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PubMed1998

[ Measuring and assessing the quality of life of patients with pulmonary tuberculosis].

OBJECTIVE: To measure and assess the quality of life (QoL) of patients with pulmonary tuberculosis. METHOD: QoL of 228 patients with pulmonary tuberculosis and 228 healty controls were marked by MOS SF-36, QLI and KPS scales, and single and multiple stepwise regression analysis were made to evaluate factors affecting QoL. RESULT: The average total mark of SF-36, marks of physical functioning, role-physical, mental health, role-emotional, social functioning, vitality, bodily pain and general health were respectively 57 +/- 17, 65 +/- 28, 22 +/- 32, 61 +/- 20, 30 +/- 36, 54 +/- 27, 56 +/- 21, 65 +/- 24 and 53 +/- 15 in the pulmonary tuberculosis group, while 77 +/- 8, 84 +/- 23, 81 +/- 34, 75 +/- 18, 81 +/- 33, 83 +/- 23, 61 +/- 21, 75 +/- 24 and 72 +/- 20 in the controls. Statistically significant differences were found between the two groups (all P values < 0.01). The average marks of QLI and KPS were 7.4 +/- 2.0 and 77 +/- 17 respectively in the pulmonary tuberculosis group, and significant differences were also found comparing with the controls (9.6 +/- 0.8, 97 +/- 9) (P < 0.01). There were statistically significant correlation among the total mark of SF-36 and the marks of the above 8 subdividions in patients with pulmonary tuberculosis. The correlation coefficients between marks of SF-36 and QLI, KPS were 0.7841, 0.8931 respectively (P < 0.001). The factors affecting the marks of SF-36 of the patients were focus size of infection, counts of white blood cells, complications, elevated ALT and duration of disease. CONCLUSION: The SF-36 scale is suitable for measurement of QoL of patients with pulmonary tuberculosis. The QoL of patients with pulmonary tuberculosis declines. The main factors affecting the QoL of the patients are focus size of infection, counts of white blood cells, complications, elevated ALT and duration of disease.

Adult↗

PubMed2002

Cumulative effects of cardiovascular disease risk factors on quality of life.

OBJECTIVES: The Medical Outcomes Study Short-Form Health Survey (SF-36) was used to assess the quality of life for adults who differed in level of risk for cardiovascular disease. METHODS: Subjects were 51 men and 80 women from southwestern Ohio between the ages of 20 and 86 years. Individuals level of risk was based on the culmination of four cardiovascular disease risk factors: hypertension (i.e., systolic BP>or=140 mmHg or diastolic BP>or= 90 mmHg), obesity (i.e., BMI>or=30), high cholesterol (i.e., total cholesterol>or=240 mg/dL), and presence/absence of smoking. RESULTS: Each risk factor was analyzed independently and cumulatively for effects on the SF-36 dimensions (i.e., Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, Mental Health). The data suggested that quality of life impairment (indicated by lower scores on the SF-36 dimensions) increased as the number of cardiovascular disease risk factors an individual had increased. CONCLUSIONS: Cardiovascular disease risk factors unknown to the participants had differential effects on the SF-36 dimensions, and quality of life decreased as the number of risk factors individuals had increased.

Adult↗

PubMed1987

[Thrombocyte function in physical exertion and induced myocardial ischemia in patients with ischemic heart disease].

Reaction to graded bicycle exercise in patients with newly developed angina pectoris, patients with chronic IHD and subjects without IHD with normal coronary arteries was studied. Platelet activation by physical exercise was significantly more often (35.7%) in patients with newly developed angina pectoris than in patients with chronic IHD (12.8%) and patients without IHD (13%). It is shown that myocardial ischemia during physical exercise does not influence the frequency of the platelet activation signs determination. Development of platelet activation in physical exercise was promoted by minor disease duration, lower basic platelet functional activity and more evident increase in haematocrite in physical exercise.

Adult↗

PubMed1999

Determinants of socioeconomic differences in change in physical and mental functioning.

Continuous decline in functioning is not an inevitable consequence of ageing, as some individuals maintain high levels of functioning to old age. The origins of functional problems in old age are not only related to current circumstances, but may be traced back to earlier life-experiences. Previous analyses show that change in functioning is related to socioeconomic status, but it is uncertain to what extent these differences can be accounted for by the same health behaviours and material and psychosocial factors that are related to socioeconomic differences in morbidity and mortality. This paper investigates socioeconomic differences in change in mental and physical functioning in a relatively young and healthy population over a three year follow-up period. The data come from the Whitehall II Study of London based civil servants aged 39-63 in 1991-93. We measured functioning with the Short Form 36 (SF-36) General Health Survey and socioeconomic status by civil service employment grade. Among lower employment grade men the odds ratio of being in the quartile of rapid decline in mental and physical functioning was 1.79 and 1.56 respectively. For women the odds ratio for physical functioning was 1.34, but employment grade differences in mental functioning were inconsistent. Among men health behaviours were the most important determinants of employment grade differences in physical functioning change. In addition, material problems and job decision latitude accounted for employment grade differences in physical as well as mental functioning change. However, among women employment grade differences in change in physical functioning can not be accounted for with these risk factors. Analyses of change in determinants may provide further insight into the underlying pathways. Early detection of functional decline and intervention may be a key to better functioning in ageing populations.

Adult↗

PubMed2004

Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty.

BACKGROUND: Heterotopic bone formation (HBF) in the soft tissues surrounding the hip joint is a frequent complication of hip surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) administered in the immediate perioperative period reduce the risk of HBF. However, the magnitude of the effect on HBF, and the effects on other associated outcomes, such as pain and physical function, are uncertain. OBJECTIVES: To determine the effects of perioperative NSAID therapy versus control on the risk of HBF and other outcomes in patients undergoing hip arthroplasty. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (October 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 3, 2002), MEDLINE (1966 to October 2002), EMBASE (1988 to 2002 Week 43), CURRENT CONTENTS (1993 Week 27 to 2002 Week 44) and reference lists of articles. We also contacted trialists and drug manufacturers. SELECTION CRITERIA: All trials which enrolled patients scheduled to undergo hip arthroplasty with random or quasi-random allocation to perioperative NSAID or control and that recorded post-operative radiographically determined HBF. The primary outcome was post-operative radiographic HBF. Secondary outcomes were pain, function (including range of motion), gastro-intestinal and other bleeding complications, and other causes of major morbidity or mortality. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality and extracted data. All analyses were conducted on dichotomised outcomes. MAIN RESULTS: Sixteen randomised and two quasi-randomised trials involving a total of 4,763 patients were included. Overall, in 17 trials that examined the effects of medium to high doses of NSAIDs, there was a reduced risk of developing HBF after hip surgery (59% reduction, 95% confidence interval 54% to 64% reduction). In contrast, one large trial examining low-dose aspirin, demonstrated no effect on the risk of HBF (2% reduction, 95% confidence interval 15% reduction to 12% increase). There was strong evidence of differences in the size of the treatment effects observed between the trials examining medium to high doses of NSAIDs, but reasons were not clearly identified. There was a non-significant one third increased risk of gastro-intestinal side effects among patients assigned NSAIDs (29% increase, 95% confidence interval 0% to 76% increase). Most of this increase was due to an increased risk of minor gastro-intestinal complications. Data on the late post-operative outcomes of pain, impaired physical function and range of joint movement were few and no formal overviews of the effects of NSAIDs on these outcomes were possible. REVIEWERS' CONCLUSIONS: Perioperative NSAIDs, apart from low dose aspirin, appear to produce between a one half and two thirds reduction in the risk of HBF. With routine use, such agents may be able to prevent 15-20 cases of HBF among every 100 total hip replacements performed. However, while medium to high doses of perioperative NSAIDs clearly produce a substantial reduction in the incidence of radiographic HBF, there remains some uncertainty about short-term side effects of treatment and substantial uncertainty about effects on long-term clinical outcomes such as chronic pain and impaired physical function. The net effect of routine HBF prophylaxis with NSAIDs requires formal assessment in a randomised trial designed to determine the balance of benefits and risks for all outcomes.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2005

Exercise following organ transplantation: A critical part of the routine post transplant care.

