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PubMed1994

Relationship between symptoms and health-related quality of life in chronic lung disease.

The authors studied the relationship between patient self-reported symptoms and responses to a general measure of health-related quality of life [Short Form 36 (SF-36)] for 102 patients who had chronic lung disease [forced expiratory volume in one second (FEV1) < 70%]. The primary diagnoses were chronic bronchitis, emphysema, and asthma; the mean age was 62 years, and 46% were women. Based upon Medical Research Council (MRC) symptom scores, the patients' disease severity was classified as mild (21%), moderate (22%), or severe (57%). The SF-36 scores differed significantly between disease severity groups in domains of health perception, physical functioning, physical role, and energy. The SF-36 physical functioning and Oxygen Cost Diagram scores correlated well (r = 0.78). The authors conclude that SF-36 is a useful and valid measure of general health status in patients with chronic lung disorders.

Female↗

PubMed1995

Predicting quality-of-life outcomes following total joint arthroplasty. Limitations of the SF-36 Health Status Questionnaire.

A group of 114 patients undergoing total hip and knee arthroplasty were evaluated to assess the effect of total joint arthroplasty on quality of life, as measured by the SF-36 Health Status Questionnaire, and to determine the predictive relationship between preoperative and postoperative scores. A highly significant improvement was seen comparing preoperative with postoperative scores at 2 years for physical function, social function, physical role function, emotional role function, mental health, energy, and pain. Despite a significant change in health status (P < or = .001), no change was seen in the patient's health perception (P = .61). Regression analysis failed to indicate a predictive relationship between preoperative and postoperative scores for any scale. Total joint arthroplasty dramatically improves the quality of life and function of patients afflicted with arthritis; however, because of the poor ability of the SF-36 to predict postoperative improvement on an individual basis, it cannot be used alone to determine treatment selection.

Activities of Daily Living↗

PubMed1997

Quality of life following bone marrow transplantation for breast cancer: a comparative study.

As more women are treated with bone marrow transplantation (BMT) for breast cancer, there is growing interest in quality of life (QOL) following treatment. Although there have been some clinical studies of QOL following BMT, this area has received little systematic attention. In particular, it is unclear how QOL for women treated with BMT for breast cancer differs from that which might be expected for 'healthy' women of about the same age. To address this issue, we compared QOL reported by women treated with autologous BMT for breast cancer with that of a group of women of similar age with no history of cancer. In addition, we examined the relationship of demographic factors, medical factors, and self-reported symptom prevalence, severity, and distress to QOL in post-BMT patients. All participants completed the SF-36 Health Survey developed from the Medical Outcomes Study (SF-36). Post-BMT patients also completed the ECOG Performance Status Rating Scale (PSR) and the Memorial Symptom Assessment Scale (MSAS). Results indicated that, compared to the women with no cancer history, post-BMT patients reported significantly impaired physical functioning, physical role functioning, general health, vitality, social functioning, and emotional role functioning. Impaired QOL following BMT was significantly associated with lower income, a longer time to engraftment, longer hospital stay, poor performance status, and greater symptom prevalence, severity, and distress. The problems identified in this study may be important targets for intervention when trying to improve QOL following BMT.

Adult↗

PubMed1997

Quality of life analysis in patients with lower limb ischaemia: suggestions for European standardisation.

INTRODUCTION AND OBJECTIVES: In this era of evidence-based medicine and limited resources we seem obliged, on clinical and economic grounds, to demonstrate that we improve not only patient survival but also the quality of patients' lives. This study aims to determine the impact of increasing lower limb ischaemia on quality of life (QOL) and which of three commonly used generic QOL instruments is the most valid, reliable, and responsive to change in patients with lower limb ischaemia. PATIENTS AND METHODS: Two hundred and thirty-five patients, 144 men and 91 women, median age 68 years (range 41-87 years) were graded according to ISCVS suggested reporting standards, i.e. 16 mild, 116 moderate and 25 severe claudicants; 33 patients had rest pain and 45 tissue loss. Patients completed Short Form 36 (SF36), EuroQol (EQ-5D) and Nottingham Health Profile (NHP) questionnaires at interview. Additional copies of questionnaires were posted to 80 patients prior to attendance. Correlation between the two sets of responses reflects test-retest reliability. Correlation between domains measured by the three instruments reflects convergent and divergent validity. Kruskal Wallis ANOVA detected QOL changes across the whole group. Spearman Rank was used to analyse validity and reliability. Responsiveness was analysed using the Mann-Whitney U-test. RESULTS: Increasing lower limb ischaemia confers significant (p < 0.05) deterioration in: SF36 measured: physical functioning, physical role, pain, general health, vitality, social functioning and mental health. EQ-5D measured: mobility, self-care, usual activities, pain and anxiety/depression. NHP measured: energy, pain, emotional reaction, sleep, social isolation and physical mobility. All three instruments are significantly reliable (rs > 0.7). The validity of SF36 and NHP (rs = 0.68-0.78) is superior to EQ-5D (rs = 0.37-0.7). SF36 & NHP are equally responsive to changes in physical activity and pain. SF36 and EQ-5D are most responsive to changes in social activity. SF36 is most responsive to changes in psychological status. CONCLUSIONS: QOL deteriorates markedly with increasing lower limb ischaemia. The SF36 would appear to be the most appropriate generic QOL analysis tool for these patients. We recommend its widespread adoption throughout Europe, thus providing a standardised tool for reporting generic QOL.

