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PubMed2002

The impact of outpatient rehabilitation on quality of life in multiple sclerosis.

It is well accepted that rehabilitative treatment can be effective in reducing disability and optimizing quality of life (QoL) of people with multiple sclerosis (MS). The aim of this study was to evaluate the effects of a comprehensive outpatient rehabilitative treatment on QoL in patients suffering from MS. We selected 111 patients from a sample of 407 patients who had consecutively entered the MS Center of Catania (which is located in southern Italy) in 1998. Fifty-eight were randomly assigned to the study treatment and 53 to a waiting list (control treatment). Kurtzke's EDSS and quality of Life (QoL)were the primary endpoints. QoL was measured with the generic multi-item SF-36 scales. We also used: the Beck Depression Inventory (BDI) for depression, the Tempelaar Social Experience Check-list (SET) for social activities and the Fatigue Impact Scale (FIS). The study treatment group was treated for 6 consecutive weeks, 6 days a week with a comprehensive rehabilitative outpatient model. The control treatment group was in a waiting list and was trained to self-exercises at home. EDSS remained unchanged in both groups. All health related QoL domains significantly improved in the study treatment (p < 0.001 in physical functioning, role physical, bodily pain, general health, and social functioning; p < 0.05 in vitality, role emotional and mental health). FIS, SET and BDI also improved significantly after the rehabilitative treatment in the study group (p < 0.001). The results of this study confirm the effectiveness of a short comprehensive outpatient model of rehabilitative treatment in people with MS and in particular in their QoL.

Adult↗

PubMed2005

Quality of life assessment before and after lumbar disc surgery.

BACKGROUND: Although operative treatment for lumbar disc herniation is a commonly performed neurosurgical procedure, no reports have described whether health-related quality of life before surgery affects the operative treatment outcome. This prospective study assessed health-related quality of life before and after surgery and evaluated the predictor variables affecting outcomes. METHODS: Subjects were 45 consecutive candidates for lumbar disc herniation surgery who gave informed consent. The Medical Outcomes Study Short Form 36 (SF-36) and 15-point Japanese Orthopaedic Association (JOA) score were evaluated before and after surgery, and the magnitude of the effect was calculated. The possible predictor variables for outcomes were physical functioning, role physical, bodily pain, general health, vitality, social functioning; role emotional and mental health from the SF-36 subscales; subjective symptoms and clinical signs from the JOA scores; and the patient's age, sex, occupation, and history of low back pain and/or leg pain. RESULTS: Four patients were excluded from the analyses because they were lost to follow-up within 1 year after operation. All subscales of the SF-36 and JOA scores increased significantly at 6 months and 1 year of follow-up with a maximum effect size in bodily pain and a minimal in general health. Operation results were 29 good, 11 fair, and 1 poor. The selected predictor variables affecting the outcomes were patient age and social functioning on SF-36. CONCLUSIONS: Surgery for lumbar disc herniation improved health-related quality of life. Patients <50 years old with a <60 score in social functioning on SF-36 were considered good candidates.

Adult↗

PubMed2006

The Portuguese version of the Epilepsy Surgery Inventory (ESI-55): cross-cultural adaptation and evaluation of psychometric properties.

The purpose of this study was to develop a Portuguese version of the Epilepsy Surgery Inventory (ESI-55) and to assess its psychometric properties. Sixty patients with temporal lobe epilepsy related to unilateral mesial temporal sclerosis who underwent presurgical evaluation at the Universidade Federal de São Paulo (UNIFESP) formed the sample for this study. The psychometric properties of the ESI-55 included: reliability, validity, and responsiveness. Internal consistency was high in all domains (Cronbach's alpha ranging from 0.76 for Social Function to 0.88 for Physical Function) except Overall Quality of Life (alpha=0.45). Test-retest reliability after 1 week was good, with the intraclass correlation coefficient ranging from 0.79 (Energy/Fatigue) to 0.92 (Role Limitations due to Emotional Problems). Interrater reliability ranged from 0.84 (Cognitive Function) to 0.94 (Role Limitations due to Physical Problems). For construct validity, we verified a high correlation between the ESI-55 and Health Assessment Questionnaire-8 for the Physical Function domain (Pearson linear correlation=-0.84), and a moderate correlation for the Pain domain (P=-0.58), but for the other subscales no correlation was detected. Beck Depression Inventory and ESI-55 domains were highly statistically correlated (ANOVA: P<0.005), but there was no association of the Cognitive Function and Role Limitations due to Memory Problems subscales with neuropsychological evaluation (Pearson coefficient: P>0.05). With respect to demographic characteristics, a statistically significant correlation was observed for the variable educational level (Student t, P<0.005) and ESI-55 scores. There was a high correlation between seizure frequency and ESI-55 domains for clinical variables (ANOVA, P<0.005). Surgical treatment in this series improved health-related quality of life in the seizure-free group in three domains--Health Perception (1.24), Emotional Well-Being (1.32), and Energy/Fatigue (1.48)-as reflected by the standard response mean and the effect size of the sample. Our results support the psychometric properties of the Portuguese version of the ESI-55 as a measure of health-related quality of life.

