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BACKGROUND: Otitis media with effusion (OME) is a common disease in ear, nose, and throat clinics characterized by aural fullness and hearing loss and mainly caused by eustachian tube dysfunction (ETD). Tympanostomy tube insertion (TTI) is a conventional surgical treatment option that can alleviate symptoms but does not provide a definitive cure, and it is prone to recurrence. Balloon dilation eustachian tuboplasty (BDET) has become a novel procedure for the treatment of ETD, demonstrating significant potential in addressing the aforementioned limitations. However, it is not widely available in the clinic and few high-quality randomized clinical trials was conducted to investigate its long-term efficacy and security in OME. Therefore, the purpose of this study is to verify the efficacy of BDET combined with TTI for patients with OME and its prospects for providing a definitive cure. METHODS AND ANALYSIS: This is a prospective, parallel-group, single-blind, randomized controlled prospective trial. Totally 124 patients with OME will be randomized into either group A or B. Group A will receive conventional therapy (TTI) while group B will use BDET therapy in addition to TTI. Outcome assessments will take place at baseline and at the 3rd, 6th, 12th, and 24th months after surgery. The primary outcome is eustachian tube function, which will be measured by the eustachian tube dysfunction questionnaire (ETDQ-7) and eustachian tube score (ETS). The secondary outcomes include middle ear function, hearing situation, and quality of life, which will be measured by acoustic impedance measurement, pure-tone audiometry, and Chinese-version Chronic Ear Survey (CCES). The main analysis of change in the outcomes will use mixed-model with repeated measures (MMRM) analyses of variance (ANOVAs). DISCUSSION: This is the first prospective trial in Chinese populations that aims to validate the long-term efficacy and safety of BDET-combined TTI therapy in patients with OME. This parallel-group, single-blind, randomized controlled trial may provide an opportunity to decrease the recurrence rate of OME and explore a definitive cure for patients with OME. This trial's rigorous design enhances the reliability of the findings, ensuring a robust answer to the research question. In the future, the research team will further expand upon the clinical evidence and applications of the BDET combined therapy. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400079632. Registered on 8 January 2024, https://www.chictr.org.cn/bin/project/edit?pid=214452 .
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Dilatación , Trompa Auditiva , Ventilación del Oído Medio , Otitis Media con Derrame , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Otitis Media con Derrame/cirugía , Otitis Media con Derrame/fisiopatología , Trompa Auditiva/cirugía , Trompa Auditiva/fisiopatología , Estudios Prospectivos , Ventilación del Oído Medio/métodos , Ventilación del Oído Medio/efectos adversos , Resultado del Tratamiento , Dilatación/métodos , Método Simple Ciego , Factores de Tiempo , Femenino , Adulto , Masculino , Calidad de Vida , Adolescente , Persona de Mediana Edad , Adulto Joven , Audición , Niño , Anciano , ChinaRESUMEN
Objectives: This study aimed to explore and visualize the relationships among multiple symptoms in patients with Meniere's disease (MD) and aid clinical nurses in the design of accurate, individualized interventions. Methods: This study included 790 patients with MD at the Eye and ENT Hospital of Fudan University from October 2014 to December 2021. A self-designed symptom checklist was used to assess 15 MD-related symptoms and construct contemporaneous networks with all 15 symptoms in R software. Qgraph package and Fruchterman-Reingold layout were used for network visualization. Bootstrapping methods were performed to assess network accuracy and stability, and three centrality indices were adopted to describe relationships among symptoms. Results: Symptom networks showed good accuracy and stability. "Anxiety and nervousness"(98.2%), "aural fullness"(84.4%) and "tinnitus"(82.7%) were the common symptom in MD patients, while "tinnitus", "aural fullness" and "decline in word recognition", were more serious. MD patients with longer disease duration had higher prevalence and severity for all symptoms (P < 0.05). Symptom networks showed good accuracy and stability. "Decline in word recognition," "fatigue," and "anxiety and nervousness" were at the center of the symptom networks, which had the largest strength values and closeness. "Decline in word recognition," "headache," and "spatial discrimination and poor orientation" were the symptoms with the highest betweenness with the strongest bridging effect. The ≥1-year disease group exhibited higher centralities for "drop attack" and "anxiety and nervousness," and a lower centrality for "headache" compared with the <1-year disease group. Conclusions: The symptom networks of MD patients with varying disease durations were revealed. Clinicians and nurses must provide precision interventions tailored to modifying symptom severity and centrality. Nursing interventions should focus on word recognition issues and associated discomfort in MD patients with multiple symptoms.
