Decrements In Physical Functioning Research Articles

Muscle group-specific skeletal muscle aging: a 5-yr longitudinal study in septuagenarians.

There is some evidence that the age-associated change in skeletal muscle mass is muscle specific, yet the number of specific muscles that have been studied to form our understanding in this area is limited. In addition, few aging investigations have examined multiple muscles in the same individuals. This longitudinal investigation compared changes in skeletal muscle size via computed tomography of the quadriceps (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius), hamstrings (biceps femoris short and long heads, semitendinosus, and semimembranosus), psoas, rectus abdominis, lateral abdominals (obliques and transversus abdominis), and paraspinal muscles (erector spinae and multifidi) of older individuals from the Health, Aging, and Body Composition (Health ABC) study at baseline and 5.0 ± 0.1 years later (n = 469, 73 ± 3 yr and 78 ± 3 yr, 49% women, 33% black). Skeletal muscle size decreased (P < 0.05) in quadriceps (-3.3%), hamstrings (-5.9%), psoas (-0.4%), and rectus abdominis (-7.0%). The hamstrings and rectus abdominis atrophied approximately twice as much as the quadriceps (P < 0.05), whereas the quadriceps atrophied substantially more than the psoas (P < 0.05). The lateral abdominals (+5.9%) and paraspinals (+4.3%) hypertrophied (P < 0.05) to a similar degree (P > 0.05) over the 5 years. These data suggest that older individuals experience skeletal muscle atrophy and hypertrophy in a muscle group-specific fashion in the eighth decade, a critical time period in the aging process. A broader understanding of muscle group-specific skeletal muscle aging is needed to better guide exercise programs and other interventions that mitigate decrements in physical function with aging.NEW & NOTEWORTHY These longitudinal analyses of six muscle groups in septuagenarians provide novel information on the muscle group-specific aging process. Although the quadriceps, hamstrings, psoas, and rectus abdominis atrophied with different magnitudes, the lateral abdominals and paraspinals hypertrophied over the 5 years. These findings contribute to a better understanding of the skeletal muscle aging process and highlight the need to complete studies in this area with a muscle-specific focus.

MUSCLE GROUP SPECIFIC SKELETAL MUSCLE AGING: A FIVE YEAR LONGITUDINAL STUDY IN SEPTUAGENARIANS

Abstract Most of the scientific literature on human skeletal muscle aging has focused on the quadriceps femoris, with the remaining few hundred skeletal muscles receiving limited specific investigation. This longitudinal investigation compared changes in skeletal muscle size via computed tomography of the quadriceps (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius), hamstrings (biceps femoris short and long heads, semitendinosus, semimembranosus), psoas, rectus abdominis, lateral abdominals (obliques and transversus abdominus), and paraspinal muscles (erector spinae and multifidi) of older individuals from the Health ABC study at baseline and 5.0±0.1 years later (n=469, 73±3y &amp; 78±3y, 49% women, 33% black). Skeletal muscle size decreased (p &amp;lt; 0.05) in quadriceps (-3.3%), hamstrings (-5.9%), psoas (-0.4%), and rectus abdominus (-7.0%). The hamstrings and rectus abdominus atrophied approximately twice as much as the quadriceps (p &amp;lt; 0.05), while the quadriceps atrophied substantially more than the psoas (p &amp;lt; 0.05). The paraspinals (+4.3%) and lateral abdominals (+5.9%) hypertrophied (p &amp;lt; 0.05) to a similar degree (p&amp;gt;0.05) over the 5 years. These data suggest that skeletal muscle mass in older individuals changes in a muscle group specific fashion in the eighth decade, a critical time period in the aging process. A broader understanding of muscle group specific skeletal muscle aging is needed to better guide exercise programs and other interventions that mitigate decrements in physical function with aging.

