Lower Physical Functioning Scores Research Articles

Diagnostic delay and health-related quality of life in Egyptian women with endometriosis

BackgroundFirstly, to measure indicators of health-related quality of life (HRQoL) in Egyptian women with endometriosis; and secondly, to estimate time interval from start of symptoms until endometriosis diagnosis is made (diagnostic delay) in Egyptian women with the disease.Material and methodsBefore laparoscopy for pelvic pain and/or infertility, eligible Egyptian women completed Global Study of Women’s Health (GSWH) questionnaire and validated Arabic version of Rand SF 36 (SF-36). According to laparoscopic findings, participants were divided to endometriosis group and control women with no pelvic abnormalities.ResultsSeventy women with endometriosis and 57 symptomatic controls without endometriosis were enrolled. A diagnostic delay of 36 months (IQR 22.5–60) was observed in women with endometriosis while symptomatic controls had a delay of 48 months (IQR 24–84). The difference was not statistically significant (P = 0.08). Bodily pain (BP) scores were significantly lower in women with endometriosis than controls [80.0 (45.0–100.0) versus 100.0 (68.75–100.0) respectively, P is 0.01]. Women with advanced endometriosis had significantly lower scores for physical functioning (PF), role limitation due to physical function (RP), and BP compared to women with mild endometriosis, and to controls. Physical component summary (PCS) scores were significantly lower in women with advanced stage endometriosis [41.51 (34.19–51.54] compared to women with early-stage disease [58.33 (50.98–60.37)] or control group [54.72 (48.81–59.58)]. Patient’s age, intensity of noncyclical pelvic pain, and disease stage are determining factors of HRQoL in women with endometriosis.ConclusionsEgyptian women with endometriosis experience relatively short diagnostic delay, poor bodily pain scores, and impaired physical health for which age, disease stage, and non-cyclic pain are determinants. Multi-disciplinary endometriosis centers, educational programs, and patient support groups are needed in Egypt.

Childhood growth, current age, and waist circumference predict biological reserve capacity, physical performance, and rapid aging in Bangladeshi women

Background: The UK Bangladeshi community is socially disadvantaged, and many adults suffer from obesity, diabetes, and other chronic illnesses. Rapid aging has been noted.
 Objectives: Analyse biosocial trade-offs in growth, adult body composition, and reproduction, which are risk factors for age-related decline in physical performance, more rapid aging, frailty, and death.
 Methods: Sample: 40 Bangladeshi mothers (40-70 years old), one of their adult daughters (N=37, 18-36 years old) in the United Kingdom (UK), and 22 mother-daughter pairs of the same age range in Bangladesh (BD). Measurements: anthropometry, including knee height, migration, demographic history, education level, current menstruation (yes/no), and a 7-component lower body physical function score (PFS). Analysis: ridge regression and St Nikolas House Analysis (SNHA).
 Results: All the women are of short stature (x̄=150cm), with especially low knee height. Daughters who migrated to the UK have shorter knee height than daughters born in the UK. Marriage age was 16-18 years and total pregnancies of ~6 per mother, ~3 per daughter. UK mothers have higher fatness and lower PFS than BD women. Greater knee height predicts greater PFS, and that greater waist circumference and older age predict a lower PFS. SNHA finds that knee height is the most direct predictor of PFS.
 Conclusion: Adult knee height may serve as a sensitive indicator of early life physical and emotional well-being and predict physical performance, a risk factor for frailty and death. International migration of daughters is associated with poorer health status and physical performance at later ages.

P172 Metabolic disorders with non-alcoholic fatty liver disease in people with inflammatory bowel disease

