Health-related Functional Status Research Articles

Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis.

More than half of older adults (age ≥ 65 yr) have 2 or more high-burden multimorbidity conditions (i.e., highly prevalent chronic diseases, which are associated with increased health care utilization; these include diabetes [DM], dementia, depression, chronic obstructive pulmonary disease [COPD], cardiovascular disease [CVD], arthritis, and heart failure [HF]), yet most existing interventions for managing chronic disease focus on a single disease or do not respond to the specialized needs of older adults. We conducted a systematic review and meta-analysis to identify effective multimorbidity interventions compared with a control or usual care strategy for older adults. We searched bibliometric databases for randomized controlled trials (RCTs) evaluating interventions for managing multiple chronic diseases in any language from 1990 to December 2017. The primary outcome was any outcome specific to managing multiple chronic diseases as reported by studies. Reviewer pairs independently screened citations and full-text articles, extracted data and assessed risk of bias. We assessed statistical and methodological heterogeneity and performed a meta-analysis of RCTs with similar interventions and components. We included 25 studies (including 15 RCTs and 6 cluster RCTs) (12 579 older adults; mean age 67.3 yr). In patients with [depression + COPD] or [CVD + DM], care-coordination strategies significantly improved depressive symptoms (standardized mean difference -0.41; 95% confidence interval [CI] -0.59 to -0.22; I2 = 0%) and reduced glycosylated hemoglobin (HbA1c) levels (mean difference -0.51; 95% CI -0.90 to -0.11; I2 = 0%), but not mortality (relative risk [RR] 0.79; 95% CI 0.53 to 1.17; I2 = 0%). Among secondary outcomes, care-coordination strategies reduced functional impairment in patients with [arthritis + depression] (between-group difference -0.82; 95% CI -1.17 to -0.47) or [DM + depression] (between-group difference 3.21; 95% CI 1.78 to 4.63); improved cognitive functioning in patients with [DM + depression] (between-group difference 2.44; 95% CI 0.79 to 4.09) or [HF + COPD] (p = 0.006); and increased use of mental health services in those with [DM + (CVD or depression)] (RR 2.57; 95% CI 1.90 to 3.49; I2 = 0%). Subgroup analyses showed that older adults with diabetes and either depression or cardiovascular disease, or with coexistence of chronic obstructive pulmonary disease and heart failure, can benefit from care-coordination strategies with or without education to lower HbA1c, reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. PROSPERO-CRD42014014489.

Functional status and annual hospitalization in multimorbid and non-multimorbid older adults: a cross-sectional study in Southern China

BackgroundHospitalization over the last one year, an indicator of health service utilization, is an important and costly resource in older adult care. However, data on the relationship between functional status and annual hospitalization among older Chinese people are sparse, particularly for those with and without multimorbidity. In this study,we aimed to examine the association between functional status and annual hospitalization among community-dwelling older adults in Southern China, and to explore the independent contributions of socio-demographic variables, lifestyle and health-related factors and functional status to hospitalization in multimorbid and non-multimorbid groups.MethodsThis cross-sectional, community-based survey, studied 2603 older adults aged 60 years and above. Functional status was assessed by Functional Independence Measure (FIM). The outcome variable was any hospitalization over the last one year (annual hospitalization). Clustered logistic regression was used to analyze the independent contributions of FIM domains to annual hospitalization.ResultsOnly in the multimorbid group, did the risk of annual hospitalization decrease significantly with increasing FIM score in walk domain (adjusted OR = 0.80 per SD increase, 95% CI = 0.70–0.91, P = 0.001) and its independent contribution accounted for 24.62%, more than that of socio-demographic variables (18.46%). However, among individuals without multimorbidity, there were no significant associations between FIM domains and annual hospitalization; thus, no independent contribution to the risk of hospitalization was observed.ConclusionsThere exist some degree of correlation between functional status and annual hospitalization among older adults in Southern China, which might be due to the presence of multimorbidity with advanced age.

