Health-related quality of life as predictor for mortality in patients treated with long-term mechanical ventilation.

BACKGROUND: The Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV). The aim of the present study was to examine whether SRI sum scores and related subscales are associated with mortality in LTMV patients. METHODS: The study included 112 LTMV patients (non-invasive and invasive) from the Norwegian LTMV registry in Western Norway from 2008 with follow-up in August 2014. SRI data were obtained through a postal questionnaire, whereas mortality data were obtained from the Norwegian Cause of Death Registry. The SRI questionnaire contains 49 items and seven subscales added into a summary score (range 0-100) with higher scores indicating a better HRQoL. The association between the SRI score and mortality was estimated as hazard ratios (HRs) with 95% confidence intervals (95% CI) using Cox regression models and HRs were estimated per one unit change in the SRI score. RESULTS: Of the 112 participating patients in 2008, 52 (46%) had died by August 2014. The mortality rate was the highest in patients with chronic obstructive pulmonary disease (75%), followed by patients with neuromuscular disease (46%), obesity hypoventilation syndrome (31%) and chest wall disease (25%) (p < 0.001). Higher SRI sum scores in 2008 were associated with a lower mortality risk after adjustment for age, education, hours a day on LTMV, time since initiation of LTMV, disease category and comorbidity (HR 0.98, 95% CI: 0.96-0.99). In addition, SRI-Physical Functioning (HR 0.98, 95% CI: 0.96-0.99), SRI-Psychological Well-Being (HR 0.98, 95% CI: 0.97-0.99), and SRI-Social Functioning (HR 0.98, 95% CI: 0.97-0.99) remained significant risk factors for mortality after covariate adjustment. In the subgroup analyses of patient with neuromuscular diseases we found significant inverse associations between some of the SRI subscales and mortality. CONCLUSIONS: SRI score is associated with mortality in LTMV-treated patients. We propose the use of SRI in the daily clinic with repeated measurements as part of individual follow-up. Randomized clinical trials with interventions aimed to improve HRQoL in LTMV patients should consider the SRI questionnaire as the standard HRQoL measurement.

Factors associated with change in health-related quality of life among individuals treated with long-term mechanical ventilation, a 6-year follow-up study.

AIMS: To examine changes and explanatory variables for changes in health-related quality of life in patients treated with long-term mechanical ventilation over a 6-year period. BACKGROUND: Long-term mechanical ventilation is a treatment for individuals with chronic hypercapnic respiratory failure, primarily caused by neuromuscular diseases, obesity hypoventilation syndrome, chronic obstructive pulmonary and restrictive thoracic diseases. Studies on long-term outcome on health-related quality of life and factors influencing it are lacking. DESIGN: Prospective cohort study. METHODS: Data were collected from the Norwegian Long-Term-Mechanical-Ventilation Registry and from patient-reported questionnaire in 2008 and 2014. Health-related quality of life was measured by the Severe Respiratory Insufficiency questionnaire, containing 49 items and seven subdomains. Linear mixed effects models were used to measure changes and identify factors for changes. RESULTS: After 6 years, 60 patients were still participating, out of 127 at baseline. Health-related quality of life improved significantly in the total score and in four subdomains of the questionnaire. Satisfaction with training in long-term mechanical ventilation was an explanatory variable for improved 'psychological well-being' and follow-up for improvement of 'anxiety'. Side effects of the treatment like facial soreness were associated with the total score. High age and high forced vital capacity were related to lower 'physical function' and improved 'social functioning', respectively. CONCLUSION: Long-term mechanical ventilation over 6 years improved health-related quality of life in most patients. Patient training, follow-up and reduction of side effects, largely delivered by trained nurses, contribute to achieve the main goal of the treatment-improved health-related quality of life.

Five-Year Outcomes After Vertical Sleeve Gastrectomy for Severe Obesity: A Prospective Cohort Study.

