Short Form-36 Scores Research Articles

Accelerometer-Assisted Physical Activity Outcomes During the First Year of Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Pilot Study.

Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this study was to compare accelerometer-measured data with traditional patient-reported measures and to determine the trajectory of physical activity from before surgery to 1 year after anterior cruciate ligament reconstruction. Adult patients undergoing primary anterior cruciate ligament reconstruction were enrolled in this prospective cohort pilot study. The Tegner activity scale, Marx activity scale, International Physical Activity Questionnaire Short Form (IPAQ-SF), Knee injury and Osteoarthritis Outcome Score (KOOS), and EuroQoL-5D were administered preoperatively and 3, 6, and 12 months postoperatively. At these intervals, each patient was asked to wear an accelerometer for 7 consecutive days. Time spent in moderate-to-vigorous physical activity (MVPA min/wk), metabolic equivalents of physical activity, and average daily steps were calculated from the accelerometer output and correlated with patient-reported measures. Twenty-eight patients were included in this study. Of the 28 patients, 20 remained, and at the 12-month analysis, 18 patients were analyzed. There were significant improvements in Tegner activity scale score, KOOS symptoms, sports/recreation, and quality of life subscales, and IPAQSF MVPA min/wk at final follow-up. All accelerometer-based outcomes had improvements at 3, 6, and 12 months. The accelerometer may be a useful tool for understanding patients' activity levels at different time points during their recovery and for providing tangible targets for patients to achieve at least an average recovery. [Orthopedics. 202x;4x(x):xx-xx.].

Comparison of Short-Term Effects of Extracorporeal Shock Wave Therapy, Low-Level Laser Therapy and Pulsed Electromagnetic Field Therapy in Knee Osteoarthritis: A Randomized Controlled Study.

Background: Knee osteoarthritis (OA) is the most prevalent form of osteoarthritis and a leading cause of chronic pain in adults. This study aimed to compare the short-term effects of extracorporeal shock wave therapy (ESWT), low-level laser therapy (LLLT), and pulsed electromagnetic field therapy (PEMF) on pain, function, and quality of life in patients with knee OA. Methods: A hundred and twenty patients with Kellgren-Lawrence grade 2-3 knee OA were randomized into four groups: ESWT (once a week for three sessions), LLLT (twice a week for eight sessions), PEMF (twice a week for eight sessions), and a control group with 30 patients in each group. All participants were instructed in a daily exercise program, including knee joint range of motion, stretching, and strengthening exercises (3 × 10 repetitions). Outcome measures, including the visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-36 (SF-36), and the Timed Up and Go (TUG) test, were assessed at baseline after treatment and at the third month. Results: There were no significant differences between groups at baseline regarding VAS, WOMAC, SF-36, and TUG scores (p > 0.05). Significant improvements were observed in all parameters post-treatment for all groups (p < 0.001). However, the improvements in the PEMF group were significantly lower than in the ESWT and LLLT groups, particularly for VAS, WOMAC pain, and SF-36 physical function scores (p < 0.05). No significant differences were found between ESWT and LLLT (p > 0.05). Conclusions: In the short-term, ESWT, LLLT, and PEMF effectively reduce pain, improve physical function, and enhance quality of life in patients with knee OA, though PEMF showed less pronounced improvements.

Exploring differences in reported mental health outcomes and quality of life between physically restrained and non-physically restrained ICU patients; a prospective cohort study.

