Mental Composite Score Research Articles

Transrectal High-Intensity Focused Ultrasound for the Management of Rectosigmoid DEEP Infiltrating Endometriosis

<h3>Study Objective</h3> Demonstrate the feasibility of Trans Rectal High intensity focused ultrasound (HIFU) treatment in patients presenting rectosigmoid endometriosis <h3>Design</h3> Phase I, non-controlled, prospective monocentric clinical study <h3>Setting</h3> Patients filled questionnaires on gynecologic and intestinal symptoms, and on quality of life (MOS-SF36 score, EHP-5) before and at one, three and six months after treatment. <h3>Patients or Participants</h3> patients older than 25 years, who presented a symptomatic single rectosigmoid location and after failure of hormonal therapy. All lesions were assessed using transvaginal sonography and MRI. <h3>Interventions</h3> Trans Rectal HIFU treatment Using the FocalOne Probe. <h3>Measurements and Main Results</h3> Twenty-three patients were included between September 2015 and October 2018. All the lesions were visualized. Twenty lesions were treated ("feasibility rate": 87.0%): thirteen entirely and seven partially. The mean duration of the procedure was 55.6 minutes. We observed a significant improvement in visual analogic scales at six month for dysmenorrhea (-3.6, p=0.004), dyspareunia (-2.4, p=0.006), diarrhea (-3.0, p=0.006), constipation (-3, p=0.002), dyschezia (-3.2, p=0.003), false urges to defecate (-3.3, p=0.007), posterior pelvic pain (-3.8, p=0.002), and asthenia (-4.3, p=0.002).There was also a significant improvement of the MOS-SF36 with an increase of both Physical Composite Score (+9.3%, p=0.002) and Mental Composite Score (+10.9%, p=0.017) at six months. No major complications occurred during and after the procedure. <h3>Conclusion</h3> HIFU therapy for rectosigmoid location is feasible. It could be an interesting minimally invasive alternative to surgery for the treatment of rectosigmoid endometriosis. A prospective multicentric study is presently performed in France to confirm these preliminary results.

Thoracoscopic ablation for symptomatic atrial fibrillation improves quality of life

Abstract Background Rhythm control has become an essential part of adequate management in atrial fibrillation (AF) to reduce symptoms and ultimately to improve health related quality of life (HRQoL). Totally thoracoscopic ablation has been established over the last years as an effective and safe rhythm control strategy, especially for persistent AF, but quality of life data are lacking. Purpose To assess the impact of totally thoracoscopic ablation on HRQoL in patients with symptomatic AF. Methods Consecutive patients with symptomatic AF undergoing totally thoracoscopic ablation at a referral centre in the Netherlands (July 2016 – October 2019) were included. The primary outcome was quality of life. Short Form 36 and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) health surveys were collected at baseline, 1, 3, 6 and 12 months. Clinical improvement was measured as the relative increase of the QoL-score at 1 year compared to the baseline score (in %). Multilevel regression modelling was used, coupled with fractional polynomials for adjustment of age differences and nonlinear time trends, to investigate the one-year clinical trajectories of sex differences in QoL subscales. Secondary outcomes included rhythm success (freedom from any recurrence of atrial tachyarrhythmia&amp;gt;30 sec), mortality and stroke. Results 191 patients were included (63.9±8.6 years, 68% male, 22.5% paroxysmal AF, 69.6% persistent AF and 7.9% long-term persistent AF, 66.5% having at least one previous failed catheter ablation, with median Cha2ds2 Vasc score of 2 [IQR 1–3]). AFEQT sum scores (52.6 points at baseline) substantially improved after three months (49.8%; p&amp;lt;0.001) and remained stable up to 1-year (54.2%; p&amp;lt;0.001) despite adverse events. Patients with recurrent AF also showed significant improvement at 3 months which remained stable up to 1-year, but patients who remained in sinus rhythm had significantly more increase (61.3% vs 26.9%, p&amp;lt;.001). The SF36 physical and mental summary composite scores significantly improved after 3 months (12.3% and 11.9% respectively; p&amp;lt;.001) and remained stable up to 1-year (16.9% and 16.4% respectively; P&amp;lt;.001). Although female patients had significantly lower AFEQT and physical subscales at baseline, similar improvement in scores were observed over time compared to men, adjusted for age and sex interactions (P&amp;lt;.001). One-year stroke rate was 1.6 per 100 patient-years with an oral anticoagulation rate of 63%. One-year survival was 99.5%. Conclusions This study reveals significant improvement of HRQoL three months after thoracoscopic ablation that persisted up to 1-year, also when adjusted for sex and age differences. Despite AF recurrence or adverse events AF related QoL still improved. Trials are necessary to confirm these data. Funding Acknowledgement Type of funding sources: None.

