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PubMed2006

Functionally oriented rehabilitation program for patients with fibromyalgia: preliminary results.

OBJECTIVE: To evaluate function and disability in patients with fibromyalgia before and after participation in a functionally oriented, multidisciplinary, 8-wk treatment program. DESIGN: A total of 23 patients who met American College of Rheumatology criteria for the diagnosis of fibromyalgia were enrolled in the study. Outcome measures included: range of motion, 6-min walk test, a modified Fibromyalgia Impact Questionnaire, a modified SF-36 Physical Functioning Scale, and the Fibromyalgia Health Assessment Questionnaire. Pretreatment and posttreatment scores were analyzed using paired t tests. RESULTS: All subjects completed the program, and there were no reported injuries. Three subjects failed to complete the survey instruments at the conclusion of the study. Intention to treat analysis including these subjects was carried out but did not significantly change results. For the remaining subjects (n = 20), a significant improvement was found on the Physical Functioning Scale (P = 0.01). Trends toward improvement on the Fibromyalgia Impact Questionnaire (P = 0.40) and Fibromyalgia Health Assessment Questionnaire (P = 0.14) were seen but did not achieve statistical significance. Range of motion testing revealed significant improvements in lumbar spine extension (P < 0.001), straight-leg raise (P < 0.001), cervical spine flexion (P < 0.01), cervical spine rotation (P < 0.05), and cervical spine side bending (P < 0.05). Distance traveled during the 6-min walk test increased significantly (P < 0.01), whereas perceived exertion as measured by the Borg scale did not change. There were no injuries or other adverse consequences of the program. CONCLUSIONS: This study utilized multiple functional outcome measures to demonstrate improved function and decreased disability in patients with fibromyalgia. Our patients reported significantly improved physical function after participation in the 8-wk intensive multidisciplinary treatment program. This progressive, functionally based exercise training program was well tolerated by all participants and outlines an effective exercise prescription for patients with fibromyalgia. Fibromyalgia patients in this study responded favorably to a treatment program that focused on function instead of pain.

Cervical Vertebrae↗

PubMed1999

alpha-Synuclein shares physical and functional homology with 14-3-3 proteins.

alpha-Synuclein has been implicated in the pathophysiology of many neurodegenerative diseases, including Parkinson's disease (PD) and Alzheimer's disease. Mutations in alpha-synuclein cause some cases of familial PD (Polymeropoulos et al., 1997; Kruger et al., 1998). In addition, many neurodegenerative diseases show accumulation of alpha-synuclein in dystrophic neurites and in Lewy bodies (Spillantini et al., 1998). Here, we show that alpha-synuclein shares physical and functional homology with 14-3-3 proteins, which are a family of ubiquitous cytoplasmic chaperones. Regions of alpha-synuclein and 14-3-3 proteins share over 40% homology. In addition, alpha-synuclein binds to 14-3-3 proteins, as well as some proteins known to associate with 14-3-3, including protein kinase C, BAD, and extracellular regulated kinase, but not Raf-1. We also show that overexpression of alpha-synuclein inhibits protein kinase C activity. The association of alpha-synuclein with BAD and inhibition of protein kinase C suggests that increased expression of alpha-synuclein could be harmful. Consistent with this hypothesis, we observed that overexpression of wild-type alpha-synuclein is toxic, and overexpression of alpha-synuclein containing the A53T or A30P mutations exhibits even greater toxicity. The activity and binding profile of alpha-synuclein suggests that it might act as a protein chaperone and that accumulation of alpha-synuclein could contribute to cell death in neurodegenerative diseases.

14-3-3 Proteins↗

PubMed2006

Effect of augmented plantarflexion power on preferred walking speed and economy in young and older adults.

