Physical Health Component Scores Research Articles

P047 Mortality in patients with rheumatic disease over a three year period encompassing the COVID-19 pandemic: clinically extremely vulnerable status and short form 12 scores are predictive

Abstract Background/Aims In the United Kingdom (UK), to combat the coronavirus disease 2019 (COVID-19) pandemic, social distancing measures were implemented to varying degrees between March-2020 and December-2021. UK policy deemed patients with rheumatic disease (RD) at higher risk from COVID-19 and many were categorised as ‘clinically extremely vulnerable’ (CEV), these patients were required to follow more stringent social distancing measures. Social isolation and loneliness are implicated as predictors of mortality; the impact of these strict social distancing measures in patients with RD on mortality is unknown. In addition, Health related quality of life (HRQoL) measures provide useful insights into a patients physical and mental wellbeing. HRQoL is recognised as an important measure of health outcomes and there is limited evidence suggesting HRQoL measures such as the Health Assessment Questionnaire (HAQ) and the Short Form-36 questionnaire (SF-36) are associated with mortality in patients with rheumatoid arthritis. The predictive value of the SF-12 (a validated, shortened version of the SF-36) in RD patient’s mortality is unknown. In this UK-based, observational cohort study we evaluated the impact of stricter social distancing measures during the pandemic on 3-year mortality and assessed the utility of the SF-12 in predicting mortality in patients with RD. Methods We distributed a web-based survey via a linked mobile-phone SMS message, to all rheumatology patients, with a validated mobile number, under follow-up at the Royal Wolverhampton Trust, April-2020. We collected demographics, CEV status, and Short Form-12 mental (MCS) and physical health component scores (PCS) for health-related quality of life. Mortality was audited July-2023. Data were analysed using SPSS version 26 and R. Results There were 7,911 active follow up patients with linked mobile numbers. Survey responses were received from 1605 (20%); responders were female (69%), white (94%), CEV (47%), had a mean age of 61years, and most had autoimmune rheumatic disease (78%). Of the responders, 58 (4%) had died by July-2023 - compared to the alive group these patients had significantly worse MCS (p < 0.001) and PCS (p = 0.004) at baseline; significantly more in those that had died were CEV (p < 0.001), and older (p < 0.001), while gender, ethnicity, and diagnosis did not differ. Conclusion These data demonstrate in a large cohort of patients with RD over a 3-year period those patients considered CEV, advised to follow more stringent social isolation measures were at significantly greater risk of death. Further, baseline SF-12 scores for both mental and physical components were lower in patients that died over a 3-year period. These data potentially highlight the utility of the SF-12 and assessing social isolation and loneliness in patients with RD to predict mortality. In addition, our methods demonstrate the merits of communicating with patients through SMS-messaging and can be used in delivering important health-care communications in future. Disclosure N. Cox: None. J. Bateman: None.

LONELINESS AND QUALITY OF LIFE IN OLDER ADULT PRIMARY CARE PATIENTS

Abstract Loneliness, defined as the perceived discrepancy in an individual’s desired and actual social relationships, is common among older adults. Loneliness among older adult primary care patients is lacking, considering the implications it has on physical and mental health. Our objective was to determine the relationship between loneliness and quality of life (QOL) in older adult primary care patients. Data come from the Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer’s disease and related dementias screening among older primary care patients and their family members. Loneliness (5-item NIH Toolbox), quality of life (QOL)—as measured by physical and mental health component scores— and depression (PHQ-9) and anxiety symptomatology (GAD-7) were measured among primary care patients aged 65 and older from April 2020 to September 2021. Spearman correlation analyses reveal that loneliness was moderately correlated with mental health (r(601) = -.43, p< 0.001), anxiety (r(601) =.44, p< 0.001), and depression (r(601) = .42, p< 0.001), while weakly correlated with physical health (r(601) = -.15, p< 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was associated with both lower mental (p< 0.001) and physical health component scores (p< 0.001). Furthermore, loneliness remained significantly associated with worse mental health when adjusting for depression, anxiety, sociodemographic characteristics, and comorbidity. Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.

Comparative Study of the Outcomes of Endoscopic Unilateral Laminotomy for Bilateral Decompression (ULBD) With Destandau Technique and Microscopic ULBD: A Randomized Double-Blinded Study of 685 Patients