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BACKGROUND: Benign Paroxysmal Positional Vertigo (BPPV) is the leading cause of vertigo, and its characteristic nystagmus induced by positional maneuvers makes it a good model for Artificial Intelligence (AI) diagnosis. However, during the testing procedure, up to 10 min of indivisible long-range temporal correlation data are produced, making the AI-informed real-time diagnosing unlikely in clinical practice. METHODS: A combined 1D and Deep-Learning (DL) composite model was proposed. Two separate cohorts were recruited, with one for model generation and the other for evaluation of model's real-world generalizability. Eight features, including two head traces and three eye traces and their corresponding slow phase velocity (SPV) value, were served as the inputs. Three candidate models were tested, and a sensitivity study was conducted to determine the saliently important features. RESULTS: The study included 2671 patients in the training cohort and 703 in the test cohort. A hybrid DL model achieved a micro-area under the receiver operating curve (AUROC) of 0.982 (95% CI 0.965, 0.994) and macro-AUROC of 0.965 (95% CI 0.898, 0.999) for overall classification. The highest accuracy was observed for right posterior BPPV, with an AUROC of 0.991 (95% CI 0.972, 1.000), followed by left posterior BPPV, with an AUROC of 0.979 (95% CI 0.940, 0.998), the lowest AUROC was 0.928 (95% CI 0.878, 0.966) for lateral BPPV. The SPV was consistently identified as the most predictive feature in the models. If the model process is carried out 100 times for a 10-min data, one single running takes 0.79 ± 0.06 s. CONCLUSION: This study designed DL models which can accurately detect and categorize the subtype of BPPV, enabling a quick and straightforward diagnosis of BPPV in clinical setting. The critical feature identified in the model helps expand our understanding of this disorder.
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Aprendizaje Profundo , Nistagmo Patológico , Humanos , Vértigo Posicional Paroxístico Benigno/diagnóstico , Inteligencia Artificial , Nistagmo Patológico/etiología , Canales SemicircularesRESUMEN
Objective:To cross-culturally adapt the Meniere's Disease Outcomes Questionnaireï¼MDOQï¼ into Chinese language, to evaluate its reliability and validity, and to apply in clinical. Methods:The MDOQ was translated according to the Brislin model. Cross-cultural adaption was done by expert discussion and pilot study. The MDOQ was applied to 101 patients to test its reliability and validity. The quality of lifeï¼QOLï¼ of 272 patients was measured by MDOQ-C, analyzing the influence factors of QOL of patients with Meniere's disease. Results:The CR value of each item of MDOQ-C exceeded 3.00, the Cronbach's α coefficient was 0.88, and the Spearman Brown coefficient was 0.90. The Pearson correlation coefficient of MDOQ-C and the DHI was 0.803ï¼P<0.01ï¼. Three factors were extracted by factor analysis, which could explain 60.503% of the total variance. The dimension composition was different from the original scale. The average QOL score of Meniere's disease patients was 52.94±13.87. The main influence factors were age, marital status, work status, with tinnitus and the number of vertigo attacks. Conclusion:The MDOQ-C is reliable and valid. After dimension reconstruction, MDOQ-C can be used to evaluate the QOL of patients with Meniere's disease. Through the preliminary clinical application, the influence factors of quality of life of patients with Meniere's disease were identified, thus providing reference for optimizing clinical management strategies.
