Why Does the Health-Related Quality of Life in Idiopathic Normal-Pressure Hydrocephalus Fail to Improve Despite the Favorable Clinical Outcome?

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Junkkari , A , Roine , R P , Luikku , A , Rauramaa , T , Sintonen , H , Nerg , O , Koivisto , A M , Hayrinen , A , Viinamaki , H , Soininen , H , Jaaskelainen , J E & Leinonen , V 2017 , ' Why Does the Health-Related Quality of Life in Idiopathic Normal-Pressure Hydrocephalus Fail to Improve Despite the Favorable Clinical Outcome? ' , World Neurosurgery , vol. 108 , pp. 356-366 . https://doi.org/10.1016/j.wneu.2017.08.170

Title: Why Does the Health-Related Quality of Life in Idiopathic Normal-Pressure Hydrocephalus Fail to Improve Despite the Favorable Clinical Outcome?
Author: Junkkari, Antti; Roine, Risto P.; Luikku, Antti; Rauramaa, Tuomas; Sintonen, Harri; Nerg, Ossi; Koivisto, Anne M.; Hayrinen, Antti; Viinamaki, Heimo; Soininen, Hilkka; Jaaskelainen, Juha E.; Leinonen, Ville
Contributor: University of Helsinki, Clinicum
University of Helsinki, Harri Sintonen Research Group
Date: 2017-12
Language: eng
Number of pages: 11
Belongs to series: World Neurosurgery
ISSN: 1878-8750
URI: http://hdl.handle.net/10138/298143
Abstract: OBJECTIVE: Occasionally, a favorable clinical diseasespecific outcome does not reflect into improved generic health-related quality of life (HRQoL) in patients with idiopathic normal-pressure hydrocephalus (iNPH) at 1 year after the installation of a cerebrospinal fluid shunt. Our aim was to identify factors causing this discrepancy. METHODS: The 1-year HRQoL outcomes of 141 patients with iNPH were evaluated with the generic 15D instrument, in which the minimum clinically important change/difference on the 0-1 scale has been estimated to be +/- 0.015.A 12-point iNPH grading scale (iNPHGS) was used as a clinical disease-specific outcome measure, in which a 1-point decrease is considered to be clinically important. We identified 29 (21%) patients with iNPH from our prospective study whose HRQoL deteriorated or remained the same despite of a favorable iNPHGS outcome. We analyzed this discrepancy using patients' clinical variables and characteristics. RESULTS: Multivariate binary logistic regression analysis indicated that a greater (worse) iNPHGS score at baseline (adjusted odds ratio [OR], 1.7; 95% confidence interval [CI] 1.3-2.3; P <0.001), comorbid chronic pulmonary disease (40% vs. 20%; adjusted OR 17.8; 95% CI 3.6-89.9; P <0.001), and any comorbid nonmetastatic tumor (62% vs. 17%; adjusted OR 11.5; 95% CI 1.5-85.3; P [0.017) predicted discrepancy between iNPHGS and 15D outcomes. - CONCLUSIONS: Frail patients suffering from certain preexisting comorbidities may not experience improvement in generic HRQoL despite of a favorable clinical diseasespecific response. Acknowledging the comorbidity burden of the patient may help clinicians and the patients to understand the conflict between patient-reported and clinical outcomes.
Subject: 15D
Comorbidity
Discrepancy
Health-Related Quality of Life
iNPHGS
Normal-pressure hydrocephalus
Patient-reported outcome
MINI-MENTAL-STATE
SPINAL SURGERY
SHUNT SURGERY
DEMENTIA
DISEASE
INSTRUMENTS
VALIDATION
SCORES
SCALES
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
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