Nottingham Health Profile Research Articles

Outcome of the modified Dunn procedure in severe chronic or acute on chronic slipped capital femoral epiphysis

BackgroundIn recent years, the modified Dunn osteotomy has gained popularity to treat slipped capital femoral epiphysis (SCFE) with various complication rates. Most studies included patients with different severities. This study aimed to determine (1) the radiological and clinical outcome, (2) the health-related quality of life, and (3) the incidence of avascular necrosis of the femoral head (AVN) in patients with severe chronic or acute on chronic SCFE treated by the modified Dunn procedure.MethodsOut of 150 patients with SCFE treated at our institution between 2001 and 2014, 15 patients (mean age 12.9 years (range 11.8–15)) were treated by the modified Dunn procedure. Eight SCFE were chronic and 7 acute on chronic. All slips were severe with a mean Southwick slip angle (SSA) of 67° (range 60–80). Radiographic and clinical outcomes were measured. Mean time of follow-up was 3.8 years (range 1–10).ResultsAnatomical reduction was achieved in all cases. Good radiological results according to the Stulberg Classification (grade 1 + 2) and the Sphericity Deviation Score (< 30) were found in 9 out of 13 patients at the last follow-up. Clinical and functional outcome analysis revealed good results in 8 out of 10 patients (Harris Hip Score > 80). The quality of life measured by the Nottingham Health Profile (NHP) was described good in 10 out of 10 patients. Four out of 15 patients developed an AVN.ConclusionsThe modified Dunn procedure has a great potential to restore proximal femur geometry in severe chronic or acute on chronic SCFE. It should be considered only if there is no other possibility to restore proximal femur geometry, as is the case in severe slips, due to the risk of AVN.

PRS60 IMPACT OF SLEEP DISTURBANCE ON HEALTH-RELATED QUALITY OF LIFE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): WHAT DO WE KNOW SO FAR?

Extrapulmonary impacts of chronic obstructive pulmonary disease (COPD) often include sleep disturbance, poor sleep quality, and daytime sleepiness resulting in detrimental impact on patients' overall health-related quality of life (HRQoL). This study evaluated the impact of sleep disturbance on HRQoL in patients with COPD. Literature searches were performed in biomedical databases until March 2019. Specific search terms identified observational studies assessing HRQoL in COPD that included sleep as a patient-reported outcome (PRO) endpoint. Only full text articles published in English were included. Out of total 1247 abstracts identified for initial screening, 177 were selected for full text review. Based on the inclusion criteria, PRO-related information from 36 studies are analyzed. Sleep disturbances and poor sleep quality was on average prevalent in more than one-third, ranging from 27%-100% of COPD patients. Sleep measures such as the Pittsburgh Sleep Quality Index (PSQI), PROMIS-sleep disturbance domain, Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and COPD and Asthma Sleep Impact Scale (CASIS) showed significant correlations (all p<0.05) with HRQoL [determined by COPD Assessment Test (CAT), 36-Item Short Form Health Survey (SF-36), the Nottingham Health Profile (NHP) and the St George's Respiratory Questionnaire (SGRQ)]. Univariate and multivariate analyses showed that sleep quality (evaluated by PSQI) is an important determinant for HRQoL in COPD. Furthermore, HRQoL is an important predictor of sleep quality, thereby establishing bidirectional relationship. “Good sleepers” (PSQI<5) have better HRQoL compared to “poor sleepers” (PSQI≥5). Increased sleep disturbance is associated with emotional impact. Both significant (all p<0.05) and non-significant (all p>0.05) results were seen for associations of sleep with disease severity. Overall, there is a bidirectional relationship of sleep quality and HRQoL in COPD. Sleep quality is an independent significant predictor of HRQoL in COPD. Hence, sleep should be considered an important HRQoL component when evaluating the health status of COPD patients.