Characteristics associated with decrements in objective measures of physical function in older patients with cancer during chemotherapy

PurposeStudy purposes were to evaluate for inter-individual variability in the trajectories of three objective measures of physical function (PF) in older patients receiving chemotherapy (n = 112) and determine which characteristics were associated with worse PF.MethodsBalance, gait speed, and chair-stand test were evaluated at initiation and 1, 3, 6, 9, and 12 months following chemotherapy. Hierarchical linear modeling was used to assess inter-individual variability in the trajectories of the three tests. Demographic, clinical, and symptom characteristics, and levels of cognitive function associated with initial levels and changes over time in each of the tests were determined.ResultsGait speed and chair-stand tests improved over time. Balance declined until month 6, then increased. Characteristics associated with decreases in balance scores at initiation of chemotherapy were lower level of education and lower Karnofsky Performance Status (KPS) score. For initial levels of poorer gait speed, older age, poorer Trail Making Test B (TMTB), and worse Attentional Function Index scores were the associated characteristics. Lower KPS scores, higher body mass index, and poorer TMTB scores were associated with poorer chair-stand times at initiation of chemotherapy. Worse trajectories of chair-stand times were associated with poorer chair-stand time at enrollment. Characteristic associated with lower initial levels and improved trajectories of balance was older age at enrollment.ConclusionsDetermination of characteristics associated with decrements in balance, gait speed, and chair-stand can assist clinicians to identify older oncology patients at risk for decrements in PF. Interventions to maintain and improve PF need to be implemented with higher risk patients.

Exercise in Octogenarians: How Much Is Too Little?

The global population is rapidly aging, with predictions of many more people living beyond 85 years. Age-related physiological adaptations predispose to decrements in physical function and functional capacity, the rate of which can be accelerated by chronic disease and prolonged physical inactivity. Decrements in physical function exacerbate the risk of chronic disease, disability, dependency, and frailty with advancing age. Regular exercise positively influences health status, physical function, and disease risk in adults of all ages. Herein, we review the role of structured exercise training in the oldest old on cardiorespiratory fitness and muscular strength and power, attributes critical for physical function, mobility, and independent living.

Posttraumatic stress phenomena in critical illness and intensive care survivors

The intensive care unit (ICU) within a hospital is typically thought of as a place for the provision of patient care for a life-threatening emergency. Less frequently do we consider it an integral part of disaster response. The COVID-19 pandemic is a public health disaster that has caused surges of critically ill patients requiring treatment in intensive care units (ICUs). However, it is important to bear in mind that survival of a critical illness can come at a cost, including to mental health. Being critically ill and requiring life-saving treatments is extremely stressful, and survivors frequently have substantial decrements in physical functioning, cognition, and emotional health. Remarkably, one in five critical illness survivors has clinically significant symptoms of posttraumatic stress disorder (PTSD). Risk factors, or markers of risk, include prior anxiety and depression, high doses of sedative medications in the intensive care unit (ICU), memories of nightmare-like experiences in the ICU, and emotional distress in early recovery. As with PTSD in other contexts, social support is a protective factor. ICU follow-up clinics, in-ICU psychological interventions, ICU diaries, post-ICU telephonic and computer-based cognitive-behavioral interventions, and virtual reality interventions all show promise in preventing long-term PTSD in critical illness survivors, perhaps particularly in those with substantial emotional distress in early recovery. However, awareness regarding this problem is still growing, as are changes to post-ICU care delivery. Hopefully, improved awareness on the part of the psychiatric community will help with recovery from the COVID-19 pandemic disaster.

Adaptability and Resilience in Aging Adults (ARIAA): protocol for a pilot and feasibility study in chronic low back pain

