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Jornal de Pneumologia

Print version ISSN 0102-3586On-line version ISSN 1678-4642

J. Pneumologia vol.29 no.4 São Paulo July/Aug. 2003

http://dx.doi.org/10.1590/S0102-35862003000400003 

Original Article

 

Questionnaire of quality of life in patients with primary hyperhidrosis*

 

 

José Ribas Milanez de CamposI; Paulo KauffmanII; Eduardo de Campos WerebeIII; Laert Oliveira Andrade FilhoIII; Sergio KuzniekIV; Nelson WoloskerV; Fábio Biscegli JateneVI; Mariane AmirVII

IAssitant - PhD, Thoracic Surgery Department
IIAssistant Professor - PhD, Vascular Surgery
IIIThoracic Surgeon
IVVascular Surgeon
VProfessor, Discipline of Vascular Surgery
VIHead of the Department of Thoracic Surgery
VIIAssistant - Department of Behavioral Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Correspondence

 

 


ABSTRACT

BACKGROUND: Hyperhidrosis or excessive sudoresis is a chronic disease associated with important subjective distress.
OBJECTIVE: To propose a specific questionnaire to evaluate the quality of life of patients with hyperhidrosis.
METHODS: From October 1995 to March 2002, 378 patients (234 females), with a mean age of 26.8 years, were evaluated before and after video-assisted thoracic sympathectomy.
RESULTS: Therapeutic success was obtained in 90% of the procedures. The recurrence rate was 10% for palmar and 11% for axillary hyperhidrosis; 27% of the patients who had recurrence were re-operated successfully. No serious complications were reported. Of the total number of patients, 91% answered to the quality of life questionnaire, and 86% of them reported improvement after the procedure.
CONCLUSIONS: Thoracic sympathectomy is a therapeutic method capable of changing the quality of life of patients with hyperhidrosis. The questionnaire applied has shown these changes.

Key words: Thoracic sympathectomy. Quality of life.


 

 

Introduction

Primary hyperhidrosis is a clinical condition defined as profuse sudoresis, occurring mainly on hands, armpits, feet and face in excess of what is considered physiologically necessary,. The etiology of primary hyperhidrosis is unknown, however it is considered to be a psychosomatic reaction and it is also called emotional hyperhidrosis. It is a chronic condition accompanied by subjective distress, because in today’s world sweating is considered unaesthetic and socially embarrassing. For some occupations it may even be dangerous and cause disability. The reported incidence is of approximately 1% being more prevalent among teenagers and young adults. There is a familial association in 13% to 57% of the cases 1. Nowadays the resection or ablation of the paraverthebral sympathetic chain is the elected therapy, because it provides permanent results 2, 3. The objective of this study was to survey the impact of thoracic sympathectomy on the quality of life of patients with primary hyperhidrosis. Based on studies by Amir et al.4 a questionnaire was developed and has been submitted to all the patients that underwent surgical treatment.

 

Method

This survey included 378 patients with primary hyperhidrosis who were submitted to video-assisted thoracic sympathectomy. Their ages ranged from 9 to 70 years (mean 26.8 ± 10.5), and 234 (62%) of them were female. The quality of life questionnaire was submitted twice: immediately before and at least 30 days after surgical treatment. The questionnaire is comprised of 20 questions divided into five domains. Each of these domains or group of functions or acts has five levels of answers based on tables which permit only one answer (Attach 1). The difference between pre-operative and post-operative evaluations was considered to be the “effect of treatment on quality of life”.

 

Results

Surgical treatment was successful in 341 (90%) patients. Recurrence of sudoresis took place in 22(10%) patients from the palmar group and in 7(11%) patients from the axillary group. Eight (27%) patients were successfully re-operated. Thirty-seven patients (10%) were not satisfied due to intense compensatory hyperhidrosis and 15 (4%) of them regretted having undergone the surgical procedure. Three-hundred and forty four (91%) patients answered the quality of life questionnaire. The results of the pre-operative answers to the questionnaire are shown in Table 1. It can be noted that all patients were in a bad or very bad condition. The results of the patients’ quality of life, at least 30 days after surgery, are shown in Table 2. It can be noted that 297 (86%) patients enjoyed an improved quality of life. When patients ranked the domains according to preference, the aspects most altered were: functional/social, personal and special circumstances.