Objective: Lumbar canal stenosis is a common finding amongst elderly patients visiting spine surgeons for back pain. Uniportal unilateral laminotomy for bilateral decompression (ULBD) is an emerging minimally invasive procedure for lumbar canal stenosis. This study compared the clinical outcomes of endoscopic ULBD with Destandau technique and microscopic lumbar canal decompression.Methods: A prospective multicenter study on 685 patients undergoing single-level spinal canal decompression. Patients with axial back pain, lumbar radiculopathy, lumbar canal stenosis & claudication distance <1,000 m were included. Parameters assessed were Dura expansion, thecal sac’s cross-sectional area, horizontal displacement, blood loss, operation time, hospital stay, modified MacNab score, visual analogue score (VAS), side changing (self) status, Oswestry Disability Index (ODI), and the Short-Form 36 for quality of life (QoL).Results: Group 1 (endoscopic ULBD with Destandau technique) had 343 patients and group 2 (microscopic ULBD) had 342 patients. Group 1 had lower horizontal displacement (0.34%±0.21%, p<0.001) and significant improvement of VAS (42.28%±3.20%, p<0.001) at 1-week postsurgery with shorter hospital stay (1±0.2 days vs. 1.8±0.8 days, p<0.01) and significant improvements of ODI and MacNab scores (42.28±3.20 and 85.30%, p<0.001). The 30-second chair test (3.4±0.13 vs. 5.6±2.41, p<0.001), 10-meter walk test (1.0±2.15 vs. 0.55±3.23, p<0.001), and SF-36 physical health component score (48.20±8.46 vs. 74.48±0.54, p<0.001) improved significantly as well. Furthermore, 92% of patients were able to change sides while in bed at 1-week postsurgery. Claudication distance improved significantly in both groups.Conclusion: Group 1 patients had better clinical and functional outcomes within 3 months of surgery than group 2 patients, with improved QoL, shorter hospital stays, claudication distance, and self-side changing ability.

What is the Impact of Social Deprivation on Mental and Physical Health Before and After Primary Total Knee Arthroplasty?

The purpose of the present study was to investigate the relationship between socioeconomic status and Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) scores before and after primary total knee arthroplasty (TKA). We hypothesized that patients with greater social deprivation would have lower PROMIS-GH scores at 3 months and 1 year following primary TKA. We retrospectively reviewed data from patients who underwent unilateral primary TKA and completed PROMIS-GH preoperatively and at 3 months (n= 257) or 1year (n= 154) postoperatively. Area Deprivation Index (ADI), calculated from 9-digit zip codes, was used to measure social deprivation. Participants were grouped into quartiles by ADI score. Minimal clinically important difference in PROMIS-GH mental (PROMIS-MH) and physical health (PROMIS-PH) component scores were compared between ADI groups. Participants in the highest ADI quartile (most disadvantaged) had significantly lower PROMIS-MH and PROMIS-PH scores at every time point relative to the lowest ADI quartile (least disadvantaged) (P < .05 for all). Both ADI groups experienced significant improvements in PROMIS-PH following TKA (P < .001 for all), but not in PROMIS-MH (P > .05 for all) at 3-months and 1-year postoperatively. Magnitude of improvement in PROMIS-PH and rates of achievement of minimal clinically important difference did not significantly differ between ADI groups (P > .05 for all). Socially disadvantaged patients benefit equally from primary TKA but are more likely to have persistently lower 1-year postoperative PROMIS-GH scores relative to less disadvantaged patients. Social deprivation should be accounted for when using PROMIS-GH to assess clinical outcomes for research and quality measures. IV, retrospective cohort study.

Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair

To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR). Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result. A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P= .005 to P= .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P= .005) and external rotation (7.13° vs 1.65°; P= .031) ROM than the control group. Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores. Level III retrospective comparative study.

98 Care Discontinuity in Burn Patients: Does it Impact Long-Term Outcomes?

Abstract Introduction Care discontinuity, or the care that is provided by disparate healthcare professionals when patients are readmitted to a hospital different than their original admission (non-index hospital), has been associated with worse outcomes among surgical patients. However, little is known about its effect on burn patients. Our aim was to determine the impact of care discontinuity on long-term outcomes in a national sample of burn patients. Methods The longitudinal Burn Model System National Database was queried from 1996 to 2021. All adult burn patients from participating sites were included. Care discontinuity was defined by having therapy or burn-related surgeries at non-index hospitals. The main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6 and 12 months after injury. Multivariable regression was used to examine the association between care discontinuity and long-term outcomes, adjusting for patient characteristics and burn injury severity. Results A total of 1,866 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 76% were white. Mean PCS scores were 43.56 (SD 10.95) and 45.17 (SD 11.18); and mean MCS scores were 48.00 (SD 12.60) and 48.25 (SD 12.55) at 6 and 12 months, respectively. Care discontinuity was reported in 423 (22.6%) burn patients, who reported having therapy or burn-related surgeries at a non-index hospital. In adjusted analyses, care discontinuity was associated with worse PCS at both 6 months (Coefficient -2.18, 95% Confidence Interval [CI] -3.44 – -0.91, p=0.001), and 12 months (Coefficient -2.16, 95% CI -3.50 – -0.82, p=0.002), compared to patients having therapy/surgery at index hospitals. Care discontinuity was not associated with MCS scores at 6 (Coefficient 0.54, 95% CI -0.04 – 2.03, p=0.473) and 12 months (Coefficient -0.90, 95% CI -2.49 – -0.67, p=0.262). Conclusions Care discontinuity was significantly associated with lower physical health component scores at long-term follow up, but not with mental health component scores. Future studies should focus on developing strategies to ensure continuity of care and/or identifying out of system patients to provide targeted resources. Applicability of Research to Practice Understanding the implications of care fragmentation on longitudinal outcomes may help clinicians develop strategies to ensure care continuity and consequently better outcomes.

