EuroQol-5 Dimensions Index Research Articles

Patient-reported allergies predict postoperative outcomes and psychosomatic markers after spine surgery

Background ContextPrior studies have shown that patient-reported allergies can be prognostic of poorer postoperative outcomes. PurposeThe objective of this study was to investigate the correlation between self-reported allergies and outcomes after cervical or lumbar spine surgery. Study Design/SettingThis is a retrospective cohort study at a single tertiary care institution. Patient SampleThe patient sample included all patients undergoing cervical or lumbar spine surgery from 2009 to 2014. Outcome MeasuresThe primary outcome measure was change in the EuroQol-5 Dimensions (EQ-5D) after surgery. Secondary outcomes included changes in the Pain Disability Questionnaire (PDQ) and in the Patient Health Questionnaire-9 (PHQ-9), achievement of the minimal clinically important difference (MCID) in these measures, and cost of admission. MethodsBefore and after surgery, EQ-5D, PDQ, and PHQ-9 were recorded for patients with available data. Paired Student t tests were used to compare changes in these measures after surgery. Multivariable linear and logistic regressions were used to assess the relationship between the log transformation of the total number of allergies and outcomes. ResultsA total of 592 cervical patients and 4,465 lumbar patients were included. The median number of reported allergies was two. The EQ-5D index increased from 0.539 to 0.703 for cervical patients and from 0.530 to 0.676 for lumbar patients (p<.01 for both). Patients experienced significant pain improvement by the PDQ (80.1–58.2 for cervical patients and 79.4–58.1 for lumbar patients, p<.01). Using multivariable logistic regression, the log transformation of the number of allergies predicted significantly higher odds of achieving the PDQ MCID (odds ratio [OR]=2.09, 95% confidence interval [CI] 1.05–4.15, p=.02, for cervical patients; OR=1.30, 95% CI 1.03–1.68, p=.03, for lumbar patients). However, this relationship was not durable for patients with follow-up exceeding 1 year. The log transformation of the number of allergies for lumbar patients predicted a significantly increased cost of admission (β=$3,597, p<.01) and trended toward significance among cervical patients (β=$1,842, p=.10). ConclusionsPatient-reported allergies correlate with subjective improvement in pain and disability after spine surgery and may serve as a marker of postoperative outcomes. The relationship between allergies and PDQ improvement may be secondary to the short-term expectation-actuality discrepancy, as this relationship was not durable beyond 1 year.

Long-Term Outcome for Scoliosis Is Dependent on Several Factors: Commentary on an article by Elias Diarbakerli, PT, MSc, et al.: "Health-Related Quality of Life in Adulthood in Untreated and Treated Individuals with Adolescent or Juvenile Idiopathic Scoliosis".

Commentary In all of medicine, we strive to identify whether the treatments that we provide for our patients have a long-lasting effect or have any effect at all. If we could combine a randomized clinical trial with long-term follow-up, it would provide the ultimate test to gauge these results. The study by Diarbakerli et al. provides long-term data in a cross-sectional study to help to understand patient-reported outcomes following the current treatment options for these patients: observation, bracing, and surgery. Our treatment algorithms come from the natural history studies that have defined the risk of curve progression for both skeletally immature patients1 and skeletally mature patients2. These treatments are predicated on the idea that patients are better off when curves are small heading into adulthood or when they are corrected and are fused if they exceed a coronal curve threshold of 50°. The authors studied a large number of patients (1,187) with patient-reported outcomes analyzed at a long-term follow-up (averaging approximately 18 years). When reviewing this study, the following should be remembered. First, the radiographs used in the study were made during the patient’s last clinical evaluation (at the age of 20 years) prior to contacting the patient for the study (at the mean ages of 39 years, 36 years, and 40 years). Second, only coronal radiographs were made, without evaluation of the important lateral radiograph. Finally, the brace and surgical groups had treatments that were current at the time but not relevant today, especially as they involved the use of first-generation techniques and instrumentation. A deep dive into the data demonstrates some interesting findings related to treatment type, curve magnitude, and outcome of the surgical procedure. For those patients who avoided a surgical procedure, curve magnitude correlated inversely with outcome, with significantly better scores in all of the Scoliosis Research Society-22r (SRS-22r) domains and the EuroQol 5-Dimensions (EQ-5D) index when the Cobb angle was <30°. The finding in the brace-treated patients that the self-image scores were better for those who had recently undergone this treatment may be a reflection of their memories of the bracing experience. A surgical procedure seems to have a detrimental effect on outcome, with worse function and self-image when compared with the untreated group and the brace-treated group. Despite similar curve magnitudes in the 3 groups (24°, 31°, and 29°), the surgical patients had worse scores in these 2 domains, which most likely reflects the various effects of the surgical procedure including the stiffness imparted by the arthrodesis of the spine, the posterior scarring and stiffness of the soft tissues, and the presence and awareness of implants and a surgical incision in these patients. The EQ-5D domain scores highlight this, as the mobility and usual activities scores are lower in the surgical group. When focusing on the surgically treated patients, the authors demonstrate a relationship between remaining motion segments and functional scores, with worse scores seen in those patients fused below L2 (both SRS-22r function and pain scores and EQ-5D index). Although this continues to be an important finding, many would suggest that a balanced spine in both the coronal and sagittal planes is essential, and these parameters were not analyzed in this study. There are several strengths to this study: it involves a large series of patients (n = 1,187) with excellent return (65%) for long-term follow-up (age between 35 and 40 years), and there are good-quality patient-reported outcomes. These strengths lead me to be confident concluding that, first, keeping curve magnitude small (preferably below 30°) when possible with bracing provides for maximum long-term outcome, and, second, attempting to avoid a surgical procedure for non-progressive curves continues to be a good idea, and when a surgical procedure is performed, it is important to preserve lumbar motion segments. There are questions that remain and could not be completely answered with this study. Can modern brace treatment improve the results of treatment, maintaining smaller curve magnitudes and ultimately improving outcomes? Will the use of modern surgical techniques and implants improve on the results of the operative group seen in this study? With large-magnitude surgical correction, does the improvement in radiographic correction provide for improved patient scores? More specifically, will this improved correction close the gap between the patients undergoing a surgical procedure and those not undergoing a surgical procedure in the function and self-image domains? This study provides valuable information to the reader confirming the detrimental effects of scoliosis on patient-reported outcomes, the value of treatment to limit curve progression, and the effectiveness of surgical treatment, especially with preservation of motion segments. The authors should be congratulated on their outstanding effort to provide us with long-term, patient-focused outcomes and help to set the stage for future studies to determine whether modern treatment improves on these results.

