Measurement Information System Short Form Research Articles

Initial Validation of AUGS-PERFORM: Construct Validity and Test-Retest Reliability.

The American Urogynecologic Society's Prolapse pERFORmance Measure (AUGS-PERFORM) patient-reported outcome measure contains 11 items designed to assess symptoms relevant for assessing the quality of treatment for pelvic organ prolapse. The aim of the study was to test AUGS-PERFORM's construct validity and test-retest reliability. For this prospective validation study, we recruited English-speaking adult participants, at a single academic institution, seeking care for pelvic organ prolapse. Participants completed AUGS-PERFORM, the Pelvic Floor Distress Inventory, and several Patient-Reported Outcomes Measurement Information System short forms at baseline. We compared the 11 AUGS-PERFORM items against items testing the same concepts on other questionnaires using percent agreement, kappa statistics, and linear regression to determine construct validity. Two weeks later and before any pelvic organ prolapse therapy, participants completed AUGS-PERFORM a second time. Test-retest reliability was assessed using intraclass correlation coefficients. We enrolled 148 participants between 27 and 86 years of age: 81% self-identified as White, 56% were sexually active, and 84% elected surgery for treatment. The AUGS-PERFORM items assessing bulge presence and bother had a high percent agreement with the Pelvic Floor Distress Inventory item #3 (83.5 and 70%, respectively). The percent agreement ranged from 69% to 75% for items assessing urinary and defecatory symptoms and from 49% to 56% for pain-related questions. Sexual function items had a strong negative correlation (expected direction based on scoring) with validated sexual function questionnaires. The intraclass correlation coefficient was estimated to be 0.86, indicating excellent test-retest reliability. The AUGS-PERFORM demonstrated good construct validity for prolapse, urinary incontinence, defecatory dysfunction, and sexual function questions, and moderate construct validity for pain-related questions. There was excellent test-retest reliability.

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

Social isolation, depression, and anxiety among young adult cancer survivors: The mediating role of social connectedness.

Social isolation and social connectedness are health determinants and aspects of social well-being with strong associations with psychological distress. This study evaluated relationships among social isolation, social connectedness, and psychological distress (i.e., depression, anxiety) over 1 year in young adult (YA) cancer survivors 18-39 years old. Participants were YAs in a large cohort study that completed questionnaires every 2 months for 1 year. Social isolation, aspects of social connectedness (i.e., companionship, emotional support, instrumental support, and informational support), depression, and anxiety were assessed with Patient-Reported Outcomes Measurement Information System short form measures. Mixed-effect models were used to evaluate changes over time. Confirmatory factor analysis and multilevel structural equation modeling were used to define social connectedness as a latent construct and determine whether relationships between social isolation and psychological distress were mediated by social connectedness. Participants (N = 304) were mean (M)= 33.5 years old (SD = 4.7) and M = 4.5 years (SD = 3.5) post-initial cancer diagnosis. Most participants were female (67.4%) and non-Hispanic White (68.4%). Average scores for social well-being and psychological distress were within normative ranges and did not change (p values >.05). However, large proportions of participants reported at least mild social isolation (27%-30%), depressive symptoms (36%-37%), and symptoms of anxiety (49%-51%) at each time point. Across participants, more social isolation was related to less social connectedness (p values <.001), more depressive symptoms (p < .001), and more symptoms of anxiety (p < .001). Social connectedness mediated the relationship between social isolation and depression (p = .004), but not anxiety (p > .05). Social isolation and connectedness could be intervention targets for reducing depression among YA cancer survivors.

Responsiveness and clinically important differences of the PROMIS short form-depression 8a, anxiety 8a, and PASS-20 in individuals with chronic low back pain.

Depression and anxiety are the most commonly reported mental health conditions. The Patient-Reported Outcomes Measurement Information System Short Form v1.0-Depression 8a (PROMIS-D-8a), Anxiety 8a (PROMIS-Anx8a), and Pain Anxiety Symptoms Scale-20 (PASS-20) measures were designed to assess depression, general anxiety, and pain-related anxiety, respectively. To examine the responsiveness and estimate the clinically important differences (CIDs) of the Thai version of these measures in individuals with chronic low back pain (CLBP). The study sample comprised 144 participants with CLBP. Responsiveness was evaluated by calculating the change scores, effect sizes (ESs), standardized response means (SRMs), area under the curve (AUC), and correlations between the change scores and associated Global Perceived Effect (GPE). We also estimated CIDs by the difference in mean change score between improved and unchanged groups and standard error of measurement (SEM) for each measure. Statistically significant differences in the mean change scores, ESs, and SRMs supported the responsiveness of all measures. The AUCs achieved acceptable discriminatory ability (0.71-0.72) for moderate improvement but not for any improvement (0.65-0.68). The correlations between GPE and change scores on all measures were low (r ranging 0.28-0.33). The estimated CIDs for the PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 were 3.64, 4.20, and 8.80, respectively. The PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 measures were sensitive for detecting clinical changes over time in individuals with CLBP. The CID values can be used as reference points for assessing meaningful improvements in the domains assessed by these scales in clinical and research practice.

Anxiety in patients with venous thromboembolism: quantification and risk factors in a prospective cohort study

BackgroundPatients with venous thromboembolism (VTE) are at risk of psychological consequences. However, as opposed to physical sequelae of VTE, mental health issues are understudied. ObjectivesTo assess anxiety after VTE and investigate associated clinical characteristics. MethodsWe conducted a prospective cohort study, including patients with acute deep vein thrombosis (DVT) and/or pulmonary embolism. Patients with cancer, pregnancy, or puerperium were excluded. Anxiety was assessed with the Patient-Reported Outcome Measurement Information System short form 8a. Standardized T-scores were calculated (reference, 50; SD, 10), with higher values indicating more anxiety. We associated clinical characteristics at baseline with T-scores at 3-month follow-up in a multivariable linear regression model. Patient clusters depending on anxiety trajectories were explored. ResultsWe included 257 patients (38.5% women) with a median (IQR) age of 54.1 (42.2-63.5) years. While mean (SD) T-scores decreased from baseline to follow-up (51.03 [9.18] to 46.74 [8.89]; P < .001), we observed an increase in 23.7% of all patients. Female sex (T-score change, 3.09; 95% CI, 0.96-5.22), older age until 45 years, and anxiety at baseline were associated with increased T-scores at follow-up. VTE history (−1.55; 95% CI, −3.62 to 0.52) and pulmonary embolism (−1.23; 95% CI, −3.16 to 0.69) were associated with reduced T-scores, albeit not reaching statistical significance. In a cluster of older female patients with DVT, anxiety tended to increase over time. ConclusionWhile most patients with VTE reported reduced anxiety over time, some patients experienced worsening. Female sex, older age, more anxiety at baseline, no VTE history, and DVT were associated with increased anxiety 3 months after VTE.

Non-inferiority study assessing the utility of postcervical and lumbar radiofrequency ablation steroid use

IntroductionMany physicians administer steroids after radiofrequency ablation (RFA) to mitigate postprocedural inflammation and decrease postprocedural pain. However, robust evidence supporting the benefits of steroids after RFA is lacking and steroids...

Cancer-related fatigue among patients with advanced cancer receiving immune-checkpoint inhibitors: a prospective study.

The aim of this study was to determine the frequency and factors associated with severity of cancer related fatigue (CRF) as assessed by Functional Assessment of Cancer Illness Therapy-Fatigue (FACIT-F), prior to, and during 12weeks of immune-checkpoint inhibitors (ICIs). We also explored the effects of ICIs on fatigue dimensions and interference with daily activities (Multidimensional Functional Symptom Inventory, MFSI-SF, Patient-Related Outcome Symptom Measurement Information System Short form Fatigue 7a, PROMIS F-SF), QOL (Functional Assessment of Cancer Therapy-General, FACT-G), and cancer symptoms (Edmonton Symptom Assessment Scale, ESAS). In this prospective, longitudinal observational study, patients with a diagnosis of advanced cancer receiving ICIs were evaluated. Patient demographics, FACT-G, FACIT-F, MFSI-SF, PROMIS F-SF, and ESAS were collected prior to, and during 12weeks of ICIs. A total of 160 of the 212 enrolled patients were analyzed. The median age was 61years, 60% were female, most common cancer was melanoma (73%), and most common ICI was nivolumab 46%. The frequency of clinically significant fatigue (defined as ≤ 34/52 on FACIT-F score) was 25.6% at baseline, 25.7% at week 8, and 19.5% at week 12. There was significant improvement in FACIT-F (P = 0.016), FACT-G physical well-being (P = 0.041), FACT-G emotional well-being (P = 0.011), ESAS anxiety (P = 0.045), and ESAS psychological distress (P = 0.03) scores from baseline to week 12 of ICIs. Multivariate analysis found significant association between clinically significant CRF and PROMIS F-SF (P < 0.001) and MFSI-SF global scores (P < 0.001). CRF is frequent prior to the initiation of ICI treatment. Over 12weeks of ICI treatment, CRF significantly improved. FACT-G physical well-being, FACT-G emotional well-being, ESAS anxiety, and ESAS psychological distress scores improved overtime. Further studies are needed to validate these findings.