Leveraging Mindfulness to Reduce Stress and Improve Quality of Life Among Pharmacy Students

ObjectiveMethods to improve stress and well-being for health profession trainees are limited. Mindfulness, elevating awareness to the present moment experience with compassion, has been shown to demonstrate effectiveness to enhance well-being. This research leverages techniques from mindfulness to develop and evaluate a credit-bearing longitudinal mindfulness elective, designed to teach mindfulness to improve stress and quality of life (QoL). MethodsA mindfulness elective was created for pharmacy students. A longitudinal, case-control, survey-based design was used to compare stress and QoL between mindfulness participants and nonparticipant controls. Stress was assessed by the Perceived Stress Scale (PSS) and QoL by the SF-12 v2 Health-Related QoL Scale (SF-12 v2 QoL). ResultsFour weeks after course completion, the average PSS score was lower among participants compared to controls (18.58 SD 5.85 vs 20.79 SD 6.31, Cohen’s d = 0.36). The Mental Health Component score of SF-12 v2 QoL was higher among participants versus controls (41.94 SD 8.58 vs 36.93 SD 9.59, Cohen’s d = 0.55). The Physical Health Component score of SF-12 v2 QoL was lower among participants than the control group (46.13 SD 5.48 vs 48.62 SD 6.53, Cohen’s d = 0.41). ConclusionThe results indicate small to moderate effect sizes associated with participation in a mindfulness elective, reducing stress and improving mental QoL among pharmacy students. The structure and potential benefits of the course can be extrapolated to other institutions. By offering course credit for mindfulness practice, health profession schools can support student wellness.

IMPACT OF PULMONARY DENERVATION ON QUALITY OF LIFE AFTER COMPLEX MITRAL VALVE SURGERY

Relevance. In recent years, concepts for assessing the quality of life have been developed. According to the WHO definition, quality of life is a person's perception of his position in life, culture and value system, it is associated with his goals, expectations, standards and concerns. Approximately three people out of every thousand have pulmonary hypertension for various reasons. This can lead to decreased exercise tolerance, quality of life, increased hospital admissions, and early death. An objective assessment of the quality of life of such patients will help achieve better clinical outcomes for patients and develop new treatments. Purpose of the study is to assessment of changes in the quality of life of patients with mitral valve disease associated with atrial fibrillation and high pulmonary hypertension (systolic blood pressure over 40 mmHg) during the first 24 months after radiofrequency denervation of the pulmonary arteries according to the SF-36 and MLHFQ questionnaires. Materials and Methods. The general population of patients (n = 202) with mitral heart disease, concomitant atrial fibrillation and high pulmonary hypertension was divided into several groups according to the complexity of surgical treatment: patients of the 1st group (n = 62) underwent only surgical correction of the mitral valve pathology (repair or replacement); patients of the 2nd group (n = 89) – surgical correction of the mitral valve pathology, as well as the Maze IV procedure using the AtriCure© bipolar ablator; patients of the 3rd group (n = 51) received complex surgical treatment by correcting mitral valvular pathology, performing the Maze IV procedure, as well as using radiofrequency denervation of the pulmonary arteries. The quality of life was assessed over several periods: initially, 6 months later, 1 and 2 years after surgical treatment. The scores were also converted to physical health component scores and mental health component scores. Results. The initial data of patients from different subgroups according to the criteria of the SF-36 questionnaire were comparable with each other. The indicators of the physical component and the psychological component of SF-36 characterize the 3rd group of patients with a lower level of quality of life in terms of the physical component, although no significant intergroup differences were found. Quality of life indicators after 6 months show positive changes in patients of all study groups without significant intergroup differences. Based on the results of 12 months, the greatest dynamics of the parameters of the questionnaire in terms of physical and mental components was observed in the 3rd group of patients. After 24 months, there is a significant advantage in changes in the indicators of patients of the 3rd group for all categories of the questionnaire. The target level after 6 months in the 3rd group was 100%, in the 2nd and 1st – 85.3% and 40.7%, respectively, maintaining differences up to 24 months. Conclusions. The use of a circular radiofrequency pulmonary artery denervation procedure is associated with a significant improvement in health status in assessing the quality of life of patients who have not undergone correction of pulmonary hypertension.

Long-term patient-related quality of life outcomes and ICD-10 symptom rating (ISR) of patients with pyogenic vertebral osteomyelitis: What is the psychological impact of this life-threatening disease?

