Functional Quality Of Life Research Articles

Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario

ABSTRACT Background The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM). Research design and methods Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers. Results One hundred and five physicians took part in the survey. Despite 94% of patients receive a regular follow-up every 3–6 months, available therapies are considered insufficient in 30% of cases. Physicians reported a lack of treatment options for 23% of symptomatic patients with reduced ejection fraction (EF) and for 66% of those without reduced EF. Approximately 3% of HF population (two patients per month per HF clinic) meets the criteria for immediate CCM treatment, which is considered a useful option by 15% of survey respondents. Conclusions Despite this relatively small percentage, considering total HF population, CCM could potentially benefit numerous HF patients, particularly the elderly, by reducing hospitalizations, improving functional capacity and QOL.

Transcranial magnetic stimulation as a feasible, non-invasive, neuromodulatory intervention in fetal alcohol spectrum disorders. A very first proof of concept

IntroductionA neurobiological feature of Fetal Alcohol Spectrum Disorder (FASD) is a global decrease in neuronal connectivity, which leads to significant impairments in everyday functionality. Non-invasive repetitive transcranial magnetic stimulation (rTMS) could potentially positively influence neuronal plasticity but has not yet been studied in FASD. The present trial addresses this gap, making it the first-ever study of rTMS in FASD. Materials and methodsThe prospective clinical trial was conducted at the LMU University Hospital Munich and enrolled eight FASD participants aged 6–16. Six sessions of 1 Hz-rTMS over the left dorsolateral prefrontal cortex were administered two times a week for three weeks consisting of 1500 pulses at 90 % of resting motor threshold in four trains of 375s. Outcome measures investigated feasibility and treatment response of rTMS on executive functions, attention/impulsivity, social-emotional regulation and quality of life (QoL) via standardized tests and the FASD parents’ app. ResultsAdherence and retention rate were 100 %. Adverse events (AEs) were mild and self-limiting, resulting in a per-session risk of 53.3 %, with local paraesthesia accounting for 54.2 % of the AEs. There were individual relevant but no significant group-level improvements in the investigated functional cerebral domains or participants' QoL. The FASD parents' app showed no significant change in participants' daily functioning or caregivers' QoL. Caregivers’ parental stress decreased significantly. ConclusionFASD is a very complex disorder that is difficult to treat. In addition, comorbidities as atypical responses to pharmacotherapies are frequent. For this reason, non-invasive, innovative therapies for children with FASD have to be developed. For the first time, rTMS was shown to be safe, tolerable, and acceptable and thus well feasible in paediatric patients with FASD. Further clinical studies with larger samples are needed to identify effective stimulation protocols and to evaluate treatment response.

Efficacy of rehabilitation after provision of ICRC lower limb prostheses in low-income and middle-income countries: A quantitative assessment from Myanmar.

Low-income and middle-income countries (LMICs) have poorly resourced health services. Lack of access to assistive devices, such as prosthetics, may limit the functional outcomes of persons with amputation and affect quality of life (QoL). The objective of this study was to assess the functional level and QoL of prosthetic users in LMICs when prescribed a prosthesis made from International Committee for Red Cross (ICRC) components. The study design included a quantitative descriptive methodology assessing functional outcomes and QoL after prosthetic provision. Participants were identified from the prosthetic service in Mandalay, Myanmar. Included participants were those with unilateral, traumatic, lower limb amputations, with ICRC devices delivered at least 6 months earlier. Participants attended the prosthetic service and were assessed using the Amputee Mobility Predictor with Prosthesis tool and the World Health Organization Quality of Life Brief and Disability modules. Thirty-five participants completed the study; of them, 63% were persons with transtibial level amputation and 37% were with transfemoral level amputation. Approximately 83% achieved a score of more than 37 using the Amputee Mobility Predictor with Prosthesis. There is a strong positive correlation between QoL and physical health (r = 0.55; p < 0.001), social relationships (r = 0.66; p < 0.001), and inclusion (r = 0.53; p < 0.001). Participants had a better QoL and overall health when they had better psychological health. The patient-based results presented within this study could be considered as a contribution to the evidence base and importance of provision of prosthetic services in LMICs. It was observed that participants with an amputation were able to achieve a high level of physical function with the ICRC prostheses while also reporting a high QoL.