BackgroundChronic low back pain (cLBP) is the leading cause of disability among older adults and one of the top reasons for seeking healthcare, resulting in significant decrements in physical functioning. Because older adults are among the fastest growing cohorts in the USA, both the incidence and burden of cLBP are expected to increase considerably, rendering geriatric pain management a top health priority. Resilience is defined as a process allowing individuals to adapt and recover from adverse and stressful conditions, and it has been highlighted as a crucial factor in positive health-related functioning. While a growing body of literature supports the use of resilience-based interventions in chronic pain, research examining their effectiveness in older adults with cLBP remains limited. The primary aims of the study are to assess the feasibility and acceptability of a psychologically oriented resilience intervention among aging adults with cLBP.MethodsIn this article, we describe the rationale and design of the Adaptability and Resilience in Aging Adults (ARIAA) study, a single-arm intervention in which 60 participants (ages ≥ 60 years) with cLBP will be recruited to participate in a 7-week group-based program aimed at enhancing psychological resilience. Intervention sessions will target positive psychology concepts (e.g., positive affect, pain acceptance, hopeful thinking, pain self-efficacy) and cognitive behavioral techniques that have established benefits in pain management. Primary study outcomes include intervention feasibility and acceptability as measured by treatment engagement, intervention credibility and satisfaction, ability to meet recruitment and retention metrics, and the feasibility of questionnaire and home activity completion. Outcomes will be assessed at baseline, immediately at posttreatment, and at the 3-month follow-up period.DiscussionThis study will establish the feasibility and acceptability of a novel intervention aimed at enhancing positive, psychological functioning, and resilience in older adults with cLBP. Achievement of these aims will provide a rich platform for future intervention research targeting improvements in pain and disability among geriatric populations and will serve as a foundation for a fully powered trial to examine treatment efficacy of the proposed intervention.Trial registrationClinicaltrials.gov, identifier NCT04068922. Registered 28 August 2019.

Common and distinct characteristics associated with self-reported functional status in older patients with cancer receiving chemotherapy.

To evaluate for inter-individual differences in two subjective measures of functional status in older patients (n = 112), as well as to determine which demographic, clinical, and symptom characteristics, and levels of cognitive function, were associated with initial levels and with the trajectory of the two measures. Functional status was assessed using self-report measures of physical function (PF) and role function (RF) from the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess inter-individual differences in and characteristics associated with initial levels and changes in PF and RF. Characteristics associated with decreases in PF at the initiation of chemotherapy were higher numbers of comorbidities and higher depression, pain, and dyspnea scores. For initial levels of poorer RF, lower Karnofsky Performance Status scores and higher pain and fatigue scores were the associated characteristics. Characteristic associated with worse trajectories of PF was not having had surgery. For RF, worse trajectories were associated with lower cognitive function and higher RF at enrollment. Characteristic associated with both lower initial levels and improved trajectories of PF was having lower performance status at enrollment. Older patients undergoing chemotherapy experience reduced functional performance. Characteristics associated with decrements in PF and RF need to be assessed and interventions implemented to maintain and increase functional status in older oncology patients.

Development of a preliminary conceptual model of the patient experience of chronic kidney disease: a targeted literature review and analysis

BackgroundPatient-reported outcome (PRO) instruments should capture the experiences of disease and treatment that patients consider most important in order to inform patient-centred care and product development. The aim of this study was to develop a preliminary conceptual model of patient experience in chronic kidney disease (CKD) based on a targeted literature review and to characterize existing PRO instruments used in CKD.MethodsPubMed, EMBASE and Cochrane databases and recent society meetings were searched for publications reporting signs/symptoms and life impacts of CKD. Concepts identified in the literature review were used to develop a preliminary conceptual model of patient experience of CKD, overall, and within patient subpopulations of differing CKD causes, severities and complications. PRO instruments, identified from PRO databases, CKD literature and CKD clinical trials, were assessed for content validity, psychometric strength and coverage of concepts in the literature review.ResultsIn total, 100 publications met criteria for analysis; 56 signs/symptoms and 37 life impacts of CKD were identified from these sources. The most frequently mentioned signs/symptoms were pain/discomfort (57% of publications) and tiredness/low energy/lethargy/fatigue (42%); the most commonly reported life impacts were anxiety/depression (49%) and decrements in physical functioning (43%). Signs/symptoms and life impacts varied across the subpopulations and were more frequent at advanced CKD stages. The preliminary conceptual model grouped signs/symptoms into seven domains (pain/discomfort; energy/fatigue; sleep-related; gastrointestinal-related; urinary-related; skin−/hair−/nails-related; and other) and life impacts into six domains (psychological/emotional strain; cognitive impairment; dietary habit disruption; physical function decrements; interference with social relationships; and other). Eleven PRO instruments were considered to be promising for use in CKD; all had limitations.ConclusionsAlthough preliminary, the proposed conceptual model highlights key PROs for people with CKD and is intended to spur development of more tailored PRO instruments to assess these concepts.