The impact of demographic and clinical characteristics on the trajectories of health-related quality of life among patients with Fabry disease

BackgroundFabry disease (FD) is an X-linked lysosomal storage disorder characterized by multiorgan dysfunction. Since individuals with FD usually experience progressive clinical disease manifestations, their health-related quality of life (HRQOL) is expected to change over time. However, there is limited longitudinal research examining HRQOL outcomes in individuals with FD. We aimed to: assess longitudinal outcomes in HRQOL in adults with FD; examine the physical- and mental HRQOL trajectories at the initial registration (baseline), 3–5 year, and 7–13 year follow-ups; and evaluate the possible associations of age, sex and medical complications with the physical- and mental HRQOL trajectories.MethodsForty-three individuals with FD (53% female) who were aged 18 to 81 years at baseline attended clinical follow-up visits between 2006 and 2020. Medical records were extracted retrospectively. Demographics and the 36-item Short-Form Health Survey (SF-36) were recorded at scheduled visits, except for the last data collection which was prospectively obtained in 2020. The physical (PCS) and mental (MCS) composite scores (SF-36) were chosen as outcome measures.ResultsThe eight SF-36 domain scores were stable over a span of 13 years, and only physical- and social functioning domains worsened clinically over this follow-up period. Mean baseline SF-36 domain scores were all significantly lower (decreased HRQOL) in the FD sample compared with Norwegian population norms. Two hierarchical linear models were run to examine whether demographics and medical complications (measured at the last clinical visit) predicted physical and mental HRQOL trajectories. Age above 47 years (p < 0.001), male sex (p = 0.027), small fibre neuropathy (p < 0.001), renal dysfunction (p < 0.001), and cerebrovascular events (p = 0.003) were associated with lower HRQOL over time. No significant interactions were found between the time of follow up and the abovementioned predictors of HRQOL.ConclusionsOverall HRQOL trajectories remained stable between baseline, 3–5 year, and 7–13 year follow-ups, with the majority of individuals reporting decreased physical and mental HRQOL. Medical complications in combination with older age and male sex are important predictors of lower HRQOL in FD. Awareness of this relationship is valuable both for health care providers and for patients. The findings provide indicators that can guide treatment decisions to improve physical and mental HRQOL outcomes.

The Effect of the Severity of Preoperative Back Pain on Patient-Reported Outcomes, Recovery Ratios, and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF)

Limited literature has addressed impact of preoperative back pain severity on patient-reported outcome measures (PROMs), recovery ratios (RRs), and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). MIS TLIFs were retrospectively identified and grouped: preoperative visual analog scale (VAS) back ≤7 or VAS back >7. PROMs, including PROMIS-PF, VAS back and leg, Oswestry Disability Index (ODI), and SF-12 Physical Composite Score and Mental Composite Score (MCS), were collected pre- and postoperatively. A PROM's RR was calculated as proportion of postoperative improvement to overall potential improvement. In total, 740 patients were included: 359 patients with VAS back ≤7 and 381 patients with VAS back >7. The VAS back >7 cohort reported significantly greater postoperative inpatient pain (P ≤ .003, both). All preoperative and the following postoperative PROMs favored the VAS back ≤7 cohort: PROMIS-PF 2-years, VAS back overall, SF-12 Physical Composite Score 12 weeks and 1 year, SF-12 MCS 6 weeks/12 weeks, VAS leg 6 weeks, 12 weeks, 6 months, and 2 years, and ODI overall (P ≤ 0.048, all). The VAS back >7 cohort demonstrated greater delta PROMs for all VAS back and ODI except 2 years (P ≤ 0.021, all). A greater proportion of patients in the VAS back >7 group achieved minimal clinically important difference for VAS back overall, ODI 6 weeks/12 weeks, PROMIS-PF 6 weeks, and SF-12 MCS 6 weeks/6 months (P ≤ 0.044, all). The VAS back>7 cohort RR was significantly greater for VAS back 6 months and VAS leg 6 months/2 years (P ≤ 0.034, all). The VAS back ≤7 cohort's postoperative satisfaction was significantly greater for VAS back 12 weeks, VAS leg 12 weeks, and ODI 6 weeks/12 weeks (P ≤ 0.046, all). Patients with greater preoperative back pain demonstrated significantly worse postoperative scores for most PROMs at most time points and significantly worse patient satisfaction for disability, back and leg pain at multiple time points.

Impact of Endometriosis in Women of Arab Ancestry on: Health-Related Quality of Life, Work Productivity, and Diagnostic Delay.

