Physical Component Score Scores Research Articles

Moving toward better health: exercise practice is associated with improved outcomes after spine surgery in people with degenerative lumbar conditions.

Background:Recovery and rehabilitation following surgery can take many months. Understanding what patients can do to facilitate recovery would be beneficial for spinal surgeons. This study sought to evaluate the impact of exercise practice, before and after surgery, on long-term outcomes of spine surgery in a robust clinical sample.Methods:This prospective longitudinal cohort study included adult patients undergoing spinal surgery for degenerative spinal conditions. Patients were administered a survey that included preoperative and postoperative exercise practices and the following patient-reported outcome measures: the physical component score (PCS) and mental component score (MCS) of the Medical Outcomes Study 36-Item Short Form Survey (Rand-36), the Oswestry Disability Index (ODI) score, the Numeric Rating Scale (NRS) score for pain and the Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference Short Form score. Random effects models investigated the relationship of exercise, follow-up time and their interaction in predicting each patient-reported outcome measure over time, with and without sociodemographic covariates.Results:There were 168 patients in the study sample with up to 12 months of follow-up data. Analysis revealed modest significant main effects of exercise on PCS, MCS, ODI and PROMIS scores and main effects of time on all outcomes. The exercise-by-time interaction was significant in predicting the trajectories of the ODI and MCS scores. When full models were adjusted for education and employment status, interaction effects were no longer significant, but exercise main effects remained significant for ODI score.Conclusion:Patients who engage in exercise before and after spine surgery have better mental health and spine-specific recovery trajectories than those who do not. All health care providers should encourage patients to exercise while they are waiting for surgery within preoperative limitations and as soon as they are able after surgery and to continue this over the long term.

Health-Related Quality of Life and Health Insurance Coverage Among Persons with Hemophilia A Inhibitors

BACKGROUNDOne of the most serious possible complications of hemophilia A is the development of an inhibitor to factor VIII. Approximately 30% of people with severe hemophilia A develop inhibitors. Inhibitors commonly occur during childhood and significantly affect treatment options. Data comparing patients with and without inhibitors on health-related quality of life (HRQoL) and insurance coverage are limited. The 2016 Inhibitor Education Summits held in Pittsburg and Salt Lake City and sponsored by the National Hemophilia Foundation were comprehensive inhibitor patient educational programs. The Hemophilia Utilization Group Studies part Va (HUGS Va) was a two-year observational study of patients with hemophilia A from six federally supported Hemophilia Treatment Centers conducted 2005-2007 located in eight geographically diverse states.OBJECTIVESTo compare HRQoL and health insurance coverage between subjects with an active hemophilia A inhibitor who participated in two Inhibitor Education Summits (inhibitor group) and hemophilia subjects with no inhibitor history in the HUGS Va (non-inhibitor group).METHODSStudy subjects completed a survey that collected data on sociodemographic and clinical characteristics, HRQoL, joint pain and limitation in joint range of motion (JROM), and health insurance coverage. HRQoL was assessed by the 12-Item Short Form Health Survey (SF-12). A logistic regression predicting subjects with an active inhibitor was used to generate propensity scores with age and hemophilia severity as independent variables. Descriptive statistics were calculated to compare the differences between the inhibitor and non-inhibitor groups using the Chi-square tests or T-tests with the propensity score weight for adjusting sample selection bias.RESULTSThere were 22 subjects (47.9% adults) in the inhibitor group and 278 (50.8% adults) in the non-inhibitor group. Inhibitor subjects had higher rate of severe hemophilia than non-inhibitor subjects (77.3% vs. 59.0%, P=0.09). The inhibitor group had significantly different employment status for adult subjects or parents of children from the non-inhibitor group (50.2% vs. 46.2% employed full-time, 12.0% vs. 21.3% worked part-time, and 37.8% vs. 32.4% unemployed, P=0.01). Inhibitor group had a higher rate of prophylactic use (47.9% vs. 32.1%, P<0.01), and reported higher rate of self-infusion or assistance from family members (87.5% vs. 59.5%, P<0.01) than non-inhibitor group. The Mental Component Score (MCS) in SF-12 was significantly lower in inhibitor group vs. non-inhibitor group (mean±SD: 45.0±38.5 vs. 50.7±10.7, P=0.04). The Physical Component Scores (PCS) were not significantly different between the two groups (inhibitor, 44.9±41.0 vs. non-inhibitor, 43.6±11.3, P= 0.64). Inhibitor subjects reported more severe joint pain even without bleeding (73.4% vs. 44.7%, P<0.01), but there was no significant difference in limitation of JROM between the two groups (61.8% vs. 62.3%, P=0.90). Inhibitor subjects were more likely to report no health insurance (8.5% vs. 4.0%), or use public insurance (55.8% vs. 30.0%), or use both public and private insurance (15.9% vs. 6.6%) than non-inhibitor subjects, P<0.0001 on a comparison across all insurance options. As compared to the non-inhibitor subjects, the inhibitor subjects were more likely to report difficulty finding health insurance (47.7% vs. 27.7%, P<0.01), and to make choices to obtain or maintain health insurance due to hemophilia, i.e ., earned less to qualify for Medicaid or other government sponsored insurance (39.6% vs. 11.9%, P<0.01); stayed in less desirable jobs (46.1% vs. 18.7%, P<0.01); spent savings/assets in order to qualify for public insurance (12.8% vs. 3.8%, P<0.01); or changed marital status (11.2% vs. 1.1%, P<0.01).CONCLUSIONSAs compared to the general U.S. population, the subjects with hemophilia A inhibitor showed decreased HRQoL in both PCS and MCS scores, but the subjects without inhibitor showed decreased PCS scores only. The inhibitor subjects also have significant lower MCS score than the non-inhibitor subjects. The inhibitor group reported more severe pain, even without bleeding, and was more likely to self-infuse factor or get assistance from family members for factor infusion. Finding and keeping adequate health insurance can be more challenging for persons with hemophilia, especially those with active inhibitors. DisclosuresNichol:Genentech: Research Funding; Pfizer: Research Funding; Bioverativ: Consultancy, Research Funding; Merck: Consultancy; Bayer: Research Funding; Baxter: Research Funding; Novo Nordisk: Research Funding; CSL Behring: Research Funding. Ning:Genentech: Research Funding. Xu:Genentech: Employment, Other: Roche stocks holder. Curtis:Novo Nordisk: Honoraria, Research Funding; Pfizer: Research Funding; CSL Behring: Research Funding; Bioverativ: Research Funding; Bayer: Research Funding, Speakers Bureau; Genentech: Honoraria, Research Funding; Gilead: Honoraria; Baxter: Research Funding. Lou:Baxter: Research Funding; Bayer: Research Funding; Bioverativ: Research Funding; CSL Behring: Research Funding; Novo Nordisk: Research Funding; Pfizer: Research Funding; Genentech: Research Funding. Riske:Genentech: Research Funding. Wu:CSL Behring: Research Funding; Baxter: Research Funding; Bioverativ: Research Funding; Bayer: Research Funding; Novo Nordisk: Research Funding; Pfizer: Research Funding; Genentech: Research Funding.

