Medical Outcomes Trust Short Form Research Articles

Abstract 5749: The association between physical health-related quality of life, physical functioning and risk of contralateral breast cancer

Abstract Background: Physical limitations and disability among older cancer patients can lead to suboptimal treatment and surveillance for secondary cancers. Our objective was to evaluate the effects of poor physical health-related quality of life (PQOL) and physical functioning (PF) on contralateral breast cancer (CBC) risk among older women diagnosed with unilateral breast cancer (UBC). Methods: We performed a nested case-control study within a cohort from the Surveillance, Epidemiology and End Results Medicare Health Outcomes Survey (MHOS) database. Women were required to have first primary UBC without prophylactic contralateral mastectomy. Among 2,938 women ages 65 years and older with stages I-III UBC between 1997 and 2011, we identified 100 subsequent CBC cases and 915 controls using incidence density sampling without replacement matched on age, race, and quarter-year of diagnosis. PQOL and PF were determined from survey responses to the Medical Outcomes Trust Short Form 36 component scores. Conditional logistic regression models were used to estimate relative risks (RR) and 95% confidence intervals (CI) for metachronous CBC. Results: Cases and controls were similar with respect to comorbidities, stage, surgery and radiation treatments but differed by hormone receptor status (ER/PR-negative, cases 23% and controls 11%). Cases had lower mean PQOL (-1.8; 95% CI -4.3, 0.7) and PF (-2.2, 95% CI -4.9, 0.5) component scores, but these differences were not statistically significant. In multivariable models, estimates suggest increased CBC risk for women in the lowest quartile of PQOL compared to those in the upper quartile (RR=1.8; 95% CI 0.8, 4.3). Compared to women in the upper quartile of physical functioning scores, women in the lower three quartiles had a 2.6-fold (95% CI 1.2, 5.9) increased risk of CBC. Conclusions: Our findings indicate that low physical health-related quality of life is common among older women diagnosed with breast cancer, and poor physical functioning is related to risk of CBC. Efforts to understand and minimize declines in physical functioning post-breast cancer diagnosis may help optimize treatment strategies to reduce the risk of this adverse outcome. Citation Format: Nita Mukand, Nadia Nabulsi, Ali Alobaidi, Alemseged Asfaw, Brian C. Chiu, Naomi Y. Ko, Gregory S. Calip. The association between physical health-related quality of life, physical functioning and risk of contralateral breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5749.

Intraosseous Basivertebral Nerve Ablation for the Treatment of Chronic Low Back Pain: 2-Year Results From a Prospective Randomized Double-Blind Sham-Controlled Multicenter Study

The purpose of the present study is to report the 2-year clinical outcomes for chronic low back pain (CLBP) patients treated with radiofrequency (RF) ablation of the basivertebral nerve (BVN) in a randomized controlled trial that previously reported 1-year follow up. A total of 147 patients were treated with RF ablation of the BVN in a randomized controlled trial designed to demonstrate safety and efficacy as part of a Food and Drug Administration-Investigational Device Exemption trial. Evaluations, including patient self-assessments, physical and neurological examinations, and safety assessments, were performed at 2 and 6 weeks, and 3, 6, 12, 18, and 24 months postoperatively. Participants randomized to the sham control arm were allowed to cross to RF ablation at 12 months. Due to a high rate of crossover, RF ablation treated participants acted as their own control in a comparison to baseline for the 24-month outcomes. Clinical improvements in the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and the Medical Outcomes Trust Short-Form Health Survey Physical Component Summary were statistically significant compared to baseline at all follow-up time points through 2 years. The mean percent improvements in ODI and VAS compared to baseline at 2 years were 53.7 and 52.9%, respectively. Responder rates for ODI and VAS were also maintained through 2 years with patients showing clinically meaningful improvements in both: ODI ≥ 10-point improvement in 76.4% of patients and ODI ≥ 20-point improvement in 57.5%; VAS ≥ 1.5 cm improvement in 70.2% of patients. Patients treated with RF ablation of the BVN for CLBP exhibited sustained clinical benefits in ODI and VAS and maintained high responder rates at 2 years following treatment. Basivertebral nerve ablation appears to be a durable, minimally invasive treatment for the relief of CLBP.

