EuroQol-5D Research Articles

Association of post-stroke-depression and health-related quality of life three months after the stroke event. Results from the Stroke Cohort Augsburg (SCHANA) study

ABSTRACT Approximately one-third of patients with stroke show depressive symptoms. The so-called post-stroke depression (PSD) has a negative influence on mortality as well as physical and mental conditions. The aim of this study was to analyse the association between PSD and health-related quality of life (HRQOL) in patients with stroke. The analysis was based on data of 326 patients from the Stroke Cohort Augsburg (SCHANA Study) collected after the stroke event by interview and three months later using a postal survey. Depressive symptoms were measured with the Patient-Health Questionnaire (PHQ-9), subjective health status with the EuroQol 5D visual analogue scale (EQ-5D VAS), and HRQOL with the Stroke Impact Scale (SIS). Patients with depressive symptoms were compared to those without depressive symptoms in terms of sociodemographic characteristics and scores of the SIS and the EQ-5D VAS. Multiple linear regression models were calculated to investigate the association between PSD and subjective health status and HRQOL. Three months after the stroke, 17.8% of patients had depressive symptoms. Patients with PSD showed significantly worse SIS and EQ-5D VAS scores. In addition, an independent negative linear association between PSD and subjective health status and between PSD and all domains of SIS could be found. The study confirmed that PSD is common in patients with mild stroke and negatively related to all stroke-specific HRQOL domains. The results underline the importance of early screening for PSD in stroke patients since it may hinder a successful rehabilitation.

Long Term Results of a Longitudinal Study of Unmet Survivorship Needs in Patients with Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> Cross-sectional studies show many unmet needs in patients with head and neck cancer (HNC); prospective studies are lacking. Our purpose was to determine the number, type, and predictors at baseline of unmet needs over time. <h3>Materials/Methods</h3> Patients with non-metastatic HNC were enrolled prior to curative treatment. Demographics, the Cancer Survivors' Unmet Needs (CaSUN), Functional Assessment of Cancer Therapy (FACT-HN) and EuroQol 5D (EQ-5D) were collected at baseline, 3-, 6-, 12- and 24-months post-treatment. Mean unmet needs at each timepoint and predictors for number of unmet needs were identified. <h3>Results</h3> Of 197 patients (median age 64, 80% male), 153 (78%) completed questionnaires at baseline, 126 (64%) at 3, 104 (53%) at 6, 103 (52%) at 12 and 97 (49%) at 24 months. Education was beyond high school in 118 (60%) and 85% had internet access. Most patients had oropharynx (n=88; 46%) and hypopharynx/larynx (n=45; 24%) cancer. The mean number of unmet needs at baseline, 3, 6, 12 and 24 months was: 7.5 ± 9.1, 3.8 ± 6, 5.3 ± 8.4, 2.9 ± 5.8 and 2.8 ± 6.5 respectively. At least one unmet need was reported at these timepoints by 68%, 52%, 56%, 41% and 39% of patients. The mean FACT-HN scores were 110.7 ± 21.6, 109.4 ± 21.9, 108.3 ± 22.9, 117.1 ± 20.5 and 118 ± 22.3 respectively, while the mean EQ-5D VAS scores were 72 ± 20.5, 73.3 ± 17.3, 75.9 ± 15.5, 79 ± 15.6 and 78.2 ± 15. The top 3 needs at baseline, 6, 12 and 24 months are shown in Table 1; qualitative change was seen. Multivariable analysis showed that education greater than high school (p < 0.01), living alone (p = 0.02), cancers of the lip and oral cavity (p < 0.01) and lower baseline FACT HN scores (p < 0.001) were associated with increased unmet needs at baseline. Having no computer access (p < 0.01), being a never smoker (p = 0.036) and lower baseline FACT HN scores (p = 0.03) are associated with increased unmet needs at 24 months. <h3>Conclusion</h3> HNC patients' unmet needs decrease and change over time. Survivorship resources are needed that serve different issues through the cancer journey.

Postoperative Patient Reported Outcomes After Cholesteatoma Surgery.

