Medical Outcomes Study 36-item Health Research Articles

Evaluation of quality of life after cardiac surgery in high-risk patients.

Conventionally, there is controversy over subjecting high-risk patients to cardiac operations, due to major postoperative complications. Higher survival rates and less morbidity as well as better quality of life can be good predictors of the outcome of surgery. This study evaluates the quality of life before and 12 months after cardiac operations on high-risk patients. In this study, the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was used to separate high-risk patients from others. The quality of life was assessed using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) before surgery and one year afterward. Based on SF-36, the score for each of the eight different dimensions of the quality of life was quantified; and, their differences between pre-surgery and post-follow up period were analyzed. 126 high-risk patients were included in this study. The mean age of the patients was 64.29 ± 12.35 years. The median of EuroSCORE II score in these cases was 6.83 (6.04-25.98). The results reveal that the majority of the quality of life dimensions, except mental health, improved significantly after the follow-up period. Cardiac surgery on high-risk patients can noticeably promote the different aspects of their quality of life; although, such improvements should be considered against surgical complications.

Outcomes of Microendoscopic Discectomy and Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation: A Comparative Retrospective Study.

Study DesignRetrospective, case control evaluation of 86 patients who underwent microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of lumbar disc herniation (LDH).PurposeTo evaluate the safety and the outcomes of MED and PTED for the treatment of LDH.Overview of LiteratureMED and PTED are minimally invasive surgical techniques for lower back pain. Studies to date have shown that MED and PTED are safe and effective treatment modalities for LDH.MethodsA retrospective study was performed in patients with LDH treated with MED (n=50) and transforaminal endoscopic discectomy (PTED; n=36) in our hospital. All patients were followed-up with self-evaluation questionnaires, Oswestry disability index (ODI), medical outcomes study 36-item short form health survey and MacNab criteria. All the patients in both groups were followed up to 12 months after the operation.ResultsODI questionnaire responses were not statistically different between the MED and PTED groups (53.00 vs. 48.72) before treatment. Average scores and minimal disability after 5 days to 12 months of follow-up were 4.96 in the MED group and 3.61 in the PTED group. According to MacNab criteria, 92.0% of the MED group and 94.4% of the PTED group had excellent or good results with no significant difference.ConclusionsThere was no significant difference between MED and PTED outcomes. Further large-scale, randomized studies with long-term follow-up are needed.

BINGE EATING DISORDER AND QUALITY OF LIFE OF CANDIDATES TO BARIATRIC SURGERY

Background : Obesity decreases the quality of life, which is aggravated by the association of comorbidities, and the binge eating disorder is directly related to body image and predisposes to overweight. Aim: Evaluate association between the presence and the level of binge eating disorder and the quality of life of the obese candidates for bariatric surgery. Methods : Cross-sectional study analyzing anthropometric data (weight and height) and socioeconomics (age, sex, marital status, education and income). The application of Binge Eating Scale was held for diagnosis of Binge Eating Disorder and the Medical Outcomes Study 36-item Short-From Health Survey to assess the quality of life. Results : Total sample studied was 96 patients, mean age 38.15±9.6 years, 80.2% female, 67.7% married, 41% with complete and incomplete higher education, 77.1% with lower income or equal to four the minimum salary, 59.3% with grade III obesity. Binge eating disorder was observed in 44.2% of patients (29.9% moderate and 14.3% severe), and these had the worst scores in all domains of quality of life SF36 scale; however, this difference was not statistically significant. Only the nutritional status presented significant statistically association with the presence of binge eating disorder. Conclusion : High prevalence of patients with binge eating disorder was found and they presented the worst scores in all domains of quality of life.

Research Trends in Measurement of Quality of Life Following Bariatric Surgery: Emerging Interest in Appearance

Introduction: This systematic review identified the instruments used in assessing quality of life (QoL) in bariatric patients. Specifically, we examined how patients' appearance changes following bariatric surgery have been assessed in the literature. Methods: A search of the literature was conducted via electronic databases, concerning bariatric patient QoL after surgery. Studies were only included if they were: (1) full-length papers, (2) published in English, and (3) contained empirical use of an instrument to measure bariatric patient QoL postsurgery. The analysis consisted of 198 empirical references with a total of 41 different instruments to measure bariatric patient QoL. These instruments were cited 301 times across the literature. Results: Two categories of instruments used for measuring QoL following bariatric surgery were identified: generic and bariatric specific. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was most frequently used in literature (n=79, 26.25%), followed...

