EQ-5D Index Research Articles

The Impact of Permanent Pacemaker Implantation After TAVI on Mortality and Quality of Life: A POPular TAVI Substudy.

Conduction disturbances are common after transcatheter aortic valve implantation (TAVI) and frequently require permanent pacemaker implantation (PPI). Data regarding its impact on mortality and morbidity are conflicting. This study aims to assess the impact of PPI before or within 30 days after TAVI on mortality and health-related Quality of Life (QoL) during the first year after TAVI. In this POPular TAVI substudy, 978 patients were included and categorized into three groups: Neither PPI before or within 30 days after TAVI (no PPI, n = 779), PPI before TAVI (PPI pre-TAVI, n = 102), PPI within 30 days after TAVI (PPI post-TAVI, n = 97). All-cause death and cardiac death were evaluated at 1 year. QoL was assessed using the SF-12 and EQ-5D-5L questionnaires at baseline and 3, 6, and 12 months. At 1-year, all-cause death was seen in 6.9% (PPI pre-TAVI, p = 0.53) and 10.3% (PPI post-TAVI, p = 0.66) of the patients compared to 8.7% of the patients (no PPI). Cardiac death was observed in 4.9% (PPI pre-TAVI, p = 0.58) and 6.2% (PPI post-TAVI, p = 0.94) of the patients compared to 6.2% of patients (no PPI). Regarding QoL, the PPI pre-TAVI group showed lower PCS-12 over time compared to the no PPI group (p = 0.04), while MCS-12, EQ-5D Index and EQ-5D VAS scores were equal. No significant differences in QoL were seen between the PPI post-TAVI group and the no PPI group. PPI before or within 30 days after TAVI was not associated with increased mortality within 1 year. PPI pre-TAVI was associated with lower physical QoL.

Long-term impact of emergency laparotomy on health-related quality of life

PurposeEmergency laparotomy can result in a range of physical and neuropsychiatric postoperative complaints, potentially impacting quality of life. This study aimed to assess the effect of emergency laparotomy on health-related quality of life (HRQoL) and how HRQoL influences the risk of readmission.MethodHRQoL was assessed in patients undergoing emergency laparotomy during a 1-year period. Patients who completed the baseline HRQoL evaluation underwent a reassessment on postoperative day (POD) 30, 90, and 180. HRQoL was measured with the EQ5D index, and patients were categorized in ‘high’ and ‘low’ HRQoL. A decrease from high baseline HRQoL to low HRQoL by POD 30 was classified as ‘acquired low HRQoL’.ResultsAll 215 patients who completed the baseline HRQoL evaluation were followed. On average, patients reported a lower mean (M) HRQoL from baseline (M = 0.876, standard deviation (SD) = 0.171) to POD 30 (M = 0.735, SD = 0.260). On POD 90, HRQoL had somewhat improved (M = 0.763, SD = 0.298), and by POD 180 HRQoL had returned to normal (M = 0.853, SD = 0.235). From the full-record population (n = 73), 20.5% acquired low HRQoL of whom 33% had not recovered by POD180. For patients with acquired low HRQoL, the risk of 180-day readmission was increased, and days alive and out of hospital within 180 days was reduced.ConclusionFor most patients, HRQoL has returned to normal within 180 days after emergency laparotomy. However, patients who acquired low HRQoL after the procedure had an increased risk of long-term readmission.

Cross-Cultural Adaptation and Validation of the Central Sensitization Inventory Into Simplified Chinese.

To translate the Central Sensitization Inventory from English into simplified Chinese (CSI-sC) and test the psychometric properties of the CSI-sC in patients with chronic pain. A cross-sectional design was used. Cross-cultural adaptation of the CSI-sC was performed following Beaton's guidelines. Using a convenient sampling method, 172 patients with chronic spinal pain and 74 healthy individuals were enrolled. The Visual Analog Scale (VAS), Insomnia Severity Index (ISI), EuroQol Five Dimensions Questionnaire (EQ-5D), and Neck Disability Index (NDI) or Oswestry Disability Index (ODI) were used to measure insomnia, pain, quality of life, and functional status. Associations between CSI-sC with these measures were examined for concurrent and convergent validity assessment. Discriminant validity was confirmed by comparing CSI-sC scores between different groups. Exploratory factor analysis was used for the structural validity assessment. Reliability was assessed by internal consistency and test-retest reliability. The Cronbach's alpha of the CSI-sC was 0.886. The intra-class correlation coefficient was 0.757. The CSI-sC showed a five-factor structure (57.2% of variances). The CSI-sC was significantly correlated with the ISI (r = 0.625), EQ-5D index (r = -0.363), EQ-5D health score (r = -0.355), VAS (r = 0.290), NDI (r = 0.432) and ODI (r = 0.333). CSI-sC scores were statistically higher in females compared to males (p = .006) and in the patient population compared to healthy controls (p < .001). The CSI-sC demonstrated good reliability and validity in chronic spinal pain patients. This study offers a good tool for the assessment and identification of central sensitization symptomology in clinical nursing practice, which may help optimize the treatment for patients with chronic pain.

