the effect of common skin disease on the QOL of patient in the local setting

My adviser wants me to modify the title from “quality of life of patient with skin disease in the local setting” to “the effect of common skin disease on the QOL of patient in the local setting”

And my adviser also wants to modify the statement of the problem.

Modifications are:

STATEMENT OF THE PROBLEM

1. What are the common dermatologic problems that patients seek for treatment @ Lucena Skin Center

2. What extent does the dermatologic problem affects their life

a. performance of activities of daily living

b. relationship with people

c. how he perceives him self

3. Is there a significant difference among the 3 factors identified and the level of impairment?

Can you make those modifications for me in 7 days? Can you also limit the number of pages to 25 including the statistical computation, because of my budget limitations? Thankyou

my advicer wanted our thesis change from comparative to descriptive correlational study.

Abstract

STATEMENT OF THE PROBLEM:

This study aims to focus on the following research questions:

1. What is the demographic profile of the respondents when they are grouped according to:

a. Age.

b. Gender

c. Diagnosis

2. Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile?

3. Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?

LOCALE OF THE STUDY:

This study will be conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.

RESPONDENTS:

The sampling technique used was criterion sampling. Both the inclusion and exclusion criteria for patient selection were adopted form the source. Consecutive patient’s, age 15 and above, whether old or new, consulting for any skin problem were included in the study. The patient’s companions whose ages were also 15 and above served as control subjects (Those who do not have skin diseases). The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous “3 months”, they should have had no apparent disability. Excluded in the study were those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.

SIGNIFICANT FINDINGS:

The study was conducted among 263 respondent’s patient and 47 controls (no skin disease) in Lucena Skin Center Clinic, Lucena City.

The demographic data were analyzed using descriptive statistics (N=263) for the patient and (N=47) for the controls. Majority of the patients where females, 142 (54%) and 121 (46%) were males. The respondents were aged from 15 to 78 years. 237 (90%) were aged less than 65 years where as 26 (10%) fell into the geriatric age group (age > = 65). For the control subset, 38 (81%) were female and 9 (19%) were males.

A total of 263 subjects responded to the IKPAS (Translated Dermatology Life Quality Index in Filipino). The average time to complete it was 5 minutes. Unanswered item was observed for item 9 on sexual activity. The difference of the mean score between 15-64 y/o group (mean score= 7.5) and 65-78 y/o group (mean score= 8.07) were not statistically significant however, the difference of the mean score between male (mean score= 7.4) and female (mean score= 26.19) were statistically significant. Among the diseases, the findings with the highest mean score (greatest effect on the quality of life) were seen in Atopic Dermatitis (11.5) and the lowest mean score in Viral Warts (4.5). IKPAS was also completed by 47 healthy control subjects. Reliability was measured in the translated instrument using the ‘s alpha Coefficient and it showed internal consistency with alpha Coefficient of a=0.71 (acceptable is >0.7). There was a significant difference between mean scores of patients (7.86) and healthy subjects (0.89) (p=0.000), demonstrating construct validity. Quality of life scores were higher in inflammatory skin diseases such as Atopic dermatitis, Contact dermatitis, Erythroderma and Lichen Simplex Chronicus as compared to Acne, Viral warts and Keloids.

The first null hypothesis was: “There is no difference in the Quality of Life of patients with skin disease when respondents were group according to their demographic profiles”.

The researchers reject the first null hypothesis.

The second hypothesis is: “There is no difference in the quality of life of patients with skin disease and those without skin disease”

The studies second null hypothesis was also rejected by the researchers.

CHAPTER ONE

THE PROBLEM AND ITS SETTING

BACKGROUND OF THE STUDY:

During our duties in clinics and hospitals, we often encounter

patients with skin diseases. We have observed that these patients were irritable, restless, and shy. They were treated for their skin problems only.

The nurses were instructed by the Physician/ Dermatologist how to take care of the patient’s skin lesions and rashes but their emotional and psychological problem were not taken into consideration.