A failure to confirm the effectiveness of a brief group psychoeducational program for mothers of children with high-functioning pervasive developmental disorders: a randomized controlled pilot trial.

ObjectiveThe purpose of this study was to examine the effectiveness of group psychoeducation to relieve the psychological distress of mothers of children with high-functioning pervasive developmental disorders (HFPDD) and to improve the behaviors of the children.MethodsSeventy-two mothers of preschool outpatients with HFPDD were randomly assigned to a four-session brief group psychoeducational program (GP). The sessions were held every second week in addition to the usual treatment (GP + treatment as usual [TAU] group), or to a TAU-alone group. The primary outcome was self-reported symptoms of maternal mental health as assessed using the 28-item General Health Questionnaire (GHQ-28) at 21 weeks post-randomization (week 21). The GHQ-28 at the end of the intervention (week 7), Aberrant Behavior Checklist (ABC) for the behavior of the children, the Zarit Burden Interview (ZBI), and the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) were carried out at weeks 7 and 21. We tested the group effects with the interaction between the intervention and the evaluation points.ResultsThe GHQ-28 score at week 21 was significantly higher in the GP + TAU group as compared to that in the TAU-alone group, indicating a greater improvement in the TAU-alone group. There was no evidence that GP + TAU led to a greater improvement of maternal mental health than TAU-alone at week 7. Similarly, no evidence was obtained to indicate that GP + TAU led to a reduction in the ABC or ZBI scores by week 7 or 21. The adjusted scores for the RF (role emotional) and MH (mental health) subscales of the SF-36 at week 21 were also significantly lower in the GP + TAU group, indicating a similar tendency to that of the change of the GHQ-28 score at week 21.ConclusionThe psychoeducational program did not alleviate maternal distress, aberrant behaviors of the children, or caregiver burden.

The predictors and outcome of psychiatric disorders among survivors post-earthquake: survey from Sichuan China

Objective: The aims of the study were to investigate predictors and outcomes of psychiatric disorders among survivors postearthquake. Design: Cross-sectional design survey. Setting: Government-aided communities with temporary shelters. Subjects: A multistage stratified and cluster sampling strategy was employed to select participants via face-to-face interviews, and a total of 1,297 survivors participated in the research. Main outcome measure: Psychiatric disorders were measured with self-reporting questionnaire-20 (SRQ-20), and quality of life was measured with medical outcomes study 36-item short form health survey (SF-36) and a series of problems were made to evaluate the demographic characteristics of survivors. Results: The findings of the present study show that psychiatric morbidity was very prevalent among survivors (76.6%). Negative correlation was found between the total score of SRQ and PCS (rs= -0.525, p<0.001), and MCS(rs= -0.679, p<0.001) by Pearson correlation analysis. The multivariate logistic regression analysis demonstrated that female, aged 60 or older, having financial burden and having >2 chronic diseases were significant risk factors for psychiatric disorder. While married, monthly income > ¥1,500, and with medical insurance were significant protection factors against psychiatric disorders. Conclusions: The psychiatric morbidity was very prevalent among survivors two years after the earthquake. The survivors with psychiatric disorders tend to have poor quality of life. Appropriate public health and medical interventions should put an emphasis on survivors who are female, aged 60 or older, having financial burden and having >2 chronic diseases because they are at heightened risk for psychiatric disorders.

The association between suicide risk and self-esteem in Japanese university students with major depressive episodes of major depressive disorder.

BackgroundThe suicide risk among young adults is related to multiple factors; therefore, it is difficult to predict and prevent suicidal behavior.AimWe conducted the present study to reveal the most important factors relating to suicidal ideation in Japanese university students with major depressive episodes (MDEs) of major depressive disorder (MDD).MethodsThe subjects were 30 Japanese university students who had MDEs of MDD, and were aged between 18 and 26 years old. They were divided into two groups – without suicide risk group (n=15), and with suicide risk group (n=15) – based on the results of the Mini-International Neuropsychiatric Interview. Additionally, healthy controls were recruited from the same population (n=15). All subjects completed the self-assessment scales including the Beck Depression Inventory 2nd edition (BDI-II), the Beck Hopelessness Scale (BHS), Rosenberg’s Self-Esteem Scale (RSES), and SF-36v2™ (The Medical Outcomes Study 36-item short-form health survey version 2), and they were all administered a battery of neuropsychological tests.ResultsThe RSES score of the suicide risk group was significantly lower than the RSES score of the without suicide risk group, whereas the BDI-II score and the BHS score were not significantly different between the two groups. The mean social functioning score on the SF-36v2 of the with suicide risk group was significantly lower than that of the without suicide risk group.ConclusionThe individual’s self-esteem and social functioning may play an important role in suicide risk among young adults with MDEs of MDD.

