EuroQol Five-dimensional Questionnaire Research Articles

Cost-utility analysis of robotic arm-assisted medial compartment knee arthroplasty.

To perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA). This was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated. rUKA was associated with a relative 0.012 QALY gain at five years, which was associated with an incremental cost per QALY of £13,078 for a unit undertaking 400 cases per year. A cost per QALY of less than £20,000 was achieved when ≥ 300 cases were performed per year. However, on removal of the cost for a revision for presumed infection (mUKA group, n = 1) the cost per QALY was greater than £38,000, which was in part due to the increased intraoperative consumable costs associated with rUKA (£626 per patient). When the absolute cost difference (operative and revision costs) was less than £240, a cost per QALY of less than £20,000 was achieved. On removing the cost of the revision for infection, rUKA was cost-neutral when more than 900 cases per year were undertaken and when the consumable costs were zero. rUKA was a cost-effective intervention with an incremental cost per QALY of £13,078 at five years, however when removing the revision for presumed infection, which was arguably a random event, this was no longer the case. The absolute cost difference had to be less than £240 to be cost-effective, which could be achieved by reducing the perioperative costs of rUKA or if there were increased revision costs associated with mUKA with longer follow-up.

Temporal associations of diabetes-related complications with health-related quality of life decrements in Chinese patients with type 2 diabetes: A prospective study among 19 322 adults-Joint Asia Diabetes Evaluation (JADE) register (2007-2018).

Patients with type 2 diabetes (T2D) are at high risk of developing multiple complications, affecting their health-related quality of life (HRQoL). Existing studies only considered impact of complication on HRQoL in the year of occurrence but not its residual impacts in subsequent years. We investigated temporal impacts of diabetes-related complications on HRQoL in a 12-year prospective cohort of ambulatory Chinese patients with T2D enrolled in the clinic-based Joint Asia Diabetes Evaluation (JADE) Register. HRQoL utility measures were derived from EuroQol five-dimensional three-level questionnaire (EQ-5D-3L) questionnaires completed by 19 322 patients with T2D in Hong Kong (2007-2018). Temporal EQ-5D utility decrements associated with subtypes of cardiovascular-renal events were estimated using generalized linear regression model after stepwise selection of covariates with p < .01 as cutoff. In this cohort (mean ± SD age:61.2 ± 11.5 years, 55.3% men, median [interquartile range] duration of diabetes:10.1 [3.0-15.0] years, glycated hemoglobin [HbA1C] 7.5 ± 1.5%), EQ-5D utility was 0.860 ± 0.163. The largest HRQoL decrements were observed in year of occurrence of hemorrhagic stroke (-0.230), followed by ischemic stroke (-0.165), peripheral vascular disease (-0.117), lower extremity amputation (-0.093), chronic kidney disease (CKD) G5 without renal replacement therapy (RRT) (-0.079), congestive heart failure (CHF) (-0.061), and CKD G3-G4 without RRT (-0.042). Residual impacts on HRQoL persisted for 2 years after occurrence of CHF or ischemic stroke and 1 year after hemorrhagic stroke or CKD G3-G4 without RRT. This is the first comprehensive report on temporal associations of HRQoL decrements with subtypes of diabetes-related complications in ambulatory Asian patients with T2D. These data will improve the accuracy of cost-effectiveness analysis of diabetes interventions at an individual level in an Asian setting.

Hand function and quality of life in patients with diabetes mellitus before and during the COVID-19 pandemic.

This study aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on patients with diabetes mellitus using patient-rated outcome measures focusing on hand function and quality of life, as well as patients' mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. It was a part of a longitudinal research involving patients with diabetes mellitus living in Sapporo, Japan. Among the 594 patients surveyed before the COVID-19 pandemic from March to June 2019, 417 patients who could be re-surveyed from March to June 2021 were included. We compared the patient-rated outcome measures, namely the Hand10 for hand function and EuroQol five-dimension questionnaire for assessing quality of life in the same population of patients with diabetes mellitus, before and during the COVID-19 pandemic. The results indicated no deterioration in the Hand10 (3.9 vs 3.6) and quality of life scores (0.89 vs 0.9), including mobility (1.25 vs 1.17), self-care (1.1 vs 1.08), pain/discomfort (1.43 vs 1.35), and anxiety/depression (1.21 vs 1.2), during the COVID-19 pandemic when compared with the pre-pandemic values. Usual activity values on the EuroQol five-dimension subscale significantly improved during the pandemic compared to those before the pandemic (1.21 vs 1.12, p<0.01). This study highlighted the effects of the COVID-19 pandemic on patients with diabetes mellitus by comparing patient-rated outcome measures in two different social situations. Patients with diabetes mellitus living in Sapporo, Japan maintained hand function and quality of life by continuing their usual activities during the COVID-19 pandemic.