Characteristics Associated With Physical Function Trajectories in Older Adults With Cancer During Chemotherapy

ContextStudies on physical function trajectories in older adults during chemotherapy remain limited. ObjectivesThe objective of this study was to determine demographic, clinical, and symptom characteristics associated with initial levels as well as trajectories of physical function over two cycles of chemotherapy in adults aged ≥65 years with breast, gastrointestinal, gynecological, or lung cancer. MethodsOlder adults with cancer (n = 363) who had received chemotherapy within the preceding four weeks were assessed six times over two cycles of chemotherapy using the Short Form-12 Physical Component Summary (PCS) score. Hierarchical linear modeling was used to evaluate for interindividual variability in initial levels and trajectories of PCS scores. ResultsMean age was 71.4 years (SD 5.5). Mean PCS score at enrollment was 40.5 (SD .45). On average, PCS scores decreased slightly (i.e., 0.21 points) at each subsequent assessment. Lower PCS scores at enrollment were associated with older age, greater comorbidity, being unemployed, lack of regular exercise, higher morning fatigue, lower evening energy, occurrence of pain, lower trait anxiety, and lower attentional function. Only higher morning fatigue and lower enrollment PCS scores were associated with decrements in physical function over time. ConclusionWhile several symptoms were associated with decrements in PCS scores at enrollment in older adults with cancer receiving chemotherapy, morning fatigue was the only symptom associated with decreases in physical function over time. Regular assessments of symptoms and implementation of evidence-based interventions should be considered to maintain physical function in older adults during chemotherapy.

Blood Flow Restriction Training: Current and Future Applications for the Rehabilitation of Musculoskeletal Injuries

Science continues to examine interventions to improve fitness, delay age-related decrements in physical function and facilitate healing and recovery after injury. These factors, or lack thereof, directly affect not only quality of life, but also the overall health care financial burden. With a surging population of seniors 65 years and older, which will swell to over 98 million by 2060, the need for interventions that may mitigate senescent changes could not be timelier. Orthopedic surgeons face many challenges in providing care to not only an aging population, but also to a younger subset that is highly active and engaged in a variety of high-impact sports. Therefore, interventions that can positively affect patient health-related outcomes from the time of injury throughout the rehabilitation process are highly warranted. This special issue will examine a novel but increasingly popular intervention, blood flow restriction (BFR) training. BFR training utilizes an automated pressure cuff placed on the proximal limbs to restrict blood flow and, when combined with light resistance exercise, produces a variety of positive physiological effects. BFR shows potential as an adjunct strategy postinjury or surgery to improve general physical conditioning, target muscle weakness around affected joints and hasten recovery. Moreover, BFR may also benefit the geriatric patient by mitigating age-related decrements in physical function. The following 6 articles will provide the reader with important information about the science, safety, and implementation of BFR training. From a health and safety perspective, Dr Loenneke and colleagues provide a thorough review of the mechanisms and science behind BFR training. Although the mechanisms are not fully understood, this paper serves as a well-crafted summary on current best evidence for the adaptations being seen via BFR. Similarly, Dr Cahalin and colleagues have expanded the review on safety to higher risk patients with hypertension. With the aging baby boomer population likely to continue to seek orthopedic care, this article describes what is currently published and the scientific understanding of applying BFR in the hypertensive patient. A primary concern during periods of disuse is the ensuing muscle atrophy that occurs. Dr Lambert and colleagues describe the potential ability of BFR to upregulate muscle protein metabolism and anabolic signaling to slow or reverse the catabolic postsurgery/injury state. Dr Hackney and colleagues discuss BFR as an intervention to mitigate age-related muscle loss (sarcopenia) and strength (dynapenia) within an aging population that can be implemented both preoperatively and postoperatively to hasten recovery following orthopedic procedures. Anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery. Dr Patterson and colleagues describe the application of BFR after ACL reconstruction. There are currently multiple clinical trials worldwide assessing the addition of BFR to ACL rehabilitation. This paper describes the rationale for the addition of BFR postsurgically, the state of the current evidence and a sample clinical protocol. Finally, Dr Bradner and colleagues have provided a thorough review on the reported side effects and safety of BFR. As this technique becomes more widespread, it is important for clinicians to understand the current applications, limitations, and safety considerations in order to effectively apply this modality to appropriate patients. Finally, we would like to thank all the authors for their time and contributions to this symposium.

