Improvement In Health-related Quality Of Life Research Articles

Fifteen-year changes in health-related quality of life after bariatric surgery and non-surgical obesity treatment

BackgroundEvidence on the long-term (≥10 years) development of health-related quality of life (HRQoL) following bariatric surgery is still limited and mainly based on small-scale studies. This study aimed to investigate (1) 15-year changes in mental, physical, social, and obesity-related HRQoL after bariatric surgery and non-surgical obesity treatment; and (2) whether sociodemographic factors and pre-operative health status are associated with 15-year HRQoL changes in the surgery group.MethodsParticipants were from the non-randomized, prospective, controlled Swedish Obese Subjects study. The surgery group (N = 2007, per-protocol) underwent gastric bypass, banding or vertical banded gastroplasty, and matched controls (N = 2040) received usual obesity care. Recruitment took place in 1987–2001 and measurements (including six HRQoL scales) were administered before treatment and after 0.5, 1, 2, 3, 4, 6, 8, 10 and 15 years. Multilevel mixed-effect regression models using all observations for estimation were conducted.ResultsSurgical patients experienced greater 15-year improvements in perceived health and overall mood, and greater reductions in depression, obesity-related problems, and social interaction limitations than controls (all p < 0.001, adjusted for baseline differences). Effect size (ES) was classified as large only for obesity-related problems (ES = 0.82). At the 15-year follow-up, surgical patients reported better perceived health (p < 0.001) and less obesity-related problems (p = 0.020) than controls. In the surgery group, patients with baseline diabetes had smaller 15-year reductions in social interaction limitations (p < 0.001) and depression (p = 0.049) compared to those without baseline diabetes. Although surgical patients with a history of psychiatric disorder reported lower HRQoL than those without such history over the 15-year follow-up, there were no significant differences in the long-term improvements between the two groups (p = 0.211–0.902).ConclusionsOver 15 years, surgical patients experienced more positive development of HRQoL compared to those receiving usual care. This difference was large for obesity-related problems, but otherwise the differences were small. Patients with pre-operative diabetes might be at increased risk for smaller long-term HRQoL improvements.

Changes in Health-Related Quality of Life by Patient Education and Rehabilitation Based on a Behavior Change Program in Knee Osteoarthritis.

The purpose of this study was to examine how rehabilitation and patient education for knee osteoarthritis improves health-related quality of life (HRQOL) and to identify factors influencing HRQOL. Between May 2020 and March 2022, 30 patients with osteoarthritis of the knee were treated conservatively and rehabilitated with a patient education program. The patient education program was based on the health belief model by Sedlak et al., and patient education using pamphlets was provided during the rehabilitation intervention. The survey items were patient basic information, instrumental activities of daily living (ADL) (FAI), fear of falling (FES), degree of depression (GDS), HRQOL (SF-8), knee function assessment (JOA score), and X-ray classification (K-L classification), and the survey method was a self-administered questionnaire at the start of rehabilitation, 1 month after the intervention, and at the end of the rehabilitation intervention. We examined factors affecting the physical component summary (PCS) and mental component summary (MCS) of HRQOL scores. JOA score, FES, FAI, GDS, and SF-8 improved significantly (p<0.01). MCS was also negatively correlated with FES and age (r=-0.486, -0.368). Sex was extracted as a factor for PCS as a factor affecting HRQOL (p<0.01). MCS was extracted with FES as a factor (p=0.046). A rehabilitation intervention incorporating patient education in osteoarthritis of the knee showed improvement in HRQOL and may be useful for improving depression, fear of falling, and instrumental ADL.

Predictors of health-related quality of life after total knee arthroplasty: a case–control study

Total knee arthroplasty (TKA) improves patients’ Health-related quality of life (HRQoL) compared to before surgery. However, based on our knowledge, the improvement in HRQoL after TKA, which depends on various factors, has yet to be investigated compared to healthy people. This study aimed to evaluate the HRQoL of patients compared to healthy people and the factors affecting the HRQoL after TKA. In this matched case–control study (1002 participants), HRQoL in 501 patients who underwent TKA between 2015 and 2022 at Shafa Yahyainan Hospital affiliated with Iran University of Medical Sciences were compared with 501 healthy controls. HRQoL was evaluated in two parts (before compared to 12 months after TKA and 12 months after TKA compared to the healthy population). The 36-item short-form health survey (SF-36) was used to evaluate HRQoL 12 months after surgery. The influencing factors on HRQoL were evaluated by multivariate logistic regression analysis. No significant difference was observed in the demographic characteristics of the participants in the two groups. The mean overall SF-36 score, 12 months after surgery, significantly improved compared to before surgery (64.21 ± 22.2 vs. 37.55 ± 15.13, p:0.001). The mean total score of SF-36 was statistically similar between the case and control groups (64.21 ± 22.2 VS 72.53 ± 25.3). The multivariate analysis showed that sex, BMI, number of comorbidities, postoperative compliance, and complications were significantly related to the decrease in patients’ HRQoL (P < 0.001).TKA can improve the HRQoL except for two subscales of happiness/vitality and physical performance, similar to the healthy population. Female gender, obesity and overweight, comorbidity, bilateral TKA, non-adherence to postoperative physiotherapy, and complications were associated with decreased HRQoL.