Quality of Life of Informal Caregivers of Hematopoietic Cell Transplant Recipients

IntroductionAutologous (auto) and allogeneic (allo) hematopoietic cell transplant (HCT) recipients face a prolonged post-HCT recovery. Given the extent of supportive care needed post-HCT, recipients are required to have an informal caregiver (IC). ICs are typically spouses, siblings, children or parents of recipients. ICs are critical to post-HCT care, providing emotional support, medication management, assistance with activities of daily living and other vital care that spans months to years of recipient recovery. Given the commitment and responsibility that caregiving requires, it follows that ICs may be burdened. To date, small studies have found that HCT ICs may experience significant levels of distress and burden, as well as poor quality of life (QoL) after HCT. Here we report a large cross-sectional evaluation of HCT IC QoL.MethodsFrom July 2015-June 2016, a survey for ICs was included with a yearly QoL survey that is sent to HCT recipients. Recipients were to give the IC survey to the appropriate person. Both recipient and IC surveys included the SF-36 QoL instrument. SF-36 scores were standardized to the general population (mean 50, standard deviation of 10). Multivariate analyses using forward stepwise logistic regression were used to examine determinants of IC QoL. The two summary scores of the SF-36, the physical component score (PCS) and the mental component score (MCS), were used as endpoints. PCS and MCS summary score >45 (representing QoL scores similar to the general population) were used as the endpoints for all analyses.ResultsSurveys were sent to 4446 recipients. In total, 849 recipient/IC pairs responded (19%), 1170 recipients responded without a corresponding IC response (26%), 43 ICs responded without a corresponding recipient response (1%) and 2384 (54%) recipient/IC pairs did not respond. Most ICs were spouses of the recipient, were caregivers during the first 100 days post-HCT, were still living with the recipient and indicated that they were still providing care to the recipient. The median ages of ICs and recipients were 63 and 62 respectively. One third of recipients received auto-HCT. Recipients were a median of 6 years post-HCT.Median IC QoL measures were at or above population norms across the SF-36 domains. IC QoL measures were significantly higher than those of recipients, apart from the mental health subscale and the MCS which were similarly at or above population norms in both groups (table 1). With respect to the PCS and MCS summary scores; 42.7% and 51.2% of ICs, respectively, scored ≥55 while 18.4% and 21.4% respectively scored ≤45. Results of multivariate analysis are reported in table 2. ICs of allo-HCT recipients were more likely to experience poor QoL (OR 0.68, p=0.05) than ICs of auto-HCT recipients.For auto-HCT ICs, relapse was associated with lower PCS and MCS. Female ICs were associated with a lower MCS while greater time post-transplant was associated with a higher MCS. Higher recipient MCS was significantly associated with higher IC MCS. For allo-HCT ICs, age >60 was associated with lower PCS but higher MCS. Higher IC educational attainment was associated with higher PCS. Higher recipient PCS was associated with higher IC PCS & MCS, while higher recipient MCS was associated with higher IC MCS. Finally, current recipient use of immunosuppressive therapy was associated with lower IC MCS. Notably, for both auto and allo-HCT, IC relationship to recipient, HCT characteristics and most recipient characteristics were not significantly associated with IC QoL.ConclusionsWe report the largest analysis of HCT IC QoL to date. Most ICs in this analysis report QoL at or above general population norms. An understanding of how the HCT experience can enhance QoL, perhaps through post-traumatic growth, might help improve QoL after other distressing events. However, about 20% of ICs in our study reported inferior QoL, with IC age (older associated with worse physical QoL but better mental QoL), IC lower education, IC female gender, lower recipient QoL, current recipient use of immunosuppressive therapy and relapse being significant determinants. Thus, IC characteristics and recipient QoL are more important drivers of IC QoL than recipient and HCT characteristics. With 1 in 5 ICs experiencing poor QoL even several years after HCT, further studies should focus on methods to counteract the adverse effects of HCT on the recipient's support network. [Display omitted] DisclosuresFlowers:Pharmacyclics: Consultancy. Lee:Mallinckrodt: Honoraria; Amgen: Other: One-time advisory board member; Bristol-Myers-Squibb: Other: One-time advisory board member; Kadmon: Other: One-time advisory board member.

Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty?

BackgroundThere is focus on the direct anterior approach (DAA) for total hip arthroplasty because of perceived postoperative functional improvement. We compared baseline, short-term, and long-term outcomes between the DAA and the posterior approach focusing on baseline function.Material and methodsMultivariate linear and logistic regression models were used to analyze prospective data on 1457 total hip arthroplasties comparing baseline characteristics, operative time, 90-day reoperation, length of stay (LOS), extended LOS (>3 days), and facility discharge. The Patient-Reported Outcome Measurement Information System-Global Health (PROMIS-10) was used to determine physical component score (PCS) and mental component score (MCS), with clinically significant improvement defined as >5 points. Adjusters included age, sex, race/ethnicity, year, Charlson Comorbidity Index, body mass index, alcohol, and tobacco use.ResultsDAA patients had higher preoperative MCS (DAA 50.4 vs posterior approach 47.4, P < .001), PCS (40.7 vs 38.5, P < .001), and postoperative PCS scores (48.9 vs 46.7, P < .001). There was no difference in mean PCS improvement (8.1 vs 8.2; P = .798) or clinically significant PCS change (P = .963). DAA was associated with shorter LOS by 0.49 days (95% confidence interval [CI] = 0.32-0.65, P < .001), lower odds of extended LOS (odds ratio = 0.33, 95% CI = 0.21-0.50, P < .001), and lower odds of facility discharge (odds ratio = 0.54, 95% CI = 0.37-0.79, P < .001). No difference in operative time (86 vs 87 minutes; P = .812) or 90-day reoperations (1 vs 1%; P = .347) was observed.ConclusionDAA patients presented with higher preoperative PCS and MCS scores, yet both groups experienced significant improvement. DAA was associated with decreased LOS and lower odds of extended LOS and facility discharge. There was no difference in operative time or reoperation.

A profile of patient response across surgical end-stage hip, knee and spine osteoarthritis