The individual and combined associations of health behaviours with health-related quality of life amongst junior high school students in China.

This study aimed to investigate the individual and joint associations of sedentary behaviour, physical activity (PA), sleep and breakfast eating on health-related quality of life (HRQoL) amongst Chinese junior high school students. Data were from 783 junior high school students who participated in a health behaviour and health survey in Jining city of Shandong province of China. HRQoL was measured by the EuroQol five-dimensional questionnaire, youth version (EQ-5D-Y). Multivariable logistic and linear regressions were applied to examine the associations between health behaviours and HRQoL. Multivariable regression analyses showed that using a computer ≥ 2 h a day (vs. < 2 h/day) is associated with increased likelihood of having health problems in the three EQ-D-Y dimensions, including walking, looking after self and doing usual activities. Lower PA is associated with more problems in feeling worried, sad or unhappy, and with a lower visual analogue scale (VAS) score. Students who had insufficient sleep time (e.g., <7 h/day), and skipped eating breakfast were more likely to experience lower HRQoL in the dimensions of having pain or discomfort, and feeling worried, sad or unhappy, and a lower VAS score than those students who had longer sleep time and no breakfast skipping. Students who reported having the combined ≥ 2 unhealthy behaviours relative to the peers with 0-1 unhealthy behaviours were more likely to have lower HRQoL. The findings in the present study underline the importance of promoting healthy behaviours in order to improve HRQoL amongst Chinese junior high school students.

Does surgical site infection affect patient-reported outcomes after spinal surgery? A multicenter cohort study

BackgroundSurgical site infections are common in spinal surgeries. It is uncertain whether outcomes in spine surgery patients with vs. without surgical site infection are equivalent. Therefore, we assessed the effects of surgical site infection on postoperative patient-reported outcomes. MethodsWe enrolled patients who underwent elective spine surgery at 12 hospitals between April 2017 and February 2020. We collected data regarding the patients' backgrounds, operative factors, and incidence of surgical site infection. Data for patient-reported outcomes, namely numerical rating scale, Neck Disability Index/Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 1 year postoperatively. We divided the patients into with and without surgical site infection groups. Multivariate logistic regression analyses were performed to identify the risk factors for surgical site infection. Using propensity score matching, we obtained matched surgical site infection-negative and -positive groups. Student's t-test was used for comparisons of continuous variables, and Pearson's chi-square test was used to compare categorical variables between the two matched groups and two unmatched groups. ResultsWe enrolled 8861 patients in this study; 74 (0.8 %) developed surgical site infections. Cervical spine surgery and American Society of Anesthesiologists physical status classification ≥3 were identified as risk factors; microendoscopy was identified as a protective factor. Using propensity score matching, we compared surgical site infection-positive and -negative groups (74 in each group). No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the groups. When comparing preoperative with postoperative pain and dysesthesia, statistically significant improvement was observed for both variables in both groups (p < 0.01 for all variables). No significant differences were observed in postoperative outcomes between the matched surgical site infection-positive and -negative groups. ConclusionsPatients with surgical site infections had comparable postoperative outcomes to those without surgical site infections.

Precise management system for chronic intractable pain patients implanted with spinal cord stimulation based on a remote programming platform: study protocol for a randomized controlled trial (PreMaSy study)