Health-Related Quality of Life in Adulthood in Untreated and Treated Individuals with Adolescent or Juvenile Idiopathic Scoliosis.

Health-related quality of life in adults with idiopathic scoliosis diagnosed before maturity has been reported to be similar between brace-treated and surgically treated individuals. The aim of this study was to compare health-related quality of life in untreated, brace-treated, and surgically treated adults with idiopathic scoliosis diagnosed before skeletal maturity. Subgroup analyses were performed on the basis of age at the time of the study, age of onset, surgical characteristics, and curve magnitude. We included 1,187 adults with juvenile or adolescent idiopathic scoliosis with a mean age (and standard deviation) of 38.8 ±12.7 years. Of these, 347 were untreated, 459 had been brace-treated, and 381 had been surgically treated. The Scoliosis Research Society-22r (SRS-22r) and EuroQol 5-Dimensions (EQ-5D) were used. Statistical analyses were performed using analysis of covariance. The mean SRS-22r subscore was 4.15 ± 0.59 points for the untreated group, 4.10 ± 0.57 points for the previously braced group, and 4.01 ± 0.64 points for the surgically treated group (p = 0.007 adjusted for age and sex). The EQ-5D index was 0.82 ± 0.20 for the untreated group, 0.82 ± 0.20 for the previously brace-treated group, and 0.79 ± 0.24 for the surgically treated group (p = 0.026, adjusted for age and sex). Brace cessation was at the mean age of 16.2 ± 1.5 years, and the surgical procedure had been performed at the mean age of 15.3 ± 2.1 years. A more caudal fusion was associated with a lower SRS-22r subscore and EQ-5D index. No differences were observed when comparing individuals with juvenile or adolescent onset scoliosis (all p > 0.05). Untreated adults with idiopathic scoliosis had similar health-related quality of life to previously brace-treated individuals, and they had marginally higher health-related quality of life compared with surgically treated individuals. Therefore, both surgical and brace treatments for idiopathic scoliosis could be considered successful from a health-related quality-of-life point of view in adulthood. The age of onset of idiopathic scoliosis does not seem to influence quality of life in adulthood. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Impact of palbociclib plus letrozole on patient-reported health-related quality of life: results from the PALOMA-2 trial