Long-Term Clinical Outcomes Following Nonsurgical Management of Salter-Harris Type II Fractures of the Proximal Phalanx of the Small Finger: A Prospective Cohort Study

Juxta-physeal fractures at the base of the proximal phalanx (FBPP) of the small finger are one of the most common hand fractures in children. Although many of these fractures are treated nonsurgically, it is unclear which fractures benefit from surgery or the degree of acceptable angulation appropriate for nonsurgical management. Our study aimed to assess long-term, patient-reported outcomes regarding function, appearance, and pain after nonsurgical management of FBPP of the small finger in a pediatric population. Our hospital Picture Archiving and Communication Systems database was queried to identify radiographs of the small finger of children between the ages of 8 and 16 years old taken from 2011 to 2021. Displacement on initial injury radiographs was calculated using the diaphyseal-metacarpal head angle. Patient-reported function, appearance, and pain were measured using standardized assessment tools sent to patients and parents electronically. Optional clinical photographs were uploaded by parents and assessed for residual clinical deformity. One hundred eighty-one eligible subjects were identified. Eighty (44%) agreed to participate, and 40 (22%) parent and 38 patient surveys were completed. The mean age at the time of injury was 11 years old (8-14 years), and the mean age at the time of survey completion was 17 years old (11-23 years). Patient T-scores were higher than the average reference T-score on the Patient-Reported Outcomes Measurement Information System Short Form v2.0-Upper Extremity. Overall, greater than 78% of patients and parents reported appearance as 8/10 or above on a VAS. Ninety-five percent (108/114) of patients reported no pain (0/10) for pain during activities and at rest. Children with up to 26° of initial coronal plane angulation reported better function than a reference population, good appearance, and no pain, at a mean of 6 years after injury. Our findings support nonsurgical management of most FBPP of the small finger in children. Therapeutic IV.

Influence of anosognosia on patient-reported outcomes for psychiatric symptoms and quality of life in Huntington's disease

IntroductionAnosognosia, defined as reduced awareness of one's deficit or symptom, is common in Huntington's disease (HD) and detectable at each disease stage. The impact of anosognosia on self-reporting in HD populations is critical to understand given growing use of patient-reported outcomes in HD clinical care and research. We aimed to determine the influence of anosognosia on patient-reported outcome measures assessing psychiatric symptoms and quality of life in HD. MethodsWe enrolled HD patients to complete a battery of patient-reported and rater-administered measures, including the Anosognosia Scale, at baseline and 6 months later. Patient-reported outcome measures included NeuroQoL short forms for depression, anxiety, satisfaction with social roles and activities, and positive affect and well-being and Patient-Reported Outcomes Measurement Information System short forms for emotional distress-anger and sleep-related impairment. Anosognosia Scale-Difference Score indexed patient-clinician agreement on patient motor, cognitive, and behavioral abilities. We conducted multivariable linear regression analyses to quantify the association of baseline anosognosia with 6-month patient-reported outcomes. ResultsOf 79 patients with complete Anosognosia Scale data at baseline, 25 (31.6 %) met the scale's criterion for anosognosia. In the regression analyses, baseline Difference Score improved prediction of 6-month patient-reported outcomes for depression, anxiety, anger, and positive affect and well-being (χ2(1) value range for likelihood ratio tests contrasting models with and without Difference Score: 13.1–20.9, p-values <0.001). Patients with more anosognosia self-reported less severe psychiatric symptoms and more positive affect and well-being. ConclusionStudy results suggest that anosognosia influences patient-reported outcomes for psychiatric symptoms and quality of life in HD populations.

