Changes In Physical Component Summary Scores Research Articles

Factors Associated With 10-Year Declines in Physical Health and Function Among Women During Midlife

Women in midlife often develop chronic conditions and experience declines in physical health and function. Identifying factors associated with declines in physical health and function among these women may allow for targeted interventions. To examine the factors associated with clinically important 10-year declines in the physical component summary score (PCS) of the Short Form 36 (SF-36), a widely used patient-reported outcome measure, in women in midlife. This longitudinal cohort study collected data from geographically dispersed sites in the US. Participants were part of the Study of Women's Health Across the Nation (SWAN), a racially and ethnically diverse cohort of women enrolled at or immediately before the menopause transition. Women have been followed for up to 21 years, between 1996 and 2016, with annual visits. Data were analyzed from October 2020 to March 2021. Demographic indicators, health status measures, and laboratory and imaging assessments. The main outcome was a clinically important decline (≥8 points) on the PCS, based on the 10-year difference in scores between ages 55 and 65 years. From the SWAN cohort of 3302 women, 1091 women (median [IQR] age, 54.8 [54.3-55.4] years; 264 [24.2%] Black women; 126 [11.6%] Chinese women; 135 [12.4%] Japanese women; 566 [51.9%] White women) were eligible for analyses based on duration of follow-up and availability of SF-36 data. At age 55, women had a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 27.0 (23.2-32.6), a median (IQR) baseline PCS of 53.1 (46.8-56.7), 108 women (9.9%) were current smokers, and 938 women (86.3%) had at least 1 comorbidity. Between ages 55 and 65 years, the median (IQR) change in PCS was -1.02 (-6.11 to 2.53) points with 206 women (18.9%) experiencing declines of 8 points or more. In multivariable models, factors associated with clinically important decline included higher baseline PCS (odds ratio [OR], 1.08; 95% CI, 1.06-1.11), greater BMI (OR, 1.06; 95% CI, 1.03-1.09), less educational attainment (OR, 1.87; 95% CI, 1.32-2.65), current smoking (OR, 1.93; 95% CI, 1.14-3.26), osteoarthritis (OR, 1.46; 95% CI, 1.01-2.09), clinically significant depressive symptoms (OR, 2.03; 95% CI, 1.34-3.09), and cardiovascular disease (OR, 2.06; 95% CI, 1.26-3.36). In this cohort study, clinically important declines in women's physical health and function were relatively common between ages 55 and 65 years. Several variables associated with these declines were identified as potentially useful components in a clinical score identifying women at increased risk of physical health and functional declines.

Health Status After Transcatheter Tricuspid Valve Repair in Patients With Functional Tricuspid Regurgitation.

The aim of this study was to investigate changes in quality of life (QoL) after transcatheter tricuspid valve repair (TTVR) for tricuspid regurgitation (TR). TTVR provides feasible and durable efficacy in reducing TR, but its clinical benefits on QoL still remain unclear. In 115 subjects undergoing TTVR for severe functional TR, QoL was evaluated using the 36-Item Short Form Health Survey (SF-36) and the Minnesota Living With HeartFailure Questionnaire (MLHFQ). All-cause mortality, heart failure (HF) rehospitalization, and a composite endpoint of all-cause mortality, HF rehospitalization, and repeat TTVR were recorded as clinical events. Successful device implantation was achieved in 110 patients (96%). Moderate or less TR at discharge was achieved in 95 patients (83%). Mean SF-36 physical component summary (PCS) score improved from 34 ± 9 to 37 ± 9 points (+3 points; 95% CI: 1-5 points; P=0.001), mean SF-36 mental component summary score improved from 49 ± 9 to 51 ± 10 points (+2 points; 95% CI: 0-4 points; P=0.017), and mean MLHFQ score decreased from 29 ± 14 to 20 ± 15 points (-8 points; 95% CI:-11 to-5 points; P< 0.001). Baseline PCS, moderate or less TR at discharge, and baseline massive or torrential TR were associated with 1-month change in PCS score (P< 0.05). Change in PCS score after 1month predicted HF rehospitalization after TTVR (adjusted HR: 0.74 [95% CI: 0.60-0.92] per 5-point increase in PCS score; P=0.008). This study demonstrates that TTVR provides improvement in QoL in patients with relevant TR. TR reduction to a moderate or less grade was associated with improvement of SF-36 and MLHFQ scores. Further, global QoL was associated with clinical outcomes and might serve as a future outcome surrogatefollowing TTVR.