PurposeWe aimed to evaluate the long-term impact of the treatment of pyogenic vertebral osteomyelitis (VO) on functional outcomes and patients' quality of life (QoL) with a special focus on psychological well-being.MethodsA total of 156 patients with VO with a minimum clinical follow-up of 12 months were retrospectively identified and asked to participate. Patient-reported outcome measures were evaluated with the EuroQol five-dimension questionnaire (EQ-5D) and German Short-Form 36 (SF-36) outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. Spine-specific outcomes were assessed with the Core Outcome Measure Index and the Oswestry disability index (ODI) or the Neck disability index (NDI), respectively.ResultsFrom n = 156 eligible patients, n = 129 patients could be contacted and n = 40 returned questionnaires, yielding a response rate of 31.0%. The mean time from hospital discharge to follow-up was 83.0 ± 3.8 (13–193) months. Spine-specific outcomes showed mild to moderate disability. The mean physical health component score of the SF-36 (37.1 ± 16.7), the mean mental health component score (38.2 ± 14.0) and the mean EQ-5D VAS rating (57.1 ± 21.5) were significantly lower in comparison with the scores of an age-matched reference population (all p < 0.05). The mean total score of the ISR was 0.53 ± 0.23. On average, the cohort did not cross the threshold of clinically relevant symptom burden on any subscale.ConclusionEven almost seven years on average after completed treatment of VO, patients report impaired QoL. Assessment of psychological disorders should be implemented in clinical practice and future prospective studies.

Abstract PD8-05: Effectiveness of Electroacupuncture Versus Auricular Acupuncture in Reducing Pain and Improving Quality of Life in Breast Cancer Survivors with Chronic Musculoskeletal Pain

Abstract Introduction: Chronic musculoskeletal pain is common and debilitating among breast cancer survivors. Recently, the Personalized Electroacupuncture (EA) versus Auricular Acupuncture (AA) Comparative Effectiveness (PEACE) trial demonstrated that both acupuncture methods reduced pain more than usual care (UC) in cancer survivors. However, the comparative effectiveness between EA and AA among breast cancer survivors is unknown. Here, we report the results of subgroup analysis of breast cancer survivors enrolled in the PEACE trial. Methods: PEACE is a three-arm, parallel, single center randomized trial investigating the effectiveness of EA and AA versus UC for chronic musculoskeletal pain in 360 cancer survivors. Patients in both EA and AA received ten weekly treatments. Patients in UC could receive ten EA treatments after week 12. The primary endpoint was the change in mean Brief Pain Inventory (BPI) pain intensity from baseline to week 12; change from baseline to week 24 and change in quality of life were secondary endpoints. We analyzed the subset of 46% of trial participants with a primary diagnosis of breast cancer. We conducted constrained linear mixed model analyses, which constrained all arms to have a common pre-randomization baseline mean. Model-based mean estimates at weeks 12 and 24 were compared between arms using model contrasts. Results: Among 165 breast cancer survivors, the baseline mean pain severity was 5.35 (95% Confidence Interval [CI]: 5.04, 5.66). At week 12, the BPI pain severity score was 2.69 (2.26. 3.13) in EA, 3.60 (3.17, 4.02) in AA, and 5.06 (4.47, 5.65) in UC. At week 24, the mean BPI pain severity was 2.84 (95% CI: 2.40, 3.28) in EA and 3.67 (95% CI: 3.23, 4.10) in AA. EA reduced pain severity significantly more than AA at both week 12, (-0.90 [-1.45, -0.36], p=0.001) and week 24 (-0.82, [-1.38, -0.27], p=0.004). There were no differences between EA and AA in improvements in PROMIS physical health or mental health component scores, but both EA and AA significantly improved both PROMIS scores at week 12 compared to UC. Mild toxicities were reported, more patients dropped out of the AA arm due to ear pain. Conclusions: EA was more effective than AA at reducing pain severity, but both similarly improved physical and mental health scores. Breast cancer survivors with chronic musculoskeletal pain may consider EA before AA. Citation Format: Ting Bao, W. Iris Zhi, Raymond Baser, Qing Li, Jun Mao. Effectiveness of Electroacupuncture Versus Auricular Acupuncture in Reducing Pain and Improving Quality of Life in Breast Cancer Survivors with Chronic Musculoskeletal Pain [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-05.

