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ReviewArticle
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
Qualityoflifeinstudieswithpatientsundertreatmentforsubstanceabuseandaddiction
Qualidadedevidaempesquisascomusuáriosemtratamentoparaabusoedependênciadesubstâncias
SelvaRiosCampêlo1,MariaAlvesBarbosa2,CelmoCelenoPorto31Psychologist.MasterstudentattheLifeSciencesGraduateProgramattheFederalUniversityofGoiás(UFG)Goiânia,Goiás,Brazil.E-mail:[email protected],Master'sdegree.AssociateprofessoroftheSchoolofNursingofUFG.Goiânia,Goiás,Brazil.E-mail:[email protected],Ph.D.inMedicine.VisitingprofessorattheLifeSciencesGraduateProgramofUFG.Goiânia,Goiás,Brazil.E-mail:[email protected].
ABSTRACT
ThepurposeofthisstudywastofindQualityofLife(QoL)instrumentsandtheirpurposeinstudieswithpatientsunder
treatmentforsubstanceabuseandaddiction.Thisisanintegrativereview,whosearticleswereavailableontheVirtual
Health Library (VHL) and published between 2010 and 2015 with the associated descriptors "Substance-Related
Disorders"and"QualityofLife".Twenty-ninetextswereanalyzedandtheinstrumentsweregroupedintofourpossible
usesofmeasurementofQualityofLife.ThemajorityusedgenericinstrumentssuchasWHOQOL-BrefforgeneralQuality
ofLifeandtheSF-36ofHealth-RelatedQualityofLife(HRQoL).Itisrecommendedthatfurtherstudiesbecarriedout
ontheuseofQualityofLifeinstrumentsinrelationtoaddiction,especiallywithspecificinstrumentsthatarebeginning
toappearinsomestudiesandwhichhavenotbeenconsolidatedinthefield.
Descriptors:QualityofLife;Substance-RelatedDisorders;Questionnaires.
RESUMO
Oestudoobjetivou identificar instrumentos deQualidadedeVida e sua finalidade empesquisas comusuários em
tratamentoparaabusoedependênciadesubstâncias.Trata-sederevisãointegrativa,cujosartigosestavamdisponíveis
naBibliotecaVirtualdeSaúde(BVS),epublicadosentre2010e2015comosdescritoresTranstornosRelacionadosao
UsodeSubstânciaseQualidadedeVidaassociados.Vinteenovetextosforamanalisadoseosinstrumentosagrupados
emquatrodiferentespossibilidadesdeutilizaçãodemedidasdeQualidadedeVida.Amaioriautilizouinstrumentos
genéricos, taiscomoWHOQOL-BrefdeQualidadedeVidageral,eSF-36deQualidadedeVidaRelacionadaàSaúde
(QVRS).Recomenda-sea realizaçãodemaisestudos relacionadosaousode instrumentosdeQualidadedeVidano
âmbitodadependência,principalmenteemrelaçãoaosinstrumentosespecíficosquecomeçamasurgirnaspesquisas
eaindanãosãoconsolidadosnaárea.
Descritores:QualidadedeVida;TranstornosRelacionadosaoUsodeSubstâncias;Questionários.
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
2
INTRODUCTION
Consumption and addiction to alcohol and other
drugs are a worldwide concern which result in several
clinicalandsocialcomplications(1),andthushavebecome
achallengeforpublichealth.Therearedifferentlevelsof
severity in individual consumption patterns. Substance
Use Disorder (SUD), for instance, concerns abuse or
addiction to a substance(2) related to increased risk of
harmfulconsequencestotheindividual.
TheNational InstituteonDrugAbuse (NIDA)of the
UnitedStatesconcludedin2009thateffectivetreatments
for SUD should address the consequences and
characteristics of abuse or addiction, as well as the
quantityandfrequencyofdruguse.Inthisway,according
tothisstudy,QualityofLife(QoL)maybeconsideredasa
primaryoutcomeoftreatment,whichbringsaboutthree
importantconsiderations.First,asubjectiveassessment
bytheindividualincreasesthepossibilityofassessingthe
patient'sevolution,whichisnotwellcapturedbyreports
that come from secondary sources, such as caregivers,
relatives, friends and medical records. Second, the
assessmentofQoLreferstoboththeimpactofabuseor
addiction and its treatment, which enables to evaluate
theeffectsoftreatmentthatreduceQoLevenwhenthey
reduce the use of drugs. And third, by the fact that
potentially harmful consequences of substance abuse
maybeseriousandaffectvariousfieldsofhumanlife,an
assessment of quality of life that distinguishes these
differentfieldswillbringaboutrelevantcontributions(3).