Psoriasis and Psoriatic Arthritis Have a Major Impact on Quality of Life and Depressive Symptoms: A Cross-Sectional Study of 300 Patients.

Psoriasis (Pso) and psoriatic arthritis (PsA) can reduce the quality of life (QoL) and are known to be associated with depression. Within this study, we aimed to assess the burden of disease, functional capacity, quality of life, and depressive symptoms and identify factors predicting functional impairment and depression in patients with psoriatic disease. A cross-sectional survey was conducted in a cohort of 300 patients with psoriatic disease including 150 patients from a university hospital dermatology outpatient clinic and 150 patients from a university hospital rheumatology outpatient clinic. Questionnaire-based assessment of signs of arthritis (Psoriasis Epidemiology Screening Tool; PEST), functional status (Functional Questionnaire Hannover; FFbH), quality of life (World Health Organization Quality of Life Brief Version; WHOQOL-BREF), and depressive symptoms (Patient health questionnaire9; PHQ-9) and retrospective medical chart analysis were performed. Despite treatment, burden of disease was high. Joint pain was reported in multiple regions in patients with Pso (n = 111) and patients with PsA (n = 189), but with differences in frequency and distribution patterns of symptoms. Functional impairment in everyday life was independently associated with diagnosis of PsA (odds ratio [OR] 9.56, p = 0.005), depressive symptoms (OR 5.44, p < 0.001) and age (OR 1.04, p = 0.033). At least mild depressive symptoms were demonstrated in 54% and 69% of patients with Pso and PsA, respectively. In a logistic regression model, depressive symptoms were independently associated with functional impairment (OR 4.50, p = 0.003), axial complaints (OR 2.80, p = 0.030), diagnosis of psoriatic arthritis (OR 2.69, p = 0.046), and number of joint regions with complaints (OR 1.10, p = 0.032). Functional impairment, QoL, and depressive symptoms are mutually interdependent. Early diagnosis of PsA and initiation of anti-inflammatory therapy are essential to avoid long-term damage, disability, and mental health complications. However, despite therapy many patients with PsA, and especially female patients, report a substantial residual disease burden due to their psoriatic disease which will need to be addressed by a more patient-centered approach.

A - 83 Associations between Subjective and Objective Cognition, Depression, and Quality of Life in Men Living with HIV.

In people living with HIV, subjective cognitive dysfunction is widely reported; however, few studies have examined the relationship between subjective cognitive functioning and performance-based measures of cognitive functioning, mood, and quality of life (QoL). Men living with HIV (MLWH) (n = 51, mean age = 54years, 67% Black) completed measures of subjective cognitive functioning (Cognitive Failures Questionnaire; CFQ), objective cognitive performance (HVLT-R, TMT, UFOV, WRAT-3 Reading), health-related QoL (Medical Outcomes Short-Form; SF-36), mood (CES-D), and overall QoL (Control, Autonomy, Self-Realization, and Pleasure Quality of Life Scale; CASP-19). Pearson and Spearman correlation analyses were conducted to examine significant associations between variables. Alpha was set at 0.01 for all analyses. The CFQ was not significantly correlated with performance on objective cognitive tests. However, significant associations were found between the CFQ and self-reported depression severity (CES-D; r = 0.655, p < 0.001), quality of life (CASP-19; r = -0.642, p < 0.001), and multiple subscales of the SF-36 (all p's < 0.003). Of note, correlations between the CFQ with SF-36 scales and CASP-19 were no longer significant after controlling for depressive symptoms. Consistent with prior work, we found that subjective cognitive functioning may inadequately capture the full range of a person's cognitive functioning status. We extend these findings to a sample of MLWH and further clarify the possible influence that depressive symptoms have on subjective cognitive functioning and self-reported QoL measures. Future studies with larger samples and a more comprehensive neuropsychological battery will be helpful in understanding the full nature of these relationships.

