Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery

<p>Abstract</p> <p>Background</p> <p>Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR).</p> <p>Methods</p> <p>We prospectively included 250 of 356 patients who were accepted to the waiting list for primary THR surgery. All participants responded to the BPI, WOMAC and SF-36 at baseline and 1 year after surgery.</p> <p>Results</p> <p>Internal consistency reliability (Cronbach's α) was >0.80 for the BPI, the WOMAC and five of the eight SF-36 scales The pattern of associations of the two BPI scales with corresponding and non-corresponding scales of the WOMAC and SF-36 largely supported the construct validity of the BPI. The responsiveness indices for change from baseline to 1 year after THR ranged from 1.52 to 2.05 for the BPI scales, from 1.69 to 2.84 for the WOMAC scales, and from 0.25 (general health) to 2.77 (bodily pain) for the SF-36 scales.</p> <p>Conclusions</p> <p>The BPI showed acceptable reliability, construct validity and responsiveness in patients with OA undergoing THR. BPI is short and therefore is easy to use and score, though the instrument offers few advantages over and duplicates scales of more comprehensive instruments, such as the WOMAC and SF-36.</p

What determines subjective health status in patients with chronic obstructive pulmonary disease: importance of symptoms in subjective health status of COPD patients

<p>Abstract</p> <p>Background</p> <p>Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV₁%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health.</p> <p>Methods</p> <p>This study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV₁%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used.</p> <p>Results</p> <p>Older patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV₁%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV₁%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%–51%).</p> <p>Conclusion</p> <p>Symptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.</p

General anxiety, depression, and physical health in relation to symptoms of heart-focused anxiety- a cross sectional study among patients living with the risk of serious arrhythmias and sudden cardiac death

<p>Abstract</p> <p>Objective</p> <p>To investigate the role of three distinct symptoms of heart-focused anxiety (cardio-protective <it>avoidance</it>, heart-focused <it>attention</it>, and <it>fear </it>about heart sensations) in relation to general anxiety, depression and physical health in patients referred to specialized cardio-genetics outpatient clinics in Norway for genetic investigation and counseling.</p> <p>Methods</p> <p>Participants were 126 patients (mean age 45 years, 53.5% women). All patients were at higher risk than the average person for serious arrhythmias and sudden cardiac death (SCD) because of a personal or a family history of an inherited cardiac disorder (familial long QT syndrome or hypertrophic cardiomyopathy). Patients filled in, Hospital Anxiety and Depression Scale, Short-Form 36 Health Survey, and Cardiac Anxiety Questionnaire, two weeks before the scheduled counseling session.</p> <p>Results</p> <p>The patients experienced higher levels of general anxiety than expected in the general population (mean difference 1.1 (p < 0.01)). Hierarchical regression analyses showed that avoidance and fear was independently related to general anxiety, depression, and physical health beyond relevant demographic covariates (age, gender, having children) and clinical variables (clinical diagnosis, and a recent SCD in the family). In addition to heart-focused anxiety, having a clinical diagnosis was of importance for physical health, whereas a recent SCD in the family was independently related to general anxiety and depression, regardless of disease status.</p> <p>Conclusion</p> <p>Avoidance and fear may be potentially modifiable symptoms. Because these distinct symptoms may have important roles in determining general anxiety, depression and physical health in at-risk individuals of inherited cardiac disorders, the present findings may have implications for the further development of genetic counseling for this patient group.</p

Health status in patients at risk of inherited arrhythmias and sudden unexpected death compared to the general population

