Changes In Physical Health-related Quality Of Life Research Articles

Health-related quality of life in adults with osteogenesis imperfecta.

Patient-reported outcome measures (PROMs) are increasingly utilized as endpoints in clinical trials. The Short Form Health Survey-12 (SF-12v2) is a generic PROM for adults. We sought to evaluate the validity of SF-12v2 in adults with osteogenesis imperfecta (OI). Physical and mental health-related quality of life (HRQoL) were assessed in a large cohort of adults in a multicenter, observational, natural history study. Physical HRQoL scores were correlated with the Gillette Functional Assessment Questionnaire (GFAQ). We calculated sample sizes required in clinical trials with crossover and parallel-group designs to detect clinically meaningful changes in physical HRQoL. Three hundred and two adults with OI types I, III, and IV were enrolled. Physical HRQoL scores in the study population were lower than population norms. Physical HRQoL scores moderately correlated with GFAQ for OI types I and IV. We found no correlations between mental and physical HRQoL. From a clinical trial readiness perspective, we show that SF-12v2 reliably measures physical function in adults with OI and can be utilized in crossover trials to detect meaningful physical HRQoL changes with small sample sizes. This study shows that SF-12v2 can be used to measure changes in physical HRQoL in response to interventions in OI.

Prognostic factors related to angina frequency and health-related quality of life during the recovery period in patients with acute myocardial infarction: A follow-up study

Background and Objective: Angina frequency (AF) and health-related quality of life (HRQoL) are important outcomes of acute myocardial infarction (AMI) survivors. The aim of this study was to identify the specific characteristics related to the changes of AF and HRQoL among AMI patients after treatment. Methods: We performed a prospective cohort study of 102 AMI patients in Taiwan. Data were collected at baseline and 1 month (T2), 3 months (T3), and 6 months (T4) after treatment. AF was assessed using the Seattle Angina Questionnaire (SAQ). The HRQoL was evaluated with the 12-Item Short-Form Health Survey (SF-12). The generalized estimating equation (GEE) model explored the prognostic factors related to the changes in AF and HRQoL. Results: Patients who received PCI had a reduction of the changes in AF compared with those in non-PCI group from baseline to T2 (B: -15.70, p < 0.05), T3 (B: -21.50, p < 0.05) and T4 (B: -22.91, p < 0.05). Occlusive vessels negatively associated with the changes in physical HRQoL from baseline to T3 (B: -11.44, p < 0.001) and T4 (B: -11.53, p < 0.05). Patients who had longer hospital stay (B: 0.86, p < 0.001) and jobs (B: 5.88, p < 0.05) showed better physical HRQoL from baseline to T3. Patients who were older (B: -4.56, p < 0.05) and unemployment (B: -6.86, p < 0.05) reported worse mental HRQoL. Conclusion: Higher risk AMI patients such as PCI therapy, older age, and occlusive vessels would take care carefully for promoting HRQoL and AF.

Bariatric surgery in patients with psychiatric comorbidity: Significant weight loss and improvement of physical quality of life

SummaryBackgroundPatients that have psychiatric comorbidity are thought to lose less weight than the general bariatric population and are therefore sometimes denied surgery. However, there is no scientific evidence for this assumption. The aim of this study is to evaluate the weight loss and health‐related quality of life (HRQoL) in patients with psychiatric disorders who undergo bariatric surgery and compare these patients with a general bariatric population.MethodPatients who underwent bariatric surgery in 2015 were included. Patients who received individual counselling and had a current DSM IV axis 1 or 2 diagnosis were included in the psychiatric group (n = 163), all other patients in the generic group (n = 2362).Weight and HRQoL were assessed before and 12‐, 24‐, 36‐ and 48‐months after surgery. Data was analysed using regression analyses.ResultsThe maximum total weight loss (TWL) was 27.4% in the psychiatric group vs 31.0% in the generic group. Difference in %TWL between the psychiatric and generic group was significant from baseline to all follow‐up moments (P < .001).Improvement of PHS was significantly higher in the generic group from baseline to 12‐month (P = .002), 24‐month (P = .0018), 36‐month (P = .025) and 48‐monthfollow‐up (P = .003). Change in mental HRQoL was only different comparing baseline to 48‐monthfollow‐up (P = .014).ConclusionAlthough weight loss and change in physical HRQoL was lower in patients with pre‐operative psychiatric disorders, results of this group were still excellent. Thus, patients with psychiatric diagnoses benefit greatly from bariatric surgery and these patients should not be denied weight loss surgery.