Introduction: Endometriosis has a negative effect on health-related quality of life (HRQoL), wellbeing and daily functioning. Endometriosis is an under-researched condition within non-western populations. Cultural representations are needed to understand the relative roles of societal norms, traditional factors, and religious sensitivities on the impact of endometriosis on HRQoL in various populations. In particular, there is a lack of emphasis placed in understanding the association of HRQoL on endometriosis in Arab women.Method: In this prospective case-control study, 2,610 Arab ancestry women in the United Arab Emirates were recruited to investigate the impact of endometriosis on HRQoL, diagnostic delay, psychological co-morbidities, work productivity, and physical activity. Participants completed the following standardized, validated questionnaires: Short Form-36 version 2 questionnaire, the World Endometriosis Research Foundation EPHect minimum clinical questionnaire version, and Work Productivity and Activity Impairment questionnaire. Translations to the Arabic language, validated using the forward-backward translation method, of the questionnaires were utilized.Results: HRQoL scores were significantly impaired in women with endometriosis, as demonstrated in the Physical Composite Scores and Mental Composite Scores in the symptomatic control group (p = 0.001; p = 0.003, respectively) and the asymptomatic control group (p < 0.001; p < 0.001, respectively). Susceptibility and severity of multiple pain syndromes and infertility in women with endometriosis was the main indicator of lower HRQoL. Anxiety (p = 0.007) and depression (p = 0.005) were significantly associated with endometriosis, in comparison to symptomatic controls. The average diagnostic delay was 11.61 years, however single women experience 15.81 years of diagnosis delay, with approximately 18% (n = 15) of the single women experiencing more than a 20-year delay in diagnosis. The intensity of physical activity was not associated with endometriosis, when compared to symptomatic (p = 0.405) or asymptomatic controls (p = 0.144).Conclusion: For the first time, we provide evidence from a combined hospital, clinic, and population-based study that Arab women with endometriosis experience significant impacts on HRQoL, substantial diagnostic delay after the onset of symptoms, significant association to psychological disorders (anxiety and depression), and a negative impact on work productivity. Future research must focus on understanding the personal and culturally centered beliefs of Arab women to ensure a positive HRQoL trajectory by improving diagnosis and management strategies.

Calprotectin in Chronic Inflammatory Demyelinating Polyneuropathy and Variants-A Potential Novel Biomarker of Disease Activity.

Background: In chronic inflammatory demyelinating polyneuropathy (CIDP), there is an urgent need for biomarkers to monitor ongoing disease activity. Serum calprotectin (CLP) induces signaling pathways involved in inflammatory processes and has been shown to correlate with markers of disease activity in other autoimmune disorders. Thus, we wanted to study the potential value of CLP in comparison to serum neurofilament light chain (sNfl) to monitor disease activity.Materials and Methods: Sera from 63 typical and atypical CIDP and 6 MMN patients with varying degrees of disease activity were analyzed in comparison with 40 healthy controls (HC) in a cross-sectional design. Association of CLP and sNfl levels with socio-demographics, disease duration, CIDP disease activity scale (CDAS), and impairment status [medical research council-sum score (MRC-SS), the inflammatory neuropathy cause and treatment disability score (INCAT-DS), grip strength, and maximum walking distance], patient-reported outcome (PRO) parameters [SF-36 questionnaire, Beck's depression index (BDI), and fatigue severity scale (FSS)], as well as treatment regime were investigated using uni- and multivariate analysis.Results: CLP and sNfl levels were significantly higher in all CIDP patients compared to HC (p = 0.0009). Multivariate analysis adjusted for age and gender revealed that CLP acts as an independent predictor for CIDP and MMN. CLP was significantly associated with active disease course according to CDAS and correlated with MRC-SS, whereas sNfl correlated with parameters of disease impairment. There was no correlation with PRO, except for sNfl and the mental health composite score. Subgroup analysis revealed no differences between typical CIDP and atypical variants.Conclusions: CLP was elevated in CIDP and variants and was associated with active disease course, whereas sNfl shows further potential as biomarker of axonal degeneration. Thus, CLP might be a suitable additive biomarker for measurement of ongoing inflammation, which is greatly needed to guide better patient care in CIDP.

Long-term Outcomes of Firearm Injury Survivors in the United States: The National Trauma Research Action Plan Scoping Review.

To describe the current literature regarding long-term physical, mental, and social outcomes of firearm injury survivors in the United States. We systematically searched the PubMed/MEDLINE and Embase databases for articles published from 2013 to 2019 that involved survivors of acute physical traumatic injury aged 18 or older and reported health outcomes between 6 months and 10 years postinjury. Out of 747 articles identified, seven reported outcomes on United States-based civilian patients whose mechanism of injury involved firearms. We extended our publication date criteria from 1995 to 2020 and expanded the search strategy to include medical subject headings terms specific for firearm injury outcomes. Ultimately, ten articles met inclusion criteria. When studied, a significant proportion of patients surviving firearm injury screened positive for posttraumatic stress disorder (49%-60%) or were readmitted (13%-26%) within 6 months postinjury. Most studies reported worse long-term outcomes for firearm injury survivors when compared both to similarly injured motor vehicle collision survivors and to the United States general population, including increased chronic pain, new functional limitations, and reduced physical health composite scores. Studies also reported high rates of posttraumatic stress disorder, reduced mental health composite scores, lower employment and return to work rates, poor social functioning, increased alcohol, and substance abuse. Research on the long-term health impact of firearm injury is scant, and heterogeneity in available studies limits the ability to fully characterize the outcomes among these patients. A better understanding of the long-term health impact of firearm injury would support systematic change in policy and patient care to improve outcomes.

