Related Quality Of Life Measures Research Articles

Abstract P6-05-21: Quality of Life and Perspectives of Older Adults with Early & Locally Advanced Breast Cancers Undergoing Pre-operative Therapy

Abstract Background: Breast cancer (BC) is the commonest diagnosed cancer in Singaporean women. Increasingly, non-metastatic BC are treated aggressively with neoadjuvant therapy (NAT). Early identification and addressing supportive care needs of NAT treated patients is important for effective cancer care whilst maintaining optimal physical, psychological and social function. This project aims to explore the longitudinal trends of quality of life (QOL) of BC patients enrolled in a NAT program. Methods: This was a prospective cohort study of females aged 21 diagnosed with non-metastatic BC, referred to the NAT program at the SingHealth network of acute hospitals. The Functional Assessment of Cancer Therapy-Breast (FACT-B) was used as a health related QOL measure prior to NAT, within 2 months post definitive breast surgery and at 1-year post diagnosis. In older adults (OA) ≥65 years, the Attitude scale, Now vs Later as well as Health Outcome tool were also performed at baseline. Here we report pre-NAT baseline FACT-B and questionnaire results of OA patients recruited into the NAT program between Jun 2020 and Jun 2021. Results: Pre-NAT median FACT-B scores was 117 (IQR 102-126) for the entire cohort (n=119) and 116 (IQR 104-126) for OA (n=22). OA had significantly lower median Social Wellbeing score at baseline compared to patients < 65 years (p=0.01), while Physical, Emotional, and Functional Wellbeing were not significantly different. More than 50% of OA favoured QOL over quantity of life on the Attitude Scale. 68% of patients would rather have QOL now than 1 year later with half expecting their QOL to reduce by 50% in this time period. When the time scale was extended to 5 years, 64% would rather have QOL 5-years from now instead of QOL now with close to 80% expecting their QOL to be lower in 5 years than presently. Of the 4 outcomes, maintaining independence scored the highest, followed by keeping alive, then reducing/eliminating pain and other symptoms. Conclusion: Our study suggests that OA with BC report similar QOL to younger patients at baseline prior to NAT. Majority of OA patients favoured QOL over quantity of life, and viewed the ability to maintain independence as more important than survival prolongation representing their unique attitude towards cancer treatment and outcomes. Citation Format: Jun Ma, Zewen Zhang, Jasmine Yun Ting Tan, Whee Sze Ong, Sulastri Kamis, Benita Kiat Tee Tan, Veronique Kiak Mien Tan, Ravindran Kanesvaran, Tira Jing Ying Tan. Quality of Life and Perspectives of Older Adults with Early & Locally Advanced Breast Cancers Undergoing Pre-operative Therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-21.

Impact of surgical treatment on parent-reported health related quality of life measures in early-onset scoliosis: stable but no improvement at 2years.

The etiology of early-onset scoliosis (EOS) has been shown to significantly influence baseline parent-reported health-related quality of life (HRQoL) measures as assessed by the Early Onset Scoliosis Questionnaire (EOSQ). We sought to assess the influence of distraction-based surgery and scoliosis etiology on EOSQ 2years following surgical intervention remains unclear. A retrospective review of a multi-center prospective EOS database was performed. Children untreated with distraction-based, growth friendly instrumentation for EOS with completed baseline and 2-year post-surgical EOSQ were included. Children were subdivided by curve etiology individually and in combined cohorts (congenital/idiopathic [C/I], neuromuscular/syndromic [NMS]). EOSQ domains and compositive HRQoL score at presentation and 2-year follow-up were compared across C-EOS etiologies. Minimal clinically important difference (MCID) was defined as ≥ 20% change in domain score and compared across etiologies. 150 children with EOS met inclusion criteria (mean 7.09 ± 2.6years, 58.9% female). There were no differences in EOSQ domains between Congenital vs. Idiopathic nor NM vs. Syndromic etiologies at any timepoint. Combined C/I children demonstrated significantly higher EOSQ scores than combined NMS at initial and 2-years post-treatment. Etiology remained the only independent predictor of 2-year EOSQ composite HRQoL score. Overall, the vast majority of children demonstrated stable HRQoL composite scores, with a trend toward more positive MCID in NMS etiologies. EOS etiology remains the most significant influence on EOSQ scores 2years following surgical intervention. However, the majority of patients, regardless of etiology, maintain stable HRQoL scores suggesting that surgery may only serve to stabilize HRQoL at 2years.

Rates of Loosening, Failure, and Revision of Iliac Fixation in Adult Deformity Surgery.

