HRQOL Measures Research Articles

P0849LOWER TRANSFERRIN SATURATION INDEX (TSAT) IS ASSOCIATED WITH WORSE HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE (NDD-CKD) PATIENTS AT BOTH HIGHER AND LOWER HEMOGLOBIN LEVELS

Abstract Background and Aims Iron Deficiency (ID) is a common condition in NDD-CKD patients that is associated with poorer clinical outcomes. In different populations, such as congestive heart failure patients, treatment of ID leads to better clinical outcomes and HRQOL. However, the impact of ID on HRQOL is previously unknown among NDD-CKD individuals. We analyzed real world data from a multinational cohort of NDD-CKD stage 3 to 5 patients under nephrology care to evaluate the association between TSAT and HRQOL measures from the KDQOL-36. Method Patients from Brazil (N=205), France (N=2015), and the US (N=293) enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps, 2013 to 2019) with available TSAT, ferritin, and HRQOL data were included in the analysis. We grouped patients according to their TSAT levels as ≤15%, >15-20%, >20-30% (reference group), >30-50%, and >50%. We considered the TSAT value that preceded the HRQOL measurement closest in time as the predictor. Linear mixed regression was used to estimate the mean differences (95% CI) in physical composite summary (PCS), mental composite summary (MCS), and KDQOL-36 subdomains across TSAT categories. Models were adjusted for potential confounders. Results 2513 patients (62% male, 44% with diabetes, mean (SD) age 67 (13) years; 48%, 44% and 8% having stage 3, 4 and 5 NDD-CKD, respectively) were included in the analysis. Mean TSAT was 25 % (10). Distribution across TSAT categories was 14%, 19%, 42%, 23, and 2%, respectively. The median [IQR] number of days between TSAT measurement and PRO collection was 24 [13, 49] days. Mean PCS was 41 (10) and MCS was 45 (11). In the multivariate analysis, TSAT ≤15% was associated with lower HRQOL scores, in particular PCS, and with less favorable effects and symptoms of kidney disease (Figure). Similarly, less favorable HRQOL scores captured in the SF-12 subdomains indicative of physical HRQOL were observed in patients with lower TSAT. The adjustment for Hb only slightly attenuated the effects, and the results were not different for subgroup of patients with hemoglobin <11.5 vs ≥ 11.5 g/dL. Conclusion Lower TSAT levels, indicative of iron deficiency, are associated with poorer HRQOL in NDD-CKD patients, particularly for physical domains and effects of kidney disease, even after adjustment for potential confounders and stratification for normal and low hemoglobin levels. Randomized controlled trials of iron replacement therapy aiming to evaluate its impact on HRQOL among NDD-CKD individuals are needed to confirm and integrate these findings into clinical practice.

Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: baseline results in a cluster preference randomised controlled trial

PurposeThe main aim of this paper is to present baseline demographic and clinical characteristics and HRQOL in the two groups of the Patient Concerns Inventory (PCI) trial. The baseline PCI data will also be described.MethodsThis is a pragmatic cluster preference randomised control trial with 15 consultant clusters from two sites either ‘using' (n = 8) or ‘not using’ (n = 7) the PCI at a clinic for all of their trial patients. The PCI is a 56-item prompt list that helps patients raise concerns that otherwise might be missed. Eligibility was head and neck cancer patients treated with curative intent (all sites, stage of disease, treatments).ResultsFrom 511 patients first identified as eligible when screening for the multi-disciplinary tumour board meetings, 288 attended a first routine outpatient baseline study clinic after completion of their treatment, median (IQR) of 103 (71–162) days. At baseline, the two trial groups were similar in demographic and clinical characteristics as well as in HRQOL measures apart from differences in tumour location, tumour staging and mode of treatment. These exceptions were cluster (consultant) related to Maxillofacial and ENT consultants seeing different types of cases. Consultation times were similar, with PCI group times taking about 1 min longer on average (95% CL for the difference between means was from − 0.7 to + 2.2 min).ConclusionUsing the PCI in routine post-treatment head and neck cancer clinics do not elongate consultations. Recruitment has finished but 12-month follow-up is still ongoing.

PND94 ASSOCIATION OF POLY-PHARMACY WITH HEALTH RELATED QUALITY OF LIFE (HRQOL) IN OLDER ADULTS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIA (ADRD) IN THE UNITED STATES.

