Short Form-36 Physical Function Research Articles

Comparison of the responsiveness of the SF-36, the Oxford Knee Score, and the Knee Society Clinical Rating System in patients undergoing total knee replacement

To compare the responsiveness of the Knee Society (KS) Clinical Rating System, the general health status measure Short Form 36 (SF-36), and both the raw and Rasch-based scores of the condition-specific Oxford Knee Score (OKS) in patients undergoing total knee replacement (TKR) METHODS: Data were prospectively collected as part of routine care from adult patients who underwent TKR between 2001 and 2006. OKS data fit the Rasch partial credit model after removing items regarding limping and kneeling. Responsiveness was assessed using effect size (ES), standardised response mean (SRM), and relative validity (RV). Among 702 patients with complete data at baseline and two follow-ups, the pain subscale of the KS (KS-P), raw-OKS, and Rasch-OKS consistently had higher levels of responsiveness than all eight SF-36 and the other KS subscales. At 6-month follow-up, Rasch-OKS had the largest ES and KS-P had the largest SRM (2.7 and 2.0, respectively). When compared to raw-OKS, the RVs of KS-P, Rasch-OKS, SF-36 bodily pain, and SF-36 physical functioning were 1.1, 0.66, 0.49, and 0.36, respectively. A similar ordering of responsiveness was observed at 24-month follow-up. The OKS and KS-P are more responsive than most SF-36 subscales in TKR patients. Raw-OKS and Rasch-OKS have comparable responsiveness. Different responsiveness indices may give different results.

Quality of life and self-reported disability in patients with knee osteoarthritis

Osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem throughout the world. The aims of this study are to assess quality of life (QoL) in patients with knee OA using the generic instrument Short Form-36 (SF-36) and to determine its relationships with conventional clinical measures and self-reported disability. Patients with knee OA (n = 112) with median age of 60 (45–76) years and 40 sex- and age-matched healthy controls were included in the study. Age, sex, body mass index (BMI), symptom duration, and Kellgren–Lawrence scores were recorded. QoL, disability, and pain were assessed using the SF-36, the Western Ontario and McMaster (WOMAC) index, the Lequesne index, and a visual analog scale (VAS) in patients. Also, QoL was assessed using the SF-36 in controls. Patients with knee OA had lower scores in all subgroups of SF-36 compared with controls. In patients, the SF-36 physical function (PF) and pain areas significantly correlated with effusion, VAS pain, and Lequesne and WOMAC subgroup scores (p < 0.05). The pain area of QoL did not show correlation with comorbidity with knee OA. We found that SF-36 and WOMAC pain scores were more severe in female patients. Patients with knee OA had significantly poorer QoL compared with healthy controls. SF-36 is related to the clinical status and functional ability of patients with OA and can be used as a sensitive health status measure for clinical evaluation. Also WOMAC can be used as a sensitive measure for disability of patients with knee OA.

Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength

BackgroundKnee extensor strength and knee extension range of motion (ROM) are important predictors of physical function in patients with a total knee arthroplasty (TKA). However, the relationship between the two knee measures remains unclear. The purpose of this study was to examine whether changes in knee extensor strength mediate the association between changes in knee extension ROM and self-report physical function.MethodsData from 441 patients with a TKA were collected preoperatively and 6 months postoperatively. Self-report measure of physical function was assessed by the Short Form 36 (SF-36) questionnaire. Knee extensor strength was measured by handheld dynamometry and knee extension ROM by goniometry. A bootstrapped cross product of coefficients approach was used to evaluate mediation effects.ResultsMediation analyses, adjusted for clinicodemographic measures, revealed that the association between changes in knee extension ROM and SF-36 physical function was mediated by changes in knee extensor strength.ConclusionsIn patients with TKA, knee extensor strength mediated the influence of knee extension ROM on physical function. These results suggest that interventions to improve the range of knee extension may be useful in improving knee extensor performance.