Neighborhood environments and intrinsic capacity interact to affect the health-related quality of life of older people in New Zealand

ObjectivesFollowing the WHO 2015 policy framework, we tested the effects of older people’s intrinsic capacity and their perceptions of their neighborhood environments on mental and physical health-related quality of life (QoL) outcomes across two years. Study designParticipants (mean age = 66) were drawn from two waves of a longitudinal study of aging (n = 2910) in 2016 and 2018. Regression analyses tested the main and interaction effects of intrinsic capacity and neighborhood factors on health-related QoL at T2 (controlling for T1). Main outcome measuresIntrinsic capacity was assessed with number of chronic conditions. Neighborhood perceptions was assessed with measures of housing suitability, neighborhood satisfaction, and neighborhood social cohesion. Health-related QoL was assessed with SF12 physical and mental health component scores. ResultsPerceptions of greater neighborhood accessibility and more trust among neighbours were associated with better mental health-related QoL two years later, but not to changes in physical health-related QoL. A significant interaction between intrinsic capacity and neighborhood access to facilities on physical health-related QoL over time showed that those reporting lower neighborhood access experienced a stronger impact of intrinsic capacity on physical health-related QoL. ConclusionsThe neighborhood environment is important to the wellbeing of older people and is amenable to policy interventions. We need more work on the aspects of the immediate environment that support QoL in older age. This study points to the need for accessible facilities and cohesive neighborhoods to support health.

Changes in Physical Health After Supported Housing: Results from the Collaborative Initiative to End Chronic Homelessness.

The permanent supported housing model is known to improve housing outcomes, but there has been sparse research on the effects of supported housing on physical health. Various organizations including the National Academy of Sciences have called for research in this area. This observational multi-site outcome study examined changes in physical health among chronically homeless adults participating in a comprehensive supported housing program and the associations between changes in physical health, housing status, and trust in primary care providers. Data are presented from an observational outcome study analyzed with mixed linear modeling and regression analyses. A total of 756 chronically homeless adults across 11 sites were assessed every 3months for 1year. The Collaborative Initiative to End Chronic Homelessness provided adults who were chronically homeless with permanent housing and supportive primary healthcare and mental health services. Days housed, physical health-related quality of life (HRQOL) measured by the Short Form-12 health survey, number of medical conditions, number of treated medical conditions, and number of preventive medical procedures received. Participants showed reduced number of medical problems and receipt of more preventive procedures over time, but there was no statistically significant change in physical HRQOL. Changes in housing were not significantly associated with changes in any physical health outcomes. Over time, participants' trust in primary care providers was positively associated with increased numbers of reported medical problems and preventive procedures received but not with physical HRQOL. Entry into supported housing with linked primary care services was not associated with improvements in physical HRQOL. Improvement in other medical outcome measures was not specifically associated with improved housing status.

Patient-Reported Quality of Life Is an Independent Predictor of Survival after Allogeneic Hematopoietic Cell Transplantation: A Secondary Analysis from the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0902

