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患者の健康寿命の阻害、 QOLの阻害はどの程度か

 

1) Bussone,G.; Usai,S.; Grazzi,L.; Rigamonti,A.; Solari,A.; D'Amico,D.
　 Disability and quality of life in different primary headaches: results from
　 Italian studies . Rev Neurol　2004; 25 Suppl 3、05-107.
論文抄録
Headaches may have a wide range of impact on patients' lives. We report the results of Italian studies in which disability and health-related quality of life (HRQOL) in patients with different primary headaches were evaluated. The Short Form 36 (SF-36) was used to assess HRQOL; the Migraine Disability Assessment Score questionnaire (MIDAS) was used to assess disability in patients with migraine without aura or with chronic migraine. Mean MIDAS total scores were evaluated in migraine without aura and chronic migraine patients. The scores at the eight SF-36 scales were calculated in patients with the three studied headaches, and were compared with Italian normative data (Student's t-test with Bonferroni correction). Primary headaches had a considerable negative impact on patients' lives, with poor quality of life and decreased ability to function in daily duties. The mean MIDAS total score was 23.4 in 264 patients with migraine without aura, and 79.2 in 150 patients with chronic migraine. Mean SF-36 scores in migraine without aura (68 subjects), chronic migraine (84) and cluster headache (56) were lower than those from the Italian general population, with significant differences for 3 scales in migraine without aura, for 6 in chronic migraine, and for all scales in cluster headache. Our results confirmed a marked personal and social burden in patients with migraine without aura, and also in the less well-studied forms of primary headaches, cluster headache and chronic migraine
文献 PubMed−ID

PM:15549514

エビデンスレベル

III

文献タイトル (日本語)

異なる一次性頭痛における障害と生活の質：イタリアの研究結果

目的
一次性頭痛患者における障害度と QOL阻害の検討
研究施設
National Neurological Institute ， Milan, Italy.
研究期間
不明
対象患者
一次性頭痛患者（前兆のない片頭痛，慢性片頭痛，群発頭痛）
主要評価項目とそれに用いた
統計学的手法

異なる頭痛を持つ一次性頭痛の患者の健康関連ＱＯＬと障害度を検討した．
健康関連 QOL：SF-36 を使用し，下位8項目のスコアを各頭痛群間と正常対象とで比較した．
片頭痛患者の障害度： MIDASを使用し，前兆のない頭痛群と慢性片頭痛群それぞれの平均MIDAS合計スコアを評価した．

結果

平均 MIDAS総得点は前兆のない片頭痛群（ｎ＝２３４）で23.4，慢性片頭痛群（n＝150）で79.2であった．
平均 SF-36スコアは前兆のない片頭痛群（n＝68），慢性片頭痛（n＝84），群発頭痛群（n＝56）で有意にイタリアの正常対象に比較して低く，特に前兆のない片頭痛群では3項目，慢性片頭痛では6項目，群発頭痛群では全項目においてQOLの阻害が認められた．

結論
前兆のない片頭痛，慢性片頭痛または群発頭痛をもつ患者においては， QOLの阻害があり，著明な個人的また社会的負担を認めた．
作成者
福原葉子

 

7) Osterhaus,J.T.; Townsend,R.J.; Gandek,B.; Ware,J.E.,Jr. Measuring
　 the functional status and well-being of patients with migraine
　 headache . Headache 1994; 34(6):337-343.

論文抄録

OBJECTIVE: Compare adult migraineurs' health related quality of life to adults in the general U.S. population reporting no chronic conditions, and to samples of patients with other chronic conditions.．METHODS: Subjects (n = 845) were surveyed 2-6 months after participation in a placebo-controlled clinical trial and asked to complete a questionnaire including the SF-36 Health Survey, a migraine severity measurement scale and demographics. Results were adjusted for severity of illness and comorbidities. Scores were compared with responses to the same survey by the U.S. sample and by patients with other chronic conditions. RESULTS: Response rate was 67%. After adjustment for comorbid conditions, SF-36 scale scores were significantly (P 0.001) lower in migraineurs, relative to age and sex-adjusted norms for the U.S. sample with no chronic conditions. Some health dimensions were more affected by migraine than other chronic conditions, while other dimensions were less affected by migraine. Measures of bodily pain, role disability due to physical health and social functioning discriminated best between migraineurs, the U.S. sample, and patients with other chronic conditions. Patients reporting moderate, severe and very severe migraines scored significantly (P < or = 0.001) lower on five of the eight SF-36 scales than the U.S. sample. CONCLUSIONS: Migraine has a unique, significant quality of life burden .

