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PubMed2004

Measurement of global functional performance in patients with rheumatoid arthritis using rheumatology function tests.

Outcome assessment in patients with rheumatoid arthritis (RA) includes measurement of physical function. We derived a scale to quantify global physical function in RA, using three performance-based rheumatology function tests (RFTs). We measured grip strength, walking velocity, and shirt button speed in consecutive RA patients attending scheduled appointments at six rheumatology clinics, repeating these measurements after a median interval of 1 year. We extracted the underlying latent variable using principal component factor analysis. We used the Bayesian information criterion to assess the global physical function scale's cross-sectional fit to criterion standards. The criteria were joint tenderness, swelling, and deformity, pain, physical disability, current work status, and vital status at 6 years after study enrolment. We computed Guyatt's responsiveness statistic for improvement according to the American College of Rheumatology (ACR) definition. Baseline functional performance data were available for 777 patients, and follow-up data were available for 681. Mean +/- standard deviation for each RFT at baseline were: grip strength, 14 +/- 10 kg; walking velocity, 194 +/- 82 ft/min; and shirt button speed, 7.1 +/- 3.8 buttons/min. Grip strength and walking velocity departed significantly from normality. The three RFTs loaded strongly on a single factor that explained >or=70% of their combined variance. We rescaled the factor to vary from 0 to 100. Its mean +/- standard deviation was 41 +/- 20, with a normal distribution. The new global scale had a stronger fit than the primary RFT to most of the criterion standards. It correlated more strongly with physical disability at follow-up and was more responsive to improvement defined according to the ACR20 and ACR50 definitions. We conclude that a performance-based physical function scale extracted from three RFTs has acceptable distributional and measurement properties and is responsive to clinically meaningful change. It provides a parsimonious scale to measure global physical function in RA.

Adult↗

PubMed2005

Comprehensive health status assessment of centenarians: results from the 1999 large health survey of veteran enrollees.

BACKGROUND: Information on the health status of centenarians provides a means for understanding the health care needs of this growing population. Therefore, we examined the health status of a national cohort of centenarian veteran enrollees. METHODS: Ninety-three centenarian veteran enrollees returned a complete health history questionnaire, which included questions about sociodemographic information, age-associated conditions, health behaviors, health-related quality of life as measured by the Veterans SF-36, and change in health status. RESULTS: Centenarian veteran enrollees are a group with major impairment across multiple dimensions of health-related quality of life despite having a relatively low prevalence of diseases. They had considerable physical limitations as reflected by their physical health summary scores (26.2 +/- 8.3). However, their mental health was comparatively good (mental health summary score 44.1 +/- 12.5). Compared to younger elderly veterans (ages 85-99), centenarians had a lower prevalence of hypertension, angina or myocardial infarction, diabetes, and chronic low back pain (p <.05). Centenarians had significantly worse physical functioning, role physical, vitality, and social functioning scores than did younger elderly veterans. The two groups did not differ in their general health, bodily pain, role emotional, and mental health scores. Centenarians did not perceive much decline in their physical or mental health during the preceding year. CONCLUSIONS: Centenarian veteran enrollees are a group with a low number of age-associated diseases and good mental health despite substantial physical limitations. These results support future studies of services directed toward improvement of function as opposed to those focused solely on the treatment of diseases.

Activities of Daily Living↗

PubMedDate not supplied

Predicting follow-up functional outcomes in outpatient rehabilitation.

