Function Subscale Research Articles

Self-assessed performance-based function test versus patient-reported outcome measures for knee and hip osteoarthritis

BackgroundPhysical function constitutes a key component of outcome assessment for almost all osteoarthritis interventions. The aim was to compare physical function measured using a self-assessed performance-based test versus self-reported function using questionnaires among individuals with knee or hip osteoarthritis (OA) participating in a digital exercise and education therapy.MethodsWe analysed data from individuals aged 40 + years participating in the digital program. We extracted data on the self-assessed 30-second chair stand test (30s CST) and the function subscales of Knee injury/Hip disability and Osteoarthritis Outcome Score 12 (KOOS-12/HOOS-12) at enrolment and 3- (n = 10884) and 12-month (n = 3554) follow-ups. Participants completed Numeric Rating Scale (NRS) pain, EQ-5D-5L, and an external anchor: global rating of change scale. Correlations were assessed using the Spearman correlation coefficient, responsiveness using standardized response mean (SRM) and receiver operating characteristic (ROC) curves, and agreement using weighted percent of agreement and weighted Gwet’s agreement coefficient.ResultsCorrelations were weak between the 30s CST and KOOS-12/HOOS-12 function (r < 0.35 for raw and r < 0.20 for change scores). Correlations with NRS pain and EQ-5D-5L were stronger for the KOOS-12/HOOS-12 function subscale than for 30s CST. Greater internal (SRM > 1 vs. SRM < 0.5) and lower external responsiveness were observed for the 30s CST versus the KOOS-12/HOOS-12 function, even though external responsiveness was generally inadequate for both (the area under the ROC curves < 0.7). The direction of change was similar for the two function measures for about 70% of subjects with moderate agreement between them (weighted Gwet’s agreement coefficient range 0.45 to 0.50).ConclusionWeak correlations and moderate agreements between function measured using performance-based test and self-reported using KOOS-12/HOOS-12 in people with knee or hip OA suggest that they may capture different aspects of functional abilities in this population.

Development and validation of the joint function and health assessment scale for juvenile idiopathic arthritis

Objective: To develop, validate and initially apply a joint function and health assessment scale for juvenile idiopathic arthritis patients. Methods: The first draft of the juvenile idiopathic arthritis joint function and health assessment scale was developed through literature analysis, discussion by the research team, semi-structured interviews, Delphi expert correspondence. From March to June 2024, a total of 260 children with juvenile idiopathic arthritis or their parents were prospectively recruited from Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University by convenience sampling method for pre-investigation and formal investigation.The reliability and validity of the scale were tested by item analysis, reliability analysis, exploratory factor analysis, content validity and criterion validity analysis, and the responsiveness of the scale to clinical changes was evaluated by estimating the minimum clinically important difference, and finally the formal scale was formed. Results: The juvenile idiopathic arthritis joint function and health assessment scale included disease activity assessment, daily activity and function assessment, pain, fatigue and disease outcome assessment, with a total of 5 dimensions and 24 items, in which the functional assessment subscale included 4 secondary dimensions and 18 items. The Cronbach's α coefficient of the function assessment subscale was 0.88, the fold-half reliability was 0.86, and the test-retest reliability after 2-4 weeks was 0.84; the item-level content validity index was 0.80-1.00, and the scale-level content validity index was 0.93. Exploratory factor analysis extracted 4 common factors with a cumulative variance contribution of 70.0%. Preliminary application indicated the functional assessment subscale was moderately correlated with childhood health assessment questionnaire (r=0.70, P<0.05), the total scale was strongly correlated with juvenile arthritis disease activity score-27 (r=0.92, P<0.05), and moderately correlated with both active and limited joint count (r=0.77, 0.68, P<0.05). Reactivity analysis suggested that the minimum clinically important difference between the two visits of 41 children with clinical improvement and 25 children with disease activity was 0.49 (0.44, 0.54) and 0.51 (0.43, 0.58). Conclusion: The juvenile idiopathic arthritis joint function and health assessment scale has good reliability and validity, and has certain responsiveness to clinical changes, is simple and operable, and can be used as a tool for assessing joint function in children with juvenile idiopathic arthritis.

