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Results for “Physical function”

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PubMed1998

Well-being, cerebral function, and physical fatigue after nocturnal hypoglycemia in IDDM.

OBJECTIVE: This study assessed the effect of nocturnal hypoglycemia on well-being cerebral function, and physical fatigue the next day in 10 subjects with IDDM. RESEARCH DESIGN AND METHODS: After an exercise test to determine work-loads corresponding to 30 and 60% VO2max, volunteers were studied twice, 4 weeks apart. Blood glucose was lowered one night to 2.3-2.7 mmol/l for 1 h, and at the control visit, hypoglycemia was avoided. The next morning, well-being was assessed using the minor symptom evaluation profile (MSEP), and cerebral function was assessed with the paced auditory serial addition test, the digit symbol substitution test, trail making part B, four-choice reaction time, and auditory P300 latency. Subjects then exercised at predetermined workloads corresponding to 30% VO2max for 30 min and 60% VO2max until exhaustion. Fatigue was assessed every 10 min using the Borg scale for rating of perceived exertion. RESULTS: All three components of the MSEP scored higher (indicating more symptoms) after the hypoglycemic night compared with the control night (P < 0.01 contentment, sleep; P < 0.001 vitality). None of the cerebral function tests performed the next day was affected by hypoglycemia. Exercise capacity was similar at both visits, but subjects were more fatigued after the hypoglycemic night (P < 0.01, analysis of variance). There were no differences in potassium, catecholamine, glucose, or lactate concentrations between visits either before or during exercise. CONCLUSIONS: One hour of hypoglycemia at night affects a subject's sense of well-being, but not cerebral function, the next day. The greater fatigue after the hypoglycemic night cannot be explained by the biochemical parameters measured.

Activities of Daily Living↗

PubMed2004

BMI and health-related quality of life in adults 65 years and older.

OBJECTIVE: To examine relationships of BMI with health-related quality of life in adults 65 years and older. RESEARCH METHODS AND PROCEDURES: In 1996, a health survey was mailed to all surviving participants > or = 65 years old from the Chicago Heart Association Detection Project in Industry Study (1967 to 1973). The response rate was 60%, and the sample included 3981 male and 3099 female respondents. BMI (kilograms per meter squared) was classified into four groups: underweight (<18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9), and obese (> or = 30.0). Main outcome measures were Health Status Questionnaire-12 scores (ranging from 0 to 100) assessing eight domains: health perception, physical functioning, role limitations-physical, bodily pain, energy/fatigue, social functioning, role limitations-mental, and mental health. The higher the score, the better the outcome. RESULTS: With adjustment for age, race, education, smoking, and alcohol intake, obesity was associated with lower health perception and poorer physical and social functioning (women only) but not impaired mental health. Overweight was associated with impaired physical well-being among women only. Both underweight men and women reported impairment in physical, social, and mental well-being. For example, multivariable-adjusted health perception domain scores for women were 50.8 (underweight), 62.7 (normal weight), 60.5 (overweight), and 52.1 (obese), respectively. Associations weakened but remained significant with further adjustment for comorbidities. DISCUSSION: Compared with normal-weight people, both underweight and obese older adults reported impaired quality of life, particularly worse physical functioning and physical well-being. These results reinforce the importance of normal body weight in older age.

Aged↗

PubMed2006

Is a generic quality of life instrument helpful for evaluating women with urinary incontinence?

OBJECTIVES: The aim of this study was to determine whether a generic health outcome instrument would be helpful for evaluating women with stress urinary incontinence (UI) combined with or without urge UI. METHODS: A total of 109 women with UI and 80 controls participated in the study. Health-related quality of life (QOL) was measured using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and the Incontinence Quality of Life (I-QoL) questionnaire. RESULTS: Among eight domains of the SF-36 questionnaire, only four domains, namely, 'role-physical functioning' (p<0.05), 'vitality' (p<0.05), 'mental health' (p<0.05) and 'bodily pain' (p<0.05) were significantly different between the groups. Comparing the I-QoL sores in the two groups, patients with UI had significantly poorer subscale scores of I-QoL than the controls (p<0.05 for all domains). When women with UI were subdivided into groups of stress and mixed UI, only 2 domains of the SF-36 questionnaire, 'role-physical functioning' (p<0.05) and 'bodily pain' (p<0.05), were significantly different. The mixed UI group had higher scores only on these two domains compared to the stress UI group. In the 'role-physical functioning' domain, there was no significant difference between the mixed UI group and the controls. In 'bodily pain' domain, there was no significant difference between the stress UI group and the controls. The mixed group had the highest scores observed. Patients with mixed UI had significantly lower total scores compared to those with stress UI, including the subscale score of 'avoidance behavior' of the I-QoL. Among eight domains of the SF-36, only 'physical functioning' (r = 0.281, p<0.01) and 'social functioning' (r = 0.239, p<0.05) were weakly correlated with 'psychological impact' of the I-QoL. CONCLUSION: Our findings show that the generic QOL instrument is not sensitive measure of QOL in women with UI.