We were wondering whether the stress of having the skin disease affect their quality of life.

The concept of quality of life was developed to interpret data obtained about the impact of diseases on patients well being. This was fostered by the World Health Organizations (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life. It usually utilizes a patient- administered questionnaire with items evaluating the effect of a disease and its treatment on patient’s symptoms, feelings and daily activities. (called domain) over a well-defined period of time. [3] The response options are arbitrary and employ a scoring system for interpretation. [4]

This study was undertaken to examine the quality of life of patients with skin disease against those who do not have skin diseases.

By studying the impact of skin diseases on the quality of life of patients with skin diseases, the researcher hope to be able to modestly contribute to the enhancement of not only the nursing profession but also the medical profession and as well as the improvement of patient care quality to uplift their quality of life.

STATEMENT OF THE PROBLEM:

This study aims to focus on the following research questions:

1. What is the demographic profile of the respondents when they are grouped according to?

a. Age

b. Gender

c. Diagnosis

2. Is there any difference in the quality of life of patients with skin disease when respondents are grouped according to their demographic profile?

3. Is there a difference in the level of the quality of life between those with skin disease and those without skin diseases?

SIGNIFICANCE OF THE STUDY:

Research is the best way to find solutions to nursing problems and to set standards for nursing practice. The problem that we have observed during our stints in hospitals and clinics led as to conceptualize a study that will answer our curiosity. The results of this study will therefore, benefit the following sectors;

NURSES- Expertise will increase as additional knowledge will be gain when educators will formulate effective psychological and emotional counseling which will be incorporated in nursing curriculum because of the output of this study.

NURSING EDUCATION- Nursing schools will be able to incorporate the results of this study into their nursing psychiatry curriculum.

PATIENTS or CLIENTS- there will be increased patients care quality. This in turn, will create increased patient satisfaction and will reflect a positive view of the hospital or clinic by the community.

MEDICAL EDUCATION- Medical schools will be able to incorporate results of this study into their medical psychiatry curriculum.

MEDICAL PROFESSION- Dermatologist will now be more aware and sensitive about their patient emotional and psychological problem brought about by their skin condition.

SCOPE AND DELIMITATION OF THE STUDY:

This study is conducted among 263 patients with skin disease and 47 subjects without skin disease (controls) in Lucena Skin Center Clinic. A private dermatology clinic in Lucena City with a board certified dermatologist.

A primary limitation of the study is posed by the source of the sample population which is from one local clinic only.

DEFINITION OF TERMS:

· Quality of Life- it refers to the satisfaction derived by the respondents in terms of their performance in the activities of daily living namely; shopping/ marketing, the way they dress, socializing, participation in sports activities, going to work and school and performing sexual activity and cognitive functioning.

· Cognitive functioning- In some forms of psychometrics, particularly those related to the Type Indicator, the cognitive functions (sometimes known as mental functions) are defined as different ways of experiencing and thinking about the

world. They are defined as “thinking”, “feeling”, “sensing” and “intuition”.

· Demographic profile- refers to the gender and age of the patient

CHAPTER TWO

THEORETICAL BACKGROUND

REVIEW OF RELATED LITERATURE AND STUDIES

RELATED LITERATURE:

Quality of Life is the degree of enjoyment or satisfaction experienced in everyday life. [5] In biblical times lepers had to live outside of society. In medieval times they had to ring a bell and call “unclean” wherever they went. Catching leprosy requires living in close contact for a long time and many labeled as lepers probably had diseases like eczema or psoriasis that are not infectious. The stigmatization of lepers was not a public health measure to control the spread but a reflection on how people view those with skin disease. Simply having skin disease is bad enough but the social response of others makes it much more difficult. [6]

As early as 1985, Quality of life has been employed as a major endpoint to evaluate and compare therapies along with clinical outcome measures such as efficacy and survival. [7] In cancer therapy, for instance, the emphasis is on the side-effect and quality of life. [8]

In dermatology where most patients are seen in the ambulatory, care setting survival is not a major end point [9] and because the therapeutic modalities here have comparable efficacies, the use of quality of life became even more important. Several well-validated dermatology-specific questionnaires have been developed, the first being ‘s Dermatology Life Quality Index in 1983.