Abstract Background Globally rising rates of obesity and consequent metabolic diseases have been reflected in the inflammatory bowel disease (IBD) population. Non-alcohol fatty liver disease (NAFLD) is a common liver disorder associated with obesity, that occurs more frequently in people with IBD. Methods A prospective single-centre cohort study. In total, we recruited 203 patients from our IBD service in a tertiary academic hospital. 7 participants were excluded due to later diagnosed non-NAFLD liver disease. Following informed consent, participants underwent a fibroscan for liver stiffness (LSM) and controlled attenuation parameter (CAP) measurement, and blood tests for HbA1c and fasting lipids. Basic demographics, past medical history, exercise measured on the Godin-Shepard Leisure Time Physical Activity Questionnaire, physical functioning on SF-36 Questionnaire, blood pressure, CAP and LSM were recorded. T-test and Fishers exact test were used to test for statistical significance as appropriate. Results Of the 196 IBD patients included, 34.7% (n=68/196) had a healthy BMI, 34.7% (n=68/196) were overweight (BMI≥25-29.9), and 30.6% (n=60/196) were obese (BMI≥30). Overall, 16.3% (n=32) had a CAP score >294dB/m consistent with NAFLD, and 2.55% (n=5) had a LSM >8.1kPa consistent with fibrosis. When compared to those without NAFLD, those with NAFLD had higher BMIs, 26.9 vs 32.3 p<0.05. They also had a much higher incidence of diabetes 28.1% vs 0% p=0.0001, higher overall rates of abnormal HbA1C (≥6%), 21.9% (n=7/32) vs 6.4% (n=10/156) p=0.0121, and higher rates of abnormal HbA1c without a diagnosis of diabetes 13% (n=3/23) vs 6.45% (n=10/155) p=0.4043. Additionally, they had non-significant higher mean systolic blood pressure and higher rates of diagnosed hypertension. Compared to those without NAFLD, the NAFLD cohort had higher rates of diagnosed hypercholesterolaemia 34.4% (n=11/32) vs 15.3% (n25/163) p=0.022 and there were higher rates of elevated total cholesterol (>5mmol/L) in those not previously diagnosed with hypercholesterolaemia, 42.9% (n=9/21) vs 31.8% (n=47/148) p=0.3292. Participants with NAFLD also had lower exercise scores 17 vs 24.9 p=0.03543, and lower scores for physical functioning 71.9 vs 83.2 p=0.00676. Of particular note, they had more than double the 10-year risk of myocardial infarction or death determined by the Framingham risk scores for hard coronary heart disease, 2.48% vs 5.75%, p=0.00012. Conclusion Our study shows that people with concurrent NAFLD and IBD have a significant cardiovascular risk profile. With increased awareness of this, metabolic syndrome conditions should be screened for and treatment initiated where appropriate, to decrease cardiovascular related mortality in this cohort.

Effect of Postoperative Immobilization Time on PROMIS Scores and Clinical outcomes in Ankle Fracture Patients.

Ankle fractures are among the most common injuries treated by orthopaedic surgeons, yet little guidance exists in postoperative protocols for ankle fractures concerning time of immobilization. Here, we aim to investigate the association between early mobilization and patient-reported outcomes. Our null hypothesis was that no difference in Patient-Reported Outcomes Measurement Information System (PROMIS) scores would be identified in patients when comparing the effect of time of immobilization. A retrospective review identified ankle fractures that underwent surgical fixation between 2015 and 2020 at a level 1 trauma center and its associated facilities. One hundred nineteen patients from 9 providers met inclusion criteria for our final analysis. Forty-seven patients were immobilized for <6 weeks (early) and 68 patients were immobilized for ≥6 weeks (late). Our primary outcome measures included the PROMIS questionnaire, time of immobilization, and time to full weightbearing. Our secondary outcome measures included time to return to work, wound complications (infection, delayed healing), and complications associated with fracture fixation (loss of reduction, delayed union, reoperation, hardware failure). Repeated measures analysis of variance as well as linear mixed outcome regression were used to predict each of the PROMIS outcomes of anxiety, depression, physical function, and pain interference. Each model included the predictors of age, sex, race, body mass index (BMI), diabetes, rheumatoid arthritis, smoking status, payor, provider, time to radiographic union, time to return to work, time to full weightbearing, and early vs late immobilized groups. We found no differences in PROMIS scores between mobilization groups even when controlling for possible confounders such as age, BMI, rheumatoid arthritis, smoking status, and diabetes mellitus (P > .05). Furthermore, we found no differences in complications associated with fracture fixation (P > .05). Across our cohort, lower physical function scores were associated with higher BMI, increasing age, and longer time to return to work/play (P < .05). Our analysis further showed that depression, anxiety, pain interference, and physical function levels improve as a function of time (P < .05). Higher BMI was also noted to have a significant impact on PROMIS depression and anxiety when controlling for other variables. African Americans had greater pain interference scores (P < .05). Our study suggests that early mobilization in a walker boot after operative treatment of ankle fractures is a safe alternative to casting in non-neuropathic patients. When considering operative treatment of ankle fractures, factors such as increasing age and BMI are likely to negatively affect postoperative anxiety, physical function, and depression PROMIS scores regardless of immobilization time. Level III, retrospective cohort study.