Adult↗

PubMed2004

Health-related quality of life in adult rhinitis: the role of perceived control of disease.

BACKGROUND: Factors affecting health-related quality of life (HRQOL) in adult rhinitis have not been well described. OBJECTIVE: To understand how symptom severity, physical functioning, psychological distress, and perceived control of disease relate to HRQOL in a population-based sample of adults with rhinitis. METHODS: We conducted telephone interviews in 109 adults with rhinitis recruited via random digit dialing. We assessed HRQOL by using the Rhinosinusitis Disability Index, physical functioning by using the physical component score of the Short Form-12, and psychological distress by using the Center for Epidemiologic Studies Depression Scale. To evaluate the role of patient-perceived control of disease in rhinitis, we developed a new 8-item instrument, the Perceived Control of Rhinitis Questionnaire. RESULTS: Lower HRQOL correlated with greater symptom severity ( r=0.57), poorer physical functioning ( r=-0.41), greater psychological distress ( r=0.44), and less perceived control ( r=-0.53). In a multivariate model, symptom severity ( P < .001), psychological distress ( P <.001), and perceived control ( P <.001) were all independent predictors of HRQOL. Adding functional and psychosocial measures to a base model with demographics and disease severity explained an additional 26% of variance in HRQOL. CONCLUSIONS: Although disease severity is an important factor in HRQOL, psychosocial factors, such as perceived control of disease, explain a substantial amount of the variability in HRQOL among adults with rhinitis.

Adolescent↗

PubMed2002

Quality of life in multiple sclerosis: influence of interferon-beta1 a (Avonex) treatment.

BACKGROUND: Numerous data argue for initiating treatment with interferon-beta (IFN-beta) at an early stage in multiple sderosis (MS). The consequences of its use may negatively influence the MS patient's quality of life (QoL). OBJECTIVE: To evaluate the QoL of MS patients before and after a one-year period of treatment with IFN-beta1a (Avonex). PATIENTS AND METHODS: QoL was assessed using the SF-36 in 121 relapsing-remitting MS patients. We compared QoL before and after treatment and with data from a normal population. We also studied the possible influence of disease progression on the SF-36 scores. RESULTS: One hundred six patients completed the study (87%). Compared to a normal population, patients were, at baseline, worse off for all QoL scales, varying from a minimum decrease of 0.73 SD in mental health, to a maximum decrease of 1.55 SD in general health. After treatment, we found no significant changes in any of the QoL scores, except for physical function, where we noted a slight but significant decrease (p = 0.03). Furthermore, there was no significant change either in the physical component summary (PCS) or mental component summary (MCS). The 'reported health transition' item was significantly improved compared to baseline (p = 0.001). At indusion, significant correlations were found between EDSS scores and scores of physical function (p < 0.001), role - physical (p < 0.01), general health and social function (both p < 0.01), and with the PCS (p < 0.01). Patients with dinical relapses and/or disability progression had a more significant decease in physical function (p < 0.05) and also in social function (p < 0.05). CONCLUSION: The QoL, assessed by the SF-36 scale, is correlated with disability in MS. IFN-beta1a treatment (Avonex) has no negative effect on MS patient's QoL.

Adjuvants, Immunologic↗

PubMedDate not supplied

How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south.

