Measuring Quality of Life in Chronic Limb-threatening Ischemia Patients and Informal Carers: A Scoping Review

Abstract

Objective: To review quality of life (QOL) instruments for chronic limb-threatening ischemia (CLTI) patients and informal carers, and their use in QOL and cost-utility analysis (CUA) studies. Background: CLTI is a global health problem with significant morbidity affecting patients and informal carers. QOL is increasingly measured for holistic outcomes assessment and CUA. However, measurement instruments in CLTI are poorly understood. Methods: MEDLINE, EMBASE, PsycINFO, CINAHL, COSMIN, PROQOLID, CEA registry, and NHS EED databases were searched for all English language studies up to May 2021. Features of instruments, evidence of measurement property appraisal, and trends in use were assessed. Prospective protocol registration (Open Science Framework: https://doi.org/10.17605/OSF.IO/KNG9U). Results: A total of 146 studies on QOL instruments (n=43), QOL outcomes (n=97), and CUA (n=9) were included. Four disease-specific QOL instruments are available for lower extremity arterial disease (intermittent claudication or CLTI). VascuQoL-25 and VascuQoL-6 have been used in CLTI. There is no CLTI-specific instrument. Of 14 generic instruments, SF-36, EQ-5D-3L, NHP, and WHOQOL-BREF were most common. Studies reporting partial measurement property appraisal favored VascuQoL-25, VascuQoL-6, and SF-36. Feasibility considerations include mode of administration and responder burden. None of 4 available carer-specific instruments have been used in CLTI. Since 1992, the number of QOL studies has increased considerably, but CUA studies are scarce. Informal carers have not been assessed. Conclusions: This review provides a comprehensive reference for QOL measurement in CLTI that helps end-users with instrument selection, use, and interpretation. However, a CLTI-specific instrument is needed. There is an opportunity to benefit society through future CUA studies and evaluation of QOL in informal carers.

Patient perspectives of quality of life in chronic limb‐threatening ischemia: a qualitative study

“…Quality of life (QOL) is an established outcome measure 1 that is frequently used to evaluate and compare treatments for chronic limb-threatening ischemia (CLTI). 2,3 It is an outcome that matters to patients and is vital within a value-based healthcare system. 4,5 Our recent review demonstrated that whilst revascularisation in CLTI may lead to modest QOL benefits, amputation and conservative management may also maintain QOL.…”

Can quality of life predict survival and value‐based care in lower extremity arterial disease?

“…Furthermore, there is no CLTI-specific QOL instrument developed in the English language. 10 Having a fit for purpose measurement instrument is imperative to data validity.…”

“…We recently outlined key considerations for an effective QOL instrument. 10 Feasibility is paramount. Ideally, an instrument would have: (i) low responder and administrative burden, (ii) simple language, design and format, (iii) multiple modes of administration, and (v) easy scoring and interpretation.…”

“…The problem is that there is currently no predictive QOL instrument for either claudication or CLTI. Furthermore, there is no CLTI‐specific QOL instrument developed in the English language 10 . Having a fit for purpose measurement instrument is imperative to data validity.…”

“…In particular, public and patient involvement is essential in ensuring QOL measurements are meaningful to both patients and clinicians. We recently outlined key considerations for an effective QOL instrument 10 . Feasibility is paramount.…”