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PubMed2006

Long-term, health-related, quality of life comparison in patients undergoing single stage vs staged resection for complicated diverticular disease.

OBJECTIVE: To evaluate long-term health-related quality of life, for single-staged and staged resections following reversal, for complicated diverticular disease. PATIENTS AND METHODS: Between 1981 and 2003, 188 patients undergoing single stage (n = 158) or staged resection (n = 30) completed the SF-36 questionnaire. Health-related quality of life (HRQL) was compared between the two groups and the US normal population based on the eight domains of the SF-36. HRQL analysis was also performed at various time intervals. The effect of age and postoperative complications on HRQL was also determined. Functional and postoperative outcomes were also assessed. RESULTS: The single and staged resection groups differed in the presence of comorbidity, degree of peritoneal contamination and operative urgency. No difference in functional outcomes or HRQL was found, even after analysing time-interval subgroups. Social functioning and general health was substantially worse in both groups when compared to US norms. Ageing was found to significantly reduce physical functioning (P < 0.001) and physical and emotional role limitations (P < 0.001 for both). Post-operative complications significantly reduced scores when compared to patients without complications, for physical functioning (63.57 vs 78.7, respectively; P < 0.001), physical role limitation (80.65 vs 86.9, respectively; P < 0.001) and bodily pain (66.67 vs 74.81, respectively; P < 0.01). CONCLUSIONS: No significant difference in long-term HRQL was found in patients undergoing single staged or staged resection for complicated diverticular disease. There was significant impact of ageing and postoperative complications on physical health. Prospective studies that include pre-operative data on HRQL are required to compare the two operative techniques, with emphasis on quality of life of patients left with a permanent stoma.

Age Factors↗
PubMed2004

Biological predictors of change in functioning in the Whitehall II study.

PURPOSE: To examine whether risk factors for CHD are related to change in functioning independent of the presence or development of disease. METHODS: Longitudinal follow up of 4768 men and 2034 women civil servants from 20 London-based departments with complete data for the SF-36, biological variables, and BMI and health related behaviors. Data are used from two phases of the Whitehall II study, phase 3 (1991-1993) and phase 4 (1995) with an interval of 36 months. Weight, height, fasting insulin, 2-hour post load glucose, total and HDL-cholesterol, fibrinogen, von Willebrand factor, diastolic and systolic blood pressure, and waist hip ratio were measured at phase 3. Demographic and socio-economic information, health related behaviors, and the SF-36 were obtained at both phases by questionnaire. RESULTS: Waist hip ratio, fasting insulin, triglycerides, and HDL-cholesterol were associated with a decline in physical functioning in the total cohort and when those with poor health at baseline were removed from the analyses. Principal component analysis revealed that these variables clustered with total cholesterol and may represent insulin resistance. The biological variables had a cumulative effect on decline in physical functioning such that those with poor waist hip ratio, fasting insulin, triglycerides, and HDL-cholesterol was two times greater than those without. This relationship was independent of exercise, smoking, and alcohol intake which explained only 17% and 5.4% of the association in men and women, respectively. CONCLUSIONS: A number of biological variables, which may represent insulin resistance, are associated with decline in physical functioning in men and women independent of prevalent ill health or health related behaviors.

Body Mass Index↗
PubMed2006

[The value of SF-36 questionnaire for the measurement of life quality in chronic obstructive pulmonary disease].