BackgroundPatient-reported outcomes are integral in benefit–risk assessments of new treatment regimens. The PALOMA-2 study provides the largest body of evidence for patient-reported health-related quality of life (QOL) for patients with metastatic breast cancer (MBC) receiving first-line endocrine-based therapy (palbociclib plus letrozole and letrozole alone). Patients and methodsTreatment-naïve postmenopausal women with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2−) MBC were randomized 2 : 1 to palbociclib plus letrozole (n=444) or placebo plus letrozole (n=222). Patient-reported outcomes were assessed at baseline, day 1 of cycles 2 and 3, and day 1 of every other cycle from cycle 5 using the Functional Assessment of Cancer Therapy (FACT)-Breast and EuroQOL 5 dimensions (EQ-5D) questionnaires. ResultsAs of 26 February 2016, the median duration of follow-up was 23months. Baseline scores were comparable between the two treatment arms. No significant between-arm differences were observed in change from baseline in FACT-Breast Total, FACT-General Total, or EQ-5D scores. Significantly greater improvement in pain scores was observed in the palbociclib plus letrozole arm (−0.256 versus −0.098; P=0.0183). In both arms, deterioration of FACT-Breast Total score was significantly delayed in patients without progression versus those with progression and patients with partial or complete response versus those without. No significant difference was observed in FACT-Breast and EQ-5D index scores in patients with and without neutropenia. ConclusionsOverall, women with MBC receiving first-line endocrine therapy have a good QOL. The addition of palbociclib to letrozole maintains health-related QOL and improves pain scores in treatment-naïve postmenopausal patients with ER+/HER2− MBC compared with letrozole alone. Significantly greater delay in deterioration of health-related QOL was observed in patients without progression versus those who progressed and in patients with an objective response versus non-responders.ClinicalTrials.gov: NCT01740427 (https://clinicaltrials.gov/ct2/show/NCT01740427)

Association between involuntary weight loss with low muscle mass and health-related quality of life in community-dwelling older adults: Nationwide surveys (KNHANES 2008–2011)

To investigate the relationship between involuntary weight loss with low muscle mass and health-related quality of life in a large representative sample of older adults. A nationwide cross-sectional study based on data from the Korea National Health and Nutritional Examination Survey, 2008 to 2011. Study participants included 2249 individuals aged ≥70 years. The participants reported an unintentional weight loss >3 kg in the past year. Appendicular lean mass was measured using dual-energy X-ray absorptiometry and calculated with the appendicular lean mass index. Health-related quality of life was measured using the EuroQol-5 dimension (EQ-5D) instrument. Univariate and multivariate survey logistic regression models were used to calculate odds ratios (OR) with 95% confidence intervals (95% CI) for the lowest quintile of the EQ-5D index. In total, 39.1% of participants were male and 60.9% were female. The weighted mean age was 75.6 years (95% CI; 75.3-75.9). Clinically significant weight loss is typically 5% of one's body weight; average, 2.8 kg (3.1 kg for men; 2.7 kg, women) for our participants. Compared with the normal reference group and after adjusting for potential confounders, the ORs for the lowest quintile of the EQ-5D indices were 1.39 (95% CI, 0.92-2.10), 2.56 (95% CI, 1.56-4.18), and 3.40 (95% CI, 2.05 to 5.63) for the low muscle mass, involuntary weight loss, involuntary weight loss with low muscle mass groups, respectively. Involuntary weight loss combined with low muscle mass was more closely associated with poor quality of life than involuntary weight loss alone in community-dwelling older adults.

Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty.

Background:The Patient-Reported Outcomes Measurement Information System (PROMIS) consists of question banks for health domains through computer adaptive testing (CAT).Hypothesis:For patients with glenohumeral arthritis, (1) there would be high correlation between traditional patient-reported outcome (PRO) measures and the PROMIS upper extremity item bank (PROMIS UE) and PROMIS physical function CAT (PROMIS PF CAT), and (2) PROMIS PF CAT would not demonstrate ceiling effects.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:Sixty-one patients with glenohumeral osteoarthritis were included. Each patient completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx Shoulder Activity Scale, Short Form–36 physical function scale (SF-36 PF), EuroQol 5 Dimensions (EQ-5D) questionnaire, Western Ontario Osteoarthritis Shoulder (WOOS) index, PROMIS PF CAT, and the PROMIS UE. Correlation was defined as high (>0.7), moderate (0.4-0.6), or weak (0.2-0.3). Significant floor and ceiling effects were present if more than 15% of individuals scored the lowest or highest possible total score on any PRO.Results:The PROMIS PF demonstrated excellent correlation with the SF-36 PF (r = 0.81, P < .0001) and good correlation with the ASES (r = 0.62, P < .0001), EQ-5D (r = 0.64, P < .001), and WOOS index (r = 0.51, P < .01). The PROMIS PF demonstrated low correlation with the Marx scale (r = 0.29, P = .02). The PROMIS UE demonstrated good correlation with the ASES (r = 0.55, P < .0001), SF-36 (r = 0.53, P < .01), EQ-5D (r = 0.48, P < .01), and WOOS (r = 0.34, P <.01), and poor correlation with the Marx scale (r = 0.06, P = .62). There were no ceiling or floor effects observed. The mean number of items administered by the PROMIS PRO was 4.Conclusion:These data suggest that for a patient population with operative shoulder osteoarthritis, PROMIS UE and PROMIS PF CAT may be valid alternative PROs. Additionally, PROMIS PF CAT offers a decreased question burden with no ceiling effects.

Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study.