Adult↗

PubMed1997

A comparison of surgeon's assessment to patient's self analysis (short form 36) after far lateral lumbar disc surgery. An outcome study.

STUDY DESIGN: Between 1984 and 1994, 170 patients had surgery for far lateral discs. Patients were assessed by the surgeon as having poor (no improvement, increased deficit), fair (mild improvement, moderate residual deficit), good (moderate improvement, mild residual deficit) or excellent (marked improvement, no deficit) physical outcomes. The Medical Outcome Trust's SF-36 survey was completed by 76 (45%) patients, using one interviewer. OBJECTIVES: Patient-based outcome studies are becoming increasingly important. A surgeon's assessment of outcome was compared with the patients' self assessment (Short Form 36) after far lateral lumbar disc surgery. SUMMARY OF BACKGROUND DATA: The SF-36 survey provides measures on eight dimensions: physical function, role physical, bodily pain, general health, vitality, social function, role-emotional, and mental health. METHODS: Patients averaged 60.1 years of age, and included 43 men and 33 women. Patients were last examined an average of 9.1 months after their surgery, and were interviewed by telephone an average of 2.8 years later. RESULTS: Patients completing the survey were evaluated on their last visit to the surgeon as having excellent (32 patients), good (24), fair (12), and poor (8) outcomes. Overall correlations between the surgeon's assessment and all 76 patients' SF-36 scores were modest. However, for those patients examined within 4.5 years of the surgeon's assessment (n = 56), correlations were statistically significant for 6 of the SF-36 measures. Only general health and social function showed correlations less than 0.25. CONCLUSIONS: The surgeon's assessment was a particularly good predictor of SF-36 measures if the surgeon assessed the patient within the past 4.5 years. The SF-36 should be useful for large-scale outcome studies.

Aged↗

PubMed2003

Adult scoliosis: a health assessment analysis by SF-36.

STUDY DESIGN: A prospective self-assessment analysis of a consecutive series of adult patients diagnosed with adult scoliosis of adolescent onset or de novo degenerative scoliosis. PURPOSE: To analyze the impact that scoliosis has on patient health perceptions. SUMMARY OF BACKGROUND DATA: There exists little data studying the effect scoliosis has on an adult's self-perception of health. METHODS: Inclusion criteria were: age > or =18 years, Cobb angle greater than 10 degrees, degenerative or idiopathic deformity, no prior surgery (spine), and complete records. Each patient completed the standard Short Form-36 (SF-36) questionnaire. For each patient, radiographic and clinical data were evaluated. After all data were collected, the mean, standard deviation (SD), and true N values of the Cobb angle were calculated. This study population was then divided into two groups: patients with a Cobb angle greater than 10 degrees and patients with a Cobb angle greater than 20 degrees. Comparison of the SF-36 data for adult scoliosis patients with the United States general population, the United States general population ages 55-64, and patients with hypertension and low back pain was undertaken. RESULTS: The mean age for the patients in this study was 63 years of age; 22 patients were diagnosed as having adult scoliosis of adolescent onset and 27 patients had de novo degenerative scoliosis. The Cobb angle in this study group was found to be greater than 20 degrees in 41 patients; of these patients, 19 patients had a diagnosis of adult scoliosis of adolescent onset and 22 patients had a diagnosis of de novo degenerative scoliosis. Taken as a whole, the patients in this study averaged scores much lower than the norms for both the general U.S. population in all 8 categories and the U.S. population for ages 55 to 64 in 7 out of 8 categories of the SF-36 questionnaire. Additionally, patients with scoliosis also showed lower scores compared to that of the norms found of patients with comorbid conditions: back pain/sciatica with hypertension in seven of the eight categories: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. Of the radiographic parameters analyzed, loss of lumbar lordosis revealed a significant correlation with social function: P = 0.018; role emotional: P = 0.038; and overall general health: P = 0.05. The other radiographic parameters did not reveal statistically significant correlation to the calculated SF-36 scores. CONCLUSION: Our data clearly demonstrate the impact that adult scoliosis has on a patient's perception of health. The severity of this impact is strikingly apparent in the SF-36 scores when compared to benchmark data on patients with comorbid conditions such as back pain and hypertension. It is our conclusion that adult scoliosis is becoming a medical condition of significant impact, affecting the fastest growing section of our society to a previously unrecognized degree.