Estimating the minimal clinically important difference for the Physical Component Summary of the Short Form 36 for patients with stroke.

ObjectiveTo determine the Physical Component Summary (PCS) score's minimal clinically important difference (MCID) on the Short Form 36 (SF-36) for people with stroke.MethodsWe conducted secondary analysis of data from a large randomized controlled trial (N = 400) in the post-hospital discharge phase of stroke rehabilitation with outcome measurement 6 and 12 months following stroke. Three methods were used for estimating the MCID: two anchor and one distribution. Method 1 compared SF-36 PCS scores at 12 months for responses to the SF-36’s Perceived Health Change (PHC) question. Method 2 compared the change in PCS score between 6 and 12 months for responses to the PHC question. Method 3 used Cohen’s method to estimate the MCID from the PCS score distribution.ResultsMethod 1: the mean PCS score increased by 3.0 units (95% confidence interval [CI] 2.2–3.9) for each unit change in the PHC question. Method 2: the mean change in PCS score increased by 2.1 units (95% CI 1.4–2.8) for each unit change in the PHC question. Method 3: the MCID was estimated to be 1.8 units.ConclusionsOur estimate of the MCID for the PCS in patients with stroke was 1.8 to 3.0 units.

Predictors of health-related quality of life among military HIV-infected individuals.

To determine long-term predictors of health-related quality of life (HRQOL) and evaluate the treatment effect of highly active antiretroviral therapy (HAART) on HRQOL in the US Military HIV Natural History Study (NHS) cohort. Participants were a nested cohort of the NHS who responded to the Rand Short Form 36 questionnaire administered from 2006 to 2010. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed using standard algorithms. HAART-status was categorized as non-protease inhibitor-based (NPI-HAART), protease inhibitor-based (PI-HAART), HAART-naïve, or off-HAART. Mixed linear random effects models were used to estimate changes in PCS and MCS over time for treatment and covariates (including CD4 count, HIV viral load, medical and mental comorbidities). Eight hundred and twelve participants met the inclusion criteria. There was no difference in PCS or MCS between those on PI-HAART compared to NPI-HAART. Significant predictors of PCS were CD4 count < 200 cells/mm3 (β = - 2.90), CD4 count 200-499cells/mm3 (β = - 0.80), and mental comorbidity (β = - 3.23). Others were medical comorbidity, AIDS-defining illness, being on NPI-HAART, HAART-naïve, age, and rank. Those with medical comorbidities experienced yearly improvement in PCS. Predictors of MCS were CD4 count < 200cells/mm3 (β = - 2.53), mental comorbidity (β = - 4.58), and being African American (β = 2.59). HRQOL was significantly affected by low CD4 count, medical and mental comorbidities. Addressing these modifiable factors would be expected to improve the physical and mental HRQOL of the cohort. Our study did not find any treatment benefit of NPI-HAART over PI-HAART on HRQOL in the long term.

An Analysis of Patient-reported Outcomes in IXORA-S: Comparing Ixekizumab and Ustekinumab over 52 Weeks in Moderate-to-severe Psoriasis.