OBJECTIVESThis study aimed to measure the level and determinants of health-related quality of life (HRQoL) in adults in Kermanshah, a city in the western region of Iran.METHODSConvenience sampling was employed to obtain a sample of 998 adults aged 18 years and older (646 males and 352 females) in the city of Kermanshah. A 2-part self-administered questionnaire was used to collect data over the period between March 1 and May 30, 2017. The first part was designed to collect information on socio-demographic characteristics, socioeconomic status, and lifestyle factors (10 items). The second part consisted of the EuroQoL 5-dimensions (EQ-5D) EuroQoL-3-level and the EuroQoL visual analog scale (EQ-VAS) questions. A multiple linear regression model was used to determine the factors associated with the EQ-5D index and EQ-VAS score among study participants.RESULTSThe mean values for the EQ-5D index and the EQ-VAS score were 0.74 (standard deviation [SD], 0.19) and 80.9 (SD, 16.5), respectively. The highest percentage of self-reported problems (‘some’ and ‘severe’ problems) across the 5 dimensions of the EQ-5D index were associated with the dimensions of anxiety/depression (35.3%) and pain/discomfort (32.9%). The percentage of self-reported problems for the dimensions of usual activities, mobility, and self-care were 19.0, 12.8, and 8.9%, respectively. Our regression analyses indicated that there were statistically significant positive associations between being physically active, monthly household income per capita, and post-secondary education and the EQ-5D index and EQ-VAS score. In contrast, negative associations were found between older age, being married, having a chronic disease, and smoking and the EQ-5D index and EQ-VAS score. A negative association was also found between being uninsured and the EQ-5D index.CONCLUSIONSOur findings suggest that interventions aiming to improve physical activity, to prevent chronic diseases, and to reduce the smoking rate among adults living in the city of Kermanshah may improve their HRQoL.

Association between joint stiffness and health-related quality of life in community-dwelling older adults

ObjectiveThis study aimed to examine the association between joint stiffness and health-related quality of life (HRQOL) in community-dwelling older adults. MethodsParticipants in this cross-sectional study were 530 Japanese community-dwelling older adults (mean age, 73.9 years; women, 64.3%). Joint stiffness was assessed at the neck, low back, shoulder, elbow, hand or wrist, hip, knee, and ankle or feet; the duration of joint stiffness was also evaluated. We assessed HRQOL using the Short Form-12 (SF-12) and EuroQOL-5 Dimension (EQ-5D) questionnaires. We calculated the physical component summary scores (PCS) and mental component summary scores (MCS) from SF-12 and the EQ-5D index from EQ-5D. ResultsThe prevalence of joint stiffness was 54.0%. Joint stiffness at two or more sites and at each site had a meaningful impact on PCS. Joint stiffness that lasted for 30min or more was meaningfully associated with low PCS and EQ-5D scores (PCS, 30–60min: beta=−6.122, P<0.05; >60min: beta=−5.962, P<0.01; EQ-5D index, 30–60min: beta=−0.068, P<0.01; >60min: beta=−0.070, P<0.01). Further, joint stiffness that lasted over 60min extended over MCS (MCS, >60min: beta=−3.212, P<0.05). ConclusionsJoint stiffness is associated with HRQOL. Assessing joint stiffness and intervention could be beneficial for HRQOL.

Health-related quality of life in type-2 diabetes patients: a cross-sectional study in East China

BackgroundUsed the EuroQoL-5 dimension (EQ-5D) to evaluate the health status of 5310 residents who live in East China, and compared the health-related quality of life (HRQoL) with 311 patients with type 2 diabetes as well as to explore the main influence factors to HRQoL in East China.MethodsThe cohort includes 5310 participants aged 18-89 years old lived in East China. EuroQoL-5 dimension (EQ-5D) scale was used for the assessment of health-related quality of life.ResultsThe mean age of the cohort was 52.2 ± 13.4 years of which 43.7% were male. A moderate level of health-related quality of life was measured of that EQ-5D index and EQ-VAS scores were 0.939 ± 0.111 and 80.06 ± 11.58, respectively. There was a significant difference between diabetes patients and non-diabetes (p = 0.029, p < 0.001, respectively). The age had an inverse correlation with the EQ-5D scores both in general population and diabetes patients. The EQ-5D Vas was weakly adversely associated with the FPG, HbA1c and HOMA-IR.ConclusionThe overall health-related quality of life of population in East-China was moderate. Diabetes patients had lower score of health-related quality. The healthy-related quality was associated with the age, gender, economic development of region, level of education and marital status.

Central Sensitization Inventory as a Predictor of Worse Quality of Life Measures and Increased Length of Stay Following Spinal Fusion.

