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PubMed1992

Left ventricular aneurysmectomy in patients with poor left ventricular function.

Physical performance and left ventricular (LV) function in the resting state were assessed in 22 patients with postinfarction anterior-apical left ventricular aneurysm (LVA) and global ejection fraction less than or equal to 20% who subsequently underwent radical LVA resection. The basic findings in the 20 survivors of surgery were significant improvement of global systolic LV function and more or less complete recovery of regional ejection fraction in the predominantly viable low and high lateral LV wall. This improvement was evident in patients with concomitant bypass grafting as well as in those with isolated and ungraftable lesions of the left anterior descending (LAD) coronary artery. We conclude that postinfarction anterior-apical LVA in a poorly functioning LV is suitable for surgical treatment, which can be accomplished with acceptable risk. All graftable stenotic major coronary arteries should be bypassed, in addition to the LVA resection, but a minority of patients with isolated, ungraftable LAD disease are likely to benefit from aneurysmectomy alone.

Adult↗

PubMed2003

Evidence-based measurement in multiple sclerosis: the psychometric properties of the physical and psychological dimensions of three quality of life rating scales.

The selection of measures of quality of life used in clinical trials of multiple sclerosis (MS) should be evidence-based. Head-to-head comparison of measures facilitates the selection of measures. The aim of the study was to compare the psychometric properties of the physical and psychological dimensions in three measures of quality of life to aid choice of the most appropriate scale for use in clinical trials of MS. One hundred and twenty-one people with MS (rehabilitation = 57; steroids = 64) completed a selection of health measures before and after treatment. The psychometric properties of three measures of physical function (MSIS-29 physical, SF-36 physical functioning, FAMS mobility) and three measures of psychological function (MSIS-29 psychological, SF-36 mental health, FAMS emotional well-being) were compared by examining data quality, scaling assumptions, acceptability, reliability, validity and responsiveness. Physical (0.63-0.71) and psychological (0.70-0.75) scales were substantially correlated indicating they measure related constructs. The MSIS-29 physical and psychological scales satisfied all criteria for internal consistency reliability (physical = 0.91; psychological = 0.89) and validity. The SF-36 physical scale had a notable floor effect (20%). The FAMS mobility scale had lower reliability (alpha = 0.78) compared to other measures. The MSIS-29 physical (effect size = 0.91) and psychological (effect size = 0.62) scales were the most responsive. In these three samples, the MSIS-29 had better measurement properties for combined physical and psychological health than the SF-36 and the FAMS.

Adult↗

PubMed2002

The impact of pain and symptoms of depression in scleroderma.

Systemic sclerosis (scleroderma) is a rare connective tissue disease that can affect multiple organ systems. Case reports and small treatment studies suggest that pain is significant in scleroderma, but few data speak of the frequency or impact of pain. This study sought to determine the frequency and impact of pain, symptoms of depression, and social network characteristics on physical functioning and social adjustment in patients with scleroderma. One hundred and forty-two scleroderma patients completed measures of pain, depressive symptoms, social network characteristics, physical functioning, and social adjustment. Sixty-three percent reported at least mild pain and 50% reported at least mild levels of depressive symptomatology. Hierarchical regression analyses revealed that pain, depressive symptoms, and employment status (disabled/unemployed vs. not) were significant, independent predictors of physical functioning, together accounting for 37% of the total variance. Pain was the single strongest predictor of physical function, accounting for 20% of the variance. Depressive symptoms, physical functioning, diversity of social network, and employment status were significant independent predictors of social adjustment, together accounting for 63% of the variance. Depressive symptoms were the single strongest predictor of social adjustment, accounting for 26% of the variance. The effects of pain and physical function on social adjustment became non-significant when depressive symptoms were entered into the model, suggesting that symptoms of depression mediate the effect of pain and physical function on social adjustment. These findings indicate that pain is common in scleroderma and that pain and depressive symptoms are significant determinants of physical functioning and social adjustment, two important components of health-related quality of life. Increased attention to effective management of pain and symptoms of depression in scleroderma will likely lead to improved functioning and quality of life.

Adult↗

PubMed2003

Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis.