Despite its recognized value, polypharmacy is still an under explored research domain in patients with dementia. There is lack of evidence extrapolating the effect of polypharmacy on the components of HRQoL in community dwelling elderly. This study investigated the association of polypharmacy to HRQoL measures among patients with ADRD in the US. The study used a cross-sectional design using pooled cross-sectional data (2007-2015) of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of civilian non-institutionalized population in the US. Study included insured older adults (age ≥ 65 years) with ADRD and were alive during the calendar year (N= 506). Polypharmacy was defined as concurrently taking multiple medication classes (>=5). HRQoL was represented by the Physical Component Summary (PCS) and the Mental Component Summary (MCS) scores of the SF-12 survey. Associations of polypharmacy to HRQoL were analyzed with unadjusted and adjusted ordinary least squares (OLS) regressions. Age-stratified analyses examined the interaction of age and polypharmacy to HRQoL. In our study, 56.6% had polypharmacy; weighted mean (SE) of PCS and MCS scores were (1.26 and 0.60) for individuals with polypharmacy. In age-stratified and fully-adjusted analysis, those with polypharmacy had lower PCS (β = − 4.82 ± 0.04, p < 0.01) and MCS scores (β = − 1.12 ± 0.14, p < 0.01) among older adults in the young-old strata (i.e. age 65-80 years). One in 1.7 older adults with ADRD reported polypharmacy use. Polypharmacy was associated with poor clinically significant HRQoL in young-old with ADRD. The results highlight the importance of incorporating patient-reported outcomes in clinical management of older adults with ADRD and polypharmacy.

Should patients aged 75years or older undergo medial unicompartmental knee arthroplasty? A propensity score-matched study.

With increasing life expectancies worldwide, more elderly patients with isolated medial compartment osteoarthritis may become suitable UKA candidates. However, there is a paucity of literature comparing outcomes between older patients (≥ 75years) and younger patients undergoing UKA. The aim of this study was to determine if there were differences in functional and HRQoL measures between older patients (≥ 75years) and younger controls (< 75years) undergoing primary UKA. Prospectively collected registry data of 1041 patients who underwent primary, cemented, fixed-bearing medial UKA at a single institution from 2002-2013 were reviewed. Propensity scores generated using logistic regression was used to match older patients (≥ 75years, n = 94) to controls (< 75years, n = 188) in a 1:2 ratio. Knee Society Scores, Oxford Knee Score, Short Form-36, satisfaction/expectation scores, proportion of patients attaining OKS/SF-36 PCS MCID and survivorship were analysed. Patients ≥ 75years had significantly lower KSFS (67.1 ± 17.9 vs 79.4 ± 18.2, p < 0.001) and SF-36 PCS (47.3 ± 10.1 vs 50.4 ± 9.1, p = 0.01) as compared to the control group. In addition, a significantly lower proportion of patients ≥ 75years attained MCID for SF-36 PCS when compared to the controls (50.0% vs 63.8%, p = 0.04). Survival rates at mean 8.3 ± 3.0years were 98.9% (95% CI, 96.7-100) in the older group versus 92.8% (95% CI, 86.8-98.8) in the younger group (p = 0.31). Our findings highlight the need to counsel older patients regarding potentially reduced improvements in functional outcomes, despite advantages of lower revision. However, UKA in older patients continues to be a viable option for isolated medial compartment osteoarthritis LEVEL OF EVIDENCE: Level III Propensity score matched study.

P332 Mindfulness-based stress reduction and cognitive intervention improve the health-related quality-of-life and ability to work in Crohn’s disease patients: A randomised controlled trial