RELATED STUDIES:

The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa. (.; ) Skin diseases can greatly affect the quality of life (QoL). Little is known, however, of their impact on QoL in the developing world. This study was designed to assess the effect of skin diseases in such a setting.

A questionnaire survey of patients using the Dermatology Life Quality Index (DLQI) modified to the cultural needs of the population. The adapted instrument was translated into Afrikaans and Xhosa. Six hundred and seven patients attending general dermatology clinics at Hospital and 53 controls were recruited. Influences on QoL of clinical severity, employment, education, age, sex, and home language were examined.

Participants included 313 (52%) English-speaking, 215 (35%) Afrikaans-speaking, and 79 (13%) Xhosa-speaking dermatology patients. Independent risk factors for having a high disability score were dermatologists’ assessment of severity, younger age, unemployment, and language (odds ratio, 0.13; 95% confidence interval (CI) of 0.03–0.5 for Xhosa speakers compared to Afrikaans speakers). Gender was not associated with a high score, but females were more likely to report effects of skin disease on self-esteem, clothing choice, treatment problems, and

In this multicultural setting, social class and language group, but not gender, influenced the impact of skin disease on overall QoL. Xhosa speakers were apparently less affected than other patients. This could be due to cultural differences in the experience of skin disease and in the perception of disability, or to biases in questionnaire responses. Anxiety and depression were relevant dimensions of QoL in this study and should be considered for inclusion in future research. The adapted and translated DLQI was valid and reliable. [10]

Eczema impairs quality of life in children to same extent as kidney disease. Children with serious skin conditions feel their quality of life is impaired to the same extent as those with chronic illnesses such as epilepsy, renal disease and diabetes, according to research published in the July issue of British Journal of Dermatology.

A team of Scottish researchers surveyed 379 five to 16 year-olds, who had been suffering from skin diseases like acne, eczema and psoriasis for more than six months, together with their parents.

They asked the children and their parents how much the condition impaired the child’s quality of life when it came to factors such as pain, loss of sleep, dietary restrictions, interference with school and play, friendships, teasing and bullying and medical treatment.

They then compared the quality of life scores given by the parents of 161 children with chronic diseases in the same age group.

Only six of the 546 parents approached by staff at Ninewells Hospital in Dundee and Perth Royal Infirmary preferred not to take part in the research. All the children included were attending outpatient clinics at the two hospitals.

Key findings included:

· The children in the study said that psoriasis (red scaly patches) and eczema were the two skin conditions that caused them the greatest distress. Both resulted in 31 per cent impairment in their quality of life score. This was followed by urticaria (itchy allergic skin rash) at 20 per cent impairment and acne at 18 per cent impairment.

· From the parent’s perspective, eczema was the biggest skin problem at 33 per cent, followed by urticaria at 28 per cent, psoriasis at 27 per cent and hair loss at 19 per cent.

· When they compared the overall results for the children with skin diseases and chronic illnesses, the researchers found that the condition that had the worst affect on quality of life was cerebral palsy at 38%. Generalized eczema and kidney disease both scored 33%t.

· Cystic fibrosis also made the top five (32%t), followed by urticaria and asthma (28%), psoriasis (27%), epilepsy and bed wetting (24 %), diabetes, hair loss and localized eczema (19%) and acne (16%).

· When children with psoriasis, and their parents, were asked to chose the things that affected the child’s quality of life most, parents rated bullying third and children rated bullying fourth.

· Teasing or bullying was also a key concern for the 11 children with hair loss, with six of the children and nine of the parents putting it first on their list.

· The biggest concern for children with eczema, psoriasis and uticaria was itching or pain, while children with acne or warts said that embarrassment was their main worry.