The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation

Questions remain as to the effect that obesity has on patients managed for symptomatic lumbar disc herniation. The purpose of this study was to determine if obesity affects outcomes following the treatment of symptomatic lumbar disc herniation. An as-treated analysis was performed on patients enrolled in the Spine Patient Outcomes Research Trial for the treatment of lumbar disc herniation. A comparison was made between patients with a body mass index of <30 kg/m² (nonobese) (n = 854) and those with a body mass index of ≥30 kg/m² (obese) (n = 336). Baseline patient demographic and clinical characteristics were documented. Primary and secondary outcomes were measured at baseline and at regular follow-up time intervals up to four years. The difference in improvement from baseline between operative and nonoperative treatment was determined at each follow-up period for both groups. At the time of the four-year follow-up evaluation, improvements over baseline in primary outcome measures were significantly less for obese patients as compared with nonobese patients in both the operative treatment group (Short Form-36 physical function, 37.3 compared with 47.7 points [p < 0.001], Short Form-36 bodily pain, 44.2 compared with 50.0 points [p = 0.005], and Oswestry Disability Index, -33.7 compared with -40.1 points [p < 0.001]) and the nonoperative treatment group (Short Form-36 physical function, 23.1 compared with 32.0 points [p < 0.001] and Oswestry Disability Index, -21.4 compared with -26.1 points [p < 0.001]). The one exception was that the change from baseline in terms of the Short Form-36 bodily pain score was statistically similar for obese and nonobese patients in the nonoperative treatment group (30.9 compared with 33.4 points [p = 0.39]). At the time of the four-year follow-up evaluation, when compared with nonobese patients who had been managed operatively, obese patients who had been managed operatively had significantly less improvement in the Sciatica Bothersomeness Index and the Low Back Pain Bothersomeness Index, but had no significant difference in patient satisfaction or self-rated improvement. In the present study, 77.5% of obese patients and 86.9% of nonobese patients who had been managed operatively were working a full or part-time job. No significant differences were observed in the secondary outcome measures between obese and nonobese patients who had been managed nonoperatively. The benefit of surgery over nonoperative treatment was not affected by body mass index. Obese patients realized less clinical benefit from both operative and nonoperative treatment of lumbar disc herniation. Surgery provided similar benefit over nonoperative treatment in obese and nonobese patients.

Comparing specialist medical care with specialist medical care plus the Lightning Process® for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME): study protocol for a randomised controlled trial (SMILE Trial)

BackgroundChronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and potentially serious condition with a limited evidence base for treatment. Specialist treatment for paediatric CFS/ME uses interventions recommended by National Institute for Health and Clinical Excellence (NICE) including cognitive behavioural therapy, graded exercise therapy and activity management. The Lightning Process® (LP) is a trademarked intervention derived from osteopathy, life-coaching and neuro-linguistic programming, delivered over three consecutive days as group sessions. Although over 250 children with CFS/ME attend LP courses each year, there are no reported studies on the effectiveness or cost-effectiveness.MethodsThis pragmatic randomised controlled trial is set within a specialist paediatric CFS/ME service in the south west of England. Children and young people with CFS/ME (n = 80 to 112), aged 12 to 18 years old will be randomised to specialist medical care (SMC) or SMC plus the LP. The primary outcome will be physical function (SF-36 physical function short form) and fatigue (Chalder Fatigue Scale).DiscussionThis study will tell us whether adding the LP to SMC is effective and cost-effective compared to SMC alone. This study will also provide detailed information on the implementation of the LP and SMC.Trial registrationCurrent Controlled Trials ISRCTN81456207 (31 July 2012).

Impact of first metatarsophalangeal joint osteoarthritis on health‐related quality of life

To determine whether there are differences in the foot-specific and general health-related quality of life (HRQOL) of people with and without first metatarsophalangeal (MTP) joint osteoarthritis (OA). The foot-specific and general HRQOL of 43 participants (mean ± SD age 50.0 ± 10.8 years) with symptomatic radiographically confirmed first MTP joint OA (case group) was compared to an age-, sex-, and body mass index-matched control group. Foot-specific HRQOL was assessed using the Foot Health Status Questionnaire (FHSQ) and general HRQOL was assessed using the Short Form 36 (SF-36) questionnaire. Both questionnaires are validated instruments with 0-100-point domains. All domains of the FHSQ were significantly lower in the case group (mean ± SD foot pain 55.5 ± 22.3 versus 93.0 ± 7.8, foot function 73.8 ± 20.9 versus 96.9 ± 11.5, footwear 39.1 ± 28.7 versus 76.6 ± 27.0, and general foot health 50.2 ± 27.0 versus 89.7 ± 16.0). Further, the SF-36 physical functioning domain was significantly lower (mean ± SD 82.8 ± 14.7 versus 95.2 ± 6.3) in the case group. People with first MTP joint OA experience more foot pain, have greater difficulty performing functional weight-bearing activities, find it more difficult to obtain suitable footwear, and perceive their feet to be in a poorer state of health. Additionally, people with symptomatic first MTP joint OA have greater difficulty performing a broad range of physical tasks and activities.

