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PubMed2004

Health-related quality of life in patients with hip or knee osteoarthritis: comparison of generic and disease-specific instruments.

Health-related quality of life (HRQL) assessment is receiving increased attention as an outcome measure in osteoarthritis (OA). The aims of the study were to assess the health status impact of hip and knee OA in the general older population and to compare the metric properties of the WOMAC disease-specific questionnaire (Western Ontario and McMaster Universities) with generic measures [i.e., the Short Form 36 (SF-36) in patients with OA of the lower extremities]. This cross-sectional survey included a total of 244 patients (99 male, 145 female), aged 50 years and over, with symptomatic OA of the hips (107 patients) and knees (137 patients). All patients completed the WOMAC and the SF-36 questionnaires and were assessed for radiographic damage and for the presence of specific comorbid conditions. The overall impact on health was substantial for both groups of patients with OA of the lower extremities. The most striking impact was seen in OA of the hip for SF-36 "physical function" (p=0.03) and "physical role" (p=0.04), as well as WOMAC "physical function" (p=0.001). Furthermore, impairment of HRQL was only weakly associated with increasing radiographic changes. The SF-36 overall scores showed a better gradient with comorbidities than the WOMAC. This investigation has confirmed that WOMAC is the instrument of choice for evaluating patients with lower limb OA. For a more general insight into patient's health and in particular cross-sectional studies of the elderly, where comorbidity is common, the SF-36 should also be used. This study also provides an estimate of the impact of OA of the hip and knee on HRQL.

Aged↗

PubMed1987

Cancer patients' quality of life over the disease course: lessons from the real world.

We examined the correlates of the Quality of Life Index (QLI) in three samples of cancer patients: newly diagnosed (N = 397), recipients of chemotherapy (N = 194), and terminal (N = 2046). The relative importance of physical, emotional, social, and disease symptom characteristics in predicting the QLI was compared across samples. Despite differences in data collection approaches (telephone, personal interview, or paper and pencil) and differences in patient characteristics, the QLI was a robust construct with its central organizing principle being physical functioning. In all samples, functioning, symptoms, depression, and social support were significant predictors of the QLI, while age and cancer type were only minimally related. The QLI significantly differentiated between patients at different disease phases and measured more than physiological functioning. However analyses suggested that the dominant factor constraining the range of human psychosocial functioning was physical condition.

Aged↗

PubMed2006

Measuring and managing pain and performance.

Pain and movement dysfunction are invariant sensory and motor expressions of health disorders. They are also complex, inter-related problems and may be accompanied by fatigue and depressed mood. Optimum management is predicated on the appropriate selection, application and interpretation of assessment measures. Research on pain and physical function using physical performance tests has shown that regardless of whether pain and impairment is a consequence of musculo-skeletal injury or systemic disease such as cancers, pain-free individuals outperform those with pain in terms of movement speed and endurance ability across a variety of performance tests (e.g. walk and reach tests, and repeated sit-to-stand and trunk flexion tests). Slow movements are characterized by fractionated and extraneous movement patterns. They are also associated with a relatively high level of muscle activity (amplitude and duration) throughout the task compared to fast movements. Slow movements are also relatively inefficient in terms of physiological energy and time burden. For a similar level of effort, individuals with pain are able to perform significantly less work. Our research has shown that individuals with pain move slower across a range of self-selected movement speeds i.e. slow, preferred and fast speeds. It is also apparent that patients systematically over estimate expected pain during task performance at faster speeds. Preliminary work using speed targeted treatment shows promise in terms of improving physical performance and reducing the burden of illness and physical dysfunction.

Humans↗

PubMed1996

The Intermittent Claudication Research Study: vascular outcomes research using home health nurses.