Physical restraints are frequently used in ICU patients, while their effects are unclear. To explore differences in patient reported mental health outcomes and quality of life between physical restrained and non-physical restrained ICU patients at 3- and 12-months post ICU admission, compared to pre-ICU health status. Prospective cohort study. Patients were included when 16years or older, admitted for at least 12h and provided informed consent. Differences between groups were analysed using linear mixed model analyses. Two ICUs, a 35 bed academic ICU and a 12 bed ICU in a teaching hospital in the Netherlands. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, post-traumatic stress disorder using the Impact of Event Scale-Revised, and Quality of life using the Short Form-36 scores. 2,764 patients were included, of which 486 (17.6%) were physically restrained for median 2 [IQR 1-6] days. Significantly worse outcomes were reported at 3-months by physically restrained patients (symptoms of depression 0.89, 95%CI 0.37 to 1.41, p<0.001; PCS -2.82, 95%CI -4.47 to -1,17p<0.001; MCS -2.67, 95%CI -4.39 to -0.96, p<0.01). At 12-months, only the PCS scores remained significantly lower (-1.71, 95%CI -3.42 to -0.004, p<0.05). Use of physical restraints is associated with worse self-reported symptoms of depression and decreased quality of life 3-months post ICU, and lower physical quality of life after 12-months. Use of physical restraints is associated with statistical significant worse mental and physical outcomes.

Ultrasonographic and pedobarographic evaluation of the effectiveness of extracorporeal shock wave therapy in patients with plantar fasciitis

Background Prior studies showing the effectiveness of extracorporeal shock wave therapy (ESWT) in patients with plantar fasciitis are mostly based on patient-reported measurements. Objective The aim of this study was to demonstrate the effectiveness of ESWT with ultrasonographic and pedobarographic measurements. Methods A total of 50 patients were included in the study. All patients were evaluated before and six weeks after ESWT treatment. Pain was evaluated with the Visual Analogue Scale (VAS), functional status with Foot Function Index (FFI), and quality of life with Short Form-36 (SF-36). Plantar pressure measurements were made with a pedobarography device, and plantar fascia thickness was measured with ultrasonography. Results After treatment, VAS-Pain decreased significantly. There was a statistically significant improvement in FFI scores after treatment. Similarly, a statistically significant improvement was seen in SF-36 scores. There was a significant decrease in ultrasonographic measurements of the plantar fascia thickness in the origo and midsection regions. There was a statistically significant decrease only in medial heel pressure measurements. Conclusion The results of this study showed that ESWT provides symptomatic and functional improvements in patients with plantar fasciitis as well as ultrasonographic plantar fascia thickness and pedobarographic medial heel pressure measurements.

A Cross-sectional Study to Evaluate the Quality of Life among Children Diagnosed with Thalassemia Major in Gujarat

Abstract Background Thalassemia, a chronic condition that lacks an effective treatment, significantly impairs a child's quality of life (QoL), affecting academic performance and various dimensions such as physical, emotional, and social functioning. The objectives of this study are to evaluate the QoL of children with thalassemia major and to investigate the relationship with selected demographic variables of children. This study addresses the crucial need to assess the QoL among children living with thalassemia major. By evaluating QoL, health care professionals can tailor treatment approaches to improve the lives of children affected by thalassemia major. Study Design and Methods This cross-sectional analytical study was conducted at the district division of the Indian Red Cross in Ahmedabad, Gujarat. The consecutive sampling technique was used. The study included 117 children with β-thalassemia major. The QoL of children aged 8 to 18 years was evaluated in September 2021 using the Short Form-36 (SF-36) questionnaire. Statistical analysis involved mean, standard deviation, and chi-square test. Results The mean age of the participants was 14.9 ± 3.1 years. The majority of the included children (56%) received blood transfusions for 15 days. The mean total score of SF-36 was 68.62 ± 12.96. Out of the total number of children, 55 had a score of more than 70, 50 had a score between 50 and 70, and 12 had a poor QoL with a score less than 50. The chi-square analysis reveals a statistically significant association between gender perception and QoL (p = 0.033). Similarly, a notable association is noted between monthly family income and QoL (p = 0.037). Conclusion This study revealed that the QoL in children diagnosed with thalassemia major is compromised. QoL assessment should be initiated for all children with thalassemia to identify and implement essential interventions that focus on the affected domains.