Retrospective cohort review of a prospective multicenter database. Identify rates and variations in lumbopelvic fixation failure after adult spinal deformity (ASD) correction. Traditional iliac (IS) and S2-alar-iliac (S2AI) pelvic fixation methods have unique technical characteristics for their application, and result in varied bio-mechanical and anatomic impact. These differences may lead to variance in lumbopelvic fixation failure types/rates. ASD patients undergoing correction with more than five level fusion and pelvic fixation, separated by pelvic fixation type (IS vs. S2AI). Fixation fracture or loosening assessed radiographically (Figure 1). Multivariate logistic regression, accounting for significant confounders, was used to examine differences between the two groups for screw loosening/fracture, rod fracture, and revision surgery. Level of significance set at P< 0.05. Four hundred eighteen of 1422 patients were included (IS = 287, S2AI = 131). The groups had similar age, body mass index (BMI), baseline comorbidities, number of levels fused (P>0.05), baseline health related quality of life measures (HRQLs) (short form survey-36, Oswestry Disability Index [ODI], Scoliosis Research Society [SRS-22], numeric rating scale [NRS] leg and back, P>0.05) and deformity (pelvic tilt [PT], pelvic incidence-lumbar lordosis [PI-LL], and sagittal vertical axis [SVA], P> 0.05). The IS group had more unilateral fixation versus S2AI (12.9% vs. 6%; P = 0.02). The overall lumbopelvic fixation failure rate was 23.74%. Pelvic fixation (13.4%) and S1 screw (2.9%) loosening was more likely with S2AI (odds ratio [OR] 2.63, P = 0.001; OR 6.05, P = 0.022). Pelvic screw (2.3%) and rod fracture (14.1%) rates similar between groups but trended toward less occurrence with S2AI (OR 0.47, P= 0.06). Revision surgery occurred in 22.7%, and in 8.5% for iliac fixation specifically, but with no differences between fixation types (P = 0.55 and P = 0.365). Pelvic fixation failure conferred worse HRQL scores (physical component score [PCS] 36.23 vs. 39.37, P= 0.04; ODI 33.81 vs. 27.93, P = 0.036), and less 2 years improvement (PCS 7.69 vs. 10.46, P = 0.028; SRS 0.83 vs. 1.03, P = 0.019; ODI 12.91 vs. 19.77, P = 0.0016). Lumbopelvic fixation failure rates were high following ASD correction, and associated with lesser clinical improvements. S2AI screws were more likely to demonstrate loosening, but less commonly associated with rod fractures at the lumbopelvic region.

Diet quality in cystic fibrosis – associations with patient reported outcome measures and enablers and barriers to eating a healthy diet: A protocol paper for a mixed methods study

Background: People with cystic fibrosis (PWCF) have increased energy requirements. However, in recent years concerns have emerged regarding the ‘cystic fibrosis (CF) diet’ in terms of reliance on energy-dense, nutrient poor foods, which tend to be higher in saturated fat, sugar, and salt. These foods lack essential nutrients and are aetiologically linked with diet-related chronic diseases. The aim is to explore habitual dietary intakes in PWCF and (i) assess adherence to CF dietary guidelines and population specific healthy eating guidelines; (ii) derive a diet quality score and the inflammatory potential for the average diet consumed by PWCF and assess associations with patient reported outcome measures; (iii) assess drivers for current consumption patterns and enablers and barriers to eating a healthy diet. Methods: The aim is to recruit between 100-180 PWCF. A mixed methods study will be performed. Using three-day food diaries and food frequency questionnaires, aims (i) and (ii) will be addressed. The Dietary Approaches to Stop Hypertension (DASH) score and Healthy Eating Index-International (HEI-I) will derive diet quality scores. The Dietary Inflammatory Index (DII®) will ascertain inflammatory potential of the diet. Validated questionnaires will be used to report health related quality of life measures. Online focus groups and semi-structured interview with PWCF will address aim (iii). Conclusions: It is timely to revise dietary priorities and targets for CF. However, a greater understanding of what adults with CF currently consume and what they require in terms of nutrition and dietary guidance into the future is needed. In doing so, this research will help to clarify nutrition priorities and simplify the dietary aspects of CF treatment, thereby supporting adherence.

Diet quality in cystic fibrosis - associations with patient reported outcome measures and enablers and barriers to eating a healthy diet: A protocol paper for a mixed methods study.

Background: People with cystic fibrosis (PWCF) have increased energy requirements. However, in recent years concerns have emerged regarding the 'cystic fibrosis (CF) diet' in terms of reliance on energy-dense, nutrient poor foods, which tend to be higher in saturated fat, sugar, and salt. These foods lack essential nutrients and are aetiologically linked with diet-related chronic diseases. The aim is to explore habitual dietary intakes in PWCF and (i) assess adherence to CF dietary guidelines and population specific healthy eating guidelines; (ii) derive a diet quality score and the inflammatory potential for the average diet consumed by PWCF and assess associations with patient reported outcome measures; (iii) assess drivers for current consumption patterns and enablers and barriers to eating a healthy diet. Methods: The aim is to recruit between 100-180 PWCF. A mixed methods study will be performed. Using three-day food diaries and food frequency questionnaires, aims (i) and (ii) will be addressed. The Dietary Approaches to Stop Hypertension (DASH) score and Healthy Eating Index-International (HEI-I) will derive diet quality scores. The Dietary Inflammatory Index (DII®) will ascertain inflammatory potential of the diet. Validated questionnaires will be used to report health related quality of life measures. Online focus groups and semi-structured interview with PWCF will address aim (iii). Conclusions: It is timely to revise dietary priorities and targets for CF. However, a greater understanding of what adults with CF currently consume and what they require in terms of nutrition and dietary guidance into the future is needed. In doing so, this research will help to clarify nutrition priorities and simplify the dietary aspects of CF treatment, thereby supporting adherence.