Relationship of Physical, Emotional Health Variables and Functional Health Status of the Elderly in Asaba, Delta State

Functional health status is the level of activities performed by an individual to realize needs of daily living in many aspects of life including physical, psychological, social, spiritual and intellectual roles. Level of performance is expected to correspond to normal expectation in the individual's nature, structure and conditions. Researching into the functional health status of the senior citizens will aid in designing a worthwhile health education programme for them. The few health-related studies carried out on the senior citizens in Asaba have not addressed their functional health status. Therefore, this study examined physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain and general health as determinants of functional health status of the senior citizens in Asaba, Delta State. The study used descriptive survey research design. The sample aged 64.93 ± 11.57years in average were two hundred and fourteen (214) drawn through multistage sampling techniques from five local government areas in Asaba, Delta State. Functional Health Status was assessed using the Medical Outcomes Trust Short Form 36 (SF-36) Health Status Questionnaire that has internal consistency reliability results based on Alpha levels to range from 0.42 to 0.91. Eight hypotheses were tested and data were analyzed with the use of descriptive statistics of frequency count, percentage, mean and standard deviation as well as non-parametric statistics of chi-square (X2) at 0.05 level of significance. Results showed that physical functioning (X2=423.87, p<0.05), role limitations due to emotional problems (X2=8.46, p<0.05), energy/fatigue (X2=148.12, p<0.05), emotional well-being (X2=616.36, p<0.05), social functioning (X2=25.30, p<0.05), pain (X2=26.30, p<0.05) and general health (X2=520.78, p<0.05) were significant determinants while role limitations due to physical health was not a significant determinant of functional health status of the senior citizens in Asaba, Delta State. It was concluded that the content of health education programme for the senior citizens should strongly take the factors examined into consideration.

The effects of cancer and racial disparities in health-related quality of life among older Americans: a case-control, population-based study.

Understanding the impact of the cancer care system on racial/ethnic disparities in health-related quality of life (HRQOL) is increasingly important as the number of cancer survivors in the United States grows. The authors prospectively assessed changes in HRQOL before and after a first cancer diagnosis among non-Hispanic whites (NHWs), African Americans (AAs), Hispanics, and Asians in a cohort of Medicare beneficiaries with and without cancer. Data from the Surveillance, Epidemiology, and End Results linked with the Medicare Health Outcomes Survey were used to identify 1778 individuals aged ≥65 years with prostate, breast, or colorectal cancer from 1998 to 2007. The Medical Outcomes Trust Short Form 36 (SF-36) instrument was used to measure HRQOL. By using propensity scores, each patient with cancer (case) was matched to 5 individuals without cancer (noncancer controls), and differences in HRQOL according to race/ethnicity were assessed. Mixed effects analysis of covariance models was used to assess differences in HRQOL, adjusting for baseline HRQOL, demographics, and self-reported comorbid conditions while controlling for each individual's managed care plan. Stratified analyses were used to assess racial/ethnic disparities between cases and noncancer controls. Before cancer diagnosis, NHWs had better HRQOL scores than AAs and Hispanics on the Role-Physical and Role-Emotional SF-36 subscales. Cancer diagnosis/treatment negatively impacted individuals' lives regardless of race/ethnicity. However, among cases, gaps between racial/ethnic groups narrowed (compared with controls) before and after cancer diagnosis for some SF-36 HRQOL measures. Racial/ethnic HRQOL gaps exist among cancer survivors but may narrow because of exposure to the cancer care system. Further research to understand why this occurs will help inform initiatives to manage the impact of cancer on HRQOL among elderly cancer survivors.

