Lower Physical Functioning Scores Research Articles

Falls and injury prevention should be part of every stroke rehabilitation plan

To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed. Prospective cohort study. Community. Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study. Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM). Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People required assistance to get up after 25 falls (38%) and 36 falls (55%) resulted in an injury. People sought professional health care after only 16 falls, and activity was restricted after 29 falls (44%). The Berg Balance Scale and Functional Independence Measure scores were lower in people who had longer lies after a fall, and who restricted their activity after a fall (p < 0.05). Lower physical function scores were also associated with falling in the morning, wearing multifocal glasses at the time of a fall, and injurious falls (p < 0.05). Falls are common when people return home after stroke. Of concern are the small number seeking health professionals' assistance after a fall, the high proportion restricting their activity as a result of a fall and the number of falls occurring towards the paretic side.

Late-onset Pompe disease primarily affects quality of life in physical health domains

To investigate quality of life in an international population of patients with late-onset Pompe disease. Data on quality of life (SF-36), age, sex, disease duration, wheelchair use, and use of artificial ventilation were collected for 210 adults with Pompe disease from Australia, Germany, the Netherlands, the United Kingdom, and the United States. SF-36 scores were compared between countries and related to patient characteristics. In addition, for the Dutch subgroup (n = 51), comparisons with the general population and 1-year follow-up assessments were performed. No significant differences between countries were found for the four physical health scales. Mean scores on the vitality, role functioning-emotional, and mental health scale differed between countries, but these differences were not consistent. Wheelchair use was associated with lower physical and social functioning scores (B = -23.6 and -15.1, p < 0.001), and the use of artificial ventilation with lower physical functioning scores (B = -8.4, p = 0.004). Patients reported significantly poorer quality of life than the general population on the physical functioning, role functioning-physical, general health, vitality, and social functioning scales. No significant differences in SF-36 scores were found between the baseline and 1-year follow-up measurement. Patients with late-onset Pompe disease are, on average, markedly affected on the physical health domains of quality of life, but score only slightly lower than the general population on the mental health domains.

Predictors of outcome in fatigued employees on sick leave: Results from a randomised trial

Objective The main objective of this study was to identify predictors of fatigue caseness, work resumption and chronic fatigue syndrome (CFS)-like caseness in a sample of fatigued employees on sick leave. Methods For 12 months, 151 fatigued employees on sick leave, 44% of whom met research criteria for CFS at baseline, were followed. Measures included fatigue, health aspects, psychological problems, burnout, causal attributions and self-efficacy. Logistic regression analysis was used to determine associations between predictor variables at baseline and outcome at follow-up. Results After 12 months, 43% of the patients were no longer fatigue cases, and 62% had resumed work. Recovery from fatigue caseness was predicted by stronger psychological attributions and other perception-related factors, whereas work resumption was predicted by lower age, male sex, CFS-like caseness and less cognitive difficulties. Lower physical functioning scores were predictive of (the development of) CFS-like caseness. Conclusion Recovering from persistent fatigue and work resumption seem to result from different underlying processes and do not necessarily fall together. As many factors associated with outcome in fatigue reflect illness perception, the prevention of persistent fatigue and CFS may partly be achieved by the modification of perception.

The Impact of Visual Impairment and Use of Eye Services on Health-Related Quality of Life among the Elderly in Taiwan: The Shihpai Eye Study

To evaluate the effect of impaired vision on health-related quality of life (HRQoL), the authors administered the Medical Outcomes Survey Short-Form 36 (SF-36) to the elderly in a metropolitan Taiwanese community and assessed their visual impairment status. A structured questionnaire was used for door-to-door data collection. Interviewers also collected information on demographics, medical history, and HRQoL. Those who were interviewed were invited to the study hospital for a detailed eye examination. An eye examination, including presenting visual acuity and best-corrected visual acuity, was conducted by ophthalmologists. Presenting visual acuity and best-corrected visual acuity were measured in the better eye. Impaired vision was defined as presenting visual acuity in the better-seeing eye worse than 6/12 (or 20/40) and was used to evaluate the correlation to HRQoL. A total of 1361 subjects at least 65 years of age participated in both the interview and eye examination. Internal-consistency and test-retest reliability of the eight scales were high. Based on the separate multiple regression model, after controlling for all other covariates, subjects in contact with vision services offered by an ophthalmologist had more positive scores on general health perceptions (beta = 4.29; p < 0.001), vitality/energy (beta = 2.73; p < 0.001), and mental health (beta = 2.06; p = 0.01). Impaired vision was associated with significantly lower scores in physical functioning (beta = -3.62; p < 0.001) and social functioning scales (beta = -3.25; p = 0.015). The findings suggest that visual impairment is associated with lower quality of life and use of eye care services is associated with higher quality of life.

Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. II. Long-Term Quality of Life

To determine the impact of nonfatal in-hospital postoperative complications on long-term quality of life and functional status, we studied consecutive patients ≥70 yr of age who had undergone noncardiac surgery. The association between the occurrence of nonfatal in-hospital postoperative complications and long-term quality of life (measured by the Medical Outcome Study Short form 36) and functional status was determined 2–3 yr after surgery. Independent predictors of quality of life and functional status were measured by multivariate logistic regression. Two-hundred-sixty-four of 353 patients (74.8%) responded to the survey. The mean Medical Outcome Study Short form 36 scores of patients with in-hospital postoperative complications were significantly lower than those without complications in the following domains: physical functioning (42.8 versus 53.9;P = 0.029), general health (52.3 versus 62.3;P = 0.02), and role emotional (45.7 versus 67.9;P = 0.00058). Patients who had postoperative complications were more likely to be dependent in daily living activities. Comparison with age-matched United States population showed that patients with postoperative complications had lower scores in physical functioning (42.8 versus 53.2;P = 0.04), role physical (26.6 versus 45.3;P = 0.0078), role emotional (45.7 versus 63.2;P = 0.025), and mental health (66 versus 74;P = 0.024). By multivariate logistic regression analysis, only a history of diabetes (odds ratios 4.2; 95% confidence interval, 1.7–10.3;P < 0.002 and new hospitalization because of medical reasons (odds ratio, 3.8; 95% confidence interval, 1.6–8.8;P < 0.002) were significant independent predictors of a long-term decrease in quality of life. Adjusting for other clinical factors, in-hospital complications no longer independently predicted changes in functional status. For geriatric patients, the occurrence of postoperative complications does not independently predict long-term quality of life or functional status. The important independent predictors are co-morbid conditions, age, and new hospitalization after discharge.

Prognostic significance of postoperative in-hospital complications in elderly patients. II. Long-term quality of life.

To determine the impact of nonfatal in-hospital postoperative complications on long-term quality of life and functional status, we studied consecutive patients > or = 70 yr of age who had undergone noncardiac surgery. The association between the occurrence of nonfatal in-hospital postoperative complications and long-term quality of life (measured by the Medical Outcome Study Short form 36) and functional status was determined 2-3 yr after surgery. Independent predictors of quality of life and functional status were measured by multivariate logistic regression. Two-hundred-sixty-four of 353 patients (74.8%) responded to the survey. The mean Medical Outcome Study Short form 36 scores of patients with in-hospital postoperative complications were significantly lower than those without complications in the following domains: physical functioning (42.8 versus 53.9; P = 0.029), general health (52.3 versus 62.3; P = 0.02), and role emotional (45.7 versus 67.9; P = 0.00058). Patients who had postoperative complications were more likely to be dependent in daily living activities. Comparison with age-matched United States population showed that patients with postoperative complications had lower scores in physical functioning (42.8 versus 53.2; P = 0.04), role physical (26.6 versus 45.3; P = 0.0078), role emotional (45.7 versus 63.2; P = 0.025), and mental health (66 versus 74; P = 0.024). By multivariate logistic regression analysis, only a history of diabetes (odds ratios 4.2; 95% confidence interval, 1.7-10.3; P < 0.002 and new hospitalization because of medical reasons (odds ratio, 3.8; 95% confidence interval, 1.6-8.8; P < 0.002) were significant independent predictors of a long-term decrease in quality of life. Adjusting for other clinical factors, in-hospital complications no longer independently predicted changes in functional status. For geriatric patients, the occurrence of postoperative complications does not independently predict long-term quality of life or functional status. The important independent predictors are co-morbid conditions, age, and new hospitalization after discharge.