Reliability and Validity of the Turkish Version of the Deglutition Handicap Index.

The Deglutition Handicap Index (DHI) is a self-reported questionnaire focus on dysphagia related quality of life of patients. The present study was aimed to translate the DHI into Turkish, and investigate the reliability and validity of the Turkish version of the DHI (T-DHI). A total of 100 patients with different diagnoses participated. The study was carried out in 3 phases including translation, reliability and validation phases. The translation phase was performed by the forward-backward-forward translation methodology. The internal consistency and test-retest reliability were used for reliability phase. The criterion validity of the T-DHI was investigated for validation phase. The Cronbach's alpha value of the T-DHI was 0.93 of which indicates excellent internal consistency. The Intraclass Correlation Coefficient ranged from 0.96 to 0.99 for test-retest reliability. There was negative and weak correlation between functional subscale score from the T-DHI and the Functional Oral Intake Scale (r=-0.29, p = 0.004), and positive and moderate to strong correlations between total and subscale scores from the T-DHI and the Turkish version of the Eating Assessment Tool (r = 0.67-0.78, p < 0.001) indicating sufficient criterion validity. The T-DHI is a reliable and valid questionnaire to define dysphagia related quality of life of patients. Clinicians could be used the T-DHI during swallowing evaluation part during the management process of deglutition disorders to plan patient centered rehabilitation, improve care and follow up.

A Complete Functional Characterization of Patients with Severe Knee Osteoarthritis in Need of Total Knee Replacement.

The current literature lacks objective criteria to correctly identify patients in need of a total knee replacement. Surgery indication can be challenging for orthopedic surgeons, which may lead to high levels of patient dissatisfaction. The objective of this study is to describe a complete set of functional characteristics to identify patients with end-stage knee osteoarthritis in need of a total knee replacement, correlating data from strength and performance tests with pain, function, and quality of life questionnaires. This was a cross-sectional study evaluating patients with end-stage knee osteoarthritis in a waiting list for total knee replacement at a University Hospital. The patients responded to subjective self-reported questionnaires and performance-based functional tests. Anthropometric data were also collected. The main outcome measures were Western Ontario and McMaster Universities Index (WOMAC), visual analog scale (VAS), Short Form-36, knee range of motion, thigh perimeter measurement, maximum voluntary isometric contraction, and 6-min walk test. We analyzed 122 patients (89 female). The functional profile of patients with severe knee osteoarthritis awaiting total knee replacement was described. Quadriceps strength (extensor torque) had a negative correlation with WOMAC (r = -0.3102; p < 0.05), VAS (r = -0.3247; p < 0.05), and a positive correlation with SF-36 Functional Capacity subscale (r = 0.321; p < 0.05). Poorer performance in the 6 min walk test also correlated with worse scores in the WOMAC (r = -0.35; p < 0.05), VAS (r = -0.48; p < 0.05) and SF-36. The present article established a functional profile of patients with severe knee osteoarthritis with indication for total knee replacement, which may help orthopedic surgeons in their decision process. We also identified quadriceps strength and a 6 min walk test as the two most important functional parameters that correlate with knee osteoarthritis severity.

Life course socio-demographic circumstances and the association between housing tenure and disability-free life expectancy in Australia: a longitudinal cohort study

IntroductionThis study aimed to assess the extent to which the association between housing tenure and disability-free life years is independent of socio-demographic circumstances from earlier in life.MethodsWe analysed nationally representative...

Impact of Open-Angle Glaucoma Severity on Vision-Related Quality of Life: A Cross-Sectional Study in a Single Center in Indonesia

