EuroQol-5 Dimensions Scores Research Articles

Determinants of health-related quality of life in patients undergoing medical expulsion therapy for acute renal colic.

Patients with ureteral stones and acute renal colic significantly impaired their quality of life (QOL). However, the factors that affect quality of life during conservative management, particularly medical expulsive therapy (MET), are not well understood. This study aimed to assess the determinant of QOL. We conducted a prospective study to longitudinally assess QOL using the EuroQol-5 Dimension (EQ-5D) in patients undergoing medical expulsive therapy. Ninety-three patients were enrolled between April 2020 and December 2022, and 187 questionnaires were completed at each visit before spontaneous passage or intervention. The study found that a higher pain intensity was significantly associated with worse QOL during the primary visit (p = 0.03). At the second visit, younger age (p < 0.01), increased frequency of renal colic attacks (p < 0.01), maximum pain intensity since the last visit (p < 0.01), and shorter time from disease onset (p = 0.03) were associated with a worse QOL. Multivariate analysis showed that only the total number of renal colic attacks was associated with EQ-5D score (p = 0.047). The stone location significantly affected the cumulative incidence of renal colic attacks (p = 0.02). The mean total number of renal colic until stone passage was 3.58 in individuals with proximal stones versus 0.86 in with distal stones (p < 0.01). This study identified pain intensity and colic frequency as key factors contributing to the decline in QOL in patients with ureteral stones. Patients with proximal stones may be good candidates for early intervention to reduce colic events.

Evaluating the efficacy of vestibular rehabilitation therapy on quality of life in persistent postural-perceptual dizziness: the role of anxiety and depression in treatment outcomes

BackgroundPersistent Postural-Perceptual Dizziness (PPPD) is a chronic disorder that significantly affects the quality of life (QoL) and daily living. Vestibular rehabilitation therapy (VRT) has emerged as a promising treatment option, yet its effectiveness, particularly in relation to symptom duration, anxiety, and depression, remains underexplored.MethodsThis cross-sectional study assessed the effect of VRT on the QoL in 188 PPPD patients, as well as the correlation between the duration of symptoms and dizziness severity and the role of anxiety and depression in the treatment response. QoL was assessed using the EuroQol-5 Dimension (EQ-5D), and dizziness-related handicap using the Dizziness Handicap Inventory (DHI) and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).ResultsNinety three patients were included in the analysis. QoL was significantly improved post-VRT with a greater mean EQ-5D score (EQ-5D post-VRT 0.72; EQ-5D pre-VRT 0.61, p = 0.032). Age was also found to correlate with increased dizziness severity (p &amp;lt; 0.001), although this was not as strong as the correlation of symptom duration (longer duration correlating with increased dizziness severity; p &amp;lt; 0.01), anxiety (r = −0.45, p = 0.002) and depression (r = −0.51, p &amp;lt; 0.001) (both significantly associated with poorer outcomes especially with reference to VRT) emerging as independent correlates of reduced effectiveness of treatment.ConclusionsThis study revealed the benefit of VRT in patients with PPPD on QoL and indicates the importance of identifying and treating psychological factors to improve the success of treatment for PPPD.

Efficacy of Platelet-Rich Plasma Versus Placebo for the Treatment of Greater Trochanteric Pain Syndrome: A Double-Blinded Randomized Controlled Trial.

Greater trochanteric pain syndrome (GTPS) is a painful condition that can impair a patient's quality of life. If nonoperative measures fail, progressively more invasive treatment options may be required. This clinical trial aimed to evaluate the effectiveness of ultrasound-guided leukocyte-rich platelet-rich plasma (LR-PRP) injections in the treatment of refractory GTPS caused by bursitis and/or gluteal tendinopathy. An ethically approved, adequately powered, double-blinded randomized controlled trial (RCT) was conducted to evaluate the clinical outcomes in randomized LR-PRP and placebo groups using the International Hip Outcome Tool-12 (iHOT-12), a visual analogue scale (VAS) for pain, the modified Harris hip score (mHHS), the EuroQol 5-Dimensions (EQ-5D) questionnaire, and the presence or absence of complications. All injections were performed under ultrasound guidance into the trochanteric bursa and gluteus medius tendon. The final analysis included 79 patients (39 in the LR-PRP and 40 in the placebo group; 73 female and 6 male; all Caucasian). Both the LR-PRP and the placebo group generally had improvement from baseline that was maintained to 12 months. The only deterioration in scores compared to baseline was seen in the LR-PRP group for the iHOT-12 at 12 months, the EQ-5D index at 3 and 6 months, and the EQ-5D VAS at all follow-up time points. However, there was no significant difference between the 2 groups at any follow-up point (p > 0.05). A multivariable linear regression model, with adjustment for age, sex, body mass index, and preoperative baseline score, did not reveal any significant associations between iHOT-12 and EQ-5D score gains at 12 months and treatment. This randomized trial found no significant difference in outcomes between LR-PRP and placebo for the treatment of greater trochanteric pain up to 6 months following the intervention. As a result, we do not support the routine use of PRP for the treatment of this condition. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Surgeon Recommendation and Outcomes of Decompression With vs Without Fusion in Patients With Degenerative Spondylolisthesis