“Our study shows that children with chronic skin diseases – and their parents – reported the same level of quality of life impairment as the parents of children with many other chronic illnesses” says lead author Dr Paula Beattie from the Royal Hospital for Sick Children in Glasgow.
“Skin diseases are often more obvious to other children than chronic diseases such as asthma or diabetes and are more likely to lead to alienation, name calling, teasing and bullying.

“Some skin conditions can also disturb children’s sleep and cause lack of self-confidence, embarrassment and poor self-esteem, especially as they get older.

“Although skin diseases may not shorten life in the same way as serious conditions like cystic fibrosis, they can cause children as much, if not more, distress in their everyday lives.”

According to co-author Dr , Consultant Dermatologist at Ninewells Hospital, Dundee and British Skin Foundation spokesperson: Measuring quality of life can be a powerful political tool as it provides the patient’s perspective on the health impact of different diseases.

“This is particularly important when arguing for vital resources, especially in dermatology, as skin diseases are not considered to have as much of an impact on people’s lives as other illnesses.

“Our study clearly shows the profound effect skin diseases can have on children’s quality of life and we hope that our findings will raise awareness of the problems they face and encourage greater sensitivity towards them.”

of the British Skin Foundation agrees: “All too often, people think of skin diseases like eczema as nothing more than a mere annoyance. Sadly, this simply is not the case.

“We frequently hear of children who cry all night because of their itchy, flaky skin. This in turn leads to a lack of sleep and extreme emotional upset for their parents too.

“The psychological impact of visible skin diseases can be massive, with children facing bullying because of the way their skin looks. We even hear of children not wanting to swim or take part in sports because they don’t want to have to reveal their skin in the changing rooms. Of course, this can lead to enormous stress for the patient’s family also.

“This is why as a charity we are dedicated to raising money for research to end the diseases that blight millions of people’s lives in the UK.” [11]

THEORETICAL & CONCEPTUAL FRAMEWORK:

We theorize that skin diseases affect patients’ well-being and their ability to perform activities of daily living just like any other medical problem in the local setting. The concept of quality of life was developed to interpret data obtained about the impact of disease on the patient’s well being. This was fostered by the World Health Organization (WHO) view of health as not merely the absence of disease or infirmity, but the ability of the person to lead a productive and enjoyable life.

We conceptualize that quality of life can be measured by asking patients to answer a questionnaire which measures the effect of skin disease and its treatment on a patient symptoms, feelings and daily activities over a specified time.

The theoretical framework guiding this research is the concept that skin disease has an adverse impact on the quality of life of the patient.

HYPOTHESIS:

The null hypothesis that was used to guide this study was:

1. There is no difference in the quality of life of patients with skin diseases when respondents are grouped according to their demographic profile.

2. There is no difference in the level of the quality of life of patients with skin diseases and those without skin diseases

CHAPTER THREE

METHODOLOGY

RESEARCH DESIGN:

This non-experimental study uses the prospective quality of life survey and analysis.

LOCALE OF THE STUDY:

The setting of the study was at the Lucena Skin Center. A Dermatology Clinic manned by a Fellow of the Phil. Dermatological Society and a Fellow of the Phil. Leprosy Society. The clinic is situated in Lucena City.

RESPONDENT AND SAMPLING PROCEDURE:

Respondents were consecutive patients, age 15 and above, whether old or new, consulting for any skin diseases were included in the study. The patients companions whose ages were also 15 and above served as the control (those who do not have skin diseases) subjects. Both the inclusion and exclusion criteria for patient’s selection were adopted from the source. As in the original, the criteria for the selection of the controls were that they should not have seen their general practitioner over the previous “3 months”, they should have had no skin problem or other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.

