Eva Lydick

The economic cost of hip fractures in community-dwelling older adults: A prospective study

OBJECTIVES: To evaluate the incremental cost in the year after hip fracture.

Development and Validation of a Discriminative Quality of Life Questionnaire for Osteoporosis (The OPTQoL)

We report the development and validation of an osteoporosis‐targeted quality of life questionnaire to measure the impact of the disease in the general population. From multiple focus groups with women with osteoporosis, healthy women at risk for osteoporosis, spouses and relatives of women with osteoporosis, and health care providers, we identified over 300 potential items related to the disease. A lengthy questionnaire incorporated these items and was administered to a second large study cohort of 222 women with clinical osteoporosis (history of fracture, significant height loss, and/or kyphosis); 101 women with known low bone mineral density levels that would categorize them as osteoporotic but who had not yet shown obvious physical manifestations of the disease; and 142 women with other conditions (such as arthritis, cancer, depression) expected to also have an impact on quality of life. Final items from among the original 300 were chosen for their demonstrated relationship with osteoporosis as measured by clinical manifestations and low bone density and with quality of life measured by a standard generic questionnaire, the SF‐36. The final questionnaire contains 26 scored items in three domains—physical activity, adaptations, and fears—and six nonscored questions relating to osteoporotic changes and diagnosis. This instrument is unique among osteoporosis‐targeted questionnaires in that it attempts to measure the total impact of the disease on quality of life within a population at a single point in time.

Vasectomy and the risk of prostate cancer in a cohort of multiphasic health-checkup examinees: second report.

The relationship of vasectomy to prostate cancer was studied in 5,119 men with a self-reported history of vasectomy, identified at multiphasic health checkups undergone during 1977–82 while members of the Northern California Kaiser Permanente Medical Care Program. Three unvasectomized comparison subjects were identified for each vasectomized man, matched for age, race, marital status, and date and location of the examination. Follow-up for incident prostate cancer was conducted for a mean length of 6.8 years. The relative risk of prostate cancer associated with vasectomy was 1.0 (95% confidence interval = 0.7–1.6); the relative risk was approximately one, regardless of length of interval (less than 10 years, 10–20 years, more than 20 years) between vasectomy and multiphasic health checkup or the age at vasectomy (less than 40 years vs more than 40 years). These data support earlier findings reported in this study group of the lack of an association of vasectomy with subsequent risk of prostate cancer.

Reliability of an osteoporosis-targeted quality of life survey instrument for use in the community : OPTQoL

A brief Osteoporosis-Targeted Quality of Life (OPTQoL) questionnaire was previously developed as a cross-sectional survey instrument to assess the community impact of osteoporosis on quality of life in women. The initial development process involving item generation through focus groups, item reduction, and content and construct validation yielded a 36-item questionnaire with three domains (physical difficulty, adaptations and fears) and 10 health-related questions. In the present study, test-retest reliability and internal consistency of the questionnaire were assessed in a mail-based study with two clinical sites. Two hundred women (50 with severe osteoporosis, 50 with osteopenia, 50 with normal bone mineral density (BMD) and 50 with osteoarthritis and normal BMD), aged 43–84 years, completed the self-administered questionnaire initially and again about 2 weeks later. Using weighted kappas, agreement between questionnaire administrations ranged from 0.60 to 0.80 for most of the individual items. Intraclass correlation coefficients to assess reliability for the domain scores were 0.93 (physical difficulty), 0.82 (adaptations) and 0.88 (fears). Internal consistency of each of the domains was also high, with Cronbach’s alpha coefficients ranging from 0.89 to 0.91. Four items were dropped from the 36-item questionnaire due to high percentage of ‘not applicable’ responses. Results of the analyses support the validity and reliability of this instrument as a cross-sectional survey tool for assessing the impact of osteoporosis on quality of life in women living in the community. The questionnaire has been translated and culturally adapted into seven languages to allow cross-cultural studies of the community impact of osteoporosis.