Background: Glaucoma is a progressive optic neuropathy characterized by the gradual loss of retinal ganglion cells (RGCs) and their axons, leading to irreversible visual field loss. This study aimed to investigate the relationship between the severity of primary open-angle glaucoma (POAG) and vision-related quality of life (VRQoL) in a single center in Indonesia. Methods: A cross-sectional study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital, Padang, Indonesia, from June to August 2024. A total of 54 patients with POAG were included and categorized into mild, moderate, and severe groups based on their cup-to-disc ratio and visual field index (VFI). VRQoL was assessed using the Indonesian version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25). Results: The mean VRQoL score was significantly lower in the severe group (60.63 ± 13.04) compared to the moderate (81.79 ± 10.42) and mild (85.04 ± 10.52) groups (p = 0.000). A strong negative correlation was observed between glaucoma severity and VRQoL (r = -0.667, p = 0.000). The social functioning subscale showed the strongest correlation with severity (r = -0.573, p = 0.000). Conclusion: The severity of POAG significantly impacts VRQoL, with more severe disease associated with lower QoL scores. The social functioning domain appears to be particularly affected. These findings underscore the importance of comprehensive glaucoma management that addresses not only clinical parameters but also the patient's overall quality of life.

Discussion: The Rhinoplasty Rosetta Stone: Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale.

Discussion: The Rhinoplasty Rosetta Stone: Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale.

Contribution of cognitive status on admission to mobility and balance at discharge from acute rehabilitation for stroke

Acute inpatient rehabilitation is crucial for improving mobility and balance for individuals with stroke. A potentially important factor in the recovery of mobility and balance is cognition. The purpose of this study was to determine the effect of cognition on mobility and balance in acute stroke rehabilitation. This was a longitudinal cohort study based on an inpatient rehabilitation unit at a large academic medical center. Participants were individuals with stroke admitted to acute rehabilitation after an acute care hospital stay (N = 281). Demographic data and predictor variables were collected on admission to the unit. Outcomes were collected at discharge from the unit. Multiple regression analyses were used to determine the associations between cognition (Montreal Cognitive Assessment) on mobility (Functional Independence Measure mobility subscale) and balance (Berg Balance Scale). Subtests from the Montreal Cognitive Assessment were also examined to determine if specific dimensions of cognition could predict balance after controlling for covariates. Dominance analysis was used to determine the relative importance of baseline predictors. In separate models, cognition was a significant predictor of mobility (B = 0.19) and balance (B = 0.28) at discharge after adjusting for admission mobility and balance, as well as age, sex, and length of stay. The most important predictors in both models were baseline mobility and balance, but cognition contributed to the models independently of baseline scores. Cognition was generally more important than age and sex while about equally important as length of stay. In separate models, the visuospatial/executive (B = 0.42) and the delayed recall (B = 0.37) subtests were also significant predictors of mobility. The models’ most important predictors were baseline mobility and balance scores. Cognition is a clinically relevant predictor of mobility and balance in acute stroke rehabilitation. Specific dimensions of cognition, such as executive function, visuospatial function, and delayed recall, may be especially important. Cognitive challenges and meta-cognitive strategies should be included in mobility and balance tasks when possible. Studies that evaluate the efficacy of dual-task training and meta-cognitive approaches are needed.

Harnessing Daily Routines for Early Detection of Cool Executive Delays: Validating the EFORTS Questionnaire.

Bakground: The early identification of executive function (EF) delays should involve parental reports on children's executive control in daily activities, capturing both "hot" and "cool" executive functions. This study aimed to revalidate the reliability and validity of the Executive Functions and Occupational Routines Scale (EFORTS) and examine whether it represents both hot and cool EFs Methods: Parents of 971 children (469 boys) aged 3 to 11 years (M = 6.08, SD = 1.8) completed the EFORTS and the Behavior Rating Inventory of Executive Functions/Preschool version (BRIEF/P). Exploratory and confirmatory factor analysis led to re-reestablishing the EFORTS daily functional routines with high internal consistency values (0.82-0.93). Results: Significant correlations were revealed between the EFORTS daily function subscales and various BRIEF/P "hot" and "cool" executive scales. Again, divided into three executive subscales, the EFORTS items showed medium-high internal reliability (α = 0.79-0.93). Significant age-related differences were demonstrated in the children's EFs in three age groups: 3.0-5.11, 6.0-7.11, 8.0-11.11. Conclusions: The results suggest that EFORTS effectively assesses children's executive control over daily functions, capturing both "cool" and "hot" EFs, making it a reliable tool for early detection of executive delays prior to formal schooling.

