MEANINGFUL IMPROVEMENT IN QUALITY OF LIFE IN DIFFERENT PATIENT POPULATIONS
Abstract number :
1.371
Submission category :
Year :
2003
Submission ID :
3825
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Ryan J. Punambolam, Samuel Wiebe, Suzan Matijevic Clinical Neurological Sciences and Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada; London Health Sciences Centre, London, ON, Canada
How much improvement in quality of life (QOL) do patients need to experience in order to consider that a new epilepsy treatment is worthwhile? Individual patients and clinicians judging the effects of epilepsy treatments need to know what is the minimum clinically important change (MIC) that a therapy can afford. Our purpose was to determine whether patients with varying epilepsy severity and at different stages of treatment would specify different thresholds of worthwhile improvement (MIC). Specifically, we tested the hypothesis that patients contemplating epilepsy surgery would require a smaller MIC than less refractory patients contemplating a change in medical therapy.
Two cohorts of patients were identified: 1) patients undergoing inpatient evaluation for epilepsy surgery. 2) outpatients contemplating a change in anti-epileptic drugs. Researchers administered a questionnaire that assessed the MIC on a seven-point Likert Scale ranging from 1([ldquo]Almost the same, hardly better at all) to 7([ldquo]A great deal better[rdquo]) in three domains: overall QOL, seizure control and work/social activities.
The medical cohort consisted of 22 males and 31 females, mean age 32.7 (SD=11.4) years. The surgical cohort included 40 males and 50 females, mean age 36.3 (SD=9.6) years. Both cohorts specified a median MIC of 4=[ldquo]moderately better[rdquo] for overall QOL and for seizure control (Interquartile Range (IQR) for difference =0.35). Similarly, the MIC for work/social activities did not differ between the surgical (median 3=[ldquo]somewhat better[rdquo]) and medical cohorts (median 4=[ldquo]moderately better[rdquo]) (IQR for difference =0.52).
Patients require an improvement equivalent to somewhat or moderately better (3 or 4 in 7-point scale), in order to consider surgical or medical treatment as worthwhile. Contrary to our hypothesis, the surgical and medical populations specified similar MICs in overall QOL, seizure control and work/social activities. The patient population and type of intervention do not seem to substantially influence the MIC.