Physical Function Scale Research Articles

Clinimetric properties of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit survivors – a cross-sectional observational study

Purpose To investigate the intra-rater reliability and the construct validity of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit (ICU) survivors. Methods Construct validity of the DEMMI was measured by correlating it with physical functioning scales. Known group comparison was made according to the Medical Research Council Sum Score (MRC-SS). Internal consistency was determined by measuring Cronbach α coefficient. Test-retest reliability was assessed by performing the DEMMI by the same researcher after 24 h and calculating the intraclass correlation coefficient (ICC). The minimal detectable change (MDC) value was calculated. Results One hundred and two patients discharged from the ICU were included. The ICC for intra-reliability was 0.972. The internal consistency was excellent (Cronbach = 0.991). The DEMMI total score was correlated with the Barthel Index (r = 0.791), Katz Index of Independence in Activities of Daily Living (r = 0.722), MRC-SS (0.614), ICU length of stay (r = –0.515), and total mechanical ventilation duration (r = –0.488). The DEMMI was able to differentiate between MRC-SS subgroups (p < 0.001), whereby higher strength was associated with higher DEMMI scores. The MDC was determined to be 6.82 out of 100 points. Conclusion The Turkish version of the DEMMI is reliable and valid for measuring mobility in ICU survivors. Trial registration number NCT05196997 Implications for Rehabilitation The Turkish version of the de-Morton Mobility Index (DEMMI) is a reliable and valid outcome measure for the assessment of functional mobility in intensive care unit survivors. The Turkish version of the DEMMI could guide clinicians working in the field of intensive care in the planning of rehabilitation programs after discharge.

Health-related quality of life in patients given ciltacabtagene autoleucel for relapsed or refractory multiple myeloma (CARTITUDE-1): a phase 1b–2, open-label study

CARTITUDE-1 is a phase 1b-2 study evaluating ciltacabtagene autoleucel (cilta-cel), a chimeric antigen receptor T cell therapy with two B-cell maturation antigen-targeting single-domain antibodies, in patients with relapsed or refractory multiple myeloma. Primary efficacy outcomes have previously been reported. Here, we report health-related quality of life (HRQOL) secondary outcomes evaluated using patient-reported outcomes. This single-arm, open-label, phwase 1b-2 study was done at 16 centres in the USA. Patients were aged 18 years or older with diagnosis of multiple myeloma and Eastern Cooperative Oncology Group performance status of 1 or less with three or more previous lines of therapy, or were double refractory to a proteasome inhibitor and immunomodulatory drug, and had received a proteasome inhibitor, immunomodulatory drug, and anti-CD38 antibody. A single cilta-cel infusion (target dose 0·75 × 106 CAR+ T cells per kg) was administered 5-7 days after lymphodepletion. Patient-reported outcomes were assessed using the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire core 30-item, pre-specified items from the EORTC myeloma module, and EuroQol five-dimensional descriptive system questionnaire. Clinically meaningful changes in patient-reported outcomes were defined by anchor-based minimally important differences. This trial is registered with ClinicalTrials.gov, NCT03548207. This trial is completed but feeding into a long-term follow-up study. Between July 16, 2018, and Oct 7, 2019, 78 patients were enrolled and underwent apheresis in phase 2 of the study. 68 patients were treated (43 [63%] male, 49 [72%] White), and their patient-reported outcomes assessed (median follow-up 16·9 months, IQR 15·7-17·5). After infusion, a transient decline was observed, followed by improvements in global health status (mean change from baseline to day 464 +8·0 points, SD 20·9), physical (+4·6 points, 21·1), and emotional functional scales (+1·9 points, 23·7) over time, and declines for symptom-based scores (-14·1 pain, SD 31·5 and -15·4 fatigue; SD 29·5), indicating improved patient HRQOL following treatment with cilta-cel. These durable HRQOL improvements are consistent with clinical findings, in which a single cilta-cel infusion led to substantial and durable responses in heavily pre-treated patients with relapsed or refractory multiple myeloma. These results support the use of cilta-cel in patients with relapsed or refractory multiple myeloma. Janssen Research & Development and Legend Biotech USA.