P96. A parameter fixed to poor outcomes: a detailed analysis of high Pelvic incidence in adult spinal deformity surgery

<h3>BACKGROUND CONTEXT</h3> Pelvic incidence (PI) serves as the cornerstone for many deformity classifications and realignment schema to create a more individualized realignment target for each patient. Yet, previous literature has linked high PI to problematic outcomes following corrective surgery, including mechanical complications and hip pathologies. <h3>PURPOSE</h3> Investigate if patients with high pelvic incidence have increased risk for complications and poor clinical outcomes following ASD surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>PATIENT SAMPLE</h3> A total of 689 ASD patients. <h3>OUTCOME MEASURES</h3> Clinical Outcomes (ODI, SF-36 PCS, MCS), mechanical failure, surgical details. <h3>METHODS</h3> ASD patients with 2-year (2Y) data included. Groups: PI >65° (HighPI) versus PI < 65° (NormPI). Means comparison tests assessed differences in demographics, surgical details and outcomes between groups. Multivariate analysis controlling for baseline age, frailty, baseline PI-LL, and history of prior fusion, analyzed complication rates and clinical improvement between groups. <h3>RESULTS</h3> Included: 445 ASD patients. There were 94 (21%) patients presented with a BL pelvic incidence greater than 65° (HighPI). HighPI patients were older (63 yrs), shorter, with higher BMI and frailty (all p<.05). HighPI were more likely to have had a prior fusion (OR: 1.9, [1.2-3.1]). HighPI were more likely to present with lower physical functioning scores, and severe pelvic compensation (OR: 5.5, [3.4-8.9]) and global deformity (OR: 3.5, [2.2-5.6]). During surgery, HighPI underwent more 3COs (OR: 1.8,[1.1-3.1]) and fusion to pelvis (OR: 2.1,[1.1-3.9]). Upon correction, adjusted analysis revealed HighPI were more likely to be undercorrected in each age-adjusted parameter compared to LowPI (OR: 4.8, [2.9-7.8]). Yet, HighPI patients were less likely to deteriorate within in-construct PI-based alignment (relative lordosis and lordosis distribution) (OR: 0.3,[0.1-0.9]). While not different at six weeks, HighPI were more likely to deteriorate in PI-based global alignment and pelvic compensation from six weeks to two years (OR: 3.2, [1.6-6.5]). This translated to a higher likelihood of developing a major or mechanical complication by 2Y (OR: 1.6, [1.04-2.6]) via adjusted analysis. <h3>CONCLUSIONS</h3> High pelvic incidence is associated with increased frailty, decreased physical functioning, and more severe lumbopelvic and global deformity upon presentation for adult spinal deformity correction. These patients are more often undercorrected by age-adjusted standards and deteriorate in out-of-construct alignment over time even when adequately corrected, leading to higher mechanical complications by two years. Despite our focus on PI-adjusted alignment, we have still not optimized treatment for the patient with high pelvic incidence. Further research should target which surgical techniques and strategies can achieve better results in this population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Determinants of sexual function in male patients with systemic lupus erythematosus.

Our study aims to describe the association between SLE and sexual function, analysing demographic variables, comorbidities and other disease-related factors. As an exploratory objective, the impact of asking about sexual function during outpatient consultation was evaluated. From 2018 to 2019, we invited sexually active men diagnosed with SLE to complete questionnaires that evaluated their sexual function and quality of life. Additionally, patients were asked if they believed they had sexual dysfunction, whether they would be interested in receiving specialized sexual care, and if they considered SLE to be detrimental to their sexual function. Epidemiological and disease-related data were retrieved from the patients' clinical records. We included 124 men with SLE. Twenty-two (18%) patients answered positively when asked if they believed they had sexual dysfunction. These patients had lower overall erectile function scores and lower physical function scores than those who did not consider they had sexual dysfunction. In the multivariable analysis, factors that were associated with better sexual function were high physical function (B = 0.126, p = .031), lower BMI (B = 0.53, p = .010) and the patient's perception of normal sexual function (B = 13.0, p < .001). Comorbidities associated with worse sexual function were type 2 diabetes (B = -8.1, p = .017) and a history of thrombosis (B = -5.12, p = .019). Sexual function of male patients with SLE is impaired, independently of disease activity, chronic disease damage or pharmacological treatment. A simple question about perception of sexual function in the outpatient clinic can be used to help determine which patients could benefit from a multidisciplinary intervention to improve sexual health.

Aging with Disability Symptoms and Ability to Participate in, and Satisfaction with, Social Participation among Persons Aged 45-64.

