Como avaliar o impacto da doença venosa crónica na qualidade de vida

 

Joana Leal*, Armando Mansilha**

* Aluna do 6º ano da Faculdade de Medicina da Universidade do Porto

** MD, PhD, FEBVS, Assistente Hospitalar de Angiologia e Cirurgia Vascular, Professor Convidado da Faculdade de Medicina da Universidade do Porto, Orientador do Projecto Opção – Mestrado Integrado em Medicina

 

RESUMO

A doença venosa crónica (DVC) tem elevada prevalência no mundo ocidental e associa-se a custos significativos. O estudo de resultados promove a compreensão das doenças e efeitos terapêuticos. Atendendo ao grande impacto social e frequente subestimativa da gravidade da DVC, torna-se pertinente utilizar instrumentos de avaliação de qualidade de vida (QdV). Vários instrumentos descritos pelo clínico têm sido utilizados, como a classificação CEAP (Clínica, Etiológica, Anatómica e Patofisiológica) ou o sistema Venous Severity Scoring (VSS). Contudo, os instrumentos de avaliação de QdV centrados na perspectiva do doente têm ganho relevo significativo, permitindo acompanhar a evolução da doença e resposta ao tratamento, assim como avaliar a qualidade dos cuidados de saúde prestados e possibilitar o fornecimento de informações importantes não adequadamente expressas pelos valores estatísticos de morbilidade e mortalidade a que o clínico tradicionalmente recorre. Assim, é de particular interesse esta avaliação no contexto da DVC, dada a gravidade da doença se alterar no decorrer do tempo. De entre os instrumentos descritos pelo doente, além dos genéricos, como o 36-Item Short Form Health Survey (SF-36) ou o Nottigham Health Profile (NHP), têm particular interesse os específicos de DVC, que constituem uma abordagem à totalidade das dimensões da QdV afectadas nesta patologia. Dos instrumentos específicos de DVC destaca-se o Chronic Venous Insufficiency Questionnaire (CIVIQ), de simples e rápida utilização, fiável e validado internacionalmente, em termos linguísticos e psicométricos. O CIVIQ revela ainda extrema capacidade de detectar mudanças de estado na DVC, sendo um instrumento valioso de avaliação da QdV de DVC.

Palavras-chave: Doença venosa crónica, Qualidade de vida, Civiq

 

How to assess the impact of the chronic venous disease on the quality of Life

ABSTRACT

Chronic venous disease (CVD) is highly prevalent in the western world and is associated with significant costs. Outcome studies promote understanding of the diseases and the results of treatment. Given the strong social impact and often underestimate of CVD severity, it is important to use instruments for assessing quality of life (QoL). Several physician-generated measurements tools have been used as the CEAP (Clinical, Etiologic, Anatomic and Pathophysiologic) or the Venous Severity Scoring System (VSS). But the patient-generated QoL tools has gained significant relief, enabling monitoring disease progression and response to treatment, as well as assessing of quality of care provided and allow the provision of important information not properly expressed by the statistical values of morbidity and mortality that physicians traditionally use. It is therefore of particular interest this assessment in the context of CVD given the severity change of the disease over time. Among the patient-generated measurements tools, besides the generic, such as the 36-Item Short Form Health Survey (SF-36) or Nottigham Health Profile (NHP), are of particular interest the specific for CVD, which are an approach to all the dimensions of QoL affected in this pathology. Among specific instruments for CVD highlight the Chronic Venous Insufficiency Questionnaire (CIVIQ), of quick and easy use, reliable and validated internationally in terms of language and psychometric. The CIVIQ also shows extreme ability to detect state changes in the CVD, being a valuable tool for assessing the QoL of CVD.

Key words: Chronic venous disease, Quality of life, Civiq

 

Texto completo disponível apenas em PDF.

Full text only available in PDF.

 

5. REFERÊNCIAS

¹ Porter JM, Moneta LG. Reporting standards in venous disease: an update. J Vasc Surg 1995;21(4):635-45.

² Epidemiology of chronic venous disease. Robertson L, Evans C, Fowkes FG. Phlebology. 2008;23(3):103-11.

³ Nicolaides A, Allegra C, Bergan J et al. Management of chronic venous disorders of the lower limbs. Guidelines according to scientific evidence; Int Angiol 2008;27: 1-59.

⁴ Nicolaides NA: Investigation of chronic venous insufficiency: A consensus statement. Circulation. 102:126-163, 2000.

⁵ The management of chronic venous disorders in the leg: An evidence-based reporto f na international task force. Phlebology 12 (suppl 1):1-126, 1999.

⁶ Ruckley CV. Socioeconomic impact of chronic venous insufficiency and leg ulcers. Angiology 1997; 48: 67-9.