A Patient-Reported Outcome Based Comparison of Cheilectomy with and without Proximal Phalangeal Dorsiflexion Osteotomy for Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Cheilectomy with and without Moberg osteotomy is used to improve function and remove pain in early- moderate stage hallux rigidus. The rise of patient-reported outcome measurements allows greater precision in comparing treatments as value-driven paradigms become increasingly important in clinical decision-making. This study provides the first comparison of patient-reported outcomes between isolated cheilectomy (C) and cheilectomy with Moberg (CM) osteotomy for hallux rigidus. We compared one and two-year PROM scores between patients who underwent C and CM for hallux rigidus using PROMIS, a validated patient-reported outcomes measurement system, and compared rates of complications and subsequent operations between the two groups. We hypothesized that patients who underwent CM would experience better clinical outcomes and fewer returns to the operating room than patients undergoing cheilectomy alone. Methods: A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent cheilectomy, with and without concomitant proximal phalangeal dorsiflexion osteotomy, for hallux rigidus between January 2016 and December 2020. An a priori power analysis determined that 24 patients per cohort were needed to detect a previously published minimum clinically important difference of 5.8 points on the PROMIS Physical Function scale with alpha = .05 and 80% power. However, all C patients were included. Because there were far fewer isolated cheilectomies (62), all C patients were compared with a commensurate number of consecutive CM cases (67) using preoperative, one-year, and two-year PROMIS scores for Physical Function, Pain Interference, Pain Intensity, Global Physical Health, Global Mental Health, and Depression, as well as complication and revision data from chart review. Age, sex, BMI, preoperative radiographic hallux rigidus grade, and preoperative range of motion were compared between the two cohorts. Results: PROMIS outcome data is given in Table 1. Both groups demonstrated statistically significant improvements in PROMIS Physical Function, Pain Interference, Pain Intensity, and Global Physical Health (P &lt;.001 for all, both preoperative to one-year and preoperative to two-year), but not Global Mental Health or Depression. There were no differences between groups among the demographic and preoperative variables compared. The CM cohort reported worse Pain Interference scores preoperatively (58.1+- 5.9 vs. 52.4 +- 7.01, P &lt; .001) and at one year (50.0 +- 9.3 vs. 45.1 +- 9.8, P = .01), while the C cohort reported worse Pain Intensity scores preoperatively (55.6 +- 7.3 vs. 49.6 +- 6.8, P &lt; .001) and at one year (45.9 +- 8.0 vs. 39.9 +- 8.2, P &lt; .001). These differences were no longer significant at two years postoperatively. There were no statistically significant differences between cohorts for additional PROMIS scores or complications data. Conclusion: The addition of a Moberg osteotomy does not appear to significantly change short-medium term outcomes of cheilectomy for hallux rigidus treatment. Our data contradicts the notion that addition of a Moberg osteotomy increases the likelihood of postoperative complications. The overall good results found for both procedures, as well as the general similarity between outcomes between them, suggest that external considerations like recovery time, comfort level with a more invasive osteotomy, and overall goals with surgery may be of greater importance than short-term clinical outcomes when deciding on the appropriate course of treatment for a given patient.

Screening of Anemia in Patients with Coronary Heart Disease in Outpatient Practice Using a Computer Monitoring System

The aim of this study was to assess the prevalence, structure, and influence of anemic syndrome on the main health indicators of patients with coronary heart disease (CHD), including the main QOL parameters. Methods and Results: The study included 1210 patients (309 men and 901 women) with an average age of 67.57±9.35 years who were registered at the dispensary with CHD (angina pectoris CCSA classes II-IV) in 2 Regional Hospitals. With the help of the computer program “Monitoring system for patients with anemia syndrome,” medical records from 2 randomly selected primary care areas were analyzed. The data directly related to anemia, comorbid pathology, and previous treatment formed the main part of the statistical data. The QOL was evaluated using the 36-Item Short Form Survey (SF-36) questionnaire. The FACT-An questionnaire was used to account for the characteristic symptoms, and their severity, accompanying anemia. Our findings indicate the presence of anemia in 500(41.3%) patients (355/71% women and 145/29% men). The average age of the patients with diagnosed anemia was 65.34±6.37 years in men and 63.49±7.05 years in women. Anemia of mild severity was observed in 410(82%) patients, moderate severity in 75(15%) patients, and severe anemia in 15(3%) patients. IDA was detected in 467(93.4%) cases and B12-deficiency anemia in 33(6.6%) cases. We found a negative correlation between the blood iron level and age (r=-0.56, P&lt;0.05), which can indirectly indicate the progression of latent iron deficiency with age in CHD patients. All 500 CHD patients with anemia were included in Group 1. Group 2 included 710 CHD patients without anemia. In Groups 1 and 2, angina severity according to CCSA classification was as follows: CCSA class II - 186(37.2%) and 456(64.2%) cases (P=0.000), CCSA class III – 248(49.6%) and 196(27.6%) cases (P=0.000), and CCSA class IV - 66(13.2%) and 58(8.2%) cases (P=0.005), respectively. Group 1 patients, in contrast to Group 2 patients, had the following characteristic clinical features: palpitation (48.2% vs. 35.0%, P=0.000), higher HR (81±9.5 bpm vs. 71.8±8.7 bpm, P=0.000) and respiratory rate (18.9±1.1 vs 18.3±1.2 per minute, P=0.000). The assessment of the impact of anemia on QOL by FACT-An revealed a statistically lower score in Group 1 than in Group 2 (32.0±5.7 vs. 44.0±6.5, P=0.000). We found a positive correlation between the Hb level and the average FACT-An score (r=0.54, P&lt;0.05) Patients in Group 1 demonstrated a low level of QOL in the physical and mental domains, according to SF-36, in comparison with Group 2. Correlation analysis revealed a direct relationship between the Hb level and the average score of the PF (physical functioning) scale (r=0.52, P&lt;0.05)) and PCS (physical component summary) (r=0.38, P&lt;0.05)) of the SF-36 questionnaire. The observed high incidence of anemic syndrome in CHD patients with angina pectoris (CCSA class II-IV) requires special attention due to the high impact on the QOL of patients and aggravation of the course of the underlying disease.

