Changes In Disease-specific Quality Of Life Research Articles

Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation (READ-ASV): protocol and cohort profile.

Although adaptive servo-ventilation (ASV) effectively supresses central sleep apnoea (CSA), little is known about real-world indications of ASV therapy and its effects on quality of life (QoL). This report details the design, baseline characteristics, indications for ASV and symptom burden in patients enrolled in the Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation (READ-ASV). This multicentre, European, non-interventional trial enrolled participants prescribed ASV in clinical practice between September 2017 and March 2021. An expert review board assigned participants to ASV indications using a guideline-based semi-automated algorithm. The primary end-point was change in disease-specific QoL based on the Functional Outcomes of Sleep Questionnaire (FOSQ) from baseline to 12-month follow-up. The registry population includes 801 participants (age 67±12 years, 14% female). Indications for ASV were treatment-emergent or persistent CSA (56%), CSA in cardiovascular disease (31%), unclassified CSA (2%), coexisting obstructive sleep apnoea and CSA (4%), obstructive sleep apnoea (3%), CSA in stroke (2%) and opioid-induced CSA (1%). Baseline mean apnoea--hypopnoea index was 48±23 events·h-1 (≥30 events·h-1 in 78%), FOSQ score was 16.7±3.0 (<17.9 in 54%) and Epworth Sleepiness Scale (ESS) score was 8.8±4.9 (>10 in 34%); 62% of patients were symptomatic (FOSQ score <17.9 or ESS score >10). The most common indications for ASV were treatment-emergent or persistent CSA or CSA in cardiovascular disease (excluding systolic heart failure). Patients using ASV in clinical practice had severe sleep-disordered breathing and were often symptomatic. One-year follow-up will provide data on the effects of ASV on QoL, respiratory parameters and clinical outcomes in these patients.

Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation

Patients with atrial fibrillation (AF) experience poor functional capacity and quality of life (QOL). High-intensity interval training (HIIT) has been shown to elicit greater improvements in functional capacity and QOL compared with moderate to vigorous intensity continuous training (MICT) in other cardiovascular populations, yet HIIT remains understudied in AF. To compare the effects of 12 weeks of HIIT and MICT-based cardiovascular rehabilitation (CR) on functional capacity and general QOL in patients with persistent and permanent AF. Disease-specific QOL, resting heart rate (HR), time in AF, and physical activity (PA) levels were also assessed. This randomized clinical trial, conducted between November 17, 2015, and February 4, 2020, at a tertiary-care cardiovascular health center in Ottawa, Canada, recruited 94 patients with persistent and permanent AF. High-intensity interval training (23 minutes: two 8-minute interval training blocks of 30-second work periods at 80%-100% of peak power output interspersed with 30-second recovery) or CR (60 minutes: continuous aerobic conditioning within 67%-95% of peak HR and 12-16 of 20 ratings of perceived exertion) twice weekly for 12 weeks. The primary outcomes were changes in functional capacity (6-minute walk test [6MWT] distance) and general QOL (Short Form 36) from baseline to 12 weeks' follow-up. Secondary outcomes included changes in disease-specific QOL (Atrial Fibrillation Severity Scale), resting HR, time in AF, and PA levels. An intention-to-treat analysis was used to compare changes between groups. Of the 94 patients who consented, 86 participated (mean [SD] age, 69 [7] years; 57 [66.3%] men). No significant differences in improvements in 6MWT distance (mean [SD], 21.3 [34.1] vs 13.2 [55.2] m; P = .42) and general QOL (Physical Component Summary, 0.5 [6.1] vs 1.1 [4.9] points; P = .87) between HIIT and CR were observed. No significant differences in improvements in disease-specific QOL (AF symptoms: -1.7 [4.3] vs -1.5 [4] points, P = .59), resting HR (-3.6 [10.6] vs -2.9 [12.4] beats per minute, P = .63), and moderate to vigorous PA levels (37.3 [93.4] vs 14.4 [125.7] min/wk; P = .35) between HIIT and CR were detected. Participants attended a mean (SD) of 18.3 (6.1) (75.1%) HIIT sessions and 20.0 (4.5) (83.4%) CR sessions (P = .36). In this randomized clinical trial, twice-weekly 23-minute HIIT was as efficacious as twice-weekly 60-minute CR in improving functional capacity, general and disease-specific QOL, resting HR, and PA levels in patients with persistent and permanent AF. ClinicalTrials.gov Identifier: NCT02602457.

The Impact of Post-thyroidectomy Paresis on Quality of Life in Patients with Nodular Thyroid Disease.

To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease. Observational study. University hospital. Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen's effect size was used to evaluate changes. Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI (P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency (P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT (P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point (P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery. Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.

Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease.

How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD). In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4weeks, and 130 at 4months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George's Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed. At 4weeks and 4months, changes in disease-specific QOL (st. β=-0.35, p<0.001, partial (p) R (2)=11-12%), depression (st. β=-0.32 to -0.36, p<0.001, pR (2)=9-12%), and anxiety (st. β=-0.21 to -0.40, p<0.02-0.001, pR (2)=4-15%) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4months (st. β=0.21, p=0.02, pR (2)=4%), but not with changes in depression. Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.