Results and success measures of cholesteatoma surgery are generally described using objective data whereas subjective data are mostly lacking. Patients experiences and complaints are becoming more important alongside clinical and audiometric outcome measures in cholesteatoma care. To investigate the course of patient-reported complaints, the impact of complaints, audiometric measures and the stability of audiometric measures, and complaints over time after primary and recurrent/residual cholesteatoma surgery. Postoperative patients were prospectively included and divided into primary acquired and recurrent/residual cholesteatoma. The EuroQol 5D (EQ-5D-3L), Otology Questionnaire Amsterdam (OQUA), and the Speech Spatial Questionnaire (SSQ) were completed by 144 patients up to 2 years postoperative. Patient-reported complaints divided in eight separate domains, postoperative hearing and impact on daily life were longitudinally assessed by means of linear mixed models. Hearing loss and tinnitus are the most reported postoperative complaints over time. Patient-reported loss of taste and the impact of all complaints decline over time. All other patient-reported complaints remain stable over time, only itch complaints fluctuate. Primary cholesteatoma patients score significantly higher on hearing loss complaints compared with recurrent/residual patients although they have comparable mean audiometric hearing loss. Furthermore, pure-tone hearing threshold, instead of asymmetric hearing loss, is correlated with the localization domain of the SSQ. This study provides important insights in the course of complaints and its impact on daily life after cholesteatoma surgery. Overall, the postoperative patient-reported complaints after cholesteatoma surgery are generally low in the studied population.

Improved joint awareness two years after total knee arthroplasty with a handheld image-free robotic system.

Literature into the short-term follow-up of total knee arthroplasty (TKA) using a handheld image- free robotic system are scarce. The purpose of this study was to compare the clinical outcomes and patient-reported outcome measures (PROMs) between patients operated for TKA with an image- free robotic system (robot group) or conventionally TKA (conventional group) 2 years postoperatively. A total of 147 patients were evaluated after TKA, respectively 73 in the robot and 74 in conventional group. Outcome measures included adverse events (AEs), hospital readmission rate, patient satisfaction and the following PROMs: Pain Visual Analogue Score (VAS), Oxford Knee Score (OKS), Forgotten Joint Score Knee (FJS-12) and the EuroQOL-5D (EQ-5D). There were no statistically significant differences in the number of AEs; 8 (10.8%) in the conventional group versus 7 (9.7%) in the robot group. The FJS (p ≤ 0.05) and OKS (p ≤ 0.05) differed statistically in favour of the robot group. The EQ-5D and EQ-5D VAS did not statistically differed between the groups (p=0.231 and p=0.373 respectively). The VAS pain improved statically significant in both groups when comparing the pre- and postoperative values (5.8 points). Patients operated with a handheld image-free robotic system have the ability to forget their artificial knee joint in everyday life as measured with the FJS-12 at short-term follow-up.

Concordance between the schedule for the evaluation of individual quality of life-direct weighting (SEIQoL-DW) and the EuroQoL-5D (EQ-5D) measures of quality of life outcomes in adults with X-linked hypophosphatemia

BackgroundAccurate measurement of any constructs in clinical studies is of critical importance, especially if the adoption of an intervention relies on detecting a significant treatment effect where one exists. Under Neutral theory, the amount of relevant and irrelevant indicators selected to operationalise the construct contribute equally to the accuracy of the observation. The Neutral or accurate observation is achieved by observing all relevant indicators only. Generic QoL instruments such as EQ-5D are increasingly being accepted as imprecise, especially in rare diseases, based on the relevance of their indicators. QoL is a construct that embodies a patient's subjectivity, individuality, and local circumstances at measurement. SEIQoL-DW is an instrument designed to respect these characteristics of QoL through eliciting indicators or cues directly from the subject along with the proportion of the overall QoL they contribute. EQ-5D and SEIQoL can therefore be considered as being at opposing ends of accuracy in QoL measurement. XLH is a hereditary, progressive, rare disease characterised by phosphate wasting, affecting both children and adults and impacting their QoL. The purpose of this study was to observe if any change in QoL of adult XLH patients were detectable using EQ-5D, SEIQoL eliciting new cues at each visit, and SEIQoL administering baseline cues overall visits (thereby silencing its time-dependency) versus baseline over 12 months. In addition, any association between the three sets of observations was explored.ResultsAll quality of life scores were observed to decrease from baseline by 13.36%, 7.32% and 2.7% based on SEIQoLvisit_cues, SEIQoLbaseline_cues, and EQ-5D assessments, respectively. The decrease in the quality of life scores was only statistically significant (p = 0.037) for SEIQoLvisit_cues. Beyond the baseline visit, the only highly positive and statistically significant pairwise association was between SEIQoLvisit_cues and SEIQoLbaseline_cues at M6 (ρ = 0.782, P value < 0.05) and M9 (ρ = 0.879, P value < 0.05).ConclusionsEQ-5D and SEIQoLbaseline_cues failed to detect the same statistically significant decrease in QoL observed by SEIQoLvisit_cues. Both sets of SEIQoL observations were more closely associated with each other than with EQ-5D. Observing constructs such as QoL in rare diseases benefit from a Neutrality in indicator selection and respecting variation in dominance of various indicators over time.