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Enfermedad de Meniere , Comparación Transcultural , Humanos , Enfermedad de Meniere/diagnóstico , Enfermedad de Meniere/cirugía , Proyectos Piloto , Calidad de Vida , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
Objective: Rotational Chair Test (RCT) is considered one of the most critical measures for vestibular functionality, which generally includes the sinusoidal harmonic acceleration test (SHAT), velocity step test (VST), and visual suppression (VS). The purpose of this study was to establish normal values for different age groups on the RCT and investigate whether motion susceptibility, such as with a history of motion sickness or migraine, has any effects on test metrics. Methods: One hundred and nine subjects aged from 20 to 59 years who were free from neurotological and vestibular disorders were enrolled. According to the history of motion sickness or migraine, participants were divided into four groups: the motion sickness (MS) group (n = 13), the migraine group (n = 8), comorbidity group (n = 11), and the control group (n = 77). The 77 subjects without any history of MS and migraine were then further separated into four age groups: youth group (20-29 years), young and middle-aged group (30-39 years), middle-age group (40-49 years), and middle-age and elderly group (50-59 years). All participants underwent SHAT, VST, and VS, and a comprehensive set of metrics including gain, phase, asymmetry, time constant (TC), and Fixation Index were recorded. Results: Regarding the VST and VS, no significant differences were observed either across the four groups (MS, migraine, comorbidity, and control group) or four age categories within the control group. For SHAT, VOR gain at the frequency of 0.01 Hz, VOR phase from 0.08 to 0.64 Hz, and asymmetry at 0.01, 0.16, and 0.64 Hz indicated significant differences among various age groups (P < 0.05 for all comparisons). The VOR phase lead was lower in the migraine and comorbidity group than that in the control group at 0.64 Hz (P = 0.027, P = 0.003, respectively). Conclusions: Age slightly affects the result of SHAT, but not for VST and VS. VOR gain is more susceptible to aging at low frequency, while the phase is opposite. Subjects with both migraine and motion sickness show abnormal velocity storage mechanisms. Phase bias should be considered when assessing motion susceptibility with the RCT. SHAT is more sensitive than VST in terms of reflecting motion susceptibility.
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Objective:To observe the effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance. Methods:Forty-five Ménière's disease patients with chronic imbalance treated in vertigo specialist clinic of Eye and ENT Hospital of Fudan University from December 2020 to December 2021 were enrolled. Patients were divided randomly into two groups, 23 patients in experimental group and 22 patients in control group. Both groups received routine outpatient treatment, and the experimental group received an additional vestibular rehabilitation for 8 weeks. All patients were evaluated with dizziness handicap inventory ï¼DHIï¼ at baseline and 8-week follow-up, and the incidence of fall was calculated. The occurrence of adverse events during the study was also recorded. Results:There was no significant difference in baseline data between the two groups ï¼P>0.05ï¼. During the study, 1 patient were lost to follow-up and 2 patients dropped out. A total of 42 patients completed the study. Intentionality analysis was performed on lost follow-up patients. After 8 weeks of the treatment, there were significant statistically differences in difference values of DHI and DHI-F scoresï¼d1=-30.22±3.78, d2=-13.09±4.85, t=-2.799, P<0.05; d1=-12.43±1.46, d2=-4.55±2.17, t=-3.043, P<0.05ï¼, while no significant difference was showed in the difference values of DHI-P and DHI-E scoresï¼P>0.05ï¼. There was no significant difference in incidence of fall between two groupsï¼P>0.05ï¼, but the incidence of experimental group decreased significantly compared with that before treatmentï¼4.35% vs 34.78%, χ²=4.973, P<0.05ï¼. No serious adverse event was reported in the two groups. Conclusion:Vestibular rehabilitation can improve the balance function and reduce risk of fall in Ménière's disease patients with chronic imbalance. Therefore, it is worthy of clinical application.
