<p><strong>Background </strong></p> <p>The EQ-5D is one of the most widely used instruments to measure health status. It consists of a descriptive profile with a corresponding scoring algorithm. Multiple scoring algorithms have since been developed from EQ-5D preference elicitation studies.</p> <p><strong>Objectives </strong></p> <p>To identify key methodological issues in the construction of EQ-5D preference elicitation studies and to assess the validity of using a standard methodology in the construction of EQ-5D scoring algorithms.</p> <p><strong>Search methods </strong></p> <p>We searched the MEDLINE, EMBASE, Cochrane Library, NHS Economic Evaluation Database, and Health Economic Evaluation Database, (1990 to 2012). The EuroQol Group website was also searched.</p> <p><strong>Selection criteria </strong></p> <p>EQ-5D preference elicitation studies that reported the directly estimated health state scores and estimated scoring algorithm.</p> <p><strong>Data collection and analysis </strong></p> <p>Two reviewers independently assessed articles for inclusion. The observed and estimated EQ-5D preference scores were compared across studies. A standard scoring algorithm with fixed variables was estimated. The model performance of the standard algorithm and the study reported algorithm were assessed and compared.</p> <p><strong>Results </strong></p> <p>A total of 38 preference elicitation studies were included in this review. Key differences identified include: method of valuation, selection of health states, transformation of health state values, and method of estimation of the scoring algorithm. The observed health state values were found to be significantly different. The predicted health state values showed high levels of rank correlation. In general, a standard scoring algorithm was found to be no different in model performance than study specific scoring algorithms, with only three studies reporting a significant better model performance using the study specified scoring algorithm.</p> <p><strong>Conclusion</strong></p> <p>Methodological differences were identified across EQ-5D valuation studies. A standard scoring algorithm may yield similar model performance to study specific scoring algorithms, however further research is needed to identify when the use of a standard algorithm is appropriate.</p> / Master of Science (MSc)

Submitted by Cleide Dantas (cleidedantas@ufpa.br) on 2014-04-15T16:28:42Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AvaliacaoQualidadeVida.pdf: 947352 bytes, checksum: 5ee5e6cbf12e59a1ac5d4c59855706d5 (MD5) / Approved for entry into archive by Ana Rosa Silva (arosa@ufpa.br) on 2014-04-30T16:56:24Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AvaliacaoQualidadeVida.pdf: 947352 bytes, checksum: 5ee5e6cbf12e59a1ac5d4c59855706d5 (MD5) / Made available in DSpace on 2014-04-30T16:56:25Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AvaliacaoQualidadeVida.pdf: 947352 bytes, checksum: 5ee5e6cbf12e59a1ac5d4c59855706d5 (MD5) Previous issue date: 2013 / O Diabetes Mellitus tipo 1 (DM1) é a endocrinopatia mais comum da infância e adolescência e impacta negativamente na qualidade de vida (QV). O EuroQol é um instrumento que afere o estado de saúde e vem sendo utilizado na grande maioria dos estudos multicêntricos mundiais em diabetes e tem se mostrado uma ferramenta extremamente útil e confiável. O objetivo desse estudo é avaliar a QV de pacientes com DM1 do Brasil, país de proporções continentais, por meio da análise do EuroQol. Para isso, realizou-se estudo retrospectivo e transversal, no qual foram analisados questionários de pacientes com DM1, respondidos no período de dezembro de 2008 a dezembro de 2010, em 28 centros de pesquisa de 20 cidades das quatro regiões do país (sudeste, norte/nordeste, sul e centro-oeste). Foram também coletados dados sobre complicações crônicas micro e macrovasculares e perfil lipídico. A avaliação da qualidade de vida pelo EuroQol mostra que a nota média atribuída ao estado geral de saúde é nitidamente menor que a encontrada em dois outros estudos populacionais com DM1 realizados na Europa (EQ-VAS da Alemanha, Holanda e Brasil foram de 82,1 ± 14; 81 ± 15 e 72 ± 22, respectivamente). O EuroQol demonstra que a região Norte-Nordeste apresenta melhor índice na avaliação do estado geral de saúde quando comparada a região Sudeste e menor frequência de ansiedade-depressão autorreferidas, quando comparada às demais regiões do país (Norte-Nordeste = 1,53 ± 0,6, Sudeste = 1,65 ± 0,7, Sul = 1,72 ± 0,7 e Centro-Oeste = 1,67 ± 0,7; p <0,05). Adicionalmente, diversas variáveis conhecidas (idade, duração do DM, prática de atividade física, HbA1c, glicemia de jejum e presença de complicações crônicas se correlacionaram com a QV (r = -0,1, p <0,05; r = -0,1, p <0,05; r = -0,1, p <0,05; r = -0,2, p <0,05; r = -0,1, p <0,05 e r= -0,1, p <0,05, respectivamente). Esse é o primeiro estudo a avaliar a qualidade de vida de pacientes com DM1 a nível populacional no hemisfério sul. Nossos dados indicam uma pior qualidade de vida dos pacientes com DM 1 no Brasil quando comparado a dados de países europeus. Apesar de ter sido