Clinical Outcomes of Coccygectomy for Coccydynia: A Single Institution Series With Mean 5-Year Follow-Up.

Prior studies of coccygectomy consist of small patient groups, heterogeneous techniques, and high wound complication rates (up to 22%). This study investigates our institution's experience with coccygectomy using a novel "off-center" wound closure technique and analyzes prognostic factors for long-term successful clinical outcomes. Retrospective review of all patients who underwent coccygectomy from 2006 to 2019 at a single center. Demographics, mechanism of injury, conservative management, morphology (Postacchini and Massobrio), and postoperative complications were collected. Preoperative and postoperative Oswestry Disability Index (ODI), visual analog scale (VAS), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and EuroQol-5D (EQ-5D) were compared. Risk factors for failing to meet minimum clinically importance difference for ODI and PROMIS-physical function/pain interference were identified. Risk factors for remaining disabled after surgery (ODI <20) and factors associated with VAS and EQ-5D improvement were investigated using stepwise logistic regression. A total of 173 patients (77% women, mean age = 46.56 years, mean follow-up 5.58 ± 3.95 years). The most common etiologies of coccydynia were spontaneous/unknown (42.2%) and trauma/accident (41%). ODI, VAS, and several PROMIS-29 domains improved postoperatively. Older age predicted continued postoperative disability (ODI >20) and history of prior spine surgery, trauma etiology, and women had inferior outcomes. No history of spine surgery (cervical, thoracic, or lumbar) prior to coccygectomy was found to predict improved postoperative VAS back scores. No outcome differences were demonstrated among the coccyx morphologies. Sixteen patients (9.25%) were noted to have postoperative infections of the incision site with no difference in long-term outcomes (all P <0.05). This is the largest series of coccygectomy patients demonstrating improvement in long-term outcomes. Compared to previous studies, our cohort had a lower wound infection rate, which we attribute to an "off-center" closure. Patients should be counseled that their surgical history, along with age, gender, and etiology of pain can influence success following coccygectomy. These data can help surgeons set realistic expectations following surgery.

Патогенетичні та терапевтичні аспекти застосування препарату Мускомед при вертеброгенних м’язово-тонічних синдромах

Проведено відкрите клінічне дослідження з вивчення ефективності та переносимості лікарського засобу Мускомед виробництва компанії World Medicine у пацієнтів з м’язово-тонічними синдромами. Препарат Мускомед містить активну речовину тіоколхікозид, напівсинтетичний міорелаксант, що отримується з натурального глікозиду колхікозиду. Справляє міорелаксуючу дію. Знижує або усуває м’язові спазми, зумовлені впливом з боку центральної нервової системи. Мета дослідження: оцінити ефективність і переносимість препарату Мускомед виробництва компанії World Medicine у пацієнтів з м’язово-тонічними синдромами. Завдання дослідження: вивчити терапевтичну ефективність препарату Мускомед, його вплив на вираженість м’язово-тонічного синдрому; вивчити переносимість та можливі побічні явища досліджуваного препарату; порівняти терапевтичний ефект препарату Мускомед і препарату Толперіл-Здоров’я при лікуванні м’язово-тонічного синдрому. Об’єкт дослідження: 60 пацієнтів обох статей у віці від 18 до 65 років з м’язово-тонічними синдромами, які перебували на стаціонарному та/або амбулаторному лікуванні у відділенні судинної патології головного мозку ДУ «Інститут неврології, психіатрії та наркології НАМН України». Залежно від одержуваної терапії всі пацієнти були розділені на 2 рівні групи: 1-ша — 30 осіб, які отримували Мускомед 2 мл 2 рази на добу в/м протягом 5 днів на тлі загальноприйнятої стандартної терапії; 2-га — 30 осіб, які отримували Толперіл-Здоров’я 1 мл 2 рази на добу на тлі загальноприйнятої стандартної терапії. Методи обстеження: загальноклінічні, клініко-неврологічне та ней­ропсихологічне дослідження з використанням шкал (проба Шобера, опитувальник Роланда — Морріса, візуальна аналогова шкала, госпітальна шкала тривоги і депресії, Мак-Гілловський больовий опитувальник, опитувальник якості життя EuroQOL 5D), інструментальні (рентгенографія, магнітно-резонансна томографія), біохімічні, клініко-лабораторні, статистичні. Результати й обговорення. Р езультати проведеного дослідження дозволили зробити висновок, що препарат Мускомед справляє досить виражений терапевтичний вплив на м’язово-тонічні синдроми, зручний у використанні, а також призводить до поліпшення фізичного благополуччя, підвищення працездатності та якості життя пацієнтів.

