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PubMed1994

Functional status in women with lung cancer.

Lung cancer remains the number one cause of cancer-related death and the third most common cancer for women in the United States. The major purpose of this study was to describe physical functional status in a sample of women with lung cancer. Functional status was objectively measured by the Karnofsky Performance Status Scale, and subjectively by the Rand Physical Function Scale, and the Physical Function Subscale of the CARES-Short Form. A convenience sample of 69 women participated in a one-time data collection. The typical subject was < 65 years of age, had lived with primary or recurrent lung cancer for > 12 months, had non-small cell limited disease, and was not currently receiving treatment. The most prevalent disruptions in physical function were reduced energy (59%), difficulty with household chores (33%), and interference with work (28%). A third of the sample had serious limitations in three or more activities. Approximately 26% of the sample had severe limitations in moderate activities, 20% in walking short distances, and 16% in walking one flight of stairs. Only a quarter were satisfied with their level of activity. Physical function was different by income category (one-way analysis of variance), with those with the lowest income having the poorest function.

Activities of Daily Living↗
PubMed1998

Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey.

Cross-sectional data from a representative sample of the general population in Japan were analyzed to test the validity of Japanese SF-36 Health Survey scales as measures of physical and mental health. Results from psychometric and clinical tests of validity were compared. Principal components analyses were used to test for the hypothesized physical and mental dimensions of health and the pattern of scale correlations with those components. To test the clinical validity of SF-36 scale scores, self-reports of chronic medical conditions and the Zung Self-Rating Depression Scale were used to create mutually exclusive groups differing in the severity of physical and mental conditions. The pattern of correlations between the SF-36 scales and the two empirically derived components generally confirmed hypotheses for most scales. Results of psychometric and clinical tests of validity were in agreement for the Physical Functioning, Role-Physical, Vitality, Social Functioning, and Mental Health scales. Relatively less agreement between psychometric and clinical tests of validity was observed for the Bodily Pain, General Health, and Role-Emotional scales, and the physical and mental health factor content of those scales was not consistent with hypotheses. In clinical tests of validity, the General Health, Bodily Pain, and Physical Functioning scales were the most valid scales in discriminating between groups with and without a severe physical condition. Scales that correlated highest with mental health in the components analysis (Mental Health and Vitality) also were most valid in discriminating between groups with and without depression. The results of this study provide preliminary interpretation guidelines for all SF-36 scales, although caution is recommended in the interpretation of the Role-Emotional, Bodily Pain, and General Health scales pending further studies in Japan.

Adult↗
PubMed2003

Physical and mental health: changes during menopause transition.

OBJECTIVE: To measure changes in physical and mental health in six groups of women defined by menopausal status or use of hormone replacement therapy (HRT). DESIGN: Longitudinal study with 2 years follow-up. PARTICIPANTS: Eight thousand six hundred and twenty three women participating in the Australian Longitudinal Study on Women's Health, aged 45-50 years in 1996. MAIN OUTCOME MEASURES: Changes in the eight dimensions of the Short Form General Health Survey (SF-36) adjusted for baseline scores, lifestyle, behavioural and demographic factors. RESULTS: At baseline, mean scores for five of the eight dimensions of the SF-36 were highest (indicating better state of health or well-being) in premenopausal women. There were declines (that is, worsening health) in the SF-36 dimensions in most groups of women. Declines were largest in physical functioning (adjusted mean change of -4.9, standard error (SE) 0.7) and physical role limitation (-5.7, SE: 1.3) in women who remained peri-menopausal throughout the study period and in women taking HRT at the time of either survey (physical functioning: -5.3 (0.7), role physical limitation: -7.5 (1.2)). They were smallest in women who remained pre-menopausal (physical functioning: -3.2 (0.7); role physical limitation: -2.1 (1.1)). CONCLUSIONS: Physical aspects of general health and well-being decline during the menopausal transition. Sensitive measures and careful analysis are needed to understand why these changes are worse for peri-menopausal women and those taking HRT.