encontrado uma inferior duração do DM e menor presença de complicações microvasculares na região Norte/ Nordeste, quando comparada à outras regiões, nossos dados sugerem a existência de elementos adicionais responsáveis pela melhor QV e menor presença de ansiedade/depressão encontradas nesta região. Novos estudos são necessários para identificar esses possíveis fatores. / The type 1 diabetes mellitus type 1 (T1DM) is the most common endocrine disease of childhood and adolescence and it negatively impacts the quality of life (QOL). The EuroQol is an instrument that assess the health state. It has been used in most global multicenter studies in diabetes and it has been shown to be an extremely useful and reliable tool. The aim of this study is to evaluate the QOL of patients with T1DM in Brazil, a country of continental proportions, by analyzing the EuroQol. For this purpose, we performed a retrospective and cross-sectional study, which analyzed questionnaires from patients with T1DM, answered in the period of December 2008 to December 2010 in 28 research centers in 20 cities of the four regions (Southeast, North-Northeast, South and Midwest). We also collected data about chronic micro and macrovascular complications and lipid profile. The assessment of quality of life by EuroQol shows that the average score assigned to general health is markedly lower than those found in two other T1DM population studies conducted in Europe (EQ – VAS from Germany, Netherlands and Brazil were 82.1 ± 14, 81 ± 15 and 72 ± 22, respectively). The EuroQol shows that the North-Northeast region has the best index in the assessment of the overall health status compared to the Southeast and lower frequency of self-reported anxiety -depression, compared to other regions of the country (North-Northeast = 1.53 ± 0.6, Southeast = 1.65 ± 0.7, South = 1.72 ± 0.7 and Midwest = 1.67 ± 0.7, p <0.05). Additionally, several known variables (age, duration of diabetes, physical activity, HbA1c, fasting glucose, and presence of chronic complications correlated with QOL (r = -0.1, p <0.05, r = -0.1, p <0.05, r = -0.1, p <0.05, r = -0.2, p <0.05, r = -0.1, p <0.05 and r = -0.1, p <0.05, respectively). This is the first population study to evaluate the quality of life of patients with type 1 diabetes in the south hemisphere. Our data indicates poorer quality of life of patients with T1DM in Brazil when compared to data from European countries. Although we found an inferior diabetes duration and lower presence of microvascular complications in the North -Northeast region compared to other regions, our data suggests the existence of additional factors responsible for better QOL and lower presence of anxiety-depression found in this region. More studies are necessary to identify these possible factors.

Bakgrund Kroniskt obstruktiv lungsjukdom (KOL) är en av de sjukdomar som orsakar flest dödsfall världen över. Personer med KOL når sällan upp till rekommenderade aktivitetsnivåer, kan erhålla ett långsammare sjukdomsförlopp, en bättre bättre livskvalitet (QoL), samt bättre hälso relaterad livskvalitet (HRQoL) om de upprätthåller rekomenderade fysiska aktivitetsnivåer.  Syfte Syftet med denna studie är att undersöka sambandet mellan objektivt mätt intensitet vid fysisk aktivitet och QoL samt HRQoL hos personer med KOL, samt skillnader mellan män och kvinnor. Vidare undersöka sambandet mellan objektivt mätt fysisk aktivitet mätt i antal steg och QoL samt HRQoL. Metod  Antal steg  i vardagen samt durationen i moderat till hög intensitet (MVPA) mättes objektivt med en accelerometer (DynaPort, McRoberts BV, The Netherlands). QoL mättes med en visuell ordinalskala i EuroQol-5D (EQ-5D) och HRQoL skattades med formulären COPD Assessment Test (CAT), Modified Medical Research Council Questionnaire (mMRC). Spearman´s rangkorrelationskoefficiet (rho) användes för att undersöka korrelationen i statistikprogramvaran Jamovi.  Resultat Sambandet mellan MVPA och QoL (EQ-5D) HRQoL (CAT, mMRC) samt HRQoL (CAT, mMRC)  för hela gruppen visade liten eller ingen korrelation förutom för mMRC som visade en låg korrelation, (rho= -.327, p= &lt;0.001). Sambandet mellan MVPA och QoL (EQ-5D)  samt  HRQoL (CAT, mMRC) för gruppen kvinnor visade alla på en liten eller ingen korrelation. Sambandet mellan MVPA och QoL (EQ-5D) samt HRQoL (CAT, mMRC) för gruppen män visade alla på en låg korrelation. Sambandet mellan antal steg och QoL (EQ-5D) samt HRQoL (CAT, mMRC) samt för hela gruppen visade på en låg korrelation förutom för CAT som visade en liten eller ingen korrelation. Slutsats  Resultatet i denna studie visade tecken på att personer med KOL som spenderar mer tid i MVPA skattar något bättre HRQoL utifrån lägre skattad dyspné jämfört de forskningspersoner som spenderar mindre tid på samma intensitet. Resultatet visade även att duration i MVPA och antal steg per dag är två variabler som kan ha minst lika stor betydelse bland personer med KOL, då de ska skatta QoL och HRQoL. Dataanalysen i denna studie visade även på att det fanns ett starkare samband för män vad gäller totalt tid spenderad i MVPA och QoL samt HRQoL än vad det gör för kvinnor.