Central sensitization is abnormal and intense enhancement of pain mechanism by the central nervous system. Patients with central sensitization may be at higher risk of poor outcomes after spinal fusion. The Central Sensitivity Inventory (CSI) was developed to identify and quantify key symptoms related to central sensitization. In 664 patients who underwent thoracic and/or lumbar fusion, we evaluated retrospectively pretreatment CSI as a predictor of postoperative quality of life measures, length of stay, and discharge status. Preoperative Pain Disability Questionnaire scores, Patient Health Questionnaire-9 scores, and EuroQol-5 Dimensions index scores were significantly worse in patients with preoperative CSI ≥40 compared with patients with preoperative CSI <40 (P < 0.0001 for all). After adjusting for demographic variables, operation duration, and preoperative health status, preoperative CSI was significantly associated with higher postoperative Pain Disability Questionnaire total score (unadjusted P<0.001, adjusted P= 0.009), higher postoperative Patient Health Questionnaire-9 score (unadjusted P < 0.001, adjusted P= 0.001), and lower postoperative EuroQol-5 Dimensions index (unadjusted P < 0.001, adjusted P= 0.001). For each 10-unit increase in CSI, average length of stay increased by 6.4% (95% confidence interval 0.4%-12.6%, P= 0.035). The odds of being discharged home after adjusting for confounders was not statistically related to preoperative CSI (P= 0.0709). Preoperative CSI was associated with worse quality of life outcomes and increased length of stay after spinal fusions. CSI may be an additional measure in evaluating patients preoperatively to better predict successful spinal fusion outcomes.

Stereotactic Radiosurgery for Trigeminal Neuralgia Improves Patient-Reported Quality of Life and Reduces Depression

To characterize quality-of-life (QOL) outcomes after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). The EuroQOL 5 Dimensions (EQ-5D) and Patient Health Questionnaire 9 (PHQ-9) were prospectively collected before and after SRS for 50 patients with TN. Pain response and treatment-related facial numbness were classified by Barrow Neurological Institute (BNI) scales. Differences in pooled QOL outcomes were tested with paired t tests and sign tests. The Kaplan-Meier method was used to estimate time-dependent improvements in the EQ-5D index, EQ-5D perceived health status (PHS), PHQ-9 score, and freedom from pain failure (BNI class IV-V) or facial numbness (BNI class III-IV). Following SRS, the 12-month rate of freedom from pain failure was 92% (95% confidence interval [CI], 77%-97%) while the 12-month rate of freedom from facial numbness was 89% (95% CI, 66%-97%). Significant improvements in the EQ-5D index (P<.01), PHS (P=.01), and PHQ-9 (P=.03) were observed, driven by the EQ-5D subscores for self-care and for pain and/or discomfort (P=.02 and P<.01, respectively). At 12months after SRS, the actuarial rates of improvement in the EQ-5D, PHS, and PHQ-9 were 55% (95% CI, 40%-70%), 59% (95% CI, 40%-76%), and 59% (95% CI, 39%-76%), respectively. The median time to improvement in each of the QOL measures was 9months (95% CI, 3-36months) for the EQ-5D index, 5months (95% CI, 3-36months) for PHS, and 9months (95% CI, 3-18months) for the PHQ-9. On multivariate analysis, only higher prescription dose (86Gy vs ≤82Gy) was associated with improvement in the EQ-5D index (hazard ratio, 5.73; 95% CI, 1.85-22.33; P<.01). Patients with TN treated with SRS reported significant improvements in multiple QOL measures, with the therapeutic benefit strongly driven by improvements in pain and/or discomfort and in self-care, along with lower rates of depression. In this analysis, there appears to be a correlation between prescription dose and treatment response as measured by the EQ-5D.

Application of early total care in treatment of unstable pelvic fractures

Objective To evaluate the clinical effect of early total care (ETC) for treatment of unstable pelvic fractures. Methods This retrospective case series study included eighteen patients with unstable pelvic fractures treated surgically from May 2013 to May 2015. There were 11 male and 7 female patients, aged (45.1±13.1)years. Eleven patients were injured due to road traffic accidents and 7 due to fall from height. Tile B type pelvic fractures were seen in 8 patients and Tile C type in 10 patients. All patients were treated with ETC method and received open reduction and internal fixation within 24 to 48 hours after the primary treatment. Data were collected, such as operation time, intraoperative blood loss, hospital length of stay and perioperative complications. Majeed score and EuroQol 5 dimension (EQ-5D) were used for evaluation of clinical outcome and quality of life respectively. Excellent and good rate of operation was assessed using the Matta clinical evaluation standard. Results Three patients died and fifteen patients survived. Operation time was (120.1±22.2)minutes, amount of intraoperative blood loss was (355.9±56.4)ml, and hospitalization was (8.5±1.6)days. Incidence of perioperative complications was 56%, including 3 patients with acute respiratory distress syndrome, 1 pneumonia, 2 acute lung injury, 1 incisional wound infection, 2 multiple organ failure and 1 diffuse intravascular coagulation. All patients were followed up for (15.1±2.4)months (range, 12-21 months). Majeed score was decreased from preoperative (93.7±6.1)points to final follow-up of (74.1±9.2)points, and the EQ-5D index was decreased from preoperative 0.96±0.04 to final follow-up of 0.74±0.19 (both P<0.05). Excellent and good rate of operation was 80%. Conclusions ECT provides satisfactory short-term outcome for treatment of unstable pelvic fractures, but the incidence of complications is high. Doctors should choose reasonable treatment plan according to the surgical indications. Key words: Pelvis; Fracture fixation, internal; Postoperative complications