Understanding Parkinson's Disease: A Basic Overview

Abstract Parkinson's disease (PD) is a multi-system disease, with clinical features typically described across three domains: motor, non-motor, and neuropsychiatric symptoms. There is no known cause or cure for PD, and diagnosis occurs often through a process of elimination, remaining one of clinical assessment, expert opinion, and observing disease progression over time. In the absence of disease modifying therapy for PD, pharmacological treatments play a role in symptomatic relief and improving quality of life (QoL). A narrowing therapeutic window and motor fluctuations present a challenge to the pharmacological management of PD. Device assisted therapies including Duodopa, Apomorphine and deep brain stimulation are based on the concept of providing stable and continuous stimulation to minimise pulsatile sudden or unexpected fluctuations. Studies continue to demonstrate the benefit of multidisciplinary input and the impact on functional status, mood, motor abilities, cognitive performance, speech skills, independence and QoL of a person with PD. Nurses are well placed to identify complications, escalate concerns, and initiate timely referral to members of a multidisciplinary team. Understanding the clinical features of PD as well as the basic assessment and management of the disease is essential in providing holistic care and supports to maintain QoL for those with PD and their caregivers.

Comparison of Quality of Life after Robotic, Video-Assisted, and Open Surgery for Lung Cancer.

Post-operative quality of life (QOL) has become crucial in choosing operative approaches in thoracic surgery. However, compared to VATS and thoracotomy, QOL results post-RATS are limited. We compared QOL before and after RATS and between RATS, VATS, and thoracotomy. We conducted a retrospective review of lung cancer surgical patients from 2015 to 2020. Patients completed validated EORTC QOL questionnaires (QLQ-C30 and QLQ-LC13). Results were analysed using the EORTC Scoring Guide, with statistical analysis. A total of 47 (94%) pre- and post-RATS questionnaires were returned. Forty-two patients underwent anatomical lung resections. In addition, 80% of patients experienced uncomplicated recovery. All global and functional QOL domains improved post-operatively, as did most symptoms (13/19). Only four symptoms worsened, including dyspnoea (p = 0.017), with two symptoms unchanged. Of the 148 returned questionnaires for all approaches (open-22/VATS-79/RATS-47), over 70% showed a high pre-operative performance status. Most patients underwent anatomical lung resection, with only VATS patients requiring conversion (n = 6). Complications were slightly higher in RATS, with one patient requiring re-intubation. RATS patients demonstrated the highest global and functional QOL. Physical QOL was lowest after thoracotomy (p = 0.002). RATS patients reported the fewest symptoms, including dyspnoea (p = 0.046), fatigue (p < 0.001), and pain (p = 0.264). Overall, RATS results in a significantly better post-operative QOL and should be considered the preferred surgical approach for lung cancer patients.

134 Evaluation of the Community Rehabilitation Inpatient Specialist Program (CRISP)—an advanced nurse practitioner (RANP)-led program for frail older adults

Abstract Background Frail older adults disproportionately access acute healthcare services. Novel integrated care programs are needed to redesign care delivery focusing on community-based health promotion, as opposed to crisis response. CRISP is a bespoke, RANP-led program that provides direct access for community-dwelling older adults to short-term (2-weeks) in-patient intensive multidisciplinary rehabilitation based on a Comprehensive Geriatric Assessment. Referrals are received from Geriatric ED services, geriatric/neurology/rehabilitation medicine outpatient clinics, ICPOP and local GPs. Admission to a Model 2 Age- Related rehabilitation centre occurs within 4–8 weeks of referral. Methods This Prospective cohort study examines the short to medium-term effects of the CRISP program. Functional, mobility and Quality-of-Life (QoL) measures were collected on admission and discharge. Fall rates, QoL and carer stress are measured four months after completion of the program. Data were analysed using Microsoft Excel. Functional outcome and QoL measurements were compared using paired t-test. Results 73 patients (78%) completed the program and attended for follow up (2021–2022), average age: 80.9 yrs, SD-6.6 yrs, frailty index 5.6 (mild to moderate frailty). There have been statistically significant gains made in performance in activities of daily living (Barthel Index; 76.7A vs 83.9 DC) (p &amp;lt; 0.001), balance (Berg Balance Scale:29.6A vs 36.3 DC) (p &amp;lt; 0.001 and QOL (EQ5D:45.2 A vs 69.8 DC) (p &amp;lt; 0.001). CRISP delivers long-term positive benefits including reduction in falls rates: 2.9(4 months pre-admission) vs 0.5 (4 months following completion of the program) (p &amp;lt; 0.001) and improvement in self-reported QoL, EQ5D:45.2 A vs 62.6 at 4 months following completion of the program. Carers who reported stress 62% (n-45), 91% reported a reduction in stress levels 4 months following the program. Conclusion CRISP provides early intervention at the lowest level of care complexity resulting in reduced fall rates and consequent crisis presentations to acute care. CRISP improves mobility and function promoting independence and improving QoL for community dwelling older adults.