The Relationship Between Loneliness and Quality of Life in Older Adults

Background/Objective: Loneliness is the self-perceived discrepancy in an individual’s desired and actual social relationships. Loneliness is common among older adults and is associated with chronic illness and poorer mental health outcomes. Our objective was to determine the relationship between loneliness and quality of life (QOL) in older adult patients, controlling for depression and anxiety.&#x0D; Methods: Secondary data analysis was conducted on baseline data from the Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) Trial, an ongoing trial evaluating benefits and risks of Alzheimer’s disease and related dementias (ADRD) screening. Patients were≥65 years old with no history of ADRD. Measures include the5-item NIH Toolbox Loneliness measure, QOL, measured by the physical (PCS) and mental health component (MCS) scores of SF-36, and depression and anxiety, measured by PHQ-9 and GAD-7, respectively. We conducted a Spearman correlation and ran unadjusted and adjusted linear regression models to assess the relationship between loneliness and QOL.&#x0D; Results: Patient mean (SD) age was73.7 (5.1) years; 44.8% male; 91.5% white; 7.5% black. We found that loneliness was moderately correlated with QOL measured by SF-36 MCS (r= -0.43, p&lt;0.001), anxiety (r= 0.44, p&lt;0.001), and depression (r= 0.42, p&lt;0.001), while weakly correlated with QOL measured by SF-36 PCS (r= -0.15, p&lt;0.001). Loneliness was associated with lower MCS (p&lt;0.001) and PCS (p&lt;0.001). After adjusting for depression and anxiety, only MCS (p&lt;0.001) was reduced by loneliness. Additionally, we found a positive association between PCS and patient report of comfortable level of income, before(p=0.002) and after(p=0.002) adjustment.&#x0D; Conclusion: We found that loneliness was significantly associated with worse quality of life as measured by mental health constructs among older adult primary care patients. Therefore, we recommend primary care providers assess loneliness with their older adult patients and if present, consider interventions aimed at reducing loneliness such as activities that maintainmeaningful social relationships

The patient burden of nocturnal polyuria in the United States: Results from the epidemiology of nocturnal polyuria (EpiNP) study.

To explore the impact of nocturnal polyuria (NP) on health-related quality of life (HRQoL), work productivity, mental health, fatigue, bother, and daytime sleepiness. This large-scale, US population-representative epidemiologic study was conducted in two parts: a web-based survey and 3-day bladder diary. Consenting participants completed the baseline Epidemiology of NP (EpiNP) survey online (Lower Urinary Tract Symptoms [LUTS] Tool, comorbidities, burden, and multiple HRQoL measures). Participants who reported ≥2 voids/night, and a random sample of 100 respondents each reporting 0 or 1 void/night, were sent urine measurement containers and asked to complete the 3-day bladder diary. NP was defined as Nocturnal Polyuria Index >0.33 (NPI33) or nocturnal urine production >90 ml/h (NUP90). Five subgroups were created: Idiopathic NP (NP with no underlying cause), NP associated with symptoms of overactive bladder (NPOAB) or bladder outlet obstruction (NPBOO; men only), NP associated with other comorbidities (NPCOM; e.g., diabetes, hypertension, heart disease, sleep apnea), and no NP (did not meet NP criteria). A total of 4893 men and 5297 women completed the EpiNP survey; mean age was 54.4 (SD = 14.7). Significantly greater patient burden (p < 0.0001) was evidenced in the nocturia group (≥2 voids/night) versus no nocturia group (0-1 void/night) on daily impact of nocturia, LUTS Bother, prostate symptoms (men only), work productivity, physical and mental health component scores, depression, fatigue, and daytime sleepiness. NP subgroup analyses showed men in the NPBOO group and women in the NPOAB group reported the greatest impact on LUTS bother, fatigue, physical health, work productivity impairment, daytime sleepiness, and depression (women only). This was the first large-scale, epidemiologic study to explore the impact of different forms of NP on patients' HRQoL. Findings demonstrate that NP associated with other urologic or comorbid conditions appears to have greater patient burden than idiopathic NP, in particular for women.

The impact of the COVID-19 pandemic and stringent social distancing measures on health-related quality of life and COVID-19 infection rates in patients with rheumatic disease: a longitudinal analysis through the pandemic.

The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and stringent social isolation measures on patients with rheumatic disease (RD) from the beginning of the pandemic (April 2020). In this UK-based single-centre, prospective, observational cohort study, all RD follow-up patients at our centre were invited by SMS text message in April 2020 to participate in the study. Participants completed questionnaires at four time points between April 2020 and December 2021. We collected demographics, clinically extremely vulnerable (CEV) status, short form 12 mental (MCS) and physical health component scores (PCS) for health-related quality of life, vaccination status, COVID-19 infection rates and incidence of long COVID. We enrolled 1605 patients (female, 69.0%; CEV, 46.5%); 906 of 1605 (56.4%) completed linked responses to our final questionnaire. MCS improved (+0.6, P < 0.05), whereas PCS scores deteriorated (-1.4, P < 0.001) between April 2020 and December 2021. CEV patients had worse mental and physical health scores than non-CEV patients at entry (PCS, 36.7 and 39.3, respectively, P < 0.001; MCS, 40.9 and 43.0, respectively, P < 0.001) and at each time point throughout the study; both mental and physical health outcomes were worse in CEV compared with non-CEV patients (P < 0.001 and P = 0.004, respectively). At study close, 148 of 906 (16.3%) reported COVID infection, with no difference in infection, vaccination or long COVID rates between CEV and non-CEV patients. Mental and physical health in RD patients has changed throughout the pandemic; outcomes for both metrics of health were worse in CEV patients, although there were no differences in infection rates between the groups. These data might assist the understanding and planning of future health-care policy and social restrictions in RD patients. ClinicalTrials.gov, www.clinicaltrials.gov, NCT04542031.