Pain, fatigue, and depression, considered aging with disability (AwD) symptoms, are known to be substantially higher among middle-aged adults with long-term disability compared to their age peers. Participation has been recognized as an important component of health. This cohort survey study reports findings on the relationship between AwD symptoms and ability to participate in, and satisfaction with participation in, social roles and activities using PROMIS measures. Data were collected at three time points from individuals aged 45–64 with an average of two decades of disability duration and primarily living in the state of Missouri, USA. This study reports on Time 1 (T1) and Time 3 (T3), pre- and post-COVID-19 pandemic declaration, respectively. Multiple regressions using both individual AwD symptoms and a composite measure demonstrated that having more pain, fatigue, and depression was associated with worse participation outcomes. Lower physical function scores were also related to lower participation scores, as was being female and living with others, and having more income reduced participation. Better physical health and identifying as African American/Black were associated with higher participation scores. Our findings suggest that AwD symptoms, along with other sociodemographic and health factors, play a substantial role in the social participation outcomes for persons aging with disability and remain consistent over time.

Health-Related Quality of Life Evaluation Using the Short Form-36 in Patients With Human T-Lymphotropic Virus Type 1-Associated Myelopathy.

BackgroundHuman T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM) is a neuroinflammatory disease, causing various neurological symptoms, including motor, sensory, and bladder and bowel dysfunctions. This study was designed to reveal the impact of HAM and related symptoms on health-related quality of life (HRQoL).MethodsWe analyzed the Short Form-36 (SF-36) and clinical data of 538 patients with HAM registered in the HAM-net, a nationwide patient registry for HAM in Japan. HRQoL was evaluated using the SF-6D (a health state utility value calculated from the SF-36) and eight SF-36 subscales. A general liner model was used to estimate the impact of major HAM-related symptoms, including gait dysfunction, sensory disturbance in the legs (pain and numbness), urinary dysfunction, and constipation, on the SF-6D and SF-36 subscale scores.ResultsThe mean age and disease duration were 62.0 and 16.5 years, respectively. Of the patients, 73.2% needed walking aid; 42.7 and 67.1% had leg pain and numbness, respectively; 92.1% had urinary dysfunction; and 77.9% had constipation. The mean SF-6D score was 0.565, which was significantly lower than the national average (0.674 in the 60–69 years age group; p < 0.001), exceeding the minimal important difference (0.05–0.1). All the major symptoms were significantly associated with a decrease in the SF-6D score. The SF-36 subscale scores were significantly lower than the national standard of 50 (p ≤ 0.001), except for mental health (MH). Gait dysfunction was associated with lower scores in physical functioning (PF), limitations on role functioning because of physical health, bodily pain, general health perception (GH), vitality (VT), and social functioning; however, no association was observed between gait dysfunction and limitations on role functioning because of emotional problems and MH. Meanwhile, sensory disturbance in the legs was associated with a decrease in scores in all subscales. Urinary dysfunction was associated with worse PF, GH, VT, and MH. Constipation was associated only with PF.ConclusionHRQoL of patients with HAM was worse than that of the general population and was associated with all major symptoms. Thus, patients should be comprehensively managed to achieve better HRQoL.

Behavioral and health outcomes from the NRG Oncology/NSABP B-36 trial comparing two different adjuvant therapy regimens for early-stage node-negative breast cancer.

The NSABP B-36 compared four cycles of doxorubicin and cyclophosphamide (AC) with six cycles of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC-100) in node-negative early-stage breast cancer. A sub-study within B-36, focusing on symptoms, quality of life (QOL), menstrual history (MH), and cardiac function (CF) was conducted. Patients completed the QOL questionnaire at baseline, during treatment, and every 6months through 36months. FACT-B Trial Outcome Index (TOI), symptom severity, and SF-36 Vitality and Physical Functioning (PF) scales scores were compared between the two groups using a mixed model for repeated measures analysis. MH was collected at baseline and subsequently assessed if menstrual bleeding occurred within 12months prior to randomization. Post-chemotherapy amenorrhea outcome was examined at 18months and was defined as lack of menses in the preceding year. Logistic regression was used to test for association of amenorrhea and treatment. CF assessment was done at baseline and 12months. Correlation analysis was used to address associations between changes in baseline and 12-month PF and concurrent CF changes measured by LVEF. FEC-100 patients had statistically significantly lower TOI scores during chemotherapy (P = 0.02) and at 6months (P < 0.001); lower Vitality score at 6months (P < 0.01), and lower PF score during the first year than AC patients. There were no statistically significant QOL score differences between the two groups beyond 12months. No significant differences in symptom severity between the two groups were observed. Rates of amenorrhea were significantly different between FEC-100 and AC (67.4% vs. 59.1%, P < 0.001). There was no association between changes in LVEF and PF (P = 0.38). Statistically significant QOL differences between the two groups favored AC; however, the magnitude was small and unlikely to be clinically meaningful. There was a clinical and statistically significant difference in risk for amenorrhea, favoring AC. NCT00087178; Date of registration: 07/08/2004.

