RAND 36-Item Health Survey Research Articles

Estimation of a Canadian preference-based scoring algorithm for the Veterans RAND 12-Item Health Survey: a population survey using a discrete-choice experiment.

Background:The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure derived from the widely used 36- and 12-item Short Form Health Surveys. We aimed to estimate a Canadian preference-based scoring algorithm for the VR-12, enabling the derivation of health utility values for generating quality-adjusted life years (QALYs).Methods:We conducted a discrete-choice experiment in a sample of the Canadian population in January and February 2019. Participants — recruited from a consumer research panel — completed an online survey, in English or French, that included 11 discrete-choice questions, each comprising 2 health profiles. We defined the health profiles using 8 VR-12 items and a duration attribute. Using conditional logit regressions, where each level of the respective VR-12 items was interacted with duration, we applied the coefficients to estimate health utility values interpretable on a scale of 0 (dead) to 1 (full health). Negative values reflect states considered worse than dead.Results:A total of 3380 individuals completed the survey. Of these, 1688 (49.9%) were females, and 3101 (91.7%) completed the English version of the survey. Across all models, “feel downhearted and blue all of the time” and “pain interferes with your normal work extremely” were associated with the largest decrements in health utility. Excluding the 685 respondents (20.3%) who provided inconsistent responses had a negligible effect on the results. The recommended model, weighted to match population demographics, had health utility values ranging from −0.589 to 1.000.Interpretation:Health utility values that reflect the preferences of the Canadian population can now be derived from responses to the VR-12. These values can be used to generate QALYs in future analyses.

The History and Applications of the Veterans RAND 12-Item Health Survey (VR-12).

There has been an increasing emphasis on placing patients at the center of clinical care and health care research and, in particular, assessing outcomes and experiences from the patient's perspective. One of the most widely used patient-reported outcome instruments is the Veterans RAND 12-item Health Survey (VR-12). This article reviews the VR-12 development and its applications over the last 2 decades, including research and potential uses in clinical care.

Outcomes of Biceps Tenotomy Versus Tenodesis During Arthroscopic Rotator Cuff Repair: An Analysis of Patients From a Large Multicenter Database.

Background:Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes.Hypothesis:It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered.Study Design:Cohort study; Level of evidence, 3.Methods:The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex.Results:Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis (P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores (P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures.Conclusion:Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient.

Health-related quality of life associated with warfarin and direct oral anticoagulants in venous thromboembolism

IntroductionVenous thromboembolism (VTE) is commonly treated with oral anticoagulants, including warfarin or direct oral anticoagulants (DOACs). Although DOACs are associated with favorable treatment satisfaction, few studies have assessed whether quality of life differs between DOAC and warfarin users. Materials and methodsWe invited adults enrolled in two California-based integrated health care delivery systems and with a history of VTE between January 1, 2015 and June 30, 2018 to complete a survey on their experience with anticoagulants. Health-related quality of life (QOL) was assessed using the RAND 36-item Short Form Health Survey (SF-36), which measures QOL in 2 general component scores (physical and mental). We used multivariable linear regression to compare mean QOL component scores between DOAC-users and warfarin-users, adjusting for patient and clinical characteristics. ResultsOverall, 2230 patients (43.1 % women and 31.8 % >75 years of age) taking anticoagulants answered at least 1 question on the SF-36, 975 taking DOACs and 1255 taking warfarin. After adjustment for patient-level factors, there were no significant differences in either physical component scores (39.2 v 38.3, p = 0.24) or mental component scores (48.5 v 49.0, p = 0.42) between DOAC and warfarin users. ConclusionsHealth-related QOL did not significantly differ between DOAC and warfarin users with a history of VTE.

Health-related quality of life following FDG-PET/CT for cytological indeterminate thyroid nodules.