Stress, coping strategies and quality of life in patients with globus

Objective: To explore the associations of stress, coping strategies and quality of life in globus patients. Methods: A total of 180 patients diagnosed with globus were retrospectively analyzed between September 2018 to July 2020 in the First Affiliated Hospital of Zhengzhou University.The questionnaire included baseline characteristics and assessment scales. Quality of life was measured by short-form health survey-36 (SF-36), which included physical composite score (PCS) and mental composite score (MCS). Perceived stress was measured by perceived stress scale 10 (PSS-10). The coping strategy was evaluated by medical coping modes questionnaire (MCMQ). We analyzed the relationship between baseline characteristics, stress, coping strategies, and quality of life, and the influential factors of quality of life. Results: PCS was affected by the number of previous chronic illness, age, stress, confrontation, and avoidance (F=3.647, r=-0.263, -0.634, 0.249, -0.329, all P<0.05). MCS was related to monthly income, marital status, stress, confrontation, and resignation (F=1.963, 5.764, r=-0.312, 0.384, -0.360, all P<0.05). Based on the data of multiple linear regression analysis, stress was negatively correlated with both PCS and MCS (t=-3.883, -9.708, all P<0.01), confrontation was positively correlated with both PCS and MCS (t=2.030, 2.798, P=0.044, 0.006), and resignation was negatively correlated with MCS (t=-1.585, P=0.025). Besides, age was negatively correlated with PCS (t=-2.736, P=0.007), and monthly income was positively correlated with MCS (t=2.497, P=0.013). Conclusion: Aging, low income, over stress, resignation rather than confrontation as a coping style impair the quality of life in globus patients.

Assessing health-related quality of life and health utilities in patients with chronic hepatitis B-related diseases in China: a cross-sectional study

ObjectivesThe health-related quality of life (HRQoL) and utilities of patients with chronic hepatitis B (CHB) virus infection, including compensated cirrhosis (CC), decompensated cirrhosis (DC) and different stages of hepatocellular carcinoma...

PD59-02 COMPLICATIONS, RECOVERY, AND PATIENT-REPORTED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive V (PD59)1 Sep 2021PD59-02 COMPLICATIONS, RECOVERY, AND PATIENT-REPORTED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY Elizabeth Green, Ali Hajiran, Richard Reich, Logan Zemp, Aymet Aydin, Roger Li, Michael Poch, Wade Sexton, Alice Yu, and Scott Gilbert Elizabeth GreenElizabeth Green More articles by this author , Ali HajiranAli Hajiran More articles by this author , Richard ReichRichard Reich More articles by this author , Logan ZempLogan Zemp More articles by this author , Aymet AydinAymet Aydin More articles by this author , Roger LiRoger Li More articles by this author , Michael PochMichael Poch More articles by this author , Wade SextonWade Sexton More articles by this author , Alice YuAlice Yu More articles by this author , and Scott GilbertScott Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002096.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although cystectomy (Cx) is a morbid surgery, information regarding the effect difficult recovery has on patient-centered outcomes is lacking. Using validated patient-reported outcome (PRO) measures, we examined the relationship between perioperative complications, readmissions, diversion-related consequences and prospectively assessed PROs after Cx. METHODS: Patients undergoing Cx were enrolled in a prospective complication and PRO study from 2014 to 2016 and followed for 12 months. Participants completed the Medical Outcomes Study Short Form (SF-36), Bladder Cancer Index (BCI), Patient Health Questionnaire for Depression (PHQ-8) and Decision Regret Scale (DRS). Perioperative complications within 90 days of Cx were abstracted from medical records using Clavien-Dindo classification and urinary diversion adverse events (AEs) were prospectively assessed and graded 6 months after surgery using Common Terminology Criteria for Adverse Events (CTCAE) standards. The association between perioperative complications, readmissions, 6-month AEs, and PROs were analyzed using multivariable regression models. RESULTS: 113 patients enrolled in this study and had complication and AE data available for analysis. 47% experienced a low grade (LG) and 22% experienced a HG complication. 35% were readmitted. 82% experienced a LG and 19% experienced a HG AE within 6 months. Improved performance status was associated with decreased HG 90-day complications (p=0.009). SF-36 mental health composite score was significantly positively associated with readmission (p=0.04), but not complication or 6-month diversion AE. There was no significant relationship between the presence of a HG 90-day complication, readmission, or 6-month AE and SF-36 physical health (p=0.21, 0.26, and 0.20 respectively), urinary (0.46, 0.20, and 0.86), bowel (p=0.62, 0.63, and 0.85) or sexual domains of BCI (p=0.35, 0.28, and 0.30), PHQ-8 (p=0.89, 0.32, and 0.44), or DRS at 6 months (p=0.15, 0.97, 0.31, Table 1). CONCLUSIONS: HG 90-day complications, readmissions and 6-month AEs did not negatively affect PROs or QOL after recovery from Cx. These data suggest that perioperative complications and AEs do not lead to long-term QOL deficits. Source of Funding: Florida Biomedical Research Program, Bankhead-Coley Research Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1051-e1051 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Green More articles by this author Ali Hajiran More articles by this author Richard Reich More articles by this author Logan Zemp More articles by this author Aymet Aydin More articles by this author Roger Li More articles by this author Michael Poch More articles by this author Wade Sexton More articles by this author Alice Yu More articles by this author Scott Gilbert More articles by this author Expand All Advertisement Loading ...