RESEARCH INSTRUMENT:

We reviewed 3 different well validated dermatology-specific quality of life tools for possible translation. Both developed in the U.S, the Dermatology Specific Quality of Life (DS8QL) [12] had 52 items for acne and contact dermatitis cohorts while the revised SKINDEX [13] had 29 item tests for patients with any skin disease. The revised Skindex Categorized domain/scale into emotion, symptom, and functioning, and had 5 responses choices. Dermatology Life Quality Index [14] [15] [16] (DLQI), a tool developed in UK, was similar to Skindex in terms of generic coverage, domains, and responses choices but consisted only of 10 items which fit on a single sheet of paper, and was those chose for translation. Quality of Life research measures the effect of a disease and its treatment on a patient’s symptoms, feelings and daily activities over a specified time. The Dermatology Life Quality Index (DLQI) questionnaire is a non-skin disease specific Quality of Life tool developed by Dr. Finlay. It consist of 10 questions and can be analyzed under the following headings: Symptoms and feelings (items 1 and 2), daily activities (items 3 and 4), leisure (items 5 and 6), work and school (item 7), personal relationships (item 8 and 9), and treatment (item 10). It is calculated by summing the score of each question (scored from 0 to 3) resulting in a maximum of 30 for the 10 items and a minimum of 0. The higher the score, the more quality of life is impaired.

TRANSLATION:

The original questionnaire was sent to 4 independent bilingual (English and Filipino) translators and their output were later “translated-back” by a bilingual lay panel consisting of 2 persons. The first item refers to the Symptoms (itchiness, pain, discomforts) while the second item on “hiya”, which loosely translates in English as “embarrassments”. Item 3 evaluates the effect on shopping or household chores while item 4 in the way of dressing. The fifth item is on social and leisure and the sixth item on sports and exercise. Items 7, 8, 9 and 10 concerns on work, school, relationships, Sexual difficulty, and treatment respectively. The following modifications were noted: (1) the tool was renamed IKPAS (Indeks ng Kalidad ng Pamumuhay ng may sakit sa balat), (2) the general patient data was omitted on the questionnaire except age, sex, and diagnosis to save on space, (3) a confidentiality clause was inserted on the introductory statement and includes the aim of the study. (4) 2 Filipino words (“Gaano” and “Paano”) were used to encompass “How much” in the original, (5) and although the attempt was to do a literal translation without any loss of the concept, for item on household chores of house keeping, buying at the market (“Pamamalengke”) was included; for item on leisure activities, watching movie (“Panunuod ng Sine”) was given as an example; For the item on sports, the word “Ehersisyo” (Exercise) was incuded; “Sex” was used in the context of sexual difficulties in the original; and on the item relationship, “Asawa” (Spouse) was used for “Partner”. Response choices scales were structured similar to the original and used the same scoring system: “Sobra-sobra” (score=3), “Sobra” (score=2), “Medyo/Oo” (score=1), “Wala/Hindi” (score=0), “Walang kinalaman” (score=0), and no answer (score=0). A higher score (total=30) indicated a lower unfavorable quality of life.

DATA COLLECTION:

The researchers collected the data from Lucena Skin Centers Clinic. Both the inclusion and exclusion criteria for patient selection were adopted from the source. Consecutive patients, age 15 and above, whether old or new, consulting for any skin disease were included in the study. The patients’ companions whose ages were also 15 and above served as control subjects. The paramedical staffs were also recruited as control subjects. As in the original, the criteria for the selection of controls were that they should not have seen their general practitioner over the previous “3 months”, they should have had no skin problem on other systemic medical disease over this time; and, that they should have no apparent disability. Excluded in the study were those with intellectual impairment or a psychiatric disorder, and those who were illiterate or were unable to communicate in Filipino unless a reliable interpreter was present.

The time needed to complete the questionnaire ranged from 1 to 36 minutes with the mean at 5.23 minutes. However, it is significant to note that 205 respondents (78%) took less than 5 minutes and another 39 (15%) took between 5 and 10 minutes to answer the questionnaire. This leaves only 19 (7%) who took more than 10 minutes to answer the questionnaire.

