Health-related quality of life in patients with Duchenne muscular dystrophy: a multinational, cross-sectional study.
OBJECTIVE
To estimate health-related quality of life (HRQOL) in patients with Duchenne muscular dystrophy (DMD).


METHODS
HRQOL was assessed using the Health Utilities Index Questionnaire (HUI) and the Pediatric Quality of Life Inventory (PedsQL) neuromuscular module version 3.0 online. Results were stratified by disease stage (early/late ambulatory/non-ambulatory) and caregivers' perceptions of patients' health and mental status.


RESULTS
A total of 770 patient-caregiver pairs (173 German, 122 Italian, 191 UK, and 284 USA) participated. Most caregivers (>84%) perceived their patients as happy/somewhat happy and in excellent/very good/good health, irrespective of current ambulatory class. In contrast, mean patient utility (reflecting public preferences: 0, dead; 1, perfect health) deteriorated with disease course, from 0.75 in early ambulatory males to 0.15 in the most severely affected patients. Mean patient PedsQL scores (0-100, higher score indicating better HRQOL) decreased from 80 to 57 across ambulatory classes.


CONCLUSIONS
HRQOL in DMD, measured through public preferences, is substantially impaired in relation to the general population and significantly associated with disease progression. Still, most patients are perceived as happy and in good health by their caregivers, indicating that influential domains of HRQOL remain intact through the disease progression. Our findings emphasize the challenges in measuring HRQOL in a rare, progressive childhood condition such as DMD.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm.
Erik
E
Landfeldt
Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Peter
P
Lindgren
GlaxoSmithKline, Research Triangle Park, NC, USA.
Christopher F
CF
Bell
Newcastle University John Walton Muscular Dystrophy Research Centre, Newcastle upon Tyne.|MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK.
Michela
M
Guglieri
Newcastle University John Walton Muscular Dystrophy Research Centre, Newcastle upon Tyne.|MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK.
Volker
V
Straub
Newcastle University John Walton Muscular Dystrophy Research Centre, Newcastle upon Tyne.|MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK.
Hanns
H
Lochmüller
Newcastle University John Walton Muscular Dystrophy Research Centre, Newcastle upon Tyne.|MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK.
Katharine
K
Bushby
D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005858:Germany; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D020388:Muscular Dystrophy, Duchenne / Q000451:nursing / Q000503:physiopathology* / Q000523:psychology*; D010290:Parents; D011788:Quality of Life / Q000523:psychology*; D006113:United Kingdom; D014481:United States; D055815:Young Adult