Validation of an instrument to measure the impact of coronary disease on patient’s daily life

To evaluate the psychometric Instrument to Measure the Impact of Coronary Disease on Patient's Everyday Life (IDCV) when applied on patients with coronary disease being followed at an outpatient clinic. One hundred and fifty-three patients with coronary disease were registered. Patients were analysed in terms of acceptability, ceiling and floor effect, reliability (using Cronbach's alpha coefficient) and convergent construct validity (by means of Spearman correlation) between the domains of IDCV and of 'Medical Outcomes Trust Short-form Health Survey (SF-36)' and 'MacNew Heart Disease Health-related Quality of Life Questionnaire'. Evidence was found for high acceptability of IDCV. No evidence was found for ceiling and floor effects regarding the total score of IDCV; however, ceiling and floor effects were found from the adjustment to the disease domain. Evidence was found for reliability of the instrument as a whole and for its domains (Cronbach's α ranged between 0·70-0·85). Similar domains on the IDCV, MacNew and SF-36 were correlated: Physical impact - symptoms on the IDCV with the physical function domain on MacNew (r = -0·64) and with most domains on the SF-36 related to the physical dimension; Social impact and emotional impact on the IDCV with emotional function (r = -0·53) and social function (r = -0·55) on the MacNew and mental health on SF-36 (r = -0·55). However, smaller correlations of moderate/high magnitude were found between different constructs entre: Social and emotional impact on the IDCV with physical function on the MacNew (r = -0·56) and with the following domains: Functional capacity (r = -0·50), general health (r = -0·52) and vitality (r = -0·50) on SF-36. The IDCV is an instrument with evidence regarding reliability and convergent validity also for the population of patients with coronary disease. Further studies to validate its factor structure could offer contributions for understanding the psychometric performance of the IDCV among patients with coronary disease.

Abstract P332: Younger Patients Report Impaired Mental Functioning in Health-Related Quality of Life After Valve Surgery

Background: Heart valve surgery is indicated for a number of presenting conditions and is performed even in young patients. It is known that younger age can be protective for surgical outcomes, such as mortality, but less is know about how age impacts quality of life in patients undergoing valve surgery. Objective: To determine if age was associated with health related quality of life (HRQL) after valve surgery. Methods: Patients who underwent valve surgery (stand alone or concomitant) since late 2005 were included in these analyses (N=288). The age range for this sample was 21-87. Patients were divided into tertiles based on age: younger (age &lt; 60 years; n=95), older (age ≥ 60 and &lt; 72; n=93) and oldest (age ≥ 72; n=100). HRQL was measured using the Medical Outcomes Trust Short Form 12 (SF-12) prior to surgery, and at 6 and 12 months post-surgery. The SF-12 mental component summary (MCS) and physical component summary (PCS) scores were calculated to assess differences in HRQL over time based on age groups. Results: There was a significant main effect of time for MCS (F=5.6, p&lt;0.006) and PCS (F=39.6, p&lt;0.001) with significant increases in HRQL from baseline through 12 months. No significant interaction of time by age group was found for MCS or PCS. All three groups increased similarly for both MCS and PCS. There was a significant main effect of group for both MCS (F=4.1, p&lt;0.02) and PCS (F=22.3, p&lt;0.001). The younger group had significantly lower MCS scores as compared to the older group (p&lt;0.02), regardless of time point. However, the younger group had significantly higher PCS scores as compared to the older (p&lt;0.04) and oldest groups (p&lt;0.001). The older group also had significantly higher PCS scores than the oldest group (p&lt;0.001). Conclusion: Improvement in HRQL was shown across all age groups in both MCS and PCS. Despite the fact that the younger patients had the highest physical HRQL, this group had the lowest mental HRQL regardless of time point. These results suggest that valve disease in the younger patients had a detrimental effect on their mental HRQL prior to and after surgery. Further study is needed to investigate the impact of valve disease and surgery on quality of life in younger patients, particularly on how to improve the psychological experience.