This article describes an ongoing, multicenter outcomes research study on intermittent claudication being conducted at 16 Chicago-area vascular surgery offices and clinics. The study relies on gathering data through a series of home health follow-up visits by visiting nurses who use portable Doppler equipment. A total of 624 patients (506 men and 118 women) have been enrolled to date. Data on study patients' baseline demographic characteristics, leg symptoms, peripheral blood flow, comorbidities, and walking impairments are presented. Initial physical functioning and walking-distance scores from patient self-report questionnaires are also presented, along with attrition and lower-extremity revascularization rates. The contribution of nursing to this type of patient outcomes research is discussed. The changing climate in health care delivery provides nursing with a great opportunity to influence the U.S. health care system. In particular, the participation of nurses can make a major contribution to research on patient outcomes and medical effectiveness, and especially to new methods of comparing treatment effects on patients' functional status. Interpretation and measurement of patient self-reported health status and quality of life are particularly relevant to nursing, which is based on interventions related to compromised function. Improvement of patients' physical functioning is the heart of nursing practice, and the focus of much of what is done in vascular medicine and surgery. This article describes the contribution of nursing skills and knowledge to an ongoing, government-funded, multicenter research study on intermittent claudication. The ability of nurses to make a unique contribution to outcomes research is demonstrated.

Activities of Daily Living↗

PubMed1999

Assessing the consistency of psychometric properties of the HRQoL scales within the EORTC QLQ-C30 across populations by means of the Mokken Scaling Model.

This paper demonstrates how the Mokken Scaling Model and other statistical tools may be useful in assessing the consistency of psychometric properties of health-related quality of life (HRQoL) scales across various populations. The main focus is the psychometric performance of the scales proposed for the EORTC QLQ-C30 in seven patient groups totalling more than 2,000 cancer patients. All scales performed satisfactorily in the total sample with the exception of the role functioning and cognitive functioning scales, which failed in terms of reliability and item discriminant validity. The descriptive statistics for the scales show that several of them, particularly those that build upon only two items, have discrimination problems at the extremes, visible in the high percentages at the maximum or the minimum observed values. The scalability analysis in the subsamples showed that the essential assumption in the Mokken Scaling Model of equal item step order does not hold for the cognitive functioning, emotional functioning and physical functioning scales. We conclude that the Mokken Scaling Model is well suited to the purpose of examining the generalizability of HRQoL scales across subpopulations although a global statistical test of the fit of the measurement model is not available.

Activities of Daily Living↗

PubMed2002

Relationship between obesity and health-related quality of life in men.

OBJECTIVE: Few studies examining the relationship between obesity and health-related quality of life (HRQOL) have used a medical outpatient population or demonstrated a relationship in men. Furthermore, most studies have not adequately considered comorbid illness. The goal of this study was to examine the relationship between body mass index (BMI) and HRQOL in male outpatients while considering comorbid illness. RESEARCH METHODS AND PROCEDURES: This cross-sectional study examined 1168 male outpatients from Durham Veterans' Affairs Medical Center. Multiple linear regression was used to examine the relationship of BMI with each subscale from the Medical Outcomes Study Short Form 36 while adjusting for age, race, comorbid illness, depression, and physical activity. RESULTS: Participants had a mean age of 54.7 +/- 5.6 years; 69% were white and 29% were African American. The distribution for BMI was as follows: 18.5 to <25 kg/m(2) (21%), 25 to <30 kg/m(2) (43%), 30 to <35 kg/m(2) (25%), 35 to <40 kg/m(2) (8%), and > or =40 kg/m(2) (3%). Mean Short Form 36 subscale scores were lower than U.S. norms by an average of 27%. Individuals with BMI > or =40 kg/m(2) had significantly lower scores compared with normal weight individuals on the Role-Physical and Vitality subscales. On the Physical Functioning and Physical Component subscales, lower scores were observed at BMI > or =35 kg/m(2). On the Bodily Pain subscale, lower scores were observed at BMI > or =25 kg/m(2). DISCUSSION: An inverse relationship between BMI and physical aspects of HRQOL exists in a population of male outpatients. Increased BMI was most prominently associated with bodily pain; this relationship should receive more attention in clinical care and research.

Body Mass Index↗

PubMed2001

Longitudinal effects of high-dose chemotherapy and autologous stem cell transplantation on quality of life in the treatment of metastatic breast cancer.