⁷ Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Vasquez MA, Munschauer CE. Phlebology. 2008;23(6):259-75.

⁸ Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res 1996;5:539–54.

⁹ Vasquez MA. Guest Editorial: Why does outcome assessment dominate the landscape of vascular surgery? Am Venous Forum 2007:1–6.

¹⁰ Chronic venous insufficiency: worldwide results of the RELIEF study. Reflux assessment and quality of life improvement with micronized Flavonoids. Jantet G. Angiology. 2002 May-Jun;53(3):245-56.

¹¹ Murray CJ, Salomon JA, Mathers CD, Lopez AD. Summary measures of population health: conclusions and recommendations. In: Murray CJ, Salomon JA, Mathers CD, Lopez AD, eds. Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications. Geneva, Switzerland: World Health Organization, 2002:731–56

¹² Valderas J, Alonso J and Guyatt G. Measuring patient-reported outcomes: moving from clinical trials into clinical practice. MJA 2008;189(2):93-94.

¹³ Valderas JM, Kotzeva A, Espallargues M, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res 2008; 17: 179-193.

¹⁴ Guyatt GH, Ferrans CE, Halyard MY, et al; Clinical Significance Consensus Meeting Group. Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice. Mayo Clin Proc 2007; 82: 1229-1239.

¹⁵ Lamping D. Measuring health-related quality of life in venous disease: practical and scientific considerations. Angiology 1997;48: 51-7.

¹⁶ Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1989;27(suppl): S217-32.

¹⁷ Kahn SR, Solymoss S, Lamping DL, Abenhaim L. Long-term outcomes after deep vein thrombosis: post-phlebitic syndrome and quality of life. J Gen Intern Med 2000;15:425-9.

¹⁸ Lamping DL, Schroter S, Kurz X, Kahn SR, Abenhaim L. Evaluating outcomes in chronic venous disorders of the leg: development of a scientifically rigorous, patient-reported measure of symptoms and quality of life. J Vasc Surg 2003;37:410-9.

¹⁹ Davies AH, Rudarakanchana N. Quality of life and outcome assessment in patients with varicose veins. In: Davies AH, Lees TA, Lane IF, eds. Venous Disease Simplified. Shropshire, England: TFM Publishing Ltd; 2006.

²⁰ Cazaubon M. Validated quality-of-life scales for measuring treatment response in chronic venous disease. Medicographia. 2006;28:141-5.

²¹ McDaniel MD, Nehler MR, Santilli SM, et al, for the Ad Hoc Committee to Study Outcomes Assessment. Extended outcome assessment in the care of vascular diseases: Revising the paradigm for the 21st century. J Vasc Surg. 2000;32:1239-1250.

²² Kundu S, Lurie F, Millward SF, et al. Recommended reporting standards for endovenous ablation for the treatment of venous insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Surg 2007;46:582–9.

²³ Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40:1248-52.

²⁴ Chiesa R, Marone EM, Limoni C, Volonte` M, Petrini O. Chronic venous disorders: correlation between visible signs, symptoms, and presence of functional disease. J Vasc Surg 2007;46:322–30.

²⁵ McLafferty RB, Lohr JM, Caprini JA, et al. Results of the National Pilot Screening Program for venous disease by the American Venous Forum. J Vasc Surg 2007;45:142–8.

²⁶ Gillet JL, Perrin MR, Allaert FA. Clinical presentation and venous severity scoring of patients with extended deep axial venous reflux. J Vasc Surg 2006;44:588–94.

²⁷ Kahn SR, M’lan CE, Lamping DL, Kurz X, Bérard A, Abenhaim LA; VEINES Study Group. Relationship between clinical classification of chronic venous disease and patient-reported quality of life: results from an international cohort study. J Vasc Surg. 2004 Apr;39(4):823-8.

²⁸ Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. American Venous Forum’s Ad Hoc Committee on Venous Outcomes Assessment. Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg 2000;31:1307–12.

²⁹ Vasquez MA, Wang J, Mahathanaruk M, Buczkowski G, Sprehe E, Dosluoglu HH. The utility of the venous clinical severity score in 682 limbs treated by radiofrequency saphenous vein ablation. J Vasc Surg 2007;45:1008–15.

³⁰ Garrat A, Ruta D, Abdalia M, Russell I. Responsiveness of the SF-36 and a condition-specific measure of health for patients with varicose veins. Qual Life Res. 1996;5:223-34.

³¹ Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. Quality of life in patients with chronic venous disease: San Diego population study. J Vasc Surg 2003;37:1047–53.

³² Rabe E, Pannier F. What have we learned from the Bonn Vein Study? Phlebolymphology 2006;13:188–94.