Purpose: Orthopaedic surgical procedures for osteoarthritis (OA) are among the most frequently performed scheduled procedures in North America. Volumes are highest for hip and knee replacements and lumbar spinal surgery. However, patient reported response is variable with 10-40% of patients reporting persistent pain and subthreshold minimal clinical improvement. Given the potential patient and economic impact, an ability to predict whether a patient will ‘respond’ to surgery or not is of considerable interest. Unfortunately, predictive factors have been variable across studies and limited in dimension, making direct comparison across hip, knee and spine surgery for OA (HKS-OA) difficult. The Longitudinal Evaluation in the Arthritis Program (LEAP) is a large prospective observational cohort study of patients undergoing surgical intervention for HKS-OA (LEAP-OA). A bio-psycho-social prognostic framework was used to select patient factors/outcomes to profile patients and recovery trajectories over a 1-year period. This report represents the first ‘bird’s eye view’ of congruent and contemporaneous surgical HKS-OA patient profiles, examining similarities and differences across groups, and outcome response using a generic health status outcome. Methods: LEAP-OA recruited consecutive patients undergoing primary hip or knee replacement for OA or decompression (with/without fusion) surgery for back and leg symptoms due to lumbar spinal stenosis due to facet OA from Nov 2015 to Dec 2018. All patients provided written informed consent. Eligibility criteria included ≥35 years of age and English fluency. Exclusion criteria included acute trauma/injury, inflammatory arthritis, revision surgery. Clinical and self-reported sociodemographic, physical, mental and social health-related data were captured pre-surgery. The generic SF-12 health measure was collected pre-surgery and at 3 and 12 months post-surgery. Follow-up response rates were >80%. Descriptive analyses assessed baseline characteristics and change in the SF-12 physical component scores (PCS) over time across groups. The primary outcome was the proportion of responders at 3 and 12 months across groups achieving a minimally clinically important improvement (MCII) using PCS (>=4.6). Results: There were 547 hip, 625 knee and 140 spine OA patients with complete data. Mean ages were 65.1, 66.2, and 67.1 years, and 46.3%, 43.4% and 57.5% were female, among hip, knee and spine patients, respectively. The proportion of patients who were overweight or obese was highest for knee patients. Mean number of concurrent symptomatic joints were 2.3, 3.2 and 3.6 for hip, knee and spine patients, respectively. Clinically relevant levels of pain catastrophizing were reported by 18.8% of spine patients vs. 13.9% and 14.5% of hip and knee patients, respectively. While mean depressive symptom scores and anxiety scores were similar, rates of moderate/severe depressive symptoms were somewhat higher among spine patients, and moderate/severe anxiety symptoms among knee patients (Table 1). Approximately half of spine patients, and 35.2% and 29.6% of knee and hip patients had neuropathic pain scores indicative of possible/likely neuropathic pain using the painDETECT questionnaire. Average pain intensity ratings were similar across groups. Pre-surgery SF-12 PCS scores were similar across groups. Mean changes in PCS scores at 3 and 12 months post-surgery were greatest for hip patients and similar for knee and spine patients (Table 2). The majority of improvement in PCS scores occurred during the first 3 months, with continuing improvement to 12 months for all groups. By 3 months, hip patients were most likely to have achieved a SF-12 PCS MCII, and by 12 months achievement rates were 80.3%, 64.6% and 62.9% for hip, knee and spine, respectively. Reported rates of satisfaction with surgical results and willingness to have the surgery again were consistently high across groups at 90% or more. By 12 months, approximately 92% of hip patients, and 82% of knee and spine patients reported being able to cope with their current symptom state. Conclusions: A comprehensive set of patient and health-related factors provided the first opportunity to identify similarities and differences across a contemporaneous group of SHK-OA patients. Our Results are consistent with current literature and reflect that a significant proportion of patients, especially those undergoing knee and spine surgery for OA, do not reach a minimal response to improvement in physical health-related quality of life, despite a very high satisfaction rate. The baseline variables, response trajectories and rates varied between OA groups suggesting that there may be unique prognostic factors across groups that explain differences in responder rates. They may also represent distinct ‘classes’ of OA patients generally. Applied to the over 1.6 million inpatient spinal fusions, hip and knee replacements performed in the US in 2014, our non-response rates translate to approximately 500,000 SHK-OA surgeries a year at cost of $10billion USD. This represents a tremendous economic argument for improved pre-operative prognostic decision making (i.e. precision surgery). Advanced analytics techniques are the next steps to determine predictive phenotypes and improve point-of-care decision making.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Relationship between Vitamin Intake and Health-Related Quality of Life in a Japanese Population: A Cross-Sectional Analysis of the Shika Study.

Although epidemiological studies revealed a relationship between psychosocial states, such as depressive symptoms, and nutritional intake, limited information is currently available on vitamin intake. The Short Form-36 Health Survey (SF-36) is not limited to a specific disease, it is constructed based on a universal concept of health and is used to evaluate the Quality of life (QOL). A three-component scoring method was developed for “Physical component score (PCS)”, “Mental component score (MCS)”, and “Role/social score (RCS)”. Collectively, these summary scores are called the “QOL summary score”, which is regarded as a more detailed health summary score. In the present study, we aimed at epidemiologically examine the relationship between vitamin intake and QOL in middle-aged and elderly population in 3162 residents in Japan. In women, a multiple regression analysis showed a positive correlation between all vitamin intake and PCS scores, and between vitamin B6, folic acid, vitamin C, and MCS scores. In consideration of depression as MCS of SF-36 and chronic pain as PCS, an insufficient vitamin intake may affect QOL in women; however, a causal relationship has not yet been demonstrated.

The impact of health-related quality of life and depressive symptoms on blood donor career-Results from the Danish blood donor study.

Blood donors report better health-related quality of life (HRQL) than non-donors. Likewise, donors reporting good health are less likely to stop donating and have a higher donation frequency. This is evidence of the healthy donor effect (HDE). This study is the first to investigate the impact of HRQL and depressive symptoms on subsequent donor career. Prospective cohort study includes 102,065 participants from the Danish Blood Donor Study applying the 12-item short-form health survey (SF-12) measuring a mental (MCS) and a physical component score (PCS) and the Major Depression Inventory (MDI). Poisson and Cox regression models were used to assess the effect of SF-12 and MDI scores on donation frequency and donor cessation. Higher MCS/PCS scores indicate good HRQL, while higher MDI score indicates higher experience of depressive symptoms. For both sexes, MCS was positively correlated with donation frequency for up to 5 years, and similarly for PCS among women. A negative correlation between MDI score and donation frequency in the year following assessment was observed only among men. No correlation was observed among women. An increase in both MCS and PCS was associated with a lower risk of donation cessation in both sexes, while an increase in MDI score was only associated with an increased risk of donation cessation in men. MCS, PCS, and MDI score affect donor career. Thus, adjusting for donation frequency may reduce HDE-bias in donor health research. However, because of the small effect sizes, other ways of quantifying HDE may be beneficial.

Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

BackgroundMany studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients’ subjective significance of impairment.MethodsA prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients’ subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID).ResultsAmong 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1–18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively.ConclusionsAmong the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required.Trial registration UMIN000034072.

Quality of life after pancreatic resection for malignant and benign disease - a cross-sectional study

Introduction: To investigate QOL trajectories following pancreatic resection for malignant or benign disease. Methods: Consecutive patients of six upper gastrointestinal surgeons who underwent pancreatic resection at one of six hospitals in Sydney, Australia between Apr-2014 and Apr-2019 were invited to participate. The main outcome was self-reported QOL using the Short Form 36 (SF-36v2) expressed as mental (MCS) and physical component scores (PCS) with values ranging from 0-100 and the Functional Assessment of Cancer Therapy - Hepatobiliary (FACT-Hep) expressed as a total score, with values ranging from 0-180. Higher scores indicate better QOL. QOL outcomes were measured at < 12, 12-23, 24-35, 36-47 and ≥48 months post-surgery. Differences at each timepoint were compared with ANOVA and multiple pairwise comparisons were made using the Bonferroni correction. Results: Of 224 invited patients, 121 (54%) responded. Mean (SD) age was 68.0 (11.9) years and 52% (n=63) were male. Malignancy was the indication for surgery in 78% (n=94), 63% (n=74) of participants underwent pancreaticoduodenectomy and 57% (n=69) were between 12 and 35 months from surgery. No difference in the PCS and total FACT-Hep score was observed for the studied period. A significant increase on the MCS was observed from < 12 month to 12-23 months postoperatively (mean difference: 9.4; 95%CI: 1.1to17.1); No difference on MCS was noted on any other time points (Figure 1). Conclusions: MCS improved significantly from < 12 months to 12-23 months. No further significant changes were observed in MCS, PCS and total FACT-Hep scores over time compared to baseline.

One-year intensive lifestyle intervention and improvements in health-related quality of life and mental health in persons with type 2 diabetes: a secondary analysis of the U-TURN randomized controlled trial

IntroductionThe effects of lifestyle interventions in persons with type 2 diabetes (T2D) on health-related quality of life (HRQoL) and subjective well-being are ambiguous, and no studies have explored the effect...

What Predicts Health-Related Quality of Life for Patients With Displaced Femoral Neck Fractures Managed With Arthroplasty? A Secondary Analysis of the HEALTH Trial.

Total hip arthroplasty (THA) has been argued to improve health-related quality of life (HRQoL) and function in femoral neck fracture patients compared with hemiarthroplasty (HA). The HEALTH trial showed no clinically important functional advantages of THA over HA. The current analysis explores factors associated with HRQoL and function in this population. Using repeated measures regression, we estimated the association between HRQoL and function [Short Form-12 (SF-12) physical component score (PCS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score] and 23 variables. THA as compared to monopolar HA, but not bipolar HA, was more likely to improve PCS scores (adjusted mean difference [AMD] 1.88 points, P = 0.02), whereas higher American Society of Anesthesiologists score (AMD -2.64, P < 0.01), preoperative use of an aid (AMD -2.66, P < 0.01), and partial weight-bearing status postoperatively (AMD -1.38, P = 0.04) demonstrated less improvement of PCS scores over time. THA improved WOMAC function scores over time compared with monopolar HA (but not bipolar HA) (AMD -2.40, P < 0.01), whereas higher American Society of Anesthesiologists classification (AMD 1.99, P = 0.01) and preoperative use of an aid (AMD 5.39, P < 0.01) were associated with lower WOMAC function scores. Preoperative treatment for depression was associated with lower functional scores (AMD 7.73, P < 0.01). Patients receiving THA are likely to receive small and clinically unimportant improvements in health utility and function compared with those receiving monopolar HA and little improvement compared with those receiving bipolar HA. Patient-specific characteristics seem to play a larger role in predicting functional improvement among femoral neck fracture patients. Prognostic Level II.

The Association Between Physical Functioning and Healthcare Utilization Among Cancer Survivors