Rasch Analysis of the 22 Knee Injury and Osteoarthritis Outcome Score–Physical Function Items in Italian Patients With Knee Osteoarthritis

ObjectivesTo replicate previous Rasch analysis (RA) that yielded the 7-item Physical Function Short Form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS7) in order to verify the consistency of the item selection process, and to analyze its main psychometric properties in a sample of Italian patients with osteoarthritis (OA). DesignMethodological research on cross-sectional data from a convenience sample. SettingUniversity hospital. ParticipantsOutpatients with symptomatic OA of the knee (N=200; women, 73%; mean age, 69.4y). InterventionsNot applicable. Main Outcome MeasureThe KOOS-PF22 (22 items comprising the 2 KOOS domains of activities of daily living and sport/recreation). Its dimensionality was investigated using exploratory factor analysis. RA was performed on KOOS-PF22, KOOS-PS7, and an item set (called KOOS-PS12) obtained by removing from KOOS-PF22 all misfitting items. ResultsKOOS-PF22 showed a 2-factor structure, with the first one largely prevailing. Ten of its 22 items did not fit the Rasch model, while item dependency was present in 7 item pairs. Five of 7 KOOS-PS7 items and all KOOS-PS12 items showed acceptable fit to the Rasch model. The person separation reliability was .79 for KOOS-PS7 and .90 for KOOS-PS12; Cronbach alpha was .81 for KOOS-PS7 and .92 for KOOS-PS12. ConclusionsRA was not able to replicate the selection process of the items included in KOOS-PS7. KOOS-PS7 reliability levels indicate that the instrument seems more useful for group decisions than for everyday clinical application in single patients. To achieve a short form of KOOS-PF22 valid for a wide spectrum of individuals with knee OA, further psychometric studies are warranted.

Quality of Life Among Obese Patients Seeking Weight Loss Surgery: The Importance of Obesity-Related Social Stigma and Functional Status

Obesity is a stigmatizing condition associated with adverse psychosocial consequences. The relative importance of weight stigma in reducing health utility or the value a person places on their current health state is unknown. We conducted a telephone survey of patients with obesity. All were seeking weight loss surgery at two bariatric centers (70 % response rate). We assessed patients' health utility (preference-based quality life measure) via a series of standard gamble scenarios assessing patients' willingness to risk death to lose various amounts of weight or achieve perfect health (range 0 to 1; 0 = death and 1 = most valued health/weight state). Multivariable models assessed associations among quality of life domains from the Short-form 36 (SF-36) and Impact of Weight on Quality of Life-lite (IWQOL-lite) and patients' health utility. Our study sample (n = 574) had a mean body mass index of 46.5 kg/m(2) and a mean health utility of 0.87, reflecting the group's average willingness to accept a 13 % risk of death to achieve their most desired health/weight state; utilities were highly variable, however, with 10 % reporting a utility of 1.00 and 27 % reporting a utility lower than 0.90. Among the IWQOL-lite subscales, Public Distress and Work Life were the only two subscales significantly associated with patients' utility after adjustment for sociodemographic factors. Among the SF-36 subscales, Role Physical, Physical Functioning, and Role Emotional were significantly associated with patients' utility. When the leading subscales on both IWQOL-lite and SF-36 were considered together, Role Physical, Public Distress, and to a lesser degree Role Emotional remained independently associated with patients' health utility. Patients seeking weight loss surgery report health utilities similar to those reported for people living with diabetes or with laryngeal cancer; however, utility values varied widely with more than a quarter of patients willing to accept more than a 10 % risk of death to achieve their most valued health/weight state. Interference with role functioning due to physical limitations and obesity-related social stigma were strong determinants of reduced health utility.