Usefulness of Percutaneous Aortic Valve Implantation to Improve Quality of Life in Patients >80 Years of Age

Older patients with aortic stenosis cannot always be offered conventional surgical aortic valve replacement at an acceptable risk. Transcatheter aortic valve implantation (TAVI) is currently considered an alternative treatment option with lower periprocedural risks. However, its effect on post-TAVI quality of life and clinical improvement has not been systematically and prospectively evaluated in those of advanced age. Thus, the aim of the present study was to assess the clinical improvement in geriatric patients after TAVI, with a special emphasis on quality of life. In the present study, we assessed the quality of life and brain natriuretic peptide in patients aged >80 years, before and 6 months after transfemoral CoreValve implantation. Of 87 prospectively studied patients with severe, symptomatic aortic stenosis at an age of ≥81 years, 80 survived for 6 months and were able to attend the follow-up visit with a quality of life assessment, using the Medical Outcomes Trust Short Form 36-Item Health Survey (average age 86 ± 2.9 years). The average scores of all 8 health components had improved significantly after TAVI. The greatest gain was seen in physical functioning (improvement from 23.4 ± 6.0 to 67.8 ± 13.7; p <0.001). The lowest gain was seen in bodily pain (improved from 37.5 ± 9.4 to 51.3 ± 11.5; p <0.05). Similarly, both the physical and the mental component summary scores improved significantly. This was consistent with significant improvement in brain natriuretic peptide levels (5,770 ± 8,016 to 1,641 ± 3,650 ng/L; p <0.0001). In conclusion, the results of the present study have shown a significant clinical benefit from TAVI in a patient population aged ≥81 years.

Health‐related quality of life in systemic sclerosis: A systematic review

A number of studies (all n <200) have assessed health-related quality of life (HRQOL) in patients with systemic sclerosis (SSc), but no systematic review of the effect of SSc on HRQOL has been done. The objective of this study was to systematically review the literature on HRQOL in SSc measured using the Medical Outcomes Trust Short Form 36 (SF-36). A comprehensive search was conducted in August 2007 using Medline, CINAHL, and EMBase to identify original research studies reporting SF-36 scores of SSc patients. Selected studies were reviewed and characteristics of the study samples and SF-36 data were extracted. Bayesian meta-analysis and meta-regression were performed to obtain pooled estimates of SF-36 physical component summary (PCS) and mental component summary (MCS) scores for all patients as well as by limited and diffuse disease status. Twelve data sets with a total of 1,127 SSc patients were included in the systematic review. HRQOL was impaired in patients with SSc, with pooled SF-36 PCS scores being more than 1 SD below the general population (38.3; 95% credible interval [95% CI] 35.2, 41.5) and pooled SF-36 MCS scores being approximately 0.5 SDs below the general population (46.6; 95% CI 44.2, 49.1). SF-36 PCS scores were 3.5 points (95% CI -1.0, 8.0) lower in patients with diffuse compared with limited disease. This study provides robust evidence of the presence and magnitude of impairment in HRQOL in patients with SSc. Although the impairment appears greater in physical health, mental health impairment is also reported.

Patients with systemic autoimmune diseases could not distinguish comorbidities from their index disease

Objective To assess the construct validity of the Self-Administered Comorbidity Questionnaire (SCQ) in patients with systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). Methods The SCQ was modified for the SSc cohort to emphasize the objective of recording problems other than the patients' scleroderma. It was administered to 406 SSc and 147 SLE patients. Construct validity of the SCQ was evaluated separately in the SSc and SLE cohorts by testing the hypotheses that a valid comorbidity index should correlate with age and health-related quality of life (Medical Outcomes Trust Short Form 36 [SF 36]) but not with disease-specific variables. Results The SCQ score correlated with age in the SSc patients only (Tau B = 0.37, P < 0.001) and not in the SLE patients. It correlated with the SF 36 in both SSc and SLE. However, it also correlated with several disease-related variables. There was significant overlap between reports of comorbidities and disease-related problems in the SSc cohort. Conclusion Patients with systemic autoimmune diseases cannot distinguish true comorbidities from conditions related to their index disease and, as such, a self-administered comorbidity questionnaire does not appear useful in these diseases.

