Review
A systematic review of quality of thyroid-specific health-related quality-of-life instruments recommends ThyPRO for patients with benign thyroid diseases

https://doi.org/10.1016/j.jclinepi.2016.03.006Get rights and content

Abstract

Objectives

To appraise the measurement properties of thyroid-specific health-related quality-of-life (HRQOL) instruments and to provide recommendations on the choice of HRQOL instruments.

Study Design and Setting

Systematic review of English-language literature published between 1993 and 2015 identified psychometric studies involving patients with thyroid disease through a search of Pubmed, Web of Science, Embase, and OVID MEDLINE. HRQOL instruments were graded on methodological quality and overall levels of evidence using a COSMIN checklist.

Results

After a review of 742 original studies, 23 studies reporting 14 standardized HRQOL instruments targeted for Graves' ophthalmopathy (n = 4), hypothyroidism (n = 3), thyroid cancer (n = 2), other thyroid disease (n = 3), and nonthyroid tumor sites (n = 2) were identified. Hypothesis testing was evaluated most frequently. The 84-item thyroid-specific patient-reported outcome measure (ThyPRO) and 16-item Graves' ophthalmopathy-specific Quality-of-Life (GO-QOL) instruments were the most extensively evaluated instrument. The highest number of positive ratings in overall level of psychometric evidence was found in ThyPRO, GO-QOL, and 11-item Thyroid Treatment Satisfaction Questionnaire (ThyTSQ) instruments.

Conclusion

The ThyPRO is recommended for the assessment of HRQOL in patients with benign thyroid diseases while measurement properties of GO-QOL and ThyTSQ are satisfactory in measuring HRQOL of patients with Graves' ophthalmopathy and hypothyroidism, respectively.

Introduction

Thyroid diseases such as thyroid dysfunctions and cancers occur not uncommonly in the general population and have imposed an increased burden on our already over-stretched healthcare system [1], [2], [3]. This increased burden is attributed to the increased incidence as well as increased ascertainment and earlier diagnosis of thyroid diseases [4]. Despite this increased burden, patients with thyroid diseases are expected to have a comparable life expectancy as the normal population [5]. Therefore, health-related quality of life (HRQOL) has become a more clinically relevant and an important outcome measurement for patients with thyroid diseases.

In accordance to classical literature, HRQOL is defined as a subjective and multidimensional construct of health and welling. Concepts of general health, physical functioning, psychological functioning, and social functioning are fundamental determinants of HRQOL in general [6] or thyroid disease populations [7]. Studies so far [8], [9], [10] have revealed that persisting symptoms in thyroid dysfunctions and treatment after diagnosis of thyroid cancer had considerable impact on HRQOL. Impaired HRQOL in patients with thyroid dysfunctions was observed when being treated with antithyroid medication [11]. Relative to the normal population, thyroid cancer survivors suffered from significant HRQOL impairment [10]. Despite the availability of various thyroid-specific instruments [8], [9], [10], there has been no recommended, commonly accepted or the best instrument in the HRQOL assessment of patients with thyroid diseases. One reason for this lack of the best instrument is the fact that measurement properties of instruments used for thyroid diseases have not been systematically assessed with agreed quality criteria to enable direct comparison [12]. Comprehensive assessment of measurement properties, including validity and reliability of instruments, should have been undertaken by systematic review [13]. However, no systematic review synthesized evidence on the critical appraisal of the measurement properties of generic and condition-specific HRQOL instruments that have been validated for use in patients with thyroid disease, especially for hypothyroidism, Graves' ophthalmopathy (GO) and thyroid cancer.

The aim of this article was to conduct a systematic literature review on the measurement properties of standardized HRQOL instruments for thyroid disease and to make recommendations on the most appropriate HRQOL instrument(s) for a specific type of thyroid disease through collective evidence from previous studies.

Section snippets

Search engines and strategies

Systematic literature searches were conducted in databases of PubMed, Web of Science using Web of Knowledge platform, Embase, and MEDLINE using OVID searching platform, to identify studies that investigated the HRQOL of patients with thyroid diseases. The Medical Subject Heading (MESH) “quality of life” term was combined with “thyroid disease,” “thyroid cancer,” “thyroid neoplasm,” “thyroid carcinoma,” or “hypothyroidism” for our target population. Studies were limited to English language, and

Results

Fig. 1 shows the process of literature identification, screening for eligibility, and selection of studies during the literature search presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram [22]. The literature search was completed in May 2015 and identified a total of 2,108 potentially relevant studies (PubMed: 266; Web of Science: 545; MEDLINE: 486; and Embase: 811) that met the searching criteria in four bibliographic databases. After the

Discussions

Despite the need for high-quality thyroid-specific HRQOL instruments, to our knowledge, no previous studies have ever reviewed and compared the measurement property of generic HRQOL instruments. This systematic review evaluated the measurement properties of 14 standardized HRQOL instruments used in thyroid diseases patients among 23 eligible studies identified in the full-text assessment stage. The most frequently evaluated HRQOL instrument was the ThyPRO [24], [25], [26], [27], [28], [29]

Conclusions

After reviewing the present literature and critically examining published HRQOL instruments, the ThyPRO, GO-QOL, and ThyTSQ were the three with the greatest number of positive ratings according to nine quality assessment criteria of measurement properties. The ThyPRO was recommended to assess HRQOL in patients with benign thyroid disease while the overall measurement properties of GO-QOL and ThyTSQ were satisfactory in measuring HRQOL in GO and hypothyroidism patients, respectively. Therefore,

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      All patients were requested to fill in a health-related quality of life (HRQoL) questionnaire before and 6 months after the TAE. This questionnaire was a reduced version of thyroid-related patient-reported outcome (ThyPRO), which is the most widely used quality of life measurement instrument in thyroid disorders (13). The subgroups of ThyPRO can be selected to evaluate specific areas of interest.

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    Funding: This study was supported by Health and Medical Research Fund (ref no.: HMRF#12132941), the Food and Health Bureau, the Government of the Hong Kong Special Administrative Region.

    Conflict of interest: None of the authors declared any conflicts. The authors have nothing to disclose.

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