The Sex Difference in Physical Functioning: How Do Risk Factors Contribute?

It is the purpose of child welfare practices to provide a protective environment for minors. However, welfare practices for children and adolescents have also been linked to a higher risk for maltreatment, trauma, and deprivation. Due to such early-life adversity, affected individuals often report a life course depicted by further trauma, socio-economic disadvantage, mental and physical ill-health. Examination of the long-term health correlates of enforced child welfare practices, as well as potential mediators, have previously been neglected in later life. It was therefore the purpose of these studies to examine the long-term correlates of enforced child welfare practices; the associated maltreatment, trauma, and deprivation; and the physical and mental health outcomes in Swiss older survivors (n=132, MAGE=71 years) and an age-matched control group (n=125). These studies further examined the mediating role of socio-economic factors (e.g., education, income), self-esteem, and self-compassion. Mental health was assessed with a structured clinical interview; physical health, self-esteem, and self-compassion with psychometric instruments. Survivors reported significantly more types and severity of childhood maltreatment, trauma, and deprivation than the control group. They also reported significantly more lifetime and current mental health disorders and more physical illnesses. Socio-economic factors and self-esteem, but not self-compassion, acted as significant mediators. Exposure to maltreatment, trauma, and deprivation in childhood and adolescence is linked to poorer mental and physical health in later life. Potential targets for intervention and health-protective measures include socio-economic factors and self-esteem, which were found to diminish the detrimental long-term impact of early-life adversity and disadvantage into later life.

Health-related quality of life in homozygous familial hypercholesterolemia: A systematic review and meta-analysis

Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disease characterized by extreme elevations of low-density lipoprotein cholesterol (LDL-C) and extremely premature atherosclerotic cardiovascular disease. To date, impacts of HoFH and its treatment on the psychosocial wellbeing of patients have been poorly characterized. We performed a systematic review of the association between HoFH and health-related quality of life (HRQL). This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus guidelines. We searched MEDLINE, Embase, The Cochrane Controlled Register of Trials (CENTRAL), Pubmed, Scopus, AfricaWide (via EBSCO), and six trial registries and grey-literature databases from inception to May 2021 for published English-language literature examining HRQL and its determinants in HoFH. Studies were eligible if they included patients with confirmed HoFH and evaluated HRQL using validated tools. We performed a narrative synthesis of qualitative findings from included studies and, where data permitted, random-effects meta-analysis reporting standardized mean differences (SMD) and 95% confidence intervals (CIs). Our review identified seven eligible studies examining HRQL in HoFH participants. Pooling data from two included studies, we found that relative to the general population, HoFH patients demonstrated significantly poorer HRQL in multiple dimensions of the 36-item Short-Form Health Survey (SF-36) with lower scores in physical functioning (SMD -0.37; 95% CI: -0.60, -0.15), role limitations due to physical health (SMD -0.63; 95% CI: -1.24, -0.02), social functioning (SMD -0.61; 95% CI: -1.19, -0.03), bodily pain (SMD -0.24; 95% CI: -0.46, -0.01), and general health (SMD -1.55; 95% CI: -1.80, -1.31). No differences were observed in domains of energy and vitality, mental health and emotional well-being, or role limitations due to emotional problems. Patients suffered high treatment burdens related to lipoprotein apheresis that compromised educational attainment and employment. However, few patients received psychological support in navigating their treatment challenges. No studies evaluated the association of HoFH with incident anxiety, depression, or other psychopathology. Limited data are available on quality of life for patients with HoFH. The available data suggest that these patients may suffer disease-related impairments in quality of life. Future work should aim to elucidate relationships between HoFH and mental health outcomes and develop interventions to improve quality of life in this population.

Predictors of continued opioid use 6months after total joint arthroplasty: a multi-site study.

Continued opioid use after total knee and hip arthroplasty (TKA/THA) is well-documented and associated with both surgical and patient-reported factors. Research examining the combined effects of a multitude of factors on continued, and even chronic, opioid use in a systematic algorithmic manner is lacking. This study prospectively evaluated the combined effect of patient-related and surgical factors associated with continued opioid use after TKA/THA. From 2016 to 2018, 198 participants undergoing TKA or THA were recruited from two tertiary care facilities. Participants completed surveys before surgery and at 2weeks, 1, 3, and 6months following surgery. A LASSO approach, followed by an exhaustive covariate selection procedure, was used to build a multivariable mixed-effects logistic regression model estimating the odds ratio of continued postoperative opioid use based on surgical factors and patient-reported factors. Approximately half of the participants underwent either TKA (49%) or THA (51%). Preoperatively, 15% of participants reported taking opioid medication. Opioid use decreased from 68% at 2-week follow-up to 7% by 6months. In addition, preoperative opioid use (95% CI 1.07-4.37), increased pain (95% CI 1.21-1.62), elevated preoperative Pain Catastrophizing Scale scores (95% CI 1.01-1.04), lower Physical Function scores (95% CI 0.87-0.95), and participants undergoing TKA, compared to THA, (95% CI 0.25-0.67) were found to be significantly associated with continued postoperative opioid use up to 6months. Preoperative opioid use, average pain, reduced physical function, and TKA were significantly associated with continued postoperative opioid use. Findings illustrate the need for preoperative and longitudinal assessment of patient-reported outcomes to mitigate poor postoperative pain outcomes. II.