Previous studies have demonstrated financial strain among cancer survivors, partly mediated by healthcare expenditures due to the increased care cancer survivors require. Healthcare expenditures among adults aged ≥ 70 years are also associated with lower physical functioning as well as increased total medical visits. However, no study to-date has examined the association between physical functioning, healthcare expenditures, and total medical visits among adult cancer survivors of all ages. Thus, we sought to assess this relationship. Data on a number of health indicators are collected in noninstitutionalized civilian adults by the U.S. Medical Expenditure Panel Survey. For this study, harmonized data of participants reporting a cancer diagnosis were extracted from the Integrated Health Interview Series from 2007-2017. The Physical Component Score (PCS) is a validated measure of physical functioning ranging in score from 0 to 100 points, higher scores representing better health. Data was collected on counts of visits in several treatments settings as proxy for healthcare utilization such as inpatient, outpatient, emergency department, home health services, and “other” medical visits. Medical expenditure data was also collected that included all medical payments for such visits. Multivariable logistic regression defined adjusted odds ratios (AOR) with 95% confidence intervals (95CI) for healthcare utilization as dependent variable and PCS as an independent variable of interest. A separate model was also run for total medical expenditure as the dependent variable and PCS as an independent variable. Among 290,700 participants, adult cancer survivors were less likely to be in the top quartiles (Q3, Q4) of PCS scores relative to adults without cancer (20.33% vs 47.15%, AOR 0.78, 95CI 0.70-0.87, P<0.001). Having cancer was also associated with increased medical expenditures (median $4,845 vs $500, AOR 3.02, 95CI 2.53-3.61, P<0.001) and increased medical visits (median 0 [IQR 0, 1] vs. 0 [IQR 0, 3] visits, AOR 1.62, 95CI 1.51-1.74, P<0.001). Among 45,975 adult cancer survivors, those in Q1 of PCS score (lowest PCS score and worst physical functioning) had the highest medical expenditures relative to other quartiles (median $7,594 Q1; $3,256 Q2; $2,113 Q3; $2,181 Q4). Furthermore, adult cancer survivors in Q1 were more likely to have the highest medical visits (median visits: Q1 [referent], 1 [IQR 0, 6]; Q2, 0 [IQR 0, 2], AOR 0.67, 95CI 0.60-0.75, P<0.001; Q3, 0 [0, 1] AOR 0.50, 95CI 0.42-0.60, P<0.001; Q4, 0 [IQR 0, 1] AOR 0.43, 95CI 0.35-0.51, P<0.001). Lower physical functioning is associated with increased medical expenditure, medical visits and increase in healthcare utilization in cancer survivors. Lower physical functioning has been shown to predict higher mortality and morbidity. Our results show the need for improving physical functioning in cancer survivors which may mitigate the high healthcare costs incurred by this population.

Implications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors

BackgroundPatients who survive critical illness suffer from a significant physical disability. The impact of rehabilitation strategies on health-related quality of life is inconsistent, with population heterogeneity cited as one potential confounder. This secondary analysis aimed to (1) examine trajectories of functional recovery in critically ill patients to delineate sub-phenotypes and (2) to assess differences between these cohorts in both clinical characteristics and clinimetric properties of physical function assessment tools.MethodsTwo hundred ninety-one adult sepsis survivors were followed-up for 24 months by telephone interviews. Physical function was assessed using the Physical Component Score (PCS) of the Short Form-36 Questionnaire (SF-36) and Activities of Daily Living and the Extra Short Musculoskeletal Function Assessment (XSFMA-F/B). Longitudinal trajectories were clustered by factor analysis. Logistical regression analyses were applied to patient characteristics potentially determining cluster allocation. Responsiveness, floor and ceiling effects and concurrent validity were assessed within clusters.ResultsOne hundred fifty-nine patients completed 24 months of follow-up, presenting overall low PCS scores. Two distinct sub-cohorts were identified, exhibiting complete recovery or persistent impairment. A third sub-cohort could not be classified into either trajectory. Age, education level and number of co-morbidities were independent determinants of poor recovery (AUROC 0.743 ((95%CI 0.659–0.826), p < 0.001). Those with complete recovery trajectories demonstrated high levels of ceiling effects in physical function (PF) (15%), role physical (RP) (45%) and body pain (BP) (57%) domains of the SF-36. Those with persistent impairment demonstrated high levels of floor effects in the same domains: PF (21%), RP (71%) and BP (12%). The PF domain demonstrated high responsiveness between ICU discharge and at 6 months and was predictive of a persistent impairment trajectory (AUROC 0.859 (95%CI 0.804–0.914), p < 0.001).ConclusionsWithin sepsis survivors, two distinct recovery trajectories of physical recovery were demonstrated. Older patients with more co-morbidities and lower educational achievements were more likely to have a persistent physical impairment trajectory.In regard to trajectory prediction, the PF score of the SF-36 was more responsive than the PCS and could be considered for primary outcomes. Future trials should consider adaptive trial designs that can deal with non-responders or sub-cohort specific outcome measures more effectively.

Are Preoperative PHQ-9 Scores Predictive of Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion?