Fonament. El concepte Qualitat de Vida Relacionada amb la Salut (QVRS) dóna informació addicional a les mesures funcionals dels usuaris de programes d'exercici físic per a gent gran. Sovintegen els estudis poblacionals que incorporen aquesta mesura perquè les dades són estables i amb poca variació estadística en el temps, el que permet una correcta fonamentació metodològica i teòrica. Objectius. 1. Conèixer la QVRS dels usuaris dels Programes d'Exercici Físic Comunitaris de Gent Gran de Catalunya (PEFCGGC's), i la relació amb la gent gran de Catalunya. 2. Conèixer la QVRS dels usuaris dels PEFCGGC's, respecte els que practiquen a l'aire lliure. 3. Conèixer les característiques socials i demogràfiques relacionades amb la QVRS dels usuaris dels PEFCGGC's. 4. Conèixer les característiques socials i demogràfiques dels subjectes analitzats.Mètode. S'ha tingut com referència la mostra de la població de l'Enquesta de Salut de Catalunya de 2002 (ESCA'02) major de 60 anys, els usuaris que practiquen en PEFCGGC's i els majors de 60 anys que ho fan a l'aire lliure. S'ha utilitzat una mostra de 2.428 enquestats, mitjançant mostreig intencional. La mesura de QVRS s'ha efectuat mitjançant l'EuroQol EQ-5D. S'han calculat Descriptius, t-Student, &#967; Quadrat, ANOVA i Coeficient de correlació.Resultats. 1. Els que practiquen exercici físic en els PEFCGGC's presenten unes valoracions superiors a la gent gran sedentària de l'ESCA'02. 2. La QVRS és diferent en els usuaris que practiquen activitat física a l'aire lliure i els institucionalitzts respecte els de la resta d'usuaris dels PEFCGGC's. 3. Els usuaris dels PEFCGGC's que mostren menor puntuació amb l'EQ-5D són les persones més grans, les dones, les que estan soles, les que tenen un nivell formatiu i econòmic menor i els que viuen en poblacions més grans. 4. Són els practicants a l'aire lliure els més joves. Els institucionalitzats, mostren una major edat. Les dones tendeixen a practicar en els PEFCGGC's, i els homes prefereixen la petanca. Els homes tenen un itinerari esportiu més dilatat. / Fundamento. El concepto Calidad de Vida Relacionado con la Salud (CVRS) da información adicional a las medidas funcionales de los usuarios de programas de ejercicio físico para personas mayores. Son frecuentes los estudios poblacionales que incorporan este tipo de medidas porque los datos son estables y con pocas variaciones estadísticas en el tiempo, lo que permite una correcta fundamentación metodológica y teórica.Objetivos. 1. Conocer la QVRS de los usuarios de los Programas de Ejercicio Físico Comunitarios dirigidos a las Personas Mayores de Cataluña (PEFCGGC's) y la relación con las personas mayores de Cataluña. 2. Conocer la QVRS de los usuarios de los PEFCGGC's, respecto los que practican al aire libre. 3. Conocer las características sociales y demográficas relacionadas con la QVRS de los usuarios de los PEFCGGC's. 4. Conocer las características sociales y demográficas de los sujetos analizados.Métodos. Se ha tenido como referencia la muestra de la Encuesta de Salud de Cataluña de 2002 (ESCA'02) mayor de 60 años, los usuarios que practican en PEFCGGC's y los mayores de 60 años que lo hacen al aire libre. Se ha utilizado una muestra de 2.428 encuestados, mediante muestreo intencional. La medida de QVRS se ha realizado mediante EuroQol EQ-5D. Se ha calculado Descriptivos, t-Student, &#967; Cuadrado y Coeficiente de Correlación.Resultados. 1. Los que practican ejercicio físico en los PEFCGGC's presentan unas valoraciones superiores a las personas mayores sedentarias de la ESCA'02. 2. La QVRS es diferente en los usuarios que practican actividad física al aire libre y los institucionalizados respecto los del resto de usuarios de los PEFCGGC's. 3. Los usuarios de los PEFCGGC's que muestran menor puntuación con el EQ-5D son las personas más mayores, las mujeres, las que están solas, las que tienen un nivel formativo i económico menor y las que viven en poblaciones mayores. 4. Son los practicantes al aire libre los más jóvenes. Los institucionalizados, muestran una mayor edad. Las mujeres tienden a practicar en los PEFCGGC's, y los hombres prefieren la petanca. Los hombres tienen un itinerario deportivo más dilatado. / Background. Health-Related Quality of Life (HRQoL) gives additional information to the functional measures about physical programs for elderly users. There are many studies that include measures on HRQoL because the information is stable and it has few statistical variations upon the time. It allows a correct methodological theoretical foundation.Aims. 1. To study HRQoL of Community Exercise Programs for Elderly Users of Catalonia (CEPEU's) and the relation with individuals over 60 years old in Catalonia. 