Patient-Reported Outcomes Following Total Knee Arthroplasty With Multiple Sclerosis Demonstrate Similar Functional Outcome Measures: A Propensity-Matched Analysis

Introduction: Multiple sclerosis (MS) may negatively influence the patient-reported outcomes measures (PROMs) when undergoing total knee arthroplasty (TKA). However, functional outcomes in this select population remains poorly characterized. This study aimed to compare clinical outcomes and rate of achieving Minimal Clinically Important Difference for Improvement (MCID-I) and Minimal Clinically Important Difference for Worsening (MCID-W) between MS and non-MS TKAs. Methods: We did a retrospective analysis of 61 TKAs in MS patients performed between 2015 and 2022 and it was propensity matched in a 3:1 ratio with 123 non-MS patients. Preoperative and postoperative assessments included Patient-Reported Outcomes Measurement Information System Global Health Mental and Physical, Patient-Reported Outcomes Measurement Information System Physical Function short form 10-a (PF-10a), and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form scores. Patients were categorized based on achieving MCID-I, MCID-W, or showing “no change” after TKA. Results: A total of 244 TKAs (61 MS and 183 matched non-MS) were analyzed. MS TKAs had similar length of stay but lower rate of home discharges (73.8% vs. 90.2%, P = 0.003) compared with non-MS patients. Notably, both cohorts had similar rates of achieving MCID-I and MCID-W among all four PROM scores. However, MS patients had a notable higher rate of 90-day postoperative complications (26.2% vs. 12.6%, P &lt; 0.001), revision surgeries (11.5% vs. 4.4%, P = .045), and revisions (6.6% vs. 0.5%, P = 0.004). Conclusion: Using MCID methodology, this study found that MS patients have similar rates of achieving MCID-I and MCID-W but have higher rate of postoperative complications, revision surgeries, and revisions when compared with non-MS patients. These findings highlight that despite the elevated risks of complications, MS patients can achieve similar improvements to their non-MS counterparts. Further investigations into the long-term outcomes of MS patients are warranted to the determine the effectiveness of this intervention.

Associations Between Stages of Diabetic Polyneuropathy and Quality of Life, Neuropathic Pain, and Well-Being: A Multicenter, Cross-Sectional Analysis Based on Electroneuromyographic Findings

This study aimed to investigate the relationship between electrophysiological findings of diabetic neuropathy (DN) and patients' quality of life, neuropathic pain levels, and well-being. A cross-sectional study was conducted in 12 centers in Turkey. DN patients were categorized into four stages based on electrophysiological findings using the Baba classification. Scales such as Short Form-36 (SF-36), Douleur Neuropathique 4-Questions (DN4), Brief Pain Inventory (BPI), and WHO-5 Well-Being (WHO-5 WB) were used to assess quality of life, pain, and well-being. Additional factors like HbA1c levels and diabetes duration were analyzed. Among 323 DN patients, 90 were in stage 1, 84 in stage 2, 72 in stage 3, and 77 in stage 4. There were no significant differences in age or gender between the stages. Diabetes duration and HbA1c levels were significantly lower in stage 1 compared to later stages. SF-36 and WHO-5 WB scores declined, while DN4 and BPI pain interference scores increased in the later stages. These findings persisted after adjusting for confounders such as age, BMI, comorbidities, and diabetes duration. Patients with advanced-stage DN experienced a poorer quality of life, greater pain, and more frequent comorbidities compared to early-stage patients. Electrophysiological findings should be considered in the clinical management of DN.

Comparison of spinopelvic fixation and iliosacral screw fixation for posterior pelvic ring injuries.