文献 PubMed−ID

PM:7928312

文献タイトル (日本語)

片頭痛患者の機能的状態と健康評価

エビデンスレベル

㈽

目的

成人片頭痛患者の健康関連 QOLを，慢性疾患を持たないアメリカ人健康対照データ，他の慢性疾患を持つ患者データと比較する

研究施設

Glaxo Research Institute, Research Triangle Park , NC

研究期間

1992年1月31日〜1992年3月4日

対象患者

スマトリプタンのプラセボ対象臨床試験に参加した 845人：　臨床試験参加2-6ヵ月後にSF-36，片頭痛重症度測定スケールと実態的人口統計に関する質問を含むアンケートに回答させた．
アメリカ人健康対照データと慢性疾患対照群データは National Survey of Functional Health Statusによるデータを使用した．

主要評価項目とそれに用いた統計学的手法

SF-36合計スコアと下位項目スコア

結果

回答率 67%.
SF-36 スコアは年齢性別調整後健康対照群と比較して，片頭痛患者において著明に低下していた(P 0.001) ．
片頭痛患者と健常対照，他の慢性疾患患者との間で最も差がみられたのは，身体疼痛、身体的健康による役割障害，社会的機能障害のスコアであり，特に中程度以上の片頭痛を持つ患者において，下位 8項目中5項目で著明に低いスコアを示し，より強いQOL阻害が認められた(P < or = 0.001)．

結論

片頭痛患者においては健常対照に対し著明な QOL阻害を認め，一部の項目では他の慢性疾患患者よりも強いQOL阻害が見られた．

作成者

福原葉子

 

9) Solomon,G.D.; Skobieranda,F.G.; Gragg, L.A. Does quality of life
　 differ among headache diagnoses? Analysis using the medical
　 outcomes study instrument . Headache 1994; 34(3):143-147.

論文抄録

BACKGROUND: To analyze the differences in quality of life associated with headache diagnoses using the Medical Outcomes Study Short Form Health Survey (SF-20). METHODS: A patient interview survey using the SF-20 Short Form Health Survey was conducted in a headache clinic within a multi-specialty group practice. All six health components of the SF-20 were included in the study. Headache diagnoses were made using IHS criteria. RESULTS: 208 consecutive headache patients were studied. Patients with cluster headache had a significantly higher (worse) pain score (P < 0.018) and higher percentage of patients with poor health due to pain (P < 0.005) than patients with migraine headache. There were fewer cluster patients with poor health associated with physical functioning than tension-type (P < 0.020) or mixed headache (P < 0.022) patients. Poor health associated with social functioning was greater for cluster (P < 0.011) and tension-type headache (P < 0.015) than for migraine. There was a significantly higher percentage of tension-type headache patients with poor health associated with mental health (P < 0.002) than patients with migraine. CONCLUSIONS: The SF-20 is a reliable and valid measure of quality of life for patients with different headache diagnoses. Distinct headache diagnoses are marked by unique patterns of impairment and quality of life

文献 PubMed−ID

PM:8200787

エビデンスレベル

㈽

文献タイトル (日本語)

QOLは頭痛診断により異なるか？医療予後評価法による分析

目的

SF-20を用いて，診断された頭痛の種類によるQOLの違いを検討する

研究施設

Headache Center of the Cleveland Clinic Foundation

研究期間

1992年1月31日〜1992年3月4日

対象患者

208人の頭痛患者（片頭痛　79，緊張型頭痛　41，群発頭痛　13，混合型（慢性緊張型頭痛＋片頭痛）49）

主要評価項目とそれに用いた統計学的手法

SF-20 を用いた患者面接方式による調査を行った．

結果

群発頭痛患者は片頭痛患者と比して pain scoreは高く（悪く）(P < 0.018)，痛みによる健康阻害（poor health due to pain）の割合が高かった(P < 0.005)．群発頭痛患者では緊張型頭痛患者，混合型頭痛患者と比して身体的機能に伴う健康阻害（poor health associated with physical functioning ）の割合は低かった．社会的機能に伴う健康阻害（Poor health associated with social functioning）は片頭痛に比して群発頭痛(P < 0.011)と緊張型頭痛(P < 0.015)で高かった．緊張型頭痛患者においては，片頭痛患者に比して心理的側面に伴う健康阻害（poor health associated with mental health ）が著明に高かった(P < 0.002)．