BackgroundSpinal cord stimulation (SCS) is a surgical technique used in patients with chronic intractable pain, and its effectiveness and safety have been validated by multiple studies. However, to maintain an optimal and steady long-term effect is still challenging. Here, we report a new management paradigm integrating smartphone application and remote programming. Chronic pain patients with SCS implants can monitor their pain status on the phone and change stimulation parameters accordingly. The PreMaSy study is a randomized controlled trial to evaluate the clinical effectiveness and safety of this precise management system.MethodsPatients with chronic intractable pain will be screened for eligibility, and 82 participants are anticipated to be enrolled in this trial. After the electrode implantation, the stimulation effectiveness will be tested. Participants with a reduction of more than 50% in the visual analog scale (VAS) will receive implantation of an implantable pulse generator and randomized (1:1) into the experimental group or control group. All participants will be asked to take online follow-ups and complete assessments using a smartphone application. Daily pain characteristic assessments and monthly quality of life questionnaires are integrated into the App, and participants will be required to complete these assessments. The daily VAS for pain intensity will be monitored and a threshold will be set based on baseline VAS score. The interventional appointment will be scheduled once the threshold is reached. The primary outcome is the health condition and quality of life assessed by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). Utility values of EQ-5D-5L will be assessed at baseline and 1, 3, and 6 months post-operative.DiscussionThe PreMaSy study aims to evaluate the effectiveness and safety of a novel App-based, patient-centered, self-assessment management system for chronic intractable pain. A randomized controlled trial is designed to test the non-inferiority of this precise management system compared to the monthly online follow-ups. It is also expected to yield valuable experiences regarding precision medicine.Trial registrationClinicalTrials.gov NCT05761392. Registered on March 07, 2023.

Mediation analysis of activities of daily living and kinesiophobia in association between cardiac function and health status of patients with chronic heart failure.

To explore the mediational effect of activities of daily living (ADL) and kinesiophobia on the cardiac function and health status of patients with chronic heart failure (CHF). From October 2021 to January 2022, a total of 244 CHF patients treated in the Department of Cardiology of general hospitals were recruited by the convenience sampling method. They were investigated with the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Barthel index for assessing ADL, and the EuroQol five-dimensional questionnaire (EQ-5D) for assessing the health status. The cardiac function and kinesiophobia of CHF patients were both negatively correlated with their health status (r = -.390 and -0.410, respectively, both p < .01). Besides, the ADL of CHF patients was positively correlated with the health status (r = .320, p < .01). The cardiac function of CHF patients was negatively correlated with the ADL (r = -.412, p < .01), but positively correlated with kinesiophobia (r = .180, p < .01). The mediation proportion of ADL plus kinesiophobia between the cardiac function and health status of CHF patients was 43.48%. Both ADL and kinesiophobia partially mediated the effect of cardiac function on health status in CHF patients, but their mediational effects showed no significant difference (p = .777). Both ADL and kinesiophobia exert obvious mediational effects between cardiac function and health status in CHF patients. Individualized cardiac rehabilitation (CR) programs based on the cardiac function, ADL and kinesiophobia of CHF patients may contribute to reduce the medical burden and improve the well-being of affected people.

Health-related quality of life and radiological and functional lung changes of patients with COVID-19 Pneumonia 3 and 10 months after discharge

BackgroundFew studies have evaluated the long-term impact on health-related quality of life (HRQoL) in patients who have been hospitalized for COVID-19 pneumonia. Specific follow-up should be carried out to detect and treat possible pulmonary abnormalities, and the worsening of HRQoL should be estimated to target necessary resources for care of these patients after acute phase. The objective was to know the impact on HRQoL of patients who have been admitted for COVID-19 pneumonia, and to evaluate the clinical-radiological and functional changes of patients who have overcome COVID-19 pneumonia at 3 and 10 months of follow-up.MethodsProspective observational study of patients who required hospitalization for COVID-19 pneumonia between April and December 2020. All patients filled out the EuroQol five-dimension (EQ-5D) questionnaire with the EuroQol Visual Analogue Scale (E-VAS) for self-assessment of health status. Respiratory function tests and chest X-ray were carried out at 3 and 10 months of follow-up.Results61 patients were included in the study. The need for ventilatory support was associated with anxiety/depression on the EQ-5D scale, as well as patients admitted to the intensive care unit (ICU). The mean EQ-5D and E-VAS index scores decreased with hospitalization time, the number of days spent in intermediate respiratory care unit (IRCU) and the level of dyspnoea at the beginning of the hospitalization period. Pulmonary sequelae were observed in 25 patients (41%) at 3 months and 17 (27.9%) at 10 months. Patients improve their forced vital capacity (FVC) by 196 ml (p = 0.001) at 10 months as well as 9% in diffusing capacity of lung for carbon monoxide (DLCO) (p = 0.001) at 10 months. DLCO was found to be correlated to lymphopenia and time spent in IRCU. Low FVC values were detected 10 months after discharge for subjects exhibiting high levels of dyspnoea at 3 months after discharge.ConclusionsHospitalization for COVID-19 pneumonia affects the HRQoL of patients, with greater anxiety/depression in those who were more serious affected and are younger. A significant percentage of patients present fibrotic abnormalities and lung function impairment at the first and second follow-up after discharge.