ASSOCIATION BETWEEN QUALITY OF LIFE AND DEPRESSION IN DYADS OF OLDER PRIMARY CARE PATIENTS AND FAMILY MEMBERS

Abstract Familial dyads experience illness as an interdependent unit. We evaluate the association of quality of life (QOL), as measured by physical (PCS) and mental health component (MCS) scores, with depression in dyads of older primary care patients and a family member. This is a cross sectional, descriptive study where QOL and depression were measured concurrently in the dyad using baseline data from 1809 dyads enrolled in a trial testing the benefits and harms of Alzheimer’s disease and related dementias (ADRD) screening. QOL was measured with the SF-36, depression was measured with the PHQ-9, and the association of depression with QOL was examined using an actor-partner interdependence model with distinguishable dyads. Patient mean (SD) age was 73.7 (5.7) years; 53.1% women; 85.1% white; 13.4% black. Family member mean (SD) age was 64.2 (13) years; 67.7% women; 13.4% black. A patient’s spouse/partner were 64.8% of family members. After controlling for dyadic relationship and gender, significant actor effects of depression on PCS for patient (β= -1.39; p&amp;lt; 0.001) and family member (β =-0.954; p&amp;lt; 0.001), and significant partner effects of depression on PCS for patient (β=-0.15, p&amp;lt; 0.05) and family member (β =-0.18; p&amp;lt; 0.01). There were significant actor effects of depression on MCS for patient (β =-1.2; p&amp;lt; 0.001) and family member (β=-1.2; p&amp;lt; 0.001), but depression had a significant partner effect on MCS only for patient (β = -0.08; p&amp;lt; 0.05). Among dyads participating in an ADRD screening trial, dyads with higher depression had lower QOL. Family member depression was associated with decreased family member and patient QOL.

PROFILES OF PERSONAL DETERMINANTS OF HEALTH AND ASSOCIATED HEALTH OUTCOMES IN OLDER ADULTS: A LATENT CLASS ANALYSIS

Abstract Personal Determinants of Health (PDOH) are considered personal resources that contribute to successful aging. Positive PDOH factors have been associated with better health outcomes in older adults; however, research in this area is still limited. Using survey and claims data among adults age 65+ (N=2,866), profiles were identified based on five key PDOH factors (resilience, purpose in life, optimism, self-perception of aging, and social connection via loneliness) utilizing Latent Class Analysis (LCA). Differences in socio-demographics and healthcare outcomes were then explored utilizing multivariate regression models. Outcomes included emergency room (ER) visits, inpatient (IP) admissions, total medical cost, and quality of life (physical and mental health component scores). LCA models yielded three main classes within our sample: high PDOH (56%, n=1,150), moderate PDOH (40%, n=1,611), and low PDOH (4%, n=125). Those within the high PDOH class were significantly younger (Mage=75.6) compared to those within the moderate (Mage=78.2) and low (Mage=78.9) PDOH classes. In addition, the high PDOH class was significantly less likely to have an ER visit (OR=1.81, 95% CI:1.23-2.66) and had 28% better physical health and 52% better mental health components scores as compared to the low PDOH class. Results demonstrate support for the PDOH model as a potential successful aging model. Combinations used to create classes using resilience, purpose in life, optimism, self-perception of aging, and social connection via loneliness indicates that those who are positive in all five aspects show the most promising health outcomes. Future implications include targeting interventions at improving these variables for at-risk older adults.

Patient-reported health outcomes of SARS-CoV-2–tested patients presenting to emergency departments: a propensity score–matched prospective cohort study

ObjectiveThis study aimed to compare the long-term physical and mental health outcomes of matched severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive and SARS-CoV-2–negative patients controlling for seasonal effects. Study designThis was a retrospective cohort study. MethodsThis study enrolled patients presenting to emergency departments participating in the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive eligible consenting patients who presented between March 1, 2020, and July 14, 2021, and were tested for SARS-CoV-2. Research assistants randomly selected four site and date-matched SARS-CoV-2–negative controls for every SARS-CoV-2–positive patient and interviewed them at least 30 days after discharge. We used propensity scores to match patients by baseline characteristics and used linear regression to compare Veterans RAND 12-item physical health component score (PCS) and mental health component scores (MCS), with higher scores indicating better self-reported health. ResultsWe included 1170 SARS-CoV-2–positive patients and 3716 test-negative controls. The adjusted mean difference for PCS was 0.50 (95% confidence interval [CI]: -0.36, 1.36) and -1.01 (95% CI: -1.91, -0.11) for MCS. Severe disease was strongly associated with worse PCS (β = −7.4; 95% CI: -9.8, -5.1), whereas prior mental health illness was strongly associated with worse MCS (β = −5.4; 95% CI: -6.3, -4.5). ConclusionPhysical health, assessed by PCS, was similar between matched SARS-CoV-2–positive and SARS-CoV-2–negative patients, whereas mental health, assessed by MCS, was worse during a time when the public experienced barriers to care. These results may inform the development and prioritization of support programs for patients.

