EuroQol Visual Analogue Scale Research Articles

Early insights from the routine use of patient reported outcome measures in elective hip and knee arthroplasty at a public teaching hospital in South Australia

Abstract Introduction For advanced osteoarthritis of the knee and hip, the most clinically effective treatment remains total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Success of these surgeries have traditionally been appraised by economic and volume-based measures. There has been a shift towards the use of patient reported outcome measures (PROMs) to quantify success and guide treatment. The present study provides analysis of three PROMS which have been validated for use in orthopaedic settings; the Oxford Knee Score (OKS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and the EuroQol-Visual Analogue Scale (EQ-VAS) - a non-disease specific measure of health. PROMs were completed pre-operatively, 6-weeks, and 1-year after elective TKA and THA undertaken in 2018 in a public teaching hospital in South Australia. Post-operative satisfaction/dissatisfaction was measured using a 5-point Likert scale and was collected at the same 6-week and 1-year points. Results PROMs were collected from 285 eligible elective knee-arthroplasty, and 205 elective hip-arthroplasty patients. There was significant average improvement, greater than minimal clinical important differences between pre-operative and 1-year post-operative scores for all three PROMs tools. Inter-PROM correlation was strongest between FJS and OKS at 1-year post TKA (rs = 0.722), and between FJS and OHS in post-THA at the same interval (rs = 0.609). TKA patients with higher pre-surgical 10-year mortality were weakly associated with lower pre-operative OKS score (rs = 0.169). BMI was weakly negatively associated with pre-operative and 6-week post-operative EQ-VAS scores (rs = -0.291 and rs = -0.149 respectively). Post-TKA satisfaction was 77.2% at 1-year, and THA 88.5% at the same interval. Conclusion This study provides an early insight from the use of the OKS, OHS, the EQ-VAS and the FJS as PROMs in primary TKA and THA at our centre. All PROMs demonstrate significant increase (improvement) at both 6-week and 1-year post-operative intervals, relative to pre-operative scores. The FJS demonstrated good sensitivity. Pre-existing co-morbidities do not appear to have any significant relation with post-operative PROMs collected in this study.

Norms for the EQ-5D-5L among the general adult population in Alberta, Canada.

To present EQ-5D-5L population norms for the general adult population in Alberta, Canada. We analyzed data from 11 population-based surveys conducted in Alberta between 2012 and 2021. By applying appropriate sampling weights, we estimated normative data for the EQ-5D-5L dimensions, index scores, and visual analogue scale (VAS) scores. This analysis was conducted for the overall population as well as for subgroups categorized by age, sex, provincial health zones, and 17 chronic conditions. The analysis included data from 60,447 respondents (ages 18-99; 51.4% female) across various survey waves, revealing minimal variations in sample characteristics and EQ-5D-5L scores over time. The most frequently reported problems were pain/discomfort (62.2%) and anxiety/depression (41.7%), while 22.5% of respondents reported no issues on any dimension. The mean (SD) EQ-5D-5L index score was 0.845 (0.137), and the mean EQ VAS score was 77.4 (16.7). There was a notable increase in the proportion of reported problems across all dimensions with age, except for anxiety/depression, which showed a decline with advancing age. Females reported slightly more problems across all dimensions compared to males. Individuals with chronic pain had the lowest EQ-5D-5L index scores, followed by those with anxiety and depression, while the lowest EQ VAS scores were observed in individuals with congestive heart failure, kidney disease, and chronic obstructive pulmonary disease. This study provides EQ-5D-5L norms for the adult population in Alberta. These reference values can be used to benchmark patients' outcomes as well as to establish burden of illness in this population and facilitate the interpretation of EQ-5D-5L scores in various applications.

MCL pie crusting for concomitant medial meniscal surgery does not appear to adversely influence primary ACL reconstruction functional outcomes

