Patient-centered measures for achalasia.
BACKGROUND
Various instruments may be used to measure health-related quality of life in patients with achalasia.


METHODS
We administered four patient-centered measures used for evaluation of achalasia severity [an achalasia severity questionnaire we developed previously, an achalasia symptom checklist, the Gastrointestinal Quality-of-Life Index (GIQLI), and the Medical Outcomes Study 36-item Short-Form survey (SF-36)] to 25 subjects enrolled in a randomized controlled trial comparing pneumatic dilatation and laparoscopic Heller myotomy. We estimated correlations between the different measures.


RESULTS
Twenty-five patients (13 male, 12 female) were studied; 12 were treated by pneumatic dilatation and 13 by laparoscopic myotomy. The average age of patients was 48.5 [range 25-69, standard deviation (SD) 13.7] years. Baseline scores demonstrated a substantial burden of impairment. The mean (SD) score on the achalasia severity measure [ranges from 0 (best) to 100 (worst)] was 62.3 (13.4). The mean (SD) symptom checklist score [ranges from 0 (best) to 36 (worst)] was 23.2 (6.6). The mean (SD) GIQLI [ranges from 0 (worst) to 144 (best)] was 77.04 (19.4). The SF-36 mean (SD) for the physical component score (PCS) was 45.29 (9.21) and the mean for the mental component score (MCS) was 37.61 (14.97). The achalasia severity measure correlated highly with the GIQLI (r = -0.57, p = 0.01), and the symptom checklist (r = 0.65, p = 0.004). The achalasia severity measure correlated well with the SF-36 PCS (r = -0.42, p = 0.039), but not with the MCS (r = -0.14, p = 0.501).


CONCLUSIONS
Subjects recruited to a randomized controlled trial of achalasia treatment demonstrated impairment in both generic quality-of-life and disease-specific measures. Scores on achalasia-specific measures correlated well with each other, but less well with measures of generic quality-of-life and mental health scales. Because of the multidimensional nature of achalasia, disease-specific measures should be combined with generic health measures for the best assessment of patient outcome.
Harnish
Julie L
JL
Division of Clinical Decision Making, Toronto General Hospital Research Institute, 200 Elizabeth Street, 13-EN-232B, M5G 2C4, Toronto, Ontario, Canada. jharnish@uhnres.utoronto.ca
Darling
Gail E
GE
Diamant
Nicholas E
NE
Kortan
Paul P
PP
Tomlinson
George A
GA
Deitel
Wayne
W
Laporte
Audrey
A
Urbach
David R
DR
D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires