Comfort Domain Research Articles

Multi-domain human-oriented approach to evaluate human comfort in outdoor environments

Human comfort outdoors is widely investigated, but most studies explore the comfort domains singularly. This paper aimed to evaluate human comfort in parks, verifying the importance of using a multi-domain (simultaneously evaluating thermal, visual, acoustic, and air quality) and multi-disciplinary (combining environmental and social fields) approach. A walk through a pre-defined path from one park to another was repeated twice per day on four consecutive days in June, with three participants per walk. The two investigated parks are in central Italy and were chosen because they differ in their design and spatial characteristics. Environmental data were recorded with an innovative wearable device during the whole walk, and surveys were used to assess people’s perceptions of the parks. Despite observed differences in collected physical parameters, the survey’s responses were similar, and different comfort domains showed dependence on each other in the two parks. Logistic regression models were developed for each park, and they revealed that the qualitative information predicted the overall comfort level more accurately than the environmental data. In detail, the models based on environmental data resulted in R2 equal to 0.126 and 0.111 in Parks 1 and 2, respectively, whereas using the survey answers increased it up to 0.820 (Park 1) and 0.806 (Park 2). This study contributes to addressing the gap in multi-domain comfort studies outdoors and confirms the importance of using multi-disciplinary and multi-domain approaches for a complete comfort analysis, supporting holistic human-biometeorology-oriented models and forecasting opportunities that can promote improvements in urban environmental quality and liveability.

Nurses’ use of the clinically aligned pain assessment tool: A mixed methods study

BackgroundAssessment of pain in the hospital has often relied on intensity rating alone. To address the gap in meeting patients' pain management expectations, a Midwestern medical center implemented the CAPA (Clinical Aligned Pain Assessment) tool for more comprehensive nursing pain assessments. AimsThis research described nurses' experience using CAPA on an adult general medicine unit and their documentation of the tool in the electronic health record (EHR) more than 5 years after CAPA implementation. DesignMixed methods exploratory sequential design. MethodsA convenience sample of nurses (N = 8) participated in 2 focus groups to describe how they used CAPA, how well it assessed pain, how it determined pain interventions, and the challenges and advantages of using CAPA. Patient EHR data (N = 373) for a 6-month period from the same unit were analyzed to evaluate CAPA documentation. ResultsQualitative themes included: benefits of using CAPA, CAPA leads to a more comprehensive picture, variation in how CAPA is used, and challenges. Quantitative findings demonstrated most frequent documentation in the comfort domain and earlier, though still delayed, reassessment when a higher level of pain was noted. Mixed methods analysis revealed variation in knowledge and practice regarding which domains to document each shift and during reassessment. ConclusionsAs patient advocates, nurses are integral to thorough assessment and treatment of pain. Findings identified the need for methodological research of CAPA. As with any assessment tool, when using CAPA, ongoing monitoring is needed to address how it is administered, coded, and used for decision-making about pain management.

Survey of Nurses’ Use of the Clinically Aligned Pain Assessment (CAPA) Tool

BackgroundLimited research is available on tools for assessing pain and its effect on function in the acute care setting. AimThis research's purpose is to describe nurses’ use of the Clinically Aligned Pain Assessment (CAPA) tool and their beliefs about its utility for assessing pain compared to the numeric rating scale (NRS) in a hospital where CAPA had been used for 6 years. DesignA cross-sectional self-report survey. MethodsNurses (N = 110) from 13 adult inpatient units in an academic center participated in this survey describing frequency of CAPA and NRS use, CAPA domains documented, and how nurses asked about pain and distinguished between categories when coding for documentation. Beliefs about the tools’ effectiveness were also reported. ResultsMost nurses used CAPA routinely for assessments; almost half used the NRS at times. They believed both tools were effective for assessment, but CAPA was more effective to determine what intervention was needed. They also believed patient report using CAPA was more likely to match the nurse's assessment; a majority reported incorporating their observations into CAPA documentation. Most asked the patient about pain without using CAPA words, although many used the specific words. Practice varied in how nurses determined which category to select in the comfort domain and which domains were assessed routinely. ConclusionsAlthough many nurses believed CAPA was effective, variation existed in how it was used to assess and document pain, increasing potential for inconsistent assessments and interpretations of pain and pain management.

