Prognostic Factors For Recovery Research Articles

High Total Cholesterol in Peripheral Blood Correlates with Poorer Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss.

Idiopathic sudden sensorineural hearing loss (ISSHL) is a common otologic emergency whose cause is still unclear. The importance of blood lipids in the pathogenesis of ISSHL is widely reported in literature. In fact elevated levels of low density lipoprotein cholesterol (LDL), total cholesterol (TC) and apolipoprotein B (Apo-B) have been proposed as risk factors for this pathology. No correlation has been described between serum lipid parameters and the prognosis of ISSHL. Aim of the present study was to identify prognostic factors associated with hearing recovery in a group of patients affected by ISSHL. Ninety-four patients with the diagnosis of ISSHL hospitalized between March 2013 and October 2014 were included in this study. Patients’ blood sampling and hearing assessments were carried out. Patients were divided into two groups as “recovered” and “unrecovered”, according to their response to the treatment. We found a statistically significant higher level of total cholesterol in the unrecovered group compared to the recovered one (p = 0.03). None of the other routine laboratory parameters have shown a statistically significant difference between the patients successfully treated and patients with poor outcomes. Total cholesterol concentrations may be a prognostic factor for recovery in ISSHL and should be assessed together with routine tests in patients with this condition. The other routine laboratory parameters seem to have no effect on the development and prognosis of this pathology.

Prognostic factors for recovery after arthroscopic rotator cuff repair: a prognostic study

Studies concerning prognostic factors of recovery after arthroscopic rotator cuff repair mostly focus on tendon integrity or functional recovery as an outcome. Little is known about how they influence quality of life after surgery. We therefore tried to identify prognostic factors having an impact on quality of life after arthroscopic rotator cuff repair. This study included 30 patients who underwent arthroscopic rotator cuff repair. We assessed Western Ontario Rotator Cuff Index as primary outcome and RAND-36, Constant-Murley score, and a shoulder hindrance score as secondary outcomes. Patients were repeatedly measured: once preoperatively and 4 times postoperatively. Preoperative range of motion, obesity, fatty infiltration, and cuff retraction were preselected as prognostic factors. Patients were significantly improved at 3 months and 6 months after arthroscopic rotator cuff repair. In multiple regression analysis, none of the preselected factors could be identified as a prognostic factor influencing quality of life after arthroscopic rotator cuff repair (measured with the Western Ontario Rotator Cuff Index). For the outcome variables RAND-36 (6 months, 1 year) and shoulder hindrance score (1 year), fatty infiltration Goutallier stages 1 and 2 and retraction grades II, III, and IV were significant predictors. Although fatty infiltration and retraction grade predict the RAND-36 and shoulder hindrance score, this study could not support preoperative range of motion, obesity, fatty infiltration, or retraction of the cuff as a prognostic factor for quality of life after arthroscopic rotator cuff repair. This study shows that if selection of patients is done properly, these factors do not influence a successful outcome.

An investigation of manual therapy treatment for juvenile spondylolysis

Background:A common conservative treatment for early and progressive-stages of juvenile spondylolysis is by a hard corset to provide rigid external support to promote bone union. However, when patients want to continue playing sports, and do not wish to use a hard corset, physiotherapists can offer an alternative conservative management approach, of individualized manual therapy and exercises. Purpose: 1. To investigate the outcome of individualized manual therapy and exercises for juvenile spondylosysis as an alternative to wearing a hard corset. 2. Identify significant prognostic factors for recovery. Methods: Study design: Retrospective audit of patient records from April 2011 to January 2014. Subjects: Male and female adolescent sports players (12–18 years), suffering juvenile spondylolysis. Data extracted from records included initial investigations, treatment decisions, and follow-up over one month. Subjects treated with a hard corset, received nerve block injection, or had complications such as herniated disc or lower limb injury, were excluded. Physiotherapy interventions were stretching exercises for lower limbs, and core stabilization exercises. These exercises were individually graduated to attain an appropriate level of difficulty, without pain. This study reported outcomes from two time points after commencing physiotherapy:

Is time of neck pain onset a prognostic factor in whiplash-associated disorders?

