Increasing exercise frequency is associated with health and quality-of-life benefits for older adults Abstract Purpose To evaluate whether health-related quality-of-life measures can be improved in a senior population by increasing participation in an exercise program. Methods The study involved a nationwide sample of adults aged 65 and older (mean age 73.2 in first study year) who participated in the SilverSneakers fitness program between 2010 and 2016. We analyzed data from 7 years of program participation records and annual participant surveys. Study members completed ≥ 2 annual surveys (n = 46,564). Participation frequency change was measured by average visits per week (AVPW) to a fitness center from the initial survey year to follow-up years. Quality-of-life measures included the 12-Item Short Form Health Survey (SF-12), Self-Rated Health, and BRFSS Healthy Days measures. Longitudinal analyses evaluated whether an increase in visit frequency among active members of SilverSneakers was associated with change in quality-of-life measures, controlling for age and gender. Results Participants with more frequent visits (higher AVPW) had better SF-12 Physical and Mental Component Scores, Self-Rated Health Status, and fewer physically and mentally unhealthy days (p < 0.001 for all measures); furthermore, participants who increased AVPW longitudinally saw improvements in all outcome measures (p < 0.001). Conclusion SilverSneakers participation frequency is associated with higher quality of life for seniors.

German value sets for the EORTC QLU-C10D, a cancer-specific utility instrument based on the EORTC QLQ-C30 Abstract Purpose The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the EORTC QLQ-C30, a widely used cancer-specific quality of life questionnaire. It covers ten dimensions: physical, role, social, emotional functioning, pain, fatigue, sleep, appetite, nausea, and bowel problems. To allow national health attitudes to be reflected, country-specific valuations are being performed by collaboration of the Multi-Attribute Utility Cancer (MAUCa) Consortium and the EORTC. The purpose of this paper is to provide German value sets (utility weights) for the QLU-C10D. Methods Valuations were run in a web-based setting in two general population samples of approximately 2000 adults in total. As the German version of the QLQ-C30 is presently undergoing a revision of the wording of one response category, valuations for both the current and the new version were performed (Germany 1 and 2). Utilities were elicited using a discrete choice experiment (DCE). Data were analyzed by conditional logistic regression and mixed logits. Results Completion rates were 88.3% (1002/1135) and 90.4% (1016/1124) for Germany 1 and Germany 2 valuations, respectively. Dimensions with the largest impact on utility weights were, in this order: physical functioning, pain, role functioning, social functioning and nausea (same ordering for both German versions). Several violations of the logical ordering of levels were observed for Germany 1; this was largely improved for Germany 2. Conclusion This study established German utility weights for the cancer-specific utility instrument QLU-C10D.

Effect of tardive dyskinesia on quality of life in patients with bipolar disorder, major depressive disorder, and schizophrenia Abstract Purpose Tardive dyskinesia (TD) is a common but serious hyperkinetic movement disorder and side effect of antipsychotic medications used to treat bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ). The purpose of this study was to evaluate health-related quality of life (HRQoL) in a population with diagnoses for BD, MDD, or SZ by comparing patients with TD (n = 197) with those without TD (n = 219). HRQoL in each group was also compared with HRQoL of the general population. Methods This study employed a cross-sectional web-based survey. HRQoL was assessed by four instruments: the SF-12 Health Survey, Version 2 (SF-12v2), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), the Social Withdrawal subscale of the Internalized Stigma of Mental Illness Scale (SW-ISMI); and two questions on movement disorders. Results Patients with TD had significantly worse HRQoL and social withdrawal than those without. The differences were more pronounced for physical HRQoL domains than for mental health domains. Patients with more-severe TD, assessed through either self-rating or clinician rating, experienced significantly worse HRQoL than did those with less-severe TD. The impact of TD was substantially greater in patients with SZ than in those with BD or MDD. Compared with the general population, patients with BD, MDD, or SZ experienced significantly worse HRQoL regardless of TD status, although this deficit in HRQoL was greater among those with TD. Conclusions The presence of TD is associated with worse HRQoL and social withdrawal. The most severe impact of TD is on physical aspects of patients’ HRQoL.

Exploring health-related quality of life of Spanish domestic adult adoptees: sociodemographic characteristics, chronic medical conditions, and gender differences Abstract Purpose The main objective is to study the health-related quality of life (HRQoL) as a positive approach to health in adult adoptees. We will also consider comparison with population norms, relation to chronic medical conditions, the role of sociodemographic variables, and gender differences among the variables in this study. Methods This was a cross-sectional study of 179 adult domestic adoptees from Spain aged between 18 and 44. They were recruited from a longitudinal study, which was on its third wave. They answered an interview and the self-report measure Health Survey Short Form (SF-12). ANOVAs and t test analyses to compare groups, and multiple regression to determine predictors of HRQoL, were performed. Results Adoptees are not different from the general population in terms of perceived physical health (PH) and mental health (MH). Both PH and MH are related to different variables (e.g., current age is negatively associated with PH, as is the number of chronic medical conditions with MH). Despite the absence of gender differences in MH perception, there were common and different predictor variables for males and females. The number of chronic medical conditions predicts HRQoL regardless of gender. For women, employment is also a predictor, and for men, other variables are being in a romantic relationship, having children, and low income. Conclusions Adult adoptees are comparable to general population in terms of HRQoL, but there are associated variables (chronic medical conditions and gender) that should be considered. Post-adoption services should promote health and support in life transitions for this group.