3D-Printed Patient-Specific Casts for the Distal Radius in Children: Outcome and Pre-Market Survey.

Background: Orthopaedic and Trauma surgery is expected to undergo profound transformation as a result of the adoption of 3D technology. Among the various applications, patient specific manufacturing of splints and casts would appear to be, particularly in children, an interesting implementation. This study aims to assess the safety of patient specific 3D casts obtained with a newly developed 3D-scanning devise in a small case series. We therefore conducted a clinical outcome and pre-marketing study in 10 consecutive patients with distal radius fractures treated at an Academic Level I Pediatric Trauma Center. After the application of the 3D cast, patients underwent three consecutive evaluations in the following 21 days. The main outcome measurements were: pain, skin lesions and general comfort, and acceptance of the cast. The three domains were measured with the Visual Analogue Scale (VAS), the NPUAP/EPUAP classification and the Positive affect-Negative affect Scale for Children (PANAS-C), the Self-Assessment Manikin (SAM) clinical psychology tests and a Likert-type five item questionnaire, respectively. A final mechanical analysis of the cast was carried out to confirm product integrity. Results: The results obtained were consistently positive in the investigated domains of general comfort, efficacy of contention and mechanical integrity of the 3D-printed cast as well as in the practicability of the supply chain. Conclusions: This study provides Level IV evidence that patient specific 3D printed casts obtained with a specifically designed software were safe in the management of “buckle” fractures of the distal radius in children. These results encourage to extend the technology to the treatment of more demanding fractures.

Evaluation of the main sensitivity drivers in relation to indoor comfort for individuals with autism spectrum disorder. Part 1: Investigation methodology and general results

The present study applies an approach to analyze the stress induced on people on the autism condition. Dedicated questionnaires were prepared, in order to guarantee an inclusive participation and then applied by means of two different surveys in living and extended care unit environments. Results permit to highlight that: (i) the four comfort domains show similar sensitivity trends, with acoustics having the greatest impact on people with autism spectrum disorder (ASD), while thermo-hygrometric, visual and IAQ sensitivity decreases as the stress scale increases; (ii) Severity of autism influenced the acoustic sensitivity, while age and the considered environment influenced thermo-hygrometric, visual and IAQ sensitivities. The proposed approach can be applied to well-being studies involving people with other types of conditions which could alter their perception of the built environment.

The NEXT.ROOM: Design principles and systems trials of a novel test room aimed at deepening our knowledge on human comfort

Occupants' interaction with building systems, and more generally occupants’ behaviour, is strongly related to human perception of the surroundings. Progresses in human comfort theories rely upon data collection during tailored experiments, stressing the influence of single or specific combinations of environmental stimuli on diversified human responses. Laboratory experiments are typically performed in test rooms, i.e., rooms that are equipped to provide continuously monitored and controlled environmental boundaries. The NEXT.ROOM is a novel test room built up for investigating the multidisciplinary complexity of human perception, by controlling and monitoring environmental factors belonging to the four domains of comfort (thermal, visual, air quality, and acoustics) through centralized and human-centred systems. The study presents rationales behind its design and the selection of human-centred dedicated devices. Trials of the installed systems provide operational ranges for designing human comfort experiments to be performed within the NEXT.ROOM. Limits in fast-dynamics and range of internal temperature are also highlighted, since the adopted systems are mainly associated to common residential uses. The internal position of the test room also limits daylight access but the window designed in-line with the external laboratory window still guarantees the outdoor view from inside the NEXT.ROOM. A further innovation is the introduction of Virtual Reality tools for testing different internal layouts or even outdoor scenarios under highly controlled and carefully monitored environmental conditions.

Satisfaction level of anti-DM medicine in DM patients in primary health service in Yogyakarta

