Physical Function Scale Research Articles

Long-term Follow-up of Lisfranc Injuries Treated With Open Reduction Internal Fixation Patient-Reported Outcomes.

Background:There remains a paucity of data regarding long-term patient-reported outcomes following Lisfranc injuries. We sought to collect long-term clinical outcome data following Lisfranc injuries using PROMIS Physical Function (PROMIS-PF) and visual analog scale–foot and ankle (VAS-FA).Methods:A chart review was performed to identify all patients who had surgical treatment of an acute Lisfranc injury at our institution from 2005 to 2014. Of the 45 patients identified, we were able to recruit 19 for a follow-up clinic visit consisting of physical examination, administration of questionnaires addressing pain and medication usage, radiographs, and completion of outcome surveys including PROMIS-Physical Function and visual analog scale–foot and ankle.Results:There were 14 female and 5 male patients enrolled in the study with a mean time of 6.25 years from the time of injury. Within this cohort, the mean PROMIS-PF score was 52.4±8.2 and the mean VAS–foot and ankle score was 76.6±22.3.Conclusion:We report satisfactory long-term patient-reported outcomes using PROMIS-PF and VAS-FA.Level of Evidence:Level III, retrospective cohort study.

Prophylaxis with ATLG Significantly Improves Chronic Graft-Versus-Host Disease / Relapse-Free Survival and Quality of Life after a Myeloablative HLA Identical Sibling Transplant for Acute Leukemia Patients in Complete Remission. Long-Term Follow-up of the Randomized ATG Familystudy

IntroductionChronic GVHD is a major complication after allogeneic stem cell transplantation (HSCT) affecting both survival and quality of life (QoL). Several strategies are currently used to limit the incidence and severity of GVHD. All but one prospective randomized studies demonstrated in the unrelated and related settings a significant reduction of cGVHD when anti-T cell lymphocyte globulin (ATLG) or anti-thymocyte globulin (ATG) is added to the standard GVHD prophylaxis (cyclosporine and methotrexate) with significant improvement of survival free from relapse and cGVHD (cGRFS), similar overall survival and no increase of relapse risk. In the setting of sibling transplants, the ATGfamilystudy demonstrated that in acute leukemia patients in complete remission the addition of ATLG (Grafalon, NEOVII) at the dose of 10 mg/kg per day from day -3 to day -1 to the standard GVHD prophylaxis within a myeloablative conditioning regimen resulted in a significant reduction of cGVHD (68.7% vs 32.2% at two years), especially of the extensive form (52.4% vs 7.6%) without a significant increase of relapse, infection and non relapse mortality (NRM). Overall survival resulted similar in the two arms while cGRFS was significantly improved (37% vs 16.7%). The risk of relapse is claimed as the major concern for a broader adoption of ATLG in the GVHD prophylaxis and a longer follow-up is strongly claimed by the scientific community to definitely unravel the issue of disease recurrence after in vivo T cell depletion with ATLG.MethodsWe updated the follow-up of the trial NCT 00612875 (Kröger et al. NEJM 2016) and analyzed data of QoL. The primary endpoint was the CI of cGVHD. CI of cGVHD, NRM, relapse, overall survival, disease-free survival and chronic GVHD and relapse-free survival (cGRFS) were analysed. The trial included also quality of life (QoL) questionnaires (EORTC QLQ-30 and HDC29 ) before and after SCT. The QLQ-C30 includes a global QoL scale, 5 functional scales (physical, role, emotional, cognitive and social function) and 9 symptom scales (fatigue, nausea-vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, financial problems).ResultsOut of 155 patients analyzed for safety and efficacy in the randomized study 119 were still alive at study end after 2 years and 114 provided any follow-up data. The median observation time was 5.2 and 6.0 years, in the experimental and control arm, respectively, with a maximum follow-up time >10 years in both groups.The CI of cGVHD overall was 31.3% (95% CI: 22.6% - 43.3%) in the ATLG arm vs 69.1% (95% CI: 59.1% - 80.7%) in the control arm (p <0.001); the CI of relapse was 36.6% (95% CI: 27.5% - 48.7%) and 23.9% (95% CI: 15.8% - 36.2%, p = 0.09). 5-ys overall survival, disease-free survival and cGRFS in the experimental and control arm were 61.8% and 67.1% (p=0.564), 53.6% and 61.7% (p=0.364), 40.4% and 18.1% (p = 0.001), respectively.Patients who received ATLG showed significantly greater improvement of global health status / QoL over time compared to non-ATLG (p=0.02), with a difference between the two arms of 2.8 ± 3.9 points (marginal mean ± SEM) at day 100 and increasing to 10.5 ± 5.3 points at month 24 in favour of ATG. Patients in the ATG arm showed also a significant superiority in 4 of the 5 functional scales as well as for several symptom scales scores such as appetite loss, insomnia, nausea-vomiting and dyspnea. For the QLQ-HDC29, significant treatment effects favoring ATG were observed for side-effects on gastrointestinal effects and impact on family, impact of family, urinary frequency, helping to distinguish what is important in life.ConclusionsThis long-term follow-up of the ATGfamilystudy confirmed a significant benefit of ATLG in reducing chronic GVHD without significant increase of relapse in patients with acute leukemia undergoing HLA-identical sibling allogeneic peripheral stem cell transplantation resulting in a significant benefit in chronic GVHD/relapse-free survival with a significant improved quality of life. DisclosuresBonifazi:Neovii: Honoraria. Solano:Neovii: Honoraria. Bethge:Neovii GmbH: Honoraria, Research Funding; Miltenyi Biotech GmbH: Consultancy, Honoraria, Research Funding. Kroeger:Neovii: Honoraria, Research Funding.