Abstract Background Crohn’s disease (CD) patients have reduced quality-of-life (QoL) in physical, emotional and social domains, and diminished work and leisure activities. We examined whether Mindfulness-Based Stress Reduction and Cognitive Intervention (‘Intervention’) can improve QoL and ability to work. Methods Patients (≥18 years), Harvey–Bradshaw Index (HBI) &amp;gt;4 and &amp;lt;16, were randomised to Intervention or Control groups. Intervention was taught in 8 weekly sessions by social workers via SKYPETM with twice-daily practice and back-report required. Medications were not controlled. HBI was completed at entry (T1) and 12 weeks (T2), and these questionnaires: (1) Short inflammatory bowel disease questionnaire (SIBDQ), disease-specific HRQoL measure. (2) Short-Form 12 (SF-12) questionnaire, generic HRQoL measure of physical health (PH) and mental health (MH). (3) EQ-5D-3L HRQoL questionnaire. (4) Work Productivity and Activity Impairment (WPAI) questionnaire, measuring absenteeism, presenteeism (reduced productivity), work impairment (composite of absenteeism and presenteeism), and leisure activity impairment. Statistics: Pearson Chi-squared, Wilcoxon signed-rank test. Results There were 39 Intervention and 43 Control patients. Demographic and medical characteristics (median, %) were: age 30 y; women 65%, married/partner 48%; higher education 83%; BMI 22; non- or past-smokers 92%; disease duration 5 y; HBI 8 (range 5–15); past surgery 17%; Montreal A2 89%, L2+L3 89%, B1+B2 89%, perianal disease 18%; drugs: corticosteroids 4%, 5-ASA 5%, immunomodulators 21%, biologics 43%; (p = ns between groups). Socio-economic status was higher in Intervention (87% = good/very good) than Control (58%, p = 0.016). HBI, SIBDQ and SF PH improved in both groups, but SF MH, EQ-5D-3L and all WPAI measures improved only in Intervention group (Table). Non-significance of WPAI indices between groups resulted from small sample size. Conclusion Mindfulness-Based Stress Reduction and Cognitive Intervention led to increased QoL and less work and activity impairment. If confirmed in a large cohort the intervention may be offered to all CD patients.

Evidence for Psoriatic Arthritis Impact of Disease (PsAID12) as Core Instrument to Measure Health-Related Quality of Life in Psoriatic Arthritis: A Systematic Review of Psychometric Properties

Objective:To evaluate and update the evidence for the measurement properties of the Psoriatic Arthritis Impact of Disease (PsAID12) questionnaire to measure health-related quality of life (HRQoL) in psoriatic arthritis (PsA).Methods:The PsAID12 psychometric evidence was gathered in a systematic literature review in PsA (registration number: CRD42016032546). The study quality was appraised using the Consensus-based Standards for the selection of health Measurement Instruments–Outcome Measures in Rheumatology (COSMIN-OMERACT) good methods check-list. Content validity, test–retest reliability, construct validity, longitudinal construct validity, discrimination, and thresholds of meaning were appraised. Additional analyses for construct validity, responsiveness, and sensitivity to change were conducted in available observational data sets after prespecified hypotheses were formulated.Results:Eight publications (129-474 patients) were analyzed. The PsAID12 fulfilled OMERACT criteria for content validity (patients and physicians endorsed content match with PsA HRQoL domain), feasibility (endorsed by patients and physicians), and test–retest reliability (intraclass correlation coefficient: 0.91-0.95). A priori construct validity hypotheses were mostly met: Psoriatic Arthritis Impact of Disease had high correlation with generic ( r = 0.76-0.87) and PsA-specific HRQol measures (0.8), and with measures of physical function (0.66-0.72), work productivity (0.69-0.75), pain (0.83), and fatigue (0.84). Psoriatic Arthritis Impact of Disease had moderate-high correlation with measures of patient global (0.49-0.84) and dermatologic HRQoL (0.36-0.53). Correlations were higher with generic HRQoL measured by short form-36 physical component score (0.47-0.73) versus short form-36 mental component score (0.22-0.60). Three studies confirmed known group validity of PsAID12 according to PsA disease activity. Psoriatic Arthritis Impact of Disease discriminated between change groups in 2 longitudinal studies (standardized response mean: 0.74-0.91, 53 and 105 patients). The minimal clinically important improvement was 3 and 1.4 points.Conclusion:Psoriatic Arthritis Impact of Disease had evidence for good content and construct validity, reliability, and longitudinal construct validity and is ready to evaluate in clinical trials.

HDQLIFE and neuro-QoL physical function measures: Responsiveness in persons with huntington's disease.