The Relationship Between Caregiver Burden and Resilience and Quality of Life in a Turkish Pediatric Rehabilitation Facility

PurposeTo investigate the effect of caregiver burden, resilience, and quality of life of the parents of patients who are followed-up in a tertiary pediatric rehabilitation clinic. Design and methodsThis is a correlational cross-sectional study. Parents of patients who attend to utilize pediatric rehabilitation outpatient clinics of a tertiary center on a regular basis were invited to participate. All participants filled in the Zarit Caregiver Burden (ZCB) scale, Family Resilience scale (FRS) and Nottingham Health Profile (NHP). ResultsA total of 107 patient and caregiver dyads were included. Fifty-five (51%) patients had cerebral palsy, 10 (9%) had spina bifida and 42 (39%) had other neurodevelopmental disorders. Eighty-one (75%) of the caregivers were mothers. There was a significant difference in the caregiver burden between ambulatory children (Mean ZCB score 30.11 ± 13.56) and non-ambulatory patients (Mean ZCB score 37.22 ± 13.91) (p = .01). There were moderate negative correlations between caregiver burden and FRS commitment to life and FRS self-sufficiency subscales. Caregiver burden significantly positively correlated with all NHP domains. ConclusionsCaregiver burden is significantly higher in parents of non-ambulatory children when compared to ambulatory children in the pediatric rehabilitation setting. Caregiver burden and resilience correlated on moderate levels, but the factors influencing them are still unclear. Practice implicationsHealthcare and social support should be given to all caregivers in pediatric rehabilitation setting, but more so to the caregivers of non-ambulatory patients.

Kinesiophobia and related factors in systemic lupus erythematosus patients

Background/aimThis study was designed to investigate the relationship between kinesiophobia and the level of physical activity, depression, disease activity, fatigue, pain, and quality of life in female patients with systemic lupus erythematosus (SLE).Materials and methodsSeventy volunteer female patients were included in the study. Kinesiophobia, physical activity level, disease activity, fatigue, depression, pain, and quality of life were assessed using the Tampa Scale for Kinesiophobia (TSK), International Physical Activity Questionnaire- Short Form (IPAQ), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), McGill Pain Questionnaire- Short Form (MPQ-SF) and Nottingham Health Profile (NHP), respectively.ResultsTwo-thirds of the patients in the study had a high degree of kinesiophobia. Although there was a significant correlation between kinesiophobia and depression and some subscales of quality of life (sleep, social isolation, emotional reactions) (P < 0.05), no significant correlation with other parameters was found.ConclusionAs a result of this study, the majority of SLE patients included in the study were identified as having high levels of kinesiophobia. Patients’ fear and avoidance reaction from movement can be influenced by psychosocial factors. Treatments focusing on kinesiophobia of SLE patients could be beneficial in increasing the success of rehabilitation.

The effect of vitamin D replacement on spinal inhibitory pathways in women with chronic widespread pain

Vitamin D replacement helps in pain reduction in patients with chronic widespread pain (CWP). But the current literature lack studies that investigate its mechanism. Cutaneous silent period (CSP) is the electrophysiologic analog of the spinal inhibitory pathways and an objective method to document their involvement. This study aims to show if vitamin D replacement has an effect on the spinal inhibitory pathways through CSP parameters. Female patients who have CWP with vitamin D deficiency were included. Patients received an 8-week replacement therapy of vitamin D. Patients’ pain were evaluated using the visual analog scale (VAS) and Leeds assessment of neuropathic symptoms and signs pain scale (LANSS). Quality of life with Nottingham Health Profile (NHP) and CSP parameters were also recorded before and after treatment. A total of 51 patients were included in the final analyses. The mean age of the patients was 44.3 ± 12.7 (minimum 18-maximum 65). Mean symptom duration was 13.1 ± 6.7 (minimum3-maximum 24) months. Patients' mean BMI was 21.6 ± 3.9 (minimum 18.0 maximum 29.1). Patients' median VAS and LANSS scores decreased significantly (p < 0.01) and NHP scores improved significantly in all subsets (p < 0.01). Vitamin D replacement did not significantly change CSP latency and duration (p = 0.06 and p = 0.12).Vitamin D replacement does not seem to work via modifying the spinal inhibitory pathways that are involved in the formation of the cutaneous silent period. This is the first study to objectively investigate the effect of vitamin D replacement on central sensitization mechanisms.

