Introduction: Asia will be at the forefront of the current epidemic of diabetes mellitus. Quality of life QOL is an important outcome measure in the assessment of diabetes care. However, few QOL instruments are culturally suitable for use in Asian countries. Individualised instruments such as the ADDQoL have the potential to be useful and less costly alternatives to computerised adaptive testing CAT , which may not be practical in developing countries.
|Published (Last):||10 January 2012|
|PDF File Size:||6.30 Mb|
|ePub File Size:||7.13 Mb|
|Price:||Free* [*Free Regsitration Required]|
Metrics details. In all the patients the level of the quality of life was investigated using the Polish language version of the ADDQoL and the psychometric properties were determined taking into consideration internal consistency, the factor loading and intraclass correlations. The treatment procedure in diabetes generally consists in the proper control of the course of this disease with achieving optimum glycaemia results and prevention against the occurrence of complications.
Numerous scientific studies have proven that both type 1 diabetes T1DM and type 2 diabetes T2DM have got a big influence on the level of the quality of life QoL of patients. The tools used for assessing the QoL are many acknowledged and widely applied questionnaires which objectify the QoL related to health [ 1 ]. These include general questionnaires which assess the QoL such as for example SF [ 2 ], WHOQoL [ 3 ], as well as questionnaires specific for a given disease which are characterized by high specificity and sensitivity.
The specific questionnaires assessing the QoL of patients with diabetes include i. The QoL in diabetes depends on many sociodemographic and clinical factors [ 8 , 9 , 10 ]. It has been demonstrated that significant impact on the lowering of the QoL in patients with diabetes is exerted by the complications related to this disease, by the necessity to take insulin and by the co-occurrence of obesity [ 11 ].
Also in another paper the patients with diagnosed diabetes related complications reported significantly lower total scores of the DSQoLS [ 12 ].
In patients with diabetes the QoL decreases both in the psychical, physical and the social realm which is related to, i. The level of the QoL related to the disease as well as its changes progressing over time should also be an important element of the monitoring of the diabetic patient. The tools applied for the assessment of the components of QoL require reliability obtained through determining the psychometric properties of the scale applied for studies. The psychometric properties include determining the structure of the scale and of its internal consistency, validity and reliability.
An optimal confirmation of the reliability of a scale is obtaining satisfactory psychometric parameters of the applied tool. It was demonstrated that the ADDQoL had good psychometric properties and provided clinicians and researchers with a useful tool for the comprehensive assessment of the QoL in adults with diabetes [ 11 , 18 ].
This questionnaire constitutes a tool allowing for individualizing the measurement of the QoL of patients with diabetes with taking into consideration 19 domains of this quality [ 4 ]. This allows the respondent to indicate the life domains which are not applicable or applicable in terms of the significance of the influence of diabetes on particular components of the QoL.
Considering the fact that the studied populations of patients with diabetes differ in particular countries in respect of sociodemographic issues, ethnic issues, culture, wealth, lifestyle and the provided medical care, determining the QoL of these patients requires analyzing the psychometric properties of the questionnaires applied in the mother tongue of the assessed population. The psychometric properties of the Polish language version of the ADDQoL applied among the native inhabitants of Poland suffering from diabetes have not been determined until now.
The survey studies were carried out by the authors of the paper EB, DDM among subsequent patients of outpatient clinics in the period from March till January All the studied patients were native inhabitants of the Southern regions of Poland. The inclusion criteria to the groups of studied patients were as follows: age from 18 to 60, the occurrence of diabetes lasting for at least a year and the ability to complete a questionnaire written in Polish.
During the patient history taking interview and on the basis of the medical case record medical history the authors of the study took account of chronic comorbidities such as the coronary artery disease, heart failure, hypertension, renal failure and stroke as well as late diabetes complications such as retinopathy, nephropathy, polyneuropathy and the diabetic foot. Comorbidities and diabetes complications were diagnosed by specialist physicians, mainly internists, cardiologists, neurologists, nephrologists, diabetologists and ophthalmologists during hospitalization or in specialist clinics.