Huntington's disease (HD) is a neurological disorder that causes severe motor symptoms that adversely impact health-related quality of life. Patient-reported physical function outcome measures in HD have shown cross-sectional evidence of validity, but responsiveness has not yet been assessed. This study evaluates the responsiveness of the Huntington Disease Health-Related Quality of Life (HDQLIFE) and the Quality of Life in Neurological Disorders (Neuro-QoL) physical function measures in persons with HD. A total of 347 participants completed baseline and at least 1 follow-up (12-month and 24-month) measure (HDQLIFE Chorea, HDQLIFE Swallowing Difficulties, HDQLIFE Speech Difficulties, Neuro-QoL Upper Extremity Function, and/or Neuro-QoL Lower Extremity Function). Of the participants that completed the baseline assessment, 338 (90.9%) completed the 12-month assessment, and 293 (78.8%) completed the 24-month assessment. Standardized response means and general linear models evaluated whether the physical function measures were responsive to self-reported and clinician-rated change over time. Small to moderate effect sizes for the standardized response means supported 12-month and 24-month responsiveness of the HDQLIFE and Neuro-QoL measures for those with either self-reported or clinician-rated declines in function. General linear models supported 12-month and 24-month responsiveness for all HRQOL measures relative to self-reported declines in health, but generally only 24-month responsiveness was supported relative to clinician-rated declines in function. Longitudinal analyses indicate that the HDQLIFE and the Neuro-QoL physical function measures are sensitive to change over time in individuals with HD. Thus, these scales exhibit evidence of responsiveness and may be useful outcome measures in future clinical trials. © 2019 International Parkinson and Movement Disorder Society.

Perceived health and quality of life in chronic and end-stage kidney disease

Abstract Background and objectives Health-related quality of life (HRQoL) is increasingly considered a major outcome in patients with chronic kidney disease (CKD), but the size of its effect on physical and mental health at different disease stages, compared with the general population, is unclear. Design, setting, participants, and measurements We compared HRQoL measures in four groups: 2,687 outpatients with moderate (stage 3, estimated glomerular filtration rate [eGFR] 30-60 mL/min/1.73 m2) or advanced (stage 4-5, eGFR &amp;lt; 30 mL/min/1.73 m2) CKD under nephrology care from 40 nationally representative facilities, 1,658 patients with a functioning graft, 1,251 dialysis patients randomly selected from the national REIN registry, and 20,574 participants in the French Decennial Health Survey, representative of the general population. Results Mean age (years) was 67, 69, and 55 in patients with non-end-stage CKD, on dialysis, or with transplants, respectively; 60% were men. Age- and gender-standardized health status was perceived as fair or poor in 27% of those with moderate CKD and more than 40% of those with advanced CKD and those on dialysis, compared with 12% in transplant patients and 3% in the general population. Compared with the general population, HRQoL physical scores adjusted for age, gender, education, obesity, and diabetes, were significantly lower, by a factor of 2.2 among patients with moderate CKD, 4.1 among those with advanced CKD, 10.2 among those on dialysis, and 4.1 among those with transplants. The effect was stronger for those younger than 65 years. The mental score was lower only for dialysis patients. Conclusions This study highlights the importance of the physical health effects beginning at the moderate stage of CKD. More attention to patients’ CKD-related perceived health is needed. Key messages Physical health declined significantly from moderate through end-stage CKD, with impact greatest among the youngest patients. More attention to CKD’s impact on quality of life is needed.

Assessing Paediatric Hrqol in Diabetes: Semantic and Pilot Validation Study of the Portuguese Versions of DISABKIDS-DM ConditionSpecific Module

Objective − This study aimed to semantically validate the Portuguese versions of the diabetes module of a pediatric health-related quality of life assessment instrument – DISABKIDS-DM – and to preliminarily explore their main psychometric properties. Materials and Methods − Two samples of children (8-12 yo) and adolescents (13-18 yo) with Type 1 diabetes and their caregivers participated in the semantic validation (n=36) and in the pilot study (n=160) and filled out the DISABKIDS-DM, the semantic validation questionnaires and the Strengths and Difficulties Questionnaire. Using classical statistical validation procedures, the reliability, interrater consistency, and construct, discriminant, convergent and divergent validity were analyzed. Results − The findings support the relevance, comprehensibility and adequacy of the Portuguese versions. Both the self and proxy versions exhibited adequate levels of reliability; interrater consistency; and convergent, divergent and discriminant validity. The instrument differentiated between HbA1c groups, with children/adolescents with lower levels reporting better HRQoL, and between groups with and without comorbidity, with participants with other chronic diseases showing worse HRQoL. The instrument did not discriminate between the gender and time of diagnosis categories. Children and adolescents tended to report higher levels of HRQoL than their parents. Conclusion − These results reinforce the importance of cross-cultural validation procedures to ensure the equivalence of pediatric HRQoL measures, particularly in the context of diabetes-specific instruments. More research is needed, with a larger and more diverse sample, to study the factorial structure. The use of the questionnaires should be encouraged in both pediatric clinical settings and research.