This study was performed in chronic obstructive pulmonary disease (COPD) patients to compare the SF-36 questionnaire with pulmonary function tests and non-functional parameters. Fourty-five COPD patients diagnosed according to GOLD 2004 criteria were included in the study. The stable patients were evaluated by spirometry, static lung volumes, diffusion capacity, 6 MWD, BORG scale, MMRC dyspnea measurement and SF-36 life questionnaire performed on the same day. The mean age of the patients was 66 +/- 10 years and the female/male ratio was 4/41. The mean FEV1/FVC ratio was 0.49 (moderate COPD n = 18, severe COPD n = 27). The RV/TLC ratio was 0.52. Walking distance was less than normal, with a mean of 375 +/- 119 m. All the SF-36 scale except pain index are low compared to normal. General health perceptions, physical functioning, role physical, role emotional, social functioning, energy and mental health index are as follows: 47 +/- 24, 50 +/- 30, 35 +/- 38, 49 +/- 37, 63 +/- 33, 49 +/- 20, 59 +/- 20, respectively. When the general health scale compared with FVC and FEV1 revealed moderate correlation was found (r = 0.56, r = 0.55, respectively). Physical functioning compared with FVC, FEV1, RV/TLC and IC revealed moderate correlation (r = 0.62, r = 0.67, r = -0.54, r = 0.65, respectively). General health and physical functioning scales correlated with the non-functional parameters (MMRC, 6 MWD) (r = -0.51, r = 0.53, r = -0.61, r = 0.64 respectively). The SF-36 general quality of life questionnaire is a useful measurement instrument for the evaluation of therapeutic efficiency and follow up of COPD patients.

Adult↗
PubMed1999

Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group.

Hepatitis C infects nearly 4 million Americans. Most have chronic hepatitis C (CHC), which progresses to cirrhosis in about 20% of patients. Interferon treatment leads to transient responses in about 40% of patients and apparent eradication of infection in 7% to 40% of patients. In this report, we document the impact of CHC on health-related quality of life (HQL), and changes in HQL among treatment responders. Three hundred twenty-four CHC patients from 10 countries who had relapsed after responding to interferon-alfa therapy were randomized to monotherapy (IFN alfa-2b + placebo) or combination therapy (IFN alfa-2b + ribavirin), treated for 24 weeks, and followed up for 24 weeks. HQL was assessed using the Hepatitis Quality of Life Questionnaire (HQLQ), containing the generic SF-36 Health Survey, three additional generic scales, and two hepatitis-specific scales. Before treatment, CHC patients were impaired in 5 of 8 SF-36 concepts (physical functioning, role-physical, general health, vitality, and social functioning) in comparison with matched population norms. Sustained virological response (SVR) to treatment yielded improvements on three generic scales (vitality, social functioning, and health distress) and the CHC-specific health distress scale. Overall response to treatment (SVR plus histological improvement) yielded the same pattern of improvements with additional gains in generic general health and CHC-specific limitations. Successful treatment of CHC improved HQL as measured by both CHC-specific and generic measures of functional health and well being.

Female↗
PubMed1981

Respiratory function during physical exercise in normal and obstructed noses.

Four healthy adults with normal nose were asked to pedal an ergometer for 3 min or more at a load of 25, 50, and 75 W/min, respectively. The same procedure was repeated on the same subjects whose nostrils were plugged. Air-flow and pressure difference between the mesopharynx and the nares, FO2 and FCO2, percutaneous-PO2 and ScO2 were recorded on a polygraph. At the start of the exercise, respiration deepened. Nasal resistance (Rn) decreased within 30 s and kept low while the exercise lasted. TcPO2 initially increased slightly for 1 min, then decreased. ScO2 also showed the same pattern, but of very slight range. At the end of the exercise Rn returned to pre-exercise level after slight rebound increase. Recovery of tcPO2 delayed for 30 s and its rebound increase lasted for more than 5 min. In case of nasal obstruction, such sequential changes of these parameters were of the same pattern as those in normal noses but were more evident. The results demonstrated that in case of moderate or severe nasal obstruction the exercise created hypoventilation despite a marked increase in the breathing activity if nasal breathing was continued.

Adult↗
PubMed2003

[Population-based reference values for the Spanish version of the SF-36 Health Survey in the elderly].