RELATIONSHIP BETWEEN FALLS AND FEAR OF FALLING AND SELF-REPORTED DUAL-TASK DIFFICULTIES, COGNITIVE AND PHYSICAL FUNCTIONS IN OLDER ADULTS

Objective: The aim of this study was to investigate the association between falls and fear of falling and self-reported cognitive and physical functions and dual-task difficulties in older adults. Method: The Falls Efficacy Scale-International (FES-I), physical functioning subscale of the 36-item Short-Form Health Survey (PFS), Cognitive Failure Questionnaire (CFQ), and Dual-task Questionnaire (DTQ) were performed. The presence of falls and the number of falls were also documented. Results: Fifty older adults were enrolled in this study (median age:69, 29 female). A moderate correlation was found between the number of falls and FES-I, CFQ, and PFS (rho=-0.394 to 0.499). However, it was strongly correlated with DTQ (rho=0.553). FES-I was weakly correlated with DTQ (rho=0.287), moderately correlated with the number of falls (rho=0.412), and strongly correlated with PFS (rho=-0.732). There was no correlation between FES-I and CFQ (r=0.243). Regression analysis showed that PFS was the determinant of fear of falling, and the model explained the 51% variance of the FES-I. Conclusion: Overall, the findings indicate that falls and fear of falling link to self-reported physical, cognitive, and dual-task measures and these perceived abilities may be an important screening tool for better-identifying persons with fall risk and fear of falling.

Bodily pain and vitality are the key factors in the disability of chronic low back pain patients under Short Form 36 base study: a five-year cohort study

BackgroundChronic low back pain (CLBP), a significant cause of disability, is expected to increase with aging. Short Form 36 (SF-36) indicated higher baseline component scores predict CLBP disability at shorter follow-ups, with unexplored five-year associations. The study aimed to test the associations of the physical and mental subscales of the SF-36 at baseline with disability at the five-year follow-up point among patients with CLBP.MethodsPatients aged between 20 and 65 years with CLBP were enrolled at baseline and followed at the five-year point. The Oswestry Disability Index (ODI), the physical functioning (PF) subscale of the SF-36, and self-reported total months of disability (TMOD) over the past five years were used as the indices of disability. The four physical and mental subscales of the SF-36 were used as independent factors, respectively. Multiple linear regression was used to compare the associations of the physical and mental subscales at baseline with disability at follow-up.ResultsTwo hundred twenty-five patients with CLBP were enrolled at baseline and 111 participated in followed at the five-year point. Among the SF-36 subscales, the scores of bodily pain (BP), vitality (VT), and social functioning (SocF) at baseline were significantly correlated with the three indices of disability at follow-up. After controlling for demographic and clinical variables, BP and VT at baseline were most strongly associated with the ODI and TMOD at follow-up among the four physical and mental subscales, respectively. PF at baseline was most strongly associated with itself at follow-up among the four physical subscales.ConclusionOur results demonstrated that both the physical and mental subscales of the SF-36 at baseline could predict disability at the five-year follow-up point among patients with CLBP. The BP and VT subscales were independent factors associated with disability among the physical and mental subscales, respectively.

Impact of Six Months of Three Different Modalities of Exercise on Stress in Post-Treatment Breast Cancer Survivors

Abstract: Background/Objectives: Extensive evidence suggests that exercise is physically and mentally beneficial for cancer survivors. This study reports on changes in self-reported stress, physiological biomarkers for stress (salivary cortisol), and HR-QOL constructs for fifty breast cancer survivors participating in one of three different exercise programs over 6 months. Methods: Fifty post-treatment breast cancer survivors were randomized to either therapeutic yoga-based exercise (YE), comprehensive exercise (CE) (aerobic, resistance, flexibility), or choosing (C) their own exercise activities. Participants completed the Perceived Stress Scale (PSS), Medical Outcomes Short-Form 36® (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). Five samples of salivary cortisol were collected on two consecutive days. The 10 samples were used to calculate the diurnal rhythm slope. Outcome measures were repeated after six months. Results: All groups improved in HR-QOL measures of PSS; PSQI sleep quality components of latency and daytime functioning; and five of the ten SF-36 scales (Mental Component Scale, Social Functioning subscale, Mental Health subscale, Physical Component Scale, Physical Functioning subscale). Although the CE group observed the most favorable change in cortisol (−0.183), where cortisol slope changes approached significance (p = 0.057), but no significant decrease in cortisol between groups were noted. Conclusion: Our results suggest that it is the engagement of, rather than the specific type of exercise, which is associated with improved HR-QOL. However, longer-term studies with better adherence monitoring and larger sample sizes are needed to better determine clinical impact.