Functional outcomes at an average of six months after outpatient rehabilitation were investigated in a pilot study with a sample of 42 patients receiving physical therapy for low back, neck, and other musculoskeletal problems. Logistic regression analyses were used to study variables related to the achievement of a predetermined level of physical functioning or to whether improvement occurred from initial to follow-up assessment. Scales used in the analyses were obtained from two measures of functioning, the Medical Outcomes Trust Short Form 36 (SF-36) and the Medical Rehabilitation Follow Along (MRFA instrument). Demographic and program characteristic variables obtained from clinic records were also included in the analyses. The independent variables entered into two groups of regression equations included age, gender, presenting problem, workers' compensation coverage, functioning at initial assessment, number of visits, length of program, and intensity of program. For the SF-36, the General Health scale and presenting problem predicted above or below a level greater than one standard deviation less than the mean on the Physical Functioning scale at follow-up. The combination of the Role Physical and Role Emotional scales predicted follow-up level on the Physical Component Summary (PCS) scale. The interaction of age and intensity of treatment was predictive for both the Physical Functioning and PCS scales. For predicting improvement or no improvement using the SF-36 scales, General Health and the interaction between age and intensity were predictive of change on the Physical Functioning scale, whereas age and the interaction between age and number of visits were predictive of change on the PCS scale. For the MRFA instrument, the interaction between age and the intensity of treatment was predictive for both a predetermined level of physical functioning and amount of improvement in physical functioning at follow-up. An intensity rating of pain and a measure of affective distress at initial assessment both improved the identification of patients at risk for not reaching a given level of functioning, whereas treatment intensity improved the identification of those patients at risk for not showing improvement at follow-up. Length of time between the end of outpatient therapy and follow-up assessment was generally not related to follow-up physical functioning. Interpretation and implications of these findings, as well as applications of this analytic approach to outcomes assessment, are discussed.

Activities of Daily Living↗

PubMed2006

Association of comorbidity with physical disability in older HIV-infected adults.

Comorbidity, aging, and their impact on physical functioning will play an increasingly greater role in HIV medical care as the number of infected adults over 50 years of age grows. The study objective was to investigate the relationship of comorbidity and age with physical functioning in HIV-infected and HIV-negative patients. Eight hundred eighty-nine HIV-infected veterans and 647 HIV-negative veterans from the Veterans Aging Cohort Study conducted between September 2001 and June 2002 were included in the study. Physical functioning was measured by self-reported difficulty with various physical activities. Regression analyses were performed to examine demographic and clinical factors associated with physical functioning. Separate models were used for HIV-infected and HIV negative subjects since these groups differed in demographic makeup. In both patient groups, chronic lung disease, coronary artery disease, hypertension, smoking, and major depression were independently associated with reduced physical functioning in age and race adjusted regression models. Increased age was associated with reduced physical functioning in both HIV-infected and HIV-negative patients. However, when comorbid conditions were entered into the models for both HIV-infected and HIV-negative patients, age coefficients were reduced and were no longer statistically significant. Among the HIV-infected patients, results remained unchanged after controlling for the impact of antiretroviral therapy and HIV disease stage. Our findings demonstrate the important role of general medical comorbidity in physical functioning in both HIV-infected and HIV-negative patients. This suggests the importance of effectively treating comorbid conditions in persons with HIV, in order to reduce the overall impact of disease on physical functioning.

Adult↗

PubMed2000

Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life.

OBJECTIVE: To describe the long-term health-related quality of life (HRQL) of survivors of sepsis and to evaluate the reliability and validity of the medical outcomes study Short Form-36 (SF-36) in this population. STUDY DESIGN: Cross-sectional survey. SETTING: University intensive care unit. PATIENTS: Surviving patients over the age of 17 yrs who met the criteria for the Society of Critical Care Medicine/American College of Chest Physicians definition of sepsis identified through a review of patients admitted to the intensive care unit from 1994 to 1998. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Baseline demographics and clinical characteristics were abstracted from the medical chart. After hospital discharge, the SF-36 and Patrick's Perceived Quality of Life scale were administered by telephone. The SF-36 was readministered 2 wks later. We screened the charts of 109 patients; 78 had a diagnosis of sepsis. Of these, 31 had died, 3 had severe communication problems, 9 refused to participate, and 5 patients could not be located. A total of 30 patients completed the first interview; 26 completed the second. Compared with established norms for the U.S. general population, survivors of sepsis scored significantly lower on the physical functioning, role physical, general health, vitality, and social functioning domains, as well as on the Physical Health Summary Scale. Mean scores on the Mental Health Summary Scale were very similar between the survivors of sepsis and U.S. norms. The SF-36 demonstrated high internal consistency (Cronbach's alpha ranged from 0.65 to 0.94) and excellent test-retest stability (intraclass correlation coefficient ranged from 0.75 to 0.97). Both the Physical Health Summary Scale and the Mental Health Summary Scale correlated well with overall Perceived Quality of Life scores (Pearson correlation coefficients 0.45 and 0.56, respectively). CONCLUSIONS: The long-term HRQL of survivors of sepsis is significantly lower than that of the general U.S. population. The SF-36 demonstrated good reliability and validity when used to measure HRQL in survivors of sepsis.

