Determination of the longitudinal sensitivity of the AVVQ-Brazil Quality of Life Questionnaire to non-surgical treatment of chronic venous disease

Leal, Flávia de Jesus; Couto, Renata Cardoso; Pitta, Guilherme Benjamin Brandão; Andreoni, Solange

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Brasil

Jornal Vascular Brasileiro

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Brasil

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ORIGINAL ARTICLE • J. Vasc. Bras. 18 • 2019 • https://doi.org/10.1590/1677-5449.190048 copy

Determination of the longitudinal sensitivity of the AVVQ-Brazil Quality of Life Questionnaire to non-surgical treatment of chronic venous disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Sensitivity determines the efficiency and quality of construction of an assessment measure, but studies of the subject are scarce in the literature.

Objective

To evaluate the longitudinal sensitivity of the AVVQ-Brazil to clinical changes after treatment for chronic venous disease (CVD).

Methods

A longitudinal intervention study, with 112 chronic venous patients receiving elective treatment, assessed with CEAP, VAPS, AVVQ-Brazil, and VEINES-QOL/Sym at pre-treatment (baseline) and post-treatment (4 weeks). Differences in the scores for the scales at different times were evaluated using Student’s t test for paired samples and Wilcoxon’s z, which were also used to asses individuals by CEAP grade and assessment time. Effect size, confidence intervals, and partial η² were used to determine the sensitivity of changes in scale scores over time. Correlations between changes in the scores of the same scales and between different scales were measured using Pearson coefficients, Spearman coefficients, and Kendall’s tau-b coefficient.

Results

The mean age of the patients was 59.51 years. The majority were female (82.1%), with standing for prolonged periods (49.1%), had completed secondary (22.3%) or higher (25%) education, and had CEAP C2 (28.6%) or C6 (32.1%) clinical severity. The following results were observed: mean scale scores reduced from baseline to post-treatment, except for the Extent of Varicosities domain of the AVVQ-Brazil and the VEINES-QOL/Sym scales; sensitivity was low for the AVVQ-Brazil and its domains and for the VAPS, and was from low to high for the other scales; there were improvements or maintenance of CEAP grade after treatment; and moderate to excellent correlations between changes in scale scores over time.

Conclusions

The AVVQ-Brazil is sensitive to longitudinal clinical changes after treatment for CVD and is an important measure for assessment of QoL and of disease severity in Brazil.

Keywords:
sensitivity and specificity; quality of life; venous insufficiency

Scale	Assessment	n	Mean	Standard deviation	Minimum	Maximum	Median
Total AVVQ-Brazil score	Baseline	112	24.57	11.86	1.52	63.40	23.88
	4 weeks	112	20.29	9.45	0.52	45.74	20.00
AVVQ-Brazil, Pain and Dysfunction	Baseline	112	33.80	30.90	0.00	100.00	25.30
	4 weeks	112	18.74	22.17	0.00	100.00	11.05
AVVQ-Brazil, Esthetic Appearance	Baseline	112	51.17	36.17	0.00	100.00	56.76
	4 weeks	112	43.14	39.35	0.00	100.00	35.15
AVVQ-Brazil, Extent of Varicosities	Baseline	112	21.50	15.49	0.93	67.81	18.10
	4 weeks	112	22.78	15.07	0.93	77.11	19.66
AVVQ-Brazil, Complications	Baseline	112	17.28	20.45	0.00	91.42	5.94
	4 weeks	112	12.92	15.99	0.00	66.00	7.02
VAPS	Baseline	112	4.10	3.17	0.00	10.00	4.50
	4 weeks	112	2.73	3.07	0.00	10.00	2.00
iVEINES-QOL	Baseline	112	55.11	22.09	9.80	94.00	54.80
	4 weeks	112	65.75	20.36	10.40	99.20	65.50
iVEINES-Sym	Baseline	112	59.48	24.99	7.00	100.00	60.50
	4 weeks	112	66.85	22.46	10.00	100.00	69.00

