J.M. Quintana

The health-related quality of life in eating disorders.

Objective: This study investigated the perception of health-related quality of life (HRQoL) in ambulatory patients with eating disorders in relation to the severity of eating symptomatology and psychological comorbidity. Methods: One hundred ninety-seven study patients were consecutively recruited at the Eating Disorders Outpatient Clinic. Short Form-36 items (SF-36), a generic HRQoL questionnaire, the Eating Attitudes Test (EAT-40), and the Hospital Anxiety and Depression Scale (HAD) were used to measure different aspects of HRQoL. The results of the SF-36 were compared with the norms of the Spanish general population for women 18–34 years of age. Results: Patients with eating disorders were more dysfunctional in all areas of the SF-36 compared with women in the general population. There were no differences among the eating disorder diagnostic groups. Higher scores on the EAT-40 and the HAD were associated with a perception of greater impairment on all SF-36 subscales. Conclusion: The evaluation of HRQoL in these patients confirms the impact of these disorders on daily life in areas not directly related to eating disorders. The SF-36 is useful for discriminating among different levels of severity of eating disorders and other psychological comorbidities of these patients.

Changes in health related quality of life among patients treated for eating disorders

Objective: To prospectively investigate changes in the perception of health-related quality of life (HRQoL) among eating disorder patients after 2 years of treatment and follow-up and clinical predictors of change. Method: One hundred and thirty-one consecutive subjects were recruited from an eating disorder outpatient clinic. Subjects completed a generic HRQoL questionnaire, the Short Form-36 (SF-36), as well as the Eating Attitudes Test (EAT-40) to measure symptom severity and the Hospital Anxiety and Depression scale (HAD), at the first visit and after 24 months. Results: Perception of HRQoL, measured by the SF-36, showed significant improvement in all but the role emotional domain after 2 years. The greatest improvements were observed in the physical function and social function domains, followed by mental health and vitality. Despite significant improvement in the summary mental health scale, scores after 2 years of treatment and follow-up were still below normative population values of women aged 18–34. Severity of eating disorder symptoms and presence of anxiety or depression at baseline significantly affected improvement in various SF-36 domains. Conclusions: Despite improvements in perception of HRQoL, eating disorder patients were more dysfunctional in all domains of the SF-36 even after 2 years of treatment and follow-up compared with women in the general population, and the severity of eating disorder symptoms was correlated with degree of dysfunction.

Burden of caregiving amongst family caregivers of patients with eating disorders.

BackgroundEating disorders (EDs) in a close relative can be particularly stressful for family members.AimsTo assess the perceived burden of caregivers of patients with EDs and to identify demographic and clinical variables that could predict this burden.MethodWe conducted a cross-sectional study involving 145 ED patients and 246 related caregivers. ED patients completed the Health-Related Quality of Life in ED-short form, the Hospital Anxiety and Depression Scale, and the Short Form-12. Caregivers completed the Involvement Evaluation Questionnaire-EU version, the Short Form-12, the Hospital Anxiety and Depression Scale, and the Anorectic Behaviour Observation Scale. Descriptive statistics, ANOVA, Chi-square, and Fisher’s exact test were applied to examine the inter-variable relationships.ResultsA high burden of caregiving was associated with being divorced (βxa0=xa014.23, SExa0=xa03.88; pxa0=xa00.001), having a low level of education (βxa0=xa04.70, SExa0=xa01.96; pxa0=xa00.02), having high levels of anxiety (βxa0=xa05.45, SExa0=xa02.13; pxa0=xa00.01) or depression (βxa0=xa05.74, SExa0=xa02.80; pxa0=xa00.04), and caring for a relative with a low physical quality of life (βxa0=xa05.91, SExa0=xa01.78; pxa0=xa00.002).ConclusionsEvaluating family caregivers of patients with ED for risk factors for increased caregiver burden and offering them assistance could reduce their perceived burden of caregiving.

Total knee replacement; minimal clinically important differences and responders

OBJECTIVEnTo provide new data on minimally clinical important difference (MCID) and percentages of responders on pain and functional dimensions of Western Ontario and McMaster Osteoarthritis Index (WOMAC) in patients who have undergone total knee replacement (TKR).nnnMETHODSn1-year prospective multicentre study with two different cohorts. Consecutive patients on the waiting list were recruited. There were 415 and 497 patients included. Pain and function were collected by the reverse scoring option of the WOMAC (0-100, worst to best). Transition items (five point scale) were collected at 1-year and MCID was calculated through mean change in patients somewhat better, Receiver Operating Characteristic (ROC) and two other questions about satisfaction. Analysis was performed in the whole sample and by tertiles of baseline severity. Likewise were calculated the percentages of patients who attained cut-off values.nnnRESULTSnGlobal MCID for pain were about 30 in both cohorts and 32 for. By ROC these values were about 20 and 24 respectively. According to the other two transitional questions these values were for pain 27 and 20 for function. By tertiles the worst the baseline score the higher the cut-off values. Percentage of responders does not change when comparing responders to the global MCID with their own tertile MCID and were about 61% for pain and 50% for function.nnnCONCLUSIONnDue to the wide variations, MCID estimates should be calculated and used according to the baseline severity score.