Activities of Daily Living↗

PubMed1997

Functional status in coronary artery disease: a one-year prospective study of the role of anxiety and depression.

PURPOSE: Although coronary disease is the second most common cause of work and functional disability, little is known about the relative contributions of biomedical and psychosocial factors to this disability. This study was conducted to determine the associations of depression and anxiety with self-reported physical function and activity interference in patients with coronary artery disease. METHODS: This was a 1-year prospective cohort study of 198 HMO members who had elective cardiac catheterization for coronary artery disease in 1992. Measures included: severity of coronary artery stenosis from cardiac catheterization reports; anxiety and depression severity using interviewer-administered Hamilton Anxiety and Depression Rating Scales; and self-reported physical function and activity interference. RESULTS: At the time of catheterization, patients' self-reported physical function differed significantly by number of main coronary vessels stenosed >70% (P <0.03), by anxiety quartiles (P = 0.001), and by depression quartiles (P = 0.001). At 1 year, physical function was no longer associated with the number of main coronary vessels stenosed at baseline, but still was significantly associated with baseline anxiety (P <0.001) and depression quartiles (P = 0.01). Moreover, change in physical function scores from baseline to 12 months was associated with baseline anxiety (P <0.001) or depression (P <0.001) quartiles, but not with baseline number of occluded coronaries. Results for activity interference were similar to those for physical function. These associations were largely unchanged when corrected for age, sex, education, social class, medical versus surgical management of CAD, and degree of medical comorbidity. CONCLUSION: Anxiety and depression have a significant and persistent effect on physical function in patients with coronary artery disease. Although current treatment methods appear to neutralize the influence of coronary stenosis on physical function during the year following catheterization, this is not true for anxiety and depression.

Age Factors↗

PubMed1999

Associates of health status in patients with systemic lupus erythematosus.

OBJECTIVE: To determine the health status of patients with systemic lupus erythematosus (SLE) and to identify the associations of this domain. METHODS: One hundred ninety-five consecutively attending patients with SLE were studied at 2 centers. Health status was measured by 8 composite scales of the Medical Outcomes Study Short Form 36 (SF-36). The mean scores for each subscale of the SF-36 for patients with SLE were compared to those of a healthy population. The effect of patients' age, sex, ethnic origin, marital status, education level, disease duration, disease activity (assessed by the Systemic Lupus Activity Measure), end organ damage (assessed by the Systemic Lupus International Coordinating Clinics/American College of Rheumatology Damage Index), social support (using the Interpersonal Support Evaluation List), and patients' satisfaction with medical care (using the Patient Satisfaction Questionnaire) on each SF-36 subscale was determined. Student's unpaired t test and multiple regression analysis were applied for statistical analysis. RESULTS: Patients with SLE had significantly lower scores in each subscale of the SF-36 compared to a control population. Higher disease activity was associated with worse physical function, role-physical, bodily pain, general health, vitality, and social function. Greater social support was associated with higher scores in physical function, bodily pain, general health, vitality, social function, role-emotional, and mental health. Increasing total end organ damage determined worse physical function and general health. Higher patient general satisfaction with care was associated with better general health. CONCLUSION: The health status of patients with SLE may be improved by increasing patients' social support and satisfaction with health care, as well as controlling SLE disease activity and preventing organ damage.

Adolescent↗

PubMed1997

Patient-specific predictors of ambulance use.