OBJECTIVE: In addition to biological markers of human immunodeficiency virus (HIV) disease progression, physical functioning, and utilization of health care may also be important indicators of health status in HIV-infected patients. There is insufficient understanding of the psychosocial predictors of health-related physical functioning and use of health services among those with this chronic disease. Therefore, the current study examines how trauma, severe stressful events, posttraumatic stress disorder (PTSD), and depressive symptoms are related to physical functioning and health utilization in HIV-infected men and women living in rural areas of the South. METHODS: We consecutively sampled patients from 8 rural HIV clinics in 5 southern states, obtaining 611 completed interviews. RESULTS: We found that patients with more lifetime trauma, stressful events, and PTSD symptoms reported more bodily pain, and poorer physical, role, and cognitive functioning. Trauma, recent stressful events, and PTSD explained from 12% to 27% of the variance in health-related functioning, over and above that explained by demographic variables. In addition, patients with more trauma, including sexual and physical abuse, and PTSD symptoms were at greater risk for having bed disability, an overnight hospitalization, an emergency room visit, and four or more HIV outpatient clinic visits in the previous 9 months. Patients with a history of abuse had about twice the risk of spending 5 or more days in bed, having an overnight hospital stay, and visiting the emergency room, compared with those without abuse. The effects of trauma and stress were not explained by CD4 lymphocyte count or HIV viral load; however, these effects appear to be largely accounted for by increases in current PTSD symptoms. CONCLUSION: These findings highlight the importance of addressing past trauma, stress, and current PTSD within clinical HIV care.

Adult↗

PubMed2004

Radiographic, clinical, and functional outcomes of treatment with adalimumab (a human anti-tumor necrosis factor monoclonal antibody) in patients with active rheumatoid arthritis receiving concomitant methotrexate therapy: a randomized, placebo-controlled, 52-week trial.

OBJECTIVE: Tumor necrosis factor (TNF) is an important proinflammatory cytokine that mediates inflammatory synovitis and articular matrix degradation in rheumatoid arthritis (RA). We investigated the ability of adalimumab, a human anti-TNF monoclonal antibody, to inhibit the progression of structural joint damage, reduce the signs and symptoms, and improve physical function in patients with active RA receiving concomitant treatment with methotrexate (MTX). METHODS: In this multicenter, 52-week, double-blind, placebo-controlled study, 619 patients with active RA who had an inadequate response to MTX were randomized to receive adalimumab 40 mg subcutaneously every other week (n = 207), adalimumab 20 mg subcutaneously every week (n = 212), or placebo (n = 200) plus concomitant MTX. The primary efficacy end points were radiographic progression at week 52 (total Sharp score by a modified method [TSS]), clinical response at week 24 (improvements of at least 20% in the American College of Rheumatology core criteria [ACR20]), and physical function at week 52 (disability index of the Health Assessment Questionnaire [HAQ]). RESULTS: At week 52, there was statistically significantly less radiographic progression, as measured by the change in TSS, in the patients receiving adalimumab either 40 mg every other week (mean +/- SD change 0.1 +/- 4.8) or 20 mg weekly (0.8 +/- 4.9) as compared with that in the placebo group (2.7 +/- 6.8) (P < or = 0.001 for each comparison). In addition, there were statistically significant changes in the components of the TSS. At week 24, ACR20 responses were achieved by 63% and 61% of patients in the adalimumab 40 mg every other week and 20 mg weekly groups, respectively, versus 30% of patients in the placebo group (P < or = 0.001 for each comparison). At week 52, ACR20 responses were achieved by 59% and 55% of patients taking adalimumab 40 mg every other week and 20 mg weekly, respectively, versus 24% of patients taking placebo (P < or = 0.001 for each comparison). At week 52, physical function as measured by the HAQ demonstrated statistically significant improvement with adalimumab 40 mg every other week and 20 mg weekly compared with placebo (mean change in HAQ score -0.59 and -0.61, respectively, versus -0.25; P < or = 0.001 for each comparison). A total of 467 patients (75.4%) completed 52 weeks of treatment. Adalimumab was generally well tolerated. Discontinuations occurred in 22.0% of adalimumab-treated patients and in 30.0% of placebo-treated patients. The rate of adverse events (both serious and nonserious) was comparable in the adalimumab and placebo groups, although the proportion of patients reporting serious infections was higher in patients receiving adalimumab (3.8%) than in those receiving placebo (0.5%) (P < or = 0.02), and was highest in the patients receiving 40 mg every other week. CONCLUSION: In this 52-week trial, adalimumab was more effective than placebo at inhibiting the progression of structural joint damage, reducing the signs and symptoms, and improving physical function in patients with active RA who had demonstrated an incomplete response to MTX.

