A pilot survey on the quality of life in respiratory rehabilitation carried out in COPD patients with severe respiratory failure: preliminary data of a novel Inpatient Respiratory Rehabilitation Questionnaire (IRRQ).

BACKGROUND: Measuring the state of health is a method for quantifying the impact of an illness on the day-to-day life, health and wellbeing of a patient, providing a quantitative measure of an individual's quality of life (QoL). QoL expresses patient point of view by a subjective dimension and can express the results of medical intervention. Pulmonary rehabilitation is an essential component in the management of COPD patients, and measuring QoL has become a central focus in the study of this disease.Although nowadays several questionnaires for measuring the QoL in COPD patients are available, there are no questionnaires specifically developed for evaluating QoL in COPD patients undergoing respiratory rehabilitation.The aim of this study was to develop a novel questionnaire for the QoL quantification in COPD patients undergoing in-patient pulmonary rehabilitation program. METHODS: The questionnaire, administered to COPD patients undergoing long-term oxygen therapy into a respiratory rehabilitation ward, was developed by a simple and graphic layout to be administered to elderly patients. It included one form for admission and another for discharge. It included only tips related to the subjective components of QoL that would be relevant for patient, although likely not strictly related to the respiratory function.A descriptive analysis was performed for the socio-demographic characteristics and both the non-parametric Wilcoxon T-test and the Cronbach's alpha index were calculated for evaluating the sensitivity of the questionnaire to the effects of respiratory rehabilitation and for identifying its consistency. RESULTS: The physical and psychological condition of the 34 COPD patients improved after the rehabilitative treatment and this finding was detected by the questionnaire (overall improvement: 14.2±2.5%), as confirmed by the non-parametric Wilcoxon test (p<0.01). The consistency detected by the Cronbach's alpha was good for both the questionnaire at admission and at discharge (0.789±0.084 and 0.784±0.145, respectively), although some items did not adequately measure the intended outcome. CONCLUSIONS: This proposed questionnaire represents a substantial innovation compared to previous methods for evaluating the QoL, since it has been specifically designed for hospitalized COPD patients undergoing respiratory rehabilitation with serious respiratory deficiency, allowing to effectively determining the QoL in these patients.

Alexithymia in respiratory rehabilitation.

PURPOSE: To date, there are no studies that have investigated the role of alexithymia in respiratory rehabilitation. We aimed to observe the prevalence of alexithymia in patients attending respiratory rehabilitation and to verify the presence of a difference between alexithymics and non-alexithymics responsiveness to the respiratory rehabilitation standard protocol. METHODS: A prospective cohort study evaluating the influence of alexithymia on functional recovery of in-patients afferent to the Respiratory Rehabilitation Unit of IRCCS San Raffaele Pisana. Sixty patients were consecutively enrolled into the study and evaluated for alexithymia, anxiety and depression. Functional recovery was assessed with the six-minute walking test (6MWT). Prior and post-completion of this test dyspnoea, oxygen saturation and cardiac frequency were recorded. RESULTS: Alexithymia was not found to be significantly affecting the functional recovery of participants in respiratory rehabilitation. The distance walked at the 6MWT (6MWD) increased in both alexithymics and non-alexithymics (p(alexithymics) = 0.014; p(non-alexithymics) < 0.0001). Dyspnoea strongly improved among non-alexithymics, although a signal for improvement was also found in alexithymics (p(alexithymics) = 0.046; p(non-alexithymics) = 0.0001). CONCLUSIONS: These findings suggest that alexithymia did not have a significant impact on functional recovery of patients in respiratory rehabilitation.

Italian validation of the McGill Quality of Life Questionnaire (MQOL-It).

INTRODUCTION: Quality of life is a dynamic concept that can undergo change with time and/or disease progression. The aim of this study was to test the reliability and validity of the Italian version of the McGill Quality of Life Questionnaire (MQOL-It), that we consider useful for assessing quality of life in Palliative Care. METHODS: The MQOL-It was administered by interview to 175 patients (M 108; F 67) admitted to a Unit of Palliative Care. All patients were suffering from advanced disease: cancer, amyotrophic lateral sclerosis, chronic heart failure. Statistical analysis was performed to assess the psychometric properties of the questionnaire. RESULTS: Factor analysis (VARIMAX) revealed four domains of quality of life, though the item composition differed, at composition analysis, from the original MQOL version. "Achieved goals" and "control over life", items classified in the English version as part of the existential domain, in the Italian version fitted the psychological domain; the item "well-being" was grouped into the physical domain and did not load clearly with other factors. Cronbach's alpha for the whole questionnaire was 0.85, with a good internal consistency for the four subscales (Cronbach's alpha > or = 0.65). All MQOL-It subscales were significantly correlated (Spearman correlation) with the Single Item rating Scale (SIS); comparison between the MQOL-It and the Nottingham Health Profile (NHP)-part I showed the instrument's concurrent validity. CONCLUSIONS: MQOL shows robust psychometric properties and appears suitable for evaluating quality of life in palliative care in Italy.