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Enfermedad de Meniere , Mareo , Humanos , VértigoRESUMEN
BACKGROUND: Questionnaires have been used in the past 2 decades to predict the diagnosis of vertigo and assist clinical decision-making. A questionnaire-based machine learning model is expected to improve the efficiency of diagnosis of vestibular disorders. OBJECTIVE: This study aims to develop and validate a questionnaire-based machine learning model that predicts the diagnosis of vertigo. METHODS: In this multicenter prospective study, patients presenting with vertigo entered a consecutive cohort at their first visit to the ENT and vertigo clinics of 7 tertiary referral centers from August 2019 to March 2021, with a follow-up period of 2 months. All participants completed a diagnostic questionnaire after eligibility screening. Patients who received only 1 final diagnosis by their treating specialists for their primary complaint were included in model development and validation. The data of patients enrolled before February 1, 2021 were used for modeling and cross-validation, while patients enrolled afterward entered external validation. RESULTS: A total of 1693 patients were enrolled, with a response rate of 96.2% (1693/1760). The median age was 51 (IQR 38-61) years, with 991 (58.5%) females; 1041 (61.5%) patients received the final diagnosis during the study period. Among them, 928 (54.8%) patients were included in model development and validation, and 113 (6.7%) patients who enrolled later were used as a test set for external validation. They were classified into 5 diagnostic categories. We compared 9 candidate machine learning methods, and the recalibrated model of light gradient boosting machine achieved the best performance, with an area under the curve of 0.937 (95% CI 0.917-0.962) in cross-validation and 0.954 (95% CI 0.944-0.967) in external validation. CONCLUSIONS: The questionnaire-based light gradient boosting machine was able to predict common vestibular disorders and assist decision-making in ENT and vertigo clinics. Further studies with a larger sample size and the participation of neurologists will help assess the generalization and robustness of this machine learning method.
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Aprendizaje Automático , Encuestas y Cuestionarios , Vértigo , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Vértigo/diagnósticoRESUMEN
INTRODUCTION: Dizziness is one of the most common symptoms seen in chronic vestibular syndrome, which has been linked to an increased risk of falls, substantial disability and negative psychological consequences. Recent evidence demonstrated that vestibular rehabilitation therapy (VRT) is effective for treating chronic vestibular symptoms. However, the delivery of VRT remains challenging because of lack of facility, insufficient qualified physiotherapist resources, as well as being in the actual situation of the pandemic. WeChat, the most widely used mobile app in China, offers a more viable way of delivering VRT than traditional office-based approaches do. This study aimed to evaluate the effectiveness of the WeChat-VRT programme for patients with chronic vestibular syndrome. METHODS AND ANALYSIS: This is a parallel-group, assessor-blinded randomised controlled trial. Fifty patients who experienced chronic vestibular symptoms longer than 3 months will be randomised into either the WeChat-VRT group or the usual care (UC) group. Participants in the WeChat-VRT group will receive 8-week VRT mainly through the WeChat app. Participants in the UC group will receive once-weekly VRT in the clinic for 8 weeks and remaining time home-based exercise. Outcome assessments will take place at baseline and at the 8th, 12th and 24th weeks after randomisation. The primary outcome will be the change from baseline to the eighth week on the patients' functional improvements quantified by the Functional Gait Assessment (FGA). The secondary outcomes will include dynamic balance function, emotional well-being, and vestibular activity and participation level. Intention-to-treat analysis will be performed using generalised estimation equation modelling. ETHICS AND DISSEMINATION: The trial has been reviewed and approved by the Institutional Review Board of Eye and Ear Nose Throat Hospital of Fudan University (reference number 2017047/1). The study findings will be disseminated via peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: ChiCTR2000029457; Pre-results.
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Terapia por Ejercicio , Enfermedades Vestibulares , China , Mareo , Humanos , Modalidades de Fisioterapia , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: While patients with benign paroxysmal positional vertigo (BPPV) commonly develop residual dizziness (RD) after successful repositioning, the factors predictive of RD remain controversial. OBJECTIVE: To identify factors predictive of RD onset in patients with BPPV following successful repositioning. METHODS: This multi-center prospective cohort study enrolled 243 patients with idiopathic BPPV. Vestibular functional and psychological wellbeing assessments administered before repositioning provided the data used to identify factors predictive of RD with a log-binomial model. The endpoint was RD at 1 week after successful repositioning. RESULTS: Of the enrolled patients, 118 reported RD. After adjusting for cofounders, mild [risk ratio (RR), 2.06; 95% confidence interval (CI), 1.39-3.04] or severe (RR, 3.08; 95% CI, 2.17-4.38) anxiety and abnormal vestibular ratio of sensory organization test (RR, 2.68; 95% CI, 1.82-3.95) were identified as risk predictors. Presence of ocular vestibular evoked myogenic potentials responses, either unilateral (RR, 0.55; 95% CI, 0.44-0.69) or bilateral (RR, 0.49; 95% CI, 0.36-0.68), were protective factors. CONCLUSIONS: Anxiety and abnormal balance are significant predictors of RD, while the presence of ocular vestibular evoked myogenic potentials responses predicts against it. These findings may help to improve BPPV outcomes by informing prognoses and guiding treatment strategies. TRIAL REGISTRATION: ChiCTR1800018004 (date of registration: 26 August 2018).