Patient-reported outcomes are valuable for assessing new psoriasis therapies. This study investigated patient-reported outcomes in patients with moderate-to-severe plaque psoriasis treated with ixekizumab or ustekinumab, dosed according to their respective labels, for 52 weeks (IXORA-S-NCT02561806). Patient-reported outcomes investigated included patient global assessment, pruritus, skin pain, health-related quality of life, and work productivity. Ixekizumab-treated patients reported greater improvements in patient-reported outcomes sooner after treatment compared with ustekinumab-treated patients, and maintained greater improvements in patient global assessment scores (ixekizumab 0.72, ustekinumab 1.19; p < 0.001), rates of Dermatology Life Quality Index (0, 1) (ixekizumab 71.3%, ustekinumab 56.6%, p < 0.01), and 36-item Short-form Health survey physical component summary score change from baseline (ixekizumab 5.53, ustekinumab 3.28; p < 0.05) at week 52. While clinically meaningful improvements in patient-reported outcomes resulted with either treatment, ixekizumab provided more rapid improvements in patient-reported outcomes and superior outcomes for some assessments through one year of treatment, while maintaining statistically superior improvements in skin severity, as assessed by either physicians or patients.

Differences in 1‑year outcome after primary total hip and knee arthroplasty : Acohort study in older patients with osteoarthritis.

Patients who undergo primary total hip (THA) and knee (TKA) arthroplasty show better clinical outcomes, improved quality of life and increased participation in leisure activities; however, the differences between primary THA and TKA in older patients are unknown. The aim of the study was to compare the Western Ontario and McMasters University osteoarthritis index (WOMAC) scores and changes in WOMAC scores, the Medical Outcomes study 12-item short-form version2 (SF-12) mental and physical health scales, satisfaction and frequency of participation in leisure activities in older osteoarthritis patients with a mean age of 67.9 ± 10.6 years who underwent primary THA and TKA. Data from 170 THA and 169 TKA patients were collected 1 week preoperatively through self-reporting of WOMAC scores and SF-12. These parameters, level of satisfaction and frequency of participation in leisure activities were collected 1 year postoperatively by self-reporting questionnaires. The THA group of patients showed better WOMAC scores (P < 0.05), changes in WOMAC scores (P < 0.05), physical component summary (PCS) of SF-12 (P < 0.01) and changes in PCS scores (P < 0.01) compared with the TKA group. In addition, the THA patients showed higher overall satisfaction (91.90% vs. 83.60%), pain relief satisfaction (87.20% vs. 77.40%) and functional improvement satisfaction (90.10% vs. 83.08%) in comparison with the TKA patients. Furthermore, a higher frequency of participation in leisure activities was achieved in THA patients, except for intellectual leisure activities. These findings suggest that primary THA provides superior clinical outcomes, quality of life, satisfaction, and participation in leisure activities compared with primary TKA in older patients.

Quality of life after surgery in secondary hyperparathyroidism, comparing subtotal parathyroidectomy with total parathyroidectomy with immediate parathyroid autograft: Prospective randomized trial

No prospective randomized data exist about the impact of various strategies of parathyroidectomy in secondary hyperparathyroidism patients on quality of life and its possible relationship with metabolic status after the operation. In a prospective randomized trial, the Short Form 36 Health Survey Questionnaire was applied to 69 patients undergoing parathyroidectomy through various approaches: subtotal parathyroidectomy (n = 23), total parathyroidectomy (PTx) with autotransplantation of 45 fragments (n = 25) and PTx with autotransplantation of 90 fragments (n = 21). The questionnaire was completed at three moments: (1) preoperatively, (2) 6 months after surgery, and (3) 12 months after surgery. Quality of life improved significantly in the physical component summary score in all three groups. Subtotal parathyroidectomy scores changed from 30.6 preoperatively to 51.7 6 months after surgery and 53.7 12 months after surgery. Total arathyroidectomy with autotransplantation of 45 fragments scores changed from 33.8 preoperatively to 52.6 6 months after surgery and 55.2 12 months after surgery. Total parathyroidectomy with autotransplantation of 90 fragments scores changed from 31.8 preoperatively to 50.5 6 months after surgery and 55.2 12 months after surgery (all groups P < .0001). No significant difference was detected in the physical component summary score change among the three groups. The physical component summary score was negatively correlated to age, parathormone, and alkaline phosphatase preoperatively. Parathyroidectomy significantly improves quality of life in hemodialysis patients with secondary hyperparathyroidism, regardless of the type of operation.

