Medical Outcomes Study 36-item Health Research Articles

Evaluating functional and health outcomes for patients with spina bifida 5 and 10 years post-transition into adult care

Background In BC, pediatric patients with spina bifida are followed by a multidisciplinary clinic at BC Children’ sH ospital. Upon graduation, patients transition into the adult healthcare system where they must coordinate their own care. The purpose of this study is to determine the functional and health outcome of graduates transitioning from the spina bifida clinic at BC Children’s Hospital. Materials and methods Graduates of up to 10 years (1999-2008) from the pediatric spina bifida clinic were mailed a questionnaire. It consisted of 11 sections, including two standardized questionnaires on quality of life (QOL), the Medical Outcomes Study 36-item short-form (SF-36) and Spina Bifida-specific Health Related QOL (SBHRQOL). Results

The Impact of Anxiety, Depression, and Suicidality on Quality of Life and Functional Status of Patients With Congestive Heart Failure and Hypertension

Congestive heart failure (CHF) and hypertension are prevalent diseases with high mortality and morbidity rates. Depression and anxiety are frequently associated with cardiovascular diseases. This observational cross-sectional study assessed depression, anxiety, suicidality, and quality of life in 240 patients with CHF (with or without hypertension) or hypertension (without CHF). Subjects were evaluated between June 2005 and June 2007 using the Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale, Medical Outcomes Study 36-item Short-Form Health Survey (both physical component score and mental component score), and Satisfaction With Life Scale (SWLS). Patients with CHF were assigned a New York Heart Association functional classification. The CHF patients had higher scores on the depressive factor and the HARS and higher suicidality. Furthermore, they had lower scores on the physical component score, higher scores on the mental component score, and lower scores on the SWLS. Depressive symptom level was a significant predictor of lower physical health (P = .012), whereas anxiety was a significant predictor of satisfaction with life (P = .002). CHF compared to hypertension was a predictor of higher mental health as measured with the mental component score and lower satisfaction with life. Higher anxiety predicted lower satisfaction with life both in patients with CHF and with hypertension. Anxiety and depressive symptoms and cardiovascular disease were frequently associated. Screening for anxiety and depression in cardiovascular patients may be crucial.

Integrating Primary Care Services Into Psychiatric Care Settings

This review assesses the outcomes of integrating primary care medical services into psychiatric care settings. PubMed, the Cochrane database, and PsycINFO were searched using the key words integrated care, family medicine, primary care, and internal medicine in combination with psychiatry or psychiatric clinic and ward to identify reports published between 1980 and December 2009 in English. Four studies evaluating medical care services on a psychiatry ward or in a psychiatry clinic were found. Trials involving psychiatric services in primary care clinics (the medical-psychiatric model) were excluded. Data describing setting, patient population, intervention, measured outcomes, and discussion points were collected. It was learned that several models of integrated care exist, and patients in these integrated groups received more preventive health measures and showed improved scores on the Medical Outcomes Study 36-item Short-Form Health Survey and Behavior and Symptom Identification Scale and reduced rates of specialist referral. These data indicate that placing primary care physicians in psychiatric care settings improves health maintenance, care coordination, and satisfaction with nonpsychiatric medical care. Future studies should further address costs, the training of primary care physicians to deliver care in these settings, and whether this integrated model is more effective in specific populations such as those with schizophrenia.

Physical activity, quality of life and symptoms of depression in community-dwelling and institutionalized older adults