ObjectiveThis study assessed the health-related quality of life (HRQoL) in patients undergoing 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT for an indeterminate (Bethesda III/IV) thyroid nodule. FDG-PET/CT accurately rules out malignancy and prevents 40% of futile diagnostic surgeries in these nodules.DesignSecondary analyses of HRQoL data from a randomised controlled multicentre trial (NCT02208544) in 126 patients from 15 hospitals in the Netherlands were done.MethodsLongitudinal HRQoL assessment was performed using the EuroQol 5-dimension 5-level (EQ-5D-5L), the RAND 36-item Health Survey v2.0 (RAND-36), and the Thyroid Patient-Reported Outcome (ThyPRO) questionnaire on baseline, 3, 6, and 12 months, relative to the date of the FDG-PET/CT scan.ResultsPatients who were randomised to active surveillance following an FDG-negative nodule instead of diagnostic surgery reported stable HRQoL scores throughout the year. Univariate analysis indicated better HRQoL for patients undergoing surveillance than surgical patients with benign histopathology on multiple physical and psychosocial domains. Univariate within-group analysis suggested both temporary and continued HRQoL deteriorations in patients with benign histopathology over time. Multivariate within-group analysis demonstrated no significant longitudinal HRQoL changes in patients undergoing active surveillance. In contrast, in patients with benign histopathology, worse HRQoL was observed with regard to ThyPRO cognitive impairment (P = 0.01) and cosmetic complaints (P = 0.02), whereas goitre symptoms (P < 0.001) and anxiety (P = 0.04) improved over time. In patients with malignant histopathology, anxiety also decreased (P = 0.05).ConclusionsThe reassurance of a negative FDG-PET/CT resulted in sustained HRQoL throughout the first year of active surveillance. Diagnostic surgery for a nodule with benign histopathology resulted in more cognitive impairment and physical problems including cosmetic complaints, but improved goitre symptoms and anxiety. Anxiety was also reduced in patients with malignant histopathology.

Intra-articular Damage and Patient Outcome Comparison Between Athletes and Nonathletes After Hip Arthroscopy

Background: The body of literature comparing hip arthroscopy between athletes and nonathletes is relatively scarce. Analyzing these groups can help to shed light on the severity of intra-articular damage and end-stage osteoarthritis that may result from participation in strenuous activities. Purpose: (1) To compare the intra-articular damage at the time of hip arthroscopy between athletes and nonathletes, and (2) to compare the pre- and postoperative outcomes between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were considered eligible for analysis if they had received a primary hip arthroscopy between August 2008 and June 2018, were participating in competitive athletics, and had preoperative baseline scores and minimum 2-year follow-up for the following patient-reported outcomes: modified Harris Hip Score, Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale, and visual analog scale. Propensity score matching was used to match eligible patients in a 1:1 ratio to patients who were not participating in any sports greater than a recreational level before surgery. Results: A total of 234 patients were included. There were no significant differences in the severity of labral tears, ligamentum teres tears, or cartilage damage (P > .05). The procedures performed between cohorts were similar (P > .05). The athlete population had higher preoperative means scores for the modified Harris Hip Score and NAHS (each P < .001). Likewise, the athlete population had higher postoperative means scores for the NAHS, Hip Outcome Score–Sports Specific Subscale, and visual analog scale (P = .031, P = .030, and P = .032, respectively). Additionally, the athlete cohort reported higher minimum 2-year outcomes than the nonathlete cohort for the 12-Item Short Form Health Survey (mental component; P = .003) and Veterans RAND 12-Item Health Survey (mental component, P = .032; physical component, P = .005). Conclusion: At the time of hip arthroscopy, athletes demonstrate similar intra-articular damage to their nonathlete counterparts. Given their higher preoperative scores, it is possible that athletes better tolerate the damage to the hip joint. Despite their strenuous activities and potentially higher tolerance to pain, athletes should not necessarily be expected to have greater severity of intra-articular pathology.

Impacts of Financial Assistance on Quality of Life Among People Living With Burn Injury: Matched Cohort Analysis of the National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System Database.