Activities of Daily Living↗

PubMed2001

Muscle power of the ankle flexors predicts functional performance in community-dwelling older women.

OBJECTIVES: To test the hypothesis that peak power of the ankle flexors is related to physical functioning in older women with functional limitations. DESIGN: A cross-sectional study. SETTING: University-based human physiology laboratory. PARTICIPANTS: Thirty-four older women (75.4 +/- 5.1 years, 67.8 +/- 11.3 kg, body mass index 27.4 +/- 4.5) with self-reported functional limitations. MEASUREMENTS: Plantarflexion (PF) and dorsiflexion (DF) peak power and isometric strength with physical performance (stair climb time, repeated chair rise time, maximal and habitual gait velocity) were determined. An isokinetic dynamometer was used to measure isometric strength, isokinetic peak torque and power of PF and DF at five angular velocities (30 degrees, 60 degrees, 90 degrees, 120 degrees, and 180 degrees.sec-1), and isometric strength. RESULTS: Peak torque for both PF and DF declined with increasing velocity of movement (PF: P <.0001; DF: P <.0001), whereas peak power increased with increasing velocity up to 120 degrees.sec-1. The strongest univariate associations were found between chair rise time and DF peak power (r = 0.50; P <.002), stair climb time and DF peak power (r = 0.49; P <.003), habitual gait velocity and PF isometric strength (r = 0.53; P <.001), and maximal gait and PF isometric strength (r = 0.47; P <.005). Multivariate regression analysis revealed that DF and PF peak power along with the physical functioning and general health scores from the Medical Outcomes Study Short Form were independent predictors of chair and stair climb performance. CONCLUSION: These data suggest that ankle muscle power together with self-reported measures of health and physical functioning are essential components of functional mobility in older women with functional limitations.

Activities of Daily Living↗

PubMed2005

Child health-related quality of life and household food security.

OBJECTIVE: To examine the association of household food insecurity with child self- or proxy-reported health-related quality of life (HRQOL). DESIGN: Cross-sectional telephone survey from January 1, 2000, through June 30, 2000. PARTICIPANTS: Three hundred ninety-nine children who live in 36 counties of the Delta region of Arkansas, Louisiana, and Mississippi. MAIN OUTCOME MEASURES: Household food insecurity status was measured using the US Household Food Security Scale. Child HRQOL was measured by the Pediatric Quality of Life Inventory, QL version 4.0. Analysis Summary statistics, linear and logistic regressions, incorporating survey weights, performed with SUDAAN version 8. RESULTS: Household food insecurity was significantly associated with total child HRQOL (P<.05) and physical function (P<.05), adjusted for child age, ethnicity, gender, and family income. Children aged 3 through 8 years in food insecure households were reported by parents to have lower physical function (P = .001), while children aged 12 through 17 years reported lower psychosocial function (P = .007). Black males in food insecure households reported lower physical function (P<.05) and lower total HRQOL (P<.05). CONCLUSIONS: Children who live in food insecure households have poorer HRQOL. The effect on physical or psychosocial function may differ by age, ethnicity, and gender. Food security should be considered an important risk factor for child health.

Adolescent↗

PubMed2005

Association between physical and cognitive function in healthy elderly: the health, aging and body composition study.

Performance measures of physical function (gait speed, chair stands, standing balance) and cognitive function [Teng-modified Mini-Mental Status Exam (3MS) and digit symbol substitution test (DSST)] were assessed at baseline in 3,075 participants in the Health, Aging and Body Composition Study. Each physical function measure was examined for the strength and magnitude of association with cognitive function. All physical function measures were associated with both the 3MS and DSST scores (p < 0.001), and in multivariate analysis each relationship was independent of demographic characteristics, weight, physical activity and comorbid health conditions of participants. The association of motor performance was consistently greater for the DSST than the 3MS and, among the motor tests, gait speed retained a significant association with both cognitive measures independent of demographic, weight, physical activity and comorbid health conditions. In this large cohort of high-functioning older adults, the correlation between physical and cognitive function was not entirely explained by demographics. Longitudinal studies are needed to determine the direction of causality in this relationship.

Aged↗

PubMed2005

Evidence of validity for the Foot and Ankle Ability Measure (FAAM).