There are many reasons for recommendation of regular physical activity for organ transplant recipients, including 1) Restoration of physical functioning following deconditioning experienced prior to transplant; 2) Most patients are physically inactivity, 3) The high prevalence of cardiovascular risk factors that may be modified by regular physical activity; 4) Physical activity will optimize physical functioning following transplant; and 5) p; hysical activity may reduce or attenuate side effects of immunosuppression. There are many recommendations for regular physical activity as an integral part of treatment of conditions that are common to transplant recipients, including: hypertension management; hyperlipidemia; Diabetes; and elevated cardiovascular disease risk. Transplant recipients tolerate progressive exercise training well and can achieve levels of functioning similar or higher than normal individuals. In order to optimize functioning and overall health in organ transplant recipients, regular physical activity should be prescribed and encouraged as a part of the routine post transplant care.

Cardiovascular Diseases↗

PubMed2001

Traditional injury scoring underestimates the relative consequences of orthopedic injury.

OBJECTIVE: To demonstrate that patients with multiple injuries who have orthopedic injuries (ORTHO) face greater challenges regarding functional outcome than those without, to identify domains of postinjury dysfunction, and to illustrate the increasing discordance of functional recovery over time for ORTHO patients in relation to nonORTHO patients. METHODS: A convenience sample of adult blunt force trauma patients admitted to a Level I trauma center was evaluated at admission, and at 6 and 12 months after injury. Data were collected from the trauma registry (Trauma One), chart review, and interviews. Mailed surveys were completed 6 and 12 months after injury. The Short Form 36 (SF36) general health survey and the Sickness Impact Profile work scale (SIPw) were administered at both time points. Data are presented as mean +/- SEM or percent (%). To compare means, t tests were conducted, and Injury Severity Score (ISS) was controlled by linear regression before the evaluation of the role of ORTHO injury pattern on outcome measures. Significance is noted at the 95% confidence level (p < 0.05). RESULTS: The 165 patients studied averaged 37.2 +/- 1.1 years in age and were 67% men. The mean ISS was 14.4 +/- 0.6 and 61% had ORTHO injury. ORTHO patients were no different from nonORTHO in any measure of baseline status including the SIPw score and all domains of the SF36, except that the ISS was greater in the ORTHO group (15.6 +/- 0.96 vs. 12.7 +/- 0.73, p = 0.017). Baseline SF36 values were similar to national norms. Follow-up was 75% at 6 months, and 51% at 12 months. Those lost to follow-up differed only in that they were more likely to be men. Sixty-four percent had returned to work 12 months after injury. After controlling for ISS with linear regression, the ORTHO patients had worse scores on all physical measures of the SF36 (bodily pain, physical function, and role-physical). By 12 months after injury, the relative dysfunction of the ORTHO patients had expanded to include the SIPw score (p = 0.016) and six of eight SF36 domains (bodily pain, physical function, role-physical, mental health, role-emotional, and social function, all p < 0.05). CONCLUSION: Injury severity affects both mortality and the potentially more consequential issues of long-term morbidity. Patients with ORTHO injury have relatively worse functional recovery, and this worsens with time. As trauma centers approach the limits of achievable survival, new advances in trauma care can be directed more toward the quality of recovery for our patients. This will be contingent on further development of screening, scoring, and treatment systems designed to address issues of functional outcome across injury boundaries for those who survive.

Activities of Daily Living↗

PubMed2001

Quality of life of patients on the waiting list for benign prostatic hyperplasia surgery.

OBJECTIVES: To assess the quality of life (QoL) of patients on the waiting list for benign prostatic hypertrophy (BPH) surgery and the relationship between prostate symptoms and QoL. MATERIALS AND METHODS: Our study included 189 BPH patients on the waiting list for surgery, during the period from January to December 1999. A survey was conducted to obtain information on sociodemographic characteristics, associated illnesses, prostate symptoms based on the International Prostate Symptoms Score (I-PSS), and QoL based on the 36-item Short Form Health Survey (SF-36). Moreover, the case history, prostate volume measured by ultrasound, and uroflowmetry results were considered. Descriptive, bivariate and multivariate analyses were conducted based on the scores recorded on the SF-36 scales and the other variables. RESULTS: The mean age was 68.8 +/- 6.9 SD. A total of 70.4% of the subjects had other chronic illnesses, 54.1% had severe symptoms (I-PSS > 19), and 69.8% reported that they were extremely dissatisfied with their symptoms. A total of 29.6% of the patients had urethral catheters. The SF-36 scale with the highest scores was social functioning (79.9, 95% CI: 76.5-83.4), whereas the lowest scores referred to role-physical (58.2, 95% CI: 52.3-64.1). Patients with more severe symptoms assigned lower scores to the physical functioning, vitality, social functioning, mental health, role-emotional and mental component summary (MCS) scales. Irritative symptoms were associated with lower vitality, social functioning, mental health and MCS. Patients with urethral catheters recorded lower scores on the physical functioning and role-physical scales. CONCLUSIONS: The QoL of BPH patients on the waiting list for surgery is poorer than that of the general population of the same age. The increased severity of prostate symptoms, particularly the irritative symptoms, leads to a poorer QoL in terms of nearly all aspects of QoL. However, this correlation was not observed for prostate volume nor uroflowmetry data.