Impact of pharmaceutical care on mental well-being and perceived health among community-dwelling individuals with type 2 diabetes Abstract Purpose Mental well-being among community-dwelling individuals with type 2 diabetes has not been well established. The primary objective was to evaluate the change in the mental well-being of individuals with diabetes. The secondary objective was to evaluate the association between changes in mental well-being and perceived health over 6 months, and any interacting factors in this association. Methods This was a prospective, multicenter study. Community-dwelling individuals aged ≥ 21 years with type 2 diabetes were invited to meet with community pharmacists monthly for 6 months. Individuals who were unable to converse independently were excluded. A 12-item General Health Questionnaire (GHQ), measuring mental well-being was administered at baseline, and after 3 and 6 months. Perception of health was measured using the visual analog scale (VAS) of the EuroQoL 5-Dimension tool. Linear mixed model was used to analyze the change in mean GHQ and VAS scores. Association between the changes in GHQ and VAS scores was determined, and moderation analysis was conducted to elucidate the interacting variables of this association. Results Ninety-six individuals (82.4%) were included for analysis. The mean age was 60.3 years with a baseline mean HbA1c of 7.6%. A mean GHQ score reduction of 1.36 (p = 0.022) was observed. This reduction of mean GHQ score was associated with the change in mean VAS score. Having a duration of diabetes diagnosis of < 3.2 years was identified as moderator of this association. Conclusion Effective integrated pharmaceutical care with individualized counseling on lifestyle management appeared to improve the mental health of community-dwelling individuals with diabetes on top of glycemic control.

Health-related quality of life in adult population before and after the onset of financial crisis: the case of Athens, Greece Abstract Purpose Trends of person-oriented indices with respect to the general population have not been adequately investigated. In Athens, two Health Surveys in 2003 and 2016 provide the opportunity to analyze HRQL in the general adult population. The objectives of this study were to investigate changes in HRQL of adults in the broader area of Athens between 2003 and 2016 and their association with certain socio-demographic determinants. Methods We compared participants from pre- and during-crisis cross-sectional surveys. We used data from 982 and 1060 adult residents of Athens from 2003 and 2016 surveys, respectively. Income-related missing data were treated using three alternative methods. Subscale and summary component SF-36 scores were compared with Mann–Whitney tests and linear regression analyses were used to estimate the effect of demographic and socio-economic variables on HRQL before and after the onset of crisis. Results The analysis was based on the results of the procedure of handling missing income data as a separate income group and showed that physical component summary score (PCS) has improved and Mental Component Summary score has deteriorated. The most important predictors of HRQL were being widowed and during the crisis not being employed. Additionally, socio-demographic characteristics explained a higher proportion of variance of HRQL after the onset of crisis, especially for PCS. Conclusion Decline in mental and improvement in physical HRQL were observed between 2003 and 2016. HRQL has been certainly affected by the recession, but it is difficult to estimate the exact impact of the financial crisis on HRQL.

Evaluating a falls prevention intervention in older home care recipients: a comparison of SF-6D and EQ-5D Abstract Purpose Health-related quality of life (HRQOL) is an important outcome in economic evaluations of health care interventions for older adults. The aim of this study was to compare two commonly used preference-based utility measures, SF-6D and EQ-5D, to provide knowledge on their applicability when evaluating falls prevention interventions in primary health care. Methods The study is a secondary analysis of longitudinal data from a randomised controlled trial, which included 155 older home care recipients participating in a falls prevention intervention in Norway. HRQOL was measured by SF-6D and EQ-5D. Physical function was measured by Berg Balance Scale, 4-m walk test, 30-s sit-to-stand and Falls Efficacy Scale International. Assessments were performed at baseline, 3 months and 6 months. The agreement between SF-6D and EQ-5D was examined using Bland–Altman plots and Spearman correlations. Elasticities from regression analysis were employed to compare the instruments’ responsiveness. Results SF-6D and EQ-5D were strongly correlated (0.71), but there were differences in the instruments’ agreement and domains of HRQOL covered. Participants with a higher mean HRQOL and/or better physical function scored generally higher on EQ-5D. Participants with a lower mean HRQOL and/or poorer physical function achieved a relatively higher score on SF-6D. EQ-5D was more responsive to changes in physical function compared to SF-6D. Conclusions SF-6D and EQ-5D have both similarities and differences regarding sensitivity, domains covered and responsiveness to changes when evaluating a falls prevention intervention. Selecting the appropriate instrument depends on the characteristics of the participants and the intervention being evaluated.