The treatment of diabetes generally consisted in adhering to a diet and taking insulin in patients with T1DM and a diet, taking derivatives of sulfonylurea and biguanides and in some cases insulin in patients with T2DM. Thus the size of the investigated sample was sufficient for the psychometric analysis. The group of patients with T1DM comprised persons including 57 women and 58 men. The group of patients with T2DM comprised persons including women and men.
The patients with T1DM were selected out of randomly chosen women and randomly chosen men with T1DM while the patients with T2DM were selected out of randomly chosen women and randomly chosen men with T2DM. The reasons for reducing the number of patients qualified for further studies were a lack of consent 23 women and 25 men with T1DM, 19 women and 21 men with T2DM , incompletely filled surveys 25 women and 27 men with T1DM, 12 women and 16 men with T2DM ; this reduction also resulted from taking into consideration the research inclusion and exclusion criteria: in patients with T1DM among women — hyperthyroidism 1 person , taking sedative or psychotropic drugs 3 and glucocorticoids 2 , in men — alcoholism 3 persons , neoplasm 1 , glucocorticoids 1 , in patients with T2DM among women — hyperthyroidism 1 person , hypothyroidism 1 , neoplasm 1 , taking sedative or psychotropic drugs 2 persons and alcoholism 1 , in men — alcoholism 3 , neoplasm 2 , taking immunosuppressive drugs 2.
The research was performed with the consent of the Bioethics Committee of the Beskidzka Regional Chamber of Physicians in Bielsko-Biala; the consent was provided during the meeting held on 11th February No. The systolic blood pressure and diastolic blood pressure were measured. The questionnaire was accompanied by brief information about the studied person including parameters such as: age, sex, place of residence, education, marital status, professional activity, body mass, height, used stimulants, comorbidities, the duration of diabetes, the occurrence of diabetes complications and the taken drugs.
It consists of two general questions referring to the QoL; the first question determines the measurement of the general, present level of the QoL — it includes a 7-grade scale excellent, very good, good, neither good nor bad, bad, very bad and extremely bad and the second question determines the concrete influence of diabetes on the QoL — it includes a 5-grade scale very much better, much better, a little better, the same and worse.
The remaining components referred to the 19 domains of the QoL without the disease and the influence of diabetes on the aspects of health. The product of impact and importance ratings determines the value of the weighted impact score. The lower the value of the weighted impact score the worse the aspect of health or life within the scope of a given domain. The average value of the weighted impact score was also calculated for the whole scale.
The license of the Polish language version was marked with the number CB Before commencing the study every person was informed about its purpose. The statistical analysis was performed using the Statistica v. Basic statistics, i.
The Mann—Whitney U test was used in order to compare two independent groups characterized by distributions which were not normal. The Chi-square test or the Yates-corrected Chi-square test were used for checking the occurrence of relationships between the considered variables.
The factor structure was explored using the Principal Components Analysis. Variables with loadings lower than 0. The number of patients in both studied groups was over thus the requirement for applying the factor analysis was met. A value exceeding 0. If it is significant this means that the factor model is appropriate for the analysed variables. This test verifies whether all the residual correlations are equal 0, i.
The age of the patients with T1DM was In terms of education the studied persons were divided into those with primary education and additionally with 3-year vocational education, with secondary education without a diploma, with secondary education with graduation, with university higher education or vocational higher education.
The comorbidities did not include clinically symptomatic peripheral arterial dieases neither any history of myocardial infarcts, strokes. For some domains the respondents assigned zero value to the importance rating Table 3 , which indicated that certain domains of the QoL assessed by the ADDQoL were not of sufficient importance to them.
With the help of this analysis in the maximum likelihood method 8 factors which explain This confirms the assumptions of the authors of the ADDQoL survey that all the questions have been formulated correctly, it is not possible to create groups of questions domains , every question carries important information and it is not possible to reduce the number of the questions without a significant loss of information provided by them.
A forced one-factor Principal Components Analysis indicated that 18 items had factor loadings exceeding 0. The forced one factor solution explained The percentual values of the ceiling effect were equal zero for almost all domains, irrespectively of the type of diabetes of the examined persons Table 4.