This study was aimed to investigate in a sample of Spanish elderly whether measures of physical activity are related to health-related quality of life (HRQoL) and symptoms of depression in community dwelling and institutionalized elderly. The sample was a cohort of 436 elderly (234 women and 202 men, aged 60–98 years) from the North of Spain. 58% were community-dwellers and 42% were institutionalized in senior residences. Participants completed measures of physical activity (Yale Physical Activity Survey, YPAS), HRQoL (Medical Outcomes Study 36-item Short Form Health Survey, SF-36) and symptoms of depression (Geriatric Depression Scale, GDS). All SF-36 domains, except role-emotional, were significantly correlated with the YPAS activity dimension summary index. Physical function, role-physical, general health and vitality correlated with total time activity, and correlations were observed between weekly energy expenditure and physical function, role physical, vitality and mental health. Depressive symptom scores correlated significantly with the YPAS activity dimension summary index and the weekly energy expenditure. Scores for various domains of the SF-36 and for depressive symptoms significantly differed among less and more active individuals of the same sex and institutionalization category. Differences generally reached a higher extent in institutionalized subjects in comparison to community dwellers. In conclusion, physical activity was related to different domains of both the physical and mental components of HRQoL and to decreased depressive symptoms. Results emphasize the positive effects of physical activity in both community-dwelling and institutionalized older adults.

Prospective evaluation of the reliability, validity, and minimally important difference of the functional assessment of cancer therapy‐gastric (FACT‐Ga) quality‐of‐life instrument

Recently, the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) was developed to measure the quality of life (QoL) of patients with gastric cancer. This newly developed instrument has not yet been validated. Eighty-two patients with gastric adenocarcinoma completed questionnaires at baseline. The FACT-Ga scores were measured as a function of disease stage and performance status, and they were correlated with the Medical Outcomes Study 36-item short-form health survey (SF-36), the Beck Depression Inventory-II, the Marlow-Crowne Social Desirability Scale, the Paulhus Deception Scale, and the State-Trait Anxiety Inventory. Patients received a second questionnaire 2 weeks after baseline to evaluate test-retest reliability and again at 3 months to evaluate the sensitivity of the FACT-Ga to changes in performance status and to estimate the minimally important differences in scores that represented meaningful change. The internal and test-retest reliability of the FACT-Ga instrument was adequate. With the exception of the social well being subscale, all FACT-Ga scores were correlated as hypothesized with other measures. Relevant components of the FACT-Ga were sensitive to changes in performance status. The current results indicated that the FACT-Ga provides a valid and reliable measurement of QoL in patients with gastric adenocarcinoma. It is a useful instrument for QoL assessment in clinical trials, and it also may be useful for the detection of significant changes in the QoL of individual patients.

Impairment and Functioning in a Sample of Primary Care Patients With Generalized Anxiety Disorder

To examine the extent of functional impairment associated with generalized anxiety disorder (GAD) in a sample of primary care patients. Participants (N = 128) were part of the Primary Care Anxiety Project (PCAP), a study conducted in 15 primary care practices in the northeastern United States. Patients were recruited in primary care practice waiting rooms from July 1997 to May 2001. Participants screening positive for anxiety symptoms received a diagnostic interview and an assessment of health-related functioning (Medical Outcomes Study 36-item Short-Form Health Survey [SF-36]). Effect sizes are reported for comparisons of SF-36 scores between patients with a DSM-IV diagnosis of GAD and general population and medical sample norms. Relative to general population normative SF-36 scores, primary care patients with GAD evidenced impaired functioning on both the physical and mental component summary scales. Patients with GAD also evidenced greater impairment in psychosocial functioning than that previously reported for samples of patients with major medical illnesses, including type II diabetes, hypertension, recent myocardial infarction, and congestive heart failure. This finding held true even when GAD patients with comorbid medical illnesses and comorbid Axis I mental disorders were excluded from the comparison. Primary care patients with GAD experience substantial impairment that cannot be accounted for by concurrent medical illnesses or comorbid Axis I mental disorders.

Effect of short‐term intensive insulin therapy on quality of life in type 2 diabetes