446 Utility of Intraoperative Motor-Evoked Potential in L4-5 Lateral Lumbar Interbody Fusion: 3-Year Prospective Study

INTRODUCTION: Nerve injury has been reported as high as 23% in direct transpsoas lateral interbody fusion (LLIF), particularly at L4-5. METHODS: This is a prospective, observational, cohort study of consecutive patients who underwent L4-5 LLIF in a 3-year interval from 2018 to 2020. Spontaneous and triggered EMG, somatosensory evoked potentials (SSEP) were routinely recorded. In addition MEPs from quadriceps and anterior tibialis muscle groups were also recorded bilaterally. Transcranial MEP were recorded every 5 minutes from the time of incision. A decrease in amplitude of 50% or more from baseline was considered a positive result, and the surgeon was alerted accordingly. Patient’s neurological exam and health related quality of life measures were collected preoperatively, immediately postoperatively, and at the time of follow up at 6 weeks, 3 months, 6 months, 1 and 2 years. RESULTS: 72 patients were included. Transient quadriceps weakness occurred in 13 patients but resolved by 6 weeks. 30 patients had a significant decrease in MEP amplitude without changes in spontaneous or triggered EMG and SSEP. Two patients had persistent dorsiflexion weakness (3/5 and 1/5) at 2 year follow up. One patient had persistent quadriceps (4-/5) and dorsiflexion (4/5) weakness at 1 year follow up. One patient the surgery was aborted at the time of introduction of retractor due to 69% reduction in MEP and inability to mitigate the changes. All instances of MEP changes were noted during retraction phase. No patient with a negative MEP developed weakness postoperatively. At predetermined level of 50% decrease of amplitude, MEP was 100% sensistive and 65% specific in detecting neural injury. CONCLUSION: MEP monitoring provides additional value to sEMG, tEMG, and SSEP during LLIF at L4-5 to avoid injury. The value of MEP is primarily during maintenance of retraction and not during traversing the psoas muscle where EMG is most valuable.

Decisional Regret Among Older Adults Undergoing Corrective Surgery for Adult Spinal Deformity: A Single Institutional Study.

Retrospective. To investigate the prevalence of decisional regret among older adults undergoing surgery for adult spinal deformity (ASD). Among older adults (≥65 years old), ASD is a leading cause of disability, with a population prevalence of 60% to 70%. While surgery is beneficial and results in functional improvement, in over 20% of older adults outcomes from surgery are less desirable. Older adults with ASD who underwent spinal surgery at a quaternary medical center from January 1, 2016 to March 1, 2019, were enrolled in this study. Patients were categorized into medium/high or low-decisional regret cohorts based on their responses to the Ottawa decision regret questionnaire. Decisional regret assessments were completed 24 months after surgery. The primary outcome measure was prevalence of decisional regret after surgery. Factors associated with high decisional regret were analyzed by multivariate logistic regression. A total of 155 patients (mean age, 69.5 yrs) met the study inclusion criteria. Overall, 80% agreed that having surgery was the right decision for them, and 77% would make the same choice in future. A total of 21% regretted the choice that they made, and 21% responded that surgery caused them harm. Comparing patient cohorts reporting medium/high- versus low-decisional regret, there were no differences in baseline demographics, comorbidities, invasiveness of surgery, length of stay, discharge disposition, or extent of functional improvement 12-months after surgery. After adjusting for sex, American Society of Anesthesiologists score, invasiveness of surgery, and presence of a postoperative complication, older adults with preoperative depression had a 4.0 fold increased odds of high-decisional regret (P = 0.04). Change in health related quality of life measures were similar between all groups at 12-months after surgery. While the majority of older adults were appropriately counseled and satisfied with their decision, one-in-five older adults regret their decision to undergo surgery. Preoperative depression was associated with medium/high decisional regret on multivariate analysis.Level of Evidence: 4.

56 EFFICACY OF AN ELECTIVE PERIOD OF IN-PATIENT REHABILITATION FOR PATIENTS LIVING WITH PARKINSON’S DISEASE AND FRAILTY: A PILOT STUDY

Abstract Background Frailty and Parkinson’s disease (PD) are more common with increasing age and are associated with syndromes such as falls, immobility, cognitive dysfunction and incontinence. PD may directly cause or co-exist with and compound frailty. A coordinated, multidisciplinary approach to care has been shown to optimize outcomes in both of these conditions. This pilot study aims to examine the short-term effects of an elective two-week in-patient rehabilitation program on frail PD patients’ function, mobility, and self-reported quality of life (QOL). Methods This prospective cohort study included all frail PD patients admitted for elective rehabilitation since the program’s conception. Patients included must be able to mobilize independently with or without an aid, or with assistance of one person. They also must be cognitively able to participate in rehabilitation. Patients received consultant-led Comprehensive Geriatric Assessment and attended daily physiotherapy and occupational therapy sessions. Functional outcome and health related QOL measurements were collected on admission and discharge and compared using a paired t-test. Frailty was quantified by the Clinical Frailty Index. Results Twelve patients completed the program (58% male). The average age was 79 (range 70–86) and average clinical frailty score was 5.6 indicating mild to moderate frailty. Performance in activities of daily living (Barthel Index: 64 vs 73, p = 0.005), overall mobility (Elderly Mobility Scale: 10.6 vs 12.9, p = 0.004), gait speed (Timed Up and Go: 35 vs 29 seconds, p = 0.05), and balance (Berg Balance Scale: 25 vs 32, p = 0.002) significantly improved from admission to discharge from the program. Health-related QOL also improved (EQ-5D: 44 vs 66, p = 0.004). Conclusion Early data suggests that a short elective in-patient rehabilitation program has highly significant benefits for frail PD patients on mobility, performance of activities of daily living, and QOL. Longer term follow-up is required to assess sustainability of these improvements and cost-effectiveness of this intervention.