Introduction: Satisfaction with anti-DM drug therapy can affect the effectiveness of and adherence to treatment in diabetic patients. This study aims to determine the description of satisfaction with anti-DM drug therapy for type 2 D.M. patients in primary care.Method: The design of this study was a cross-sectional study of D.M. Patients. We included 109 DM Patients Participants. Data is collected from a perspective and carried out by face-to-face interviews using a questionnaire. We used the Therapy satisfaction questionnaire Medicine (TSQM) for assessing satisfaction with anti-DM drug therapy. We performed uni- and bivariate data analysis using the free-to-play version of SPSS. Characteristic of subject and TSQM scores were presented descriptively.Result: The results of calculations with the help of SPSS version 25 are TSQM mean effectiveness domain 61.583 ± 11.598, side effects domain 54.011 ± 32.340, comfort domain 66.883 ± 8.805, global satisfaction domain 55.715 ± 11.274. Based on the research data, it is known that the level of global satisfaction therapy of D.M. patients in primary health facilities is sufficient. The lowest therapeutic domain of satisfaction is the domain of side effects, and the highest domain is the domain of satisfaction with comfort in drug therapy.Conclusion: The level of D.M. patient satisfaction with anti-DM drug therapy is sufficient. Patients need to be educated about the possible emergence of side effects due to drug use.

Comparing the patient experience between a novel 360° gamma camera (VERITON-CT) and a conventional dual head gamma camera.

Aims: To explore whether the novel 360° gamma camera design of VERITON-CT adversely affects the rate of scan non-completion due to claustrophobia or other patient experience factors, when compared to a standard dual-headed gamma camera. Methods: Single centre prospective study of all nuclear medicine studies on either of two gamma cameras; the VERITON-CT (Spectrum Dynamics Medical) and Discovery NM/CT 670 (GE Healthcare). It was recorded whether the patient had completed the scan as protocoled or, due to claustrophobia, had a shortened scan or no scan. The patients were also offered a patient experience questionnaire, with domains of comfort, scan time, scan noise and claustrophobia assessed using a five-point Likert scale. Results: Over a four-month period, there were 296 patients scanned on the Discovery scanner and 274 patients scanned on the VERITON-CT scanner. There was a scan non-completion rate, due to claustrophobia, of 1.35 % for the Discovery and 1.46 % for the VERITON-CT scanner. 354/570 (62%) of all patients involved returned their questionnaires. There was no statistical difference between the responses for comfort, scan time, scan noise and feelings of claustrophobia. Conclusion: The study provides evidence that the novel 360° gamma camera design of VERITON-CT does not lead to a significantly increased scan failure rate due to claustrophobia and there is no change in the subjective experience for patients.

Environmental thermal influence over soundscape perception: a test room experimental campaign involving the psychological and physiological description of the indoor environment

Human environmental perception leads occupants’ behaviour when interacting with buildings components, affecting the final building energy performance. A solid understanding of human comfort perception includes simultaneous multisensory stimuli and cross-modal interactions among different comfort domains. This study aims to explore the cross-modal effect between thermal and acoustic domains. Each of the 40 subjects took part in a multisensory survey under two different stationary environmental temperature settings. Results show that people in thermally warm conditions are less confident in describing the provided acoustic records. To perform the same procedure but providing a decreasing air temperature ramp would lead to a better interpretation of the results of this campaign.

Impact of early eyelid weight placement on the development of synkinesis and recovery in patients with idiopathic facial paralysis.

PurposeDetermine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis (IFP) on the recovery of facial function in patients with lagophthalmos.MethodsThis is a retrospective review of patients with incomplete recovery of IFP—defined as a Sunnybrook Facial Grading Scale (FGS) score of less than 100, 3 months after onset. Only patients with FGS and Facial Clinimetric Evaluation (FaCE) scores recorded at 3 and 12 months were included. Patients were categorized into 3 groups: Group A, lagophthalmos with eyelid weight placement; Group B, lagophthalmos without eyelid weight placement; Group C, complete eye closure (CEC) without eyelid weight placement. The eye comfort domain and composite score of the FaCE questionnaire were analyzed. Voluntary eye closure, synkinesis with eye closure, overall synkinesis and the composite score of the FGS were also analyzed. Paired two-tailed t-test was used to evaluate the data comparing the 3 and 12 month FaCE and FGS scores within and between the 3 groups.ResultsThe change in composite FGS score significantly increased from month 3 to month 12 in Group A as compared to Group B (37 vs 4.25, P = 0.01). While Group A had significantly lower eye comfort (−12.5, P = 0.01), voluntary eye closure (−1.75, P = 0.05) and overall FGS scores (−28.75, P = 0.04) at 3 months compared to those in Group C, there were no differences between these two groups at 12 month follow-up.ConclusionsFor patients with lagophthalmos at 3 months, early eyelid weight placement may lead to improved facial function at 12 months.