結論

頭痛診断の違いはそれぞれに特徴的な QOL阻害のパターンを伴っていることが明らかとなった．SF-20 は異なる頭痛においても信頼しうる有用なQOL評価法といえる．

作成者

福原葉子

 

11) Stewart,W.F.; Lipton,R.B.; Whyte,J.; Dowson,A.; Kolodner,K.;
　 Liberman,J.N.; Sawyer,J. An international study to assess reliability
　 of the Migraine Disability Assessment (MIDAS) score . Neurology
　 53(5):988-994

論文抄録

BACKGROUND: The Migraine Disability Assessment (MIDAS) instrument is a five-item questionnaire developed to measure headache-related disability and improve doctor-patient communication about the functional consequences of migraine. OBJECTIVES: To examine the test-retest reliability and internal consistency of the five items and of the overall MIDAS score in population-based samples of migraine sufferers in two countries and to compare consistency across countries. METHODS: Using a clinically validated telephone interview, population-based samples of migraine-headache sufferers were identified in the United States ( Baltimore , MD ) and the United Kingdom (Merton and Sutton, Surrey ). Eligible individuals completed the MIDAS questionnaire on two occasions an average of 3 weeks apart. The MIDAS score is derived from five questions about missed time from work and household work (one question each about missed days and days with at least 50% reduced productivity) and missed days of nonwork activities. RESULTS: A total of 97 migraine-headache sufferers from the United States and 100 from the United Kingdom completed the MIDAS questionnaire twice. Mean and median item values and overall MIDAS scores were similar between the United States and the United Kingdom . Test-retest Spearman correlations of individual items ranged from 0.46 to 0.78. No significant differences in item-specific correlations were observed between the United States and United Kingdom . The test-retest Pearson correlation of the MIDAS score (i.e., sum of lost days and reduced-effectiveness days in each domain) was 0.80 in the United States and 0.83 in the United Kingdom . The Cronbach alpha, a measure of internal consistency, was 0.76 in the United States and 0.73 in the United Kingdom . CONCLUSIONS: This is the first international population-based study to assess the reliability of a disability-related illness severity score for migraine. The reliability and internal consistency of the Migraine Disability Assessment score are similar to that of a previous questionnaire (Headache Impact Questionnaire). However, the Migraine Disability Assessment score requires fewer questions, is easier to score, and provides intuitively meaningful information on lost days of activity in three domains

文献 PubMed−ID

PM:10496257

エビデンスレベル

㈽

文献タイトル (日本語)

Migraine Disability Assessment（MIDAS）スコアの信頼性を評価する国際的検討

目的

MIDASスコアの再現性と下位5項目の内的整合性，および2国間での結果の整合性を比較すること

研究デザイン

電話インタビューによる質問表回答

研究施設

ボルチモア（アメリカ），マートン，サットン（イギリス）

対象患者

197人の片頭痛患者（アメリカ　97人，イギリス　100人） 調査はアメリカ（ボルチモア）とイギリス（マートン，サットン）にて電話によるインタビューにより，平均 3週間の間隔をあけてMIDAS質問表に2回答えさせる形で行われた．

主要評価項目とそれに用いた統計学的手法

下位項目の平均値，中央値， MIDAS合計スコア，クロンバッハ値

結果

下位項目の平均値，中央値， MIDAS合計スコアは両国間で差がなかった．下位項目特異的な相関の違いも両国間でみられなかった．内的整合性を表すクロンバッハ値はアメリカで0.80，イギリスで0.83と共に妥当であった．

結論

MIDASは片頭痛患者の健康障害の評価法として妥当である．

作成者

福原葉子