A Comparative Study of the Efficacy of Platelet-Rich Plasma (PRP) vs. Other Conservative Treatments for Lateral Epicondylitis.

Background Lateral epicondylitis, also known as tennis elbow, is a degenerative condition that affects a significant portion of the adult population, particularly those between the ages of 35 and 55. Conventional treatments, including analgesics, physiotherapy, and bracing, often lead to a high recurrence rate. Platelet-rich plasma (PRP) therapy has emerged as a promising alternative, offering regenerative benefits that may enhance tissue healing. This study evaluates the effectiveness of PRP injections compared to traditional conservative therapies in alleviating pain and improving function in individuals with chronic lateral epicondylitis. Methods This prospective observational study was conducted at Father Muller Medical College Hospital from April 2018 to August 2019. A total of 44 patients aged 18-60 years with chronic lateral epicondylitis were randomly assigned to two groups: PRP (n = 22) and conservative treatment (n = 22). The conservative group received a combination of physiotherapy, analgesics, and a counterforce brace. The primary outcome was measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE) score, assessed at baseline, four weeks, eight weeks, three months, and six months. The PRTEE score includes pain and function subscales. Data was analyzed using appropriate statistical methods, and significance was considered at p < 0.05. Results Both groups significantly improved pain and function during the first eight weeks. However, the PRP group demonstrated superior long-term outcomes. At three and six months, the PRP group had significantly lower pain scores (26.00 ± 3.55 and 19.55 ± 3.33, respectively, p < 0.001) compared to the conservative group (32.23 ± 3.75 and 33.64 ± 3.63). Similarly, the PRP group showed better functional improvement at six months (PRTEE function subscale: 20.00 ± 3.19 in PRP vs. 30.73 ± 4.11 in conservative, p < 0.001). No complications were reported in either group. Conclusions PRP injections provide superior long-term pain relief and functional recovery compared to conservative management in patients with chronic lateral epicondylitis. While conservative treatments are effective in the short term, PRP offers a more durable solution with no reported complications. These findings support the use of PRP as a viable alternative for the long-term management of lateral epicondylitis.

The Impact of Fu's Subcutaneous Needling on Lower Limb Muscle Stiffness in Knee Osteoarthritis Patients: Study Protocol for a Pilot Randomized Controlled Trial.

Knee osteoarthritis (OA) is a leading cause of disability worldwide, with clinicians often observing increased muscle stiffness associated with joint pain and dysfunction. This study examines the impact of Fu's Subcutaneous Needling (FSN), a non-pharmacological technique, on muscle stiffness in the lower limbs of individuals with knee OA. This study protocol is a pilot, single-center, randomized controlled trial. Sixty knee OA patients will be allocated equally for FSN or electroacupuncture (EA) treatments. Interventions will be applied thrice weekly for the first two weeks and twice weekly for the subsequent two weeks for a total of ten sessions. Assessments will be conducted at baseline, post-initial session, after four weeks of intervention, and at the end of a four-week follow-up. The primary outcome will be the muscle stiffness in the lower extremities, as measured by shear wave elastography (SWE). Secondary outcomes include response rate, a reduction in the mean pain intensity on the Numerical Rating Scale (NRS) by at least two points and on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale by six points at week four compared with baseline. Weekly monitoring of the NRS and WOMAC scores will determine the rapidity of pain alleviation and functional improvement, along with 12-item short-form (SF-12) score changes from baseline to week four. This is the first standardized protocol examining the effects of FSN on lower limb muscle stiffness in patients with knee OA by SWE. We hypothesize that FSN could outperform EA in alleviating lower limb stiffness associated with knee OA. Findings will contribute to the body of knowledge regarding the efficacy of acupuncture-derived interventions in managing muscle stiffness and may guide future research directions. The trial has been registered on the Chinese Clinical Trial Registry (Registered number: ChiCTR2300073615). Registered 17 July 2023.

