Abstract: Quality of Life of Children and Adolescents in Inpatient Rehabilitation Introduction: Health related quality of life (QoL) has been discussed as relevant criterion to assess well-being and function in children with chronic health conditions. The aim the study presented was to confirmatorily test the psychometric properties of the revised version of the German KINDL questionnaire and to exploratorily inspect the course of rehabilitation with regard to QoL in three groups of chronically ill children.…Methods: Children and adolescents aged 8 to17 years, with the diagnosis of asthma, atopic dermatitis or obesity, admitted to one of seven German inpatient paediatric rehabilitation clinics, as well as their parents were included in this study. They filled in the revised KINDL generic Quality of Life Questionnaire with disease-specific modules (KINDL-R) as well as psychosocial and sociodemographic characteristics prior to, and at the end of inpatient rehabilitation, as well as 3 and 12 months after rehabilitation. Results: In addition to good psychometric properties gender-, age- and diagnosis-specific impairments in QoL were found. Over time children improved, most clearly children with obesity and among those children with the highest degree of obesity. Psychosocial predictors of QoL one year after rehabilitation were identified. Discussion: The study shows that QoL assessment in children with chronic conditions is feasible also in an inpatient setting. The psychometric robustness of the revised KINDL-R questionnaire could be demonstrated and results suggest the likelihood of children to profit from rehabilitation programs. Controlled/randomised study protocols are needed to further assess the QoL benefit in paediatric rehabilitation.
Keywords: Health-related quality of life, KINDL-Questionnaire, children and adolescents, rehabilitation, psychometrics
Abstract: Assessing elderly persons' health-related quality of life with the WHOQOL-BREF questionnaire In the last years the evaluation of subjective, health-related quality of life (HRQOL) is increasingly integrated as an outcome criterion in the health system. Especially in gerontology there is however still great need for validated instruments assessing HRQOL and comprehensive generic quality of life (QOL), including for example also environmental aspects. To measure generic QOL under the patronage of the World Health Organisation,…the WHOQOL Group developed the WHOQOL-BREF, a generic QOL instrument with 26 items, attributed to four subscales (psychological well-being, physical well-being, social relations and environment). First results using the swiss/french version of the WHOQOL-BREF in older swiss french speaking individuals (N = 178, mean age 74 years) are presented. Its psychometric properties were adequate and are comparably to those found in an older german group (N = 354, mean age 73; Matschinger et al. in preparation). For the two samples, the original four-factor structure was not easily reproducible. Nevertheless this structure was kept as in other publications (Leplège et al., 2000; Skevington, Lotfy & O'Connel, 2004). Unlike as in other studies no link was found between socio-demographic variables and QOL. The correlation between the number of health problems and depression on the one hand and QOL on the other hand was negative, as expected. However age moderated the relation between health problems and QOL: in older age, the negative effect of health problems on QOL was less pronounced.
Keywords: Generic quality of life, old age, intercultural questionnaire development, WHOQOL-BREF
Abstract: Preference-based Quality of Life measurements in medical rehabilitation: A comparison There are different instruments available in German language to measure health-related quality of life for use in health-economic studies. Yet, virtually no information is available regarding the applicability and the methodological quality of preference-based instruments in rehabilitation research. In our study we evaluate the applicability and methodological properties of preference-based quality of life measures as applied in rehabilitation research. The…set of questionnaires included validated German language versions of the SF-36, QWB-SA, EQ-5D, Health Utilities Index (HUI) and 15D. The results show that all instruments appear to be highly acceptable for rehabilitation patients. If small changes are expected in evaluative studies, application of SF-6D or 15D should be recommended. Comparisons of distributions and mean index scores in this sample demonstrate that results obtained with different preference-based measures are not equivalent.
Keywords: Preference-based Quality of Life, comparative study, Quality-Adjusted Life Years, Cost-Utility-Analysis
Abstract: Factors influencing the duration of diagnosing a Multiple Sclerosis Problem: This survey analyses if there are factors influencing the duration of diagnosing a Multiple Sclerosis (MS). Method: In 2003 in cooperation with the German Multiple Sclerosis Association an anonymous standardized questionnaire was sent to 2012 members in Saxony and Saxony-Anhalt. 995 patients were included, 72% female and 18% male. The average age was 49,6 years. Patients are knowing diagnosis "MS" for about…12,1 years. In average beginning of symptoms was at the age of 31,5 years and age of diagnosis 37,5 years. Results: The duration of diagnosing MS took about 6 years. Parameters as gender, age at the first symptoms and moment of diagnosis significantly influence duration of diagnosing a Multiple Sclerosis. Males were significantly earlier diagnosed than females. The higher the age at first symptoms the earlier patients were diagnosed. Especially in younger patients the duration of diagnosis can reach > 15 years. Patients were diagnosed faster during the last decades. Conclusion: Gender, age at beginning of symptoms and moment of diagnosis influence the duration of diagnosis. Main therapist of MS is the established neurologist and the family doctor or general practitioner. Therefore they should be sensitised for this gender and age problem.
Keywords: Multiple Sclerosis, duration of diagnosis, gender difference, Yentl-effect
Abstract: Disease management and integrated health care for depression: Is there evidence for effects on the course of disease, quality of life, and utilization patterns? Depression is one of the most common diseases world-wide associated with high societal costs and reduced quality of life. New approaches in health care delivery such as integrated care or disease management programs (DMP) aim at compensating major care deficits, but evidence regarding the actually achieved benefits for Germany is…still lacking. This paper gives an overview on two recently performed studies focussing both approaches. The first study provides an evaluation of DMP for the treatment of depression. A meta-analysis has been performed including 10 RCT. Findings suggest that quality of care in terms of 'depression severity', 'patient satisfaction', and 'implementation of guideline driven care' can be enhanced by comprehensive DMP. Health related quality of life was analysed in only 4 of 10 RCT showing heterogeneous results. The other study compares primary care patients with psychological problems in a gate keeper system (the Netherlands) and in an open access system (Germany). The gate keeper system restrains utilization of care in terms of physician contacts and intensity of treatment, while at the same time part of specialist treatment is transfered to inpatient services. The question remains unanswered whether, in contrast to the expected advantages of integrated health care concepts, this does not indicate inadequate ambulatory care.
Keywords: Depression, disease management, integrated health care, utilization of medical services, gatekeeping