Impact of fears on quality of life in patients with a silent disease: osteoporosis☆

Fears and apprehensions are often cited as contributing to decreased quality of life; however, questions relating to worry over the future are rarely included in generic quality-of-life questionnaires. We report an effort to quantify the effect of fear on quality-of-life domains as measured by using the Short-Form 36 (SF-36) Health Survey. In the course of developing an osteoporosis-targeted quality-of-life (OPTQoL) questionnaire, we asked participants to complete the SF-36 Health Survey and another questionnaire containing items that women with osteoporosis could be expected to find difficult or worrisome. Two hundred twenty-two women with established osteoporosis (loss of height, kyphosis, history of fractures); 101 women with known low bone mineral density (BMD) but without established osteoporosis; and 142 women with no known osteoporosis completed both the osteoporosis questionnaire and the SF-36 Health Survey. This test version of the OPTQoL contained two domains for fears of osteoporosis and the consequent fractures and deformities; these domains were termed fears now and fears future. After adjusting for age and selected comorbidities, we estimated the additional contribution of the two fears domains on the domain scores of the SF-36 Health Survey. For women with established osteoporosis, the fears now domain explained 4% to 8% of the variance within each domain of the survey. For women with low BMD only, fears now had a significant effect only on the physical functioning domain of the survey and explained 4% of the variance of that domain. Fears future had a significant role in explaining the SF-36 Health Survey score on all domains except physical functioning among women with established osteoporosis; however, the fears future domain explained less of the variance (2% to 5%) among these women than did the fears now domain. For women with low BMD only, fears future had a significant impact only on the mental health and the general health domains (4% and 5% of the variance, respectively). Osteoporosis-related fears appear to explain a small but significant percentage of the variation in quality of life for women in midlife.

Fears, Knowledge, and Perceptions of Osteoporosis among Women

In an effort to quantify the effect of osteoporosis on the quality of life (QOL) of all women, a study was undertaken to develop an osteoporosis-targeted QOL questionnaire. The results presented refer to information obtained from 465 women during the item reduction phase and seem to indicate that nonosteoporotic as well as osteoporotic women are affected by the implications of the disease. The majority of women, whether osteoporotic or not, expressed fears of future fractures and future limitations due to the disease. Nearly 48% of nonosteoporotic women reported some fear of future limitations due to osteoporosis, while 53% of this group reported at least occasionally being afraid of falling. Many expressed feelings of dissatisfaction with health care professionals regarding the education, treatment, and communication available on osteoporosis. Clearly, physicians need to be aware of the lack of understanding and fears regarding osteoporosis among their patients. Education of all women, young and old, regarding the disease and diagnostic and therapeutic interventions is essential. Physicians should adequately assess and address their patients fears and concerns regarding osteoporosis and its future impact.

ITEM GENERATION FOR QUESTIONNAIRES: THE MEDIUM MAY DETERMINE THE MESSAGE

The first phase in the construction of a quality of life questionnaire is usually compiling a set of potential items for inclusion in the questionnaire. The preferred method of item generation is, inmost cases, direct solicitation from individuals, usually from focus groups or semistructured interviews. The authors experience in developing a disease-specific questionnaire for osteoporosis in which the same women were asked to respond in both settings resulted in unique items from both. The type of items and the problems that women were willing to express differed, however, between the two modes. Investigators may want to employ both individual and group interviews in order to identify as many quality of life deficits as possible.

Introduction to Abstracts: Quality of Life Evaluation Symposium

The symposium highlighted major accomxad plishments and issues currently facing the field of health-related quality of life (QOL) research. Interest in this area is cerxad tain to intensify in the future. Health care reform will require greater accountability, emphasizing the need for quality of life measures as well as clinical, safety, and economic outcomes for evaluating health care delivery. Further research on methodxad ology, validation of instruments, analysis, and interpretation of data, and applicaxad tions of QOL measures to the study of pharmaceutical agents will likely lead to development of guidelines for use of these data in registrations around the globe. As more experience in interpreting QOL outxad comes is gained, clinicians, health care managers, and patients will appreciate, and perhaps demand, this information for use in selecting alternative treatments. There is an obvious need to continue the exchange of information and research exxad perience in QOL research, in the form of publications and future meetings. The program committee wishes to thank all of the presenters and session chairs for their significant contributions to the Charleston program. Copies of the abxad stracts are printed in this issue of the Drug Information Journal.