The Influence of Structural Brain Changes on Cognition in the Context of Healthy Aging: Exploring Mediation Effects Through gBAT-The Graphical Brain Association Tool.

The contribution of age-related structural brain changes to the well-established link between aging and cognitive decline is not fully defined. While both age-related regional brain atrophy and cognitive decline have been extensively studied, the specific mediating role of age-related regional brain atrophy on cognitive functions is unclear. This study introduces an open-source software tool with a graphical user interface that streamlines advanced whole-brain mediation analyses, enabling researchers to systematically explore how the brain acts as a mediator in relationships between various behavioral and health outcomes. The tool is showcased by investigating regional brain volume as a mediator to determine the contribution of age-related brain volume loss toward cognition in healthy aging. We analyzed regional brain volumes and cognitive testing data (Montreal Cognitive Assessment [MoCA]) from a cohort of 131 neurologically healthy adult participants (mean age 50 ± 20.8 years, range 20-79, 73% females) drawn from the Aging Brain Cohort Study at the University of South Carolina. Using our open-source tool developed for evaluating brain-behavior associations across the brain and optimized for exploring mediation effects, we conducted a series of mediation analyses using participant age as the predictor variable, total MoCA and MoCA subtest scores as the outcome variables, and regional brain volume as potential mediators. Age-related atrophy within specific anatomical networks was found to mediate the relationship between age and cognition across multiple cognitive domains. Specifically, atrophy in bilateral frontal, parietal, and occipital areas, along with widespread subcortical regions mediated the effect of age on total MoCA scores. Various MoCA subscores were influenced by age through atrophy in distinct brain regions. These involved prefrontal regions, sensorimotor cortex, and parieto-occipital areas for executive function subscores, prefrontal and temporo-occipital regions, along with the caudate nucleus for attention and concentration subscores, frontal and parieto-occipital areas, alongside connecting subcortical areas such as the optic tract for visuospatial subscores and frontoparietal areas for language subscores. Brain-based mediation analysis offers a causal framework for evaluating the mediating role of brain structure on the relationship between age and cognition and provides a more nuanced understanding of cognitive aging than previously possible. By validating the applicability and effectiveness of this approach and making it openly available to the scientific community, we facilitate the exploration of causal mechanisms between variables mediated by the brain.

Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT.