There is no consensus in the literature regarding the optimal treatment method for posterior pelvic ring injuries. This study aims to compare the radiologic and clinical outcomes, as well as complications of spinopelvic fixation (SPF) and iliosacral screw fixation (ISF) in patients with posterior pelvic ring injuries. This retrospective study analyzed 54 patients (37 females, 17 males; mean age 38.9±18.7 years) with pelvic ring injuries classified as Tile type B and type C involving the posterior pelvic ring. These patients were treated with either SPF or ISF and followed for at least one year at two centers between 2016 and 2023. Of these, 28 patients comprised the SPF group, and 26 patients were in the ISF group. Comparisons were made regarding perioperative data (hemoglobin loss, blood product replacement, hospitalization duration, intensive care unit stay, surgery time, and fluoroscopy duration) and clinical outcomes (limb length discrepancy, Majeed score, visual analogue scale (VAS) score, and Short Form-36 (SF-36) score). Radiological outcomes were assessed using Matta outcome grading. Complications were also investigated. Hemoglobin loss (median 2.2 vs. 1 g/dL; p=0.027) and surgery time (67±10.6 vs. 37.7±11.3 minutes; p<0.001) were higher in the SPF group, whereas fluoroscopy duration (median 2 vs. 51.5 seconds; p<0.001) was higher in the ISF group. Other perioperative parameters did not differ between the groups. At a minimum follow-up of one year, clinical scores (Majeed score, VAS, SF-36), limb length discrepancy, and Matta outcome grades were similar between the groups. The SPF group had higher total complication rates (46.4% vs. 19.2%; p=0.034) and infection rates (42.9% vs. 3.8%; p<0.001), while rates of neurological deficits, screw malposition, and other hospitalization complications (e.g., thromboembolic or cardiovascular events, pulmonary complications, sepsis) were not significantly different. Both spinopelvic fixation and iliosacral screw fixation techniques are similarly effective in terms of clinical and radiological outcomes, with both methods demonstrating a low rate of complications. However, SPF was associated with higher infection rates and greater hemoglobin loss, while ISF required increased fluoroscopy exposure.

WHO Disability Assessment Schedule 2.0: responsiveness in detecting long-term functional disability after surgery.

The WHO Disability Assessment Schedule (WHODAS) 2.0 is widely used for detecting postoperative functional disability. Its responsiveness for detecting disability has been evaluated at 1 year after surgery, with no long-term evaluation. The aim of this study was to examine the responsiveness of the WHO Disability Assessment Schedule in detecting functional disability at 5 years after surgery. This study was a secondary analysis of a prospective observational study. Patients were enrolled who were aged 55 years or older and underwent elective non-cardiac surgery under general anaesthesia. They were asked to complete the 12-item WHO Disability Assessment Schedule and the Medical Outcome Study Short Form questionnaires before surgery and at 5 years after surgery. The correlation between changes in WHO Disability Assessment Schedule score and Medical Outcome Study Short Form physical score (change in physical component score) was evaluated using the Spearman rank correlation coefficient (ρ). The standardized response means were also calculated for typical subgroups for which functional disability was predicted to improve or decline and compared with the overall standardized response mean. In the analysis, 2596 patients were included. A moderate correlation (ρ = -0.47) existed between changes in WHO Disability Assessment Schedule and physical Medical Outcome Study Short Form scores. The overall standardized response mean was 0.17. The standardized response means for the patients with functional disability predicted to improve ranged from -0.45 to -0.67, whereas those for patients predicted to decline ranged from 0.17 to 0.56. These findings indicated high responsiveness. The WHO Disability Assessment Schedule 2.0 has a high responsiveness at 5 years after surgery. It can be used to detect functional disability at 5 years after surgery.

Efficacy and Safety of Juan Bi Pill with Add-on Methotrexate in Active Rheumatoid Arthritis: A 48-Week, Multicentre, Randomized, Double-Blind, Placebo-Controlled Trial.