Functional status in patients with medically unexplained physical symptoms: Coping styles and their relationship with depression and anxiety

This study examined how coping styles are related to functional status in patients with medically unexplained physical symptoms and to what extent depression and anxiety account for this relationship. In 90 Dutch adult patients presenting medically unexplained physical symptoms, coping styles, health-related functional status, anxiety, and depression were measured. Multiple regression analyses and mediation analysis showed that coping styles were directly and indirectly related to functional status. In this relationship, depression and anxiety played an important role. The findings highlight the relevance of addressing coping styles, depression, and anxiety when targeting the functional status of patients with medically unexplained physical symptoms in clinical practice.

The Impact of Coronary Bifurcation Stenting Strategy on Health-Related Functional Status: A Quality-of-Life Analysis From the BBC One (British Bifurcation Coronary; Old, New, and Evolving Strategies) Study

This study sought to assess the impact of coronary bifurcation stenting on health-related functional status, using the Seattle Angina Questionnaire (SAQ), for participants in the BBC ONE (British Bifurcation Coronary; Old, New, and Evolving Strategies) trial and to compare simple versus complex bifurcation stenting strategies in this regard. Large randomized studies have examined outcomes from bifurcation stenting with drug-eluting stents. They have reported on major adverse cardiovascular events and angiographic follow-up. However, a principal goal of percutaneous coronary intervention is symptom control and improvement in quality of life, yet there are no published data from these trials on this aspect. Furthermore, it is unknown whether simple versus complex stenting strategies have different effects on angina control and quality of life. The BBC ONE study randomized 500 subjects to bifurcation stenting using either a simple (provisional T) or complex (crush or culotte) approach. Subjects completed the SAQ at baseline and at 9 months after percutaneous coronary intervention. Canadian Cardiovascular Society class and antianginal drug use were also evaluated. Bifurcation stenting was associated with significant improvements on SAQ scales and in Canadian Cardiovascular Society class (baseline: 5.3% subjects were class 0; follow-up: 64.0% were class 0; p < 0.001) and a significant reduction in the number of antianginal drugs used (median decrease: 1; p < 0.001). Simple and complex strategies did not differ significantly for changes in the SAQ, actual SAQ scores, or use of antianginal drugs. Regardless of chosen strategy, bifurcation stenting produced significant functional improvements in angina-related health. No significant difference between simple and complex strategies was found in this regard.

Quality of life of patients with amyotrophic lateral sclerosis

The aim of this study is to evaluate the correlation between different measures of quality of life (QoL), functional status and mood status in patients with amyotrophic lateral sclerosis (ALS). A sample of 40 patients with ALS was recruited and scales for the evaluation of health-related QoL (SF36), patient-centered QoL (SEIQoL), functional status (ALSFRS) and depression (ZDS) have been administered to them. All the correlations (Pearson's r) between the scores have been considered and the t-test was performed in order to compare male with female patients. No correlation emerged between the different measures of QoL and functional status, apart from the scores of the Physical Functioning subscale of the SF36 which resulted positively correlated (p < 0.01) with those of the ALSFRS. Mood status resulted negatively correlated with many aspects of health-related QoL but not with patient-centred QoL. Data suggest that the relationship between functional status and different domains of QoL in this population of patients with a severely compromising disease is not linear and that the satisfaction with life of the patients themselves is not strongly related to the level of physical impairment.

Psychometric properties of the patient activation measure among multimorbid older adults.

The Patient Activation Measure (PAM) quantifies the extent to which people are informed about and involved in their health care. Objectives were to determine the psychometric properties of PAM among multimorbid older adults and evaluate a theoretical, four-stage model of patient activation. Methods. A cross-sectional analysis was used to assess the psychometric properties of PAM. Internal consistency was assessed using Cronbach α. Construct validity was evaluated using general linear modeling to compute associations between PAM scores and health-related behaviors, functional status, and health care quality. Latent class analysis was used to evaluate the theoretical four-stage structure of patient activation. Participants in a randomized trial of Guided Care (N = 855), a model of comprehensive health care for older adults with chronic conditions that put them at risk of using health services heavily during the coming year. Higher PAM activation scores and stage were positively associated with higher functional status, health care quality, and adherence to some health behaviors. Latent class analysis supported the multistage theory of patient activation. The PAM is a reliable, valid, and potentially clinically useful measure of patient activation for multimorbid older adults.