Aims: One possible prognostic factor for whiplash-associated disorders which to date has not been investigated, is time of pain onset. We hypothesized that immediate onset of neck pain post-collision may indicate a different origin of the injury, with a prolonged recovery, compared to an injury with delayed onset of neck pain. Therefore, the aim was to investigate this in a prospective cohort study. Methods: Data was collected from insurance claimants (n = 1,308). Questionnaires at baseline provided information on time of neck pain onset, and potential confounders. Exposure was time of pain onset, trichotomized into; at the scene of the collision, 1-12 hours, and >12 hours post-collision. At a 6-month follow-up, pain-related disability was assessed with the pain disability index (PDI) and trichotomized into scores based on the median and the 75th percentile; PDI = 0, 1–18 and >18. Results: Twenty-eight percent of persons with pain onset at the scene of collision rated in the PDI >18 category at follow-up, compared to 21% respectively of those with onset 1–12 hours and those with onset >12 hours post collision. Persons with pain onset at the scene were more likely to rate PDI >18 compared to those with onset >12 hours post-collision. When adjusted for confounders, the result was attenuated and not statistically significant or 1.3 (95% CI; 0.8–2.2). Conclusion: Time of neck pain onset is not a prognostic factor in recovery from whiplash-associated disorders in this study. Further studies are warranted to confirm the results.

A clinical analysis of sudden sensorineural hearing loss cases.

Background and ObjectivesHigh-dose systemic steroid therapy is the mainstay treatment for sudden sensorineural hearing loss (SSNHL). Recovery rates from SSNHL range are about 47-63% and are influenced by various prognostic factors. To evaluate the prognostic value of specific clinical parameters, we reviewed 289 cases by clinical and statistical analysis.Subjects and MethodsThis study included 289 patients with SSNHL who visited the Department of Otolaryngology at Soonchunhyang University Hospital from January 2005 to December 2012. The cases were reviewed retrospectively based on clinical charts. Hearing improvement was evaluated in relation to pure-tone audiogram results, duration between SSNHL onset and time of initial treatment, seasonal incidence, dizziness, patient age, degree of hearing loss, patterns of initial pure-tone audiogram and presence of underlying disease.ResultsHearing improvement was observed in 196 of 289 (67.8%) patients; such improvement began within 7 days in most patients, followed by rapid hearing recovery. Cases that failed to show improvement within 14 days were unlikely to achieve hearing recovery. The more severe the hearing loss during the early stage, the lower the hearing recovery rates. Patients aged less than 60 years appear to have better prognosis of hearing improvement compared to those who are over 60 years.ConclusionsImportant prognostic factors for recovery in patients with SSNHL include the time of initiating treatment after symptom onset, the degree of early-stage hearing loss, and the age of the affected patient.

The influence of self-reported leisure time physical activity and the body mass index on recovery from persistent back pain among men and women: a population-based cohort study

BackgroundThere is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population.MethodsThe study population (n=1836) in this longitudinal cohort study consisted of participants reporting persistent back pain in the baseline questionnaire in 2002-2003. Data on leisure time physical activity, BMI and potential confounders were also collected at baseline. Information on recovery from persistent back pain (no back pain periods ≥ 7 days during the last 5 years) was obtained from the follow-up questionnaire in 2007. Log-binomial models were applied to calculate Risk Ratios with 95 percent Confidence Intervals (CI) comparing physically active and normal weight groups versus sedentary and overweight groups.ResultsCompared to a sedentary leisure time, all measured levels of leisure time physical activity were associated with a greater chance of recovery from persistent back pain among women. The adjusted Risk Ratios was 1.46 (95% CI: 1.06, 2.01) for low leisure time physical activity, 1.51 (95% CI: 1.02, 2.23) for moderate leisure time physical activity, and 1.67 (95% CI: 1.08, 2.58) for high leisure time physical activity. There were no indications that leisure time physical activity influenced recovery among men, or that BMI was associated with recovery from persistent back pain either among men or among women.ConclusionsRegular leisure time physical activity seems to improve recovery from persistent back pain among women.

Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study

BackgroundThere has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain.Methods/DesignAll participating patients were recruited (Jan 2003-Dec 2008) from the same rehabilitation centre and were evaluated by means of (postal) questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement) behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours), followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months) and long-term (12 months) follow-up after start of therapy.DiscussionIn a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint.