Activities of Daily Living↗

PubMed1998

SF-36 summary scores: are physical and mental health truly distinct?

OBJECTIVES: Data from 536 primary care patients initiating antidepressant treatment were used to examine the performance of the Medical Outcomes Study SF-36 Physical Component and Mental Component summary scores. METHODS: The SF-36 was administered at baseline and readministered after 1 month and 3 months (n = 482). RESULTS: At the baseline assessment, patients reported modest impairment on the Physical Function, Role--Physical, Bodily Pain, and General Health Perceptions subscales (0.10 to 0.68 standard deviations below national norms), but the Physical Component summary (mean = 51) indicated no impairment based on a population norm of 50. During 3 months of follow-up evaluation, the Physical Function, Role--Physical, Bodily Pain, and General Health Perceptions subscales all showed moderate and statistically significant improvement (range from 0.28 to 0.49 standard deviation units), whereas the Physical Component summary score was essentially unchanged (mean = 50 at both 1-month and 3-month assessments). This pattern of results is a natural consequence of the assumptions and methods used to calculate these summary scores-orthogonal factor rotation and negative scoring coefficients. CONCLUSIONS: These findings suggest caution in the interpretation of Mental Component Summary and Physical Component Summary scores when the condition or treatment of interest has strong effects on scales with negative scoring coefficients (Mental Health and Role--Emotional for the Physical Component; Physical Function, Role--Physical, and Bodily Pain for the Mental Component).

Adolescent↗

PubMed1992

Racial and social correlates of age-related changes in functioning.

Six waves of observations spanning a decade on a panel of 566 Black and 5,196 non-Black survivors were utilized to examine social and racial differences in age-related changes in functioning. An index consisting of three dimensions was used to assess functioning: physical functioning, self-care capacity, and self-rated well-being. Growth curve analysis was used to assess variations in trajectories of functional impairment across Black/non-Black, poor/nonpoor, male/female, and high-school/non-high-school graduate subpanels. Trajectories vary across social groups in the expected manner. However, we note that the trajectories are not linear and that substantial variability exists within both the Black and non-Black subpanels. Moreover, we note that Blacks report poorer functional status than non-Blacks even with income and education controlled. However, age changes do not differ across Black and non-Black subpanels, as predicted by the multiple-jeopardy hypothesis.

Activities of Daily Living↗

PubMed1998

The impact of postoperative pain on the development of postoperative delirium.

UNLABELLED: We performed a prospective observational study to examine the role of postoperative pain and its treatment on the development of postoperative delirium. Pain was measured in direct patient interviews using a visual analog scale (VAS) and was assessed for pain at rest, pain with movement, and maximal pain over the previous 24 h. Postoperative delirium was diagnosed during these interviews by using the confusion assessment method (CAM) and/or by using data from the medical record and the hospital's nursing intensity index. The method of postoperative analgesia, type of opioid, and cumulative opioid dose were also recorded. After controlling for known preoperative risk factors for delirium (age, alcohol abuse, cognitive function, physical function, serum chemistries, and type of surgery), higher pain scores at rest was associated with an increased risk of delirium over the first 3 postoperative days (adjusted risk ratio 1.20, P = 0.04). Pain with movement and maximal pain were not associated with delirium. Method of postoperative analgesia, type of opioid, and cumulative opioid dose were not associated with an increased risk of delirium. We conclude that more effective control of postoperative pain reduces the incidence of postoperative delirium. IMPLICATIONS: We performed daily interviews in a large population of patients undergoing noncardiac surgery to measure their level of pain and development of delirium. We found an association between higher pain levels at rest and the development of delirium. Our results suggest that better control of postoperative pain may reduce this serious complication.