With age, loss of skeletal muscle mass (sarcopenia) results in decreased muscle strength and power. Decreased strength and power, in turn, are closely linked with declines in physical function. Preferred walking speed, a marker of physical function, is slower in older adults compared to young adults. Research suggests that older adults may walk slower as a consequence of decreased plantarflexor power at push-off. In this study, we hypothesized that providing additional plantarflexion (PF) power during push-off would (1) increase preferred walking speed, and (2) reduce metabolic cost of transport (MCOT), in young and older adults. PF power was augmented using powered ankle-foot orthoses (PAFOs). The PAFOs, which use pneumatic actuators to provide an additional PF moment, were based on a design by Ferris et al. [Ferris DP, Czerniecki JM, Hannaford B. An ankle-foot orthosis powered by artificial pneumatic muscles. J Appl Biomech 2005;21:189-97.]. Nine young (23.3+/-1.6 years) and seven older (74.6+/-6.6 years) adults participated. For the young adults, eight out of nine increased their preferred walking speed when push-off power was augmented (1.18+/-0.16 to 1.25+/-0.16m/s, p=0.03). A similar, but non-significant, trend in preferred walking speed was observed for the older adults. With augmented push-off power, MCOT for young adults decreased from 0.395+/-0.057 to 0.343+/-0.047 (p=0.008); indicating that the neuromuscular system was able to adapt to use external energy to reduce metabolic cost. Only three older adults were tested but MCOT values showed a similar trend. Augmenting PF power increases gait speed and reduces MCOT in young adults. Older adults may need a longer period to take advantage of additional push-off power.

Adult↗

PubMed1996

Functional and physical interactions between the Epstein-Barr virus (EBV) proteins BZLF1 and BMRF1: Effects on EBV transcription and lytic replication.

The Epstein-Barr virus (EBV) proteins BZLF1 and BMRF1 are both essential for lytic EBV replication. BZLF1 is a transcriptional activator which binds directly to the lytic origin of replication (oriLyt) and plays a critical role in the disruption of viral latency. The BMRF1 protein is required for viral polymerase processivity. Here we demonstrate that the BMRF1 gene product functions as a transcriptional activator and has direct (as well as indirect) interactions with the BZLF1 gene product. The BMRF1 gene product activates an essential oriLyt promoter, BHLF1, but does not activate two other early EBV promoters (BMRF1 and BHRF1). Direct interaction between the BMRF1 and BZLF1 gene products requires the first 45 amino acids of BMRF1 and the bZip domain of BZLF1. The effect of the BZLF1-BMRF1 interaction on early EBV transcription is complex and is promoter specific. The oriLyt BHLF1 promoter is activated by either the BZLF1 or BMRF1 gene product alone and is further activated by the combination of the BZLF1 and BMRF1 gene products. Enhanced activation of BHLF1 transcription by the BMRF1-BZLF1 combination does not require direct interaction between these proteins. In contrast, BZLF1-induced activation of the BMRF1 promoter is inhibited in the presence of the BMRF1 gene product. A point mutation in the BZLF1 protein (amino acid 200), which prevents in vitro interaction with the BMRF1 protein but which does not reduce BZLF1 transactivator function, allows the BZLF1 protein to activate the BMRF1 promoter equally well in the presence or absence of the BMRF1 gene product. Therefore, direct interaction between the BZLF1 and BMRF1 proteins may inhibit BZLF1-induced transcription of the BMRF1 promoter. BZLF1 mutated at amino acid 200 is as efficient as wild-type BZLF1 in promoting replication of an oriLyt plasmid. However, this mutation reduces the ability of BZLF1 to induce lytic replication of the endogenous viral genome in D98/HE-R-1 cells. Our results indicate that functional and physical interactions between the BMRF1 and BZLF1 proteins may modulate the efficiency of lytic EBV infection. The BMRF1 gene product clearly has a transcriptional, as well as replicative, role during lytic EBV infection.

Antigens, Viral↗

PubMed2006

The influence of brace on quality of life of adolescents with idiopathic scoliosis.

