Physical Function Scale Research Articles

Psychometric Evaluation of the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-Fatigue) in Patients with Chronic Lymphocytic Leukemia (CLL)

Introduction: The shift toward long-term, targeted therapies for patients with CLL requires fit-for-purpose patient-reported outcome instruments (PROs) to assess overall treatment benefit. The FACIT-Fatigue is designed to assess fatigue-related symptoms and their impact on daily functioning, with extensive published evidence of its reliability and validity in cancer populations, although not specifically for CLL. This study evaluates the psychometric properties of the FACIT-Fatigue in patients with relapsed or refractory CLL to determine if it is fit-for-purpose in this population. Methods: Data were from baseline assessments in a multicenter, open-label, phase 3 study that enrolled patients with relapsed or refractory CLL (ClinicalTrials.gov Identifier: NCT02970318). Patients completed the following PROs at baseline: FACIT-Fatigue; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC QLQ-C30); and EuroQol 5-Dimension 5-Level instrument (EQ-5D-5L), including its global health visual analog scale (EQ-VAS). The FACIT-Fatigue includes a 5-item symptom scale (Sx) and an 8-item impact scale (Imp) that together make up the 13-item Total score. Item responses range from 0 ("not at all") to 4 ("very much"). Scores for negatively worded items are reversed, such that higher scores are better (i.e. less fatigue). The EORTC QLQ-C30 contains 8 multi-item function (Physical, Role, Cognitive, Emotional, Social) and symptom (Fatigue, Pain, Nausea/Vomiting) scales, 5 single-item symptom scales (Dyspnea, Insomnia, Appetite Loss, Constipation, Diarrhea), a Global Health Status scale and a single-item financial impact scale. The EQ-5D-5L comprises five impairment-related dimensions (Mobility, Self-care, Usual Activities, Pain/Discomfort, Anxiety/Depression). EQ-VAS is a 0-100 scale of a patient's health status. FACIT-Fatigue psychometric assessments included descriptive statistics for items and scales, item-to-item and item-to-total analysis, internal consistency reliability and construct (convergent and known-groups) validity. Convergent validity was assessed based on correlations with the EORTC QLQ-C30 and EQ-VAS. Baseline known-groups were defined by Eastern Cooperative Oncology Group (ECOG) status (0 or 1 vs. 2), hemoglobin level (<110 g/L vs. ≥110 g/L) and constitutional symptoms (night sweats, fever, unexplained weight loss, significant fatigue [none vs. ≥1 symptom]). Cluster analysis (based on groupings by FACIT-Fatigue and EORTC QLQ-C30 scores) was performed to identify a FACIT-Fatigue severity cut-off score. Results: Baseline PRO data were available for 263 patients. Mean scores ranged from 1.01 to 1.84 for Sx items and from 0.40 to 2.23 for Imp items. The proportion of patients answering "not at all" was >25% for 1 of 5 Sx items but for 7 of 8 Imp items, indicating that at baseline there was low impact of fatigue on activities. Most item-to-item correlations and all item-to-total correlations were moderate to strong (Spearman's rank correlation coefficient r≥0.3). The FACIT-Fatigue demonstrated good internal consistency reliability, with Cronbach's coefficient α of 0.87, 0.86 and 0.91 for the Sx, Imp and Total scores, respectively. Sx, Imp and Total scores correlated strongly with the EORTC QLQ-C30 Global Health Status, Physical Function, Role Function and Fatigue scale scores, and the EQ-5D-5L VAS score (all Spearman's r≥0.5), demonstrating convergent validity. Weak correlations (r≤0.3) were observed between the FACIT-Fatigue scales and the EORTC QLQ-C30 Insomnia, Constipation and Diarrhea scales, indicating that there is no relationship between fatigue and these symptoms, and demonstrating discriminant validity. Known-groups validity of the FACIT-Fatigue scales was demonstrated by significant differences between groups defined by baseline ECOG status, hemoglobin level, and constitutional symptoms (Table). Cluster analysis supported a FACIT-Fatigue Total score threshold of either 30 or 34 (Cohen's kappa coefficients of 0.76 and 0.67, respectively) to define a severe fatigue population. Conclusions: Psychometric analyses in patients with relapsed or refractory CLL demonstrated that the FACIT-Fatigue has good psychometric properties and is fit-for-purpose in this population. Results support the use of the FACIT-Fatigue in these patients in the clinical trial setting. Disclosures Eek: AstraZeneca: Employment, Equity Ownership. Ivanescu:Astellas: Consultancy. Kool-Houweling:IQVIA: Employment. Cella:FACIT.org: Equity Ownership.

