Abstract
Objective: To develop and test a questionnaire for measuring quality of life in patients with craniocervical dystonia.
Methods: A 29-item pool was developed based on semi-structured interviews of patients with cervical dystonia (CD) and blepharospasm (BSP). This preliminary questionnaire was administered to 203 consecutive patients with CD and BSP from Austrian dystonia and botulinum toxin outpatient clinics. For scale generation, a combination of exploratory factor and cluster analysis was applied. This resulted in the 24-item version of the instrument (CDQ-24) based on five subscales: Stigma, Emotional wellbeing, Pain, Activities of daily living, and Social/family life. The validity and reliability of the CDQ-24 was assessed in 231 consecutive patients with CD and BSP different from those examined with the preliminary questionnaire. This second survey included the CDQ-24, a generic QoL instrument (SF-36) and clinical rating scales. Sensitivity to change was analysed in 51 previously untreated (de novo) patients four weeks and one year following the first botulinum toxin treatment.
Results: Internal consistency reliability was satisfactory for all subscales, with values of Cronbach's α ranging from 0.77 to 0.89. The CDQ-24 subscales showed moderate to high correlations with those SF-36 subscales measuring similar aspects (Pearson's correlation r = 0.50–0.73; p<0.001, each). Sensitivity to change was confirmed by highly significant improvements of all CDQ-24 subscores in the de novo patients from baseline to four week follow up. One year follow up data revealed a stable improvement.
Conclusion: The CDQ-24 is the first fully validated and disease specific questionnaire to evaluate quality of life of patients with cervical dystonia and blepharospasm and we propose its use in clinical trials as well as in daily clinical practice.
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Selected References
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- Ben-Shlomo Y., Camfield L., Warner T., ESDE collaborative group What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry. 2002 May;72(5):608–614. doi: 10.1136/jnnp.72.5.608. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brans J. W., Lindeboom R., Aramideh M., Speelman J. D. Long-term effect of botulinum toxin on impairment and functional health in cervical dystonia. Neurology. 1998 May;50(5):1461–1463. doi: 10.1212/wnl.50.5.1461. [DOI] [PubMed] [Google Scholar]
- Gudex C. M., Hawthorne M. R., Butler A. G., Duffey P. Effect of dystonia and botulinum toxin treatment on health-related quality of life. Mov Disord. 1998 Nov;13(6):941–946. doi: 10.1002/mds.870130613. [DOI] [PubMed] [Google Scholar]
- Hilker R., Schischniaschvili M., Ghaemi M., Jacobs A., Rudolf J. Health related quality of life is improved by botulinum neurotoxin type A in long term treated patients with focal dystonia. J Neurol Neurosurg Psychiatry. 2001 Aug;71(2):193–199. doi: 10.1136/jnnp.71.2.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jankovic J., Schwartz K., Donovan D. T. Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm. J Neurol Neurosurg Psychiatry. 1990 Aug;53(8):633–639. doi: 10.1136/jnnp.53.8.633. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jenkinson C., Wright L., Coulter A. Criterion validity and reliability of the SF-36 in a population sample. Qual Life Res. 1994 Feb;3(1):7–12. doi: 10.1007/BF00647843. [DOI] [PubMed] [Google Scholar]
- Kazis L. E., Anderson J. J., Meenan R. F. Effect sizes for interpreting changes in health status. Med Care. 1989 Mar;27(3 Suppl):S178–S189. doi: 10.1097/00005650-198903001-00015. [DOI] [PubMed] [Google Scholar]
- Lindeboom R., Brans J. W., Aramideh M., Speelman H. D., De Haan R. J. Treatment of cervical dystonia: a comparison of measures for outcome assessment. Mov Disord. 1998 Jul;13(4):706–712. doi: 10.1002/mds.870130417. [DOI] [PubMed] [Google Scholar]
- Marsden C. D. Psychogenic problems associated with dystonia. Adv Neurol. 1995;65:319–326. [PubMed] [Google Scholar]
- Müller J., Kemmler G., Wissel J., Schneider A., Voller B., Grossmann J., Diez J., Homann N., Wenning G. K., Schnider P. The impact of blepharospasm and cervical dystonia on health-related quality of life and depression. J Neurol. 2002 Jul;249(7):842–846. doi: 10.1007/s00415-002-0733-1. [DOI] [PubMed] [Google Scholar]
- Müller J., Kiechl S., Wenning G. K., Seppi K., Willeit J., Gasperi A., Wissel J., Gasser T., Poewe W. The prevalence of primary dystonia in the general community. Neurology. 2002 Sep 24;59(6):941–943. doi: 10.1212/01.wnl.0000026474.12594.0d. [DOI] [PubMed] [Google Scholar]
- Odergren T., Tollbäck A., Borg J. Efficacy of botulinum toxin for cervical dystonia. A comparison of methods for evaluation. Scand J Rehabil Med. 1994 Dec;26(4):191–195. [PubMed] [Google Scholar]
- Papathanasiou I., MacDonald L., Whurr R., Jahanshahi M. Perceived stigma in Spasmodic Torticollis. Mov Disord. 2001 Mar;16(2):280–285. doi: 10.1002/mds.1055. [DOI] [PubMed] [Google Scholar]
- Peto V., Jenkinson C., Fitzpatrick R. PDQ-39: a review of the development, validation and application of a Parkinson's disease quality of life questionnaire and its associated measures. J Neurol. 1998 May;245 (Suppl 1):S10–S14. doi: 10.1007/pl00007730. [DOI] [PubMed] [Google Scholar]
- Poewe W., Deuschl G., Nebe A., Feifel E., Wissel J., Benecke R., Kessler K. R., Ceballos-Baumann A. O., Ohly A., Oertel W. What is the optimal dose of botulinum toxin A in the treatment of cervical dystonia? Results of a double blind, placebo controlled, dose ranging study using Dysport. German Dystonia Study Group. J Neurol Neurosurg Psychiatry. 1998 Jan;64(1):13–17. doi: 10.1136/jnnp.64.1.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tsui J. K., Eisen A., Stoessl A. J., Calne S., Calne D. B. Double-blind study of botulinum toxin in spasmodic torticollis. Lancet. 1986 Aug 2;2(8501):245–247. doi: 10.1016/s0140-6736(86)92070-2. [DOI] [PubMed] [Google Scholar]
- Ware J. E., Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998 Nov;51(11):903–912. doi: 10.1016/s0895-4356(98)00081-x. [DOI] [PubMed] [Google Scholar]