Medial collateral ligament "pie-crusting" (MCLPC), selective release of the superficial MCL, has been shown to improve the arthroscopic access to the posterior horn of the medial meniscus without adversely affecting the outcomes of isolated meniscal surgery. However, whether MCL PC, to address concomitant meniscal lesions during anterior cruciate ligament reconstruction (ACLR) surgery, adversely affects ACLR outcomes is unknown. The aim of this study was to assess whether patients who had undergone MCLPC at the time of ACLR had similar post outcomes to patients undergoing isolated ACLR. 55 consecutive patients (33 male and 22 female), with minimum 2-year follow-up, who had undergone MCLPC with concomitant primary ACLR (PC group) were retrospectively matched on the basis of age, sex and follow-up with 55 patients who underwent isolated primary ACLR. Post-operative outcome measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, Tegner activity score, the EuroQol five-dimension health questionnaire and EuroQol visual analogue scale. The two groups' median postoperative EQ 5D-VAS, EQ 5D-index and Tegner scores were similar. The difference between pre-operative and post-operative KOOS scores was similar for the two group for all subscales except the ADL subscale which was higher in the MCLPC group (24, IQR= 6-32) than in the isolated ACLR group (5, IQR= 0-9.74). The median post op IKDC score was 84 in the MCLPC group and compared with 90 in the isolated ACLR group. However, the difference between pre-operative and post-operative IKDC scores was higher in patients in the MCLPC group (40, IQR= 25-49) than in the isolated ACLR group (32, IQR=19.6-46.8). MCLPC, performed at the time of ACLR does not appear to adversely affect the functional post-operative outcomes. IV.

Impacts of chronic diseases and multimorbidity on health-related quality of life among community-dwelling elderly individuals in economically developed China: evidence from cross-sectional survey across three urban centers

ObjectiveAs the ageing process in China further accelerates and the average life expectancy increases, chronic disease prevalence and multimorbidity rates are constantly rising, especially among elderly individuals. However, few previous studies have explored the impacts of chronic diseases and multimorbidity on health-related quality of life (HRQoL). This study aimed to investigate this association among community-dwelling elderly individuals in China.MethodsA cross-sectional study was conducted in communities in three cities (Suzhou, Qingdao, and Guangzhou). The basic characteristics, chronic diseases and HRQoL of participants were collected, and HRQoL was measured by the EuroQol 5-Dimensions 3-Level version (EQ-5D-3L). Logistic regression, Tobit regression and generalized linear models were used to assess the impacts of chronic diseases and multimorbidity on HRQoL.ResultsApproximately 83.2 percent of the 1,218 respondents had chronic conditions, with 30 percent having multimorbidity. After controlling for sociodemographic and health behaviour factors, patients with stroke were more likely to report problems in all five dimensions of the EQ-5D and had a lower EQ-5D utility index (UI) (b = -0.342) than patients with other chronic conditions. Patients with chronic pulmonary obstruction had a lower EuroQol Visual Analog Scale (EQ-VAS) (b = -11.169) than patients with other chronic conditions. Furthermore, patients with multimorbidity had worse HRQoL (P < 0.001).ConclusionsBoth chronic condition probability and multimorbidity rates were high among Chinese community-dwelling elderly individuals. Different disease types had varying degrees of impact on HRQoL, and patients with multimorbidity had worse HRQoL. This study proposes that the government enhance the quality of life of community-dwelling elderly individuals with multimorbidity by establishing long-term care insurance and expanding comprehensive community-based home health care services.

Arthroscopic treatment for femoroacetabular impingement yields favourable patient-reported outcomes and method survivorship at 10-year follow-up.

To compare the outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) preoperatively and at minimum 10-year follow-up using patient-reported outcome measures (PROMs). A total of 128 patients with FAIS were prospectively included. The patients underwent arthroscopic surgery for FAIS between 2011 and 2013 and had a minimum of 10-year follow-up. The International Hip Outcome Tool short version (iHOT-12) was the primary outcome. Secondary outcomes were the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the European Quality visual analogue scale (EQ VAS), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analogue Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. The Wilcoxon signed rank test was used to compare pre- and postoperative PROMs. There was a significant improvement (p < 0.001) of iHOT-12, HAGOS subscales, EQ-5D, EQ VAS and VAS for overall hip function. A total of 83% of the patients were satisfied with their surgery. The survivorship of hip arthroscopy, defined as nonconversion to total hip arthroplasty (THA), at the end of the follow-up period was 77%. Patients undergoing arthroscopic treatment for FAIS reported statistically significant and clinically relevant improved outcomes at 10-year follow-up. Case series, level IV.

Distinguishing pain profiles among individuals with long COVID.