Improvements in Health-Related Quality of Life and Symptoms in Patients with Previously Untreated Chronic Lymphocytic Leukemia: Final Results from the Phase II GIBB Study of the Combination of Obinutuzumab and Bendamustine

Improvements in Health-Related Quality of Life and Symptoms in Patients with Previously Untreated Chronic Lymphocytic Leukemia: Final Results from the Phase II GIBB Study of the Combination of Obinutuzumab and Bendamustine

Reliability and validity of the Arabic translation of the palliative performance scale.

The aim of this study was to translate the Palliative Performance Scale (PPSv2) into Arabic and to test the reliability and validity of the PPS Arabic translation (PPS-Arabic). The PPSv2 was translated into Modern Standard Arabic using a forward-backward method. Inter-rater and intra-rater reliabilities were tested in a pilot study that included 20 patients. The validation study included 150 cancer patients. Patients were divided according to their treatment plan into three groups (in-remission, palliative chemotherapy, and best supportive care) to perform hypothesis-testing construct validity. Validity was further evaluated by correlating PPS-Arabic with the Karnofsky Performance Scale (KPS), the Eastern Cooperative Oncology Group (ECOG) scale, and Physical Functioning (PF2) and Role Functioning (RF2) scales of the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30). The intraclass correlation coefficients for the intra-rater and inter-rater reliability were 0.935 (95% CI: 0.88-0.965; p < 0.001) and 0.965 (95% CI: 0.934-0.981; p < 0.001), respectively. The PPS-Arabic internal consistency Cronbach's alpha was 0.986. The average PPS-Arabic score differed significantly (p < 0.001) between the three groups of patients being 89 for in-remission, 58 for palliative chemotherapy, and 38 for best supportive care. The PPS-Arabic score correlated significantly (p < 0.001) with the KPS, ECOG performance scale, and the EORTC QLQ-C30 PF2 and RF2 scales. The PPS-Arabic is a reliable and valid tool for the assessment of performance status of cancer patients.

A Walking Intervention to Increase Weekly Steps in Dialysis Patients: A Pilot Randomized Controlled Trial

Patients receiving dialysis report very low physical activity. We implemented a pilot trial to assess the feasibility of a pedometer-based intervention to gather preliminary evidence about its impact on physical activity, symptoms, and surrogates of cardiovascular risk. Pilot randomized controlled trial. 60 dialysis patients from San Francisco dialysis clinics. Participants were randomly assigned 1:1 to receiving pedometers with weekly step goals or usual care for 3 months. The primary outcome was step counts, measured using pedometers. Secondary outcomes included physical performance using the Short Physical Performance Battery, the Physical Function and Vitality scales of the 36-Item Short Form Health Survey, the Dialysis Symptoms Index, and the Center for Epidemiologic Studies-Depression Scale, with endothelial function as a secondary and heart rate variability as an exploratory surrogate measure of cardiovascular risk. Targeted enrollment was 50% and targeted completion was 85%. 49% of approached patients were enrolled, and 92% completed the study. After 3 months, patients randomly assigned to the intervention (n=30) increased their average daily steps by 2,256 (95% CI, 978-3,537) more than the 30 controls (P<0.001). Heart rate variability (standard deviation of N-N intervals) increased by 14.94 (95% CI, 0.31-33.56) millisecondsin the intervention group as compared with controls (P= 0.05). There were no statistically significant differences across intervention groups in symptoms, physical performance, or endothelial function. Participants in the intervention group reverted to baseline steps during the postintervention follow-up. The Northern California study setting may limit generalizability. Walking does not capture the full spectrum of physical activity. A short-term pedometer-based intervention led to increased step counts in dialysis patients, but the increase was not sustained. Pedometer-based interventions are feasible for dialysis patients, but future studies are needed to address whether more prolonged interventions can improve physical function or symptoms. Supported by grants from the American Kidney Fund, National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases, and International Society of Nephrology. Registered at ClinicalTrials.gov with study identifier NCT02623348.