Parallel-group randomised controlled trial. Adolescents aged 11-17 years, diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome and with no local specialist treatment centre, were referred to a specialist service in South West England. Fatigue In Teenagers on the interNET in the National Health Service is a web-based myalgic encephalomyelitis/chronic fatigue syndrome-focused cognitive-behavioural therapy programme for adolescents, supported by individualised written, asynchronous electronic consultations with a clinical psychologist/cognitive-behavioural therapy practitioner. The comparator was videocall-delivered activity management with a myalgic encephalomyelitis/chronic fatigue syndrome clinician. Both treatments were intended to last 6 months. Estimate the effectiveness of Fatigue In Teenagers on the interNET in the National Health Service compared to Activity Management for paediatric myalgic encephalomyelitis/chronic fatigue syndrome. Estimate the effectiveness of Fatigue In Teenagers on the interNET in the National Health Service compared to Activity Management for those with mild/moderate comorbid mood disorders. From a National Health Service perspective, estimate the cost-effectiveness of Fatigue In Teenagers on the interNET in the National Health Service compared to Activity Management over a 12-month horizon. 36-item Short Form Health Survey Physical Function subscale at 6 months post randomisation. Web-based, using minimisation with a random component to balance allocated groups by age and gender. While the investigators were blinded to group assignment, this was not possible for participants, parents/carers and therapists. The treatment of 314 adolescents was randomly allocated, 155 to Fatigue In Teenagers on the interNET in the National Health Service. Mean age was 14 years old and 63% were female. At 6 months, participants allocated to Fatigue In Teenagers on the interNET in the National Health Service were more likely to have improved physical function (mean 60.5, standard deviation 29.5, n = 127) compared to Activity Management (mean 50.3, standard deviation 26.5, n = 138). The mean difference was 8.2 (95% confidence interval 2.7 to 13.6, p = 0.003). The result was similar for participants meeting the National Institute for Health and Care Excellence 2021 diagnostic criteria. Fatigue In Teenagers on the interNET in the National Health Service participants attended, on average, half a day more school per week at 6 months than those allocated Activity Management, and this difference was maintained at 12 months. There was no strong evidence that comorbid mood disorder impacted upon the relative effectiveness of the two interventions. Similar improvement was seen in the two groups for pain and the Clinical Global Impression scale, with a mixed picture for fatigue. Both groups continued to improve, and no clear difference in physical function remained at 12 months [difference in means 4.4 (95% confidence interval -1.7 to 10.5)]. One or more of the pre-defined measures of a worsening condition in participants during treatment, combining therapist and patient reports, were met by 39 (25%) participants in the Fatigue In Teenagers on the interNET in the National Health Service group and 42 (26%) participants in the Activity Management group. A small gain was observed for the Fatigue In Teenagers on the interNET in the National Health Service group compared to Activity Management in quality-adjusted life-years (0.002, 95% confidence interval -0.041 to 0.045). From an National Health Service perspective, the costs were £1047.51 greater in the Fatigue In Teenagers on the interNET in the National Health Service group (95% confidence interval £624.61 to £1470.41). At a base cost-effectiveness threshold of £20,000 per quality-adjusted life-year, the incremental cost-effectiveness ratio was £457,721 with incremental net benefit of -£1001 (95% confidence interval -£2041 to £38). At 6 months post randomisation, compared with Activity Management, Fatigue In Teenagers on the interNET in the National Health Service improved physical function and school attendance. The additional cost of Fatigue In Teenagers on the interNET in the National Health Service and limited sustained impact mean it is unlikely to be cost-effective. This trial is registered as ISRCTN18020851. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/109) and is published in full in Health Technology Assessment; Vol. 28, No. 70. See the NIHR Funding and Awards website for further award information.

Topical Nigella Sativa oil versus diclofenac gel for knee osteoarthritis: A randomized open-labeled active-controlled clinical trial

Osteoarthritis (OA) is the most common cause of pain and disability among older adults. This study aims to compare the effect of topical use of Nigella Sativa (NS) oil and diclofenac gel on pain and function in knee OA (KOA). This randomized clinical trial was performed in a rheumatology clinic. Patients who fulfilled the American College of Rheumatology criteria for OA were selected. The subjects were randomly assigned to apply NS oil or diclofenac gel on the knee joint 4 times a day for 3 weeks. The outcomes, including pain and physical activity, were measured with a visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Of the initial 200 KOA patients who were assessed for eligibility, data from 60 patients (30 in each group) were analyzed. The two groups had no significant difference regarding age, sex, and body mass index. Both interventions showed statistically significant within-group differences in terms of the WOMAC subscales of pain, stiffness, function and VAS of pain (P &lt; 0.001). However, there was no significant difference between the groups. Our findings suggested that topical use of NS oil could be as effective as diclofenac gel in reducing pain and stiffness and improving function in KOA.

Effectiveness of art-based health education on anemia and health literacy among pregnant women in Western Nepal: A randomized controlled trial.

