Samantha C. Sodergren

Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales

We constructed a new type of global quality of life (QOL) scale deriving from the Borg symptom scales and compared four versions of this new type of scale (H scale) with four category rating (CR) scales and four visual analogue (VA) scales. Mean self-ratings and mean scenario ratings on different scales showed small but significant differences, and intercorrelations were higher amongst the H scales than amongst the CR or VA scales. H scales were on average most preferred (by undergraduates and elderly subjects) followed by CR and lastly VA scales in terms of ease of use and perceived accuracy of representation. We investigated the preferred polarity of the scales: subjects preferred ‘Perfect quality of life’ to be indicated by 20 or 100 (with slight preference for the latter) rather than 0. The H scales have eight additional quantifiers between the end labels and there was good agreement about the perceived magnitude of these quantitiers.

What are the positive consequences of illness

Abstract Fifty five people, either currently sick or having recovered from their illness, were recruited if they reported positive consequences of illness. They were questioned about their experiences of illness, 41 by semi-structured interview and 14 by open-ended questionnaire and responses were classified into 17 categories. The categories were similar but slightly more extensive than previous accounts of positive consequences reported in the literature. The content of the interviews and questionnaires was used to construct a 66 item questionnaire about positive consequences of illness which was then completed by 97 patients. A principal components analysis indicated a large first factor accounting for 27% of the variance. Endorsement of items varied between 87% and zero for chronic lung disease patients attending pulmonary rehabilitation. However, all patients endorsed at least one item and the median number of items endorsed was 31. Positive consequences of illness are highly varied and more common than often realised, and this has implications for the concept and measurement of quality of life.

Development of a Shortened Version of the Breathing Problems Questionnaire Suitable for Use in a Pulmonary Rehabilitation Clinic: A Purpose-Specific, Disease-Specific Questionnaire

One hundred and thirty-eight chronic obstructive pulmonary disease (COPD) patients completed the Breathing Problems Questionnaire (BPQ) before and after a comprehensive programme of rehabilitation. Examination of the changes on individual items showed improvement on 22 items, of which four items were significant at p < 0.05 and deterioration on nine items, of which two were significant at p < 0.01. All deteriorating items were consistent with lifestyle adaptations encouraged as part of the rehabilitation programme. We examined the psychometric properties of a reduced ten item version of the BPQ limited to the items most sensitive to change. We recommend the purpose-specific, disease-specific COPD scale for measuring change in pulmonary rehabilitation assessment in contrast to the longer 33 item questionnaire, which, however, may be more useful for cross-sectional assessment.

Positivity in illness: self-delusion or existential growth?

OBJECTIVES This study investigated the relationship between a measure of positivity in illness, the Silver Lining Questionnaire (SLQ), and measures of personality and spirituality/religious beliefs as a way of determining whether positivity in illness is a delusion or existential growth. METHOD This is a cross-sectional study comparing response to the SLQ, to the Eysenck Personality Questionnaire (EPQ-R), breathlessness, illness type, and spiritual and religious beliefs in a final total sample of 194 respiratory outpatients. RESULTS The SLQ was associated positively with extraversion (r =.16, p<.05), unrelated to neuroticism (r =.11, n.s.) and repression (r =.10, n.s.) and was positively associated with spiritual and religious beliefs, F(2; 187) = 7.12, p < 001, as predicted by the existential growth but not the delusion interpretation. There was no relationship between positivity and age, r(194) =.09, n.s., or between positivity and gender t(192) = -1.27, n.s., and nor were there relationships with type of illness, F(4, 188) = 2.17, n.s., or breathlessness, F (5, 173) = 0.42, n.s. CONCLUSIONS The results suggest that positivity in illness is associated with existential growth, though the cross-sectional nature of the study precludes a conclusion of causal direction. The non-significant correlation between the SLQ and neuroticism is in the opposite direction predicted by the delusion explanation, but the non-significant relationship between the SLQ and repression is in the predicted direction. We cannot rule out the possibility that some positivity is delusion.