Female↗
PubMed2001

The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis (OA) of the knee. METHODS: Forty-six community dwelling patients, aged 55 years or older with knee pain and radiographic evidence of knee OA, were randomized to a 4 month home based progressive strength training program or a nutrition education program (attention control). Thirty-eight patients completed the trial with an adherence of 84% to the intervention and 65% to the attention control. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index pain and physical function subscales. Secondary outcomes included clinical knee examination, muscle strength, physical performance measures, and questionnaires to measure quality of life variables. RESULTS: Patients in the strength training group who completed the trial had a 71% improvement in knee extension strength in the leg reported as most painful versus a 3% improvement in the control group (p < 0.01). In a modified intent to treat analysis, self-reported pain improved by 36% and physical function by 38% in the strength training group versus 11 and 21%, respectively, in the control group (p = 0.01 for between group comparison). In addition, those patients in the strength training group who completed the trial had a 43% mean reduction in pain (p = 0.01 vs controls), a 44% mean improvement in self-reported physical function (p < 0.01 vs controls), and improvements in physical performance, quality of life, and self-efficacy when compared to the control group. CONCLUSION: High intensity, home based strength training can produce substantial improvements in strength, pain, physical function and quality of life in patients with knee OA.

Aged↗
PubMed1997

A revised group exercise program for osteoarthritis of the knee.

The purpose of this study was to determine the effectiveness of a group exercise program for subjects with osteoarthritis of the knee referred for physiotherapy in terms of pain, physical function and gait. This study was initiated after an initial group exercise program at this centre failed to demonstrate significant changes in pain, physical function or gait. The study was based on repeated measures with a two month follow up, carried out in the outpatients department of a large public hospital. Pain levels in various functional situations were assessed on visual analogue scales, physical function with the Stanford Health Assessment Questionnaire, and quantitative gait variables at a normal and a fast self-selected speed with an electric foot switch walkway. On completion of the program (n = 40) more than 90% of the pain and physical function scores demonstrated significant improvements without increases in medication, use of walking aids or fatigue. The gait variables of velocity, cadence and stride length at both self-selected speeds demonstrated significant increases at this assessment without deterioration of gait symmetry. All improvements were maintained at the two month follow up assessments. This study suggests that a clinically realistic group exercise program supplemented with a home program can reduce pain, increase physical function and objective gait measures in subjects with osteoarthritis of the knee.

Aged↗
PubMed2004

Impaired health-related quality of life in Romanian patients with chronic viral hepatitis before antiviral therapy.

BACKGROUND AND AIM: Chronic hepatitis is a disabling condition leading to impairment of a patient's quality of life. We investigated the impact of chronic viral hepatitis on health-related quality of life. The relationship between transaminase level and score in the quality-of-life questionnaire was also investigated. METHODS: We studied 66 patients with chronic viral hepatitis (27 with hepatitis B, 38 with hepatitis C, 1 with hepatitis B+C; 32 men, 34 women) naive to any previous antiviral therapy. All had high levels of transaminases. Patients with chronic disease or those using drugs to modify their quality of life were discarded. The control group consisted of 36 healthy volunteers (17 men, 19 women). Both groups completed the Short Form 36 health survey, with the exception of the items concerning bodily pain. RESULTS: Significant differences between the two groups for every domain of quality of life (physical functioning, role physical, mental health, role emotional, social functioning, vitality and general health) were recorded. We found no significant correlation between the level of transaminases and any item of the health-related quality-of-life questionnaire. In hepatitis B patients, several quality-of-life scores (general health, social functioning, mental health) were better than in hepatitis C patients. CONCLUSIONS: Patients with chronic viral hepatitis not receiving antiviral therapy have an impaired quality of life as estimated by the Short Form 36 health survey.

Adult↗
PubMed2004

Health-related quality of life in end-stage renal disease patients: the effects of renal rehabilitation.

Health-related quality of life (HRQoL) consists of a number of components like functional status, psychological and social functioning, cognition and disease and treatment-related symptoms. End-stage renal disease (ESRD) patients display emotional disturbances, as well as non-adherence to treatment and fluid and food intake, depression, anxiety, social withdrawal and cardiovascular and other co-existing disease morbidity. They have very low functional capacity and physical limitations in their daily activities that affect their mortality and morbidity. Exercise training in ESRD patients is effective in increasing work related activities and important components of their daily life and improving physical functioning. A physical rehabilitation program also leads to a reduction in depression and improvement in family and social interactions. Therefore, renal rehabilitation should be considered as an important therapeutic method for improving physical fitness, social function, well-being and thus health-adjusted quality of life in ESRD patients.

Activities of Daily Living↗
PubMed1991

Racial variations in ischemic stroke-related physical and functional impairments.