Donor quality of life after living donor liver transplantation: a review of the literature.

Living donor liver transplantation (LDLT) provides a source for transplant in the setting of the deceased donor organ shortage. Seeing as living donors do not derive any medical benefit from the procedure, fully understanding the impact of donation on donor health-related quality of life (HRQOL) is essential. A systematic search of the MEDLINE database was performed from 2008–2020, using relevant Medical Subject Headings. Articles were evaluated for study design, cohort size and follow-up time and excluded if they contained significant methodological flaws. A total of 43 articles were included: 20 (47%) were cross-sectional and 23 (53%) were longitudinal. The mean number of donors per study was 142 (range:8–578) with follow-up ranging from 12–132 months. Forty-two unique HRQOL metrics were implemented across the 43 studies, the majority of which were questionnaires. Of the 31 studies that used the Medical Outcomes Study Short Form 36 questionnaire, 9.1% of donors reported physical QOL did not return to pre-LDLT levels for at least 2 years after donation. Mental QOL remained stable or improved after LDLT, with mean mental composite scores increasing from 50 to 52 at 3 months post-LDLT in one study. The predicted probability of poor sexual desire decreased at 1-year post-LDLT (male: 0.08, female: 0.26) relative to pre-LDLT (male: 0.44, female: 0.76; P<0.001) and three months post-LDLT (male: 0.35, female 0.69; P=0.001). Forty percent of donors found LDLT to be financially burdensome at 3 months and 19% at 2 years post-LDLT. Female gender and obesity were consistent predictors of worse HRQOL. Laparoscopy-assisted donor hepatectomy was associated with shorter hospitalizations than open donor hepatectomy (10.3 vs. 18.3 days, P=0.02). No studies used the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) measures of HRQOL. Our review demonstrates that LDLT can have a long-lasting negative impact on physical QOL in 9.1% of donors and can cause both sexual dysfunction and significant financial strain. Future studies should consider using standardized and extensively validated patient reported outcomes measures, such as PROMIS, in order to directly compare outcomes across studies and gain further insight into the impact of LDLT on D-HRQOL.

219. Assessing PHQ-9 vs SF-12 mental composite score as predictors of postoperative outcomes

<h3>BACKGROUND CONTEXT</h3> A number of previous studies have demonstrated the significance of preoperative mental health scores, such as the Patient-Health Questionnaire-9 and the 12-Item Short Form Mental Composite Score (SF-12 MCS), as predictors of postoperative patient-reported outcome measures (PROMs) for physical health. However, these measures have not yet been compared as predictors of physical health outcomes following spine surgery. <h3>PURPOSE</h3> To assess the predictive value of PHQ-9 and SF-12 MCS in patients undergoing minimally invasive lumbar decompression (MIS LD). <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> This study included 416 patients undergoing primary, elective, single- or multilevel MIS LD procedures for degenerative spinal pathology. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, Patient Health Questionnaire-9 (PHQ-9), Short Form 12 Mental Composite Score (SF-12 MCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Composite Score (PCS), visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI). <h3>METHODS</h3> A prospectively maintained surgical database was retrospectively reviewed for patients who underwent primary, elective, single- or multilevel MIS LD procedures for degenerative spinal pathology. Patient demographics, baseline characteristics, pre-existing spinal pathology, and perioperative outcomes were collected. PROMs including PHQ-9, SF-12 MCS, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Composite Score (PCS), Visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were administered preoperatively and at postoperative timepoints. Descriptive statistics were performed for baseline and perioperative variables. Paired Student's t-test was used to assess postoperative improvement in PROM scores from preoperative baseline. PHQ-9 and SF-12 MCS were assessed as predictors of postoperative scores in other PROMs using linear regression analysis at each timepoint. Post-hoc estimations were performed using standardized beta coefficients to compare PHQ-9 and SF-12 MCS as predictors of postoperative PROM scores. <h3>RESULTS</h3> A total of 416 MIS LD patients were included with a mean age of 45.7. A majority were male (69.0%), and non-obese (58.2%). Mean preoperative PHQ-9 and SF-12 MCS scores were 5.8 ± 5.5 and 48.8 ± 11.8, respectively. PROMIS PF, SF-12 PCS, VAS back, VAS leg, and ODI demonstrated significant improvements from preoperative baseline at all postoperative timepoints (all p<0.001). PHQ-9 was a significant predictor of PROMIS PF and SF-12 at preoperative, 6-week, 12-week, and 2-year timepoints (all p≤0.045), VAS back at all timepoints except 1-year (all p≤0.047), VAS leg at preoperative, 6-week, 12-week, and 1-year timepoints (all p≤0.021), and ODI from preoperative through 1-year timepoints (all p≤0.005). SF-12 MCS was a significant predictor of PROMIS PF at preoperative, 6-week, 12-week, and 2-year timepoints (all p≤0.016), SF-12 PCS at 6-week, 12-week, and 2-year timepoints (all p≤0.022), VAS back at preoperative, 12-week, and 6-month timepoints (all p≤0.017), and VAS leg and ODI at all timepoints except 2-years (all p≤0.025). Significant differences in effect size as predictor variables were demonstrated between PHQ-9 and SF-12 MCS at all timepoints except 6-months and 1-year for PROMIS PF and SF-12 PCS (all p≤0.027), 1-year for VAS back (all p≤0.015), and 2-years for VAS leg (all p≤0.014). <h3>CONCLUSIONS</h3> Both PHQ-9 and SF-12 MCS were demonstrated as significant predictors of physical function, pain, and disability PROMs at most timepoints. However, significant differences in the effect sizes of these predictive models were demonstrated. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