TheintroductionoftheconceptofQoLasanoutcome
measure appeared in the 1970s. The attempt to assess
chronic diseases in a situation of progress of medicine
revealed that the traditional methods based on
laboratoryexamsandclinicalevaluationwereinsufficient
toassessthewaypeoplelivedformoreyearswhenthey
underwenttreatmentsthatdidnothealbutallowedfor
controllingsymptomsoradelayinitsnaturalcourse(4-5).
Substanceusedisorderisachronicconditionformost
affectedindividuals.Inthiscase,theimprovementofQoL
becomes a rather important objective. From that
perspective,treatmentforsubstanceabuseoraddiction
must be a broad objective for recovery, defined as
abstinence plus quality of life(6). Therefore, the
importanceofQoLrates inservicesandstudies isclear,
withthepurposeofimprovingtreatmentoutcomes.
Despite the acknowledgment of the importance of
assessingQoL, the lackofconsensuson its concepthas
leadtotheformulationofdifferentdefinitionsandtothe
development of different instruments(4). The World
Health Organization (WHO) defined QoL as the
"individuals' perception of their position in life in the
contextofthecultureandvaluesystemsinwhichtheylive
andinrelationtotheirgoals,expectations,standardsand
concerns"(7:3). This definition is based on the broad
overviewofhealthasastateofcompletephysical,mental
andsocialwell-being,notonlytheabsenceofillness.
ThetheoreticalmodelsofQoLmaybegroupedinthe
satisfactionmodelandthefunctionalistmodel.Whereas
the theoreticalmodelof satisfaction ismoreassociated
with general QoL by assessing broad objectives of
individual satisfaction with life, the functionalist model
considers mainly the individual's functional and health
statuses. Instruments based on the functionalistmodel
were grouped according to the term Health-Related
QualityofLife(HRQoL)(4).
General or overall QoL is related to patients'
satisfactionwithlifeasawholeandnotonlytolimitations
resultingfromadisease.Themostusedinstrumentsare
theWHOQOL-100anditsabbreviatedversion,WHOQOL-
Bref(6).HRQoLisrelatedtotheindividuals'perceptionof
theeffectsofanillnessonthephysical,mentalandsocial
aspectsofwell-being.Themostusedinstrumentsarethe
Medical Outcome Study SF-36 and its abbreviated
version, SF-12(6). There are also HRQoL instruments
intended to a specific disease, which search for more
sensitivityintheassessmentofclinicalchanges(8).
As regards addiction, the QoL construct has been
used for different objectives, such as describing and
comparingsubpopulationsofdrugusers;understanding
how QoL is associated with other variables related to
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
3
abuseoraddiction;usingQoLasavariableoftherapeutic
outcome; and finally, analyzing the metric properties
usedtomeasurethisconstructindrugusers(9).
Despite the potential of using aQoL assessment in
health, it is still recent and little explored in the
monitoringoftreatmentsandinstudieswithalcoholand
drug abusers and addicts, when compared to other
fields(6,10-12).
Theliteratureshowscertaingapsintheinvestigation
ontheuseofQoLinstrumentsformonitoringtreatments
and for studies with the population of abusers and
addicts,whichjustifiesthisstudy.Thisreviewenablesto
synthesize knowledge produced on the topic and to
supportprofessionalsand researcherswhowork in this
field,contributingtoaredirectionofactionsinhealthand
tothedevelopmentoffuturestudies.
Thus, the purpose of this study was to find
instruments for measuring QoL and their purpose in
studies with patients under treatment for substance
abuseandaddiction.
METHOD
Thisisanintegrativereviewcarriedoutfollowingthe
steps recommended by the literature(13). The first is
relatedtotheidentificationofthetopicandtheguiding
question,thesecondistheestablishmentofinclusionand
exclusion criteria in studies and how the search in the
literature is performed to obtain the sample. The third
refers to the definition of information that will be
extractedfromtheselectedstudies.Thefourthstepisan
assessmentthatissimilartothedataanalysisofstudies
included in the review. The fifth consists of the
interpretationanddiscussionofresults found instudies
andthesixthsteppresentstheknowledgesynthesis.