Electroacupuncture plus moxibustion therapy for patients with major depressive disorder: study protocol for a randomized controlled trial

BackgroundMajor depressive disorder (MDD) is one of the most prevalent mental health disorders and has a significant societal economic burden. Antidepressants and cognitive behavioral therapy are two primary interventions for the standardized treatment of MDD. However, their weaknesses, such as a low response rate, a high risk of adverse events from medication, and the high cost of cognitive behavioral therapy, have resulted in a need for complementary and alternative medicine (CAM). Among the various therapeutic interventions in CAM, electroacupuncture and moxibustion have been widely used to treat various mental illnesses, including MDD. The aim of this study is to evaluate the feasibility of conducting a full-scale randomized controlled trial to investigate the efficacy and safety of electroacupuncture plus moxibustion therapy for MDD.Methods/designWe will include patients between the ages of 19 to 65 years with MDD. A total of 30 participants will be recruited, and they will be randomly allocated into two groups at a 1:1 ratio. Patients in the treatment and control groups will, respectively, receive real and sham electroacupuncture/moxibustion treatments, for a total of 20 sessions over 8 weeks. The primary outcome will be the Hamilton Rating Scale for Depression, and the secondary outcomes will be Beck’s Depression Inventory, the Insomnia Severity Index, the State-Trait Anxiety Inventory, the EuroQol 5-Dimension Index, the Measure Yourself Medical Outcome Profile version 2, and electroencephalography. Adverse events will be monitored at each visit to assess safety. All outcomes will be assessed and analyzed by researchers blinded to the treatment allocation.DiscussionThis is a two-armed, parallel-design, patient-assessor blinded, multicenter, randomized, sham-controlled pilot clinical trial. Data will be analyzed before and after treatment and during a 4-week follow-up. The results of the trial will provide a basis for further studies assessing the efficacy and safety of electroacupuncture plus moxibustion treatment for MDD.Trial registrationKorean Clinical Trial Registry, CRIS-KCT0001810. Registered on 5 February 2016 (retrospectively registered; date of enrollment of the first participant to the trial: 2 December 2015).

Quality of Life in Patients with Osteoporotic Vertebral Compression Fractures.

BackgroundThis study aimed to evaluate quality of life (QOL) using the EuroQOL-5 dimensions (EQ-5D) index and to examine factors affecting QOL in patients with an osteoporotic vertebral compression fracture (OVCF).MethodsThis ambispective study used a questionnaire interview. Patients over 50 years old with an OVCF at least 6 months previously were enrolled. Individual results were used to calculate the EQ-5D index. Statistical analysis was performed, and factors related to QOL were examined.ResultsOf 196 patients in the study, 84.2% were female, with an average age of 72.7 years. There were 66 (33.7%) patients with multilevel fractures. Conservative management was used in 75.0% of patients, and 56.1% received anti-osteoporosis treatment. The mean EQ-5D index was 0.737±0.221 and was significantly correlated with the Oswestry disability index score (correlation coefficient −0.807, P<0.001). The EQ-5D index was significantly correlated with age (Spearman's rho=−2.0, P=0.005), treatment method (P=0.005), and history of fracture (P=0.044) on univariate analysis and with conservative treatment (P<0.001) and osteoporotic treatment (P=0.017) on multivariate analysis.ConclusionsOVCF markedly lowers QOL in several dimensions for up to 12 months, even in patients who have healed. Treatment of osteoporosis and conservative treatment methods affect QOL and should be considered in OVCF management.

Factors Influencing Health-related Quality of Life in Korean Elderly with Rheumatoid Arthritis

Objectives: This study was conducted to identify factors that are associated with health-related quality of life (HRQoL)in elderly people with Rheumatoid Arthritis (RA). Methods/Statistical Analysis: A total of 184 subjects, aged 65 to 89 years old, who have RA were selected from the data of the Korea National Health and Nutrition Examination Survey (KNHANES 2010-2014). Socio-demographic, health related, lifestyle and disease related characteristics were measured through a questionnaire. HRQoL was evaluated using EuroQol 5-dimension (EQ-5D). Descriptive statistics, t-test, ANOVA and hierarchical multiple regression analysis were conducted with SPSS/WIN 22.0. Findings: The mean score of EQ-5D index of subjects was 0.77, indicating a moderate level of HRQoL. The results of multiple regression analysis showed that the knee joint stiffness, subjective health status, sleep duration, employment, and age significantly predicted HRQoL in the elderly people with RA, explaining 39.5% of the variance. Improvements/Applications: Health care providers should consider that interventions improving knee joint stiffness and sleep duration are required to enhance the HRQoL in the elderly people with RA.

