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PubMed2005

Diagnosis and relation to general health of shoulder disorders presenting to primary care.

OBJECTIVES: To prospectively evaluate the incidence, spectrum of disease and relation to general health of shoulder disorders in primary care. METHODS: Patients presenting with shoulder pain to two large general practices in the Cambridge area over a 1-month period were invited to participate. After consulting their general practitioner, patients were administered a demographic information questionnaire, a shoulder pain and disability index (SPADI) and a short form 36 (SF-36) health survey. Subsequent review in a clinic held by a rheumatology registrar every 2 weeks was undertaken. RESULTS: The sex- and age-standardized incidence of shoulder pain was 9.5 per 1000 (95% confidence interval 7.9 to 11.2 per 1000). Rotator cuff tendinopathy was found in 85%, signs of impingement in 74%, acromioclavicular joint disease in 24%, adhesive capsulitis in 15% and referred pain in 7%. On the SPADI the mean disability subscale score was 45 (95% confidence interval 41 to 50) and the mean pain score was 58 (95% confidence interval 53 to 62) (range 0 to 100). Evaluation of general health status using the SF-36 showed the difference between population norms and those with shoulder pain was significant in six of the eight domains, being especially marked (greater than 20 point reduction) for emotional role, physical function and physical role. CONCLUSION: Shoulder pain, most commonly due to rotator cuff tendinopathy, is associated with significantly reduced health when measured by both specific and generic means. Effort towards prevention and early intervention in these complaints is warranted.

Acromioclavicular Joint↗

PubMed2006

Quality of life is associated to the orthopaedic status in haemophilic patients with inhibitors.

Inhibitors represent one major complication of haemophilia treatment, as they increase the risk of bleeding, physical disability and mortality. The Cost Of Care Inhibitors Study (COCIS) showed that modern strategies applied to manage patients with inhibitors adsorb high amounts of resources but provide satisfactory levels of Health-Related Quality-of-Life (HR-QoL). This paper focuses on determinants of HR-QoL in inhibitory patients. Fifty adult patients, enrolled by 11 Italian Haemophilia Centres, were clinically assessed and filled in two HR-QoL generic questionnaires: the EuroQol instrument (EQ-5D) and the Short Form-36 (SF-36). According to our results, bleeding frequency and inhibitor titres were not found associated with HR-QoL. Global HR-QoL, and in particular the physical component of wellbeing in these patients was found negatively associated with their orthopaedic condition: the EQ-5D Visual Analogue Scale (P<0.001) scores, the SF-36 domain 'physical functioning' and 'physical component summary' (P<0.01) scores were found significantly correlated with the orthopaedic joint score, even after adjusting for patients' age. These results were confirmed by those from the EQ-5D profile. To conclude, the COCIS study is the first study showing that HR-QoL in inhibitory patients is impaired by their orthopedic status, while other aspects do not seem to influence patients' global wellbeing. Our results suggest that while the management of this complication is satisfactory, the attention has now to be focused on the prevention of the orthopaedic problems in these patients, which nowadays constitute one of the most important aspects to be considered in the haemophilia care.

Adolescent↗

PubMed1994

Assessing health-related quality of life in elderly outpatients: telephone versus face-to-face administration.

OBJECTIVE: While health-related quality of life (HRQOL) is increasingly being used as an outcome in clinical trials, it is unknown whether HRQOL assessments are influenced by the method of administration. Within the context of a randomized, controlled trial evaluating a pharmacist intervention for elderly outpatients prescribed at least five medications, we compared telephone and face-to-face administration of the SF-36, a widely used HRQOL measure. DESIGN: Survey. SETTING: General Medicine Clinic, Veterans Affairs Medical Center. PATIENTS: At entry, participants in the randomized trial received continuous care from a general medicine clinic physician, were > or = 65 years of age, and were prescribed > or = 5 regularly scheduled medications. Patients were excluded if they were cognitively impaired and had no caregiver available to participate in the study as a proxy or if they resided in a nursing home. MEASUREMENTS: Subjects completed the SF-36 by telephone at closeout and face-to-face at clinic visits within 1 month (mean = 16.7 days). MAIN RESULTS: Telephone administration required significantly less time than face-to-face interviews (10.2 vs 14.0 minutes, P < 0.001). Although systematic differences between modes of administration were generally small, there were substantial nonsystematic discrepancies for all eight SF-36 scales (mean absolute difference scores ranged from 10.8 to 30.1). Discrepancies were greatest for emotional role functioning, physical role functioning, social functioning, and bodily pain; these four scales also demonstrated low to moderate correlations (.33 to .58). CONCLUSIONS: The two modes of administration may not produce interchangeable results. Researchers should be cautious when mixing modes of administration to elderly patients.