Thermal comfort in physiotherapy centers: Evaluation of the neutral temperature and interaction with the other comfort domains

Not many studies regarding comfort in physiotherapy centers are present in literature. These facilities host both therapists and patients, who can have different age and health status and perform different activities. For this reason, the assessment of indoor environment can be difficult, and models available in technical standards and in the literature may poorly represent the occupants of physiotherapy centers. In this study, environmental well-being of therapists and patients was analysed in two facilities located in Italy and Denmark, in terms of thermal comfort and its interaction with other environmental quality domains (visual, air quality, acoustic). Separately for the heating and non-heating periods, measurements of the physical quantities and subjective questionnaire surveys were applied. Fanger's and adaptive models were used, while the influence of metabolic rate and subjective parameters on thermal comfort of occupants was investigated with statistical analyses. The neutral temperatures of the different occupants were assessed by means of different methods, and statistical analyses allowed to study the interaction of thermal comfort with the other domains. The study highlighted: 1. Limitations of current thermal comfort models when used in physiotherapy centers, being the metabolic rate difficult to estimate and subjective thermal sensation and satisfaction dependent on subjective parameters not included in the models (type of occupant, age, health status and gender); 2. Unsuitability of linear regression for estimating the neutral temperatures; 3. High tolerance and adaptability of therapists and patients to the temperatures in both seasons; 4. Association of thermal satisfaction with satisfaction with other environmental parameters.

Using Telerehabilitation to Deliver a Home Exercise Program to Youth With Arthrogryposis: Single Cohort Pilot Study.

BackgroundArthrogryposis multiplex congenita (AMC) is characterized by joint contractures and muscle weakness, which limit daily activities. Youths with AMC require frequent physical therapeutic follow-ups to limit the recurrence of contractures and maintain range of motion (ROM) and muscle strength; however, access to specialized care may be limited because of geographical distance. Telerehabilitation can offer a potential solution for delivering frequent follow-ups for youth with AMC, but research on the use of telerehabilitation in children with musculoskeletal disorders is scarce.ObjectiveThe study aims to evaluate the feasibility of delivering a home exercise program (HEP) by using telerehabilitation for youth with AMC. We also aim to explore the effectiveness of the HEP as a secondary aim.MethodsYouths aged between 8 and 21 years with AMC were recruited at the Shriners Hospitals for Children–Canada. The participants completed baseline and post-HEP questionnaires (the Physical Activity Questionnaire for Adolescents, Pediatrics Outcomes Data Collection Instrument, and Adolescent and Pediatric Pain Tool), and clinicians assessed their active ROM using a virtual goniometer. Clinicians used the Goal Attainment Scale with the participants to identify individualized goals to develop a 12-week HEP and assess the achievement of these goals. Follow-ups were conducted every 3 weeks to adjust the HEP. Data on withdrawal rates and compliance to the HEP and follow-ups were collected to assess the feasibility of this approach. The interrater reliability of using a virtual goniometer was assessed using the intraclass correlation coefficient and associated 95% CI. Nonparametric tests were used to evaluate feasibility and explore the effectiveness of the HEP.ResultsOf the 11 youths who were recruited, 7 (median age: 16.9 years) completed the HEP. Of the 47 appointments scheduled, 5 had to be rescheduled in ≤24 hours. The participants performed their HEP 2.04 times per week (95% CI 1.25-4.08) and reported good satisfaction with the approach. A general intraclass correlation coefficient of 0.985 (95% CI 0.980-0.989) was found for the web-based ROM measurement. Individualized goals were related to pain management; endurance in writing, standing, or walking; sports; and daily activities. In total, 12 of the 15 goals set with the participants were achieved. Statistically significant improvements were observed in the pain and comfort domain of the Pediatrics Outcomes Data Collection Instrument (preintervention: median 71; 95% CI 34-100; postintervention: median 85; 95% CI 49-100; P=.08) and Physical Activity Questionnaire for Adolescents (preintervention: median 1.62; 95% CI 1.00-2.82; postintervention: median 2.32; 95% CI 1.00-3.45; P=.046).ConclusionsThe remote delivery of an HEP for youth with AMC is feasible. Promising results were found for the effectiveness of the HEP in helping youths with AMC to achieve their goals. The next step will be to assess the effectiveness of this exercise intervention in a randomized controlled trial.International Registered Report Identifier (IRRID)RR2-10.2196/18688