Efficacy of Inhaled Corticosteroids in Patients with Bronchiectasis without Airway Hyperresponsiveness: A Pilot Study

ABSTRACT Background: The effect of inhaled corticosteroids (ICS) in stable cases of bronchiectasis without hyperresponsiveness has not been studied. The objective of the study was to assess the effect of inhaled fluticasone 500 μg twice daily on health-related quality of life (HRQoL), pulmonary function, and frequency of exacerbations in stable patients of bronchiectasis without bronchial hyperresponsiveness (BHR) diagnosed by indirect bronchoprovocation test. Materials and Methods: It was a pilot study with an open-label randomized control design conducted in a Tertiary Care Chest Hospital, with 40 patients in each arm. Bronchiectasis was diagnosed by high-resolution computed tomography chest. Patients with BHR were excluded by performing an indirect bronchoprovocation test using inhaled adenosine monophosphate. Eighty patients meeting the inclusion criteria were randomized into intervention group (IG) receiving 500 μg fluticasone propionate twice a day and control group (CG) receiving standard care without ICS. Both groups were assessed monthly till 6 months. Clinical data (mainly forced expiratory volume in 1st s [FEV1], number of exacerbations, HRQoL by St. George respiratory questionnaire (SGRQ) was collected at baseline and end of 6 months. Results: Eighty (IG - 40, CG - 40) patients of stable state noncystic fibrosis bronchiectasis completed the study. The mean age in our study was IG 49.7 ± 17.6 vs. CG 49.9 ± 16.6, males IG 62.5% vs. CG 60%, most common etiology was tuberculosis IG 40% (16/40) vs CG 37.5% (15/40). Difference in SGRQ score (baseline end of treatment) IG 5.47 vs. CG 1.65 (p = 0.00). Difference in FEV1 IG 0.054L vs. CG 0.004L (P = 0.00), mean number of exacerbations at end of treatment IG – 1 ± 0.9 vs. CG 1.2 ± 1.1. Conclusion: Patients with stable bronchiectasis without BHR, treated with inhaled fluticasone 500 μg twice daily for 6 months showed a clinically significant improvement in HRQoL. No statistically significant difference was seen in pulmonary function and frequency of exacerbations.

Evaluating the Health-Related Quality of Life in Patients with COPD and Chronic Heart Failure Post-Hospitalization after COVID-19 Using the EQ-5D and KCCQ Questionnaires.

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) frequently coexist, significantly impacting health-related quality of life (HRQoL). This study evaluated HRQoL in patients with CHF, COPD, or both, three months post-COVID-19 discharge using EQ-5D and KCCQ questionnaires to guide targeted healthcare interventions. We conducted a cross-sectional study at "Victor Babes" Hospital in Timisoara, enrolling 180 patients who had recovered from COVID-19 (60 in each group including CHF, COPD, and both conditions). HRQoL was assessed via EQ-5D and KCCQ. Significant disparities in HRQoL measures were noted across the groups. Patients with both CHF and COPD reported the worst outcomes, especially in terms of hospital stay lengths due to COVID-19 (11.63 days) and initial oxygen saturation levels (88.7%). HRQoL improvements from discharge to three months post-discharge were significant, with EQ-5D mobility scores improving notably across all groups (CHF and COPD: 2.87 to 2.34, p = 0.010). KCCQ results reflected substantial enhancements in physical limitation (CHF and COPD: 38.94 to 58.54, p = 0.001) and quality of life scores (CHF and COPD: 41.38 to 61.92, p = 0.0031). Regression analysis revealed that dual diagnosis (CHF and COPD) significantly impacted usual activities and quality of life (β = -0.252, p = 0.048; β = -0.448, p = 0.017), whereas the initial severity of COVID-19 was a significant predictor of worse HRQoL outcomes (β = -0.298, p = 0.037; β = -0.342, p = 0.024). The presence of both CHF and COPD in patients recovering from COVID-19 was associated with more severe HRQoL impairment compared with either condition alone. These findings emphasize the need for specialized, comprehensive post-COVID-19 recovery programs that address the complex interplay among chronic conditions to optimize patient outcomes and enhance quality of life.