Disparities in socioeconomic status and minority status affect the risk of burn injury and the severity of that injury, thus affecting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Participants ≥18 from Burn Model System National Longitudinal Database (BMS) with complete demographic data were included (n = 4330). Nonresponders to financial assistance questions were analyzed separately. The remaining sample (n = 1255) was divided into participants who received financial assistance because of burn injury, those who received no financial assistance, and those who received financial assistance before injury and as a result of injury. A demographic and injury-characteristic comparison was conducted. Health-related quality of life metrics (Satisfaction with Life, Short Form-12/Veterans RAND 12-Item Health Survey, Community Integration Questionnaire Social Component, and the Post-Traumatic Growth Inventory) were analyzed preinjury, then 6-months, 1-year, and 2-years postinjury. A matched cohort analysis compared these scores. When compared to their no financial assistance counterparts, participants receiving financial assistance due to burns were more likely to be minorities (19% vs 14%), have more severe injuries (%TBSA burn 21% vs 10%), and receive workers' compensation (24% vs 9%). They also had lower health-related quality of life scores on all metrics except the post-traumatic growth inventory. Financial assistance may aid in combating disparities in posttraumatic growth scores for participants at the greatest risk of financial toxicity but does not improve other health-related quality of life metrics.

Validation of the RAND 36-Item Health Survey questionnaire in Brazil.

Health-related quality of life is frequently used as an outcome measure that improves the quality of care. The SF-36 and RAND-36 were derived from the Medical Outcomes Study. The present study aimed to validate the RAND-36 in Brazil, in healthy individuals and patients with liver disease. Confirmatory factor analysis (CFA) was conducted by using JASP Software. The parameters of the items were estimated using the Robust Diagonally Weighted Least Squares (RDWLS) approach. Comparative fit index (CFI), Goodness-of-fit index (GFI), Tucker-Lewis Index (TLI) and the root mean square error of approximation (RMSEA) were evaluated. Internal consistency was measured using the Composite reliability index. Convergent validity between RAND-36 domains and Work Ability Index (WAI) was conducted. This validation study included 763 individuals, 400 (52.4%) with chronic liver disease. The most prevalent liver diseases were hepatitis C (13.9%), alcoholic liver disease (11.8%), and steatosis (12.1%). The measurement model tested using the CFA obtained the following adjustment indicators: X2 (df): 599.65 (498); CFI: 0.998; GFI: 0.998; TLI: 0.998; RMSEA: 0.016 (90%CI: 0.011-.021). Convergent validity of RAND-36 and total WAI ranged from medium to large correlation. The RAND-36 is effective in measuring the perception of health-related quality of life in individuals with and without chronic liver disease. The results of our study support the developer's claims for the reliability of the RAND-36 version 1 as a measure of health-related quality of life. The evidence for the construct validity of the RAND-36 was substantial.

Combinations of Preoperative Patient-Reported Outcome Measure Phenotype (Pain, Function, and Mental Health) Predict Outcome After Total Knee Arthroplasty.

Value-driven healthcare models prioritize patient-perceived benefits to quantify the quality of care through patient-reported outcome measures (PROMs). The Patient Acceptable Symptom State (PASS) is the highest level of symptom beyond which a patient considers his/her condition satisfactory. We identified preoperative phenotypes of PROMs associated with not achieving PASS at 1 year following total knee arthroplasty (TKA) and explored the relationships between such phenotypes with hospital utilization parameters. A prospective institutional cohort of 5,274 primary TKAs for osteoarthritis from 2016 to 2019 with 1-year follow-up were included. Preoperative scores on Knee Disability and Osteoarthritis Outcome Score (KOOS) Pain, KOOS-Physical function Short form (PS), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were used to develop patient phenotypes. Associations between preoperative "phenotype" and 1-year PASS, discharge disposition, length of stay, 90-day readmission, and 1-year reoperation were evaluated using multivariate regression. In total, 16.3% (n= 862) of patients reported their state as "not acceptable" at 1 year. A combination of low scores in each of the presently examined PROMs was associated with the highest odds of 1-year dissatisfaction (odds ratio 2.18, 95% confidence interval 1.74-2.74). The PROM phenotypes were the greatest drivers compared to sociodemographic variables in predicting satisfaction. Combinations of low scores in VR-12 MCS and KOOS-PS were significantly associated with both non-home discharge status and prolonged length of stay. Patients with combined lower preoperative scores across multiple PROMs (KOOS-Pain <41.7, KOOS-PS <51.5, and VR-12 MCS <52.8) have increased odds of dissatisfaction after TKA. Measuring pain, function, and mental health concurrently as phenotypes may help identify TKA patients at risk for not achieving a satisfactory outcome at 1 year.