The Long-COVID autonomic syndrome in hospitalized patients: A one-year prospective cohort study

Long-COVID syndrome is characterized by fatigue, orthostatic intolerance, tachycardia, pain, memory difficulties, and brain fog, which may be associated with autonomic nervous system abnormalities. We aimed to evaluate the short and long-term course of COVID-19 autonomic symptoms and quality of life (QoL) after SARS-CoV-2 infection through a one-year follow-up combined with validated questionnaires. Additionally, we aimed to identify patients with worsening autonomic symptoms at 6 and 12 months by dividing the patient cohort into two sub-groups: the Post-COVID healed Control sub-group (total score<16.4) and the Long-COVID autonomic syndrome sub-group (total score>16.4). This prospective cohort studied 112 SARS-CoV-2 positive patients discharged from Humanitas Research Hospital between January and March 2021. Autonomic symptoms and QoL were assessed using the composite autonomic symptom scale 31 (COMPASS-31) and Short Form Health Survey (SF-36) questionnaires at various time points: before SARS-CoV-2 infection (PRE), at hospital discharge (T0), and at 1 (T1), 3 (T3), 6 (T6), and 12 (T12) months of follow-up. COMPASS-31 total score, Orthostatic Intolerance and Gastrointestinal function indices, QoL, physical functioning, pain, and fatigue scores worsened at T0 compared to PRE but progressively improved at T1 and T3, reflecting the acute phase of COVID-19. Unexpectedly, these indices worsened at T6 and T12 compared to T3. Subgroup analysis revealed that 47% of patients experienced worsening autonomic symptoms at T6 and T12, indicating Long-COVID autonomic syndrome. Early rehabilitative and pharmacological therapy is recommended for patients at the T1 and T3 stages after SARS-CoV-2 infection to minimize the risk of developing long-term autonomic syndrome.

Development and Validation of the Parosmia Olfactory Dysfunction Outcomes Rating (DisODOR).

Develop and validate a quality-of-life (QoL) outcome measure for patients with dysosmia. Cross-sectional survey study. Otolaryngology clinics, research registries, and Facebook support groups. A 59-item pilot survey with questions addressing parosmia concerns was developed using input from subjects with parosmia and clinical expertise from Otolaryngologists. After item reduction, the Parosmia Olfactory Dysfunction Outcomes Rating (DisODOR) was reduced to its final 29 items. DisODOR maximum score is 116 (each item score 0-4) with higher scores indicating a higher degree of dysfunction from smell distortion. DisODOR was validated using participants with parosmia persisting >3 months after severe acute respiratory syndrome coronavirus 2 (cases) and healthy controls. Reliability, face and content validity, internal consistency, convergent validity, discriminative validity, sensitivity to change, and the minimal clinically important difference (MCID) were assessed. A total of 134 cases and 20 controls completed DisODOR. The mean (SD) age was 45.9 (12.2) for cases and 29.6 (8.9) for controls. The mean score difference between cases and controls was 45.0 (95% confidence interval, 40.5-49.5) displaying good discriminative validity. DisODOR showed strong test-retest reliability (r = .942) with high internal consistency (Cronbach's α = .971). DisODOR had a moderate correlation with SNOT-22 scores (r = .619) indicating good convergent validity. There is an excellent association with the global impression of severity categories (η2 = 0.447). Based on the distribution method, the MCID is 15. DisODOR is a valid, reliable QoLinstrument for parosmia that can be used to measure the functional impact and QoL impairment for parosmia patients. DisODOR is sensitive to change and thus can be used in studies investigating treatments for parosmia.