The role of symptom reduction in improving health-related quality of life through brief cognitive behavioral therapy

Objective Brief cognitive behavior therapy (bCBT) is effective in reducing symptoms of depression and anxiety disorders and improving health-related quality of life (HRQoL). However, the mechanisms through which cognitive behavior therapy impact HRQoL are not well understood. This study evaluated whether anxiety and depression symptom reduction is a mechanism of treatment for HRQoL outcomes. Method: Using secondary data from a multisite, pragmatic, randomized trial, this study evaluated bCBT vs enhanced usual care in 16 VA community-based outpatient clinics. Ordinary least-squares path analysis testing multiple mediators was used to evaluate the role of change in depression and anxiety symptoms in the relationship between treatment condition and HRQoL. Results: Receiving bCBT (vs. enhanced usual care) was significantly negatively associated with change (reduction) in depression and anxiety scores. The indirect effect of treatment on mental HRQoL was significant with change in depression scores as mediator. A similar pattern was observed for physical HRQoL and change in anxiety scores as mediator. Conclusion: Findings suggest reduction of depression and anxiety symptoms as a mechanism through which bCBT for depression promoted improvements in HRQoL, with important implications for understanding how CBT impacts functioning, as well as the utility of bCBT in nontraditional mental health settings. Trial registration: ClinicalTrials.gov identifier: NCT02466126.

Health-related quality of life in elderly cardiac patients undergoing cardiac rehabilitation and the association with exercise capacity: The EU-CaRE study.

The ability to be physically active is pivotal to the quality of life in elderly patients. This study aims to describe the association between exercise capacity and health-related quality of life (HRQoL), anxiety, and depression following an exercise-based cardiac rehabilitation (CR) program in elderly cardiac patients. Patients aged ≥65 years with acute and chronic coronary syndrome or heart valve surgery were consecutively included from 8 CR centers in 7 European countries. Exercise capacity (VO2peak(ml/kg/min)) was assessed with a cardiopulmonary exercise test (97%) or a six-minute walk test. Outcome variables included HRQoL (SF-36 physical and mental component scores (PCS and MCS)), anxiety (GAD-7), and depression (PHQ-9). Mixed models were used to address the association between baseline and the development in VO2peak, and outcome variables stratified on sex, and adjusted for baseline values, age, and CR center. A total of 1,633 patients were included (T0), 1,523 (93%) completed end-of-CR assessment (T1), and 1,457 (89%) 1-year follow-up (T2). Women had higher % of predicted VO2peak, but poorer scores in HRQoL, anxiety and depression at all time-points. All scores improved in both sexes at follow-up. We found significant associations between VO2peak at baseline as well as development in VO2peak and all outcome variables at T1 and T2 in men (all p < 0.001). In women, VO2peak was only associated with PCS scores (p < 0.001). Improvements in exercise capacity was strongly associated with improvements in HRQoL and mental health, however with stronger associations in men. The results highlight the importance of physical fitness for HRQol and mental health. The findings from this study might be useful to better target individual CR programs.

Patient-Reported and Clinical Outcomes of Surgically Treated Patients With Symptomatic Spinal Metastases: Results From Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO), a Prospective, Multi-Institutional and International Study.

The palliative impact of spine surgery for metastatic disease is evolving with improvements in surgical technique and multidisciplinary cancer care. The goal of this study was to prospectively evaluate long-term clinical outcomes including health-related quality-of-life (HRQOL) measures, using spine cancer-specific patient-reported-outcome (PRO) measures, in patients with symptomatic spinal metastases who underwent surgical management. The Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO, ClinicalTrials.gov identifier: NCT01825161) trial is a prospective-observational cohort study that included 10 specialist centers in North America and Europe. Patients aged 18 to 75 years who underwent surgery for spinal metastases were included. Prospective assessments included both spine tumor-specific and generic PRO tools which were collected for a minimum of 2 years post-treatment or until death. Two hundred and eighty patients (51.8% female, mean age 57.9 years) were included. At presentation, the mean Charlson Comorbidity Index was 6.0, 35.7% had neurological deficits as defined by the American Spinal Cord Injury Association scores, 47.2% had high-grade epidural spinal cord compression (2-3), and 89.6% had impending or frank instability as measured by a Spinal Instability Neoplastic Score of ≥7. The most common primary tumor sites were breast (20.2%), lung (18.8%), kidney (16.2%), and prostate (6.5%). The median overall survival postsurgery was 501 days, and the 2-year progression-free-survival rate was 38.4%. Compared with baseline, significant and durable improvements in HRQOL were observed at the 6-week, 12-week, 26-week, 1-year, and 2-year follow-up assessments from a battery of PRO questionnaires including the spine cancer-specific, validated, Spine Oncology Study Group Outcomes Questionnaire v2.0, the Short Form 36 version 2, EuroQol-5 Dimension (3L), and pain numerical rating scale score. Multi-institutional, prospective-outcomes data confirm that surgical decompression and/or stabilization provides meaningful and durable improvements in multiple HRQOL domains, including spine-specific outcomes based on the Spine Oncology Study Group Outcomes Questionnaire v2.0, for patients with metastatic spine disease.