Poster 50: Health-related Functional Status Evaluations in Patients with Osteoarthritis Pain Treated With Tapentadol Extended Release

Poster 50: Health-related Functional Status Evaluations in Patients with Osteoarthritis Pain Treated With Tapentadol Extended Release

Functional independence and health-related functional status following spinal cord injury: A prospective study of the association with physical capacity

To determine changes in functional independence following spinal cord injury and to evaluate the association between functional independence and physical capacity. Multi-centre prospective cohort study. Patients with spinal cord injury admitted for initial rehabilitation. The motor Functional Independence Measure (FIMmotor) was determined at the start of rehabilitation (n = 176), 3 months later (n = 124), at discharge (n = 160) and one year after discharge from inpatient rehabilitation (n = 133). One year after discharge, physical and social dimensions of health-related functional status (Sickness Impact Profile 68; SIP68) were determined. On each occasion, physical capacity was established by measuring arm muscle strength, peak power output and peak oxygen uptake. Multi-level random coefficient analyses revealed that FIMmotor improved during inpatient rehabilitation, but stabilized thereafter. Changes in FIMmotor were associated with peak power output. Multiple regression models showed that FIMmotor and peak power output at discharge were associated with FIMmotor one year after discharge (R2 = 0.85), and that peak power output at discharge was associated with the social dimension of the SIP68 (R2 = 0.18) one year after discharge. Functional independence improves during inpatient rehabilitation, and functional independence is positively associated with peak power output.

Effects of training and albuterol on pain and fatigue in facioscapulohumeral muscular dystrophy

BackgroundWe recently reported a randomised controlled trial on the efficacy of strength training and the β 2-adrenergic agonist albuterol in patients with facioscapulohumeral muscular dystrophy (FSHD). Strength training and albuterol appeared safe interventions with limited positive effect on muscle strength and volume. We concurrently explored the prevalence and the characteristics of pain and fatigue in the participating FSHD patients, because these are probably underreported but clinically relevant symptoms in this disorder. Next, we studied the effects of albuterol and strength training on pain, experienced fatigue, healthrelated functional status and psychological distress.MethodsSixty-five patients were randomised to strength training of elbow flexors and ankle dorsiflexors or nontraining. After 26 weeks, albuterol (sustained-release, 8 mg bid) was added in a randomised, doubleblind, placebo-controlled design. Outcomes comprised self-reported pain, experienced fatigue, functional status and psychological distress obtained with validated questionnaires at 52 weeks.ResultsEighty percent of patients reported chronic persistent or periodic, multifocal pains. Thirtyfour percent of the participants were severely fatigued. Strength training and albuterol failed to have a significant effect on all outcomes.ConclusionsPain and fatigue are important features in FSHD. Strength training and albuterol do not have a positive or negative effect on pain, experienced fatigue, functional status and psychological distress.

Recall bias did not affect perceived magnitude of change in health-related functional status

Background and Objective It was hypothesized that within an invasively treated group and within a group that improved in angina pectoris no difference in effect size would occur between prospective and retrospective measures. Furthermore, it was hypothesized that assessment of perceived change at post-test may be invalid because of recall bias and present-state bias. Study Design and Setting Effect sizes (as standardized response means) were used as indicators of magnitude of change. Linear structural equation analysis (with LISREL) was used to investigate the relationship between the estimates of recall accuracy and retrospectively assessed change. Results No significant differences were found between prospective and retrospective measures of change over time in health-related functional status. Recall bias was not associated with retrospective measurement of change within a 12-week interval. An expected present-state effect was found in a structural equation model. Conclusion Prospective and retrospective indices of magnitude of change were similar between groups receiving treatment of known efficacy. Recall bias seems to be an acceptable risk in short-term follow-up studies.