STUDY OBJECTIVE: To determine patient-specific socioeconomic and health status characteristics for patients arriving by ambulance at an emergency department. METHODS: Ambulance use among adult ED patients presenting with abdominal pain, chest pain, head trauma, or shortness of breath was studied at five urban teaching hospitals in the north-eastern United States. Cross-sectional analysis within a prospective cohort study of 4,979 consecutive patients was performed using an interval sequence subset of 2,315 patients (84% of those eligible) to whom questionnaires were administered. Ambulance use (21% of surveyed patients; 26% of all patients) was analyzed with logistic regression. RESULTS: Predictors of ambulance use included age greater than 65 years (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.34 to 2.82); clinical severity (OR, 3.11; 95% CI, 2.27 to 4.25); poverty (OR, 1.40; 95% CI, 1.08 to 1.83); physical function (OR, 1.05; 95% CI, 1.02 to 1.09 for each point of worsening function on a 12-point physical function scale); and various types of health insurance coverage. Race, sex, education, Medicaid coverage, frequency of ED use, living arrangements, and primary physician availability were not predictive in multivariate analysis of surveyed patients. CONCLUSION: Ambulance use varies by age, clinical severity, income, patient-specific characteristics of physical function, and type of health insurance. Medicaid coverage and frequent ED use are not predictive of increased ambulance use.

Acute Disease↗

PubMed2003

Are the ICF Activity and Participation dimensions distinct?

OBJECTIVE: To test the hypothesis that distinct Activity and Participation dimensions of the International Classification of Functioning, Disability, and Health could be identified using physical functioning items drawn from the Late Life Function and Disability Instrument. DESIGN: A cross-sectional, survey design was employed. SUBJECTS: The sample comprised 150 community-dwelling adults aged 60 years and older. METHODS: Exploratory factor analysis was used to identify interpretable dimensions underlying 48 physical functioning questionnaire items. RESULTS: Findings revealed that one conceptual dimension underlying these physical functioning items was not sufficient to adequately explain the data (X2 = 2383; p < 0.0001). A subsequent solution produced 3 distinct, interpretable factors that accounted for 61.1% of the variance; they were labeled: Mobility Activities (24.4%), Daily Activities (24.3%), and Social/Participation (12.4%). All 3 factors achieved high internal consistency with coefficient alphas of 0.90 or above. CONCLUSION: Within physical functioning, distinct concepts were identified that conformed to the dimensions of Activity and Participation as proposed in the ICF. We believe this is the first empirical evidence of separate Activity and Participation dimensions within the International Classification of Functioning, Disability, and Health classification.

Activities of Daily Living↗

PubMed2004

Health-related quality of life in cardiac patients with dyslipidemia and hypertension.

BACKGROUND: Hypertension is associated with lower health-related quality of life (HRQOL). Similar association may be found for dyslipidemia. However, controversies exist regarding the HRQOL with dyslipidemia. We evaluated the HRQOL of cardiac patients with and without dyslipidemia and hypertension. METHODS: In a cross-sectional study, 284 cardiac patients rated their HRQOL using SF-36 Health Survey (SF-36), and three preference-based measures (Rating Scale, Time Trade-off and Standard Gamble). RESULTS: Compared to those without dyslipidemia, those with dyslipidemia reported better HRQOL on all preference-based measures and most SF-36 scales particularly on the physical health scales. Adjusted mean differences and 95% confidence interval (95% CI) were equal to 4.5 (0.5, 8.5), 10.8 (2.8, 18.8), and 2.2 (0.2, 4.2) on the Physical Functioning, the Role-Physical and the Physical Component Summary scales, respectively. Exactly the opposite trends were observed among patients with hypertension. The adjusted mean differences (95% CI) were equal to -2.7 (-6.7, 1.4), -10.9 (-19.1, -2.8), and -2.9 (-4.9, -0.9) on the Physical Functioning, the Role-Physical and the Physical Component Summary scales, respectively. CONCLUSION: Cardiac patients with hypertension reported lower physical health than those without hypertension while cardiac patients with dyslipidemia reported better physical health than those without dyslipidemia. The reason for these different trends is not known. Possible explanations are discussed.