Activities of Daily Living↗

PubMed1997

Evidence for physical and functional interactions among two Saccharomyces cerevisiae SH3 domain proteins, an adenylyl cyclase-associated protein and the actin cytoskeleton.

In a variety of organisms, a number of proteins associated with the cortical actin cytoskeleton contain SH3 domains, suggesting that these domains may provide the physical basis for functional interactions among structural and regulatory proteins in the actin cytoskeleton. We present evidence that SH3 domains mediate at least two independent functions of the Saccharomyces cerevisiae actin-binding protein Abp1p in vivo. Abp1p contains a single SH3 domain that has recently been shown to bind in vitro to the adenylyl cyclase-associated protein Srv2p. Immunofluorescence analysis of Srv2p subcellular localization in strains carrying mutations in either ABP1 or SRV2 reveals that the Abp1p SH3 domain mediates the normal association of Srv2p with the cortical actin cytoskeleton. We also show that a site in Abp1p itself is specifically bound by the SH3 domain of the actin-associated protein Rvs167p. Genetic analysis provides evidence that Abp1p and Rvs167p have functions that are closely interrelated. Abp1 null mutations, like rvs167 mutations, result in defects in sporulation and reduced viability under certain suboptimal growth conditions. In addition, mutations in ABP1 and RVS167 yield similar profiles of genetic "synthetic lethal" interactions when combined with mutations in genes encoding other cytoskeletal components. Mutations which specifically disrupt the SH3 domain-mediated interaction between Abp1p and Srv2p, however, show none of the shared phenotypes of abp1 and rvs167 mutations. We conclude that the Abp1p SH3 domain mediates the association of Srv2p with the cortical actin cytoskeleton, and that Abp1p performs a distinct function that is likely to involve binding by the Rvs167p SH3 domain. Overall, work presented here illustrates how SH3 domains can integrate the activities of multiple actin cytoskeleton proteins in response to varying environmental conditions.

Actins↗

PubMed1999

Quality of life, functional status, and depression in male liver transplant recipients with recurrent viral hepatitis C.

BACKGROUND: The quality of life, psychologic sequelae, and functional status of liver transplant recipients with recurrent hepatitis C virus (HCV) hepatitis have not been well defined. METHODS: Perceived quality of life, psychologic distress, depression, adaptive coping, and functional status were prospectively assessed in 59 liver transplant recipients at baseline (before transplantation) and 6 and 12 months after transplantation; comparisons were made between patients with recurrent HCV hepatitis and all other patients. RESULTS: Recurrent HCV hepatitis developed in 41% (14/34) of the patients with HCV. At 6 months, the patients with recurrent HCV hepatitis had significantly lower functional status (P=0.013) and experienced less gain in physical functioning from baseline than other patients (P=0.02). Quality of life, depression, and psychologic distress were not different at 6 months for patients with recurrent HCV hepatitis compared with all other patients. At 12 months, the patients with recurrent HCV hepatitis had significantly lower quality of life (P=0.003), greater depression (P=0.045), higher psychologic distress (P=0.05), and lower physical functioning (P=0.008) than all other patients. CONCLUSION: Recurrent HCV hepatitis in liver transplant recipients is associated with impairment in quality of life, functional status, and greater depression compared with patients who did not have HCV and those without HCV recurrence.

Adult↗

PubMed2006

Patient-reported quality of life after abdominal aortic aneurysm surgery: a prospective comparison of endovascular and open repair.