Multivariate Analysis of Risk Factors Predisposing to Kinesiophobia in Persons With Chronic Low Back and Neck Pain

ObjectiveThe purpose of this study was to analyze the interaction between kinesiophobia and pain-related variables classified according to International Classification of Functioning in individuals with chronic neck and low back pain by using multivariate analysis. MethodsThe 504 persons with chronic neck and low back pain filled out questionnaires assessing impairments in body functions and structures, limitations in activities of daily living, participation, and personal factors. Univariate analyzes were performed to investigate whether there are differences between individuals with and without kinesiophobia or not. Binary logistic regression analysis was used to evaluate whether independent variables were statistically significant predictors. ResultsIn the univariate analyses, the persons who had high-level kinesiophobia had a significantly lower level of education and had significantly higher scores for the Million Visual Analogue Scale, Neck Disability Index, Hospital Anxiety and Depression Scale, and Nottingham Health Profile (P < .001). In the final logistic regression analysis, only educational level (P = .01), Million Visual Analogue Scale (P = .002) and Hospital Anxiety and Depression Scale (P = .008, P = .012) were retained significantly as the predictors of kinesiophobia. ConclusionIn this group of people with chronic neck and low back pain, educational level, low back pain-associated disability, and emotional states like depression and anxiety were associated with kinesiophobia.

Outcomes and Quality of Life in Patients with Upper Limbs Amputations in Cotonou National Teaching Hospital- Benin

Background: Upper limbs amputations disturb relational life. Outcomes of upper limb amputees were studied, functional outcomes and quality of life were analyzed. Objectives: The purpose of this study was to examinate the outcomes of an upper limb amputation on a functional, social and economic level, and to investigate the epidemiological and clinical factors that bear the functional outcomes and quality of life of these patients. Methods: an analytical prospective study over seven years which included 37 patients managed at the referral hospital in Benin was performed. They were mean aged of 36.3 years and 22 were in couple. The mean time of follow-up was 3.0 ± 2.1 years. The rate of fitting prosthesis, relateralization, presence of bi-manual activity, Disabilities of the Arm, Shoulder and Hand (DASH) score, handicap imposed by the amputation, and its socio-economic impact were recorded. Quality of life of amputees evaluated using Nottingham Health Profile (NHP) score was also studied. Statistical analysis was performed with Chi2 and Kruskal-Wallis tests. A p-value ≤0.05 was established as statistically significant. Results: No patient had been fitted; one had been able to re- lateralize; 24 patients demonstrated bi-manual activity. The mean DASH score was 40.1 ± 13.7. Thirteen patients were able to dressthemselves and 10 needed an additional help to go to the toilet. Socially, 21 patients had given up their hobbies, and 5/22 were no longer in a couple. Economically, 27 patients had a decreased monthly income. Factors influencing functional outcomes were the level of amputation and gender (p of 0.005 and 0.006, respectively). The mean NHP score was 5.8 ± 0.2. There was a statistically significant relationship between quality of life, age and level of amputation (p of 0.02 and 6x10-4, respectively). Conclusion: Upper limb amputations strongly affect quality of life. A better social reintegration policy for upper limb amputees should be contemplated in Benin.

Cultural Adaptation, Reliability and Validity of The Pelvic Girdle Questionnaire in Pregnant

Objectives: The aims of this study were to translate the Pelvic Girdle Questionnaire(PGQ) to Turkish and to assess its test-retest reliability and validity in pregnant women. Materials and Methods: One hundred and thirty-five pregnant with pelvic girdle pain were recruited in the study. Visual analog scale was used to evaluate pain intensity, PGQ for condition-specific health related quality of life, Nottingham Health Profile for health related quality of life, Oswestry Disability Index for disability level, The guidelines for cross-cultural adaptation in PGQ was used. Results: A total of 135 pregnant with a mean age of the 30±4.77 years included in the study. Interclass correlation coefficient score for test-retest reliability was 0.972 (95% CI= 0.968-0.977) for PGQ activity subscale, 0.910 (95% CI=0.905-0.915) for PGQ symptom subscale and 0.979 (95% CI= 0.975-0.983) for PGQ total. Conclusion: The study demonstrated that Turkish version of PGQ is a valid and reliable tool for measuring both disability and symptom and good psychometric properties in Turkish speaking pregnants with pelvic girdle pain.

The Effect of Chest Physiotherapy After Bariatric Surgery on Pulmonary Functions, Functional Capacity, and Quality of Life.