For many people with long COVID (LC), new-onset pain is a debilitating consequence. This study examined the nature of new-onset pain and concomitant symptoms in patients with LC to infer mechanisms of pain from the relationships between pain and health-related factors. Pain and other symptoms were evaluated in 153 individuals with LC using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs, EuroQoL Visual Analog Scale, and Quality of Life in Neurological Disorders. The relationships between pain and patient factors were analyzed using Chi Square and independent t-tests. 20.3% of individuals who reported new-onset pain had neuropathic pain, which was associated with lower quality of life and higher rates of cognitive dysfunction compared to those with non-neuropathic pain. Other symptoms were similar between groups, however heart-related symptoms were more prevalent in individuals with neuropathic pain and mood swings were more prevalent for individuals with non-neuropathic pain. Characterizing the relationships between NP and quality of life in individuals with LC can aid in developing better clinical management strategies. Understanding the associations between NP and cognitive dysfunction provides the imperative foundation for future studies further examining the pathophysiological mechanisms underlying pain development in LC.

Platelet-Rich Plasma Injections Do Not Improve the Recovery After Arthroscopic Partial Meniscectomy: A Double-Blind Randomized Controlled Trial

Background: Arthroscopic meniscectomy is one of the most performed surgical procedures in orthopaedics. Different approaches have been proposed to improve patient recovery but with unsatisfactory results. Platelet-rich plasma (PRP) augmentation has been proposed as a strategy to improve the recovery after meniscectomy. Purpose: To investigate the clinical benefits of an intra-articular PRP injection after meniscectomy, in terms of faster and better patient recovery. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Ninety patients were randomized into a treatment group, with arthroscopic partial meniscectomy immediately followed by a 5-mL injection of autologous conditioned plasma, and a control group with partial meniscectomy alone. Patients were evaluated at baseline and at 15, 30, 60, and 180 days of follow-up with the visual analog scale (VAS) score for pain (primary outcome), as well as with International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score subscales, Tegner score, and EuroQol-Visual Analog Scale score. Objective evaluation was performed analyzing knee range of motion and circumference and the International Knee Documentation Committee objective score. Complications, patient judgment, and satisfaction were documented as well. Results: No major complications and an overall significant improvement in the clinical scores were observed in both groups. Overall, the comparative analysis did not demonstrate significant between-group differences in absolute values or improvements of both subjective and objective scores, as well as activity level. The improvement in terms of VAS pain score for the treatment group was significant already at 15 days (from 4.3 ± 2.5 to 2.5 ± 2.5; P = .014), while in the control group it became significant at 30 days (from 3.7 ± 2.3 to 2.0 ± 2.4; P = .004). No significant differences were observed between the 2 groups in terms of judgment of treatment results and satisfaction. Conclusion: A single postoperative injection of PRP was not able to significantly improve patient recovery after arthroscopic partial meniscectomy. PRP augmentation did not provide overall benefits at a short-term follow-up (6 months) in terms of pain relief, function, objective parameters, and return-to-sport activities. Registration: NCT02872753 (ClinicalTrials.gov identifier).

Leukocytes Do Not Influence the Safety and Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial

Background: Platelet-rich plasma (PRP) is increasingly used for the injection treatment of knee osteoarthritis (OA). However, the role of leukocytes contained in PRP is controversial, with some preclinical studies suggesting detrimental effects and others emphasizing their contribution in secreting bioactive molecules. Purpose: To compare the safety and effectiveness of leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) for the treatment of knee OA. Hypothesis: That leukocytes could influence results both in terms of adverse events and clinical outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This double-blind randomized controlled trial included 132 patients with Kellgren-Lawrence grade 1-3 knee OA who were randomized to a 3-injection cycle of either LR-PRP or LP-PRP. Patients were prospectively assessed at baseline and at 2, 6, and 12 months with subjective evaluations comprising the International Knee Documentation Committee (IKDC) subjective score, the KOOS (Knee injury and Osteoarthritis Outcome Score), the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the visual analog scale for pain, the EuroQol–visual analog scale, the EuroQol–5 dimensions, and the Tegner activity scale. Objective evaluations consisted of the IKDC objective score, active/passive range of motion, and circumference of the index and contralateral knees. Patient judgment of the treatment was recorded as well as adverse reactions and failures. Results: An overall improvement in subjective and objective outcomes was documented, with no differences between the 2 groups, except for the improvement in the IKDC subjective score at 2 months, which was greater for the LR-PRP group compared with the LP-PRP group (14.8 ± 14.8 vs 8.6 ± 13.3, respectively; P = .046), as well as for active (P = .021) and passive (P = .040) ROM of the index knee at 6 months, showing statistically significant higher values in the LP-PRP group; and for quadriceps circumference of the index (P = .042) and contralateral (P = .045) knees at 12 months, which were significantly greater in the LR-PRP group. The IKDC subjective score improved from 42.5 ± 17.6 at baseline to 55.6 ± 21.4 at 12 months for the LR-PRP group (P < .0005) and from 45.7 ± 16.4 to 55.3 ± 20.4 for the LP-PRP group (P = .001). No differences in terms of patient treatment judgment were observed at all follow-up time points. No severe adverse events related to the treatment were reported, but some mild adverse events related to the treatment were observed: 16 in the LR-PRP group and 17 in the LP-PRP group. Treatment failed in 5 patients in the LR-PRP group and 2 in the LP-PRP group. Conclusion: This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. Both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points, without showing differences in subjective and objective outcomes or in adverse events and treatment failures. Registration: NCT04187183 (ClinicalTrials.gov).