The ability of surgeons to choose the right patient for fusion in addition to decompression when operating for degenerative spondylolisthesis with symptomatic spinal stenosis is debated. The addition of fusion increases risk, morbidity, and costs but has been claimed to give better results for selected patients. To investigate whether following surgeons' opinions regarding fusion was associated with clinical outcomes. This cohort study was conducted alongside the Norwegian Degenerative Spondylolisthesis and Spinal Stenosis randomized clinical trial, which showed noninferiority for decompression alone compared with decompression with fusion. From February 12, 2014, to December 18, 2017, trial surgeons from 16 Norwegian departments denoted their preferred treatment for 222 of 267 patients with symptomatic spinal stenosis and degenerative spondylolisthesis. For this analysis, the clinical outcomes of the patients who were and were not randomized to the recommended treatment were compared. The primary outcome was a reduction of at least 30% from baseline to 2 years after surgery on the Oswestry Disability Index, ranging from 0 (no impairment) to 100 (maximum impairment). Secondary outcomes included the Zürich Claudication Questionnaire, leg and back pain scores, and the EuroQol 5-Dimension score. Among 222 patients (155 [70%] female; mean [SD] age, 66.2 [7.7] years), decompression alone was recommended for 112 patients, of whom 59 received only decompression, and additional fusion for 110 patients, of whom 57 received fusion. At 2-year follow-up, 87 of 116 patients (75%) who received surgery in agreement with the surgeons' recommendations and 77 of 106 (73%) who received surgery in disagreement with the surgeons' recommendations reached the primary outcome (difference, 2.4 percentage points; 95% CI, -9.1 to 13.9 percentage points). All secondary outcomes were in the same direction as the primary outcome. In this cohort study of 222 patients with degenerative spondylolisthesis who participated in a randomized clinical trial, surgeons' recommendations were not associated with better outcomes than a random allocation when deciding between decompression alone and decompression with instrumented fusion. The results suggest that surgeons performing degenerative spondylolisthesis surgery could rely safely on evidence of operating with decompression alone, despite the conflict of expert opinion.

Comparison between in situ fixation and fixation after closed reduction in valgus impacted femoral neck fractures: A Multicenter Study.

The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 and above with valgus impacted femoral neck fractures using data from multiple centers. Design: Retrospective multicenter cohort study. Five tertiary-care university hospitals. Patients aged 50 and above, treated with operative fixation of valgus impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019. Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score (HHS), and Koval's grade were compared. The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50 to 95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs 26.7% of fixation after CR group, p = 0.002). Reoperation was required for 10.2% (7.5% of in situ fixation group vs 20% of fixation after CR group, p = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after CR group than in the in-situ fixation group (odds ratio = 4.757, p = 0.002 and odds ratio = 3.104, p = 0.023, respectively). At the two-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the two groups (p = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group (p = 0.027, 0.044, respectively). Postoperative EQ-5D and HHS scores showed no statistically significant differences between the two groups. In patients aged 50 years or older with valgus impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared to in-situ fixation. There was no significant difference in the incidence of ONFH in valgus impacted femoral neck fractures regardless of whether reduction was performed. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Early physiotherapy referral for low back pain reduces healthcare utilisation for advanced imaging and specialist spine surgery consultations.