Assessment of the impact of eating disorders on quality of life using the disease-specific, Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire

ObjectiveTo evaluate and compare the quality of life (QOL) in patients with eating disorders (ED) and general population, using the disease-specific Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire.MethodsA total of 358 patients with ED completed the HeRQoLED questionnaire as well as the SF-12 and the Eating Attitudes Test (EAT-26) at baseline; 273 patients completed the same instruments after 1xa0year of multidisciplinary treatment. A total of 305 individuals recruited from the general population completed the HeRQoLED once. Comparison of means was used to assess change. Multivariate models were created to determine variables predictive of change in HeRQoLED scores.ResultsPatients with anorexia nervosa had higher baseline scores (indicating worse perception of QOL) on the HeRQoLED questionnaire and experienced smaller improvements than patients with other diagnoses after 1xa0year of treatment. After adjustment by relevant variables, body-mass index (BMI) and EAT-26 scores were associated with changes in QOL. SF-12 scores showed significant improvement in the physical health component but not in mental health. General population had lower baseline scores on the HeRQoLED.ConclusionsAs measured by the disease-specific HeRQoLED and generic instruments, QOL in patients with ED improved after 1xa0year of treatment, though it did not reach the values of the general population.

Quality of life among caregivers of patients with eating disorders

PurposeTo analyse health-related quality of life (HRQoL) and its associated social and clinical variables among a sample of caregivers of patients with eating disorders (ED).MethodsIt is a cross-sectional study involving 145 patients receiving outpatient treatment for an ED and 246 related caregivers. ED patients completed two self-administered questionnaires: the Health-Related Quality of Life in ED-short form and Eating Attitudes Test-26 questionnaires. Caregivers completed four self-administered questionnaires: the Short Form-12, Involvement Evaluation Questionnaire-EU version, Hospital Anxiety and Depression Scale and Anorectic Behaviour Observation Scale. Descriptive statistics, ANOVA, Chi-square and Fisher’s exact test were applied to examine the inter-variable relationships.ResultsCaregivers had low scores on the mental health component of the SF-12 (Pxa0<xa00.05). Low SF-12 scores were associated with a greater perceived care burden in the stress domains in interpersonal relationships (betaxa0=xa0−0.360, SExa0=xa00.162, Pxa0=xa00.029) and the need to urge their sick relatives to undertake healthful activities (betaxa0=xa0−0.340, SExa0=xa00.155, Pxa0=xa00.031).ConclusionsLow scores in the mental health domain of HRQoL among caregivers of patients with EDs indicate the need to pay particular attention to caregivers’ emotional status, especially among mothers and partners.

Prevalence of symptoms of knee or hip joints in older adults from the general population

Background and aims: The prevalence of knee and hip symptoms varies from study to study, or is unknown. The goals of this study were to determine the prevalence of these symptoms, of diagnosed osteoarthritis and the use of prostheses, by age and gender, in a sample of the general older population. Methods: We mailed a questionnaire to 11,002 people aged 60 to 90 years who were selected by stratified random sampling. The questionnaire included questions on pain, functional limitations, diagnosed osteoarthritis, previous operations on either or both joints, and sociodemographic data. Descriptive statistics were performed. Results: From 10,150 people who fulfilled the selection criteria, 74.6% answered the questionnaire. Up to 49.2% of the subjects reported pain in either knee or hip or both, with pain in the knee reported more frequently (38.3%) than the hip (23.8%). Functional limitations were present in 51.6% of respondents, with 42.5% having limitations in the knees and 27.7% in the hips. The symptoms increased with age and were more prevalent in women. About 6.6% of respondents reported that they had already had prosthesis implant (hip 3.9%; knee 2.6%). The presence of a hip prosthesis was slightly lower in women than in men and more women had a knee prosthesis. Physicians had already diagnosed osteoarthritis in 38.5% of the sample, 19.4% of the hip and 31% of the knee. Conclusions: The prevalence of pain symptoms is relatively high among older people, more often in the knee and, in both pints, more often in women, but the rate of prosthetic surgeries was low, which means that additional studies are necessary to gain insight into the healthcare needs of the population.

A randomized controlled trial of a 10 week group psychotherapeutic treatment added to standard medical treatment in patients with functional dyspepsia.