44. Does robotic vs freehand screw placement affect patient reported outcomes in 1-3 level lumbar fusion?

<h3>BACKGROUND CONTEXT</h3> Studies have shown robotically-assisted surgery demonstrates increased pedicle screw accuracy when compared to conventional freehand surgery. However, little research has been done to determine if this increased accuracy translates to improved clinical outcomes. <h3>PURPOSE</h3> The purpose of this study is to compare patient reported outcome measures (PROMs) for patients undergoing one to three level lumbar fusion using robotically-assisted vs freehand screw placement. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Patients who underwent either robotically-assisted or freehand lumbar fusion surgery of one to three levels from January 1, 2014 to August 31, 2020. <h3>OUTCOME MEASURES</h3> Oswestry Disability Index (ODI), Form-12 Physical (PCS-12) and Mental (MCS-12) Composite scores, visual analogue scale (VAS) back and leg scores, incidence of revisions and surgical complications. <h3>METHODS</h3> Clinical and surgical outcomes were compared between groups. Recovery ratios (RR) and the number of patients achieving the minimally clinically important difference (MCID) were calculated for ODI, PCS-12, MCS-12, VAS Back and VAS Leg at 1-year postoperative. Surgical outcomes included complication and revision rates. Multivariate linear regression analysis was performed to determine the effect of surgery type (robotically assisted or freehand) on PROMs, controlling for age, gender, BMI and number of levels fused. <h3>RESULTS</h3> A total of 262 patients were included in the study, 85 robotically-assisted and 177 freehand. No significant differences were found in ∆PROM scores, RR, or MCID between patients who underwent robotically-assisted vs freehand screw placement. The rates of revisions (1.70% in freehand group vs 1.18% in robotic group, p = 1.000) and complications (1.10% in freehand vs 1.18% in robotic group, p=1.000) between the two groups were not statistically significant. Controlling for demographic factors, procedure type (robot vs freehand) did not emerge as a significant predictor of ∆PROM scores on multivariate linear regression analysis. <h3>CONCLUSIONS</h3> Robotically-assisted screw placement did not result in significantly improved clinical or surgical outcomes compared to conventional freehand screw placement. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Musculoskeletal Injury History Is Associated With Lower Physical and Mental Health in a Historical Cohort of Former National Football League Players.

Little research has examined health-related quality of life in former National Football League (NFL) players. Examine the association of musculoskeletal injury history and current self-reported physical and mental health in former NFL players. Cross-sectional questionnaire. Historical cohort of 2,103 former NFL players that played at least one season between 1940 and 2001. Players were grouped by self-reported professional career musculoskeletal injury history and whether injuries affected current health: (1) no musculoskeletal injury history; (2) musculoskeletal injury history, currently affected by injuries; and (3) musculoskeletal injury history, not currently affected by injuries. The Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being (SF-36) yielded physical and mental health composite scores (PCS and MCS, respectively); higher scores indicated better health. Multivariable linear regression computed mean differences (MD) among injury groups. Covariates included demographics, playing history characteristics, surgical intervention for musculoskeletal injuries, and whether injury resulted in premature end to career. MD with 95% CI excluding 0.00 were deemed significant. Overall, 90.3% reported at least one musculoskeletal injury during their professional football careers, of which 74.8% reported being affected by their injuries at time of survey completion. Adjusting for covariates, mean PCS in the "injury and affected" group was lower than the "no injury" (MD = -3.2; 95% CI: -4.8, -1.7) and "injury and not affected" groups (MD = -4.3; 95% CI: -5.4, -3.3); mean MCS did not differ. Many players reported musculoskeletal injuries, highlighting the need for developing and evaluating injury management interventions.