Traditionally, the effectiveness of brace treatment on adolescents with IS is based on curve magnitude and to some extent on vertebral rotation and rib hump. QoL has been introduced in the recent years in order to evaluate the effectiveness of brace treatment. The aim of the study is to determine the influence of brace on quality of life (QoL) of adolescents with idiopathic scoliosis (IS).Thirty-six patients with a mean age of 13,9 (range 12-17) years old, a mean Cobb angle 28,2 degrees (range 19-38 degrees and a mean angle of trunk inclination (ATI) 7,8 degrees (range 4 degrees -17 degrees) who were treated conservatively with a modified Boston brace for a minimum of 2 years, filled the form of Brace Questionnaire (BrQ). BrQ is a validated, disease specific instrument, its score ranges from 20 to 100 and higher BrQ scores mean better quality of life. Correlations were determined by the Pearson correlation coefficient, with p<0.05 considered significant. Mean overall score of BrQ was 73,8 (SD 15. 8). Lower scores were observed in physical functioning (55,4, SD 15,9) and vitality (55, SD 25,9). School activity (98, SD 4,4) was affected less. The Cobb angle correlated significantly only with school activity (p<0,02). The ATI correlated significantly with social functioning (thoracolumbar ATI, p<0.038; lumbar ATI, p<0.035). There were no significant correlations between either Cobb angle or ATI with BrQ overall scores. Cobb angle and ATI significantly influenced school activity and social functioning respectively, but not general health perception, physical functioning, emotional functioning, vitality, bodily pain and self-esteem and aesthetics.

Adolescent↗

PubMed2004

Physical and functional interaction of CARMA1 and CARMA3 with Ikappa kinase gamma-NFkappaB essential modulator.

CARMA proteins are scaffold molecules that contain a caspase recruitment domain and a membrane-associated guanylate kinase-like domain. CARMA1 plays a critical role in mediating activation of the NFkappaB transcription factor following antigen receptor stimulation of both B and T lymphocytes. However, the biochemical mechanism by which CARMA1 regulates activation of NFkappaB remains to be determined. Here we have shown that CARMA1 and CARMA3 physically associate with Ikappa kinase gamma/NFkappaB essential modulator (IkappaKgamma-NEMO) in lymphoid and non-lymphoid cells. CARMA1 participates to an inducible large molecular complex that contains IkappaKgamma/NEMO, Bcl10, and IkappaKalpha/beta kinases. Expression of the NEMO-binding region of CARMA3 exerts a dominant negative effect on Bcl10-mediated activation of NFkappaB. Thus, our results provide direct evidence for physical and functional interaction between CARMA and the IkappaK complex and offer a biochemical framework to understand the molecular activities controlled by CARMA-1, -2, and -3 and Bcl10.

Adaptor Proteins, Signal Transducing↗

PubMed2006

Physical activity and functional limitations in older women: influence of self-efficacy.

This study examined the role of self-efficacy and physical function performance in the relationship between physical activity and functional limitations. Older women (age, M = 68.2 years) completed measures of physical activity, self-efficacy, physical function performance, and functional limitations at the baseline of an ongoing study. Analyses indicated that physical activity was associated with self-efficacy for exercise, efficacy for gait and balance, and physical function performance. Both measures of efficacy and physical functional performance were associated with functional limitations. Demographic and health status variables did not differentially influence these relationships. Although cross-sectional in nature, our findings suggest that physical activity, self-efficacy, and functional performance may all play a role in reducing functional limitations. Of particular relevance is the fact that both physical activity and self-efficacy represent important, modifiable factors that can enhance function.

Activities of Daily Living↗

PubMed2006

Multiple joint pain and lower extremity disability in middle and old age.

