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dc.contributor.authorJunkkari Antti
dc.contributor.authorRoine Risto P
dc.contributor.authorLuikku Antti
dc.contributor.authorRauramaa Tuomas
dc.contributor.authorSintonen Harri
dc.contributor.authorNerg Ossi
dc.contributor.authorKoivisto Anne M
dc.contributor.authorHäyrinen Antti
dc.contributor.authorViinamäki Heimo
dc.contributor.authorSoininen Hilkka
dc.contributor.authorJääskeläinen Juha E
dc.contributor.authorLeinonen Ville
dc.date.accessioned2018-01-12T13:21:24Z
dc.date.available2018-01-12T13:21:24Z
dc.date.issued2017
dc.identifier.urihttps://erepo.uef.fi/handle/123456789/5179
dc.description.abstractObjective 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. Methods 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. Results 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. Conclusions 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.en
dc.language.isoENen
dc.publisherElsevier BVen
dc.relation.ispartofseriesWORLD NEUROSURGERYen
dc.relation.urihttp://dx.doi.org/10.1016/j.wneu.2017.08.170en
dc.rightsCC BY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subject15Den
dc.subjectComorbidityen
dc.subjectDiscrepancyen
dc.subjectHealth-Related Quality of Lifeen
dc.subjectiNPHGSen
dc.subjectNormal-pressure hydrocephalusen
dc.subjectPatient-reported outcomeen
dc.titleWhy does the health-related quality of life in idiopathic normal pressure hydrocephalus fail to improve despite the favorable clinical outcome?en
dc.description.versionfinal draften
dc.contributor.departmentSchool of Medicine / Clinical Medicineen
dc.contributor.departmentSosiaali- ja terveysjohtamisen laitos / Toimintaen
uef.solecris.id49447483en
dc.type.publicationinfo:eu-repo/semantics/articleen
dc.rights.accessrights© Elsevier Inc.en
dc.relation.doi10.1016/j.wneu.2017.08.170en
dc.description.reviewstatuspeerRevieweden
dc.format.pagerange356-366en
dc.publisher.countryYhdysvallat (USA)en
dc.relation.issn1878-8750en
dc.relation.volume108en
dc.rights.accesslevelopenAccessen
dc.type.okmA1en
dc.type.versioninfo:eu-repo/semantics/acceptedVersionen
uef.solecris.openaccessEi


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