To explore the efficacy and safety of Juan Bi Pill (JBP) in treatment of active rheumatoid arthritis (RA). From February 2017 to May 2018, 115 participants from 4 centers were randomly divided into JBP group (57 cases) and placebo group (58 cases) in a 1:1 ratio using a random number table method. Participants received a dose of JBP (4 g, twice a day, orally) combined with methotrexate (MTX, 10 mg per week) or placebo (4 g, twice a day, orally) combined with MTX for 12 weeks. Participants were required with follow-up visits at 24 and 48 weeks, attending 7 assessment visits. Participants were undergo disease activity assessment 7 times (at baseline and 2, 4, 8, 12, 24, 48 weeks) and safety assessments 6 times (at baseline and 4, 8, 12, 24, 48 weeks). The primary endpoint was 28-joint Disease Activity Score (DAS28-ESR and DAS28-CRP). The secondary endpoints included American College of Rheumatology (ACR) criteria for 20% and 50% improvement (ACR20/50), Health Assessment Questionnaire Disability Index (HAQ-DI), clinical disease activity index (CDAI), visual analog scale (VAS), Short Form-36 (SF-36) score, Medial Outcomes Study (MOS) sleep scale score, serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tender joint count, swollen joint count, and morning stiffness. The adverse reactions were observed during the treatment. After 12 weeks of treatment, DAS28-ESR and DAS28-CRP scores in both groups were lower than before treatment (both P<0.01), while the remission rate of DAS28-ESR and DAS28-CRP and low disease activity of JBP group were higher than those in the placebo group (both P<0.01). JBP demonstrated better efficacy on ACR20 and ACR50 compliance rate at 12 and 48 weeks comparing to placebo (all P<0.05). The CDAI and HAQ-DI score, pain VAS and global VAS change of RA patients and physicians, the serum ESR and CRP levels, and the number of tenderness and swelling joints were lower than before treatment at 4, 8, 12, 24, 48 weeks in both groups (P<0.05 or P<0.01), while the reduction of above indices in the JBP group was more obvious than those in the placebo group at 12 weeks (ESR and CRP, both P<0.05) or at 12 and 48 weeks (all P<0.01). There was no difference in adverse reactions between the 2 groups during treatment (P=0.75). JBP combined with MTX could effectively reduce disease activity in patients with RA in active stage, reduce the symptoms of arthritis, and improve the quality of life, while ensuring safety, reliability, and fewer adverse effects. (Trial Registration: ClinicalTrials.gov, No. NCT02885597).

Fibromyalgia comorbidity in Systemic Lupus Erythematosus patients: assessing impact on quality of life

IntroductionThe prevalence of Fibromyalgia in patients with Systemic Lupus Erythematosus (SLE) is significantly higher compared to the general population. Despite this frequent association, Fibromyalgia remains underdiagnosed and consequently inadequately treated, negatively affecting the quality of life of these patients.ObjectiveThis study aims to evaluate the occurrence of Fibromyalgia and its impact on the quality of life of Brazilian patients with SLE treated at a University Hospital in the state of Paraiba.Materials and methodsThis descriptive, observational, and cross-sectional study included patients with SLE diagnosed according to the 2012 criteria of the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC). The occurrence of Fibromyalgia was assessed using the American College of Rheumatology (ACR) criteria of 1990 and 2010/2011, revised in 2016. Quality of life was evaluated using the Short-Form 36 (SF-36) questionnaire for all patients, while the Fibromyalgia Impact Questionnaire (FIQ) was applied to those diagnosed with Fibromyalgia.ResultsThe sample comprised 107 SLE patients, with an average age of 54.1 years (SD:12.1), of whom 95.4% (102) were women. The prevalence of Fibromyalgia among SLE patients was 19.1% (21), all of whom were women with a mean age of 45.6 years (SD 9.6). The SF-36 scores of SLE patients with Fibromyalgia were consistently lower across all eight domains compared to those without Fibromyalgia, indicating a significant negative impact of this comorbidity. Conclusion: These findings are consistent with existing literature, highlighting the significant negative impact of Fibromyalgia on the quality of life of patients with SLE.ConclusionThese findings are consistent with existing literature, highlighting the significant negative impact of Fibromyalgia on the quality of life of patients with SLE.

Conservative treatments for women with stress urinary incontinence: a systematic review and network meta-analysis.