Social support and health‐related quality of life in women with breast cancer: a longitudinal study

A breast cancer diagnosis is a distressing event that impacts on physical and psychological functioning. This study examined the longitudinal relationships among a diagnosis of breast cancer, social support, and health-related quality of life (HRQOL). Participants were 412 women from the 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health who self-reported a new diagnosis of breast cancer between 1998 and 2007. The three surveys of longitudinal data analyzed included data 3 years before diagnosis, at diagnosis (baseline), and 3 years after diagnosis (follow-up). Social support was measured using the 19-item Medical Outcomes Study Social Support Survey; HRQOL was measured using the Medical Outcomes Study 36-item Short-Form Health Survey. Compared with pre-diagnosis HRQOL, women newly diagnosed with breast cancer reported significantly poorer HRQOL in subscales related to pain, physical functioning, and health and vitality. At 3-year follow-up, HRQOL had improved in most domains to levels consistent with pre-diagnosis. Levels of social support remained stable across time. The structural equation model showed that social support was positively predictive of better physical and mental HRQOL at 3-year follow-up. Longitudinal analyses indicate that social support appears to be an important predictor of HRQOL in women diagnosed with breast cancer. In particular, positive emotional and informational support that may normally be provided by a partner is important in maintaining HRQOL. Identification of those lacking social support, especially patients without partners, will enable them to be guided to appropriate support networks and programs.

Delirium in the ICU and Subsequent Long-Term Disability Among Survivors of Mechanical Ventilation*

Survivors of critical illness are frequently left with long-lasting disability. The association between delirium and disability in critically ill patients has not been described. We hypothesized that the duration of delirium in the ICU would be associated with subsequent disability and worse physical health status following a critical illness. Prospective cohort study nested within a randomized controlled trial of a paired sedation and ventilator weaning strategy. A single-center tertiary-care hospital. One hundred twenty-six survivors of a critical illness. Confusion Assessment Method for the ICU, Katz activities of daily living, Functional Activities Questionnaire (measuring instrumental activities of daily living), Medical Outcomes Study 36-item Short Form General Health Survey Physical Components Score, and Awareness Questionnaire were used. Associations between delirium duration and outcomes were determined via proportional odds logistic regression with generalized estimating equations (for Katz activities of daily living and Functional Activities Questionnaire scores) or via generalized least squares regression (for Medical Outcomes Study 36-item Short Form General Health Survey Physical Components Score and Awareness Questionnaire scores). Excluding patients who died prior to follow-up but including those who withdrew or were lost to follow-up, we assessed 80 of 99 patients (81%) at 3 months and 63 of 87 patients (72%) at 12 months. After adjusting for covariates, delirium duration was associated with worse activities of daily living scores (p = 0.002) over the course of the 12-month study period but was not associated with worse instrumental activities of daily living scores (p = 0.15) or worse Medical Outcomes Study 36-item Short Form General Health Survey Physical Components Score (p = 0.58). Duration of delirium was also associated with lower Awareness Questionnaire Motor/Sensory Factors scores (p 0.02). In the setting of critical illness, longer delirium duration is independently associated with increased odds of disability in activities of daily living and worse motor-sensory function in the following year. These data point to a need for further study into the determinants of functional outcomes in ICU survivors.

Health economics and health preference concepts to orthopedics practitioners.

