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Dimension nhp md q1q3 pain physical mobility emotional

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Unformatted text preview: ity Social functioning Claudicants n = 48 Critical ischaemia n = 42 P-value 29.9 (27.2–48.5) 30.8 (10.3–50.2) 11.4 (0.0–39.3) 60.5 (0.0–100) 0.0 (0.0–24.2) 54.2 (28.8–84.2) 47.3 (20.6–66.7) 10.0 (0.0–25.2) 47.0 (0.0–100) 0.0 (0.0–25.1) .003 .03 .42 .65 .75 36.5 (22.0–42.0) 25.0 (15.0–40.0) 68.0 (56.0–88.0) 45.0 (31.2–60.0) 68.7 (50.0–87.5) 31.0 (22.0–41.0) 25.0 (15.0–45.0) 68.0 (51.0–77.0) 45.0 (20.0–60.0) 62.5 (50.0–78.1) .27 .93 .54 .47 .41 *A higher score (100) indicates more perceived problems. ** A higher score (100) indicates fewer perceived problems. a P-value, claudicants versus critical ischaemia patients before revascularization. Tested by Mann-Whitney U-test. p-value = <0.05 showed a higher internal consistency except for social functioning one-year postoperatively and was more responsive in detecting changes over time in the IC group. The NHP was more sensitive in discriminating among levels of ischaemia regarding pain and more able to detect changes in the CLI group. The attrition or loss of subjects (27%) in this study could have affected the outcome. Further analysis showed that there were no significant differences in quality of life, sex, age, method of treatment and severity of disease between the attrition group and those who completed the study. The fact that the NHP and SF-36 differ in their nature and content may limit the study design. Therefore the analyses in this study focused only on the comparable domains of the two instruments, including the basic domains of physical, mental and social health identified by the WHOQOL group [7]. A suitable quality of life instrument for patients with chronic lower limb ischaemia should not only be valid, reliable and responsive but also simple for elderly people to understand and complete. In this study there was no difference in response rate between the two instruments and both seemed to be user-friendly and took about 5–10 minutes to complete. The findings strengthen earlier results suggesting that both scales are practical and acceptable to use in elderly patients [37,38]. A generic quality of life instrument, designed for a variety of populations and measuring a comprehensive set of health concepts, is likely to have problems with "ceiling" and "floor" effects [24]. In this study the NHP showed higher "ceiling" effects in all dimensions than the SF-36. There were minor "floor" effects in both the NHP and SF36, indicating the lowest possible quality of life. This is in accordance to Klevsgård et al, [1] who also showed higher "ceiling" effects in social isolation, emotional reactions and energy for the NHP than the SF-36. Other studies have also reported fewer "ceiling" and "floor" effects in the SF-36 than in the NHP in patients with chronic obstructive pulmonary disease [39] and after a myocardial infarction [37]. The advantage of the SF-36 may be due to its use of a Likert-type response format with a number of possible different scores and its ability to detect positive as well negative states of health, whereas the NHP items are dichotomous and state more extreme ends of ill health [39]. This could mean that a patient with ac...
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