Health-related quality of life in non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation with tyrosine kinase inhibitors treatment: a systematic review

Tyrosine Kinase Inhibitors (TKIs) have been recommended by the National Comprehensive Cancer Network (NCCN) as first-line therapy in Non-Small Cell Lung Cancer (NSCLC) patients with EGFR mutations. In addition to prolonging Progression-Free Survival and Overall Survival, one of the treatment goals also considers improving the health-related quality of life (HRQOL), which can help to achieve the patients' treatment targets. Several systematic review studies related to HRQOL in advanced NSCLC patients have already been carried out, but there are only a few studies of HRQOL in NSCLC patients who experience EGFR mutations and are treated with TKIs in their specific treatment. This Systematic review aims to provide an overview of the impact of TKIs on HRQOL. Relevant studies were identified from Science Direct, PubMed, and Scopus. They were limited to articles explaining TKIs as first-line therapy, written in English, not a systematic review or meta-analysis, and not containing incomplete text. Electronic data-based search produced 112 articles, with 21 articles matched the title and abstract, yet only nine articles met the inclusion and exclusion to be reviewed. In general, the impact of HRQOL on TKIs is better than platinum and placebo-based chemotherapy. Afatinib, erlotinib, and gefitinib further improved HRQOL compared to platinum and placebo-based chemotherapy seen from the improvements in symptoms, physical function, and social function scale. However, gefitinib vs erlotinib showed no significant difference in patients’ the quality of life. TKIs provide better HRQOL than platinum and placebo-based chemotherapy.

Preoperative PROMIS Scores as a Predictive Method for Postoperative Success in Posterior Tibial Tendon Dysfunction Surgery

Category:HindfootIntroduction/Purpose:Patient Reported Outcomes Instrumentation System (PROMIS) pain interference (PI) and physical function (PF) scales were recently validated for foot & ankle surgery. Few studies have explored PROMIS in advanced posterior tibial tendon dysfunction (PTTD) surgery. We examined the change in PROMIS scores after PTTD reconstruction surgery and aimed to determine whether preoperative PROMIS scores, radiographic data, and demographic data can model and predict surgical improvement.Methods:PF and PI scores were prospectively obtained on 215 patients between November 2013 and May 2017. Of the 34 patients who had PTTD surgery, 25 patients were included with a minimum follow-up of 7-months (mean 21.8). Paired t-tests and multivariable linear regression models tested the difference in PROMIS scores pre- to postoperatively. Minimal clinically important differences (MCID) and receiver operator curve (ROC) analysis determined the accuracy of using preoperative scores in predicting postoperative change. The MCID for PROMIS PI and PF was defined as half of its respective standard deviation.Multivariable linear regressions with preoperative PROMIS scores, changes in radiographic imaging, and BMI were created to model change in PROMIS scores.Results:There was a significant difference in pre- to postoperative mean PI PROMIS scores (p = 0.0016, average change = -7.16). Mean PF scores improved postoperatively, but not significantly (p = .0595, average change = +4.17). Improvement in PI remained significant (p= 0.02) after adjusting for significant predictors (education level and diabetes status). Multivariable regression models utilizing preoperative PROMIS scores, radiographic variables, and BMI were unable to predict changes in PF and PI scores (p > 0.05). Using pre-determined MCID criteria, 68% achieved surgical success for PI (defined as change of at least -3.45) and 52% achieved surgical success for PF (defined as change of at least +3.00). However, preoperative PI (p=0.310) and PF (p=0.054) scores were unable to significantly predict MCID surgical success or failure.Conclusion:After major PTTD reconstruction, PI scores improve to significance but PF scores may not. After PTTD reaches an advanced stage, surgery may provide significant pain relief and improvement in physical function and radiographic parameters, but it may be difficult to predict clinical improvement based solely on preoperative PROMIS scores. Realistic expectations of improvements in pain and functionality should be maintained postoperatively in advanced PTTD surgery.