Comparative effectiveness of alternative clinical pathways for primary hip and knee joint replacement patients: a pragmatic randomized, controlled trial

Total hip replacement (THR) and total knee replacement (TKR) (arthroplasty) surgery for end-stage osteoarthritis (OA) are ideal candidates for optimization through an algorithmic care pathway. Using a comparative effectiveness study design, we compared the effectiveness of a new clinical pathway (NCP) featuring central intake clinics, dedicated inpatient resources, care guidelines and efficiency benchmarks vs. the standard of care (SOC) for THR or TKR. We compared patients undergoing primary THR and TKR who received surgery in NCP vs. SOC in a randomised controlled trial within the trial timeframe. 1,570 patients (1,066 SOC and 504 NCP patients) that underwent surgery within the study timeframe from urban and rural practice settings were included. The primary endpoint was improvement in Western Ontario and McMaster University osteoarthritis index (WOMAC) overall score over 12 months post-surgery. Secondary endpoints were improvements in the physical function (PF) and bodily pain (BP) domains of the Short Form 36 (SF-36). NCP patients had significantly greater improvements from baseline WOMAC scores compared to SOC patients after adjusting for covariates (treatment effect=2.56; 95% confidence interval (CI) [1.10-4.01]). SF-36 BP scores were significantly improved for both hip and knee patients in the NCP (treatment effect=3.01, 95% CI [0.70-5.32]), but SF-36 PF scores were not. Effects of the NCP were more pronounced in knee patients. While effect sizes were small compared with major effects of the surgery itself, an evidence-informed clinical pathway can improve health related quality of life (HRQoL) of hip and knee arthroplasty patients with degenerative joint disorder in routine clinical practice for up to 12 months post-operatively. CLINICALTRIALS.GOV IDENTIFIER: NCT00277186.

External Fixation Versus ORIF for Distal Intra-articular Tibia Fractures

Tibia plafond fractures have historically demonstrated high complication rates. The purpose of this study was to assess the outcomes of tibia plafond fractures following treatment with definitive external fixation vs delayed open reduction and internal fixation (ORIF). Sixty patients were enrolled in a prospective cohort trial at 1 Level I trauma center. No differences were noted between the 2 treatment groups in terms of age, smoking history, presence of comorbidities, mechanism of injury, incidence of open fractures, or Orthopaedic Trauma Association fracture classification. Complete 12-month follow-up was available for 18 patients in the definitive external fixation group and 27 patients in the ORIF group. No difference was noted in articular reduction between the groups at 6 and 12 months postoperatively. Delayed union or non-union occurred in 4 (22.2%) of 18 patients in the external fixation group and 1 (3.7%) of 27 patients in the ORIF group (P=.05). Deep infection was equally likely in either group (P=.33). The ORIF group had improved Iowa Ankle Scores at 6 (23.6 ± 12.1 vs 11.1 ± 7.7; P<.05) and 12 months (5.5 ± 2.2 vs 3.1 ± 1.7; P<.05) postopertively and improved Short Form-36 Physical Function scores at 6 months (49.7 ± 30.1 vs 25.5 ± 8.0; P<.05) postoperatively compared with the external fixation group.External fixation and ORIF can attain bony union with adequate articular reduction and similar infection rates. Patients treated with ORIF appeared to have improved union rates and early outcomes with ankle function and Short Form-36 Physical Function scores.

Fear of movement/(re)injury and activity avoidance in persons with neurogenic versus vascular claudication