BACKGROUND AND OBJECTIVE: The SF-36 Health Survey questionnaire is the most widely used instrument to measure health-related quality of life. Reference measures are needed to interpret its results in clinical and population studies. In 1996, a study provided population-based norms for Spain, but these were not disaggregated by age in subjects aged 75 years and over, even though health status changes with aging among those who overpass such age. Moreover, health status in elderly people from developed countries has improved over the last years. This study obtains population-based norms for the Spanish version of the SF-36 Health Survey in five-year age-groups for those aged 60 to 85 and over. SUBJECTS AND METHOD: Cross-sectional survey on a sample of 3,949 non-institutionalised subjects representative of the Spanish population aged 60 years and over. Information on the SF-36 Health Survey was obtained through house-hold personal interviews. Central position and dispersion statistics, as well as percentiles, were calculated for each of the eight SF-36 scales by age and sex. Cronbach's alpha coefficients were calculated to assess the internal reliability of each scale. RESULTS: Subjects reported higher scores for emotional role (mean [SD] 84.8 [32.9]), social functioning (79.2 [28.0]) and physical role (73.3 [41.1]). For all scales, mean scores were higher (better perceived health) among men than women (p < 0.0001). As age increased, mean scores in all scales decreased (p for linear trend < 0.001) except for mental health (p for linear trend = 0.29 in women, p for lineal trend = 0.14 in men), yet the decrease was greater for physical functioning and physical role. Reliability was very high for all scales (Cronbach's alpha from 0.84 to 0.95). RESULTS were similar to those of the study carried out in 1996. CONCLUSIONS: These results extend those obtained in 1996 and facilitate the interpretation of the SF-36 Health Survey values in clinical and population studies in the Spanish population aged 60 years and older.

Aged↗
PubMed2004

Functional limitations and well-being in injured municipal workers: a longitudinal study.

Two instruments, the Health Assessment Questionnaire (HAQ) and the Short Form-36 (SF-36), were used to document both the immediate and short-term effects of workplace injuries in municipal workers. Telephone interviews were conducted up to 3 months following the injury. One hundred fourteen subjects agreed to participate in the study; 90 workers completed at least one useable interview. The relationship between functional limitation and lost days was evaluated using Cox proportional hazards models. At 3 months following the onset of injury, SF-36 scores for physical function, role-physical, and bodily pain differed significantly from population norms. Using one standard deviation of change, statistically significant hazard ratios were seen in subjects with lower SF-36 physical component summary, physical function, and bodily pain scores, and higher HAQ disability and fatigue scores. Functional limitations persisted in workers after relatively minor workplace injuries despite a 91% return to work rate.

Accidents, Occupational↗
PubMed2005

Quality of life after unilateral acoustic neuroma surgery via middle cranial fossa approach.

CONCLUSIONS: Patients with acoustic neuroma experienced reduced quality of life (QOL) after surgery. Individual factors did not have a significant effect on QOL. In the future, QOL should be a basic factor in the outcome evaluation of different therapeutic regimens in the treatment of acoustic neuroma. OBJECTIVE: To measure the QOL of patients who underwent unilateral acoustic neuroma surgery via the middle cranial fossa approach. MATERIAL AND METHODS: The Short Form-36 (SF-36) Health Survey and a self-designed disease-specific questionnaire were used during follow-up examinations to assess health-related QOL. The pure-tone average was used to specify hearing ability. Facial nerve function was described using the House-Brackmann grading system. A total of 28 male and 14 female patients who underwent surgery between 1997 and 2001 were included in the study. RESULTS: Patients' QOL scores revealed significant reductions in QOL in comparison to normative German QOL data. Gender, age, tumor size or location and clinical symptoms such as hearing loss and restricted facial nerve function did not have an effect on QOL. The SF-36 scales physical functioning, role functioning-physical, bodily pain, general health, social functioning and role functioning-emotional demonstrated significant QOL reductions.

Adult↗
PubMed1993

Development and validation of a physical performance instrument for the functionally impaired elderly: the Physical Disability Index (PDI).