Activities of Daily Living↗

PubMedDate not supplied

Survival and quality of life after cardiac surgery complicated by prolonged intensive care.

AIM: To determine survival, factors determining survival and evaluate quality of life (QOL) after 1 year, in patients who had prolonged intensive care unit (ICU) stay after cardiac surgery. METHODS: In the year 2001, 804 patients underwent various cardiac procedures utilising cardiopulmonary bypass (CPB). Eighty-nine consecutive patients requiring ICU stay of > or = 5 days constituted the study group, majority of these suffered from multiorgan failure (> 2 organ systems). Survival was determined in the study group after 1 year. Patients with an uncomplicated postoperative course were matched to the survivors in the study group with respect to age, gender, type of surgery, risk scores, and duration of follow-up and constituted the control group. The, Short Form Health Survey was used to assess QOL at the end of 1 year in these patients. QOL was compared between the study group and the control group and to that of general population. RESULTS: Seventy percent of the patients in the study group suffered from failure of at least three organ systems. Mean ICU stay was 13 +/- 3 days (median nine, maximum 53). At the end of 1 year the mortality in the study group was 34%. The independent predictors of mortality were: preoperative cardiac support, lower ejection fraction, higher Parsonnet score, higher Euroscore, pulmonary complications, renal failure necessitating hemofiltration, CNS complications, and failure of three or more organ systems. The QOL was lower in the study group than the control group in all eight dimensions measured (significant in five p < 0.05): Physical function, Role physical, Vitality, Mental health, General health, and Bodily pain. CONCLUSION: One year mortality in patients with prolonged ICU stay after cardiac surgery remains high. Identification of risk factors will help to reduce the mortality with help of regular follow up. The QOL remains low in all dimensions especially those measuring physical aspects and pain.

Adult↗

PubMed2005

Psychological and quality-of-life outcomes from a comprehensive stress reduction and lifestyle program in patients with coronary artery disease: results of a randomized trial.

BACKGROUND: Stress reduction and comprehensive lifestyle modification programs have improved atherosclerosis and cardiac risk factors in earlier trials. Little is known about the impact of such programs on quality-of-life (QoL) and psychological outcomes. Given recent significant improvements in cardiac care, we evaluated the current benefit of stress reduction/lifestyle modification on QoL and emotional distress in patients with coronary artery disease (CAD). METHODS: 101 patients (59.4 +/- 8.6 years, 23 female) with CAD were randomized to a 1-year lifestyle/stress management program (n = 48) or written advice (n = 53). QoL and psychological outcomes were assessed with the SF-36, Beck Depression, Spielberger State/Trait Anxiety, Spielberger State/Trait Anger and Perceived Stress Inventories. Group repeated-measures analyses of variance were performed for all measures. RESULTS: Adherence to the program was excellent (daily relaxation practice 39 +/- 5 vs. 5 +/- 8 min, respectively; p < 0.001). Both groups improved comparably in most dimensions of QoL, and significantly greater improvements for the lifestyle group were found for physical function and physical sum score (p = 0.046 and p = 0.045). Depression, anxiety, anger and perceived stress were reduced similarly in both groups. However, intervention x gender interaction effects revealed greater benefits among women in the lifestyle intervention vs. advice group for depression and anger (p = 0.025 and p = 0.040), but no effects for men. CONCLUSIONS: A comprehensive lifestyle modification and stress management program did not improve psychological outcomes in medically stable CAD patients. The program did appear to confer psychological benefits for women but not men. Further trials should investigate gender-related differences in coronary patient responses to behavioral interventions.