Activity avoidance and fear of movement/(re)injury are increasingly being recognized as important factors in the rehabilitation of persons suffering from chronic low back pain, yet these factors have not been thoroughly explored in persons suffering from neurogenic claudication resulting from lumbar spinal stenosis. To determine, compare, and explain differences in the degree of fear of movement/(re)injury and activity avoidance in persons with neurogenic claudication, vascular claudication, and asymptomatic volunteers. Prospective controlled cohort study at an academic medical center. Eighty-two adults aged between 55 and 90 years with neurogenic claudication, vascular claudication, or no back and leg symptoms. Subjects completed a visual analog scale for pain, the Center for Epidemiological Studies Depression Scale, the Quebec Back Pain Disability Scale, Short Form 36 (SF-36), and the 13-item version of the Tampa Scale for Kinesiophobia (Tampa). They were also asked to estimate their maximum walking distance. The difference in the level of fear of movement/(re)injury and activity avoidance in the two symptomatic populations, as well as the predictive validity of self-reported measures such as pain level, functional impairment, and depression in determining fear avoidance. The total Tampa score was significantly higher in individuals with neurogenic claudication (M=31.68; standard deviation [SD]=7.56; N=39) than vascular claudication (M=24.07; SD=6.57; N=15) (p=.002), whereas both symptomatic groups were significantly different from controls (M=18.71; SD=6.3; N=28) (p<.001 vs. neurogenic; p<.05 vs. vascular). Tampa scores were strongly correlated to the Center for Epidemiological Studies Depression Scale score (r=0.515; p<.001), SF-36 Physical Functioning score (r=-0.632; p<.001), and the visual analog scale average level of pain in a week (r=0.461; p<.001). Using a standard multiple regression model (R²=0.406; F(3,62)=13.47; p<.001), the amount of functional impairment, that is, the SF-36 Physical Functioning score, was the strongest contributor to the variance in the Tampa total score (β=-0.371; p=.014). The average level of pain did not make a significant or unique contribution in predicting the Tampa total score. Functional impairment as measured by the SF-36 Physical Functioning was strongly correlated with both pain (r=-0.740; p<.001) and depression (r=-0.488; p<.001). Persons with neurogenic claudication have important elevations in fear and avoidance, higher than those with claudication from another source (vascular insufficiency). The impact of fear and avoidance along with other factors such as depression on pain, disability, and quality of life for persons with claudication and spinal stenosis need to be explored.

Responsiveness of the OARSI–OMERACT osteoarthritis pain and function measures

To assess the responsiveness of the Intermittent and Constant Osteoarthritis Pain (ICOAP) measure, Hip Disability and Osteoarthritis Outcome Score Physical Function Short Form (HOOS-PS), and the Knee Disability and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) in a pharmacological trial. Data were obtained from a randomized double-blind trial comparing naproxcinod with naproxen and ibuprofen in individuals with hip or knee osteoarthritis (OA) (NCT00662896). Participants completed the ICOAP, HOOS-PS/KOOS-PS, and Western Ontario and McMaster Universities OA Index (WOMAC) Likert version 3.0 before and 13 weeks after treatment. In hip and knee OA participants separately, the mean pre-post treatment change in scores, effect size (ES) and standardized response mean (SRM) were determined for each measure by treatment arm, and for all arms combined. Of 349 trial participants, 156 with knee OA and 48 with hip OA completed all measures at both time-points and were included (mean age 61 years; two-thirds female). Although there was both within treatment and between treatment variability in response, among knee OA participants, ICOAP intermittent, constant, and total scores and KOOS-PS scores showed, on average, moderate effects, with ESs ranging from 0.46 to 0.54 and SRMs from 0.49 to 0.56. Similar changes were seen for the WOMAC pain and function subscales (0.58 and 0.58, respectively). In those with hip OA, no significant improvement in symptoms was seen for any measure. Responsiveness to pharmaceutical intervention was demonstrated for ICOAP and KOOS-PS among participants with knee OA. Absence of treatment response precluded assessment of responsiveness in hip OA.

Quality of Life Among Liver Transplantation Patients

BackgroundOrthotopic liver transplantation (OLT) is the treatment of choice for end-stage disease. It offers a chance to return to an active and prolonged life. Recently, more attention is being paid to the health-related quality of life (HRQoL) of patients and their spouses or caregivers after OLT. The aim of this study was to analyze the pre- versus posttransplantation HRQoL of patients and their spouses or caregivers using generic and disease-specific health questionnaires. Material and MethodsThe study was performed between October 2010 and January 2011 using the Short Form-36 (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ) to evaluate the HRQoL. ResultsPosttransplantation patients (N = 59, mean age 53.39 [range, 23 to 76] years, male 63.2%, female 36.8%) and their spouses and caregivers showed significantly better generic SF-36 HRQoL scores, namely, physical and social functioning, role limitations because of physical or emotional problems, bodily pain, vitality, as well as general and mental health compared with pretransplantation patients (N = 57, mean age 54.56 (range, 22 to 69) years, male 71.2%, female 28.8%). Similarly, the posttransplantation group showed significantly improved CLDQ scores in all domains: fatigue, activity, abdominal symptoms, systemic symptoms, emotional function, and worry. ConclusionOLT improved HRQoL of end-stage liver patients and their spouses or caregivers.