Preoperative Psychopharmacological Treatment Is Not a Risk Factor for Poorer Patient-Reported Improvements 12 months After Hip or Knee Arthroplasty: A Multicenter Registry-Based Cohort Study of 7,247 Procedures

BackgroundPreoperative psychopharmacological treatment (PPT) has been associated with increased hospital length of stay and readmission rate after hip and knee arthroplasty. However, little is known regarding the association between PPT and improvements in patient-reported outcomes postoperatively in a multicenter fast-track setting. Thus, the primary objective was to investigate whether PPT is a risk factor for poorer patient-reported improvements 12 months after surgery. Secondary objectives included assessment of additional time points and subgroups of PPT. MethodsThis multicenter registry-based cohort study included 4,021 primary hip and 3,226 primary knee arthroplasties performed from 2016 to 2020 at three fast-track departments in Denmark due to primary osteoarthritis. The Oxford Hip Score/Oxford Knee Score (OHS/OKS), EuroQol-5 Dimensions-3 Levels/EuroQol-5 Dimensions-5 Levels, and EuroQol visual analog scale were collected at baseline and 3, 6, 12, and 24 months after surgery. Exposure status was assigned using the Danish National Prescription Registry. Marginal mean differences (MD) with 95% confidence intervals (CIs) were estimated using multilevel Tobit regression and adjusted for age, sex, and the Charlson Comorbidity Index obtained from the Danish National Patient Register. ResultsNo associations were found between PPT and improvements in OHS (MD −0.5, CI −1.4 to 0.4) or OKS (MD −0.3, CI −1.2 to 0.5) after 12 months. However, PPT was associated with lower baseline OHS (MD −1.4, CI −2.2 to −0.6) and OKS (MD −2.1, CI −2.9 to −1.3), and 12 months follow-up OHS (MD −1.9, CI −2.8 to −1.1) and OKS (MD −2.4, CI −3.2 to −1.6). Similar findings were observed at other time points, using EuroQol-5 Dimensions-3 Levels/EuroQol-5 Dimensions-5 Levels or EuroQol visual analog scale, and when evaluating PPT subgroups. ConclusionsIn hip and knee arthroplasty, PPT was not a risk factor for poorer patient-reported improvements 12 months after surgery. However, PPT was associated with marginally poorer baseline and follow-up scores. Thus, arthroplasties remain effective treatments despite PPT from a patient-centered perspective.

Metabolic syndrome and patient-reported outcome two years after hip and knee arthroplasty.

The influence of metabolic syndrome (MetS) on the outcome after hip and knee arthroplasty is debated. We aimed to investigate the change in patient-reported outcome measure (PROM) scores after hip and knee arthroplasty, comparing patients with and without MetS. From 1 May 2017 to 30 November 2019, a prospective cohort of 2,586 patients undergoing elective unilateral hip and knee arthroplasty was established in Denmark. Data from national registries and a local database were used to determine the presence of MetS. Patients' scores on Oxford Hip Score (OHS) or Oxford Knee Score (OKS), EuroQol five-dimension five-level questionnaire (EQ-5D-5L), University of California, Los Angeles (UCLA) Activity Scale, and Forgotten Joint Score (FJS) at baseline, three, 12, and 24 months after surgery were collected. Primary outcome was the difference between groups from baseline to 12 months in OHS and OKS. Secondary outcomes were scores of OHS and OKS at three and 24 months and EQ-5D-5L, UCLA Activity Scale, and FJS at three, 12, and 24 months after surgery. Generalized linear mixed model was applied, adjusting for age, sex, Charlson Comorbidity Index, and smoking to present marginal mean and associated 95% CIs. A total of 62.3% (1,611/2,586) of the cohort met the criteria for MetS. Both groups showed similar increase in mean OHS (MetS group 22.5 (95% CI 21.8 to 23.1), non-MetS group 22.1 (21.3 to 22.8); p = 0.477) and mean OKS (MetS group 18.0 (17.4 to 18.6), non-MetS group 17.8 (17.0 to 18.7); p = 0.722) at 12 months' follow-up. Between groups, similar improvements were seen for OHS and OKS at three and 24 months postoperatively and for the mean EQ-5D-5L, EuroQol-visual analogue scale (EQ-VAS), UCLA Activity Scale, and FJS at every timepoint. Patients meeting the criteria for MetS obtain the same improvement in PROM scores as individuals without MetS up to 24 months after hip and knee arthroplasty. This is important for the clinician to take into account when assessing and advising patients with MetS.