Physical Functioning in Older Breast Cancer Survivors

The largest age group of breast cancer survivors (BCS) in the U.S. is comprised of women ages 65+, who are susceptible to age-related decrements in physical function accelerated by cancer treatment toxicities. Though exercise is known to reverse age-related functional limitations, older BCS may be heterogeneous in baseline functioning which may affect the efficacy of exercise to reverse functional declines. PURPOSE: Determine the efficacy of each aerobic and resistance training to improve physical function in older BCS, considering baseline physical functioning. METHODS: Older, early-stage, BCS (mean age=72), who underwent chemo- or radio-therapy in the previous 2 years were randomized to 12 months of supervised, group aerobic (AER) or resistance (RES) training or control (CON) flexibility exercise, followed by 6 months of home-based training. Physical function was assessed by the Physical Performance Battery (PPB), 5x chair stand time (sec), maximum bench and leg press (kg), and 4-meter usual walk speed (m/sec) tests and self-reported lower-body function with the Late-Life Function and Disability Instrument (LLFDI). A linear mixed effects model was used to assess function after 12 and 18 months on the full sample and only in BCS with PPB scores ≥9. RESULTS: 114 BCS were enrolled and randomized to AER (n=37), RES (n=39), or CON (n=38). Within the full sample there was a significant improvement in bench press strength at 12 months (p=0.03) and PPB at 18 months in RES vs CON. After removing participants with low baseline physical functioning (n=79), the following additional significant differences were found between: 1) RES (αmean=2.72±1.7) and CON (αmean=-3.06±2.0) for self-report physical function at both 12 (p=0.04) and 18 months (p=0.005), 2) AER (αmean=0.4±0.0) and CON (αmean=-0.03±0.0) at 12-months for average walk speed and, 3) AER (αmean=0.32±0.3) and RES (αmean=0.50±0.2) at 18 months, for chair time (p=0.05). CONCLUSIONS: Although AE and RT are efficacious in improving physical function in older BCS across a range of baseline physical functioning, broader improvements may only be possible among women with better functioning and thus capable of achieving a greater dose of exercise. Older BCS may need to be stratified into groups based on their initial functioning, then matched to appropriate training.

Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy

ContextAlthough physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX). ObjectivesIdentify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality-of-life (QOL) outcomes. MethodsLatent profile analysis was used to identify groups of older oncology patients (n = 363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary score from the Short Form 12. Differences, among the groups, in demographic and clinical characteristics and QOL outcomes were evaluated using parametric and nonparametric tests. ResultsThree groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative Physical Component Summary scores. Characteristics associated with membership in the Well Below class included the following: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared with the Above class, patients in the other two classes had significantly poorer QOL outcomes. ConclusionAlmost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high-risk patients and initiate appropriate interventions.

Health-Related Quality of Life in Australasian Survivors of H1N1 Influenza Undergoing Mechanical Ventilation. A Multicenter Cohort Study.