The aim of this study was to investigate the effect of chest physiotherapy (CP) applied to patients undergoing bariatric surgery on pulmonary functions, dyspnea levels, functional capacity, and quality of life. The patients were randomized and divided into two groups each comprising 74 patients. CP and mobilization was applied to the patients in the first group, and only mobilization was applied to the patients in the second group. The treatment of the patients was started on the first postoperative day and continued until the postoperative 4th day. CP and mobilization were applied twice a day, 8 times in total. The following parameters were evaluated: arterial blood gas, oxygen saturation, respiratory function test for pulmonary functions, pulmonary artery pressure for pulmonary hypertension, Borg dyspnea score for severity of dyspnea, 6-min walk test(6MWT) for functional capacity, Nottingham Health Profile for quality of life. The mean age of the patients was 38.00 ± 7.04years. Compared with pretreatment and posttreatment dyspnea score, 6MWT, oxygen saturation, vital capacity, tidal volume, PEF, pulmonary arterial pressure, and quality of life were significantly higher in patients who underwent CP compared with the control group(p=0.008, 0.004, 0.005, 0.027, 0.029, 0.028, 0.007, 0.012).There was a significant improvement in all the parameters of the patients who underwent chest physiotherapy when compared with the intragroup comparisons, whereas in the control group, only 6MWT and quality of life score showed a significant improvement in the border (p=0.037, 0.046). Postoperative CP applied to patients who had bariatric surgery showed that the patients improved their respiratory functions, regulated arterial blood gases, increased oxygen saturation, functional capacity and quality of life, and decreased dyspnea levels.

Effects of different percentages of body weight-supported treadmill training in Parkinson’s disease: a double-blind randomized controlled trial

Background/aimBody weight-supported treadmill training (BWSTT) might have greater effects than conventional treadmill training (TT) in neurological diseases such as Parkinson's disease (PD). The aim of this study was to evaluate the effects of different percentages of BWSTT on gait, balance, quality of life, and fatigue in PD.Materials and methodsThirty-five patients with moderate to advanced PD were randomized into three BWSTT groups according to the supported percentage of body weight: 0% BWSTT (control group; unsupported TT), 10% BWSTT, or 20% BWSTT. Five patients were excluded due to early discharge and 30 patients completed BWSTT sessions lasting 30 min, 5 days a week, for 6 weeks during their inpatient rehabilitation stay. The primary outcome was 6-min walk distance (6MWD). Secondary outcomes were Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Nottingham Health Profile (NHP), Fatigue Impact Scale, and Fatigue Severity Scale scores. Measurements were performed before and after the training. ResultsThe unsupported TT group demonstrated no significant improvement in the outcome measures after a 6-week training except for BBS and NHP emotional subscores. Moreover, the NHP pain subscore increased in the unsupported TT group after training. The 10% and 20% supported BWSTT groups demonstrated significant improvements in 6MWD (P = 0.004 and P < 0.001, respectively), UPDRS - motor score (P = 0.012 and P = 0.005, respectively), NHP pain subscore (P = 0.003 and P = 0.002, respectively), and fatigue (P = 0.005 for both) after training. The 20% BWSTT provided the highest improvement in balance among the three groups (P < 0.001) and greater relief of fatigue than 10% BWSTT (P = 0.002).ConclusionSix weeks of BWSTT improved walking distance and balance ability, relieved fatigue, and additionally reduced pain in patients with moderate to advanced PD.

Efficiency of pulsed electromagnetic fields on pain, disability, anxiety, depression, and quality of life in patients with cervical disc herniation: a randomized controlled study

Background/aimIn this study, it was aimed to investigate the effects ofpulsed electromagnetic field(PEMF) therapy on pain, disability, psychological state, and quality of life in cervical disc herniation.Materials and methods Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0–10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment.Results A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment. Conclusion PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.

Fibromyalgia in the Patients With Allergic Rhinitis: Its Prevalence and Impact on the Quality of Life