Using Item Response Theory to Identify Responders to Treatment: Examples with the Patient-Reported Outcomes Measurement Information System (PROMIS\xae) Physical Function Scale and Emotional Distress Composite

The reliable change index has been used to evaluate the significance of individual change in health-related quality of life. We estimate reliable change for two measures (physical function and emotional distress) in the Patient-Reported Outcomes Measurement Information System (PROMIS®) 29-item health-related quality of life measure (PROMIS-29 v2.1). Using two waves of data collected 3 months apart in a longitudinal observational study of chronic low back pain and chronic neck pain patients receiving chiropractic care, and simulations, we compare estimates of reliable change from classical test theory fixed standard errors with item response theory standard errors from the graded response model. We find that unless true change in the PROMIS physical function and emotional distress scales is substantial, classical test theory estimates of significant individual change are much more optimistic than estimates of change based on item response theory.

P515 A 12-week tailored physical training program including dietary advice in children with Inflammatory Bowel Disease: a randomized crossover trial

BackgroundInflammatory Bowel Disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract. Recently, physical activity has been suggested to improve the quality of life and course of disease in adult IBD patients. The aim of this study was to investigate physical functioning in paediatric IBD patients and to determine the effects of a tailored 12-week lifestyle intervention including a physical training program.MethodsFigure 1 shows our study design and measurements. The tailored 12-week lifestyle intervention consisted of 3 strenuous physical training sessions a week and dietary advice. Effects on exercise capacity, endurance, physical activity levels, disease activity, quality of life, and fatigue were measured in paediatric IBD patients. Mild disease activity was defined as a PCDAI between 10 - 27.5 or PUCAI between 10 - 34. ResultsSixteen paediatric IBD patients (median age 15 [9 - 17]) were included, 13 patients successfully completed the training program, 2 patients are still participating. At baseline, most patients had mild disease activity (n=9). Patients had reduced exercise capacity (76.8%±17.7% of predicted PeakVO2 , and reduced physical activity levels as shown by 80.3%±7.4% of measured time being spent in sedentary activity. PCDAI/PUCAI scores decreased significantly over the intervention period (13.8±11.7 vs. 3.65±4.5, P=0.002). Fecal calprotectin also decreased significantly (400 [18–3089] vs. 128 [20–2704], P=0.041). All patients but one had no changes in medical regimens before or during the lifestyle intervention that could have influenced disease activity. After the 12-week lifestyle intervention period, 9 out of 13 patients were in clinical remission. Maximum walked distance increased significantly (503±69 vs. 540±77 meters, P=0.001), although PeakVO2 and percentage of time spent in moderate-to-vigorous activity did not. Patients improved on overall quality of life measured by the Impact III questionnaire (+2.4 points, p=0.017). The Child Health Questionnaire showed a significant improvement on the child-reported physical functioning scale and on 5 parent-reported scales of quality of life. Child-reported fatigue measured by the PedsQol MFS did not improve significantly, parents-reported fatigue did. No changes were found on mentioned outcomes during the control period. After baseline measurements, the COVID-19 lock-down period started, possibly affecting normal daytime activities of the patients during the lifestyle intervention period.ConclusionA 12-week tailored physical training program including dietry advice is safe and beneficial for paediatric IBD patients and may contribute to better control of inflammation.

External Validation of the Minimum Clinically Important Difference in the Timed-up-and-go Test After Surgery for Lumbar Degenerative Disc Disease.

