Zusammenfassung
Einleitung: Die gesundheitsbezogene Lebensqualität (health-related quality of life, HRQOL) spielt im Gesundheitswesen eine zunehmende Rolle. Die Arbeitsgruppe Lebensqualität im Kompetenznetz chronisch entzündliche Darmerkrankungen hat zum Ziel, Instrumente der HRQOL-Messung zu erarbeiten und als Standards in die klinische Versorgung und Forschung zu integrieren. Methodik: Der „Inflammatory Bowel Disease Questionnaire” (IBDQ) hat sich international als valides krankheitsspezifisches HRQOL-Messinstrument erwiesen. Eine deutsche Version (IBDQ-D) wurde jetzt von uns entwickelt und bei 415 ambulant betreuten Patienten mit Morbus Crohn (MC; n = 306) oder Colitis ulcerosa (CU; n = 109) erstmals geprüft. Ziel war, durch die Testung psychometrischer Eigenschaften, durch Vergleich der erhaltenen IBDQ-D-Werte mit den Ergebnissen internationaler Varianten sowie durch die Korrelation der IBDQ-Werte mit der Krankheitsaktivität, die Qualität der generierten deutschen Version zu prüfen. Ergebnisse: Die getesteten psychometrischen Eigenschaften ergaben keine Hinweise auf die Notwendigkeit einer wesentlichen Überarbeitung des IBDQ-D. Der Vergleich zu internationalen Daten deutet darauf hin, dass der IBDQ-D ein robustes Messinstrument der HRQOL von deutschsprachigen MC- und CU-Patienten darstellt. Für beide Erkrankungen findet sich zwischen der Krankheitsaktivität und dem IBDQ-D-Gesamtscore eine statistisch signifikante negative Korrelation. Mit Hilfe des IBDQ-D ist es möglich, die Messung der HRQOL als Endpunkt für klinische Studien im Bereich CED in Deutschland zu etablieren.
Abstract
Background: Health-related quality of life (HRQOL) is an important outcome-parameter in health research and care. The aim of the working group Quality of Life in the Competence Network Inflammatory Bowel Disease (IBD ; in the original German: “Kompetenznetz chronisch entzündliche Darmerkrankungen”) is to generate instruments for assessment of HRQOL and its implementation as standards in clinical trials, health care and research in IBD. Methods: The Inflammatory Bowel Disease Questionnaire (IBDQ) is an international validated disease specific instrument for HRQOL-assessment. A German version of the IBDQ was elaborated and tested in 415 outpatients with Crohn’s disease (CD, n = 306) and ulcerative colitis (UC, n = 109). The aim of the study was to compare the results of HRQOL-assessment (IBDQ-D) with international investigations, to correlate HRQOL results with disease activity and to preform a pretest of psychometric properties. Results: International data suggest that the IBDQ-D is a suitable instrument for HRQOL-assessment in CD and UC. For both disease a statistically significant negative correlation with disease activity was found. Tested psychometric properties do not suggest that a revision of the IBDQ-D is required. The IBDQ-D offers the HRQOL-assessment as an primary or secondary outcome in clinical trials in IBD in Germany.
Schlüsselwörter
Gesundheitsbezogene Lebensqualität - chronisch entzündliche Darmerkrankung - Morbus Crohn - Colitis ulcerosa - IBDQ-D
Key words
Health-related quality of life - inflammatory bowel disease - Crohn’s disease - ulcerative colitis - IBDQ-D
Literatur
1
Häuser W, Grandt D.
Lebensqualitätsmessung in der Gastroenterologie – Konzepte, Instrumente und Probleme.
Z Gastroenterol.
2001;
39
475-481
2
Lopez-Vivancos J, Casellas F, Badia X. et al .
Validation of the Spanish Version of the Inflammatory Bowel Disease Questionnaire on Ulcerative Colitis and Crohn’s Disease.
Digestion.
1999;
60
274-280
3
Guyatt G, Mitchell A, Irvine E J. et al .
A new measure of health status for clinical trials in inflammatory bowel disease.
Gastroenterology.
1989;
96 (3)
804-810
4
Irvine E J.
Quality of Life – Rationale and Methods for Developing a Disease-specific Instrument for Inflammatory Bowel Disease.
Scand J Gastroenterol.
1993;
28 Suppl 199
22-27
5
Love J R, Irvine E J, Fedorak N.
Quality of Life in Inflammatory Bowel Disease.
J Clin Gastroenterol.