BACKGROUND: We present 5-year outcomes after vertical sleeve gastrectomy (VSG), including complications and revisions, weight change, obesity-related diseases and health-related quality of life (HRQOL). METHODS: Patients operated from December 2005 to November 2010 were included. All variables except HRQOL (obtained using Short Form-36) were assessed prospectively. HRQOL data was assessed cross-sectionally, comparing 5-year results to both a baseline cohort of severely obese patients prior to bariatric surgery and to Norwegian norms. RESULTS: Of 168 operated patients (mean age, 40.3 ± 10.5 years; 71% females), 92% completed 2-year and 82% 5-year follow-up. Re-intervention for complications occurred in four patients, whereas revision surgery was performed in six patients for weight regain and in one patient for gastroesophageal reflux disease (GERD). Mean body mass index (BMI) decreased from 46.2 ± 6.4 kg/m2 at baseline to 30.5 ± 5.8 kg/m2 at 2 years and 32.9 ± 6.1 kg/m2 at 5 years. Remission of type 2 diabetes mellitus (T2DM) and hypertension occurred in 79 and 62% at 2 years, and 63 and 60% at 5 years, respectively. The percentage of patients treated for GERD increased from 12% preoperatively to 29% at 2 years and 35% at 5 years. The physical and mental SF-36 summary scores showed significantly better HRQOL at 5 years compared with the baseline cohort, but did not reach population norms. CONCLUSION: The majority of VSG patients maintained successful weight loss and improvement of T2DM, hypertension and HRQOL at 5 years. Preventing weight regain and GERD are important considerations with this procedure.

The Norwegian version of the Severe Respiratory Insufficiency Questionnaire.

The aims of this study were to translate and adapt the Severe Respiratory Insufficiency (SRI) questionnaire into Norwegians and to test its reliability and validity.Data were collected from a cross-sectional survey and were linked to the Norwegian Registry of patients receiving long-term mechanical ventilation (LTMV). Of 193 potential participants, 127 responded to the SRI questionnaire. Reliability as measured with Cronbach's α varied between 0.68 and 0.88 for the subscales and was 0.94 for SRI-sum score. Construct validity was obtained with high correlations between subscales in SF-36 and SRI. The SRI questionnaire discriminated well between universally accepted clinical differences among categories of patients receiving LTMV by significant dissimilarities in SRI-sum score and SRI subscales. The Norwegian version of SRI has well-documented psychometric properties regarding reliability and validity. It might be used in clinical practice and in international studies for assessing health-related quality of life in patients receiving LTMV.

Translation, adaptation, validation and performance of the American Weight Efficacy Lifestyle Questionnaire Short Form (WEL-SF) to a Norwegian version: a cross-sectional study.

Background. Researchers have emphasized a need to identify predictors that can explain the variability in weight management after bariatric surgery. Eating self-efficacy has demonstrated predictive impact on patients' adherence to recommended eating habits following multidisciplinary treatment programs, but has to a limited extent been subject for research after bariatric surgery. Recently an American short form version (WEL-SF) of the commonly used Weight Efficacy Lifestyle Questionnaire (WEL) was available for research and clinical purposes. Objectives. We intended to translate and culturally adapt the WEL-SF to Norwegian conditions, and to evaluate the new versions' psychometrical properties in a Norwegian population of morbidly obese patients eligible for bariatric surgery. Design. Cross-sectional Methods. A total of 225 outpatients selected for Laparoscopic sleeve gastrectomy (LSG) were recruited; 114 non-operated and 111 operated patients, respectively. The questionnaire was translated through forward and backward procedures. Structural properties were assessed performing principal component analysis (PCA), correlation and regression analysis were conducted to evaluate convergent validity and sensitivity, respectively. Data was assessed by mean, median, item response, missing values, floor- and ceiling effect, Cronbach's alpha and alpha if item deleted. Results. The PCA resulted in one factor with eigenvalue > 1, explaining 63.0% of the variability. The WEL-SF sum scores were positively correlated with the Self-efficacy and quality of life instruments (p < 0.001). The WEL-SF was associated with body mass index (BMI) (p < 0.001) and changes in BMI (p = 0.026). A very high item response was obtained with only one missing value (0.4%). The ceiling effect was in average 0.9 and 17.1% in the non-operated and operated sample, respectively. Strong internal consistency (r = 0.92) was obtained, and Cronbach's alpha remained high (0.86-0.92) if single items were deleted. Conclusion. The Norwegian version of WEL-SF appears to be a valid questionnaire on eating self-efficacy, with acceptable psychometrical properties in a population of morbidly obese patients.