Low vision status and declining vision decrease Health-Related Quality of Life: Results from a nationwide 11-year follow-up study Abstract Purpose The impact of visual acuity (VA) on Health-Related Quality of Life (HRQoL) and the cross-sectional and longitudinal differences in HRQoL during the 11-year follow-up were investigated. The aim was to examine the impact declining vision has on HRQoL and to provide comparable data to facilitate the allocation of health-care resources. Methods We utilized nationwide health examination surveys carried out by the National Institute for Health and Welfare in 2000 and 2011, providing a representative sampling of the Finnish adult population aged 30 and older. VA was assessed through Snellen E test, and HRQoL scores were evaluated using EQ-5D and 15D questionnaires. Multiple imputations with Markov chain Monte Carlo method was used to utilize the data more effectively. Regression analyses were conducted to assess the impact of declining VA on HRQoL, adjusted for incident comorbidities. Results Lower VA status was associated with significantly lower HRQoL at both time points, most clearly observable below the VA level of 0.5. Declining VA resulted in statistically significant decline in HRQoL during the follow-up, greater with distance than near VA. 15D impairment associated with decline in the distance VA was also clinically meaningful and greater than that associated with any of the examined comorbidities. Conclusions HRQoL was significantly and meaningfully impaired even before the threshold of severe vision loss or blindness was reached. The results encourage the improvement of available treatment options aiming to postpone the onset of visual impairment or declining VA, to maintain better quality of life among the population.

Development of a mental health recovery module for the WHOQOL Abstract Purpose The WHOQOL tools are widely used, multi-faceted, patient-rated, quality of life (QoL) measures, developed by the World Health Organization. The WHOQOL questionnaires are used to assess generic quality of life issues affected by all health problems. This study developed a module to use with the WHOQOL tools to improve their sensitivity to Health Related QoL issues relevant to mental health recovery. Methods Using a sequential mixed-methods approach, two research stages occurred. A qualitative stage invited 88 participants with experience of mental health recovery, into focus groups and importance rating activities, to identify candidate items for the new module. Following this, a quantitative stage involved 667 participants with, and without, mental health/addiction issues completing online or paper-based questionnaires to analyze which candidate items differentiated between those with and without mental health/addiction issues. Classical test theory and iterative Partial Credit Rasch Analysis were used to identify the most suitable candidate items for a reliable and valid mental health recovery module to be used with the WHOQOL tools. Results Seventeen candidate items captured important HRQoL facets relevant to mental health recovery. Rasch analysis removed 10 misfitting items. The final 7-item module, which demonstrated the best Rasch model fit, enquires about recovery beliefs, identifying strengths, self-awareness, acceptance, capacity to relate, feeling understood, and recovery progress. Ordinal-to-interval conversion tables have been developed to optimize measurement precision when using the module. Conclusions Important HRQoL issues central to mental health recovery can be reliably evaluated by using the recovery module with the WHOQOL tools.

A comprehensive catalogue of EQ-5D scores in chronic disease: results of a systematic review Abstract Purpose Chronic diseases are associated with impaired health-related quality of life (HRQoL) outcomes. Comparison of HRQoL outcomes between different diseases and with the general population is of major importance to health economists, epidemiologists, clinicians, and policy makers. The aim of this systematic literature review was to develop a catalogue with EQ-5D scores in chronic non-communicable diseases, and to compare these scores with reference values from the general population. Methods MEDLINE, Embase, and Web of Science were systematically searched independently by two reviewers. Studies were included if they reported mean EQ-5D index values for the adult population and if these scores were compared with the general population. The QualSyst tool for quantitative research was used for quality appraisal. Results Two hundred and seven articles met the inclusion criteria. An extensive catalogue summarizes the EQ-5D scores in a wide variety of chronic diseases. Mean EQ-5D index values ranged between − 0.20 and 1. Lower EQ-5D scores are reported in chronic diseases compared to the general population, specifically in neurological disorders. Most of the diseases demonstrate a substantial disutility, although a minority of diseases have equal or even higher index scores than the general population. Conclusion A comprehensive, international catalogue has been developed to provide EQ-5D index scores for diverse chronic diseases compared with reference values based on the available literature. The catalogue gives a clear overview of the existing EQ-5D scores and can be rapidly accessed by researchers worldwide for different applications such as health economic evaluations, decision making, resource allocation, and other policy objectives. Future studies should focus on unexamined diseases and specific patient groups to expand the evidence base on HRQoL in chronic diseases.