Study Protocol: Effect of Prune on Fracture Healing in Men and Women With a Wrist Fracture

ObjectivesPrune has been shown to be beneficial in several chronic conditions including cardiovascular disease, cancer, and osteoporosis. Specifically, daily fresh prune consumption may increase serum values of bone formation as well as protect and improve values of bone mineral density. However, the effect of prune on fracture healing has not been investigated. The objective of this study is to determine the efficacy of prune in enhancing distal radius fracture healing.MethodsA total of 50 men and women between the ages of 50 to 85 years, body mass index (BMI) range of 18.5–35.0 kg/m2, with a confirmed, closed, distal radius fracture will be recruited for this study. Three fracture types included are listed from least to most severe: extra-articular; non-comminuted, intra-articular; and comminuted, intra-articular. Participants will be randomly assigned to one of two groups: 1) 100 g daily of prune + standard of care (500 mg Calcium and 400 IU Vitamin D, twice daily; providing a total of 1000 mg Calcium and 800 IU Vitamin D) or 2) standard of care alone (500 mg Calcium and 400 IU Vitamin D, twice daily) daily for 12 weeks. Radius Union Scoring System (RUSS) for rate of healing will be assessed using anteroposterior and lateral X-ray. Additionally, range of motion (ROM), handgrip strength, and pain and functionality (via QuickDASH, the Veterans Rand 12-Item Health Survey (VR-12), and the Visual Analog Scale for Pain (VAS Pain)) will be assessed. For continuous variables (e.g., serum analyses), two-way mixed ANOVAs will be performed. For dichotomous variables, c2 tests will be performed to compare proportions between groups. For ordinal variables, Kruskal-Wallis H tests will be performed to compare ranking. Significance will be set at P ≤ 0.05. The findings of this study will further our understanding of the role of prune on fracture healing.ResultsN/AConclusionsN/AFunding SourcesCalifornia Prune Board.

Trends in Complications and Outcomes in Patients Aged 65 Years and Younger Undergoing Total Knee Arthroplasty: Data From the American Joint Replacement Registry.

Introduction:The purpose of this study was to identify common complications and the rates of readmission and revision in total knee arthroplasty (TKA) patients younger than 65 years.Methods:Using the American Joint Replacement Registry, we conducted a retrospective review of all TKAs done in patients aged 18 to 65 years from 2012 to 2020. Demographic factors such as age, sex, Charlson Comorbidity Index (CCI), and preoperative Veterans RAND 12-Item Health Survey Physical Component Summary (VR-12 PCS) scores were collected. We excluded patients older than 65 years and revision, oncologic, and nonelective cases. Primary outcomes included cumulative revision rate, 90-day readmission rate, and reason for revision. Univariate analysis and the Kaplan-Meier method were used.Results:Six thousand one hundred seventy-nine patients were included. The average age was 58.8 years (SD 5.5 years), 61% were female, 82% were White, and 88% had a CCI of 0 (1 = 8% and ≥2 = 4%). The mean follow-up was 42.51 months. Seventy-four patients (1.2%) underwent revision. Sixty-nine patients (1.1%) were readmitted within 90 days. No factors assessed increased revision rates. Revision-free survivorship was 98.7% (95% CI 98.4 to 99.0) and 98.6% (95% CI 98.2 to 99.0) at 5 and 8 years, respectively. Infection (15%), aseptic loosening (14%), and instability (12%) were the most common indications for revision.Conclusion:TKA done in young and presumed active patients has excellent survivorship. Long-term follow-up is needed to assess survival trends in this growing population.

Mental health status, not resilience, influences functional recovery after arthroscopic rotator cuff repairs

