Validation of a simple disease-specific, quality-of-life measure for diabetic polyneuropathy: CAPPRI.

OBJECTIVE: We studied the performance of a 15-item, health-related quality-of-life polyneuropathy scale in the clinic setting in patients with diabetic distal sensorimotor polyneuropathy (DSPN). METHODS: Patients with DSPN from 11 academic sites completed a total of 231 Chronic Acquired Polyneuropathy Patient-Reported Index (CAPPRI) scales during their clinic visits. Conventional and modern psychometric analyses were performed on the completed forms. RESULTS: Conventional and modern analyses generally indicated excellent psychometric properties of the CAPPRI in patients with DSPN. For example, the CAPPRI demonstrated unidimensionality and performed like an interval-level scale. CONCLUSION: Attributes of the CAPPRI for DSPN include ease of use and interpretation; unidimensionality, allowing scores to be summed; adequate coverage of disease severity; and the scale's ability to address relevant life domains. Furthermore, the CAPPRI is free and in the public domain. The CAPPRI may assist the clinician and patient with DSPN in estimating disease-specific quality of life, especially in terms of pain, sleep, psychological well-being, and everyday function. The CAPPRI may be most useful in the everyday clinical setting but merits further study in this setting, as well as the clinical trial setting.

A prospective observational study of ethnic and racial differences in neuraxial labor analgesia request and pain relief.

BACKGROUND: As ethnic and racial diversity increases, it is important that anesthesia providers understand the expectations and concerns of this changing population regarding labor analgesia. Our objective was to evaluate ethnic/racial differences in labor analgesia characteristics with regard to the timing of request for neuraxial analgesia. METHODS: Three hundred ninety-seven parturients were enrolled in this prospective observational cohort study. Term laboring parturients who planned vaginal delivery and requested neuraxial labor analgesia were eligible for inclusion. Data collected included cervical dilation at the time of neuraxial analgesia request, self-identified ethnicity/race, parity, education, insurance status, pain score before and after the initiation of neuraxial analgesia, and mode of delivery. The primary outcome was cervical dilation at the time of neuraxial analgesia request. Ethnicity/race classification was determined by asking the patient, "How would you define your ethnicity?" Patients were categorized into the ethnic/racial groups of non-Hispanic White, African American, Hispanic, or other. Univariate associations between cervical dilation and categorical variables were examined. Multivariate analysis was performed for the primary outcome of cervical dilation at the time of initiation of neuraxial analgesia. RESULTS: At the time of neuraxial analgesia placement, the mean difference in cervical dilation of Hispanic parturients was 0.8 cm compared to non-Hispanic Whites (95% confidence interval [CI], 0.1-1.4; P = 0.047). After controlling for education, reason for placement, labor augmentation, and mode of delivery in a multivariate model, Hispanic parturients had 0.5 cm greater cervical dilation compared to non-Hispanic Whites, which was not significant (95% confidence interval, -0.1 to 1.1; P = 0.089). CONCLUSIONS: Our data indicate that ethnicity/race plays a small role in acceptance and request for neuraxial labor analgesia.