P286 Sustained improvement in health-related quality of life outcomes in patients with Ulcerative Colitis with long-term tofacitinib treatment in the open-label extension study, OCTAVE Open

Abstract Background Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Tofacitinib induction and maintenance therapy has previously been shown to improve health-related quality of life (HRQoL) outcomes. Here, we present HRQoL data from patients (pts) with UC who received tofacitinib 5 or 10 mg twice daily (BID) in the Phase 3 open-label, long-term extension (OLE) study (OCTAVE Open; NCT01470612), up to Month (M)72. Methods Proportions of pts with an Inflammatory Bowel Disease Questionnaire (IBDQ) total score ≥170, and EuroQol-5D (EQ-5D) and Short Form-36 Health Survey (SF-36) scores were analysed up to M72 in 4 subpopulations in the OLE study: ‘maintenance remitters’ completed OCTAVE Sustain in remission and received tofacitinib 5 mg BID in the OLE study; in contrast, ‘maintenance treatment failures’ (induction responders who experienced treatment failure), ‘maintenance non-remitters’ and ‘induction non-responders (IndNR)’ received tofacitinib 10 mg BID in the OLE study (Figure 1). Data were analysed for each subpopulation overall and stratified by prior tumour necrosis factor inhibitor (TNFi) failure, prior immunosuppressant failure and baseline corticosteroid use. Results Baseline demographics and clinical characteristics for each subpopulation are shown in Table 1. Among the 163 maintenance remitters, HRQoL outcomes were maintained up to M72: 80.0% of pts had an IBDQ total score ≥170 (Figure 1); changes from baseline in EQ-5D scores up to M72 and SF-36 scores up to M33 were minimal (eg M72 EQ-5D utility score -0.07 [standard deviation 0.10]; M33 SF-36 physical functioning score -1.3 [8.3]). Among pts continuing long-term tofacitinib treatment, improvement in IBDQ total score was maintained/achieved by M2 (first post-baseline assessment), and was stable up to M72, with maintenance treatment failures and IndNR subpopulations experiencing the largest improvements from baseline (Figure 1). Similar trends were observed for improvement in EQ-5D and SF-36 scores. Improvements in HRQoL outcomes were independent of prior TNFi failure, prior immunosuppressant failure or baseline corticosteroid use, eg in maintenance remitters with prior TNFi failure, 90.9% of pts had IBDQ total score ≥170 at M60 vs 88.9% of pts without prior TNFi failure. Conclusion Sustained beneficial effects in HRQoL were observed among pts continuing long-term tofacitinib treatment in OCTAVE Open. In maintenance remitters, improvements in all HRQoL outcomes were maintained with tofacitinib therapy. In pts who entered the OLE study not in remission and received tofacitinib 10 mg BID, HRQoL improvements were observed within the first 2 months, and were maintained up to M72, regardless of treatment history including prior TNFi failure.

Are There Differences in Long-Term Functioning and Recovery Between Hemorrhagic and Ischemic Stroke Patients Receiving Rehabilitation?