As Nepalese pregnant women vary widely in literacy levels and cultural backgrounds and are reluctant to make decisions about their health, general interventions are insufficient to improve maternal anemia. This study aimed to assess the effectiveness of "face-to-face health education using educational material created using pictures, photos, and nomograms" in reducing anemia and improving health literacy. A total of 156 Nepalese pregnant women with hemoglobin (Hb) levels below 11.0 g/dl were divided into three groups: the education group received three sessions of face-to-face health education using art-based material unaffected by literacy skills; the distribution group received material used in the education group; and the control group underwent general perinatal checkups. Hb levels and health literacy scores were assessed at baseline early pregnancy (8-12 weeks) and late pregnancy (36-40 weeks). A Nepalese version of the 14-item Health Literacy Scale (HLS-14) was developed to assess health literacy. The post-intervention three-group comparison showed a statistically significant difference (P < 0.042) in mean Hb levels after the intervention. Dunnett's test showed a statistically significant difference (P < 0.044) between the education and control groups but no significant difference between the distribution and control groups (P = 0.972). No significant differences in health literacy (total scores and subscales) were observed among the three groups before the intervention in the Kruskal-Wallis test and after the intervention (although there was a trend towards improvement). Total health literacy scores before and after the intervention were statistically significantly different for the total group and all three groups (P<0.001). Only the education group showed statistically significant differences in functional (P<0.012), communication (P<0.004), and critical (P<0.014) literacy subscale scores. Continuous face-to-face health education using literacy material significantly reduced anemia and improved health literacy among Nepalese pregnant women. UMIN Clinical Trials Registry (UMIN-CTR), URL: https://www.umin.ac.jp/ctr/ (Registration number: UMIN000049603).

The association between anxiety and depression symptoms and clinical and pain characteristics in patients with hip and knee osteoarthritis.

This study aimed to estimate the prevalence of anxiety and depression symptoms and explore the association between these symptoms and clinical and pain characteristics in patients with chronic pain (CP) due to hip and knee osteoarthritis (OA). In this cross-sectional study, adult patients with CP and knee and/or hip OA were included. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale. Visual analogue scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) and PainDetect Questionnaire assessed pain characteristics and Health Assessment Questionnaire (HAQ) evaluated functional disability. Correlation coefficients were used to explore the associations between anxiety and depression symptoms and clinical and pain characteristics. A total of 61 patients (age 66.2±9.4 years, 67.2% female) were included. Most patients (70.5%) had clinically significant anxiety and/or depression symptoms. Patients with anxiety and/or depression symptoms had higher pain severity (p=0.032) and disability (p=0.014). Depression symptoms had a moderate positive correlation with WOMAC physical function subscale (r=0.520), WOMAC total (r=0.511) and HAQ (r=0.405). Anxiety and depression symptoms are prevalent in knee or hip OA patients with CP and were associated with higher pain severity and functional disability. These findings support the screening of anxiety and depression symptoms in OA patients, in order to develop more effective multidisciplinary treatments.

Validation of the hip disability osteoarthritis outcome Score-12 shortform in a German cohort

IntroductionTo consider the inherent respondent burden of PROMs, the HOOS-12 as a shortform of the well-established HOOS questionnaire has been published. While the HOOS-12 has been validated in an initial study, further evaluation in other, non-English speaking cohorts is necessary. We therefore aimed to evaluate responsiveness, convergent construct validity, internal consistency, and floor and ceiling effects of the HOOS-12 in a cross-sectoral german cohort.Materials and MethodsEuropean Quality of Life 5 Dimensions scores and HOOS data of patients undergoing total hip arthroplasty (THA) were used for the analyses. HOOS-12 scores were calculated from the full length HOOS. Statistical analysis was conducted, investigating internal consistency, floor and ceiling effects, convergent and discriminant validity, responsiveness, and known-group comparisons.ResultsA ceiling effect was present for postoperative HOOS-12 score and its pain, function and QoL subscales. Internal consistency was high between baseline and all follow ups, inter-item correlation was high (Cronbach’s alpha > 0.30) for HOOS-12 score and all subscales. Correlation of HOOS-12 pain with HOOS pain was high (r = 0.9). Correlation of HOOS-12 function with HOOS ADL and HOOS S/R was high (r = 0.89, r = 0.74). Correlation was moderate between HOOS-12 pain and HOOS-12 function with its respective EQ-5D score (r=-0.58, r=-0.59).ConclusionThe HOOS-12 showed good convergent construct validity and is responsive to changes in pain, function, QoL and hip impact between preoperatively and 1 year postoperatively. A substantial ceiling effect for all subscales at 1 year postoperatively limits the ability to capture variance across particularly well performing patients.Trial RegistrationThe Trial is registered with the German Clinical Trials Register (https://www.drks.de; DRKS00013972; 23 March 23, 2018).