Adult↗

PubMed2006

Impact on quality of life of different lower urinary tract symptoms in men measured by means of the SF 36 questionnaire.

OBJECTIVE: To describe how different lower urinary tract symptoms (LUTS) affect the quality of life (QOL) in men. MATERIAL AND METHODS: The study included 1008 men aged 40-80 years living in the community of Surahammar, Sweden who had answered a questionnaire concerning stress incontinence, urgency and post-micturition dribbling 12 months earlier. The occurrence and severity/frequency of 12 specific LUTS were assessed using the Danish Prostatic Symptom Score questionnaire. QOL was evaluated using the Short Form 36 (SF-36) questionnaire. RESULTS: Post-micturition dribbling was the most frequently reported symptom (71%) and stress incontinence the least common (11%). Men who experienced urge, stress or "other incontinence" had lower mean scores for all of the eight dimensions measured by the SF-36 than men without such symptoms. Furthermore, men who experienced a moderate/severe degree of weak stream or nocturia reported a poorer QOL for all dimensions compared to men with a mild level of the same symptoms. QOL was found to decrease with increasing age. Men aged 66-80 years with "other incontinence" reported lower mean SF-36 scores for physical functioning, role physical, role emotional, social functioning and body pain than 40-65-year-old men. CONCLUSIONS: LUTS in men affect QOL dimensions differently. Storage symptoms appear to reduce QOL more than voiding and post-micturition symptoms. Urinary incontinence affected all eight of the dimensions evaluated. Elderly men with LUTS reported a lower QOL than younger men.

Adult↗

PubMedDate not supplied

The pediatric outcomes data collection instrument detects improvements for children with ambulatory cerebral palsy after orthopaedic intervention.

The purpose of this study was to assess whether the Pediatric Outcomes Data Collection Instrument (PODCI) was able to detect changes in function, as perceived by the parents of children and adolescents with cerebral palsy who had undergone lower limb soft tissue and/or bony surgeries. This was a retrospective study of 80 ambulatory patients who were seen in the motion laboratory and classified with the Gross Motor Functional Classification System (GMFCS). Significant changes (P < 0.05) were detected in the PODCI scores for upper extremity function, transfers and mobility, physical function and sports, and global function after surgery, by approximately 4% to 5%, whereas comfort (pain-free) did not significantly change. There was a significant difference in the PODCI scores preoperatively between GMFCS levels I, II, and III for upper extremity function, transfers and mobility, physical function and sports, and global function. Postoperative improvements were of equal magnitude for each GMFCS level. This suggests that the PODCI did not have a ceiling effect for high-functioning children. Age (+/-10 years) and surgery (soft tissue/soft tissue plus bony) were not significant factors for any of the subcategories preoperative to postoperative. In conclusion, the PODCI detected improvement as perceived by the parents in ambulatory children with cerebral palsy after lower-limb soft tissue and/or bony surgeries in 4 areas by a magnitude of approximately 4% to 5%.

Adolescent↗

PubMed2005

The impact of epilepsy on health status among younger and older adults.

PURPOSE: The incidence of epilepsy is highest among the elderly, yet our understanding of the impact of epilepsy is based predominantly on inferences from studies of younger adults. This study examines the impact of epilepsy on patients' subjective health status in a population that includes both younger and older adults. METHODS: We used national administrative and survey databases from the Veterans Health Administration to examine health status as measured by a modification of the SF-36 (RV-36) in patients from three age cohorts: young adults (18-40 years), middle-aged adults (41-64 years), and older adults (65 years and older). Because chronicity of epilepsy may influence these outcomes, we compared scores for patients with new-onset epilepsy, chronic epilepsy, and no epilepsy by using analysis of covariance, controlling for patient demographic and clinical characteristics that may also affect health status. RESULTS: With the exception of physical status measures, older adults appeared to cope better with their epilepsy than did middle-aged patients. Young adults with new-onset epilepsy reported poor general health and worse mental health, but high levels of physical function and physical activity. Middle-aged patients with new-onset epilepsy scored lowest in all domains, and their peers with chronic epilepsy also reported poor general physical health and emotional functioning. CONCLUSIONS: Although having fewer physiologic reserves, older adults appeared most resilient in facing this chronic illness, and middle-aged adults fared the worst. Interventions to improve quality of life among patients with epilepsy should be tailored to age and epilepsy chronicity.