Recent literature has shown the importance of patient psychosocial status in overcoming stressful events, such as surgery. Resilience, the ability to "bounce back" from adversity, has been recently correlated to outcomes following arthroscopic rotator cuff repair (RCR). Overall mental well-being has also been shown to be important because patients with clinical depression and anxiety may have worse outcomes. Substantial clinical benefit (SCB) is the threshold of outcome improvement that a patient perceives as considerable. The purpose of this study was to assess the influence of preoperative resilience, mental health status, and rotator cuff tear size on patient outcome recovery measured by the American Shoulder and Elbow Surgeons (ASES) score. Patients undergoing arthroscopic RCR performed from 2016 through 2019 at a single tertiary institution by fellowship-trained sports surgeons with a high-volume shoulder practice were included. The Brief Resilience Scale (BRS) score and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) were collected preoperatively. ASES scores were obtained preoperatively, as well as 6 and 12 months postoperatively. Patients were divided into 2 groups based on the SCB threshold of 87 for the ASES score based on validated, established literature. Rotator cuff tear size was classified as small (≤3 cm) or large (>3 cm). VR-12 MCS, BRS, and ASES scores were compared at baseline, 6 months, and 1 year using separate mixed-model analyses of variance between the tear size and SCB groups. For ASES score comparison, the VR-12 MCS was used as a covariate to account for differences in baseline mental status. RCR was performed in 119 patients, with an average age of 61 years (standard deviation, 10 years). There were 71 male and 48 female patients. At 6 months, 43% of patients met the SCB threshold. The VR-12 MCS was significantly different between RCR patients who met the SCB threshold for the ASES score and those who did not at 6 and 12 months for large rotator cuff tears (P=.001) but not small tears (P=.07). The BRS score was not different between the tear size and SCB groups at any time point (P=.12). Our results show that patients who met the SCB threshold at 6 months postoperatively after arthroscopic RCR demonstrated higher preoperative VR-12 MCS values; however, higher preoperative BRS scores were not seen in those meeting the SCB threshold. In fact, when baseline VR-12 MCS values were accounted for in patients with large rotator cuff tears, the differences in ASES scores normalized. This finding suggests that baseline mental health status, as measured by the VR-12 MCS, significantly influenced patients' functional recovery following RCR. Future research should focus on preoperative psychosocial well-being to optimize postoperative outcomes.

Utilising Electronic PROMs to Measure a Change in Health Following Elective Laparoscopic Cholecystectomy: A Feasibility Study

BackgroundThe collection of patient-reported outcome measures (PROMs) has many benefits for clinical practice. However, there are many barriers that prevent them from becoming a part of routine clinical care. The aim of this feasibility study was to pilot the use of a digital platform to facilitate the routine collection of pre- and post-operative electronic PROMs (ePROMs) in participants undergoing elective laparoscopic cholecystectomy and to validate the use of existing patient-reported outcomes for our population.MethodsParticipants scheduled for elective laparoscopic cholecystectomy were asked to complete digital versions of the Otago gallstones Condition-Specific Questionnaire (CSQ), and the RAND 36-item health survey (SF36). An assessment of methodological quality of ePROM questionnaires was also performed.ResultsPreoperative ePROMs were completed by 200 participants undergoing laparoscopic cholecystectomy. Post-operatively attrition was high (completion at 30 days, 3 months, and 6months: n = 61, 54, and 38, respectively) due to difficulties accessing our ePROMs portal. Of those able to complete, a significant improvement in quality of life was seen across all health domains post-operatively when compared with baseline preoperative values for both disease-specific and generic PROMs. Methodological quality was assessed as good to excellent in both digital questionnaires.ConclusionThe collection of ePROMs is possible with current technological advances. Although it may be an acceptable, and convenient process for patients, and a useful measure of quality-of-life trends for clinicians, further developmental work is necessary to improve accessibility for patients, improve compliance, and reduce reporting bias from high attrition rates.

Medial Patellofemoral Ligament Repair with Suture Tape Augmentation: A Case Series With Five-Year Follow Up.

The medial patellofemoral ligament (MPFL) is the main restraining force against lateral patellar displacement in the first 20 degrees of knee flexion and is often disrupted following patellar subluxation or dislocation. MPFL reconstruction is commonly performed to restore patellar stability but requires autograft harvest with associated donor site morbidity. The aim of this study was to assess the five-year outcomes of MPFL repair performed with suture tape augmentation. All patients who underwent isolated MPFL repair for recurrent patellar instability between 2011 and 2017 were included. Patients requiring any additional surgery, such as osteotomy, were excluded. Patient-reported outcomes were measured at two-year follow up using the Knee Injury and Osteoarthritis Outcome (KOOS) Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Pain Scale (VAS-pain), Veterans RAND 12-Item Health Survey (VR-12), Marx Activity Scale, and an overall satisfaction questionnaire. At the end of the study period, any complications or secondary surgeries were determined. Eighteen patients underwent MPFL repair with one lost to follow up. There was a significant improvement in all subscales of the KOOS scoring systems, the WOMAC functional score, and the VR-12 physical score. A significant decrease was seen in the VAS-pain score. A non-significant decrease was seen in the Marx activity scale from pre-injury. The majority of patients reported satisfaction with reduction in pain and return to sporting activities. There were no complications with no further instability episodes. This is the first study that describes the five-year follow-up results of patients treated with MPFL repair and suture tape augmentation. Our results show that this technique is an alternative treatment to traditional MPFL reconstruction with comparable outcomes and avoidance of autograft harvest.