Impact of a community-based lifestyle intervention with initial sedentary reduction or physical activity increasing goals on self-reported health-related quality of life.

In previous efforts, health-related quality of life (HRQoL) improved for individuals at high risk of type 2 diabetes and cardiovascular disease after participation in community-based lifestyle interventions (LI) with a moderate-to-vigorous physical activity (MVPA) movement goal. It is unknown whether HRQoL improves with LI when the primary movement goal is to reduce sedentary behavior. HRQoL changes were examined among adults with overweight and prediabetes and/or metabolic syndrome randomized to a 12-month Diabetes Prevention Program-based Group Lifestyle Balance (DPP-GLB) community LI work with goals of weight-loss and either increasing MVPA (DPP-GLB) or reducing sedentary time (GLB-SED). Study participants (N = 269) completed the Euroqol 5 dimension 3 long (EQ5D-3L index and EuroQol Visual Analog Scale (EQVAS)-visual analog scale) at baseline, and 6 and 12 months. Paired t-tests were used to evaluate pre-to-post-intervention changes by arm. Mean EQVAS improvements for the GLB-SED arm at 6 and 12 months were +5.6 (SE = 1.3; P < .0001) and +4.6 (SE = 1.4; P = .0006), respectively. Similar mean EQVAS improvements were reported for the DPP-GLB arm; +5.9 (SE = 1.2; P < .0001) and +4.9 (SE = 1.2; P = .0001) at 6 and 12 months, respectively. Mean EQ5D index improvements were significant in the GLB-SED arm [6 months: +0.03 (SE = 0.01; P = .004); and 12 months: +0.04 (SE = 0.01; P = .006)], but not in the DPP-GLB arm. Participation in community LI with a primary movement goal to reduce sedentary behavior improved HRQoL at least as well as traditional LI focused more on MVPA improvement, supporting an alternate intervention strategy for those who can't or won't engage in MVPA as the primary movement goal.

Relationships between Chronic Cough and Asthma Control and Quality-of-Life in Patients with Severe Asthma: A 6-Month Longitudinal Analysis.

The prevalence and clinical implications of chronic cough (CC) in patients with severe asthma receiving asthma treatment remain relatively unknown. This study aimed to evaluate the relationships between CC and asthma control and quality-of-life (QoL) in patients with severe asthma through longitudinal analysis. Baseline and 6-month follow-up data from the Korean Severe Asthma Registry were analyzed. CC was defined as a cough visual analog scale (VAS) score of ≥40 at both baseline and 6-months. Demographic parameters and clinical outcomes were compared between patients with severe asthma and CC and those without CC. Generalized estimating equation (GEE) analysis was performed to identify associations of CC with asthma control and QoL scores. Of the total 286 participants with severe asthma, 116 (40.6%) were defined as having CC. Patients with CC had higher baseline cough and wheeze severity VAS scores (all P<0.001), poorer asthma control (P<0.001), and worse QoL (Severe Asthma Questionnaire [SAQ] and Euro-QoL 5-dimension [EQ-5D] index, all P<0.001), compared to those without CC. During follow-up, patients with CC were more frequently exposed to oral corticosteroids (58.6% vs. 38.6%, P=0.010) and experienced more frequent asthma exacerbations (48.3% vs. 28.6%, P=0.009) than those without CC. GEE analysis revealed that CC was independently associated with poor asthma control, lower SAQ scores, and lower EQ-5D index after adjusting for confounders. The presence of CC was associated with worse asthma control and QoL in patients with severe asthma. Further studies are warranted to better evaluate and manage CC in these patients.

Lymphedema, Fatigue, and Quality of Life in Breast Cancer Survivors with Axillary Lymph Node Dissection.

