published_or_final_version / Medicine / Master / Master of Research in Medicine

published_or_final_version / Public Health / Master / Master of Public Health

Background: Stroke has become the second most cause of death and leading cause of disability worldwide. Patients-reported health related quality of life measures are often used in evaluating stroke outcomes. However, many stroke patients can not participate in the outcome assessments due to severe disability or aphasia or cognitive impairment. In this case, proxy respondents can be used as secondary information sources. The principle thing needs to be paid attention to in using proxy’s assessments is the reliability or agreement between patient and proxy. Western studies have shown that the agreement between patient and proxy was moderate to substantial. However, such studies are limited in China. Simply applying overseas research outcomes on local population is not appropriate. Therefore, we conducted this study to find out the agreement between stroke patients and proxy assessments about quality of life in China. Methods: 100 patient-proxy pairs were enrolled in our study. Our study was a hospital-based study. The included patients were 3 months after stroke, and patients with more than moderate aphasia or cognitive impairment were excluded. Proxies were people who knew the patients > 1 year, contacted with the patients ≥ 3 days per week, were responsible for ≥ 2 caregiving tasks, and ≥ 18 years. The Chinese version of Stroke-specific quality of life scale (SS-QoL) was used to assess the stroke patients’ QoL, and proxy version of SS-QoL was used in proxies’ evaluation. The evaluation process of patient and proxy was separately and concurrently. Method of self-reported combined with interview-administered was adopted. Paired t tests or Wilcoxon signed ranks tests were performed to test the systematic differences between patient and proxy. The agreement level between patient and proxy assessments on stroke QoL was estimated by Intraclass correlation coefficient (ICC). Multiple linear regression was performed to find out factors affecting the patient-proxy agreement. Results: Patients were older (61 versus 48 years) and more often male (63% versus 44%). Mean systematic differences ranged from 0.03 to 0.44. Only 3 domains of differences were statistical significant (Language, Personality, and Work/productivity). The strength of agreement between patient and proxy reporting ranged from fair to perfect (ICC: 0.31 to 0.87). Better agreement was observed in more objective domains while worse agreement was reported in more subjective domains. Proxy education was tested to be a significant predictor of the overall patient-proxy score difference, which indicated that higher proxy education level was associated with greater agreement. It was shown that higher overall patient-reported or proxy-reported SS-QoL score was associated with less stroke impairments. Factors of stroke impairments, patient/proxy education level, patient/proxy gender, and stroke type separately have significant impacts on the agreement between patient and proxy in different domains of QoL. Conclusion: Our findings indicate that proxies may provide reliable information for assessments about stroke patients’ quality of life in China. And the outcomes are more appropriate for mind to moderate stroke patients. For further studies, the reliability of proxy information about severe stroke patients should be paid attention to. Research about changes of agreement between patient and proxy along with the disease development process would be focused on. / published_or_final_version / Public Health / Master / Master of Public Health

Cataract is one of the most common causes of visual impairment (VI) and blindness in the elderly population. In Hong Kong, the total population and the number of people over the age of 65 has been increasing over the past 10 years. The number of people suffered from cataract has also increased due to population growth and limited availability of medical resources. The waiting time for cataract surgery is long. Patients’ visual acuity (VA) continues to deteriorate while they are waiting for the surgery. Therefore, it is important for healthcare providers to explore the impact of VI on the quality of life (QOL) of cataract patients, and develop strategies to help patients overcome their difficulties. Patients who were on the cataract surgery waiting list with no cognitive impairment were recruited from the Department of Ophthalmology, Queen Mary Hospital, Hong Kong. A purposive sampling method was used. 24 patients were recruited based on their age and VA. Each group contained the same number of male and female patients. Informed consent was obtained before the start of the interview. Patients’ demographics and clinical data were extracted from their medical records. A mix of qualitative and quantitative approaches was adopted. Data were collected through semi-structural interviews (qualitative) and the administration of the Chinese version of the 25-Item National Eye Institute Visual Function Questionnaire (CHI-VFQ-25) (quantitative). Our results suggested that patients had poor knowledge regarding the definition and symptoms of cataract. In-depth interviews revealed that patients were having troubles in various ADLs, including cooking and dining, reading and writing, housekeeping, grooming and watching television (TV). Difficulties with mobility and transportation, together with the inability to recognize faces, were found to affect patients’ social lives. The fear of future deterioration in VA and the loss of abilities resulted in a range of negative feelings, such as sadness, frustration, irritation, insecurity and feeling of burden to others. Strategies used to tackle the difficulties in ADLs and patients’ adjustments to their negative emotions were also described. Certain comorbid diseases, for example stroke, arthritis and hearing impairment, further complicated patients’ QOL. Quantitative analyses showed that patients had suboptimal scores in all subscales of CHI-VFQ-25, except for ocular pain and peripheral vision. In general, the CHI-VFQ-25 composite scores reflected that patients had little to moderate difficulties in their ADLs. Working status also affected the CHI-VFQ-25 scores. Patients who were working had lower scores in almost all subscales (except general health, ocular pain, colour vision and peripheral vision) than retired patients. Intergroup comparison suggested that patients who were older and had lower VA scored worst in the CHI-VFQ-25. In conclusion, although our patients have been suffered from cataract for years, they had poor knowledge about this common eye disease. Both qualitative and quantitative analyses showed that patients experienced a lot of difficulties in their ADLs, which eventually led to a variety of negative impacts on their emotional and psychosocial wellbeing. / published_or_final_version / Anatomy / Master / Master of Philosophy