BACKGROUND AND PURPOSE: We sought to determine whether there are racial differences in physical and functional impairments resulting from an initial ischemic stroke. METHODS: We conducted a prospective, county-wide, multisite cohort study including a university hospital, a community hospital, and a Veterans Affairs hospital. The study population was an inception cohort of 145 patients hospitalized for ischemic stroke. Physical and functional impairments were measured using a modified form of the Fugl-Meyer test and the Barthel Index, respectively. Nurses trained to use these tests made assessments at admission and 5, 30, 90, and 180 days after admission. Patient and disease-specific data along with treatment data and vital status were collected. RESULTS: Forty-one patients (28%) were black. Compared with whites, black stroke patients were more likely to be widowed (51% versus 26%) and hypertensive (83% versus 63%) but less likely to be male (42% versus 69%) and alert on admission (66% versus 76%). There were no racial differences in mortality. Physical impairment was significantly more severe in black than in white patients at admission, and although physical impairment improved, it remained significantly worse in blacks. Functional impairment was also greater in black patients initially but was similar to that in white patients 90 days after the event. Multivariable analyses confirmed these findings. CONCLUSIONS: These results indicate that blacks may have greater residual physical deficits from stroke than whites.

Activities of Daily Living↗
PubMed2004

Does parallel item content on WOMAC's pain and function subscales limit its ability to detect change in functional status?

BACKGROUND: Although the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) is considered the leading outcome measure for patients with osteoarthritis of the lower extremity, recent work has challenged its factorial validity and the physical function subscale's ability to detect valid change when pain and function display different profiles of change. This study examined the etiology of the WOMAC's physical function subscale's limited ability to detect change in the presence of discordant changes for pain and function. We hypothesized that the duplication of some items on the WOMAC's pain and function subscales contributed to this shortcoming. METHODS: Two eight-item physical function scales were abstracted from the WOMAC's 17-item physical function subscale: one contained activities and themes that were duplicated on the pain subscale (SIMILAR-8); the other version avoided overlapping activities (DISSIMILAR-8). Factorial validity of the shortened measures was assessed on 310 patients awaiting hip or knee arthroplasty. The shortened measures' abilities to detect change were examined on a sample of 104 patients following primary hip or knee arthroplasty. The WOMAC and three performance measures that included activity specific pain assessments--40 m walk test, stair test, and timed-up-and-go test--were administered preoperatively, within 16 days of hip or knee arthroplasty, and at an interval of greater than 20 days following the first post-surgical assessment. Standardized response means were used to quantify change. RESULTS: The SIMILAR-8 did not demonstrate factorial validity; however, the factorial structure of the DISSIMILAR-8 was supported. The time to complete the performance measures more than doubled between the preoperative and first postoperative assessments supporting the theory that lower extremity functional status diminished over this interval. The DISSIMILAR-8 detected this deterioration in functional status; however, no significant change was noted for the SIMILAR-8. The WOMAC pain scale demonstrated a slight reduction in pain and the performance specific pain measures did not reflect a change in pain. All measures showed substantial improvement over the second assessment interval. CONCLUSIONS: These findings support the hypothesis that activity overlap on the pain and function subscales plays a causal role in limiting the WOMAC physical function subscale's ability to detect change.

Activities of Daily Living↗
PubMed1992

A health-related quality of life instrument for patients evaluated for epilepsy surgery.

The goals of surgery in treating intractable epilepsy are to eliminate seizures and improve quality of life. This report describes the development of the Epilepsy Surgery Inventory (ESI)-55, a 55-item measure of health-related quality of life for epilepsy patients. The ESI-55 includes the following scales (number of items in parentheses): health perceptions (9), energy/fatigue (4), overall quality of life (2), social function (2), emotional well-being (5), cognitive function (5), physical function (10), pain (2), and three separate scales of role limitations due to emotional, physical, or memory problems (5 items each). Also included is one change in health item. The ESI-55 was completed by 89% of 224 adults who had undergone a protocol evaluation for epilepsy surgery since 1974. Alpha internal consistency reliability coefficients ranged from 0.76 to 0.88 except for social function (alpha = 0.68). Multitrait scaling analyses supported item discrimination across scales. Factor analysis confirmed previously identified mental and physical health factors, and yielded a third factor defined by cognitive function and role limitations scales. Construct validity was supported by correlations of the ESI-55 with a mood profile instrument. Analysis of ESI-55 scale scores by seizure classification showed that the 44 patients who were seizure-free following surgery scored higher than did 55 patients who continued to have seizures (P less than 0.05 for all comparisons); 43 patients having seizures without loss of consciousness scored in between. Results of this study indicate that the ESI-55 is reliable, valid, and sensitive to differences in seizure status.

Adult↗
PubMed2006

Long-term predictors of outcome in fatigued employees on sick leave: a 4-year follow-up study.