BACKGROUND: There is no universally accepted instrument that can be used to evaluate changes in self-reported physical function for individuals with leg, ankle, and foot musculoskeletal disorders. The objective of this study was to develop an instrument to meet this need: the Foot and Ankle Ability Measure (FAAM). Additionally, this study was designed to provide validity evidence for interpretation of FAAM scores. METHODS: Final item reduction was completed using item response theory with 1027 subjects. Validity evidence was provided by 164 subjects that were expected to change and 79 subjects that were expected to remain stable. These subjects were given the FAAM and SF-36 to complete on two occasions 4 weeks apart. RESULTS: The final version of the FAAM consists of the 21-item activities of daily living (ADL) and 8-item Sports subscales, which together produced information across the spectrum ability. Validity evidence was provided for test content, internal structure, score stability, and responsiveness. Test retest reliability was 0.89 and 0.87 for the ADL and Sports subscales, respectively. The minimal detectable change based on a 95% confidence interval was +/-5.7 and +/--12.3 points for the ADL and Sports subscales, respectively. Two-way repeated measures ANOVA and ROC analysis found both the ADL and Sports subscales were responsive to changes in status (p < 0.05). The minimal clinically important differences were 8 and 9 points for the ADL and Sports subscales, respectively. Guyatt responsive index and ROC analysis found the ADL subscale was more responsive than general measures of physical function while the Sports subscale was not. The ADL and Sport subscales demonstrated strong relationships with the SF-36 physical function subscale (r = 0.84, 0.78) and physical component summary score (r = 0.78, 0.80) and weak relationships with the SF-36 mental function subscale (r = 0.18, 0.11) and mental component summary score (r = 0.05, -0.02). CONCLUSIONS: The FAAM is a reliable, responsive, and valid measure of physical function for individuals with a broad range of musculoskeletal disorders of the lower leg, foot, and ankle.

Activities of Daily Living↗

PubMed2004

Physical and sexual function in women with chronic kidney disease.

BACKGROUND: Cross-sectional studies suggest an association between functional status and chronic kidney disease (CKD). Whether physical function deteriorates with progression of CKD is unknown. METHODS: To determine associations among CKD, physical function, and sexual function in women, we conducted cross-sectional and longitudinal analyses of 2,761 women enrolled in the Heart and Estrogen/Progestin Replacement Study. Physical and sexual function were evaluated using the Duke Activity Status Index (DASI) and the Sexual Problems Scale of the Medical Outcomes Study, respectively. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease regression equation. In addition to analyses across the spectrum of GFR, CKD was categorized as mild (estimated GFR, 45 to 60 mL/min/1.73 m2), moderate (estimated GFR, 30 to 44 mL/min/1.73 m2), and severe (estimated GFR, <30 mL/min/1.73 m2) according to a modification of recently established classification guidelines. RESULTS: Mean age of study participants was 67 +/- 7 years, and mean estimated GFR was 61 +/- 14 mL/min/1.73 m2. In unadjusted analyses, mean baseline DASI score was 10 points lower in women with an estimated GFR less than 30 mL/min/1.73 m2 than in women with an estimated GFR of 60 mL/min/1.73 m2 or greater (P < 0.0001). Estimated GFR remained significantly associated with DASI score after multivariable adjustment. In longitudinal analyses, a decline in estimated GFR was associated with a significant decline in DASI score independent of baseline estimated GFR and other factors. There were no significant associations between estimated GFR and psychosocial aspects of sexual function. CONCLUSION: CKD is associated with impaired physical function, and a decline in estimated GFR is associated with a decline in physical function.

Activities of Daily Living↗

PubMed2005

Intradialytic exercise as anabolic therapy in haemodialysis patients -- a pilot study.