This study determined the effects of high-dose chemotherapy (HDCT) with autologous blood stem cell transplantation (ASCT) on quality of life (QL) in women with metastatic breast cancer prior to, and during treatment, and up to 1-year post-ASCT. Thirty-three women diagnosed with metastatic breast cancer participated in a phase 1 clinical trial of a new combination of cyclophosphamide (CTX) and mitoxantrone (MXT), with dose escalation of paclitaxel. Longitudinal QL data were collected using the functional living index-cancer (FLIC) and symptom scales at seven time periods: pre-induction chemotherapy (CT), post-induction CT, post-high dose CT (HDCT), and at 3, 6, 9 and 12 months post-ASCT. FLIC scores indicated that the worst problems for patients were feelings of hardship on themselves and their families, followed by psychological functioning and physical functioning problems. The time around diagnosis of the metastatic disease and following HDCT were the worst times for all levels of quality of life, but anxiety and depression symptoms continued to increase in severity across the entire follow-up period. The symptoms that were most problematic were worry about the future, loss of sexual interest, anxiety about the treatment, general worrying, and joint pain. These data highlight the problems that women with metastatic breast cancer encounter at different stages of the disease and treatment process, and can be used to tailor psychosocial interventions appropriate for treating the relevant issues at different points in time.

Adolescent↗

PubMed2006

The relationship of excess body weight and health-related quality of life: evidence from a population study in Taiwan.

OBJECTIVE: Excess body weight is related to significant morbidity and mortality. However, less is known about the relationship of body weight to health-related quality of life (HRQOL), especially for Asian populations. We examined the relationship of excess weight and HRQOL in a general population sample from Taiwan. RESEARCH METHODS AND PROCEDURES: This cross-sectional study used a national representative sample (n = 14,221) from the 2001 Taiwan National Health Interview Survey. Body weight was categorized using body mass index (BMI in kg/m2) as normal (18.5-24.9), overweight (25-29.9), and obese (> or = 30). HRQOL was measured using the Taiwan version of the SF-36. We compared the body weight-HRQOL relationships by age, gender, and status of chronic condition, respectively. We especially used the Generalized Estimating Equations (GEE) to examine the relationships of BMI and HRQOL by taking into account the correlations of HRQOL within households. Four models were developed to adjust sequentially for sets of covariates: Model 1 with no adjustment; Model 2 adjusting for sociodemographic variables; Model 3 adding chronic conditions; Model 4 further adding smoking status. RESULTS: Unadjusted physical HRQOL was best for normal weight, worse for overweight, and worst for obese individuals. For unadjusted mental HRQOL, overweight subjects had at least as good mental domain scores of HRQOL as those with normal weight or obesity, depending on the subscales. As age increased, excess weight was associated with worse physical, but not mental HRQOL. Compared to men, women with excess weight showed a greater deficit in physical HRQOL. Multivariable analyses suggested that obesity was associated with worse physical HRQOL compared to overweight, which, in turn, was worse or comparable to normal weight. Specifically, in the model adjusting for demographic variables, the deficit in physical functioning and physical component scores for the obese vs normal weight were statistical significant (P < 0.05) and clinically important difference (effect size > or = 0.3). Both obesity and overweight were associated with higher mental component scores than normal weight, but the effect size was < 0.3. CONCLUSION: In Taiwan, excess weight was related to worse physical, but not mental HRQOL. The lack of impact of increased body weight on mental health status presents a potential challenge to preventing the increases in obesity. More research is needed to elucidate the mechanisms by which excess weight affects specific domains of HRQOL, and to develop effective prevention strategies.

Adolescent↗

PubMed2003

Outcome after intramedullary nailing of femoral shaft fractures.