PURPOSE: This study evaluated and compared changes over time in health-related quality of life reported by patients with infrarenal abdominal aortic aneurysm (AAA) undergoing elective endovascular (EVAR) and open aneurysm (OR) repair. METHODS: A prospective, nonrandomized cohort of 76 patients (62 men, 14 women; age range, 42 to 89 years) undergoing elective, infrarenal AAA repair (EVAR, n = 43; OR, n = 33) at two university teaching hospitals during a 15-month period were administered the Medical Outcomes Study Short-Form 36-item (SF-36) health survey preoperatively and then 1 week, 1 month, and 6 months postoperatively. Patient demographics, procedural details, postoperative follow-up data, and SF-36 scores were compared between groups. RESULTS: Both groups had total SF-36 scores that were significantly lower than preoperative scores at 1 week and 1 month after surgery but were not significantly different from the preoperative scores at 6 months (OR 66.2 +/- 21.1 to 72.3 +/- 19.8, P > .1; and EVAR 61.0 +/- 17.7 to 58.7 +/- 19.4, P > .1). Six-month total SF-36 scores were significantly higher in the OR group compared with the EVAR group (mean 72.3 +/- 19.8 OR vs 58.7 +/- 19.4 EVAR; P = .009). In the postoperative period, a significant drop occurred in mean scores in six of the eight domains of the SF-36 in the OR patients (physical function, PF; role physical, RP; bodily pain, BP; vitality, VT; social function, SF; role emotional, RE) and five domains for EVAR patients (PF, RP, BP, SF, RE). In two domains, RE and PF, scores returned to baseline values significantly sooner in EVAR patients than in OR patients (RE, EVAR 1 month vs OR 6 months; and PF, EVAR 1 month vs OR 6 months). In the VT domain, no significant postoperative drop occurred in the EVAR group, but in the OR group, mean scores were significantly lower at 1 week and 1 month compared with preoperative values. In the domains of general health and mental health, no significant drop occurred in SF-36 score postoperatively in either group. CONCLUSIONS: Patient reported health-related quality of life after infrarenal AAA repair is significantly impaired in the early postoperative period but returns to baseline by 6 months in patients treated with EVAR and OR. Patients having EVAR had significantly more rapid return to preoperative scores in selected domains of the SF-36. Even though EVAR is associated with shorter and less invasive perioperative hospital course and fewer postoperative complications, EVAR patients had lower quality of life scores 6 months after surgery than OR patients.

Activities of Daily Living↗

PubMed2000

Defining post-stroke recovery: implications for design and interpretation of drug trials.

Measurement of stroke recovery is complex because definition of successful recovery is highly variable across measures and cut-off points for defining successful outcomes vary. The purpose of this paper is to describe patterns of recovery in stroke patients of varying severity when different measures are used and when different cut-off points are selected. 459 individuals enrolled in a prospective cohort study were assessed within 14 days post stroke and re-evaluated at 1, 3, and 6 months. Recovery was assessed using the NIH Stroke Scale, the Fugl-Meyer Assessment of Motor Recovery, the Barthel Index of Activities of Daily Living, the Physical Function Index of the SF-36, and the Modified Rankin Outcome Scale. Subjects also defined their preference (utility) for their current health state with a time-trade off question. We compared patterns of recovery using the different measures and varying the cut-off points for defining successful recovery. The percentage of patients who are believed to have recovered depends on how recovery is defined. If recovery is defined at the disability level (Barthel > 90), the majority 57.3% of stroke survivors experience a full recovery. Fewer individuals are considered to be fully recovered if impairments are measured (NIH </= 1, 44.9% and Fugl-Meyer > 90, 36.8%. Less than 25% of stroke survivors are considered recovered if recovery is defined relative to reported prior function in higher levels of physical activity. Shifting the definition of recovery on the modified Rankin scale from </= 1 to </= 2 shifts the percentage of those deemed recovered from </= 25% to 53.8%. In designing drug trials the methods for defining stroke recovery should be carefully considered. If recovery is defined in terms of disability, a higher proportion of the placebo group will achieve the outcome than if impairments are used to define recovery. The benchmarks for recovery in minor strokes must include measures of higher functioning (e.g. the SF-36 physical functioning index or a Rankin 0 (no symptoms).

