The Influence of Alcohol Abuse History on the Differential, Longitudinal Patterns of Mental and Physical Quality of Life Following Liver Transplantation
ABSTRACT This prospective, longitudinal study investigated change in physical and mental health quality of life (QoL) in a sample of 65 end-stage liver disease patients before and after liver transplantation. Physical and mental health QoL were assessed using the SF-36 Physical Health Summary and Mental Health Summary, respectively. Baseline data were collected prior to transplant and follow-up data were collected at 1 and 6 months after transplantation. Repeated-measures analysis of variance results indicate that physical QoL did not improve significantly between baseline and 1-month follow-up (F = .031, P = .860) but did between 1- and 6-month follow-up (F = 20.873, P < .001). Significant between-subject effects suggested attenuated improvement for patients with alcohol abuse histories (F = 6.213, P = .017). Physical QoL did not improve between 1- and 6-month follow-up for patients with alcohol abuse history (t((13)) = -1.074, P = .112). By contrast, mental health QoL improved significantly between baseline and 1-month follow-up (F = 13.840, P < .001), but not between 1- and 6-month follow-up (F = .750, P = .391). No significant differences were found on the Mental Health Summary index based on alcohol abuse history for either time period. Post hoc multivariate analysis of variance results suggested worse functioning (F = 2.674, P = .013) for individuals with alcohol abuse history on SF-36 Physical Functioning (F = 5.55, P = .021), Body Pain (F = 13.578, P < .001), Vitality (F = 4.337, P = .040), and Social Functioning (F = 10.50, P = .002) subscales. For liver transplant patients, improvements in psychosocial functioning and QoL precede improvements in physical QoL. Attenuated physical QoL improvements for patients with alcohol abuse histories are related to greater pain and physical deficits.
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- "Among the factors which predicted better quality of life were abstinence duration (Morgan 2004; Peters 2003), longer recovery (Laudet 2005), and perceived better social support (Ponizovsky 2008). Attenuated physical QoL improvements for patients with alcohol abuse histories are related to greater pain and physical deficits (Eshelman 2010). QoL improvement after a residential treatment was related to low QoL scores at admission. "
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ABSTRACT: Patient-reported outcomes are important to consider when the relative success of liver transplantation (LT) is being evaluated. Our primary objective was to examine the expectations for LT and the criteria for its success across 4 domains of functioning (pain, fatigue, emotional distress, and interference with daily activities) from the perspective of patients who were wait-listed for LT. One hundred four adult patients with a mean wait-list time of 16.5 ± 13 months completed a semistructured interview with a modified version of the Patient-Centered Outcomes Questionnaire (PCOQ). The patients reported moderate usual levels of pain, fatigue, emotional distress, and interference with daily activities (mean rating range = 3.8-6.2), and they attached great importance to improvements in these domains after LT (mean rating range = 7.3-8.0). Patients considered a mean reduction in pain of 33% to be a successful LT outcome. A reduction in fatigue of 56%, a reduction in emotional distress of 44%, and a reduction in interference with daily activities of 54% represented successful LT across these domains. Patients with more severe illness had higher expectations for fatigue (r = -0.30, P = 0.002) and interference with daily activities (r = -0.24, P = 0.015). Cluster and correlational analyses provided support for the validity of the PCOQ with LT patients. Our findings underscore the importance and value of using patient-centered assessments to better understand the ways in which patients prioritize LT outcomes and define transplantation success. Patient-centered assessments have the potential to facilitate provider-patient communication by helping patients to prioritize their goals for LT and make informed choices on the basis of those priorities.Liver Transplantation 11/2011; 17(11):1309-17. DOI:10.1002/lt.22355 · 3.79 Impact Factor
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ABSTRACT: BACKGROUND: Dysfunctional use of alcohol is a problem with broad consequences. Moreover, there exists little evidence about the impact of dysfunctional use on quality of life. OBJECTIVE: To evaluate the quality of life of patients with liver diseases and to verify its possible associations with alcohol consumption and sociodemographic variables. METHOD: Transverse study with masculine patients between 20 and 59 years of age and with at least 5 years of primary school completed, assessed between April and December 2009 in a hepatology service. Instruments: CAGE, AUDIT, WHOQOL-Bref and sociodemographic questionnaire. RESULTS: CAGE positive patients had a lower average in the physical domain of WHOQOL (p = 0.027). Those who never used alcohol had higher scores in the social domain compared to patients with medium and high risk consumption or probable dependence in the past year (p = 0.023 and p = 0.036 respectively). Abstainers and low-risk users recorded the highest average in the social domain compared to medium risk users in the past year (p = 0.031). DISCUSSION: The lowest levels of quality of life in the physical (CAGE) and social (AUDIT) domains reported by patients with alcohol consumption of high risk or probable dependence are consistent with findings in the literature.Revista de Psiquiatria Clínica 12/2011; 39(1):5-11. DOI:10.1590/S0101-60832012000100002 · 0.89 Impact Factor