The aim of this study was to describe concepts of health economics in order to update and provide the orthopedic practitioner decision making parameters based on preferences. Four basic types of studies of economical evaluation were presented (cost minimization analysis, cost-benefit, cost-effectiveness and cost-utility), as well as the origin, the concept, advantages and disadvantages of using QALY and utility. It was discussed the importance of costs and of SF-6D, an instrument able to get through the utility data from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physicians, especially orthopedic practitioners, are increasingly using technologies which are progressively expensive, thus, they should be able to understand health economics concepts, the importance of utility in clinical decision making process and economic analysis in health.09+

Interrelationship of sleep quality with fatigue, neuroticism and global health in unexplained chronic fatigue

The interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with unexplained chronic fatigue, referred with presumed chronic fatigue syndrome (CFS), was explored. Patients with unexplained chronic fatigue filled out two independent fatigue scales (Fatigue Questionnaire, FQ and Checklist Individual Strength, CIS), NEO-Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-item Short Form Health Survey (SF36). Path and regression analyses were performed. Out of 296 eligible patients, 203 subjects were included (mean age 39.0 years, SD 10.37, 89% female). In a first path analysis, using FQ for assessment of fatigue, night-time PSQI sleep quality had a direct effect on SF36 physical health quality of life (PHQL) and no effect on FQ fatigue. This was confirmed by a subsequent path analysis with CIS fatigue and by regression analyses. These unexpected results raised the question whether FQ or CIS fatigue sufficiently reflects fatigue. For both scales, the introduction of a latent variable into the model resulted in a significant improvement of fit, with an indirect effect of PSQI sleep quality on SF36 PHQL through this latent variable. Furthermore, this variable had a direct effect on FQ or CIS fatigue, respectively, and on the two SF36 variables. A latent variable was introduced as missing link in the relationship between different subjective complaints of patients with presumed CFS and outcome measures of quality of life. Hence, this finding holds promise for a more cohesive framework of the different dimensions in the construct of chronic fatigue and CFS and needs to be developed as a clinical tool.

Polysomnographic and MSLT data in a large sample of patients with unexplained chronic fatigue: comparison with a reference sample and relation with subjective scores

This study aimed to assess objective parameters of sleep and sleepiness in a large sample of patients with unexplained chronic fatigue and to compare the results with data from a reference population. Furthermore, the relation was assessed between these objective parameters and subjective scores probing mental and physical health, sleep quality, daytime sleepiness and fatigue. Objective sleep parameters were derived from polysomnography (PSG) and multiple sleep latency testing (MSLT). Subjective assessment consisted of the administration of validated questionnaires: Medical Outcomes Study 36-item Short Form Health Survey for the assessment of global mental and physical health, Epworth Sleepiness Scale for excessive daytime sleepiness, Pittsburgh Sleep Quality Index for global sleep quality and Fatigue Questionnaire for fatigue severity. Out of 377 eligible patients, 245 subjects were included (mean age 38.6 years, SD 10.69, 86.1% female). Sleep disorders were prevalent in 55.5% (sleep apnea, 32.7%; insomnia, 16.7%; periodic limb movements, 13.9%). Significant differences in several objective sleep parameters were observed between the unexplained chronic fatigue and reference groups (i.e. decreased total sleep time, sleep efficiency and %REM; increased sleep latency, %NREM1, wake after sleep onset and arousal index). Neither PSG nor MSLT data were correlated with fatigue, and were only weakly correlated with mental health and subjective sleepiness. Increased sleepiness in the Epworth Sleepiness Scale was not substantiated by objective data from the MSLT. An insomnia phenotype was suggested in patients with unexplained chronic fatigue, based on the observed sleep profile. The overall lack of correlation between subjective scores and objective indices derived from PSG and MSLT may suggest that the latter are inappropriate to explain symptoms of daytime sleepiness and fatigue in patients with unexplained chronic fatigue. However, their application remains justified for the demonstration of comorbid primary sleep disorders in this patient group.

Does Health‐Related Quality of Life Predict Hospitalization or Mortality in Patients with Atrial Fibrillation?

Poor health-related quality of life (QOL) is related to morbidity and mortality in coronary heart disease and ventricular arrhythmias as well as to mortality in patients with heart failure (HF) and atrial fibrillation (AF). This study examined the contributions of QOL to the prediction of 1-year hospitalization and mortality in patients with AF, independent of HF. This study used the public use dataset from the NHLBI/NIH AFFIRM randomized clinical trial. Patients enrolled in the QOL substudy (N = 693) were randomly assigned to rate or rhythm control. QOL was assessed with the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and the Quality of Life Index-Cardiac Version (QLI-CV). Data were analyzed with logistic regression to predict 1-year hospitalization and Cox proportional hazards analysis to predict mortality. In the first year of participation in the study 37% (n = 256) were hospitalized; mortality was 14.3% (n = 93) with mean follow-up of 3.5 years. Patients' mean age was 69.8 ± 8.2 years, were largely male (62%), and white (93%). Patient histories included 70.8% hypertension, 38.2% coronary artery disease (CAD), and 23.7% HF. History of stroke, HF, rhythm control arm, lower SF-36 mental component scores (MCS), and lower SF-36 physical component scores (PCS) predicted hospitalization (P < 0.001). Diabetes, female gender, older age, CAD, hypertension, and lower PCS predicted mortality (P < 0.001). QOL adds meaningful information beyond traditional biomedical factors to the prediction of mortality and/or hospitalization of patients with AF. Interventions for improving QOL and helping patients adapt to AF treatments may decrease hospitalization and improve survival.