Balance impairment after acoustic neuroma surgery.

OBJECTIVE: The aim of this study was to assess the incidence of balance problems after acoustic neuroma surgery, evaluating whether disequilibrium is disabling. STUDY DESIGN: Retrospective observational study. SETTING: Rehabilitation center. PATIENTS: A group of 386 patients who underwent acoustic neuroma surgery. INTERVENTIONS: Patients were selected from a population of 459 subjects who had undergone surgery for acoustic neuroma. MEAN OUTCOME MEASURES: The Dizziness Handicap Inventory, The Activities-specific Balance Confidence Scale (ABC), and a specific questionnaire on oscillopsia. RESULTS: The specific questionnaire emphasized that 39 patients (10.10%) perceived disequilibrium as disabling, and the oscillopsia handicap score result was moderate in 73.32% of the sample, mild in 21.50%, and severe in 5.18% of patients. The Dizziness Handicap Inventory and ABC scales revealed the presence of handicap and disability due to disequilibrium and the influence of some variables such as sex and a higher oscillopsia handicap score. Dizziness Handicap Inventory and ABC scores were higher in symptomatic patients. CONCLUSION: Disequilibrium influences handicap and disability after acoustic neuroma surgery. This symptom is also present after several years since surgery, and some patients perceived disequilibrium as disabling.

Quality of life after acoustic neuroma surgery.

OBJECTIVE: The aim of this study is to assess patients' quality of life after acoustic neuroma surgery, and if some patients' characteristics, parameters of tumor and surgical parameters affect patients' quality of life. STUDY DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENTS: A group of 386 patients who underwent acoustic neuroma surgery. INTERVENTION: Patients included were derived from a population of 459 subjects operated for acoustic neuroma by the Otologic Group of Piacenza. MEAN OUTCOME MEASURE: The outcome of the questionnaires on quality of life (SF 36), the Dizziness Handicap Inventory (DHI) and a questionnaire of patients' histories were analyzed. RESULTS: In our sample a group of 231 patients were asymptomatic after surgery, while 155 patients reported very really disabling symptoms. Hearing loss was perceived as the most disabling symptom. The scores of questionnaire on quality of life were lower than scores for the normal population. The indices of disablement influenced the perception of quality of life. CONCLUSION: Our study has shown that patients perceived a worsening of their quality of life, in particular women and patients over 45. Surgery caused a higher percentage of disability. Patients' quality of life can be used as a parameter for the timing of surgery. Our data indicate that an early surgical approach for intrameatal tumor is better than waiting for an increase in the tumor size. A "wait-and-scan" strategy for extrameatal neuromas which do not affect the brainstem is preferable, since these patients have a worsening of their quality of life after surgery independently of the tumor size.

The physical therapist-patient relationship. Does physical therapist' occupational stress affect patients' quality of life?

Our pilot study investigated the patient-physical therapist relationship. Physical therapists see and are actively involved in the consequences of and the improvements in patients' health status. This close involvement, together with their own expectations, renders physical therapists vulnerable to different kinds of stress. The aim of this study was to investigate whether physical therapists' occupational stress is related to patients' perceived quality of life. Eight patient-physical therapist pairs were enrolled. The following measures were administered to the participants: Occupational Stress Indicator (OSI); World Health Organization Quality of Life-Brief (WHOQoL-Brief); Hospital Anxiety and Depression Scale (HADS). Our study demonstrated the existence of different kinds of relationship between physical therapists' occupational stress (measured by OSI) and patients' perceived quality of life (measured by WHOQoL-Brief). It was found that patients' quality of life and therefore outcome are affected by the possible presence of physical therapists' occupational stress. Our study identified traits (both personal and professional) in physical therapists that positively affect patients' perceived quality of life.

Italian validation of the Royal Free Interview for Religious and Spiritual Beliefs.

Interest in the relevance of religion and spirituality to medicine is growing and concerns the possible association between religiousness, spirituality and well-being. In the rehabilitation field these factors may affect outcome. We translated the "Royal Free Interview for Religious and Spiritual Beliefs" into Italian and validated the Italian language version. The translation the Royal Free Interview was accomplished in several steps. Certain adaptations were necessary in order to take into account certain peculiarities of the Italian language and of the Italian-speaking world. The Italian translation presented in this study shows internal consistency: Cronbach's alpha coefficient 0.82 (spiritual scale) and 0.80 (philosophical scale) in the 53 healthy volunteers; alpha coefficient 0.79 (spiritual scale) and 0.64 (philosophical scale) in the stroke patients. Test-retest reliability, evaluated by means of the intraclass correlation coefficient, was 0.83 (spiritual scale) and 0.99 (philosophical scale). There are two main reasons why an Italian translation of a religious coping scale was deemed necessary: i) there is a growing awareness of the possible impact of faith on stress and on the outcome of many disabling diseases; ii) Italy has a large and aging population and thus a high prevalence of disabled patients.