Low back pain (LBP) is one of the most common presenting complaints among patients and the costliest orthopaedic condition. This study aimed to compare the healthcare utilisation rates of advanced imaging and specialist consultations for LBP between patients presenting with early physiotherapy (EPT) before specialist review and routine physiotherapy (RPT) after specialist review. Consecutive patients who (n = 311) had been referred to specialist spine surgery for LBP in 2021 were retrospectively reviewed. Baseline demographics, healthcare utilisation rates and clinical outcomes were compared between those who attended EPT before spine surgery consultation and those who attended RPT after specialist consultation. There were no significant differences in baseline demographics or clinical outcomes of Visual Analogue Scale pain scores, EuroQol 5-Dimension scores and surgery rates between the EPT (n = 183) and RPT (n = 128) groups. At 6 months follow-up, EPT was associated with significantly lower magnetic resonance imaging (MRI) rates (P = 0.026), decreased likelihood of requiring MRI (odds ratio [OR] 0.865, 95% confidence interval [CI] 0.757-0.990), reduced number of specialist spine surgery consultations (P < 0.001), decreased likelihood of requiring additional specialist consultations (OR 0.770, 95% CI 0.655-0.905), fewer physiotherapy sessions (P = 0.001) and decreased likelihood of requiring additional physiotherapy sessions (OR 0.835, 95% CI 0.553-1.261). Early physiotherapy reduces the (a) overall treatment duration from the first referral by the primary physician, (b) number of advanced imaging ordered (and thus, associated imaging costs), and (c) total number of clinic and therapy sessions, and it is safe and allows patients to achieve comparable functional outcomes to their counterparts undergoing RPT. These findings support the implementation of EPT for patients with LBP to reduce healthcare utilisation and associated costs for patients, providers and healthcare systems.

Comparison between microendoscopic laminectomy and open posterior decompression surgery for two-level lumbar spinal stenosis: a multicenter retrospective cohort study

BackgroundExcellent surgical outcomes of microendoscopic laminectomy (MEL) have been reported for patients with lumbar spinal canal stenosis (LSCS). However, few reports have directly compared MEL with open laminectomy for multi-level LSCS. This study conducted a comparative analysis of patient-reported outcomes (PROs) and perioperative complications in patients undergoing two-level posterior decompression for LSCS by MEL versus open laminectomy.MethodsThis multicenter retrospective cohort study involved prospectively registered patients who underwent two-level posterior lumbar decompression surgery for LSCS at one of eight high-volume spine centers between April 2017 and February 2020. Chart sheets were used to prospectively evaluate demographic data, including diagnosis, operative procedure, operation time, estimated blood loss, and perioperative complications. The PROs evaluated were the numerical rating scale (NRS) score for lower back pain and leg pain, 12-item Short Form Health Survey (SF-12) score, EuroQol 5-Dimension (EQ-5D) score, Oswestry Disability Index (ODI) score, and patient satisfaction with the treatment.ResultsOf the 882 patients enrolled, 410 underwent MEL (MEL group) and 472 underwent open decompression (open group). A total of 667 (75.6%) patients completed the 1-year follow-up. Intraoperative blood loss was significantly lower in the MEL group than in the open group. The complication rate was comparable (12.4% in MEL group, 12.5% in open group). Although the revision rate did not differ significantly, the incidence of surgical site infection (SSI) was markedly lower in the MEL group (0.0% in MEL group, 1.3% in open group). Propensity score matching was employed to compare 333 patients who underwent MEL with 333 patients who underwent open laminectomy. Intraoperative blood loss was significantly lower in the matched MEL group than in the matched open group. The incidence of SSI was markedly lower in the matched MEL group (0.0% in matched MEL group, 1.2% in matched open group). No significant differences in the preoperative and postoperative values of the PROs or patient satisfaction were observed between the two groups.ConclusionsMEL required an equivalent operating time and resulted in less intraoperative blood loss compared with laminectomy in two-level procedures. The incidence of SSI was significantly lower in the MEL group.

Correlation between severity of preoperative low back pain and postoperative outcomes in lumbar disc herniation surgery: a retrospective cohort study