ObjectivePrevious research suggested better recovery in functioning of patients with hemorrhagic as compared to ischemic stroke. Now that more effective acute treatment for ischemic stroke, i.e. thrombolysis and thrombectomy, has become available, this observational cohort study aimed to examine if current rehabilitation outcomes differ between patients with hemorrhagic and ischemic stroke. Materials and MethodsThe Barthel Index, 4 domains of the Stroke Impact Scale (SIS) and the EuroQol 5Dimensions were completed in all consecutive patients who received stroke rehabilitation at start of rehabilitation and during follow-up (for Barthel Index at discharge, SIS and EuroQol 5D after three and six months). Outcomes and recovery (i.e. change of scores between baseline and last follow-up) were compared between patients with hemorrhagic stroke and ischemic stroke (total and categorized by initial hospital treatment) using the Kruskall Wallis test. In addition, recovery was compared between ischemic and hemorrhagic stroke in multiple regression analyses with bootstrapping. ResultsBaseline functioning did not differ between 117 patients with a hemorrhagic stroke, 118 ischemic stroke patient treated with reperfusion therapy, and 125 ischemic stroke patients without reperfusion therapy. There were no differences in functioning at follow-up nor in recovery concerning the Barthel Index, SIS domains ‘mobility’, ‘communication’, ‘memory and thinking’ and ‘mood and emotions’, and EuroQoL 5D between the three categories. ConclusionsIn a rehabilitation population the recovery and functioning at three or six months did not differ between ischemic stroke patients and hemorrhagic stroke patients, regardless of the hospital treatment they had received.

TEleRehabilitation Nepal (TERN) for People With Spinal Cord Injury and Acquired Brain Injury: A Feasibility Study.

BACKGROUND:Spinal Cord Injury (SCI) or Acquired Brain Injury (ABI) leads to disability, unemployment, loss of income, decreased quality of life and increased mortality. The impact is worse in Low-and Middle-Income Countries (LMICs) due to a lack of efficient long-term rehabilitative care. This study aims to explore the feasibility and acceptability of a telerehabilitation programme in Nepal.METHODS:Prospective cohort feasibility study in a community setting following discharge from a specialist rehabilitation centre in Nepal. Patients with SCI or ABI who had previously accessed specialist rehabilitation were connected to a specialist Multidisciplinary Team (MDT) in the centre through a video conference system for comprehensive remote assessments and virtual individualised interventions. Data were captured on recruitment, non-participation rates, retention, acceptability (via end-of-study in-depth interviews with a subset of participants) and outcome measures including the Modified Barthel Index (MBI), Depression Anxiety Stress Scale (DASS) and EuroQol-5D (EQ-5D), completed pre- and post-programme.RESULTS:97 participants with SCI (n = 82) or ABI (n = 15) discharged from the centre during an 18-month period were approached and enrolled on the study. The telerehabilitation programme facilitated the delivery of support around multiple aspects of rehabilitation care, such as spasticity treatments and pain management. Outcome measures indicated a significant improvement in functional independence (P < .001), depression, anxiety and stress (P < .001) and quality of life (P < .001). Qualitative interviews (n = 18) revealed participants found the programme acceptable, valuing regular contact and input from MDT professionals and avoiding expensive and lengthy travel.CONCLUSION:This is the first study in Nepal to identify telerehabilitation as a feasible and acceptable approach to augment the provision of specialist rehabilitation. Future research is needed to assess the suitability of the programme for other conditions requiring specialist rehabilitation and determine the mechanisms underpinning improved outcomes for people with SCI or ABI.TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT04914650