Theguidingquestiondefinedforourstudywas:what
are the QoL instruments used in studies with patients
underSUDtreatmentandwhatistheaimoftheirusein
thesestudies?
Thesearchforscientificoutputwascarriedoutinthe
Virtual Health Library (VHL), by selecting the following
databases:theSpanishBibliographicIndexoftheHealth
Sciences(IBECS),theLatin-AmericanLiteratureinHealth
Sciences(LILACS)andtheMedicalLiteratureAnalysisand
RetrievalSystemOnline(MEDLINE).Toconductthestudy,
anadvancedsearchwasperformedontheVHLportalby
means of the Boolean operator "AND", which found
documents with the descriptors "Quality of life" and
"Substance-RelatedDisorders"appearingsimultaneously.
The inclusion criteria for selecting the research
material considered: articles from studies which used
instruments of QoL in treatments for alcohol and drug
abuse and addictionof people agedover 18, published
between January 2010 and July 2015, in English,
PortugueseandSpanish.Theexclusioncriterionwasthe
unavailability of full texts on theVHLplatform, if these
could not be retrieved on the CAPES portal. Figure 1
shows the flowchart of the selection process of the
scientificoutputofthereview.
For data collection, completed in August 2015, the
following items were investigated: level of evidence,
populationandplaceoftreatment,QoLinstrumentsused
andpurposesoftheQoLinstrumentforthisstudy.These
itemswerecreatedwiththeaimofleadingtothestudy
question.
Theintegrativereviewoftheliteratureisoneofthe
possibilities of evidence-based practice, which is an
approach that enables decision making by healthcare
professionals for solving problems related to clinical
practice. The classification of evidence found in
publications becomes necessary for this decision to be
made carefully. Considering the amount of scientific
output on evidence-based practice in health care, we
chosetoadoptforthisreviewaclassificationofevidence
levels already used by Brazilian authors, especially
nurses(13-14), proposed by Stetler et al.(15). Supported by
thisapproach,theclassificationofevidencelevelsofthe
analyzed articleswas performed by the researchers, as
showninthechartbelow.
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
4
Figure1:Flowchartoftheselectionprocessofthescientificoutputanalyzed.
Chart1:ClassificationofevidencelevelsastothenatureofstudiesLevelI Meta-analysisofmultiplecontrolledstudiesLevelII Individualexperimentalstudies(randomizedclinicaltrial).
LevelIIIQuasi-experimentalstudies-Non-randomizedclinicalstudies,singlepre-andpost-testgroup,time
seriesandcase-controlstudies.
LevelIVNon-experimentalstudies-descriptive,correlatedandcomparativestudies,qualitativestudiesand
casestudies.LevelIV Datafromassessmentofprogramsobtainedsystematically.LevelVI Specialists'opinion,experiencereports,consensus,regulationsandlegislation.
Source:Stetleretal.(1998).
RESULTS
Twenty-ninearticlesmettheinclusionandexclusion
criteriaandwereselectedforanalysis.Theresultswere
summarizedinChart2,whichshowsthedetailsregarding
thetitle,author,country,year,journal,levelofevidence
ofthestudy,populationundertreatment,instrumentof
QoLusedand itspurpose in that study.Although these
studiesusedotherrelatedinstruments,thepresentstudy
tookintoconsiderationonlyQoLinstruments.
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
5
Chart2:Synthesisofarticlesincludedintheintegrativereview
Title/Author/Country/YearJournalandlevelofevidenceofthe
article
Populationundertreatment(Samples)
QoLinstrumentanditspurposeinthestudy
Lacalidaddevidaenpacientescontrastornopordependenciaalalcoholcontrastornosdelapersonalidade:relacióncomelajustepsicológicoycraving.MartínezGonzálezJM,etal.,Spain,2010(16)
Psicothema(Oviedo)III
65alcoholaddictedpatientsundertreatmentattheprovincialcenterofdrugaddicts,Granada,Spain.