INTRODUCTIONPatient reported outcomes (PROs) including symptoms and health related quality of life (HRQOL) predict mortality in multiple cancers, such as myeloma, head and neck, lung and prostate cancer. The relationship of PROs with survival is not clear in hematopoietic cell transplantation (HCT). We tested three hypotheses about the relationship between HRQOL and survival after HCT: (1) Pre-HCT HRQOL (particularly physical HRQOL) reflects functional status and predicts survival after allogeneic (allo) HCT independently of traditional risk factors and indices; (2) Post-HCT change in physical HRQOL reflects the “toll” of the HCT and predicts subsequent outcomes, including survival, among early survivors; (3) Since autologous (auto) HCT is associated with lower risks for treatment-related morbidity and mortality, PROs may not be as predictive for this group. METHODSWe tested these hypotheses using data from the 711 participants in BMT CTN 0902 (sponsored by NHLBI and NCI, NCT 01278927), a randomized study of pre-transplant exercise and stress management training for patients undergoing auto or allo HCT. Because the primary analysis for BMT CTN 0902 did not show a significant effect for exercise or stress management training, intervention groups were combined for these analyses. However, auto and allo recipients were analyzed separately because of the expected substantial differences in the subsequent risks for morbidity and mortality in the two populations. The HRQOL measures used were the physical component score (PCS) and mental component score (MCS) from the SF-36, measured pre-HCT and at day 100. RESULTSAmong 310 alloHCT recipients with a median follow-up of 23 months, while there were no pre-HCT clinical covariates (including age, conditioning intensity, donor type, graft source, disease, disease stage) that predicted survival, pre-HCT physical HRQOL (PCS on the SF-36) was strongly prognostic for survival (HR for death of 0.72 per 10 points increase, 95% CI 0.60-0.85, p<0.001) while pre-HCT MCS was not (HR 0.99, 95% CI 0.84-1.16, p=0.29). Survival estimates for the first, second, third, and fourth quartiles of baseline PCS were, respectively, 67%, 72%, 81%, and 91% at 6 months and 50%, 65%, 75%, and 83% at one year (Figure 1). Among the eight SF-36 subscales, higher pre-HCT Physical Functioning and General Health scores were strongly associated with better survival. Among day 100 survivors, the PCS change score from baseline to Day 100 was also strongly prognostic for subsequent survival after adjusting for pre-HCT PCS (HR 0.55 per 10 points improvement, 95% CI 0.42-0.72, p<0.001) as was the MCS change score after adjusting for pre-HCT MCS (HR 0.70, 95% CI 0.56-0.89, p=0.003). In models that included patient age and the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI), the EBMT Score, or the Disease Risk Index (DRI), the findings for both pre-HCT values and change scores remained statistically significant with similar hazard ratios, suggesting that PROs convey independent prognostic information for survival despite inclusion of traditional risk factors. Analyses of transplant-related mortality (TRM) in alloHCT recipients showed similar patterns. Higher pre-HCT PCS was predictive of lower TRM. Among patients alive and disease-free at day 100, PCS change score was also associated with lower TRM after adjusting for pre-HCT PCS (HR 0.28, 95% CI 0.17-0.47, p<0.001) and the HCT-CI, EBMT and DRI; pre-HCT MCS and change in MCS did not predict TRM. Among autoHCT recipients (n=337), there were no pre-HCT clinical covariates that predicted survival. Pre-HCT HRQOL also was not prognostic of survival in autoHCT (physical PCS from the SF-36 p=0.82, mental MCS from the SF-36, p=0.56), nor were early changes in either the PCS or the MCS. CONCLUSIONIn summary, among alloHCT recipients who participated in BMT CTN 0902, lower pre-HCT physical HRQOL and early decline in physical HRQOL were strongly predictive for worse overall survival and higher transplant-related mortality. These results suggest that patient-reported data are an important component of risk assessment and could assist in clinical decision-making. High-risk individuals could be targeted for different management strategies or more aggressive supportive care interventions to reduce treatment-related morbidity and mortality in this population. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Longitudinal analysis of the relationship between PTSD symptom clusters, cigarette use, and physical health-related quality of life

Posttraumatic stress disorder (PTSD) symptoms, particularly numbing and hyperarousal symptoms, are related to poor physical health-related quality of life (HRQoL). Tobacco dependence is also associated with poor HRQoL, and individuals with PTSD may smoke at higher rates than the general population. Our study aimed to examine the impact of quitting smoking and changes in PTSD symptoms over time on changes in physical HRQoL. The study used archival data from enrollees (N = 943) in a smoking cessation clinical trial for veterans with PTSD (VA Cooperative study #519). Two of the physical HRQoL domains were sensitive to changes in PTSD symptoms over time: General Health and Vitality. Our findings suggest that particular physical HRQoL domains may be subject to improvement if PTSD symptoms decrease over time.