만성폐쇄성폐질환 환자의 삶의 질 관련요인

본 연구는 국내 COPD 환자의 삶의 질 정도 및 삶의 질과 관련이 있는 요인을 확인하기 위해 시도되었다. 2013년도 국민건강영양조사의 일반적 및 질병관련 변수, 폐기능검사 결과, 삶의 질(EuroQol-5Dimension) 자료를 이용하여 가중치를 적용한 후 복합표본 교차분석과 복합표본 회귀분석으로 분석하였다. 연구결과, EQ-5D Index는 COPD 환자 0.916점, 정상인 0.941점으로 COPD 환자가 정상인보다 통계적으로 유의하게 낮았다. 삶의 질 하부 영역인 이동, 자가간호, 일상활동, 통증/불편감, 불안/우울 모두 COPD 환자는 정상인과 비교하여 문제 없음의 비율이 낮고 문제 있음의 비율이 높았지만, 기도폐쇄 정도에 따른 삶의 질은 자가간호 영역만 유의한 차이가 있었다 (<TEX>${\chi}^2=9.50$</TEX>, p=.013), COPD 환자의 삶의 질과 관련이 있는 요인은 연령, 성별, 교육수준, 가구당 수입, 흡연상태, 동반질환 수이었다. 본 연구결과를 바탕으로, COPD 환자의 삶의 질에 대한 관심과 함께 이동, 자가간호, 일상생활을 증진하고 통증/불편감, 불안/우울을 감소하는 등 삶의 질을 향상시키기 위한 포괄적인 접근이 이루어져야 할 것이다. The purpose of this study was to identify the degree of quality of life (QoL) and its related factors in patients with Korean Chronic Obstructive Pulmonary Disease (COPD). With data collected by Korea National Health and Nutrition Survey in 2013, general and disease-related variables, pulmonary function test, and EuroQol-5Dimension (EQ-5D) were analyzed. The mean of EQ-5D index was 0.916 in patients with COPD and 0.941 in non-COPD. The EQ-5D index and its sub dimensions (mobility, self-care, usual activity, pain/discomfort, anxiety/depression) of COPD patients were significantly lower than that of non-COPD. However, difference in COPD patients' airway limitation was significant only for self-care of EQ-5D (<TEX>${\chi}^2=9.50$</TEX>, p=.013). The related factors of QoL in COPD patients were age, gender, level of education, quartile of household income, smoking status, and number of comorbid diseases. Based on the results, it is important to pay close attention to COPD patients' QoL as well as comprehensive interventions which possibly improve their QoL.

Independent predictors of a clinically significant improvement after lumbar fusion surgery

Background ContextMultiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist. PurposeTo determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery. Study DesignThis is a retrospective review of patients who underwent instrumented lumbar fusion. Patient SampleWe included patients who underwent lumbar fusion for any indication between 2008 and 2013. Outcome MeasuresOutcome measures included preoperative and postoperative EQ-5D Index scores. Materials and MethodsThe medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values. ResultsA total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively. ConclusionsThis study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively.

Self-reported quality of life in multiple sclerosis patients: preliminary results based on the Polish MS Registry.

BackgroundThe aim of the study was to analyze selected clinical and sociodemographic factors and their effects on the quality of life (QoL) of multiple sclerosis (MS) patients registered in the Polish MS Registry.MethodsThis was a cross-sectional observational study performed in Poland. Data on personal and disease-specific factors were collected between January 1, 2011, and December 31, 2015, via the web portal of the Polish MS Registry. All patients were assessed by a physician and asked to complete the Polish language versions of the following self-evaluation questionnaires: EuroQol 5-Dimensions, EuroQoL Visual Analog Scale, and Multiple Sclerosis Impact Scale. Univariate analysis and logistic regression were performed to determine the factors associated with QoL.ResultsThe study included 2,385 patients (female/male ratio 2.3:1) with clinically confirmed MS (mean age 37.8±9.2 years). Average EuroQol 5-Dimensions index was 0.72±0.24, and the mean EuroQoL Visual Analog Scale score was 64.2±22.8. The average Multiple Sclerosis Impact Scale score was 84.6±11.2 (62.2±18.4 for physical condition and 23.8±7.2 for mental condition). Lower QoL scores were significantly associated with higher level of disability (odds ratio [OR], 0.932; 95% confidence interval [CI], 0.876–0.984; P=0.001), age >40 years (OR, 1.042; 95% CI, 0.924–1.158; P=0.012), longer disease duration (OR, 0.482; 95% CI, 0.224–0.998; P=0.042), and lack of disease modifying therapies (OR, 0.024; 95% CI, 0.160–0.835; P=0.024). No significant associations were found between QoL, sex, type of MS course, patient’s education, and marital status.ConclusionThe Polish MS Registry is the first national registry for long-term observation that allows for self-evaluation of the QoL. QoL of Polish patients with MS is significantly lower compared with the rest of the population. The parameter is mainly affected by the level of disability, duration of the disease, and limited access to immunomodulatory therapy.