Patients surviving acute respiratory distress syndrome suffer decrements in physical function and health-related quality of life (HR-QoL); however, it is unclear whether HR-QoL is disproportionately affected in those with H1N1 influenza. The objective was to compare the HR-QoL of patients with a diagnosis of H1N1 influenza who were mechanically ventilated, 12 months after intensive care unit (ICU) discharge with healthy population data and ICU survivor data. A prospective, observational, binational, multicenter cohort study was conducted in 11 ICUs in Australia and New Zealand during June-September 2009. Eligible participants were mechanically ventilated in the ICU with a confirmed diagnosis of H1N1 influenza. People were excluded if they were less than 18 years of age or could not speak English. Two validated HR-QoL questionnaires (Short Form-36 version 2 [SF-36], and Assessment of Quality of Life [AQoL]) were administered 1 year after ICU discharge. Sixty-two patients (48% male) had a median (interquartile range) age of 42 (29-53) years and an APACHE II score of 18.0 (14-20); ventilation days, 10.0 (4-23); and ICU and hospital length of stay, 12.5 (7-27) and 20.0 (15-38) days, respectively. Hospital mortality was 7%, and 31% of the cohort received a tracheostomy. The mean (SD) health utility score at 1 year was 0.68 (0.30) compared with the healthy age-matched population (0.81 [0.23]). The mean (SD) SF-36 physical and mental component summary scores were within population normal ranges at 44.4 (12.3) and 45.5 (12.5), respectively. Health-related quality of life of Australasian survivors of severe H1N1 influenza was comparable to the healthy population 1 year after ICU discharge. Consensus should be sought on standardization of follow-up time points and outcome measurement. Clinical trial registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12609001037291).

Alterations in Whole-Body Insulin Sensitivity Resulting From Repeated Eccentric Exercise of a Single Muscle Group: A Pilot Investigation.

Unaccustomed eccentric exercise using large muscle groups elicits soreness, decrements in physical function and impairs markers of whole-body insulin sensitivity; although these effects are attenuated with a repeated exposure. Eccentric exercise of a small muscle group (elbow flexors) displays similar soreness and damage profiles in response to repeated exposure. However, it is unknown whether damage to small muscle groups impacts upon whole-body insulin sensitivity. This pilot investigation aimed to characterize whole-body insulin sensitivity in response to repeated bouts of eccentric exercise of the elbow flexors. Nine healthy males completed two bouts of eccentric exercise separated by 2 weeks. Insulin resistance (updated homeostasis model of insulin resistance, HOMA2-IR) and muscle damage profiles (soreness and physical function) were assessed before, and 48 h after exercise. Matsuda insulin sensitivity indices (ISI Matsuda) were also determined in 6 participants at the same time points as HOMA2-IR. Soreness was elevated, and physical function impaired, by both bouts of exercise (both p < .05) but to a lesser extent following bout 2 (time x bout interaction, p < .05). Eccentric exercise decreased ISI Matsuda after the first but not the second bout of eccentric exercise (time x bout interaction p < .05). Eccentric exercise performed with an isolated upper limb impairs whole-body insulin sensitivity after the first, but not the second, bout.

Measuring the functional decline of people with advanced-stage non-small cell lung cancer (NSCLC).

e19605 Background: People affected by lung cancer maybe highly symptomatic. This study aimed to quantify changes in physical function and health-related quality of life (HRQoL) in patients with advanced NSCLC. Methods: A prospective cohort study was performed. Patients with stage III and IV NSCLC were recruited within one month of starting treatment and assessed at baseline, 2, 4 and 6 months or until they became too unwell. HRQoL and functional status were measured using the EORTC QLQ-C30, the 6-minute walk test (6MWT) and timed up and go test (TUG). Comparisons between baseline and follow-up assessments were carried out by fitting linear mixed models to each outcome separately. Results: 39 patients (21 male) were included in the analysis; median age of 63 (range 40-80). 59% were receiving treatment with curative intent. 28% had stage 4 disease with 26% deceased by 4 months. Response rates at 2 and 4 months were 71.8% and 53.8% for 6MWT and TUG and 87.2% and 64.1% for EORTC. The mean 6MWT at baseline was significantly lower than predicted for the age, sex and height of the cohort (417.9 versus 550.4 metres, p&lt;0.0005). Significant decline in mean 6MWT distance was seen at 2 (decrease of 42.4m, 95%CI -59.0, -25.7, p&lt;0.0005) and 4 month follow-ups (decrease of 63.6m, 95%CI -85.6, -41.5, p&lt;0.0005) compared to baseline. Significant increases in time taken to complete the TUG were also seen at 2 (increase of 0.76 sec, 95%CI 0.54 – 0.98, p&lt;0.0005) and 4 month follow-ups (increase of 1.01 sec, 95%CI 0.76 – 1.27, p&lt;0.0005) compared with baseline. In contrast, global health status and physical functioning as assessed by the QLQ-C30 showed small but significant decreases at the 2 month follow-up compared to baseline (decrease of 8.04, p=0.01 and decrease of 7.67, p=0.024 respectively), but no significant differences between baseline and the 4 month follow-up. Conclusions: Patients with advanced NSCLC show clinically and statistically significant decrements in physical function at commencement of treatment. This continues to decline rapidly and significantly over time, despite small changes in self-reported HRQoL. The 6MWT demonstrated clinically relevant changes in physical function. Interventions to address this problem are urgently needed.