Physical activity, self-efficacy, and health-related quality of life in persons with multiple sclerosis: analysis of associations between individual-level changes over one year

Physical activity and self-efficacy represent behavioral and psychological factors, respectively, that are compromised in persons with multiple sclerosis (MS), but might be modifiable through intervention and result in better health-related quality of life (HRQOL). The present study adopted a panel research design and examined the associations between individual-level changes in physical activity, self-efficacy, and HRQOL over a one-year period in persons with MS. The sample consisted of 269 persons with relapsing-remitting MS who completed the Godin Leisure-Time Questionnaire (GLTEQ), Multiple Sclerosis Self-Efficacy (MSSE) Scale, and Multiple Sclerosis Quality of Life-29 (MSIS-29) Scale on two occasions that were separated by 1year. The data were analyzed using panel analysis in Mplus 3.0. The initial panel analysis indicated that individual-level change in physical activity was associated with individual-level change in both physical and psychological HRQOL. The subsequent panel analysis indicated that (a) individual-level change in self-efficacy for functioning with MS was associated with individual-level change in physical HRQOL, whereas individual-level change in self-efficacy for control was associated with individual-level change in psychological HRQOL; (b) individual-level change in self-efficacy for functioning with MS, but not self-efficacy for control, mediated the association between individual-level change in physical activity and physical HRQOL; and (c) individual-level change in self-efficacy for controlling MS was the strongest predictor of individual-level change in HRQOL. Physical activity and self-efficacy both might be important targets of subsequent behavioral and self-management interventions for improving the HRQOL of persons with MS, although self-efficacy is seemingly more important than physical activity.

Psychosocial predictors of change in quality of life in patients after coronary interventions

Objective Health-related quality of life (HRQOL) after coronary interventions (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty) usually improves in patients, but not in all patients. Some patients actually show a significant decline in HRQOL. Our aim was to explore the potential of psychologic well-being (anxiety, depression), vital exhaustion, Type D personality, and socioeconomic position as predictors of HRQOL in patients with coronary disease. Methods A total of 106 patients scheduled for coronary angiography were interviewed before (baseline) and 12 to 24 months after coronary angiography. Socioeconomic status was evaluated by education. The General Health Questionnaire 28 was used for measuring psychologic well-being (anxiety, depression), the Maastricht interview was used for measuring vital exhaustion, and the Type D questionnaire was used for measuring personality. HRQOL was assessed using the Short Form-36 (physical and mental components) questionnaire. Functional status was assessed with a combination of New York Heart Association and Canadian Cardiovascular Society classifications. Linear regressions were used to analyze data. Results A change in physical HRQOL was predicted by baseline psychologic well-being (β = −.39; 95% confidence interval [CI], −1.00 to −.16) and baseline HRQOL (β = −.61; 95% CI, −.83 to −.34). A change in mental HRQOL was predicted by (baseline) psychologic well-being (β = −.37; 95% CI, −.99 to −.09), vital exhaustion (β = −.21; 95% CI, −.69 to −.03), and baseline HRQOL (β = −.76; 95% CI, −1.03 to −.44). Ejection fraction did not significantly predict HRQOL. Conclusion Psychosocial factors (psychologic well-being, vital exhaustion) seem to be more important predictors of change in HRQOL compared with some objective medical indicators (ejection fraction) among patients with coronary disease.

Partnership and outcomes in men with prostate cancer

Being in a supportive relationship may have improved the health-related quality of life (HRQOL) of men with prostate cancer, if the support was strong and positive. In the current study, the authors sought to examine the impact of partnership status on the mental health of men treated for localized prostate cancer. Participants had clinically localized prostate cancer and chose treatment with radical prostatectomy (n=307), external-beam radiotherapy (n=78), or brachytherapy (n=91). The authors prospectively assessed subject characteristics and HRQOL outcomes and evaluated associations between partnership outcomes and HRQOL measures. Two multivariate linear regression models were then created, 1 for baseline HRQOL outcomes and 1 for change in HRQOL from baseline to 12 months, with partnership status as the main predictor and subject characteristics as covariates. Partnership status was not found to be associated with either baseline physical or mental health, but partnered participants had less bowel bother (P=.02) and a lower fear of recurrence (P=.03) at baseline than did unpartnered subjects. Men with fewer comorbid conditions scored better across almost all baseline HRQOL domains. Primary treatment type was significantly associated with changes in physical HRQOL, with men undergoing radical prostatectomy describing better changes in physical health than those treated with brachytherapy (P=.04) or those receiving external-beam radiotherapy (P<or=.01). Physical and mental health was found to be comparable in the study cohort of partnered and unpartnered men treated for prostate cancer. The universally high socioeconomic status of the current study cohort may mitigate differences in HRQOL by partnership status.