Sleep quality is associated with psychosocial functioning and health-related quality of life in pediatric transplant recipients.

This study examined patient-reported sleep quality in a single-center cross-sectional sample of adolescents with solid organ transplants and evaluated associations between sleep quality, psychosocial functioning (ie, depression/anxiety symptoms), and HRQOL. Health disparities associated with minority race/ethnicity and socioeconomic variables were also examined. Sixty-nine adolescents (M=16.51years; SD=1.63) who received a solid organ transplant (kidney: n=25; liver: n=24; heart: n=20) completed self-report measures of sleep quality, psychosocial functioning, and HRQOL. Adolescent transplant recipients endorsed significantly lower levels of sleep quality (ie, falling asleep) compared with previously published norms of healthy peers (t=-3.60; P≤.001). Higher sleep quality was significantly associated with fewer anxiety and depressive symptoms (r=-.31 to -.40), and higher physical and psychosocial HRQOL (r=.33-.43). Adolescents from minority backgrounds had significantly worse sleep quality compared with non-Hispanic Whites. Adolescent transplant recipients, particularly those from minority backgrounds, may be at increased risk for experiencing poor sleep quality. Suboptimal sleep is a risk factor for higher levels of anxiety and depressive symptoms, as well as lower levels of physical and psychosocial HRQOL. Sleep is an important modifiable factor that, if improved, may contribute to lower anxiety/depressive symptoms and better HRQOL in adolescent transplant recipients.

Physical performance reflects cognitive function, fall risk, and quality of life in community-dwelling older people

This report searched for relationships between physical performance and other health indices through a detailed investigation of a randomly sampled cohort from a basic town resident registry. Residents between the age of 50 and 89 years were randomly sampled from the basic resident registry of a cooperating town for construction of a 415-participant cohort that minimized selection bias. Cognitive function measures, annual fall frequency, and SF-8 as an HRQOL measure were the outcomes of interest. The impact of physical function on outcomes was predicted using multivariate regression models with age and gender as covariates. Knee muscle strength, grip strength, one-leg standing time, and two-step test score had a significant impact on cognitive scores and SF-8 physical component summary scores. A shift of -1 standard deviation for grip strength, the stand-up test, and the two-step test increased fall risk by 39%, 23%, and 38%, respectively. In conclusion, diminished physical performance is related to serious problems in older individuals, specifically cognitive deterioration, increased fall risk, and inability to maintain HRQOL. These factors are independent of age and gender. Thus, the higher physical function can be maintained in older people, the better the other conditions appear to remain.

P82. Sexual dysfunction due to lumbar stiffness is not diminished following adult spinal deformity surgery

BACKGROUND CONTEXT Sexual function is an important contributor to quality of life. Adult spinal deformity (ASD) patients have been shown to have sexual limitations due to their deformity. PURPOSE This investigation sought to assess sexual dysfunction due to lumbar stiffness before and after fusion surgery. STUDY DESIGN/SETTING Retrospective analysis of a multi-center, prospectively-collected, consecutive cohort of ASD patients. PATIENT SAMPLE Only patients with 2-year follow-up were included. In total, 365 patients were included in this study, comprising 76 males and 289 females. OUTCOME MEASURES The primary outcome in this study was the Lumbar Spine Disability Index (LSDI) question 10: “Choose the statement that best describes the effect of low back stiffness on your ability to engage in sexual intercourse.” METHODS Differences in sexual function between baseline and 2-year follow-up were assessed with a Wilcoxon-Mann-Whitney test. Patient factors associated with poor baseline sexual function were evaluated with multiple linear regression. The association between sexual function and HRQOL at baseline and 2-year follow-up was evaluated with multiple linear regression, adjusting for all factors previously included in analyses of baseline sexual function. RESULTS Baseline LSDI sexual function scores averaged 2.7 (SD 1.3), which improved to 2.3 (SD 1.2) at 2-year postsurgical follow-up (p = 0.0009). Predictors of poorer baseline sexual function included older age, BMI, and higher Charlson Comorbidity Index (p CONCLUSIONS This study found that sexual dysfunction due to lumbar stiffness is strongly related to HRQOL measures such as ODI and SRS-22r total score. Further, sexual function was not diminished postoperatively, possibly due to reduced pain that accompanied improved stability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Quality of life can be good after slide tracheoplasty for long-segment tracheal stenosis.