Adolescent↗

PubMed1996

Comparison of measures to assess outcomes in total hip replacement surgery.

OBJECTIVES: To compare the performance of a disease specific and a general health questionnaire in assessing changes resulting from total hip replacement. DESIGN: Two stage prospective study of patients undergoing total hip replacement surgery involving an assessment at a clinic before and six months after surgery. 60(32%) patients were followed up by post. SETTING: Outpatient departments at a specialist orthopaedic hospital and peripheral clinics within Oxfordshire. PATIENTS: 188 patients admitted for unilateral total hip replacement between February and mid-August 1994. MAIN MEASURES: Patients' self assessed scores with the 12 item Oxford hip score and SF-36 general health questionnaire together with surgeons' assessment with Charnley hip score obtained before and again at six months after surgery. RESULTS: 186 patients were followed up six months after total hip replacement; a subsample (n=60) by post. Of the 60 postal patients, 59(98.3%) fully completed the Oxford hip score compared with 44(73.3%) who fully completed the SF-36. For the followup sample as a whole, post operative changes in scores produced a large effect size of 2.75 on the Oxford hip score, compared with -1.89 physical function (SF-36), -2.13 pain (SF-36). With the exception of physical function and role (physical), postoperative SF-36 scores were shown to be similar to or better than those found by two population surveys on patients of comparable age. The responsiveness of a disease specific questionnaire, the Oxford hip score, and relevant sections of a general questionnaire, SF-36, were found to be similar as assessed by three different criteria. CONCLUSIONS: A disease specific questionnaire, the Oxford hip score, and a general state of health questionnaire, SF-36, performed similarly in assessing outcomes of total hip replacement except that the disease specific questionnaire resulted in a higher completion rate and greater responsiveness in some sections. On the other hand the general health questionnaire drew attention to broader problems of physical function not considered by the Oxford hip score. The health questionnaires examined here offer a valid and practical means of monitoring outcomes of hip replacement surgery.

England↗

PubMed2000

A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults.

OBJECTIVE: Older adults hospitalized for nondisabling diagnoses can lose functional ability. Lack of exercise or physical activity during the acute illness and recovery may be contributory. This study evaluated whether increased exercise in hospital and afterward would shorten length of stay and improve physical function at 1 month. DESIGN: A randomized controlled trial. SETTING: A 700-bed community-based hospital with academic and teaching programs. PARTICIPANTS: Three hundred patients (mean age 78.2 years +/- 5.6) with nondisabling medical and surgical diagnoses who were admitted to an acute care hospital between December 1990 and April 1992. All patients had an expected length of stay 5 or more days, were ambulatory before admission, and were not expected to die within 12 months. INTERVENTION: A hospital-based general exercise program was administered to intervention patients along with encouragement to continue the program, self-administered, at home. MEASUREMENTS: The primary outcome was hospital length of stay. Secondary outcomes at 1 month post-discharge included measures of physical function and other general health indicators. RESULTS: There was no significant difference in length of stay between treatment and control groups controlling for baseline characteristics and diagnoses. The intervention was associated with better function in instrumental activities of daily living (beta = .433 (95% CI, 0.044-0.842)) at 1 month but no change in perceived general health status and other measures of physical function. CONCLUSIONS: An exercise program started during hospitalization and continued for 1 month did not shorten length of stay but did improve functional outcome at 1 month.