Associations between physical activity and quality of life outcomes in adults with severe obesity: a cross-sectional study prior to the beginning of a lifestyle intervention.

BACKGROUND: Severely obese individuals who seek lifestyle interventions have impaired quality of life (QoL). Research suggests that physical activity (PA) plays a role in weight reduction and improved health in this group, but knowledge about the association of PA with QoL outcomes is sparse and inconsistent. The aim of this study was to investigate whether a higher level of PA was independently associated with higher QoL in severely obese individuals prior to the beginning of a lifestyle intervention. METHODS: During 2010, a total of 49 severely obese individuals who began a lifestyle intervention programme in Western Norway agreed to participate in the study. Data were collected prior to the beginning of the intervention. QoL was measured by a one-item scale on life satisfaction and the SF-36, PA was measured by an accelerometer, and clinical data were collected by health staff. Linear regression analyses were used to determine the associations between PA and QoL outcomes (life satisfaction, physical functioning, and mental health), adjusting for age, gender, and body mass index (BMI). RESULTS: In the adjusted analyses, we found positive relationships between PA and life satisfaction (Stand. coeff. 0.39, p = 0.024) and physical functioning (Stand. coeff. 0.34, p = 0.025). There was no association between PA and mental health (Stand. coeff. 0.15, p = 0.376). CONCLUSION: This study detected associations between objectively measured PA and life satisfaction as well as physical functioning in a group of severely obese individuals before they began a lifestyle intervention programme.

Five-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch.

BACKGROUND: Long-term data of health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) procedure are lacking. The aim of this study was to evaluate changes in HRQL from baseline to 5 years after BPDDS. METHODS: Fifty morbidly obese patients were followed for 5 years after BPDDS procedure. The sample consisted of 27 women and 23 men, the mean age was 37.8 years, and the mean body mass index (BMI) was 51.7 units. HRQL was measured with the Short Form 36 questionnaire (SF-36). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed model was used to investigate the change scores. The SF-36 scores and HADS scores of the sample were also compared with a Norwegian population norm, adjusted for age, gender, and BMI. RESULTS: Mental summary scores (MCS) and physical summary scores (PCS) were very low preoperatively but significantly improved (P < 0.05) 5 years after surgery. The PCS was comparable to the population norm, while MCS was lower. Depression improved significantly from baseline to the 5-year follow-up (P = 0.004), but anxiety did not (P = 0.595). CONCLUSIONS: This study demonstrates a sustained weight loss and improved, although somewhat fading, HRQL scores 5 years after BPDDS. The study also shows that BPDDS is associated with a sustained reduction in depression symptoms but not in anxiety symptoms.

Validity of the SF-36 in patients with morbid obesity.

BACKGROUND: The Medical Outcome Study 36-Item Short Form Health Survey (SF-36) is one of the most commonly applied generic quality of life instruments. The construct validity of the instrument in patients with morbid obesity is not established. PARTICIPANTS AND METHODS: A total of 475 morbidly obese patients (68% women) with a mean (standard deviation) age of 44.7 (11.8) years, weight of 123.5 (24.1) kg and BMI of 41.7 (6.3) kg/m(2), who had been referred to a rehabilitation center, completed the SF-36 form. Exploratory factor analyses were performed to examine the underlying component structure of the questionnaire. Confirmatory factor analyses were performed to assess model fit. RESULTS: The analysis suggested a 6-component structure rather than the 8-component structure used in the original SF-36. The first component consisted of items from the physical functioning subscale, the role physical subscale and the general health subscale, and explained 31% of the variance. The 6 components explained 61% of the total variance. The items loaded as expected in a physical and mental component. The assessment of model fit confirmed these findings. CONCLUSION: The 2 summary scales of the SF-36 have satisfactory validity in patients with morbid obesity. However, the validity of the 8 subscales is questionable, and the subscales should be interpreted with care.