The study investigated whether providing autonomy support and implementation intention would enhance participants’ subjective well-being in a counting blessings intervention. One hundred and one senior secondary school students were randomly assigned into four conditions: (1) with both autonomy support and implementation intention; (2) with autonomy support only; (3) with implementation intention only; and (4) without autonomy support and implementation intention (control). They were then instructed to count three blessings daily for two weeks. The results indicated that participants’ positive affect was significantly enhanced by counting blessings intervention with autonomy support; while their life satisfaction and positive affect were significantly promoted by the intervention supplemented with implementation intentions. Implications of the findings were discussed. / published_or_final_version / Educational Psychology / Master / Master of Social Sciences

Dysphagia, which refers to difficulties in swallowing, is a common clinical dysfunction with high morbidity in the ageing population. At least four validated questionnaires are available for assessing swallowing-related quality of life. These include the M. D. Anderson Dysphagia Inventory (MDADI), the Swallow Quality-of-Life Questionnaire (SWAL-QOL), the Sydney Swallowing Questionnaire (SSQ) and the Dysphagia Handicap Index (DHI). However, these questionnaires are either designed for some specific dysphagic populations or only focused on the impact of swallowing disorders at the impairment level. The Swallowing Activity and Participation Profile (SAPP) has been developed and validated as a self-reported tool for dysphagic population to assess the effects of swallowing problems on the physical, functional and social aspects of quality of life. It is common to find the elderly population exhibiting cognitive impairment. Elderly people with cognitive impairment may have difficulties completing the questionnaire by themselves. In such cases, family members or caregivers are often asked to judge how the dysphagic individuals are affected by the swallowing dysfunction. There are, however, most of the previous studies failed to investigate the validity and reliability of such proxy method. Thus, the objective of this study was to verify the reliability of proxy method in assessing swallowing-related quality of life for frail elderly people who are not able to finish the self-reported questionnaire because of their cognitive impairment. Forty-six elderly individuals (24 males and 22 females) and their respective caregivers (six males and 36 females) participated in this study. All the elderly received a clinical swallowing assessment to confirm the existence and the severity of dysphagia. They were assigned into the dysphagic group and the non-dysphagic group according to the results of swallowing assessment, and then asked to complete a quality of life questionnaire (SAPP) and a swallowing function scale, called Eating Assessment Tool (EAT-10). Their caregivers were invited to complete the same assessment tasks from the perspective of the elderly and to report how they perceived the elderly persons’ swallowing–related quality of life as the proxies. The scores obtained from the questionnaires filled out by the elderly participants and their caregivers were compared. The findings showed that there was no statistically significant agreement between the elderly and the caregivers. The association between the responses of the elderly and the caregivers on quality of life was not as strong as what was hypothesized at the beginning of this study. However, the test-retest reliability of the instrument of this study was good, as shown by the intra-class correlation coefficient in the elderly group. The current study found that dysphagia had a negative impact on the dysphagic elderly’s emotional well-being, but was not clear if the proxy method could be used as a valid and reliable method for assessing the elderly’s swallowing-related quality of life. Further studies with a larger sample size and a wider range of dysphagia severity are needed. / published_or_final_version / Speech and Hearing Sciences / Master / Master of Philosophy

Background: The world is facing an ageing population. Physical inactivity is considered as the fourth leading risk factor for non-communicable diseases. Walking is recognized as an affordable exercise to elderly people. However there is rarely any systematic review conducted to examine the effect of walking on quality of life of elderly people Objective: This systematic review of randomized controlled trials is to examine the effect of walking on quality of life (QoL) of older people. Methods: Articles were searched through Medline and Ovid by using keywords of “elderly people”, “aged, 50 or more”, “old people”, “elderly”, “the aged”, “walk”, “walking”, “QoL” and “quality of life”. PICO criteria were used for the criteria in selecting articles for this review. CONSORT 2010 checklist was used to assess the quality of included studies. Results and Discussion: 8 articles out of 237 articles from Medline and 883 articles from Ovid were included in this systematic review after applying the inclusion and exclusion criteria. Studies were from 4 different countries. Average age of the subjects was above 60. Subjects were randomized to intervention (walking) and control groups. Outcome measures were QoL indicators. There was significant improvement in various QoL dimensions while other studies have results of either no significant difference between intervention and control groups, or results favoring the control group. Subjects’ adherence was high in the initial phase, yet it was doubtful whether subjects could maintain the habit without the assistance of experimenter and the assisting measures. Conclusions: From this systematic review, the effect of walking on quality of life on elderly people is still unclear. More large scale research works, especially randomized controlled trials are needed to examine the effect of walking on elderly people. / published_or_final_version / Public Health / Master / Master of Public Health

Not available / text

Not available / text

Objectives: The purpose of this study was threefold: 1) to explore the physical activity (PA) levels of gynaecologic cancer survivors; 2) to explore the associations between PA and quality of life (QOL); 3) to examine the level of agreement between self-reported and objectively measured PA; and 4) to identify PA preferences. Methods: In Phase I, 900 gynaecologic cancer survivors were mailed a questionnaire measuring PA, QOL, and various PA preferences. In Phase II, 20 survivors wore an accelerometer for nine consecutive days, completed a questionnaire, and participated in a 20 minute semi-structured interview. Results: Approximately 30% of participants met the public health PA guidelines, with survivors meeting the PA guidelines reporting higher scores on physical well-being. Over 66% of participants were/may be interested in a PA program. The level of agreement between self-reported and objectively measured PA was poor. Conclusions: This research demonstrates the importance of PA for cancer survivors. / N/A