This study aimed to compare the effectiveness of various conservative treatment strategies for women with stress urinary incontinence. A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted from their inception through March 2024, without restrictions on language or location. Randomized controlled trials (RCTs) comparing the efficacy of conservative treatments for stress urinary incontinence, using short-term pad test or the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score as outcome measures, were included. We conducted a network meta-analysis using a random-effects model to compare the effectiveness of different conservative treatment strategies, employing prediction interval plots and league tables, and ranked them according to the surface under the cumulative ranking curve (SUCRA). The quality of the included studies was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. A total of 31 RCTs involving 1,900 patients across 8 intervention categories were included in the analysis. SUCRA rankings indicated that electrical stimulation (SUCRA = 95.9%) was the most effective therapy for improving ICIQ-UI SF scores, followed by biofeedback electrical stimulation (SUCRA = 84.9%), radiofrequency (SUCRA = 77.5%), biofeedback (SUCRA = 57.8%), magnetic stimulation (SUCRA = 45.3%), pelvic floor muscle training (SUCRA = 38.4%), Er: YAG laser (SUCRA = 37.4%), and CO2 laser (SUCRA = 7.4%). In terms of reducing urine leakage, the treatments were ranked in descending order as follows: Er: YAG laser (SUCRA = 97.5%), biofeedback electrical stimulation (SUCRA = 83.4%), biofeedback (SUCRA = 67.0%), radiofrequency (SUCRA = 59.5%), electrical stimulation (SUCRA = 48.4%), pelvic floor muscle training (SUCRA = 43.0%), magnetic stimulation (SUCRA = 27.8%), and CO2 laser (SUCRA = 21.4%). Based on the clustered rankings of the two metrics, biofeedback electrical stimulation was identified as the most effective therapy for improving stress urinary incontinence. Based on the combined analysis of two indicators, we found that biofeedback electrical stimulation may be the optimal therapy for the conservative management of stress urinary incontinence. https://www.crd.york.ac.uk/prospero/, identifier CRD42024569845.

Patient-reported outcome measures in an outpatient parenteral antimicrobial therapy program: a prospective cohort study

ObjectivesTo evaluate the improvements in the mean Short Form-36 (SF-36) score (95% CI) from predischarge to postdischarge among prospective participants of a Swiss Outpatient Parenteral Antimicrobial Therapy (OPAT) programme using...

Visual analogue scale foot and ankle vs. short-form 36 quality of life scores: artificial intelligence using machine learning analysis with an external validation.

We aimed to utilize artificial intelligence (AI) via machine learning (ML) to analyze the relationship between visual analogue scale foot and ankle (VASFA) and short-form 36 (SF-36) quality of life scores and determine AI's performance over the aforementioned analysis. We collected data from our registry of 819 data units or rows of datasets of foot and ankle patients with VASFA, SF-36 scores, and other demographic data. They were prepared and verified to be a proper input for building ML models using a web-based algorithm platform. After the first ML model was developed using random forest regression, the SF-36 percentage value was set as an endpoint. We developed a second ML model to evaluate it against the current algorithm. This new model employed a gradient-boosting regressor, where we omitted a key parameter, SF_Total, to correct the overfitting. We performed an external validation based on an unseen dataset from 42 data units of patients. Internal validity showed an excellent relationship among the VASFA, SF-36 total score, and overall SF-36 percent values at a correlation coefficient (R2 score) of 1.000 based on the random forest regression model of ML (first model: 28XJ). The VASFA percent value of the total score (0=worst; 100=best) demonstrated the dynamic changes in the three zones of the score levels; these were unsatisfactory: ≤ 57.25; borderline: 57.26-80.99; satisfactory: ≥ 81 and could impact the levels of overall SF-36 percent value. A second ML model (model FK13) showed an R2 score of 0.977, which was a great performance. External validation showed no significant difference between the predicted and actual values, with a two-tailed p-value of 0.2136. Our ML models predicted excellent relationships among VASFA, with or without SF-36 total score and overall SF-36 percentage values, with evidence from external validation.

Osteosynthesis with anatomic reduction after malleolar fractures improves ten years outcome: a single center trial