Quality of Life After Implantation of Bileaflet Prostheses in Elderly Patients: An Anticoagulation Work Group Experience

The aim of the study was to examine our experience with the implant of bileaflet mechanical prostheses and with a centralized management of anticoagulation and the related risks in patients aged older than 70 years, focusing on the resulting expectancy and quality of life. Between January 1988 and January 2005, 681 consecutive patients older than 70 years (mean age, 73 +/- 3.3 years) underwent bileaflet prostheses implantation in an isolated procedure (77%) or concomitant with other procedures (23%). Data were retrospectively collected, and follow-up was conducted by mean of outpatient chart review and outpatient clinic controls. Follow-up included assessment of perceived quality of life through the Medical Outcomes Trust Short Form 36-Item Health Survey tool (SF-36). The scores obtained by the patients were compared with those of the Italian general population matched for age and sex. Hospital mortality was 11.8%, and 74 late deaths (12.3%) occurred. Mean follow-up was 4.38 +/- 2.85 years. Actuarial survival was 85.2% +/- 0.014% at 1 year, 77.9% +/- 0.017% at 5 years, 74.2% +/- 0.02% at 10 years, and 71.8% +/- 0.031% at 15 years. The mean international normalized ratio variability was 4.5% +/- 1.2%. Freedom from bleeding was 98.7% +/- 0.005% at 5 years and 98.3% +/- 0.007% at 10 and 15 years. Freedom from thromboembolism was 99.1% +/- 0.004% at 5 years, and 98.3% +/- 0.007% at 10 and 15 years. The mean SF-36 scores in the study patients were significantly higher than those of the general population matched for age and sex (p < 0.001 in all domains). Septuagenarian patients receiving mechanical valve prostheses did not experience increased rates of anticoagulation-related complications and perceived a satisfactory quality of life.

Impact of Chronic Kidney Disease on Health-Related Quality-of-Life Improvement After Coronary Artery Bypass Surgery

Little is known about the impact of chronic kidney disease (CKD) on health-related quality-of-life outcomes after coronary artery bypass grafting (CABG). Our objective was to examine the changes in physical function (PF) and mental health (MH) 6 months after CABG in 1055 patients with and without CKD. The primary end points were mean change in score and status of "improved" or "worsened" in both PF and MH subscales of the Medical Outcomes Trust Short Form 36-Item Health Survey from baseline to 6 months after CABG, stratified by CKD stage (0-5). Absolute PF and MH scores at baseline and at 6 months varied by renal impairment level. Patients with severe CKD (stages 4-5) had a mean (SD) decrease in PF score at 6 months of 3 (3) compared with increases in the rest of the cohort (P<.001). After adjustment for baseline score, 21% of patients with advanced CKD experienced worsened PF scores, compared with 0% of patients with stages 0 to 2 and stage 3 CKD (P<.001). In contrast to PF scores, patients with and without CKD had similar improvements in mean MH scores at 6 months, and patients with stages 4 to 5 CKD had the highest frequency of those with improved MH scores (77%). After adjustment, no patients experienced worsened MH scores. After 6 months, patients with severe CKD who underwent CABG had improvement in MH but not improvement in PF and may have had worsened PF compared with those without severe CKD. Comparable evidence regarding quality-of-life outcomes in the absence of CABG is needed to more fully inform decision making regarding patients with severe CKD and coronary artery disease.

Health related quality of life after mitral valve repairs and replacements

The decision to replace or repair mitral valves is often a difficult decision, and outcomes from the patients' perspective should guide decision-making. We investigated whether the change in health related quality of life (HRQOL) after mitral valve surgery is different after valve repairs compared with replacements. We prospectively studied 25 patients with mitral valve replacement and 45 patients with valve repairs performed in 1998-99. We measured HRQOL at baseline and at 18 months using the Medical Outcomes Trust Short Form 36-item Health Survey (SF-36) questionnaire. We compared mean HRQOL scores of the groups with age-adjusted U.S. population scores. We used analysis of covariance to determine a change in HRQOL within groups (repair or replacement) and if the change in HRQOL was different between the groups. We found few differences between the groups, with more men and simultaneous coronary artery bypass graft surgery in the valve repair group and more prior operation in the valve replacement group. HRQOL improved after surgery in most domains, and was comparable to age-adjusted U.S. norms in the valve repair group. In the multivariable analysis, mitral valve repair recipients reported higher social functioning compared with patients who received valve replacement (p = 0.04). We did not find other statistically significant differences. However, the adjusted improvements in the component scales of physical functioning (PCS) and mental functioning (MCS) were substantial in the valve repair group (mean changes: PCS = 6.8, p = 0.003; MCS = 8.1, p = 0.014) and less pronounced in the replacement group (mean changes: PCS = 3.6, p = 0.09; MCS = 4.3, fsp = 0.16). While many considerations influence the decision to repair or replace mitral valves, these findings suggest that repair may be better from the health status perspective. Further studies are necessary to validate this finding.