<p>Abstract</p> <p>Background</p> <p>The possibilities in the molecular genetics of long QT syndrome (LQTS) and hypertrophic cardiomyopathy (HCM) has made family screening, with diagnostic and predictive genetic testing part of the health care offer in genetic counselling of inherited arrhythmias, potentially affecting the subjective health among these individuals. The study compared health status among patients at risk of arrhythmia because of family history or clinical diagnosis of LQTS and HCM with reference health status scores of the general population.</p> <p>Methods</p> <p>In the period 2005-2007, 127 patients (mean age 45 years, 53.5% women), with a family history of arrhythmia (n = 95) or a clinical diagnosis of LQTS (n = 12) or HCM (n = 19) referred for genetic counselling at the medical genetic departments in Norway filled in a questionnaire (Short Form Health Survey SF-36) measuring health status on eight domains. The patient SF-36 scores were compared to expected scores of the general population by t-test, and the relationship between the socio-demographic variables, clinical status, and SF-36 domains were analysed by multiple linear regression.</p> <p>Results</p> <p>The total sample reported significant lower SF-36 score as compared to the general population scores for the domain of general health (mean difference -7.3 (<0.001). When analysing the sample in subgroups according to clinical status, the general health was still significant lower for the group of family risk and in the group of HCM. In addition the physical functioning, role physical, vitality and role emotional domains were reduced for the latter group. In general, employment, higher education and being referred to genetic counselling through a family member were associated with better scores on the health status domains.</p> <p>Conclusions</p> <p>Having a genetic risk of arrhythmia affects general health significantly. In addition, patients with a clinical diagnosis of HCM demonstrate a significantly poorer health in both physical and mental domains.</p

The complexity of the relationship between chronic pain and quality of life: a study of the general Norwegian population

The aims of this paper were to evaluate the relationship between chronic pain and global quality of life (GQOL) and to explore the effect of possible confounders, mediators, and moderators such as selected demographic variables, chronic illnesses, stress-related symptoms, fatigue, and subjective health of the relationship between chronic pain and GQOL. We used a cross-sectional design, including 1,893 respondents from a population of 4,000 of Norwegian citizens, aged 19–81 years, who were randomly drawn from the National Register by Statistics Norway in November 2000 (48.5%). Pain duration of more than 3 months was categorized as having chronic pain. The Quality of Life Scale, the Fatigue Severity Scale, and the Posttraumatic Stress Scale were used as our main dependent and independent variables, respectively. A series of multiple regression analyses (GLM in SPSS) were applied using GQOL as the dependent variable, entering subsets of independent variables in a theoretically predefined sequence. In the total model, there was no significant relationship between chronic pain and GQOL. The model explained 39% of the variance in GQOL. For direct effect sizes, stress-related symptoms were related most strongly to GQOL, followed by subjective health, fatigue, chronic illnesses, and selected demographic variables. These findings support the assumption of a complex and indirect relationship between chronic pain and GQOL

The coping styles of adolescents with type 1 diabetes are associated with degree of metabolic control