Background Allergic rhinitis (AR) is a common allergic diseases which affect a patient’s quality of life. Another important disease which has a negative impact on quality of life is fibromyalgia (FM). Some studies have suggested that a probable relationship exists between atopic diseases and FM. Objectives This study was designed to determine the prevalence of FM and its impact on quality of life among AR patients. Methods One hundred five consecutive adult patients with AR who were between 18 and 57 years old were prospectively recruited in this study between April 2017 and May 2018. All patients were evaluated for the presences of FM. Patients were diagnosed with FM according to the classification criteria of the 2010 American College of Rheumatology. The patients’ quality of life was evaluated by Turkish versions of the Rhinoconjunctivitis Quality of Life Questionnaire and the Nottingham Health Profile (NHP). Results Thirty-four patients were diagnosed as having FM (32.4%). The percentage of FM was considerably higher than in the general population (2%–5%). Median individual domain scores except practical problems ( P = .108) and eyes symptoms ( P = .227) were significantly higher in AR with FM patients ( P &lt; .001). All median levels of the NHP domains were significantly higher in AR with FM patients ( P &lt; .001). Conclusion We would like to suggest that FM may be considered as one of the overlooked comorbid conditions in AR patients. Physicians should be aware of the occurrence of FM, especially in patients with impaired quality of life.

Effectiveness of balance training with kinesthetic ability trainer (KAT 2000) in patients with peripheral neuropathic pain: a randomised controlled study

Objectives: The aim of this study isto determine the effectiveness of balance training with Kinesthetic Ability Trainer (KAT 2000) in patients with peripheral neuropathic pain related balance disorder. Methods: Sixty patients were included into this controlled prospective study and randomized into either balance exercises group (Group 1) or KAT 2000 exercises group (Group 2). Balance exercises were given to all patients. Also, KAT 2000 balance exercises were given all patients in Group 2 (n = 30). All patients received 45-min individualized training session for three times a week for 4 weeks. Douleur Neuropathique 4 (DN4) questionnaire for neuropathic pain; visual analogue scale (VAS) for pain severity; KAT 2000 for static and dynamic balance; Nottingham Health Profile (NHP) for Quality of Life (QoL) was used. Dynamic balance and mobility also was assessed using the Berg Balance Scale (BBS) and Time Up and Go (TUG) test. Patients were evaluated at baseline and the end of the 4-week exercise program. Results: At the end of the treatment; VAS, BBS, KAT 2000, TUG, NHP, physical activity, NHP pain, NHP social isolation and NHP emotional reactions scores improved significantly in both groups (p &amp;lt; 0.05) except NHP sleep and NHP energy level scores in balance exercises group (p &amp;gt; 0.05). Statistical differences in VAS pain on movement, global assessment of patient, global assessment of doctor, NHP energy level scores were found between the groups (p &amp;lt; 0.05); but there were no statistical difference in VAS at rest, VAS at night, BBS, KAT 2000, TUG, NHP physical activity, NHP pain, NHP sleep, NHP social isolation and NHP emotional reactions scores between the groups (p &amp;gt; 0.05). Conclusion: When combined with the KAT 2000 device, positive effects of balance-coordination exercises on pain on movement and energy level are more evident in patients with peripheral neuropathic pain.

The Effect of Bolus Vitamin D Supplementation

Objectives : Vitamin D plays an important role in musculoskeletal and nervous system health. Although, the prevalence of vitamin D deficiency is fairly high and it may lead to bone abnormalities and muscle weakness, it is a preventable condition. The aim of this prospective study was to assess the effects of vitamin D supplementation on balance, mobility, grip strength, fatigue, depression and quality of life. Materials and Methods : Between October 1, 2015 and December 31, 2015, a total of 92 patients with vitamin D insufficiency/deficiency were included in the study. Demographic characteristics of age, gender, height, weight, serum 25-hydroxyvitamin [25-(OH)D], parathyroid hormone, alkaline phosphatase (ALP), calcium, and phosphorus levels were recorded. The primary outcome was assessed the [25-(OH) D] levels at 1 month and 3 month post-treatment. The secondary outcomes were the efficacy of vitamin D administration on fatigue, mobility, balance, depression, quality of life (QoL), muscle strength using The Multidimensional Assessment of Fatigue Scale (MAF), Timed Up and Go Test (TUG), Single leg stance test (SLS), Beck Depression Inventory (BDI), The Nottingham Health Profile(NHP), hand dynamometer, respectively at all visits. Results : After the 1 month, the vitamin D supplementation had significantly improved muscle strength, balance ability, mobility, QoL, depression, and fatigue symptoms. The levels of [25-(OH) D] significant decreased after 3 months. Conclusion : Supplemental vitamin D consistently demonstrated beneficial effects on muscle strength, mobility, balance control, depression, fatigue and QoL. The 300,000 bolus of vitamin D was well-tolerated and safe in adult population. We would recommend evaluating vitamin D status once in three months.