IntroductionMalleolar fractures are the most common ankle fractures and a major risk factor for ankle osteoarthritis in the long-term. Little is known about modifiable risk factors for a satisfactory outcome. This study aimed to assess the long-term clinical, functional and radiological outcomes in patients after osteosynthesis.MethodsIn this retrospective single center study, we assessed the difference in patients who underwent surgical intervention for malleolar fractures sustained between 2007 and 2014. The reduction was assessed on the first postoperative radiograph. At follow-up patients completed a questionnaire, including the European Foot and Ankle Society (EFAS) and Short Form-12 (SF-12) scores to evaluate patient-reported outcomes and quality of life. Ankle osteoarthritis was assessed using the Kellgren and Lawrence classification.ResultsOne hundred seventeen patients, 102 with anatomic reduction and 15 with malreduction, were reached at mean follow-up at 11.4 years and 10.9 years. The mean EFAS score was 18,0 for anatomic and 16,1 for nonanatomic reduction and 6.1 and 4.5 for the sport component. The rate of satisfaction with the result was 8.2 in anatomic reduction and 7.5 in the malreduction. There was no significant difference in the SF-12 group between the two groups. Anatomic reduction is a protective facture for a satisfactory outcome in the univariate model with the hazard ratio of 5.94.ConclusionAnatomic reduction is one of the strongest protective factors for satisfactory outcome after malleolar fractures in a follow-up of more than 10 years.

Evaluating a New Short Self-Management Tool in Heart Failure Against the Traditional Flinders Program.

Background/Objective: Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and major adverse cardiovascular events (MACE). CDSM programs can be complex and are not user-friendly in clinical settings, particularly for vulnerable patients. The aim of this study was to investigate whether a simplified one-page CDSM tool, the SCReening in Heart Failure (SCRinHF), is comparable to a comprehensive Flinders Program of Chronic Disease Management, specifically in triaging self-management capabilities and in predicting readmission and MACE. Methods:SELFMAN-HF is a prospective, observational study based on community cardiology. Eligible patients, consecutively recruited, had HF with left ventricular ejection fraction <40% and were placed on sodium-glucose co-transporter-2 inhibitors (SGLT2-i) within 3 months of recruitment. SGLT2-i is the newest of the four HF treatment pillars; self-management skills are assessed at this juncture. CDSM was assessed and scored independently via the long-form (LF) and short-form (SF) tools, and concordance between forms was estimated. The primary endpoint is the 80% concordance across the two CDSM scales for predicting hospital readmission and MACE. Results: Of the 117 patients, aged 66.8 years (±SD 13.5), 88 (75%) were male. The direct comparisons for SF versus LF patient scores are as follows: "good self-managers", 13 vs. 30 patients (11.1% vs. 25.6%); "average", 46 vs. 21 patients (39.3% vs. 17.9%), "borderline", 20 vs. 31 patients (17.1% vs. 26.5%), and "poor self-managers" (vulnerable), 38 vs. 35 patients (32.5% vs. 29.9%). These findings underscore the possibility of SF tools in picking up patients whose scores infer poor self-management capabilities. This concordance of the SF with the LF scores for patients who have poor self-management capabilities (38 vs. 35 patients p = 0.01), alongside readmission (31/38 vs. 31/35 p = 0.01) or readmission risk for poor self-managers versus good self-managers (31/38 vs. 5/13 p = 0.01), validates the simplification of the CDSM tools for the vulnerable population with HF. Similarly, when concurrent and predictive validity was tested on 52 patients, the results were 39 (75%) for poor self-managers and 14 (27%) for good self-managers in both groups, who demonstrated significant correlations between SF and LF scores. Conclusions: Simplifying self-management scoring with an SF tool to improve clinical translation is justifiable, particularly for vulnerable populations. Poor self-management capabilities and readmission risk for poor self-managers can be significantly predicted, and trends for good self-managers are observed. However, correlations of SF to LF scores across an HF cohort for self-management abilities and MACE are more complex. Translation to patients of all skill levels requires further research.

Females report worse outcomes than males one year after ventral hernia repair.

