Use of the Dermatology Life Quality Index in filarial lymphoedema patients
Identifieur interne : 005E53 ( Istex/Corpus ); précédent : 005E52; suivant : 005E54Use of the Dermatology Life Quality Index in filarial lymphoedema patients
Auteurs : B. V. Babu ; A. N. Nayak ; K. Rath ; A. S. KerkettaSource :
- Transactions of The Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 2006-03.
English descriptors
Abstract
The global programme to eliminate lymphatic filariasis has alleviation of suffering and disability as one of its components, and many efforts are being taken across the globe in this direction. However, there is no effective tool to assess the impact of these efforts on patients’ quality of life and/or lessening of disability and suffering. The present paper reports the use of the Dermatology Life Quality Index (DLQI) in filarial lymphoedema patients. DLQI scores were collected from 203 patients recruited from a clinic and from the community. The DLQI score ranged from 0 to 17, and a mean score of 2.7 (SD 4.4) or 9.0% disability. This score is lower than many skin diseases reported so far. The scores for individual questions vary, but the degree of consistency of responses between questions is high. The differences between sexes, place of recruitment and grades of lymphoedema are not significant. Although the DLQI measures the quality of life due to lymphoedema, this study further warrants development of a good quality-of-life index for lymphoedema patients.
Url:
DOI: 10.1016/j.trstmh.2005.05.022
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ISTEX:C9BDD5184C2019F2822D5B55B2169AA9C91045B1Le document en format XML
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The present paper reports the use of the Dermatology Life Quality Index (DLQI) in filarial lymphoedema patients. DLQI scores were collected from 203 patients recruited from a clinic and from the community. The DLQI score ranged from 0 to 17, and a mean score of 2.7 (SD 4.4) or 9.0% disability. This score is lower than many skin diseases reported so far. The scores for individual questions vary, but the degree of consistency of responses between questions is high. The differences between sexes, place of recruitment and grades of lymphoedema are not significant. 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Tropical Medicine and Hygiene</publisher><availability><p>OUP</p></availability><date>2006</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Use of the Dermatology Life Quality Index in filarial lymphoedema patients</title><author xml:id="author-0000" corresp="yes"><persName><forename type="first">B.V.</forename><surname>Babu</surname></persName><email>babubv@satyam.net.in</email><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation></author><author xml:id="author-0001"><persName><forename type="first">A.N.</forename><surname>Nayak</surname></persName><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation></author><author xml:id="author-0002"><persName><forename type="first">K.</forename><surname>Rath</surname></persName><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation></author><author xml:id="author-0003"><persName><forename type="first">A.S.</forename><surname>Kerketta</surname></persName><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation></author><idno type="istex">C9BDD5184C2019F2822D5B55B2169AA9C91045B1</idno><idno type="DOI">10.1016/j.trstmh.2005.05.022</idno></analytic><monogr><title level="j">Transactions of The Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">Trans R Soc Trop Med Hyg</title><idno type="pISSN">0035-9203</idno><idno type="eISSN">1878-3503</idno><idno type="PublisherID">trstmh</idno><idno 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<front>
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<journal-title>Transactions of The Royal Society of Tropical Medicine and Hygiene</journal-title>
<abbrev-journal-title>Trans R Soc Trop Med Hyg</abbrev-journal-title>
<issn pub-type="ppub">0035-9203</issn>
<issn pub-type="epub">1878-3503</issn>
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<publisher-name>Royal Society of Tropical Medicine and Hygiene</publisher-name>
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<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Use of the Dermatology Life Quality Index in filarial lymphoedema patients</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Babu</surname><given-names>B.V.</given-names></name><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Nayak</surname><given-names>A.N.</given-names></name>
</contrib>
<contrib contrib-type="author">
<name><surname>Rath</surname><given-names>K.</given-names></name>