This is a retrospective study. The objective of this study was to determine if there is an association between preoperative depression, as quantified by Patient Health Questionnaire-9 (PHQ-9), and postoperative improvement in pain and disability after anterior cervical discectomy and fusion (ACDF). Few studies have quantified depression symptoms in the preoperative period using PHQ-9 and have tracked patient-reported outcomes (PROs) following ACDF. Patients undergoing ACDF were retrospectively reviewed and stratified by their preoperative PHQ-9 score. PROs, including Neck Disability Index (NDI), Visual Analogue Scale (VAS) neck and arm pain, and 12-Item Short Form (SF-12) Physical Component Score (PCS), were measured preoperatively and at 6-week, 3-month, 6-month, and 1-year postoperatively. PRO scores were analyzed amongst PHQ-9 cohorts using multiple linear regression. Achievement of minimum clinically important difference (MCID) was compared using χ analysis. Higher PHQ-9 scores were associated with increased preoperative NDI, VAS neck, and VAS arm scores and significantly lower SF-12 PCS scores preoperatively. Cohorts experienced similar VAS pain scores up to 1-year following surgery, except for VAS neck pain at 3 months when patients with greater depression symptoms had more pain. High PHQ-9 patients had higher NDI values at 6 weeks and 3-month marks but had similar NDI scores at 6 months and 1-year. Similarly, SF-12 PCS scores were lower for patients with a higher PHQ-9 score at 3 and 6 months, however, both groups had similar scores at 1-year follow-up. A greater percentage of the high PHQ-9 cohort achieved MCID for NDI, however, there were no differences in MCID achievement for VAS neck, VAS arm, or SF-12 PCS. Patients with worse preoperative mental health reported significantly greater preoperative disability and pain. However, both cohorts demonstrated similar clinical recovery at the 1-year follow-up. These findings suggest patients with worse preoperative mental health can expect significant improvements in PROs following surgery.

Association between frailty and family functionality on health-related quality of life in older adults.

To investigate the longitudinal association between frailty and health-related quality of life (HRQoL) in older adults and to examine whether family functionality moderates the association between frailty and HRQoL. It's a longitudinal observational study. The sample was drawn from three waves (2006, 2010, and 2015) of the Health, Well-Being, and Aging Study (Saúde, bem-estar e envelhecimento; SABE) collected in São Paulo, Brazil with adults aged 60years and older. HRQoL was based on the Short Form (SF-12) Health Survey, from which the physical component score (PCS) and mental component score (MCS) were obtained. Frailty status was determined according to the Fried frailty criteria. Family support was measured using the family APGAR instrument. Mixed effects linear regression was used to determine the associations of frailty on longitudinal changes in HRQoL and to examine whether family functionality attenuates this association. Being frail was negatively associated with MCS and PCS scores. Familiar functionality was found to be a protective factor for MCS only. These findings are innovative and make an important contribution to the study of HRQoL among older adults in developing countries.

Mental Component Score (MCS) from Health-Related Quality of Life Predicts Incidence of Dementia in U.S. Males.

The Medical Outcomes Study Questionnaire Short Form 36 health survey (SF-36) measures health-related quality of life (HRQoL) from the individual's point of view and is an indicator of overall health status. To examine whether HRQoL shows differential changes over time prior to dementia onset and investigate whether HRQoL predicts incidence of dementia. Prevention of Alzheimer's Disease (AD) by Vitamin E and Selenium (PREADViSE) trial, which recruited 7,547 non-demented men between 2002 and 2009. A subset of 2,746 PREADViSE participants who completed up to five SF-36 assessments at annual visits was included in the current analysis. Secondary data analysis of PREADViSE data. A subset of 2,746 PREADViSE participants who completed up to five SF-36 assessments at annual visits was included in the current analysis. Two summary T scores were generated for analysis: physical component score (PCS) and mental component score (MCS), each with a mean of 50 (standard deviation of 10); higher scores are better. Linear mixed models (LMM) were applied to determine if mean component scores varied over time or by eventual dementia status. Cox proportional hazards regression was used to determine if the baseline component scores were associated with dementia incidence, adjusting for baseline age, race, APOE-4 carrier status, sleep apnea, and self-reported memory complaint at baseline. The mean baseline MCS score for participants who later developed dementia (mean± SD: 53.9±9.5) was significantly lower than for those participants who did not develop dementia during the study (mean±SD: 56.4±6.5; p = 0.005). Mean PCS scores at baseline (dementia: 49.3±7.9 vs. non-dementia: 49.8±7.8) were not significantly different (p = 0.5) but LMM analysis showed a significant time effect. For MCS, the indicator for eventual dementia diagnosis was significantly associated with poorer scores after adjusting for baseline age, race, and memory complaint. Adjusted for other baseline risk factors, the Cox model showed that a 10-unit increase in MCS was associated with a 44% decrease in the hazard of a future dementia diagnosis (95% CI: 32%-55%). The SF-36 MCS summary score may serve as a predictor for future dementia and could be prognostic in longitudinal dementia research.

Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?

Retrospective analysis. Determine whether deformity corrections should vary by pelvic incidence (PI). Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for adult spinal deformity (ASD) surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and Short Form 36 Survey (SF-36) Physical Component Score (PCS). Baseline relationships between TPA, age, PI, and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. Nine hundred three ASD patients (mean 53.7 yr) and 111 normative subjects (mean 50.7 yr) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, >75); and age: elderly (>65 yr, n = 375), middle age (45-65 yr, n = 387), and young (18-45 yr, n = 141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r = 0.42, P < 0.0001). ODI correlated with PCS (r = 0.71, P < 0.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI. 3.

Health related quality of life (HRQoL) in mothers of premature infants at NICU discharge.