The Multi-Ethnic Pediatric Eye Disease Study: Design and Methods

Purpose: To summarize the study design of the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). Methods: The objectives of the MEPEDS are to: (1) estimate age- and ethnicity-specific prevalence of strabismus, amblyopia, and refractive error; (2) evaluate the association of selected risk factors with these ocular disorders; and (3) evaluate the association of ocular conditions on limitations in health-related functional status in a population-based sample of 12,000 children aged 6–72 months from four ethnic groups—African-American, Asian-American, Hispanics/Latinos and non-Hispanic White. Each eligible child undergoes an eye examination, which includes an interview with his/her parent. The interview includes an assessment of demographic, behavioral, biological, and ocular risk factors and health-related functional status. The examination includes fixation preference testing, visual acuity, stereoacuity, axial length measurement, cycloplegic refraction, keratometry, eye alignment, and anterior and posterior segment examination.

Long term effect (more than five years) of intrathecal baclofen on impairment, disability, and quality of life in patients with severe spasticity of spinal origin

Objectives: To evaluate long term change in impairment, disability, and health related functional status in patients with severe spasticity who received intrathecal baclofen. Methods: A long term (more than five...

Individual quality of life is not correlated with health-related quality of life or physical function in patients with amyotrophic lateral sclerosis.

We compared the change over time of individual quality of life (QOL) versus health-related QOL (HRQOL) and functional status in palliative care patients with amyotrophic lateral sclerosis (ALS). Forty-two patients with ALS performed the following assessments: the ALS functional rating scale (ALSFRS), the Sickness Impact Profile (SIP), the Short Form 36 (SF-36), and the Schedule for the Evaluation of Individual QOL-Direct Weighting (SEIQOL-DW). The SF-36 and the SEIQOL-DW were assigned at random. Patients were examined at least three times at 2-month intervals. There was a significant decrease from visit 1 to 3 (4-month period) in the function-based values of the SIP, SF-36, and ALSFRS. Despite this progressive decline of physical function and HRQOL, individual QOL as assessed by the SEIQOL-DW remained stable throughout the observation period. Correspondingly, there was a clear correlation between the ALSFRS, the SIP, and the SF-36, but no correlation between these scales and the SEIQOL-DW. The QOL domains most often named in the SEIQOL-DW were family, friends/social life, health, and profession. Thus, individual QOL appears to be largely independent from physical function in severely ill patients with ALS. Because of the characteristics of the scale, assessment of individual QOL may have an interventional value in palliative care.

Monitoring the functional health status of stroke patients: the value of the Stroke-Adapted Sickness Impact Profile-30

Purpose: To further validate the Stroke-Adapted Sickness Impact Profile-30 (SA-SIP30) and to determine its responsiveness in a stroke rehabilitation population.Method: Data of 122 communicative stroke patients (mean age 57 years), selected for an inpatient rehabilitation programme, were available. All had suffered different types of stroke. Six months and one year post-stroke, the patients completed the SIP68 plus nine stroke-specific questions from the SIP136, enabling us to derive the SA-SIP30 from the questionnaire. We determined internal consistency, construct and clinical validity and responsiveness of the SA-SIP30. Total, physical and psychosocial dimension scores were calculated.Results: Internal consistency was moderate to good (α > 0.68) and correlation between the SIP68 and the SA-SIP30 was high (r > 0.85), indicating good construct validity for total score and both dimension scores. Clinical validity assessment showed that total and psychosocial dimensions scores were significantly higher for patients with a cortical infarction compared to respectively subarachnoid haemorrhage and subcortical infarction (p < 0.05). Effect sizes for the SA-SIP30 were moderate (between 0.56 and 0.65).Conclusions: The SA-SIP30 proved valid and responsive in our stroke rehabilitation population. The major advantages of the SA-SIP30 are the lesser number of items and, therefore, the shorter completion time and the fact that it is a stroke-specific scale to determine health-related functional status.