</contrib>
<contrib contrib-type="author">
<name><surname>Kerketta</surname><given-names>A.S.</given-names></name>
</contrib>
<aff>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">
<label>*</label>Corresponding author. Tel.: +91 674 230 3002; fax: +91 674 230 1351. <italic>E-mail addresses:</italic> <email>babubv@satyam.net.in</email>, <email>bontha99@hotmail.com</email> (B.V. Babu).</corresp>
</author-notes>
<pub-date pub-type="ppub">
<month>3</month>
<year>2006</year>
</pub-date>
<volume>100</volume>
<issue>3</issue>
<fpage>258</fpage>
<lpage>263</lpage>
<history>
<date date-type="received">
<day>10</day>
<month>12</month>
<year>2004</year></date>
<date date-type="rev-recd">
<day>11</day>
<month>5</month>
<year>2005</year></date>
<date date-type="accepted">
<day>11</day>
<month>5</month>
<year>2005</year></date>
</history>
<permissions>
<copyright-year>2006</copyright-year>
<copyright-holder>Royal Society of Tropical Medicine and Hygiene</copyright-holder>
</permissions>
<abstract>
<title>Summary</title>
<p>The global programme to eliminate lymphatic filariasis has alleviation of suffering and disability as one of its components, and many efforts are being taken across the globe in this direction. However, there is no effective tool to assess the impact of these efforts on patients’ quality of life and/or lessening of disability and suffering. The present paper reports the use of the Dermatology Life Quality Index (DLQI) in filarial lymphoedema patients. DLQI scores were collected from 203 patients recruited from a clinic and from the community. The DLQI score ranged from 0 to 17, and a mean score of 2.7 (SD 4.4) or 9.0% disability. This score is lower than many skin diseases reported so far. The scores for individual questions vary, but the degree of consistency of responses between questions is high. The differences between sexes, place of recruitment and grades of lymphoedema are not significant. Although the DLQI measures the quality of life due to lymphoedema, this study further warrants development of a good quality-of-life index for lymphoedema patients.</p>
</abstract>
<kwd-group xml:lang="en">
<title>Keywords</title>
<kwd>Lymphatic filariasis</kwd>
<kwd>Lymphoedema</kwd>
<kwd>Dermatology Life Quality Index</kwd>
<kwd>India</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec>
<label>1</label>
<title>Introduction</title>
<p>Lymphatic filariasis (LF) has been ranked as the second leading cause of disability worldwide (<xref ref-type="bibr" rid="bib28">WHO, 1995</xref>). Lymphoedema, the commonest chronic manifestation of LF involving the lymphatic system and skin, has adverse effects on patients’ lives, including social and economic domains (<xref ref-type="bibr" rid="bib3">Babu et al., 2002</xref>; <xref ref-type="bibr" rid="bib11">Gyapong et al., 1996</xref>; <xref ref-type="bibr" rid="bib21">Ramaiah et al., 1999</xref>). However, few attempts are made at assessing the quality of life in filarial lymphoedema patients, although there is growing interest in many other disorders leading to disability (<xref ref-type="bibr" rid="bib9">Finlay and Kelly, 1987</xref>). The quality of life is an inclusive concept incorporating all factors that impact upon an individual's life, and good quality of life is present when the hopes of an individual are matched by experience (<xref ref-type="bibr" rid="bib4">Calman, 1984</xref>). The quality-of-life measures are appropriate outcome measures, giving a patient-based view of service effectiveness (<xref ref-type="bibr" rid="bib19">Parry et al., 1995</xref>). The technique used to measure quality of life is usually a questionnaire based on patients’ views. The concepts involved in the development of quality-of-life measures have been described elsewhere (<xref ref-type="bibr" rid="bib26">Teeling Smith, 1988</xref>). These measures either cover all ways in which patients’ lives can be affected by any disease, or are more specific to diseases of systems or individual diseases (<xref ref-type="bibr" rid="bib8">Finlay, 1997</xref>). The impact of treatment and morbidity management regimens in lymphoedema is usually measured through clinical assessment, for example reduction of oedema. The global programme to eliminate LF has alleviation of suffering and disability as one of its components, and many efforts are being taken across the globe in this direction (<xref ref-type="bibr" rid="bib22">Seim et al., 1999</xref>; <xref ref-type="bibr" rid="bib29">WHO, 2004</xref>). However, there is no effective tool to assess the impact of these efforts on patients’ quality of life and/or lessening of disability and suffering. A few attempts are made to assess the quality