Hepatic schistosomiasis, upper gastrointestinal bleeding, and health related quality of life measurements from the Albert Nile Basin

BackgroundHealth related quality of life measurements are vital elements of public health surveillance that uncover unmet health needs and predict the success of health interventions. We described health related quality of life measurements using the EuroQoL 5-dimension (EQ-VAS/EQ-5D) instrument and associated factors among patients with upper gastrointestinal bleeding (UGIB) and hepatic schistosomiasis at a rural health facility in the Albert Nile Basin, Uganda.Methods and materialsThis was a cross-sectional study at Pakwach Health Centre IV. Participants included adult inpatients and outpatients with a history of UGIB and ultrasound evidence of hepatic schistosomiasis. We evaluated and recorded each participant’s medical history, physical examination, laboratory tests results, ultrasound results, and endoscopy findings. We also recorded health related quality of life measurements using the EuroQoL 5-dimension instrument and derived disability weights from EQ-VAS and EQ-5D measurements. These were our dependent variables. Descriptive and inferential statistics were generated summarizing our findings.ResultsWe found 103 participants had a history of upper gastrointestinal bleeding and hepatosplenic schistosomiasis. Sixty percent were between the ages of 30–49 years, 59% were females, 74% were farmers, 92% had splenomegaly, 88% had varices at endoscopy, 22% were medical emergencies with acute variceal upper gastrointestinal bleeding, and 62% had anemia. Measures of the different dimensions of health from 101 participants with patient reported outcomes revealed 77 (76%) participants experienced problems in self-care, 89 (88%) participants reported anxiety or depression, and 89 (88%) participants experienced pain or discomfort. The median EQ-VAS derived disability weights and median EQ-5D index-derived disability weights were 0.3 and 0.34, respectively. Acute upper gastrointestinal bleeding, praziquantel drug treatment, and age by decade predicted higher EQ-VAS derived disability weights (p value < 0.05). Under weight (Body mass index ≤ 18.5), acute upper gastrointestinal bleeding, ascites, age by decade, female gender, and praziquantel drug treatment predicted higher EQ-5D index- derived disability weights (p value < 0.05).ConclusionAdult patients with upper gastrointestinal bleeding and hepatic schistosomiasis from this primary health facility experience poor health and considerable health loss. Several factors predicted increased health loss. These factors probably represent key areas of health intervention towards mitigating increased health loss in this population.

The Perception of Religious Coping and Health Related Quality of Life in The Case of an ALS Caregiver During COVID-19

Research ObjectivesTo investigate the degree to which the progression of disease and loss of swallowing and communication in amyotrophic lateral sclerosis (ALS) patients affect the quality of life and religious coping of a caregiver over time. To investigate the perceptions of the impact of the coronavirus on caregiving.DesignMixed method longitudinal time 1 (T-1) and time 2 (T-2) case study design for a duration of 24 weeks from September 2020 to February 2021.SettingPhone interviews, per Centers for Disease Control and Prevention (CDC) social distancing guidelines, were held in the general community.ParticipantsA single informal (non-compensated) family caregiver of a spouse with ALS. Convenience sample: The participant was referred by a hospital-based speech language pathologist.InterventionsNot applicable.Main Outcome Measures1) Qualitative interviews, 2) the Brief RCOPE (a 14-item measure of positive and negative religious coping with major life stressors), and 3) a health-related quality of life survey instrument (SF12v2).ResultsLongitudinal case study findings revealed changes from T-1 to T-2 for all measures. Negative religious coping was essentially unchanged, with two notable exceptions. At T-2, she no longer felt punished by God, nor questioned God's love for her. She also “somewhat wondered” whether her church had abandoned them. Positive religious coping which measures a sense of connection to God decreased. The health related quality of life measure indicated a decline in energy, physical health, and level of task accomplishment. Perceptions of the impact of the coronavirus were mixed. At T-1, she reported decreased pressure for managing appointments and visitors. By T-2, her feelings of isolation and loneliness increased.ConclusionsIn this case study, the ALS caregiver's perceptions of health related quality of life and religious coping appeared declined in the face of losses due to major life stressors; communication and swallowing abilities. This was evidenced by reporting feeling less connected to God, less productive during completion of tasks, and reduced energy. The duration of coronavirus precautions resulted in perceived increase in isolation and loneliness.Author(s) DisclosuresNo conflicts for any authors.

MP54-08 THE GERMAN LINGUISTIC VALIDATION OF THE WISONSIN STONE QUALITY OF LIFE QUESTIONNAIRE (WISQOL)