Activities of Daily Living↗

PubMed2003

Cardiac hypertrophy and diastolic function in physically well trained and in obese men.

OBJECTIVE: The aim of the present study was to compare cardiac hypertrophy and diastolic function in extremely obese male patients and physically active adult male subjects of similar age (means 43.0-43.4 y). DESIGN: Data of male patients referred to our hospital ward in order to reduce their body weight (BW) were compared with those of physically active and nonactive healthy males. SUBJECTS: The groups contained 21-24 male subjects, very active and moderately active subjects taking part in regular competitive or leisure time physical activity were in the two athletic groups, severely overweight patients constituted the obese group and healthy persons served as controls. MEASUREMENTS: Two-dimensionally guided M-mode and Doppler recordings. RESULTS: In comparison with the controls, obese patients had larger left atrial systolic and left ventricular (LV) diastolic internal diameters, LV diastolic wall thickness and muscle mass. Of the body size-related indices, only the left atrial systolic diameter index was significantly higher. LV systolic and diastolic functions were impaired as indicated by a decreased ejection fraction (EF), higher heart rate (HR), decreased E/A quotient and increased isovolumetric relaxation time. In the physically very active subjects, a thicker LV diastolic wall was seen without LV dilatation. Body size-related wall thickness and muscle mass were significantly higher than in the controls. EF and HR did not differ from those of the controls. CONCLUSION: The most useful help to distinguish between physiological and pathological left ventricular hypertrophy can be to investigate diastolic functions. The most salient difference appeared in diastolic function, because E/A quotient was higher in the very active subjects than in the controls and it was the lowest in the obese persons.

Adult↗

PubMed2004

Physical scoring function based on AMBER force field and Poisson-Boltzmann implicit solvent for protein structure prediction.

A well-behaved physics-based all-atom scoring function for protein structure prediction is analyzed with several widely used all-atom decoy sets. The scoring function, termed AMBER/Poisson-Boltzmann (PB), is based on a refined AMBER force field for intramolecular interactions and an efficient PB model for solvation interactions. Testing on the chosen decoy sets shows that the scoring function, which is designed to consider detailed chemical environments, is able to consistently discriminate all 62 native crystal structures after considering the heteroatom groups, disulfide bonds, and crystal packing effects that are not included in the decoy structures. When NMR structures are considered in the testing, the scoring function is able to discriminate 8 out of 10 targets. In the more challenging test of selecting near-native structures, the scoring function also performs very well: for the majority of the targets studied, the scoring function is able to select decoys that are close to the corresponding native structures as evaluated by ranking numbers and backbone Calpha root mean square deviations. Various important components of the scoring function are also studied to understand their discriminative contributions toward the rankings of native and near-native structures. It is found that neither the nonpolar solvation energy as modeled by the surface area model nor a higher protein dielectric constant improves its discriminative power. The terms remaining to be improved are related to 1-4 interactions. The most troublesome term is found to be the large and highly fluctuating 1-4 electrostatics term, not the dihedral-angle term. These data support ongoing efforts in the community to develop protein structure prediction methods with physics-based potentials that are competitive with knowledge-based potentials.

Algorithms↗

PubMed2004

Health-related quality of life in patients with obstructive sleep apnea: effects of long-term positive airway pressure treatment.

The aim of the present study was to determine the effect of middle and long-term positive airway pressure (CPAP) treatment on the health-related quality of life in patients with obstructive sleep apnea. We prospectively studied two groups of patients with this disease; a group of 42 patients (33 men and 9 women) with a mean age of 55.2 +/- 7.4 years and a body mass index of 33.5 +/- 6.4 kg/m2 treated with CPAP for 6-months, and another group of 42 patients (34 men and 8 women) with a mean age of 54.4 +/- 10.5 years and a body mass index of 33.2 +/- 4.0 kg/m2 treated with CPAP for 18-months. The health related quality of life was assessed by administering a Medical Outcomes Study Short Form-36 (SF-36) questionnaire before and after CPAP therapy. Patients treated with CPAP for 6 months only improved significantly in the vitality dimension and this change was clinically relevant (standard error of the measurement = 1.43 SEmeas). In contrast, those treated with CPAP for a long period (18-month) showed statistically significant improvement at post-treatment in five SF-36 dimensions: physical functioning (P < 0.001), role physical (P < 0.01), social functioning (P < 0.01), vitality (P < 0.001), and general health perception (P < 0.001). In four of these dimensions the improvement was clinically relevant: role physical (1.16 SEmeas), social functioning (1.35 SEmeas), vitality (1.35 SEmeas), and general health perception (2.05 SEmeas). Using two different global rating of change (independent measures or anchors), the minimal change important difference for patients treated with CPAP for 6 months ranged from 20.7 to 24.2 points on the vitality dimension; and for patients with CPAP for 18-months it ranged from 2.5 to 7.5 points on the physical role, 5.5-6.6 points on social functioning, 7.5-8.7 on vitality, and 13.5-15.5 on general health perception dimension. We conclude that health-related quality of life of obstructive sleep apnea patients improves with long term CPAP treatment and these changes are clinically relevant in several health dimensions.