Activities of Daily Living↗

PubMed2002

Relations between fatigue, neuropsychological functioning, and physical activity after treatment for breast carcinoma: daily self-report and objective behavior.

BACKGROUND: Previous research indicates that disease free breast carcinoma survivors who experienced severe fatigue also had many problems with regard to neuropsychological functioning and physical activity, measured with general self-report questionnaires. Both neuropsychological functioning and physical activity can be measured with daily self-report measures in addition to measures of objective behavior. The main objective of this study was to examine the relations between 1) fatigue and 2) daily self-reported and objective measures of neuropsychological functioning and physical activity. METHODS: Disease free breast carcinoma survivors and age-matched women with no history of breast carcinoma filled out a daily self-observation list and wore an actometer during a period of 12 days. Furthermore, they performed two standardized tests to assess neuropsychological functioning. RESULTS: No differences were found between severely fatigued disease free breast carcinoma survivors, nonseverely fatigued disease free breast carcinoma survivors, and women in a control group with regard to daily self-reported and objective physical activity. The severely fatigued disease free patients reported more impairment in neuropsychological functioning on daily questionnaires compared with nonseverely fatigued disease free patients and women in the control group. However, no differences were found between these three groups on a standardized concentration task. On a standardized reaction time task, no significant differences were found between the two groups of disease free breast carcinoma survivors: However, women in the severely fatigued group had a significantly longer reaction time compared with women in the control group. CONCLUSIONS: Fatigue is correlated strongly with daily self-reported neuropsychological functioning, but not with objective neuropsychological functioning, in a laboratory setting. In the current study, fatigue was not correlated with daily self-reported and objective physical activity.

Activities of Daily Living↗

PubMedDate not supplied

Internal health status belief and lower perceived functional deficit are related among anterior cruciate ligament-deficient patients.

PURPOSE: Health locus of control has been shown to influence the recovery process after injury and surgery. This study attempted to determine relationships between patient perceptions of health locus of control and their perceived functional limitations after anterior cruciate ligament (ACL) rupture. An external health locus of control refers to the belief that one's outcome after injury or surgery is under the control of powerful others or is determined by fate, luck, or chance. An internal health locus of control refers to the belief that one's outcome is directly related to individual patient behaviors. TYPE OF STUDY: Quasi-experimental, posttest only design. METHODS: Over a 1-year time period, 70 consecutive patients with unilateral ACL deficiency (acute, <1 month after onset) agreed to participate in this study. All data were collected 1 week before ACL reconstruction. Subjects completed the Health Locus of Control Scale (HLC) and the physical function section of the Short Form 36 (SF-36) Health Survey. A Kruskal-Wallis 1-way analysis of variance was used to assess group differences (P <.05) based on SF-36 physical function score classification. RESULTS: Subjects with minimal perceived functional limitations (SF-36 physical function group 3) displayed lower (more internal) HLC scores (29.6 +/- 4.4; range, 24-36) than subjects with moderate perceived functional limitations (SF-36 physical function group 2) (33.0 +/- 6.1; range, 22-44) or subjects with maximal perceived functional limitations (SF-36 physical function group 1) (33.9 +/- 2.8; range, 30-38). CONCLUSIONS: Subjects with lower perceived functional limitations regarded their health status as being controlled more by internal factors. It is not proven whether there is a cause-and-effect relationship or which of these parameters is the antecedent. Related reports suggest that perception of control may positively influence functional outcome and disability levels. Patients who perceive preoperative pain and functional limitation to be excessive may have low tolerance for the stressors associated with surgery and postoperative rehabilitation. With these patients, a more conservative surgical and rehabilitation approach may be better. Alternatively, methods to change their perceptions, such as cognitive therapy, may have a positive role.

Activities of Daily Living↗

PubMed2000

Assessment of health-related quality of life in renal transplant and hemodialysis patients using the SF-36 health survey.