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Vértigo Posicional Paroxístico Benigno , Potenciales Vestibulares Miogénicos Evocados , Vértigo Posicional Paroxístico Benigno/diagnóstico , Mareo , Humanos , Posicionamiento del Paciente , Estudios ProspectivosRESUMEN
Objective:To translate the English version of vestibular rehabilitation benefit questionnaire ï¼VRBQï¼ into Chinese, and to test its reliability and validity. Method:The VRBQ was forward and backward-translated according to the Brislin model. Cultural adaption was done by expert discussion and pilot study. The scale was applied to 158 patients to test its reliability and validity. Result:The Cronbach's α coefficient was 0.90, and the test-retest reliability was 0.98, the total scale responsiveness is 2.066. Chinese version of VRBQ consisted of 22 items. Four factors were extracted by factor analysis, which could explain 73.341% of the total variance. Conclusion:The Chinese version of VRBQ is reliable and valid, therefore can be used to evaluate the quality of life and rehabilitation efficacy of patients with vestibular dysfunction in Chinese cultural background.
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Calidad de Vida , Humanos , Proyectos Piloto , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
BACKGROUND: The activities and participation component of the International Classification of Functioning, Disability and Health (ICF) has gained increasing recognition in rehabilitation field. The vestibular activities and participation measure (VAP) was the first instrument using the ICF to evaluate activities and participation outcomes for vestibular research and clinical practice. OBJECTIVES: This study aimed to cross-culturally adapt the VAP into Chinese language and to examine the psychometric properties of the Chinese version of VAP (VAP-C). METHODS: A standard "forward-backward" translation procedure was followed and the results were presented to the panel of experts and consensus was sought. Internal consistency was assessed using Cronbach's alpha and test-retest reliability examined by intraclass correlation coefficient (ICC). Convergent validity was determined by calculating the Pearson's correlation coefficient between the VAP-C and the Visual Analog Scale (VAS) and the Dizziness Handicap Inventory (DHI). Discriminative validity for test subjects versus control subjects was evaluated by Receiver Operating Characteristic curve (ROC) analysis. RESULTS: Minor revisions were made during translation to ensure semantic equivalence and to suit Chinese culture. A total of 121 patients complaining of dizziness or vertigo due to peripheral vestibular disorders (test subjects) and 41 control subjects were enrolled. Cronbach's alpha was 0.94 for the VAP-C total scale and greater than 0.80 for the two subscales. ICC for the VAP-C total scale was 0.78, and for subscale one was 0.77 and subscale two 0.76. The VAP-C had strong correlations (râ=â0.85-0.88) with the VAS and fair to moderate correlations (râ=â0.23-0.53) with DHI. Through ROC analysis, we found the VAP-C discriminated significantly between patients and control subjects. Based on the estimate of Youden J, the optimal cut-off values for VAP-C total and the two subscales were established. CONCLUSIONS: The VAP-C shows evidence of reliability and validity, which can be applied for evaluating the impact of the vestibular disorder on patients' activities and participation in Chinese language populations.