MP13-18 IMPACT OF COMPREHENSIVE HEALTH INSURANCE COVERAGE ON QUALITY OF LIFE IN LOW-INCOME MEN WITH PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022MP13-18 IMPACT OF COMPREHENSIVE HEALTH INSURANCE COVERAGE ON QUALITY OF LIFE IN LOW-INCOME MEN WITH PROSTATE CANCER Allen E.D. Siapno, Thomas W. Gaither, Megha D. Tandel, Lorna Kwan, Ying-Ying Meng, Sally Maliski, Arlene Fink, and Mark S. Litwin Allen E.D. SiapnoAllen E.D. Siapno More articles by this author , Thomas W. GaitherThomas W. Gaither More articles by this author , Megha D. TandelMegha D. Tandel More articles by this author , Lorna KwanLorna Kwan More articles by this author , Ying-Ying MengYing-Ying Meng More articles by this author , Sally MaliskiSally Maliski More articles by this author , Arlene FinkArlene Fink More articles by this author , and Mark S. LitwinMark S. Litwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002542.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Affordable Care Act (ACA) expanded Medicaid coverage to a portion of previously uninsured low-income men receiving free disease-focused navigation-based care through the Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT) program. To determine the effect of the transition to comprehensive health insurance on health-related quality of life (QoL), we compared men who transitioned to full-scope insurance through the ACA to men who were ACA-ineligible and continued care in IMPACT. METHODS: We retrospectively reviewed survey data on IMPACT enrollees when the ACA went into effect in 2014, creating a natural experimental cohort with some men transitioning from IMPACT to ACA coverage (intervention group) and other men remaining in IMPACT (control group). Subjects completed three surveys: one year before, at, and one year after the transition. The main outcomes were two composite domains of general QoL in the RAND 12-Item Health Survey (SF-12) and six domains of prostate cancer-specific QoL in the UCLA Prostate Cancer Index. Statistical analysis compared demographics, clinical characteristics, and the QoL measures. We assessed the independent effects of ACA coverage on QoL outcomes using repeated-measures regression. RESULTS: 84 men (30 intervention, 54 control) met inclusion criteria. Mean age was 61.3 years (SD 7.4), 82% were Hispanic, and 64% were living with their spouse/partner. At the transition, the intervention group was enrolled in IMPACT for less time (40% vs 70% enrolled >1 year, p=0.02) and were less likely to be actively smoking (30% vs 54%, p=0.04). QoL scores at the transition were similar for both groups except for better sexual function in the intervention group (40.0 vs 23.7, p=0.01). QoL did not differ over time between the groups, but sexual function in both groups declined from pre- to post-transition (Table 1). CONCLUSIONS: Both of those who transitioned to full-scope insurance or remained in a free prostate cancer treatment program had stable general and prostate cancer-specific QoL. Decline in sexual function may be time- or age-related. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes. Source of Funding: IMPACT receives funding from the California Department of Health Care Services. Research was funded by the American Cancer Society Research Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e229 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Allen E.D. Siapno More articles by this author Thomas W. Gaither More articles by this author Megha D. Tandel More articles by this author Lorna Kwan More articles by this author Ying-Ying Meng More articles by this author Sally Maliski More articles by this author Arlene Fink More articles by this author Mark S. Litwin More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Effect of a Dispersible Curcumin (HydroCurc®) Compared to a Placebo for Reducing Joint Pain in an Adult Population – A Randomised, Double-Blind Study