BACKGROUND CONTEXTLow back pain (LBP) frequently occurs in patients with lumbar disc herniation (LDH), however the extent to which discectomy ameliorates it and how preoperative LBP influences postoperative outcomes remains unclear. PURPOSETo evaluate the improvement in LBP and its impact on postoperative patient-reported outcome measures (PROMs). STUDY DESIGN/SETTINGMulticenter retrospective observational study. PATIENT SAMPLEPatients undergoing discectomy for LDH at 8 hospitals from April 2017 to March 2021. OUTCOME MEASURESData were collected on patients’ backgrounds, operative factors, and PROMs, including the Numeric Rating Scale (NRS) for pain in the low back, buttock, or leg, EuroQol 5 Dimension (EQ-5D), Oswestry Disability Index (ODI) scores, and postoperative satisfaction. METHODSPatients were categorized into mild (NRS 0–3), moderate (NRS 4–7), or severe (NRS 8–10) LBP groups. Inverse probability weighting with propensity scores was used to adjust for demographic and clinical differences between groups. Chi-square tests and one-way analysis of variance were conducted to compare background data and clinical characteristics. Additionally, multivariate logistic regression was performed to identify risk factors for less than 50% improvement in LBP. RESULTSThis study included 928 patients: 270 mild, 343 moderate, and 315 severe. After adjustment, preoperative NRS scores were significantly different across groups, with scores of 1.6 (SD 1.3), 5.6 (SD 1.0), and 8.8 (SD 0.9), respectively. Postoperative NRS scores also varied significantly, with worse outcomes observed in the severe group compared to the mild group, yet similar to the moderate group. A total of 46.8% of the mild group, 86.6% of the moderate group, and 72.9% of the severe group achieved a 50% decrease in NRS scores of LBP. Preoperative EQ-5D and ODI scores were significantly worse in the severe group compared to the mild or moderate groups, but postoperative scores were not significantly different between the severe and moderate groups. No significant differences in postoperative satisfaction were observed among the groups. Being female was a significant risk factor for less than 50% improvement in LBP (odds ratio = 1.56, p=.022). CONCLUSIONSDiscectomy significantly improved LBP in patients with LDH, including those with moderate or severe LBP. Patients with severe LBP showed similar improvements in PROMs as those with moderate LBP. Female gender emerged as a significant risk factor for less than optimal improvement in LBP.

A Case Report of Korean Medicine in the Treatment of a Patient with Traumatic Facial Nerve Palsy Induced by a Traffic Accident

Objective: The aim of this case report was to present the effects of Korean medicine in the treatment of a patient with traumatic facial palsy induced by a traffic accident.Methods: A 35-year-old male patient was treated with pharmacopuncture (Shinbaro2), acupuncture, and Ansinjitong-tang over 35 days of hospitalization. Facial palsy was assessed using the House-Brackmann (HB) scale, Yanagihara score, and EuroQoL 5 Dimensions (EQ-5D).Results: After 35 days of treatment, the symptoms improved, as measured by HB (from 4 to 2), Yanagihara (from 16 to 34), and EQ-5D scores (from 0.405 to 0.913). Furthermore, there were no side effects during treatment compared with other types of pharmacopuncture or medicine.Conclusion: These results show that Korean medicine treatment may have a positive clinical effect in patients with traumatic facial palsy. However, further well-designed studies are required to confirm these findings.

A Case Report of Korean Medicine in Treating Postmenopausal Syndrome with Dyspepsia and Arthralgia

Objective: The aim of this case report was to present the effect of Korean medicine in the treatment of a patient with postmenopausal syndrome with dyspepsia, post neck pain and shoulder pain.Methods: A 51-year-old female patient was treated with Cheongpa-Jeon H, &lt;i&gt;Gamisoyo-san&lt;/i&gt;, &lt;i&gt;Gamiguibi-tang&lt;/i&gt;, Jstrogen, acupuncture, and pharmacopuncture over 39 days of hospitalization. Dyspepsia, post neck pain, and shoulder pain were assessed using the numeric rating scale (NRS), EuroQoL 5 dimensions (EQ-5D), neck disability index (NDI), shoulder pain and disability index (SPADI), and Nepean dyspepsia index–Korean version (NDI-K).Results: After 39 days of treatment, the NRS, NDI, SPADI, and NDI-K scores decreased, while the EQ-5D scores increased.Conclusion: These results show that postmenopausal syndrome with dyspepsia and arthralgia can be relieved with Korean medicine treatment.

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes.

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Methods: Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS (n = 41) and post-ERAS (n = 47) groups. Outcomes included opioid and antiemetic consumption, pain scores (numerical rating scale (NRS)), functional recovery (Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D)), and complication rates. Pain was assessed daily for the first four postoperative days and at 6 months. Linear Mixed Effects Model analysis evaluated pain trajectories. Results: The post-ERAS group showed significantly lower opioid (p = 0.005) and antiemetic (p < 0.001) use. No significant differences were observed in NRS pain scores in the first 4 postoperative days. At 6 months, the post-ERAS group reported significantly lower leg pain (p = 0.002). The time:group interaction was not significant for back (p = 0.848) or leg (p = 0.503) pain. Functional outcomes at 6 months, particularly ODI and EQ-5D scores, showed significant improvement in the post-ERAS group. Complication rates were lower in the post-ERAS group (4.3% vs. 19.5%, p = 0.024), while hospital stay and fusion rates remained similar. Conclusions: The ERAS protocol significantly reduced opioid and antiemetic use, improved long-term pain management and functional recovery, and lowered complication rates in lumbar fusion patients. These findings support the implementation of ERAS protocols in spinal surgery, emphasizing their role in enhancing postoperative care.