DATA PROCESSING AND ANALYSIS

Consecutive patients who passed the entire inclusion and exclusion criterion were politely asked to answer the IKPAS (translated questionnaire) after giving their permission.

When all the data were at hand, we computed the reliability of our translated questionnaire using the ‘s alpha Coefficient and then we analyze our findings on the effect of the skin disease on the quality of life of patients with skin disease and compare the findings with those without skin diseases. There was a significant difference between scores of the patients (6.89, SD: 4.55) and controls (0.89, SD: 1.8) (p=0.000), demonstrating construct validity.

RELIABILITY TEST TOOL:

When analyzing the reliability of your instrument, the best is to retest the subjects using the same instrument to see if the subjects are consistent with their answer. But researchers have devised a formula to compute the reliability of a survey instrument. The reliability test is called ‘s alpha coefficient. Its formula is:

= n1 + n2 = N (total number of patients)

= Pearson Correlation

Pearson Correlation formula:

= Total score of male

= Total score of female

= square root

SS = Sum of the squares

Other methods of analysis included simple mean, standard deviation, variance, simple percentage

Statistical Method: Variance formula:

/n-1

x = score

= mean (total score/ no. of patients)

n = no. of patients

Simple Mean:

= refers to the sum of the values

= is the number of items

Standard Deviation:

= is the score of each item

= is the computed mean

= is the number of items

Simple Percentage:

= number of respondents

= total number of respondents

Validity test total:

To test for validity of the instrument that we uses, we compared the score of patients with that of the healthy controls and test for its validity using Mann Whitney U-test . Its formula is:

= total number of males

= total number of females

= total rank of males

Kruskal Wallis Test formula:

= is the number of observation in group g

= is the rank (among all observations) of observation j from group i

= is the total number of observation across all groups

= is the average of all the equal no (+ 1) /2

CHAPTER FOUR

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

A total of 263 patients with skin disease and 47 subjects without skin disease participated in the study. The respondents were patients and companions of patients including the paramedical staff of the Lucena Skin Center Clinic.

DEMOGRAPHIC PROFILE

For the demographic 142 patients (54%) were female and 121 (46%) were male. The respondents were aged from 15 to 78 years. 237 (90%) were aged less than 65 whereas 26 (10%) fell into the geriatric aged group 65-78 y/o (Figure 1a). In the control subset, 38 (81%) were female and 9 (19%) were male.

The results are summarized in Table 1 below.

Table 1a. Diagnosis, age and sex distribution of the patients along with the healthy controls

Diagnosis

No. of Patients

Male: Female Ratio

Mean age (years)

Atopic dermatitis

0/9

33.2

Acne

12/29

24.9

Contact dermatitis

10/37

43.5

Erythroderma

6/0

62.6

Leprosy

26/14

34.2

Keloids

14/11

33.8

Lichen Simplex Chronicus

9/12

48.4

Psoriasis

13/7

43.5

Tineas

24/18

39.2

Viral warts

7/5

36.1

Controls

9/38

35.5

Table 1b. Distribution of disease with their mean score and range

Diagnosis

Mean score

Range

Atopic dermatitis

11.5

3-30

Acne

5.0

0-13

Contact dermatitis

9.4

1-25

Erythroderma

11.1

2-25

Leprosy

7.1

0-20

Keloids

5.0

0-15

Lichen Simplex Chronicus

9.4

0-23

Psoriasis

7.3

1-22

Tineas

8.3

0-25

Viral warts

4.5

0-24

Controls

0.9

0-9

247 patients (94%) completed all ten items. The distribution of unanswered items is shown in (Figure 1b). We will note that 11 (4%) failed to answer item no. 9, which deals with sexual activity.

Shown below is a comparison of the scores of patients and controls for all the ten items (Figure 2).