234P - Effects of supervised and adapted exercise program in the quality of life and strength of breast cancer survivors: MAMA MOVE Gaia trial

BackgroundTreatments for early breast cancer have side effects that affect quality of life (QoL) and cause deconditioning. Physical exercise might have a supportive and coadjuvant role in the rehabilitation of breast cancer survivors. We aimed to analyse the preliminary results of a community-based supervised exercise training program on QoL and muscle strength in breast cancer survivors. MethodsTwenty breast cancer female survivors were recruited to a single-arm clinical trial consisting of sequential 16 weeks (wk) of control phase (CP) and 16 wk intervention phase (IP). Four evaluations were carried out: M1 (8 wk on CP), M2 (immediately previous IP), M3 (8 wk CP) and M4 (16 wk IP). The IP consisted of 3 sessions per week of combined aerobic and strength exercise (60min) at moderate to vigorous exercise (65-85% of maximum heart rate or 6-8 points on OMNI scale). The primary endpoint was QoL, which was evaluated by EORTC QLQ-C30 questionnaire. Secondary endpoints included handgrip strength and sit-to-stand (STS) test. ResultsOf the 20 recruited women, 19 initiated and 15 concluded the program, with a mean compliance to the exercise intervention of 63.6%. The median age was 59 years old (39-72). All but 3 were diagnosed with invasive carcinoma. After surgery, 13 (62%) underwent radiotherapy, 15 (71%) chemotherapy and 18 (86%) were under hormonotherapy. During the control phase, no significant differences were observed in the efficacy variables. There was no changes over time for any domain of QoL, except for physical functioning scale (p=0.038), where it was observed a trend to increase between M2 and M3 (77.3±14.0 to 85.3±10.1, p=0.051). A significant increase in handgrip strength of non-operated (22.2±3.9 to 25.6±5.3kg.f, p=0.004) and operated limb (22.6±4.7 to 26.9±6.6kg.f, p=0.001) was shown after exercise training. Similar results were also observed for STS test [12 (11-13.5) to 17 (13-21) repetitions, p=0.002]. ConclusionsAn exercise program appears to be beneficial for QoL, particularly in the physical functioning of breast cancer survivors. Moreover, it seems to have an important role on strength levels. Legal entity responsible for the studyAssociação de Investigação e Cuidados de Suporte em Oncologia. FundingLiga Portuguesa Contra o Cancro. DisclosureAll authors have declared no conflicts of interest.

675PD - POLO: Health-related quality of life (HRQoL) of olaparib maintenance treatment versus placebo in patients with a germline BRCA mutation and metastatic pancreatic cancer (mPC)

675PD - POLO: Health-related quality of life (HRQoL) of olaparib maintenance treatment versus placebo in patients with a germline BRCA mutation and metastatic pancreatic cancer (mPC)

Effects of silent myocardial ischemia on functional fitness and physical independence in 60–79-year-old adults

ObjectiveWe examined the effect of silent myocardial ischemia (SMI) on functional fitness levels and physical independence in 60–79-year-old individuals. MethodsWe conducted a cross-sectional study with 716 older adults and used an electrocardiograph and an ambulatory electrocardiogram to diagnose those with SMI. Physical independence was assessed using the Composite Physical Function scale, whereas physical fitness was assessed using the Senior Fitness Test battery. ResultsThe 60-79-year-old females and males with SMI were more likely to have lower scores for lower and upper body strength, agility/dynamic balance, and aerobic endurance (p < 0.05) than those without SMI. The scores for lower and upper body flexibility in all age groups for both genders were not significant (p > 0.05). Binary logistic regression analysis revealed that old adults with SMI had a higher risk of losing physical independence later in life than those without SMI (p < 0.05). ConclusionThis study showed that individuals with SMI have lower fitness levels and increased risk of losing physical independence than those without SMI.

Health-Related Quality of Life and Cosmesis After Thyroidectomy: Long-Term Outcomes.