Prospective observational cohort study. The aim of this study was to provide external validation of the minimum clinically important difference (MCID) of the Timed-up-and-go (TUG) test. The TUG test is one of the best explored and most frequently applied objective task-based functional outcome measure in patients with lumbar degenerative disc disease (DDD). The increased use of the TUG test is based on its solid psychometric properties; however, an external validation of the originally determined MCID is lacking. Forty-nine patients with lumbar DDD, scheduled for elective spine surgery, were assessed pre- and 6-weeks (W6) postoperative. MCID values were calculate for raw TUG test times (seconds) and standardized TUG z scores using three different computation methods and the following established patient-reported outcome measures (PROMs) as anchors: Visual Analog Scales (VAS), Core Outcome Measures Index Back, Zurich Claudication Questionnaire (ZCQ). The three computation methods generated a range of MCID values, depending on the PROM used as anchor, from 0.9 s (z score of 0.3) based on the VAS leg pain to 3.0 seconds (z score of 2.7) based on the ZCQ physical function scale. The average MCID of the TUG test across all anchors and computation methods was 2.1 s (z score of 1.5). According to the average MCID of raw TUG test values or TUG z scores, 41% and 43% of patients classified as W6 responders to surgery, respectively. This study confirms the ordinally reported TUG MCID values in patients undergoing surgery for lumbar. A TUG test time change of 2.1 seconds (or TUG z score change of 1.5) indicates an objective and clinically meaningful change in functional status. This report facilitates the interpretation of TUG test results in clinical routine as well as in research.Level of Evidence: 3.

Minimally invasive or open oesophagectomy for localized oesophageal cancer: Results of the ROMIO phase 3 randomized controlled trial.

e16057 Background: Patients with localised oesophageal adenocarcinoma or squamous cell cancer are frequently offered surgery, usually with neoadjuvant treatment. Whether minimally invasive surgical approaches are superior to standard open procedures in terms of patient recovery and survival benefit is unclear. Well-designed and well-conducted pragmatic trials are limited. The ROMIO study compared laparoscopic abdominal surgery and thoracotomy (LAO) with open oesophagectomy (OO), to test the hypothesis that LAO allows faster recovery than OO whilst maintaining the survival benefit of surgery. Methods: A pragmatic multi-centre randomised controlled trial (1:1 LAO vs. OO) was conducted in 9 major cancer centres in the UK. Included were patients with localised adenocarcinoma or squamous cell cancer selected by a multi-disciplinary team for oesophagectomy with or without neoadjuvant treatment. Surgery was quality assured by provision of a protocol, pre-operative video assessment of the 40 participating surgeons and intra-operative photographs of key agreed surgical components. The primary outcome was the physical function scale of the EORTC QLQ-C30 assessed during the first 3 months. Results: At enrolment to ROMIO 447 (85%) of 526 participants were male, mean age was 67 years (SD 9), 469 (89%) had an adenocarcinoma, 368 (70%) had a clinically staged T3 or T4a tumour, 295 (56%) had clinically positive nodes, and 438 (83%) underwent neoadjuvant treatment. 263 were randomly allocated to each of the two procedures, with 241 (92%) undergoing their allocated open surgery and 237 (91%) undergoing their allocated LAO (hybrid) surgery. Analyses are underway and this presentation will include the primary outcome measure and other short-term clinical outcomes including key complications and survival during the first 90 days (clinical data &gt;95% complete). Conclusions: ROMIO is the largest multi-centre randomised controlled surgical trial of minimal access versus open surgical approaches for oesophageal cancer. The provision of a surgical quality assessment tool will supplement trial data to provide for the first-time evidence of surgical standards of both approaches. Clinical trial information: ISRCTN10386621.

Measuring Physical Function in Psoriatic Arthritis: Comparing the Multidimensional Health Assessment Questionnaire to the Health Assessment Questionnaire–Disability Index

To compare physical function scales of the Multidimensional Health Assessment Questionnaire (MDHAQ) with that of the Health Assessment Questionnaire-Disability Index (HAQ-DI) in patients with psoriatic arthritis (PsA), and to examine whether either questionnaire is less prone to "floor effects." Data were collected prospectively from 2018 to 2019 across 3 UK hospitals. All patients completed physical function scales within the MDHAQ and HAQ-DI in a single clinic visit. Agreement was assessed using medians and the Bland-Altman method. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability. Two hundred ten patients completed the clinic visit; 1 withdrew consent. Thus, 209 were analyzed. Sixty percent were male, with mean age of 51.7 years and median disease duration of 7 years. In clinic, median MDHAQ and HAQ-DI including/excluding aids scores were 0.30, 0.50, and 0.50 respectively. Although the median score for HAQ-DI was higher than for MDHAQ, the difference between the 2 scores was mostly within 1.96 SDs from the mean, suggesting good agreement. The ICCs demonstrated excellent test-retest reliability for both the MDHAQ and HAQ-DI. Similar numbers of patients scored 0 on the MDHAQ and HAQ-DI including/excluding aids (48, 47, and 49, respectively). Using a score of ≤ 0.5 as a cutoff for minor functional impairment, 23 patients had a MDHAQ ≤ 0.5 when their HAQ-DI including aids was > 0.5. Conversely, 4 patients had a MDHAQ > 0.5 when the HAQ-DI including aids was ≤ 0.5. Both the MDHAQ and HAQ-DI appear to be similar in detecting floor effects in patients with PsA.