Radiological hip shape and patient-reported outcome measures in healed Perthes' disease.

This study aimed to evaluate the relationship between hip shape and mid-term function in Perthes' disease. It also explored whether the modified three-group Stulberg classification can offer similar prognostic information to the five-group system. A total of 136 individuals aged 12 years or older who had Perthes' disease in childhood completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility score (function), Nonarthritic Hip Score (NAHS) (function), EuroQol five-dimension five-level questionnaire (EQ-5D-5L) score (quality of life), and the numeric rating scale for pain (NRS). The Stulberg class of the participants' hip radiographs were evaluated by three fellowship-trained paediatric orthopaedic surgeons. Hip shape and Stulberg class were compared to PROM scores. A spherical hip was associated with the highest function and quality of life, and lowest pain. Conversely, aspherical hips exhibited the lowest functional scores and highest pain. The association between worsening Stulberg class (i.e. greater deviation from sphericity) and worse outcome persisted after adjustment for age and sex in relation to PROMIS (predicted mean difference -1.77 (95% confidence interval (CI) -2.70 to -0.83)), NAHS (-5.68 (95% CI -8.45 to -2.90)), and NRS (0.61 (95% CI 0.14 to 1.08)), but not EQ-5D-5L (-0.03 (95% CI -0.72 to 0.11)). Patient-reported outcomes identify lower function, quality of life, and higher pain in aspherical hips. The magnitude of symptoms deteriorated with time. Hip sphericity (i.e. the modified three-group classification of spherical, oval, and aspherical) appeared to offer similar levels of detail to the five-group Stulberg classification.

Health utilities and quality-adjusted life years for patients with amyotrophic lateral sclerosis receiving reldesemtiv or placebo in FORTITUDE-ALS

AimsTo estimate the health utilities and quality-adjusted life years (QALYs) in patients with amyotrophic lateral sclerosis (ALS) receiving reldesemtiv versus placebo in FORTITUDE-ALS.Materials and methodsWe performed a post hoc analysis of clinical trial data from FORTITUDE-ALS (NCT03160898). This Phase IIb, double-blind, randomized, dose-ranging, placebo-controlled, parallel-group, 12-week trial evaluated reldesemtiv in patients with ALS. Health utilities from the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) were estimated using ALS Functional Rating Scale-Revised (ALSFRS-R) scores collected during the trial. QALYs were estimated using the area under the curve method.ResultsThe full analysis set consisted of 456 patients (reldesemtiv n = 342, placebo n = 114), who received at least one dose of the double-blind study drug, and had ALSFRS-R assessed at baseline and at least one post-baseline assessment. The difference in EQ-5D-5L utility least-squares (LS) mean change from baseline to week 12 for reldesemtiv versus placebo, adjusted for baseline values, was statistically significant (0.03, 95% confidence interval [CI]: 0.01, 0.05; p = .0008). The incremental QALY of reldesemtiv versus placebo adjusted for baseline utility values showed a modest, but statistically significant, difference (0.004, 95% CI: 0.001, 0.007; p = .0058).ConclusionsThis post hoc analysis of FORTITUDE-ALS suggests that reldesemtiv showed a modest but significant benefit in health utilities and QALYs compared with placebo. Future long-term studies that include direct collection of EQ-5D-5L data will be needed to confirm our findings. ClinicalTrials.gov identifierNCT03160898

Long-term patient-related quality of life outcomes and ICD-10 symptom rating (ISR) of patients with pyogenic vertebral osteomyelitis: What is the psychological impact of this life-threatening disease?

PurposeWe aimed to evaluate the long-term impact of the treatment of pyogenic vertebral osteomyelitis (VO) on functional outcomes and patients' quality of life (QoL) with a special focus on psychological well-being.MethodsA total of 156 patients with VO with a minimum clinical follow-up of 12 months were retrospectively identified and asked to participate. Patient-reported outcome measures were evaluated with the EuroQol five-dimension questionnaire (EQ-5D) and German Short-Form 36 (SF-36) outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. Spine-specific outcomes were assessed with the Core Outcome Measure Index and the Oswestry disability index (ODI) or the Neck disability index (NDI), respectively.ResultsFrom n = 156 eligible patients, n = 129 patients could be contacted and n = 40 returned questionnaires, yielding a response rate of 31.0%. The mean time from hospital discharge to follow-up was 83.0 ± 3.8 (13–193) months. Spine-specific outcomes showed mild to moderate disability. The mean physical health component score of the SF-36 (37.1 ± 16.7), the mean mental health component score (38.2 ± 14.0) and the mean EQ-5D VAS rating (57.1 ± 21.5) were significantly lower in comparison with the scores of an age-matched reference population (all p < 0.05). The mean total score of the ISR was 0.53 ± 0.23. On average, the cohort did not cross the threshold of clinically relevant symptom burden on any subscale.ConclusionEven almost seven years on average after completed treatment of VO, patients report impaired QoL. Assessment of psychological disorders should be implemented in clinical practice and future prospective studies.