Demographic profile

Although the mean score of both the 15-64 age group and the 65-78 age group compared to the controls shows that their quality of life were impaired. The difference of the mean score between 15-64 y/o group (mean score= 7.5) and 65-78 y/o group (mean score= 8.07) were not statistically significant (Figure 3). The lack of statistically significant difference could be due to a small sample size of the geriatric group (65-78 y/o) which only has 26 subjects. Many of the would be geriatric respondents were excluded because they were either illiterate or visually impaired.

The difference of the mean score between male (mean score= 7.4) and female (mean score= 26.19) were statistically significant (Figure4).

Females have a higher mean score (26.19) meaning that their quality of life were most affected due to the fact that female are more sensitive to their perception and reaction to everyday activities and daily living.

The subjects and their diseases with the highest (i.e most severely affected quality of life) to the lowest score, the mean score and ranges for each disease, are shown below (Table 2).

Table 2. Highest score, Mean score and range

Diagnosis

Highest Score

Mean Score

Range

Atopic dermatitis

11.5

3-30

Acne

5.0

0-13

Contact dermatitis

9.4

1-25

Erythroderma

11.1

2-25

Leprosy

7.1

0-20

Keloids

5.0

0-15

Lichen Simplex Chronicus

9.4

0-23

Psoriasis

7.3

1-22

Tineas

8.3

0-25

Viral warts

4.5

0-24

Controls

0.9

0-9

The mean scores of subjects with different disease are compared and the results are shown in Figure 5. Using the post-hoc pair wise comparison based on the Kruskal-Wallis Test, there was a significant difference between scores of patients with acne and those with Atopic dermatitis. The scores, however, of subjects with viral warts were significantly less than those of the other diseases except for acne.

Controls

Patients

Mean Total Score

0.89

7.86

Standard deviation

1.8

4.55

Median

Range

0-9

0-30

263

Our objective in this study was to determine the effect of the various skin conditions on the quality of life of the patients 15 year old and above at the local setting. Hence, we search the literature for a quality of life instrument which was dermatology-specific and which was brief enough to be used in a busy out-patient clinic setting without causing too much inconvenience to either the patients or the doctor. The Dermatology Life Quality Index is dermatology specific but not disease specific quality of life questionnaire. It has been validated in a variety of dermatologic setting, and has been translated into several languages. More over, it is composed of only 10 items. All of these features made it ideal for our purpose.

The general guidelines for translating an existing questionnaire were followed (cite language and translation issues). The Dermatology Life Quality Index was given to 4 independent bilingual translators and these were unified into a primary questionnaire by one of the investigators (Ms. ). This was then back-translated by two. Simultaneously, the questionnaire was also shown to the dermatologist of the setting (Lucena Skin Center) and the translations and comments were integrated in the production of the final form of the questionnaire, the IKPAS.

Since our starting point was a previous validated Quality of Life questionnaire, we did not need to go through the entire process of identifying items and domains. Our primary goal in the translation was to achieve conceptual equivalence with the original questionnaire, and to modify it only to make it more culture specific. This way, the psychometric properties of the DLQI (i.e Validity and Reliability) would also apply to the translation.

Nevertheless, we also validated the questionnaire in the local setting. To test for construct validity, the scores of the patients were compared to those of the healthy controls. There was a significant difference between the total score of control and patients, using the Mann Whitney U Test (p value= 0.000) indicating that the questionnaire is valid in terms of identifying those with and without skin disorder.

Ideally, the scores of the controls should have been uniformly zero. However 2 of those 47 controls had scores >=1. One had even a score of 9. We can think of two possible explanations. First, since we chose as our controls the companions of patients, it is possible that some of them mistakenly answered the questionnaire by attempting to put themselves in the point of view of the patients they were accompanying. Secondarily, those respondents may have had an unrecognized skin disorder, meaning that they were not true controls.