Scale	n	Change median (4 weeks - baseline)	Wilcoxon’s z	p	Change median (4 weeks - baseline)	Standard deviation of the change	95%CI of the change	t	p	Observed power (%) with alpha = 0.05
AVVQ-Brazil, total score	112	-2.62	-3.61	<0.001	-4.28	11.44	-6.42 to -2.13	-3.96	< 0.001	97.51
AVVQ-Brazil, Pain and Dysfunction	112	-6.62	-4.73	< 0.001	-15.06	29.16	-20.52 to -9.60	-5.47	< 0.001	99.97
AVVQ-Brazil, Esthetic Appearance	112	0.00	-2.31	0.020	-8.04	35.06	-14.60 to -1.47	-2.43	0.017	67.18
AVVQ-Brazil, Extent of Varicosities	112	0.93	-0.91	0.363	1.28	14.31	-1.40 to 3.96	0.94	0.347	15.48
AVVQ-Brazil, Complications	112	0.00	-2.42	0.015	-4.36	17.90	-7.70 to -1.00	-2.58	0.011	72.32
VAPS	112	0.00	-3.64	< 0.001	-1.38	3.68	-2.06 to -0.69	-3.95	< 0.001	97.47
iVEINES-QOL	112	9.80	-5.93	< 0.001	10.64	16.76	7.50 to -13.78	6.72	< 0.001	99.99
iVEINES-Sym	112	7.00	-3.86	< 0.001	7.37	20.87	3.46 to -11.28	3.74	< 0.001	95.95

Scale	Change mean (4 weeks - baseline)	Standard deviation of the change	Standard deviation baseline	Effect size (SD of the change)	95%CI Effect size (SD of the change) ^* * SD = standard deviation used.	Effect size (Baseline SD)*	partial η²
AVVQ-Brazil, Total score	-4.28	11.44	11.86	-0.374	-0.565 to -0.181	-0.361	0.124
AVVQ-Brazil, Pain and Dysfunction	-15.06	29.16	30.90	-0.517	-0.713 to -0.318	-0.487	0.212
AVVQ-Brazil, Esthetic Appearance	-8.04	35.06	36.17	-0.229	-0.416 to -0.041	-0.222	0.050
AVVQ-Brazil, Extent of Varicosities	1.28	14.31	15.49	0.089	-0.097 to 0.275	0.083	0.008
AVVQ-Brazil, Complications	-4.36	17.90	20.45	-0.243	-0.431 to -0.055	-0.213	0.056
VAPS	-1.38	3.68	3.17	-0.373	-0.564 to -0.181	-0.435	0.123
iVEINES-QOL	10.64	16.76	22.09	0.635	0.431 to -0.837	0.482	0.289
iVEINES-Sym	7.37	20.87	24.99	0.353	0.161 to -0.543	0.295	0.112

CEAP		4 weeks							Wilcoxon signed rank test for paired samples
baseline		1	2	3	4	5	6	Total	z	p
2	n	9	21	2	0	0	0	32	-5.15	< 0.001
	% of overall total	8.0	18.8	1.8	0.0	0.0	0.0	28.6
3	n	1	5	8	1	0	0	15
	% of overall total	0.9	4.5	7.1	0.9	0.0	0.0	13.4
4	n	0	3	4	17	0	0	24
	% of overall total	0.0	2.7	3.6	15.2	0.0	0.0	21.4
5	n	0	0	0	0	4	1	5
	% of overall total	0.0	0.0	0.0	0.0	3.6	0.9	4.5
6	n	0	0	0	0	16	20	36
	% of overall total	0.0	0.0	0.0	0.0	14.3	17.9	32.1
Total	n	10	29	14	18	20	21	112
	% of overall total	8.9	25.9	12.5	16.1	17.9	18.8	100