³³ Franks PJ, Bosanquet N, Brown D, Harper DR, Ruckley CV. Perceived health in a randomised trial of single and multilayer bandaging for chronic venous ulceration. Phlebology.1995;(suppl 1):17-19.

³⁴ Franks PJ, Moffatt CJ. Health related quality of life in patients with venous ulceration: use of the Nottingham health profile. Qual Life Res. 2001;10(8):693-700.

³⁵ Furtado K, Pina E, Franks PJ, Moffatt CJ. Quality of life in patients with leg ulcers in Portugal. Rev Port Cir Cardiotorac Vasc. 2005 Jul-Sep;12(3):169-74. Portuguese.        [ Links ]

³⁶ Negle´n P, Hollis K, Olivier J, Raju S. Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg 2007;46:979–90.

³⁷ Perrin M. The impact on quality of life of symptoms related to chronic venous disorders. Medicographia 2006;28:146–52.

³⁸ Erevnidou K, Launois R, Katsamouris A, Lionis C. Translation and validation of a quality of life questionnaire for chronic lower limb venous insufficiency into greek. Int Angiol. 2004;23:394-99.

³⁹ Lozano FS, Launois R. Reflux Assessment and Quality of Life Improvement with Micronized Flavonoids (RELIEF) ish group. Quality of life (Spain and France): validation of the chronic venous insufficiency questionnaire (CIVIQ). Methods Find Exp Clin Pharmacol. 2002;24:425-29.

⁴⁰ Guex J, Myon E, Didier L, Nguyen C, Taieb C. Chronic venous disease: health status of a population and care impact on this health status through quality of life questionnaires. Int Angiol 2005;24(3):258-264.

⁴¹ Intsertov MA. [Assessment of the efficacy of surgical management of lower limb varicosity from the viewpoint of patients’ quality of life as dependent on their psychological status]. Angiol Sosud Khir. 2005;11(3):60-3. Russian.

⁴² Veverková L, Kalac J, Jedlicka V, Wechsler J. [Analysis of surgical procedures on the vena saphena magna in the Czech Republic and an effect of Detralex during its stripping] Rozhl Chir. 2005 ;84:410-2, 414-6. Czech.

⁴³ Gavrilenko AV, Sandrikov VA, Vakhratian PE, et al. [Role of valvular insufficiency of the femoral vein in clinical course and relapse of lower limb varicosity]. Angiol Sosud Khir. 2006;12:61-66. Russian.

⁴⁴ Lorenz D, Gabei W, Redtenbacher M, et al. Randomized clinical trial comparing bipolar coagulating and standard great saphenous stripping for symptomatic varicose veins. Br J Surg. 2007;94:434-40.

⁴⁵ Pokrovsky AV, Saveljev VS, Kirienko AI, et al. Surgical correction of varicose vein disease under micronized diosmin protection (results of the Russian multicenter controlled trial DEFANS). Angiol Sosud Khir. 2007;13:47-55. English, Russian.

⁴⁶ Kalteis M, Berger I, Messie-Werndl S, et al. High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study. J Vasc Surg. 2008;47:822-829.

⁴⁷ Vayssairat M, Ziani E, Houot B. [Placebo controlled efficacy of class 1 elastic stockings in chronic venous insufficiency of the lower limbs] J Mal Vasc. 2000;25:256-62. French.

⁴⁸ Andreozzi GM, Córdova RM, Scomparin A, et al. Quality of Life Working Group on Vascular Medicine of SIAPAV. Quality of life in chronic venous insufficiency. An Italian pilot study of the Triveneto Region. Int Angiol. 2005;24:272-277.

⁴⁹ Le Tohic A, Bastian H, Pujo M, et al. [Effects of electrostimulation (Veinoplus) on lower limbs venous insufficiency-related symptoms during pregnancy. Preliminary study]. Gynecol Obstet Fértil. 2009;37:18-24.

⁵⁰ Kurz X, Lamping D, Kahn S, et al. Do varicose veins affect quality of life? Results of an international population-based study. J Vasc Surg 2001;34:641–8.

⁵¹ Kahn SR, M’lan CE, Lamping DL, Kurz X, Bérard A, Abenhaim LA; VEINES Study Group. Relationship between clinical classification of chronic venous disease and patient-reported quality of life: Results from an international cohort study. J Vasc Surg 2004;39:823–8.

⁵² Garratt AM, Macdonald LM, Ruta DA, Russell IT, Buckingham JK, Krukowski ZH. Towards measurement of outcome for patients with varicose veins. Qual Health Care 1993;2:5–10.

⁵³ Smith JJ, Guest MG, Greenhalgh RM, Davies AH. Measuring the quality of life in patients with venous ulcers. J Vasc Surg 2000;31:642–9.