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP54)1 Sep 2021MP54-08 THE GERMAN LINGUISTIC VALIDATION OF THE WISONSIN STONE QUALITY OF LIFE QUESTIONNAIRE (WISQOL) Martin Gottstein, Manolis Pratsinis, Sabine Güsewell, Patrick Betschart, Dominik Abt, and Thomas Knoll Martin GottsteinMartin Gottstein More articles by this author , Manolis PratsinisManolis Pratsinis More articles by this author , Sabine GüsewellSabine Güsewell More articles by this author , Patrick BetschartPatrick Betschart More articles by this author , Dominik AbtDominik Abt More articles by this author , and Thomas KnollThomas Knoll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002084.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goal of this study was to develop and validate a German version of WisQoL. METHODS: The German version of the WisQoL was developed following a standardized multistep process. Patients were recruited prior to stone treatment, and completed the questionnaire as well as the SF-36v2 (36-Item Short Form Health Survey). This was repeated 1, 3 and 6 months after stone surgery. Scores of the 28 questionnaire items were summarized into sum scores for four domains and a total score. The psychometric properties of the questionnaire were statistically analyzed. RESULTS: The German WisQoL demonstrated excellent internal consistency (Cronbach’s α > 0.90 for all domains at all visits). All inter-domain associations were positive. The test-retest reliability for patients with unchanged self-reported health state was considered satisfactory (Spearman’s rho for total score 0.70 [95% CI 0.55 to – 0.80]). The German WisQoL demonstrated good convergent validity with the validated SF-36v2 (correlation between corresponding items 0.44 to 0.64). All domain scores showed significant sensitivity to change induced by stone treatment (p≤0.05). Total WisQoL scores generally improved during the first three months following stone treatment, and remained stable thereafter. CONCLUSIONS: The German WisQoL proved to be a reliable and robust instrument to evaluate health related quality of life measures of kidney stone patients in the clinical setting. It is expected to be of use for further research in patients with kidney stones. Source of Funding: Study costs were covered by unspecific internal research funds of the two recruiting study centers © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e951-e952 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Gottstein More articles by this author Manolis Pratsinis More articles by this author Sabine Güsewell More articles by this author Patrick Betschart More articles by this author Dominik Abt More articles by this author Thomas Knoll More articles by this author Expand All Advertisement Loading ...

179. Correcting ASD patients to normative alignment results in no functional benefit but more PJK and PJF

<h3>BACKGROUND CONTEXT</h3> A previous study utilized normative alignment to determine overcorrections and predict mechanical complications in adult spinal deformity (ASD) surgery. Other studies have recommended alignment targets that optimize age-appropriate physical function. The difference in functional outcomes and mechanical complications between these prescribed alignment targets has not been explored. This study utilizes a component angle of the T1 pelvic angle (TPA) within the fusion to compare normative and age-pelvic incidence (PI) optimal alignment in terms of proximal junctional kyphosis (PJK), proximal junctional failure (PJF) and health related quality of life measures (HRQL). Using the component of TPA within the fusion, the T4-pelvic angle (T4PA), allows for the measurement spinopelvic alignment separate from that of the unfused thoracic spine and any PJK that may occur postoperatively. <h3>PURPOSE</h3> To compare ASD patients corrected to normative alignment vs age-PI optimal alignment in terms of PJK/PJF and outcomes. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of a prospective multicenter ASD database and a database of asymptomatic subjects. <h3>PATIENT SAMPLE</h3> This study included 1,916 ASD patients and 118 asymptomatic subjects for formula development; 288 ASD patients with 2-year X-ray and HRQL follow-up. <h3>OUTCOME MEASURES</h3> SF36-PCS, ODI, SRS-22, NRS back/leg, PJK (change in UIV to UIV+2 >10°), PJF (defined as severe PJK with change >21.6°, or UIV olisthesis, or proximal junctional fracture). <h3>METHODS</h3> Baseline relationships between age, PI and T4PA, were analyzed in the ASD patients and compared to the asymptomatic subjects. Linear regression modeling was used to determine alignment based on PI and age in asymptomatic subjects (normative alignment), and in ASD patients, alignment corresponding to age-appropriate functional status (optimal alignment). ASD patients with UIV above T4 were grouped based on their corrections: normative vs optimal. Extreme over or under corrected patients were excluded (greater than or less than 2SD from mean postop T4PA). For each group, the rate of PJK and PJF were determined. <h3>RESULTS</h3> In the multilinear regression analysis of the 119 asymptomatic subjects, T4PA correlated with age and PI, r=.713, p<.0001. 1916 ASD patients were included in the optimal formula development. In the 288 ASD patients included in the pre- to postop analysis (137 normative, 151 optimal), there was no difference in baseline alignment or HRQL between the groups. At 6 weeks, the normative aligned group had smaller T4PA (4.45 vs 14.1) and PI-LL (-7.24 vs 7.4), all p<.0001. Normative aligned patients had the higher PJK rate (40% vs 27.2%, p=.03) compared with optimal; and a higher PJF rate (17% vs 6.8%, p=.008). PJF patients had -1.2°of T4PA offset from normative alignment and -5.2°of offset from optimal alignment. By contrast, no PJF patients had 3.8° of T4PA offset from normative alignment and -0.42° of offset from optimal alignment. There was a trend toward worse 2-year SF36-PCS in patients who suffered PJF (37.7 vs 41.6, p=.09). Both the Normative and Optimal groups improved in outcomes from baseline to 2-year (p<.001) with no difference in 2-year HRQL. <h3>CONCLUSIONS</h3> Correcting ASD patients to normative alignment resulted in higher rates of PJK and PJF without improvements in HRQL. ASD patients should not be corrected to match the alignment of their asymptomatic unfused peers, rather they should be realigned optimally to match age-appropriate physical function. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