Q-LES-QTorelateQoLwithdualdiagnosis,
psychologicaladjustmentandcraving
Predictorsofmotivationforabstinenceattheendofoutpatientsubstanceabusetreatment.LaudetAB,StanickV.,E.U.A,2010(17)
JournalSubstanceTreatment
IV
250usersofmultiplesubstancesoftwooutpatienttreatmentprogramscarriedoutwithpublicfunding,New
York,USA
WHOQOL-100–itemofgeneralsatisfactionwithlife
TorelateQoLwithcommitmentofabstinencebytheendoftreatment
Qualityoflifeamongtreatmentseekingmethamphetamine-dependentindividuals.GonzalesRetal.,USA,2011(18)
TheAmericanJournalonAddictions
IV
838methamphetamine-dependentindividualsofaprojectcarriedoutbetween1999and2001,fromeightoutpatienttreatmentprograms,California,Montanaand
Hawaii,USA.
SF-36TorelateQoLwithsociodemographicandpsychosocialdata,severityofuse,
doctorsandpsychiatrists.
Qualityoflifeprofilesandchangesinthecourseofmaintenancetreatmentamong1,015patientswithsevereopioiddependence.
KarowA,etal.,Germany,2011(19)
SubstUseMisuseIII
1,015opioid-dependentpatientsunderoutpatienttreatmentwithheroininjectionsundersupervisionormethadonemaintenanceinsevenGermancities.
MSQoLTocompareQoLbetweendifferent
groups(drugusers,depressedpatients,schizophrenicpatients,healthy
individuals)
Clinicalcorrelatesofhealth-relatedqualityoflifeamongopioid-dependentpatients.HeslinKC,etal.,USA,2011(20)
QualityofLifeResearch
IV
344opioid-dependentindividuals,ofwhich113werehospitalizedand231wereunderoutpatienttreatment,treatedattheCTN(NationalInstituteonDrugAbuseClinicalTrialsNetwork)indifferentstatesoftheUSA
SF-36TorelateQoLwithphysiologicalfactors,withdrawalsymptoms,
addictionseverity
Developmentandvalidationofaqualityoflifeinstrumentforpatientswithdrugdependence:comparisonswithSF-36and
WHOQOL-100.WanCetal.China,2011(12)
InternationalJournalofNursingStudies
LevelIV
212drugaddicts,54heroin-dependents,caredforatacompulsoryrehabilitationanddetoxificationcenterin
Kunming,China
SF-36WHOQOL-100
TovalidateanotherQoLinstrument,calledQOL-DA
Useofitemresponsetheoryandlatentclassanalysistolinkpoly-substanceusedisorderswithaddictionseverity,HIVrisk,and
qualityoflifeamongopioid-dependentpatientsintheClinicalTrialsNetwork.WuLT,etal.,USA,2011(21)
DrugAlcoholDependIV
113hospitalizedand230outpatientopioid-dependentpatientsof12treatmentprogramsintheUSA
SF-36TorelateQoLwiththeuseofdifferent
substances.
Problemareasreportedbysubstanceabusingindividualsandtheirconcernedsignificantothers.HussaatsPetal.,Netherlands,
2012(22)
TheAmericanJournalonAddictions
IV
32usersunderoutpatienttreatment,(and32concernedsignificantothers),inamentalhealthcenterin
SpijkenisseandRotterdam,Netherlands.
EQ-5DTocompareQoLamongdifferentgroups(drugusers,relativesor
significantothers)
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
6
Title/Author/Country/YearJournalandlevelofevidenceofthe
article
Populationundertreatment(Samples)
QoLinstrumentanditspurposeinthestudy
Qualityoflifeanddepressivesymptomsamongcaregiversanddrugdependentpeople.