Abstract 10757: Patient-Reported Quality of Life Outcomes in Hypertrophic Cardiomyopathy Patients

Background: Few studies have systematically assessed quality of life (QOL) in hypertrophic cardiomyopathy (HCM) patients not meeting the septal reduction therapy (SRT) threshold, but require avoiding isometric exertion and weightlifting. We prospectively studied a newly developed QOL instrument to examine the associations between patient characteristics and self-reported QOL scores in HCM patients not anticipated to undergo SRT for at least 6 months. Methods: A single-center, prospective sample of 51 adult HCM patients (54±14 years, mean interventricular septum thickness = 1.7±0.4cm, 65% with left ventricular outflow tract (LVOT) obstruction, mean provokable LVOT gradient 65±42 mmHg, 59% men) completed a baseline 70-item QOL instrument, adapted from validated QOL questionnaires. All patients signed informed consent. Results: Mean self-reported QOL scores (on a 5-point Likert scale with higher scores indicating higher QOL) were as follows: physical function (3.5±1), depression (3.7±1), anxiety (3.6±1), post-traumatic stress disorder (PTSD) (3.7±1), social function (4.1±1), spiritual acceptance of diagnosis (3.8±1), self-efficacy (4±1), and resilience (4±1). Men vs. women reported higher physical function (3.9±1 vs. 2.9±1), less depression (4±1 vs. 3.3±1), less anxiety (3.8±1 vs. 3.3±1), and higher social function (4.3±0.7 vs. 3.8±1) (all p&lt;0.05). Patients with obstructive HCM reported lower physical function scores (3.3±0.8) vs. non-obstructive HCM (3.8±0.8), p=0.03. Symptomatic patients reported lower physical function (3.2±0.8 vs. 4.3±0.5), social function (3.8±0.8 vs. 4.5±0.6) and worse depression (3.5±0.7 vs. 4.3±0.6), anxiety (3.4±0.8 vs. 4.1±0.7) and PTSD (3.5±0.8 vs. 4.3±0.9) scores (all p&lt;0.01). Presence of an implantable cardioverter defibrillator (ICD) was associated with lower vs. higher physical (2.9±0.4 vs. 3.5±1) and social function (3.6±1 vs. 4.1±1) (all p&lt;0.05). Conclusion: In HCM patients not requiring SRT, higher physical function scores were significantly associated with a better self-perceived overall health. Being a woman, having LVOT obstruction, presence of a defibrillator and presence of symptoms was significantly associated with worse perceived physical and social function.

EVALUATION OF THE QUALITY OF LIFE OF CAREGIVERS OF PATIENTS WITH A GASTROSTOMY FEEDING TUBE

The life quality of patient's caregivers who have a gastrostomy feeding tube at home has not been adequately researched, although it consists of an integral part of good home care. The aim of this study was to investigate the quality of life (QoL) of caregivers and identify the effective factors. A quantitative sample was created by 120 caregivers of patients with a gastrostomy feeding tube. The participants answered the following collection of questions: a sociodemographic characterization form, the SF-36 Health Research Questionnaire, the Greek Multidimensional Fatigue Questionnaire (MFI), and the Caring Behaviors Inventory-24 (24-item CBI or CBI-24). Regarding the SF-36 questionnaire, the lowest scores were recorded for the summary mental health scale (average value 43.8), the summary physical health scale (average value 49.8), as well as for the physical role dimension (average value 57.1). The data showed a positive correlation between married caregivers and cohabitants and physical functioning scores (P = 0.001) and that increasing year of care was associated with lower physical functioning scores (P = 0.001). In addition, an increase in the overall fatigue score (MFI-20) was associated with a decrease in the overall health score (P &lt;0.001), vitality, emotional role, mental health (P &lt;0.001), physical pain. (P &lt;0.001) and social functionality (P &lt;0.001). Moreover, informal caregivers had a higher score of physical pain than standard caregivers (P = 0.010). The results of this analysis suggest that the QoL of caregivers is affected across various domains and underscore the importance of QoLresearch particularly in the target populations.