Patient Health Questionnaire-9 Is a Valid Assessment for Depression in Minimally Invasive Lumbar Discectomy.

ObjectiveThe Patient Health Questionnaire-9 (PHQ-9) is a screening tool for evaluating depressive symptoms. Research is scarce regarding the validity and correlation of PHQ-9 scores with other patient-reported outcomes of mental health after minimally invasive lumbar discectomy (MIS LD). We aim to validate PHQ-9 as a metric for assessing mental health in MIS LD patients. MethodsA database was retrospectively reviewed for patients who underwent elective, single-level MIS LD. Patients were excluded if they had incomplete preoperative PHQ-9, 12-item Short Form Health Survey (SF-12), or Veterans RAND 12-item health survey (VR-12). Survey scores were collected preoperatively and postoperatively through 1 year. Mean scores were used to calculate postoperative improvement from preoperative scores. Correlation of PHQ-9 with SF-12 mental composite score (MCS) and VR-12 MCS scores was also calculated. Correlation strength was assessed by the following categories: 0.1 ≤ |r| < 0.3 = low; 0.3 ≤ |r| < 0.5 = moderate; |r| ≥ 0.5 = strong. ResultsA total of 239 patients underwent single-level MIS LD. PHQ-9, VR-12 MCS, and SF-12 MCS all demonstrated statistically significant increases from preoperative scores at all postoperative timepoints (p ≤ 0.001). SF-12 MCS and VR-12 MCS were each observed to have strong and significant correlations with PHQ-9 at all timepoints when evaluated with both Pearson correlation coefficients and partial correlation coefficients. ConclusionWe observed that PHQ-9, SF-12 MCS and VR-12 MCS all significantly improve following lumbar discectomy and that PHQ-9 scores strongly correlated with these previously established measures. Our results substantiate evidence from other surgical fields that PHQ-9 scores are a valid tool to evaluate pre- and postsurgical depressive symptoms.

Preoperative Neck Disability Severity Limits Extent of Postoperative Improvement Following Cervical Spine Procedures.

ObjectiveOur study aims to evaluate the impact of severity of preoperative Neck Disability Index (NDI) on postoperative patient-reported outcome measures (PROMs). MethodsA retrospective review of primary, elective, single or multilevel anterior cervical discectomy and fusion or cervical disc arthroplasty procedures between 2013 and 2019 was performed. Visual analogue scale (VAS) neck and arm, NDI, 12-item Short Form physical and mental composite score (SF-12 PCS and MCS), Patient-Reported Outcome Measurement Information System physical function, and 9-item Patient Health Questionnaire (PHQ-9) were collected preoperatively and postoperatively. Patients were categorized by preoperative NDI: none-to-mild disability (< 30); moderate disability (≥ 30 to < 50); severe disability (≥ 50 to < 70); complete disability (≥ 70). The impact of preoperative NDI on PROM scores and minimum clinically important difference (MCID) achievement rates were evaluated. ResultsThe cohort included 74 patients with none-to-mild disability, 95 moderate, 76 severe, and 17 with complete disability. Patients with greater preoperative disability demonstrated significantly different scores for NDI, VAS neck, SF-12 MCS, and PHQ-9 at all timepoints (p < 0.001). Patients with more severe disability demonstrated different magnitudes of improvement for NDI (all p < 0.001), VAS neck (p ≤ 0.009), VAS arm (p = 0.025), and PHQ-9 (p ≤ 0.011). The effect of preoperative severity on MCID achievement was demonstrated for NDI and for PHQ-9 (p ≤ 0.007). ConclusionPatients with severe neck disability demonstrated differences in pain, disability, physical and mental health. MCID achievement also differed by preoperative symptoms severity. Patients with more severe neck disability may be limited to the degree of improvement in quality of life but perceive them as significant changes.

Plasma neurofilament light chain is associated with cognitive decline in non-dementia older adults

Neurofilament light chain (NfL) has been associated with cognitive status in multiple neurodegenerative conditions. Studies about plasma NfL and cognitive decline in older adults are still limited. 504 older adults (median age 75 years) who expressed memory complaints were selected from the Multidomain Alzheimer’s Preventive Trial (MAPT) and were classified as normal cognition (NC) or mild cognitive impairment (MCI). Cognitive functions were measured as mini mental state examination (MMSE) and composite cognitive score (CCS) over a 4-year period. Plasma NfL was measured at the first or the second year of the MAPT. Mixed-effects linear models were performed to evaluate cross-sectional and longitudinal associations. In the whole population, higher plasma NfL was cross-sectionally associated with lower cognitive functions (MMSE: β = − 0.007, 95% CI [− 0.013, − 0.001]; CCS: β = − 0.003, 95% CI [− 0.006, − 0.001]). In adults with MCI, but not NC, higher plasma NfL was associated with lower CCS at the cross-sectional level (β = − 0.003, 95% CI [− 0.005, − 0.0002]). The upper quartile NfL group further demonstrated more over time decline in CCS (β = − 0.07, 95% CI [− 0.12, − 0.01]) under the MCI status. Plasma NfL can be a promising biomarker of progressive cognition decline in older adults with MCI.