Disability status, depression and anxiety are important determinants of quality of life (QoL) in patients with multiple sclerosis (MS). We investigated whether anxiety and depression influence the relation between disability status and QoL in our cohort of recently diagnosed patients. Disability status [Expanded Disability Status Scale (EDSS)], anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], and QoL (SF-36) were prospectively obtained in 101 MS patients. The relation between EDSS and SF-36 scales was examined using regression analyses, without and with adjustment for anxiety and depression. Interaction effects were investigated by comparing the relation between EDSS and QoL in patients with high and low anxiety and depression. In the unadjusted analyses, EDSS was significantly related to all SF-36 physical and mental health scales. After adjustment for anxiety and depression, EDSS was significantly related only to the SF-36 physical functioning, role-physical functioning and bodily pain scales. The relation between EDSS and these SF-36 scales was consistently higher in patients with more symptoms of anxiety or depression, suggesting that anxiety and depression strengthened the association of EDSS in these SF-36 physical health scales. After adjustment for anxiety and depression, EDSS was not significantly related to the SF-36 mental health scales and the general health scale. This finding is compatible with the hypothesis that anxiety and depression are intermediate factors in the association of EDSS with these SF-36 scales. Screening for symptoms of anxiety and depression is recommended in studies that use QoL as an outcome measure of treatment or intervention efficacy.

Activities of Daily Living↗

PubMed2002

Determinants of disability in older coronary patients.

BACKGROUND: Patient-reported physical function is a major component of disability determinations and an important contributor to health-related quality of life. Prior studies of coronary disability have shown a surprisingly poor correlation between real-life activity profile and exercise capacity measured on the treadmill. The goal of the current investigation was to evaluate the relative importance of medical factors, sex, fitness-related measures, and psychologic factors as determinants of patient-reported physical function score in older persons with established coronary heart disease (CHD). METHODS: Determinants of disability were studied in 51 community-dwelling patients >65 years old (71 +/- 5 years, range 65-83 years) with established chronic CHD. Patient-reported physical function score (scaled 0-100) was measured by the Medical Outcomes Study Short Form physical function section. Independent variables included clinical and demographic data, treadmill testing, rest and exercise echocardiography, measures of body composition, strength, aerobic fitness, and a depression score. RESULTS: Patients with a diagnosis of myocardial infarction had a lower physical function score than did patients with other CHD diagnoses (68 +/- 19 vs 82 +/- 22, P <.05). Univariate predictors of patient-reported physical function score included peak aerobic capacity (R = 0.62), treadmill test duration (R = 0.61), depression score (R = -0.60), handgrip strength (R = 0.42), and comorbidity score (R = -0.39). Peak aerobic capacity (R2 = 0.38) and depression score (cumulative R2 = 0.60) were the best independent predictors of physical function. Women had lower physical function scores than men (64 +/- 22 vs 78 +/- 20, P <.05) despite a similar age, diagnostic distribution, depression score, and comorbidity score. Resting left ventricular ejection fraction was not a predictor of physical function score. CONCLUSIONS: Peak aerobic capacity and depression score were the best independent predictors of patient-reported physical function score in older coronary patients. These data focus on the potential for exercise training and treatment of mental depression to prevent and treat coronary disability in older coronary patients.

Absorptiometry, Photon↗

PubMed1996

[Assessment of biological age and indices of aging].

People age at different rates. Accurate assessment of aging is indispensable for research in gerontology and geriatrics. Biological age can be estimated from age-related changes in physiological and physical functions. Disease, physical activity, and life-style have been shown to affect aging. Biological age was estimated by multiple regression. We studied how external appearances, diet, job status, smoking and alcohol consumption were related to aging. The subjects were 2,385 people of both sexes whose ranged from 15 to 87 years. Aging estimated by external appearance strongly correlated with changes in physiological functions and in physical strength. Diet was also found to be significantly related to aging. Biological age was significantly lower than calendar age in subjects with managerial jobs in non-smokers, and in those who drank a moderate amount of alcohol. These results show that biological age can be useful in aging research.

Adolescent↗

PubMed2003

[Impact or physiological factors on some dimensions of health-related quality of life of elder men].