Aged↗

PubMed1999

A prospective study of weight change and health-related quality of life in women.

CONTEXT: The mean body weight of US adults increased by 3.6 kg (7.6 lb) during the past 15 years, but few studies exist that examine the impact of such weight change on functional health status. OBJECTIVE: To investigate, prospectively, the association between weight change and health-related quality of life in women. DESIGN AND SETTING: Nurses' Health Study, a 4-year prospective observational study from 1992 to 1996, using the Medical Outcomes Study Short-Form 36 Health Status Survey (a self-administered 36-item questionnaire) to measure quality of life. PARTICIPANTS: A cohort of 40098 women (from 46-71 years old in 1992) grouped according to 3 patterns of weight change over the 4-year period: women whose weight remained within 2.25 kg (5 lb) of their baseline weight, women who lost 2.25 kg (5 lb) or more, and women who gained 2.25 kg (5 lb) or more. MAIN OUTCOME MEASURES: Change in scores on 7 health-related quality-of-life dimensions: physical functioning, vitality, bodily pain, limitations in role functioning due to emotional or physical problems, social functioning, and mental health, measured by the Short-Form 36 Health Status Survey. RESULTS: A total of 15602 women (39%) maintained their weight, 15160 (38%) gained between 2.25 and 9.0 kg (5-20 lb), and 6667 (17%) lost between 2.25 and 9.0 kg (5-20 lb). Weight gain was associated with decreased physical function and vitality, and increased bodily pain regardless of baseline weight. For example, the odds ratio for developing role limitations due to physical problems was 2.05 (95% confidence interval, 1.69-2.49) for the leanest women who gained 9.0 kg (20 lb) or more. Weight loss in overweight women was associated with improved physical function and vitality as well as decreased bodily pain. Weight change was more strongly associated with physical rather than mental health. The impact of weight change, especially weight gain, was just as strong in women 65 years and older as in women younger than 65 years. CONCLUSIONS: These longitudinal data support current US guidelines for women of all body mass index levels to avoid weight gain. Weight maintenance and, in cases of overweight, weight loss are desirable and likely to be beneficial for physical function, vitality, and bodily pain.

Aged↗

PubMed1989

Associations among family support, family stress, and personal functional health status.

The self-reported family support and stress of 249 ambulatory adult patients, aged 18-49 years, were studied relative to their self-reported functional health. Support from family members was found to be related positively with emotional function. Stress from family members was associated negatively with symptom status, physical function, and emotional function. Patients' severity of illness was related negatively to their symptom status, physical function, and social function, but not to their emotional function. During the study a new self-report instrument, the Duke Social Support and Stress Scale (DUSOCS), was developed to measure family and non-family support and stress. Also, a new chart audit methodology, the Duke Severity of Illness Scale (DUSOI), was designed to assess severity in the ambulatory setting. Reliability and validity of the DUSOCS and the DUSOI were supported. The importance of the patient's perception of health and its family determinants is emphasized.

Adolescent↗

PubMed2005

Introduction to veterinary physical rehabilitation.

Physical therapy is a profession with an established scientific basis in human beings and companion animals. It has a large number of clinical applications in the restoration, maintenance, and promotion of optimal physical function. In providing physical therapy, the goal is to restore, maintain, and promote optimal function, optimal fitness, wellness, and quality of life as they relate to movement disorders and health. A major emphasis is to prevent or minimize the onset, clinical signs, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, and injuries.

Animal Diseases↗