How to cite this article: Carranza-Lira S. Effect of weight in scales to determine the quality of life in postmenopause. Rev Med Inst Mex Seguro Soc. 2015 Jan-Feb;53(1):40-3.
Received: March 28th 2014
Accepted: July 18th 2014
aJefatura de la División de Educación en Salud, Hospital de Ginecología y Obstetricia “Luis Castelazo Ayala”, Instituto Mexicano del Seguro Social, Distrito Federal, México.
Communication with: Sebastián Carranza-Lira
Telephone and fax: (55) 5528 4657
Background: Several scales are available to measure quality of life (QoL) in climacteric women (Cervantes scale [CS], Kupperman Index [KI] and SUMEVA scale). The aim is to determine the correlation between modified KI (mKI), KI and SUMEVA scale, as well as its behavior according to corporal weight.
Methods: 29 postmenopausal women were studied. To all of them the modified KI, the QoLCS and the SUMEVA scales were applied. Afterwards the group was divided according to body mass index (BMI). Group 1, BMI ≤ 27 and Group 2 BMI > 27. For the comparison between the groups Student’s t test for independent samples was used. Pearson’s correlation analysis was applied in the whole group in each separated group divided according to BMI.
Results: 29 patients aged 49.9 ± 6.2 years were studied. The score obtained with the different scales was: for the mKI: 24.5 ± 11.7, SUMEVA: 65.0 ± 48.4, and QoLCS: 67.2 ± 30.6. There was a correlation between mKI and QoLCS (0.681, p < 0.001), between mKI and SUMEVA (0.860, p < 0.001) and between SUMEVA and QoLCS (0.770, p < 0.001).
Conclusion: SUMEVA scale is a confident scale to evaluate QoL in postmenopausal women.
Keywords: Cervantes scale; Kupperman index; SUMEVA; Quality of life; Postmenopause
During menopause the quality of life is affected, due, among other things, to changes in various areas, including the presence of mainly vasomotor symptoms, impairment of health, aging, anxiety, depression, changes to sexuality, psychosocial concerns, and obesity.1,2
Quality of life, assessed by the Menopause-Specific Quality of Life (MENQOL), which evaluates vasomotor, psychosocial, physical, and sexual symptoms, has shown that the highest scores in the areas of vasomotor, psychosocial, and physical symptoms are in uneducated individuals, and vasomotor symptoms are higher in home-makers.3
The Menopause Rating Scale (MRS) has shown a high correlation with others such as the SF-36 and in particular with those items related to menopausal transition.4
Other scales have been designed to try to measure the degree of impact on quality of life in menopausal individuals, including the Cervantes Scale (CS) and the Kupperman Index (KI). CS comprises two elements: quality of life and personality. The quality of life CS assesses 31 items in four domains or subscales (menopause and health, psychological domain, sexuality, and relationship with partner).5
The modified KI evaluates 13 items, including the urogenital area and sexuality, and all can be weighted.6 While this scale was initially designed to evaluate symptoms, it has been shown to be highly correlated with the MRS (0.74);7,8 however, the former is more sensitive in detecting mild menopausal symptoms.
Years ago a scale called SUMEVA was designed based on the sum of distinct symptoms self-assessed by the patient on a visual analog scale. This scale has been used in the Mexican population and has a significant correlation with the KI and the Greene index.9
The aim of this study was to determine the degree of correlation among SUMEVA scale and quality of life CS and KI unweighted to determine their usefulness to assess quality of life as well as their behavior based on body weight.
Twenty-nine postmenopausal women were studied at the Endocrine Gynecology outpatient clinic of the Unidad Médica de Alta Especialidad, Hospital de Gineco Obstetricia “Luis Castelazo Ayala”. These patients had not received nor were receiving hormone therapy. In all participants, age, weight, and height were documented, and body mass index (BMI) calculated. All were given the three scales, two of which were already used to assess symptoms and quality of life, which were the modified KI and quality of life CS. They also received the SUMEVA scale, which has been used to assess menopausal symptoms and which is easy to apply.
The modified KI is a scale that evaluates 13 items, and with which patients were asked to qualify the magnitude of each symptom from 0-3, where 0 is the absence of symptoms and the grades 1-3 indicate symptom magnitude from low to high. Each of the items can be weighted to obtain the final KI value.