Oral Appliance Versus Continuous Positive Airway Pressure in Obstructive Sleep Apnea Syndrome: A 2-Year Follow-up

Oral appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of oral appliance therapy and CPAP in patients with OSAS. Cohort study of a previously conducted randomized clinical trial. University Medical Center, Groningen, The Netherlands. One hundred three patients with OSAS. CPAP and oral appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA). Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apnea-hypopnea index (AHI) was < 5 or showed substantial reduction, defined as reduction in the index of at least 50% from the baseline value to a value of < 20 in a patient without OSAS symptoms while undergoing therapy. Regarding the proportions of successful treatments, no significant difference was found between oral appliance therapy and CPAP in treating mild to severe OSAS in a 2-year follow-up. More patients (not significant) dropped out under oral appliance therapy (47%) compared with CPAP (33%). Both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes. However, CPAP was more effective in lowering the AHI and showed higher oxyhemoglobin saturation levels compared to oral appliance therapy (P < 0.05). Oral appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apnea-hypopnea syndrome: oral appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167.

Association Between Health-Related Quality of Life, Physical Fitness, and Physical Activity in Older Adults Recently Discharged From Hospital

The purpose of this study was to determine the relationship among health-related quality of life (HRQOL), physical fitness, and physical activity in older patients after recent discharge from hospital. One hundred fifteen independent-living older adults (ages 70-92 years) were included. HRQOL (Medical Outcomes Study 36-item Short Form Health Survey), physical activity (Physical Activity Scale for the Elderly), and physical fitness (Senior Fitness Test) were measured 2-4 weeks after discharge. Higher levels of physical activity and physical fitness were correlated with higher self-reported HRQOL. Although cause and effect cannot be determined from this study, the results suggest that a particular focus on the value of physical activity and physical fitness while in hospital and when discharged from hospital may be important to encourage patients to actively preserve independence and HRQOL. It may be especially important to target those with lower levels of physical activity, poorer physical fitness, and multiple comorbidities.

Validity and Reliability of the Achilles Tendon Total Rupture Score

The best treatment of acute Achilles tendon rupture remains debated. Patient-reported outcome measures have become cornerstones in treatment evaluations. The Achilles tendon total rupture score (ATRS) has been developed for this purpose but requires additional validation. The purpose of the present study was to validate a Danish translation of the ATRS. The ATRS was translated into Danish according to internationally adopted standards. Of 142 patients, 90 with previous rupture of the Achilles tendon participated in the validity study and 52 in the reliability study. The ATRS showed moderately strong correlations with the physical subscores of the Medical Outcomes Study 36-item Short-Form Health Survey (r = .70 to .75; p < .0001) and Victorian Institute of Sports Assessment-Achilles questionnaire (r = .71; p < .0001). Test-retest of the ATRS showed no significant difference in the mean (2.41; p = .07). The limits of agreement were ±18.53. A strong correlation was found between test and retest (intercorrelation coefficient .908); the standard error of measurement was 6.7, and the minimal detectable change was 18.5. The Danish version of the ATRS showed moderately strong criterion validity. For study and follow-up purposes, the ATRS seems reliable for comparisons of groups of patients. Its usability is limited for repeated assessment of individual patients. The development of analysis guidelines would be desirable.