MarconSRetal.Brazil,2012(23)
LatinAmericanNursingMagazine
IV
109individualsunderoutpatienttreatment(and109caregivers),selectedfrom4PsychosocialCareCenters-Drugsandalcohol(CAPS),inthestateofMatoGrosso,
Brazil
SF-361.TorelateQoLwithdepressive
symptoms2.TocompareQoLamongdifferent
groups(drugusers,relatives/caregivers)
Theapplicationofthedruguserqualityoflifescale(DUQOL)inAustralia.ZubaranCetal.,Australia,2012(24)
HealthQualityofLifeOutcomes
IV
120drugusersunderhospitaloroutpatienttreatmentinthewesterndistrictofSydney,Australia
WHOQOL-BrefTovalidateanotherQoLinstrument,
calledDUQOL
Improvementofqualityoflifefollowing6monthsofmethadonemaintenancetherapyinMalaysia.BaharomNetal.,Malaysia,2012(25)
SubstAbuseTreatPrevPolicy
IV
122drugusersoftwogovernmentprogramsofmethadonemaintenanceinthedistrictofTampin,
Negeri,Sembilan,Malaysia
WHOQOL-Bref1.TouseQoLasavariableof
therapeuticoutcome.2.TorelateQoLwithsociodemographicvariables,HIV,hepatitisC,beginning
anddurationofdruguseComparisonofthecourseofsubstanceusedisordersamongindividualswithandwithoutgeneralizedanxietydisorderina
nationallyrepresentativesample.MagidsonJFetal.,USA,2012(26)
JPsychiatrResIII
6016drugusers.SUD:5730andSUDandgeneralizedanxietydisorder(GAD):286accessedintheNational
EpidemiologicalSurveyonAlcoholandRelatedConditions(NESARC)intheUSA
SF-12TocompareQoLamongdifferent
groups(druguserswithoutSUD,druguserswithSUD)
Prospectivepatternsandcorrelatesofqualityoflifeamongwomeninsubstanceabusetreatment.TracyAMetal.,USA,2012(27)
DrugAlcoholDependIV
240womeninsubstanceabusetreatmentinCleveland,Ohio,USA.
WHOQOL-BrefTorelateQoLwithsociodemographic,clinicalandsocialsupportvariables
Health-relatedqualityoflifeinpatientswithdualdiagnosis:clinicalcorrelates.
BenaigesIetal.,Spain,2012(28)
HealthQualLifeOutcomes
IV
125users:35withSUDandseverementaldisorders(SMD);35withSMDonlyand35withSUDonly(3rdgroupintreatmentinthetherapeuticcommunityof
Gressol,Barcelona,Catalonia,Spain
SF-36TocompareQoLamongdifferent
groups(druguserswithoutSMD,druguserswithSMD,patientswithSMD
withoutSUD)TDAHenpacientesconadicciónasustancias:análisisdela
prevalenciaydelosproblemasrelacionadosconelconsumoenunamuestraatendidaenunserviciodetratamientoambulatorio.
TorricoLinaresJ,E,etal.,Spain,2012(29)
TrastoradictIV
162substanceusersundertreatmentattheprovincialcenterofdrugaddictsofHuelva,Spain.
TECVASPTorelateQoLwithattentiondeficit
hyperactivitydisorder(ADHD)
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
7
Title/Author/Country/YearJournalandlevelofevidenceofthe
article
Populationundertreatment(Samples)
QoLinstrumentanditspurposeinthestudy
Improvingphysicalhealthandreducingsubstanceuseinpsychosis-randomizedcontroltrial(IMPACTRCT):studyprotocolforaclusterrandomizedcontrolledtrial.GaughranFetal.,UnitedKingdom,
2013(30)
BMCPsychiatryII
392druguserswithSMD,assistedbytheCommunityMentalHealthTeamofSouthLondon,UnitedKingdom
SF-36TouseQoLasavariableoftherapeutic
result
Doesbuprenorphinemaintenanceimprovethequalityoflifeofopioidusers?
DhawanA;ChopraA,India,2013(31)
IndianJMedResIII
231opioidusersselectedfromfivetreatmentunits,twoinDelhiandthreeineasternIndia
WHOQOL-BrefTouseQoLasavariableoftherapeutic
result
Drogodependientesvs.Usuáriosdesaludmentalcomtranstornosdepersonalidade:surelacióncomlacalidadedevida,la
psicopatologiaemEjeI,elajustepsicológicoydinâmicafamiliar.Martínez-GonzálezJMetal.,Spain,2013(32)
An.psicol.IV
68patientswithpersonalitydisorder(PD),ofwhich42.6%wereuserswithoutSUD,57.4%weredrugaddictsunderoutpatienttreatmentattheprovincialcenterof
drugaddictsinGranada,Spain
Q-LES-QTocompareQoLindifferentgroups
(individualswithPDandSUD,individualswithPDwithnoSUD)
Qualityoflife,self-esteemandself-identityofdrugaddictsSilveiraCDetal.,Brazil,2013(33)
CienSaudeColetIV
100hospitalizedusersorunderoutpatienttreatmentattheSãoJoséinstituteinthestateofSantaCatarina,Brazil
WHOQOL-BrefTorelateQoLwithself-esteem,self-
identity
QualityoflifedeterminantsinpatientsofaPsychosocialCareCenterforalcoholandotherdrugusers.MariniM,etal.,Brazil,
2013(34)
IssuesMentHealthNursIV
77substance-dependentpatientsunderoutpatienttreatmentataPsychosocialCareCenterforalcoholand
drugs(CAPSad),inthesouthofBrazil
WHOQOL-BrefTorelateQoLwithaddictionseverity
anddepression
Auricularacupuncturefordrugdependence:anopen-labelrandomizedinvestigationonclinicaloutcomes,health-related
qualityoflife,andpatientacceptability.LuaPL;TalibNS,Malaysia,2013(35)
AlternTherHealthMedII
69opioid-dependentindividualsundertreatmentwithmethadonemaintenanceinagovernmenthospitaland2
communityclinicsinTerengganu,Malaysia
WHOQOL-BrefTouseQoLasavariableoftherapeutic
result
SeverityofpsychiatricandphysicalproblemsisassociatedwithlowerqualityoflifeinmethadonepatientsinIndonesia.IskandarS,
etal.,Indonesia,2013(36)
AmJHorthopsychiatr.