Relationship of HIV viral loads, CD4 counts, and HAART use to health-related quality of life.

To understand the relationship of viral load (VL), CD4 counts, and highly active antiretroviral therapy (HAART) use to health-related quality of life (HRQL). Cross-sectional analysis of 513 HIV-infected patients. Primary outcomes were four domains of HRQL: physical functioning (PF), role function (RF), energy levels (EL), and health perceptions (HP). The authors examined univariate and multivariate relationships between VL, CD4, and HAART use to each HRQL domain, after adjustment for potential confounders. In univariate analyses, compared with patients with CD4 > 500, those with CD4 < 200 (p =.001) or 200 to 500 (p =.002) had lower PF and RF scores, and patients with undetectable VL had higher PF scores than patients with VL log10 2.6 to 4.0 (p =.02) and > log10 4.0 (p =.01). In multivariate analyses, compared with patients with CD4 > 500, patients with CD4 < 200 had lower PF (-8.8 points; p <.01), RF (-9.3 points; p <.01), and HP (-7.8 points; p <.001). Patients with log10 VL 2.6 to 4.0 had lower PF scores (-7.7 points; p <.01) versus undetectable VL. After adjusting for VL and CD4 counts, HAART use was associated with lower PF scores (-5.4 points; p <.05). Efforts to improve patients' CD4 counts are likely to also improve HRQL. Lowering viral loads may improve physical functioning, but only if VL are suppressed to undetectable levels. In this analysis, HAART had negative effects on PF that were independent of its effects on CD4 and VL. For adherent patients, these adverse effects of HAART on PF are likely to be outweighed by the positive effects that HAART exerts through lowering VL and increasing CD4 counts.

Determinants of disability in older coronary patients

Background Patient-reported physical function is a major component of disability determinations and an important contributor to health-related quality of life. Prior studies of coronary disability have shown a surprisingly poor correlation between real-life activity profile and exercise capacity measured on the treadmill. The goal of the current investigation was to evaluate the relative importance of medical factors, sex, fitness-related measures, and psychologic factors as determinants of patient-reported physical function score in older persons with established coronary heart disease (CHD). Methods Determinants of disability were studied in 51 community-dwelling patients >65 years old (71 ± 5 years, range 65-83 years) with established chronic CHD. Patient-reported physical function score (scaled 0-100) was measured by the Medical Outcomes Study Short Form physical function section. Independent variables included clinical and demographic data, treadmill testing, rest and exercise echocardiography, measures of body composition, strength, aerobic fitness, and a depression score. Results Patients with a diagnosis of myocardial infarction had a lower physical function score than did patients with other CHD diagnoses (68 ± 19 vs 82 ± 22, P <.05). Univariate predictors of patient-reported physical function score included peak aerobic capacity (R = 0.62), treadmill test duration (R = 0.61), depression score (R = –0.60), handgrip strength (R = 0.42), and comorbidity score (R = –0.39). Peak aerobic capacity (R2 = 0.38) and depression score (cumulative R2 = 0.60) were the best independent predictors of physical function. Women had lower physical function scores than men (64 ± 22 vs 78 ± 20, P <.05) despite a similar age, diagnostic distribution, depression score, and comorbidity score. Resting left ventricular ejection fraction was not a predictor of physical function score. Conclusions Peak aerobic capacity and depression score were the best independent predictors of patient-reported physical function score in older coronary patients. These data focus on the potential for exercise training and treatment of mental depression to prevent and treat coronary disability in older coronary patients. (Am Heart J 2002;143:151-6.)