A Hierarchy Of Correlates Of Physical Independence In Portuguese Older Adults: A Data Miming Approach

Physical independence (PI) represents the ability to perform everyday tasks of living and is considered an important health marker during older adulthood. Since lower levels of PI are associated with frailty and morbidity, identifying which correlates best predict distinct levels of PI is paramount. PURPOSE: To establish a hierarchy of multidimensional correlates predicting low and medium-to-high levels of PI in Portuguese older adults. METHODS: Data from 1435 older adults (65-79 yrs: n = 784; 80+ yrs: n = 651) who participated in the 2018 Portuguese national survey were analyzed. A Chi-Square Automatic Interaction Detection (CHAID) decision tree - data miming approach - was used to comprehensively identify and hierarchize 30 self-reported correlates related to socio-demographic, behavioral, health, and environmental domains. PI was assessed using a 12-item composite physical function (CPF) scale, and age-reference categories were used to dichotomize levels of PI into low or medium-high. RESULTS: Out of 1435 older adults assessed, 750 and 685 had low and medium-to-high levels of PI, respectively. In the 65-79 yrs age group, the cluster of correlates related to lower PI levels consisted of older adults not owning a computer, spending prolonged times sitting and not having stores in the neighborhood (n = 80; response index (RI) = 1.75), whereas owning a computer, having an income >500€ and frequently breaking sitting time represented the most likely group to have medium-to-high PI (n = 11; RI = 0.18). For the 80+ yrs age group, having a low-income and spending prolonged hours sitting represented the cluster of correlates corresponding to lower PI (n = 126; RI = 1.34), whereas having an income >500€, breaking sitting every hour/multiple times per hour, and having a family that exercises (n = 32; RI = 0.48) formed the group with a greater likelihood of having moderate-to-high PI. CONCLUSIONS: To successfully prevent the deterioration of PI of older adults, future healthcare interventions should prioritize older adults with limited accessibility to technologies and with lower incomes. Additionally, promoting strategies to reduce and frequently break-up prolonged sitting time will help to reduce higher levels of PI and, thus, reduce the overall risk of frailty and vulnerability in this age-group.

Effectiveness of Exercise in Patients with Overweight or Obesity Suffering from Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Objectives: The main purpose of this study was to review the evidence about the effectiveness of exercise in patients with overweight or obesity suffering from knee osteoarthritis. Methods: Randomized clinical trials (RCTs) published between January 2002 and May 2022 were included. Results: A total of 64 articles were identified, of which six met the criteria for meta-analysis. The pain scale score was higher in the control group (mean difference 0.95; confidence interval 0.42–1.47; p < 0.001; I2 = 44%). The physical function scale (lower scores indicate lower levels of symptoms or physical disability) presented a higher score in the control group (mean difference 3.74; confidence interval 0.85–6.53; p < 0.05; I2 = 56%). Moreover, the intervention group achieved a greater distance (meters) walking in a 6 min interval (mean difference 38.18; confidence interval 20.01–56.35; p < 0.001; I2 = 0%). Conclusions: Exercise interventions seem effective in improving quality of life in people with overweight or obesity suffering from knee osteoarthritis, reducing pain and improving physical function.

Quality of Life in Pediatric Patients with Continent Urinary Diversion-A Single Center Experience.

Background and Objectives: The advancement of surgical strategies in various types of urological conditions has resulted in improved functional outcomes, but the issues of patient perception and life quality remain difficult to assess, particularly in pediatric populations. We aimed to critically analyze the outcomes of urinary continent diversion in pediatric patients treated in our institution for various bladder conditions. Materials and Methods: We conducted a cross-sectional study, reviewing the records of patients treated for bladder evacuation problems between 2003 and 2014, and analyzing the data of those with continent urinary diversion. We used two types of questionnaires to assess the impact on life quality: the Qualiveen-30 and the SF-36 Health Survey. Results: The study included one hundred thirty-four patients with bladder conditions, and eight underwent urinary diversion, at a median age of 6.5 years. Seven of them, aged 10–23 years, completed questionnaires, with all seven scoring high on physical functioning scale but low on the social functioning scale. Conclusions: Continent urinary diversion remains the treatment of choice in well selected patients, but the results must be considered both in terms of functional outcomes and the impact on these patients’ emotional and mental health.