Self-Reported Well-Being of Family Caregivers of Children with Medical Complexity

ObjectiveProvide an in-depth and psychometrically rigorous profile of the emotional well-being and sleep-related health of family caregivers of children with medical complexity (CMC). MethodsCross-sectional survey study of family caregivers of CMC receiving care from a pediatric complex care center between May 2021 and March 2022. Patient Reported Outcomes Measurement Information System Short-Forms (PROMIS-SF) assessed global mental health, emotional distress (anxiety, depression, anger), psychological strengths (self-efficacy, emotional regulation, meaning and purpose), and sleep-related health (fatigue, sleep-related impairment). Student’s t-tests compared the sample’s mean T-scores to US population norms. Pearson’s correlation coefficient (ρ) examined associations between measures of psychological strengths and emotional distress. Unadjusted linear regression analyses explored relationships between well-being outcomes and child and caregiver characteristics. ResultsCompared to US population norms, caregivers of CMC (n = 143) reported significantly lower global mental health and emotional regulation ability as well as elevated symptoms of anxiety, depression, anger, fatigue, and sleep-related impairment (all P < .01). Whereas participants reported a significantly higher sense of meaning and purpose (P < .05), levels of self-efficacy were not significantly different from population norms. We observed moderate-to-strong inverse relationships between psychological strengths and emotional distress (ρ range, −0.39 to −0.69); with the strongest inverse associations found between emotional regulation ability and emotional distress. In exploratory analyses, caregiver race and ethnicity, socioeconomic status, and child health insurance type were significantly associated with caregiver well-being. ConclusionFamily caregivers of CMC report poor well-being, most notably, increased symptoms of anxiety and reduced global mental health and sleep-related health.

Cross-cultural adaptation and psychometric properties of the Thai version of the patient-reported outcomes measurement information system short form– depression 8a in individuals with chronic low back pain

BackgroundThe study aimed to cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0 - Depression 8a (PROMIS SF v1.0 - Depression 8a) into Thai and evaluate its psychometric properties in individuals with chronic low back pain (CLBP).MethodsThe PROMIS SF v1.0– Depression 8a was translated and cross-culturally adapted into Thai using the Functional Assessment of Chronic Illness Therapy translation methodology. Two hundred and sixty-nine individuals with CLBP completed the Thai version of PROMIS SF v1.0– Depression 8a (T-PROMIS-D-8a) scale and a set of measures assessing validity criterion domains. Structural validity, internal consistency, and test-retest reliability at a 7-day interval of the T-PROMIS-D-8a scale were computed and its construct validity was evaluated by computing correlations with the Thai version of Patient Health Questionnaire-9 (T-PHQ-9), Numeric Rating Scale of pain intensity (T-NRS), and Fear Avoidance Beliefs Questionnaire (T-FABQ).ResultsData from 269 participants were analyzed. Most participants were women (70%), and the sample had a mean age of 42.5 (SD 16.6) years. The findings supported the unidimensionality, internal consistency (Cronbach’s alpha = 0.94), and test-retest reliability (ICC [2,1] = 0.86) of the T-PROMIS-D-8a. A floor effect was observed for 16% of the sample. Associations with the T-PHQ-9, T-NRS, and T-FABQ supported the construct validity of the T-PROMIS-D-8a.ConclusionsThe T-PROMIS-D-8a was successfully translated and culturally adapted. The findings indicated that the scale is reliable and valid for assessing depression in Thai individuals with CLBP.

Stigma and anxiety and depressive symptoms in parents of sexual and gender minority youth.

Parents of sexual and gender minority (SGM) youth play an important role in supporting their SGM child's mental health in the face of stigma. Yet, parents of SGM youth may themselves experience stigma, including discrimination/rejection, and its emotional consequences, including vicarious stigma and shame. The present cross-sectional study leveraged a national sample of parents of SGM youth to investigate associations between parents' stigma experiences and self-reported anxiety and depression symptoms. Further, we additionally explored sociodemographic and contextual correlates of parents' stigma experiences. Participants included 264 parents (Mage = 46) who reported having at least one SGM child under age 30 (Mage = 18). The Lesbian, Gay, Bisexual-Affiliate Stigma Measure (LGB-ASM) assessed parents' experiences of discrimination/rejection (e.g., actual and anticipated rejection experiences due to having an SGM child), vicarious stigma (e.g., worry and concern for one's SGM child), and shame (e.g., feeling embarrassed for having an SGM child). Parents indicated their anxiety and depressive symptoms using respective Patient-Reported Outcomes Measurement Information System-short forms. Results showed that vicarious stigma and shame, but not discrimination/rejection, were uniquely associated with parents' increased symptoms of anxiety (vicarious stigma: β = 1.59, p < .001; shame: β = 2.15, p < .001) and depression (vicarious stigma: β = 0.90, p < .01; shame: β = 2.77, p < .001). Further, parents with more accepting religious, racial, ethnic, and/or cultural communities reported lower stigma experiences. This study advances understanding of how the psychological consequences of stigma extend beyond SGM people themselves and contribute to mental health difficulties in parents of SGM youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cross-Cultural Adaptation and Psychometric Properties of The Thai Versions of The Patient-Reported Outcomes Measurement Information System Short Form – Anxiety 8a and the Pain Anxiety Symptoms Scale-20 in Individuals with Chronic Low Back Pain