The Exercise Right for Active Ageing study: A pre-post evaluation of health-related quality of life and cost-utility in older Australians following a 12-week exercise programme

ObjectivesTo determine the effect of a 12-week subsidised exercise programme on health-related quality of life (HRQoL) in community-dwelling older Australians, and the cost-utility of the programme. DesignQuasi-experimental, pre-post study. MethodsParticipants included community-dwelling older adults, aged ≥65 years, from every state and territory of Australia. The intervention consisted of 12 one-hour, weekly, low-to-moderate-intensity exercise classes, delivered by accredited exercise scientists or physiologists (AESs/AEPs). Health-related quality of life was measured before and after programme participation using the EQ-5D-3L and converted to a utility index using Australian value tariffs. Participant, organisational and service provider costs were reported. Multivariable linear mixed models were used to evaluate the change in HRQoL following programme completion. Cost-utility outcomes were reported as incremental cost-effectiveness ratios (ICERs), based on programme costs and the change in utility scores. Results3511 older adults (77 % female) with a median (IQR) age of 72 (69–77) years completed follow-up testing. There was a small improvement in EQ-5D-3L utility scores after programme completion (0.04, 95 % CI: 0.04, 0.05, p < 0.001). The cost per quality-adjusted life year (QALY) gained was $12,893. ConclusionsOlder Australians who participated in the Exercise Right for Active Ageing programme reported small improvements in HRQoL following programme completion, and this included older adults living in regional/rural areas. Funding subsidised exercise classes, may be a low-cost strategy for improving health outcomes in older adults and reducing geographic health disparities. Clinical trial registrationThe study was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12623000483651).

Improved physical functioning, sleep, work productivity and overall health-related quality of life with bimekizumab in patients with axial spondyloarthritis: results from two phase 3 studies

ObjectiveTo assess the impact of bimekizumab on physical functioning, sleep, work productivity and overall health-related quality of life (HRQoL) in patients with non-radiographic (nr-) and radiographic (r-) axial spondyloarthritis (axSpA)...

Impact of clinical response and AEs on health-related quality of life (HRQoL) in patients (pts) with R/R large B-cell lymphoma (LBCL): Pooled data from 4 lisocabtagene maraleucel (liso-cel) trials.

11105 Background: Four liso-cel clinical trials in R/R LBCL (TRANSCEND NHL 001, PILOT, OUTREACH, and TRANSFORM) demonstrated a favorable clinical profile with high response rates (73%–80%) and positive changes in HRQoL after treatment. This analysis pooled data across 4 trials to assess the impact of clinical response and AEs on HRQoL. Methods: The EORTC QLQ-C30 and EQ-5D-5L were used to assess HRQoL repeatedly at prespecified time points up to Day 730. Six clinically relevant domains (EORTC QLQ-C30 global health status/quality of life [GHS/QoL], physical functioning, cognitive functioning, fatigue, pain, and the EQ-5D-5L visual analog scale [VAS]) were analyzed in liso-cel–treated pts pooled across trials with HRQoL scores at baseline and postbaseline visits. Linear mixed-effects regression models examined changes in HRQoL over time, with clinical response status and AEs as time-varying covariates, adjusting for relevant baseline and other time-varying factors. Trends in HRQoL change up to Day 730 over time were examined by cytokine release syndrome (CRS) and neurological events (NE) occurring ≤ 30 days after infusion. Results: The analysis included 368 and 372 pts for EORTC QLQ-C30 and EQ-5D-5L VAS, respectively. Achieving a clinical response (CR or PR) was associated with significant HRQoL improvement versus stable disease (SD) or PD in all 6 domains (Table). Meaningful improvement occurred ≤ 30 days after achieving CR or PR for all domains except cognitive functioning, where improvement occurred ≤ 90 days, and was sustained across remaining follow-up visits. CRS and NEs were associated with HRQoL worsening in selected domains; however, pts who experienced CRS or NEs ≤ 30 days after infusion recovered to levels of pts without the AE by Day 60 and maintained thereafter. Conclusions: Among liso-cel–treated pts with R/R LBCL, positive clinical response was associated with meaningful and sustained improvement in nearly all HRQoL domains. CRS and NEs may negatively impact certain HRQoL domains but are temporary. As liso-cel has demonstrated high response rates and a manageable safety profile across studies, these findings further support the pt-reported benefits of liso-cel for R/R LBCL. [Table: see text]

Health-related quality of life does not deteriorate while waiting for anterior cruciate reconstruction.