Application of WeChat-based cognitive behavioural stress management for early-stage cervical cancer patients: a randomised controlled study

Background This randomised controlled study was aimed at investigating the effects of WeChat-based cognitive behavioural stress management (WB-CBSM) on the mental health of patients with early-stage cervical cancer treated with surgical resection. Methods A total of 184 patients with early-stage cervical cancer were randomised to receive either WB-CBSM (n = 92) or normal care (NC) (n = 92) for 8 weeks. Results Compared with the NC group, the WB-CBSM group exhibited reduced Hospital Anxiety and Depression Scale (HADS)–anxiety scores at months (M)1 (t = 2.022, P = 0.045), M3 (t = 2.575, P = 0.011), and M6 (t = 2.709, P = 0.007); anxiety rates at M3 (χ2 = 4.834, P = 0.028) and M6 (χ2 = 5.182, P = 0.023); HADS–depression scores at M3 (t = 2.069, P = 0.040) and M6 (t = 2.449, P = 0.015); and depression rates at M6 (χ2 = 4.268, P = 0.039). Moreover, the WB-CBSM group showed increased Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being scale scores at M1 (t = −2.001, P = 0.047), M3 (t = −2.281, P = 0.024), and M6 (t = −3.501, P = 0.001); the Quality of Life Questionnaire-Core 30 (QLQ-C30) global health score at M3 (t = −2.034, P = 0.043) and M6 (t = −2.426, P = 0.016); and QLQ-C30 function score at M3 (t = −2.009, P = 0.046). However, the groups exhibited decreased EuroQol-5 dimension scores at M3 (t = 2.056, P = 0.041) and M6 ((t = 2.242, P = 0.026) and QLQ-C30 symptom scores at M1 (t = 2.026, P = 0.044) and M3 (t = 2.210, P = 0.028). Conclusion WB-CBSM reduced anxiety and depression and improved the spiritual well-being and quality of life of patients with early-stage cervical cancer treated with surgical resection.

Suture fixation versus tension band wiring in simple displaced olecranon fractures - a study protocol.

Olecranon fractures, particularly the Mayo Type 2A two-part fracture, are typically treated with Kirschner wires (K-wires) and tension band wiring. While effective, this method is associated with a high complication risk, leading to reoperations. Recently, new suture fixation techniques have been described that do not involve the insertion of metal. This new technique may mitigate risks associated with K-wires and tension band wiring without impacting healing or function. This study compares the reoperation rate and outcome of suture fixation with traditional tension band wiring. This is a prospective, randomised, double-blinded, multicentre study. The allocation ratio is 1:1, and the groups are parallel. A total of 88 adult participants will be recruited. Participants will be assigned to receive either suture fixation or traditional tension band wiring. Follow-up is one year. The primary outcome is the reoperation rate. Secondary outcome measures include the Disabilities of the Arm, Shoulder and Hand (DASH), the EuroQol-5 Dimensions (EQ-5D) score, radiological outcomes and complications. There is room for improvement in treating Mayo Type 2A fractures, and this study will allow us to investigate a new treatment method. The new suture fixation technique for treating olecranon fractures can potentially offer a similar or improved functional outcome compared to tension band wiring while lowering the reoperation rate significantly. The study is initiated and conducted by the participating physicians within the financial framework of the participating departments. The trial is registered with www. gov, ID number: NCT04189185.