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

There is evidence for an association between Modic type 1 and pain in patients with low back pain (LBP), but little knowledge about its effect on clinical outcomes. (1) To assess the prevalence of Modic changes, (2) to determine if Modic changes influence the clinical course of LBP, and (3) to identify prognostic factors for recovery. Prospective clinical cohort study, with a 1-year follow-up. The treatment consisted of brief intervention and instruction in stretching. PATIENT'S SAMPLE: Two hundred and sixty-nine patients with chronic low back pain. Socio-demographic variables, education, profession, self-reported measures, degenerative changes on MRI. Linear growth model and Cox regression analysis. Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes. Modic changes were not significant covariates for the clinical course of pain, function or fear avoidance beliefs. Education was a strong prognostic factor for recovery. Modic changes did not influence the clinical course of back pain and were not prognostic factors for recovery. Education was strongly associated with recovery.

Recovery in Whiplash-Associated Disorders: Do You Get What You Expect?

Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of "expectations" to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities. A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities. After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller. Patients' early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.

Contribution of relapses to disability in multiple sclerosis

The impact of relapses on long-term disability in multiple sclerosis remains unclear; however some evidence suggests that relapses play an important role in determining subsequent prognosis. We report on outcome, prognostic factors for recovery and the contribution of relapses to the accumulation of fixed disability in a large series of patients with documented relapses. Two hundred and seventy-nine relapses in 182 patients were assessed before, during and after relapse by expanded disability status scale and data analysed to assess degree of recovery. Factors affecting outcome were considered including sex, age and site of relapse. Mean EDSS prior to relapse was 3.73, during relapse 5.18 and post relapse 4.23. Mean interval to post relapse assessment was 127 days post relapse. Mean residual change in EDSS score (pre to post relapse) was 0.50 points. Overall 49.4 % of patients had a residual increase in disability post relapse of at least 0.5 EDSS points and 32.7 % had an increase of at least 1 point. No significant difference was observed in mean residual EDSS for sex, site of relapse or age at relapse or in the proportion of patients with a residual increase in disability of > or = 1 EDSS point post relapse. 14.4 % of patients had no increase in EDSS score during relapse compared to pre relapse. These results suggest that acute relapses are commonly associated with an objective worsening of disability in the majority of patients with MS and that recovery is incomplete in approximately half and not influenced by gender, age or site of lesion. Therapies which reduce relapse frequency and/or severity might therefore be expected to slow or prevent worsening of disability if initiated prior to the onset of more permanent damage.

Neurocognitive fitness in the sub-acute stage after mild TBI: The effect of age

Objective: Age is assumed to be a negative prognostic factor in recovery from moderate-to-severe traumatic brain injury (TBI). Little is known on cognitive performance after mild TBI in relation to age in the sub-acute stage after injury.Method: Ninety-nine mild TBI subjects (age 15–75) were compared with 91 healthy control subjects (age 14–74) in a case-control design. Patients were matched on age, sex and level of education, with control subjects. Mean interval between injury and cognitive assessment was 13 days. Neurocognitive test battery contained tests of verbal memory, selective attention, general speed of information processing and verbal fluency.Results: An overall effect was found of a single mild TBI on neurocognitive performance in the sub-acute stage after injury. Age did not add significantly to the effect of mild TBI on cognitive functioning.Conclusion: Patients suffering from mild TBI are characterized by subtle neurocognitive deficits in the weeks directly following the trauma. The notion that elderly subjects have a worse outcome in the sub-acute period after mild TBI is at least not in line with the results of this study.

Intravenously Administered Immunoglobulin in the Treatment of Childhood Guillain-Barré Syndrome: A Randomized Trial

To determine the optimal treatment for childhood Guillain-Barré syndrome (GBS). We performed a randomized, multicenter study of GBS according to international diagnostic criteria. In study 1 (early treatment), children able to walk unaided for 5 meters were randomized for 1 g/kg intravenously administered immunoglobulin (IVIG) over 2 days or no treatment. The primary outcome measure was the degree of disability at nadir. In study 2 (treatment for severe GBS), children unable to walk 5 meters unaided were randomized for 1 g/kg IVIG over 2 days or 0.4 g/kg IVIG over 5 days. The primary outcome measure was the number of days needed to regain the ability to walk unaided. Children randomized for no treatment in study 1 could enter study 2 if loss of unaided walking occurred. Ninety-five children with GBS were registered in 40 months. Twenty-one children were randomized in study 1 and 51 in study 2 (5 after deterioration in study 1). Twenty-eight children were not randomized for various reasons. Eleven of 21 patients in study 1 lost the ability to walk unassisted and 6 were bedridden, with no statistically significant difference between the children initially randomized for treatment versus no treatment. Recovery occurred faster in the group randomized for early treatment. In study 2, recovery did not differ significantly between the children treated for 2 days versus 5 days (median time to unaided walking: 19 days vs 13 days). Secondary transient deterioration in the disability score occurred more frequently in the group with the 2-day regimen than in the group treated for 5 days (5 of 23 patients vs 0 of 23 patients). Multivariate analysis with Cox regression showed that disease severity at the nadir was the only prognostic factor for recovery. Treatment with IVIG before loss of unaided walking did not give rise to a less severe course, but recovery occurred somewhat faster. However, given the small number of patients, the power of this conclusion is low. For treatment after loss of unaided walking, there was no significant difference in the effectiveness of 2 g/kg IVIG administered over 2 days versus 5 days. Early "relapses" occurred more frequently after the shorter treatment regimen.