Patient & staff perceptions of animal-assisted therapy in psychiatric rehabilitation

AimsTo study patients' subjective experiences of having access to a therapy dog and to assess the staff perception of the impact of pet therapy. Hypothesis: pet therapy services are acceptable for rehabilitation patients.BackgroundAnimal-assisted therapy (AAT) is the supervised use of an animal in a therapeutic setting to help in the treatment of physical or psychological disorders in humans. The use of dogs in the context of AAT - ‘dog therapy’ (DT) - has been piloted in the context of stroke rehabilitation; schizophrenia in elderly patients; depression, loneliness and anxiety in elderly patients; Alzheimer's disease; symptom reduction in PTSD; cognitive impairment; and dementia. The impact of pet therapy in long term psychosis care has not been adequately assessed.MethodThis feasibility pilot study used questionnaires to assess patient (n = 12) and staff (n = 10) perceptions of dog therapy in an in-patient psychiatric rehabilitation setting. 24 patients on a rehabilitation ward with complex psychosis were offered the opportunity to interact with ‘Nugget,’ a corgi trained in the United States as a ‘therapy dog.’ A ‘patient questionnaire’ (PQ) and a ‘staff questionnaire’ (SQ) assessed the acceptability and self-rated benefits of the intervention.ResultAll patients (100%) rated highly on the enjoyment, anxiety, calmness, and comfort domains during the dog therapy, and expressed willingness to receive further sessions in the future. The SQ measured staff perceptions of patients’ engagement, enjoyment, comfort and emotional response to the therapy. 100% of staff rated highly on all questions and thought the interventions had recovery value. Engagement was one key factor noted in the feedback. There were no reported adverse reactions to the intervention.ConclusionOur preliminary results showed high acceptability and perceived value for Animal assisted therapy in a psychiatric rehabilitation setting. Given the impact of social isolation and need for connectedness, we recommend access to pet therapy where possible to be integrated into individual recovery programmes.

Influence of Facial Morphology on Masticatory Function and Quality of Life in Elders Using Mandibular Overdentures: 3-Year Results.

Background: Facial types may interfere in the oral health-related quality of life (OHRQoL) and masticatory performance of implant-retained mandibular overdenture (IMO) wearers.Purpose: Investigate the medium-term changes in the masticatory function (MF) and OHRQoL parameters of IMO users, as a function of facial pattern, anteroposterior skeletal discrepancy, and sex.Methods: Forty IMO users, most of them Caucasian (90%) with average age of 69.17 years were classified according to their facial pattern and antero-posterior discrepancy prior to rehabilitation. MF was evaluated by the multiple sieves method to determine the average particle size (X50), heterogeneity (B) and masticatory efficiency (ME, calculated as the percentage of material retained in the 5.6 and 2.8 mm sieves), using Masticatory performance (MP) and swallowing threshold (ST) tests. OHRQoL was measured by applying the dental impact on daily life (DIDL) questionnaire. The data were analyzed by Wilcoxon-paired tests to analyze changes in MF parameters over time, and mixed-effect multilevel regression models were employed to verify differences between groups.Results: Significant changes were still observed in the 3rd year for the ST test with improvements in B for Mesofacial and in time for Dolichofacial individuals, while ME_2.8 deteriorated for Brachyfacial participants. B values of Class I and male individuals improved and brachyfacial individuals still presented worse homogenization (B) than Mesofacial participants in both masticatory tests. Class II and III participants still showed improvements in ME_5.6 and time compared to Class I despite increases in X50. Class II individuals needed less cycles than Class I in the 3rd year. Brachyfacial participants scored lower in the Appearance domain than Mesofacial ones in the 3rd year. Dolichofacial participants and Class III patients scored lower in the Oral Comfort domain than Mesofacial and Class I, respectively. In addition, age influenced the Pain, Oral Comfort and General Performance domains in the 3rd year.Conclusions: Differences in facial morphology continue to influence the MF and OHRQoL outcomes in the 3rd year, and age influenced some OHRQoL domains. Brachyfacial individuals continue to benefit least from rehabilitation with IMO according to masticatory parameters.

Rethinking indoor thermal comfort in the era of rebound and pre-bound effect for the developing world: A systematic review.