OBJECTIVES: To determine whether the health-related quality of life (HQOL) for renal transplant patients improved using SF-36 survey scores and to examine which clinical measures after renal transplantation are connected to aspects of their HQOL. METHODS: A total of 117 renal transplant patients and 114 hemodialysis patients, including 49 awaiting transplantation and 65 not awaiting transplantation, were included in this study. The scale scores of the SF-36 survey concerning HQOL were compared between the two groups of patients. The relationships of the clinical episode and complications with the scale scores were examined. RESULTS: The renal transplant patients had significantly higher scores in the physical functioning, bodily pain, general health, and social functioning scales than did the hemodialysis patients. The role-physical functioning, bodily pain, and social functioning scales of the transplant patients were significantly higher than those of the hemodialysis patients not awaiting transplantation. In contrast, the scores, except for that of general health, of the transplant patients were not significantly different from those of the hemodialysis patients awaiting transplantation. Multiple regression analysis demonstrated that the scale scores of physical functioning, general health, and vitality were significantly dependent on the serum level of creatinine in the renal transplant patients (P <0.05). The scores of physical functioning and general health of the patients with a creatinine level >2 mg/dL were significantly lower than those of the patients with 1 mg/dL < creatinine level </=1.5 mg/dL or a creatinine level </=1 mg/dL (P <0.05). An episode of hospitalization was not related to the scale scores, but an instance of rejection had an effect on the scores of social functioning and role-emotional functioning. CONCLUSIONS: The SF-36 health survey is a short but comprehensive scale for evaluating a patient's HQOL. The renal transplant patients' HQOL improved compared with that of the hemodialysis patients. The most important factor affecting HQOL was the serum creatinine level at the time of testing with the SF-36 survey.

Adult↗

PubMed2005

A multi-centre European study of factors affecting the discharge destination of older people admitted to hospital: analysis of in-hospital data from the ACMEplus project.

OBJECTIVES: to examine the relationship between seven predictor variables (recorded on Day 3 of hospital admission) and discharge destination in non-elective medical patients aged 65+ years. DESIGN: prospective cohort. SETTING: eight centres in six European countries. PREDICTOR VARIABLES: age, gender, living alone, physical function (three categories based on Barthel Index), cognition (Katzman's orientation-memory-concentration test), main body system affected (based on International Classification of Diseases), number of geriatric giants (GGs) involved in the referral (a GG being a problem with falling, mobility, continence or cognition). MAIN OUTCOME MEASURES: discharge destination (by Day 90) in three categories: 'HOMESAME' (return to previous residence), 'INSTIN90' (discharge to alternative residence or still in hospital at 90 days), 'DEADINHO' (death in hospital), RESULTS: in 1,626 patients, discharge destination was HOMESAME in 84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay was 17.7 days, median 12. Univariate analyses showed a statistically significant relationship between all seven predictor variables and discharge destination. Physical function was the best single predictor with a seven-fold difference in adverse outcome rates between the best and worst categories. On multiple logistic regression, significant predictor variables were as follows. (i) For DEADINHO: physical function, cognition, gender; (ii) for INSTIN90: physical function, living alone, GGs, age, gender. Multiple linear regression identified physical function, GGs and living alone as predictors of loge length of stay. CONCLUSION: case-mix systems to compare risk-adjusted hospital outcome in older medical patients need to incorporate information about physical function, cognition and presenting problems in addition to diagnosis.

Activities of Daily Living↗

PubMed2003

Health-related quality of life of Japanese patients with chronic heart failure: assessment using the Medical Outcome Study Short Form 36.

Chronic heart failure is characterized by impaired cardiac function, but the relationship between clinical indices and subjective perception is not clear. This study was undertaken to investigate the relationship between cardiac function, exercise capacity and clinical classification, and the health-related quality of life (HRQOL) in 91 outpatients with an left ventricular ejection fraction (LVEF) less than 40%. Exercise capacity was evaluated by the Specific Activity Scale, and HRQOL by the Medical Outcome Study Short Form 36. Exercise capacity and the cardiothoracic ratio were correlated with the HRQOL related to physical functioning, although the correlation between exercise capacity and mental health was not significant. LVEF was not related to HRQOL. Factor analysis revealed (1) LVEF was independent of physical functioning; (2) physical function and exercise capacity comprise a factor reflecting physical HRQOL; and (3) socio-emotional functioning is the third factor independent of LVEF and physical function. Physical and socio-mental HRQOL measurement included information independent of the widely used clinical indices such as LVEF and New York Heart Association classification. The evaluation of HRQOL should be included in the assessment of patient status.