Introduction: Health-related quality of life (QOL) has gained importance due to the increasing incidence of breast cancer and the survival rate of breast cancer patients. We aimed to investigate the relationship between lymphedema, fatigue, and QOL in breast cancer survivors with axillary lymph node dissection. Methods: A total of 122 female breast cancer survivors with axillary lymph node dissection who applied to the oncology center of a teaching and research hospital between April 1, 2022, and July 1, 2022, were included in the cross-sectional study. An individual identification form, the EQ-5D General Quality of Life Scale, and the Cancer Fatigue Scale were used to collect data. Mann-Whitney U test, Kruskal-Wallis H test, Bonferroni post hoc test, and Spearman's correlation were used to assess differences between the survivor groups. Results: The study found that 40.2% of breast cancer survivors experienced lymphedema. The mean scores on the EQ-5D index, Visual Analogue Scale (VAS), and Cancer Fatigue Scale were 0.27 ± 0.25, 71.12 ± 14.21, and 35.86 ± 6.98, respectively. The Cancer Fatigue Scale total score and the EQ-5D VAS showed a strong positive correlation (r = 0.630; p < 0.05). Conversely, the total Cancer Fatigue Scale and the EQ-5D VAS scores showed a significant negative correlation (r = -0.626; p < 0.05). Conclusions: The study found that almost half of the breast cancer survivors experienced lymphedema. They also had excellent general health, moderate fatigue, and a good overall QOL.

Associations of reverse triiodothyronine serum levels with anxiety, depression, and health related quality of life after experiencing acute ischemic stroke.

This study intended to explore associations of reverse triiodothyronine (rT3) with emotional disturbances and health-related quality of life (HRQoL) after experiencing acute ischemic stroke (AIS). Serum samples from individuals with AIS were collected on admission to three Lithuania stroke centers and investigated for free tetraiodothyronine, free triiodothyronine (fT3), rT3, and thyroid stimulating hormone levels. At discharge, emotional disturbance was evaluated using the Hospital Depression and Anxiety Scale (HADS), and HRQoL using the EQ-5D-5L scale. Analyses included 159 individuals (59.7% male and 40.3% female; mean (SD) aged 66.4 [10.3] years), 52.83% of which showed increased rT3 levels upon admission. After adjustment for age, sex, National Institutes of Health Stroke Scale scores, previous stroke, modified Rankin Scale before AIS ≤ 2, and diabetes mellitus, multivariable linear regression revealed negative associations of rT3 with HADS total score (β = -0.163; p = 0.046) and HADS-D subscale score (β = -0.187; p = 0.019). Analyses supported a positive relationship between the fT3 ratio to rT3 with HADS-D score (β = 0.157; p = 0.046) and rT3, rT3 × fT3 product with EQ-5D index score (β = 0.157; p = 0.044 and β = 0.179; p = 0.023, respectively). We found that individuals who experienced AIS and had higher levels of rT3 at hospital admission had less emotional disturbance and better HRQoL when discharged.

Health-related quality of life in a large cohort of patients with cardiac implantable electronic devices A registry-based study

Aim The association of cardiac implantable electronic devices (CIED), namely pacemaker (PM), implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with (CRT-D) or without defibrillator (CRT-P) with health-related quality of life (HRQoL) is lacking. Methods and results Data from the Swedish Pacemaker and ICD Registry collected from January 2019 to February 2022 was used to analyze the responses to the European Quality of Life-5 Dimension questionnaire (EQ-5D) before and after one year of the CIED implant. Descriptive analysis was performed using Pearson’s chi-square test, the analysis of variance ANOVA, the Kruskal-Wallis test and Wilcoxon signed-rank test when appropriate. A multivariable regression analysis was used to compare the EQ-5D index and EQ-VAS variation after 1 year. Of 1,479 who completed the EQ-5D, 80% had a PM, 10% an ICD, 5% a CRT-P and 6% a CRT-D. The median age was 77 years with females constituting 38% of the PM group and 17% of the ICD group. The EQ-VAS and the EQ-5D index significantly increased after one year from the PM and CRT-P implant (EQ-VAS +2.8, standard deviations (SD) 23 and +5.8, SD 24.9; EQ-5D index +0.019, SD 0.114 and +0.051, SD 0.125) while only the EQ-5D index increased after one year from the ICD implant (+0.002, SD 0.104). After adjusting for age, sex and HRQoL at baseline, the presence of defibrillator was associated with lower EQ-VAS (ICD EQ-VAS variation: -3.4, 95% confidence intervals (CI) -6.7; -0.1 and CRT-D EQ-VAS variation -4.8, 95% CI -8.8;-0.7) and EQ-5D index (ICD EQ-5D index variation: -0.018, 95% CI -0.035; -0.0003 and CRT-D EQ-5D index variation -0.025 95% CI 0.046;0.004) after one year compared to PM. Conclusion These findings, showing the HRQoL associated with CIED, are important to support physicians’ and pacemaker nurses’ care after device implantation by embracing the patients’ perspectives.