Symptoms of Extraesophageal Reflux in a Community-Dwelling Sample

Extraesophageal reflux disease (EERD) is linked with serious and varied health concerns. The authors' goal was to determine the prevalence of EERD and the effect on health-related quality of life in adults within a large community-based sample. Survey study conducted in a community setting. In the Madison, Wisconsin area, 1845 adult subjects were surveyed. Main outcome measures were frequently of GERD and laryngeal symptoms, the Medical Outcomes Trust Short Form 12 (SF-12), Voice Handicap Index (VHI), and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires. More than 66% of subjects reported either GERD or laryngeal symptoms, and 26% reported both GERD and laryngeal symptoms (which reflect symptoms commonly reported for EERD). In addition, 39% of our sample took medicine for heartburn. Forty-four percent of subjects with both GERD and laryngeal symptoms reported occasional breathing difficulties, and 38% of these subjects reported a voice disorder. Significant reductions in perceived quality of general health, digestive health, and voice-related quality of life were found in subjects with both GERD and laryngeal symptoms, in comparison with subjects manifesting each symptom group alone, or in subjects with no symptoms. The presence of GERD and laryngeal symptoms, and their concurrence, was identified in a substantial number of subjects. The GERD and laryngeal symptoms surveyed represent those most commonly reported for EERD. Because EERD has been linked with tissue damage and reductions in health-related quality of life, it is important to identify these persons and provide treatment before progression of the condition.

Quality of life after aortic valve replacement with tissue and mechanical implants

Objectives We sought to determine whether changes in quality of life at 18 months following aortic valve replacement differ depending on the use of tissue valves or mechanical valves. Methods We prospectively studied 73 patients with tissue valve replacements and 53 patients with mechanical valve replacements performed from April 1998 through March 1999 at Yale-New Haven Hospital. Quality of life was measured at baseline and at 18 months using the Medical Outcomes Trust Short Form 36-Item Health Survey. Results Baseline unadjusted mean quality-of-life scores were lower in tissue valve recipients than in mechanical valve recipients and, for both groups, were generally lower than US population norms. At 18 months postoperatively, quality-of-life scores were greatly improved in both groups and were comparable to population norms (ie, within one-half a standard deviation). After adjusting for baseline quality of life, age, and other prognostic factors in an analysis of covariance, improvements in quality-of-life scores for tissue valve recipients versus mechanical valve recipients were similar. Of 10 (8 domains and 2 summary) scales examined, the only significant difference between the 2 groups was for the improvement in role limitations due to physical problems (Role Physical), which was more favorable in patients with mechanical valve implants ( P = .04). Conclusions The use of tissue valve implants versus mechanical valve implants has little influence on improvement in quality of life at 18 months following aortic valve replacement. Thus, decisions about whether to choose a tissue valve or mechanical valve implant should depend upon other factors such as rates of complications and differences in the life span of the implants.