PUR1: HEALTH STATUS OF ELDERLY DIALYSIS PATIENTS

OBJECTIVES: The elderly comprise approximately half of new patients undergoing dialysis, an expensive, lifesaving treatment. We report the health status of 3 elderly age groups, including novel information about patients 85 years, hypothesizing that as age increases health status will decrease. METHODS: This retrospective analysis reports on 6154 patients treated by one dialysis chain (48.4% male, 61.5% white, 39.1% diabetes as primary diagnosis). Health status is reported by a single administration of the SF-36 between 10/30/90 and 10/30/00. RESULTS: Although not statistically significant at p < .01, with increasing age, there are trends to lower Physical Function and Role Physical scores. The Physical Component Score shows a statistically significant difference between groups 1 and 2. Group 3, the very elderly, are not significantly different from groups 1 or 2. Other scales show no change. CONCLUSIONS: As hypothesized, physical health of dialysis patients appears vulnerable to age. However, other domains of health status remain robust. The very elderly receiving dialysis maintain their mental health when compared to patients in the 2 younger age groups. (See table below.) Table for PUR1 Mean SF-36 SCORE (SD) 1652 1 Physical Function Role Physical Bodily Pain General Health Vitality Social Function Role Emotional Mental Health Physical Component Score* Mental Component Score * = p < .01 Group 1 65–74 36.9 (27.8) n = 3687 29.3 (37.9) n = 3609 58.5 (29.0) n = 3674 43.2 (20.1) n = 3587 42.7 (22.8) n = 3635 62.8 (28.8) n = 3687 55.7 (43.6) n = 3577 69.2 (20.0) n = 3621 31.8 (10.1) n = 3445 48.3 (11.3) n = 3445 Group 2 75–84 32.4 (26.2) n = 2117 26.8 (36.4) n = 2059 58.1 (28.4) n = 2111 44.2 (20.0) n = 2073 40.8 (22.4) n = 2098 61.3 (30.0) n = 2119 54.2 (43.9) n = 2038 69.5 (20.1) n = 2089 30.9 (9.4) n = 1957 48.4 (11.6) n = 1957 Group 3 85 30.0 (27.1) n = 267 26.8 (37.5) n = 257 58.7 (58.7) n = 266 46.8 (21.1) n = 254 42.1 (23.0) n = 261 63.5 (30.1) n = 267 53.6 (44.5) n = 257 71.5 (19.1) n = 258 30.7 (10.0) n = 244 49.5 (11.0) n = 244

Hypertension and health-related quality of life: an epidemiological study in Sweden

The aim of this study was to describe the relationship between hypertension and health-related quality of life (HRQL) in a Swedish general population using the 36-item short form questionnaire (SF-36). The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20–84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that those with hypertension scored lower in the linear regression analyses in most of the eight domains of the SF-36 than those without hypertension after controlling for age, sex, sociodemographic factors, and comorbidity. Diabetes and angina pectoris were related to lower scores in most of the domains of the SF-36. Previous myocardial infarction was associated with lower general health and vitality. Those with a previous stroke had lower scores in physical functioning, general health, vitality, and social functioning. The findings suggest that hypertensives represent a vulnerable population that merits special attention from health care providers and systems. This is especially important given that low HRQL can be a risk factor for subsequent cardiovascular events or complications.

Determinants of physical functioning in coronary patients: response to cardiac rehabilitation.

Coronary heart disease is a major cause of disability. There has been little study of the effect of cardiac rehabilitation on measures of self-reported physical functioning. Physical functioning was measured using the Medical Outcomes Study-Short-Form Questionnaire. Determinants of physical function were analyzed in 303 patients with coronary heart disease. Response of physical function to a 3-month exercise rehabilitation program was then determined. At baseline, women had lower physical function scores than men, despite similar age and diagnostic distribution. Older patients had lower physical function than younger patients. Aerobic exercise capacity, leg and arm strength, and comorbidity and depression scores were all significant predictors of baseline physical function (r range, 0.46 to -0.22). Physical function score increased significantly after exercise conditioning, with a mean (+/- SD) overall score increase from 66 +/- 23 to 80 +/- 20 on a scale of 0 to 100. The best baseline determinant of a favorable physical function improvement after rehabilitation was a low baseline physical function score. The best training-related correlate of improved physical function score was a decrease in mental depression score. Self-reported physical function in coronary patients is related to age, sex, fitness, and mood state. Physical functioning improves after cardiac rehabilitation in all age, sex, and diagnostic groups, but particularly in patients with low baseline values. These data support the concept that cardiac rehabilitation effectively prevents and treats cardiac disability.