Objective: To translate and cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0–Anxiety 8a and the Pain Anxiety Symptoms Scale-20 into Thai versions (T-PROMIS-Anx8a and T-PASS-20, respectively) and evaluate their psychometric properties in individuals with chronic low back pain (CLBP).Material and Methods: The translations and cultural adaptations were performed using the Functional Assessment of Chronic Illness Therapy (FACIT) guidelines. Thai individuals with CLBP completed the T-PROMIS-Anx8a and T-PASS-20. Psychometric evaluation including: internal consistency, test-retest reliability, and dimensionality. Construct validity was evaluated by computing correlations among the scores on the T-PROMIS-Anx8a, T-PASS-20, Thai version of the Hospital Anxiety and Depression Scale–Anxiety (T-HADS-A), and Thai version of the Fear Avoidance Beliefs Questionnaire (T-FABQ).Results: A total of 269 individuals with CLBP were included in the analyses. The T-PROMIS-Anx8a showed unidimensionality and the T-PASS-20 evidenced a 4-factor structure. Both measures demonstrated good to excellent internal consistency (Cronbach’s alphas ranged from 0.85 to 0.95), good test-retest reliability (ICC(2,1) ranged from 0.79 to 0.88), and neither ceiling nor floor effects were observed for any of the scales. Both measures evidenced acceptable convergent and discriminant validity, based on their associations with the T-HADS-A and T-FABQ.Conclusion: The T-PROMIS-Anx8a and T-PASS-20 were culturally adapted and evidenced acceptable psychometric properties for assessing anxiety in Thai individuals with CLBP.

Cross-Cultural Adaptation and Psychometric Properties of The Thai Versions of The Patient-Reported Outcomes Measurement Information System Short Form – Anxiety 8a and the Pain Anxiety Symptoms Scale-20 in Individuals with Chronic Low Back Pain

Objective: To translate and cross-culturally adapt the Patient-Reported Outcomes Measurement Information System Short Form v1.0–Anxiety 8a and the Pain Anxiety Symptoms Scale-20 into Thai versions (T-PROMIS-Anx8a and T-PASS-20, respectively) and evaluate their psychometric properties in individuals with chronic low back pain (CLBP).Material and Methods: The translations and cultural adaptations were performed using the Functional Assessment of Chronic Illness Therapy (FACIT) guidelines. Thai individuals with CLBP completed the T-PROMIS-Anx8a and T-PASS-20. Psychometric evaluation including: internal consistency, test-retest reliability, and dimensionality. Construct validity was evaluated by computing correlations among the scores on the T-PROMIS-Anx8a, T-PASS-20, Thai version of the Hospital Anxiety and Depression Scale–Anxiety (T-HADS-A), and Thai version of the Fear Avoidance Beliefs Questionnaire (T-FABQ).Results: A total of 269 individuals with CLBP were included in the analyses. The T-PROMIS-Anx8a showed unidimensionality and the T-PASS-20 evidenced a 4-factor structure. Both measures demonstrated good to excellent internal consistency (Cronbach’s alphas ranged from 0.85 to 0.95), good test-retest reliability (ICC(2,1) ranged from 0.79 to 0.88), and neither ceiling nor floor effects were observed for any of the scales. Both measures evidenced acceptable convergent and discriminant validity, based on their associations with the T-HADS-A and T-FABQ.Conclusion: The T-PROMIS-Anx8a and T-PASS-20 were culturally adapted and evidenced acceptable psychometric properties for assessing anxiety in Thai individuals with CLBP.

Patient-Reported Outcomes Measurement Information System Pediatric Symptom Profiles of Children With Cancer in China: A Latent Profile Analysis.