Age does not limit quality of life improvement in cardiac valve surgery

ObjectivesWe sought to determine the association of age with the change in quality of life (QOL) after valve surgery. BackgroundImprovement in QOL is one of the principal goals of valve surgery. These procedures are being done with increasing frequency for older patients. MethodsWe prospectively studied 148 patients with aortic valve procedures and 72 patients with mitral valve procedures. Patients' QOL was measured at baseline and at 18 months using the Medical Outcomes Trust Short Form 36-Item (SF-36) Health Survey (response rate 90%). The association of age with change in QOL was measured by multiple regression analysis and based on two meta-scores of the SF-36: the Mental Component Summary (MCS) and the Physical Component Summary (PCS). ResultsOverall improvement in most domains of the SF-36, including the MCS and the PCS scores, was substantial. Improvement in the MCS score was not influenced by age in either aortic (0.09 score point improvement per 10-year age increments; p = 0.9) or mitral (0.90 score point improvement per 10-year age increments; p = 0.3) patients. Similarly, improvement in the PCS score did not vary by age in aortic patients (−1.00 score points per 10-year age increments; p = 0.2) and only slightly varied by age in mitral patients (−1.90 score points per 10-year age increments, p = 0.02). In the latter, despite statistical significance, the association was not substantial or clinically important. ConclusionsAmong patients referred for cardiac valve surgery, age does not appear to limit the QOL benefits of surgery.

The Management of One-Level Anterior Cervical Corpectomy with Fusion Using Atlantis Hybrid Plates: Preliminary Experience

To limit high pseudarthrosis rates encountered after cervical procedures for adjacent two-level disease, one-level anterior corpectomy with fusion was performed using the newly available Atlantis hybrid plates (fixed screws placed superiorly and variable screws placed inferiorly). Eight one-level anterior corpectomies with fusion were performed using iliac autografts and Atlantis hybrid plates. Nurick and Medical Outcomes Trust Short Form 36 scores were recorded before operation (Nurick grade 2.3) and 6 months after operation. Fusion status was followed an average of 9 months (range, 8 to 11 months). Fusion was confirmed an average of 6 months after operation in seven patients, when the mean Nurick grade was 0.2 and all had improved on the eight Medical Outcomes Trust Short Form 36 health scales. Atlantis plates contributed to successful fusion in seven of eight patients undergoing one-level anterior corpectomy with fusion using Atlantis hybrid plates.

Prevalence and identification of problems in daily functioning in a primary medicine clinic

Purpose : This pilot study compares scores on a health status/functional assessment measure to clinician identification of problems in functioning and referrals for these problems, based on examination of information in the patient's medical chart. Method : A sample of 194 participants at a primary medicine clinic in an urban general hospital completed a measure of health status and functioning, the Medical Outcomes Trust Short Form 36 (SF-36). Chart reviews were conducted to assess whether problems in functioning were addressed by the primary care clinician. Results : Overall, levels of functioning on the scales of the SF36 were well below norms for the general US population from the Medical Outcomes Study. Older adults showed lower physical functioning and higher emotional functioning than younger adults. Participants with 1, 2, or 3 chronic conditions showed increasingly lower levels of physical functioning. For participants with functional assessment scale scores in the lowest quartile, problems in functioning noted in the chart ranged from 13%-28%. Only 6%-20% of participants with marked problems in functioning were referred for further assessment or treatment. Conclusions : Functional problems are frequently important indicators of risk of development of secondary complications and need for referral. Questionnaire screening may increase identification and referral for problems in functioning in primary care settings.

Predicting follow-up functional outcomes in outpatient rehabilitation.

Functional outcomes at an average of six months after outpatient rehabilitation were investigated in a pilot study with a sample of 42 patients receiving physical therapy for low back, neck, and other musculoskeletal problems. Logistic regression analyses were used to study variables related to the achievement of a predetermined level of physical functioning or to whether improvement occurred from initial to follow-up assessment. Scales used in the analyses were obtained from two measures of functioning, the Medical Outcomes Trust Short Form 36 (SF-36) and the Medical Rehabilitation Follow Along (MRFA instrument). Demographic and program characteristic variables obtained from clinic records were also included in the analyses. The independent variables entered into two groups of regression equations included age, gender, presenting problem, workers' compensation coverage, functioning at initial assessment, number of visits, length of program, and intensity of program. For the SF-36, the General Health scale and presenting problem predicted above or below a level greater than one standard deviation less than the mean on the Physical Functioning scale at follow-up. The combination of the Role Physical and Role Emotional scales predicted follow-up level on the Physical Component Summary (PCS) scale. The interaction of age and intensity of treatment was predictive for both the Physical Functioning and PCS scales. For predicting improvement or no improvement using the SF-36 scales, General Health and the interaction between age and intensity were predictive of change on the Physical Functioning scale, whereas age and the interaction between age and number of visits were predictive of change on the PCS scale. For the MRFA instrument, the interaction between age and the intensity of treatment was predictive for both a predetermined level of physical functioning and amount of improvement in physical functioning at follow-up. An intensity rating of pain and a measure of affective distress at initial assessment both improved the identification of patients at risk for not reaching a given level of functioning, whereas treatment intensity improved the identification of those patients at risk for not showing improvement at follow-up. Length of time between the end of outpatient therapy and follow-up assessment was generally not related to follow-up physical functioning. Interpretation and implications of these findings, as well as applications of this analytic approach to outcomes assessment, are discussed.