WSTĘP. Celem badania była analiza różnych sposobów radzenia sobie z problemami w grupie młodzieży chorej na cukrzycę typu 1 i ocena zależności między kontrolą metaboliczną a jakością życia związaną z cukrzycą. MATERIAŁ I METODY. Z grupy 116 osób chorych na cukrzycę typu 1, będących w okresie dojrzewania (wiek 13-18 lat), w badaniu wzięły udział 103 osoby (89%) &#8212; 52 chłopców i 51 dziewcząt. Pacjenci wypełnili kwestionariusz dotyczący sposobów radzenia sobie z problemem i oceny jakości życia związanej z cukrzycą. Średni wiek badanych (&plusmn; SD) wynosił 14,9 &plusmn; 1,6 roku, czas trwania cukrzycy 7,1 &plusmn; 3,8 roku, stężenie HbA1c 9,4 &plusmn; 1,6%. WYNIKI. Wykazano istotny statystycznie związek między podwyższonym stężeniem HbA1c a większym nasileniem myślowego (r = 0,25; p < 0,05) i behawioralnego (r = 0,33; p < 0,01) uciekania od problemów oraz częstszym wykorzystywaniem agresji jako sposobu radzenia sobie z nimi (r = 0,33; p < 0,01). Wielokrotna krokowa analiza regresji wykazała, że częstsze stosowanie agresji jako jednego ze sposobów radzenia sobie z problemami (p < 0,05) i behawioralnego uciekania od problemu (p < 0,05) były istotnie statystycznie związane z podwyższonym stężeniem HbA1c. Aktywne radzenie sobie z problemami (p < 0,05) wiązało się istotnie z obniżeniem stężenia HbA1c. Analiza korelacji cząstkowych wykazała, że niższa punktacja dotycząca jakości życia związanej z cukrzycą wiązała się z częstszym stosowaniem emocjonalnych sposobów radzenia sobie z problemem (r = -0,22 do -0,49). Wielokrotna krokowa analiza regresji wykazała, że częstsze myślowe unikanie problemu zmniejszało odczuwanie wpływu cukrzycy na życie. WNIOSKI. U osób w wieku dojrzewania, chorych na cukrzycę typu 1, zła kontrola metaboliczna i niska jakość życia związana z cukrzycą powodują częstsze stosowanie emocjonalnych sposobów radzenia sobie z problemami.INTRODUCTION. To systematically study the various coping styles in a population-based sample of adolescents with type 1 diabetes, exploring the association of different coping styles with metabolic control and adolescent self-reported diabetes-related quality of life. MATERIAL AND METHODS. Of a total population of 116 adolescents with type 1 diabetes (age 13&#8211;18 years), 103 (89%) participated in the study, completing a questionnaire to obtain information on coping styles and perception of diabetes-specific quality of life. The mean age (&#177; SD) was 14.9 &#177; 1.6 years, diabetes duration 7.1 &#177; 3.8 years, HbA1c 9.4 &#177; 1.6%, and male-to-female ratio 52:51. RESULTS. There was a significant correlation between higher HbA1c values and higher degree of mental (r = 0.25, P < 0.05) and behavioral (r = 0.33, P < 0.01) disengagement and aggressive coping (r = 0.33, P < 0.01). Stepwise multiple regression analyses indicated that greater use of aggressive coping (P < 0.05) and behavioral disengagement (P < 0.05) were significantly related to increase in HbA1c. Greater use of active coping (P < 0.05) was signifi- cantly related to a decrease in HbA1c. Partial correlation analysis showed that lower scores on diabetes-specific quality of life were significantly related to greater use of emotion-focused coping (r = &#8211;0.22 to &#8211;0.49). Stepwise multiple regression analyses showed that greater use of mental disengagement was significantly related to lower degree of perceived diabetes- related impact. CONCLUSIONS. Poor metabolic control and lower degree of diabetes-related quality of life are associated with greater use of emotion-focused coping in adolescents with type 1 diabetes

Psychosocial family factors and glycemic control among children aged 1-15 years with type 1 diabetes: a population-based survey

Background: Being the parents of children with diabetes is demanding. Jay Belsky’s determinants of parenting model emphasizes both the personal psychological resources, the characteristics of the child and contextual sources such as parents’ work, marital relations and social network support as important determinants for parenting. To better understand the factors influencing parental functioning among parents of children with type 1 diabetes, we aimed to investigate associations between the children’s glycated hemoglobin (HbA1c) and 1) variables related to the parents’ psychological and contextual resources, and 2) frequency of blood glucose measurement as a marker for diabetes-related parenting behavior. Methods: Mothers (n = 103) and fathers (n = 97) of 115 children younger than 16 years old participated in a population-based survey. The questionnaire comprised the Life Orientation Test, the Oslo 3-item Social Support Scale, a single question regarding perceived social limitation because of the child’s diabetes, the Relationship Satisfaction Scale and demographic and clinical variables. We investigated associations by using regression analysis. Related to the second aim hypoglycemic events, child age, diabetes duration, insulin regimen and comorbid diseases were included as covariates. Results: The mean HbA1c was 8.1%, and 29% had HbA1c ≤ 7.5%. In multiple regression analysis, lower HbA1c was associated with higher education and stronger perceptions of social limitation among the mothers. A higher frequency of blood glucose measurement was significantly associated with lower HbA1c in bivariate analysis. Higher child age was significantly associated with higher HbA1c both in bivariate and multivariate analysis. A scatterplot indicated this association to be linear. Conclusions: Most families do not reach recommended treatment goals for their child with type 1 diabetes. Concerning contextual sources of stress and support, the families who successfully reached the treatment goals had mothers with higher education and experienced a higher degree of social limitations because of the child’s diabetes. The continuous increasing HbA1c by age, also during the years before puberty, may indicate a need for further exploring the associations between child characteristics, context-related variables and parenting behavior such as factors facilitating the transfer of parents’ responsibility and motivation for continued frequent treatment tasks to their growing children

Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery

Abstract Background: Pain is a cardinal symptom of osteoarthritis (OA) of the hip and important for deciding when to operate. This study assessed the internal consistency reliability, validity and responsiveness of the Brief Pain Inventory (BPI) among patients with OA undergoing total hip replacement (THR). Methods: We prospectively included 250 of 356 patients who were accepted to the waiting list for primary THR surgery. All participants responded to the BPI, WOMAC and SF-36 at baseline and 1 year after surgery. Results: Internal consistency reliability (Cronbach’s a) was >0.80 for the BPI, the WOMAC and five of the eight SF- 36 scales The pattern of associations of the two BPI scales with corresponding and non-corresponding scales of the WOMAC and SF-36 largely supported the construct validity of the BPI. The responsiveness indices for change from baseline to 1 year after THR ranged from 1.52 to 2.05 for the BPI scales, from 1.69 to 2.84 for the WOMAC scales, and from 0.25 (general health) to 2.77 (bodily pain) for the SF-36 scales. Conclusions: The BPI showed acceptable reliability, construct validity and responsiveness in patients with OA undergoing THR. BPI is short and therefore is easy to use and score, though the instrument offers few advantages over and duplicates scales of more comprehensive instruments, such as the WOMAC and SF-36

Assessing fear of hypoglycemia in a population-based study among parents of children with type 1 diabetes – psychometric properties of the hypoglycemia fear survey – parent version

Background: In the treatment of childhood type 1 diabetes, being aware of the parents’ fear of hypoglycemia is important, since the parents’ fear may influence the management of treatment and the children’s blood glucose regulation. The availability of proper instruments to assess the parents’ fear of hypoglycemia is essential. Thus, the aim of this study was to examine the psychometric properties of the Hypoglycemia Fear Survey – Parent version (HFS-P). Methods: In a Norwegian population-based sample, 176 parents representing 102 children with type 1 diabetes (6–15 years old) completed the HFS-P, comprising a 15-item worry subscale and a 10-item behavior subscale. We performed exploratory and confirmatory factor analysis and further analysis of the scales’ construct validity, content validity and reliability. Results: The Norwegian version of the HFS-P had an acceptable factor structure and internal consistency for the worry subscale, whereas the structure and internal consistency of the behavior subscale was more questionable. The HFS-P subscales were significantly correlated (from moderately to weakly) with symptoms of emotional distress, as measured by the Hopkins Symptom Checklist – 25 items. The mothers scored higher than fathers on both HFS-P subscales, but the difference was not statistically significant for the worry subscale. Conclusions: The HFS-P worry subscale seems to be a valid scale for measuring anxiety-provoking aspects of hypoglycemia, and the validity of the HFS-P behavior subscale needs to be investigated further

Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes

Objective: Emotional problems are common in adults with diabetes, and knowledge about how different indicators of emotional problems are related with glycemic control is required. The aim was to examine the relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with glycosylated hemoglobin (HbA1c). Methods: Of the 319 adults with type 1 diabetes attending the endocrinology outpatient clinic at a university hospital in Norway, 235 (74%) completed the Diabetes Distress Scale, the Problem Areas in Diabetes Survey, the Hospital Anxiety and Depression Scale, and the World Health Organization-Five Well-Being Index. Blood samples were taken at the time of data collection to determine HbA1c. Regression analyses examined associations of diabetes-specific emotional distress, anxiety, depression, and overall well-being with HbA1c. The relationship between diabetes-specific emotional distress and HbA1c was tested for nonlinearity. Results: Diabetes-specific emotional distress was related to glycemic control (DDS total: unstandardized coefficient = 0.038, P b .001; PAID total: coefficient = 0.021, P = .007), but depression, anxiety, and overall well-being were not. On the DDS, only regimen-related distress was independently related to HbA1c (coefficient = 0.056, P b .001). A difference of 0.5 standard deviation of baseline regimen distress is associated with a difference of 0.6 in HbA1c. No significant nonlinearity was detected in the relationship between diabetesspecific distress and HbA1c. Conclusions: To stimulate adequate care strategies, health personnel should acknowledge depression and diabetesspecific emotional distress as different conditions in clinical consultations. Addressing diabetes-specific emotional distress, in particular regimen distress, in clinical consultation might improve glycemic control