Long term follow-up of quality of life and functional ability in patients with ICU acquired Weakness – A post hoc analysis

PurposeICU acquired Weakness (ICUaW) is a common complication of critical illness. The aim of our study was the assessment of quality of life (QoL) and functional ability of patients with ICUaW, 6 months post hospital discharge. Material and methodsEight hundred seventy eight consecutive patients who had been discharged from the ICU were evaluated and 128 of them, 36 with ICUaW, were eligible for the study. Muscle strength was evaluated with MRC and Hand grip dynamometry. The Functional Independence Measure (FIM) was used to evaluate the functional ability while QoL was assessed with the Nottingham Health Profile and with the SF-36 questionnaire. ResultsPatients with ICUaW continued to have low MRC at hospital discharge, [53(49–56) vs. 59(58–60), p < 0.05]. Patients who developed ICUaW had lower Hand grip dynamometry at ICU, hospital discharge and 6 months after (p < 0.05). Patients with ICUaW have significantly lower FIM score at hospital discharge, 3 and 6 months post hospital discharge (p < 0.05) and persistently lower QoL at 3 and 6 months post hospital discharge(p < 0.05). ConclusionsICUaW is associated with persistent deficiencies in functional ability and Qol leading to a prolonged period of recovery. Further research is needed in the field of prevention and targeted rehabilitation of functionality in this patient group.

Screening preoperative anxiety – when does it relate to the quality of life among patients before total joint replacement? Preliminary reports

BackgroundAnxiety among patients undergoing joint replacement increases the risk of post-surgery complications and mental health problems, and impairs health-related quality of life (HRQoL). Since clinical procedures require adequate, but possibly simple and cost-saving tools, an augmenting application of a one-item visual analogue scale for anxiety (VAS-A) has been observed. The purpose of the present study is to validate the VAS-A using the State-Trait Anxiety Inventory (STAI) and consider both as HRQoL predictors among patients waiting for total joint replacement.Participants and procedurePatients (n = 68, 34% male), hospitalized for total hip or knee replacement, participated before surgery in this cross-sectional study. They completed the Nottingham Health Profile (NHP) to assess their HRQoL, the VAS-A and STAI for anxiety, and the Visual Analogue Scale for pain as a control variable.ResultsAlthough the VAS-A correlated with the STAI score (r = .29, p = .019 for the state anxiety subscale), this conven-ient measure did not relate to the NHP results (NHP total score β = –0.03, p = .799), while the STAI results did, especially the trait subscale (β = 1.29, p &lt; .001, CI 0.82 to 1.75).ConclusionsThe value of the VAS-A regarding HRQoL is limited while trait anxiety seems a disregarded factor significantly referring to HRQoL. Its assessment, in addition to the evaluation of temporary emotional states, might provide benefits in the clinical management of patients within surgery, orthopedic and rehabilitation care. Intervention possibilities for those with altered trait anxiety are discussed.

Health-Related Quality of Life in Turner Syndrome and the Influence of Growth Hormone Therapy: A 20-Year Follow-Up.

ContextThe factors that affect the health-related quality of life (HRQoL) of women with Turner syndrome (TS) are controversial.ObjectiveThe aim was to describe the HRQoL of women with TS with a focus on how given GH treatment and comorbidity influence HRQoL in adulthood and to compare HRQoL of women with TS with that of women in the general population.DesignLongitudinal cohort study, up to 20 years.SettingThe Turner Center at the Section for Endocrinology and Department of Reproductive Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden.ParticipantsWomen with TS (n = 200), age range 16 to 78 years, were included consecutively and monitored every fifth year between 1995 and 2018. Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease project were used as reference populations.Interventions and Main Outcome MeasuresHRQoL was measured using the Psychological General Well-Being index and the Nottingham Health Profile. Associations with somatic variables were assessed using longitudinal linear regression models.ResultsHRQoL was not associated with GH treatment in TS in spite of a mean 5.7 cm taller height. HRQoL was only associated with height per se in one of 13 subscales (P < 0.01). HRQoL was negatively affected by higher age, higher age at diagnosis, and hearing impairment in TS. Women with TS reported a similar HRQoL to the reference population.ConclusionsNo association between previous GH treatment and HRQoL was found during the up to 20 years of follow-up in women with TS. HRQoL of women with TS and the reference population was similar.