Activities of Daily Living↗

PubMed1998

Self-rated health and diabetes of long duration. The Wisconsin Epidemiologic Study of Diabetic Retinopathy.

OBJECTIVE: To evaluate the self-reported quality of life in individuals with diabetes of long duration. RESEARCH DESIGN AND METHODS: An interview was administered 14 years after baseline to two cohorts of individuals with diabetes who have been followed in an epidemiological study periodically since 1980. Responses to the Medical Outcomes Study Short Form 36 as related to complications of diabetes, age, glycosylated hemoglobin level, and other characteristics were assessed. RESULTS: Physical function, physical role, general health scales, and a general question about health were related to diabetes characteristics in older- and younger-onset individuals. Symptoms of sensory neuropathy were associated with the four measures in both younger- (n = 645) and older-onset (n = 292) individuals. Other descriptive variables in the younger-onset group were the presence of nephropathy, cardiovascular disease, smoking, peak expiratory flow, physical activity, and glycosylated hemoglobin. Hypoglycemic reactions were of only borderline significance and that for only one scale (physical role). In older-onset individuals, cardiovascular disease, physical activity, and sex were descriptive of responses to the quality-of-life questions. CONCLUSIONS: Factors related to diabetes contribute to self-assessed health. some of these factors may be modifiable, which, if altered, may lead to improved quality of life.

Activities of Daily Living↗

PubMed1992

Quality of life measurements in oncology.

Quality of life (QOL) has transcended from an implicit concern to an explicit measurement in oncology. In contemporary clinical research, QOL can now often be identified and objectively measured in health as well as in illness. The major domains which comprise QOL in patients with cancer include symptoms and side effects, social function, physical function, and psychological status. One of the preferred methods for measuring QOL consists of self-administered questionnaires. A number of instruments have been developed which vary in features such as type of domains included, number of items, response options, specificity for disease type, and psychometric assessments. The role of QOL assessment is becoming increasingly important in clinical oncology.

Activities of Daily Living↗

PubMed1985

Reasons for patient referral to occupational therapy units by health care professionals.

This study sought to discover the main reasons four professional groups--physicians, nurses, physical therapists, and mental health professionals--referred patients to occupational therapy services. A total of 162 subjects completed a specially devised questionnaire listing various reasons for referral. Seven factors were uncovered representing reasons for referring patients. Significant differences were found among professional groups and among the type of institutional settings--psychiatric, geriatric, or physical care. Interpretation of the results revealed one main motivation for referring patients to occupational therapists involving the contributions in the psychological aspects of patient care. Another major motivation for referral was the medical contributions of occupational therapy in improving physical functions. Physical therapists differed considerably from the three other professional groups, tending to place greater emphasis on referral motives related to the latter approach.

Female↗

PubMed1995

The evaluation of pain in patients with knee osteoarthritis: the knee pain scale.

OBJECTIVE: To develop and validate a knee pain scale (KPS) for use with osteoarthritis (OA) of the knee. METHODS: Patients with documented evidence of knee OA completed the KPS and a test battery including measures of physical functioning, physical performance, and depression. Analyses were conducted to confirm the 4-factor structure of the measure, determine alpha reliabilities, assess the test-retest reliability, and examine the construct validity of the KPS. RESULTS: Confirmatory factor analysis revealed that the KPS has 4 subscales, including frequency and intensity of pain experienced during both ambulation/climbing and transfer activities. All reliabilities were in excess of 0.80 and the subscales of the KPS shared expected variance with both self-reported and objective indices of dysfunction. CONCLUSION: The KPS has good psychometric properties for assessing pain experienced in conjunction with the performance of activities of daily living. Although at present it is a research tool, with further study it should prove valuable in clinical practice as well.

Activities of Daily Living↗

PubMed1987

Functional and physical characteristics of rat Leydig cell populations isolated by metrizamide and Percoll gradient centrifugation.