8-year survivorship of a 4th Generation Fixed Bearing Total Ankle Replacements

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Infinity (Wright Medical Group) Total Ankle Replacement (TAR) has been implanted in patients since 2014 and is now the most common primary ankle used in the National Joint Registry of England and Wales. We report a prospective series of 106 Infinity TARs, with 8-year survivorship data from two, non-designer centres in the UK. The primary aims were to assess survivorship and complications of the Infinity TAR. The secondary aims were to assess patient reported and radiological outcomes. Methods: Prospectively collected data between March 2014 to December 2016 was assessed from two specialist centres in the United Kingdom. All operations were performed, or supervised, by one of 5 surgeons with a minimum experience of 10 TAR per year. Inclusion criteria were any patient with end-stage tibiotalar arthritis, considered by the operating surgeon to be suitable for primary TAR. Revision TAR, or conversion from arthrodesis, were not included in this study. Implant survivorship, complications, patient reported outcome scores (PROMS) and radiological data were collected for each patient. PROMS data comprised the Manchester Oxford Foot Questionnaire (MOX-FQ) and the EuroQol-5 Dimension (EQ5D-5L) score. Pre-operatively, weight bearing radiographs were assessed for the degree of sagittal and coronal deformity. Post-operatively, weight bearing radiographs at 6 weeks were assessed for the degree of deformity correction. Cystic radiolucencies on the most recent follow up radiograph was assessed by using an established scoring system. Results: 102 patients, comprising 106 TARs, were included. Mean age at implantation was 68 years (range 42 to 89 years). Mean follow up time was 98 months (range 83 to 113 months). 12 patients received further surgeries: 8 revision TARs, 3 debridement and grafting of talar cysts, and 1 capsular release. The reasons for revision surgery were unexplained pain (5 patients), proven deep infection (1 patient), tibial subsidence (1 patient) and instability (1 patient). Mean time to revision surgery was 43 months (range 15 to 82 months). Current survivorship of the cohort is 91%. Cystic radiolucencies were present in 35% of patients but the majority were small and asymptomatic. MOXFQ and EQ5D-5L PROMS showed significant and sustained post-operative improvements (p &lt; 0.01). Conclusion: This series of 106 modern fixed bearing TAR shows an 8-year survivorship of 91%. 3 cases of talar cysts were grafted. The most common reason for revision surgery was unexplained pain and the deep infection rate was 1%. The fixed bearing Infinity TAR appears to be a safe, effective intervention in the treatment of end stage ankle osteoarthritis and gives significant improvement in disease specific and general health status outcomes.

Relationships Between Various Parameters of Prolonged Sedentary Bouts and Health-Related Quality of Life (HRQOL) in Patients on Chronic Hemodialysis: A Cross-Sectional Study.

Previous studies have revealed that sedentary behavior, including quantitative and qualitative parameters, was associated with health-related quality of life (HRQOL) in patients on chronic hemodialysis. The present study examined the relationships between various parameters of prolonged sedentary bouts on non-hemodialysis daysand HRQOLin patients on chronic hemodialysis. A total of 110 patients (47.2%) on chronic hemodialysis (64 men and 46 women, aged 71.4 ± 11.2 years) among 233 patients, who were outpatients at a hospital in Hiroshima prefecture, Japan, were enrolled in this cross-sectional study. Prolonged sedentary bouts were evaluated using a tri-accelerometer, i.e., sedentary behavior (minutes), median sedentary bouts (minutes), maximum sedentary bouts (minutes), sedentary bouts (bouts and minutes/bout), and prolonged sedentary bouts(≥5, ≥10, ≥30, and ≥60minutes; bouts and minutes/bout). HRQOL was assessed using EuroQol 5-Dimension (EQ-5D). The EQ-5D score was 0.755 ± 0.216. All prolonged sedentary parameters, except for sedentary bouts (bouts), correlated with HRQOL, and higher correlation coefficients were observed between sedentary behavior (minutes) and HRQOL (r = -0.416) and between maximum sedentary bouts (minutes) and HRQOL (r = -0.436) than between other parameters. These parameters were also identified as factors affecting HRQOL, even after adjustments for confounding factors. In summary, sedentary behavior (minutes) and maximum sedentary bouts (minutes) on non-hemodialysis days, which may be representative of quantitative parameters for sedentary behavior, correlated with HRQOL in patients on chronic hemodialysis.

Clinical Significance of Myocardial Injury in Patients Hospitalized for COVID-19: A Prospective, Multicenter, Cohort Study

BackgroundHospitalized COVID-19 patients with troponin elevation have a higher prevalence of cardiac abnormalities than control individuals. However, the progression and impact of myocardial injury on COVID-19 survivors remain unclear. ObjectivesThis study sought to evaluate myocardial injury in COVID-19 survivors with troponin elevation with baseline and follow-up imaging and to assess medium-term outcomes. MethodsThis was a prospective, longitudinal cohort study in 25 United Kingdom centers (June 2020 to March 2021). Hospitalized COVID-19 patients with myocardial injury underwent cardiac magnetic resonance (CMR) scans within 28 days and 6 months postdischarge. Outcomes were tracked for 12 months, with quality of life surveys (EuroQol-5 Dimension and 36-Item Short Form surveys) taken at discharge and 6 months. ResultsOf 342 participants (median age: 61.3 years; 71.1% male) with baseline CMR, 338 had a 12-month follow-up, 235 had a 6-month CMR, and 215 has baseline and follow-up quality of life surveys. Of 338 participants, within 12 months, 1.2% died; 1.8% had new myocardial infarction, acute coronary syndrome, or coronary revascularization; 0.8% had new myopericarditis; and 3.3% had other cardiovascular events requiring hospitalization. At 6 months, there was a minor improvement in left ventricular ejection fraction (1.8% ± 1.0%; P < 0.001), stable right ventricular ejection fraction (0.4% ± 0.8%; P = 0.50), no change in myocardial scar pattern or volume (P = 0.26), and no imaging evidence of continued myocardial inflammation. All pericardial effusions (26 of 26) resolved, and most pneumonitis resolved (95 of 101). EuroQol-5 Dimension scores indicated an overall improvement in quality of life (P < 0.001). ConclusionsMyocardial injury in severe hospitalized COVID-19 survivors is nonprogressive. Medium-term outcomes show a low incidence of major adverse cardiovascular events and improved quality of life. (COVID-19 Effects on the Heart; ISRCTN58667920)