Czynniki warunkujące jakość życia po implantacji kardiostymulatora

Introduction. Health-related quality of life (HRQoL) after pacemaker (PM) implantation has been studied according to stimulation mode and indications, however these do not fully explain HRQoL changes. Aim of the study is to evaluate other factors. Materials and methods. Single-center, prospective, observational study on 101 adult PM-recipients, with no periproce- dural complications was performed. The study group was surveyed twice: periprocedural and 18 month follow-up (FU). Nottingham Health Profile to evaluate general HRQoL was performed. 83 participants completed full study protocol. Comparative analysis (periprocedural vs. end-of-FU) was performed to measure relationship between HRQoL-change and gender, place of residence, disability level, physical activity, level of care and support, BMI, diet, percentage of atrial and ventricular pacing (Ap&Vp), symptoms associated with rhythm and conduction disorders, severity of coronary heart disease and heart failure. Results. Total HRQoL improvement occurred for the rural residents, obese and Vp > 79%. The study group improved significantly in two HRQoL domains: emotional reactions (E.R.) and sleep disorders (S.D.). Analyzing specific HRQoL do- mains (energy, pain, E.R.S.D. social alienation, movement limitations) improved patients are: female, self-mobile, high level of care and support, eating habits — changers, without syncope and angina symptoms. Age and body mass index (BMI) were identified as factors changing HRQoL-improving domain. Conclusions. The improvement of HRQoL after PM implantation seems to be mainly related to S.D. and E.R. Important factors influencing HRQoL change are: place of residence, BMI and Vp. This impact of PM implantation on HRQoL re- quires further study

Comparison between different instruments for measuring health-related quality of life in a population sample, the WHO MONICA Project, Gothenburg, Sweden: an observational, cross-sectional study

ObjectiveThe general aim was to meet the need for empirical comparative studies of health-related quality of life (HRQoL) assessment instruments, by evaluating and comparing the psychometric properties and results of...

Effects of activity modification in older population having osteoarthritis of knee: a randomized clinical trial

Purpose: The purpose of this study was to assess whether modification of the activities can decrease symptoms, improve functional ability and the quality of life in older adults with knee osteoarthritis (OA) who are accustomed to a traditional lifestyle which includes postures and activities that increase mechanical stress in the knee joints. Methods: In this prospective randomized clinical trial, total 157 adults (both male and female), age between 60-75 years having mechanical pain in the knee joints, difficulty in some of their activities of daily living (due to dysfunction of knee joint) and mild to moderate degree of radio-graphic changes of knee OA were included. All of the participants were previously continuing a traditional lifestyle which includes frequent squatting, climbing stairs, prolong standing, lifting heavy weights, using low sitting stools etc. for last forty to fifty years. They were randomly divided into two groups. Group 1 (n= 77) was treated with shortwave diathermy and Ibuprofen for initial two weeks and exercise and activity modification was continued throughout the whole period of study. Group 2 (n= 80) was treated with shortwave diathermy and Ibuprofen for initial two weeks and exercise was continued throughout the whole period of study. After initial assessment at entry, condition of the patients were assessed further after 3 weeks and 6 weeks, according to pain, functional capacity, and quality of life parameters. Visual analogue scale (VAS) and Western Ontario McMaster osteoarthritis index (WOMAC) of pain score were used to evaluate pain. While WOMAC physical function index was used to measure the functional capacity. Quality of life was assessed by the Nottingham Health Profile questionnaire (NHPQ). 69 from Group 1 and 67 from Group 2 reported timely in the subsequent visits after 3 and 6 weeks of their entry. In Group 1,all of the participants who reported regularly more or less followed the activity modification instructions. Results: After 3 weeks, there was no statistically significant difference of VAS scores and WOMAC pain and physical functional scores in between two groups.Result of the NHPQ also did not show statistically significant difference between the groups. After 6 weeks, VAS scores and WOMAC pain and physical functional scores were statistically lower in Group 1 than in the Group 2 (P<0.001). Result of the NHPQ also showed a statistically significant improvement in the group 1 when compared to the Group 2 (P<0.05). Conclusions: From the findings of this study we conclude that activity modification play an important role in decreasing pain, improving functional capability and providing better quality of life in older population with knee OA.