The physical and functional properties of Leydig cell populations obtained by centrifugation of testicular cells in two different density gradient media, Percoll and Metrizamide, were compared. Percoll-gradient centrifugation yielded two Leydig cell bands (Peak I and Peak II) that were comparable, as to their density and testosterone-producing capacity, to the respective Leydig cell bands, Population I and Population II, isolated in a Metrizamide gradient. The denser Leydig cell band (II) had a greater capacity for testosterone production than the less dense band (I), regardless of the type of gradient used for its isolation. Metrizamide gradient centrifugation separated the majority of germ cells from the "light" (Population I) Leydig cells, whereas in the Percoll gradient, germ cells comigrated with Peak I Leydig cells. Leydig cell separation by Percoll gradients was highly dependent on the presence of Ca2+ and Mg2+ in the medium, while these cations had no effect on the separation of Leydig cells by Metrizamide. In conclusion, Metrizamide gradient centrifugation yielded two Leydig cell populations of similar functional and physical properties to the respective populations isolated in Percoll gradients.

Animals↗

PubMed1993

Functional health and well-being in patients with severe atherosclerotic peripheral vascular occlusive disease.

Functional health and sense of well-being are known to be adversely affected by chronic illness. The extent to which peripheral vascular occlusive disease (PVOD) alters these factors independent of other comorbid conditions is unknown. Sixty patients with PVOD severe enough to have required aortobifemoral bypass (AFB) between 1985 and 1990 were selected for evaluation. Although all were heavy smokers and 20% had suffered previous myocardial infarction, all had adequate cardiopulmonary function to survive AFB. The SF-20 questionnaire, validated in the Medical Outcomes Study (MOS), was used to evaluate patients' functional health and well-being at least 6 months after AFB. All grafts were patent at the time of questionnaire completion. Three measures of functional health (physical function, role function, and bodily pain) and three measures of well-being (mental health, health perception, and social function) were scored from SF-20 responses using the MOS protocol. These PVOD patients were then compared to MOS norms for patients without any chronic disease, to MOS norms adjusted for age and other comorbidities of the PVOD patients sampled, and to patients with congestive heart failure or recent myocardial infarction. Physical function, role function, and health perception were worse and bodily pain greater in patients with severe PVOD after surgical treatment as compared with MOS patients even after adjustment for comorbidities. Decrements in physical function, role function, and health perception for PVOD patients were comparable to MOS patients with congestive heart failure or recent myocardial infarction, whereas level of bodily pain was worse in PVOD patients than in these other groups. After adjustment for comorbidities, social function and mental health were not independently affected by PVOD. Functional health and well-being were not significantly different when PVOD patients with limb threat were compared to those with claudication. Severe PVOD is associated with decrements in functional health and well-being comparable to or greater than other severe chronic illness, even after successful revascularization. Further study is needed to examine the effect of revascularization on functional health.

Activities of Daily Living↗

PubMed1995

Comparing outcomes and charges for patients with acute myocardial infarction in three community hospitals: an approach for assessing "value".

OBJECTIVE: To assess the value of care (i.e. outcomes in relation to charges) for acute myocardial infarction (Acute MI) patients in three community hospitals after controlling for patient mix differences. DESIGN: An observational study of a cohort of acute MI patients admitted to hospital for care were studied based on medical record review and on patient-completed questionnaires at 8 weeks post-discharge. SETTING: Three community hospitals located in urban areas in the southeastern region of the United States. PATIENTS: A consecutive sample of 133 non-transfer Acute MI patients were entered into the study based on EKG results, enzyme tests and chest pain characteristics. Hospital medical record and charge data were available on all patients and patient-reports on 86% of survivors. MAIN OUTCOME MEASURES: Data were gathered on clinical outcomes (death, angina, dyspnea), functional outcomes (physical and psychosocial), satisfaction, and resource intensity (length of stay, total hospital charges, ancillary charges). Because of patient mix differences across hospitals, outcomes were adjusted for severity of Acute MI, comorbidity and demographics. RESULTS: There were important patient mix differences across hospitals. For example, Hospital C had more comorbidity than Hospital B (57.78% of Hospital C patients vs 15.00% of Hospital B patients were rated moderate or severe using a well tested index, p < 0.0001). After adjusting for patient mix differences, Hospital C scored significantly better on four of six outcome measures (i.e. angina, dyspnea, physical functioning, psychosocial functioning). For example, Hospital C's patients' mean scores on physical functioning at 8 week follow-up averaged 75.19 (on a 0-100 scale), while Hospital A's was 63.03 and Hospital B's was 48.57 (F-ratio = 4.95; p < 0.05). However, Hospital A scored significantly lower on all three resource intensity indicators (length of stay, ancillary charges, and total charges). For example, Hospital A's ancillary charges averaged $10,752 while Hospital B's and C's averaged $11,432 and $16,598 respectively. Between-hospital comparisons on adjusted mortality and satisfaction did not differ significantly. CONCLUSION: The "value" profiles (i.e. outcomes related to charges) produced by these three hospitals were substantially different. Studies that simultaneously measure outcomes, costs, patient mix and processes have potential to: (a) enable clinical teams to improve the measurable value of clinical care; and (b) enable purchasers to better evaluate which providers to select as preferred sources of care.