Understanding preoperative health-related quality of life in rotator cuff tear patients: role of patients’ characteristics

BackgroundAssessing health-related quality of life (HRQoL) is a widely employed method in orthopedics to evaluate patient well-being and measure the effectiveness of surgical interventions. Understanding the relationship between specific baseline factors and preoperative HRQoL can help clinicians identify patients at risk for low quality of life and thus, develop preventive strategies that adequately address individual patient needs. The objective was to assess associations between baseline factors and preoperative HRQoL in patients undergoing arthroscopic rotator cuff repair (ARCR).MethodsThis study is part of a multicenter prospective Swiss cohort study that included patients undergoing ARCR between June 2020 and November 2021. Data were derived from baseline and surgery forms. HRQoL was assessed using the European Quality of Life 5-Dimension 5-Level (EQ-5D-5L) questionnaire to calculate EQ-5D index and EQ VAS scores. Univariable and multivariable linear regression models examined associations between the 21 factors and preoperative HRQoL. Final models were determined using stepwise backward regression.ResultsA total of 973 included patients (mean age [SD], 57.3 [9.4] years; 611 men [63%]) had a mean [SD] EQ-5D index and EQ VAS of 0.70 [0.23] and 68.7 [19.8], respectively. Being male (regression coefficient (β), 0.05; 95% CI [0.02–0.08]), having a higher age (β, 0.02; 95% CI [0.01–0.03]) and higher education levels (e.g., university, college: β, 0.11; 95% CI [0.06–0.16]) were associated with a higher EQ-5D index. Increased body mass index (β, -0.02; 95% CI [-0.04 to -0.01]) and worse sleep quality (β, -0.03; 95% CI [-0.04 to -0.03]) were associated with a lower EQ-5D index. Factors negatively associated with overall EQ VAS health were depression (e.g., moderate: β, -12.70; 95% CI [-16.18 to -9.21]), presence of at least one comorbidity (β, -3.71; 95% CI [-5.91 to -1.52]), and pain (β, -1.81; 95% CI [-2.36 to -1.26]).ConclusionOur results suggest that preoperative HRQoL is highly associated with sociodemographic and patient-related factors. Specifically addressing these factors may improve orthopedic care.

A Systematic Literature Review of Important and Meaningful Differences in the EQ-5D Index and Visual Analog Scale Scores.

We aimed to provide a comprehensive summary, synthesis, and appraisal of minimally important difference (MID) estimates for EQ-5D instruments. We conducted a systematic search using relevant terms related to "minimally/clinically, meaningful/ important difference/change" and "EQ-5D" in 6 major databases, including MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and Cochrane Library (up to January 2023). We included studies that provided at least 1 original MID estimate for the EQ-5D. A total of 90 studies reporting 840 MID estimates were included. MID estimates for the EQ-5D-3L index score ranged from 0.075 to 0.8 using distribution-based approaches (239 estimates; 20 studies), from 0.003 to 0.72 using anchor-based approaches (189 estimates; 43 studies), and from 0.038 to 0.082 using instrument-defined approaches (4 estimates; 1 study). For the EQ-5D-5L, MID estimates ranged from 0.023 to 0.115 using distribution-based approaches (17 estimates; 12 studies), from 0.01 to 0.41 using anchor-based approaches (97 estimates; 15 studies), and from 0.037 to 0.101 using instrument-defined approaches (62 estimates; 8 studies). For the EQ visual analog scale, MID estimates ranged from 0.96 to 16.6 using distribution-based approaches (87 estimates; 14 studies) and from 0.42 to 51.0 using anchor-based approaches (84 estimates; 24 studies). MID estimates varied by underlying clinical conditions, baseline scores, and direction of change. A wide range of MID estimates for EQ-5D instruments were identified, highlighting the variability of MID across populations, estimation methods, direction of change, baseline scores, and EQ-5D versions. These factors should be carefully considered when selecting an appropriate MID for interpreting EQ-5D scores.

Health-related quality of life in patients treated with en bloc resection for primary tumors of the spine.

Retrospective analysis. The aim of this study is to evaluate the functional outcomes and the health-related quality of life (HRQOL) in patients undergoing en bloc resection of spinal tumor. En bloc resection in the spine is a surgical procedure designed to completely remove a tumor in one piece, with wide margins preserved, in order to reduce the risk of local recurrences. This demanding procedure has been shown to improve local control and survival rate, besides a relatively high morbidity. Between 2016 and 2021, 70 patients underwent en bloc resection surgery for a primary spine tumor and 38 came out to be eligible for this analysis. Eligibility criteria include at least one follow-up visit within a two-year period from surgery and Patient Reported Outcomes evaluation collected prospectively at baseline and at least one follow- up in the range 4-24 months. The outcome variables (EQ5D Numeric Scale and Index, SF36 scores and NRS score) were analyzed with multilevel linear mixed-effects regression. Baseline- (age, gender, localization, histotype, number of levels of resection, previous surgery) and time-dependent covariates (adverse events, spinal cord damage) were included. Beside a slight improvement of all the scores, no significant differences were found between baseline and follow up times for EQ-5D-3L Numeric Scale and Index and for SF-36 Standardized Physical component. SF-36 Standardized Mental component appeared to be significantly better at 12-month FU compared to baseline. Ultimately, age over 50 years old and the occurrence of adverse events emerged to be as the two main factor determining worsening in several HRQOL scores. Pain came out to be significantly reduce at 24-month compared to baseline. The aim of en bloc resection in the treatment of primary spinal tumors is to improve survival rates and reduce local recurrences. Despite its radicality, our preliminary results suggest that patients experience a slight to moderate improvement postoperatively compared to their preoperative perceived health status.