The objectives of this study were to measure 'health-related quality of life' (HRQoL) in children following slide tracheoplasty for long-segment tracheal stenosis (LSTS) and to explore the relationship of comorbidities and parental mental health with HRQoL outcomes. A cross-sectional study was undertaken with children who had undergone slide tracheoplasty. Participants included parents and children (age 5-15 years) recruited over a 13-month period, who were asked to complete validated measures of HRQoL, development and behaviour. Scores were compared to published norms. Forty-two children (male 69%; n = 29) were included; mean age was 5.3 (standard deviation 3.5) years and mean follow-up was 45 (range 4-179) months. Mean total HRQoL scores for children with repaired LSTS did not differ from those of healthy norms other than for children aged 13-23 months, but 10 children (24%) had scores >2 SD below the mean for healthy children. HRQoL was poorer in children with non-cardiac congenital comorbidities than in those with isolated LSTS (mean scores 60.34 ± 17.19 and 85.52 ± 12.19, respectively, P = 0.01). There was good agreement between children's and parents' scores, although children rated their HRQoL as better than their parents did. Anxious parents rated their children's HRQoL as significantly worse than non-anxious parents (P<0.001). Older children with isolated LSTS can have excellent HRQoL after surgery. Younger children, at an earlier time point postoperatively, and those with non-cardiac congenital comorbidities have poorer HRQoL. Further longitudinal evaluation is required to identify psycho-social (including parental) predictors of outcome which may inform, or be amenable to, intervention.

Treatment of Adult Scoliosis Fractional Curve With Minimally Invasive Surgery: Anterior Versus Posterior Approach?

Abstract INTRODUCTION The fractional curve in adult scoliosis often causes radiculopathy and may be managed in varied manners with minimally invasive (MIS) deformity correction. There are inherent risks and benefits to anterior and posterior interbody reconstruction techniques, and the purpose of this study was to evaluate for differences in outcomes or complication rates by fractional curve treatment via MIS anterior vs. posterior interbody fusion METHODS Inclusion criteria were age = 18 yr, and one of the following: coronal cobb &gt; 20°, SVA &gt; 5 cm, PT &gt; 20°, PI-LL &gt; 10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery and had 2-yr minimum follow-up. Patient were divided into two groups: anterior or posterior interbody fusion at the lumbosacral junction (L4-S1). HRQOL measures included Oswestry Disability Index (ODI), visual analog score (VAS). RESULTS A total of 112 patients who underwent MIS adult deformity surgery with minimum 2-yr follow up. A total of 74 patients underwent anterior and 38 patients underwent posterior interbody reconstruction at L4-S1 utilizing MIS technique. Preoperative spinopelvic parameters, radiographic parameters, and VAS were not different, but ODI was higher in the anterior group (53 vs 48, P = .047). Complications and reoperation rates were not different (P = .089, P = .597), but posterior had more infections (15.8% vs 2.7%, P = .01). When subdivided for cMIS only surgery, 38 had anterior and 19 underwent posterior interbody fusions in the fractional curve. Pre- and postoperative VAS leg, ODI, and fractional curve magnitude were not different. In the anterior surgery cohorts, laminectomies at L4-S1 were performed in 22% of hybrid cases and in 8% of cMIS cases. CONCLUSION Treatment of the fractional curve of adult scoliosis appears to be similarly effective in reducing VAS, ODI, and fractional curve magnitude regardless of anterior vs posterior approach. However, posterior interbody reconstruction was associated with higher infection rate than anterior, regardless of application in cMIS or hybrid technique.

HEALTH-RELATED QUALITY OF LIFE MEASUREMENT USING EQ-5D-3L QUESTIONNAIRE

Health-related quality of life is becoming the standard measure of personal well-being and human’s health worldwide. Indicators of the population quality of life allow taking into account the subjective incidence, which is often overlooked during routine medical care. In Russia, the health-related quality of life is becoming particularly relevant in connection with the problems of an ageing population, the development of national strategies and programs in the social and healthcare systems, and the increasing prevalence of chronic diseases. The basis of the HRQoL measurement should be based on a proven and reliable methodology that generates comparable estimates of human well-being. Like any complex subjective indicator, HRQoL does not have an unambiguous direct method of measurement. The aim of this paper is a comprehensive description of the methodology for conducting and presenting the results of the study of the HRQoL using the European Quality of Life Questionnaire, EQ-5D. The paper discusses the measurement of HRQoL as a critical component of a modern health care system, describes in detail the administration of HRQoL data using the EQ-5D-3L questionnaire, and provides a methodology for analyzing and presenting the collected data in studies of population and patient health. We address the discussion to clinicians, healthcare providers, and researchers dealing with the problems of studying and measuring the health-related quality of life.