Limitations on participation and global quality of life among CRC survivors with permanent stomas: moderated mediation analysis of psychological distress and family functioning.

Although a cancer diagnosis and stoma creation leave colorectal cancer (CRC) survivors with significant limitations on participation in life activities that would impair their global quality of life (QoL), the underlying psychological mechanisms are understudied. The aim of this cross-section study was to examine whether psychological distress mediates the association of limitations on participation in life activity with global QoL, and whether family functioning moderated the indirect effects of limitations on participation in life activities on global QoL through psychological distress. CRC survivors with permanent stomas (n = 282) completed questionnaires assessing socio-demographic and clinical characteristics, limitations on participation in life activities, psychological distress, family functioning, and global QoL. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS. Mediation analysis showed that the association of limitations on participation in life activities with global QoL was partially mediated by psychological distress (indirect effect = -0.087, 95% CI = -0.135 to -0.041). Moderated mediation analysis indicated that the indirect effects of limitations on participation in life activities on global QoL through psychological distress were significantly moderated by family functioning. Specifically, the indirect effects decreased were significant as family functioning levels increased. CRC survivors with permanent stomas experienced poor global QoL. The moderated mediation model provides a better understanding of how limitations on participation in life activities, psychological distress, and family functioning work together to affect global QoL. Interventions aiming to improve QoL among CRC survivors with permanent stomas should consider targeting these aspects.

The impact of moderate to severe osteoarthritis on the physical performance and quality of life: a cross-sectional study in Greek patients (PONOS study)

BackgroundOsteoarthritis (OA) represents a leading cause of disability with limited data available for the Greek patients.ObjectivesTo evaluate the impact of moderate to severe symptomatic hip/knee OA under treatment on physical performance and quality of life.MethodsA non-interventional, cross-sectional, epidemiological study of patients with moderate/severe OA, recruited in a single visit from 9 expert sites in Athens, Greece. Assessments were based on commonly used outcome scales: the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol-5-Dimensions 3-levels questionnaire (EQ-5D-3L).ResultsOne hundred sixty-four patients were included in the analysis. Most of the patients were females (78.7%), with a mean age of 70.5 ± 10.2 years. Comorbidities were reported by 87.2% of patients with hypertension being the most frequently reported (53.7%), followed by dyslipidemia (31.1%), obesity (24.4%) and diabetes mellitus (23.2%). Paracetamol was the most common treatment (96%), followed by NSAIDs (75%), opioids (50%) and locally applied medications (42.7%). Both hip and knee OA patients showed substantial deterioration in health-related quality of life (QoL) and health status as reflected by the HOOS/KOOS (Function in sport and recreation was the most impaired subscale, followed by Hip- or Knee-related QoL). The mean EQ-5D-3L index score was 0.396 ± 0.319 and the mean EQ-VAS score was 52.1 ± 1.9. When compared indirectly to the local population norms our OA population had worse QoL indices.ConclusionOur findings suggest the functional disability and impaired QoL of Greek patients with moderate/severe hip/knee OA under treatment emphasizing the need for novel treatments that will reduce the burden of the disease.

Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?

BackgroundClinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥ 90 years. MethodsWe conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR patients among nonagenarians was compared to the provincial estimated survival for an age- and sex-matched general population. QoL was assessed up to 1 year postintervention, using standardized questionnaires. ResultsDuring the study period, n = 268 patients aged ≥ 90 years were evaluated for severe aortic stenosis. TAVR was performed in n = 171 (48% female; median [IQR] Rockwood Clinical Frailty Scale score: 4 [3-4]); n = 84 underwent medical therapy; and n = 13 underwent surgical aortic valve replacement. Survival was significantly better following TAVR, compared to that after MT (adjusted hazard ratio [95% CI]: 1.99 [1.37-2.88], P < 0.001). TAVR patients demonstrated a survival advantage compared with the general population, with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1 year compared to baseline (all P < 0.05): the 6-minute walk test results improved from 192 to 252 m; the Kansas City Cardiomyopathy Questionnaire score improved from 64 to 81; the Duke Activity Status Index score improved from 13 to 16; and the health state scale result of the Euro Quality of life - 5 Dimensions improved from 63% to 74%. ConclusionsNonagenarians undergoing TAVR experience a slightly better survival rate, compared to that of an age- and sex-matched general population, and they have significant improvements in functional status and several QoL indices following the procedure.