Effect of biologic therapies on quality of life in severe asthma: Findings from the PRISM study

BackgroundAnti-type 2 (T2) biologic therapies (biologics) improve exacerbation rates, lung function, and asthma-related quality of life (QoL) in patients with severe T2 asthma. However, studies comparing different biologics are lacking. We evaluated the QoL in patients with severe asthma comprehensively and compare the efficacy of different T2-directed biologics using QoL questionnaires. MethodsWe compared the QoL between severe and mild-to-moderate asthma and between severe asthma with and without biologics treatment. Data of mild-to-moderate were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea, and data of severe asthma were collected from the Precision Medicine Intervention in Severe Asthma. We included 183 patients with severe asthma treated with T2 biologics or conventional therapy between April 2020 and May 2021 and assessed QoL of them using the Questionnaire for Adult Korean Asthmatics (QLQAKA), Severe Asthma Questionnaire (SAQ), and EuroQoL-5Dimensions (EQ-5D) at baseline and 6 months. ResultsThe EQ-5D index (0.803) of severe asthma was lower than that of other chronic diseases representing a worse QoL. The scores for all questions of QLQAKA, except “cough,” were lower (less control) in the severe asthma group than in the mild-to-moderate asthma group at baseline and 6 months (P < 0.05). The total scores and subscores of all domains of the QLQAKA, SAQ, and EQ-5D improved significantly 6 months after biologic therapy but not after conventional therapy. The total QLQAKA, SAQ, and EQ-5D scores improved after 6 months in the anti-IL-5 (P < 0.05) and anti-IL-4/IL-13 (P < 0.05) treatment groups with no significant difference between groups (P > 0.05). ConclusionQoL was worse in severe asthma than in mild-to-moderate asthma and other chronic diseases. T2 biologics equally improved QoL in patients with severe asthma.

No Difference in 10-year Clinical or Radiographic Outcomes Between Kinematic and Mechanical Alignment in TKA: A Randomized Trial.

There is continuing debate about the ideal philosophy for component alignment in TKA. However, there are limited long-term functional and radiographic data on randomized comparisons of kinematic alignment versus mechanical alignment. We present the 10-year follow-up findings of a single-center, multisurgeon randomized controlled trial (RCT) comparing these two alignment philosophies in terms of the following questions: (1) Is there a difference in PROM scores? (2) Is there a difference in survivorship free from revision or reoperation for any cause? (3) Is there a difference in survivorship free from radiographic loosening? Ninety-nine patients undergoing primary TKA for osteoarthritis were randomized to either the mechanical alignment (n = 50) or kinematic alignment (n = 49) group. Eligibility for the study was patients undergoing unilateral TKA for osteoarthritis who were suitable for a cruciate-retaining TKA and could undergo MRI. Patients who had previous osteotomy, coronal alignment > 15° from neutral, a fixed flexion deformity > 15°, or instability whereby constrained components were being considered were excluded. Computer navigation was used in the mechanical alignment group, and patient-specific cutting blocks were used in the kinematic alignment group. At 10 years, 86% (43) of the patients in the mechanical alignment group and 80% (39) in the kinematic alignment group were available for follow-up performed as a per-protocol analysis. The PROMs that we assessed included the Knee Society Score, Oxford Knee Score, WOMAC, Forgotten Joint Score, and EuroQol 5-Dimension score. Kaplan-Meier analysis was used to assess survivorship free from reoperation (any reason) and revision (change or addition of any component). A single blinded observer assessed radiographs for signs of aseptic loosening (as defined by the presence of progressive radiolucent lines in two or more zones), which was reported as survivorship free from loosening. At 10 years, there was no difference in any PROM score measured between the groups. Ten-year survivorship free from revision (components removed or added) likewise did not differ between the groups (96% [95% CI 91% to 99%] for the mechanical alignment group and 91% [95% CI 83% to 99%] for the kinematic alignment group; p = 0.38). There were two revisions in the mechanical alignment group (periprosthetic fracture, deep infection) and four in the kinematic alignment group (two secondary patella resurfacings, two deep infections). There was no statistically significant difference in reoperations for any cause between the two groups. There was no difference with regard to survivorship free from loosening on radiographic review (χ2 = 1.3; p = 0.52) (progressive radiolucent lines seen at 10 years were 0% for mechanical alignment and 3% for kinematic alignment). Like the 2-year and 5-year outcomes previously reported, 10-year follow-up for this RCT demonstrated no functional or radiographic difference in outcomes between mechanical alignment and kinematic alignment TKA. Anticipated functional benefits of kinematic alignment were not demonstrated, and revision-free survivorship at 10 years did not differ between the two groups. Given the unknown long-term impact of kinematic alignment with regard to implant position (especially tibial component varus), we must conclude that mechanical alignment remains the reference standard for TKA. We could not demonstrate any advantage to kinematic alignment at 10-year follow-up. Level I, therapeutic study.