Unpleasant symptoms are common in children with cancer. However, research identifying subgroups of children with cancer who experience similar levels of self-reported symptoms in China is limited. This study aimed to classify the symptom profiles of children with cancer and detect the possible predictors of the profiles and their effect on children's quality of life (QoL). A total of 272 children aged 8 to 17 years completed the Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System short form measures, the Pediatric QOL Inventory general core and cancer modules. Latent profile analysis was used to identify symptom profiles, and ordinal logistic regression and analysis of variance were used to examine predictors of symptom profile membership and profile differences on QoL. The best fit was a 3-profile model: low, moderate, and severe symptom distress. Children who had been inpatients in the past 7 days and were currently under treatment are more likely to have severe symptoms. Participants in the low symptom distress profile reported significantly greater QoL than those in the other profiles. Children with cancer are heterogeneous in their experience of symptoms. Children's characteristics, such as inpatient history and treatment status, are predictors of profiles; different symptom profiles are associated with QoL. This study identified distinct groups of patients who predictably experience higher symptoms and their predictors, which could help to place children within a profile and perhaps allow nurses to provide targeted supportive care to match children's specific symptom profile.

Patterns and predictors of anxiety and depression symptom trajectories in patients diagnosed with primary brain tumors.

Patients with primary brain tumors (pPBTs) often exhibit heightened distress. This study assesses how symptoms of anxiety and depression change over time in pPBTs and identifies factors that may predict patients' symptom trajectories. Ninety-nine adult pPBTs completed psychosocial assessments at neuro-oncology appointments over 6-18months. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Brain; symptoms of anxiety and depression were assessed with the Patient-Reported Outcomes Measurement Information System short forms. The prevalence of patients with clinically elevated symptoms and those who experienced clinically meaningful changes in symptoms throughout follow-up were examined. Linear mixed-effects models evaluated changes in symptoms over time at the group level, and latent class growth analysis (LCGA) evaluated changes in symptoms over time at the individual level. At enrollment, 51.5% and 32.3% of patients exhibited clinically elevated levels of anxiety and depression, respectively. Of patients with follow-up data (n = 74), 54.1% and 50% experienced clinically meaningful increases in anxiety and depression scores, respectively. There were no significant changes in anxiety or depression scores over time, but better physical, functional, and brain-cancer well-being predicted lower levels of anxiety and depression (p < 0.001). Five sub-groups of patients with distinct symptom trajectories emerged via LCGA. pPBTs commonly experience elevated symptoms of anxiety and depression that may fluctuate in clinically meaningful manners throughout the disease. Routine screening for elevated symptoms is needed to capture clinically meaningful changes and identify factors affecting symptoms to intervene on.

Is the VISA-A Still Seaworthy, or Is It in Need of Maintenance?

Background:The Victorian Institute of Sport Assessment–Achilles (VISA-A) questionnaire is validated and widely used in Achilles tendinopathy. How well it can evaluate treatment outcomes is not well understood.Purpose:To evaluate the responsiveness of the VISA-A in midportion Achilles tendinopathy and compare it with other patient-reported outcome measures.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Enrolled were 97 participants with clinically diagnosed Achilles tendinopathy (median age, 50 years [interquartile range, 18 years]; symptom duration, 10 months [interquartile range, 28.7 months). The participants underwent a baseline evaluation and completed between 1 and 6 follow-up evaluations at 8, 16, 24, 32, 40, and/or 48 weeks. Participants completed the VISA-A, the Patient Reported Outcomes Measurement Information System short form Version 2.0 (PROMIS) Physical Function and Pain Interference subscales, and the Tampa Scale for Kinesiophobia (TSK). Three thresholds were evaluated with a receiver operating characteristic analysis (minimal clinically important difference [MCID], substantial benefit [SB], and complete recovery [CR]) using an 11-point global rating of change scale as an anchor. Thresholds were evaluated on raw scores as well as changes from baseline.Results:The VISA-A was able to detect all 3 thresholds for changes over time, with raw scores >70.5, >77.5, and >89.5 representing the MCID, SB, and CR, respectively; thresholds for changes from baseline on the VISA-A were increases of 23.5, 19.5, and 37.5 points from baseline, respectively. The PROMIS subscale raw scores had identical thresholds for SB and CR (52.45 for Physical Function and 45.6 for Pain Interference). A score <34.5 on the TSK was the threshold for SB.Conclusion:The VISA-A was the most responsive outcome measure evaluated. Raw scores had increasingly higher thresholds for the MCID, SB, and CR, which were therefore logically consistent.