Patient needs in women of childbearing age with psoriasis: retrospective analysis from the German PsoBest registry.

Women of childbearing age (WoCBA) with psoriasis face additional burden related to contraindications of systemic treatments during pregnancy/lactation and to the physical and psychosocial impact of psoriasis on their intimate/sexual relationships. Within a people-centered health care model, this study aimed to identify specific patient needs and their correlates in WoCBA (18-45 years), in comparison to same-age men and women above 45 years. Baseline data from the German PsoBest registry, including patients with moderate/severe plaque-type psoriasis with the indication for systemic therapy, were retrospectively analyzed. Psoriasis severity was assessed with the Psoriasis Area and Severity Index and patient-reported outcomes included EuroQoL Visual Analogue Scale, Dermatology Life Quality Index (DLQI), and Patient Needs Questionnaire. The participants were 2308 WoCBA, 3634 men between 18 and 45 years of age, and 3401 women older than 45 years. In comparison to both control groups, WoCBA reported more DLQI impairments and higher needs to reduce social impairments (eg, "to be able to lead a normal working life"; "to be less burdened in your partnership"; "to be able to have a normal sex life"). These patient needs were associated with having psoriasis arthritis, previous systemic therapy, worse general health, and more DLQI impairments. Retrospective analysis of an established dataset limited the examination of specific developmental, sexual, and reproductive variables. The specific needs of WoCBA with psoriasis were particularly related to the work context/financial stability and intimate relationships, which are crucial aspects in family planning. These results claim for a sex/age-sensitive approach in the psoriasis health care, by considering these needs as qualifiers in the clinical decision for systemic treatment.

Prospective Trial of Sacroiliac Joint Fusion Using 3D-Printed Triangular Titanium Implants: 5-Year Follow-Up.

Prospective, multicenter, single arm study with 5-year follow up. To report long-term (5-year) safety, effectiveness, and radiographic outcomes after sacroiliac (SI) joint fusion (SIJF) with 3D-printed triangular titanium implants (TTI) and compare them with solid titanium plasma spray coated implants. A large literature base supports minimally invasive SIJF with TTI for chronic SIJ dysfunction. SIJF with TTI was performed in 51 subjects and scheduled follow-up occurred at 3, 6, 12, 24 and 60 months. Postoperative visits included quality of life questionnaires and functional tests. A high-resolution CT scan was performed at either 6 or 12 months, and again at 60 months. All CT scans were interpreted by an independent musculoskeletal radiologist. 5-year follow-up was available in 36 of 51 subjects (71%). At 5 years, improvements in SI joint pain (58.1 points [0-100 scale]), SIJ-related disability (Oswestry Disability Index [ODI], 25.4 points) and quality of life (EuroQOL 5D, 0.24 points, and EuroQOL visual analog scale, 13.4 points) were sustained and showed no signs of diminution. The percentage of patients using opioids for SIJ pain decreased markedly from baseline (57%) to 5 years (17%). Physical function tests showed persistent improvements from baseline. There was no evidence of device breakage, migration or subsidence and few late adverse events occurred attributable to the device. Independent analysis of CT scans showed bone opposed to implants in all cases, and evidence of bone bridging in 90% of cases, and no evidence of radiolucency or other adverse bone reactions. Prospective 5-year follow-up showed that SIJ fusion using 3D-printed TTI resulted in immediate, marked, and persistent improvements in pain and quality of life, with improved physical function, reduced opioid use, and a low rate of revision surgery. Radiographic evidence showed implant integration and joint fusion. Level II.