of life in general as well as the impact of healthcare interventions among patients with non-filarial lymphoedema such as post-mastectomy lymphoedema (<xref ref-type="bibr" rid="bib2">Alliot and Launois, 2002</xref>; <xref ref-type="bibr" rid="bib5">Campisi, 2002</xref>; <xref ref-type="bibr" rid="bib6">Coster et al., 2001</xref>; <xref ref-type="bibr" rid="bib14">Launois et al., 1996</xref>; <xref ref-type="bibr" rid="bib20">Pereira de Godoy et al., 2002</xref>) and filarial lymphoedema (<xref ref-type="bibr" rid="bib16">McPherson, 2003</xref>). Hence, we attempted to use a widely used index, namely the Dermatology Life Quality Index (DLQI), to assess the quality of life of filarial lymphoedema patients. The DLQI has been developed and widely used for assessing quality of life in various skin diseases (<xref ref-type="bibr" rid="bib10">Finlay and Khan, 1994</xref>; <xref ref-type="bibr" rid="bib15">Loo et al., 2003</xref>). <xref ref-type="bibr" rid="bib16">McPherson (2003)</xref> also used the DLQI among 14 patients with filarial lymphoedema in Guyana to assess the impact of a patient education programme. The DLQI has also been used in developing countries for a few conditions such as vitiligo (<xref ref-type="bibr" rid="bib1">Aghaei et al., 2004</xref>), acne (<xref ref-type="bibr" rid="bib31">Yazici et al., 2004</xref>) and atopic dermatitis (<xref ref-type="bibr" rid="bib30">Won et al., 2004</xref>) as well as for a few common skin diseases in South Africa (<xref ref-type="bibr" rid="bib12">Jobanputra and Bachmann, 2000</xref>) and Tanzania (<xref ref-type="bibr" rid="bib7">Etemesi, 2002</xref>). As the DLQI is not disease-specific but is widely encompassing and used to compare quantitatively the disability experienced by patients with a wide range of skin diseases, in this study we report the possibility of using the DLQI in filarial lymphoedema patients.</p>
</sec>
<sec sec-type="methods">
<label>2</label>
<title>Methods</title>
<p>This study was based on DLQI scores collected from 203 patients (101 from the community and 102 from the institute-run filariasis clinic at the state Headquarters Hospital) living in Khurda district of Orissa, India, following the prescribed procedure (<xref ref-type="bibr" rid="bib10">Finlay and Khan, 1994</xref>). The original DLQI questionnaire is available in English (Appendix 1) (for more information, see <ext-link ext-link-type="uri" xlink:href="http://www.dermatology.org.uk">http://www.dermatology.org.uk</ext-link>). In the present study, the questionnaire was administered in Oriya, the native language of Orissa. The Oriya version of the DLQI questionnaire was made by translating the original English version. Multiple drafts were created and pre-tested to produce an accurate version that best reflected each question in the original English version of the questionnaire. The Institutional Ethical Committee of the Regional Medical Research Centre approved the study, and the consent of the patients was obtained after explaining the purpose of the study. Patients were in the age range 13–83 years (median, 42 years) and were suffering from lymphoedema grade 1, 2, or 3.</p>
</sec>
<sec>
<label>3</label>
<title>Results and discussion</title>
<p>All the respondents correctly responded to all questions and none of the questions were left unanswered. The patients’ characteristics along with the mean scores of the DLQI are shown in <xref ref-type="fig" rid="tbl1">Table 1</xref>
<fig id="tbl1">
<label>Table 1</label>
<caption>
<p>Patient characteristics and mean Dermatology Life Quality Index (DLQI) scores</p>
</caption>
<graphic mimetype="image" xlink:href="100-3-258-tbl001.tif"></graphic>
</fig>. The DLQI scores ranged from 0 to 17, with a mean DLQI score of 2.7 (SD 4.4). The DLQI can be expressed as a percentage of the maximum possible score of 30. The percentage of DLQI score among these patients is up to 56.7%, with a mean of 9% (SD 14.7). The mean scores for each individual DLQI question along with topics of questions are shown in <xref ref-type="fig" rid="fig1">Figure 1</xref>
<fig id="fig1" position="float">
<label>Figure 1</label>
<caption>
<p>Mean score for each Dermatology Life Quality Index (DLQI) question for lymphoedema patients.</p>
</caption>
<graphic mimetype="image" xlink:href="100-3-258-fig001.tif"></graphic>