Aged↗

PubMed2004

Self-rated health and mortality: does the relationship extend to a low income setting?

Although a relationship between poor self-reported health status and excess mortality risk has been well-established for industrialized countries, almost no research considers developing countries. We use data from Indonesia to show that in a low-income setting, as in more advantaged parts of the world, individuals who perceive their health to be poor are significantly more likely to die in subsequent follow-up periods than their counterparts who view their health as good. This result characterizes both men and women, holds for multiple time periods, and remains after inclusion of measures of nutritional status, physical functioning, symptoms of poor physical health and depression, and hypertension. We also consider the correlates of self-rated health. Symptoms and physical functioning are strong predictors of reporting poor rather than good health, but neither these indicators nor other covariates we consider distinguish between reports of excellent rather than good health.

Data Collection↗

PubMedDate not supplied

Advance directives: a policy-capturing approach.

Policy capturing was used to provide insight into those factors that people consider important in the decision of whether to accept life-sustaining medical treatment. First, open-ended interviews with community-dwelling elderly persons (n = 30) were conducted to determine the factors they would consider when drafting an advance directive. College students (n = 53) then made judgments as to whether they would accept life-sustaining treatment for each of 100 hypothetical vignettes comprising a similar set of factors. Results revealed that 1) students made consistent judgments, 2) there was considerable variability in their mean judgments, 3) the most influential factors were mental and physical functioning, 4) mental and physical functioning had an interactive effect on judgments, and 5) subjective estimates of importance were significantly related to policy-capturing weights. This approach for studying the relationship of individuals' values to their acceptance of life-sustaining therapy may be useful in future studies of patient and surrogate decision making.

Advance Directives↗

PubMed2005

Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement.

BACKGROUND: Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form-36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported. HYPOTHESIS: Short Form-36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The records of active-duty soldiers who underwent hip arthroscopy at the authors' institution were retrospectively reviewed. Forty consecutive patients who underwent hip arthroscopy for the primary indication of labral tear formed the basis of the study group. Patients completed the modified Harris hip score, the Short Form-36 general health survey, and a subjective overall satisfaction questionnaire. RESULTS: Thirty-three patients, with a mean age of 34.6 years, were available for follow-up at a mean of 25.7 months postoperatively. Fourteen (43%) patients were undergoing medical evaluation boards (military equivalent of workers' compensation or disability claim). Pearson correlation coefficients for comparing the Short Form-36 Bodily Pain, Physical Function, and Physical Component subscale scores to the modified Harris hip score were 0.73, 0.71, and 0.85, respectively (P < .001). The mean modified Harris hip score was significantly lower in patients on disability status than in those who were not (92.4 vs 61.1; P < .0001). The Short Form-36 subscale scores were significantly lower in disability patients (P < .02). Patient-reported satisfaction rates (70% overall) were 50% for those undergoing disability evaluations and 84% for those who were not (P < .04). There was no significant difference in outcomes based on patient age, surgically proven chondromalacia, or gender for military evaluation board status. CONCLUSION: The Short Form-36 demonstrated good correlation with the modified Harris hip score for measuring outcomes after arthroscopic partial limbectomy. Arthroscopic debridement yielded a high percentage of good results when patients undergoing disability evaluations were excluded. Disability status may be a negative predictor of success after hip arthroscopy.

Acetabulum↗

PubMed2004

Value of health-related quality of life to predict disability course in multiple sclerosis.