Individual and cumulative health afflictions are associated with greater impairment in physical and mental function in former professional American style football players.

BackgroundFormer American style football players (ASF players) have recognized health concerns associated with prior sport participation. It remains unknown whether categorizations of current health conditions, referred to in this report as afflictions (conceptually framed as neurocognitive, cardiovascular, cardiometabolic, sleep apnea, and chronic pain) are associated with physical and mental function.ObjectiveTo evaluate the association of afflictions to physical and mental function. It was hypothesized that former National Football League players with any affliction would have worse function compared to unafflicted participants. It was anticipated that multiple afflictions would result in cumulative loss of function.DesignCross‐sectional retrospective design.SettingAcademic medical multisite hospital system.ParticipantsA total of 3913 of 15,611 former ASF players who played professionally from 1960 to 2019 (response rate 25%). Assessment of Risk Factors Self‐report survey.Main Outcome MeasuresEach participant completed the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale and Physical Function questionnaires. Responses were used to generate two physical function and one mental function subscale scores. Raw scores were converted to T‐scores categorized as impaired (T‐score < 40) or unimpaired (T‐score ≥ 40). Primary analyses measured the association of affliction to function (impaired or unimpaired).ResultsAfter adjusting for confounders (age, race, position, number of seasons, age of first exposure to football, alcohol use, smoking history, and current body mass index), each affliction was associated with reduced physical function on the Global physical function subscale (risk ratio [RR] = 1.23‐2.45, all P < .005), physical function scale (RR = 1.24‐2.75, all P < .01), and mental function scale (RR = 1.34‐2.87, all P < .001), except that cardiovascular affliction was not associated with mental function (RR = 1.15, P = .15). The lowest functional measures were observed in those afflicted by chronic pain. Cumulative afflictions were associated with worse function.ConclusionsAfflictions are associated with cumulative reduction of function. Research evaluating how afflictions interact may help elucidate mechanisms for illness and develop interventions to optimize function.

Feasibility of exercise and weight management for people with hip osteoarthritis and overweight or obesity: A pilot study

ObjectiveDetermine the feasibility of a 6-month exercise and weight management intervention for people with hip osteoarthritis (OA). Design18 participants with clinical and radiographic hip OA with a body mass index ≥28 ​kg/m2 and <41 ​kg/m2 participated. Six consultations with a physiotherapist and six consultations with a dietitian via videoconferencing over six months to deliver, and support, an exercise program and a ketogenic very low-calorie diet with meal replacements. Recruitment rate and retention rate, adherence, adverse events and intervention acceptability were assessed. Overall hip pain, physical function and body weight were assessed via numeric rating scale (NRS, 0–10), Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale (WOMAC, 0–68) and home-scales respectively, at baseline, 3 and 6 months. ResultsEighteen (11% of 157 people screened) participants were enrolled and 16 (89%) completed 6-month assessments. Participants reported acceptable adherence to the intervention. Most (88%) participants were “extremely satisfied” with the intervention. Ten minor adverse events were exercise related. Overall hip pain reduced by −1.9 units (95%CI -2.8 to −0.9) at 3 months and by −3.3 (−4.3 to −2.2) at 6 months. Physical function improved by −8.5 units (95%CI -13.2 to −3.6) and −14.2 (−18.1 to −7.5) at 3 and 6 months respectively. Body weight reduced by 9.8% [95%CI -12% to −8%] and 11.3% [-13.6% to −9%] at 3 and 6 months respectively. ConclusionsThe feasibility of a large clinical trial evaluating this exercise and weight management intervention is supported.