Adolescent↗

PubMed1997

Quality-of-life outcomes and the use of antihistamines in a French national population-based sample of patients with perennial rhinitis.

Our primary objective in designing the first large-scale nationwide population-based survey in France was to assess the impact of perennial rhinitis on quality of life. Our secondary objective was to describe the use of drug treatment, including histamine H1 antagonists, in that population. A pollbase of 20,000 households was screened for symptoms of rhinitis. 16,786 households responded, including 35,615 patients aged over 15 years, giving an overall response rate of 84%. Using an algorithm, 1367 patients with probable perennial rhinitis were selected for a cross-sectional collection of data about the history of their condition, comorbidity, use of medical resources, sick leave and nasal symptom-related quality of life [according to the Medical Outcomes Study 36-Item Short-Form Questionnaire (SF-36)]. Finally, multivariate regression techniques were used to describe the relationship between quality-of-life scores and treatment subgroups, controlling for some other confounding factors. The point prevalence of perennial rhinitis was estimated to be 4.1% [95% confidence interval (CI): 3.9 to 4.3%]. Association of perennial rhinitis with a history of asthma was highly significant (13.4% in those with perennial rhinitis vs 3.8% in those without; odds ratio 3.26; p < 0.001). 38% of the patients with perennial rhinitis reported having taken regular medication during the last 3 months. Antihistamine use was associated with use of decongestant or topical nasal products in about one-third of patients. Four SF-36 dimensions (physical functioning, role physical, bodily pain, social functioning) showed significantly higher mean scores (indicating better quality of life) in patients receiving non-anticholinergic histamine H1 antagonist therapy, relative to those receiving other treatments, a difference that was maintained after controlling for gender, age, level of nasal symptoms, medical history of asthma and number of general practitioner visits. These results established the long term impact of perennial rhinitis on quality of life (generic and specific), and raised questions about appropriate therapy, since a positive association between current use of non-anticholinergic antihistamines with improvements on some SF-36 dimensional scores in patients with perennial rhinitis was observed.

Adult↗

PubMed2006

Comparison of functional status after coronary artery bypass grafting in patients with and without diabetes mellitus.

Although previous studies have shown increased risk of morbidity and mortality in patients with diabetes mellitus (DM) who undergo coronary artery bypass grafting (CABG), data are conflicting on whether the gains in physical function and mental health after CABG achieved by patients with DM are similar to, or less than, those achieved by patients without DM. We compared the gains in physical function and mental health at 6 months after CABG surgery between 696 consecutive patients with DM and 376 without DM who underwent their first CABG from February 1999 to February 2001. Physical function and mental health were measured using the Short Form 36-item Health Survey. From the baseline and follow-up Short Form 36-item Health Survey data, the physical and mental component scales were derived. At 6 months, the patients with and without DM had significant improvement in physical function and mental health, but those without DM had improved significantly more than those with DM with respect to physical functioning. After adjusting for baseline characteristics, a lower proportion of patients with DM had experienced improvement (an increase of > or = 5 points) in the physical component scale score compared with those without DM (45.0% vs 58.0.%, RR = 0.78, p = 0.002). Moreover, a higher proportion of patients with DM experienced a decrease in the physical component scale score compared with those without DM (14.9% vs 7.8%, RR = 1.91, p = 0.006). In contrast, no significant differences were found in the mental component scale score changes by DM status. In conclusion, CABG is associated with lower gains in physical function in those with DM than in those without DM. Special attention should be paid to the physical function of patients with DM after CABG, and any barriers to functional recovery in this group should be promptly identified and addressed.