The article presents a fragment of the study exploring relations between various factors and health-related quality of life (HRQOL) of elder men. The aim of this article is to describe predictive influence of physiological variables (arterial blood pressure, body mass index (BMI), forced expiratory volume in 1 second (FEV(1))) on several dimensions of HRQOL assessed by "Rand-36 Health Survey" questionnaire. MATERIAL AND METHODS. The study enroled 575 male outpatients aged 59-78 from seven small towns of Lithuania. The study population was based on the original sample, formerly explored by the staff of the Department of Propedeutics to Internal Medicine, Kaunas University of Medicine. Measures of BMI, FEV(1) and blood pressure came from the baseline investigation carried out in 1983. HRQOL was assessed by means of standardized generic questionnaire. The predictive influence of physiological factors on current scores of HRQOL dimensions was determined by logistic regression analysis, controlling for the influence of sociodemographic, lifestyle and other factors. RESULTS. Physiological factors predicted scores of physical functioning, general health perceptions and emotional wellbeing. Systolic blood pressure >129 mmHg was associated with increased odds of relatively poor emotional status (OR=1.79, p=0.047). Diastolic blood pressure >80 mmHg was associated with a twofold increase in odds of poor physical functioning (OR=2.34, p=0.0013). Body mass index >34.9 kg/m(2) predicted poor physical functioning and worse general health perceptions in older age (OR=1.97, p=0.027 and OR=2.38, p=0.009, respectively). Measures of FEV(1) were associated with scores of physical functioning. 10% increase in FEV(1) was associated with reduction in odds of poor physical functioning by 52% (OR=0.48, p=0.045). CONCLUSIONS. BMI>34.9 kg/m(2) among men in adult age was related to poor physical functioning and worse perceptions of health in older age. Systolic blood pressure >129 mmHg and diastolic blood pressure >80 mmHg were predictive of worse emotional wellbeing and physical functioning, respectively. Higher measures of FEV(1) were associated with better physical functioning in later years.

Age Factors↗

PubMed2002

Elderly people with hypothalamic-pituitary disease and untreated GH deficiency: clinical outcome, body composition, lipid profiles and quality of life after 2 years compared to controls.

OBJECTIVE: Elderly patients with GH deficiency (GHD) have significant impairments in multiple aspects of quality of life (QOL) but similar lipid profiles compared to age-matched control subjects. There are, however, no data on changes in these parameters with time. This study assessed the impact of untreated GHD over a period of 2 years in a group of elderly patients with hypothalamic-pituitary disease in relation to new illnesses and differences in body composition, circulating lipid profile levels and QOL. Control subjects were also followed for 2 years. SUBJECTS: Twenty-seven elderly patients (> 65 years) with hypothalamic-pituitary disorders and GHD (mean peak stimulated GH response 1.6 mIU/l, range 0.6--5.0) were studied initially. Two years later 21 (13 males) agreed to attend for reassessment. Mean age was then 72.7 +/- 5.04 years (range 67--85). Eighteen patients had pituitary tumours, three had craniopharyngiomas. Twenty-seven control subjects were studied at baseline and 17 (7 males) agreed to attend for reassessment. Mean age was then 75.9 +/- 6.97 years (range 67--88). METHODS: Weight, body mass index (BMI), total fat mass (FM) (bioelectrical impedance), serum IGF-1 and fasting lipid profile (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol) were measured. QOL was assessed in both groups using five interviewer-administered self-rating questionnaires: the Nottingham Health Profile, Short Form-36, Hospital Anxiety and Depression Scale, Mental Fatigue Questionnaire and Life Fulfillment Scale. The GHD group also completed the Disease Impact Scale. RESULTS: Two of the 27 patients with GHD died during the 2-year follow-up (myocardial infarction and probable cerebrovascular accident). Four controls could not be traced but there were no deaths in the other 23. In the 21 GHD patients after 2 years, mean serum IGF-1 and BMI were unchanged (12.6 +/- 5.8 vs. 13.3 +/- 5.1 nmol/l, P = 0.5 and 28.3 +/- 4.3 vs. 29.1 +/- 4.2, P = 0.5, respectively) at the 2-year follow-up and there were no significant changes in the lipid profiles. However, there was a significant reduction in fat mass (31.7 +/- 11.2 vs. 28.5 +/- 10.9%, P = 0.04). In the 17 control subjects after 2 years, serum IGF-1 levels (17.2 +/- 4.0 vs. 15.7 +/- 5.6 nmol/l, P = 0.4), BMI and fat mass were unchanged. However, there was a significant fall in total cholesterol levels over the 2-year follow-up (6.3 +/- 0.9 vs. 5.7 +/- 0.9 mmol/l, P < 0.0001), although LDL cholesterol, triglycerides and HDL cholesterol were unchanged. Analysing the QOL data, the GHD patients had less energy (P < 0.05), more depression (P < 0.05), more pain (P < 0.05) and lower life fulfillment scores (P < 0.01) after 2 years. However, the control subjects also had less energy (P < 0.05), less vitality (P < 0.05) and lower self-esteem (P < 0.05), more depression (P < 0.05), worse mental health (P < 0.05), life fulfillment personal (P < 0.01), life fulfillment material (P < 0.02), physical functioning and role physical functioning (P < 0.05) after 2 years. Comparing the patients and controls at baseline, there were significant differences in IGF-1, BMI, FM, LDL cholesterol, personal life fulfillment, mental fatigue, general health and mental health. However, after 2 years, only BMI and depression scores were significantly different. CONCLUSION: These patients with untreated GHD did not have deterioration of body composition or lipid profiles when reassessed after a period of 2 years. In fact, fat mass fell. The control subjects did have a significant decrease in total cholesterol but no change in other lipids or body composition. Some quality of life domains did deteriorate in the patients with GHD. However, the control subjects also had worse quality of life scores after 2 years which were then little different from the GHD patients. These results raise doubts about the benefits of GH replacement in elderly people with GHD.