PURPOSE: To determine whether the extent of multiple-site lower extremity joint pain contributes to disability in middle and old age and describe patterns of severity in site-specific measures amongst those with multiple-site pain. METHOD: Population-based, cross-sectional postal survey. Adults aged 50 years and over registered with three general practices and reporting pain lasting one month or longer in the previous year in at least one hip, knee, or foot were included. Respondents completed a generic measure of physical function and site-specific measures of severity for each relevant joint pain. RESULTS: Of 2429 eligible participants, 1801 reported multiple-site lower limb joint pain. Lower limb joint pain count was independently associated with reduced physical function after adjusting for a range of covariates. The severity of pain and disability attributed to each site increased as the number of painful sites increased. CONCLUSION: Many older people with joint pain in the lower limb have more than one joint affected. Generic and site-specific measures of disability both show the same pattern of reduced physical function. Treatment targeted at a single joint may have only a marginal effect on reducing disability in individuals with multiple joint involvement unless treatment is also conferring benefit at other sites.

Aged↗

PubMedDate not supplied

Evaluating a measure of everyday problem solving for use in African Americans.

Results from previous research on everyday problem solving involving Caucasians suggests that it may be a useful concept in studying cognitive aging in African Americans. The purpose of this investigation was to examine: (1) the factor structure of an everyday problem solving in a sample of African Americans, (2) the internal consistency of everyday-problem solving in a sample of African Americans, and (3) the relationship of problem solving to demographic factors, physical functioning, and measures of fluid ability. The sample included subjects recruited from Baltimore, MD. The sample consisted of 249 community dwelling African-American adults with a mean age of 67.8 years (SD = 8.47). Variables included the Everyday Problem Solving Test (EPT), gender, age, education, physical functioning, and inductive reasoning. Everyday problem solving as a latent construct was confirmed and the split half reliability was high (.89). As in previous research, inductive reasoning and physical functioning were related to everyday problem solving abilities. We also found that certain domains of the EPT are more influenced by demographic factors than others. Our finding suggest that the Everyday Problems Test is appropriate for use with African American samples.

Adult↗

PubMedDate not supplied

Quality of life and related factors among elderly nursing home residents in Southern Taiwan.

This study explored subjectively perceived quality of life and related factors of elderly nursing home residents. In this study, 161 residents aged 65 and older were selected from 10 nursing homes in Southern Taiwan. The results showed: (1) the mean score of quality of life was 15.86 and the standardized score was 52.87, a medium rating for the overall sample; (2) different educational levels, and socioeconomic status were significantly different in the quality of life, the other sociodemographic variables were not significantly different in the quality of life. (3) length of residence in the nursing home was significantly negative relative to the quality of life. Physical function, activities of daily living, social support from nurses, social support from nursing aides, social support from families, and frequency of family interaction were significantly positive relative to the quality of life. (4) Activities of daily living, social support from nurses, socioeconomic status, and physical function were the significant predictors in the quality of life, which explained 40.1% of the total amount of variance. Activities of daily living, social support from nursing aids, socioeconomic status, physical function and frequency of interaction with family were the significant predictors in the quality of life, which explained 39.5% of the total amount of variance. Results generated from this study may act as a reference for the staff of nursing homes to understand the quality of life and related factors among elderly residents. This study also acts as a reference for future intervention programs in this field.

Activities of Daily Living↗

PubMed1999

Disease-specific and generic health outcomes: a model for the evaluation of long-term intrathecal opioid therapy in noncancer low back pain patients.

