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What is the Relationship between Quality of Life and Physical Functions of Patients Undergoing Palliative Care? Nanyang Polytechnic PhysiotherapyTRANSCRIPT
IMAGINE…
Aneesa A., Gay W.Y.E, Chua Q.Y.F, Ng W.Y.K, Seet Z.T., Sim H.Z.T
What is the Relationship between Quality of Life and Physical
Functions of Patients Undergoing Palliative Care?
ContentIntroduction & Literature Reviews
Our HypothesesMethodResults & DiscussionLimitationsSuggestions for Future StudiesConclusion
Introduction and Literature Reviews
Introduction
Cancer
• 1 out of 4 Singaporeans will die of cancer (Hock 2002)
• Early screening and treatment
Palliative Care
• Singapore Hospice to increase beds by 20% in 5 to 7 years (Ministry of Health, Channel Newsasia, 14th Oct 2008,)
• Improve QOL (Granda-Cameron et al., 2008)
QOL
• Multi-factorial (World Health Organisation, 2002)
• Measured by QOL questionnaire
Quality of Life
Social Relations
hip
Physical Function
ing
Level of Independ
ence
Environmental
Factors
Psychological State
Personal Beliefs
(World Health Organisation, 1997)
Physical Function
ing
AgilityFlexibili
ty
Balance
Strength
Endurance
(Reuben et al., 2003)
Correlation of QOL to Physical Objective
MeasuresPhysical Component score SF-36 correlated
strongly (r=0.766) with distance walked in 6-minute walk test in liver transplant patients.
(Hsieh et al., 2010)
Strong correlations (r>0.7) between 6-minute walk distance and Dyspnoea, Fatigue, Emotion and Total QOL scores of Chronic Heart Failure Questionnaire.
(O'Keeffe et al., 1998)
SF-36 physical scores has a strong relationship with 6-minute walk distance in bronchiectasis patients (r=0.71, p < 0.001).
(Lee et al., 2009)
EORTC QLQ-C30 physical functioning strongly correlates with 6-minute walk distance in palliative patients (r2=0.70).
(Nicklasson et al., 2007)
Correlation of QOL to Physical Objective
Measures
AIM:Determine the
correlation of physical objective measures and
questionnaire scores for the overall wellness of patients undergoing
palliative care
QOL
Patient
Caregiver
Caregiver’s Rating of Patient’s QOL
Moderate levels (r=0.68) of correlation in patient-caregiver mental health scores of SF12 and CES-D (depression questionnaire)
(Fleming et al., 2006)
Fair to moderate levels of agreement in patient-caregiver QOL scores of older adults with cognitive impairments.
(Logsdon et al., 2002)
Caregiver’s Rating of Patient’s QOL
AIM:To determine the correlation of the
ratings of palliative patient’s QOL by
themselves and their caregivers.
Primary HypothesisHo: There is NO relationship between
Quality of Life Questionnaire Score and Physical Objective Measures among terminally ill cancer patients undergoing palliative care.
Ha: There is A relationship between Quality of Life Questionnaire Score and Physical Objective Measures among terminally ill cancer patients undergoing palliative care.
Secondary Hypothesis
Ho: There is NO agreement between the Quality of Life Questionnaire answers of the caregivers and the patients.
Ha: There is AN agreement between the Quality of Life Questionnaire answers of the caregivers and the patients.
Method
EORTC QLQ – C15 PAL
Derived from EORTC QLQ – C30EORTC QLQ-C30 is a reliable and well-
validated tool of measuring QOL. (Nicklasson et al., 2007)
Similar trend observed between overseas and local population (Luo et al., 2005)
EORTC QLQ - C30 questions are not relevant to palliative care setting (Fredheim et al., 2007)
EORTC QLQ – C15 PAL
Shows good content validity for palliative care (Groenvold et al., 2006)
EORTC QLQ – C15 PAL
Global Quality of Life
Physical functionEmotional functionFatigueDypsnoeaConstipationPainNauseaInsomniaLoss of appetite
EORTC QLQ – C15 PAL
* Questions are directly plucked out from C30
Physical Objective Measures - Endurance
The six-minute walk test, which has been found to reflect activities of daily living better than other walk tests, measures of walking capacity (Solway et
al., 2001).
Physical Objective Measures – Upper Limb Strength
Handheld dynamometer test has been shown to correlate with gold standard methods of strength testing, such as repetition maximum testing (Lippincott et al., 2006).