Adenoma↗

PubMed2002

Health-related quality of life after radical cystectomy for bladder cancer: a comparison of ileal conduit and orthotopic bladder replacement.

OBJECTIVE: To compare the health-related quality of life (HRQoL) after radical cystectomy in patients with an ileal conduit or an orthotopic neobladder. PATIENTS AND METHODS: The study included 85 men who underwent radical cystectomy for bladder cancer, comprising 48 with an orthotopic neobladder (26 with an ileal and 22 with a colon neobladder) and 37 with an ileal conduit. HRQoL was evaluated using the Short Form-36 survey containing 36 questions assessing eight aspects, including physical functioning, role-physical functioning, bodily pain, general health, vitality, social functioning, role-emotional functioning and mental health. RESULTS: The mean follow-up periods for patients with a neobladder (ileal and sigmoid) and with an ileal conduit was 45.9 (38.2 and 53.1, respectively) and 130.9 months, respectively. Scale scores were not affected by the duration of follow-up in either group. There was no significant difference in any scale scores between the neobladder and ileal conduit groups. However, general health and social functioning in both the neobladder and ileal conduit groups appeared to be significantly lower than those in the general population in the USA. Furthermore, patients with a colon neobladder had a significantly higher score for role-emotional functioning than those with an ileal neobladder, while there was no significant difference in the remaining seven scores between patients with ileal and colon neobladders. CONCLUSIONS: Six of the eight scales of HRQoL were favourable in both patients with a neobladder or an ileal conduit, and there was no significant difference between these groups. In addition, the HRQoL of patients with an orthotopic neobladder (except for role-emotional functioning) was unaffected by the segment of the intestine used for neobladder construction. Therefore, patients with both types of urinary diversion were generally satisfied with their overall health and quality of life.

Colon↗

PubMed2001

Comparison of older adult subject and proxy responses on the SF-36 health-related quality of life instrument.

Studies of older adults' health status and health-related quality of life (HRQoL) often rely on proxy responses when subjects have problems that affect their ability to respond. With the increased interest in outcomes research in health care, it is important to examine proxy reliability on HRQoL instruments. This study compares 32 pairs of subject-andproxy responses on the eight subscales and two summary scales of the Short Form 36 (SF-36). Subjects and their proxies, recruited from senior centers and residential facilities, were interviewed face-to-face within a seven-day period. Subjects were 60 years of age or older and had passed a brief cognitive screen, and proxies were geographically proximate and had seen the subject during the past week. Results showed that although moderate intra-class correlations were found on six of the eight measures, an item-level kappa statistic indicated poor to fair agreement on all subscales except items of Physical Functioning and Role Physical. Moreover, paired t-tests revealed proxy mean scores that were significantly lower on the Physical Functioning, Vitality, and Mental Health subscales. Given the mixed findings, until further research is done, researchers and clinicians should exercise caution when using proxy responses for older adults with the SF-36.

Activities of Daily Living↗

PubMed2002

Late Life Function and Disability Instrument: II. Development and evaluation of the function component.