Quality of life in obese schoolchildren

Introduction. According to the latest data, about forty-three million children under 5 years of age are overweight worldwide and more than 340 million children and adolescents aged 5 to 19 years are overweight or obese. Health-related quality of life is a promising tool that allows including a subjective description of the condition by the patient himself, along with laboratory, instrumental and other examinations, for a more complete assessment of his clinical status. Aim. To study the influence of the severity of obesity and individual components of the metabolic syndrome on the indicators of the quality of life in schoolchildren. Materials and methods. The study included twenty-eight obese children (SDS BMI ≥+2), 17 boys (60.7%), 11 girls (39.3%), mean age 12.2 ± 1.9 years. Obesity Ι degree (SDS BMI 2-2.5) was diagnosed in 13 cases, ΙΙ degree (SDS BMI ≥ 2.6-3.0) - in 7, ΙΙΙ degree (SDS BMI 3.1-3.9) - in 8 children. When establishing the diagnosis of metabolic syndrome, the standard criteria for metabolic syndrome in patients over 10 years were used. The comparison group consisted of 30 conditionally healthy children of comparable age. The quality of life was assessed using the Russian version of the Pediatric Quality of Life Inventory - PedsQLTM4.0. Results. Obese children scored lowest on emotional well-being (62.4; 95% CI 54.5-70.3) and school functioning (61.1; 95% CI 54.6-67.5) in relation to the responses of healthy children (EF - 79.1; 95% CI 77.3-80.8 points; FFS - 85.7; 95% CI 82.7-88.7 points; p &lt; 0.001). A negative correlation was found between the severity of obesity (SDS BMI) and the scale of physical functioning. Arterial hypertension has the most pronounced negative impact on the quality of life, and on indicators of physical and psychosocial functioning. The identified disorders of lipid and carbohydrate metabolism were determined have no any significant impact on the quality of life parameters. Conclusion. In obese children, there is a significant decrease in quality of life indicators for all studied parameters (p &lt; 0.001), excluding the indicator of social functioning (p = 0.249). Among the components of the metabolic syndrome, arterial hypertension has a significant negative impact on the indicators of physical and psychosocial functioning.

Mapping PROMIS physical function and pain interference to the modified low back pain disability questionnaire.

The Modified Low Back Pain Disability Questionnaire (MDQ) is a commonly used tool to assess functioning of patients with low back pain (LBP). Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) was suggested as an alternative platform to assess LBP patient-reported health. We sought to map between the MDQ and PROMIS Physical Function (PROMIS-PF) and Pain Interference (PROMIS-PI) scales using multiple methods. In a retrospective analysis of LBP patients seen at Cleveland Clinic 11/14/18-12/11/19, T-scores from each PROMIS scale were mapped to MDQ total score individually and together. MDQ item and total scores were mapped to each PROMIS scale. Linear regression as well as linear and equipercentile equating were used. Split sample internal validation using root mean squared error (RMSE), mean absolute error (MAE), and correlations were used to assess accuracy of mapping equations. 13585 patients completed the three scales. In the derivation cohort, average age was 59.0 (SD = 15.8); 53.3% female and 82.9% white. Average MDQ total, PROMIS-PF, and PROMIS-PI T-scores were 40.3 (SD = 19.0), 37.2 (SD = 7.6), and 62.9 (SD = 7.2), respectively. For estimating MDQ total scores, methods that used both PROMIS-PF and PROMIS-PI had closest estimated means, lowest RMSE and MAE, and highest correlations. For estimating each of PROMIS-PF and PROMIS-PI T-scores, the best performing method was equipercentile equating using the MDQ items. We created and internally validated maps between MDQ and PROMIS-PF and PROMIS-PI using linear regression, linear and equipercentile equating. Our equations can be used by researchers wishing to translate scores between these scales.

Nutritional risk and its relationship with physical function in community-dwelling older adults