Prognostic factors associated with recovery from mechanical ventilation in advanced cancer patients admitted to intensive care units

8179 Background: The outcome of mechanical ventilation for cancer patients is poor. It is often complicated to decide which patients should receive aggressive intensive care units (ICU) care. Old age, leukopenia, performance status, progression or recurrence of cancer have been known to be prognostic factors of recovery from mechanical ventilation. We have analyzed the treatment outcome of cancer patients requiring mechanical ventilation to identify prognostic factors for survival from hospital care. Methods: We have reviewed medical records of advanced cancer (including solid tumor and lymphoma) patients who admitted to medical ICU and required mechanical ventilation from January, 2003 to June, 2004 in Seoul National University Hospital. Patients who admitted to ICU for perioperative care after curative surgery were excluded. Results: 80 patients were evaluated. 51(63.8%) patients died in ICU, and among 29(36.3%) patients who survived their ICU stay, additional 13(16.2%) died in general ward. Overall in-hospital mortality was 80%. (64/80) Median survival from the time of intubation was 13 days for all patients (including survivors). Uncontrolled disease (disease progression after previous chemotherapy) and intubation more than three days after hospitalization were significantly associated with in-hospital deaths in uni-variate and multi-variate analysis. Old age (>60yrs), leukopenia, and performance status were not significant prognostic variables associated with in-hospital deaths. Conclusions: Mortality of cancer patients admitted to ICU for mechanical ventilation was very high. Patients with uncontrolled disease or long-term hospitalization prior to respiratory failure are not likely to benefit from intensive care. No significant financial relationships to disclose.

Platelet GPIaC807T polymorphism is associated with negative outcome of sudden hearing loss

To determine the relevance of inherited prothrombotic risk factors in sudden hearing loss, we investigated 85 patients with sudden hearing loss of ⩾60 dB for the presence of inherited prothrombotic risk factors. The FV G1691A, FII G20210A, GPIa C807T, GPIIIa PIA1/A2, PAI-1 4G/5G, t-PA Alu repeat ID, MTHFR C677T and CBS 844ins68 genotypes were investigated. Allele frequencies found in patients were compared to those of 85 healthy control subjects of the same ethnic background using χ 2 and odds-ratio analysis. The frequency of the GPIa807T allele was significantly elevated in patients compared to controls. In addition, allele frequency and genotype distribution of GPIa was significantly elevated in the patient group without recovery after 3 months of sudden hearing loss onset. Allele frequencies of all other prothrombotic risk factors investigated here did not differ from those of the control subjects. The single-nucleotide polymorphism of GPIa C807T seems to play a role as a prognostic factor in recovery from sudden hearing loss.

Quality of life after hip fracture: a comparison of four health status measures in 208 patients

Objectives: We compared four health status measures for the evaluation of quality of life after hip fracture. Methods: Two hundred and eight elderly hip fracture patients were followed up to 4 months after hospital admission. We used two interviewer-administered instruments (the Rehabilitation Activities Profile (RAP) and the Barthel Index (BI)) that focus on functional status, and two self-assessment instruments (the Nottingham Health Profile (NHP) and the COOP/WONCA charts) that additionally include psychological and social health domains. The score distribution, internal consistency, construct validity, and sensitivity to change were investigated. Results: At 4 months only 18% of surviving patients had reached the same level of functioning as before the fracture and, compared with reference values, lower scores of health status were found in the areas of physical mobility and emotional reactions. The number of comorbidities at hospital admission was the most important prognostic factor for recovery of health status at 4 months. The RAP and the BI both performed well in the assessment of functional status in regard to score distribution, internal consistency and construct validity. In contrast to the BI, the RAP also assessed instrumental activities of daily living and perceived problems with existing disabilities. The generic health status measures produced no added value in the assessment of functional status. The NHP covered a wider range of psychological health dimensions (emotion, pain, energy, and sleep) and had better psychometric properties than COOP/WONCA. None of the four instruments performed well in assessing social functioning. Conclusions: To assess health status after hip fracture, we recommend the RAP for functional status and the NHP for changes in emotion, pain, and energy. These instruments detected poor recovery in functional and emotional status at 4 months after fracture.