Acute Disease↗

PubMed1991

Physical therapy diagnosis and the relationship between impairments and function.

Physical therapy diagnosis refers to both a process and a particular label within a classification scheme. This article reviews the development of the concept of diagnosis in physical therapy and evaluates the clinical utility of using the World Health Organization's International Classification of Impairments, Disabilities, and Handicaps (ICIDH) as a taxonomy for physical therapy. In place of the ICIDH, a model developed by Nagi is suggested. If this model is applied to physical therapy, the relationship between impairments and functional limitations is identified as the primary diagnostic focus of physical therapy. Exploration and expansion of this model may best serve the development of a classification scheme for physical therapy diagnosis.

Activities of Daily Living↗

PubMed1993

An evaluation of the physical and functional characteristics of infant resuscitators.

Self-inflating resuscitators (SIRs) are commonly used to assist ventilation in the newborn. Despite their widespread use, there is limited information available on the functional and physical characteristics of SIRs. We studied five new infant bag-valve units to compare their physical characteristics, including reservoir, accumulator, and dead space volumes (VD), pressure relief mechanism (PRM), inspiratory resistance (RI), and functional mechanics including stroke volume (SV), fraction of delivered oxygen (FDO2), and cycle frequency at -5 degrees C, 20 degrees C, and 49 degrees C, using a test lung apparatus and experienced respiratory therapists. In addition, deficiencies and features that may render them less than ideal were sought. All SIRs met minimum standards for reservoir and accumulator volumes, RI (< 20 cmH2O/L/sec), SV (20-70 ml), and FDO2 (> 90%) as determined by the Canadian Standards Association (CSA) and the American Society for Testing of Materials (ASTM). However, the following deficiencies were noted: 1) MPR and Pulmanex had no PRM (ASTM requirement); 2) MPR could not cycle at -5 degrees C; 3) the VDs for Pulmanex (10 ml) and MPR (15 ml) were high; 4) the CPR connector broke during normal use, and the MPR connector frequently disconnected; 5) the Laerdal expiratory valve was incompetent; and 6) the Laerdal and CPR could be misassembled for use. Our study shows that some commercially available SIRs do not meet all CSA and ASTM standards and may not be ideal in specific clinical situations. The choice of a SIR may be dictated by the clinical situation in which its use is intended.

Equipment Design↗

PubMed1992

[Physical training in coronary patients with poor left ventricular function].

Physical training is beneficial in patients with coronary artery disease, and in those after myocardial infarction in whom left ventricular function and ejection fraction (LVEF) are relatively well preserved. However, little is known about the effect of physical training in coronary patients with impaired left ventricular function. 12 patients after myocardial infarction (range 42-60 years) with LVEF of 30% or less at rest were evaluated after 11 months of isotonic physical training. Mean LVEF increased from 28.0% to 33.0% (p less than 0.002) at rest and from 29.4% to 33.2% (p less than 0.002) on effort. Exercise tolerance increased 228 seconds by the end of the study (p less than 0.001); the double product at symptom limit effort increased (p less than 0.001) and the double product at the same work load decreased (p less than 0.002). During training there was no cardiovascular deterioration and all patients returned to work within a mean of 3.7 months. The results show that patients with severe left ventricular impairment should not necessarily be excluded from cardiac rehabilitation programs involving physical training.

Adult↗

PubMed1977

Membrane associated cytoplasmic mRNA in Artemia salina; functional and physical changes during development.

The physical and functional properties of the mRNA population from developing embryos of the brine shrimp Artemia salina were characterized. About 20% of the total poly(A)-rich mRNA in these embryos appears to be specifically associated with the membrane fraction throughout early development, and physically differs markedly from the free cytoplasmic mRNA. The membrane-associated mRNA fraction consists of two well-defined populations of molecular weight of 5.2x10(5) and 3.6x10(5), whose relative amount changes during the various stages of embryo development. The size of the poly(A) tail at the 3'-end of the mRNA molecules, as estimated by processive phosphorolysis, was found to consist of 180 and 210 adenosine residues for the two respective mRNA species. The in vitro translation products of the membrane-bound mRNA molecules are apparently similar to those of the free mRNA molecules.

Animals↗