Immunologic Abnormalities Associated With Health Status of Heart Recipients Long Term After Transplantation

With improvements in survival rates, health-related quality of life is an important outcome parameter to evaluate the effectiveness of transplantation. We aimed to identify potential immunologic abnormalities as factors associated with poorer health-related quality of life at distinct scales of the 36-Item Short Form Health Survey in heart transplant recipients long term after transplantation. One hundred heart transplant recipients were evaluated in a single center. Short-form 36 questionnaires were sent by mail to participants. All patients were clinically and immunologically evaluated after the first year of heart transplantation. A high prevalence of several immunologic abnormalities persisted even after the first year of transplantation, including IgG hypogammaglobulinemia, low IgG-specific antipneumococcal antibodies, C4 hypocomplementemia, CD8 T-cell lymphocytopenia, and CD19 B-cell lymphocytopenia. Older recipients (>55 years), posttransplant diabetes, digestive complications, and posttransplant infections were associated with lower physical functioning scores (scale < 60). Older recipients (>55 years), pretransplant diabetes, pretransplant arterial hypertension, posttransplant digestive complications, and lower CD8 counts were associated with lower physical role scores (scale <25). In a single center study, lower CD8 cell counts were found to be associated with poorer health status in heart recipients after the first year of transplantation.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

MO886ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE IN PATIENTS ON HEMODIALYSIS USING RAND36 SCORE

Abstract Background and Aims Evaluation of Health-related quality of life (HRQoL) is an important, albiet neglected component of health care in patients with End Stage Renal Disease (ESRD). RAND-36 is a validated scoring system for evaluating HRQoL. Patients on hemodialysis experience decrease in various aspects of HRQoL. Various disease related and socio-economic factors influence HRQoL. There is limited data on HRQoL among patients of ESRD on hemodialysis from Indian subcontinent. In the present study, we aim to evaluate the HRQoL using RAND-36 score &amp; the factors which influence it’s various aspects. In addition, we aim to evaluate patient perception of ease of access to dialysis related health care and its impact on RAND-36 score. Method This cross sectional, multi-centric study was performed in Nov 2020. A random sampling was employed to select the study participants. Patients with history of psychiatric illness, significant impairment of hearing, speech, or cognitive disturbances were excluded. RAND 36-Item Health Survey (Version 1.0) was used and circulated amongst dialysis patients across 10 dialysis centres in hospitals across India. Final scores were calculated using standard guidelines. A proprietary software from Bloom Value Corporation was used for data capture by electronic means and Power BI was used for analysis. Results 257 ESRD patients on hemodialysis completed the survey. Mean age was 52.9 years. 65.4 % participants were males, 39.69% were Diabetics and 75.88% had hypertension. Accessibility to healthcare was reported by 36% and 27.7% patients as ‘excellent‘ and ‘very good’ respectively. The mean scores in various scales were Physical Functioning (PF) 47.27±27.87 %, Role limitations due to physical health (RP) 54.18 ± 40.97 % , Role limitations due to emotional problems (RE) 55.38 ± 43.57 %, Energy/fatigue (EF) 49.80 ± 19.38 %, Emotional wellbeing (EW) 57.71 ± 22.04 %, Social functioning (SF) 58.02 ± 25.32%, Pain (BP) 68.28 ± 23.52 % and General Health (GH) 48.11 ±16.43%. Lower PF Scores were seen with higher age (NS), ≥ 2 comorbidities (NS). PF scores were higher in patients with Government insurance and higher perception of healthcare accessibility (NS). RP Scores were higher in males and with advancing age (NS). Employed patients had lower RP scores (p=0.009). RE scores were lower in patients with ≥ 2 comorbidities (NS) and among Employed patients (p=0.04). EF Scores were higher in males (p=0.07) and lower in patients with ≥ 2 comorbidities (NS). EW scores were higher in males (p=0.09) and among patients with higher perception of healthcare accessibility (NS). SF Scores were higher in males (p=0.08) and with higher perception of healthcare accessibility (NS). BP Scores were higher among patients with≥ 2 comorbidities (p=0.04) and higher perception of healthcare accessibility (NS). GH scores were higher with Government Insurance availability and higher perception of healthcare accessibility (NS). Conclusion To our knowledge this is the first multi-centric study conducted amongst ESRD patients in India, evaluating HRQoL using RAND36 scores. There is significant heterogeneity in patient reported outcomes and it’s determinants. Government Insurance support and a higher perception of healthcare availability have positive impact on many aspects of HRQoL. This is a valuable tool in executing patient centred care.