BACKGROUND: Self-reported capability in physical functioning has long been considered an important focus of research for older persons. Current measures have been criticized, however, for conceptual confusion, lack of sensitivity to change, poor reproducibility, and inability to capture a wide range of upper and lower extremity functioning. METHODS: Using Nagi's disablement model, we wrote physical functioning questionnaire items that assessed difficulty in 48 common daily tasks. We constructed the instrument using factor analysis and Rasch analytic techniques and evaluated its validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 years and older who had a range of functional limitations. RESULTS: Our analyses resulted in a 32-item function component with three dimensions--upper extremity, basic lower extremity, and advanced lower extremity functions. Expected differences in summary scores of known-functional limitation groups support its validity. Test-retest stability over a 1- to 3-week period was extremely high (intraclass correlation coefficients =.91 to.98). CONCLUSIONS: The Late-Life Function and Disability Instrument has potential to assess activity concepts related to upper and lower extremity functioning across a wide variety of daily physical tasks and individual levels of physical functioning.

Activities of Daily Living↗

PubMed2004

Health-related quality of life after chemotherapy for advanced germ cell tumors: a comparison of standard-dose and high-dose chemotherapy.

BACKGROUND: The objective of this study was to evaluate the health-related quality of life (HRQoL) in patients with germ cell tumors who received standard-dose chemotherapy or high-dose chemotherapy combined with peripheral blood stem cell transplantation (PBSCT), and to compare the HRQoL of these patients with patients who had undergone surveillance therapy only. METHODS: Among the 102 patients included in this study, 38 underwent standard-dose cisplatin-based combination chemotherapy alone, 24 received high-dose chemotherapy with PBSCT following standard-dose chemotherapy, and 40 underwent surveillance monitoring. HRQoL was evaluated using the SF-36 survey, which contains 36 questions that assess eight quality-of-life aspects, including physical functioning, role-physical functioning, bodily pain, general health, vitality, social functioning, role-emotional functioning and mental health. RESULTS: The follow-up period of the surveillance group was significantly longer than that of the remaining two groups receiving chemotherapy; however, scale scores were not affected by the duration of follow up in either group. No significant difference was observed in any scale scores between the patients undergoing chemotherapy and those in the surveillance group. In comparison with the general population in the USA, social functioning in both the chemotherapy and surveillance groups was significantly lower, whereas vitality in these two groups was significantly higher. Patients undergoing standard-dose chemotherapy alone had a significantly higher score for mental health than those undergoing high-dose chemotherapy. However, there were no significant differences in the remaining seven scores, irrespective of the type of chemotherapy. CONCLUSIONS: Seven of the eight scale scores of HRQoL were favorable in patients who received chemotherapy or surveillance, and no significant difference was observed between these two groups. Moreover, with the exception of the mental health score, HRQoL was not significantly affected by the type of chemotherapy. Therefore, patients who received chemotherapy, including high-dose chemotherapy with PBSCT, seem to be generally satisfied with their overall HRQoL.

Adult↗

PubMed2000

[Reduced quality of life in liver cirrhosis].

BACKGROUND: Greater interest for quality of life in chronic diseases has been given recently. Method for examination is application of SF-36 form. In this study we followed changes in quality of life for patients with liver cirrhosis in Bosnia and Herzegovina. PATIENTS AND METHODS: 45 patients suffered from liver cirrhosis, 15 in class A, 15 in class B and 15 in class C according to Child, completed answers in form SF-36. 45 healthy control volunteers completed the same form. Results of score were compared to control group and to each other. RESULTS: Significantly reduced quality of life in physical functioning and role physical were in class Child A compared to control group. In class Child B significant decrease in score for physical functioning, general health perception and energy and vitality compared to Child A. In Child C 6 of 8 scores were significantly decreased compared to class Child B. Ascites decreased significantly score for quality of life in Class Child B and in class Child C portal encephalopathy decreased quality of life too. CONCLUSION: Health related quality of life was reduced in liver cirrhosis. Quality of life was reduced more in disease with more complications.

Female↗

PubMed2004

Health-related quality of life in patients with testicular cancer: a comparative analysis according to therapeutic modalities.