Aged↗

PubMed2004

Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of cognitive behaviour therapy for adolescents aged 10-17 years with chronic fatigue syndrome. DESIGN: Randomised controlled trial. SETTING: Department of child psychology. PARTICIPANTS: 71 consecutively referred patients with chronic fatigue syndrome; 36 were randomly assigned to immediate cognitive behaviour therapy and 35 to the waiting list for therapy. INTERVENTION: 10 sessions of therapy over five months. Treatment protocols depended on the type of activity pattern (relatively active or passive). All participants were assessed again after five months. MAIN OUTCOME MEASURES: Fatigue severity (checklist individual strength), functional impairment (SF-36 physical functioning), and school attendance. RESULTS: 62 patients had complete data at five months (29 in the immediate therapy group and 33 on the waiting list). Patients in the therapy group reported significantly greater decrease in fatigue severity (difference in decrease on checklist individual strength was 14.5, 95% confidence interval 7.4 to 21.6) and functional impairment (difference in increase on SF-36 physical functioning was 17.3, 6.2 to 28.4) and their attendance at school increased significantly (difference in increase in percentage school attendance was 18.2, 0.8 to 35.5). They also reported a significant reduction in several accompanying symptoms. Self reported improvement was largest in the therapy group. CONCLUSION: Cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome in adolescents.

Absenteeism↗

PubMed2000

Measuring health status in Israeli patients with fibromyalgia syndrome and widespread pain and healthy individuals: utility of the short form 36-item health survey (SF-36).

OBJECTIVES: To examine the usefulness of the Medical Outcomes Study Short Form-36 (MOS SF-36) in measuring health-related quality of life (QOL) in fibromyalgia syndrome (FMS) patients, and to determine whether subscale scores of SF-36 could distinguish patients with FMS from patients with widespread pain alone, and from healthy individuals. METHODS: The study population included three groups of women: 90 patients with FMS, 96 patients with widespread pain, and 50 healthy controls. In all subjects, health-related QOL was assessed by SF-36. The Health Assessment Questionnaire was used to evaluate functional disability, helplessness and psychological status. FMS-related symptoms and tenderness also were assessed. RESULTS: The 8 subscales of SF-36 showed a consistent pattern for physical function, physical role functioning, body pain, general health, vitality, and social function, with the lowest scores in patients with FMS, intermediate scores in patients with widespread pain alone, and the highest scores in healthy subjects. Emotional role functioning and mental health scores were significantly higher among healthy controls than among patients. The SF-36 subscales of physical functioning, bodily pain, and social functioning were highly correlated with another measure of functional disability (from the Health Assessment Questionnaire) in all patient groups. Most of the subscales were associated with psychological variables (helplessness, depression, and anxiety). All eight subscales of SF-36 were strongly correlated with the mean score of another measure of quality of life, QOL-16. CONCLUSIONS: Most of the SF-36 subscales represent health dimensions relevant to patients with FMS and widespread pain alone. The severity of functional impairment as assessed by the SF-36, distinguishes patients with FMS and widespread pain alone from healthy individuals, and also discriminates between patients with widespread pain alone and FMS patients.

Activities of Daily Living↗

PubMed2002

Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care.

OBJECTIVES: To evaluate the long term effect of ongoing intervention to improve treatment of depression in primary care. DESIGN: Randomised controlled trial. SETTING: Twelve primary care practices across the United States. PARTICIPANTS: 211 adults beginning a new treatment episode for major depression; 94% of patients assigned to ongoing intervention participated. INTERVENTION: Practices assigned to ongoing intervention encouraged participating patients to engage in active treatment, using practice nurses to provide care management over 24 months. MAIN OUTCOME MEASURES: Patients' report of remission and functioning. RESULTS: Ongoing intervention significantly improved both symptoms and functioning at 24 months, increasing remission by 33 percentage points (95% confidence interval 7% to 46%), improving emotional functioning by 24 points (11 to 38) and physical functioning by 17 points (6 to 28). By 24 months, 74% of patients in enhanced care reported remission, with emotional functioning exceeding 90% of population norms and physical functioning approaching 75% of population norms. CONCLUSIONS: Ongoing intervention increased remission rates and improved indicators of emotional and physical functioning. Studies are needed to compare the cost effectiveness of ongoing depression management with other chronic disease treatment routinely undertaken by primary care.