Premature delivery and a potential Neonatal Intensive Care Unit admission may be associated with the risk of poor maternal health. We aimed to examine the mothers' health-related quality of life (HRQoL) at the time of infant discharge. Fifty mothers completed the Medical Outcomes Study-Short Form 12. It has a Physical Component Score (PCS) and Mental Component Score (MCS), both with a mean of 50 and standard deviation of 10. Analysis included infant, maternal, and pregnancy-related characteristics. In multivariable analyses, a household income of <150K lowered the PCS by 10 points (p = 0.003) compared to those with higher incomes. Marginal significance was noted in GA, for every week gained the PCS score was lower by 1.5 points. Several risk factors are associated with lower physical health ratings in mothers of preterm infants at discharge. This information can be used to inform providers in their anticipatory guidance to the family and follow-up plans.

P040 TEXT MESSAGE-BASED TELEMEDICINE DOES NOT IMPROVE QUALITY OF LIFE OR DEPRESSIVE SYMPTOMS IN IBD PATIENTS

Inflammatory bowel disease (IBD) is a chronic debilitating condition involving the gastrointestinal (GI) tract that has a negative impact on quality of life (QoL). Depressive symptoms (DS) are common in affected patients and contribute to decreased QoL. Telemedicine is the use of information technology to remotely deliver health care; it is poised to gain widespread use in the care of IBD patients. However, its effect on DS and QoL is unknown in IBD. We investigated the impact of telemedicine on DS and QoL over time. This was a one-year, multicenter, randomized, controlled trial evaluating disease activity and QoL in IBD patients using text message-based telemedicine. Participants were randomized to three groups: standard of care and telemedicine weekly or every other week (EOW). Using mobile phones, telemedicine participants relayed information on their clinical symptoms and treatment plans were similarly conveyed to them. DS and QoL were measured using the Mental Health Inventory (MHI-5) and Short Form (SF-12) respectively. The SF-12 score has a physical component score (PCS) and a mental component score (MCS). Change in MHI-5 and SF-12 scores from baseline to 12 months was assessed, and comparison was made between the intervention and control groups. Of the 217 study participants, 59% were woman and 69% had Crohn’s disease. The number of participants in the control, telemedicine weekly and EOW groups were 72, 71, and 74 respectively. The baseline PCS, MCS, and MHI-5 scores were 46.9, 48.6, and 74.9 for all participants. Increase in mean PCS (p=0.0003) and MCS (p=0.04) was significant in the standard of care group over the study period. After controlling for confounding variables, there was no significant difference in the mean change in PCS (p=0.06), MCS (p=0.89), and MHI-5 (p=0.70) scores among the standard of care, weekly and EOW telemedicine groups. Text message-based telemedicine does not lead to improvement of DS or QoL when compared to standard of care in IBD patients. Although telemedicine has been shown to reduce healthcare utilization and improve access to care, caution should be exercised in overstating its benefits with regards to outcomes such as DS and QoL. Future studies should explore the impact of telemedicine on DS and QoL in other settings such as community practices.

P040 TEXT MESSAGE-BASED TELEMEDICINE DOES NOT IMPROVE QUALITY OF LIFE OR DEPRESSIVE SYMPTOMS IN IBD PATIENTS

Inflammatory bowel disease (IBD) is a chronic debilitating condition involving the gastrointestinal (GI) tract that has a negative impact on quality of life (QoL). Depressive symptoms (DS) are common in affected patients and contribute to decreased QoL. Telemedicine is the use of information technology to remotely deliver health care; it is poised to gain widespread use in the care of IBD patients. However, its effect on DS and QoL is unknown in IBD. We investigated the impact of telemedicine on DS and QoL over time. This was a one-year, multicenter, randomized, controlled trial evaluating disease activity and QoL in IBD patients using text message-based telemedicine. Participants were randomized to three groups: standard of care and telemedicine weekly or every other week (EOW). Using mobile phones, telemedicine participants relayed information on their clinical symptoms and treatment plans were similarly conveyed to them. DS and QoL were measured using the Mental Health Inventory (MHI-5) and Short Form (SF-12) respectively. The SF-12 score has a physical component score (PCS) and a mental component score (MCS). Change in MHI-5 and SF-12 scores from baseline to 12 months was assessed, and comparison was made between the intervention and control groups. Of the 217 study participants, 59% were woman and 69% had Crohn’s disease. The number of participants in the control, telemedicine weekly and EOW groups were 72, 71, and 74 respectively. The baseline PCS, MCS, and MHI-5 scores were 46.9, 48.6, and 74.9 for all participants. Increase in mean PCS (p=0.0003) and MCS (p=0.04) was significant in the standard of care group over the study period. After controlling for confounding variables, there was no significant difference in the mean change in PCS (p=0.06), MCS (p=0.89), and MHI-5 (p=0.70) scores among the standard of care, weekly and EOW telemedicine groups. Text message-based telemedicine does not lead to improvement of DS or QoL when compared to standard of care in IBD patients. Although telemedicine has been shown to reduce healthcare utilization and improve access to care, caution should be exercised in overstating its benefits with regards to outcomes such as DS and QoL. Future studies should explore the impact of telemedicine on DS and QoL in other settings such as community practices.View Large Image Figure ViewerDownload Hi-res image Download (PPT)