한국 노인의 악력과 건강관련 삶의 질 연관성

The purpose of this study is to provide primary data for promoting healthier lives in older adults. To this end, this study analyzed the correlation between grip strength and the health-related quality of life(HRQoL; EQ-5D) in the elderly. The participants of this research were 4,917(2,264 male and 2,653 female) who underwent a grip strength test and responded to a questionnaire for those older than 65. The data collected from the participants were analyzed with SPSS 25.0 statistical software. Specifically, descriptive statistics were measured for mean, standard deviation, frequency and ratio, and as for analysis, the general linear modeling method and chi-square test were conducted. according to the result, there was a positive correlation between grip strength and the quality of life measures. On top of that, three linear models were generated to investigate which HRQoL measures were more likely to be affected by the difference in grip strength. The factors that influence the HRQoL(e.g., age, body mass index(BMI), education, household income, smoking, alcohol consumption, physical activity, residential area, marital status, hypertension, diabetes and cancer) were considered in the modeling. The result of the general linear modeling showed that in both sexes, the quality of life was higher in those with stronger grip strength.BR In conclusion, these results can indicate that the loss of grip strength among the Korean elderly of 65 or older can be related to the deteriorating HRQoL. This study suggests, based on this conclusion, the need for an exercise intervention that strengthens the muscle in promoting the HRQoL indicators among the elderly.

Evaluation of the responsiveness of Short Form-12 Health Survey version 2 (SF-12v2) in Chinese patients with hypertension in primary care.

There is limited evidence on the responsiveness of the Short Form-12 Health Survey version 2 (SF-12v2) in hypertensive patients. This study aimed to evaluate both the responsiveness of the SF-12 measures in Chinese hypertensive patients. A prospective longitudinal study was conducted on hypertensive patients managed in public primary care clinics between 2012 and 2013. A total of 583 and 431 patients were surveyed and completed SF-12v2 at baseline and at 12-month follow-up interviews, respectively. Using global rating of change scale as an external anchor, the responsiveness was assessed by linear mixed effect models, multiple linear regression models, and receiver operating characteristic (ROC) curve analysis. SF-12v2 managed to detect negative changes among hypertensive patients in worsened general health group but failed to identify changes among hypertensive patients in improved general health group. Meanwhile, some domains of SF-12v2 detected a significant difference in difference between patients of worsened and stable/improved group and between patients of stable and improved group, but none of the domains and the summary scales reached the recommended standard of 0.7 in any comparisons in ROC analysis. The SF-12v2 was responsive to worsening of HRQOL but not to improvements in HRQOL among hypertensive patients. The overall responsiveness of SF-12v2 in hypertensive patients is unsatisfactory. Further studies are needed to identify HRQOL measures with good internal and external responsiveness for hypertensive patients.

Patient-proxy agreement on health-related quality of life in juvenile fibromyalgia syndrome

BackgroundHealth-related quality of life (HRQoL) measures serve as important indicators of pain-related physical and psychosocial function in youth with juvenile fibromyalgia syndrome (JFMS). While the administration of parent-proxy reported HRQoL measures in the assessment of JFMS is common, its added clinical value to patient self-reports is unclear. We aimed to determine the level of agreement on HRQoL among patients with JFMS as well as their parent-proxies and to determine factors associated with this agreement.MethodsWe performed a retrospective, cross-sectional cohort study of children aged 8 to 17 years diagnosed with JFMS and presenting for initial evaluation to a pediatric rheumatology pain clinic between April 2017 and May 2018. All patients and proxies were administered the Pediatric Quality of Life Short Form 15 Generic Core Scales (PedsQL SF-15) as part of routine clinical care. We calculated absolute discrepancy scores (absolute value of parent-proxy score minus patient score) to describe the extent of difference in HRQoL scores between parent-proxies and patients. We examined agreement between parent-proxy report and patient self-report via intraclass correlation coefficients (ICCs), stratified by age and sex, as well as Bland-Altman plots. We also used multivariate regression models to determine factors associated with level of agreement.ResultsA total of 65 patient-proxy pairs were included in this study. ICCs demonstrated good to excellent agreement between all parent-proxy and patient measures of HRQoL irrespective of the patient’s age or sex. The level of agreement was not associated with pain duration or pain severity but less agreement on psychosocial HRQoL was associated with older patient age (β = 1.30; p < 0.05).ConclusionsThis study in youth with JFMS demonstrated good to excellent patient-proxy agreement across all domains of the PedsQL SF-15 irrespective of patient’s age or sex. Our findings suggest that parent-proxy reports do not provide additional information beyond that obtained from the patient self-report of HRQoL according to the PedsQL SF-15. In order to facilitate children and adolescents with JFMS becoming partners in their own healthcare, and to decrease the burden of multiple questionnaires, we propose focusing on patients’ own perceptions of HRQoL in the clinical setting.