208. Improvements in outcomes and cost after adult spinal deformity corrective surgery between 2008 and 2019

<h3>BACKGROUND CONTEXT</h3> As surgical methods and technology advance, so should improvements in patient outcomes and cost effectiveness. <h3>PURPOSE</h3> To assess whether patient outcomes and cost effectiveness have improved over the past 10 years. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>PATIENT SAMPLE</h3> This study included 1,236 adult spinal deformity (ASD) patients. <h3>OUTCOME MEASURES</h3> Complications, reoperations, health related quality of life measures (HRQL), total cost, utility gained, quality adjusted life years (QALYs). <h3>METHODS</h3> ASD patients with baseline (BL) and up to 2-year (2Y) HRQL data between the years of 2008-2019 were included. Incomplete yearly data from 2008 and 2019 were combined with 2009 and 2018, respectively. ANCOVA established estimated marginal means for outcome measures (complication rates, reoperations, HRQLs, total cost, utility gained, QALYs, cost efficiency [cost per QALY]) by year of initial surgery adjusting for covariates including age, gender, decompression or osteotomy, surgical approach, invasiveness, and BL deformity (pelvic tilt, pelvic incidence, lumbar lordosis). Trend-line slope indicated yearly changes. Cost was calculated using the PearlDiver database and assessed for complications/major complications and comorbidities according to CMS.gov definitions. These costs represented national averages of Medicare pay-scales for services within a 30-day window including length of stay and death differentiated by complication/comorbidity, revision, and surgical approach. Internal cost data were based on individual patient DRG codes, limiting revisions to those within 2 years of the initial surgery. <h3>RESULTS</h3> A total of 1,236 patients (2009: 117 patients, 2010: 97, 2011: 75, 2012: 45, 2013: 106, 2014: 127, 2015: 115, 2016: 204, 2017: 202, 2018: 148) were included with no significant differences in baseline ODI by year. There was an overall decrease in rates of any complication (0.78 vs 0.61), any reoperation (0.25 vs 0.10), and minor complication (0.54 vs 0.37) between 2009 and 2018 (all p<0.05). Minor complications decreased by 2.48% per year (R2=0.5179), with a 1.84% yearly decrease in any complication (R2=0.8322), 1.33% decrease in any reoperation (R2=0.2211), and 0.82% decrease in major complication (R2=0.1435). BL to 2Y difference in SF-36 PCS had the greatest improvement (0.2526 increase per year, R2=0.3985) and ODI BL to 2Y difference improved by 0.3687 per year (R2=0.3683). National average 2Y cost decreased at a yearly rate of $3,194 (R2=0.6602), 2Y utility gained had a yearly increase of 0.0041 (R2=0.57), 2Y QALYs gained increased yearly by 0.008 (R2=0.57), and 2Y cost per QALY decreased yearly by $39,953 (R2=0.6778). Adjusting for inflation since 2009, internal DRG data verified the trend of national average costs, as overall costs (including revisions within 2Y) have decreased at a rate of $793 each year (R2=0.0483). This resulted in a decrease in cost per QALY at 2Y of $19,903 per year (R2=0.3181). <h3>CONCLUSIONS</h3> Between 2008 and 2019, rates of complications have decreased concurrently with improvements in patient reported outcomes, resulting in improved cost effectiveness according to national Medicare average and individual patient cost data. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

121. Identifying the utility of Hounsfield units (HU) to predict proximal junctional kyphosis in adult spinal deformity

<h3>BACKGROUND CONTEXT</h3> Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are two of the most challenging complications in adult spinal deformity (ASD) surgery. Bone quality has been identified as an important factor in outcomes of ASD patients. The association between Hounsfield units (HU) on CT scan at UIV and L1, and PJK occurrence remains poorly defined. Previous published literature has found HU<120 to indicate poor bone health. <h3>PURPOSE</h3> Hounsfield units at the UIV and L1 can predict the occurrence of PJK in ASD. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected multicenter data. <h3>PATIENT SAMPLE</h3> A prospective database with inclusion criteria of age >18, PI-LL >10, PT>25, SVA>5, TK >60 and Cobb >20 was retrospectively reviewed and patients included only if complete: preop Hounsfield unit data at L1 and UIV, PJK prophylaxis data (PRPH), fusion to the pelvis and 2-year radiographic data. <h3>OUTCOME MEASURES</h3> Development of PJK or PJF. These were defined as per Glattes et al as: PJA <-10 & ΔPJA < -10 at 2 years postoperation and PJK as per Lafage et al as: PJA <-28 & ΔPJA < -22 at 2 years or revision surgery for PJK before 2 years postoperation. Health related quality of life measures (HRQL) included SF 36, ODI, SRS-22. <h3>Methods</h3> Retrospective review of prospectively collected multicenter data. Data analyzed with SPSS software. Multilinear regression models were run to identify independent variables associated with PJK and PJF. Odds ratios calculated. Decision tree analysis used to see if the effect of HU is not conditional of other parameters. <h3>Results</h3> This study included 240 patients, avg age 64 (31-84), BMI 28.9 (17.7-46), CCI 2.1 (0-8), and 188 (78.3%) females. Of the total patients, 17.1% (41) reported osteoporosis and 56.3% had previous spine surgery. There was significant in improvement in all HRQL from pre- to postsurgery (p<0.001). PJK occurred in 45% (108/240) and PJF in 13% (31/240). HU as an independent variable did not correlate with PJK magnitude. When controlling for PRPH, there was no correlation. Multilinear regression found that HU was not an independent predictor of PJK or PJF. PJK/F was subclassified as bony (bPJK) and analysis revealed that bPJK had larger angular deformity, higher rate with LT UIV, and associated with HU at UIV (p=0.011) as did bony PJF (p=0.037). UIV HU<120 was associated with bPJK (p=0.029) and bPJF (p=0.000). Odds ratio for UIV HU<120 to develop bPJK is 2.33 (CI: 1.07-5.08) and 4.67 for bPJF (CI: 1.87-11.7). Decision tree analysis, however, showed UIV HU was a conditional predictor of PJK in patients who have a PI-LL corrected >13 and with global realignment >19. <h3>Conclusions</h3> Hounsfield units alone are not an independent predictor of PJK or failure in ASD. Decision tree analysis, however, reveals that in the setting of patients requiring major global realignment and lordosis generation, HU are predictive of PJK. Furthermore, UIV HU<120 is 2.3 times more likely to result in bPJK and 4.6 times more likely in bPJF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Long term outcome of functional independence and quality of life after traumatic SCI in Germany