Psychosocial adaptation to chronic heart failure in patients with coronary heart disease

Aim. To assess the effects of acquired social status, neurotic conditions, type D personality, cognitive functions, quality of life and adherence to treatment on psychosocial adaptation of patients with coronary heart disease (IHD) to chronic heart failure (CHF), depending on the severity of decompensation.&#x0D; Methods. 87 patients with coronary artery disease and chronic heart failure aged between 55 and 72 years were examined. All patients were divided into two groups depending on the functional class of chronic heart failure [New York Heart Association (NYHA) class IIV]. The first group included 41 patients with NYHA functional class III, the second group 46 patients with NYHA functional class IIIIV. For a comprehensive study of the psychosocial adaptation of patients, a set of standardized questionnaires was used: the abridged variant of the Minnesota Multiphasic Personality Inventory (SMOL), a clinical questionnaire for identifying and assessing neurotic condition, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 36-Item Short Form Health Survey Questionnaire (SF-36), the Mini Mental State Examination (MMSE), 14-question test Type D Scale-14 (DS14), MoriskyGreen test, the short version of the AUDIT questionnaire (AUDIT-C). We collected data on the patient's social status: gender, education, income level. The results obtained were analyzed.&#x0D; Results. Based on the SMOL personality profiles, patients of the second group were classified as neurotic an increase was noted in three neurotic scales: hypochondria (U=541; p=0.030), hysteria (U=579; p=0.048), and autism/schizoid (U=577.5; p=0.047) compared with patients of the first group. According to the results of the clinical questionnaire for the identification and assessment of neurotic condition, the greatest differences were found between patients of first and second groups on the scale of autonomic disorders (U=571; p=0.039) and neurotic depression (U=576; p=0.046). Comparing the groups according to the MLHFQ score, quality of life in patients of the second group was markedly reduced (U=447.5; p 0.001). According to the SF-36 questionnaire, a decrease in the quality of life was also found in patients of the second group on the scale Physical functioning (U=554; p=0.032) and Physical component of health (U=573.5; p=0.044). The cognitive status in patients of the second group was significantly decreased compared with the first group (U=427; p 0.001). No significant differences were found in adherence to treatment between the two groups (U=757; p=0.666). Also, there were no patients with type D personality on both subscales (U=717.5; p=0.483, U=784; p=0.933) and according to the AUDIT-C scores, there are no significant differences between men (U=681.5; p=0.257) and women (U=728.5; p=0.425) in both groups of patients.&#x0D; Conclusion. Signs of social maladjustment in patients with more severe NYHA functional class of the disease are expressed by significantly more pronounced social isolation (autism), a tendency to avoid communicating with others, isolation on their own problems and hypochondriacal attention to the somatic manifestations of chronic heart failure; probably, the main reason that reduces the level of social adaptation is a high score in neuroticism, which leads to a functional decrease in cognitive abilities and a significant deterioration in quality of life.

Cognitive-Behavioral Therapy and Hypnosis Intervention on Anxiety, Depression, and Quality of Life in Patients with Breast Cancer Undergoing Chemotherapy: A Clinical Trial

Background: Women with breast cancer undergo painful and distressing treatment procedures. Hypnotherapy and cognitive-behavioral therapy (CBT) could be considered as an effective therapy. Method: In this clinical trial, 50 women aged 25 to 65 were assigned to three groups (CBT, hypnosis, and control groups). Eight one-hour treatment sessions were run for each of the hypnosis and CBT groups. We utilized The European Organization for Research and Treatment of Breast Cancer-specific Quality of Life (QoL), The European Organization for Research and Treatment of Cancer QoL questionnaires, and The Hospital Anxiety and Depression Scale for the evaluation of the QoL, anxiety, and depression at the beginning and end of the treatment, as well as six months post-treatment. Results: The improvements in the stress, depression, and qoL amongst the three groups were significant, although these improvements in CBT group were more than those in hypnosis group, and in hypnosis and CBT groups were not significant. Physical functioning, body image, sexual functioning, arm symptoms, breast symptoms, future perspective, pain, digestive problems, and functional scale significantly changed in CBT and hypnosis groups (p <0.05). Memory and social functioning; however, did not change in the groups and across the three groups. In addition, sleeping disorders and emotional malfunctioning were recovered only in the hypnosis group, which was statistically significant. Conclusion: We found hypnosis exclusively effective on reducing certain problems of breast cancer patients, such as sleeping disorders and emotional malfunctioning; therefore, it is suggested as an efficient solution for these patients’ problems.