Short-term intensive insulin therapy (IIT) early in the course of type 2 diabetes can improve pancreatic beta-cell function and even induce normoglycemia that persists post-therapy. In spite of this benefit, insulin is often delayed until late in the course of disease partly because of its perceived negative impact on quality of life (QOL). Therefore, we sought to examine the effect of early implementation of short-term IIT on patient-reported QOL and treatment satisfaction. A total of 34 patients with type 2 diabetes (5.9 ± 6.6 years duration, on zero to two oral antihyperglycaemic agents) underwent 4-8 weeks of IIT consisting of basal detemir and pre-meal insulin aspart. Patient-reported QOL, treatment satisfaction and symptom distress were assessed at baseline and post-IIT using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), Diabetes Quality of Life Measure (DQOL), and Diabetes Symptoms Checklist-Revised (DSC-R). There was a significant improvement in glycated haemoglobin post-IIT (mean 6.5% vs. 7%; P < 0.001). All 34 patients tolerated IIT well with no severe hypoglycaemia. Following IIT, the SF-36 showed a significant improvement compared to baseline in reported physical functioning (mean 88.2 vs. 83.3, P = 0.009), general health (69.4 vs. 65.6, P = 0.03), and general mental health (85.2 vs. 82.2, P = 0.04). The DQOL demonstrated a significant improvement in global health perception (P = 0.02), diabetes worry (P = 0.006) and treatment satisfaction (P = 0.007). The DSC-R revealed a significant improvement in the diabetes-related total symptom score (P = 0.01). Contrary to popular perception, a short course of IIT resulted in significant improvements in QOL and treatment satisfaction, demonstrating the patient acceptability of early insulin therapy.

Added Burden of Mental Disorders on Health Status Among Patients With Chronic Obstructive Pulmonary Disease

Patients with chronic obstructive pulmonary disease (COPD) and comorbid mental disorders are known to have worse health status. The association between these variables remains complex and poorly understood. We sought to better understand the association between COPD severity, mental disorders (depression/anxiety), and health status. This cross-sectional study compared participants without COPD or with mild COPD (n = 162) to those with moderate (n = 25), severe (n = 38), and very severe (n = 26) COPD. We recruited participants from a primary care and a pulmonary clinic at a veterans affairs medical center between July 2001 until September 2002. We used the Patient Health Questionnaire to screen for depression and anxiety and the Posttraumatic Stress Disorder Checklist to screen for posttraumatic stress disorder. Health status was assessed with the veteran's version of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and the Shortness of Breath Questionnaire (SOBQ). COPD severity was associated with worse physical status and dyspnea as measured by the SF-36 physical component summary and the SOBQ but was not associated with worse mental status as measured by the SF-36 mental component summary. At each level of COPD severity, participants with mental disorders had worse health status and dyspnea as measured by the SF-36 physical component summary, mental component summary, and SOBQ. Significant linear trends with COPD severity were associated with increased prevalence of any depressive disorder, major depressive disorder, and nonpanic/non-PTSD anxiety disorders (all tests for linear trend, P < .01). Independent of COPD severity, comorbid mental disorders were associated with worse health status and dyspnea. Studies are needed to determine whether patients with comorbid mental disorders may have more significant improvement in physical symptoms and functioning if providers focus more on psychiatric conditions.

Outcomes Associated with Opioid Use in the Treatment of Chronic Noncancer Pain in Older Adults: A Systematic Review and Meta‐Analysis

This systematic review summarizes existing evidence regarding the efficacy, safety, and abuse and misuse potential of opioids as treatment for chronic noncancer pain in older adults. Multiple databases were searched to identify relevant studies published in English (1/1/80-7/1/09) with a mean study population age of 60 and older. Forty-three articles were identified and retained for review (40 reported safety and efficacy data, the remaining 3 reported misuse or abuse outcome data). The weighted mean subject age was 64.1 (mean age range 60-73). Studies enrolled patients with osteoarthritis (70%), neuropathic pain (13%), and other pain-producing disorders (17%). The mean duration of treatment studies was 4 weeks (range 1.5-156 weeks), and only five (12%) lasted longer than 12 weeks. In meta-analyses, effect sizes were -0.557 (P<.001) for pain reduction, -0.432 (P<.001) for physical disability reduction, and 0.859 (P=.31) for improved sleep. The effect size for the Medical Outcomes Study 36-item Health Survey was 0.191 (P=.17) for the physical component score and -0.220 (P=.04) for the mental component score. Adults aged 65 and older were as likely as those younger than 65 to benefit from treatment. Common adverse events included constipation (median frequency of occurrence 30%), nausea (28%), and dizziness (22%) and prompted opioid discontinuation in 25% of cases. Abuse and misuse behaviors were negatively associated with older age. In older adults with chronic pain and no significant comorbidity, short-term use of opioids is associated with reduction in pain intensity and better physical functioning but poorer mental health functioning. The long-term safety, efficacy, and abuse potential of this treatment practice in diverse populations of older persons remain to be determined.