The aim of this study was to determine how preoperative health-related quality of life (HRQoL) is affected by the duration of the wait time (WT) for anterior cruciate ligament reconstruction (ACLR) once a decision is made to proceed with surgery. This was a multi-centre prospective cohort study. One hundred and twenty-two patients 14 years of age and above waiting for ACLR completed the International Knee Documentation Committee (IKDC) demographic, current health assessmentand subjective knee evaluation (SKF) forms on the day of decision to operate and the day of surgery. Changes in scores were analyzed for the entire cohort, adjusted for WTsand a subset was compared for patients with isolated anterior cruciate ligament (ACL) tears and ACL tears with concurrent meniscal involvement. Changes in HRQoL scores from the day of the decision to operate to the 9-month postoperative appointments were also assessed. Energy/Fatigue (p < 0.05), Pain (p < 0.05), General Health (p < 0.05)and the IKDC-SKF Score (p < 0.05) significantly increased between the day of the decision to operate and the day of surgery. Only the change in IKDC-SKF score remained significantly higher after adjusting for WT. Baseline HRQoL scores significantly improved by the 9-month postoperative appointment. The length of time waiting for ACLR did not adversely influence HRQoL in this study. However, low preoperative HRQoL and the significant improvement in HRQoL of patients followed postoperatively suggest that timely surgery is beneficial for this patient population. Level II.

Long-term effects of catheter ablation versus antiarrhythmic drugs on health-related quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial revisited

Abstract Background Data on long-term effects of catheter ablation versus antiarrhythmic drugs (AAD) on health-related quality of life (HRQoL) and atrial fibrillation (AF) burden are limited. The study aimed to assess long-term HRQoL and rhythm data in symptomatic AF patients. Methods The 75 patients who underwent ablation and 74 receiving AAD in the Catheter Ablation compared with Pharmacological Therapy for Atrial Fibrillation (CAPTAF) trial were followed for 48 months comparison of General Health using 36-Item Short-Form Health Survey, time to first AF-episode ≥1 hour, and AF burden, recorded by implantable cardiac monitors. Results 147 patients completed follow-up, with seven crossovers in the ablation group and 34 crossovers in the AAD group. General Health improved by ablation, median 62 points at baseline to 79.2 points at follow-up (p&amp;lt;0.001), and by AAD from median 67 to 77 points (p&amp;lt;0.001), without treatment differences (p=0.77). Time to first AF-episode ≥1 hour was longer, median 257 days (ablation group) versus 180 days (AAD group), p=0.025. The cumulative AF burden during follow-up was lower in the ablation (median 0.3% [interquartile range 0, 1.4]) versus AAD group (1.6% [0.1, 11.0]), p=0.01. The cumulative reduction in AF burden compared with baseline was greater in the ablation (median -89.5% [-98.4, -51.3]) versus AAD group (-52.7% [-92.6, 263.6]), p=0.001). Conclusions HRQoL improvement at long-term did not differ between ablation and AAD despite a larger reduction in AF burden after ablation. The results should be interpreted in the light of a four times higher crossover rate in the AAD group.

#2892 The role of physical activity in onco-nephrology; a new weapon in the management of urological malignancies