BackgroundMalnutrition is a serious concern in older populations. Simple screening approaches are needed to identify signs of early nutritional risk in older people, to allow intervention before overt malnutrition develops, along with the poorer health outcomes associated with it, such as sarcopaenia and frailty. The main aim of this study was to compare nutrition risk scores, calculated from the DETERMINE Checklist (‘Determine Your Nutritional Health’, also known as the Nutrition Screening Initiative Checklist), with physical function variables in a group of community-dwelling older adults. Another aim was to assess the prevalence of nutrition risk using the DETERMINE and the MUST (Malnutrition Universal Screening Tool).MethodsParticipants of the Hertfordshire Cohort Study (HCS) were recruited and visited at home by a trained researcher. Self-reported physical function was assessed using the SF-36 PF (Short Form-36 Physical Function) scale. The Short Physical Performance Battery (SPPB) was performed, which included the assessment of gait speed, chair rise time and standing balance. Handgrip strength was measured using a Jamar dynamometer. Frailty was assessed according to the presence of at least three of the following Fried frailty criteria: unintentional weight loss, weakness, self-reported exhaustion, slow gait speed and low physical activity. Nutrition risk scores were calculated from the DETERMINE checklist (range 0–21). Nutritional risk was also assessed using the MUST. Analyses were adjusted for sex, age, age left education and number of comorbidities.ResultsIn the study, 176 participants (94 men and 82 women), median age 83.3 (IQR 81.5–85.7) years, were assessed. Almost half (47%) scored either ‘moderate’ (score 3–5) or ‘high’ (score ≥ 6) nutritional risk (9% were at high risk), using the DETERMINE checklist, whereas 8% were at risk using the MUST. Higher nutrition risk scores, calculated from DETERMINE, were associated with poorer self-reported physical function (difference in SF-36 PF score: − 0.36, 95% CI (− 0.60, − 0.12) SD per unit increase in nutrition risk score, P = 0.004) and higher odds of being frail (odds ratio Fried frailty: 2.23, 95% CI (1.15, 4.33), P = 0.017). There were no significant associations between DETERMINE nutrition risk scores and the other variables examined.ConclusionCross-sectional associations between higher nutrition risk scores, assessed from the DETERMINE checklist, and poorer self-reported physical function and greater likelihood of frailty suggest that this screening tool may have utility for screening older populations. Prospective studies are required to explore the ability of the tool to predict poor physical function and frailty, though these data suggest it has potential for early, simple detection of nutritional problems in community-living older adults.

Frequently Used Patient-Reported Outcome Measures of General Physical Function Were Highly Correlated With a Multitask Performance Outcome Test Battery

ObjectivesThis study aimed to determine the relationship between frequently used patient-reported outcome (PRO) measures and a multitask performance outcome (PerfO) measure of general physical function (PF) and to examine the association of these measures with depressive mood, pain, and age. MethodsFrequently used PRO measures of general PF (Patient-Reported Outcomes Measurement Information System [PROMIS] PF item bank, PROMIS PF Short Form 20a, Short Form 36 Physical Function Scale) and a PerfO test battery, namely, the Physical Performance Test (PPT), were administered to 78 adult patients from 3 inpatient clinics (cardiology and angiology, rheumatology and clinical immunology, and psychosomatic medicine) at Charité – Universitätsmedizin Berlin. Pearson correlations were used to investigate the associations between PRO measures and the PPT. To explore the predictive value of age, depressive symptoms, and pain intensity, we conducted multiple linear regression analysis for each PF measure. ResultsWe found strong linear relationships between PRO measures and PPT sum scores. Correlations between PPT sum scores and PROMIS PF T-scores were r > 0.75. For all PRO and PerfO measures, age was a predictor of general PF whereas depressive mood was not found to be a relevant predictor. Moreover, pain intensity was found to be a significant predictor of PRO measures but not for PPT sum scores. ConclusionsOur findings suggest that frequently used PRO measures and a multitask PerfO measure of general PF can be used to measure a common PF construct. Nevertheless, PF scores based on PRO measures should ideally be controlled for self-rated pain intensity.

P-91 Quality of life (QoL)-based end-points for patients with advanced pancreatic ductal adenocarcinoma (aPDAC): Results from the PanDA prospective observational study

Adequate design of clinical trials using QoL-based primary-end points to assess benefit derived from supportive interventions such as exercise, nutrition or complementary therapies is challenging in PDAC due to a lack of available data describing baseline QoL and changes over time for this patient population. PanDA was a prospective observational study of prevalence, assessment and treatment of pancreatic exocrine insufficiency in patients with aPDAC (NCT03616431). QoL data using the EORTC QlQ-C30 and QLQ-PAN26 questionnaires were collected for the follow-up cohort at baseline (BSL), week6 (W6) and month3 (M3). This post-hoc analysis included patients with aPDAC and explored the mean and standard deviation (SD) of the Physical Functioning Scale (PhFS) at BSL, W6, M3) and mean (SD) intra-patient changes over time (W6-BSL and M3-BSL). Subgroup analysis by stage (locally-advanced vs metastatic) was also performed. Percentage of patients evaluable at each time point was reported. Descriptive statistical analysis was performed (Stata v.17). Of 37 patients recruited into the follow-up cohort, 32 met eligibility criteria for this post hoc analysis. Thirty (93.8%), 17 (53.1%; all had paired BSL data) and 13 (40.6%; all had paired BSL data) patients were evaluable with PhFS data available at BSL, W6 and M3, respectively. PhFS (mean (SD); number of observations) did not vary over time when all patients were analysed together (BSL: 76.17(26.46);30) (W6: 79.18(12.74);17) (M3: 74.46(16.76);13). Intra-patient mean changes at W6 (-6.59(15.13);17) or M3 (-5.46(24.82);13). Subgroup analysis identified that changes in W6 were more marked in patients with metastatic disease (-12.14(15.54);7) compared to locally advanced (-2.70(14.32);10). Changes on PhFS over time were likely impacted by selection bias. Intra-patient mean changes at W6 or M3 seemed more reliable to be utilised as primary-end point and sample size calculation in future clinical trials. Subgroup analysis identified that changes in W6 were more marked in patients with metastatic Intra-patient changes rather than pooled results may be more reliable when designing clinical trials with QoL-based primary end-points in aPDAC. W6 assessment may be most informative, as waiting until M3 may compromise the power of the study due to significant drop out.