Haemodialysis (HD) patients are characterized by muscle wasting and consequently decreased physical functioning and poor outcome. This pilot study investigated if a novel intradialytic exercise programme could increase lean mass via up-regulation of the insulin-like growth factor (IGF) system. Nine HD patients were assessed before (w-12) and after a 3-month control phase (w0), after a three-month intradialytic interval training programme using high intensity cycle exercise (w12), and after a withdrawal of treatment phase (w24). Body composition was determined by dual energy X-ray absorptiometry (DEXA) and bioelectrical impedance spectroscopy (BIS); physical functioning by knee extensor strength (KES) and 30-s sit stand test (SST); and IGF-I and IGFBP-3 in serum and muscle by radioimmunoassay. Despite significant increases in training load (+274%, P<0.001), peak power output (+71%, P<0.001) and physical function (KES: +19%, P<0.05; SST: +20%, P<0.05) following the intervention phase, lean masses by DEXA, intra cellular water by BIS (a surrogate measure of body cell mass) and serum and muscle IGFs remained unchanged following training. Although this novel exercise programme, utilizing high intensity interval training, was safe, clinically feasible and beneficial in terms of physical functioning, the 12 weeks of intradialytic cycle exercise failed to reverse the muscle atrophy characteristic of this population. Future studies, using primary outcome measures similar to those employed in the present study, should investigate other anabolic interventions to determine potential treatments for the muscle wasting associated with end stage renal disease.

Adult↗

PubMed2000

Effects of angiotensin-converting enzyme inhibitors and digoxin on health outcomes of very old patients with heart failure. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology.

BACKGROUND: Randomized trials have shown that angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity, and improve symptoms and exercise tolerance in selected patients with congestive heart failure (CHF). There is, however, no evidence on the effectiveness of ACE inhibitors in the typical, very old and frail patients with CHF. OBJECTIVE: To compare the effects of ACE inhibitors and digoxin on 1-year mortality, morbidity, and physical function among patients aged 85 years. METHODS: We conducted a retrospective cohort study using the SAGE database, a long-term care database linking patient information with drug utilization data. Among 64637 patients with CHF admitted to all nursing homes in 5 states between 1992 and 1995, we identified 19492 patients taking either an ACE inhibitor (n = 4911) or digoxin (n = 14890). Record of date of death was derived from Medicare enrollment files, and we used the part A Medicare files to identify hospital admissions and discharge diagnoses. As a measure of physical function, we used a scale for activities of daily living performance. The effect of ACE inhibitors was estimated using Cox proportional hazards models with digoxin users as the reference group. RESULTS: The overall mortality rate among ACE inhibitor recipients was more than 10% less than that of digoxin users (relative rate, 0.89; 95% confidence interval, 0.83-0.95). Mortality was equally reduced regardless of concomitant cardiovascular conditions and baseline physical function. Treatment with ACE inhibitors was associated with a tendency toward reduced hospital admissions that was more evident among patients with greater functional impairment. The adjusted relative rate for hospitalization for any reason was 0.96 (95% confidence interval, 0.91-1.01). The rate of functional decline was greatly reduced among ACE inhibitor recipients (relative rate, 0.74; 95% confidence interval, 0.69-0.80), and this effect was consistent and independent of background comorbidity and baseline physical function. CONCLUSIONS: These data suggest that survival and functional benefits of ACE inhibitor therapy extend to patients with CHF 85 years and older, and mostly women, both systematically underrepresented in randomized trials. Alternatively, digoxin has a detrimental effect in this population.

Activities of Daily Living↗

PubMed2003

Burden of illness of Crohn's disease in Spain.

OBJECTIVE: To evaluate the burden of Crohn's disease in Spain. DESIGN: Observational, cross-sectional study of patients affected with Crohn's disease who were attended to in hospitals in Spain. METHODS: Three structured questionnaires were used: one completed by the gastroenterologists to obtain demographic, clinical and disease activity data; a phone interview to obtain epidemiological and drug utilisation data; and the Spanish version of the Short-Form Health Survey (SF-36). RESULTS: The annual cost per patient was estimated at Euro 6808-Euro 2104 from direct medical costs and Euro 4704 from indirect costs. Approximate effect sizes for health-related quality of life were as follows: 0.8 for general health, social function, role functioning--physical and vitality; 0.5 for role functioning--emotional, body pain and mental health; and 0.2 for physical function. CONCLUSION: Crohn's disease causes a significant decrease in health-related quality of life for patients and a considerable economic cost to society, mainly due to hospitalisations and loss of productivity. This burden indicates the importance of health programmes and interventions in reducing the heavy impact of the disease on both patients and society.

Adult↗

PubMedDate not supplied

Functional status improvement in the elderly following coronary artery bypass graft.