Study designMulticenter observational study.ObjectiveTo describe the long-term outcome of functional independence and quality of life (QoL) for individuals with traumatic and ischemic SCI beyond the first year after injury.SettingA multicenter study in Germany.MethodsParticipants of the European multicenter study about spinal cord injury (EMSCI) of three German SCI centers were included and followed over time by the German spinal cord injury cohort study (GerSCI). Individuals’ most recent spinal cord independence measure (SCIM) scores assessed by a clinician were followed up by a self-report (SCIM-SR) and correlated to selected items of the WHO short survey of quality of life (WHO-QoL-BREF).ResultsData for 359 individuals were obtained. The average time passed the last clinical SCIM examination was 81.47 (SD 51.70) months. In total, 187 of the 359 received questionnaires contained a completely evaluable SCIM-SR. SCIM scores remained stable with the exception of reported management of bladder and bowel resulting in a slight decrease of SCIM-SR of −2.45 points (SD 16.81). SCIM-SR scores showed a significant correlation with the selected items of the WHO-QoL-BREF (p < 0.01) with moderate to strong influence.ConclusionSCIM score stability over time suggests a successful transfer of acquired independence skills obtained during primary rehabilitation into the community setting paralleled by positively related QoL measurements but bladder and bowel management may need special attention.

Effectiveness and cost-effectiveness of integrating the management of depression into routine HIV Care in Uganda (the HIV\u2009+\u2009D trial): A protocol for a cluster-randomised trial

BackgroundAn estimated 8–30 % of people living with HIV (PLWH) have depressive disorders (DD) in sub-Saharan Africa. Of these, the majority are untreated in most of HIV care services. There is evidence from low- and middle- income countries of the effectiveness of both psychological treatments and antidepressant medication for the treatment of DD among PLWH, but no evidence on how these can be integrated into routine HIV care. This protocol describes a cluster-randomised trial to evaluate the effectiveness and cost-effectiveness of the HIV + D model for the integration of a collaborative stepped care intervention for DD into routine HIV care, which we have developed and piloted in Uganda.MethodsForty public health care facilities that provide HIV care in Kalungu, Masaka and Wakiso Districts will be randomly selected to participate in the trial. Each facility will recruit 10–30 eligible PLWH with DD and the total sample size will be 1200. The clusters will be randomised 1:1 to receive Enhanced Usual Care alone (EUC, i.e. HIV clinicians trained in Mental Health Gap Action Programme including guidelines on when and where to refer patients for psychiatric care) or EUC plus HIV + D (psychoeducation, Behavioural Activation, antidepressant medication and referral to a supervising mental health worker, delivered in a collaborative care stepwise approach). Eligibility criteria are PLWH attending the clinic, aged ≥ 18 years who screen positive on a depression screening questionnaire (Patient Health Questionnaire, PHQ-9 ≥ 10). The primary outcome is the mean depressive disorder symptom severity scores (assessed using the PHQ-9) at 3 months’ post-randomisation, with secondary mental health, disability, HIV and economic outcomes measured at 3 and 12 months. The cost-effectiveness of EUC with HIV + D will be assessed from both the health system and the societal perspectives by collecting health system, patient and productivity costs and mean DD severity scores at 3 months, additional to health and non-health related quality of life measures (EQ-5D-5 L and OxCAP-MH).DiscussionThe study findings will inform policy makers and practitioners on the cost-effectiveness of a stepped care approach to integrate depression management in routine care for PLWH in low-resource settings.Trial registration: ISRCTN, ISRCTN86760765. Registered 07 September 2017, https://doi.org/10.1186/ISRCTN86760765.

PNS253 Tunisian EQ-5D-5L Crosswalk-Based VALUE SET

The 5-level EQ-5D version (EQ-5D-5L) was introduced by the EuroQol Group to improve the instrument’s sensitivity and to reduce ceiling effects, as compared with the EQ-5D-3L. The aim of this study was to develop an interim EQ-5D-5L value set. The crosswalk method developed by the EuroQol Group allows to estimate a utility value for each of the 3125 EQ-5D-5L health states based on a 3L value set through a transition-probability matrix. Following this methodology, we mapped an EQ-5D-5L value set using the Tunisian value set for the EQ-5D-3L. Both value sets were examined, values were compared in terms of mean and median utility values, distribution of values across each value set and proportions of health states considered worse than dead. Although both value sets share the same utility range [-0.79; 1], the distribution of the utilities was quite different. Higher values were observed in the EQ-5D-5L value set when compared with the EQ-5D-3L value set in terms of mean (0.31 vs 0.25), median (0.35 vs 0.28), lower quartile (0.13 vs -0.13) and proportion of health states considered to be worse than death (16.38% vs 25.9%). The same discrepancies between the original and the crosswalk value sets were observed in other studies in Poland and Sri-Lanka. The Tunisian crosswalk-based value set offers utility values for the 3125 health states described in the EQ-5D-5L. Currently, this is the only 5-Level value set available in the Arab speaking countries and therefore should be considered in studies using the EQ-5D-5L for health related quality of life measurement in the North African region.