			Pearson		Spearman		Kendall’s τ-b
Change in	Change in	n	Correlation	p	Correlation	p	Correlation	p
Total AVVQ-Brazil score	VAPS	112	0.498	< 0.001	0.475	< 0.001	0.358	< 0.001
Total AVVQ-Brazil score	iVEINES-QOL	112	0.065	0.652	0.173	0.225	0.113	0.267
Total AVVQ-Brazil score	iVEINES-Sym	112	-0.290	0.039	-0.232	0.102	-0.177	0.098
Total AVVQ- Brazil score	CEAP	112	0.427	0.002	0.416	0.002	0.345	0.003
AVVQ-Brazil, Pain and Dysfunction	VAPS	112	0.363	0.009	0.342	0.014	0.260	0.011
AVVQ-Brazil, Pain and Dysfunction	iVEINES-QOL	112	-0.075	0.603	0.115	0.421	0.082	0.421
AVVQ-Brazil, Pain and Dysfunction	iVEINES-Sym	112	-0.309	0.028	-0.201	0.157	-0.154	0.151
AVVQ-Brazil, Pain and Dysfunction	CEAP	112	0.425	0.002	0.445	0.001	0.370	0.002
AVVQ-Brazil, Esthetic Appearance	VAPS	112	0.384	0.005	0.372	0.007	0.274	0.007
AVVQ-Brazil, Esthetic Appearance	iVEINES-QOL	112	0.254	0.072	0.389	0.005	0.278	0.006
AVVQ-Brazil, Esthetic Appearance	iVEINES-Sym	112	-0.153	0.283	-0.082	0.569	-0.064	0.550
AVVQ-Brazil, Esthetic Appearance	CEAP	112	0.375	0.007	0.350	0.012	0.290	0.013
AVVQ-Brazil, Extent of Varicosities	VAPS	112	0.392	0.004	0.438	0.001	0.322	0.002
AVVQ-Brazil, Extent of Varicosities	iVEINES-QOL	112	-0.050	0.726	-0.053	0.711	-0.037	0.718
AVVQ-Brazil, Extent of Varicosities	iVEINES-Sym	112	-0.109	0.447	-0.049	0.731	-0.029	0.788
AVVQ-Brazil, Extent of Varicosities	CEAP	112	0.166	0.245	0.163	0.254	0.135	0.250
AVVQ-Brazil, Complications	VAPS	112	0.166	0.245	0.131	0.360	0.094	0.360
AVVQ-Brazil, Complications	iVEINES-QOL	112	0.009	0.950	-0.073	0.612	-0.046	0.651
AVVQ-Brazil, Complications	iVEINES-Sym	112	-0.135	0.344	-0.147	0.302	-0.119	0.268
AVVQ-Brazil, Complications	CEAP	112	0.149	0.297	0.137	0.337	0.114	0.332
VAPS	iVEINES-QOL	112	0.171	0.229	0.216	0.127	0.167	0.117
VAPS	iVEINES-Sym	112	-0.121	0.399	-0.034	0.812	-0.030	0.792
VAPS	CEAP	112	0.203	0.153	0.209	0.142	0.181	0.140
iVEINES-QOL	iVEINES-Sym	112	-0.168	0.238	-0.190	0.182	-0.148	0.184
iVEINES-QOL	CEAP	112	0.136	0.343	0.386	0.005	0.332	0.006
iVEINES-Sym	CEAP	112	-0.180	0.207	-0.153	0.284	-0.139	0.280
Total AVVQ-Brazil score	AVVQ-Brazil, Pain and Dysfunction	112	0.781	<0.001	0.762	<0.001	0.585	< 0.001
Total AVVQ-Brazil score	AVVQ-Brazil, Esthetic Appearance	112	0.740	<0.001	0.731	<0.001	0.563	< 0.001
Total AVVQ-Brazil score	AVVQ-Brazil, Extent of Varicosities	112	0.603	<0.001	0.564	<0.001	0.414	< 0.001
Total AVVQ-Brazil score	AVVQ-Brazil, Complications	112	0.589	<0.001	0.520	<0.001	0.369	< 0.001
AVVQ-Brazil, Pain and Dysfunction	AVVQ-Brazil, Esthetic Appearance	112	0.548	<0.001	0.483	<0.001	0.345	< 0.001
AVVQ-Brazil, Pain and Dysfunction	AVVQ-Brazil, Extent of Varicosities	112	0.230	0.104	0.232	0.102	0.152	0.120
AVVQ-Brazil, Pain and Dysfunction	AVVQ-Brazil, Complications	112	0.219	0.123	0.137	0.339	0.116	0.235
AVVQ-Brazil, Esthetic Appearance	AVVQ-Brazil, Extent of Varicosities	112	0.130	0.365	0.168	0.239	0.109	0.265
AVVQ-Brazil, Esthetic Appearance	AVVQ-Brazil, Complications	112	0.215	0.130	0.221	0.119	0.157	0.109
AVVQ-Brazil, Extent of Varicosities	AVVQ-Brazil, Complications	112	0.486	<0.001	0.423	0.002	0.300	0.002

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.