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Psicometría/instrumentación , Enfermedades Vestibulares/diagnóstico , Adulto , Anciano , Estudios de Casos y Controles , Comparación Transcultural , Evaluación de la Discapacidad , Mareo/diagnóstico , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Vértigo/diagnósticoRESUMEN
INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is recognised as the leading cause of peripheral vertigo in adults. The canalith repositioning procedure (CRP) can be used for effective treatment of BPPV. However, some patients experience residual dizziness (RD) even after successful CRP, resulting in a significant negative impact on their daily function and quality of life. Exercise-based vestibular rehabilitation (VR) has been proven as an effective method for managing dizziness and has been applied in patients with various vestibular disorders. However, the efficacy of VR to specifically target RD post-BPPV is unknown. This study aims to investigate the efficacy of VR, compared with betahistine or VR plus betahistine treatment, in the treatment of patients experiencing RD after successful CRP. METHODS AND ANALYSIS: A randomised single-blinded controlled trial will be carried out to determine the efficacy of VR compared with betahistine or VR plus betahistine treatment in mitigating RD and improving balance function. Patients with BPPV who experience RD after successful CRP will be recruited. Participants will be randomised into one of three groups to receive VR, betahistine or VR plus betahistine. There will be 61 participants in each group. The primary outcomes will be changes in the patient's daily function as measured by the Vestibular Activities and Participation questionnaire and balance ability assessed by computerised dynamic posturography. The secondary outcomes will be dizziness-related handicap, otolith function and duration of RD symptoms. Outcome measures will be noted at baseline and at 2, 4 and 8 weeks post-randomisation. This study has the potential to reduce unnecessary anti-vertigo drug prescriptions and may lead to a general consensus regarding the use of VR as a first-line treatment for RD in patients with BPPV. ETHICS AND DISSEMINATION: This trial received ethical approval from the Institutional Review Board of Eye and ENT Hospital of Fudan University (reference number 2017046). The study results will be disseminated via peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT03624283; Pre-results.
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Vértigo Posicional Paroxístico Benigno/fisiopatología , Betahistina/uso terapéutico , Mareo/fisiopatología , Posicionamiento del Paciente/efectos adversos , Vasodilatadores/uso terapéutico , Adulto , Anciano , Vértigo Posicional Paroxístico Benigno/rehabilitación , Vértigo Posicional Paroxístico Benigno/terapia , Mareo/rehabilitación , Mareo/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Vestíbulo del LaberintoRESUMEN
INTRODUCTION: Total laryngectomy (TL) with neck dissection (ND) is considered as crucial management for advanced-stage of laryngeal cancer. Shoulder dysfunction has long been recognized as a potential complication resulting from neck dissection. The aim of this study was to evaluate the effect of early prophylactic rehabilitation program in patients who underwent TL with ND. METHODS: A prospective, nonrandomized design was used. Seventy-six participants who underwent TL with ND were assigned into either an intervention or a control group. The control group received current standard care with no formal shoulder exercise provided, while the intervention group attended early preventive rehabilitation lasting 12 weeks. Participants were assessed at baseline, and at 3 and 6 months after surgery. Measured outcomes included shoulder function and patient-reported quality of life. General linear models with repeated measures were used to examine outcome changes in both groups over the designated assessment intervals. RESULTS: Improvement in shoulder function and patient-reported quality of life were both statistically significant over time, with no significant difference between control or intervention groups, indicating little or no benefit of preventative intervention on shoulder function outcomes. Analysis involving five subscales and the summary score of the quality of life questionnaire had only statistically significant improvement over time for both the control or intervention groups, except for physical well-being domain which had statistical significance both over time and between the control and intervention groups. CONCLUSION: In this study, preventative exercise program initiated immediately after surgery had a limited impact on both shoulder function and perceived quality of life.
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Terapia por Ejercicio/métodos , Laringectomía/rehabilitación , Enfermedades Musculoesqueléticas/prevención & control , Disección del Cuello/rehabilitación , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/prevención & control , Hombro/fisiopatología , Adulto , Anciano , Carcinoma de Células Escamosas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/fisiopatología , Disección del Cuello/métodos , Complicaciones Posoperatorias/fisiopatología , Estudios Prospectivos , Calidad de Vida , Resultado del TratamientoRESUMEN
PURPOSE: The aim of the study was to investigate the vision-related quality of life in glaucoma patients and identify the possible predictors for outcomes. METHODS: A total sample of 167 subjects with glaucoma was recruited using a convenience sampling strategy. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Glaucoma Self-Management Questionnaire were used for assessing vision-related quality of life and self-management behavior, respectively. The demographic and disease-related data were also collected. RESULTS: Regarding the vision-related quality of life, the lowest scores were for general health (32.78±23.59), followed by general vision (46.35±19.52). The highest score was for the dimension of color vision (89.02±20.76). Multiple linear regression analysis demonstrated that self-management behavior, positive glaucoma family history, and binocular visual acuity were predictors of vision-related quality of life in this patient group. CONCLUSIONS: The current study indicates that vision-related quality of life in glaucoma patients is at a moderate level in China. Self-management behavior is an important predictor. Demographic data may not increase the explanatory effect. Future research should focus on how to integrate self-management skills into routine nursing practice for patients with glaucoma.