94 Agreement Between Proxy- and Self-Report PROMIS Scores in Pediatric Burn Survivors

Abstract Introduction Reporting by proxy is necessary when patients are not able to report their own experience, such as young children or those too sick to respond. PROMIS pediatric proxy-report item banks are a set of generic measures that facilitate comparisons across populations and studies. Our objectives were to (1) examine agreement in pediatric burn survivors between child self- and caregiver proxy-report on multiple PROMIS domains and (2) examine factors associated with differences between self- and proxy-reports. Methods Data were collected from children 8–17 years with moderate to severe burn injury and their respective caregivers between 6 months and 15 years after injury. The PROMIS-25 and Anger v1.0 short form were completed by pediatric burn participants. Caregivers completed either custom (depression, pain interference) or standard (Physical Function (PF) 8a, Peer 7a, Anger 5a) PROMIS proxy short forms. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen’s effect size, and intraclass correlation coefficients (ICC(2,1)) and by agreement across severity of symptoms based on recommended cutoffs. Regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences. Results A total of 274 child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on PF, pain, and anger (all p≤0.01). Cohen’s d ranged from 0.05 (depression) to 0.25 (PF), with all domains except PF in the small effect size range (&amp;lt; 0.2). Similarly, ICCs were all of moderate agreement and ranged from 0.51 (pain) to 0.69 (depression). The percentage of dyads in agreement by severity groups was high with only 5% (pain), 8% (PF, peer relationships), and 9% (depression, anger) of pairs discordant. Regression models indicated only higher self-report score was associated (all p&amp;lt; 0.05) with greater differences across all domains, though female gender was also associated with greater differences on depression only. Conclusions This study provides support for the use of pediatric proxy PROMIS depression, PF, peer relationships, pain interference, and anger scales in pediatric burn patients. Although agreement was moderate to good, proxy report should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.

Influencia de la desnutrición en la calidad de vida del paciente oncológico antes del inicio del tratamiento quimio/radioterápico

Introducción: La medición de la calidad de vida (CV) en el paciente oncológico permite establecer una percepción del individuo sobre su estado de salud - enfermedad y el tratamiento instaurado. El objetivo del presente estudio es analizar la influencia de la situación nutricional en la CV de los pacientes.Material y métodos: Se llevó a cabo un estudio transversal en el Hospital Ramón y Cajal en 53 pacientes oncológicos durante un periodo de 6 meses.A estos pacientes se les realizó la valoración global subjetiva (VGS), un recuerdo 24h de la ingesta del día anterior y se les administró el cuestionario European Organisation for Research and Treatment of Cancer quality of Life Questionnaire Core 30 (EORTC QLQ-C30). De estos 53 pacientes, 9 fueron excluidos debido a una incompleta cumplimentación del cuestionario EORTC QLQ C-30. De los 44 pacientes restantes, el 52,3% pertenecía al grupo de normonutridos sin riesgo (VGS A); el 27,3 % al grupo de pacientes en riesgo de desnutrición o desnutrición moderada (VGS B) y el 20,5% restantes al grupo de pacientes con grave desnutrición (VGS C)Resultados: Las escalas funcionales (funcionamiento físico, social, emocional y cognitivo) fueron las menos afectadas por la situación nutricional de los pacientes, con valor de p&gt;0,05, mientras que la escala funcional o de rol (p 0,002), junto con la escala global de salud (p 0,049), así como los síntomas defatiga (p 0,011), náuseas y vómitos (p 0,004)y el ítem simple de pérdida de apetito (p 0,001) son las que mostraron una asociación estadísticamente significativa con la situación nutricional.Conclusiones: La desnutrición afecta negativamente a la CV de los pacientes oncológicos especialmente en las escalas de funcional, escala global de salud y de síntomas. Son necesarios más estudios para evaluar si la intervención nutricional precoz puede revertir esta influencia negativa de la desnutrición.

Health-related quality of life in Iranian adolescents: a psychometric evaluation of the self-report form of the PedsQL 4.0 and an investigation of gender and age differences

BackgroundResearch on the psychometric properties of the Persian self-report form of the Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0) in adolescents has several gaps (e.g., convergent validity) that limit its clinical application and therefore the cross-cultural impact of this measure. This study aimed at investigating the psychometric properties of the PedsQL 4.0 and the effects of gender and age on quality of life in Iranian adolescents.MethodThe PedsQL 4.0 was administered to 326 adolescents (12–17 years). A subsample of 115 adolescents completed the scale two weeks after the first assessment. Confirmatory Factor Analysis (CFA), correlation of the PedsQL 4.0 with the Weiss Functional Impairment Rating Scale-Self-report (WFIRS-S), and Item Response Theory (IRT) analysis were conducted to examine validity. Cronbach’s alpha, McDonald’s Omega, and Intra class correlation (ICC) were calculated as well to examine reliability. Gender and age effects were also evaluated.ResultsInternal consistency and test–retest reliability of the total PedsQL 4.0 scale was .92 and .87, respectively. The PedsQL 4.0 scores showed negative moderate to strong correlations with the WFIRS-S total scale. The four-factor model of the PedsQL 4.0 was not fully supported by the CFA—the root mean square error of approximation and the comparative fit index showed a mediocre and poor fit, respectively. IRT analysis indicated that all items of the PedsQL 4.0 fit with the scale and most of them showed good discrimination. The items and total scale provided more information in the lower levels of the latent trait. Males showed significantly higher scores than females in physical and emotional functioning, psychosocial health, and total scale. Adolescents with lower ages showed better quality of life than those with higher ages in all scores of the PedsQL 4.0.ConclusionThe PedsQL 4.0 showed good psychometric properties with regard to internal consistency, test–retest reliability, and convergent validity in Iranian adolescents, which supports its use in clinical settings among Persian-speaking adolescents. However, factor structure according to our CFA indicates that future work should address how to improve fit. In addition, studies that include PedsQL 4.0 should consider gender and age effects were reported.