Abstract Background and Aims New clinical evidence demonstrated that Physical Activity (PA) brings numerous benefits both at the level of Health-RelatedQuality of Life (HRQoL), biological mechanisms and at the psychological level. Indeed, it is well known that cancer treatments results in a series of symptoms and side effects that debilitates the patients with cancer and can be counteracted with physical activity. PA has an effect on several aspects of biological mechanisms: sex hormones, metabolic hormones, inflammation and adiposity, and immune function. Furthermore, strong evidence shows that aerobic or combined (aerobic and endurance) training reduces symptoms of anxiety, depression and fatigue. Combined training also leads to improvements in HRQoL, preventing and improving muscle loss and sarcopenia. This study aims to assess the influence of physical activity on this improved scenario. Method A consecutive cohort of 82 pts was enrolled in the Urological Department at San Raffaele Scientific Institute between 2018-2021. The control group (CT) was composed of 31 patients affected by CKD alone (GFR &amp;lt; 60 ml/min/1.73 m2, K-DIGO 2012 classification) and 51 patients with CKD and a recent history of urological malignancies (within 12 months) represented the case group (CS). Inclusion criteria were: Age (&amp;gt;18 years old), eGFR (&amp;lt;60 ml/min/1.73), Malnutritional Screening Tool (MST&amp;lt;2), Urological Cancer aggressiveness (no metastatic process), Informed consent (signed). Each patient underwent an initial nephrological and nutritional evaluation during which a conventional CKD Mediterranean-like diet with a controlled protein intake (MCPD) (0.6-1 g total protein/kg body weight/die and 30-35 kcal/kg body weight/die) was prescribed together with physical activity recommendation according to The National Kidney Foundation (NKF) for a period of 6 months (±2 months). Physical activity recommendations included some aerobic exercise for 30 min on most days of the week, plus other activities to increase muscle strength (exercises with resistance bands) e/o to improve flexibility (such as stretching) once or twice a week. To assess the influence of physical activity within the collaborative nephrologist-nutritionist approach (NNCA) on enhanced kidney function, the Rapid Assessment of Physical Activity (RAPA) test was administered to each patient. The test consists of two indicators: RAPA 1 will indicate aerobic physical activity levels (from 0=sedentary to 7=physically active), while RAPA 2 will indicate other types of exercises (0=none; 1=strength; 2=flexibility; 3=both). Subsequently, Bioelectrical Impedance Analysis (BIA) was conducted on all participants in the cohort to collect data on Body Cell Mass per height squared (BCM/h2), Phase Angle (PA), Extracellular Mass (ECM)/BCM, and Extracellular to Intracellular water ratio (ECW/ICW). Statistical analysis: Linear regression and Pearson's Chi-Squared test; Data analysis: R programming language and RStudio integrated development environment. Results Table 1 shows the patient's baseline characteristics. Table 2 shows anthropometric indices and parameters at pre- and post-dietary and nephrological intervention. Table 3 underlines the poor condition prevalent in CKD patients with or without oncological history, also confirmed by the low level of usual physical activity detected by the RAPA test at T0. Sure enough, our population was mainly inactive and sedentary. Results show that, after the intervention, our patients became regularly active (RAPA 1 score T0: 2.47; RAPA 1 score T1: 3.17; Delta = + 0.7, p &amp;lt; 0.0001); the same trend was observed for RAPA 2 score (observed increase 14%, p &amp;lt; 0.002). Conclusion Based on these findings, it can be inferred that standard clinical care should incorporate thorough assessment of both nutritional status and PA. The adoption of a MCPD, coupled with exercise training within a collaborative nephrologist-nutritionist approach, emerges as a potential strategy to enhance the HRQoL of this particular kind of patient.

#1137 Association between cognitive function, depressive symptoms and quality of life in older patients with severely reduced GFR and kidney failure

Abstract Background and Aims Impaired cognitive function and reduced health-related quality of life (HRQoL) are common in older patients with chronic kidney disease (CKD) with severely reduced GFR and kidney failure. Older patients with CKD often regard HRQoL as a health priority, but it is unknown whether cognitive function associates with HRQoL and whether depressive symptoms mediate this association. We therefore aim to examine the association between cognitive function and HRQoL, and explore the mediating role of depressive symptoms. Method Patients aged 65 years and older with an eGFR between 20 and 10 mL/min/1.73 m2 participating in the ongoing DIALysis or not: Outcomes in older kidney patients with GerIatriC Assessment (DIALOGICA) study were included. Cognitive function, depressive symptoms and HRQoL were assessed using the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS-15) and Twelve-Item Short Form Health Survey (SF-12) questionnaire, respectively. The SF-12 yields a Mental Component Summary (MCS) score and Physical Component Summary score (PCS). We created a diagram of the hypothesized direct and indirect pathways between cognition and HRQoL, with depressive symptoms as the purported mediator (Fig. 1). We used cross-sectional multivariable linear regression analyses to examine the association between cognitive function and both mental and physical HRQoL, and multivariable mediation analyses to explore the role of depressive symptoms. Results In total, 403 patients were included with a mean age of 76.5 years, with a standard deviation (SD) of 5.8 and a mean eGFR of 14.5 mL/min/1.73 m2 (SD 3.0). A majority of patients were male (71.5%). Cognitive function associated significantly with mental HRQoL (adjusted β 0.30, 95% confidence interval (CI) 0.05; 0.55, p 0.021), but not with physical HRQoL (adjusted β 0.18, 95% CI −0.09; 0.44, p 0.20). The mediation effect of depressive symptoms between cognitive function and MCS remained significant after adjustment (indirect effect 0.15, 95% CI 0.04; 0.26). Thus, lower cognitive function was associated with lower mental HRQoL, which was partly mediated by corresponding increases in depressive symptoms. Conclusion Cognitive function is associated with mental HRQoL, but not with physical HRQoL in older patients with severely reduced GFR and kidney failure. This association is partially mediated by depressive symptoms. These findings underline the importance of screening for cognitive impairment and depressive symptoms in this population and may increase the understanding of what potentially affects HRQoL. As HRQoL is seen as a health priority, further research should explore whether cognitive interventions or treatment of depressive symptoms result in improvement of HRQoL in this population.