Retina analysis with optical coherence tomography in patients with fibromyalgia

AbstractPurposeTo evaluate the inner layers of the retina in patients with fibromyalgia (FM) compared to healthy subjects using a posterior pole protocol analysis in optical coherence tomography (OCT) and the relationship of structural measures with quality of life.MethodsSeventy‐four eyes of healthy subjects and 55 eyes of FM patients were analyzed. FM group was divided into three subgroups depending on the phenotype of the disease (group 1, biologic phenotype; group 2, depressive phenotype; group 3, atypical phenotype). All of them were evaluated using Pole Posterior protocol of OCT Spectralis, which analyzes the thickness of the macular area divided into 64 cells. The thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell layer (GCL) were evaluated. All patients completed the EuroQol questionnaire (EQ‐5D) and the Fibromyalgia Impact Questionnaire (FIQ) to assess health‐related quality of life.ResultsThe FM patients presented a significant thinning of the RNFL in 17/64 cells and the GCL in 47/64 cells, compared with the control group. The depressive FM phenotype presented the highest number of cells significantly decreased compared to controls. A significant correlation was observed between the GCL and the EuroQol 5D questionnaire results in the lower temporal cells of the posterior pole grid.ConclusionsFM patients showed a loss of retinal ganglion cells and RNFL detectable by the Posterior Pole protocol of OCT. This is a safe, easy and fast test which provides very complete macular data to quantitatively and objectively assess the disease and its different phenotypes in this patients.

Quality of Life in Adults with Metabolic Dysfunction-Associated Fatty Liver Disease.

The aims of this study were as follows: to investigate the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and health-related quality of life (HRQoL), to evaluate whether stress perception and mental health among patients with MAFLD affect HRQoL, and to identify the underrated burden on MAFLD patients. Nationwide data from the 5th Korean National Health and Nutrition Examination Survey (KNHANES V, 2010 to 2012) were used. MAFLD was defined by a fatty liver index (FLI) of ≥60, and the EuroQol-5D (EQ-5D) was used to assess HRQoL. Logistic regression analysis and odds ratios (ORs) were used to determine the associations of MAFLD with stress, mental health, and HRQoL. Previous suicidal impulse was not found to be significantly associated with HRQoL. The risk of MAFLD increased 1.265-fold with an increase in stress levels based on the stress perception rate (confidence index (CI): 1.046–1.530; p < 0.05), while it increased 1.091-fold with a 1-point decrease in the EQ-5D score (CI: 1.019–1.169; p < 0.05). HRQoL impairment and stress levels are associated with MAFLD. It is important to evaluate stress levels among MAFLD patients and implement stress management and HRQoL improvement strategies.

Quality of life and functional status of patients treated with venovenous extracorporeal membrane oxygenation at 6 months.

Quality of life (QoL) outcomes of patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) have been conflicting. This study reports on QoL outcomes for a broad group of ARDS patients managed with up-to-date treatment modalities. We prospectively recruited patients at a quaternary hospital in the United Kingdom from 2013 to 2015 who were treated with ECMO for ARDS. We evaluated their pulmonary function and QoL at 6-months after admission using three QoL instruments: EuroQoL 5D (EQ-5), HADS, and PTSS-14. Forty-three patients included in the analysis had near-normal pulmonary function at 6 months. HADS showed moderate-to-severe anxiety and depression in 32% and 11% of patients, respectively. PTSS-14 showed 29% had signs of post-traumatic stress disorder. EQ-5D showed that 67% of patients had difficulty returning to usual activities, 74% suffered some pain, none reported severe problems and 77% were able to return to work. No clinical or demographic variables were associated with poor 6-month QoL. Patients with ARDS treated with ECMO generally had good QoL outcomes, similar to outcomes reported for patients managed without ECMO. With respect to QoL, VV-EMCO represents a valid treatment modality for patients with refractory ARDS.

Effectiveness of telemedicine for cardiovascular disease management: systematic review and meta-analysis.

With the development of information communication technology (ICT), telemedicine has become a promising option for patients with chronic diseases who need continuous monitoring at home or in remote health care facilities. As cardiovascular disease (CVD) is responsible for an estimated 17.9 million deaths globally each year, it is appropriate to evaluate the effectiveness of telemedicine for the health care management of CVD patients. The Library of Congress, LISTA (EBSCO), PubMed (NLM), and Web of Science databases were searched with a date limitation from 1 January 2000 until 5 August 2021 for Randomized Controlled Trial (RCT) studies. Two independent researchers screened the records for inclusion and extracted the data for synthesis, supported by RevMan 5.0 software. As one of the clinical outcomes, the mean difference and standard deviation of systolic blood pressure were synthesized. For the Quality-of-life measures, EuroQol-5D (EQ-5D) scores were also synthesized and for the depression level, CESD-10 scores were synthesized. We identified 23 studies for qualitative analysis and 21 studies for quantitative analysis. 21 studies included systolic blood pressure as an outcome measure and the results show a statistical difference (P<0.05) between the intervention group and the control group and a favorable inclination toward the Telemedicine enhanced health care program over the usual care. Of the six studies that included body mass index (BMI) as an outcome measure, there was no significant difference in BMI between the telemedicine and usual health care groups. A total of five studies assessed patients' quality of life using the EQ-5D instrument. After excluding one study following the sensitivity analysis, telemedicine was shown to significantly improve patients' quality of life. Three studies that investigated patients' mental health (CSE-D-10) also showed a significantly beneficial effect of telemedicine over usual health care. This review found limited evidence to support some of the outcomes in the original study designs. Overall, our findings suggested a favorable effect of telemedicine intervention in the field of health care for CVD patients. Due to the unavoidable heterogeneity within the selected literature, a more detailed investigation and analysis of the unclear outcomes is recommended.