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Glaucoma de Ángulo Cerrado/psicología , Glaucoma de Ángulo Abierto/psicología , Calidad de Vida/psicología , Autocuidado , Visión Binocular/fisiología , Agudeza Visual/fisiología , Adulto , Anciano , Femenino , Glaucoma de Ángulo Cerrado/fisiopatología , Glaucoma de Ángulo Abierto/fisiopatología , Encuestas Epidemiológicas , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Autocuidado/psicología , Perfil de Impacto de Enfermedad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: To assess vision-related quality of life (VRQoL) in Chinese glaucoma patients and explore its sociodemographic, clinical and psychological correlates, and determine which of them explain the largest variation. METHODS: This cross-sectional study included 508 Chinese glaucoma patients. Chinese-version Glaucoma Quality of Life-15 questionnaire (CHI-GQL-15) and Hospital Anxiety and Depression Scales were administered to all participants to evaluate their VRQoL and psychological distresses. Visual functions (habitual-corrected visual acuity (HCVA), intraocular pressure, and mean defect (MD) of visual field) were assessed through clinical examinations by professionals. Sociodemographic information and other treatment histories were collected via interviews and chart review. Stepwise multiple linear regression analyses were performed to identify sociodemographic, clinical, and psychological predictors of VRQoL. RESULTS: The mean summary score for CHI-GQL-15 was 28.79 ± 12.74. Patients exhibited the greatest difficulty in activities involving glare and dark adaptation (28.19 ± 22.86), followed by central and near vision (26.18 ± 26.56), peripheral vision (18.03 ± 21.37), and the least difficulty for outdoor mobility (15.06 ± 24.57). Moderate and heavy economic burden, HCVA and MD of both the better and the worse eyes, number of glaucoma surgeries in the treatment history and the presence of depression were independent predictors for VRQoL of glaucoma patients. Clinical factors explained the largest variation. CONCLUSION: VRQoL of glaucoma patients is multifactorial and was primarily determined by clinical indices. VRQoL assessment could be informative when adopted as a complement to objective visual measures in clinical practice.
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Glaucoma/psicología , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , China/epidemiología , Comorbilidad , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Análisis Factorial , Femenino , Glaucoma/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Escalas de Valoración Psiquiátrica , Autoinforme , Factores Socioeconómicos , Encuestas y Cuestionarios , Agudeza Visual , Campos Visuales , Adulto JovenRESUMEN
BACKGROUND: Maintaining glaucoma patients' quality of life (QoL) has become one of the most important goals for treatments. The purpose of this study is to develop a Chinese version of Glaucoma Quality of Life-15 item Questionnaire (GQL-15-CHI), and examine its psychometric properties. METHODS: The Glaucoma Quality of Life-15 item Questionnaire (GQL-15) was translated and culturally adapted into Chinese, and administered to glaucoma patients recruited from Shanghai Eye and ENT Hospital. Visual functions: habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), and mean defect (MD) of visual field) were assessed through clinical examination by professionals. Sociodemographic and other clinical data were collected via interviews and chart review. According to Nelson's glaucoma staging system, patients were stratified as mild, moderate, and severe visual field loss (VFL). The psychometric properties, including internal consistency, test-retest reliability, item-scale correlations and factor analysis were conducted. The divergent validity was assessed through bilateral comparisons of the GQL-15-CHI composite and subscale scores between patients of different VFLs after controlling for potential confounders. RESULTS: A total of 508 glaucoma patients were recruited (male: 265, female: 243). The mean age was 55.41 years. The Cronbach's α coefficients ranged from 0.75 to 0.91 for the subscales. The test-retest reliability, as estimated by the intraclass correlation coefficients, were above 0.70 for all subscales. Statistically significant differences were showed in the GQL-15-CHI summary and subscale scores after controlling for sociodemographic and clinical confounders (P < 0.05) among patients with different VFLs. CONCLUSION: The GQL-15-CHI showed psychometric properties comparable to those of the original English version, and thus could be used as a reliable and valid tool for assessment of QoL in Chinese glaucoma patients.