Primary knee arthroplasty for osteoarthritis restores patients' health-related quality of life to normal population levels.

This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population. This retrospective case-control study compared HRQoL data from two sources: patients undergoing primary KA in a university-teaching hospital (2013 to 2019), and the Health Survey for England (HSE; 2010 to 2012). Patient-level data from the HSE were used to represent the general population. Propensity score matching was used to balance covariates and facilitate group comparisons. A propensity score was estimated using logistic regression based upon the covariates sex, age, and BMI. Two matched cohorts with 3,029 patients each were obtained for the adjusted analyses (median age 70.3 (interquartile range (IQR) 64 to 77); number of female patients 3,233 (53.4%); median BMI 29.7 kg/m2 (IQR 26.5 to 33.7)). HRQoL was measured using the three-level version of the EuroQol five-dimension questionnaire (EQ-5D-3L), and summarized using the Index and EuroQol visual analogue scale (EQ-VAS) scores. Patients awaiting KA had significantly lower EQ-5D-3L Index scores than the general population (median 0.620 (IQR 0.16 to 0.69) vs median 0.796 (IQR 0.69 to 1.00); p < 0.001). By one year postoperatively, the median EQ-5D-3L Index score improved significantly in the KA cohort (mean change 0.32 (SD 0.33); p < 0.001), and demonstrated no clinically relevant differences when compared to the general population (median 0.796 (IQR 0.69 to 1.00) vs median 0.796 (IQR 0.69 to 1.00)). Compared to the general population cohort, the postoperative EQ-VAS was significantly higher in the KA cohort (p < 0.001). Subgroup comparisons demonstrated that older age groups had statistically better EQ-VAS scores than matched peers in the general population. Patients awaiting KA for osteoarthritis had significantly poorer HRQoL than the general population. However, within one year of surgery, primary KA restored HRQoL to levels expected for the patient's age-, BMI-, and sex-matched peers.

Impact of major age-related eye disorders on health-related quality of life assessed by EQ-5D: a systematic review and meta-analysis.

This study is to quantitatively estimate the health-related quality of life (HRQOL) impact of major age-related eye diseases (AREDs) including cataract, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR) assessed by the EuroQoL Five-Dimensional Questionnaire (EQ-5D). PubMed, Embase, Cochrane Library, and CINAHL were searched until October 20, 2022. Studies were included if they reported the EQ-5D health utility score (HUS) or visual analogue scale (VAS) score of both AREDs patients and healthy controls. The mean difference (MD) in HUS or VAS score between cases and controls and its 95% confidence interval (95%CI) were pooled using the random-effects model. We also performed sensitivity analysis using the leaving-one-out method and subgroup analyses by sample size and race. The prevalence in reporting any problems in the five EQ-5D dimensions was summarized and compared between cases and controls using the Chi-square test. Fifteen articles involving 30,491 participants were included in this review. Pooled estimates indicated reduced HUS in AMD patients (MD = -0.04, 95%CI -0.07, -0.01; P = 0.009), DR patients (MD = -0.03, 95%CI -0.05, -0.01; P = 0.01), and glaucoma patients (MD = -0.06, 95%CI -0.10, -0.01; P = 0.01), compared with the controls. Significantly lower EQ-5D VAS score was also observed in cataract patients (MD = -11.33, 95%CI -13.47, -9.18; P < 0.001) and DR patients (MD = -6.41, 95%CI -10.64, -2.18; P = 0.003). AREDs patients reported usual activities and anxiety/depression problems more frequently than the control group. Our findings confirmed the HRQOL impairment caused by major AREDs including AMD, cataract, DR, and glaucoma. High-quality studies with large sample sizes are warranted to further verify our results.

Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial

This study investigated the effects of transcatheter arterial embolization (TAE) on pain, function, and quality of life in people with early-stage symptomatic knee osteoarthritis (OA) compared to a sham procedure. A total of 59 participants with symptomatic Kellgren-Lawrence grade 2 knee OA were randomly allocated to TAE or a sham procedure. The intervention group underwent TAE of one or more genicular arteries. The control group received a blinded sham procedure. The primary outcome was knee pain at 12 months according to the Knee injury and Osteoarthritis Outcome Score (KOOS) pain scale. Secondary outcomes included self-reported function and quality of life (KOOS, EuroQol five-dimension five-level questionnaire (EQ-5D-5L)), self-reported Global Change, six-minute walk test, 30-second chair stand test, and adverse events. Subgroup analyses compared participants who received complete embolization of all genicular arteries (as distinct from embolization of some arteries) (n = 17) with the control group (n = 29) for KOOS and Global Change scores at 12 months. Continuous variables were analyzed with quantile regression, adjusting for baseline scores. Dichotomized variables were analyzed with chi-squared tests. Overall, 58 participants provided questionnaire data at 12 months. No significant differences were found for the primary and secondary outcomes, with both groups improving following the procedure. At 12 months, KOOS pain scores improved by 41.3% and 29.4% in the intervention and control groups, respectively. No adverse events occurred. Subgroup analysis indicated that the complete embolization group had significantly better KOOS Sports and Recreation, KOOS Quality of Life, and Global Change scores than the control group; 76.5% of participants who received complete embolization reporting being moderately or much better compared to 37.9% of the control group. TAE might produce benefits above placebo, but only when complete embolization of all genicular arteries is performed. Further comparative studies are required before definitive conclusions regarding the effectiveness of TAE can be made. Level of evidence: I.

Responsiveness and minimal clinically important difference of EQ-5D-5L in patients with coronary heart disease after percutaneous coronary intervention: A longitudinal study.

Although the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) has been validated in various diseases, no empirical study has evaluated the responsiveness and minimal clinically important difference (MCID) of the instrument in patients with coronary heart disease (CHD), which limits the interpretability and clinical application of EQ-5D-5L. Therefore, this study aimed to determine the responsiveness and MCID of EQ-5D-5L in patients with CHD who underwent percutaneous coronary intervention (PCI) and identify the relationship between the MCID values and minimal detectable change (MDC). Patients with CHD were recruited for this longitudinal study at the Tianjin Medical University's General Hospital in China. At baseline and 4 weeks after PCI, participants completed the EQ-5D-5L and Seattle Angina Questionnaire (SAQ). Additionally, we used the effect size (ES) to assess the responsiveness of EQ-5D-5L. The anchor-based, distribution-based, and instrument-based methods were used in this study to calculate the MCID estimates. The MCID estimates to MDC ratios were computed at the individual and group levels at a 95% CI. Seventy-five patients with CHD completed the survey at both baseline and follow-up. The EQ-5D-5L health state utility (HSU) improved by 0.125 at follow-up compared with baseline. The ES of EQ-5D HSU was 0.850 in all patients and 1.152 in those who improved, indicating large responsiveness. The average (range) MCID value of the EQ-5D-5L HSU was 0.071 (0.052-0.098). These values can only be used to determine whether the change in scores were clinically meaningful at the group level. EQ-5D-5L has large responsiveness among CHD patients after undergoing PCI surgery. Future studies should focus on calculating the responsiveness and MCID for deterioration and examining the health changes at the individual level in CHD patients.

Functional outcomes and length of stay with early and high-intensity rehabilitation after simultaneous bilateral total knee arthroplasty.

Length of stay and functional outcomes after total knee arthroplasty (TKA) are related to the timing and intensity of post-operative rehabilitation. To determine the effectiveness of early and high-intensity rehabilitation after simultaneous bilateral TKA. Prospective cohort data of 156 patients (11 men and 145 women; average age 72.0 ± 5.6 years) who underwent simultaneous bilateral primary TKA were analyzed. The intervention group (n= 82) underwent a high-intensity rehabilitation (phase II) after early postoperative standard rehabilitation (phase I) between June 2019 and May 2021. The control group (n= 74) underwent a lower-intensity rehabilitation (phase II) after phase I rehabilitation between July 2017 and May 2019. The timed up-and-go (TUG) test, timed stair climbing test (SCT), 6-minute walk test, isometric knee extensor and flexor strength of both knees, knee flexion and extension range of motion, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and functional levels, and the EuroQol five-dimension questionnaire were assessed preoperatively and 6 weeks after TKA. The average length of hospital stay was shortened by 5.7 days (p< 0.001). Phase II rehabilitation started earlier in the intervention group than in the control group (7.7 ± 1.3 vs 13.5 ± 2.0, p< 0.001). Compared with the control group, the intervention group showed significant improvements in the measures of mobility (WOMAC-function and SCT) and strength (isometric strength of both knee extensors and flexors) 6 weeks after TKA by statistically controlling for age and preoperative functional status. This study demonstrated that early and high-intensity rehabilitation could achieve functional improvement and shorten the length of hospital stay.