Individual quality of life of patients undergoing autologous peripheral blood stem cell transplantation

Most quality-of-life (QoL) studies in autologous Peripheral Blood Stem Cell Transplantation (PBSCT) are descriptive and concentrate on symptom severity and functional deficits. The aim of this study is to compare individual QoL (iQoL) with health-related QoL (hrQoL) and functional status of patients before high-dosed therapy/PBSCT. Multiple Myeloma, non-Hodgkin's Lymphoma and other tumor patients were asked to complete the following measures before high-dosed therapy/PBSCT: the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-life Questionnaire Core 30 (QLQ-C30), and the Schedule for the Evaluation of Individual QoL-Direct Weighting (SEIQoL-DW), a patient-generated instrument which allows the patients to nominate the five most important domains (cues) for their present QoL. The SEIQoL-DW assessment generates: (1) a global QoL score (SEIQoL-INDEX), calculated as Sigma(levelsxweights); (2) the current overall QoL, rated on a visual analogue scale (VAS). Additional measures included demographic data, clinical disease status of remission and Karnofsky's index. Seventy-nine patients completed both types of questionnaires. The QoL domains nominated by the patients were assigned to groups (aggregated cues), the most frequent of which were family (89%), hobbies/pastimes (74%), health (physical, including mobility) (70%), profession/occupation (51%), social life/friends (47%) and marriage/partnership (33%). There was no correlation between the SEIQoL-DW total scores and the EORTC QLQ-C30 scale or the Karnofsky index. Individual QoL as assessed by the SEIQoL-DW is unrelated to standard health-status measures such as the EORTC QLQ-C30 or the Karnofsky index. Patient-perceived iQoL in PBSCT seems to depend largely on areas others than health and physical functioning, with the family playing a prominent role.

Un outil francophone de mesure de la qualité de vie de l’aphasique : le SIP-65

Objectives. – To develop and demonstrate validity and reliability of a aphasic-adapted version of the Sickness Impact Profile (SIP-136), a generic widespread questionnaire used to measure quality of life (QoL). Design. – Survey, outpatient oral interviews. Population. – Aphasic people from 20 to 80 years old, with a time from stroke or trauma of more than 12 months, living at home for more than six months, able to understand the questions with a Z-score profile at Boston Diagnostic Aphasia Examination above average for oral comprehension. Method. – 1. Developments of the short version of the SIP-136, from a first sample of aphasic people; 35 patients were included with a mean time from stroke or trauma of 17 months. This first step consisted in excluding the least relevant items and/or subscales, rewriting some items to make them easier to understand, studying redundancy by multiple components analysis (MCA) and deleting some redundant items. 2. Validity compared with initial SIP-136 and reliability (inter-rater and test-retest) from a second sample of 55 aphasic people (mean time from stroke or trauma = 23 months). Results. – 1. The first step of development led to a short version with eight subscales and 65 items (SIP-65) exploring physical, psychological and social components of QoL; it took about 16 min to fill it, less than half of the time necessary for the SIP-136. 2. Linear correlation of the responses between SIP-65 and SIP-136 was good: r = 0.97 ; p < 10 –6. SIP-65 demonstrated a good test-retest ( r = 0.97 ; p < 10 –6) and inter-rater ( r = 0.92 ; p < 10 –6) reliability. Discussion and conclusion. – SIP-65, a short version of SIP-136, is feasible and clinically sound and must be recommended to assess health-related functional status of French aphasic people.

Health related functional status in men with spinal cord injury: relationship with lesion level and endurance capacity.