BACKGROUND: The results of intramedullary nailing of femoral shaft fractures from Australian institutions have not been widely reported. This study examines a consecutive group of patients treated at a major metropolitan trauma centre and reports on the injury statistics and outcome data, and compares this to previously reported results from the literature. METHODS: A total of 101 fractures in 97 consecutive adult patients were included in the study. Nine patients were excluded. At a minimum of 6 months post injury, 54 patients were interviewed by telephone and 35 patients presented for clinical review and underwent physical examination, computed tomography (CT) scanogram of the lower limbs and Short Form 36 questionnaires. RESULTS: Road trauma accounted for 81% of injuries and 15% of fractures were open. Of the 54 patients reviewed, 13 (23%) required further surgery for delayed or non-union. Of the 35 who presented for physical examination, there was poor correlation between perceived leg length discrepancy and measured leg length discrepancy on examination or scanogram. Presence of a limp correlated with measured leg length discrepancy of more than 1 cm but did not correlate with rotational abnormality measured on CT scanogram. Pain at the hip, thigh or knee was present in 60% of patients. The Short Form 36 scores for physical functioning, role--physical, bodily pain, general health and vitality were all significantly lower than population norms with P values ranging from <0.001-0.05. Subgroup analysis comparing isolated femur fracture to multi-trauma patients for all five of these parameters revealed significant differences only in the multi-trauma group. CONCLUSION: The incidence of pain, limp, leg length discrepancy and delayed or non-union is higher in this study than in previously reported results of intramedullary nailing for femoral shaft fractures. This may be due to differences in the patient population, the skill level of the operating surgeon, or incomplete follow up.

Adolescent↗

PubMed2003

Environmental components of mobility disability in community-living older persons.

OBJECTIVES: To examine the relationship between characteristics of the physical environment and mobility disability in community-living older persons. DESIGN: Cross-sectional study conducted on three groups of community-dwelling older adults. SETTING: Community-dwelling older people in Seattle, Washington, and Waterloo, Ontario, Canada. PARTICIPANTS: Fifty-four older adults (> or =70) were recruited from two geographic sites and grouped according to level of physical function (elite, physically able, physically disabled). MEASUREMENT: Subjects reported on frequency of encounter versus avoidance of 24 features of the physical environment, grouped into eight dimensions, using a five-point ordinal scale (never, rarely, sometimes, often, always). Never and rarely responses were combined and coded as not encountered or not avoided, whereas the sometimes, often or always responses were combined and coded as encountered or avoided. RESULTS: Disabled older adults reported fewer encounters with and concomitantly greater avoidance of physical challenges to mobility than nondisabled older adults. However, both encounter and avoidance varied by environmental dimension. CONCLUSION: Results support the hypothesis that mobility disability results from an interaction of individual and environmental factors. Mobility disability is associated with avoidance of some, but not all, physically challenging features within the environment, suggesting that some environmental features may disable community mobility more than others.

Age Factors↗

PubMed2001

Long saphenous vein stripping and quality of life--a randomised trial.

OBJECTIVES: To assess the quality of life of patients undergoing sapheno-femoral junction (SFJ) ligation and long saphenous vein stripping (LSV), using two different techniques. DESIGN: Prospective, randomised trial. MATERIALS AND METHODS: Eighty patients were recruited and randomised to either Perforate Invagination (PIN) stripping (43) or Conventional stripping (37). Patients completed the Short Form 36 (SF-36) and EuroQol (EQ) questionnaires preoperatively, and postoperatively at 6 weeks and 6 months. RESULTS: Bodily pain, role function and physical summary were significantly improved at 6 months in the PIN stripping group. In the Conventional group, bodily pain and physical function were similarly improved, but not role function. EQ global quality of life was significantly and progressively improved at 6 weeks and 6 months in the PIN group (global score p<0.003; self-rated score p <0.001). In the Conventional group there was no overall improvement in global score or self-rated health. CONCLUSIONS: Primary varicose vein surgery is associated with significant and progressive improvements in quality of life scores. Whilst overall quality of health does improve in the Conventional group, this appears to be to a lesser extent than in the PIN group.

Adult↗

PubMed2001

[Background and first results about methodological characteristics of the Aachen Life Quality Inventory].