Aged↗

PubMed2000

Association of patients' perception of health status and exercise electrocardiogram, myocardial perfusion imaging, and ventricular function measures.

BACKGROUND: Patients' viewpoint of their health status is increasingly used as an important outcome measure of the success of treatments. Because clinicians rarely formally measure patients' health-related quality of life, the question arises whether noninvasive testing for ischemia can provide similar information regarding physical functioning and general health perception. METHODS: We measured physical functioning and general health status with the Medical Outcomes Study Short Form (SF-36) survey in 195 consecutive patients (68% male, mean age 55.6 +/- 11.1 years) referred for exercise testing with myocardial perfusion imaging. The survey was completed immediately before the exercise test. RESULTS: In the multivariate analysis, the strongest predictor of physical functioning and general health perception was metabolic equivalents. However, the best model, including demographic, clinical, and test variables, predicted only 14% of the variation in physical functioning and 10% of the variability in general health perception. CONCLUSIONS: The variation in physical functioning and general health perception, as measured by the SF-36, among patients referred for exercise testing is not predicted well by the results of the test. As expected, several test results are significantly associated with physical functioning and general health perception; however, there was substantial overlap among individual patients, suggesting that the parameters are poor surrogates for the actual assessment of the domains. If these domains are deemed important to tracking patient outcomes, then they should supplement the current assessments of these patients.

Adult↗

PubMed2004

Are physician-derived disease severity indices associated with health-related quality of life in patients with end-stage liver disease?

OBJECTIVES: Model for end-stage liver disease (MELD) score is now often used as an overall indicator of health status for patients with end-stage liver disease. However, there are no data evaluating the associations between MELD scores and patient reports of health-related quality of life (HRQOL). METHODS: Two hundred-three patients with end-stage liver disease completed a disease-targeted HRQOL instrument (the LDQOL 1.0). Patients also rated the severity of their liver disease and reported number of disability days attributed to their liver disease in the preceding month. MELD and Child Turcott Pugh (CTP) scores were calculated for all patients. Associations of MELD and CTP scores with patient-derived outcomes were estimated. RESULTS: The mean MELD and CTP scores were 12 and 7, respectively, indicating mild severity of liver disease. HRQOL of patients was generally poor, with the mean SF-36 physical and mental component summary scores of 35 and 40. Seventy percent of patients rated their liver disease symptoms as moderate to severe. Similarly, 70% reported being disabled from their liver disease. MELD was associated with physical functioning scale and the physical component summary (PCS) score in patients with end-stage liver disease. In contrast, CTP score was significantly associated with physical functioning, role limitations due to physical health problems, PCS score, effects of liver disease, sexual functioning, and sexual problems. Both MELD and CTP scores correlated with self-rated severity of liver disease symptoms but not with self-reported disability days. CONCLUSIONS: Despite objectively mild liver disease, the subjective HRQOL of this cohort was severely impaired. CTP score was more closely associated with patient-reported estimates of HRQOL than the MELD score. CTP or disease-specific HRQOL instruments may compliment MELD by providing insights into outcomes of importance to patients with low risk of mortality.

Adult↗

PubMed1993

Change in self-reported functioning in older persons entering a residential care facility.

We evaluated the responsiveness of measures of function in admissions to a long-term care facility. Between baseline and follow-up assessment, one-fifth or more of the subjects either worsened or improved in most aspects of reported function. We compared two measures of self-reported function (COOP charts and a short-form survey). Convergent validity was observed for changes in pain, social health, and mental health (r = 0.39-0.74), but not for physical functioning. Although the short-form physical function measure discriminated worsening on several performance-based external criteria of physical functioning (area under ROC curves up to 0.82), the COOP and other measures of physical functioning were less likely to do so. All physical function measures were less responsive for detecting improvement. Clinicians and investigators intending to monitor change in function must consider the responsiveness of their measures.

Activities of Daily Living↗