Impact of continued medical therapy in patients with refractory chronic rhinosinusitis

Patients with refractory chronic rhinosinusitis (RCRS) have persistent symptoms despite best medical therapy. Some evidence suggests continued medical therapy (CMT) is appropriate for patients with RCRS. The primary objective of this study was to evaluate the clinical impact of CMT in patients with RCRS who have significant reductions in baseline disease-specific quality of life (QoL) and would be considered candidates for endoscopic sinus surgery (ESS). A prospective longitudinal observational study was undertaken between August 2011 and June 2013. age >18 years, CRS defined by American Academy of Otolaryngology (AAO) adult sinusitis guidelines, failed medical therapy (defined by a 3-month minimum of topical intranasal steroid, minimum 7-day course of systemic corticosteroid, ± 2-week course of broad spectrum systemic antibiotic), and elected ESS. Primary outcomes were change in disease-specific QoL and endoscopic scores between enrolment and immediately prior to ESS. Secondary outcomes included medication consumption and work days missed. A total of 31 patients were enrolled. Following CMT for a mean of 7.1 months, there was an absolute worsening in mean 22-item Sino-Nasal Outcomes Test (SNOT-22) score between baseline and preoperative follow-up, 57.6 to 66.1, respectively (p = 0.006). There was a significant worsening of mean endoscopic score between baseline and preoperative follow-up, 6.9 to 7.7, respectively (p = 0.002). There was an increase in budesonide irrigations along with a reduction in use of topical nasal steroid sprays prior to ESS. Patients experienced a mean increase of 3.6 work days lost while receiving CMT (p = 0.023). Results from this study suggest that patients with RCRS who have significant reductions in baseline disease-specific QoL do not experience clinical improvement while receiving CMT.

Prospective studies on mental status and quality of life in patients with head and neck cancer treated by radiation

Factors affecting the quality of life (QOL) in patients undergoing radiation therapy for head and neck cancer were determined in a prospective study. Full psychiatric interviews and self-report questionnaires concerning patients' QOL, pain, anxiety, mood, coping style and personality were administered to 35 patients with Stage I or II head and neck cancer before radiation therapy (week 0), and approximately one month (week 4) and two months (week 8) after starting of radiation. Anxiety, depression and pain were more severe at week 4 than at baseline. Anxiety was less at week 8, but depressive symptoms remained remarkable. Stepwise regression analyses revealed that changes in depressed mood and pain partially accounted for changes in disease-specific QOL. General health QOL related to a premorbid personality of openness and an emotional aspect of a coping style. Therapeutic interventions including psychiatric management of depression and physical management of pain appear to be crucial for preserving QOL during radiation treatment of patients with head and neck cancer.

Patient, operative, and surgeon factors that influence the effect of superficial venous surgery on disease-specific quality of life.

Superficial venous surgery for CEAP 2 disease leads to an improvement in disease-specific quality of life (QoL) in the short term. However, which factors influence the magnitude of this improvement, how surgery affects QoL in patients with CEAP 4 to 6 disease, and whether this improvement is durable are not known. The objective of this study was to identify patient, operative, and surgeon factors that might influence the change in disease-specific QoL in the 2 years after superficial venous surgery. This prospective study was comprised of 203 unselected, consecutive patients with CEAP 2 to 6 disease who underwent saphenous with or without subfascial endoscopic perforator surgery and who completed the Aberdeen Varicose Vein Symptoms Severity Score (AVVSSS) before surgery and at 4 weeks, 6 months, and 2 years after surgery. Univariate and multivariate analyses were performed. At baseline, recurrent and ulcer (CEAP 5 and 6) diseases were associated with a higher (worse) AVVSSS. Surgery was associated with a significant improvement in median (interquartile range [IQR]) AVVSSS: baseline, 17.8 (11.8 to 27.2); 4 weeks, 13.8 (7.9 to 21.3); 6 months, 9.6 (4.2 to 15.8); and 2 years, 8.1 (4.0 to 14.7). One hundred seventy-five patients (86%) at 6 months and 177 patients (87%) at 2 years reported an improvement in AVVSSS. Postoperative AVVSSS at both 6 months and 2 years was most significantly influenced by preoperative score (P <.0001). After adjustment for baseline AVVSSS, the following factors were identified in multivariate analysis as having a significant and independent positive (+) or negative (-) impact on AVVSSS: at 6 months, (-) recurrent disease (P =.009), (-) CEAP 4 disease (P =.026); and at 2 years, (+) long saphenous surgery (P =.02), (-) CEAP 5 disease (P =.030). In this unselected series, saphenous surgery with or without subfascial endoscopic perforator surgery led to an improvement in disease-specific QoL in 87% of patients out to 2 years. Although univariate analysis results suggested that many baseline factors might be associated with outcome, multivariate analysis results suggested that only surgery for recurrent disease and for CEAP 4/5 disease remained as significant negative, and only long saphenous surgery as significant positive, independent prognostic factors. These data provide evidence of the medium-term clinical effectiveness of venous surgery across the full spectrum of CEAP clinical grades, show the importance of multivariate analysis, and reemphasize the importance of minimization of recurrence.