 

 

 

 

Discussion

Today, quality of life has become an important measure in the evaluation of medical results and, this psychosocial aspect has fundamental implications for management of patients. In severe diseases, such evaluations can be performed more easily. For chronic and/or recurrent diseases, with complex etiologies and also with functional, emotional, psychological and professional implications, evaluation is carried out with questionnaires, not yet transposed. In 1998, Sayeed et al. 5 observed that “the impact of video-assisted sympathectomy on patient quality of life had not been reported in literature”. The authors used the Short-Form Questionnaire-36 (SF-36) for health evaluation and reported that despite the high incidence of compensatory hyperhidrosis (81%), both symptoms as well as patient quality of life improved after treatment. Lau et al.6 also attempted to evaluate the efficacy of sympathectomy to improve patient quality of life by using the questionnaire SF-36 and concluded that “notwithstanding that sympathectomy brought about some body pains and compensatory hyperhidrosis, those effects were compensated by the improvement of the initial symptoms and of the overall quality of life”. Questionnaire SF-36 for health evaluation has been largely used because it is easy to apply, reliable, sensitive and a helpful tool after surgical procedure7. Nevertheless, its sensitivity to changes in the health condition may be limited, due to good health in the post-operative period and especially because it is a general questionnaire5, 6. Thus, additional specific questionnaires, emphasizing the patient’s actual condition, have become necessary.

Using a dermatology questionnaire as an index of quality of life, Swan & Paes8 reported that 10 consecutive patients showed significantly improved quality of life after thoracic sympathectomy. This survey, although not using a specific questionnaire, was able to efficiently assess most of the perceived alterations. Fredman et al.9, used another surgical questionnaire for patients with palmar and axillary hyperhidrosis, given to 626 patients operated at least six months earlier. Aiming to determine if the adverse effects could modify the patients’ level of satisfaction, they concluded that 64% were very satisfied, 25% were satisfied and only 11% regretted having undergone a surgical procedure.

Therefore, in our opinion a specific questionnaire is needed to better evaluate each disease under study. Based on the paper by Amir et al.4 which describes the early development stages of a brief specific health questionnaire to evaluate the impact of hyperhidrosis on patients’ quality of life, we developed the questionnaire in Attach 1. Thereby, the basic parameters for the development of a questionnaire on quality of life specific for hyperhidrosis was produced, enabling adequate measurement of the surgical procedure’s impact on the patients.

On the other hand, in this series there is a methodological constraint as the questionnaire was applied only to the population scheduled for surgery, implying that those were patients with more severe conditions.

Therefore, results may be valid only for patients with significant symptoms that is, for the 378 operated patients of the more than 1800 interviewed at our outpatient service. Results, disclosed that 86% of the patients showed a better quality of life after surgical procedure.

To summarize, it was demonstrated that the specific questionnaire on quality of life was easy to understand and to apply and was also able to assess alterations in the quality of life achieved after sympathectomy in patients with primary hyperhidrosis.  In addition to the efficacy of the method, the factor which most influenced the patients’ quality of life was the presence of compensatory hyperhidrosis, whose intensity can negatively affect quality of life. All patients must be painstakingly informed about this eventuality. Among the domains, or group of functions or acts that were evaluated (Attach 1), it was noted that the domain most changed by thoracic sympathectomy was the functional/social one, that is, the domain related to the practical aspects of daily life. The questionnaire, therefore, clearly demonstrates, that primary hyperhidrosis negatively affects routine activities. The other two domains personal and or special circumstances were also significantly altered, because patients feel much more confident about their personal relationships and their normal environment after the surgical procedure.

 

Acknowledgement

The authors wish to thank Dr. Ricardo Beyruti, for his encouragement to search for funding and to investigate quality of life in patients with primary hyperhidrosis.