Investigating health-related quality of life (HRQoL) in testicular cancer patients has become important, because of an increasing number of young survivors with recent advance of multimodal therapy. The objective of this study was to compare the HRQoL in patients with advanced testicular cancer according to the types of treatment they received. Among 130 patients included in this study, 40 underwent surveillance monitoring (group A), 64 received cisplatin-based combination chemotherapy (group B), and 26 underwent infradiaphragmatic radiotherapy (group C). HRQoL in these 3 groups were evaluated using the SF-36 survey containing 36 questions that assess 8 aspects, including physical functioning, role-physical functioning, bodily pain, general health, vitality, social functioning, role-emotional functioning and mental health. Furthermore, HRQoL in group B were analyzed according to the experience with retroperitoneal lymph node dissection (RPLND) or high-dose chemotherapy with peripheral blood stem cell transplantation (PBSCT). The follow-up period of the chemotherapy group was significantly shorter than that of the remaining 2 groups; however, scale scores were not affected by the duration of follow-up in these 3 groups. There were no significant differences in any scale scores among the 3 groups. In comparison with the general population in the USA, social functioning in the 3 groups with testicular cancer was significantly lower, whereas vitality in these groups was significantly higher. Furthermore, in group B, there were no significant differences in any scale scores between patients with and without RPLND, while patients undergoing standard-dose chemotherapy alone had a significantly higher score for mental health than those undergoing high-dose chemotherapy following standard-dose chemotherapy despite the absence of a significant difference in the remaining 7 scores irrespective of the experience with high-dose chemotherapy. These findings suggest that 7 of the 8 scale scores of HRQoL examined by the SF-36 survey were satisfactory in patients with testicular cancer regardless of the 3 treatment modalities, and that there were no significant differences in any scale scores among these groups. Moreover, the HRQoL was not affected by experience with RPLND or high-dose chemotherapy except for mental health in patients undergoing high-dose chemotherapy. Therefore, the overall HRQoL in patients with testicular cancer may be generally favorable and not affected by differences in treatment type.

Adult↗

PubMed2001

[Assessment of quality of life in patients with diabetes mellitus and impaired glucose tolerance].

OBJECTIVES: To understand the quality of life (QOL) in patients with diabetes mellitus and impaired glucose tolerance, and investigate factors affecting their QOL. METHODS: Using the SF-36 instrument to assess QOL among 108 patients with diabetes mellitus, 109 patients with impaired glucose tolerance and 116 normal glucose tolerance subjects. RESULTS: In subjects with diabetes mellitus, the proportion of general perceived health assessed to be excellent or good was 12.04%; as compared with the same-age people, the proportion assessed to be good or fairly good was 62.04%. In subjects with impaired glucose tolerance, the two proportions was 13.76% and 69.72% respectively. The total score attained excellent or good level was 72.23% and 83.49% respectively in patients with diabetes mellitus and impaired glucose tolerance. The mean score of multi-item dimensions assessment (ranged from 58.33 to 87.38) decreased in diabetes mellitus; the lowest score being emotional role functioning and the highest mean score being physical functioning. Compared with normal glucose tolerance subjects, the mean score of physical functioning, physical role functioning, general health perception, vitality and the total score in diabetes mellitus was significantly decreased; and compared with in impaired glucose tolerance patients, the mean score of vitality, mental health and the total score was significantly decreased in diabetes mellitus. The result of correlation analysis demonstrated that age, occupational, duration of disease, number of symptoms and complications, level of fasting blood glucose and 2-hour past oral blood glucose affected the QOL of diabetes mellitus patients. CONCLUSIONS: The results suggested that to enhance the QOL in patients with diabetes mellitus, control of plasma glucose, pay attention to psychological treatment and measures related to diabetes mellitus with different characteristics must be early adopted.

Adult↗

PubMed1993

Influence of age on measurement of health status in patients undergoing elective surgery.

PURPOSE: To assess the influence of age on the relationships between global measures of health and specific health dimensions. DESIGN: Cross-sectional cohort study. SETTING: University tertiary care hospital. PATIENTS: Patients older than 50 years admitted for major elective non-cardiac surgery. MEASUREMENTS: Consenting patients underwent preoperative evaluations including a medical history, physical examination, and administration of health status assessment instruments. Global health status was measured with the Medical Outcomes Study Short Form (SF-36) and with a 0 to 100 verbal measure of global health. Specific health dimensions (physical function, role function, social function, mental health, energy and fatigue, and pain) were measured using the SF-36. Subjects also completed a second validated measure of physical functioning, the Specific Activity Scale (SAS). RESULTS: Although patients aged > 70 years (n = 276) had poorer role function, energy, and fatigue scores and poorer physical function on both the SF-36 and SAS than younger patients (n = 469) (P < 0.05), they had similar overall health perception. In the entire population, global health status as measured with the SF-36 health perception scale had the greatest correlation with the energy and fatigue scale (r = .45), correlated moderately with mental health (r = .35), social function (r = .32), and physical function (r = .33), and correlated less well with the surgically remediable dimension of pain (r = .23). However, correlations of global health perception with pain and global health perception with role functioning were significantly (P < or = 0.05) lower in older patients when compared with subjects 70 years or younger (r = .13 vs .28 and r = .19 vs .33, respectively). CONCLUSION: Despite poorer role function, poorer energy and fatigue scores, and poorer physical function, elderly persons have similar global health perception when compared with younger individuals. These data indicate that global health perception may be determined by different factors in the elderly or that the elderly have fundamentally different expectations of what their global health status should be. Our findings emphasize the importance of multidimensional scales when evaluating quality of life because, particularly in the elderly, the use of global measures alone may not reflect critically important dimension-specific impairments in health.