For reliability testing ‘s alpha Coefficient was calculated for all of the items. The alpha coefficient was found to be 0.71 indicating internal consistency (acceptable=>0.7) we opted not to check for test-retest reliability, since it would have been technically difficult to call the patients back to the clinic simply to answer the questionnaire a second time. Moreover, since all patients were given treatment for their skin condition, any change in the test-retest scores would indicate a response to treatment rather than a lack of reliability. 11 patients (4%) did not give any answer to item no. 9 (which pertains to sexual relations) indicates that some of those in study population may have found the question too personal.

There was a wide range in the time it took to administer the questionnaire (1-36mins). This may have been because of variations in the educational background of the respondents. With regards to the quality of life scores, we compared the mean total scores for the 10 skin conditions, namely psoriasis, acne, contact dermatitis, atopic dermatitis, hansen’s disease, viral warts, erythroderma, keloids, lichen simplex chronicus and tineas. The mean scores were highest for those with atopic dermatitis followed by erythroderma, contact dermatitis and lichen simplex chronicus, then tineas, in that order. As expected, those with viral warts had the lowest mean quality of life scores. Difference in the quality of life scores reflect difference in disease severity as well as difference in the way individuals react to and cope with their skin conditions. Inflammatory skin diseases like atopic dermatitis, contact dermatitis, erythroderma, lichen simplex chronicus are more pruritic and extensive or mostly affect the expose parts of the body so that the patients with those skin disease have their quality of life most impaired.

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION

SUMMARY OF FINDINGS

The study was conducted among 263 respondent’s patient and 47 controls (no skin disease) in Lucena Skin Center Clinic, Lucena City.

The diagnosis for the disease that were treated and included in the study were the following; Atopic dermatitis, contact dermatitis, acne, erythroderma, leprosy, keloids, lichen simplex chronicus, psoriasis, tineas, viral warts.

The first null hypothesis was: “There is no difference in the Quality of Life of patients with skin disease when respondents were group according to their demographic profiles”.

The researchers reject the first null hypothesis.

The second hypothesis is: “There is no difference in the level of the quality of life of patients with skin disease and those without skin disease”

The studies second null hypothesis was also rejected by the researchers.

CONCLUSION

The findings of the study have allowed the researchers to make the following conclusions:

1. That IKPAS, the translated Dermatology Life Quality Index was found to be reliable and valid in the local setting.

2. That there is impairment of the quality of life of patients with skin diseases.

3. That the impairment of quality of life is higher in inflammatory skin disease.

4. That there is difference in the quality of life of patients with skin disease when respondents are group according to their demographic profile.

RECOMMENDATION

Based on the findings and conclusions of this study, the researcher submits the following recommendations:

1. Nurses must not only attend to the skin lesion of patients with skin disease but also to their emotional and psychological problem brought about by their skin diseases.

2. The researchers recommend IKPAS to those in the future will conduct similar studies.

IMPLICATION OF THE STUDY

This study shows that quality of life in patients with skin diseases were impaired. These findings will help nurses to formulate nursing care plan addressing the emotional and psychological problem of patients with skin disease to improve patient care quality.

Appendix A: Index ng Kalidad ng Pamumuhay ng may Sakit sa Balat (IKPAS)

IKPAS Iskor:___

Taong Gulang:___ Kaurian: Babae___/Lalake___ Sakit sa Balat:__________

Layunin ng pagtatanong na ito na masukat ang epekto ng sakit sa balat sa iyong pamumuhay sa NAKARAANG LINGGO. Paki-tsek √ ang isang sagot sa bawat tanong. Anumang impormasyong nakalathala rito ay mananatiling lihim at ang iyong duktor lamang ang nakakaalam.

1. Sa nakaraang linggo, gaano kakati, kahapdi o kasakit ang iyong balat?

Sobra-sobra___ Sobra___ Medyo___ Wala___

2. Sa nakaraang linggo, nahihiya ka ba dahil sa iyong balat?

Sobra-sobra___ Sobra___ Medyo___ Wala___

3. Sa nakaraang linggo, gaanong abala ito sa iyong pag-shopping o pamamalengke o gawaing bahay?