Exercise interveNtion outdoor proJect in the cOmmunitY for older people \u2013 results from the ENJOY Seniors Exercise Park project translation research in the community

BackgroundMany research studies evaluate physical activity interventions for older people in the community, however relatively few successfully promote maintenance of physical activity beyond the completion of the intervention. This study aimed to implement and evaluate the effects of sustained engagement in physical activity on mental, social and physical health outcomes through the use of the Seniors Exercise Park physical activity program for older people (the ENJOY project).MethodPeople aged ≥60 years underwent a 12-week structured supervised physical activity program using outdoor exercise park equipment followed by 6 months unstructured independent use of the exercise park. Participants were assessed at baseline, 3 months and 9 months and completed a test battery evaluating physical activity, physical function and health related quality of life measures. Repeated measures ANOVA was used to compare differences between baseline, 3 and 9 months.ResultsOf the 95 participants, 80 (84.2%) completed the 3 months supervised program, and 58 (61%) completed the 9 month assessment (the latter impacted by COVID-19 restrictions). A significant increase in physical activity level was demonstrated following the 12 weeks intervention (p < 0.01). Significant improvements were also demonstrated in all physical function measures (p < 0.01), self-rated quality of life (p < 0.05), wellbeing (p < 0.01), fear of falls (p < 0.01), falls risk (p < 0.01), depressive symptoms (p = 0.01) and loneliness (p = 0.03) at 3 months. At the 9 months follow up, significant improvements from baseline were demonstrated in the frequency, duration and total of physical activity level (p < 0.05), and all physical function measures (p < 0.05), with no decline in these measures from 3 to 9 months. At 9 months, significant changes were observed in the health related quality of life mobility and self care domains with reductions in both fear of falls and falls risk (p < 0.05).ConclusionThe Seniors Exercise Park may be an effective modality for improving and sustaining older people’s physical function and wellbeing and can be an important public health infrastructure investment in promoting physical activity for older people. Future work should focus on wider implementation of the program and on scaling up this initiative to achieve public health benefit for the community.Trial registrationTrial registration number ACTRN12618001727235, Date of registration 19th October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375979

The German linguistic validation of the Wisconsin Stone Quality of Life questionnaire (WisQoL).

WisQoL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The goal of this study was to develop and validate a German version of WisQoL. The German version of the WisQoL was developed following a standardized multistep process. Patients were recruited prior to stone treatment, and completed the questionnaire as well as the SF-36v2 (36-Item Short Form Health Survey). This was repeated 1, 3, and 6months after stone surgery. Scores of the 28 questionnaire items were summarized into sum scores for four domains and a total score. The psychometric properties of the questionnaire were statistically analyzed. The German WisQoL demonstrated excellent internal consistency (Cronbach's α > 0.90 for all domains at all visits). All inter-domain associations were positive. The test-retest reliability for patients with unchanged self-reported health state was considered satisfactory (Spearman's rho for total score 0.70 [95% CI 0.55 to - 0.80]). The German WisQoL demonstrated good convergent validity with the validated SF-36v2 (correlation between corresponding items 0.44 to 0.64). All domain scores showed significant sensitivity to change induced by stone treatment (p ≤ 0.05). Total WisQoL scores generally improved during the first 3months following stone treatment, and remained stable thereafter. The German WisQoL proved to be a reliable and robust instrument to evaluate health related quality of life measures of kidney stone patients in the clinical setting. It is expected to be of use for further research in patients with kidney stones.

Assessing quality of life in psychosocial and mental health disorders in children: a comprehensive overview and appraisal of generic health related quality of life measures

BackgroundMental health problems often arise in childhood and adolescence and can have detrimental effects on people’s quality of life (QoL). Therefore, it is of great importance for clinicians, policymakers and researchers to adequately measure QoL in children. With this review, we aim to provide an overview of existing generic measures of QoL suitable for economic evaluations in children with mental health problems.MethodsFirst, we undertook a meta-review of QoL instruments in which we identified all relevant instruments. Next, we performed a systematic review of the psychometric properties of the identified instruments. Lastly, the results were summarized in a decision tree.ResultsThis review provides an overview of these 22 generic instruments available to measure QoL in children with psychosocial and or mental health problems and their psychometric properties. A systematic search into the psychometric quality of these instruments found 195 suitable papers, of which 30 assessed psychometric quality in child and adolescent mental health.ConclusionsWe found that none of the instruments was perfect for use in economic evaluation of child and adolescent mental health care as all instruments had disadvantages, ranging from lack of psychometric research, no proxy version, not being suitable for young children, no age-specific value set for children under 18, to insufficient focus on relevant domains (e.g. social and emotional domains).