A Pilot Study on the Recovery from Paresis After Lumbar Disc Herniation

Although the existence of a motor defect in discogenic sciatica is a sign of severity, the literature does not provide evidence for an immediate requirement for surgery. To assess the course of sciatica with discogenic paresis and to determine possible prognostic factors for recovery or improvement. This open prospective multicenter study included patients with discogenic sciatica with paresis that had been developing for less than 1 month and was rated < or =3 on a 5-grade scale. Pain, the strength of 11 muscles, return to work, and analgesic intake were assessed at 1, 3, and 6 months. Recovery and improvement were defined by pain not exceeding 20 mm or < or =50% of the initial pain score and a score of either 5 (recovery) or 4 (improvement) for the weakest muscle at inclusion. Sixty-seven patients were enrolled; 39 (58%) patients were treated surgically and 28 (42%) medically. Surgically treated patients differed from medically treated patients by a higher rate of extruded herniation, a higher number of paretic muscles (6.3 vs. 5; P = 0.051), and a longer course of sciatica (31.4 vs. 17.3 days; P = 0.034). At 6 months, 7 (10.4%) patients were lost to follow-up; 32 (53.3%) had improved, including 18 (30%) recovered, 33 (85%) back to work and having a professional activity, and 22 (39%) still taking analgesics. The only significant difference between recovered and not recovered patients was mean age at inclusion (43 vs. 51 years, P = 0.034). There were no significant differences between improved and not improved patients. Moreover, the outcome was not different in the two treatment groups: there were 17 (53%) improvements in surgically treated patients, including 8 (25%) recoveries, and 14 (56%) improvements in medically treated patients, including 8 (40%) recoveries. This pilot study showed no difference between surgical or medical management for recovery or improvement in patients with discogenic paresis. These results need confirmation by a randomized study.

Impact of social support on outcome in first stroke.

The purpose of this study is to examine the impact of social support on outcome after first stroke in a prospective cohort study. Although modest evidence exists for the importance of several psychosocial factors, studies have failed to use widely recognized measures of outcome and social support, have failed to control for time since onset, and have not used longitudinal techniques. Forty-six surviving patients were followed for 6 months after stroke. Recovery was measured using repeated measures of functional status as indicated by the Barthel Index of activities of daily living. Perceived social support was measured at 1, 3, and 6 months after onset. Repeated-measures multivariate analysis of variance was used to analyze changes in functional status. Significant differences were found across levels of social support in trajectories of functional status (p = 0.002). A significant three-way interaction between stroke severity, social support, and outcome was also found (p = 0.012). Patients with more severe stroke and the largest amount of social support attained an average Barthel Index that was 68 points (65%) higher than the group reporting the least support. High levels of social support were associated with faster and more extensive recovery of functional status after stroke. Social support may be an important prognostic factor in recovery from stroke. Socially isolated patients may be at particular risk for poor outcome.

Prognostic factors for recovery from coxo-femoral dislocation in cattle.

Details were recorded of 47 cases of coxo-femoral dislocation observed in cattle over 1 year. Treatment was successful in 20/47 (42.6%) cases using a method of closed reduction. Factors that most strongly influenced the prognosis were identified. The most useful single prognostic factor was whether the cow was able to stand before reduction. Other factors that also had a strong positive influence on the prognosis were: age less than 3y, bodyweight less than 400kg and duration of dislocation less than 12h. Nineteen unsuccessful cases were examined at the knackery. Four were found to have a fracture of the proximal femur. The coxo-femoral joint was carefully dissected in the other 15 cases and there was no evidence of hip dysplasia. A seasonal incidence of dislocations, which coincides with the calving and mating periods, was demonstrated during the survey and from practice records for the previous 3 years.