Does work after retirement affect health-related quality of life: Evidence from a propensity score matching study in China.

Extending working life is considered as an important initiative to respond to the population aging and pension payment dilemma. This study aimed to investigate whether work after retirement is related to improved health-related quality of life. We used two waves of data from the China Health and Retirement Longitudinal Study in 2011 and 2018. Work after retirement was ascertained based on self-reported retirement and work status, and health-related quality of life (HRQOL) was measured with the three-level EuroQol five-dimensions. The impact of work after retirement on HRQOL was analyzed using the propensity score matching with difference-in-difference approach. A total of 1043 retirees were included. The results showed that work after retirement was associated with significant improvement in HRQOL among retirees (β = 0.072, P < 0.001). Heterogeneity analyses did not show specificity on sex (P for sex interaction >0.05), but older-aged retirees seemed more sensitive to the benefits of work after retirement on HRQOL than their younger-aged counterparts (≥65 years: β = 0.167, P < 0.001 vs <65 years: β = -0.047, P > 0.05; P for age interaction = 0.010). Work after retirement shows a positive impact on HRQOL among community-dwelling adults in China. Policy-makers should take the health of retirees into account when implementing policies related to delayed retirement, and reduce health inequity. Geriatr Gerontol Int 2024; 24: 722-729.

Effects of sintilimab plus chemotherapy as first-line treatment on health-related quality of life in patients with advanced esophageal squamous cell carcinoma: results from the randomized phase 3 ORIENT-15 study

In ORIENT-15 study, sintilimab plus chemotherapy demonstrated significant improvement on overall survival (OS) versus placebo plus chemotherapy in first-line treatment of advanced esophageal squamous cell carcinoma (ESCC). Here, we report effect of sintilimab plus chemotherapy on health-related quality of life (HRQoL) in patients with advanced ESCC. From December 14, 2018 to August 28, 2022, HRQoL was evaluated in all randomized patients using European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 items (QLQ-C30), EORTC Quality of Life Questionnaire Oesophageal Cancer Module 18 items (QLQ-OES18), and visual analogue scale (VAS) of the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L). Mean scores of each scale were described by treatment group through week 60. Least-squares mean (LSM) score change from baseline through week 24 were analyzed using the mixed-model repeated-measures method. Time to the first onset of deterioration (TTD) and OS for each scale were estimated. Clinical Trials Registration: NCT03748134. As of August 28, 2022, 689 of 690 enrolled patients were assessed for HRQoL analysis (sintilimab group: 340, placebo group: 349). Median follow-up was 32.2 months. Differences in LSM favored sintilimab over placebo for QLQ-C30 social functioning (LSM difference: 3.06, 95% CI: 0.55 to 5.57; P=0.0170), pain (-2.24, 95% CI:-4.30 to-0.17; P=0.0337), fatigue (-2.24, 95% CI:-4.46 to-0.02; P=0.0479), constipation (-3.27, 95% CI-5.49 to-1.05; P=0.0039), QLQ-OES18 pain (-1.77, 95% CI-3.11 to-0.43; P=0.0097), trouble swallowing saliva (-2.09, 95% CI:-3.77 to-0.42; P=0.0146), and choked when swallowing (-3.23, 95% CI:-5.60 to-0.86; P=0.0076). TTD favored sintilimab over placebo for QLQ-OES18 dysphagia (Hazard ratio [HR]: 0.76, 95% CI: 0.61-0.94, P=0.0104), and trouble swallowing saliva (HR: 0.48, 95% CI: 0.35-0.67, P<0.0001). Improved OS were observed in patients with better performance in several functioning and symptom scales of QLQ-C30 and QLQ-QES18. The statistically significant differences of several HRQoL scales and improvements in delayed deterioration observed in our study further support the use of sintilimab plus chemotherapy as first-line treatment for advanced ESCC. This study was funded by Innovent Biologics and was co-funded by Eli Lilly.