Kynurenine Metabolism as a Mechanism to Improve Fatigue and Physical Function in Postmenopausal Breast Cancer Survivors Following Resistance Training.

This pilot examines whether resistance training (RT) can induce changes in kynurenine (KYN) metabolism, which may contribute to improved physical function in breast cancer survivors (BCSs). Thirty-six BCSs (63.2 ± 1.1 years) underwent assessments of physical function and visual analog scale (100 cm) fatigue and quality of life before and after 12 weeks of RT (N = 22) or non-exercise control (CBCT©: Cognitively Based Compassion Training, N = 10). Blood was collected before and after interventions for assessment of KYN, kynurenic acid (KYNA), and peroxisome proliferator-activated receptor γ co-activator 1α (PGC-1α). At baseline, the women were moderately fatigued (mean score: 46 cm) and at risk of poor functional mobility. A group*time interaction was observed for all measures of strength with improvements (~25–35%) following RT (p’s < 0.01), but not CBCT. Time effects were observed for fatigue (−36%) and quality of life (5%) (p’s < 0.01), where both groups improved in a similar manner. A group*time interaction was observed for KYN (p = 0.02) and PGC-1α (p < 0.05), with KYN decreasing and PGC-1α increasing following RT and the opposite following CBCT. These changes resulted in KYN/KYNA decreasing 34% post-RT, but increasing 21% following CBCT. These data support RT as a therapeutic intervention to counteract the long-term side effect of fatigue and physical dysfunction in BCSs. Additionally, the results suggest that this effect may be mediated through the activation of PGC-1α leading to alterations in KYN metabolism.

THE EFFECT OF HEAVY MENSTRUAL BLEEDING ON WOMEN'S QUALITY OF LIFE: A CASE CONTROL STUDY

Introduction: Heavy menstrual bleeding (HMB) is dened as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and material quality of life. In India, 16% of the women aged between 15 and 44 are diagnosed with HMB. HMB has signicant effects on personal, social, family, and work life of women and thereby reduces their quality of life Aim And Methods: In this study, we aim to identify menstruation characteristics of the women and the effects of HMB on women's quality of life. The participants are 150 volunteer women who were not pregnant or had menopause at the time the study was conducted and who consulted to the Department of Gynecology and Obstetrics at a Rajarajeswari Medical College and Hospital, Bengaluru between November 2020 and January 2021. The patients who had HMB complaint were included in the case group (฀ = 75) while the relatives of the participants who did not have any specic health problems composed the control group (฀ =75 ). Results: Mean age of the participants in the case group was 45.5 year (p&lt;0.05) . 23.9% women had HMB &gt;3years , frequent cycles noted with average length of cycle being 22.79 days and 53.3% being diagnosed with myoma . We evaluated the participants' quality of life and found that HMB group members were affected more signicantly in all subscales of the SF-36 scale (physical functioning, pain, general health, vitality, social role functioning, emotional role functioning, and mental health) when compared to the women in the control group and was found to be statistically signicant with p &lt; 0.05. Conclusion: HMB has negative effects on women's quality of life. Therefore, quality of life of the women with HMB complaint should be investigated and effective approaches should be designed.

Association between TNFi anti-drug antibodies, smoking, and disease activity in patients with inflammatory arthritis: Results from a Norwegian cross-sectional observational study.

IntroductionWe aimed to compare demographics and clinical characteristics between patients with inflammatory arthritis (IA) with vs. without neutralizing anti-drug antibodies (nADAb) against tumor necrosis factor inhibitors (TNFi). A secondary aim of the study was to explore if current smokers were more frequently nADAb-positive.MethodsTNFi-treated outpatients with IA were recruited and a broad range of disease activity measures were assessed. nADAb were assessed using a reporter gene assay. Comparisons between nADAb-positive and -negative patients were done in unadjusted analyses as well as in adjusted logistic regression and general linear models.ResultsA total of 282 patients with IA currently under treatment with TNFi were included. nADAb were identified in 11 patients (nine treated with infliximab, one with etanercept and one with certolizumab pegol). Patients with nADAb reported significantly worse joint pain, patient’s global assessment, Health Assessment Questionnaire, Bath Ankylosing Spondylitis Disease Activity/Functional Index and Short-Form-36 physical functioning scale score than patients without nADAb (p < 0.04, adjusted analyses). 28-joint Disease Activity Score, Simplified Disease Activity Index and Maastricht Ankylosing Spondylitis Enthesitis score were also significantly worse in the nADAb-positive patients (p < 0.04, adjusted analyses), as were serum calprotectin, C-reactive protein and numbers of circulating peripheral leukocytes (p ≤ 0.001). A significantly higher proportion of nADAb-positive patients were current smokers (46 vs. 15%), in unadjusted as well as adjusted analyses (p ≤ 0.008).ConclusionsnADAb-positive patients were more frequently smokers and had significantly worse disease activity, physical function, and inflammatory markers, than patients without nADAb. The association between smoking and nADAb positivity warrants further examination.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-022-00464-7.