Adult↗

PubMed2006

Health-related quality of life among haemodialysis patients--relationship with clinical indicators, morbidity and mortality.

AIM: To verify the association between quality of life and morbidity, mortality and clinical indicators in haemodialysis patients. BACKGROUND: While a number of therapies have been reported to increase quality of life in end-stage renal disease, patients report that they remain substantially burdened by limited physical functioning and by dialysis-related symptoms. Indeed, quality of life may be the most critical outcome for those undergoing haemodialysis. Furthermore, quality of life has been associated with clinical indicators, morbidity and survival in haemodialysis patients. DESIGN: Descriptive cohort study of patients undergoing haemodialysis at the Nephrology Hemodialysis Unit of the Hospital de Clínicas in Porto Alegre, Brazil. METHODS: Forty haemodialysis patients were followed for 12 months and evaluated for demographics, time on dialysis, diabetes mellitus, clinical indicators (dose of dialysis--Kt/V, haematocrit and serum albumin) and comorbidities. The comorbidities were evaluated with the end-stage renal disease severity index and health-related quality of life with The Medical Outcomes Study 36 (SF-36). RESULTS: Men present higher health-related quality of life scores in the energy and fatigue component (P = 0.04). Patients treated for over one year at the beginning of follow up and patients with less schooling had better results in General Health Perception (P < 0.05). The health-related quality of life evaluation of patients who later died showed that they already had a worse perception of physical functioning as compared to the survivors (P = 0.05). Patients with diagnosed diabetes perceived their physical functioning more negatively compared with those with other etiologies of end-stage renal disease (P = 0.045). We found a correlation between physical functioning and serum albumin (r = 0.341, P < 0.05) and between physical functioning and haematocrit (r = 0.317, P < 0.05). The end-stage renal disease severity index was more strongly related to physical functioning (r = -0.538, P < 0.001). Comparing the patients' results to the indicators above and below the established targets, we observed a trend to worse health-related quality of life in patients with Kt/V above target. However, in the case of albumin, patients with results above target tended to have better results. CONCLUSION: A close relationship was observed between quality of life and morbidity and mortality. Among the clinical indicators, albumin and haematocrit have the greatest influence on quality of life. RELEVANCE TO CLINICAL PRACTICE: Haemodialysis patients experience various problems that may adversely influence their quality of life. Special care must be given to those who have diabetes mellitus, high morbidity scores, low serum albumin and low haematocrits.

Brazil↗

PubMed1998

The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.

Cross-Cultural Comparison↗

PubMed1996

The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system.

BACKGROUND AND PURPOSE: Disorders of the facial neuromuscular system can result in marked disfigurement of the face and difficulties in activities of daily living such as eating, drinking, and communicating. No systematic means of measuring the disability associated with facial nerve disorders exists. The purpose of this investigation was to examine the reliability and construct validity of the Facial Disability Index (FDI), a disease-specific, self-report instrument for the assessment of disabilities of patients with facial nerve disorders. SUBJECTS AND METHODS: The FDI was administered to 46 ambulatory patients of the University of Pittsburgh Medical Center's Facial Nerve Center. The relationship of the FDI subscale and total scores with clinical impairment measures was determined, and a comparison of the use of the FDI and subscales of the more general SF-36 was made. RESULTS: The FDI subscales produced reliable scores (theta reliability: physical function = .88; social/well-being function = .83). Construct validity of the FDI physical function subscale was demonstrated by a correlation with the clinician's physical examination of facial movement. The FDI social/well-being subscale was associated with the FDI physical function subscale and with a clinical assessment of psychosocial status within a subset of the sample (n = 14). The FDI represented the relationship between impairments, disability, and psychosocial status better than the generic SF-36 did. CONCLUSION AND DISCUSSION: The FDI subscales produce reliable measurements, with construct validity for measuring patient-focused focused disability of individuals with disorders of the facial motor system.

Activities of Daily Living↗