Why does the health-related quality of life in idiopathic normal pressure hydrocephalus fail to improve despite the favorable clinical outcome?
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CitationJunkkari Antti. Roine Risto P. Luikku Antti. Rauramaa Tuomas. Sintonen Harri. Nerg Ossi. Koivisto Anne M. Häyrinen Antti. Viinamäki Heimo. Soininen Hilkka. Jääskeläinen Juha E. Leinonen Ville. (2017). Why does the health-related quality of life in idiopathic normal pressure hydrocephalus fail to improve despite the favorable clinical outcome?. WORLD NEUROSURGERY, 108, 356-366. 10.1016/j.wneu.2017.08.170.
Occasionally, a favorable clinical disease-specific outcome does not reflect into improved generic health-related quality of life (HRQoL) in patients with idiopathic normal-pressure hydrocephalus (iNPH) at 1 year after the installation of a cerebrospinal fluid shunt. Our aim was to identify factors causing this discrepancy.
The 1-year HRQoL outcomes of 141 patients with iNPH were evaluated with the generic 15D instrument, in which the minimum clinically important change/difference on the 0–1 scale has been estimated to be ±0.015. A 12-point iNPH grading scale (iNPHGS) was used as a clinical disease-specific outcome measure, in which a 1-point decrease is considered to be clinically important. We identified 29 (21%) patients with iNPH from our prospective study whose HRQoL deteriorated or remained the same despite of a favorable iNPHGS outcome. We analyzed this discrepancy using patients' clinical variables and characteristics.
Multivariate binary logistic regression analysis indicated that a greater (worse) iNPHGS score at baseline (adjusted odds ratio [OR], 1.7; 95% confidence interval [CI] 1.3–2.3; P < 0.001), comorbid chronic pulmonary disease (40% vs. 20%; adjusted OR 17.8; 95% CI 3.6–89.9; P < 0.001), and any comorbid nonmetastatic tumor (62% vs. 17%; adjusted OR 11.5; 95% CI 1.5–85.3; P = 0.017) predicted discrepancy between iNPHGS and 15D outcomes.
Frail patients suffering from certain pre-existing comorbidities may not experience improvement in generic HRQoL despite of a favorable clinical disease-specific response. Acknowledging the comorbidity burden of the patient may help clinicians and the patients to understand the conflict between patient-reported and clinical outcomes.