Quality of Life in Dialysis Patients: A Retrospective Cohort Study

Background/Aim: Physical component summary (PCS) and mental component summary (MCS) scores are associated with hospitalization and mortality in patients with end-stage renal disease. Most studies in these patients are cross-sectional in nature. This study aimed to assess the dynamics of health-related quality of life (HRQOL) over time, as well as determinants of changes in HRQOL. Also, the relation between changes in HRQOL with respect to both hospitalization and mortality was assessed. Methods: A cross-sectional analysis was performed in 77,848 hemodialysis (HD) patients whereas changes in HRQOL were assessed in 8,339 patients over a 1-year time period. HRQOL measurements were assessed with Kidney Disease Quality of Life-36 questionnaires. Also, relevant biomarkers (albumin, creatinine, hemoglobin, sodium) and equilibrated normalized protein catabolic rate (enPCR) were measured. Results: HRQOL were found to be decreased in HD patients. Nutritional indices like creatinine (r = 0.23; p < 0.0001) and serum albumin (r = 0.21; p < 0.0001) positively correlated with PCS scores. An increase in levels of albumin, creatinine, hemoglobin, enPCR and serum sodium over time are significantly (p < 0.0001) associated with positive changes in PCS scores. Changes in PCS scores were found to be predictive for hospitalization and mortality. The correlates of predictors for MCS scores were less strong compared to that of PCS scores. The strongest positive predictors of MCS scores were age (r = 0.08; p < 0.0001), albumin (r = 0.05; p < 0.0001) and sodium (r = 0.05; p < 0.0001). Conclusions: Nutritional factors are strongly associated with changes in HRQOL, especially with regard to PCS scores (change over time in HRQOL was an independent predictor of hospitalization and mortality). Increased scores of HRQOL over time are positively associated with survival.

Comparative outcomes and cost-utility after surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee—part 1: long-term change in health-related quality of life

Background contextIt is well accepted that total hip and knee arthroplasty (THA/TKA) for osteoarthritis (OA) is associated with reliable and sustained improvements in postoperative health-related quality of life (HRQoL). Although several studies have demonstrated comparable outcomes with THA/TKA after surgical intervention for lumbar spinal stenosis (LSS), the sustainability of the outcome after LSS surgery compared with THA/TKA remains uncertain. PurposeThe primary purpose of this study is to assess whether improvements in HRQoL after surgical management of focal lumbar spinal stenosis (FLSS) with or without spondylolisthesis are sustainable over the long term compared with that of THA/TKA for OA. Study designSingle-center, retrospective, longitudinal matched cohort study of prospectively collected outcomes, with a minimum of 5-year follow-up (FU). Patient samplePatients who had primary one- to two-level spinal decompression with or without instrumented fusion for FLSS and THA/TKA for primary OA. Outcome measuresPostoperative change from baseline to last FU in Short-Form 36 physical component summary (PCS) and mental component summary (MCS) scores among groups was used as the primary outcome measure. MethodsAn age, sex-matched inception cohort of primary one- to two-level spinal decompression with or without instrumented fusion for FLSS (n=99) was compared with a cohort of primary THA (n=99) and TKA (n=99) for OA and followed for a minimum of 5 years. Linear regression was used for the primary analysis. ResultsMean (percent) FUs in months were 80.5+16.04 (79%), 94.6+16.62 (92%), and 80.6+16.84 (85%) for the FLSS, THA, and TKA cohorts, respectively, with a range of 5 to 10 years for all three cohorts. The number of patients who have undergone revision including those lost to FU for the FLSS, THA, and TKA cohorts were n=20 (20.2%, same site [n=7] and adjacent segment [n=13]) requiring 27 operations, n=3 (3%, same site) requiring 5 operations, and n=8 (8.1%, same site) requiring 12 operations, respectively (p<.01). The average time to first revision was 56/65/43 months, respectively. Mean postoperative PCS (p<.0001) and MCS (p<.02) scores improved significantly and were durable for all groups at the last FU. The mean changes from baseline PCS/MCS scores to last FU were 8.5/6.4, 12.3/7.0, and 8.3/4.9 for FLSS, THA, and TKA, respectively. Adjusting for baseline age, sex, body mass index, PCS score, and MCS score, there was a strong trend in favor of greater sustained change in the PCS score of THA over FLSS (p=.07) and TKA (p=.08). No difference was noted for change in PCS score between FLSS and TKA (p=.95). No differences were noted for change in MCS score among all three cohorts (p>.1). ConclusionsSignificant improvements in HRQoL after surgical treatment of FLSS with or without spondylolisthesis and hip and knee OA are sustained for a mean of 7 to 8 years, with a minimum of 5-year FU. Despite a higher revision rate, patients undergoing surgery for FLSS can expect a comparable long-term average improvement in HRQoL from baseline compared with their peers undergoing TKA and to a lesser extent THA.