Risk factors for obesity in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

Many Childhood Cancer Survivor Study (CCSS) participants are at increased risk for obesity. The etiology of their obesity is likely multifactorial but not well understood. We evaluated the potential contribution of demographic, lifestyle, treatment, and intrapersonal factors and self-reported pharmaceutical use to obesity (body mass index ≥ 30 kg/m2) among 9,284 adult (> 18 years of age) CCSS participants. Independent predictors were identified using multivariable regression models. Interrelationships were determined using structural equation modeling (SEM). Independent risk factors for obesity included cancer diagnosed at 5 to 9 years of age (relative risk [RR], 1.12; 95% CI, 1.01 to 1.24; P = .03), abnormal Short Form-36 physical function (RR, 1.19; 95% CI, 1.06 to 1.33; P < .001), hypothalamic/pituitary radiation doses of 20 to 30 Gy (RR, 1.17; 95% CI, 1.05 to 1.30; P = .01), and paroxetine use (RR, 1.29; 95% CI, 1.08 to 1.54; P = .01). Meeting US Centers for Disease Control and Prevention guidelines for vigorous physical activity (RR, 0.90; 95% CI, 0.82 to 0.97; P = .01) and a medium amount of anxiety (RR, 0.86; 95% CI, 0.75 to 0.99; P = .04) reduced the risk of obesity. Results of SEM (N = 8,244; comparative fit index = 0.999; Tucker Lewis index = 0.999; root mean square error of approximation = 0.014; weighted root mean square residual = 0.749) described the hierarchical impact of the direct predictors, moderators, and mediators of obesity. Treatment, lifestyle, and intrapersonal factors, as well as the use of specific antidepressants, may contribute to obesity among survivors. A multifaceted intervention, including alternative drug and other therapies for depression and anxiety, may be required to reduce risk.

The Role of Neuropsychological Performance in the Relationship Between Chronic Pain and Functional Physical Impairment

In this study, the relationship between pain intensity, neuropsychological, and physical function in adult chronic pain patients was examined. Thirty participants with chronic pain completed neuropsychological tests tapping mental processing speed, memory, and executive function. Pain intensity was measured with three visual analog scales and the Pain Rating Index of the McGill Pain Questionnaire. A grip strength test, the 6-minute walk test, the Unipedal Stance Test and the Lifting Low Test were administered in order to obtain a performance-based measure of physical capacity. Self-reported physical ability was assessed with the Disability Rating Index and the Short Form-36 Physical Functioning, and Role Physical scales. Psychosocial function was examined using the Mental Health and Role Emotional subscales of the Short Form-36. The study was set in two outpatient physical therapy clinics in The Netherlands. The analysis showed that a lower mental processing speed was related to a higher level of pain, as well as to a lower performance-based and self-reported physical functioning. In addition, both performance-based and self-reported physical function revealed an inverse correlation with pain intensity. Psychosocial function turned out to be an important mediator of the relationship between pain and self-reported, but not performance-based, physical function. Mental processing speed, on the other hand, was found to mediate the relationship between pain and performance-based physical functioning. The results suggest that in chronic pain patients, mental processing speed mediates the relationship between pain and physical function.

Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS‐PS), Knee Outcome Survey Activities of Daily Living Scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS),