OBJECTIVEnEpidemiological evidence suggests an association between psychological factors and functional dyspepsia (FD). Yet few randomized controlled trials (RCTs) of psychological interventions have been conducted for FD. We conducted an RCT to evaluate the efficacy of psychotherapy among chronic FD.nnnMETHODSnOne hundred fifty-eight consecutive patients with FD were randomized to medical therapy plus psychotherapy consisted in 8 group and 2 individual sessions focused on teaching techniques for coping with FD (intensive treatment (IT); n=76) or medical therapy alone (conventional treatment (CT); n=82). Patients completed validated self-reported questionnaires before and after the 10-week treatment and 6 months later. Linear mixed-effects models were used, in intention-to-treat analysis.nnnRESULTSnAt the end of treatment period, statistically significant improvements were observed for IT compared with CT for dyspepsia-related quality of life (DRQoL). DRQoL mean changes of 6.09 and 3.54 were obtained in IT and CT patients, respectively (p=<0.0001); and SS mean changes of 11.55 and 4.57 were obtained in IT and CT patients, respectively (p=0.0013). Those improvements, measured by minimum clinically important difference (MCID), were clinically significant (DRQoL: 77% of the IT patients exceeded the MCID vs. the 45% of the CT; SS: 75% vs. 48%). Six months after treatment, those statistically significant improvements persisted for DRQoL (p=0.0067) and for SS (p=0.0405). Clinical improvements persisted for SS (63% vs. 41%).nnnCONCLUSIONSnThese findings suggest that adding psychotherapy to standard medical therapy improves short-term outcomes in patients with FD and may have long-term effects as well. The cost-effectiveness of intensive therapy needs to be evaluated. Registration number and name of trial registry: NCT01802710.

Waiting list management: priority criteria or first-in first-out? A case for total joint replacement.

BACKGROUNDnTotal joint replacements are interventions with large waiting times from indication to the surgery management. These patients can be managed in two ways; first-in first-out or through a priority tool. The aim of this study was to compare real time on waiting list (TWL) with a priority criteria score, developed by our team, in patients awaiting joint replacement due to osteoarthritis.nnnMETHODSnConsecutive patients placed on waiting list were eligible. Patients fulfilled a questionnaire which included items of our priority tool and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) specific questionnaire. Other priority items were extracted from the clinical history. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the differences among categories and TWL by means of one-way analysis of variance. Correlational analysis was used to evaluate association among priority score and TWL and WOMAC baseline and gains at 6 months with priority score and TWL.nnnRESULTSnWe have studied 684 patients. Women represented 62% of sample. The mean age was 70 years. There were not association between the categories of priority score and TWL (P = 0.12). The rho correlation coefficient between TWL and priority score was -0.11. Among baseline WOMAC scores and priority score, the rho coefficients were 0.79, 0.7 and 0.52 with function, pain and stiffness dimensions, respectively. There were differences in the mean scores of WOMAC dimensions according to the three priority categories (P < 0.001) but no with TWL categories. Data of gains in both health-related quality of life dimensions at 6 months were similar, with differences according to priority categories but no regarding TWL.nnnCONCLUSIONSnThe results of the study support the necessity of implementing a prioritization system instead of the actual system if we want to manage the waiting list for joint replacement with clinical equity.

Predictors of change in perceived burden among caregivers of patients with eating disorders.

BACKGROUNDnLittle is known about whether the perceived burden of caring for someone with an eating disorder (ED) changes over time or what may predict such change.nnnMETHODSnIn this prospective study of ED patients and their caregivers, caregivers answered the Involvement Evaluation Questionnaire - EU Version (IEQ-EU), the Hospital Anxiety and Depression Scale (HADS), the SF-12, and the Anorectic Behaviour Observation Scale (ABOS) at baseline and after one and two years of follow-up. On the same schedule, patients answered the HADS and the SF-12, as well as the Eating Attitudes Test (EAT-26) and the Health-Related Quality of Life in ED - short form (HeRQoLED-s). The psychiatrists assessed ED severity using the Clinical Global Impressions (CGI) scale.nnnRESULTSnPerceived caregiver burden significantly improved over the first year of follow-up; no further improvement was observed with longer follow-up. Reduction in perceived burden was associated with lower anxiety in caregivers and patients, and lower caregivers perception of the severity of the patients ED. With a decrease in patients depressive symptoms, caregivers felt less need to urge them to carry out activities of self-care.nnnLIMITATIONSnThe IEQ-EU evaluates burden of caring in psychosis and mood disorders, but not for EDs. Loss of participants during the study could limit the generalization of results for the second year of follow-up.nnnCONCLUSIONSnThese data corroborate the need to monitor the health of caregivers of ED patients and provide them with tools to manage the consequences of these disorders, because these consequences can determine the burden perception independent of patients symptoms.