1992;
14 (1)
15-19
6 Drossmann D A. Inflammatory Bowel Disease. Spilker B. Quality of Life and Pharmacoeconomics in Clinical Trials 2nd Edition Philadelphia; Lippincott-Raven 1996: 925-935
7
Drossmann D A, Patrick D L, Mitchel C M. et al .
Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns.
Dig Dis Sci.
1989;
34
1379-1386
8
Testa M A, Simson D C.
Assessment of Quality of life outcomes.
New England Journal of Medicine.
1996;
334 (13)
835-840
9
www.who.int/about/definition/en.
10
Ellert U, Knopf H.
Satisfaction with living conditions and health.
Gesundheitswesen.
1999;
61
145-150
11
Priebe S, Kaiser W, Huxley P.
Quality of life as a planning and evaluation criterion in psychiatric management.
Gesundheitswesen.
1996;
58 (Suppl 1)
86-90
12
Ravens-Sieberer U, Holling H, Bettge S. et al .
Assessment of psychological health and quality of life with The Child and Adolescent Health Survey.
Gesundheitswesen.
2002;
64 (Suppl 1)
30-35
13
Mitchell A, Guyatt G, Singer J. et al .
Quality of life in patients with inflammatory bowel disease.
J Clin Gastroenterol.
1988;
10
306-310
14
Pukrop R, Möller H J, Saß H. et al .
Quality of Life. A contribution to construct validation and the development of a modular system.
Nervenarzt.
1999;
70
41-53
15
Han S W, McColl E, Steen N. et al .
The Inflammatory Bowel Disease Questionnaire: A Valid and Reliable Measure in Ulcerative Colitis Patients in the North East of England.
Scand J Gastroenterol.
1998;
33
961-966
16
de Boer AGEM. et al .
Inflammatory Bowel Disease Questionnaire: cross-cultural adaption and further validation. European Journal of Gastroenterology &.
Hepatology.
1995;
7
1043-1050
17
Russel M GVM. et al .
Validation of the Dutch Translation of the Inflammatory Bowel Disease Questionnaire (IBDQ): A Health-Related Quality of Life Questionnaire in Inflammatory Bowel Disease.
Digestion.
1997;
58 (3)
282-288
18
Kim W H. et al .
Quality of life in Koreans patients with inflammatory bowel diseases: ulcerative colitis, Crohn’s disease and intestinal Behcet’s disease.
Int J Colorect Dis.
1999;
14
52-57
19
Pallis A G, Vlachonikolis I G, Mouzas I G.
Quality of life of Greek patients with inflammatory bowel disease. Validation of the Greek translation of the inflammatory bowel disease questionnaire.
Digestion.
2001;
63
240-246
20
Bernklev T, Moum B, Moum T (IBSEN).
Quality of life in patients with inflammatory bowel disease: translation, data quality, scaling assumptions, validity, reliability and sensitivity to change of the norwegian version of IBDQ.
Scand J Gastroenterol.
2002;
37
1164-1174
21
Hjortswang H. et al .
Validation of the inflammatory bowel disease questionnaire in Swedish patients with ulcerative colitis.
Scand J Gastroenterol.
2001;
36
77-85
22
Leong R WL. et al .
Quality of life in Chinese patients with inflammatory bowel disease: validation of the Chinese translation of the inflammatory bowel disease questionnaire.
Aliment Pharmacol Ther.
2003;
17
711-718
23
Cheung W Y. et al .
The UK IBDQ – a British version of the inflammatory bowel disease questionnaire: development and validation.
J Clin Epidemiol.
2000;
53
297-306
24
Irvine E J, Feagan B G, Wong C J.
Does self-administration of a quality of life index for inflammatory bowel disease change the results?.
J Clin Epidemiol.
1996;
49
1177-1185
25
Irvine E J, Feagan B, Rochon J. et al .
(CCRPT). Quality of Life: A Valid and Reliable Measure of Therapeutic Efficacy in the Treatment of Inflammatory Bowel Disease.
Gastroenterology.
1994;
106
287-296
26
Sutherland M F, Beck I T, Anderson A H. et al .
Oral 5ASA versus prednisone in short term treatment of Crohn’s disease: a multicentre controlled trial.
Can J Gastroenterol.
1990;
4
452-457
27
www.kompetenznetz-ced.de/www.kompetenznetze-medizin.de.
28
Janke K H, Raible A, Bauer M. et al .
Questions on Life Satisfaction (FLZM = Instrument zur LQ-Erfassung) in inflammatory bowel disease.
Int J Colorectal Dis.