The Dance Functional Outcome Survey (DFOS) is Reliable, Valid, and Responsive in Pediatric Dancers.

The Dance Functional Outcome Survey (DFOS) is a dance-specific questionnaire developed for use with ballet and modern dancers at all training levels. To date, no study has assessed the psychometric properties of the DFOS in pediatric dancers. The purposes of this study were to determine: 1. the reliability of the DFOS when used with healthy and injured pediatric dancers; 2. the validity of the DFOS com- pared to a well-established generic scale, the Pediatric Quality of Life Inventory Physical Function Scale (PedsQL-PFS); and 3. the sensitivity and responsiveness to change of the DFOS in injured dancers. One hundred and two dancers completed the DFOS twice within 10 days. Intra-class correlation coefficients (ICCs) were used to assess test-retest reliability. In a sample of 148 dancers, construct validity was explored by comparing the DFOS to the PedsQL-PFS using Pearson correlations, and Exploratory Factor Analysis (EFA) and Cronbach's alpha were used for internal consistency analyses. A sub-set of 22 injured dancers was employed to examine responsiveness using repeated measures analysis of variance (p < 0.05). The DFOS demonstrated high test-retest reliability (ICC ≥ 0.90). The DFOS total score, activities of daily living (ADL), and dance technique sub-scores had strong construct validity compared to the PedsQL-PFS (r ≥ 0.79). Cronbach's alpha was high ( α = 0.92), indicating excellent internal consistency. There were significant differences across time in DFOS scores (p < 0.001), demonstrating responsiveness to change. There were no floor or ceiling effects. Thus, the DFOS demonstrates excellent reliability, strong validity, and good responsiveness over time and is a viable tool for assessing function in pediatric dancers.

The features of comorbid status and its impact on the quality of life of patients with chronic kidney disease on programmed hemodialysis

The purpose of the research is to study the features of comorbid status in patients with chronic kidney disease (CKD) Stage 5 on programmed hemodialysis (PHD) and its impact on quality of life (QOL). Methodology: we examined 86 patients (60 men and 26 women) with CKD Stage 5 receiving PHD treatment. The average age of the patients was 55.5±13.9 years. The study protocol included an assessment of the QOL level according to the KDQOL-SF™ questionnaire, the comorbidity index according to M.E. Charlson (CCI), clinical and instrumental studies in accordance with clinical guidelines. Results: the most common causes of CKD Stage 5 in the examined patients were chronic glomerulonephritis and diabetes mellitus (26.7% each), tubulointerstitial renal diseases (23.3%) and polycystic kidney disease (13.3%). High and medium levels of CCI were found in 67.4% of the examined patients. Among the comorbidities, cardiovascular diseases rank first (51.2%). QOL of patients with CKD Stage 5 on PHD was characterized by the lowest scores on the scales of physical functioning and the burden of kidney disease. Correlation analysis revealed that comorbidities in patients with CKD Stage 5 who are on PHD negatively affect their QOL. Conclusion: the obtained results can be used in planning and organizing the provision of medical care to patients with CKD. The introduction of the used QOL and CCI assessment methods in the protocol for the management of patients with CKD Stage 5 in dialysis centers will make it possible to monitor the individual QOL indicators of patients, evaluate the effectiveness of patient treatment and correct it in a timely manner.

Agreement between proxy- and self-report scores on PROMIS health-related quality of life domains in pediatric burn survivors: a National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study.

To examine agreement between pediatric burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between self- and proxy-reports. Children 8-17years of age and their caregivers completed PROMIS measures (physical function, depression, peer relationships, pain interference, and anger) between 6months and 15years after injury. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen's effect size, and intraclass correlation coefficients (ICC) and by agreement across severity of symptoms based on recommended cutoffs. Ordinary least squares regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences. Two hundred and seventy four child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on physical function, pain, and anger (all p ≤ 0.01). The effect sizes were small across all domains except physical function. Similarly, ICCs were all of moderate agreement. The percentage of dyads in agreement by severity groups was high with only 5%-9% of pairs discordant. Only higher self-report score was associated (all p < 0.05) with greater differences across all domains in regression analyses. This study supports the use of pediatric proxy PROMIS depression, physical function, peer relationships, pain interference, and anger scales in pediatric burn patients. Although agreement was moderate to good, assessing proxy-report alone as a surrogate should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.

Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collegiate Athletes Compared With Noncollegiate Athletes: A 5-Year Follow-Up.

The effect of athletic participation on lifelong health among elite athletes has received increasing attention, as sport-related injuries can have a substantial influence on long-term health. To determine the current health-related quality of life (HRQoL) of former National Collegiate Athletic Association Division I athletes compared with noncollegiate athletes 5 years after an initial assessment. Cohort study. Online survey. From the former Division I athletes, 193 responses were received (response rate = 83.2%; 128 men, 65 women; age = 58.47 ± 6.17 years), and from the noncollegiate athletes, 169 surveys were returned (response rate = 75.1%; 80 men, 89 women; age = 58.44 ± 7.28 years). The independent variables were time (baseline, 5 years later) and group (former Division I athlete, noncollegiate athlete). Participants completed 7 Patient-Reported Outcomes Measurement Information System scales: sleep disturbance, anxiety, depression, fatigue, pain interference, physical function, and satisfaction with participation in social roles. Sleep disturbance, depression, fatigue, pain, and physical function were significant for a time × group interaction (P < .05), with the largest differences seen in pain and physical function between groups at time point 2 (22.19 and 13.99 points, respectively). Former Division I athletes had worse scores for depression, fatigue, pain, and physical function at follow-up (P < .05), with the largest differences seen on the depression, fatigue, and physical function scales (8.33, 6.23, and 6.61 points, respectively). Because of the competitive nature of sport, the long-term risks of diminished HRQoL need to become a priority for health care providers and athletes during their athletic careers. Additionally, physical activity transition programs need to be explored to help senior student-athletes transition from highly structured and competitive collegiate athletics to lifestyle physical activity, as it appears that individuals in the noncollegiate athlete cohort engaged in more physical activity, weighed less, and had increased HRQoL.

Assessment of the Minimum Clinically Important Difference in the Smartphone-based 6-minute Walking Test After Surgery for Lumbar Degenerative Disc Disease.

Prospective cohort study. The aim of this study was to determine the minimum clinically important difference (MCID) of the 6-minute walking test (6WT) after surgery for lumbar degenerative disc disease (DDD). The smartphone-based 6WT is a valid and reliable tool to quantify objective functional impairment in patients with lumbar DDD. To date, the MCID of the 6WT has not been described in patients with DDD. We assessed patients pre- and 6-weeks postoperatively, analyzing both raw 6-minute walking distances (6WD; in meters) and standardized 6WT z scores. Three methods were applied to compute MCID values using established patient-reported outcomes measures (PROMs) as anchors (VAS back/leg pain, Zurich Claudication Questionnaire [ZCQ], Core Outcome Measures Index [COMI]): average change, minimum detectable change, and the change difference approach. We studied 49 patients (59% male) with a mean age of 55.5 ± 15.8 years. The computation methods revealed MCID values ranging from 81 m (z score of 0.9) based on the VAS back pain to 99 m (z score of 1.0) based on the ZCQ physical function scale. The average MCID of the 6WT was 92 m (z score of 1.0). Based on the average MCID of raw 6WD values or standardized z scores, 53% or 49% of patients classified as 6-week responders to surgery for lumbar DDD, respectively. The MCID for the 6WT in lumbar DDD patients is variable, depending on the calculation technique. We propose a MCID of 92m (z score of 1.0), based on the average of all three methods. Using a z score as MCID allows for the standardization of clinically meaningful change and attenuates age- and sex-related differences.Level of Evidence: 3.

A neuronal blood marker is associated with mortality in old age

Neurofilament light chain (NfL) has emerged as a promising blood biomarker for the progression of various neurological diseases. NfL is a structural protein of nerve cells, and elevated NfL levels in blood are thought to mirror damage to the nervous system. We find that plasma NfL levels increase in humans with age (n = 122; 21-107 years of age) and correlate with changes in other plasma proteins linked to neural pathways. In centenarians (n = 135), plasma NfL levels are associated with mortality equally or better than previously described multi-item scales of cognitive or physical functioning, and this observation was replicated in an independent cohort of nonagenarians (n = 180). Plasma NfL levels also increase in aging mice (n = 114; 2-30 months of age), and dietary restriction, a paradigm that extends lifespan in mice, attenuates the age-related increase in plasma NfL levels. These observations suggest a contribution of nervous system functional deterioration to late-life mortality.