Anthracyclines-induced cardiotoxicity in patients with early breast cancer carrying germline BRCA1/2 mutation: the BRCAN study.

BRCA1/2 genes play a critical role in genome stability and DNA repair. In animal models, loss of cardiomyocyte-specific BRCA1/2 is associated with DNA damage, apoptosis, cardiac dysfunction, and mortality following anthracycline exposure. However, whether these preclinical findings translate to humans remains unclear. Assess the impact of germline BRCA1/2 (gBRCA1/2) status on anthracyclines-induced cardiotoxicity (AIC) in patients with early breast cancer and no prior anti-HER2 therapy. This single-center retrospective/prospective cohort study focused on early breast cancer patients, treated with anthracycline-based chemotherapy in the neo/adjuvant setting, no prior anti-HER2 therapy, and known gBRCA1/2 status, normal baseline left ventricular ejection fraction (LVEF), and no previous cardiovascular disease. Follow-up assessments involved myocardial dysfunction blood biomarkers (MDBB), transthoracic echocardiography (TTE), and quality of life (QoL) questionnaires. The primary objective was LVEF changes comparing BRCA1/2 mutation carriers (gBRCA1/2m) vs non-carriers (gBRCA1/2wt). Secondary objectives included differences in MDBB and QoL. A total of 137 patients were included (103 gBRCA1/2wt and 34 gBRCA1/2m). Baseline characteristics were similar between groups. Compared to baseline, LVEF% reduction was -4.7[-12.0, 0.0] vs -9.5[-18.0, -5.0] in gBRCA1/2wt vs gBRCA1/2m, (P = .027). After adjusting for confounders, the difference in reduction in LVEF remained statistically significant at -4.5 [95%CI, -8.6, -0.4; P = .032]. No differences between MDBB (C-reactive protein, hsTnI, NT-proBNP, D-Dimer, ST-2, or Galectine-3) or QoL (MLHFQ and EQ5-D index) were detected. gBRCA1/2m patients could represent a higher-risk population for AIC. gBRCA1/2 status should be one of the factors to consider in deciding on adjuvant anthracycline necessity. This population could benefit from a cardio-oncology closer follow-up and cardioprotective strategies.

Health-related quality of life of HIV patients with comorbidities of hypertension or diabetes in Ghana.

Clinical studies, particularly in the context of HIV/AIDS, have utilized health-related quality of life (HRQoL) and health state utility values to assess both clinical and economic implications. Improvement in HIV management with antiretroviral therapy (ART) has coincided with an increased morbidity of chronic conditions such as diabetes and hypertension among people living with HIV. The study offers empirical evidence establishing a link between HIV, comorbidities like hypertension and diabetes, and their collective impact on HRQoL. A cross-sectional quantitative study among 418 HIV patients in three regions of Ghana in the Savannah, Middle Belt, and Coastal belt. Face-to-face interviews were conducted using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) in combination with EuroQol-Visual Analog Scales (EQ-VAS). Ugandan EQ-5D-5L value set was used for computing the utility values. Patients' socio-demographic and clinical data were obtained from medical records and analyzed descriptively. Mann-Whitney U and Kruskal Wallis tests were used to evaluate the relationship between patient socio-demographic and clinical variables and health status. Overall median utility value was 0.93(IQR=0.79, 1.00) from the EQ-5D index and 90 (IQR = 80, 100) from the EQ-VAS scores. Prevalence of hypertension and diabetes were 9.1% and 2.4% respectively. There was significant difference in EQ-VAS score between HIV patients with hypertension and those without hypertension (z = 2.146 p = 0.032). There was also a significant difference in the EQ-VAS scores (z = 2.381, p = 0.017) of patients with diabetes and those without diabetes. Region, sex, age, education, marital status, employment status, place of residence, monthly income level, duration of infection, adherence to ART, and other illness were significantly associated with EQ-5D-5L utility and EQ-VAS scores at 0.05 significant level. HRQoL among HIV positive individuals in Ghana was high. Comorbidities such as hypertension or diabetes had nuanced effects on perceived health status. A patient-centered, multidisciplinary approach to HIV care should be adopted considering regional differences and the presence of comorbidities.