Introduction: This study aimed to assess the efficacy of a novel curcumin formulation, HydroCurc®, for alleviating joint pain and improving quality of life in adults. Method: A randomised, double blind, placebo-controlled study was conducted on adults aged 25–70 years reporting joint pain. Eighty participants received either curcumin or a placebo daily for 2 weeks. The primary outcome was a self-assessed reduction in pain as assessed by a visual analogue scale (VAS) for pain, completed daily in the morning and evening. Quality of life was assessed by the RAND 36-Item Health Survey (SF-36) and the Profile of Mood States (POMS). Results: VAS pain scores reduced over the 2 weeks of treatment in both groups. Morning VAS scores were significantly reduced from baseline in the curcumin and placebo groups from day 6 and 12, respectively. Morning VAS scores were significantly lower in the curcumin group compared to the placebo group for days 11, 13, and 14 (p < 0.05). Evening VAS scores were significantly reduced from baseline in the curcumin and placebo groups from day 5 and 6, respectively. There were no differences in the evening VAS scores, SF-36 nor POMS between groups. Conclusion: This study demonstrates that HydroCurc® is an effective option for reducing morning joint pain. Future studies would benefit from investigating whether long-term supplementation and/or a split dose can show further improvements in pain scores.

Opioid Use After Simple Arthroscopic Knee Surgery

Background: Evidence-based prescribing guidelines are lacking for opioids after most orthopaedic surgical procedures. Hypothesis: Opioids are commonly overprescribed after simple knee arthroscopy. Study Design: Case-control study; Level of evidence, 3. Methods: A cohort of 174 patients who underwent simple arthroscopic knee surgery were prospectively evaluated using data from the Outcome Management and Evaluation database. All patients received 10 combined hydrocodone 5 mg and acetaminophen 325 mg pills postoperatively. Patients were excluded if they (1) had revision surgery, (2) had concomitant complex surgery (eg, ligament surgery, osteotomy), (3) had current opioid use, (4) had open surgery for removal of hardware, (5) or had bilateral knee surgery. Total opioid consumption was reported at the first postoperative visit, and a distribution was created based on patient response. Based on the distribution, patients were separated into low (0-2 pills) versus high (3 or more pills) opioid consumption groups for evaluating risk factors for opioid use. The risk factors included were age, body mass index, smoking status, education level, baseline pain (Knee injury and Osteoarthritis Outcome Score pain subscale [KOOS Pain]), and baseline mental health (Veterans RAND 12-Item Health Survey Mental Component Score), as well as intraoperative findings such as synovial characteristics and extent of osteoarthritis in the multivariate model. Results: Total opioid consumption ranged from 0 to 19 pills. The median pill count was 2 (25th; 75th interquartile range, 0; 4). Of total patients, 59% were categorized as having low opioid consumption, and the remaining 41% were in the high opioid consumption group. Only 23 patients (13.2%) took 6 or more pills. Preoperative pain as measured by KOOS Pain score was a significant predictor of high opioid consumption postoperatively (odds ratio, 0.97; 95% CI, 0.95-0.99; P = .003). Conclusion: The clinically relevant conclusion is that opioids are overprescribed after simple arthroscopic knee surgery. Based on distribution, the authors recommend that 4 pills be prescribed after simple arthroscopic knee surgery. After accounting for confounding variables, preoperative pain was associated with higher postoperative opioid consumption.

Concomitant Total Shoulder Arthroplasty and Ipsilateral Carpal Tunnel Release: Is It Safe?

Symptomatic carpal tunnel syndrome in patients with advanced ipsilateral glenohumeral arthritis requiring total shoulder arthroplasty (TSA) may be easily overlooked. Even when diagnosed beforehand, most upper extremity surgeons have historically chosen to perform TSA and carpal tunnel release (CTR) separately. We hypothesized that combined single-stage TSA and CTR is feasible and yields results comparable with those when the 2 procedures are performed separately, while avoiding 2 surgeries. This was a retrospective review of patients who underwent single-stage primary TSA and ipsilateral CTR between 2015 and 2019. The shoulder outcomes included pain, range of motion, and validated quality of life (QoL) questionnaires: Veterans RAND 12-Item Health Survey (VR-12) and Penn Shoulder Score. The CTR outcomes included pain, grip, pinch, VR-12, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), and Boston Carpal Tunnel Questionnaire. The time to the initiation of rehabilitation and complications were also analyzed. The comparison group consisted of patients who underwent independent TSA or CTR during the same period. Forty-one patients underwent concomitant TSA and CTR, 248 underwent isolated TSA, and 154 underwent isolated CTR. The shoulder outcomes of patients who underwent the combined procedure were similar to those of patients who underwent isolated TSA in terms of pain, range of motion, general QoL (VR-12), and shoulder-specific QoL (Penn Shoulder Score). The outcomes of patients who underwent the combined procedure were similar to those of patients who underwent isolated CTR in terms of pain, grip and pinch, general QoL (VR-12), QuickDASH, and Boston Carpal Tunnel Questionnaire. The time to the initiation of rehabilitation was also comparable. Concomitant CTR and TSA are feasible. The functional outcomes and QoL of patients who underwent the concomitant treatment were comparable with those of patients who underwent the 2 procedures separately. Therapeutic IV.