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Glaucoma/psicología , Lenguaje , Calidad de Vida/psicología , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , China , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
OBJECTIVES: To assess the prevalence of anxiety and depression in Chinese glaucoma patients, and explore their predictive factors. METHODS: This cross-sectional study included 506 Chinese glaucoma patients. Hospital Anxiety and Depression Scales (HADS) and the Chinese-version Glaucoma Quality of Life-15 questionnaire (CHI-GQL-15) were administered to all participants to evaluate their psychological distresses and quality of life (QoL). Visual functions (habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), and mean defect (MD) of visual field) were assessed through clinical examinations by professionals. Sociodemographic information and other treatment histories were collected via interviews and chart review. Multiple linear regression analyses were performed to identify predictors of anxiety and depression. To evaluate the impact of anxiety or depression on patients QoL, the CHI-GQL-15 summary and subscores of patients with and without psychological disturbances were compared using covariate-adjusted regression analyses. RESULTS: The prevalence of anxiety and depression in Chinese glaucoma patients was 22.92% and 16.40%, respectively. A younger age (ß=-0.058, p<0.001), female gender (ß=1.219, p=0.001), moderate and heavy economic burden (ß=1.186, p=0.009; ß=2.705, p<0.001, respectively) and the CHI-GQL-15 summary score (ß=0.101, p<0.001) were independent predictors of anxiety. Significant independent predictors of depression included the duration of glaucoma (ß=-0.065, p=0.019) and the CHI-GQL-15 summary score (ß=0.147, p<0.001). Difference in the CHI-GQL-15 summary and its subscores of patients with and without psychological disturbance were statistically significant (p<0.001). CONCLUSIONS: Prevalence of anxiety and depression among Chinese glaucoma patients is relatively high. Self-reported measures were informative in evaluating patients' psychological disturbances, whereas objective measures of visual function were not.
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Ansiedad/epidemiología , Depresión/epidemiología , Glaucoma/epidemiología , Calidad de Vida/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/diagnóstico , Ansiedad/psicología , Pueblo Asiatico , China/epidemiología , Comorbilidad , Estudios Transversales , Depresión/diagnóstico , Depresión/psicología , Femenino , Glaucoma/psicología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Autoinforme , Encuestas y CuestionariosRESUMEN
AIM: To explore the life experiences of those living with glaucoma and describe their strategies to deal with the consequences of this disorder. BACKGROUND: Glaucoma, the second most common cause of worldwide blindness, often imposes limitations on the daily functions of its victims, thus resulting in a decline in their quality of life and high costs in healthcare. METHODS: A hermeneutical phenomenological research approach was adopted. Fourteen people with glaucoma were selected for in-depth interviews, and another ten were interviewed in two focus groups. Participants were recruited from a specialized eye hospital in Shanghai. The data were collected from July to September 2009. An interpretive analysis of the data was performed. FINDINGS: The core theme was identified while interpreting the data on the patients' life experiences as 'learning to living with glaucoma' by one of our participants. The meaning of this is demonstrated in four interwoven themes: (1) seeking support; (2) coping with everyday tasks; (3) living with future uncertainties; and (4) adapting to the declined quality of life. CONCLUSION: This paper provides an insight into the living experiences of the patients with glaucoma using 1-on-1 and focus-group interviews, suggesting that the latter can also offer a means of phenomenological inquiry. We found that those with glaucoma can experience uncertainty surrounding treatment, illness prognosis and family members' risk status. In addition, the Chinese culture can influence the patients' strategies of maintaining a healthy lifestyle. In helping those with glaucoma considerations should be taken towards the feelings of future uncertainty that may develop.