2004;
19 (4)
343-353
29 Snaith P, Zigmont A S. Hospital anxiety and depression scale: HADS-D. Herrmann C, Buss U. Deutsche Version; ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin; Testdokumentation und Handanweisung Bern; Huber 1995
30 Deutsche Arbeitsgemeinschaft Epidemiologie (DAE), Arbeitsgruppe Epidemiologische Methoden .Messung und Quantifizierung soziographischer Merkmale in epidemiologischen Studien. In: Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS), Deutsche Gesellschaft für Sozialmedizin und Prävention (DGSMP), Deutsche Region der Internationalen Biometrischen Gesellschaft (DR-IBS). 1999; DAE-Website: http://medweb.uni.muenster.de/institute/epi/dae/vorstand.htm#gep
31
Hoffmann W, Latza U, Terschuren C.
Guidelines and recommendations for ensuring Good Epidemiological Practice (GEP) – revised version after evaluation.
Gesundheitswesen.
2005;
67 (3)
217-225
32
Kohlmann T, Bullinger M, Kirchberger-Blumstein I.
Die deutsche Version des Nottingham Health Profile (NHP): Übersetzungsmethodik und psychometrische Validierung.
Sozial- und Präventivmedizin.
1997;
42 (3)
175-185
33
Mathias S D, Fifer S K, Patrick D L.
Rapid translation of quality of life measures for international clinical trials: avoiding errors in the minimalist approach.
Quality of Life Research.
1994;
3
403-412
34
Best W R, Becktel J M, Singelton J W. et al .
Development of a Crohn’s disease activity index. National Cooperative Crohn’s disease study.
Gastroenterology.
1976;
70
439-444
35
Kjeldsen J, Schafalitzky de Muckadell OB.
Review – Assessment of Disease Severity and Activity in Inflammatory Bowel Disease.
Scand J Gastroenterol.
1993;
28
1-9
36
Harvey R F, Bradshaw J M.
A simple index of Crohn’s disease activity.
Lancet.
1980;
1
514
37
Myren J, Bouchier I AD, Watkinson G. et al .
The O.M.G.E. multinational inflammatory bowel disease survey 1976 – 1982. A further report on 2,657 cases.
Scand J Gastroenterol.
1984;
19 (Suppl. 95)
1-27
38 WHO Technical Report Series No. 854. .Geneva; WHO 1995. http://chd-taskforce.de/guidelines/kap22.htm and http://www.who.int/dsa/cat98/nut8.htm#Obesity (and Poverty)
39
Rachmilewitz D.
Coated mesalazine (5-amino-salicylic acid) versus sulpasalazine in the treatment of active ulcerative colitis: a randomised trial.
Br Med J.
1989;
198
82-86
40
Guillemin F, Bombardier C, Beaton D.
Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines.
J Clin Epidemiol.
1993;
46
1417-1432
41
Pallis A G, Vlachonikolis I G, Mouzas I G.
Assessing health-related quality of life in patients with inflammatory bowel disease, in Crete, Greece.
BMC Gastroenterology.
2002;
2
1
, http://www.biomedcentral.com/1471 – 230X/2/1
42
Nordin K, Pahllman L, Larsson K. et al .
Health related quality of life and psychological distress in a population-based sample of Swedish patients with inflammatory bowel disease.
Scand J Gastroenterol.
2002;
37
450-457
43
Latza U, Stang A, Bergmann M. et al .
The problem of response in epidemiological studies in Germany (part 1).
Gesundheitswesen.
2004;
66 (5)
326-336
44
Hoffmann W, Terschuren C, Holle R. et al .
The problem of response in epidemiological studies in Germany (part 2).
Gesundheitswesen.
2004;
66 (8 – 9)
482-491
45
Irvine E J.
Quality of Life in Inflammatory Bowel Disease: Biases and Other Factors Affecting Scores.
Scand J Gastroenterol.
1995;
208
136-140
46
Cellier C, Sahmoud T, Froguel E. et al. and the Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives .
Correlation between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn’s disease. A prospective multicenter study of 121 cases.
Gut.
1994;
35
231-235
47
Sandborn W J, Feagan B G, Hanauer S B. et al .
A Review of Activity Indices and Efficacy Endpoints for Clinical Trials of Medical Therapy in Adults With Crohn’s Disease.
Gastroenterology.
2002;
122
512-530
Dr. med. W. Häuser
Klinikum Saarbrücken, Medizinische Klinik I
Winterberg 1
66119 Saarbrücken
Email: whaeuser@klinikum-saarbruecken.de