Validation of the SF-36 in patients with endometriosis

ObjectivesEndometriosis presents with significant pain as the most common symptom. Generic health measures can allow comparisons across diseases or populations. However, the Medical Outcomes Study Short Form 36 (SF-36) has not been validated for this disease. The goal of this study was to validate the SF-36 (version 2) for endometriosis.MethodsUsing data from two clinical trials (N = 252 and 198) of treatment for endometriosis, a full complement of psychometric analyses was performed. Additional instruments included a pain visual analog scale (VAS); a physician-completed questionnaire based on patient interview (modified Biberoglu and Behrman—B&B); clinical global impression of change (CGI-C); and patient satisfaction with treatment.ResultsBodily pain (BP) and the Physical Component Summary Score (PCS) were correlated with the pain VAS at baseline and over time and the B&B at baseline and end of study. In addition, those who had the greatest change in BP and PCS also reported the greatest change on CGI-C and patient satisfaction with treatment. Other subscales showed smaller, but significant, correlations with change in the pain VAS, CGI-C, and patient satisfaction with treatment.ConclusionsThe SF-36—particularly BP and the PCS—appears to be a valid and responsive measure for endometriosis and its treatment.

Predicting health-related quality of life 2 years after moderate-to-severe traumatic brain injury

To describe health-related quality of life (HRQL) 2 years after moderate-to-severe traumatic brain injury (TBI) and to assess predictors of HRQL. A prospective cohort study of 91 patients, aged 16-55 years, admitted with moderate-to-severe TBI to a trauma referral centre between 2005 and 2007, with follow-up at 1 and 2 years. Mean age was 31.1 (SD = 11.3) years, and 77% were men. Injury severity was evaluated by the Glasgow Coma Scale (GCS), head CT scan (using a modified Marshall Classification), Injury Severity Score (ISS) and post-traumatic amnesia (PTA). The Functional Independence Measure (FIM), Community Integration Questionnaire (CIQ), Beck Depression Inventory (BDI) and Medical Outcomes 36-item Short Form Health Survey (SF-36) were administered at follow-up visits. The main outcome measures were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36. HRQL appears to be relatively stable between 1 and 2 years after injury. In the multivariate linear regression, younger age (β = -0.20, P = 0.032), more severe TBI (β = 0.28, P = 0.016), more severe overall trauma (β = 0.22, P = 0.026), higher levels of community integration (β = 0.36, P = 0.019) and higher positive change in PCS scores from 1 to 2 years (β = 0.41, P < 0.001) predicted better self-reported physical health 2 years post-TBI. Lower scores for depression (β = -0.70, P < 0.001) and a higher positive change in MCS scores (β = 0.62, P < 0.001) predicted better self-reported mental health. Future interventions should focus on aspects related to HRQL that are more easily modified, such as physical functioning, home and social integration, productivity, and mental and emotional status.