The psychometric properties of the amharic version of EuroQoL five-dimensions-five level among Ethiopian cervical cancer patients

BackgroundDespite being a widely used generic measure of health-related quality of life worldwide, there is limited evidence on the psychometric properties of the EuroQoL Five-dimensions five level (EQ-5D) among cervical cancer patients in Ethiopia.ObjectiveTo evaluate psychometric properties of the Amharic version of EQ-5D among Ethiopian cervical cancer patients.MethodsA longitudinal survey of cervical cancer patients receiving treatment at two Ethiopian tertiary care facilities was conducted from March 2022 to July 2023. Participants completed the EQ-5D and the European Organization for Research and Therapy of Cancer (EORTC QLQ-C30) at baseline and after three months on treatment. Effect size and standardized response mean were used to assess responsiveness. Anchor-based and distribution-based methods were used to calculate the minimal clinically important difference (MCID). Minimal detectable change (MDC) ratios were computed at the individual and group levels. Statistical significance was determined at p < 0.05.ResultsThree hundred seventy-one patients completed the survey at baseline and follow-up with a mean age of 49.72 (10.80) years. The majority (268,73%) of the patients had early-stage cancer. The EQ-5D index and EQ VAS scores respectively improved by 0.04 and 7.0 post-treatment.The physical domains of EORTC QLQ-C30 had showed high correlation with physical dimensions of EQ-5D (r > 0.6) and the instrument showed good discriminate validity between patients with different health states. The effect size ranged between − 0.12 and 0.60 for the EQ-5D index value and − 0.12 to 1.16 for the EQ VAS, indicating small to large responsiveness. The average (range) MCID value of the EQ-5D index was 0.10–0.15. The findings showed that MCID to MDC ratios at the group level were more clinically meaningful than the individual level.ConclusionThe EQ-5D effectively detected changes and discriminate patients with different levels of health. While group-level MCIDs were established in this study, further studies are recommended to prove its usefulness at the individual-level.

Spinal Cord Stimulation vs Medical Management for Chronic Back and Leg Pain

Chronic back and lower extremity pain is one of the leading causes of disability worldwide. Spinal cord stimulation (SCS) aims to improve symptoms and quality of life. To evaluate the efficacy of SCS therapies compared with conventional medical management (CMM). MEDLINE, Embase, and Cochrane Library were systematically searched from inception to September 2, 2022. Selected studies were randomized clinical trials comparing SCS therapies with sham (placebo) and/or CMM or standard treatments for adults with chronic back or leg pain who had not previously used SCS. Evidence synthesis estimated odds ratios (ORs) and mean differences (MDs) and their associated credible intervals (CrI) through bayesian network meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline for network meta-analyses was followed. The primary outcomes were pain-related end points, including pain intensity (measured by visual analog scale) and proportion of patients achieving at least 50% pain relief (responder rate) in the back or leg. Quality of life (measured by EQ-5D index score) and functional disability (measured by the Oswestry Disability Index score) were also considered. A total of 13 studies of 1561 patients were included in the network meta-analysis comparing conventional and novel SCS therapies with CMM across the 6 outcomes of interest at the 6-month follow-up. Both conventional and novel SCS therapies were associated with superior efficacy compared with CMM in responder rates in back (conventional SCS: OR, 3.00; 95% CrI, 1.49 to 6.72; novel SCS: OR, 8.76; 95% CrI, 3.84 to 22.31), pain intensity in back (conventional SCS: MD, -1.17; 95% CrI, -1.64 to -0.70; novel SCS: MD, -2.34; 95% CrI, -2.96 to -1.73), pain intensity in leg (conventional SCS: MD, -2.89; 95% CrI, -4.03 to -1.81; novel SCS: MD, -4.01; 95% CrI, -5.31 to -2.75), and EQ-5D index score (conventional SCS: MD, 0.15; 95% CrI, 0.09 to 0.21; novel SCS: MD, 0.17; 95% CrI, 0.13 to 0.21). For functional disability, conventional SCS was superior to CMM (MD, -7.10; 95% CrI, -10.91 to -3.36). No statistically significant differences were observed for other comparisons. This systematic review and network meta-analysis found that SCS therapies for treatment of chronic pain in back and/or lower extremities were associated with greater improvements in pain compared with CMM. These findings highlight the potential of SCS therapies as an effective and valuable option in chronic pain management.

The association between health literacy and quality of life of patients with type 2 diabetes mellitus: A cross-sectional study.