IV
112opioid-dependentindividualsundertreatmentwithmethadonemaintenanceinBanung,Indonesia
EQ-5DTorelateQoLwithotherclinical
aspects(QoLandseverityofphysicalandpsychiatricissues)
Theefficacyofatomoxetineasadjunctivetreatmentforco-morbidsubstanceusedisordersandexternalizingsymptoms.BenegalV,et
al.,India,2013(37)
AsianJPsychiatrIII
14usersofalcohol,tobaccoandotherdrugswithexternalizationofsymptoms,underoutpatienttreatmentinade-addictioncenterinIndia
WHOQOL-BrefTouseQoLasavariableoftherapeutic
result
AvalidationstudyoftheALQoL9tomeasurequalityoflife.ZubaranCetal.,Australia,2014(38)
AmJDrugAlcoholAbuseIV
138alcohol-dependentorabuserindividuals,underoutpatienttreatmentorhospitalizedinthewestern
districtofSydney,Australia
WHOQOL-BrefTovalidateanotherQoLinstrument,
calledALQoL9
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
8
Title/Author/Country/YearJournalandlevelofevidenceofthe
article
Populationundertreatment(Samples)
QoLinstrumentanditspurposeinthestudy
Engaginginjob-relatedactivitiesisassociatedwithreductionsinemploymentproblemsandimprovementsinqualityoflifeinsubstanceabusingpatients.PetryNM,etal.,E.U.A.2014(39)
PsycholAddictBehavIII
185substance-dependentpatientsunderoutpatienttreatmentin3community-basedclinics,USA
QOLITouseQoLasavariableoftherapeutic
result
Correlationbetweendepressivesymptomsandqualityoflifeinusersofpsychoactivesubstances.MarconSRetal.,Brazil,2014(40)
VerEscEnfUSPIV
109substanceusersunderoutpatienttreatmentassistedin4CAPSadofthecenter-westregionofBrazil
SF-36TorelateQoLwithdepressive
symptoms
Qualityoflifeinacohortofhigh-dosebenzodiazepinedependentpatients.LugoboniF,etal.,Italy,2014(41)
DrugAlcoholDependIV
622benzodiazepinedependentpatientshospitalizedfordetoxificationattheuniversityhospitalofVerona,Italy
SF-36GHQ-12
TorelateQoLwithsociodemographicfactors,andexpectedQoL
Painandemotionaldistressamongsubstance-usepatientsbeginningtreatmentrelativetoarepresentativecomparisongroup.
WiestKL,etal.,USA,2014(42)
JAddictMedIV
406substance-dependentpatientsbeginningtreatment,170withmethadonemaintenanceand236underoutpatienttreatmentof3clinicslocatedinOregon,
PennsylvaniaandWashington,USA
PROMISTocompareQoLbetweendifferentgroups(patientsundermethadonetreatment,othertreatments,general
population)Combinationofclassicaltesttheory(CTT)anditemresponsetheory(IRT)analysistostudythepsychometricpropertiesoftheFrench
versionoftheQualityofLifeEnjoymentandSatisfactionQuestionnaire-ShortForm(Q-LES-Q-SF).Bourion-BédèsS,etal.,
France,2015(43)
QuallifeResIV
124alcohol-oropioid-dependentpatientsunderoutpatienttreatmentin4centersoftworegionsof
France
SF-12TovalidateanotherQoLinstrument,
calledQ-LES-Q-SF
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
9
Most of the studies analyzed used generic
instrumentsofQoL,ofbothoverallQoL(12texts),which
usedmainlyWHOQOL-Bref,andHRQoL(18texts),which
usedmainlySF-36.Despitethefactthatonlyonearticle
usedaspecificinstrumentforSUD,threeanalyzedstudies
referred to the validation of specific scales for the
disorder.