Does Compliance with Nutrition Guidelines Lead to Healthy Aging? A Quality-of-Life Approach

We aimed to estimate, in a large French cohort of middle-aged adults derived from the Supplémentation en Vitamines et Minéraux Antioxydants trial, the association of compliance with the guidelines of the French Nutrition and Health Program (PNNS) assessed at inclusion and change in health-related quality of life (HRQoL) over 12 years. A secondary objective was to identify the relative contribution of diet and physical activity to long-term change in HRQoL. Subjects were Supplémentation en Vitamines et Minéraux Antioxydants trial participants aged 45 to 60 years at inclusion in the cohort. Compliance with nutrition guidelines (diet and physical activity) was assessed by the PNNS Guideline Score (maximum 15 points) at inclusion. HRQoL was measured by the Medical Outcomes Survey Short Form 36 (SF-36) at 1 year (initial measurement) and 13 years (final measurement) after inclusion. The primary end point was change in the SF-36 physical component summary (PCS) and mental component summary (MCS) scores over 12 years. In total, 3,005 subjects (mean age 51.4 ± 4.3 years) completed the SF-36 at the initial and final measurement. The mean PNNS Guideline Score was 7.8 ± 1.9 and the mean PCS and MCS was 52.2 ± 6.4 and 50.3 ± 7.0, respectively, at the initial measurement and 48.0 ± 9.6 and 51.2 ± 8.7 at the final measurement. Better compliance with nutritional guidelines was associated with better initial and final HRQoL but not associated with change in HRQoL. Compliance with dietary guidelines was associated with positive change in PCS score but not associated with initial PCS score. In contrast, compliance with dietary guidelines was related to positive initial MCS score but not related to change in MCS score. Compliance with physical activity guidelines was related to initial PCS and MCS scores but not related to change in PCS and MCS scores. Following physical activity guidelines may be associated with better concomitant HRQoL and following dietary guidelines with better future physical HRQoL.

First-Year Trends in Self-reported General Health Predict Survival in Patients With Head and Neck Cancer

To demonstrate that first-year trends in a self-reported subjective general health assessment tool can provide prognostic information and help predict long-term survival in patients with head and neck cancer. Prospective observational cohort study. Tertiary care center. Four hundred three patients with head and neck cancer who were enrolled in a longitudinal outcomes project between January 1, 1995, and December 31, 2005. Self-reported general physical health assessments were collected using the Medical Outcomes Study 36-Item Short-Form Health Survey at diagnosis (pretreatment) and at 3, 6, 9, and 12 months after diagnosis. Actuarial 5-year observed (all deaths) and disease-specific (death with cancer present) survival. Mean physical component summary (PCS) scores decreased at 3 months in all patient groups. While patients who died within the second or third year exhibited virtually no recovery, those who died within the fourth or fifth year exhibited some recovery, and those who survived 5 years or longer approached baseline PCS scores by 12 months. Shorter survival correlated with a greater net decrease in PCS score at 12 months. Groups based on pretreatment and 12-month PCS scores had significantly different survival curves. The net change in PCS score at 12 months (DeltaPCS) was a predictor of both observed and disease-specific survival at univariate analysis and an independent predictor of disease-specific survival in multivariate analysis. First-year trends in the 36-Item Short-Form Health Survey PCS score, a self-reported subjective measure of general physical health, are predictive of long-term survival.

Determinants of Change in Quality of Life from 1 to 6 Months following Acute Stroke

