QUESTIONNAIRE  FOR THE PATIENTS

The Catquest questionnaire.

The Catquest has been developed within the Swedish National Cataract Register.
In Catquest questionnaire the questions have been picked out through a pre-study in cataract patients using 37 questions about daily life activities. The questions chosen for the questionnaire were the most decisive questions, concerning activities frequently performed, weighted high by the patients, and affected by a cataract extraction1. One question in Catquest concerns a free activity named by the patient as a preferred hobby or leisure activity.
Included in the Catquest questionnaire are also questions concerning activity level, cataract symptoms and independence. This means that the questionnaire evaluates changes not only in perceived visual disabilities but also in activity level including car driving and employment and perceived problems from cataract symptoms. The Catquest questionnaire has been shown to have a good validity and a high reliability2.
The evaluation is done by use of a decision tree. Briefly the idea is that the more areas that have improved, the higher benefit level is achieved. No benefit means deterioration in perceived disabilities and questionable benefit means status quo.
The magnitude of change does not matter and for activity level maintenance of a certain activity level after surgery is also counted as a positive event. The reason for this is that the method is supposed not to give highest credit for surgery in a late stage of the disease but also promote early surgery care.
In Catquest a certain score sum before surgery is compared to a certain score sum after surgery in each area of evaluation and individually for each patient3. A lower score sum means an improvement. In Catquest only non-parametric statistics is used. This is opposite to other questionnaires were mean values of ranking scores are multiplied to achieve index values which are compared.

The Catquest questionnaire is self-instructing and meant as a postal questionnaire or questionnaire to be filled out by the patient alone. There is no need for an interview by a medical staff person. This simplifies the procedure but gives of course a loss as it is used on a voluntary basis.
The Catquest has been used in the Swedish Cataract Outcome Study for eleven years and 21.364 completed questionnaires are in the database (Table 1).
The Catquest questionnaire is available in Danish, Czechish, English, German, Italian, Norwegian, Portuguese, and Swedish languages.


References, Catquest.

1. Lundström M, Fregell G, Sjöblom A. Vision related daily life problems in patients waiting for a cataract extraction. Br J Ophthalmol. 1994;78:608-611.

2. Lundström M, Roos P, Jensen S, Fregell G. Catquest questionnaire for use in cataract surgery care: Description, validity and reliability. J Cataract Refract Surg 1997;23:1226-1236.

3. Lundström M, Stenevi U, Thorburn W, Roos P. Catquest questionnaire for use in cataract surgery care: Assessment of surgical outcomes. J Cataract Refract Surg 1998;24:968-974.

4. Lundström M, Stenevi U, Thorburn W. Outcome of cataract surgery considering the pre-operative situation. – A study of possible predictors of the functional outcome. Brit J Ophthalmol. 1999;83:1272-1276.

5. Lundström M, Brege KG, Florén I, Stenevi U, Thorburn W. Impaired visual function following cataract surgery assessed using the Catquest questionnaire. J Cataract Refractive Surg. 2000;26:101-108.

6. Lundström M, Stenevi U, Thorburn W. Cataract surgery in the very elderly. J Cataract Refractive Surg. 2000;26:408-414.

7. Lundström M, Stenevi U, Thorburn W. Quality of life aspects of first and second eye cataract surgery. An analysis of five years data collected by the Swedish National Cataract Register. J Cataract & Refract Surg. 2001;27:1553-1559

 8. Lundström M, Stenevi U, Thorburn W. The Swedish National Cataract Register – A nine-year review. Acta Ophthalmol Scand. 2002;80:248-257.

9. Kobelt G, Lundström M, Stenevi U. Cost-effectiveness of cataract surgery: Method to assess cost-effectiveness using registry data. J Cataract & Refract Surg 2002; 28:1742-1749.

10. Lundström M, Brege KG, Florén I, Lundh B, Stenevi U, Thorburn W. Cataract surgery and quality of life in patients with age-related macular degeneration (AMD). Brit J Ophthalmol 2002;86:1330-1355.

11. Lundström M & Wendel E. Duration of self-assessed benefit of cataract extraction – a long-term study. Br J Ophthalmol 2005;89:1017-1020.

12. Lundström M, Albrecht S, Nilsson M, Åström B. Patients benefit from bilateral same-day cataract extraction – a randomised clinical study. J Cataract Refract Surg. 2006; 32:826-830.

 
Table 1.
Average benefit of cataract surgery care in different groups of Swedish patients
as defined by the Catquest questionnaire.

Date:		 2006-11-20
No of patients in the database: 21.364

Meaning of benefit levels:
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
     

Improvement

  
Status quo  

Worse
All patients: N = 21.364
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
42.3% 5.8% 36.1% 7.3% 8.5%

 
First eye surgery: N = 13.389
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
40.1% 5.4% 38.9% 6.5% 9.1%

 
Second eye surgery: N = 7.969
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
46.0% 6.5% 31.5% 8.6% 7.4%

 
No ocular co-morbidity: N = 14.205
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
45.3% 5.5% 35.9% 6.7% 6.6%

 
Ocular co-morbidity: N = 7.158
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
36.2% 6.4% 36.6% 8.5% 12.3%

 
Age group - 64: N = 2.508
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
57.6% 2.9% 28.9% 4.9% 5.7%

 

Age group 65 - 84: N = 15.465
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
42.2% 5.8% 36.6% 7.3% 8.0%

 

Age group 85 + : N = 3.391
Very good benefit Good benefit Moderate benefit Questionable benefit No benefit
31.2% 8.0% 39.2% 9.1% 12.5%

   

Proportion of inportant case-mix variables in the database:
Second eye surgery: 37.3% Age group - 64 11.7%
Ocular co-morbidity: 33.5% Age group 65-84: 72.4%
    Age group 85+: 15.9%
 
Last uppdate 2006-11-21