Patient-Reported Measures and Lifestyle Are Associated With Deterioration in Nutritional Status in CKD Stage 4-5: The EQUAL Cohort Study

The aim of this study was to explore the changes in nutritional status before dialysis initiation and to identify modifiable risk factors of nutritional status decline in older adults with advanced renal disease. The European Quality Study on treatment in advanced chronic kidney disease (EQUAL) is a prospective, observational cohort study involving six European countries. We included 1,103 adults >65years with incident estimated glomerular filtration rate <20mL/min/1.73 m2 not on dialysis, attending nephrology care. Nutritional status was assessed with the 7-point Subjective Global Assessment tool (7-p SGA), patient-reported outcomes with RAND-36 and the Dialysis Symptom Index. Logistic regression was used to estimate the associations between potential risk factors and SGA decline. The majority of the patients had a normal nutritional status at baseline, 28% were moderately malnourished (SGA ≤5). Overall, mean SGA decreased by -0.18 points/year, (95% confidence interval -0.21; -0.14). More than one-third of the study participants (34.9%) deteriorated in nutritional status (1 point decline in SGA) and 10.9% had a severe decline in SGA (≥2 points). The proportion of patients with low SGA (≤5) increased every 6months. Those who dropped in SGA also declined in estimated glomerular filtration rate and mental health score. Every 10 points decrease in physical function score increased the odds of decline in SGA by 23%. Lower physical function score at baseline, gastrointestinal symptoms, and smoking were risk factors for impaired nutritional status. There was an interaction between diabetes and physical function on SGA decline. Nutritional status deteriorated in more than one-third of the study participants during the first year of follow-up. Lower patient-reported physical function, more gastrointestinal symptoms, and current smoking were associated with decline in nutritional status.

Quality of life in adults with achondroplasia in the United States

Studies examining quality of life (QoL) in adults with achondroplasia are limited. We report on QoL and psychiatric illness diagnoses in a modern cohort of adults with achondroplasia. SF-36 Health Survey scores from adults with achondroplasia were compared to general population scores. Demographics, physical measurements, and psychiatric illness diagnoses were recorded from medical records. The achondroplasia population had lower scores than the general population in all categories. Most people with achondroplasia (56%) had a diagnosed psychiatric illness. Those with a diagnosed psychiatric illness had lower scores in physical functioning, role limitations due to physical and emotional health, and mental health. Pain, energy/fatigue, and general health scale scores were roughly equivalent (<2 points difference). Social functioning was >15 points higher in individuals with psychiatric illness diagnoses. Adults with achondroplasia report significantly lower physical and mental well-being and had nearly 3× the rate of psychiatric illness diagnosis than the general population, highlighting the importance of total care for this population. Healthcare providers must understand the physical and mental comorbidities of achondroplasia, beyond short stature and orthopedic issues, so they can proactively improve QoL across the lifespan for patients and families.

The relationship between self-reported physical functioning, mental health, and quality of life in Service members after combat-related lower extremity amputation

Purpose Service members with amputations experience numerous challenges, yet few studies have examined patient-reported outcomes, including physical functional status, mental-health screening status, and quality of life (QOL) or the relationship between these outcomes. Materials and methods Service members with combat-related lower extremity amputations (N = 82) and participants in the Wounded Warrior Recovery Project were included. Patient-reported outcomes of physical functional status, posttraumatic stress disorder (PTSD), depression screening status, and QOL were compared, while accounting for amputation level. Linear regression assessed relationships between physical functional status and QOL, as well as mental-health screening status. Results Higher physical functioning scores were associated with better QOL, and lower physical functioning scores were associated with screening positive for PTSD or depression. When stratified by mental-health screening, a significant relationship was observed between mean physical functioning scores and amputation level with a negative PTSD or depression screen only. Additionally, those with bilateral amputation reported lower physical functioning. Conclusions Physical functioning was associated with patient-reported outcomes, including QOL and mental-health screening. Screening positive for PTSD or depression was associated with worsened self-reported physical function and may outweigh the impact of amputation severity on physical functioning. Successful rehabilitation requires the integration of physical and mental health domains in order to achieve optimal functioning. Implications for rehabilitation The current study shows that physical functioning in participants with combat-related amputation is related to the amputation level, quality of life, and mental-health symptom screening. Good mental health is crucial to optimal functioning, as presence of adverse mental-health symptoms may exacerbate physical functional limitations among those with combat-related amputations. Assessing variables related to adverse mental-health symptoms and ultimate physical functioning outcomes is critical for clinicians to optimize rehabilitative strategies and outcomes.