Health-related quality of life has become an important criterion for assessing disease impact and treatment outcome. Therefore, we developed a questionnaire called Aachen Life Quality Inventory (ALQI) for the use in neurosurgical patients with brain damage. The ALQI is derived from the German version of the Sickness Impact Profile (SIP). The 117 items are formulated on a concrete behavioral level covering the following dimensions of health-related quality of life: 1. activation; 2. mobility; 3. house-work; 4. social contact; 5. family relations; 6. ambulation; 7. work; 8. free-time activities; 9. autonomy; 10. communication; 11. cognitive capacity. As in the SIP, a summary score of total impairment (ALQI Total score), a summary score covering the psycho-social dimension (ALQI Psycho-social score) and a summary score covering aspects of physical functioning (ALQI Physical score) can be calculated. The ALQI consists of a self-rating and a parallel proxy-rating version. The ALQI was validated and psychometrically verified using the data of as yet 231 neurosurgical patients with brain damage of mixed etiology (subarachnoid hemorrhage, closed-head injury, benign brain tumors). Internal consistency (Cronbach's Alpha) ranged from.68 to.91 for the subscales, while it was.97 for the whole instrument,.94 for the psycho-social and.93 for the physical score. The internal consistency for the subscales of the proxy-rating version of the ALQI ranged between.77 and.92, while it was.97 for the whole inventory and.94 for the psycho-social and the physical scores, respectively. Examination of construct validity revealed substantial correlations with a wide range of relevant neurological, neurosurgical and neuropsychological parameters. Beyond other findings, substantial associations emerged with several neuropsychological tests (r =.30 to r =.50), the Glasgow Outcome Scale (r =.39; p <.00) and in patients after subarachnoid hemorrhage with the Hunt& Hess grading (r =.28; p <.001). According to these results, the ALQI promises to become a valid and reliable means for assessing quality of life in patients with brain damage. Nevertheless, further analyses using larger patient samples and with particular emphasis on the investigation of the retest-reliability and the prognostic validity are called for in the future.

Attitude to Health↗

PubMed2002

Modulation of the hepatitis C virus RNA-dependent RNA polymerase activity by the non-structural (NS) 3 helicase and the NS4B membrane protein.

The hepatitis C virus (HCV) nonstructural protein 5B (NS5B) is believed to be the central catalytic enzyme responsible for HCV replication but there are many unanswered questions about how its activity is controlled. In this study we reveal that two other HCV proteins, NS3 (a protease/helicase) and NS4B (a hydrophobic protein of unknown function), physically and functionally interact with the NS5B polymerase. We describe a new procedure for generating highly pure NS4B, and use this protein in biochemical studies together with NS5B and NS3. To study the functional effects of the protein-protein interactions, we have developed an in vitro replication assay using the natural noncoding 3' regions of the respective positive ((+)-3'-untranslated region) and negative ((-)-3'-terminal region) RNA strands of the HCV genome. Our studies show that NS3 dramatically modulates template recognition by NS5B and changes the synthetic products generated by this enzyme. The use of an NTPase-deficient mutant form of NS3 demonstrates that the NTPase activity (and thus helicase activity) of this protein is specifically required for these effects. Moreover, NS4B is found to be a negative regulator of the NS3-NS5B replication complex. Overall, these results reveal that NS3, NS4B, and NS5B can interact to form a regulatory complex that could feature in the process of HCV replication.

DNA Primers↗

PubMed2004

Physical activity interventions in the elderly: cancer and comorbidity.

The relationship among age, comorbidity, and physical activity have been relatively understudied among breast, colorectal, and prostate cancer populations despite their known impact on morbidity and mortality. In this article, we review evidence supporting the efficacy of physical activity interventions in improving cardiovascular risk groups, the elderly and cancer patients. Preliminary studies conducted with older patients suggest that physical activity interventions can reduce fatigue, elevate mood, improve physical functioning, reduce physical, role limitations, decrease falls, attenuate losses in bone density, promote weight loss, and modify CHD risk factors. Although relatively few randomized clinical trials have assessed the efficacy of physical activity interventions in cancer patients, the research suggests that these interventions can have both physical and mental health benefits. The implications and limitations of these findings are discussed. Further studies that use larger sample sizes and examine possible moderating variables, such as age, on the efficacy of such interventions are needed.

Aged↗

PubMed2003

Depression and drug use impact health status among marginally housed HIV-infected individuals.

A representative sample of HIV-positive homeless and marginally housed individuals completed SF-36 health surveys and responses were analyzed for associations with sociodemographic, health, health care, and drug use variables. Among 330 respondents, 83% were male, 43% were African American, and the median age was 39 years. Negative associations were found between female gender and vitality as well as physical functioning; older age and physical functioning; drug use or drug treatment and role-emotional, social functioning, body pain, as well as vitality; health care utilization and depression with all scales. It appeared that depression and drug-related variables were associated with multiple dimensions of health status in this population. Interventions to treat depression and addiction may improve the health status of HIV-infected HMH.