Health-related quality of life as associated with asthma control, psychological status and insomnia.

Asthma is associated not only with lower health-related quality of life (HRQL) but also with psychological health and insomnia. The aim of this study was to investigate associations between HRQL, asthma symptoms, psychological status and insomnia in adults from three Nordic countries. This study comprised 2,270 subjects aged 29-55 from Sweden, Iceland and Norway. HRQL was measured with the 36-Item Short Form Health Survey (SF-36). The physical (PCS) and mental health (MCS) component scores were calculated with higher values, indicating better health status. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Insomnia was assessed with the Basic Nordic Sleep Questionnaire. An asthma score consisting of a sum of the positive answers to five respiratory symptoms was used in the analysis. Spirometry and allergy tests were also performed. High HADS and sleep disturbance scores were both related to a low PCS and MCS, respectively, after adjusting for confounders. High age and high body mass index (BMI) were associated with low scores on the PCS, whilst the opposite was found for the MCS. A higher asthma score was related to a low PCS. An interaction between the HADS and the asthma symptom score was observed for the PCS (P = 0.0002), where associations between psychological status and the PCS were more pronounced for individuals with more symptoms than for individuals without symptoms. In this study, we found that HRQL of life was independently related to the HADS, insomnia and asthma symptoms. Further prospective studies to identify the most efficient target for intervention in order to improve asthma control are needed.

Revision lumbar fusions have higher rates of reoperation and result in worse clinical outcomes compared to primary lumbar fusions

BACKGROUND CONTEXTIndications for revision lumbar fusion are variable, but include recurrent stenosis (RS), adjacent segment disease (ASD), and pseudarthrosis. The efficacy of revision lumbar fusion has been well established, but their outcomes compared to primary procedures is not well documented. PURPOSEThe purpose of this study was to compares surgical and clinical outcomes between (1) revision and primary lumbar fusion, (2) revision lumbar fusion based on indication (ASD, pseudarthrosis, or RS), and (3) revision lumbar fusion based on whether the index procedure included an isolated decompression or decompression with fusion. STUDY DESIGN/SETTINGRetrospective single-institution cohort study. PATIENT SAMPLEFour thousand six hundred seventy-one consecutive lumbar fusions from 2011 to 2021, of which 892 (23.6%) were revision procedures. The indication for revision procedures included 502 (56.3%) for ASD, 153 (17.2%) for pseudarthrosis, and 237 (26.6%) for RS. Of the 892 revision procedures, 694 (77.8%) underwent an index fusion while 198 (22.2%) underwent an index decompression without fusion. OUTCOME MEASURESHospital readmissions, all-cause reoperation, need for subsequent revision and patient reported outcome measures (PROMs) at baseline, 3-months postoperatively, and 1-year postoperatively, including the Mental Health Component score (MCS-12) and Physical Health Component score (PCS-12) of the Short Form 12 survey, the Oswestry Disability Index (ODI), and the Visual Analog Scale (VAS) for Back and Leg pain. METHODSPatient demographics, comorbidities, surgical characteristics, and outcomes were collected from electronic medical records. Twenty-eight percent of patients had preoperative and postoperative PROMs. A delta PROM score was calculated for the 3-month and 1-year postoperative timepoints, which was the change from the preoperative to postoperative value. Univariate comparisons were performed to compare revision fusions to primary fusions. Multivariate logistic regression was performed for all-cause reoperation and subsequent revision surgery, while multivariate linear regression was performed for ∆PROMs at 3-months and 1-year. Revision procedures were then separately regrouped based on indication for revision fusion and whether they underwent a fusion for their index procedure. Univariate comparisons and multivariate linear regressions for ∆PROMs were then repeated based on the new groupings. RESULTSThere was no difference in hospital readmission rate (5.38% vs. 4.60%, p=.372) or length of stay (4.10 days vs. 3.94 days, p=.129) between revision and primary lumbar fusion, but revision fusions had a higher rate of all-cause reoperation (16.1% vs. 11.2%, p<.001) and subsequent revision (13.7% vs. 9.71%, p=.001), which was confirmed on multivariate logistic regression (Odds Ratio (OR): 1.42, p=.001 and OR: 1.37, p=.007, respectively). On multivariate analysis, a revision procedure was an independent risk factor for worse improvement ∆ODI, ∆VAS Back, ∆VAS Leg, and ∆PCS-12 and 1-year postoperatively. Regardless of the indication for revision lumbar fusion, patients significantly improved in the 3-month and 1-year postoperative PCS-12, ODI, VAS Back, and VAS Leg, with the exception of the 3-month PCS-12 for pseudarthrosis (p=.620). Patients undergoing revision for ASD had significantly worse 1-year postoperative PCS-12 (32.3 vs. Pseudarthrosis: 35.6 and RS: 37.0, p=.026), but there were no differences in ∆PROMs. There was no difference in hospital readmission, all-cause reoperation, or subsequent revision based on whether a patient had an index lumbar fusion or isolated decompression. Multivariate linear regression analysis found that a surgical indication of pseudarthrosis was a significant predictor of decreased improvement in 3-month ∆VAS Leg (ref: ASD, β=2.26, p=.036), but having an index fusion did not significantly predict worse improvement in ∆PROMs when compared to isolated decompressions. CONCLUSIONSRevision lumbar fusions had a higher rate of reoperation and subsequent revision surgery when compared to primary lumbar fusions, but there were no difference in hospital readmission rates. Patients undergoing revision lumbar fusion experience improvements in all patient reported outcome measures, but their baseline, postoperative, and magnitude of improvement are worse than primary procedures. Regardless of whether the lumbar fusion is a primary or revision procedure, all patients have significant improvements in pain, disability and physical function. Further, the indication for the revision procedure is not correlated with the expected magnitude of improvement in patient reported outcomes. Finally, no differences in baseline, postoperative, and ∆PROMs for revision fusions were identified when stratifying by whether the patient had an index decompression or fusion.