Patient-reported measures of knee function are important for the comprehensive assessment of rheumatology conditions in both clinical and research contexts. To merit inclusion in this review, measures of knee function were required to be patient reported and assess aspects considered important by adult patients with knee problems such as injury or osteoarthritis (OA). Therefore, measures used in rheumatology, orthopedics, and sports medicine were considered. Dimensions deemed to be important to patients included pain, function, quality of life, and activity level. To identify instruments fulfilling these criteria, we utilized published reviews of knee instruments (1), knee OA instruments (2), and measures for use in patellofemoral arthroplasty (3). Based on these reviews, as well as extensive searches of more recent literature, we included the following 9 patient-reported outcomes: Activity Rating Scale, International Knee Documentation Committee Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form, Knee Outcome Survey Activities of Daily Living Scale, Lysholm Knee Scoring Scale, Tegner Activity Scale, Oxford Knee Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Although the WOMAC can be applied to the hip and knee, this study contains data only applicable to the knee. Measures assessing activity level are listed separately. Psychometric data pertaining to the reliability and responsiveness of each patient-reported outcome are shown in Tables 1 and ​and2.2. The number of psychometric reports concerning each instrument ranges from 2–27. A higher number of reports indicates a higher degree of certainty in interpretation of the psychometric properties. Table 1 Summary of reliability data* Table 2 Summary of responsiveness data* Psychometric properties were based on data provided in Tables 1 and 2, and interpreted using standardized guidelines. Internal consistency was considered adequate if Cronbach’s alpha was at least 0.7 (4), and test–retest (intra-rater) reliability was adequate if the intraclass correlation coefficient was at least 0.8 for groups and 0.9 for individuals (5). Floor and ceiling effects were considered to be absent if no participants scored the bottom or top score, respectively, and acceptable if 0.8 were considered large (9). In this context, the minimum clinically important difference is the amount of change of a patient-reported outcome that represents a meaningful change to the patient, while the patient-acceptable symptom state is the least abnormal function score at which patients would consider themselves having acceptable function (10).

Subtalar Arthroscopy and Flurosocopy in Percutaneous Fixation of Intra-Articular Calcaneal Fractures: The Best of Both Worlds

Fixation of intra-articular calcaneal fractures has traditionally been guided by intraoperative fluoroscopy. Recent reports indicate that there is a role for subtalar arthroscopy in surgical fixation of these fractures. The earliest reports described the use of subtalar arthroscopy for joint assessment during late hardware removal. It then served as an adjunct for joint inspection in open reduction and internal fixation. In its final permutation, percutaneous arthroscopy was performed with minimally invasive reduction and fixation, minimizing soft tissue complications commonly associated with the open approach. In practiced hands, this technique yields good results with minimal morbidity. We performed a prospective analysis of 22 consecutive patients with Sanders II, AO-OTA 83-C2 intra-articular calcaneal fractures who underwent dual-modality imaging (subtalar arthroscopic- and intraoperative fluoroscopic-) guided percutaneous fracture fixation with a minimum follow-up of 2 years. Maximum accepted postreduction step-off was 1 mm. Fractures were fixed definitively with four to eight percutaneous cancellous screws. There was significant correction of Böhler's tuberosity-joint angle from 4.2 degrees±11.1 degrees preoperatively to 21.3 degrees±8.8 degrees on immediate postoperative radiographs, with minimal subsidence to 20.1 degrees±8.2 degrees at 2 years. Böhler's angle correction and joint surface restoration could not be achieved percutaneously in one patient with an impacted, depressed joint fragment. Compared with preoperative values, there was significant improvement in mean Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score, and Short Form-36 (Physical Function) scores at 3 months, with further improvement up to 2-years. Subtalar arthroscopy augments intraoperative fluoroscopy in anatomic reduction of the posterior calcaneal facet of the subtalar joint and is most useful for Sanders type II, AO-OTA 83-C2 fractures. The percutaneous approach further avoids soft tissue complications associated with open reduction. However, this procedure has a steep learning curve, and conversion to open reduction must be considered when percutaneous reduction fails.

Impact of obesity on functioning among women with systemic lupus erythematosus

Obesity is associated with high rates of disability in the general population. The nature of the relationship between obesity and disability in systemic lupus erythematosus (SLE), a condition with a high background rate of disability, is unknown. Data were from 2 interviews, 4 years apart, of a longitudinal cohort of individuals with SLE (n = 716 women). Body mass index (BMI) was calculated from self-reported height and weight; obesity was classified by usual (BMI ≥30) and revised (BMI ≥26.8) definitions. Three measures of functioning were examined: the Short Form 36 (SF-36) Health Survey physical function (PF) subscale, Valued Life Activities (VLA) Disability Questionnaire, and employment. Multivariate analyses controlled for demographics, SLE duration and disease activity, glucocorticoid use, depression, and comorbidities. Prospective analyses also controlled for baseline function. At a BMI of ≥30, 27.8% of the subjects were obese; at a BMI of ≥26.8, 40.6% of the subjects were obese. Regardless of obesity definition, obese women exhibited poorer baseline function, with decrements ranging from 20-33% depending on the functional measure and obesity definition. With a BMI of ≥26.8, the adjusted SF-36 PF scores were 4.3 points lower for obese women (P < 0.0001), VLA difficulty was 0.09 higher (P = 0.01), and odds of employment were 80% of nonobese women (odds ratio 0.8, 95% confidence interval 0.5-1.1). At the 4-year followup, women who were obese at baseline had poorer function and experienced greater functional declines. Obesity was associated with clinically significant negative effects on function, both concurrently and prospectively. This negative impact occurred at a lower BMI than is often considered problematic clinically. Because of the high rate of SLE-related disability, addressing preventable risk factors such as obesity may improve long-term SLE outcomes.