Patient-reported physical function as a preoperative predictor of recovery after vascular surgery

ObjectivePreoperative risk assessment in vascular surgery often relies on the clinical subjectivity of providers and assessment tools with poor discrimination. Patient-reported outcome measures (PROMs) may provide a more objective assessment of an individual’s own health status before surgery and ability to recover after a vascular procedure. We designed this study to determine whether PROMs assessed for physical function (PROM-PF) prior to vascular surgery could be used to predict patient risk for postoperative complications and delayed recovery. MethodsWe identified all patients who completed a PROM-PF survey prior to undergoing a vascular surgery procedure captured in the Society for Vascular Surgery-Vascular Quality Initiative registry (carotid endarterectomy, abdominal aortic aneurysm, endovascular aneurysm repair, thoracic endovascular aneurysm repair, peripheral vascular intervention, infra-inguinal bypass, and supra-inguinal bypass) at a single academic institution between January 2016 and June 2020. PROM-PF assessment was obtained electronically using the validated Patient-Reported Outcome Measurement Information System short form (v1.2) instrument. All patient demographics and comorbidities were collected as part of the Society for Vascular Surgery-Vascular Quality Initiative registry. After stratifying patients based on high vs low preoperative PROM-PF, multivariable regression models were used to assess the risk-adjusted odds ratios (ORs) for perioperative complications, extended hospital length of stay (LOS), and discharge to a care facility. ResultsA total of 240 patients (mean age, 68 years; 69% male; and 88% Caucasian) completed a PROM-PF assessment <30 days before a vascular surgery intervention, of which 54% had low PF. Patients with high PF were more likely than those with low PF to undergo an open vascular procedure (43% high PF vs 42% low PF; P < .001). Rates of perioperative complications and/or mortality were similar between groups, although patients with low-PF were more likely to have an extended hospital LOS (48% low PF vs 33% high PF; P < .05) and/or be discharged to a care facility (17% low PF vs 7% high PF; P < .05). These results were confirmed in risk-adjusted models showing that patients with low PF scores were significantly more likely to have an extended LOS (adjusted OR, 1.86; 95% confidence interval, 1.06-3.28) and be discharged to a care facility (adjusted OR, 2.72; 95% confidence interval, 1.06-7.00). ConclusionsLow preoperative PROM-PF was associated with a higher risk of extended inpatient LOS and discharge to a care facility following vascular surgery. PROMs allow patients to provide valuable presurgical information about their own health status that can be used to anticipate postoperative recovery.

Immunological and psychosocial functioning in parents of children with cancer.

Research has shown that parents of children with cancer exhibit an altered immune profile compared to parents of healthy children, reflective of increased susceptibility to illness. These parents are also at risk for poorer psychosocial outcomes and quality of life. The current study compares peripheral blood cell analyses and psychosocial self-reports from parents of children being treated for cancer (n = 21) to parents of healthy children (n = 30). A blood sample was drawn from parents to analyze immune profiles. Parents also completed the Perceived Stress Scale (PSS), Medical Outcomes Study Short Form-36 (MOS), and Patient-Reported Outcomes Measurement Information System Short Form v1.0 Emotional Distress-Anxiety 8a, and Emotional Distress-Depression 8a (PROMIS). Mann-Whitney U tests and independent samples t-tests were conducted to examine differences in outcomes between parent groups. Parents of children with cancer exhibited higher monocyte percentages in their peripheral blood compared to peers with healthy children. Parents of children with cancer also reported poorer psychosocial outcomes: higher perceived stress, higher anxiety and depression symptoms, more role disability resulting from emotional problems, poorer general and mental health, and poorer social functioning. These findings support research that has shown a direct effect of chronic stress on the immune system. Symptoms reported by parents of children with cancer indicate unmet psychosocial needs that could potentially affect long-term health. Given the central role of parents in their children's cancer care, it is compelling to address and work to improve parent immunological and psychosocial well-being.

Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey

ObjectivesTo examine the prevalence of mental health symptoms during the first surge of COVID-19 in the USA, and their associations with COVID-19-related emotional distress, health self-management and healthcare utilisation.DesignCross-sectional analysis...