Factors Influencing Quality of Life in Atopic Dermatitis NE. Hampson1, DM. Meads1, SP. McKenna1, LC. Doward1, F. Turk2 1
Galen Research, Manchester Science Park, Manchester, UK Novartis Pharmaceuticals, Basel, Switzerland
2
Figure 1: Significant predictors of Quality of Life in Atopic Dermatitis
Objectives QoLIAD
To identify the most important determinants of quality of life (QoL) for adults with Atopic Dermatitis (AD) and for the parents of children with AD.
Woken in the Night Depression
To examine the relative importance of clinical and non-clinical factors in determining QoL in AD.
Data collected in a 6-month, multinational, open-label study of AD treatments were analysed using Stepwise Multiple Regression. Demographic, symptom and disease-related variables were included in the analyses. Data were available from 319 AD patients who completed the QoLIAD (Age Range 18-85, Mean=37.9, SD=14.8) and 182 parents of children with AD who completed the PIQoLAD (Age of child 2-12, Mean=7.6, SD=4.9). Scores on the QoLIAD ranged from 0-25 (Mean=7.3, SD=5.7) and scores on the PIQoLAD ranged from 0-24 (Mean=6.9, SD=4.8). Regression analyses were conducted to help identify which factors were the most important in determining parent and adult QoL. Stepwise regression was chosen to identify which independent variables were the best at predicting QoL score. The potential predictor variables entered into the regression included: Gender Age Visibility of Flare-up (yes/no) Duration of Flare-up Time Spent with Flare-up Per Year Itch (moderate/severe/extreme) Swelling (moderate/distinct/very distinct) Redness of AD (noticeable/red/bright red) Number of Nights sleep affected Number of Times Woken in the Night Percentage of Work Performance Affected Number of Days off School/Work Percentage of Body Affected Number of Flares Per Year Treatment Concern (5-point: very-not at all) Unhappy/Depressed (5-point: always-never) Severity of AD (moderate/severe)
Work Performance
Needs-Based Quality Of Life
Woken in the Night Body Percentage
Age of child Depression Flares per year
Age
Methodology
The 25-item QoLIAD and the 28-item PIQoLAD both have a simple dichotomous yes/no response format, with scores on the QoLIAD ranging from 0 to 25and scores on the PIQoLAD ranging from 0 to 28. A high score indicates poor QoL.
Days of School
Work Performance
To examine whether the variables identified as important are similar for both adults with AD and the parents of children with AD.
Galen Research have developed two needsbased QoL instruments specific to patients with AD; The Quality of Life Index for Atopic Dermatitis (QoLIAD) for use with adults with AD, and the Parent’s Index of Quality of Life in Atopic Dermatitis (PIQoL-AD) for use with the parents of children with AD.
PIQoL-AD
Time spent with Flare
Results
PIQoL-AD Analyses
QoLIAD Analyses
For the PIQoL-AD 32.9% of the variance (p < 0.0001) was accounted for by seven of the predictor variables.
Regression analyses for the QoLIAD identified five variables accounting for 27.2% of the variance in patients' reported quality of life (p < 0.0001).
Table 2 shows the relative impact that each of these variables had on the PIQoL-AD regression model. The predictor variables were entered into the regression in the order that they contribute to the variance. Therefore, the variable that has the highest correlation with PIQoL-AD is:
These five variables were the only potential explanatory variables that significantly contributed to the regression model. Table 1 shows the relative impact of each of these variables.
Amount woken in the night due to flare-up Followed by:
Each predictor variable was entered into the regression in the order that they contribute to the variance. Therefore, the variable that has the highest correlation with QoLIAD score is:
Number of days the child misses school Performance at work Age of child How unhappy/depressed their child’s flareups make them feel Number of flare-ups per year Total time spent with a flare-up each year
How unhappy/depressed the flare-ups make them feel Followed by: Performance at work Amount woken in the night due to flare-up The percentage of their body affected Age Table 1: Relative Impact of variables in the QoLIAD regression model Unstandardized Coefficients B (Constant) Depression % Work Nights woken % of body Age
1.92 -.539 .009 .081 .005 -.005
Std.Error .123 .086 .002 .021 .002 .003
Standardized Coefs
t
Sig.
15.621 -6.236 3.827 3.856 2.152 -2.071
.000 .000 .000 .000 .032 .039
Beta -.309 .196 .193 .110 -.100
Table 2: Relative Impact of variables in the PIQoL-AD regression model Unstandardized Coefficients B (Constant) Nights woken Dayoff School % work Age Depression Flares per year Time flare
1.86 .090 .030 .011 -.035 -.231 -.019 .001
Std.Error .130 .024 .008 .003 .014 .115 .006 .000
Standardized Coefs
t
Sig.
14.325 3.824 3.744 3.564 -2.562 -1.998 -3.131 2.407
.000 .000 .000 .000 .011 .047 .002 .017
Beta .250 .241 .235 -.160 -.129 -.295 .223
There were consistencies across the groups regarding the most important determinants of QoL, such as how depressed the flare-ups make people feel, their influence on performance at work, and the number of times woken during the night. However, specific symptoms such as swelling, itch and redness did not contribute significantly to either model.
Conclusions These results reveal that the QoL of adults with AD and the parents of children who have AD are influenced by a number of similar variables. However, specific clinical factors such as Itch, Swelling and Redness did not influence QoL scores. Therefore, a focus solely on the symptoms of AD would omit important influences on QoL. References: McKenna SP, Whalley D, Dewar AL, Erdman RA, Kohlmann T, Niero M, Baro E, Cook SA, Crickx B, Frech F, van Assche D. International development of the Parents' Index of Quality of Life in Atopic Dermatitis (PIQoL-AD). Qual Life Res. 2005 Feb;14(1):231-41. Whalley D, McKenna SP, Dewar AL, Erdman RA, Kohlmann T, Niero M, Cook SA, Crickx B, Herdman MJ, Frech F, Van Assche D. A new instrument for assessing quality of life in atopic dermatitis:international development of the Quality of Life Index for Atopic Dermatitis (QoLIAD). Br J Dermatol. 2004 Feb;150(2):274-83.
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