Bariatric Surgery: An Opportunity to Improve Quality of Life and Healthy Habits.

Bariatric surgery therapy (BST) is an effective treatment for obesity; however, little is known about its impacts on health-related quality of life (HRQoL) and related factors. This study aimed to evaluate changes in HRQoL and its relationship with weight loss, depression status, physical activity (PA), and nutritional habits after BST. Data were obtained before and 18 months postprocedure from 56 obese patients who underwent BST. We administered four questionnaires: Short Form-36 health survey for HRQoL, 14-item MedDiet adherence questionnaire, Rapid Assessment of PA (RAPA) questionnaire, and Beck's Depression Inventory-II. Multivariable linear regression analysis was used to identify factors associated with improvement in HRQoL. After the surgery, MedDiet adherence and HRQoL improved significantly, especially in the physical component. No changes in PA were found. Patients without previous depression have better mental quality of life, and patients who lost more than 25% of %TBWL have better results in physical and mental quality of life. In the multivariable analysis, we found that %TBWL and initial PCS (inversely) were related to the improvement in PCS and initial MCS (inversely) with the MCS change. In conclusion, BST is an effective intervention for obesity, resulting in significant weight loss and improvements in HRQoL and nutritional habits.

The impact of time-restricted eating on health-related quality of life: a systematic literature review.

Time-restricted eating (TRE) is a novel dietary intervention shown to facilitate weight loss and improve metabolic health. However, like any dietary intervention, long-term success largely depends on individual adherence, which can be influenced by whether the intervention impacts the individual's health-related quality of life (HR-QoL). Despite the growing body of research investigating TRE as a dietary approach and its potential impact on HR-QoL in adults, to date there has been no systematic review to summarize these findings. To examine the impact of TRE on HR-QoL in adults. All randomized controlled trials, pre-post and pilot/feasibility studies were searched in PubMed, EMBASE via Ovid, CINAHL, Cochrane Library, and PsycINFO via Ovid until March 20, 2023. Two researchers were involved in the screening and paper selection process. A single researcher extracted all relevant data from eligible studies. Overall, 10 studies were eligible for inclusion in this systematic review. Four studies reported improvements in overall HR-QoL scores among participants with type 2 diabetes, middle-aged women with obesity, generally healthy adults, and generally healthy adult employees. Three studies reported significant and nonsignificant improvements in some domains of HR-QoL assessment tools among overweight, sedentary older adults, overweight or obese adults, and 24-hour shift workers. No studies reported that TRE adversely affected HR-QoL. Improvements in HR-QoL appeared to occur primarily at 12 weeks/3 months. There was no clear relationship between HR-QoL scores and TRE protocol, additional study outcomes, participant health status, age, or adherence. Although further research is required to elucidate the impact of TRE on HR-QoL, the findings reveal that no studies show that TRE adversely affects HR-QoL. Open Science Framework (OSF) (The Impact of Time-Restricted Eating on Health-Related Quality of Life: A Systematic Review; https://doi.org/10.17605/OSF.IO/9NK45).

The Effect of Yoga Intervention on Psychological Symptoms, Health-Related Quality of Life, and Cardiovascular Risk Factors in People with Coronary Artery Disease: A Systematic Review and Meta-Analysis

Abstract Background: Whether yoga is effective in the cardiac rehabilitation of people with coronary artery disease (CAD) remains controversial. Objective: The aim of this study was to investigate the effects of yoga intervention on psychological symptoms, health-related quality of life (HRQoL), and major cardiovascular risk factors in people with CAD. Methods: We searched MEDLINE/PubMed, Cochrane, EMBASE, and Physiotherapy Evidence Database (from the earliest date available to July 2023). Mean difference (MD), standardized MD (SMD), and 95% confidence interval (CI) were calculated. Results: Seventeen studies, with 5,698 patients, met the study criteria. Compared to control (no exercise), yoga resulted in improved depression MD −0.83 (95% CI: −1.35 to −0.31), stress MD −3.83 (95% CI: −4.8 to 2.86), HRQoL SMD 1.48 (95% CI: 0.55 to 2.4), major cardiovascular risk factors (peak VO2 MD 1.7 mL/kg/min [95% CI: 0.2 to 3.3], systolic blood pressure MD −3.2 mmHg [95% CI: −5.9 to −0.5], and diastolic blood pressure MD −2.42 mmHg [95% CI: −4.08 to −0.76]). Conclusions: Yoga was effective in the improvement of psychological symptoms, HRQoL, and cardiovascular risk factors.