Physical Objective Measures – Lower Limb Strength
5 times Sit-To-Stand Test measures the ability to stand from a chair by testing lower-extremity strength and balance (Lord et al., 2002).
Physical Objective Measures - Balance
Functional reach, a well-known clinical measure of balance, has shown to correlate with activities of daily living (Duncan et al., 1990).
Physical Objective Measures - Agility
The Timed Up and Go Test is a measure of the subject’s mobility and balance which are crucial for those who are home or community ambulant. The test is also used to assess fall risk (Overcash et al., 2008).
MethodExperimental Procedure
5 subjects recruited by judgment sampling from Assisi Hospice
EORTC QLQ C15-PAL(VERBAL) administered to subjects and caregivers
5 Physical Objective Measures performed on subjects
Inclusion Criteria:• Palliative care cancer patient with <1 year prognosis• 21 years and above• understands or have a caregiver who understands conversational English or Chinese• home ambulant with or without walking aid• meet PAR-Q standards or recommended by hospice healthcare professionals
Exclusion Crieria:•Inability to follow simple instructions
•Other conditions which limit physical ability and function (blindness, deafness, etc)
MethodPhysical Objective measures
Questionnaire
Functional reach EORTC QLQ-C15 PAL (subjects)
EORTC QLQ-C15 PAL (caregivers)
Hand grip dynamometer
5 times sit to stand
Timed up and go
6 minute walk test
Pearson’s correlation (r)
Scores generated from EORTC Scoring Formula
Results & Discussion
EORTC QLQ – C15 vs Physical Objective
Measures
Physical functioni
ng
6 minute walk test 0.749 0.145
Dyspnoea
Functional reach 0.750 0.144
Handheld dynamom
eter0.860 0.061
Global QOL
Correlation
Significance
Domains of EORTC QLQ - C15
Physical objective measures
Handheld dynamome
ter-0.826 0.085
Functional reach -0.950 0.013
Negative Correlation for Global QOL
Global QOL
EORTC-
QLQ-C15-PAL
Emotional
Function
Physical Functio
n
Fatigue
Nausea
Pain
Dypsnoea
Insomnia
Appetite Loss
Constipation
“How would you rate your overall quality of life during the past week?”
“How would you rate your overall quality of life during the past week?”
Quality of Life
Social Relations
hip
Physical Functioni
ng
Level of Independ
ence
Environmental
Factors
Psychological State
Personal Beliefs
(World Health Organisation, 1997)
Recall…
Caregiver Questionnaire vs
Subjects Questionnaire
SubjectCaregive
r
Pearson’s
Correlation
Sig.Fig
Physical Physical FunctioninFunctionin
gg
Physical Physical FunctioninFunctionin
gg0.9520.952 0.0130.013
FatigueFatigue FatigueFatigue 1.0001.000 0.0000.000
Inability to compute results
5 out of 10 domains in correlation of EORTC QLQ – C15 scores and physical objective measures
7 out of 10 domains in correlation of caregivers’ and subjects’ responses
Questions are not discriminative enough
Inability to compute results
LimitationsJudgement sampling of higher
functioning subjects Frail patients undergoing palliative care may
not be willing to participate in the physical objective measures
Homogenous population therefore not representative of entire palliative care population
Suggestions for Future Studies
Include subjects of various physical functioning status
Source for suitable subjects who are not involved in centre activities
Conclusion
ConclusionOnly 3 consistent, strong correlation found:
Subjects’ Physical functioning scores and 6 minute walk test
Caregivers’ and subjects’ physical functioning scores of the EORTC QLQ C15 PAL
Caregivers’ and subjects’ fatigue scores of the EORTC QLQ C15 PAL
ConclusionPhysiotherapists have to encourage
patients to maintain active lifestyle despite medical condition
There is still a need establish patient’s physical functions through physical objective measures
Quality of Life of patients has to be determined by patients themselves
Special Thanks!Mr Abdul Rashid
Jailani for his guidance and
advice
Mr Andy Ongfor his statistical
expertise
Mr Patrick Tanfor his technical and
logistical support throughout out project
Dr Bala S. Rajaratnam for providing us with
all the necessary resources needed
Ms Grace Simfor her enthusiasm in
assisting us
Staff and Patients of Assisi Homefor bringing us much
joy during our visits
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