Adult↗

PubMed1995

The prognostic significance of protein-energy malnutrition in geriatric patients.

Although it has been shown that protein-energy malnutrition is a predictor of adverse outcome in geriatric patients, it is unclear whether this is due to underlying disease or disability, or whether malnutrition is an independent outcome predictor. To clarify the predictive role of malnutrition, we analysed the 4.5-year mortality and living location follow-ups of 219 geriatric patients admitted to a geriatric assessment unit. Prevalence of anthropometric and serological malnutrition indicators were between 13.7% and 39.8% at hospital admission. In bivariate models, prealbumin, subnormal arm muscle area, and subnormal body weight were predictors of mortality and survival at home. On the other hand, albumin, transferrin, and triceps skin-fold thickness did not predict these outcomes. In multivariate models the hazard ratio (HR) of 4.5-year mortality remained significant with an HR of 1.8 (95% CI 1.3-2.6) for subnormal arm muscle area, and 1.6 (95% CI 1.0-2.6) for subnormal body weight. Prealbumin was the strongest serological outcome predictor (multivariate mortality HR 1.9, 95% CI, 1.3-2.8). In these models, subnormal cognitive function, impaired physical function, and creatinine clearance < 30 ml/min were also associated with increased mortality. Malnutrition did not predict hospital discharge location, but among patients discharged home, those with initial malnutrition had a decreased length of survival at home. Our findings indicate that certain protein-energy malnutrition indicators are independent risk factors predicting decreased length of overall survival and survival at home in geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1998

Antecedents of frailty over three decades in an older cohort.

Studies of disability in old age have focused on gross measures of physical functioning. More useful results for prevention might be gleaned from examining risk factors associated with frailty, a concept implying a broader range of more subtle problems in multiple domains. This study conceptualized frailty as involving problems or difficulties in two or more functional domains (physical, nutritive, cognitive, and sensory) and analyzed prospective predictors. Subjects were 574 Alameda County Study respondents age 65-102. One-fourth scored as frail; there was no gender difference. Frail persons reported reduced activities, poorer mental health, and lower life satisfaction. Cumulative predictors over the previous three decades included heavy drinking, cigarette smoking, physical inactivity, depression, social isolation, fair or poor perceived health, prevalence of chronic symptoms, and prevalence of chronic conditions. By modifying these risk factors, it may be possible to postpone the onset of frailty or ameliorate its further development.

Age Distribution↗

PubMed2003

Early referral and planned initiation of dialysis: what impact on quality of life?

BACKGROUND: Early patient referral correlates with improved patient survival on dialysis. We examine whether early referral and a planned first dialysis affect quality of life (QoL). METHODS: All patients commencing dialysis in nine centres in seven European countries between 1 July 1998 and 31 October 1999 were recruited. DEFINITIONS: early referral=followed by a nephrologist >1 month before first dialysis (<1 month=late referral); planned=early referral and previous serum creatinine >300 micro mol/l and non-urgent first dialysis (early referral and no creatinine >300 micro mol/l or urgent first dialysis=unplanned). QoL was measured at 8 weeks using a visual analogue scale (VAS) and Short Form 36 (SF-36). RESULTS: VAS was significantly higher in early referral patients [mean (SD) 58.4 (20) vs 50.4 (19), P=0.005], particularly if the first dialysis was planned [60.7 (20) vs 54.2 (20), P=0.03]. Planned patients also had higher SF-36 mental summary scores [45.4 (12) vs 39.7 (11), P=0.003], role emotional scores [58.0 (43) vs 30.9 (38), P=0.003], and mental health scores [63.7 (24) vs 54.6 (22), P=0.01] than unplanned patients. Adjusting for centre and other confounding variables showed that having a planned first dialysis had an independent effect on QoL (VAS, and the SF-36's mental summary score, physical functioning, role physical, general health, role emotional and mental health). Early referral had no independent effect on QoL. Socio-economic status had an important positive effect on physical QoL. CONCLUSIONS: While the effect of early referral to a nephrologist on QoL appeared centre dependent, a smooth transition onto dialysis was associated with significantly better early QoL, independent of other variables.

Adult↗