Questionnaire and tools: clinical powerful instrument in acromegaly diagnosis and management

Acromegaly Quality of Life Questionnaire (AcroQoL)

Patient quality of life (QoL) can be assessed using many different indices. One of the most commonly used is the AcroQoL questionnaire, developed specifically to assess HRQoL (Health-Related QoL) in acromegalic patients by Webb et al. and first validated in 2002 [8].

Originally developed in Spanish and later translated into English, AcroQoL is currently available in 12 languages: Spanish, English, German, Dutch, French, Italian, Greek, Portuguese, Turkish, Swedish, Hungarian, and Polish. Studies using different languages AcroQoL are shown in Table 1. AcroQoL is now considered an excellent tool that clinicians can combine with the outpatient visit to improve patient follow-up [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55].

Table 1 Studies using AcroQOL in different states: year of publication, number of enrolled patients and number of studies

The questionnaire is designed to be easily used in outpatient clinical practice. It is simple, self-reported, and short, taking an average of 7 min to complete. It consists of 22 items, presented in Fig. 1, which the patient must complete by ticking the answer, among those listed, that best describes the frequency of the event or the degree of agreement with the statement expressed by the item [3]. It uses a Likert scale from 0 to 5. The 22 items survey different aspects of the patient's life: 8 items explore the physical aspect, 14 the psychological aspects, 7 items physical appearance, and 7 items are used to determine the personal relationships (Fig. 1). The highest achievable score is 110 (100%) and corresponds to an optimal QoL, while the lowest score is 22 (0%) [3, 8, 16].

Fig. 1figure 1

AcroQoL items and subscales

In the literature, AcroQoL is one of the most frequently used disease-specific questionnaires, especially when assessing changes in QoL after therapy and/or correlation with normalization of laboratory parameters. As mentioned above, some studies show significant improvement in quality of life in patients assessed before and after initiation of treatment, or higher AcroQoL scores in well-controlled patients compared with those with active disease [3, 4]. Current studies agree on the presence of a decrease in quality of life in acromegaly patients compared to the general population and on the possibility of improvement after therapy. At the same time, other studies also point to the possibility that normalization of quality of life is never achieved, even with optimal biochemical control. In this context, studies such as the one by Paisley et al. from 2007 [22] should be mentioned, but also some more recent ones, such as that of Broersen et al. from 2021 [4], that of Wolters et al. from 2020 [15], or that of Guo et al. from 2021 [9]. All these studies showed the importance of the evaluation of quality of life in acromegaly patients, highlighting numerous factors, such as medical treatments, surgery, radiotherapy, comorbidities, symptoms, and gender as quality of life determinants. Table 2 shows the main QoL determinants in acromegaly patients [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. In particular, in the recent meta-analysis by Broersen et al. [4], the authors found an improvement of HRQoL after acromegaly treatment, but they suggested that the type, frequency, and severity of symptoms and lifestyle factors needed to be considered when evaluating quality of life. The AcroQoL is also often used to validate other questionnaires on well-being and quality of life used in the general population and acromegaly-specific tools, such as the acromegaly treatment satisfaction questionnaire (Acro-TSQ) [14] and SAGIT® [5]. It was also used in comparison with EuroQoL instrument (EQ-5D-5L), Short Form-12 (SF12), Short Form-36 (SF36), EQ-5D-3L and sociodemographic questionnaire to determine a grade of comparison between different tools [5, 9, 14, 16, 17, 20]. Despite the increasing use of the AcroQoL and its recognition as a useful clinical tool, the investigation of the relationship between biochemical disease control and quality of life is still considered a controversial topic, because of the inconclusive consistency of evidence across different studies [56,

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