The role of memories on health-related quality of life after intensive care unit care: an unforgettable controversy?

BackgroundDecreased health-related quality of life (HRQoL) is a significant problem after an intensive care stay and is affected by several known factors such as age, sex, and previous health-state. The objective of this study was to assess the association between memory and self-reported perceived HRQoL of patients discharged from the intensive care unit (ICU).MethodsA prospective, multicenter study involving nine general ICUs in Portugal. All adult patients with a length of stay >48 hours were invited to participate in a 6-month follow-up after ICU discharge by answering a set of structured questionnaires, including EuroQol 5-Dimensions and ICU memory tool.ResultsA total of 313 (52% of the eligible) patients agreed to enter the study. The median age of patients was 60 years old, 58% were males, the median Simplified Acute Physiology Score II (SAPS II) was 38, and the median length of stay was 8 days for ICU and 21 days for total hospital stay. Eighty-nine percent (n=276) of the admissions were emergencies. Seventy-eight percent (n=234) of the patients had memories associated with the ICU stay. Patients with no memories had 2.1 higher chances (P=0.011) of being in the bottom half of the HRQoL score (<0.5 Euro-Qol 5-Dimensions index score). Even after adjusting for pre-admission characteristics, having memories was associated with higher perceived HRQoL (adjusted odds ratio =2.1, P=0.022).ConclusionThis study suggests that most of the ICU survivors have memories of their ICU stay. For the ICU survivors, having memories of the ICU stay is associated with a higher perceived HRQoL 6 months after ICU discharge.

제 4~5번 요추 추간판 탈출 정도와 요통의 한의학적 치료 효과의 상관성 연구

Objectives The purpose of this study was to compare the effects between the degree of herniated intervertebral lumbar disc (HIVD) at L4-5 level and improvement of low back pain treated by Korean Medicine therapy. Methods 567 patients who received inpatient treatment from May 2014 to December 2015 in the Daejeon-Jaseng of Korean Medicine Hospital were divided into 6 groups by the degree of HIVD at L4-5 level confirmed with a Lumbar spine magnetic resonance imaging. All patients received a combination of treatment including acupunture, chuna manual therapy, pharmacopunture, herbal medication. They were compared and analyzed on the basis of improvement between measuring Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index) as they were hospitalized and as they were discharged. The statistically significance was evaluated by SPSS 23.0 for windows. Results After treatment, Normal stage on Intervertebral Lumbar Disc at L4-5 level group's Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQol-5 Dimension Index (EQ5D Index) improvement was <TEX>$1.30{\pm}1.62$</TEX>, <TEX>$4.52{\pm}11.82$</TEX> and <TEX>$0.04{\pm}0.11$</TEX> respectively. Bulging group's improvement was <TEX>$3.25{\pm}2.81$</TEX>, <TEX>$8.28{\pm}13.02$</TEX> and <TEX>$0.09{\pm}0.17$</TEX> respectively. Spinal canal occupying ratio (SOR) less than 20 group's improvement was <TEX>$2.15{\pm}1.92$</TEX>, <TEX>$11.79{\pm}17.81$</TEX> and <TEX>$0.13{\pm}0.23$</TEX> respectively. SOR 20 to less than 40 stage group's improvement was <TEX>$2.13{\pm}1.92$</TEX>. <TEX>$10.79{\pm}15.93$</TEX> and <TEX>$0.10{\pm}0.26$</TEX> respectively. SOR 40 to less than 60 group's improvement was <TEX>$2.16{\pm}2.24$</TEX>, <TEX>$9.80{\pm}16.62$</TEX> and <TEX>$0.15{\pm}0.25$</TEX> respectively. Surgery group's improvement was <TEX>$2.47{\pm}2.21$</TEX>, <TEX>$11.64{\pm}18.53$</TEX> and <TEX>$0.15{\pm}0.27$</TEX> respectively (p<0.03). But there was no statistically significance between 6 group's improvement after treatment (p>0.05). Conclusions After inpatient treatment by Korean Medicine therapy, Most patient's pain, disability and Health Related Quality of Life was improved significantly. But there was no statistically correlation between the degree of HIVD at L4-5 level and improvement of low back pain. So We think that future research of higher quality and correct statistics shall be necessary.