Validity and reliability testing of the Chinese (mainland) version of the 39-item Parkinson’s Disease Questionnaire (PDQ-39)

The 39-item Parkinson's Disease Questionnaire (PDQ-39) has been tested in many languages, but not in Chinese mainland. We aimed to assess the Chinese (mainland) version of the PDQ-39. Seventy-one subjects with Parkinson's disease (PD) completed the PDQ-39 and the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). All subjects were retested with the PDQ-39 a week later. The united Parkinson's disease rating scale (UPDRS) and the Hoehn and Yahr (H & Y) scale were also used to evaluate the subjects. Reliability was assessed by Cronbach's alpha and intra-class correlation coefficient (ICC). Validity was examined in terms of agreement with SF-36, UPDRS, and H & Y scales. The Chinese (mainland) version of the PDQ-39 demonstrated acceptable reliability (Cronbach's alpha: 0.84-0.88; ICC: 0.56-0.82). The item-total correlations (0.33-0.88) and scaling success rates (77.56%) indicated satisfactory convergent and discriminant validity of the PDQ-39 items. The correlations between related constructs of the PDQ-39 and UPDRS (r=0.44-0.68) and between those of the PDQ-39 and SF-36 (r=(-0.46)-(-0.69)) were all statistically significant (P<0.01). Except for stigma, cognitions, and bodily discomfort, all other dimensions of the PDQ-39 significantly discriminated patients at different H & Y stages indicated by the H & Y scale. Although our observations indicate that some problematic subscales of this version of the PDQ-39 could be improved upon, this study suggests acceptable reliability and validity of the Chinese (mainland) version of the PDQ-39.

Quality of life and urodyanmic characteristics in nonparalytic spinal cord dysfunction patients with neurogenic underactive bladder

Objective To investigate the change of quality of life and urodynamics after the enterocystoplasty combined with clean intermittent self-catheterisation (CISC) in nonparalytic spinal cord dysfunction (NSCD) patients with neurogenic underactive bladder by the Medical Outcomes study 36-item short-form general health survey (SF-36). Methods The quality of life of 72 NSCD patients with NUB were measured by SF-36 questionnaire, who had been taken enterocystoplasty combined with CISC or only CISC according to urodynamic results. In total, 58(81% ) patients were successfully followed for one year by SF-36 questionnaire and urodynamic examination, including 30 men (mean age 27±5 year) and 28 women (mean age 26±4 year). The normal volunteers without lower urinary tract symptom were set as control group, including 20 men (mean age 28 ± 4 year) and 20 women (mean age 29±4 year). Results At the follow-up, physical role, vitality and social function of men and women were 55±14 and 45±15, 76±19 and 74±15, 52±19 and 59±13 respectively, significantly higher than those before the treatment (35 ± 10 and 32 ±11, 27 ± 18 and 33 ± 17, 40 ±12 and 34 ±15). The bladder compliance and maximum cystometric capacity were (320 ± 44 ) ml and ( 338 ±50)ml,(55±15)cm H2O and (60±17)cm H2O respectively, also significantly higher than those before the treatment (131±30ml and 140±35ml,5±3 cm H2O and 6±4 cm H2O). However, detrusor leakage point pressures were (6±2)cm H2O and (6±3)cm H2O respectively, significantly lower than those before the treatment (28 ±9 cm H2 O and 25 ± 6 cm H2O). Except for physical function and bodily pain, the all domains of quality of life in both men and women patients were significantly lower than those in control group. Only 17 % of men and 7 % of women believed their health is better than that one year ago. There was no significant difference in the remission rate between men and women (89% vs 76%) in the patients with RUUTD before treatment. Conclusions It is suggested that urodynamic parameters are significantly improved. Many domains of quality of life were not improved and the reduced quality of life still occurred in NSCD patients with NUB using enterocystoplasty and CISC. Key words: Spinal disearse; Bladder, neurogenic; Urodynamics