The CS consists of two scales, quality of life CS and personality CS. The first consists of 31 items and four domains or subscales, namely: menopause and health, which is divided into three subdomains, vasomotor symptoms (3 items) health (5 items) and aging (7 items); the psychological domain, which measures the impact of anxiety and depression on quality of life (9 items); the sexuality domain, which measures the degree of satisfaction and interest, and changes in the frequency of sexual relations (4 items); and the relationship domain, which measures the role of the patient in their relationship with their partner (3 items). The personality CS was not applied. Software designed for the purpose was used for calculation.10
The SUMEVA scale is a scale that analyzes 22 symptoms, which are self-assessed by the patient using a visual analog scale of 10 cm where 0 is the absence of the symptom and 10 is the maximum intensity of the symptom.10
For the sample size calculation MedCalc, version 220.127.116.11 was used. An alpha error of 0.05, a beta error of 0.10 and a correlation coefficient of 0.6 were considered, resulting in 25 patients.
Pearson correlation test was performed between the different scales. Then they were divided according to BMI into two groups: Group 1, BMI ≤ 27 and Group 2, BMI > 27. The comparison was made between groups with Student's t test for independent samples, and Pearson correlation analysis was done for the total and for each group separately.
Twenty-nine patients were studied, age was 49.9 ± 6.2 years, weight 70.1 ± 14.0, height 1.6 ± 0.07, and BMI 28.2 ± 5.5. Modified KI unweighted score was 24.5 ± 11.7, SUMEVA score was 65.0 ± 48.4, and quality of life CS score was 67.2 ± 30.6.
The correlation between modified KI and quality of life CS was 0.681 (p < 0.001), between modified KI and SUMEVA was 0.860 (p < 0.001), and between the SUMEVA and quality of life CS was 0.770 (p < 0.001).
Upon comparison after dividing based on BMI, no difference was found in age, modified KI score, quality of life CS, or SUMEVA (Table I).
|Table I General data of the two patient groups by BMI|
|≤ 27||> 27||p|
|Age (years)||51.2 ± 5.6||48.7 ± 6.7||NS|
|Weight (kg)||59.0 ± 7.3||79.1 ± 11.5||0.001|
|Height (m)||1.6 ± 0.07||1.6 ± 0.06||NS|
|BMI||23.6 ± 2.4||31.9 ± 4.3||0.001|
|Modified KI||24.6 ± 13.1||24.6 ± 10.8||NS|
|SUMEVA||73.1 ± 55.7||58.3 42.4 ±||NS|
|Quality of life CS||67.6 ± 30.2||66.9 32.0 ±||NS|
|BMI = body mass index;KI = Kupperman Index;CS = Cervantes Scale|
Once the group was divided by BMI, the correlation analysis found that there were statistically significant differences between modified KI and quality of life CS, between KI and SUMEVA, and between SUMEVA and quality of life CS (Table II).
|Table II Analysis of correlation between groups by BMI|
|≤ 27||p||> 27||p|
|Modified KI and Quality of life CS||0.779||0.002||0.600||0.014|
|Modified KI and SUMEVA||0.906||0.000||0.823||0.000|
|SUMEVA and Quality of life CS||0.810||0.001||0.766||0.001|
|BMI = body mass index;KI = Kupperman Index;CS = Cervantes Scale|
The quality of life changes in postmenopause.1,2 There are different scales designed for this purpose such as KI and quality of life CS.5,7 The SUMEVA scale, which was initially designed to evaluate symptoms, was used to assess quality of life in this study.
The correlation analysis found that correlation was high among the modified KI, the quality of life CS, and SUMEVA, confirming the usefulness of the SUMEVA scale for assessing quality of life, as well as symptoms.
In terms of ease of application, the SUMEVA scale also has this advantage when compared, for example, with CS.
When comparing the results of different scales, once the group was divided according to BMI, no difference was found between them. However, the score in the SUMEVA scale was greater in the group with BMI ≤ 27. The lack of significance is probably due to sample size, calling for another study with a larger number of patients to confirm or deny this observation.
In conclusion, one can say that the SUMEVA scale is useful for evaluating the quality of life regardless of body weight.
Conflict of interest statement: The authors have completed and submitted the form translated into Spanish for the declaration of potential conflicts of interest of the International Committee of Medical Journal Editors, and none were reported in relation to this article.