Health-related quality of life (HRQoL) after thyroidectomy has been recently reported with conflicting conclusions. In this study, we assess HRQoL and neck scar cosmesis of thyroid patients several years after thyroidectomy for benign and malignant pathology. Three hundred and thirty patients who underwent thyroidectomy between 2000 and 2010 answered the SF-36 Health Survey and Patient Scar Assessment Questionnaire (PSAQ) in 2010 and at the end of 2018. Changes in the SF-36 and PSAQ scores were analyzed taking into account various demographic, surgical and medical characteristics of the patients. Patients reported worse SF-36 scores after 8.5years, in scales of physical functioning (p < 0.001), social role functioning (p = 0.002), bodily pain (p = 0.001) and general health perceptions (p < 0.001). Interestingly enough, there were no significant changes in scales of physical role functioning (p = 0.304), mental health (p = 0.681), emotional role functioning (p = 0.903) and vitality (p = 0.121). Multivariate analysis showed that several chronic diseases were related to worse HRQoL scores. On the other hand, PSAQ appearance, symptoms and consciousness scores improved during this period (p < 0.001). In the long term, patients undergoing thyroidectomy do not show worse HRQoL outcomes in terms of mental health, emotional functioning and vitality, whereas scar cosmesis perception is improved. They show deteriorated outcomes in terms of physical, social functioning and bodily pain, which is mainly related to specific chronic diseases that are common to the aging person.

Social Network Mapping and Functional Recovery Within 6 Months of Ischemic Stroke

Objective. Stroke recovery is a multidimensional process influenced by biological and psychosocial factors. To understand the latter, we mapped the social networks of stroke patients, analyzing their changes and effects on physical function at 3 and 6 months after stroke. Methods. We used a quantitative social network assessment tool to map the structure and health habits embedded in patients’ personal social networks. The physical function outcome was determined using the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Scale (0-100, mean 50 for US general population). We used mixed-effects models to assess changes in social network metrics. We used multivariable models to test the association between social networks and physical function, independent of demographics, socioeconomic status, clinical characteristics, comorbidities, cognition, and depression. Results. The cohort consisted of 172 patients, with mostly mild motor-predominant stroke (median NIH Stroke Scale of 2) with retention of 149 at 3 months and 139 at 6 months. An average patient’s network over 6 months contracted by 1.25 people and became denser and family oriented. Network composition also became healthier with pruning of ties with people who smoked or did not exercise. The baseline network size, and not density or health habits in the network, was independently associated with 3- and 6-month physical function PROMIS scores. Patients embedded in small kin-based networks reported more negative social interactions. Conclusions. Despite social networks becoming smaller and close-knit after stroke, they also become healthier. Larger baseline social networks are independently associated with better patient-reported physical function after stroke.

Generic and psychological patient-reported deficits in those with chronic ankle instability: A cross sectional study

ObjectivesTo quantify differences in generic and psychological patient-reported outcomes (PROs) between those with CAI and uninjured controls. To determine associations between generic and psychological PROs, in those with CAI, to regional PROs and injury history characteristics. DesignCross-sectional, descriptive. SettingSport Medicine Research Laboratory. ParticipantsIncluded 45 individuals with CAI and 45 uninjured controls. CAI was defined based on the recommendations of the International Ankle Consortium. Main outcome measuresTwo regional PROs (e.g. Foot and Ankle Ability Measure), and several generic and psychological PROs (e.g. SF-36, select PROMIS short forms, Fear Avoidance Beliefs Questionnaire). ResultsThose with CAI had worse scores, relative to controls, in PROs related to regional function, generic physical function, pain, ability to participate in social roles and activities, and injury related fear. The number of giving way episodes, CAI severity, and regional PROs associated with generic physical function scales as well as a pain scale. ConclusionsSelect generic physical function and psychological scales can detect differences between those with and without CAI. Specific injury history characteristics and regional PROs associate with generic and psychological PROs.

The psychosocial needs and quality of life of family caregivers of patients with organ transplant.