Impact of coronavirus disease pandemic on performance and satisfaction, physical activity, and quality of life of the elderly.

The aim of this study was to examine the effects of the coronavirus disease pandemic in the elderly. A total of 140 elderly with a mean age of 71.30±6.00 years (69 females, 71 males) who spent the coronavirus disease pandemic period at home were included. Canadian Occupational Performance Measure, Visual Analog Scale (for pain intensity at rest and activity), International Physical Activity Questionnaire-Short Form, and EuroQol Five-Dimensional Questionnaire, Three-Level Version Health States were used in the evaluation. Two scores are obtained in Canadian Occupational Performance Measure: one for performance and one for satisfaction. EuroQol Five-Dimensional Questionnaire, Three-Level Version consists of two parts: EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale. While female gender (p=0.006, p=0.001), using walking assistant (p=0.001, p=0.001), being single/widow (p=0.031, p=0.007), and history of falling (p=0.004, p=0.001) made difference in Visual Analog Scale (rest, activity), female gender (p=0.013) and being single/widow (p=0.020) made difference in satisfaction scores of Canadian Occupational Performance Measure. Female gender (p=0.001), using walking assistant (p=0.001), and history of falling (p=0.010) made difference in EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system. In addition, performance scores of Canadian Occupational Performance Measure had a low correlation with Visual Analog Scale (rest r=-0.198, p=0.019; activity r=-0.188, p=0.026) and had a moderate correlation with EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system (r=0.327, p=0.001) and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale (r=0.307, p=0.001). Satisfaction scores of Canadian Occupational Performance Measure had a low correlation with Visual Analog Scale (rest r=-0.247, p=0.003; activity r=-0.223, p=0.008) and had a moderate correlation with EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system (r=0.399, p=0.001) and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale (r=0.306, p=0.001). The elderly who were women, single/widowed, using walking assistant, and having a history of falling were more affected during the coronavirus disease period.

Оценка эффективности третьего этапа реабилитации пациентов после перенесенного COVID-19 в условиях дневного стационара

Introduction. For patients with the consequences of COVID-19 it seems relevant to undergo a rehabilitation program to restore the respiratory function, oxygen uptake by tissues, increase exercise tolerance, etc. Rehabilitation includes aerobic-based exercises adequate to the patient’s state and physical capabilities, breathing exercises and physiotherapy modalities. Aim. To evaluate the effectiveness of the third stage rehabilitation in patients aged 18–45 years with the consequences of COVID-19 (U07.1) in a day hospital of multispecialty hospital. Materials and methods. One hundred and thirty-nine patients aged 18–45 years with a verified diagnosis of pneumonia associated with COVID-19 (U07.1) were examined in a day hospital of multispecialty hospital. The patients were divided into 2 groups: 107 patients of the 1st group underwent the third stage rehabilitation; 32 people from who made up the 2nd group refused rehabilitation. The severity of dyspnea was assessed using the Medical Research Council (MRC) Dyspnea Scale; functional impairment in the performance of activities of daily living – according to the Baseline Dyspnea Index and Transitional Dyspnea Index scales; exercise tolerance – according to the 6-minute walk test and the modified Borg Scale; the severity of anxiety and depression – according to the Hospital Anxiety and Depression Scale (HADS); pain intensity – according to the Visual Analogue Scale (VAS); quality of life – according to the EuroQoL Five-Dimension Questionnaire (EQ-5D). Statistical processing of the obtained results was carried out. Results. In the group of patients who completed rehabilitation, upon follow-up examination, there was a significant decrease in complaints, normalization of a number of hemodynamic parameters, an improvement in the 6-minute walk test scores, a decrease in the severity of dyspnea according to the MRC Dyspnea Scale by 1.8 times, a decrease in anxiety according to the HADS by 2.1 times, a decrease in pain according to the VAS by 3.2 times, an improvement in exercise tolerance according to the modified Borg Scale by 1.8 times and quality of life – according to the EQ-5D by 1.4 times. In the group of patients who refused rehabilitation, the change in these indicators was not significant. Conclusion. For patients who have had pneumonia associated with SARS-CoV-2, it is advisable to go through the third stage rehabilitation in a day hospital in order to restore the respiratory functions, increase exercise tolerance, reduce anxiety and improve quality of life.