Health literacy-driven interventions in patients with type 2 diabetes have been found to play an important role in achieving glycemic control and enhancing diabetic self-management outcomes. The present study aimed to examine the role of health literacy as a predictor of quality of life among diabetic patients in Jordan. This cross-sectional study enrolled 400 Type 2 diabetic patients visiting the endocrinology department at the outpatient clinic at Al Basheer Hospital in Amman, Jordan. The data were collected between 1st of August and 28th of December 2023, using the validated Jordanian Diabetic Health Literacy Questionnaire and the EuroQol-5D tool. A quantile regression analysis was conducted to explore the factors associated with health-related quality of life among the study participants. This study included 68.8% females, with a median age of 58 (50-64) years. The median EQ5-D index score was 0.66 (0.41-0.78). Findings from regression analysis indicated as patients' age increased, their quality of life scores significantly decreased (-0.004, 95%CI (-0.006, -0.001), p = 0.002). Additionally, higher JDHLQ scores were significantly associated with higher EQ5-D scores (0.012, 95% CI (0.006-0.018), p<0.001). Moreover, patients with only an elementary education had significantly lower EQ5-D scores compared to those with a postgraduate education (-0.106, 95%CI (-0.190, -0.023), p = 0.013). The findings of the present study emphasize the importance of including health literacy assessments and interventions in the diabetes care plans of patients in Jordan.

Sex-related differences in health-related quality-of-life measured using the EuroQol 5-Dimension questionnaire across the LVEF spectrum in DAPA-HF and DELIVER

Abstract Background Although sex-related differences in response to disease-specific health-related quality-of-life (HRQL) instruments such as the KCCQ have been investigated in patients with heart failure (HF), this is not the case for generic HRQL instruments. Purpose To assess the sex-specific differences in health status measured using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) in patients with HF with reduced and mildly reduced or preserved ejection fraction (HFrEF and HFmrEF/HFpEF), and to assess the effect of dapagliflozin on EQ-5D-5L index scores. Methods Using patient-level data from the DAPA-HF and DELIVER trials comparing dapagliflozin to placebo, we analysed patient-reported outcomes for each dimension of the EQ-5D index scores between men and women. The 5 dimensions of the descriptive section of the EQ-5D-5L include mobility ("walking around"), self-care ("washing or dressing self"), usual activities ("e.g., work, study, housework, family or leisure activities"), pain/discomfort ("pain or discomfort"), and anxiety/depression ("anxious or depressed"). Each dimension is divided into 5 levels (1-5) i.e., no problem, slight problem, moderate problem, severe problem, and extreme problem (cannot do activity/extreme symptom). Results Of 4744 patients with HFrEF, 4390 completed the EQ-5D-5L index scores (3408 men and 982 women, 77.6% vs. 22.4%). The correresponding numbes in 6263 patients with HFmrEF/HFpEF were 5745 overall and 3320 men vs. 2425 women (57.8% vs. 42.2%). Regardless of HF phenotype, women had significantly worse (lower) baseline index scores overall compared to men (0.849 vs. 0.899 in HFrEF and 0.844 vs. 0.884 in HFmrEF/HFpEF, both p&amp;lt;0.001). Although scores varied markedly by question, women generally had worse health status in all the dimensions as compared with men in patients with HFrEF (39% vs. 29% reporting a moderate or greater problem for mobility, 17% vs. 9% for self-care, 36% vs. 25% for usual activities, 29% vs. 19% for pain/discomfort, and 21% vs. 13% for anxiety/depression, all p&amp;lt;0.001) (Figure, top panel). A broadly similar pattern was observed in HFmrEF/HFpEF (Figure, bottom panel). In all patients, across the range of LVEF, there dapagliflozin led to a significant placebo corrected increase (improvement) in index score (0.008, 95% CI 0.002 to 0.014), with no interaction between sex and the effect of dapagliflozin (p for interaction with sex = 0.50). Conclusions Women reported significantly poorer health status in both HFrEF and HFmrEF/HFpEF compared to men. Dapagliflozin treatment improved EQ-5D index scores irrespective of sex across the range of ejection fraction. Figure Sex differences in the distribution of responses to EQ-5D-5L questionnaire. EQ-5D-5L, EuroQol 5-Dimension 5-Level questionnaire; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