OBJECTIVE: To determine the value of health-related quality of life (HRQoL) to predict change in disability status in patients with multiple sclerosis (MS). METHODS: Over a 5-year period, data were collected on HRQoL (Medical Outcomes Study Short Form-36 Health Survey) and disability status (Expanded Disability Status Scale) from a heterogeneous group of 81 Dutch-speaking patients with MS. RESULTS: Multivariate logistic regression analysis showed that HRQoL in the domains of Physical Functioning and Role-Physical Functioning is a significant predictor of change in disability status. CONCLUSIONS: A patient's subjectively perceived health-related quality of life may not be only a clinically and psychosocially meaningful outcome per se but may also be a predictor of objective outcomes such as change in disability status over a substantial period of time.

Adult↗

PubMed2003

Exercise for patients with chronic disease: physician responsibility.

Patients with chronic disease typically become severely deconditioned, which often leads to physical disability. Every effort should be made to recommend and encourage patients to adopt and maintain a program of physical activity. Although there are no specific exercise guidelines for many chronic conditions, patients should be instructed to start a routine of physical activity that is gradual for most (if not all) days of the week, working up to 30 minutes per session at an exertion level that is easily tolerated. It is critical that assessment of physical functioning and recommendations for physical activity be included as a part of routine medical care. In doing so, we change the expectations of patients and family members, and work toward optimizing physical functioning and quality of life.

Cardiovascular Diseases↗

PubMed2002

Functional and physical interaction between Sgs1 and Top3 and Sgs1-independent function of Top3 in DNA recombination repair.

A mutant allele of SGS1 of Saccharomyces cerevisiae was identified as a suppressor of the slow-growth phenotype of top3 mutants. We previously reported the involvement of Top3 via the interaction with the N-terminal region of Sgs1 in the complementation of methylmethanesulfonate (MMS) sensitivity and the suppression of hyper recombination of a sgs1 mutant. In this study, we found that several amino acids residues in the N-terminal region of Sgs1 between residues 4 and 33 were responsible for binding to Top3 and essential for complementing the sensitivity to MMS of sgsl cells. Two-hybrid assays suggested that the region of Top3 responsible for the binding to Sgs1 was bipartite, with portion in the N- and C-terminal domains. Although disruption of the SGS1 gene suppressed the semi-lethality of the top3 mutant of strain MR, the sgsl-top3 double mutant grew more slowly and was more sensitive to MMS than the sgsl single mutant, indicating that Top3 plays some role independently of Sgs1. The DNA topoisomerase activity of Top3 was required for the Top3 function to repair DNA damages induced by MMS, as shown by the fact that the TOP3 gene carrying a mutation (Phe for Tyr) at the amino acid residue essential for its activity (residue 356) failed to restore the MMS sensitivity of sgs1-top3 to the level of that of the sgs1 single mutant. Epistatic analysis using the sgs1-top3 double mutant, rad52 mutant and sgs1-top3-rad52 triple mutant indicated that TOP3 belongs to the RAD52 recombinational repair pathway.

Adenosine Triphosphatases↗

PubMed2003

The psychosocial impact of the implantable cardioverter defibrillator: a meta-analytic review.

OBJECTIVE: The implantable cardioverter defibrillator (ICD) has become the treatment of choice for ventricular arrhythmia (VA; abnormal heart rhythms) and the prevention of sudden cardiac death (SCD). Recent clinical trials have shown the ICD to be superior to anti-arrhythmic medication in reducing mortality; however, research has suggested that ICD recipients experience poor psychosocial adjustment following implantation of the device. This aim of this study was to identify the key psychological characteristics associated with ICD implantation and to establish whether poor psychosocial outcome can be attributed directly to the device and its therapy. METHOD: Studies which reported valid and reliable measures of psychological functioning in ICD patients and appropriate comparison groups were considered for inclusion in a meta-analytic review. A systematic search of electronic databases and reference lists identified 20 studies which fulfilled the inclusion criteria. RESULTS: There were no significant differences in psychosocial outcome between ICD patients and drug-maintained VA patients or between pre- and post-implant ICD patients. However, ICD patients reported significantly worse psychological functioning and physical functioning than other cardiac controls. CONCLUSION: These findings suggest that poor psychosocial outcome in ICD patients may occur as a result of variables associated with the underlying VA condition, rather than as a direct response to implantation of the device and its therapy. This holds important implications for the development and implementation of psychological interventions for patients experiencing VA, in preference to ICD-specific programmes.