Effects of adding aerobic physical activity to strengthening exercise on hip osteoarthritis symptoms: protocol for the PHOENIX randomised controlled trial

BackgroundHip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Most evidence is based on muscle-strengthening exercise, but aerobic physical activity has potential to enhance clinical benefits. The primary aim of this study is to test the hypothesis that adding aerobic physical activity to a muscle strengthening exercise leads to significantly greater reduction in hip pain and improvements in physical function, compared to a lower-limb muscle strengthening exercise program alone at 3 months.MethodsThis is a superiority, 2-group, parallel randomised controlled trial including 196 people with symptomatic hip OA from the community. Following baseline assessment, participants are randomly allocated to receive either i) aerobic physical activity and muscle strengthening exercise or; ii) muscle strengthening exercise only. Participants in both groups receive 9 consultations with a physiotherapist over 3 months. Both groups receive a progressive muscle strengthening exercise program in addition to advice about OA management. The aerobic physical activity plan includes a prescription of moderate intensity aerobic physical activity with a goal of attaining 150 min per week. Primary outcomes are self-reported hip pain assessed on an 11-point numeric rating scale (0 = ‘no pain’ and 10 = ‘worst pain possible’) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at 3 months. Secondary outcomes include other measures of self-reported pain (assessed at 0, 3, 9 months), self-reported physical function (assessed at 0, 3, 9 months), performance-based physical function (assessed at 0, 3 months), joint stiffness (assessed at 0, 3, 9 months), quality of life (assessed at 0, 3, 9 months), muscle strength (assessed at 0, 3 months), and cardiorespiratory fitness (assessed at 0, 3 months). Other measures include adverse events, co-interventions, and adherence. Measures of body composition, serum inflammatory biomarkers, quantitative sensory measures, anxiety, depression, fear of movement and self-efficacy are included to explore causal mechanisms.DiscussionFindings will assist to provide an evidence-based recommendation regarding the additional effect of aerobic physical activity to lower-limb muscle strengthening on hip OA pain and physical function.Trial registrationAustralian New Zealand Clinical Trials Registry reference: ACTRN 12619001297112. Registered 20th September 2019.

Quality of Life of Patients Treated for Abdominal Aortic Aneurysm: Open Surgery and Endoprosthesis.

Objectives: To determine the degree of long-term health-related quality of life (HRQoL) of patients undergoing surgery for abdominal aortic aneurysm (AAA) and to analyze the results according to the type of treatment, namely, open abdominal repair (OAR) or endoprosthesis (EVAR). Patients and Methods: This was a prospective cross-sectional observational study. Patients receiving intervention for AAA between January 2013 and December 2020 were included. The Spanish version of the SF-36 questionnaire was used. A single survey was performed on all patients, and the time elapsed since the intervention was recorded. Results: On all health scales and in the two groups of patients, the highest scores were recorded at six months postoperatively. At that time, the EVAR and OAR groups had similar values. Between 13 and 16 months postoperatively, EVAR patients presented a transient but significant decrease in their scores for physical function (p = 0.016), vitality (p = 0.035) and social function (p = 0.041). From that moment, there were progressive decreases in the scores of the two groups of patients on all the scales of the SF-36 questionnaire, although this trend was less pronounced in the OAR group. At 60 months after the intervention, the latter group showed significantly higher values than EVAR for physical function (p = 0.01), vitality (p = 0.032) and mental health (p = 0.029). Additionally, at 60 months after the intervention, the Sum of the psychological component (MCS) and Sum of the physical component (PCS) scores were significantly higher in the OAR group (p = 0.040 and p = 0.039, respectively). Conclusions: In the short term, patients treated for AAA by EVAR or OAR showed similar results on the SF-36 questionnaire. In the long term, patients treated by EVAR had lower scores on the physical function, vitality and mental health scales.