Health-Related Quality of Life and Psychological Distress in Patients With Hypermobility Type Ehlers-Danlos Syndrome

Patients with Ehlers-Danlos Syndrome, hypermobile type (hEDS) often report a decrease of health-related quality of life (HRQoL), symptoms of anxiety and depression, and show a prevalent incidence of psychiatric disorders. Still, there seems to be a lack of a more thorough analysis addressing the relations between these entities. We studied the HRQoL and its relations with depressive symptoms and subgroups of anxiety in a group of patients with hEDS ( n = 81) compared to a comparison group ( n = 90) of healthy controls (HC). HRQoL was assessed with the RAND 36-item health survey, depressive symptoms were measured with the 21-item Beck Depression Inventory (BDI-II) and State/trait anxiety inventory (STAI) was used to estimate levels of state and trait anxiety. The hEDS group showed significantly lower scores on total HRQoL, on all subscales as well on calculated subgroups of physical and mental HRQoL than the HC group. Depression, state, and trait anxiety scores were significantly higher in hEDS group than in the HC group. However, both state and trait anxiety showed a lower degree of negative associations with social functioning in the hEDS group when compared to the HC group. Patients with hEDS present with a lower HRQoL and greater psychological distress than healthy individuals. These factors play a significant role in the patients’ overall functional capacity and should be noticed when examining and treating patients with hEDS.

755 Does Military Service History Make a Difference in Outcomes after Burn Injury?

IntroductionThere is little published research on the long-term outcomes of military service members with burn injuries. Military service members are often exposed to extraordinary challenges and adverse experiences that might influence their recovery from a burn injury. Therefore, to better understand the outcomes of service members with burn injuries, this study compares characteristics and health outcomes between burn survivors who have and do not have a history of military service.MethodsData from the Burn Injury Model System National Longitudinal Database (2015-2021) were analyzed. Military and civilian groups were identified by the following question administered at hospital discharge: “have you ever served in the military?”. The database does not identify if military service members were active duty at time of injury. Demographic and clinical characteristics as well as outcome measures at one year after injury were compared between groups. Patient reported outcome measures included: Veterans Rand 12-Item Health Survey (VR-12) physical and mental health, Satisfaction with Life Scale (SWL), 4-D Itch, Post Traumatic Stress Disorder (PTSD) Check List, self-reported PTSD diagnosis, and employment status. Multivariate regression analyses examined associations between outcome measures and military service status, controlling for age, gender, burn size, race, and ethnicity.ResultsThe study population included 672 burn survivors, 105 with and 567 without military service history, respectively. Participants with military service history were more likely to be male (93% vs. 65%, p < 0.001), older (55 vs. 45 years, p < 0.001) and have Medicare/Medicaid insurance (46.6% vs. 37.2%, p< 0.01) than those without military service history. Race, ethnicity, education, marital status, injury etiology, burn size, length of stay, burns to critical areas, amputation, and number of surgeries were not significantly different between groups. Regression analyses also demonstrated that none of the outcome measures examined (VR-12, SWL, 4-D Itch, PTSD Check List, self-reported PTSD, employment) were significantly different between groups at one-year after injury (p >0.05).ConclusionsNo significant differences in outcomes were found in the BMS Database between burn survivors with and without a history of military service. Harmonization of these data with other military service datasets will help us better understand long-term outcomes of this population.