OBJECTIVE: The present study provided comprehensive characterization of the long-term outcomes of intrathecal opioid administration via a drug administration system (DAS) in chronic pain patients with predominantly low back pain. A conceptual framework based on multidimensional outcomes is proposed using both disease-specific and generic measures. DESIGN: Pre-post longitudinal data were collected in a retrospective fashion on 38 patients receiving intraspinal opioid therapy for a minimum of 36 months (average = 50 months). MAIN OUTCOME MEASURES: Disease-specific measures included magnitude of infused opioid, side effects/complications, pain ratings, McGill Pain Questionnaire, Beck Depression Inventory, Oswestry Disability Questionnaire, and patient estimated improvement in pain (0-100%). Generic measures of health included the Quality of Well-Being Scale, Medical Outcomes Study (MOS) Short Form 36 (SF-36), return to work, patient estimated improvement in functioning, overall patient satisfaction, and family opinion of patient improvement. RESULTS: Disease-specific outcomes. Patients receiving long-term intrathecal opioid administration showed a sixfold increase in morphine equivalents infusion rates across time. DAS patients showed a small but significant decrease in pain ratings from pre-treatment levels. Following 3 years or more of intrathecal opioid infusion, patients endorsed high pain levels on the McGill Pain Questionnaire, severe levels of disability via the Oswestry Disability Questionnaire, mild levels of depression based on the Beck Depression Inventory, and multiple side effects associated with the intrathecal opioids and complications related to the infusion system. On retrospective questioning, patients receiving long-term intrathecal opioid administration reported an average of 64% improvement in their pain and 48% improvement in functioning. Family members of patients reported that they observed on average a 61% improvement in patient's pain. Generic outcome measures. On the Quality of Well-Being Scale, patients reported significantly lower health-related quality of life than health maintenance organization enrollees with no known chronic condition and patients with rheumatoid arthritis (p < 0.001). On the MOS SF-36, patients reported significantly lower physical functioning than the U.S. general population, patients with uncomplicated medical conditions, diabetes-type II patients, and congestive heart failure patients. Mental functioning was comparable to the U.S. general population (p > 0.001). Fourteen percent of patients were working following implantation. Eighty-nine percent of patients reported good to excellent satisfaction with the long-term intrathecal opioid therapy. CONCLUSIONS: Results from this study revealed differences in findings across the outcome measures, highlighting the complexity of intrathecal opioid therapy. Generally, patients after 3 years or more of intrathecal opioid therapy can be characterized as hav ing substantially impaired physical functioning with a high prevalence of side effects. Despite poor physical functioning, patients endorsed relatively good mental health status with only mild depressive symptoms. Longitudinal pain ratings showed a modest decrease from pretreatment levels. On retrospective evaluation, patients and their family endorsed high levels of pain relief secondary to intrathecal therapy. Overall, findings support that intrathecal opioid therapy provides some therapeutic benefit although substantial physical impairment continues to cause debilitation in the patient population.

Female↗

PubMed2003

Exercise for osteoarthritis of the hip or knee.

BACKGROUND: Biomechanical factors, such as reduced muscle strength and joint mal-alignment, have an important role in the initiation and progression of osteoarthritis (OA) of the hip or knee. Currently, there is no known cure for OA, however, disease-related factors, such as impaired muscle function and reduced fitness, are potentially amenable to therapeutic exercise. OBJECTIVES: To determine whether land-based therapeutic exercise is beneficial for people with OA of the hip or knee in terms of reduced joint pain, improved physical function and/or the patient's global assessment of therapeutic effectiveness. SEARCH STRATEGY: Five databases (the Cochrane Controlled Trials Register, the Cochrane Musculoskeletal Group Trials Register, MEDLINE, CINAHL, PEDro) were searched up until November 2002. SELECTION CRITERIA: All randomized controlled trials comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes. MAIN RESULTS: Only 2 studies totaling about 100 participants, could potentially provide data on people with OA of the hip. However, for OA of the knee, 17 included studies provided data on 2562 participants. For pain, combining the results revealed a beneficial treatment effect (standardised mean difference) of.39 (95% confidence interval (CI).30 -.47) while for self-reported physical function a beneficial treatment effect of.31 (95% CI.23 -.39). Group format programs appeared to be as effective as treatments provided on a one-to-one basis. The results were sensitive to various aspects of study design methodology. REVIEWER'S CONCLUSIONS: Land-based therapeutic exercise was shown to reduce pain and improve physical function for people with OA of the knee. There were insufficient data to provide useful guidelines on optimal exercise type or dosage. Supervised exercise classes appeared to be as beneficial as treatments provided on a one-to-one basis.

Exercise Therapy↗

PubMed2005

Physical and functional interaction between Elongator and the chromatin-associated Kti12 protein.

