Irena Senečić-Čala

The IMPACT-III (HR) Questionnaire: A valid measure of health-related quality of life in Croatian children with inflammatory bowel disease

BACKGROUND AND AIMS To assess the reliability and validity of IMPACT-III (HR), a disease-specific, health-related quality of life instrument in Croatian children with inflammatory bowel disease. METHODS In a multicenter study, 104 children participated in a validation study of IMPACT-III (HR) cross-culturally adapted for Croatia. Factor analysis was used to determine optimal domain structure for this cohort, analysis of Cronbachs alpha coefficients to test internal reliability, ANOVA to assess discriminant validity, and correlation with Pediatric Quality of Life Inventory, Version 4.0 (PedsQL) using Pearson correlation coefficients to assess concurrent validity. RESULTS Cronbachs alpha for the IMPACT-III (HR) total score was 0.92. The most robust factor solution was a 5-domain structure: Symptoms, Concerns, Socializing, Body Image, and Worry about Stool, all of which demonstrated good internal reliability (α=0.60-0.89), but two items were dropped to achieve this. Discriminant validity was demonstrated by significant differences (P<0.001) in mean IMPACT-III (HR) scores between quiescent and mild or moderate-severe disease activity groups for total (148 vs. 139 or 125) and following factor scores: Symptoms (84 vs. 71 or 61), Socializing (91 vs. 83 or 76), and Worry about Stool (significant only between quiescent and moderate-severe groups, 90 vs. 62, respectively). Concurrent validity of IMPACT-III (HR) with PedsQL showed significant correlation, which was strongest when similar domains were compared. CONCLUSION IMPACT-III (HR) appears to be useful tool to measure health-related quality of life in Croatian children with Crohns disease and ulcerative colitis.

Short health scale: a valid, reliable, and responsive measure of health-related quality of life in children with inflammatory bowel disease.

Background:Inflammatory bowel disease (IBD) presents a growing medical and epidemiological problem. In respect to patients, health-related quality of life (HRQOL) emerged as informative means to evaluate the impact of disease burden on health. The Short Health Scale (SHS), a disease-specific HRQOL instrument with only 4 questions (symptoms, functioning, worry, and general well-being), was demonstrated as valid, reliable, and responsive in adults. Aim of this study was to assess its psychometric properties in children with IBD. Methods:In a multicentric prospective study, HRQOL was assessed in 104 children with IBD by generic (PedsQL) and disease-specific questionnaires (IMPACT-III (HR) and SHS), which were cross-culturally adapted for Croatian. Forty-one patients completed the questionnaires at the second visit 6 to 12 months later. Of them, 27 patients changed from remission to active disease or vice versa and were included in responsiveness to change analysis. Results:Patients in remission had significantly better scores for symptoms (P = 0.022) and functioning (P = 0.003) than those with active disease. Each of the 4 SHS questions was strongly correlated with the corresponding dimensions of PedsQL and IMPACT-III (HR) questionnaires (rs = 0.50–0.72, P < 0.001). Reliability was confirmed with Cronbachs &agr; = 0.74. Patients who changed from remission to active disease or vice versa showed significant change in following SHS scores: symptoms (P = 0.032), functioning (P = 0.008), and worry (P = 0.021). Conclusions:SHS appears to be valid, reliable, and responsive tool to measure HRQOL in children with IBD. Simplicity of use, compactness, and the possibility of immediate interpretation make SHS well suited for both clinical practice and research studies.

Resistance index in mural arteries of thickened bowel wall: predictive value for Crohn disease activity assessment in pediatric patients

SummaryObjectiveTo define reliable Doppler parameters in mural arteries of affected bowel loops for quantitative assessment of Crohn disease (CD) activity in pediatric population and compare Doppler parameters with Pediatric Crohn Disease Activity Index (PCDAI).Patients and methodsThirty-four pediatric patients (7 with inactive, 27 with active disease of different severity; 13 male and 21 female; mean age 13; range 7–18) with CD were prospectively evaluated by Doppler ultrasound (DUS) of affected bowel segments. Using semiquantitative color and power Doppler assessment of vascularization of thickened bowel wall and mesentery, patients were divided in four grades. Spectral measurements (peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI)) of mural arteries were compared with PCDAI.ResultsThere was a significant difference in distribution of semiquantitative color values between inactive and active group. PSV and EDV values showed no significant difference between inactive and active group, while mean RI was significantly higher in the inactive group. RI was also significantly negatively correlated with PCDAI.ConclusionIntensity of color and power Doppler signals and RI measurement of mural arteries in thickened bowel wall is linked to CD activity and therefore might be of use in pediatric patients.ZusammenfassungZielDas Ziel dieser Studie war es, die zuverlässigen Doppler-Parameter in den intramularen Arterien der betroffenen Darmschlingen zur quantitativen Bewertung der Aktivität des Morbus Crohn (CD) bei der pädiatrischen Population zu definieren und die Doppler-Parameter mit dem pädiatrischem Morbus Crohn Aktivitätsindex (PCDAI) zu vergleichen.Patienten und MethodenDer Zustand von 34 pädiatrischen Patienten (7 mit inaktiver, 27 mit aktiver Erkrankung unterschiedlichen Schweregrades, 13 männliche und 21 weibliche, Alter 7–18, Durschnittsalter 13) mit M. Crohn wurde prospektiv anhand des Doppler-Ultraschall (DUS) betroffener Darmsegmente ausgewertet. Anhand der semi-quantitativen Farb- und Power-Doppler-Beurteilung der Vaskularisation der verdickten Darmwand und des Mesenteriums wurden die Patienten in 4 Gruppen unterteilt. Die spektrale Messungen (die maximale systolische Strömungsgeschwindigkeit – PSV, die enddiastolische Strömungsgeschwindigkeit – EDV, der Resistance-Index – RI) intramuraler Arterien wurden mit PCDAI verglichen.ErgebnisseEs bestand ein signifikanter Unterschied in der Verteilung der semi-quantitativen Farbwerte zwischen der inaktiven und aktiven Gruppe. PSV und EDV-Werte zeigten keinen signifikanten Unterschied zwischen der inaktiven und der aktiven Gruppe, während der mittlere RI in der inaktiven Gruppe signifikant höher war. Der RI war ebenfalls signifikant negativ mit dem PCDAI korreliert.SchlussfolgerungDie Intensität der Farb- und Power-Doppler-Signale und die RI-Messung in den intramuralen Arterien der verdickten Darmwand stehen im Zusammenhang mit der Aktivität des Morbus Crohn und können daher bei pädiatrischen Patienten von Nutzen sein.