Article describes development of the Physical Disability Index (PDI), an observer-administered, performance-based instrument measuring physical disability in frail-elderly persons without severe cognitive impairment. Sixty-five items in four subscales encompassing Range of Motion (ROM), Strength (STR), Balance (BAL), and Mobility (MOB) were measured. Subjects were randomly selected frail nursing home residents (N = 103) with a Folstein Mini-Mental State Exam (MMSE) score of > or = 11. Using correlation matrices, cluster analysis, and regression techniques, the scale was reduced to 54 items. All individual item values were standardized and aggregated into subscale and summary PDI scores, each with a range of 0-100. Test-retest and interrater reliability were evaluated. Discriminant and convergent validity were established using MMSE, Physical Self-Maintenance Scale (PSMS), and Sickness Impact Profile-Physical Dimension (SIP-PD). PDI is a performance-based instrument that appears to discriminate among frail individuals with differing levels of physical function. Further testing is warranted in other populations of frail-elderly persons to ascertain its applicability and generalizability.

Activities of Daily Living↗
PubMed1998

Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome.

OBJECTIVES: Despite considerable progress in intensive care management of the acute respiratory distress syndrome (ARDS), little is known about health-related quality of life in long-term survivors. In addition, intensive care treatment can be extremely stressful, and many survivors of ARDS report adverse experiences such as respiratory distress, anxiety, or pain during intensive care unit (ICU) treatment. This study was performed to assess health-related quality of life in survivors of ARDS and to test the hypothesis that adverse experiences during ICU treatment result in posttraumatic stress disorder (PTSD) and negative effects on health-related quality of life. DESIGN: Retrospective, cohort, case-controlled analyses. SETTING: A 12-bed multidisciplinary ICU of a tertiary care university hospital, capable of providing extracorporeal life support for adults with severe ARDS. PATIENTS: We studied 80 patients who were admitted to our hospital from 1985 to 1995 and who survived an episode of ARDS. ARDS was defined according to the criteria of the American-European Consensus Conference on ARDS. INTERVENTIONS: Health-related quality of life was measured using the Health Status Questionnaire of the self-administered Medical Outcomes Study Short Form Survey that consists of 36 questions (SF-36) and the German version of the Post Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10), a self-report scale for the diagnosis of posttraumatic stress disorder based on the Diagnostic and Statistical Manual (Third Edition) criteria (American Psychiatric Association). The number of adverse experiences (anxiety, respiratory distress, pain, and nightmares) during intensive care was evaluated by means of a structured questionnaire. For each patient with ARDS, three age- and gender-comparable controls were randomly selected from databases providing normal values for the SF-36 and PTSS-10 scores in populations at risk for posttraumatic stress disorder. MEASUREMENTS AND MAIN RESULTS: Survivors of ARDS showed statistically significant impairments in all eight health dimensions of the SF-36 when compared with normal controls (median reduction 21.3%, p < .006) with maximal impairments in physical function (median reduction 28.9%, p = .000) and a 38% higher frequency of chronic pain (p = .0001). Three of 34 patients reporting none, or one, adverse experience had evidence of posttraumatic stress disorder vs. 19 of 46 patients remembering multiple traumatic episodes (p = .007). Patients reporting multiple adverse experiences described the lowest health-related quality of life, with maximal impairments in psychosocial functioning (p < .005) and only small limitations in physical function. CONCLUSIONS: Long-term survivors of ARDS describe a good overall health-related quality of life. Major impairments in mental health domains of health-related quality of life are associated with the development of posttraumatic stress disorder and are a possible result of traumatic experiences during ICU therapy.

Adolescent↗
PubMed1997

Does transplantation produce quality of life benefits? A quantitative analysis of the literature.