Comparative characteristics of the quality of life in patients with senile asthenia and history of COVID-19 three and six months after discharge from the hospital

Background. Patients with COVID-19 and senile asthenia syndrome (SA) are characterized by extremely high comorbidity, heterogeneity, atypical course of the disease, and large number of complications. We carried out a comprehensive assessment of the quality of life (QOL) in patients with COVID-19 and SA considering the high prevalence of this category of patients and the absence of such studies.Material and Methods. Group 1 included 37 patients with SA and history of COVID-19 three months after discharge from the hospital. Group 2 included 35 patients with CA and history of COVID-19 six months later. Control group comprised 34 patients with SA aged over 65 years who did not have COVID-19. The assessment of QOL was carried out according to the SF-36 questionnaire.Results. There was a decrease in absolutely all indicators of physical and psychosocial aspects of health three months after discharge from the hospital. There was a more pronounced decrease in the scales of physical functioning (PF), role-physical functioning (RP), general health (GH), and mental health (MH) after six months. There was a lower QOL in female population according to most scales (PF, RP, GH, MH, and role-emotional functioning (RE)) regardless of the time from the moment of discharge from the hospital, and a higher incidence of depression compared to men.Conclusions. All QOL indicators of patients with SA and history of COVID-19 decreased within the first three months after discharge from the hospital. At the same time, after six months, a decrease in physical status was most pronounced, while the indicators of mental sphere reduced only according to the MH scale. At three and six months after discharge, the quality of life in the male population was higher than in the female population according to the same evaluation scales (PF, RP, GH, MH, and RE). The best indicators of pain scale in men were characteristic only for the first group of patients, whereas there was no statistically significant difference according to the social functioning and MH data. There was a higher incidence of depression in the female population, while the prevalence of anxiety was higher at three months after discharge than after six months.

One Year of COVID-19 in Spain, Longitudinal Study on Mental and Physical Health

The objective of this longitudinal study carried out with the same participants, with two repeated measurements, the first taken in March 2020 (M1) and the second measurement in March 2021 (M2), is to investigate the impact of the COVID-19 pandemic throughout one year on the levels of Affect, Psychological Well-being, Depression and Mental and Physical Health, as well as to learn about the evolution of those levels from M1 to M2. Comparison of the mean scores of the variables analyzed between the two measurements (M1 and M2) show significant differences in the following scales: Positive Affect (PANAS), with lower scores at M2; Total Depression (BDI-II) and the two Cognitive-Affective and Somatic-Motivational factors, with higher scores at M2; the physical and mental health scales (SF-36) of Physical Functioning, Role Physical, Vitality, Social Functioning, Role Emotional, and Mental Health, and the two Physical and Mental Health components, with lower scores at M2 in all of them; and the Purpose in Life (PWB) scale, with a lower score at M2. We can conclude that the one-year pandemic situation has affected all the variables analyzed in this work, showing a decrease in positive affect, an increase in the score of the depression inventory, worse physical and mental health, and less psychological well-being. Throughout the pandemic year, the results show that age has a moderation effect on the Somatic-Motivational factor and on the Total Depression, Physical Functioning, Vitality, and Role Emotional scales. Gender shows no moderation effect on any of the four variables analyzed.

Health-Related Quality of Life in Patients With Locally Advanced Gastric Cancer Undergoing Perioperative or Postoperative Adjuvant S-1 Plus Oxaliplatin With D2 Gastrectomy: A Propensity Score-Matched Cohort Study.

BackgroundSome high-quality clinical trials have proven the efficacy and safety of perioperative and postoperative S-1 with oxaliplatin (peri-SOX and post-SOX) for patients with locally advanced gastric cancer (LAGC) undergoing D2 gastrectomy. However, little is known about how health-related quality of life (HRQOL) changes over time in patients receiving peri-SOX or post-SOX chemotherapy.MethodsA prospective observational cohort (NCT04408859) identified 151 eligible patients with LAGC who underwent D2 gastrectomy with at least six cycles of peri-SOX or post-SOX chemotherapy from 2018 to 2020. HRQOL was assessed using the EROTC QLQ-C30 and its gastric module, QLQ-STO22, at indicated measurements, including the baseline, 1st, 3rd, 6th and 12th month after initiation of therapy. Baseline characteristics, therapeutic effects, and longitudinal HRQOL were compared between the peri-SOX and post-SOX groups after propensity score matching. HRQOL changes over time and the risk factors for scales with severe deterioration were further analyzed.ResultsNo statistically significant differences in longitudinal HRQOL were observed between patients in the peri-SOX and post-SOX groups, with comparable surgical outcomes and adverse chemotherapy events. Scales of social functioning, abnormal taste, and anxiety improved earlier in the peri-SOX group than in the post-SOX group. Score changes in both groups indicated that general deterioration and slower recovery usually occurred in the scales of physical, social, and role functioning, as well as symptoms of fatigue, reflux, diarrhea, and anxiety.ConclusionPeri-SOX showed a longitudinal HRQOL comparable to post-SOX in patients with LAGC who underwent D2 gastrectomy. The peri-SOX group had better performance in social functioning, abnormal taste, and anxiety at some measurements.