Adaptation, Psychological↗

PubMed2003

[Long-term health-related quality of life in chronic hepatitis B patients].

OBJECTIVE: To evaluate their long-term outcome and the efficacy and economic significance of antiviral drugs by investigating the long-term health-related quality of life (HQL) in chronic hepatitis B (CHB) patients. METHODS: The HQL of 101 CHB patients with biopsy-proven 6 to 18 years ago and 105 persons of general population as control was studied with revised SF-36 questionnaire. RESULTS: The HQL in CHB patients was lower than that in general population in physical functioning, role physical, general health, mental health, and specific symptoms (mu > or = 2.10, P<0.05). CONCLUSIONS: The long-term HQL in chronic hepatitis B patients is poor.

Adolescent↗

PubMed2004

[Validation of the Japanese-translated version Multiple Sclerosis Quality of Life-54 instrument].

The Multiple Sclerosis Quality of Life-54 instrument (MSQOL-54) is a specific quality of life (QOL) scale in English for multiple sclerosis (MS). It is composed of 54 items, and is a combination of the 36-item short form health survey (SF-36) and 18 disease-specific questions, such as fatigue, mental sexual and cognitive dysfunction. We developed the Japanese-translated version of MSQOL-54. The SF-36 has been previously validated and published in Japanese; therefore the translation work was performed mainly on the 18 MS specific items. The Japanese-translated version MSQOL-54 was examined in 62 Japanese patients with MS. The mean age of the patients was 42.8 years; mean expanded disability status scale (EDSS) score was 3.0. The ratio of respondents was almost complete for all scales except for those within the sexual scales. Internal consistency reliability estimates for the 11 multi-item scales ranged from 0.65 to 0.93 in 62 patients. Test-retest intraclass correlation coefficients ranged from 0.61 to 0.95 in 20 patients. Compared to the previous reported mean scores of general Japanese population of SF-36, the mean scores of patients with MS had lower scores in all scales. In comparison with an original article in English, the validation of the Japanese-translated version MSQOL-54 may be acceptable. There were no correlations between the results of the Japanese-translated version MSQOL-54 and EDSS except for physical function and physical health composite score. The Japanese-translated version of MSQOL-54 may provide unique information not readily evaluated by EDSS, and may be useful as clinical outcome measures in patients with MS.

Adult↗

PubMed2006

Effectiveness of physical therapy for the management of chronic spine disorders: a propensity score approach.

BACKGROUND AND PURPOSE: Evidence on the effectiveness of physical therapy for the management of chronic spine disorders is limited. The purpose of this study was to use a large current database, the National Spine Network database, to assess the effectiveness of physical therapy in the management of chronic spine disorders. SUBJECTS: The participants were people who had spine problems lasting 3 months or longer and who were seen for an initial visit and a follow-up visit (N=4,479) at 1 of 17 US spine centers. METHODS: A propensity score approach was used to create a matched sample of participants who received physical therapy (intervention group) and participants who did not receive physical therapy (control group). The 2 groups were similar with regard to more than 50 baseline characteristics. Outcomes were assessed with the Oswestry Disability Index (ODI) and the 36-Item Short-Form Health Survey (SF-36). RESULTS: Both the intervention and control groups improved between the initial and the follow-up visits on ODI scores and on SF-36 physical function, role physical, and bodily pain scores. Although the amount of improvement in the outcome measures was significantly greater for the intervention group than for the control group, the differences were small (3-5 points). When the subgroup of participants who had the greatest propensity for receiving physical therapy was examined, differences in the amount of improvement between the intervention and control groups were larger (5-13 points). DISCUSSION AND CONCLUSION: Physical therapy was effective in the management of chronic spine disorders in participants with the greatest propensity for receiving physical therapy. When the entire sample was considered, differences in the amount of improvement between the intervention and control groups were not clinically relevant.