Health-related quality of life improves after entecavir treatment in patients with compensated HBV cirrhosis.

Antiviral therapy is effective in decreasing disease progression in HBV cirrhosis. However, the long-term effect of antiviral therapy on health-related quality of life (HRQoL) in patients with compensated HBV cirrhosis is unknown. The patients with compensated HBV cirrhosis enrolled in a randomized controlled trial of entecavir-based therapy were recruited in the present study, if they had HRQoL score at 5-year follow-up or who developed liver-related events (LRE) during follow-up were included. HRQoL was measured with 36-Item Short-Form Health Survey (SF-36) and EuroQol-5D (EQ-5D) at baseline and yearly during follow-up. LRE was defined as the development of decompensation, HCC, or death. A total of 161 patients were included in the present study, with a median age of 48.0 (41.0, 53.0) years, 77.6% being male and 37.2% being HBeAg-positive. During 5years, 45 patients developed LRE. All eight dimensions of SF-36 were significantly improved after 5years of antiviral therapy (all p < 0.001), with all dimensions improved more than five points except for physical functioning. Proportion of patients reporting no problems in all five dimensions in EQ-5D increased from 57.8 to 72.0%; visual analogue scale (VAS) and utility index (UI) increased significantly (VAS 79.8 ± 16.4 to 84.4 ± 13.2, UI 0.91 ± 0.13 to 0.95 ± 0.10, both p < 0.001). HRQoL improved or kept stable in the majority of patients who had LRE during follow-up, even stratified by Baveno VI criteria for clinically significant portal hypertension. After 5years of ETV treatment, HRQoL significantly improved in patients with compensated HBV cirrhosis. (NCT01943617, NCT02849132).

Clinical outcome following decompression and short or long instrumented fusion in lumbar degenerative spinal stenosis. A prospective case-control analysis

ObjectivesThere is limited data on the direct clinical comparison between short and long fusion following surgery for lumbar spinal stenosis. The hypothesis that regardless their baseline characteristics and morbidity, clinical outcome is similar in patients with lumbar stenosis treated with decompression plus posterior instrumented fusion in one or two versus three to five levels was tested. MethodsSubjects were divided into Group A and Group B corresponding to stenotic pathology and instrumented fusion in one or two levels and three to five levels, respectively. Primary outcome measures at one year were the change in SF-36 physical component (PCS) and Oswestry Disability Index (ODI). Secondary outcome measures included the EuroQol-5D (EQ-5D), the Visual Analog Scale (VAS), the mental component (MCS) of SF-36 scale and the Zung Self-Rating Depression Scale. ResultsSeventy seven (77) patients were included (Group A, n = 42; Group B, n = 35). Patients in Group B were older, surgery lasted longer and intraoperative blood loss was greater than patients in Group A (p < 0.05). A significant clinical improvement was noted in both Groups on all scales (p < 0.01). Clinical outcome at one year was equally favorable in both Groups (p > 0.05). The evaluation of depression for Group A showed a significant improvement at one year (p = 0.02) compared to the preoperative status. ConclusionsOlder individuals are more likely to have multilevel stenosis and more co-morbidities and they were associated with longer instrumentation. However, complications are similar and clinical outcome is equally favorable compared to short instrumented fusion for fewer levels of disease.

Classifying Patients Operated for Spondylolisthesis: A K-Means Clustering Analysis of Clinical Presentation Phenotypes.