Families of patients with organ transplants experience many problems, both with the onset of illness and during the hospitalisation of their relative for an organ transplant. The healthcare providers try their best to give high-quality care to patients. However, they neglect quality of life and psychosocial needs of family caregivers. This study aimed to assess the psychosocial needs and quality of life of the family caregivers of post-transplant patients and the relationship between these two variables. This descriptive correlational study was conducted on liver, kidney and bone marrow transplant wards in the largest transplant centre affiliated with a university of medical science in south-eastern Iran. The sample included 230 family caregivers of post-transplant patients, who were selected using quota sampling. Data were collected using the 45-item questionnaire of psychosocial needs (the Critical Care Family Needs Inventory) with five dimensions (assurance, comfort, information, proximity and support), and the Short Form-36 Quality of Life questionnaire with eight scales (physical functioning, physical problems, emotional problems, social functioning, pain, vitality, mental health and perception of health). In the Critical Care Family Needs Inventory, 1 indicates not important and 4 very important. In the Short Form-36 Quality of Life questionaire, 0 indicates the worst health and 100 the best health. The participants rated the mean of their psychosocial needs as important (3.18 ± 0.27). Also, the mean of quality of life of participants was at an undesirable level (45.17 ± 92.66). The psychosocial needs of the caregivers showed a poor, inverse significant relationship with their quality of life (r = -0.16, p = 0.01). The results showed that with increasing psychosocial needs of family caregivers of post-transplant patients, their quality of life declines. Healthcare providers should implement developed plans and appropriate strategies to fulfil psychosocial needs and improve the quality of life of family caregivers of these patients.

Relationship between motivation, adherence to diet, anxiety symptoms, depression symptoms and quality of life in individuals with celiac disease

ObjectiveCeliac disease is an immuno-mediated pathogenesis disease characterised by a malabsorption of nutrients that causes partial or total atrophy of intestinal villi and the alteration of the absorbing epithelium. Several studies have demonstrated the presence of anxiety and depression symptoms and poor quality of life in people with celiac disease and emphasised the importance of diet in modulating these effects. However, few studies have investigated the role of motivation and the relationship it has with these factors. The purpose of this study was to fill this gap and investigate the relationship between motivation, diet adherence, anxiety symptoms, depression symptoms and physical functioning in people with celiac disease. MethodsQuestionnaires were administered to 433 people with celiac disease aged between 18 and 79 years (M = 32.73, DS = 11.54) to measure anxiety symptoms (State-Trait Anxiety Inventory-Y2), depression symptoms (Beck Depression Inventory), physical functioning (Scale of Physical Functioning), adherence to diet (Celiac Dietary Adherence Test) and motivation (Treatment Self-Regulation Questionnaire). ResultsWe used Structural Equation Modelling to examine the relationships of variables. Results revealed a direct relationship between motivation and diet adherence, anxiety symptoms, depression symptoms and physical functioning. They also illustrated the role played by diet adherence in mediating the relationship between motivation and anxiety symptoms, depression symptoms and physical functioning. ConclusionThe results highlight the vital role played by motivation in people; indeed, analysis showed that motivation correlated to adherence to diet. It is therefore necessary to take this factor into account in the treatment of individuals with celiac disease.

Level of motor, sensory and functional impairment from stroke at admission and hospital discharge in Brazil

ABSTRACTPrimary Objective: To compare the level of motor, sensory and functional impairment of individuals hospitalized in a stroke unit in Brazil at the time of admission and the profile observed at hospital discharge.Design: Observational and longitudinal outcome study.Methods and Procedure: We assessed 41 patients with ischemic stroke at admission and hospital discharge by using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Physical Performance Scale (FM), Functional Independence Measure (FIM) and Modified Rankin Scale (mRS) and divided in the group that received or not the thrombolytic therapy. Were used wilcoxon and spearman tests.Results: Significant differences were found between admission and hospital discharge assessment (p < .0001) indicating clinical improvement for individuals submitted to thrombolytic treatment. A moderate correlation was observed for total FM and total FIM (ρ = 0.729; p value<.0001); total FM and motor FIM (ρ = 0.705; p value<.0001); and a moderate negative correlation for NIHSS and total FM (ρ = −0.709; p value<.0001). Strong correlation between motor FIM and total FIM was also observed (ρ = 0.972; p value<.0001).Conclusions: Clinical severity was softened along the hospitalization period. The clinical, motor, sensory and functional characterization enlarges the understanding of the stroke sequelae, besides monitoring the deficits and the level of disability in this population in Brazil.