Clinical and psychobehavioral features of outpatients with somatic symptom disorder in otorhinolaryngology clinics

ObjectiveIn the Otorhinolaryngology Department, patients exhibiting somatic symptoms without a medical cause are frequently neglected and left untreated. The aim of this study was to characterize the psychosomatic features of outpatients with somatic symptom disorder (SSD) to better identify patients needing treatment. MethodsThis cross-sectional study enrolled 883 consecutive patients with medically unexplained symptoms. A semistructured clinical interview was employed to confirm the diagnosis of SSD. Data, including sociodemographic and clinical measures, were collected. The Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Scale-China (SSS-CN) were used to assess the severity of somatic symptoms; the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression; the General Anxiety Disorder-7 (GAD-7) was used to assess anxiety; and the 12-item Short-form Health Survey (SF-12) was used to assess quality of life (QoL). ResultsBased on the DSM-5 criteria, 641 patients were placed in the SSD group, and 212 were placed in the normal group. Compared with the normal group, the SSD group had significantly more doctor visits, longer symptom durations, higher GAD-7 and PHQ-9 scores, and lower physical composite scores (PCSs) and mental composite scores (MCSs). Spearman's correlation analysis and multiple linear regression analyses showed that the SSS-CN score, PHQ-15 score and the patient's subjective feeling that his or her daily life was affected by the disorder were significant risk factors for low PCSs; the SSS-CN, PHQ-15, PHQ-9, and GAD-7 scores were independent risk factors for low MCSs. ConclusionOur findings demonstrated that SSD patients are not rare in otorhinolaryngology clinics in China and that their QoL is significantly affected by SSD. Otolaryngologists should thoroughly evaluate these patients from the perspective of psychosomatic medicine.

Physical and Psychological Recovery Following Toxic Epidermal Necrolysis: A Patient Survey.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening diseases that cause sloughing of the skin and mucous membranes. Despite improved survival rates, few studies focus on long-term outcomes. We conducted a single-center review of all patients with SJS/TEN admitted from January 2008 to 2014. SJS/TEN survivors were invited to participate in the validated Veterans RAND 12-Item Health Survey (VR-12) to assess health-related quality of life using a mental health composite score and physical health component score (PCS). The sample was compared to U.S. norms using one-sample two-tailed t tests. A second questionnaire addressed potential long-term medical complications related to SJS/TEN. Of 81 treated subjects, 24 (30%) long-term survivors responded. Participants identified cutaneous sequelae most frequently (79%), followed by nail problems (70%), oral (62%), and ocular (58%) sequalae. Thirty-eight percent rated their quality of life to be "unchanged" to "much better" since their episode of SJS/TEN. The average PCS was lower than U.S. population norms (mean: 36 vs 50, P = .006), indicating persistent physical sequelae from SJS/TEN. These results suggest that SJS/TEN survivors continue to suffer from long-term complications that impair their quality of life and warrant ongoing follow-up by a multidisciplinary care team.

Mental and Physical Health of Students Who Study in Post-conflict North Kosovo

Objective – To examine health-related quality of life (HRQoL) among Serbian students who study in the northern Kosovo prov­ince and to explore potential differences in HRQoL relative to students’ region of origin. Materials and Methods – This study was conducted from April to June 2015. A total of 514 students from the University of Priština temporarily settled in Kosovska Mitrovica were enrolled in the study. The students completed the socio-demographic and lifestyle questionnaire, Beck Depres­sion Inventory (BDI) and the generic HRQoL questionnaire Short Form-36 (SF-36). The region of origin was classified based on the area in which the students were originally from: Republic of Serbia vs. North Kosovo vs. Southern enclaves. Results – The highest scores were observed for Physical Functioning and the lowest for Vitality. No difference in HRQoL was observed between students from the Republic of Serbia, North Kosovo and Southern enclaves. Compared to females, males scored better on Bodily Pain, General Health, Social Functioning and Mental Health. They also had better Physical and Mental Composite scores and Total HRQoL than females. Worse depressive symptoms were consistently associated with poorer HRQoL across all three groups of students. Conclusion – The HRQoL among Serbian students in the northern Kosovo province does not differ based on their region of origin. Health care services for university students should prioritize prevention, early recognition and treatment of de­pressive symptoms.