Depression and Anxiety Mediate the Associations between Nutritional Status, Functional Capacity, and Quality of Life in Patients with Cancer

Cancer patients are at risk of malnutrition, which influences their functional status, mental health (MH), and quality of life (QoL). This study aimed to examine the associations between nutritional status, functional capacity, and aspects of QoL in cancer patients, as well as the potential mediating role of depression and anxiety in these associations. Patients with various types of cancer (n = 152) were recruited from the Attikon University Hospital, Greece. Validated questionnaires were used to assess nutritional status (PG-SGA), QoL (SF-36 and EQ-5D-3L), functional capacity (ECOG), depression, and anxiety (HADS and BEDS). Handgrip strength (HGS) was also measured. Poor nutritional status was inversely associated with functional capacity, QoL, depression, and anxiety, after adjusting for confounding factors (all P ≤ 0.05). Mediation analysis indicated a significant indirect effect of nutritional status on various parameters of functional capacity and QoL through depression and anxiety, after adjusting for age and sex. Mediated proportion ranged from 26.3–34% to 23.1–82.8% for functional capacity and QoL, respectively. A significant proportion of the effect of nutritional status on QoL and functional capacity can be partly attributed to psychological effects, highlighting the significance of integrating all aforementioned aspects in the nutritional intervention for cancer patients.

Quality of life after pediatric cancer: comparison of long-term childhood cancer survivors’ quality of life with a representative general population sample and associations with physical health and risk indicators

BackgroundThis study aimed to compare the quality of life (QoL) reported by childhood cancer survivors (CCS) drawn from a cohort of the German Childhood Cancer Registry with a representative general population sample and, within CCS, to test associations between QoL and health behavior, health risk factors, and physical illness.MethodsCCS (N = 633, age at diagnosis M = 6.34 (SD = 4.38), age at medical assessment M = 34.92 (SD = 5.70)) and a general population sample (age-aligned; N = 975) filled out the EORTC QLQ-C30. Comparisons were performed using General linear models (GLMs) (fixed effects: sex/gender, group (CCS vs. general population); covariates: age, education level). CCS underwent an extensive medical assessment (mean time from diagnosis to assessment was 28.07 (SD = 3.21) years) including an objective diagnosis of health risk factors and physical illnesses (e.g., diabetes and cardiovascular disease). Within CCS, we tested associations between QoL and sociodemographic characteristics, health behavior, health risk factors, and physical illness.ResultsCCS, especially female CCS, reported both worse functional QoL and higher symptom burden than the general population. Among CCS, better total QoL was related to younger age, higher level of education, being married, and engaging in active sports. Both health risk factors (dyslipidemia and physical inactivity) and manifest physical illnesses (cardiovascular disease) were associated with lower total QoL.ConclusionsIn all domains, long-term CCS reported worse QoL than the comparison sample. The negative associations with risk factors and physical illnesses indicate an urgent need for long-term surveillance and health promotion.

Functions of Resiliency Traits and Processes in Differential Effects of CBSM on Quality of Life in Breast Cancer Survivors: A Moderated Mediation Model.