Assessing outcomes for dysphonic patients.

This study was designed to evaluate a disease-specific outcome measure for patients with selected voice disorders and to relate this instrument to a standardized quality of life measurement. In addition, the study attempts to document the degree of handicap for dysphonia patients globally, between different vocal pathologies, and in comparison to other chronic diseases. In this prospective, observational study, 260 adult patients evaluated for alterations of voice completed a general quality of life measure (the Medical Outcomes Trust Short Form 36-Item[SF-36]) and a voice-specific instrument (Voice Handicap Index [VHI]) pretreatment. The highest correlation was between the social functioning score of the SF-36 and the total score of the VHI and the physical, emotional, and functional subscales (p < 0.001) of the VHI. Significant correlation was also obtained for the SF-36 domains mental health (p < 0.01), general health (p < 0.01), and role functioning emotional (p < 0.017) with the three VHI domains and the total VHI score. Patients had significantly lower scores than the general U.S. population in five of the eight domains of SF-36. Patients with vocal fold paralysis had the highest level of pretreatment disability as measured on both the VHI and SF-36 among voice patients. The patients with dysphonia had a lower level of physical functioning than the patients with chronic sinusitis (p < 0.01), reflecting a greater handicap. In addition, the dysphonia group had lower levels of social functioning than the angina (p < 0.01) and sciatica (p < 0.01) groups and a lower score for mental health than the angina group (p < 0.01). The SF-36 correlates with the VHI in the domains of social functioning, mental health, and role functioning emotional. The baseline handicap for voice disorders represents a significant disability even in comparison to conditions such as angina pectoris, sciatica, and chronic sinusitis.

The effects of a group nutrition education program on nutrition knowledge, nutrition status, and quality of life in hemodialysis patients

Objective: To assess the effects of a group nutrition education program (GNEP) on nutrition knowledge, nutrition status, and quality of life in hemodialysis (HD) patients. Design: A 5-month study of patients on HD receiving group nutrition education compared to a control group of HD patients receiving individualized monthly nutrition counseling. Pre-study and post-study, participants completed a questionnaire that assessed nutrition knowledge and solicited demographic data and the Medical Outcomes Trust Short Form 36 Quality of Life Health Survey (SF-36). Laboratory test results for albumin, potassium, phosphorus, and calcium levels were recorded pre-study and post-study along with dry weight and fluid gains. Setting: Two free-standing dialysis centers that treated approximately 40 to 75 patients daily. Patients: Eighty-seven chronic HD patients (group education: n = 53, control: n = 34) who had been on dialysis an average of 23 months. Interventions: The GNEP teaching and support program consisted of five monthly 45-minute sessions conducted with nine groups of 7 to 10 HD patients seated in the same area while undergoing their HD treatment. A standardized format was used for each session. Main Outcome Measured: Changes in pre-study and post-study nutrition knowledge, nutrition status as indicated by laboratory values, and quality of life as assessed through the SF-36. Results: Patients in both groups had significantly improved albumin levels from pre-study to post-study. Nutrition knowledge scores improved in the GNEP cohort, but not at a statistically significant level. The GNEP had significantly improved composite scores on the SF-36 from pre-assessment to post-assessment. There were no significant differences between the control and GNEP cohort in any of the parameters measured. Conclusions: Group education may be an effective as well as efficient method for providing nutrition education to HD patients.