Cells lacking KTI12 or Elongator (ELP) genes are insensitive to the toxin zymocin and also share more general phenotypes. Moreover, data from low stringency immunoprecipitation experiments suggest that Elongator and Kti12 may interact. However, the precise relationship between these factors has not been determined. Here we use a variety of approaches to investigate the possibility that Elongator and Kti12 functionally overlap. Native Kti12 purified to virtual homogeneity under stringent conditions is a single polypeptide, but depletion of Kti12 from a yeast extract results in co-depletion of Elongator, indicating that these factors do interact. Indeed, biochemical evidence suggests that Elongator and Kti12 form a fragile complex under physiological salt conditions. Purified Kti12 does not affect Elongator histone acetyltransferase activity in vitro. However, a variety of genetic experiments comparing the effects of mutation in ELP3 and KTI12 alone and in combination with other transcription factor mutations clearly demonstrate a significant functional overlap between Elongator and Kti12 in vivo. Intriguingly, chromatin immunoprecipitation experiments show that Kti12 is associated with chromatin throughout the genome, even in non-transcribed regions and in the absence of Elongator. Conversely, RNA-immunoprecipitation experiments indicate that Kti12 only plays a minor role for Elongator association with active genes. Together, these experiments indicate a close physical and functional relationship between Elongator and the highly conserved Kti12 protein.

Acetyltransferases↗

PubMed2004

Psychosocial functioning and physical symptoms in heart failure patients: a within-individual approach.

OBJECTIVE: Heart failure (HF) markedly diminishes an individual's quality of life. However, little is known about how psychosocial functioning is related to heart failure physical symptom expression (e.g., chest pain or heaviness, shortness of breath) on a day-to-day basis. METHODS: Fifty-eight HF patients completed daily diaries that evaluated mood, social support, coping, and physical symptoms for 2 weeks. RESULTS: After being prewhitened for serial dependencies, the data were entered into regression analyses to determine the concurrent and lagged relationships among them. Significant concurrent relationships were obtained between physical symptoms and depression, social conflict, positive and negative mood, and symptom-focused coping. Furthermore, negative mood and distraction coping predicted greater physical symptoms the next day, while action/acceptance coping predicted fewer physical symptoms the next day. CONCLUSION: Our data provide evidence for an association between daily psychosocial functioning and HF physical symptoms. Implications for research and clinical work with HF patients are discussed.

Adaptation, Psychological↗

PubMed2001

The relationship between health-related quality of life and weight loss.

OBJECTIVE: This is a report of health-related quality of life (HRQOL) changes in obese patients completing at least 1 year of outpatient treatment in a weight reduction program combining phentermine-fenfluramine and dietary counseling. RESEARCH METHODS AND PROCEDURES: Participants were 141 women (87.6%) and 20 men (12.4%) who had an average body mass index at intake of 41.1 kg/m(2) (SD = 7.0, range = 29.5 to 67.0 kg/m(2)) and an average age of 44.9 years (SD = 9.3, range = 23 to 65 years). HRQOL was assessed at intake and at 1-year follow-up using the Impact of Weight on Quality of Life (IWQOL)-Lite questionnaire. The relationship between HRQOL changes and weight loss was examined using Pearson correlations. Clinically meaningful change in HRQOL was defined as a 1.96 SEM reduction in IWQOL-Lite total score. RESULTS: On average, participants lost 20.2 kg or 17.6% of their weight over the 1-year period. Of the participants, 15.5% lost <10% of their weight, 24.2% lost 10% to 14.9%, 23.6% lost 15% to 19.9%, and 36.6% lost 20% or more. All five IWQOL-Lite scales and total score showed statistically significant improvement over the 1-year period. Changes in IWQOL-Lite scores from intake to 1 year showed statistically significant correlations with percentage of weight loss for all subscales and total score. Subscale correlations with weight loss ranged from 0.166 (Public Distress) to 0.396 (Physical Function) and was 0.370 for the total score. Forty-four percent of participants losing <10% met the criterion of clinically meaningful change, compared with 51.3% losing 10% to 14.9%, 55.3% losing 15% to 19.95%, and 76.3% losing >20%. For total score and for three of the five IWQOL-Lite scales (Physical Function, Self-Esteem, and Sexual Life), the relationship between weight loss and clinically meaningful change was linear and was significant at p < 0.05. Physical Function and Self-Esteem were most strongly affected by weight loss. DISCUSSION: HRQOL changes, as measured by an obesity-specific instrument (IWQOL-Lite), are strongly related to weight reduction.