Self-rated physical and psychosocial health in a cohort of young adults with juvenile idiopathic arthritis

Objective: To explore self-rated physical and psychosocial health in a cohort of young adults with juvenile idiopathic arthritis (JIA) 18.3 years after symptom onset, make comparisons with population-based data, and illuminate possible predictors of self-rated health.Methods: Of a baseline cohort of 84 patients with JIA, 55 (65.5%) answered the self-administered questionnaires of the Health Assessment Questionnaire (HAQ), the Visual Analogue Scale (VAS) of pain, fatigue, and illness, the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), and the General Health Questionnaire (GHQ-30). Telephone interviews were conducted with 51/55 patients. Population-based norm-data of SF-36 were used for comparison.Results: Significantly impaired physical health but no difference in psychosocial health was found as compared to the general Norwegian population. The level of education was significantly higher whereas no difference was found in employment status as compared to norm-data. Pain was a significant correlate of the education level. Predictors of physical impairment were physical disability and pain, whereas psychiatric distress and female sex were predictors of mental ill-health.Conclusion: Physical disability does not seem to have a negative influence on the patients' functioning psychosocially.

Relation Between Quality of Life of Mothers of Children With Cerebral Palsy and the Children's Motor Functioning, After Ten Months of Rehabilitation

This study aims to analyze the quality of life of mothers of children with cerebral palsy, correlated with the evolution of their children's gross motor function after ten months of rehabilitation. An observational, longitudinal study was carried out in Goiânia, Goiás, Brazil, involving 100 mothers and children with cerebral palsy. The children's motor function was evaluated using the Gross Motor Function Measure (GMFM) and the mothers' quality of life using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). After ten months of rehabilitation, the children's gross motor function had significantly improved (p<0.001), while the mothers only presented a significant improvement (p<0.001) in the bodily pain domain. The improvement in the motor function of children with cerebral palsy did not influence the changes in the mothers' quality of life.

The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery

To examine the change in pain and function related to the knee scheduled for surgery, change in health-related quality of life (HRQoL) and change in contralateral knee pain during pre-surgery wait up until time of surgery. One hundred and fifty-three patients scheduled for knee replacement were recruited from three hospitals in Québec City, Canada, and followed until surgery. Pre-surgery wait, defined as the time between enrolment on the pre-surgery wait list and surgery, was considered in five categories (< or =3, >3-6, >6-9, >9-12 and >12 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the medical outcomes study 36-item short form health survey. Mean pre-surgery wait time was 183 (s.d. 121.9) days. Subjects having waited >9-12 months showed significant deterioration of the WOMAC pain (-9.9; 95% CI -19.2, -0.54) and function (-11.1; 95% CI -18.7, -3.4) scores. On the HRQoL SF-36 physical functioning scale, a significant deterioration was seen in subjects having waited >9-12 months (-11.3; 95% CI -18.4, -4.2) and >12 months (-7.1; 95% CI -12.9, -1.3). On the contralateral knee WOMAC pain score, a significant deterioration was observed in subjects having waited >6-9 months (-10.4; 95% CI -16.9, -3.9) and >12 months (-10.7; 95% CI -19.7, -1.7). Pre-surgery wait time has a negative significant impact on pain, function and HRQoL at the time of surgery. The magnitude of deterioration seen in this study may be clinically important. The effects of this pre-surgery deterioration on post-surgery outcomes need to be investigated.