Poor emotional well-being is associated with rapid progression in amyotrophic lateral sclerosis.

The study aimed to determine the impact of emotional well-being on disease aggressiveness and survival in amyotrophic lateral sclerosis (ALS). In 224 patients with ALS (without significant cognitive deficits) the revised ALS Functional Rating Scale (physical function), the ALS Assessment Questionnaire (ALSAQ-40) for health-related Quality of Life and survival data were collected. Data analysis comprised logistic regression, Kaplan-Meier curves analyses and Cox regression model. Most patients reported to be worried about how the disease will affect them in the future and 67% reported to feel depressed. Patients with good emotional well-being were characterized by better physical function (higher ALSFRS-R) and lower disease aggressiveness. The association between high emotional well-being and lower disease aggressiveness was confirmed in the univariate analysis and also after adjustment for known predictors of disease progression. In the Kaplan-Meier survival curve analysis the overall 1-year, 2-year and 3-year mortality did not significantly differ between patients with poor and good emotional well-being. Our study demonstrates an association between emotional well-being and disease progression. Knowing that subjective well-being is neither a necessary nor a sufficient cause of health, longitudinal studies are necessary to explore when well-being does and does not influence disease progress and survival in ALS.

Quality of life in patients with bronchiectasis: a 2-year longitudinal study.

Bronchiectasis is a condition of increasing incidence and prevalence in the United States, defined by the presence of bronchial dilatation on chest-computed tomography. Most patients suffer from chronic daily cough and sputum production. Patients suffering from this disease often have a poor health-related quality of life (HRQoL), with increased morbidity and mortality, and increased health care burden. Little is known about trends in HRQoL among patients with bronchiectasis, therefore, we examined these trends over 2 years using a bronchiectasis-specific HRQoL instrument. We present data obtained from administering the Quality of Life-Bronchiectasis (QOL-B) questionnaires at three time points: (I) baseline at the time of first visit to the University of Connecticut Center for Bronchiectasis Care; (II) 1 year follow-up; and (III) a 2-year follow-up. Responses from the 36-item questionnaire evaluate eight scales (Physical Functioning, Role Functioning, Vitality, Emotional Functioning, Social Functioning, Treatment Burden, Health Perceptions, and Respiratory Symptoms); scores are standardized on a 0-100 point scale with higher scores indicating better HRQoL. Twenty-six patients provided baseline QOL-B data, with seven lost to follow-up, leaving nineteen patients in the longitudinal study. Statistically significant improvement between the initial visit and the one-year follow-up visit was shown in three of the eight domains: Physical Functioning, Role Functioning, and Health Perceptions. At 2 years, these improved HRQoL scores were generally maintained. This study demonstrates patients with bronchiectasis can demonstrate improved HRQoL after treatment at a specialized care center and these improvements are maintained for most patients 2 years after the initial visit.

Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence

Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. The objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension. This planned secondary analysis of a 2× 2 factorial randomized trial included 374 women randomized to receive uterosacral (n= 188) or sacrospinous (n= 186) vaginal vault suspension to treat both stages 2-4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers. Participants were also randomized to receive perioperative pelvic muscle therapy or usual care. All patients received transvaginal native tissue repairs and a midurethral sling. Participants completed the Surgical Pain Scales (0-10 numeric rating scales; higher scores= greater pain) and Activity Assessment Scale (0-100; higher score= higher activity) prior to surgery and at 2 weeks, 4-6 weeks, and 3 months postoperatively. The MOS 36-item Short-Form Health Survey was completed at baseline and 6, 12, and 24 months after surgery; the bodily pain, physical functioning, and role-physical subscales were used for this analysis (higher scores= less disability). Self-reported pain medication use was also collected. Before surgery, average pain at rest and during normal activity were (adjusted mean ± SE) 2.24 ± 0.23 and 2.76 ± 0.25; both increased slightly from baseline at 2 weeks (+0.65, P = .004, and+0.74, P= .007, respectively) and then decreased below baseline at 3 months (-0.87 and -1.14, respectively, P < .001), with no differences between surgical groups. Pain during exercise/strenuous activity and worst pain decreased below baseline levels at 4-6 weeks (-1.26, P= .014, and -0.95, P= .002) and 3 months (-1.97 and -1.50, P < .001) without differences between surgical groups. Functional activity as measured by the Activity Assessment Scale improved from baseline at 4-6 weeks (+9.24, P < .001) and 3 months (+13.79, P < .001). The MOS 36-item Short-Form Health Survey Bodily Pain, Physical Functioning, and Role-Physical Scales demonstrated significant improvements from baseline at 6, 12, and 24 months (24 months:+5.62,+5.79, and+4.72, respectively, P < .001 for each) with no differences between groups. Use of narcotic pain medications was reported by 14.3% of participants prior to surgery and 53.7% at 2 and 26.1% at 4-6 weeks postoperatively; thereafter use was similar to baseline rates until 24 months when it decreased to 6.8%. Use of nonnarcotic pain medication was reported by 48.1% of participants prior to surgery, 68.7% at 2 weeks, and similar to baseline at 3 months; thereafter use dropped steadily to 26.6% at 2 years. Uterosacral ligament suspension resulted in less new or worsening buttock pain than sacrospinous suspension at 4-6 weeks postoperatively (4.6% vs 10.5%, P= .043) but no difference in groin or thigh pain. Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stages 2-4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4-6 weeks.

Socio-Demographic Pattern of Physical Function and Self-Rated Health of Older Adults in an Oil-Rich State of Nigeria

ABSTRACTThe physical function (PF) and self-rated health (SRH) of older adults (50–80+ years), and the association with their socio-demographic characteristics was investigated in a Nigerian setting. Questionnaire-based SRH and PF scales were used to obtain information from 1480 respondents selected by age-stratified sampling. Although it varied by socio-demographic characteristics (age, gender, marital status, education, economic status, occupation, housing, suburban/urban residence, loneliness) the overall prevalence of poor SRH and PF was 39.2% and 44.1%, respectively. All the socio-demographic factors were predictors of SRH and PF except gender which was not significantly associated with PF (P > .05; OR, 1.28; 95% CL, 0.78–2.10). SRH was significantly (P < .01) associated with the three domains of PF: function (OR = 20.25, 95% CL = 11.18–46.35); satisfaction with physical activity (OR = 3.37, 95% CL = 2.11–5.38); and mobility (OR = 30.00, 95% CL = 16.19–54.60). In conclusion, a welfare scheme guided by socio-demographic factors is required to improve SRH and PF of older adults in this Nigerian setting.

Validity and reliability of the Gout Impact Scale in a multi-ethnic Asian population.

The emphasis on capturing patient-reported outcomes (PRO) is increasing, but gout-specific PRO are lacking. We evaluated the reliability and validity of the 24-item Gout Impact Scale (GIS) of the Gout Assessment Questionnaire 2.0 (GAQ2.0) in a multi-ethnic Asian population. Participants with gout in an academic medical center in Singapore completed the GIS which comprises five scales. Confirmatory factor analyses (CFA) were performed. Known-groups validity, divergent validity and internal consistency were evaluated. We analyzed data of 267 participants (mean [SD] age 52.2 [16.08] years, 92.1% men and 76.0% Chinese). CFA based on the original GIS factor structure had good model fit based on Tucker-Lewis Index (TLI) of 0.946 but not when based on Root Mean Square Error Of Approximation (RMSEA), which was 0.123 (90% CI: 0.116-0.130). Internal consistency of GIS exceeded 0.7 in all except one scale, consistent with previous studies. Hypotheses related to known-groups validity were largely supported. Scores were significantly higher (ie greater impact) for participants reporting at least some problem on the EQ-5D-3L anxiety/ depression item across all GIS scales. Correlations between RAND-36 Physical Functioning (PF) scale and all five scales in the GIS were poor (Spearman rank correlation coefficients: -0.2355 to 0.0426), implying that GIS does not measure impact of gout on physical health. The GIS is valid and reliable for assessing gout-specific psychosocial functioning in a multi-ethnic Asian population.