RegardingthepurposeoftheuseofQoLinstruments
inthestudiesanalyzed,14studiesusedQoLtorelateitto
other clinical characteristics, seven studies did it to
compareitbetweendifferentgroups,sixstudiesusedit
asavariableoftherapeuticoutcome,andfourstudiesdid
it to validate a new instrument of QoL. In Chart 3, the
instruments used or validated in the articles are
described.
Chart3:Descriptionofinstrumentsusedorvalidatedinthestudies
Instruments InstrumentdescriptionWorldHealthOrganization
QualityofLife1.WHOQOL-1002.WHOQOL-Bref
Generic.100itemsthatassesssixaspects:physical,psychological,degreeofdependence,socialrelationships,environmentandspirituality
WHOQOL-Brefisitsabbreviatedform,with26items
3.QualityofLifeInventory-QOLIGeneric.17aspects:work,lifeevents,home,love,friendship,leisure,self-esteem,life
philosophy,learning,creativity,socialservices,civicaction,community,neighborhood,health,relationshipwithchildrenandparents
MedicalOutcomesStudy4.MOSSF-36:5.MOSSF-12:
HRQoL(generic).36items.Physical(functionalcapacity,physicalaspects,pain,generalstateofhealth)andmentalaspects(vitality,socialaspects,emotionalaspects,mentalhealth)
MOSSF-12isitsabbreviatedform,with12items6.EuropeanQualityofLifeScale-
EQ-5DHRQoL(generic).Fiveitems:mobility,self-care,usualactivities,pain/discomfort,anxiety/depression.Thesecondpartinquiresaboutthecurrenthealthstate
7.QualityofLifeEnjoymentandSatisfactionQuestionnaire-Q-
LES-Q8.Q-LES-Q-SF
HRQoL(generic).Psychiatric/psychologicaldisorder.93items,whichreflectsatisfactionwithphysicalhealth,subjectivefeelings,work,domesticchores,school,leisure,socialrelationships
andgeneralactivities,andsatisfactionwithmedicationandlifeasawhole.Q-LES-Q-SFisitsabbreviatedform,with14items
9.ModularSystemforQualityofLife-MSQoL
HRQoL(generic).Mentaldisorders.39itemsmeasuringphysicalhealth,vitality,psychosocialQoL,emotionalQoL,materialsatisfaction,freetime,andoneitemmeasuringoverallQoL.
Optionalmodulesoffamily,childrenandoccupation
10.GeneralHealthQuestionnaireGHQ-12
HRQoL(generic).12itemsthatdescribemood:lostsleep,tension,lackofconcentration,unhappiness,depression,lackofconfidence,uselessness,andtheinabilitytoplayauseful
role,tofaceproblems,tomakedecisions,toovercomedifficulties,toenjoyeverydayactivities.
11.Patient-ReportedOutcomesMeasurementInformation
System-PROMIS
HRQoL(generic).Itemresponsetheory(IRT)model.4measures(impactofpain,anxiety,depression,fatigue).Italsoassessesresponsetopain,angerandtheabilitytoperform
everydayduties
12.DrugUsersQualityofLifeScale-DUQOL
SUDspecific.22aspects:tofeeluseful,drugs,drugtreatment,education,family,well-being,friends,harmreduction,health,medicalassistance,housing,freedomofchoice,leisure,
money,neighborhoodsecurity,partner(s),communityresources,sex,spirituality,transport,future,treatmentbyothers.