Quality of life predicts one-year survival in patients with implantable cardioverter defibrillators

This study examines the contributions of known predictors of survival and quality of life (QOL) to 1-year survival in ICD recipients. This study used the data set from the antiarrhythmia versus implanted defibrillator (AVID) controlled clinical trial conducted by the National Institutes of Health, National Heart, Lung, and Blood Institute. The 507 patients randomly assigned to the ICD treatment were included in the analysis. Patients were mostly male (78.3%), with mean age of 64.85 +/- 10.81 and mean left ventricular ejection fraction of 32.2 +/- 13.45%. QOL was measured with the medical outcomes study 36-item short form health survey (SF-36) and quality of life index-cardiac version (QLI-CV). Data were analyzed with descriptive statistics and logistic regression. Fifty-four (10.6%) patients died in the first year after ICD implantation. Angiotensin-converting enzyme inhibitor (ACE) medication, age, and QLI-CV were significant independent predictors of 1-year survival. The odds of survival of a younger patient with ACE medication and good QOL were approximately three times (OR = 3.96) greater than for an older patient, without ACE medication and with poor QOL. Quality of life is an important factor predicting 1-year survival in patients with ICDs. ACE medication and younger age also predict 1-year survival independent of QOL and each other.

Does Multilevel Lumbar Stenosis Lead to Poorer Outcomes?

A subanalysis study. The purpose of this study was to determine the impact of multilevel lumbar stenosis with or without degenerative spondylolisthesis compared to single level disease on patients' baseline symptoms and clinical outcomes over time. Previous studies have demonstrated better clinical outcomes with surgery than nonoperative treatment in patients with spinal stenosis with or without degenerative spondylolisthesis. However, the impact of multilevel stenosis has not been studied in these patients. The results from a multicenter randomized and observational study, the Spine Patient Outcomes Research Trial (SPORT) comparing surgical versus nonoperative treatment for spinal stenosis with or without spondylolisthesis, were analyzed. The primary outcomes measures were the Bodily Pain and Physical Function scales of the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Secondary outcome measures included the stenosis bothersomeness index, leg pain bothersomeness, low back pain bothersomeness, and patient satisfaction. In this subanalysis of SPORT data, multilevel spinal stenosis did not demonstrate worse baseline symptoms or worse treatment outcomes in isolated spinal stenosis; however, if concomitant degenerative spondylolisthesis existed, patients with only single level stenosis tended to improve more than those with multilevel stenosis, particularly after surgery. Patients with spinal stenosis without associated degenerative spondylolisthesis or scoliosis can be managed nonoperatively irrespective of the number of levels involved. If surgery is performed, the number of levels treated does not predict outcome. In contrast, patients with concomitant degenerative spondylolisthesis and single level stenosis do better surgically than those with additional levels of stenosis. This study emphasizes the importance of shared decision-making between the physician and patient when considering treatment for spinal stenosis.

Determinants of quality of life in survivors of cardiac arrest

To study factors related to quality of life after a hypoxic period due to cardiac arrest. Retrospective cohort study. Eighty-eight survivors of out-of-hospital cardiac arrest, admitted to a Dutch academic hospital between 2001 and 2006. Patients received a set of questionnaires at home. The main outcome measures were physical and mental quality of life (Medical Outcomes Study 36-item Short Form Health Survey; SF-36). Potential determinants were cognitive complaints, emotional problems depression/anxiety), post-traumatic stress, fatigue, daily functioning and participation in society. Multiple linear regression analyses were performed with physical and mental quality of life as dependent variables. Sixty-three (72%) patients responded. Mean time since cardiac arrest was 36 months (standard deviation (SD) 19). Backward regression analyses showed that physical quality of life was significantly (p < 0.001, adjusted R2 = 0.531) related to cognitive complaints (beta = -0.378), instrumental daily life activities (beta = 0.262), post-traumatic stress (beta = -0.246) and fatigue (beta = -0.226). Mental quality of life was significantly (p < 0.001, adjusted R2 = 0.664) explained by anxiety/depression (beta = -0.609), fatigue (beta = -0.177) and cognitive complaints (beta = -0.175). Quality of life is related to cognitive complaints, fatigue, anxiety/depression, post-traumatic stress and difficulties in daily activities in survivors of out-of-hospital cardiac arrest. Rehabilitation programmes for this group should specifically address these topics.