Trials of lumbar spondylolisthesis are difficult to compare because of the heterogeneity in the populations studied. To define patterns of clinical presentation. This is a study of the prospective Quality Outcomes Database spondylolisthesis registry, including patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Twenty-four-month patient-reported outcomes (PROs) were collected. A k-means clustering analysis-an unsupervised machine learning algorithm-was used to identify clinical presentation phenotypes. Overall, 608 patients were identified, of which 507 (83.4%) had 24-mo follow-up. Clustering revealed 2 distinct cohorts. Cluster 1 (high disease burden) was younger, had higher body mass index (BMI) and American Society of Anesthesiologist (ASA) grades, and globally worse baseline PROs. Cluster 2 (intermediate disease burden) was older and had lower BMI and ASA grades, and intermediate baseline PROs. Baseline radiographic parameters were similar (P >.05). Both clusters improved clinically (P <.001 all 24-mo PROs). In multivariable adjusted analyses, mean 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), Numeric Rating Scale Leg Pain, and EuroQol-5D (EQ-5D) were markedly worse for the high-disease-burden cluster (adjusted-P <.001). However, the high-disease-burden cluster demonstrated greater 24-mo improvements for ODI, NRS-BP, and EQ-5D (adjusted-P <.05) and a higher proportion reaching ODI minimal clinically important difference (MCID) (adjusted-P=.001). High-disease-burden cluster had lower satisfaction (adjusted-P=.02). We define 2 distinct phenotypes-those with high vs intermediate disease burden-operated for lumbar spondylolisthesis. Those with high disease burden were less satisfied, had a lower quality of life, and more disability, more back pain, and more leg pain than those with intermediate disease burden, but had greater magnitudes of improvement in disability, back pain, quality of life, and more often reached ODI MCID.

Abstract 10394: Long-Term Functional and Quality-of-Life Outcomes of Cardiac Arrest Survivors Stratified by Shock Provider: A 10 Year Retrospective Study

Introduction: To assess the long-term functional recovery and health related quality-of-life (HRQoL) outcomes for out-of-hospital cardiac arrest (OHCA) survivors stratified by shock provider. Methods: We included adult OHCA in initial shockable rhythms between 2010-2019. Those surviving to 12 months post arrest were invited to participate in telephone interviews to identify functional recovery and HRQoL outcomes, using the following assessment tools, Glasgow Outcome Scale-Extended (GOS-E), EuroQol-5D (EQ-5D), and 12-Item Short Form (SF-12). Results: Of the 1,581 patients surviving to 12 months, 1,325 (85.5%) responded to the interviews, of these, 227 (17.1%) and 144 (10.9%) were initially shocked by bystanders and first responders, respectively. A higher proportion of patients shocked by bystanders were located in public (p&lt;0.001), received bystander CPR (p&lt;0.001) and received initial defibrillation faster from time of collapse (P&lt;0.001). Survivors receiving bystander defibrillation reported higher rates of living at home without care (p=0.004), upper good recovery (GOS-E) (p=0.008) and EQ-5D index score of 1 (perfect health) (p=0.023). After adjustment, bystander defibrillation was associated with a 64% increase in the odds of an EQ-5D current Visual Analogue Scale ≥ 80 (AOR 1.64, 95%CI: 1.17-2.31; p=0.004) and a 45% increase in the odds of a good functional recovery (GOS-E ≥ 7) (AOR 1.45, 95% CI: 1.02-2.06; p=0.037), than those initially shocked by paramedics. No improvement in adjusted outcomes were observed for survivors initially defibrillated by first responders. Conclusion: Patients receiving bystander defibrillation reported better functional recovery and HRQol outcomes at 12 months compared to those defibrillated by first responders and paramedics.

Health-related quality of life and disability in adults with juvenile idiopathic arthritis: comparison with adult-onset rheumatic diseases

ObjectiveTo compare physical disability, mental health, fatigue and health-related quality of life (HRQoL) across juvenile idiopathic arthritis (JIA) categories in adulthood and between JIA and adult-onset rheumatic diseases.MethodsCross-sectional analysis nested...

P.219 The effect of peri-operative adverse events on long-term patient reported outcomes after lumbar spine surgery

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p&lt;0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.