Adult↗

PubMedDate not supplied

Health needs of the elderly.

Elderly residents in two high-rise apartments in Erie, Pennsylvania, were surveyed to identify health needs in this type of congregate dwelling. Responses to a 20-item structured questionnaire were analyzed in relation to health condition, physical functioning, and access to medical care. When the elderly surveyed were divided into subsamples of males living alone, females living alone, and pairs, some differences were found. For example, females living alone had most difficulty in ambulatory activities (physical functioning) and 24.3 percent of the total elderly surveyed were not well in health condition. Recommendations included: A nurse practitioner could assess their health status at a specified health center or in their own apartments. Community groups or a home health aide could provide assistance for the 32 percent of the elderly surveyed who indicated difficulty with physical functioning activities. For the 11.7 percent who reported no access to medical care, a counseling or referral service monitored by a health professional could be provided.

Activities of Daily Living↗

PubMed1993

Depression and quality of life in the elderly in a special nursing home.

Using a Japanese version of the Self-Rating Depression Scale by Zung (SDS) and the Quality of Life (QOL) rating scale designed by Iida et al. (QOL scale), we compared the QOL and depressive state of special nursing home residents and the elderly in the general community. The QOL scale has four categories: physical functioning, emotional adjustment, interpersonal relationships and attitudes toward life. High scores in either examination indicate a greater impairment. The SDS scores of the residents in the special nursing home were significantly lower than those of the elderly in the community, but the scores in 3 categories and the total score, except for those of physical functioning of the QOL, were significantly higher in the nursing home residents. In the nondepressed elderly rated by the SDS, the physical functioning score of the elderly in the community significantly exceeded that of the special nursing home residents. In the depressed elderly, all the scores including the total score were significantly higher than those in the special nursing home residents. Our results suggest that while the QOL of the depressed elderly in a special nursing home was poorer than that of the elderly in the community, their depression could be treated. However, the QOL cannot be improved by treatment alone.

Activities of Daily Living↗

PubMed1996

Patient-related risk factors that predict poor outcome after total hip replacement.

OBJECTIVE: To identify factors associated with poor outcome after total hip replacement (THR) surgery. DATA SOURCES: This article is the first to present results from the American Medical Group Association (AMGA) THR consortium. STUDY DESIGN: The outcomes evaluated were pain and physical function. Eight patient risk factors were evaluated. These included the age, sex, race, marital status, and education of the patient; whether the patient had polyarticular disease or other comorbid conditions; and the patient's preoperative pain and physical function score. DATA COLLECTION: Data were collected from patients using AMGA-approved, self-administered questionnaires preoperatively and at six weeks, three months, six months, one year, and two years postoperatively. PRINCIPAL FINDINGS: Of the patient risk factors studied, race, education, number of comorbid conditions, and preoperative Health Status Questionnaire (HSQ) score were found to be associated with poor outcome. These risk factors were found to have an effect on both pain and physical function at six months postoperatively. Patients with higher preoperative scores were found to have higher postoperative scores, but substantially fewer of these patients received any benefit from their surgery. For each 10-point increase in preoperative score, patients could expect at least a 6-point decrease in postoperative improvement. CONCLUSIONS: Our study indicates that preoperative status is an important predictor of outcome for THR.

Activities of Daily Living↗