BACKGROUND: Despite numerous reports published since the early 1970s, it is frequently asserted that quality of life (QOL) outcomes of transplantation have seldom been investigated and/or that little is known about QOL. This view may have persisted due to lack of adequate cumulation and synthesis of existing data. We performed an exhaustive, quantitative literature review to determine the nature and degree of any QOL benefits associated with transplantation in adults. METHODS: All independent, peer-reviewed empirical, English-language QOL studies were retrieved for six areas of transplantation: kidney, pancreas/combined kidney-pancreas, heart, lung/combined heart-lung, liver, and bone marrow. Studies' findings were analyzed to determine whether the weight of evidence suggested that (a) QOL improved from pre- to posttransplant, (b) transplant recipient QOL was better than that of patient comparison groups, and (c) recipient QOL equaled that of healthy nonpatient samples. RESULTS: A total of 218 independent studies, evaluating a total of approximately 14,750 patients, were identified. The majority of studies demonstrated statistically significant (P<0.05) pre- to posttransplant improvements in physical functional QOL, mental health/cognitive status, social functioning, and overall QOL perceptions. The majority documented physical functional and global QOL advantages for transplant recipients relative to ill comparison groups. The studies did not indicate that recipient QOL in specific functional areas equaled that of healthy, nonpatient cohorts, although global QOL perceptions were often high. CONCLUSIONS: Although transplantation may not restore to the patient the "normal" life he/she may once have had, convergent evidence from six areas of transplantation, a variety of study designs, and demographically diverse study cohorts suggests that there are distinct QOL benefits of transplantation. Future work is required to identify background and personal factors that influence the degree of QOL benefits that any individual patient realizes from transplantation.

Adult↗
PubMed2005

The impact of obesity on health related quality of life before and after radical prostatectomy (data from CaPSURE).

PURPOSE: Health related quality of life (HRQOL) is an important measure of outcomes among patients with prostate cancer due to disease related and treatment related effects on physical and emotional health. We determined if there are differences in the HRQOL of obese men at diagnosis and after radical prostatectomy compared to the HRQOL of men with normal body mass index (BMI). MATERIALS AND METHODS: Data were abstracted from Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE), a disease registry of 10,018 men with prostate cancer. A total of 1,884 men were included in study who were treated with radical prostatectomy between 1989 and 2002, had BMI information available and had completed 1 initial HRQOL questionnaire. Of these men 672 who completed at least 2 followup questionnaires were assessed further. RESULTS: The BMI (kg/m) distributions were 24% normal (less than 24.9 kg/m), 56% overweight (25 to 29.9), 16% obese (30 to 34.9) and 4% very obese (greater than 35 kg/m). Higher BMI was associated with worse physical function, bodily pain, general health, vitality and role physical, but better bowel bother at diagnosis independent of race. Higher BMI was also associated with worse HRQOL after radical prostatectomy for physical function, general health and vitality, but better bowel bother. HRQOL differences between BMI groups were similar among times for all measured variables. Compared to the normal group, the higher BMI groups had similar HRQOL after radical prostatectomy. CONCLUSIONS: In the majority of domains men with higher BMI had lower HRQOL at diagnosis than men of normal BMI. Obese men have a similar recovery pattern of HRQOL after radical prostatectomy, with minimal additive long-term impairment in HRQOL relative to men of normal weight.

Activities of Daily Living↗
PubMed2002

Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial.

OBJECTIVES: To determine whether a home based exercise programme can improve outcomes in patients with knee pain. DESIGN: Pragmatic, factorial randomised controlled trial of two years' duration. SETTING: Two general practices in Nottingham. PARTICIPANTS: 786 men and women aged >/=45 years with self reported knee pain. INTERVENTIONS: Participants were randomised to four groups to receive exercise therapy, monthly telephone contact, exercise therapy plus telephone contact, or no intervention. Patients in the no intervention and combined exercise and telephone groups were randomised to receive or not receive a placebo health food tablet. MAIN OUTCOME MEASURES: Primary outcome was self reported score for knee pain on the Western Ontario and McMaster universities (WOMAC) osteoarthritis index at two years. Secondary outcomes included knee specific physical function and stiffness (scored on WOMAC index), general physical function (scored on SF-36 questionnaire), psychological outlook (scored on hospital anxiety and depression scale), and isometric muscle strength. RESULTS: 600 (76.3%) participants completed the study. At 24 months, highly significant reductions in knee pain were apparent for the pooled exercise groups compared with the non-exercise groups (mean difference -0.82, 95% confidence interval -1.3 to -0.3). Similar improvements were observed at 6, 12, and 18 months. Regular telephone contact alone did not reduce pain. The reduction in pain was greater the closer patients adhered to the exercise plan. CONCLUSIONS: A simple home based exercise programme can significantly reduce knee pain. The lack of improvement in patients who received only telephone contact suggests that improvements are not just due to psychosocial effects because of contact with the therapist.