13.QualityofLifeforIndividualswithDrugAddiction/Dependence
-QOL-DA
SUDspecific.4aspects:physicalfunction,(bodymovement,sensoryperception,appetite,sexuality,sleepandenergy),psychologicalfunction(emotion,cognition,resistancetostressandself-esteem),socialfunction(socialsupportandfamilyadaptationandcareersupport)
andeliminationofsymptomsandsideeffects.14.TestparalaEvaluacióndelaCalidaddeVidaenAdictosaSustanciasPsicoactivas–
TECVASP
SUDspecific.22items.Physicalaspect(functionalactivity,pain,sleep,nausea,fatigue,physicaldependence).Psychosocialaspect(psychologicaldependence,depression,anxiety,aggressiveness,memory,hallucinations,concentration,orientation,perceptionofphysical
andpsychologicalhealth,socialfunctioning,expectations.
15.9-itemQoLscale-ALQoL9SUDspecific.9itemsthatassesshealthandtheconsequencesofalcoholismonindividuals
whicharenotrelatedtohealth.DesignedbyacondensationoftheSF-36andtheinclusionofaspectsrelatedtoalcoholism.
CampêloSR,BarbosaMA,PortoCC..
Rev.Eletr.Enf.[Internet].2015oct/dec;17(4).Availablefrom:http://dx.doi.org/10.5216/ree.v17i4.31515.
10
DISCUSSION
Most articles studied used generic instruments of
QoL, overall QoL(17,24-25,27,31,33-35,37-39) or HRQoL(12,16,18-
23,26,28,30,32,36,40-43).Onlyone studyusedan instrumentof
HRQoLthatwasspecifictoSUD(29),althoughthreeofthe
selected studies referred to the validation of these
scales(12,24,38).Except for thepurposeof "comparingQoL
betweendifferentgroups",whichonlyusedinstruments
ofHRQoL,theothersusedinstrumentsofoverallQoLand
HRQoL.
These results confirm previous reviews on the
topic(6,9).Genericinstrumentsareusedmainlywhenthe
purposeofthestudyistocompareHRQoLofdrugabusers
with other groups of patients or with general
population(8,44) or alsowhen there are no valid specific
instruments(45), which justifies its wider use in cases of
dependence, for which there are few valid specific
instruments.
Thelimitationofassessmentsmadebygenericscales,
especially HRQoL, has been pointed out by some
authors(8-9,12), which indicates a current trend of
validationanduseofSUD-specificscales,adaptedtothe
population of drug abusers, enabling to select more
importantaspectsoflifeforthemandthustoassessmore
carefully the outcomes of treatment for SUD(8,12,24).
Examplesofspecificscalesinadditiontothosementioned
previously: Health-Related Quality of Life Test in Drug
Abuser (HRQOLDA), Injection Drug User Quality of Life
Scale(IDUQOL)(44).
Divergent positions are frequent among authors
regardingtheuseofinstrumentsofQoLintheassessment
of individuals undergoing treatment for abuse or
dependence of alcohol and drugs. Whereas some
authors(8,12,24,44)arguethatspecificinstrumentsallowfor
a more careful assessment of the outcomes of drug
dependence treatments, others(6,17,27) recommend the
use of generic instruments of overall QoL such as the
WHOQOL as they consider these instruments aremore
directly related to rehabilitation goals than HRQoL
measures.
Therefore,althoughitissaidthatgenericinstruments
shouldbemoreusedinsituationssuchasthecomparison
ofgroupsofdrugabuserswithotherpatientsorwiththe
general population, and that specific instruments may
assess a therapeutic intervention more precisely, the
findingsofthediscrepanciesmentionedaboveshowthe
needforfurtherstudies,especiallyonthedistinctionof
specific instruments that have been emerging and
WHOQOL generic instruments developed by theWHO,
whichseemtoalsomeasuresignificantaspectsrelatedto
therehabilitationofusersofalcoholanddrugs.
CONCLUSIONS
The articles analyzed in this review, most of them
with a level of evidence of IV, used instrumentswith a
generic approach of QoL, both the overall QoL
instruments, such as the WHOQOL-Bref, and HRQoL
instruments,suchastheSF-36.
Asforthepurposeoftheiruseinstudieswithusers
undergoing treatment for drug and alcohol abuse or
dependence, the instruments were randomly used
amongthedifferentpossibilitiesofuseofQoL,exceptfor
the purpose of "comparing QoL between different
groups",whichonlyusedinstrumentsofHRQoL.
Itisrecommendedthatfurtherstudiesbecarriedout
regardingtheuseofqualityoflifeinstrumentsinrelation
to addiction, especially in relation to recent specific
instrumentsthathavenotbeenconsolidatedinthefield.
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