Functional Health Status in Adult Survivors of Operative Repair of Tetralogy of Fallot

We aimed to determine late functional health status of the growing adult population with repaired tetralogy of Fallot (TOF). We studied all 840 patients with TOF born from 1927 through 1984 who survived to adulthood (> 18 years of age). Clinical follow-up was by chart review, telephone interview (n = 706), and echocardiographic reports (n = 339). Functional health status was assessed using Short Form-36 (SF-36) surveys (n = 396) indexed to normative data. Risk of reoperation was low (≈ 1%/year) but increased beyond age 40 years. At latest follow-up moderate or severe pulmonary regurgitation was common (54%) and right ventricular outflow tract stenosis presented in 1/3. Consequently, evidence of right ventricular dilatation and dysfunction and tricuspid regurgitation was typical. Left-sided abnormalities were also common: hypertrophy (p < 0.0001) and outflow tract dilation (p < 0.0001) with at least mild aortic regurgitation in > 50%. Cardiorespiratory symptoms were reported in 45% (palpitations 27%, dyspnea 21%, chest pain 17%). SF-36 scores were significantly below normal for 4 physical domains (p < 0.001). Decrements in physical functioning were associated particularly with older age at follow-up (p < 0.0001), associated syndromes/lesions, reoperations, ventricular dysfunction, tricuspid regurgitation, residual septal defects, and cardiorespiratory symptomatology. Echocardiographic abnormalities were more common in older patients (p < 0.0001). All 3 SF-36 domains specific to psychosocial well-being were normal. In conclusion, despite excellent survival prospects, physical compromise is common in adults with repaired TOF. Greater decrements in older patients may reflect late deterioration with advancing age or cohort effects related to historical management. Efforts to limit ventricular and outflow tract dysfunction may translate into improved late functional status.

The Influence of Body Mass Index on Self-report and Performance-based Measures of Physical Function in Adult Women

Little is known about limitations in physical function across BMI categories in middle aged women using both self-report and performance-based measures. Furthermore, the impact of BMI on the measurement of function has not been explored. The purpose of this study was to assess physical function in adult women across BMI categories using self-report and performance-based measures and determine the influence of BMI on the relationship between the measures. Fifty sedentary females (10 in each BMI category: normal weight, overweight, obese class I, II, and III) aged 51.2 ± 5.4 years participated. Assessments included demographics, past medical history, physical activity level, BMI, and self-report (Late Life Function and Disability Instrument) and performance-based measures of physical function (6-Minute Walk Test, timed chair rise, gait speed). Physical function was compared between BMI categories using analysis of variance. The influence of BMI on the relationship of self-report and performance-based measures was analyzed using linear regression. Compared to those that were normal weight or overweight, individuals with obesity scored lower on the self-report measure of physical function (LLFDI) for capability in participating in life tasks and ability to perform discrete functional activities. On the performance-based measures, the individuals with obesity had slower gait speed compared to the normal and overweight weight groups. For the 6-Minute Walk Test and timed chair stands, individuals with obesity had poorer performance compared to those who were normal weight. Linear regression analyses revealed that BMI attenuated the relationship between the self-report and performance-based measures by approximately 50%. While those with severe obesity were most impaired, adult women with less severe obesity also demonstrated significant decrements in physical function.