</fig>. The scores are higher for question number 7 regarding the impact of the disease on working and studying. The degree of consistency of responses between questions was tested using the rank correlation test. The consistency between all questions when paired was found to be statistically significant (<italic>P</italic> < 0.05), except for questions 4 vs. 6, 4 vs. 9 and 6 vs. 10. The higher the correlation value, the higher the consistency, showing that if a patient feels miserable in one area, he/she is more likely to feel similar in another area or in general. With regard to quality of life, the higher the score, the greater the number and severity of perceived problems. The mean DLQI score of the present studied lymphoedema patients (2.7 or 9.0%) is lower than many skin diseases, but slightly higher than some skin diseases (<xref ref-type="bibr" rid="bib10">Finlay and Khan, 1994</xref>). In their study in which the DLQI was introduced, <xref ref-type="bibr" rid="bib10">Finlay and Khan (1994)</xref> reported an average DLQI score of 0.5 among healthy controls, and various DLQI scores have been reported among patients with psoriasis (8.9), pruritus (10.5), atopic eczema (12.5), other eczema (8.6), acne (4.3), solar keratosis (3.4), viral wart (6.7), seborrhoeic wart (1.8), basal cell carcinoma (2.0) and moles (1.0). In the present study, there was no difference between men and women in the mean DLQI score (<italic>F</italic> = 0.022; <italic>P</italic> > 0.05). However, patients recruited from the clinic had higher DLQI scores than those recruited from the community, but this difference was not significant (<italic>F</italic> = 1.787; <italic>P</italic> > 0.05). The differences in scores across various grades of lymphoedema were also not significant (<italic>F</italic> = 0.247; <italic>P</italic> > 0.05). Thus, DLQI measures the quality of life caused by lymphoedema, but variability across different grades of lymphoedema is low. This may be due to less variability in the impact of different grades of lymphoedema. Other measures of disease severity may be expected to relate more closely to quality of life among lymphoedema patients, in particular the frequency of acute episodes of adenolymphangitis. <xref ref-type="bibr" rid="bib17">McPherson and Penzer (2003)</xref> showed that the DLQI score was not significantly associated with lymphoedema grades but was significantly related to the frequency of lymphangitis episodes. The important advantage of this index may be that it provides an additional patient-oriented measure, particularly to assess the effectiveness of drug and behavioural interventions. It has been used earlier to measure changes in quality of life before and after hospital admission for patients with skin disease (<xref ref-type="bibr" rid="bib13">Kurwa and Finlay, 1995</xref>; <xref ref-type="bibr" rid="bib27">Touw et al., 2001</xref>). Although it has been used widely to assess the impact of various interventions in skin diseases, it must be validated among filarial lymphoedema patients in the context of intervention. <xref ref-type="bibr" rid="bib16">McPherson (2003)</xref> showed a significant difference in DLQI score among 11 filarial lymphoedema patients by giving an educational intervention. Also, it appears to be easy to use this index both in the hospital and field settings, and it took little time to obtain a score from a patient (less than 10 min). Although LF is in the elimination phase, many patients who have already developed chronic lymphoedema remain in the community and unfortunately there is no cure for the condition except to alleviate disability and suffering. Many strategies to alleviate disability and suffering, including promoting foot care and foot hygiene, have been initiated across endemic countries (<xref ref-type="bibr" rid="bib29">WHO, 2004</xref>) and some trials are still going on to develop treatment regimens. Hence, an appropriate scale or index is necessary to assess the impact of these regimens, particularly the patient-perceived benefits. Use of the DLQI for this purpose may further be explored by relating it to the frequency of acute lymphangitis episodes, as it is well established that many interventions targeting filarial lymphoedema patients, including those with foot hygiene, result in preventing/decreasing the frequency of lymphangitis episodes (<xref ref-type="bibr" rid="bib18">Oslzewski, 1996</xref>; <xref ref-type="bibr" rid="bib23">Shenoy et al., 1998</xref>, <xref ref-type="bibr" rid="bib24">1999</xref>; <xref ref-type="bibr" rid="bib25">Suma et al., 2002</xref>). Thus, this study provides some insight into the issue and warrants behavioural scientists working in concert with filarialogists and dermatologists to develop a good quality-of-life index for lymphoedema patients.</p>
</sec>
</body>
<back>
<sec>
<title>Conflicts of interest statement</title>
<p>The authors have no conflicts of interest concerning the work reported in this paper.</p>
</sec>
<ack>
<title>Acknowledgements</title>