Insomnia among patients with chronic pain: A retrospective study.

Insomnia can coexist with chronic pain and is a major cause of rapidly increasing medical expenses. However, insomnia has not been fully evaluated in patients with chronic pain. This retrospective study aimed to identify the risk factors for insomnia in patients with chronic non-cancer pain. A total of 301 patients with chronic non-cancer pain were enrolled. Patients with the Athens insomnia scale scores ≥ 6 and < 6 were classified into insomnia (+) and insomnia (-) groups, respectively. All patients completed self-report questionnaires as part of their chronic pain treatment approach. Univariate and multivariate analyses were performed to predict insomnia. We found that 219 of 301 (72.8%) patients met the AIS criteria for insomnia. Significant differences were depicted between patients with and without insomnia in terms of body mass index, numeric rating scale, pain catastrophizing scale, hospital anxiety, and depression scale (HADS), pain disability assessment scale, EuroQol 5 dimension (EQ5D), and pain self-efficacy questionnaire. Multiple regression analysis identified the numeric rating scale, HADS, and EQ5D scores as factors related to insomnia in patients with chronic non-cancer pain. Anxiety, depression, and disability were associated with a greater tendency toward insomnia. HADS and EQ5D scores are useful screening tools for preventing insomnia in patients with chronic non-cancer pain.

A comparison of dysphagia rates between long-segment anterior versus posterior cervical fusion.

The goal of this study was to compare rates of dysphagia and patient-reported outcomes (PROs) following long-segment (≥ 3 levels) anterior cervical spinal fusion (ACF) and posterior cervical spinal fusion (PCF) at 3 and 12 months postoperatively. PROs were also compared for patients with dysphagia versus those without dysphagia. A prospectively collected quality improvement database was used to identify patients who had a long-segment cervical spinal fusion. Cohorts were divided into ACF and PCF groups. Eating Assessment Tool-10 scores and PROs were obtained for all patients preoperatively and at 3 and 12 months postoperatively to compare. Multivariate analysis was also performed to evaluate risk factors for dysphagia. A total of 132 patients met the inclusion criteria, 77 of whom had undergone ACF and 55 of whom had undergone PCF. Dysphagia rates between ACF and PCF cohorts were similar at baseline (13.0% vs 18.2%, p = 0.4). New-onset dysphagia rates were also comparable at 3-month follow-up (39.7% vs 23.1%, p = 0.08) and 12-month follow-up (32.6% vs 32.4%, p > 0.99). Patients who underwent PCF had worse Neck Disability Index (NDI) scores at 3 months than did patients with ACF (13.67 ± 9.49 vs 10.55 ± 6.24, respectively; p = 0.03). There were significantly higher NDI scores for patients with dysphagia at 3 months in both the ACF and PCF groups and at 12 months for those in the PCF group. Analogously, EuroQol-5 Dimensions scores were worse for patients with dysphagia; however, this was only significant for patients in the ACF group at 3 months. There were no significant risk factors for the development of dysphagia found on multivariate analysis. Similar rates and severity of dysphagia were seen following ACF and PCF at 3- and 12-month follow-up. This suggests that long-term dysphagia following cervical fusion surgery may be due to structural changes from the fusion rather than the surgical approach. However, the ACF cohort was significantly younger, and this may have partially accounted for the findings. PROs were also compared for patients with and without dysphagia, demonstrating worsened outcomes in some domains for patients who presented with dysphagia at 3- and 12-month follow-up. This suggests that dysphagia may be associated with a decreased quality of life after cervical fusion.