This study assessed functional status changes among elderly persons (aged 65+) during the first 2 years following an elective coronary artery bypass graft. Physical functional status increased 39.1% from baseline to 1 year and 2.1% from 1 to 2 years. Role functioning increased 42.7% at 1 year and slightly decreased by 2.1% from 1 to 2 years postsurgery. From baseline to 1 year, female patients nearly doubled the percent gain of men for both Physical Function (.3% vs +33.9%, respectively) and Role Function (+62.0% vs +37.8%, respectively). Physical Function scores continued to increase from 1 to 2 years for women (+9.5%) compared to men (+0.7%). These findings suggest that elderly persons can expect postsurgical functional status to increase steadily during the first 2 years after surgery.

Activities of Daily Living↗

PubMed2006

Incidence and outcomes of knee and hip joint replacement in veterans and civilians.

BACKGROUND: This article describes the incidence of total knee and hip replacement, and compares post-surgery health status outcomes in veterans and civilians. METHODS: The numbers of male veterans and civilians who had a knee and/or a hip replacement in South Australia (1994-2002) were obtained. Standardized morbidity ratios, and odds ratios for age group by veteran/civilian interactions, were calculated. Presurgery and 1-year post-surgery Medical Outcomes Short Form (36) Health Survey, Knee Society and Harris hip scores were completed. Independent samples t-tests were used to compare presurgery scores. ancova models were used to determine any differences between veterans and civilians post-surgery. RESULTS: For veterans, standardized morbidity ratios were 0.987 and 0.715 for knee and hip replacements, respectively (P < 0.0001). Veterans' odds ratios for knee and hip replacements were significantly lower in the 65- to 74-year age group (P < 0.001), similar in the 75- to 84-year and above 85-year age groups for hip replacement, but significantly higher in the above 85-year age group for knee replacement (P < 0.001). Presurgery, veterans reported significantly lower scores (P < 0.003) for knee function. After knee replacement, veterans reported significantly lower Medical Outcomes Short Form (36) Health Survey scores for bodily pain, physical functioning, role - physical, role--emotional, social functioning and physical component summary (P < 0.033). Significantly lower physical functioning, role--physical and physical component summary scores (P < 0.02) were reported by veterans post-surgery for hip replacement. CONCLUSION: Veterans are delaying joint replacement. Presurgical knee function is worse in veterans. Post-surgery, the veterans are worse off in a number of health status outcomes.

Aged↗

PubMed2002

Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population.

BACKGROUND: Heart failure and left ventricular systolic dysfunction (LVSD) are increasingly common disorders, with outcomes worse than many cancers. Evidence-based therapies, such as ACE inhibitors and beta-blockers, improve prognosis and symptoms, and reduce healthcare expenditure. However, despite the high prevalence and malignant prognosis, few studies have reported the impact of heart failure and LVSD on overall quality of life and, more crucially, have not researched the elderly or those in the community. METHODS: All patients attending the Echocardiographic Heart of England Screening (ECHOES) study of the prevalence of heart failure and LVSD in the community were assessed by clinical history and examination, electrocardiogram and echocardiography, and also completed the SF36 health status questionnaire. Quality of life in patients found to have heart failure, LVSD, and other cardiac and medical conditions are compared with the randomly selected general population sample. Data are generalisable to the UK. RESULTS: 6162 people in the community were screened in the ECHOES study, of whom 5961 (97%) completed the SF36. The health perceptions of 3850 people aged 45 years or older selected randomly from the population were compared with those of 426 patients diagnosed as having definite heart failure. Those with heart failure had significant impairment of all the measured aspects of physical and mental health, in addition to declines in physical functioning. Significantly worse impairment was found in those with more severe heart failure by NYHA class: indeed, NYHA functional class was closely correlated to SF36 score. Patients with asymptomatic left ventricular dysfunction and patients rendered asymptomatic by treatment had similar scores to the random population sample. Those with heart failure reported more severe physical impairment of quality of life than people giving a history of chronic lung disease or arthritis, with less impact on mental health than patients reporting depression. CONCLUSIONS: Patients with heart failure have statistically significant impairment of all aspects of quality of life, not simply physical functioning. The physical (role and functioning) health burden was significantly greater than that suffered in other serious common chronic disorders, whether cardiac or other systems. Optimising treatment to improve NYHA class appears to improve perceptions of quality of life for patients with heart failure. Given the dramatic decline in quality of life with heart failure, this end-point should be a much more important target for healthcare interventions, especially treatments such as ACE inhibitors and beta-blockers that are shown to improve quality of life.

Activities of Daily Living↗