<p>This work is part of an intramural project funded by the Regional Medical Research Centre (Indian Council of Medical Research), Bhubaneswar, India. Thanks are also due to Dr S.K. Kar, Director of the institute, for his co-operation. The authors are thankful to Prof. Andrew Y. Finlay of University of Wales College of Medicine, Cardiff, UK, for giving permission to use the DLQI questionnaire.</p>
</ack>
<app-group>
<app>
<title>Appendix A. The Dermatology Life Quality Index (DLQI) questionnaire</title>
<fig id="fig2" position="float">
<graphic mimetype="image" xlink:href="100-3-258-fig002.tif"></graphic>
</fig>
</app>
</app-group>
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</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Use of the Dermatology Life Quality Index in filarial lymphoedema patients</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Use of the Dermatology Life Quality Index in filarial lymphoedema patients</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">B.V.</namePart><namePart type="family">Babu</namePart><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation><affiliation>E-mail: babubv@satyam.net.in</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.N.</namePart><namePart type="family">Nayak</namePart><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K.</namePart><namePart type="family">Rath</namePart><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A.S.</namePart><namePart type="family">Kerketta</namePart><affiliation>Division of Clinical and Epidemiology, Regional Medical Research Centre, Indian Council of Medical Research, SE Rly Project Complex (Post), Bhubaneswar 751023, India</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Royal Society of Tropical Medicine and Hygiene</publisher><dateIssued encoding="w3cdtf">2006-03</dateIssued><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>The global programme to eliminate lymphatic filariasis has alleviation of suffering and disability as one of its components, and many efforts are being taken across the globe in this direction. However, there is no effective tool to assess the impact of these efforts on patients’ quality of life and/or lessening of disability and suffering. The present paper reports the use of the Dermatology Life Quality Index (DLQI) in filarial lymphoedema patients. DLQI scores were collected from 203 patients recruited from a clinic and from the community. The DLQI score ranged from 0 to 17, and a mean score of 2.7 (SD 4.4) or 9.0% disability. This score is lower than many skin diseases reported so far. The scores for individual questions vary, but the degree of consistency of responses between questions is high. The differences between sexes, place of recruitment and grades of lymphoedema are not significant. Although the DLQI measures the quality of life due to lymphoedema, this study further warrants development of a good quality-of-life index for lymphoedema patients.</abstract><subject lang="en"><genre>Keywords</genre><topic>Lymphatic filariasis</topic><topic>Lymphoedema</topic><topic>Dermatology Life Quality Index</topic><topic>India</topic></subject><relatedItem type="host"><titleInfo><title>Transactions of The Royal Society of Tropical Medicine and Hygiene</title></titleInfo><titleInfo type="abbreviated"><title>Trans R Soc Trop Med Hyg</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0035-9203</identifier><identifier type="eISSN">1878-3503</identifier><identifier type="PublisherID">trstmh</identifier><identifier type="PublisherID-hwp">trstmh</identifier><part><date>2006</date><detail type="volume"><caption>vol.</caption><number>100</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>258</start><end>263</end></extent></part></relatedItem><identifier type="istex">C9BDD5184C2019F2822D5B55B2169AA9C91045B1</identifier><identifier type="DOI">10.1016/j.trstmh.2005.05.022</identifier><recordInfo><recordContentSource>OUP</recordContentSource><recordOrigin>Royal Society of Tropical Medicine and Hygiene</recordOrigin></recordInfo></mods></metadata><covers><json:item><extension>tiff</extension><original>true</original><mimetype>image/tiff</mimetype><uri>https://api.istex.fr/document/C9BDD5184C2019F2822D5B55B2169AA9C91045B1/covers/tiff</uri></json:item></covers><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/document/C9BDD5184C2019F2822D5B55B2169AA9C91045B1/annexes/jpeg</uri></json:item><json:item><extension>gif</extension><original>true</original><mimetype>image/gif</mimetype><uri>https://api.istex.fr/document/C9BDD5184C2019F2822D5B55B2169AA9C91045B1/annexes/gif</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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