Cross-sectional study. To determine the relationship of health related functional status with lesion level and endurance capacity in persons with spinal cord injury (SCI). Thirty-seven men with SCI were divided in four lesion groups: high tetraplegia (motor complete; C5-C6, n=10), low tetraplegia (motor complete, C6/7-C8, n=9), motor incomplete tetraplegia (n=7), and paraplegia (n=11). Health related functional status was measured with the short version of the Sickness Impact Profile (SIP68), including a physical (SOM), psychological (PSY) and social subscore (SOC). Endurance capacity, defined as maximal power output (PO(max)) and peak oxygen uptake (VO(2peak)), was measured in a maximal exercise test on a wheelchair ergometer. Total SIP68-score and SOM were significantly different between lesion groups, showing higher values in the high- and low-tetraplegia group. There were no differences between lesion groups for PSY and SOC subscores. VO(2peak) and PO(max) were significantly higher in the paraplegia group, compared to the high and low tetraplegia groups. VO(2peak) was also higher in the motor incomplete versus other tetraplegia groups. Significant Spearman correlation coefficients were found for VO(2peak) and PO(max) with SIP68 and SOM (ranging from -0.68 to -0.79) and SOC (ranging from -0.39 to -0.51). No significant relationship was found with PSY. Hierarchical regression analysis showed that after correction for lesion level, 22% of the variance of SIP68, 8% of the variance of SOM, and 30% of the variance of SOC was explained by PO(max) or VO(2peak). Results indicate that there is an evident relationship between the physical dimensions of health related functional status and lesion level, but not for the psychological and social dimensions. After controlling for lesion level a significant amount of the variance of health related functional status can be explained by endurance capacity parameters. Although no causal relationships can be established in this cross-sectional study, these results suggest that functional status may be improved by increasing the endurance capacity.

How to validate clinically important change in health-related functional status. Is the magnitude of the effect size consistently related to magnitude of change as indicated by a global question rating?

Some clinical trials perform repeated measurement over time and estimate clinically relevant change in an instrument's score with global ratings of perceived change or so-called transition questions. The conceptual and methodological difficulties in estimating the magnitude of clinically relevant change over time in health-related functional status (HRFS) are discussed. This paper investigates the concordance between the amount of serially assessed change with effect size estimates (the researcher's perspective) and global ratings of perceived change (the patient's perspective). A total of 217 patients who were scheduled for diagnostic examination were included, and the Minnesota Living with Heart Failure Questionnaire, extended with MOS-20 items, was assessed before and after medical intervention (percutaneous transluminal coronary angioplasty, coronary artery bypass grafting or pharmaco-therapy). Global questions were applied to assess perceived change over time for every item from domains of physical and emotional functioning and used as the external criterion of relevant change in the analysis of items. Global questions corresponding with overall change in these domains were used in the comparison of change in physical and emotional functioning scales. Two effect size indices were used: (i) ES (mean change/SDpooled) and (ii) ES (mean change/SDchange). A method is described to calculate a value indicating the extent of discordance between the researcher's interpretation of magnitude of change and the external criterion (the patient's perspective). Findings suggest that effect size (ES) (mean change/SDpooled) was in keeping with the magnitude of change indicated by patients' judgements, or their category of subjective meaning, for all scales. Furthermore, in cases in which the magnitude of change estimated with the SRM (mean change/SDchange) was not confirmed empirically by the external criterion ratings, the discordance could be interpreted as a trivial discordance.

Health-Related Functional Status in Pregnancy

Health-Related Functional Status in Pregnancy

Health-related functional status in pregnancy: relationship to depression and social support in a multi-ethnic population

Objective: To describe perceived well-being and functional status during uncomplicated late pregnancy among low-income minority women, and to examine the relationship of functional status to depression and social support. Methods: Hispanic and black women with low-risk pregnancies completed an interview consisting of demographics, the Medical Outcomes Study Short Form 36 (SF-36), Beck Depression Inventory-II (BDI-II), and the Norbeck Social Support Questionnaire. Results: Of the 155 women who were eligible and asked to participate, 41 refused for a participation rate of 74%. Results of the SF-36 showed lowest perceived well-being in the vitality and physical role dimensions. Depressive symptomatology was high, with a mean BDI score of 15 (standard deviation 8.6). Using a BDI score of 14 as the cutoff point, over half of the sample was categorized as having significant depressive symptoms. Significantly lower functional status was seen for depressed subjects in all subscales of the SF-36 compared with nondepressed subjects. Although functional status was negatively correlated with BDI score in all dimensions ( r = .23–.69), correlation of SF-36 scores with social support was much weaker ( r = .06–.24). Conclusion: Elevated levels of depressive symptomatology are strongly correlated with lowered health-related functioning and perceived well-being. Social support is not associated with increased physical or emotional well-being but is weakly associated with mental health as measured by the SF-36.