 

References

1. Kao MC, Lee WY, Yip KM. Palmar hyperhidrosis in children: treatment with video endoscopy laser sympathectomy. J Pediatr Surg 1994;29: 387-91.        [ Links ]

2. Hashmonai M, Kopelman D, Kein O. Upper thoracic sympathectomy for primary palmar hyperhidrosis: long-term follow-up. Br J Surg 1992; 79:268-71.        [ Links ]

3. Kauffman P, Milanez JRC, Jatene FB, Puech Leão P. Simpatectomia cervicotorácica por videotoracoscopia: experiência inicial. Rev Colégio Brasileiro de Cirurgiões 1998;25:235-9.        [ Links ]

4. Amir M, Arish A, Weinstein Y. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci 2000;37:25-31.        [ Links ]

5. Sayeed RA, Nyamekye I, Ghauri SK. Quality of life after transthoracic endoscopic sympathectomy for upper limb hyperhidrosis. Eur J Surg 1998;Suppl 580:39-42.        [ Links ]

6. Lau WT, Lee JD, Dang CR. Improvement in quality of life after bilateral transthoracic endoscopic sympathectomy for palmar hyperhidrosis. Hawaii Med J 2001;60:126-37.        [ Links ]

7. Garrat AM, Ruta DA, Abdalla MI. The SF-36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? Br Med J 1993;306:1440-4.        [ Links ]

8. Swan MC, Paes T. Quality of life evaluation following endoscopic transthoracic sympathectomy for upper limb and facial hyperhidrosis. Ann Chir Gynaecol 2001;90:157-9.        [ Links ]

9. Fredman B, Zohar E, Shachor D. Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe? Surg Laparosc Endosc Percutan Tech 2000;10:226-9.        [ Links ]

 

 

Correspondence to
José Ribas Milanez de Campos, MD
Rua Almirante Soares Dutra, 520
05654-000 – São Paulo, SP – Brasil
Fax +5511-3746-7478, 11-3747-3523
e-mail: jribas@usp.br

Received for publication on 16/5/3
Approved after review on 3/7/3

 

 

* This study was performed at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e Hospital Israelita Albert Einstein, São Paulo – Brasil.

 

 

Attach 1

Quality of life questionnaire - Hyperhidrosis

 

1) In general, you would say that your Quality of Life related to hyperhidrosis BEFORE THE SURGERY was:

 

Excellent

1
 

Very good

2
 

Good

3
 

Bad

4
 

Very bad

5

2) Compared to the period before your surgery, you would classify your Quality of Life at least 30 days AFTER THE SURGERY as:

 

Much better

1
 

A little better

2
 

The same

3
 

A little worse

4
 

Much worse

5

3) FUNCTIONAL/SOCIAL Domain: regarding the group of functions or acts below you would classify your Quality of Life in relation to the following items as:

  Before surgery: After surgery:
Writing: 1  2  3  4  5 1  2  3  4  5
Handcrafting: 1  2  3  4  5 1  2  3  4  5
Favorite hobbies: 1  2  3  4  5 1  2  3  4  5
Practice of sports: 1  2  3  4  5 1  2  3  4  5
Holding objects: 1  2  3  4  5 1  2  3  4  5
Handshaking (people) 1  2  3  4  5 1  2  3  4  5
Be/friends(public places) 1  2  3  4  5 1  2  3  4  5
Dancing socially 1  2  3  4  5 1  2  3  4  5

4) PERSONAL Domain: Regarding  your partner, how would you classify your quality of life in relation to:

  Before surgery: After surgery:
Holding hands? 1  2  3  4  5 1  2  3  4  5
Intimate touching? 1  2  3  4  5 1  2  3  4  5
Intimate relations? 1  2  3  4  5 1  2  3  4  5

5) EMOTIONAL Domain : SELF or WITH OTHERS; how would you classify the fact that after sweating excessively

  Before surgery: After surgery:
You have to justify yourself? 1  2  3  4  5 1  2  3  4  5
Other people showed rejection? 1  2  3  4  5 1  2  3  4  5

6) SPECIAL CIRCUMSTANCES Domain: how would you classify your Quality of life when you were :

  Before surgery: After surgery:
In closed/hot places? 1  2  3  4  5 1  2  3  4  5
Tense or worried? 1  2  3  4  5 1  2  3  4  5
Thinking about it? 1  2  3  4  5 1  2  3  4  5
Before a test / speaking in public? 1  2  3  4  5 1  2  3  4  5
Wearing sandals / barefoot? 1  2  3  4  5 1  2  3  4  5
Wearing colorful clothes? 1  2  3  4  5 1  2  3  4  5
Having problems at school / work? 1  2  3  4  5 1  2  3  4  5

TOTAL : _____________ _____________

The effect of treatment of Quality of life:      Before surgery (20 Excellent – 100 very bad/ bad)
(the closest value to)                                        After surgery (20 Much better – 100 much worse)

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