P108. Five Year Outcomes in Patients Treated with the X-STOP Interspinous Process Device for Neurogenic Intermittent Claudication Due to Lumbar Spinal Stenosis

BACKGROUND CONTEXT: Patients with neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis experience pain, decrements in physical function and quality of life. The X-STOP interspinous process device (IPD) is a minimally invasive treatment option. Results of a multicenter randomized trial demonstrated that 2-year treatment success with the X-STOP IPD was significantly better compared with non-surgical care.

Stroke Symptoms in Individuals Reporting No Prior Stroke or Transient Ischemic Attack Are Associated With a Decrease in Indices of Mental and Physical Functioning

Stroke symptoms in the absence of recognized stroke are common, but potential associated dysfunctions have not been described. We assessed quality-of-life measures using the Physical and Mental Component Summary scores of the Short Form 12 (PCS-12 and MCS-12) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Differences in mean PCS-12 and MCS-12 scores were assessed among participant groups symptoms-free (n=16 090); history of stroke symptoms but free of stroke/transient ischemic attack (n=3404); history of stroke (n=1491); and history of transient ischemic attack (n=818). Participants with symptoms (but no diagnosis) had average PCS-12 scores 5.5 (95% CI: 5.2 to 5.9) points lower than those without symptoms, a difference similar to transient ischemic attack (6.0; 95% CI: 5.3 to 6.7) and over one half the effect of stroke (8.4; 95% CI: 8.0 to 9.0). MCS-12 scores were 2.7 (95% CI: 2.4 to 3.0) points lower for those with symptoms, -0.5 for transient ischemic attack (95% CI: 0.0 to -1.1), and -1.6 for stroke (95% CI: -1.2 to -2.0). Differences in demographic and vascular risk factors, health behaviors, physiological measures, and indices of socioeconomic status did not fully explain these differences. Those reporting history of weakness or numbness had larger current decrements in physical functioning, and those reporting history of inability to express themselves or understand language had larger current decrements in mental functioning. Individuals with clinically consistent symptoms but no stroke diagnosis have a lower quality of life than those without symptoms. The difference in physical functioning is substantial with a smaller decline in mental functioning. Apart from so-called "silent stroke," there appear to be many individuals with possibly symptomatic cerebrovascular disease-either stroke or transient ischemic attack-who are not being diagnosed. Furthermore, these symptomatic but undiagnosed strokes may not be benign.

Anxiety Sensitivity and Health-Related Quality of Life in Children With Chronic Pain

Anxiety sensitivity (AS), or the fear of anxiety sensations, has been shown to independently predict poorer health-related quality of life (HRQOL) in adults with chronic pain. Specifically, AS was found to contribute to decrements in psychological well-being and social functioning but not to decrements in physical functioning. Existing studies have not examined the relationship between AS and HRQOL in children with chronic pain. The present study used multivariate regression analysis to test the association between AS and self-reported HRQOL in 87 children (62 girls; mean age = 14.4 years +/-2.3) presenting for treatment at a tertiary, multidisciplinary clinic specializing in pediatric chronic pain. After controlling for key sociodemographic and pain-related characteristics, higher AS was associated with poorer perceived general and mental health, greater impairment in family activities, lower self-esteem, increased behavior problems, and more social/academic limitations due to emotional problems. AS accounted for 4% to 28% of incremental variance in these HRQOL domains above and beyond the demographic and pain-related variables. However, AS was not significantly associated with physical functioning or with academic/social limitations due to physical health. Additional research is required to delineate possible mechanisms by which AS may influence certain aspects of children's HRQOL but not others. The present findings support the evaluation of AS in pediatric chronic pain patients as part of a comprehensive assessment battery. The links between AS and multiple HRQOL domains suggest that treatment components aimed at reducing AS may lead to enhanced psychosocial well-being in children with chronic pain.