Construct validity of the late life function and disability instrument for adults with chronic conditions

Objectives. To evaluate the validity of the late life function and disability instrument (LLFDI) when applied to adults aged 44–65 years with chronic conditions.Design. We applied a convergent cross-sectional construct validity design to examine the association between the LLFDI subscales and the medical outcomes study (MOS) 36-Item Health Survey Physical Component Score (SF36 PCS), MOS Physical Functioning scale (PF10), 2-minute walk distance (2MWD) and 8-foot walk test (8FWT).Participants. Our sample consisted of 174 community-dwelling adults age 45–65 years with one or more chronic conditions.Setting. Participants were enrolled at a multidisciplinary family health practice.Results. The LLFDI function correlated strongly with the PF10 (r = 0.84) and moderately with the 2MWD (r = 0.53) and 8FWT (r = −0.48). The LLFDI disability limitation correlated moderately with the SF36 PCS, 2MWD and 8FWT (r = 0.67, 0.45, −0.32, respectively). The LLFDI disability frequency correlated moderately with the SF36 PCS, 2MWD and 8FWT (r = 0.44, 0.33, −0.31). Ninety-five percent confidence intervals on all correlation coefficients excluded zero.Conclusion. Cross-sectional convergent validity of the LLFDI was supported when applied to adults 45–65 years of age with chronic conditions.

Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well‐being of caregivers

Few studies have addressed the physical and mental health effects of caring for a family member with bipolar disorder. This study examined whether caregivers' health is associated with changes in suicidal ideation and depressive symptoms among bipolar patients observed over one year. Patients (N = 500) participating in the Systematic Treatment Enhancement Program for Bipolar Disorder and their primary caregivers (N = 500, including 188 parental and 182 spousal caregivers) were evaluated for up to one year as part of a naturalistic observational study. Caregivers' perceptions of their own physical health were evaluated using the general health scale from the Medical Outcomes Study 36-item Short-Form Health Survey. Caregivers' depression was evaluated using the Center for Epidemiological Studies of Depression Scale. Caregivers of patients who had increasing suicidal ideation over time reported worsening health over time compared to caregivers of patients whose suicidal ideation decreased or stayed the same. Caregivers of patients who had more suicidal ideation and depressive symptoms reported more depressed mood over a one-year reporting period than caregivers of patients with less suicidal ideation or depression. The pattern of findings was consistent across parent caregivers and spousal caregivers. Caregivers, rightly concerned about patients becoming suicidal or depressed, may try to care for the patient at the expense of their own health and well-being. Treatments that focus on the health of caregivers must be developed and tested.

Lifestyle, participation, and health‐related quality of life in adolescents and young adults with myelomeningocele

This study aimed to describe participation and health-related quality of life (HRQoL) in adolescents and young adults with myelomeningocele and to explore their relationships with lifestyle-related factors. Fifty-one individuals with a mean age of 21 years 1 month (SD 4y 6mo) years participated (26 males, 25 females; 82% hydrocephalus, 55% wheelchair-dependent). Participation was assessed using the Life Habits Questionnaire, and HRQoL was assessed using the Medical Outcomes Study 36-item Short-form Health Survey. Physical activity was measured using an accelerometry-based activity monitor, fitness (peak oxygen uptake) was measured during a maximal exercise test, and the sum of four skin-folds was assessed to indicate body fat. Relationships were studied using logistic regression analyses. Of the participants, 63% had difficulties in daily activities and 59% in social roles. Participants perceived lower physical HRQoL than a Dutch reference population. Participants with higher levels of physical activity and fitness had fewer difficulties in participating in daily activities (odds ratio [OR]=8.8, p=0.02 and OR=29.7, p=0.02 respectively) and a higher physical HRQoL (OR=4.8, p=0.02 and OR=30.2, p=0.006 respectively), but not mental HRQoL. Body fat was not related to participation or HRQoL. In conclusion, a large proportion of individuals with myelomeningocele had difficulties in participation and perceived low physical HRQoL. Higher levels of physical activity and fitness were related to fewer difficulties in participation and higher physical HRQoL.