BACKGROUND: Persistent fatigue is strongly associated with functional status and can lead to absenteeism and work disability. Despite several prognostic studies on chronic fatigue, little attention has been paid to occupational outcomes. METHOD: A total of 127 fatigued employees on sick leave were followed-up after 4 years to determine long-term predictors of work disability, fatigue caseness and chronic fatigue syndrome (CFS)-like caseness. Measures included fatigue, physical functioning, illness attributions, psychological problems and emotional exhaustion. RESULTS: Thirty-three participants (26%) were receiving work disability benefits at the 4-year follow-up. Older age and lower levels of physical functioning predicted work disability. Weaker psychological attributions and lower levels of physical functioning were predictors of fatigue caseness. CFS-like caseness was predicted by female gender and lower levels of physical functioning. Self-reported physical functioning remained a strong and statistically significant determinant of work disability [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.24-0.87] and CFS-like caseness (OR 0.20, 95% CI 0.09-0.43) after controlling for confounders. CONCLUSIONS: This study suggests that physical functioning plays an important role in the persistence of fatigue complaints and work disability in employees on sick leave. The course of fatigue is a complex process, and exploring temporal relationships between fatigue, functional status and work status in future research could provide valuable information for the improvement of fatigue management.

Adult↗
PubMed2005

Health status in patients with sub-clinical hypothyroidism.

OBJECTIVE: Sub-clinical hypothyroidism (SCH) is a common disorder. People with this condition may have symptoms which could affect their perception of health. Therefore, the perceived health status of people with SCH was assessed and compared with population-matched norms. DESIGN: A prospective cross-sectional survey. METHODS: Seventy-one adults with SCH, age range 18-64 years were studied. Perceived health status was measured by the Short Form-36 (SF-36) version 2 questionaire, which has been validated in a UK population setting. The SF-36 has eight scales measuring physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health. Their SF-36 scores were compared with UK normative data after matching for age and sex and are reported as z-scores. RESULTS: Scores of all eight SF-36 scales were significantly lower in people with SCH compared with the normative population. A negative score (compared with zero of the normative population) indicates worse health status. The most significantly impaired aspects of health status were vitality and role limitations due to physical problems (role physical scale) with z-scores (95% confidence intervals) of -1.01 (-0.74 to -1.29) and -0.73 (-0.43 to -1.04) respectively. Thyroid autoimmunity did not influence the results. CONCLUSION: Perceived health status is significantly impaired in people with SCH when compared with UK normative population scores. This needs to be taken into consideration by clinicians when managing patients with this disease.

Adult↗
PubMed2006

Lower extremity strength and power are associated with 400-meter walk time in older adults: The InCHIANTI study.

BACKGROUND: It has been suggested that lower extremity muscle power is more important for physical function in older adults compared to strength, and that there is a nonlinear relationship between power or strength and physical function that might be indicative of a threshold above which the association between muscle function and physical function is no longer evident. This study examined the association between lower extremity strength or power with the time to complete a 400-meter walk, and attempted to identify thresholds within the relationship. METHODS: A cross-sectional analysis of a sample of 384 females and 336 males aged > or = 65 years from the InCHIANTI study ("Invecchiare in Chianti," i.e., Aging in the Chianti Area) was conducted. Measures included 400-meter walk time, lower extremity strength and power, comorbidities, and sociodemographic variables (age, gender, height, education, cognitive function, depression). RESULTS: Linear regression models showed that both lower extremity strength and power were significant predictors of 400-meter walk time, although power explained marginally more of the variance in 400-meter walk time. Quadratic models of lower extremity strength and power fit the data slightly better than the linear models. Regardless of gender, comorbidities, or normalization scheme for strength and power, the curvilinear form of the relationship between strength or power and 400-meter walk time remained the same. CONCLUSIONS: Lower extremity muscle strength and power are both important predictors of the 400-meter walk time. Although curvilinear relationships existed between muscle strength and power and the 400-meter walk time, the data do not indicate a clear threshold for either strength or power above which the performance in the 400-meter walk test plateaus.

Aged↗
PubMed2006

Determinants of physical health in frail older people: the importance of self-efficacy.