The internal consistency estimate for the 19 items indicated very good results, close to the reported value of the original version of the ADDQoL developed by Badley et al. In case of the modified ADDQoL the internal consistency was similar to that of its English version and the single factor solution was supported [ 4 ]. The results mentioned in this paper demonstrate that although the ADDQoL is a sophisticated scale, it may be used in population-based large-scale studies.
Considering the above results of our studies and additionally the achieved values of the floor and ceiling effects it is possible to suggest satisfactory reliability of this scale. The appropriate test structure of the ADDQoL applied by us is indicated by the obtained results of the factor analysis, which constitutes good construct validity. Even though these studies were not supported by the assessment of validity, they confirmed that the ADDQoL is an important and useful tool aimed at determining the QoL in the period of taking care of patients with diabetes [ 15 ].
It was demonstrated that the Portuguese language version of the ADDQoL had similar psychometric properties as in our own studies. If we move to regions which are culturally different from those of Europe, i. Also in our own study in patients with T2DM the value of the loading factor proved to be lower than 0.
This study is associated with some limitations. Firstly, the generalizability of our findings to the general population with diabetes may be limited because the studied population was not too big, especially the number of patients with T1DM which was about 2 times smaller than the number of persons in the group of patients with T2DM. Nevertheless, it may be assumed that the population of patients with T1DM and T2DM examined by us was representative for the patients with diabetes in Poland, especially in terms of the method of treatment and the lifestyle.
It should be however noted that despite of the fact that the patients studied by us were selected for the studies randomly, they demonstrated a well controlled course of diabetes which is proven by the concentration of glycated hemoglobin equal on average 6. Secondly, no other scales determining the QoL were used in order to make a comparison with the results of the assessed psychometric properties of the ADDQoL.
The ADDQoL in the Polish language version is a reliable tool which may be applied for the assessment of the individual quality of life of patients with type 1 and type 2 diabetes in Poland and is recommended to be used among Polish-speaking patients with diabetes.
Measurement of health-related quality of life in diabetes mellitus. Diabetol Prakt. Google Scholar. Med Care. Qual Life Res. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life; the ADDQOL.
Validation of the diabetes of the diabetes care profile. Eval Health Prof. Measurement of health status in diabetic patients: diabetes impact measurement scales.
Diabetes Care. Validation of a diabetes-specific quality-of-life scale for patients with type 1 diabetes. The quality of life of adults with type 2 diabetes in a hospital care clinic in Taiwan.
Living with diabetes: rationale, study, design and baseline characteristics for Australian prospective cohort study. BMC Public Health. The Tayside insulin management course: an effective education programme in type 1 diabetes. Int J Clin Pract. The audit of diabetes-dependent quality of life 19 ADDQoL : feasibility, reliability and validity in a population-based sample of Australian adults.
Linguistic and psychometric validation of the diabetes-specific quality-of-life scale in U. English for adults with type 1 diabetes. Pharm Pract. BMC Res Notes. Audit of diabetes-dependent quality of life ADDQoL [Chinese version for Singapore] questionnaire: reliability and validity among Singaporeans with type 2 diabetes mellitus.
Appl Health Econ Health Policy. Adaptation of the audit of diabetes-dependent quality of life questionnaire to people with diabetes in China.
Audit of Diabetes Dependent QoL (ADDQoL)
The original ADDQoL item version was developed in the early s; The item version was developed in ; The item version in The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual Life Res. Bradley C, Speight J. Patient perceptions of diabetes and diabetes therapy:assessing quality of life. Diabetes Metab Res Rev. Review PubMed Abstract.
ADDQoL: Audit of Diabetes Dependent Quality of Life - 19 Items
Diabetes mellitus type 2 T2D is a chronic metabolic disease with a great impact on health status and quality of life QoL in terms of physical, social, and psychological well-being. The aim of the present study was to measure diabetes-dependent QoL and affecting factors in patients with T2D. The Audit of Diabetes-Dependent Quality of Life questionnaire was carried out in all study participants. Diabetes mellitus type 2 had a negative impact to QoL in The results of logistic regression analysis showed that QoL was related with age [odds ratio OR 0. Age and marital status were the only determinants of QoL.