PDB105 HEMOGLOBIN A1C (HBA1C) TESTING FREQUENCY AND HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH TYPE 2 DIABETES: AN ELECTRONIC HEALTH RECORDS LINKED WITH PATIENT-REPORTED OUTCOMES STUDY

Frequency of HbA1c testing is associated with type 2 diabetes (T2D) management and control, but limited data exists on the relationship between HbA1c testing and patient-reported measures such as HRQoL. This study used patient-reported survey data linked with laboratory tests from electronic health records (EHR) to assess differences in HRQoL associated with HbA1c testing frequency. Patient-Centered-Research (PaCeR) US data (2015-2018; N=345,184), consisting of nationally-representative patient-reported survey data, were linked with a large US ambulatory EHR database (2015-2018; N=50 million+) in a HIPAA-compliant linking methodology. The study population consisted of linked respondents who were diagnosed with T2D and had at least one HbA1c test result in the EHR within six months of survey participation. Study participants were grouped by HbA1c testing frequency (1-2 tests/year, 3-4 tests/year, 5+ tests/year) and compared on sociodemographic and HRQoL measures using two-sample t-tests and chi-square tests. HRQoL measures included SF-36v2 (mental and physical component summary scores [MCS and PCS] and SF-6D health utility index). Of 492 total T2D patients who met the study criteria [mean age = 61.3 years, 54.7% female, 85.6% White, 38.8% uncontrolled HbA1c (≥ 7%)], 58.1% had 1-2 HbA1c tests/year, 26.6% had 3-4 HbA1c tests/year, and 15.2% had 5+ HbA1c tests/year. T2D patients with 1-2 HbA1c tests/year had significantly lower MCS compared to those with 3-4 HbA1c tests/year (mean = 48.8 vs. 51.8, p = 0.01). Vitality (mean = 47.6 vs. 50.0, p = 0.04) and mental health (mean = 48.6 vs. 52.1, p < 0.005) domain scores were also lower among patients with 1-2 HbA1c tests/year compared to patients with 3-4 HbA1c tests/year. There were no differences in HRQoL between the 1-2 tests/year and 5+ tests/year groups. Linking patient-reported outcomes with EHR data facilitated analysis of HbA1c testing with HRQoL. Results showed that less frequent HbA1c testing was associated with lower MCS.

Association of current and past opioid use disorders with health-related quality of life and employment among US adults

BackgroundTo examine the association of current and past Opiate Use Disorder (OUD) with measures of HRQOL and employment in a nationally representative sample of adults. MethodsThe 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized civilian adults (≥18 years) in the US (n = 36,309 unweighted). Using DSM-5 criteria, adults without history of OUD were compared to those with current and past OUD. Using the SF-12 items, standard measures of the mental and physical component scores of HRQOL and of quality-adjusted life years (QALYs) were constructed. Employment in the past year (yes/no) was also assessed. Multivariable-adjusted regression analyses were used to adjust for covariates. ResultsOverall, 0.9% of the study sample, representing 2.1 of 235.4 million adults, met criteria for current OUD; 1.2%, representing 2.7 million adults, met criteria for past OUD. Adults with current or past OUD had large and moderately reduced mental component (MCS) and physical health component (PCS) summary scores compared to adults who never had OUD (p < 0.001, respectively). Current OUD was associated with lower odds of being employed compared to never experiencing OUD (Adjusted odds ratio = 0.65; 95% CI: 0.48, 0.88; p = 0.005), as was past OUD. Adjustment for potentially confounding factors reduced the independent association of OUD and HRQOL by about 40–50% but did not change employment comparisons. ConclusionAdults with current OUD are associated with large reductions in HRQOL and likelihood of not being employed, and adults with past OUD also have considerable residual impairment.