Combined Korean Medicine Treatment of a Patient Diagnosed with Posterior Limb of Internal Capsule Infarction Presenting with Hiccups as the Chief Complaint - A Case Report

Objective: Hiccup is a sudden, involuntary contraction of the diaphragm and intercostal muscles, followed by laryngeal closure. Persistent hiccups can occur in the central nervous system following a cerebral infarction. While medications, for example chlorpromazine, are commonly used for treatment, they often fail to fully resolve the hiccups, showing little to no improvement in symptoms. The aim of this study was to present the treatment response of a patient diagnosed with posterior limb of internal capsule (PLIC) infarction, who was experiencing hiccups and was treated with combined Korean medicine after taking chlorpromazine.Case Presentation: A 71-year-old male diagnosed with left PLIC infarction was experiencing problems in daily life due to hiccups and dysarthria. During the 10-day hospitalization, he received treatment that included herbal medicine (modified Hyeolbuchugeo-tang, Xiěfǔzhúyūtāng), acupuncture (GV20, LI11, ST36, LI4, LR3, and submandibular area acupoint), moxibustion, cupping, and physical therapy. After 10 days of hospitalization, the patient’s hiccups disappeared, and he did not have to take any chlorpromazine. The score on the Numerical Rating Scale fell from 7-8 to 1-2. The 5-level EQ-5D version (EQ-5D-5L) fell from 11 to 7, and the EQ Visual Analogue Scale (EQ-VAS) rose from 20 to 80. The frequency (times per minute) of hiccups decreased and almost disappeared. During outpatient treatment, the patient stated that he did not experience hiccups for 7 months, and no significant side effects were observed.Conclusion: This study suggests that a patient with hiccups as a chief complaint can be effectively treated with combined Korean medicine. However, more studies with control groups are needed to confirm these findings.

Exploring the factors influencing the health-related quality of life in patients experiencing adverse drug reactions: a cross-sectional study

BackgroundThis study aimed to assess the factors influencing health-related quality of life (HRQoL) in patients experiencing adverse drug reactions (ADRs) at a tertiary care public sector hospital. A cross-sectional study was conducted over a period of 18 months, and included both male and female patients aged 18 years and above. Patients who visited the outpatient and inpatient departments with complaints associated with ADRs were included in this study. HRQoL data were collected using the EuroQol—5 Dimension—5 Level (EQ-5D-5L) questionnaire to assess five dimensions of health on a five-level scale. Descriptive statistics, t-tests, and analysis of variance were used to analyze the data. Multivariate regression analysis was performed to identify the potential determinants of HRQoL.ResultsA total of 316 patients were included in the study among these participants, of which 54% were female, and 65% were from rural areas. The majority (68%) of the patients had moderately severe ADRs, and 63% of the participants had an income < 2.5 lakh Indian rupees (3009 USD). The mean EQ-5D-5L and EuroQoL Visual Analog Scale (EQ VAS) scores of the study participants were 0.714 and 69.73, respectively. The variables ADR severity, income, and age showed a significant difference (p < 0.05) in HRQoL.ConclusionThis study provides insights into HRQoL among patients with ADRs and identifies the determinants of HRQoL. The findings of this study will contribute to improving patient-centered care and optimizing patient outcomes.

Health-related quality of life with rivaroxaban plus aspirin vs. aspirin alone in chronic stable cardiovascular disease: Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.

This study aimed to compare the effects of the combination of rivaroxaban and aspirin with aspirin alone on health-related quality of life in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial. Health-related quality of life assessed using the EQ-5D-3L. The treatment effects on health utility and EQ visual analogue scale (EQ VAS) scores were compared between rivaroxaban plus aspirin and aspirin alone in terms of adjusted mean difference in change from baseline and odds ratio of having deterioration events. Nine thousand forty-nine (98.9%) and 6916 (75.5%) completed the EQ-5D-3L at baseline and at final visit, respectively. Nine thousand twenty-eight (98.9%) and 6887 (76.3%) completed the EQ-5D-3L at baseline and final visit, respectively. Mean (standard deviation) health utility and EQ VAS scores at baseline were 0.871 (0.141) and 76.0 (15.3), respectively, for the rivaroxaban plus aspirin group, compared with 0.873 (0.139) and 75.8 (15.1) for the aspirin group. Adjusted mean difference in change from baseline utility was -0.002 [95% confidence interval (CI), -0.006, 0.002, P = 0.30] between the combination therapy group and the aspirin group. The odds ratio (95% CI) of experiencing deterioration in health utility was 1.01 (95% CI, 0.93, 1.10, P = 0.81) between the two groups. Adjusted mean difference in change from baseline EQ VAS was 0.02 (95% CI, -0.43, 0.47, P = 0.93) between the two groups. This analysis of the COMPASS trial demonstrated that the quality of life of patients was similar between the rivaroxaban plus aspirin group and the aspirin alone group. Trial registration number: ClinicalTrials.gov number (NCT01776424). Trial protocol and statistical analysis plan: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118#APPNEJMoa1709118PRO.