Factors associated with sleeping difficulties in patients with heart failure

Abstract Background Sleeping difficulties is prevalent in heart failure (HF) and a predictor of cardiac events in patients with HF. Purpose To describes the prevalence of sleeping difficulties in patients with HF and factors associated. Method This study used data of a multicentre RCT entitled Tele-Yoga study (clincialtrials.gov:NCT03703609). Patients were included in the analysis when they were diagnosed with HF and completed a questionnaire on sleeping difficulties. Sleeping difficulties were measured with the Minimal Insomnia Symptom Scale (MISS), patients with a score a 6 or higher patients were characterised as having sleeping difficulties. Through a literature search we identified factors that could be associated with sleeping difficulties. Demographic and clinical background variables (age, sex, BMI, marital status, working status, having atrial fibrillation and/or diabetes), anxiety and depressive symptoms (Hospital Anxiety and Depression scale) and Health related Quality of Life (EQ-5D index score) were considered. Logistic regression was performed with backwards elimination of the factors considered associated with having or not having sleeping difficulties. Results In total 244 patients were included (mean age 67±10, 28% women), whereas 27% had sleeping difficulties (n = 68, a score a 6 or higher on the MISS); 28% had moderate till very severe difficulties initiating sleep (n=77), 53% had moderate till very severe problems by waking up at night (n=130), 38% had moderate till very severe problems by not feeling refreshed by sleep (n=92). The logistic regression showed that patients with sleeping difficulties were significantly more often single (27% vs. 18%, OR 0.336 P-value=0.023), more often not working (72% vs. 69%, OR 2.524, P-value=0.047) more often experienced symptoms of anxiety (45% vs. 10%, OR 4.882, P-value&amp;lt;001) and had a lower quality of life, (0.637±0.261 vs. 0.786±0.203, OR 0.042 P-Value=0.001) compared to patients with no sleeping difficulties. Conclusion Patients having symptom of anxiety were at five times greater risk of experiencing sleeping difficulties. Being in a relationship and being employed were associated with less sleeping difficulties. Additionally, patients with sleeping problems reported lower quality of life.

Relationship between locus of control and health-related quality of life in chronic stroke patients: a cross-sectional study

IntroductionStroke is a major cause of disability in adults and the elderly worldwide. Post-stroke rehabilitation success largely depends on consistent participation in treatment sessions and adherence to prescribed physical exercises; however, factors such as individual belief about their health status often affect motivation, slowing recovery. Addressing these influences is essential for improving health-related quality of life and optimizing recovery outcomes.MethodsThis study employed a cross-sectional and correlational design with convenience sampling. The aim was to explore the relationship between recovery locus of control (RLOC) and health-related quality of life (HRQoL) among chronic stroke survivors. The Recovery Locus of Control scale and the EuroQol 5D-5L scale were utilized for assessment.ResultsA total of 69 participants were included in this survey. The mean RLOC score was 34.91, with internal RLOC at 21.16 and external RLOC at 13.77 and the total EQ5D index was 0.659. Age was a significant grouping factor, with the 30–39 age group showing a significant positive relationship (r = 1.000, p = 0.002), pain and anxiety/depression (p = .045), mobility and anxiety/depression (p = .009), anxiety/depression and self-care (p = .047), IRLOC and ERLOC (p = .013).ConclusionThe study found that while respondents exhibited high RLOC scores, there was no significant relationship between RLOC scores and the EQ5D-5L index score, suggesting that other factors may play a more critical role in influencing HRQoL among chronic stroke survivors.

Results of tendon transfers for stabilization of wrist joints for patients with rheumatoid arthritis

Objectives. The high incidence of damage to small joints of the hand in rheumatoid arthritis (RA), leading to persistent disability, is an important problem in rheumatoidology. A common operation for arthrodesis of the wrist joint to correct emerging deformities is traumatic and limits the function of the hand. In recent years, at the V.A. Nasonova Research Institute of Rheumatology, it has been replaced by new soft tissue joint-saving operations, which allow maintaining good hand function and preventing the development of severe deformities in the future. Target. Comparison of the results of performing soft tissue stabilizing operations on transposition of the tendons of the long radial and ulnar extensor carpi and arthrodesis of the wrist joint in patients with RA. Methods. The study included 69 patients operated on at the V.A. Nasonova Federal State Budgetary Institution NIIR in the period from 2018 to 2023. 24 patients underwent transposition of the long radial and ulnar extensor carpi (transposition ECU + ECRL - extensor carpi ulnaris and extensor carpi radialis longus) with subsequent tenodesis. The control group consisted of 45 patients who underwent arthrodesis of the wrist joint. The DASH questionnaire was used to assess functional status before and after surgery. To assess quality of life - EQ-5D index, pain - VAS, disease activity was assessed using the DAS28 index. The average follow-up period for patients after surgery was 6 months. Results. The functional status of patients after surgery, assessed by the DASH scale, was significantly better in the group of patients who underwent transposition of the tendons of the long radial and extensor carpi ulnaris 39.41±10.17 compared to the control group of wrist arthrodesis 46.4±15.8 (p0.05). Conclusions: ECU+ECRL tendon transpositions are an effective method for stabilizing the wrist joints and correcting hand deformities, but they have a number of limitations, the most important of which is the degree of damage to the wrist joints and the severity of the deformities.