Although there is evidence that cognitive behavioral therapy (CBT)-based group interventions can improve quality of life (QoL) in women undergoing treatment for breast cancer (BC) little is known about factors that mediate and moderate these effects. We examined a) the mediating role of benefit finding on QoL changes after a Cognitive Behavioral Stress Management (CBSM) intervention, and b) whether this mediation effect differed based on baseline optimism in the first year following surgery for BC. We used data from a prior CBSM trial in 240 women with stage 0-3 BC who completed measures of benefit finding (Benefit Finding Scale, BFS), QoL (Functional Assessment of Cancer Treatment, FACT-G), and optimism (Life Orientation Test-Revised) at baseline (2 - 10weeks post-surgery), 6-months and 12-months after randomization. CBSM-related changes and mediation and moderation effects were assessed using latent growth curve models. We found CBSM increased benefit finding (b = 2.65, p < 0.01), emotional (b = 0.53, p < 0.01), and functional QoL (b = 0.71, p < 0.05) over time. CBSM-related changes in emotional QoL were mediated by increased benefit finding (indirect effect = 0.68, 95% bootstrapped CI: 0.17, 1.56) but only among participants with low to moderate optimism at baseline. CBSM intervention improved emotional QoL over the first year of breast cancer treatment by increasing benefit finding among women who reported low trait optimism suggesting those who will most likely benefit from improving benefit finding during this stressful period.

Clinical effects of sodium hyaluronate combined with platelet-rich plasma injection on rotator cuff injury in arthroscopic repair

ObjectiveRotator cuff injury is one prevalent shoulder condition that often leads to pain and dysfunction. The study explored the clinical effects of sodium hyaluronate combined with platelet-rich plasma (PRP) injection on rotator cuff injury in arthroscopic repair. MethodsA total of 92 cases with rotator cuff injury were randomly divided into the control group (n = 46, treated with shoulder arthroscopy repair combined with subacromial space injection of sodium hyaluronate) and the experimental group (n = 46, treated with subacromial space injection of autologous PRP on the basis of the treatment in the control group). Visual analogue scale (VAS), Constant-Murley scale (CMS), University of California, Los Angeles (UCLA), American Shoulder and Elbow Society (ASES), and quality of life (QOL) scores, as well as complications were compared in the two groups before surgery and at 3 and 6 months after surgery. Shoulder range of motion (ROM) was measured before and after surgery. ResultsVAS scores of patients in the two groups at 3 and 6 months after surgery were lower than those before surgery, and the VAS scores of patients in the experimental group at 3 and 6 months after surgery were much lower than those in the control group (all P < 0.05). The scores of CMS, UCLA, ASES, and QOL, and shoulder ROM in both groups at 3 and 6 months after surgery were higher than those before surgery, and these shoulder joint function scores, QOL and shoulder ROM in the experimental group at 3 and 6 months after surgery were higher than those in the control group (all P < 0.05). No statistically significant difference presented in the incidence of complications between the two groups (P > 0.05). ConclusionArthroscopic rotator cuff repair and sodium hyaluronate combined with PRP injection can effectively reduce pain symptoms, improve shoulder joint function and shoulder ROM, and improve QOL in patients with rotator cuff injury.

Postoperative Limb Function and QOL in Elderly Patients With Malignant Bone Tumor/Soft Tissue Sarcoma.

Malignant bone tumors (MBT) and soft tissue sarcomas (STS) require wide excision. Although the number of elderly patients is increasing, wide excision may decrease limb function and quality of life (QOL) for elderly patients. However, no detailed evaluation of the functional prognosis or QOL of elderly patients with sarcoma has been reported. This study evaluated postoperative limb function and QOL in elderly patients with MBT and STS. This retrospective study included 67 patients aged >70 years with MBT or STS who underwent surgery at a single institution. The Toronto Extremity Salvage Score (TESS), EuroQoL 5-dimension 5-level (EQ-5D-5L) questionnaire, Musculoskeletal Tumor Society (MSTS) score, and psoas muscle index (PMI) were evaluated. We also assessed factors associated with the postoperative TESS and EQ-5D-5L index. Detailed examination of the MSTS items perioperatively revealed significant decline in manual dexterity/walking ability and support but significant improvement in pain and emotional acceptance. The mean PMI decreased significantly from 4.7 to 4.23 perioperatively. The postoperative mean TESS and EQ-5D-5L index was 76.9 and 0.74, respectively. Patients with good performance status and clinical frailty scale scores preoperatively had better postoperative TESS and EQ-5D-5L scores. The current study strongly suggests the possibility of maintaining postoperative limb function, satisfaction, and QOL in patients with MBT and STS by choosing patients in good condition and the appropriate procedure that the patient desires. However, perioperative progression of sarcopenia should be noted.