Chronic pain at 1-year following knee arthroplasty is associated with a worse joint-specific function and health-related quality of life.

The purpose of this study was to identify independent variables associated with chronic pain (CP) at 1 year following knee arthroplasty (KA) and whether this influenced functional outcomes. This retrospective study was conducted over a 2-year period and included 2588 patients with completed Oxford knee score (OKS) and EuroQol (EQ)-five domains (5D) preoperatively and at 1 and 2 years postoperatively. The OKS pain component score was used to define patients with CP (≤14 points). The mean age was 70.0 (range 34-94) years and there were 1553 (60.0%) females. There were 322 (12.4%) patients with CP at 1 year. A worse preoperative EQ-5D (p = 0.025), EQ-visual analogue scale (VAS) (p = 0.005) and OKS questions relating to washing (p = 0.010), limping (p = 0.007), kneeling (p = 0.003) and night pain (p = 0.004) were independently associated with risk of CP. However, the preoperative OKS (area under the curve [AUC]: 72.0, p < 0.001) and EQ-5D score (AUC: 70.1, p < 0.001) were the most reliable predictors, with threshold values of <18-points and <0.300 being predictive of CP, respectively. Of those with CP at 1 year, 231 were followed up at 2 years, of which 92 (39.8%) had resolution of their CP. A worse response to OKS question 11 (ability to shop) and EQ-5D (p = 0.028) at 1 year was independently associated with persistent CP. Patients with CP had significantly (p < 0.001) worse OKS, EQ-5D and EQ-VAS at 1 year compared to those without. However, for those that had resolution of their CP at 2 years, their outcomes were clinically equal to those that did not have CP at 1 year. One in eight patients had CP at 1 year following surgery, which was associated with clinically worse knee-specific outcomes and quality of life. However, by 2 years, two in five patients had resolution of their CP and had functional outcomes clinically equal to those without CP at 1 year. The risk factors identified could be used to inform patients of their risk for CP and the potential for resolution. Level III retrospective study.

Subthalamic Stimulation Improves Short-Term Satisfaction with Life and Treatment in Parkinson's Disease.

The effect of subthalamic stimulation (STN-DBS) on patients' personal satisfaction with life and their Parkinson's disease (PD) treatment is understudied, as is its correlation with quality of life (QoL). Therefore, we tested the hypothesis that STN-DBS for PD enhances satisfaction with life and treatment. In a prospective, multicenter study with a 6-month follow-up involving 121 patients, we measured the main outcomes using the Satisfaction with Life and Treatment Scale (SLTS-7). Secondary outcomes included the eight-item PD Questionnaire (PDQ-8), European QoL Questionnaire (EQ-5D-3L), EQ-Visual Analogue Scale (VAS), Non-Motor Symptom Scale (NMSS), Hospital Anxiety and Depression Scale (HADS), and Unified PD Rating Scale (UPDRS). Longitudinal outcome changes, effect sizes (Cohen's d), and correlations between outcome changes were analyzed. SLTS-7 scores improved at the 6-month follow-up, particularly in the domains of 'satisfaction with physical health' and 'satisfaction with treatment'. Change scores correlated strongly (EQ-VAS), moderately (PDQ-8 SI and HADS), and weakly (UPDRS-activities of daily living and EQ-5D-3L) with other scales. Satisfaction with physical health, psychosocial well-being, or treatment was not related to UPDRS-motor examination. This study provides evidence that STN-DBS enhances patients' personal satisfaction with life and treatment. This satisfaction is associated with improvements in the QoL, daily activities, and neuropsychiatric aspects of PD rather than its motor aspects.

The relationship between self-efficacy, health literacy, and quality of life in patients with chronic diseases: a cross-sectional study in China.

