease duration 7.2+/-6.8). The Multidimensional Fatigue Inventory (5 dimensions), the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale and the Unified Parkinsons Disease Rating Scale were used. Demographic data were obtained in a structured interview. Multiple linear regression was used to analyse the data. RESULTS Sleepiness did not show significant association with fatigue in any of the fatigue domains; neither did quality of sleep. Depression was significantly associated with all domains of fatigue, the strongest being the relationship with general fatigue (beta .42), reduced motivation (beta .39), mental fatigue (beta .35) (p<.001), and physical fatigue (beta .31) (p<.01), while the relationship with reduced activity was less strong (beta .22) (p<.05). Worse functional status was significantly related to reduced activity (beta .50), general fatigue (beta .35), physical fatigue (beta .35), and mental fatigue (beta .35) (p<.001). CONCLUSION Fatigue is not related to daytime sleepiness or night-time sleep dysfunction. Fatigue is more strongly influenced by the presence of depression and worse functional status.

Embrace, a model for integrated elderly care : study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care

BackgroundOngoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care.Methods/DesignThe CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program – combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period.DiscussionThis study could provide evidence for the effectiveness of Embrace.Trial registrationThe Netherlands National Trial Register NTR3039

Operative treatment of anterior thoracic spinal cord herniation: three new cases and an individual patient data meta-analysis of 126 case reports.

OBJECTIVE Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. METHODS An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. RESULTS Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P < 0.036). CONCLUSION Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder.

The distressed (Type D) personality is independently associated with tinnitus : A case-control study

BACKGROUND Tinnitus is a common and disturbing condition, reported by 10% to 20% of the general population. OBJECTIVE The authors sought to determine personality characteristics associated with tinnitus patients versus a control group of ear-nose-throat (ENT) patients without tinnitus. METHOD Adult chronic tinnitus sufferers (N=265) and ENT patients without tinnitus (N=265) participated in a cross-sectional study. The authors evaluated personality characteristics with tests for distressed personality (Type D), neuroticism, extraversion, and emotional stability. RESULTS As compared with control subjects, tinnitus patients had statistically significant and clinically relevant higher levels of neuroticism, negative affectivity, and social inhibition, on one hand, and lower levels of extraversion and emotional stability on the other hand. Also, tinnitus patients were more likely to have a type D personality. CONCLUSIONS Neuroticism, reduced extraversion, and reduced emotional stability were associated with tinnitus, but the level of prediction of the model improved with the addition of type D personality to the single traits. This might indicate that personality characteristics, and type D personality, in particular, are associated with having tinnitus and might contribute to its perceived severity.

Self-rated health and employment status in patients with multiple sclerosis

Purpose. The aim is to explore the association between self-rated health and employment status in patients with multiple sclerosis (MS) when controlling for age, gender, functional disability, disease duration, anxiety and depression. Method. One hundred eighty-four people with MS completed a sociodemographic questionnaire that included questions on employment status, the first item of the Short Form-36 Health Survey and the Hospital Anxiety and Depression Scale. Functional disability was assessed using the Expanded Disability Status Scale. The probability of good self-rated health in employed persons was investigated using stepwise logistic regression analyses. Results. Patients with MS who reported good self-rated health were 2.46 times more likely to be employed (95% confidence interval [CI]: 1.08–5.59). Patients without anxiety were 2.64 times more likely to be employed (95%CI: 1.23–5.67). Patients with higher EDSS scores were 0.49 times less likely to be employed (95%CI: 0.33–0.70). Age, gender, disease duration and the presence of depression did not show an increased chance of patient employment. Conclusions. Patients with MS with good self-rated health are more likely to be employed, even after adjusting for age, gender, education, functional disability, disease duration, depression and anxiety. Dependent on the findings of longitudinal studies unravelling the relevant causal pahways, self-rated health might be used as a quick and cheap prognostic marker, which could warn about the possible loss of employment, or changes in functional disability.