Treatment of Periprosthetic Joint Infection and Fracture-Related Infection With a Temporary Arthrodesis Made by PMMA-Coated Intramedullary Nails - Evaluation of Technique and Quality of Life in Implant-Free Interval.

BackgroundAntimicrobial coating of intramedullary nails with polymethyl methacrylate (PMMA) bone cement promises infection control and stabilization for subsequent bone healing. However, when removing the implant, bone cement can debond and remain in the medullary cavity of the long bones, representing a nidus for reinfection. This work presents a technique comprising reinforcement of PMMA-coated intramedullary nails with cerclage wire to prevent such problems in patients treated for fracture-related infection (FRI) or knee periprosthetic joint infection (PJI) with a static spacer as temporary arthrodesis allowing weight-bearing in the implant-free interval. Outcomes of this surgical treatment were evaluated in terms of (i) associated complications and (ii) patient-reported quality of life.MethodsIn this retrospective case series, 20 patients with PJI (n = 14, 70%) and FRI (n = 6, 30%) treated with PMMA-coated intramedullary nails reinforced with cerclage wire between January 2021 and July 2021 were included. Quality of life during the implant-free interval was evaluated with the EQ-5D, SF-36, and an ICD-10 based psychological symptom rating and compared with previously analyzed cohorts of successfully treated PJI and FRI patients in whom eradication of infection and stable bone consolidation was achieved.ResultsComplications during the implant-free interval comprised a broken nail in one case (5.0%) and a reinfection in one case (5.0%). Coating-specific side effects and cement debonding during removal did not occur. The mean physical health component score of SF-36 was 26.1 ± 7.6, and the mean mental health component score reached a value of 47.1 ± 18.6. The mean EQ-5D index value was 0.36 ± 0.32 and the mean EQ-5D visual analogue scale rating was 47.4 ± 19.4. The scores were significantly lower than those in the successfully treated FRI cohort but not in the PJI cohort. The mean ICD-10-based symptom rating scores revealed psychological symptom burden on the depression scale and enhanced levels of anxiety in comparison with healed FRI and PJI patients.ConclusionReinforcement of PMMA bone cement-coated implants seems to be a reasonable treatment option to create a temporary arthrodesis, preventing detachment of the bone cement when the implant was removed.Level of Evidence: IV.

Quality of life after fracture-related infection of the foot

BackgroundFracture related infection (FRI) of the foot is a serious hazard. Despite successful therapy, the physiological and psychological involvement seems to be high. Therefore, we aim to analyze the impact of an FRI of the foot on the quality of life after successful surgical therapy and infect eradication. MethodsIn total, 25 patients from two German hospitals treated for FRI of the foot between March 2011 to January 2020 were retrospectively included. Quality of life was assessed by the German Short Form 36 (SF-36) and the EuroQol five-dimension three-level questionnaire (EQ-5D) as well as the ICD-10 based psychological symptom rating (ISR), and compared to a norm obtained from the general population of Germany. Results3.0 years (range 0.7–7.9 years) following final surgery after fracture-related infection of the foot, the mean physical health component score (PCS) of the SF-36 was 35.6 ± 12.3, and the mean mental health component score (MCS) of the SF-36 reached a value of 41.3 ± 12.9. Both values were significantly lower than in the general population of Germany (p< .019). The mean scores of the ISR of the cohort crossed the threshold of mild symptom burden in total, as well as for the subscales depression and somatization. The mean EQ-5D VAS rating (62.1 ± 18.6) and the EQ-5D index value (0.66 ± 0.27) were significantly lower in comparison to a score of 72.9 ± 1.0 and 0.88 obtained from an age-matched reference population (p < .01). ConclusionFRI of the foot represents a major burden for the patient. Physical and mental well-being of affected patients is restricted albeit successful treatment in terms of infect eradication and bone union has been achieved after a mean follow-up of 3.0 years. A patient-centered treatment approach focusing on improvement of quality of life during and after treatment is therefore warranted.