Activities of Daily Living↗

PubMedDate not supplied

Further clues to recognition of patients with fibromyalgia from a simple 2-page patient multidimensional health assessment questionnaire (MDHAQ).

OBJECTIVE: To analyze quantitative scores for pain, fatigue, functional disability, and the number of symptoms on a review of systems on a multidimensional health assessment questionnaire (MDHAQ), including the ratios of scores for pain to physical function and fatigue to physical function, and to further study how these scores can help to identify patients with fibromyalgia. METHODS: All consecutive patients seen at a rheumatology clinic completed a 2-sided, 1-page MDHAQ at each visit to assess physical function, pain, fatigue, global status, helplessness and review of systems, and had their erythrocyte sedimentation rate (ESR) measured. Scores for these variables were analyzed in 78 consecutive patients with fibromyalgia over a two-year period, and in 149 patients with rheumatoid arthritis (RA) as a "control" group. A subset analysis was conducted in patients with RA who were classified independently according to clinical criteria as having or not having coexistent fibromyalgia. Descriptive statistics, logistic regression, and receiver-operating-characteristic curves were computed for patients with fibromyalgia and compared to patients with RA. RESULTS: Patients with fibromyalgia had high ratios of pain:physical function and fatigue:physical function scores, and a high number of reported symptoms. These quantitative data differed significantly from patients with RA. Patients with fibromyalgia also had a lower ESR than patients with RA, whose scores were similar whether or not there was coexistent fibromyalgia. Patients with fibromyalgia were distinguished equally well from patients with RA by patient questionnaire data as by the ESR. CONCLUSION: A simple 1-page, 2-sided patient questionnaire provides quantitative information which may contribute to identify patients with fibromyalgia, including patients with RA who may also have coexistent fibromyalgia.

Blood Sedimentation↗

PubMed2005

Effects of kinesthesia and balance exercises in knee osteoarthritis.

BACKGROUND: In patients with knee osteoarthritis (OA), there is a prominent loss in proprioception and kinesthesia sensation compared with control subjects of the same age and gender. OBJECTIVES: The aim of this study is the investigation of short-term clinical effects of kinesthesia and balance exercises in patients with knee OA. METHODS: This 8-week study was conducted on 66 female patients with knee OA who were randomized into 2 groups. The first group received kinesthesia and balance exercises (such as retrowalking, walking on their toes, leaning to the sides, balance board exercises, minitrampoline exercises, plyometric exercises, and so on) in addition to strengthening exercises. The second group received only strengthening exercises. RESULTS: : Statistically significant improvements were observed postexercise for both groups with respect to baseline for WOMAC, SF-36 Form, times for performing activities of daily living, isokinetic quadriceps muscle strength, and proprioceptive sensation levels. In the first group with kinesthesia training, compared with the second group, significantly greater improvements were obtained in all the subparameters that measure functional status (WOMAC-physical function value, SF-36 Form [physical function, role limitations-physical and vitality-energy or fatigue variables], 10 stairs climbing, and 10-m walking times) and in isokinetic muscle strength at high angular velocities (P < 0.05). The absolute angular error percentage (to assess proprioceptive accuracy) was significantly improved postexercise in both groups. There were no differences between the groups. CONCLUSIONS: Additive positive effects of kinesthesia and balance exercises in knee OA have been demonstrated. Used in clinical applications, they should be able to increase the functional capacities of patients. Long-term studies about efficacy and cost-effectivity of these exercises are needed.

Activities of Daily Living↗