This paper presents a review on thermal comfort research that is informed by changes in occupant behavior, lifestyle, and income leading to rebound or pre-bound effect. It explores the current state of research in thermal comfort domain through a systematic review to identify the gaps and opportunities specifically focusing on energy-intensive developing countries. This review argues that adaptive thermal comfort is a continuously evolving domain owing to dynamic modifications in occupant behavior occurring from changes in the cost of energy services and preference of comfort (rebound/pre-bound effect). A conceptual framework linking thermal comfort, rebound/pre-bound effect, and occupant behavior is forwarded through the introduction of an exogenous factor related to occupant well-being. The results ascertain that there is a need of localized thermal comfort model with an occupant-centric approach that can help in enhancing comfort and reducing energy consumption.

Relationship between the comfort level of chronic renal patients and sociodemographic and clinical variables.

To assess the association between the comfort level of chronic hemodialysis patients with sociodemographic and clinical variables using the General Comfort Questionnaire. Cross-sectional study, with a quantitative approach, considering 180 chronic hemodialysis renal patients. Two instruments were used: one for sociodemographic and clinical variables; and the General Comfort Questionnaire, Brazilian version. Mann-Whitney's, Kruskal-Wallis's, and Spearman's tests were used for data analysis. The overall comfort level of patients was 78.16%. The socio-cultural domain presented the lowest level of comfort and the psychospiritual the highest level. Some variables were significantly associated with the domains, such as marital status, education, and considering oneself to be anxious. In the four domains of comfort, it was possible to identify patients' needs, such as the presence and intensity of pain, anxiety, constipation and type of access, making it possible to guide nurses in the systematization of care and improve the comfort of these patients.

Elbow Release and Tricepsplasty in Arthrogrypotic Patients: A Long-Term Follow-Up Study

Obtaining elbow flexion to improve hand-to-mouth reach capability is an essential component of achieving functional independence in pediatric patients with arthrogryposis. This study analyzed the long-term outcomes of elbow release and tricepsplasty in a series of children with arthrogryposis at a tertiary institution. Medical records of patients with arthrogryposis who underwent elbow release and tricepsplasty from 1993 to 2015, with at least 2 years of follow-up, were reviewed. Collected measures included preoperative elbow passive range of motion (ROM), postoperative elbow passive and active ROM, shoulder passive and active ROM, and Pediatric Outcomes Data Collection Instrument (PODCI) scores. Our analysis compared pre- and postoperative follow-up of elbow passive ROM and reviewed PODCI scores with age-adjusted normative values. Seventeen patients (4 female and 13 male) with 24 affected upper extremities (10 left elbow and 14 right elbow) were included in final analysis. Age at final follow-up averaged 11 years (range, 4-20 years), mean age at surgery was 2.7 years (range, 9.6 months-9.3 years) with mean follow-up by extremity at 8.3 years (range, 2-18 years). Differences in pre- and post-operative passive elbow ROM were significant for extension, flexion, and total arc of motion. Most parent and self-reported PODCI scores were less than the age-adjusted normal population, except in the domains of Comfort and Pain and Happiness. Long-term follow-up of elbow release and tricepsplasty in patients with arthrogryposis indicates both increased and sustained elbow flexion and arc of motion. Although PODCI scores were lower compared with the age-adjusted norm, pediatric patients with arthrogryposis were just as happy and had no more discomfort than their unaffected age-adjusted norms. Therapeutic IV.

An innovative methodology to define the bus comfort level

Abstract On-board comfort is one of the factors influencing bus users’ perceptions. Investigating on comfort levels can support transit agencies in monitoring service performance and implementing strategies to improve the service. The specific objective of this paper is to develop an innovative methodology that provides a measure of the quality level of a bus ride in terms of comfort on board, considering instantaneous values of lateral and longitudinal vehicle acceleration. This methodology is based on the matching of subjective and objective measures of comfort. More specifically, authors identify subjective thresholds from the perception of comfort on board and objective thresholds from kinematic parameters recorded along bus routes. The proposed methodology allows to identify a comfort domain and to recognise where passengers experiment comfort/discomfort conditions associated with the driving style of bus drivers.

Assessing the Risk-Benefit Ratio of Scoliosis Surgery in Cerebral Palsy: Surgery Is Worth It.