Self-efficacy and health literacy are closely related to the quality of life in patients with chronic diseases; however, it remains unclear whether their combined effects on the quality of life (QoL) in these patients operate through mediation, interaction, or a combination of both. The research occurred in China between July 10 and September 15, 2021. A multi-stage random sampling technique was utilized to gather information on self-efficacy, health literacy, and QoL among individuals with chronic diseases. Linear regression models investigated the relationships between these patients' self-efficacy, health literacy, and QoL. Additionally, the four-way decomposition method was used to decompose the overall effects of self-efficacy and health literacy on the QoL in patients with chronic diseases. Significant correlations were found between self-efficacy, health literacy, and QoL among individuals with chronic diseases (all p < 0.05). In the four-way decomposition results, the results of the European Quality of Life Five Dimension Five Level (EQ-5D-5L) displayed the interaction effects mediated by self-efficacy, and the reference interaction effects were not significant, with small effect sizes observed. The influence of health literacy levels on the QoL in these patients was primarily attributed to the controlled direct effect (CDE), accounting for approximately 86.12% [excess relative risk = 0.00415; 95% CI: 0.00326, 0.00504; p < 0.0001]. The proportion solely attributable to the pure indirect effect (PIE) of self-efficacy was 14.5% [excess relative risk = 0.0007; 95% CI: 0.00031, 0.00109; p < 0.0001]. In the EQ visual analog scale (EQ-VAS) results, the proportion of the controlled direct effect was 84.9% [excess relative risk = 0.62443; 95% CI: 0.52269, 0.72618; p < 0.0001], while the proportion solely attributable to the pure indirect effect of mediation was 14.8% [excess relative risk = 0.10876; 95% CI: 0.06409, 0.15344; p < 0.0001]. Self-efficacy and health literacy primarily influence QoL in patients with chronic diseases through controlled and pure indirect effects. Enhancing patients' health literacy and self-efficacy can contribute to improving their QoL.

Prognosticating Residual Dysplasia at Skeletal Maturity Following Closed Reduction for Developmental Dysplasia of the Hip: A Long-Term Study with an Average 20-Year Follow-up.

Patients with developmental dysplasia of the hip (DDH) are at risk for residual acetabular dysplasia even after successful closed reduction. The aim of this study was to identify predictors of long-term outcomes in order to guide prognostication and management. Patients who were treated for DDH at 2 institutions between 1970 and 2010 and had follow-up until skeletal maturity were screened for inclusion. Hips that underwent open reduction were excluded to reduce iatrogenic confounding. Syndromal (including neuromuscular and arthrogrypotic) hip instability with collagenopathies were excluded. Demographic characteristics, Tönnis grade, age at the time of the reduction, surgical treatment, acetabular index, lateral center-edge angle, residual dysplasia graded using the Severin classification, and the presence and type of proximal femoral growth disturbance categorized using the Bucholz and Ogden classification were assessed. In addition, the the acetabular angle was recorded at the latest follow-up before secondary procedures, and the Oxford Hip Score and 5-level EuroQoL (EQ)-5 Dimension score were recorded at the latest follow-up. To account for repeated measures, generalized estimating equations (GEE) logistic regression was utilized for the multivariable analysis. A support vector machine model and a receiver operating characteristic curve analysis were utilized to identify prognostication thresholds. One hundred and seven hips (96 female, 11 male) that were followed to skeletal maturity, with a mean follow-up of 20 years (range, 10 to 54 years), were included in the analysis. Eighty-nine hips (83%) demonstrated a good outcome at skeletal maturity, with a Severin grade of I or II. Major growth disturbances of Bucholz and Ogden types II, III, or IV were present in 13 hips (12%). At the latest follow-up after skeletal maturity (before any secondary procedures), the mean acetabular angle was 45° ± 4° and the mean lateral center-edge angle was 26° ± 8°. The mean Oxford Hip Score and EQ visual analog scale values were 47 and 86, respectively. A GEE logistic regression analysis of 1,135 observations revealed that the acetabular index (odds ratio [OR], 1.16 per degree; p < 0.001) and age (OR, 1.20 per year; p = 0.003) were significant predictors of a poor outcome (i.e., Severin grade III, IV, or V). Significant differences in acetabular indices across all age groups were found between hips with a good outcome and those with a poor outcome. Age-specific acetabular index prognostication cutoff values are presented. This long-term follow-up study demonstrated that the age-specific acetabular index remains an important predictor of residual dysplasia at skeletal maturity. The proposed prognostication chart and thresholds herein can help to guide orthopaedic surgeons and parents when contemplating the use of an intervention versus surveillance to optimize long-term outcomes. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Assessment of joint health in patients receiving prophylaxis for haemophilia A: a cross-sectional survey in five European countries

ObjectivesTo evaluate joint health, pain and health-related quality of life (HRQoL) in patients with moderate/severe haemophilia A in Europe.DesignMultinational, cross-sectional survey, with retrospective data collection. Data were taken from the...