Subthalamus deep brain stimulation for primary dystonia patients: A long‐term follow‐up study

Deep brain stimulation has generated sustained improvement in motor function for patients with dystonia, but the long-term impact of subthalamic nucleus stimulation on dystonia has not been elucidated. Patients with primary dystonia underwent bilateral subthalamic nucleus stimulation and were evaluated with the Burke-Fahn-Marsden dystonia rating scale and the Medical Outcomes Study 36-item Short-Form General Health Survey at baseline and 1 month, 1 year, and 3 to 10 years postoperatively. Improvements in motor function according to the Burke-Fahn-Marsden dystonia rating scale at 1 month, 1 year, and 3 to 10 years of stimulation were 55%, 77%, and 79%, respectively. The quality of life improved after 1 month of stimulation (P < 0.001), progressed within 1 year (P < 0.001), and then remained stable. Disease duration was negatively correlated with an improvement in motor function. Our results demonstrate that the subthalamus is an alternative to the globus pallidus internus as a target for deep brain stimulation to treat primary dystonia.

Open-Label Milnacipran for Patients With Persistent Knee Pain 1 Year or Longer After Total Knee Arthroplasty

The current study investigates whether milnacipran is effective in reducing pain and improving function in patients with persistent pain ≥ 1 year after total knee arthroplasty. This was a 12-week open-label study of flexibly dosed milnacipran in patients (N = 5) experiencing chronic persistent knee pain ≥ 1 year following total knee arthroplasty in the absence of new injury, infection, or implant failure. Subjects were identified from October 2010 to August 2011 through the Duke University Medical Center orthopedic clinic (Durham, North Carolina), typically during 1-year postoperative follow-up visits, and were referred by their orthopedic surgeon. Milnacipran treatment was associated with reduction in pain according to the primary outcome measure of the visual analog scale (VAS) score for pain (effect size of 1.15) and secondary outcome measures of Knee Society Score (KSS) evaluation subscale score (effect size of 1.37) and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) bodily pain subscale (effect size of 1.16) at week 12. Secondary outcome measures of functional change were mixed in such that, at week 12, the SF-36 physical functioning subscale showed improvement (effect size of 1.16), but the KSS function subscale score was just below the threshold for meaningful effect size (0.98). Open-label milnacipran demonstrated reduced pain and some evidence of functional improvement in this small sample of patients with chronic persistent pain 1 year or more after total knee arthroplasty such that well-powered studies are warranted.

Yoga Effects on Mood and Quality of Life in Chinese Women Undergoing Heroin Detoxification

Yoga, as a mind-body therapy, is effective in improving quality of life for patients with chronic diseases, yet little is known about its effectiveness in female heroin addicts. The aim of this study was to evaluate the effects of yoga on mood status and quality of life among women undergoing detoxification for heroin dependence in China. This study was a randomized controlled trial. Seventy-five women aged 20-37 years undergoing detoxification for heroin dependence at AnKang Hospital were allocated randomly into an intervention or a control group. Women in the intervention group received a 6-month yoga intervention in addition to hospital routine care, and women in the control group received hospital routine care only. Mood status and quality of life were assessed using the Profile of Mood States and Medical Outcomes Study 36-item Short-Form Health Survey at baseline and following 3 and 6 months of treatment. Repeated-measures analysis of variance was used to evaluate treatment and time effects on mood and quality of life. Most female heroin addicts were young and single, with a low education level. Most had used heroin by injection. Mood state and quality of life of female heroin addicts were poor. The intervention group showed a significant improvement in mood status and quality of life over time compared with their counterparts in the control group. Yoga may improve mood status and quality of life for women undergoing detoxification for heroin dependence. Yoga can be used as an auxiliary treatment with traditional hospital routine care for these women.

Does self-management counseling in patients with heart failure improve quality of life? Findings from the Heart Failure Adherence and Retention Trial (HART)

Heart failure (HF) is associated with poor health-related quality of life (HRQOL). The purpose of our study is to determine the effect of a self-management intervention on HRQOL domains across time, overall, and in prespecified demographic, clinical, and psychosocial subgroups of HF patients. HART was a single-center, multi-hospital randomized trial. Patients (n=902) were randomized either to a self-management intervention with provision of HF educational information or an enhanced education control group which received the same HF educational materials. HRQOL was measured by the Quality of Life Index, Cardiac Version, modified, and the Medical Outcomes Study 36-item Short-Form Health Survey physical functioning scale. Analyses included descriptive statistics and mixed-effects regression models. In general, overall, study participants' HRQOL improved over time. However, no significant differences in HRQOL domain were detected between treatment groups at baseline or across time (p>0.05). Subgroup analyses demonstrated no differences by treatment arm for change in HRQOL from baseline to 3years later. We conclude that in our cohort of patients, the self-management intervention had no benefit over enhanced education in improving domains of HRQOL and HRQOL for specified HF subgroups.