2. To study HRQoL of the subjects belonging to CEPEU's, in relation to those outdoors practitioners. 3. To study the social and demographic characteristics related to HRQoL of CEPEU's users. 4. To study the social and demographic characteristics of analyzed subjects, related to the king of program.Methods. The sample of the Catalan Health Survey of 2002 (CHS'02) over 60 years, users of CEPEU's, and elderly over 60 age who exercise outdoors, have been studied. CHS'02 has been administrated to a sample of 2.428 individuals, after a cross-sectional selection. Data were obtained of the Spanish version of EuroQol EQ-5D. Descriptives, t-Student, &#967; Square, ANOVA, Correlation Coefficient were calculated for statistical analysis.Results. 1. CEPEU's data showed higher values than sedentary subjects of CHS'02. 2. HRQoL were significantly different to that subjects that exercised outdoors and institutionalized elderly related to the other subjects of CEPEU's. 3. The CEPEU's subjects who presented lower scores on the EQ-5D correlated positively with increasing age, being female, being in a lower academic and economic levels, those living alone and those living in higher villages. 4. Outdoors exercising subjects are the youngest. Institutionalized are the oldest. Women were more numerous at CEPEU's while men prefer petanque. The men have a more extensive sports itinerary.

The overall aim of this research project was to explore and describe the significance of assistive devices in daily life. The project involves two qualitative and two quantitative studies. Three of these studies were from the perspective of persons with stroke and one from the perspective of spouses of persons with stroke. A hermeneutic phenomenological lifeworld approach was used in the qualitative studies and data was obtained through conversational interviews with the two study groups, 22 persons with stroke and 12 spouses of persons with stroke, after the devices had been used for about a year. The results indicated that the lived experiences of assistive devices in respect of the different lifeworld existentials (lived body, lived space, lived time, lived human relation) are closely interconnected in both study groups. The lived body existential included aspects of habits, feelings and the incorporation, figuratively speaking, of the devices into their own bodies. Lived space concerned the gradual development of a new view of the environment and the devices’ role as a prerequisite for being able to live at home. The devices brought about a changed relation to lived time with respect to the temporal perspectives of past, present and future. To be able to take control of one’s own time was an important experience that the devices facilitated. Assistive devices were an integral part of the lived human relation between the couples in the study groups, as well as between the disabled persons/spouses and other people, including the health-care professionals. The devices contributed either to the maintenance or the change of social roles, but they sometimes also gave rise to the experience of being stigmatised. The results in the case of both study groups showed that the use of different devices is complex and often contradictory, especially when it comes to persons with stroke. Overall the persons’ experiences of the advantages of the devices overshadowed their experiences of the disadvantages. The quantitative studies included a pre- and post-assessment design. Thirty-two persons with disabilities after stroke were included. The impact of an outdoor powered wheelchair on activity and participation (IPPA, WHODAS II) and quality of life (PIADS, EQ-5D) was measured. Statistical analysis with mainly non-parametric tests was used to determine significant within-group and between-group changes after intervention. The conceptual framework ICF was used in one of the quantitative studies when classifying the participants’ stated problems. The results showed that the outdoor powered wheelchair is an essential device for persons with disabilities after stroke with regard to overcoming activity limitation and participation restrictions in everyday life. Furthermore it mostly has a positive impact on such users’ quality of life. However, it is also important to highlight the negative experiences of a few with regard to the use of powered wheelchairs. In sum, these results will enable prescribers to better understand the individual experiences of using assistive devices and the individuals’ and the families’ need for support in connection with the prescription of assistive devices, the particular example being powered wheelchairs.