Arthralgia↗
PubMed2000

Patient-based health status assessments in an outpatient psychiatry setting.

OBJECTIVE: The reliability, validity, and feasibility of the routine use of a generic health status instrument, the Short-Form-36 Health Survey (SF-36), were examined in a psychiatric outpatient clinic of a general hospital. METHODS: The sample comprised 411 patients referred to an outpatient psychiatry department between April 1994 and March 1995. They filled out the SF-36 along with their admission forms. Scores and reports were generated, and the results were returned to the charts and used at weekly clinical conference discussions. Feasibility was evaluated using subjective and objective data on administration of the instrument, its psychometric properties, and costs. Results from the outpatient psychiatry patients were compared with those from patients scheduled for elective surgery and a healthy normative sample. RESULTS: Routine administration of the SF-36 was successfully achieved with minimal resistance from staff and patients. The SF-36 provided reliable and valid data. As predicted, patients with emotional disorders scored lower, indicating more impairment, on scales measuring mental health than did the elective surgery patients and the normative sample. However, the psychiatric patients' scores on the physical health scale were lower than clinicians expected. Compared with the elective surgery patients, the psychiatric patients were less impaired on only the physical functioning and bodily pain scales; no difference was found between the two groups in role functioning due to physical problems. CONCLUSIONS: Routine use of the SF-36 in a general hospital psychiatric outpatient clinic was feasible, and the results were reliable, valid, and helpful to clinicians. Psychiatric patients' significantly lower scores in physical health and social and role functioning provided additional information about their difficulties.

Adolescent↗
PubMed2001

Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau: a minimum five-year follow-up study.

BACKGROUND: There is little information in the literature regarding the outcome of total knee arthroplasty following open reduction and internal fixation of fractures of the tibial plateau. The goal of this study was to evaluate the results of such procedures after a minimum of five years of follow-up. METHODS: We retrospectively analyzed the outcomes of fifteen total knee arthroplasties performed at an average of 38.6 months (range, eight months to eleven years) after open reduction and internal fixation of a fracture of the tibial plateau in fifteen consecutive patients. The average duration of follow-up after the total knee arthroplasty procedures was 6.2 years (range, 5.4 to 11.1 years). The average age of the patients was fifty-six years (range, thirty-seven to sixty-eight years) at the time of the arthroplasty. We evaluated the outcomes on the basis of the Hospital for Special Surgery knee score, the Short Form-36 score, and radiographs of the knees. RESULTS: The average Hospital for Special Surgery knee score was 51 points (range, 20 to 74 points) before the arthroplasty, and it increased to 80 points (range, 44 to 91 points) postoperatively. Four knees were scored as excellent, eight had a good result, one was rated as fair, and two had a poor result. The average Short Form-36 scores were 58.0 points for general health, 72.4 points for bodily pain, 72.1 points for mental health, 58.3 points for physical functioning, 84.6 points for physical role functioning, 81.0 points for social functioning, and 57.7 points for vitality. The average active postoperative arc of motion was 105 degrees (range, 70 degrees to 135 degrees ) compared with 87 degrees (range, 20 degrees to 125 degrees ) preoperatively. Incomplete radiolucencies were noted on all of the postoperative radiographs made after the total knee arthroplasties. There was a high rate of infection (three patients), patellar tendon disruption (two patients), and postoperative secondary procedures (three patients required closed manipulation). The patients with infection were considered to have a failure of treatment: two required arthrodesis, and one required a two-stage exchange. CONCLUSION: On the basis of our results, we concluded that total knee arthroplasty after open reduction and internal fixation of a fracture of the tibial plateau decreases pain and improves knee function, but the procedure is technically demanding and is associated with a high failure rate (five of fifteen).

Adult↗
PubMed2004

Thrust during ambulation and the progression of knee osteoarthritis.