Adolescent↗

PubMed2006

Gait, quality of life, and their association following total hip arthroplasty.

PURPOSE: Total hip arthroplasty (THA) surgery is one of the most common orthopedic procedures performed on individuals with end-stage osteoarthritis of the hip. This study: () compared temporal spatial gait parameters and quality of life (QOL) scores of individuals with unilateral total hip arthroplasty (THA) to those of healthy older adults ages 65 to 85 years and (2) explored the relationship between the variables. METHODS: Three dimensional motion analysis was used to calculate walking velocity, cadence, stride length, single support time, and double support time. All participants completed the Medical Outcome Survey Short Form 36 Health Survey (SF 36(R)) to measure health related QOL subscales. RESULTS: The individuals with THA walked slower (P = .005) with a longer double support phase (P = .02) and rated physical functioning (P < .0001 ) and role physical scores (P = .001 ) lower than the healthy older adults. For all subjects combined, a positive correlation was identified between walking velocity and physical functioning (P = .001 ), role-physical scores (P = .001 ) and bodily pain (P = .001 ); a negative correlation was identified between double support time and role physical score (P = .002) and bodily pain (P =.002). CONCLUSION: Individuals who undergo THA surgery have gait deficits that relate to physical subscales of the SF36(R). These findings provide guidance for physical therapy interventions focused on gait performance after THA.

Aged↗

PubMed1997

The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: the Whitehall II Study.

OBJECTIVES: This study measured the association between socioeconomic status and the eight scale scores of the Medical Outcomes Study short form 36 (SF-36) general health survey in the Whitehall II study of British civil servants. It also assessed, for the physical functioning scale, whether this association was independent of disease. METHODS: A questionnaire containing the SF-36 was administered at the third phase of the study to 5766 men and 2589 women aged 39 through 63 years. Socioeconomic status was measured by means of six levels of employment grades. RESULTS: There were significant improvements with age in general mental health, role-emotional, vitality, and social functioning scale scores. In men, all the scales except vitality showed significant age-adjusted gradients across the employment grades (lower grades, worse health). Among women, a similar relationship was found for the physical functioning, pain, and social functioning scales. For physical functioning, the effect of grade was found in those with and without disease. CONCLUSIONS: Low socioeconomic status was associated with poor health functioning, and the effect sizes were comparable to those for some clinical conditions. For physical functioning, this association may act both via and independently of disease.

Adult↗

PubMed2004

Regulation of dopamine D1 receptor function by physical interaction with the NMDA receptors.

Functional interactions between dopamine D1-like receptors and NMDA subtype glutamate receptors have been implicated in the maintenance of normal brain activity and neurological dysfunction. Although modulation of NMDA receptor functions by D1 receptor activation has been the subject of extensive investigation, little is known as to how the activation of NMDA receptors alters D1 function. Here we report that NMDA receptors regulate D1 receptor function via a direct protein-protein interaction mediated by the carboxyl tail regions of both receptors. In both cotransfected cells and cultured hippocampal neurons the activation of NMDA receptors increases the number of D1 receptors on the plasma membrane surface and enhances D1 receptor-mediated cAMP accumulation via a SNARE-dependent mechanism. Furthermore, overexpression of mini-genes encoding either NR1 or D1 carboxyl tail fragments disrupts the D1-NR1 direct protein-protein interaction and abolishes NMDA-induced changes in both D1 cell surface expression and D1-mediated cAMP accumulation. Our results demonstrate that the D1-NR1 physical interaction enables NMDA receptors to increase plasma membrane insertion of D1 receptors and provides a novel mechanism by which the activation of NMDA receptors upregulates D1 receptor function. Understanding the molecular mechanisms by which D1 and NMDA receptors functionally interact may provide insight toward elucidating the molecular neurobiological mechanisms involved in many neuropsychiatric illnesses, such as schizophrenia.

Animals↗