Prospective double-blind randomized study comparing Perfix® plug-and-patch with Lichtenstein patch in inguinal hernia repair: one year quality of life results

SummaryBackgroundThe 14 day results of this study reported elsewhere demonstrated that the Perfix® plug-and-patch was as effective as the Lichtenstein patch but not as cost-effective. The present analysis looks at the results at one year to measure quality of life between the two groups.Patients and Methods141 patients were randomly allocated in a doubleblind manner to receive either a Lichtenstein patch (patch) or a Perfix® plug- and-patch (plug-and-patch) for primary inguinal hernia. Quality of life at 6 months and one year was assessed by the short-form 36 (SF36). On a 3 point scale patients were asked at one year to rate groin, wound and testicular discomfort.ResultsPhysical function by SF36 was similar in the 2 groups at 6 months, but at one year in the patch group (95.11 +/-20.07) was significantly better (p < 0.05) than physical function in the plug-and-patch group (82.5 ± 20.98). At one year the number of patients with wound discomfort limiting work or social activities was significantly greater in patients receiving the plug-and-patch (n = 12) compared with patients receiving the patch (n = 4), p < 0.031. At one year, 4 of 70 patients receiving the plug-and-patch had required reoperation to remove the preformed plug-and-patch device and replace it with a flat Lichtenstein patch, because of wound pain which was limiting activity.ConclusionA significant proportion of patients suffer chronic pain after placement of a Perfix® plug-and-patch for primary inguinal hernia repair. Removal of the Perfix® device is required in approximately i in 20 patients (5.6% in this series).

The Effect of Rehabilitation on Positive Interpretations of Illness

This study investigated changes in positive perceptions of illness following rehabilitation. Patients completed the 38 positive-item Silver Lining Questionnaire (SLQ) on two occasions: 20 chronic obstructive pulmonary disease (COPD) patients on entry to a waiting list and at the start of rehabilitation; 35 COPD and 29 cardiac patients at the start and end of a rehabilitation programme. At first assessment, on average, between seven and 13 items were endorsed depending on group. Positivity increased after rehabilitation for COPD patients ( p <0.01), and cardiac patients ( p <0.001): on average three and four additional items were endorsed respectively. There was no change in positivity for patients on the waiting list. The data suggest that rehabilitation leads to an increase in perceived positive consequences of illness.

Variety of activity: relationship with health status demographic variables and global quality of life.

This paper describes the impact of health and demographic variables on the variety of reported activity as measured by a positive activity checklist. In a sample of 360 people drawn from the general population total activity scores were related to subjective health status age education and economic status but not to gender or home ownership. In a sample of 52 patients with chronic obstructive pulmonary disease (COPD) patients reported lower total activity scores than the population equivalent and total activity score correlated with physiological parameters of disease. In the COPD sample total activity score also correlated with global quality of life (QOL) and a disease-specific QOL scale: however the pattern of correlations between either form of assessment and other subjective and objective assessments was different. Total activity score was comparatively more closely related to physiological parameters associated with COPD morbidity whereas QOL was comparatively more influenced by perceived health status. A persons ability to engage in a variety of activities is restricted by poor health and some demographic variables. (authors)

Chronic Fatigue Syndrome The Role of Positivity to Illness in Chronic Fatigue Syndrome Patients

Fifty-three chronic fatigue syndrome patients treated at a complementary medical centre were assessed over 12 months. Measures included the Chalder Fatigue scale, the General Health Questionnaire (GHQ) and positivity in illness (Silver Lining Questionnaire, SLQ). The SLQ measured at 6 and 9 months predicted (p < .01) mental (but not physical) fatigue at 12 months independently of current mental fatigue, initial mental fatigue, duration since diagnosis and time between start of treatment and entry to the study. The GHQ did not predict fatigue at any time point. The results suggest that a caring therapeutic intervention increases positive interpretations of illness prior to improvements in mental fatigue, but that positivity does not play a causal role in the reduction of fatigue.