Background and Purpose: Little information is available about change in health-related quality of life (HRQoL) during the first few months following acute stroke, and whether baseline variables can predict who will have the largest improvement in HRQoL. This study assessed the change in HRQoL from 1 to 6 months following acute stroke and the determinants of these changes. Methods:Patients >60 years of age, who had experienced an acute stroke and were admitted to hospital within 24 h of onset, were followed longitudinally. HRQoL was assessed with the Short Form 36 (SF-36) health status questionnaire. Results:Of 550 eligible stroke patients, 315 fulfilled the inclusion criteria and were alive after 30 days. At 1 month, 179 patients responded to the questionnaire, of whom also 140 responded at 6 months following acute stroke. From 1 to 6 months following stroke, all dimensions of the SF-36 improved. The magnitude of change was largest on the role-physical and role-emotional scales and lowest on the bodily pain and mental health scales. Higher physical component summary (PCS) score at 1 month was associated with lower odds of being above the 75th percentile of change in PCS score between the assessments, and higher baseline mental component summary (MCS) score was associated with lower odds of being above the 75th percentile of change in MCS. Treatment in a stroke unit was associated with an increase in the MCS score and higher neurological score with an increase in PCS score of the SF-36. Conclusion: This prospective study showed a considerable improvement in HRQoL from 1 to 6 months after stroke; however, no baseline variables except baseline scores were associated with changes in HRQoL during the 5-month period.

Burden of medical illness in drug- and alcohol-dependent persons without primary care.

Little is known about the frequency, severity, and risk factors for disease in drug- and alcohol-dependent persons without primary medical care. Our aims are to assess the burden of medical illness, identify patient and substance dependence characteristics associated with worse physical health, and compare measures of illness burden in this population. This was accomplished through a cross-sectional study among alcohol-, heroin- or cocaine-dependent persons without primary medical care who were admitted to an urban inpatient detoxification unit. The mean age of these patients was 35.7 (SD 7.8) years; 76% were male and 46% were Black. Forty-five percent reported being diagnosed with a chronic illness, and 80% had prior medical hospitalizations. The mean age-adjusted SF-36 Physical Component Summary (PCS) score was lower than the general U.S. population norm (44.1 vs 50.1; p<0.001). In multivariable analysis, female gender (adjusted mean change in PCS score: -3.71 points, p=.002), problem use of hallucinogens (-3.51, p=0.013), heroin (-2.94, p=0.008), other opiates (-3.20, p=.045), living alone (-3.15, p=.023), having medical insurance (-2.26, p=0.014) and older age (-.22 points per year, p=0.001) were associated with worse health. From these data, it seems that alcohol- and drug-dependent persons without primary medical care have a substantial burden of medical illness compared to age- and gender-matched U.S. population controls. While the optimal measure of medical illness burden in this population is unclear, a variety of health measures document this medical illness burden in addicted persons.

Poster 73: Does inpatient rehabilitation affect long-term perceived health status after total hip or knee replacement for osteoarthritis

Objective: To compare baseline characteristics and change in perceived health status 1 year after total hip (THR) or knee (TKR) replacement between patients who received inpatient rehabilitation (IR) and those who did not (NR). Design: Longitudinal pre-post outcomes study. Assessments were conducted before and 10 to 14 months after surgery. Setting: Large tertiary care orthopedic surgery center. Participants: Consecutive patients, scheduled for primary unilateral THR or TKR, with a diagnosis of osteoarthritis (OA). Interventions: Inpatient subacute rehabilitation. Main Outcome Measures: Medical Outcomes Survey Short-Form 36-Item Health Survey (SF-36) Physical Component Summary (PCS); and questionnaires from the American Academy of Orthopaedic Surgeons Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). Results: Baseline data was obtained on 299 patients, and 212 patients returned a follow-up questionnaire. 80% of respondents received inpatient rehabilitation. The IR and NR groups differed significantly in age ( P<.001), gender ( P<.001), presence of a caregiver ( P<.002), education level ( P=.008), number of comorbidities ( P<.001), symptom severity ( P=.001), and baseline PCS (median for IR, 29.1; for NR, 35.3; P<.001). After adjusting for significant predictors, regression analysis showed no significant association between inpatient rehabilitation and change in PCS scores. Conclusions: Inpatient rehabilitation does not affect long-term change in perceived health status after THR or TKR for OA. However, in practice, patients referred to inpatient rehabilitation are more likely to present a combination of unfavorable characteristics, which may negatively impact their functional recovery after surgery. A randomized controlled study is needed to further investigate the usefulness of inpatient rehabilitation in this population.