The true benefits of scoliosis surgery in cerebral palsy (CP) remain uncertain. Our aims were to determine the benefits of spinal fusion according to health-related quality of life (HRQoL) improvement at long-term follow-up and to explore the effect of surgery-related complications on clinical outcomes. The cases of consecutive patients who had Gross Motor Function Classification System (GMFCS) level-IV or V cerebral palsy with 5-year follow-up from a prospective, longitudinal, multicenter database were analyzed. Caregivers completed the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire and 4 Likert-type anchor questions preoperatively and at 1, 2, and 5 years of follow-up. Data on complications were collected prospectively. Preoperative CPCHILD scores were compared with postoperative scores at the 1, 2, and 5-year follow-up evaluations. Preoperative CPCHILD scores were compared with postoperative scores at the 1, 2, and 5-year follow-up evaluations using repeated-measures analysis of variance (ANOVA). Spearman correlation coefficient was used to explore the association between changes in the CPCHILD at 1, 2, and 5-year follow-up and the reported complications within the follow-up period. Similarly, a comparative analysis between the percentage distribution of the answers to the 4 anchor questions and the reported complications was also performed. Sixty-nine patients with a mean age (and standard deviation) of 13.4 ± 2.6 years at enrollment were analyzed. The major Cobb angle was a mean of 81.9° ± 26.7° preoperatively and improved to a mean of 28.7° ± 14.4° at 2 years and 30.7° ± 15.3° at 5 years postoperatively. Significant improvements in CPCHILD personal care, positioning, and comfort domains were noted at all time points. The mean increase in the total score was 7.19 (p < 0.001) at 1 year, and the score gain was maintained at 2 and 5 years postoperatively. The overall complication rate was 46.4% at 1 year, 1.4% between 1 and 2 years, and 4.3% at 2 to 5 years postoperatively, with surgical intervention required in 6 patients within 1 year and in 2 additional patients within 5 years following scoliosis surgery. There was no correlation between complications and CPCHILD scores postoperatively at all time points, with the only exception of a weak correlation (ρ = -0.450, p = 0.002) with CPCHILD comfort score at 1 year after surgery. Scoliosis surgery in patients with CP leads to a significant improvement in HRQoL, which is maintained 5 years following surgery. The substantial complication rate does not correlate with HRQoL changes postoperatively, suggesting that the benefits of surgery outweigh the risks in this fragile population. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

How does mandibular bone atrophy influence the masticatory function, OHRQoL and satisfaction in overdenture wearers? Clinical results until 1‐year post‐loading

This longitudinal clinical study investigated the differences in the masticatory function (MF), satisfaction and oral health-related quality of life (OHRQoL) between atrophic patients (AP) and non-atrophic patients (NAP) before and after rehabilitation with mandibular overdenture (MO). Twenty-six complete denture (CD) wearers were categorised into two groups, according to the mandibular bone atrophy (MBA) degree. MF was evaluated before and after 1, 3, 6 and 12months of the MO loading via 2 standardised tests: (i) MP, masticatory performance (MP_X50, MPB, ME 5·6, ME 2·8) and (ii) ST, swallowing threshold (time, number of cycles, ST_X50, STB, ME 5·6, ME 2·8). The dental impact on daily living (DIDL) questionnaire measured changes in the satisfaction level and OHRQoL. MP comparisons showed significant difference only for ME 5·6 12months after MO loading (AP=33·79±23·6; NAP=17·58± 20·1). ST presented significant differences before MO loading for: ST_X50 (AP=5·48±0·83; NAP=4·31 ±1·44), ME 5·6 (AP=53·17±24·71; NAP=29·83± 31·45) and ME 2·8 (AP=8·76±6·91; NAP=18·61± 10·71). One month after MO loading, NAP performed the ST test 21% faster than AP. After 3months, significant improvements in STB (AP=4·93±4·82; NAP=2·73 ±1·27) and ME 2·8 (AP=17·15±10·00; NAP=24·69± 7·82) also were observed. DIDL evaluation showed significant differences in the oral comfort domain after 3months (AP=0·66±0·29; NAP=0·87±0·16) and after 6months (AP=0·79±0·22; NAP=0·98± 0·08), with lower satisfaction levels in the AP. MBA negatively affects the MF mainly the ST. After 6months, differences between AP and NAP disappeared and ST results were equalised. AP initially has lower satisfaction levels reaching similar levels of satisfaction as NAP after 1year.