OBJECTIVE: To determine whether the presence of varus thrust at baseline increases the risk of progression of medial tibiofemoral osteoarthritis (OA), whether knees with thrust have a greater adduction moment, whether thrust has any additional impact on top of static varus, and whether thrust is associated with poor physical function outcome. METHODS: Two hundred thirty-seven patients with knee OA (definite osteophytes and symptoms) underwent baseline gait observation to assess varus thrust and full-limb radiography to assess alignment. Sixty-four of these 237 patients also underwent quantitative gait analysis to determine the maximum knee adduction moment. Two hundred thirty patients (97%) returned for followup at 18 months. At baseline and 18 months, the 230 participants had semiflexed, fluoroscopically confirmed knee radiographs (with progression defined as worsening of medial joint space grade); self-reported and performance-based measures of function were also assessed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) for medial OA progression, after excluding knees that were not at risk for progression. RESULTS: Varus thrust was present in 67 of 401 knees. Thrust increased 4-fold (age-, sex-, body mass index-, and pain-adjusted OR 3.96, 95% confidence interval [95% CI] 2.11-7.43) the odds of medial progression, with some reduction after further adjustment for varus alignment severity. In varus-aligned knees, thrust increased the odds of OA progression 3-fold (adjusted OR 3.17, 95% CI 1.60-6.31). In the gait substudy, the adduction moment was greater in knees with a thrust compared with knees without a thrust. Having a thrust in both knees versus neither knee was associated with a 2-fold increase in the OR for poor physical function outcome (P not significant). CONCLUSION: Varus thrust is a potent risk factor, identifiable by simple gait observation, for disease progression in the medial compartment, the most common site of OA involvement at the knee. Varus thrust may also predict poor physical function outcome. Varus thrust increased the odds of progression among varus-aligned knees considered separately, suggesting that knees with a thrust are a subset of varus-aligned knees at particularly high risk for progression of OA.

Aged↗
PubMed2005

Associations between physical activity, peripheral atherosclerosis and bone status in healthy Japanese women.

The aim of this cross-sectional study was to investigate whether physical activity and bone status may affect arterial thickening and stiffening in healthy Japanese women. Healthy women (n = 149; mean age, 54 years) were recruited from those who participated in a local health check program at the Osaka City University Hospital. Physical activity was assessed by physical functioning score of SF-36, and bone status by bone mineral density (BMD) in lumbar spine and calcaneus osteo-sono index (OSI). Arterial wall thickening assessed by intima-media thickness (IMT) in common carotid artery (CA) and femoral artery (FA), and arterial wall stiffening by peak wave velocity (PWV) in heart-carotid (hc) and heart-femoral (hf) as central segment and in heart-brachial (hb) and femoral-ankle (fa) as peripheral segment, respectively. By Spearman Rank correlation, lumbar spine BMD was correlated negatively with CA IMT (rho = -0.225, p < 0.05) and FA IMT (rho = -0.215, p < 0.05), and calcaneus OSI with FA IMT (rho = -0.330, p < 0.0001) but not CA IMT (rho = -0051, p = 0.5335). Both lumbar spine BMD and calcaneus OSI correlated negatively with PWV in all segments (all p < 0.05). Physical functioning score correlated weakly but significantly in a negative manner with all PWV segments (all p < 0.05) but not IMT. Multiple regression analyses revealed a significant association of calcaneus OSI (beta = -0.240, p = 0.0039) but not lumbar spine BMD (beta = -0.067, p = 0.4541) with FA IMT, although neither lumbar spine BMD nor calcaneus OSI was associated with CA IMT. Furthermore, physical functioning score was independently associated with hb and fa PWV but not hc and hf PWV, suggesting the preferential association with peripheral segment including lower extremities. Neither lumbar spine BMD nor calcaneus OSI was associated with any segment of PWV. In conclusion, it was suggested that calcaneus OSI might be associated with arterial wall thickening preferentially in femoral artery, and that physical activity may be associated with arterial wall stiffening in peripheral segment including lower extremity but not in central segment in healthy Japanese women.

Atherosclerosis↗