Postoperative relative decrease in skeletal muscle mass as a predictor of quality of life in patients with gastric cancer.

Low skeletal muscle mass reflects poor nutritional condition, which may impair the functional status and quality of life (QOL) of survivors of gastrectomy. The present cross-sectional study examined the association between a relative change in skeletal muscle mass and perceived postoperative health and QOL in patients with gastric cancer. The study comprised 74 patients (48 men and 26 women; median age, 68.5 years) who underwent surgery for stage I-III gastric cancer. Outcomes were measured using the Postgastrectomy Syndrome Assessment Scale-45, which was specifically developed to measure post-gastrectomy symptoms, living status, dissatisfaction with daily life and generic QOL. The skeletal muscle mass index (SMI) was estimated using computed tomography by tracing the area of the psoas major muscle to calculate the ΔSMI, defined as: (SMI before surgery-SMI at completion of the PGSAS-45 survey)/SMI before surgery x100. Associations between ΔSMI and health outcomes were assessed using univariate and multivariate analyses. The mean ΔSMI (SD) was 8.64% (10.6%). The effect size (Cohen's d) of ΔSMI <10% compared with ΔSMI ≥10% was 0.50 (95% CI: 0.02 to 0.97) for total symptom scores, -0.51 (-0.98 to -0.03) for general health, and -0.52 (-0.99 to -0.05) for the physical component summary (PCS). Multiple regression analysis showed that ΔSMI was significantly associated with PCS decline, and its standardized regression coefficient was -0.447 (-0.209 to -0.685). Determining ΔSMI may help clinicians to facilitate the objective evaluation of low skeletal mass, which reflects poor nutritional condition that can impair functional status and QOL of postoperative patients surviving gastrectomy.

Left atrial strain is associated with the burden of symptoms in cardiac amyloidosis: a speckle tracking study

Abstract Funding Acknowledgements Type of funding sources: None. Background cardiac amyloidosis (CA) is characterized by an impairment of cardiac diastolic and, in the severe state of the disease, systolic function, with increasing worsening of functional capacity and quality of life (QoL). Six minute walking test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ) are two well-known and validated methods to assess the impact of heart failure (HF) symptoms and functional capacity. Left atrial strain by speckle tracking echocardiography has emerged as an index of left ventricular (LV) diastolic function and filing pressure, and is also associated with symptoms in HF. However, its possible association with functional capacity and QoL in CA has not yet been investigated. Objectives in this observational pilot study, our aim was to evaluate the relationship of left atrial strain with 6MWT and KCCQ in patients with CA (both AL and ATTR). Methods we enrolled consecutive patients with CA during routine follow up visits. Patients underwent clinical and echocardiographic evaluation. On the same day, 6MWT was performed and KCCQ was administered. Speckle tracking analysis was performed offline by an experienced operator blinded to the other data. Correlation analysis was conducted using Pearsons’ coefficient and linear regression analysis Results overall, 43 patients with CA (25 ATTR, 18 AL) were enrolled. Mean age was 74 ±11, 16% (n=7) were female. Most patients showed normal left ventricular (LV) ejection fraction (55±9) and reduced LV global longitudinal strain (GLS =−12 ± 7%), 32 of them with apical sparing pattern (Table 1). Mean global peak atrial longitudinal strain (PALS) was 14 (median[IQR]=6.5;23.5), mean 6MWT score = 382 ± 104 and mean KCCQ score= 67 ± 24. Global PALS showed a strong direct correlation with 6MWT (Fig 1, P= 0.4, R2=0.2, p-value=0.032) and a trend towards correlation with KCCQ (R2=0.3, p-value=0.06), although not reaching statistical significance, probably due to the low sample size. The correlation between PALS and 6MWT was even stronger in patients with ATTR (p = 0.7, R2 0.4; p-value&amp;lt;0.0001). Conclusions our preliminary results show that, global PALS is associated with functional capacity and the burden of HF symptoms in ATTR and AL, suggesting its role as a more objective marker of disease severity in CA.