OBJECTIVE: There is continued uncertainty regarding the strength of association between performance-based and self-report measures of physical functioning, and of their relationship to self-efficacy and health-related quality of life (HRQoL). This study assessed the inter-relationships between such measures, and the predictors of 'physical' aspects of HRQoL in frail older patients. DESIGN: We used statistical models to determine the predictors of 'physical' HRQoL, according to the physical component summary score and the physical functioning domain of the 36-item short form (SF-36) questionnaire. SETTING: Patients were recruited from hospitals in Australia and New Zealand and followed up in their homes. SUBJECTS: Two hundred and forty-three frail older patients. MAIN MEASURES: Physical functioning was assessed using three performance-based measures (Timed Up and Go Test, gait speed and the Berg Balance Scale) and five self-report measures, including the modified falls self-efficacy scale, at three and six months after registration. RESULTS: A moderate association (r = 0.48-0.55) was found between each of the performance-based and self-report measures, including the SF-36 physical component summary score. Multiple linear regression analyses showed that the performance-based measures and falls self-efficacy predicted 33% of the SF-36 physical component summary score. Falls self-efficacy was the single highest predictor of both the SF-36 physical component summary score and SF-36 physical functioning domain. A curvilinear relationship was found between the SF-36 physical functioning domain and two variables: falls self-efficacy and the Berg Balance Scale. CONCLUSIONS: Although performance-based and self-report measures provide complementary but distinct measures of physical function, psychosocial factors such as self-efficacy have a strong influence on the HRQoL of frail older people.

Activities of Daily Living↗
PubMed1998

Burden of illness of multiple sclerosis: Part II: Quality of life. The Canadian Burden of Illness Study Group.

OBJECTIVE: To measure the quality of life (QoL) of multiple sclerosis (MS) patients in Canada using a generic QoL instrument, the SF-36. METHODS: QoL was assessed in 198 MS patients, recruited from 14 MS Clinics in Canada, and stratified into three levels of disease severity, based on their Expanded Disability Status Scale (EDSS) score. Statistical tests were used to compare QoL scores between severity groups and to identify possible relationships between QoL and patient sociodemographic, clinical and economic parameters. RESULTS: QoL scores for all eight scales of the SF-36 were substantially reduced early in the disease. Compared to the normal population, QoL scores for patients with mild MS were on average 30% lower for all SF-36 scales. With EDSS progression a statistically significant decrease in three of the SF-36 domains (physical function, role-physical, and social function) was observed. There were no significant correlations between patient parameters considered and QoL scores. CONCLUSIONS: QoL of MS patients collapses early in the disease. With EDSS progression, physical functioning scales show further decreases in QoL. The absence of further changes in the mental SF-36 scales may be a reflection of patient adaptation to the disease and/or effective support care. However, the SF-36 instrument may be insensitive to some of the QoL changes in MS and a disease-specific instrument may provide additional information on QoL, particularly at later stages of the disease. This study provides a basis for future research aimed at improving management of MS.

Adult↗
PubMed1997

A cost-effectiveness analysis of home care and community-based nursing homes for stroke patients and their families.

A prospective study designed for 336 hospitalized patients with stroke and their families, who were followed from the discharge day to the third month after being discharged, was carried out in order to compare the costs and effectiveness of home care with the community-based nursing homes for stroke patients with different physical function disabilities in terms of ADL scores and their families. The ADL scores of the patients with severe physical function disability did not improve with or without long-term care; however, the patients with moderate physical function disability were significantly improved at the end of the third month, even without interventions from long-term care. The family costs of the patients in nursing homes were substantially lower than the costs for the patients who stayed at home, and the relationship of the family costs of the patients cared for in their own homes was proportional to the patients' physical function status. The labour input from family caregiving accounted for at least 60% of the total family costs of the patients who stayed at home, and the paid for long-term care services accounted for at least 60% of total family costs when the patients stayed in nursing homes. The multiple linear regression demonstrated that the degree of caregiving from families was a predictor of the amount of the costs families incurred for patients with severe physical function disability; as a result the ADL scored on discharge significantly influenced the average total family costs for the patients cared for in their own homes.

Activities of Daily Living↗
PubMedDate not supplied

[Evaluation of health-related quality of life in hospitalized schizophrenics].

Health related quality of life was evaluated in 40 schizophrenics from day hospital at admission, during the treatment and after 8 weeks. In contrast to the psychopathology which significantly decreased after 4 weeks already, the improvement of quality of life was found to be significant only at the discharge from day hospital. The quality of life did not correlate with the severity of schizophrenic symptoms. The older and more frequently hospitalized patients were, the less favorably they evaluated the quality of life. Patients professionally disabled were also less pleased with their quality of life. All quality of life domains improved after treatment with the exception of physical functioning and reported health transition. Physical functioning, role-physical, general health and mental health correlated inversely with severity of schizophrenia after treatment. There was no correlation between clinical improvement after treatment and quality of life domains. The higher was the patients' educational level the better they evaluated their vitality, social functioning and reported health transition.

Adult↗