Serum Vitamin E Concentrations and Recovery of Physical Function During the Year After Hip Fracture

Poor nutritional status after hip fracture is common and may contribute to physical function decline. Low serum concentrations of vitamin E have been associated with decline in physical function among older adults, but the role of vitamin E in physical recovery from hip fracture has never been explored. Serum concentrations of α- and γ-tocopherol, the two major forms of vitamin E, were measured in female hip fracture patients from the Baltimore Hip Studies cohort 4 at baseline and at 2-, 6-, and 12-month postfracture follow-up visits. Four physical function measures-Six-Minute Walk Distance, Lower Extremity Gain Scale, Short Form-36 Physical Functioning Domain, and Yale Physical Activity Survey-were assessed at 2, 6, and 12 months postfracture. Generalized estimating equations modeled the relationship between baseline and time-varying serum tocopherol concentrations and physical function after hip fracture. A total of 148 women aged 65 years and older were studied. After adjusting for covariates, baseline vitamin E concentrations were positively associated with Six-Minute Walk Distance, Lower Extremity Gain Scale, and Yale Physical Activity Survey scores (p < .1) and faster improvement in Lower Extremity Gain Scale and Yale Physical Activity Survey scores (p < .008). Time-varying vitamin E was also positively associated with Six-Minute Walk Distance, Lower Extremity Gain Scale, Yale Physical Activity Survey, and Short Form-36 Physical Functioning Domain (p < .03) and faster improvement in Six-Minute Walk Distance and Short Form-36 Physical Functioning Domain (p < .07). Serum concentrations of both α- and γ-tocopherol were associated with better physical function after hip fracture. Vitamin E may represent a potentially modifiable factor related to recovery of postfracture physical function.

Impaired physical quality of life in patients with diastolic dysfunction associates more strongly with neurohumoral activation than with echocardiographic parameters: Quality of life in diastolic dysfunction

Quality of life (QoL) is impaired in diastolic heart failure. Little is known about QoL in diastolic dysfunction (DD) without heart failure. In the DIAST-CHF observational study, outpatients with risk factors for or a history of heart failure were included. In a cross-sectional analysis, we classified patients with preserved systolic function as having normal diastolic function (N, n = 264) or DD without (DD-, n = 957) or with (DD+, n = 321) elevated filling pressures according to echocardiography. Quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. Short Form 36 physical function (SF-36-PF) was worse in DD+ (mean ± SD 67.2 ± 25.6) than in DD- (76.2 ± 22.7, P < .05) than in N (mean ± SD 81.1 ± 23.5, P < .01). Other physical dimensions and the physical component score were also lower in DD, whereas the mental component score did not differ. The SF-36-PF correlated weakly with echocardiographic indicators of diastolic function. In multivariate linear regression controlling for age, sex, body mass index, depressiveness as assessed by Patient Health Questionnaire 9, N-terminal probrain-type natriuretic peptide, and midregional proadrenomedullin (MR-proADM), individual echocardiographic parameters or grade of DD was not independently associated with SF-36-PF, whereas the presence of DD+ was. Both N-terminal probrain-type natriuretic peptide and MR-proADM were independently associated with SF-36-PF, with MR-proADM showing the stronger association. Physical dimensions of QoL are reduced in DD. Impaired SF-36-PF is only weakly associated with DD per se but rather seems to be contingent on the presence of elevated filling pressures. Biomarkers are more strongly and independently associated with SF-36-PF and may be more adequate surrogate markers of QoL in DD than echocardiographic measurements.