Obtaining EQ-5D-3L utility index from the health status scale of traditional Chinese medicine (TCM-HSS) based on a mapping study

BackgroundAlmost all traditional Chinese medicine (TCM) quality of life measures are non-preference-based measures (non-PBMs), which do not provide utilities for cost-utility analysis in pharmacoeconomic evaluation. Whereas the mapping has become a new instrument to obtain utilities, which builds a bridge between non-PBMs and PBMs.PurposeTo develop mapping algorithms from the health status scale of traditional Chinese medicine (TCM-HSS) onto the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L).MethodsThe cross-sectional data were collected by questionnaire survey from a tertiary hospital visit population and community residents in China, and randomly divided into training and validation set by 2:1. Based on the training set, direct and indirect mapping methods (7 regression methods and 4 model specifications) were conducted to establish alternative models, which were comprehensively evaluated based on the validation set by mean absolute error, root mean square error, and Spearman correlation coefficient between predicted and observed values. Based on the whole sample, the preferred mapping algorithm was developed.ResultsA total of 639 samples were included, with an average age of 45.24 years and 61.66% of respondents were female. The mean EQ-5D-3L index was 0.9225 [SD = 0.1458], and the mean TCM-HSS index was 3.4144 [SD = 3.1154]. The final mapping algorithm was a two-part regression model including the TCM-HSS subscales, interaction terms, and demographic covariates (age and gender). The prediction performance was good. The mean error was 0.0003, the mean absolute error was 0.0566, the root mean square error was 0.1039, and 83.10% of the prediction errors were within 0.1; the Spearman correlation coefficient between predicted and observed EQ-5D-3L values was 0.6479.ConclusionIt is the first study to develop a mapping algorithm between the TCM-HSS and EQ-5D-3L, which demonstrates excellent prediction accuracy and estimates utility value for economic evaluation from TCM quality of life measures.

Computer Navigation Assisted Restricted Kinematic Alignment Improves Short-Term Outcomes in Total Knee Arthroplasty: An Ambispective Cohort Study.

Mechanical alignment (MA)-total knee arthroplasty (TKA) has been challenged due to the excessive soft tissue release and the evidence of the clinical outcomes of computer assisted navigation is still limited. The aim of this ambispective cohort study was to: (i) investigate whether computer assisted navigation is capable to achieve restricted kinematic alignment (rKA)-TKA; and (ii) compare the short-term outcomes between rKA-TKA and MA-TKA. We retrospectively included 41 patients diagnosed with osteoarthritis who received MA-TKA between April 2019 and January 2021 and 43 patients diagnosed with osteoarthritis who received rKA-TKA were included in the prospective cohort from January 2021 to September 2021. Demographical, peri-operative, and radiological data were collected and compared. Unpaired two-sample t-test for continuous variables and χ2 test for categorical variables were used to compare various measurements in two groups. The patient-reported outcome measures at baseline, 10 days (T1), and 6 months (T6) after surgery were statistically analyzed by generalized estimating equation (GEE) models. Fourty-one patients (45 knees) and 43 patients (48 knees) were included in the MA and the rKA group respectively. Three constitutional knee phenotypes (II, I, IV) were the commonest in our population. Navigation improved the surgical accuracy (1.5° vs 3.5°, p < 0.001) and precision (interquartile range 4.0 vs 2.0, p < 0.001) in the rKA group than the MA group. The changes in Knee Injury and Osteoarthritis Outcome Score 12 (KOOS12), EuroQol five-dimension questionnaire (EQ5D) from baseline to T1 and T6 for patients with on-target rKA were larger than on-target MA counterparts (26.053 vs 18.607, P < 0.001(KOOS12, T1) , 0.457 vs 0.367 p < 0.001(EQ5D, T1) ; 51.017 vs 46.896, P=0.023(KOOS12, T6) , 0.606 vs 0.565, P=0.01(EQ5D, T6) ). Patients with on-target rKA had better Forgotten Joint Score (FJS) at T1 (54.126 vs 40.965, P=0.002) compared with on-target MA counterparts. Computer assisted navigation achieved the level of accuracy required by rKA-TKA. rKA-TKA offered significantly better short-term outcomes than MA-TKA.