To assess sex differences in patient-reported quality of life, pain, and hernia recurrence after adjusting for confounding features of hernia disease in a large national registry one year after ventral hernia repair. Data were analyzed retrospectively from the Abdominal Core Health Quality Collaborative national registry from pre-operatively until one year post-operatively. 3,172 patients undergoing elective ventral hernia repair with 1-year follow-up data were included for analysis after propensity score matching (1:1 match; females: mean [interquartile range] age, 60 [49, 68]; body mass index, 32 [27, 36]; males: age, 60 [52, 68]; 31 [28, 35]. The primary outcome of interest between sexes was the Hernia Related Quality of Life survey (HerQLes), and secondary outcome measures included the Patient-Reported Outcomes Measurement Information System Pain Intensity (PROMIS) short form (3a) score and hernia recurrence. Female sex was associated with worse HerQLes and PROMIS pain 3a scores at 1 year follow up (adjusted mean difference, -2.42, 95% confidence interval (CI) -4.11 to -0.72; p = 0.004; adjusted mean difference, 1.27, 95% CI 0.67 to 1.87; p < 0.001) compared to male sex. Hernia recurrence rates at 1 year were not different between sexes. Females reported worse quality of life and higher levels of pain at 1-year post ventral hernia repair after accounting for age, BMI, hernia width, and baseline quality of life compared to males. There were no differences between females and males with respect to hernia recurrence at 1-year follow-up, and 1 in 5 patients experienced a recurrence at this time point.

Clinical evaluation of the efficacy of focused extracorporeal shock-wave therapy in patients with cervical spondylosis: A randomized control trial.

Extracorporeal shock wave therapy (ESWT) has emerged as a contemporary modality in physiotherapy, demonstrating efficacy in addressing musculoskeletal disorders. Despite its potential, the clinical efficacy of ESWT in the context of cervical spondylosis remains understudied, with a dearth of robust empirical evidence. To bridge this gap, the present study was designed to evaluate the therapeutic impact of focused ESWT (fESWT) on pain alleviation and functional improvement in individuals afflicted with cervical spondylosis. A multicenter, randomized controlled clinical study was conducted, collecting data from 5 clinical studies on the treatment of cervical spondylosis with fESWT from June 2021 to March 2024. The inclusion criteria were patients diagnosed with cervical spondylosis, aged 20 to 70, without severe underlying diseases such as heart disease, hypertension, diabetes, etc. The exclusion criteria included pregnant women, nursing women, patients with bleeding tendencies, or those with cardiac pacemakers. The control group underwent a sham fESWT, while the experimental group received fESWT administered via the Duolith SD1 Tower device. The main observation indicators included the Visual Analogue Scale (VAS) for pain scoring, Neck Disability Index (NDI) scoring, cervical range of motion (ROM) scoring, and the Short Form-36 (SF-36) quality of life survey scoring. A total of 320 subjects were included in the study, with 160 in the experimental group and 160 in the control group. Post-treatment, the VAS and NDI scores in the experimental group were significantly lower than those in the control group (P < .05), while the cervical range of motion (ROM) and SF-36 scores were significantly higher than in the control group (P < .05). The overall treatment efficacy rate in the experimental group exceeded 90%, markedly higher than the approximately 70% rate in the control group (P < .05). There was no significant difference in the incidence of adverse reactions between the 2 groups. The fESWT has shown promising therapeutic effects in the treatment of cervical spondylosis. It effectively reduces patient pain, improves cervical function, and enhances the quality of life, making it worthy of clinical promotion and application.

Abstract 4127909: Smartphone-enabled, home-based exercise in patients with symptomatic peripheral arterial disease: the Smart Step Grady randomized trial

Introduction: About 10% of peripheral artery disease (PAD) patients develop claudication, with African Americans at higher risk and more severe symptoms. While supervised exercise therapy (SET) is a primary treatment, its uptake is low. We assessed the feasibility and effectiveness of smartphone-delivered home-based exercise therapy (HBET) in improving functional capacity and PAD symptoms in low-resource settings lacking SET. Methods: We conducted an interim analysis of Smart Step, a pilot randomized trial (1:1 ratio) comparing smartphone-enabled HBET to usual care (UC) in symptomatic PAD patients at Grady Memorial Hospital, a public safety net hospital in Atlanta, GA, from August 2018 to March 2024. The HBET group received virtual exercise coaching, app-based education, messaging, and reminders for 12 weeks. The primary outcome was the change in 6-minute walking distance (6MWD) at 12 weeks. Secondary outcomes included changes in the Walking Impairment Questionnaire (WIQ) and Short Form 36 (SF-36) scores. Data were analyzed using intention-to-treat, with mixed model repeated measures regression assessing the association between 6MWD and treatment. Results: We screened 102 patients and enrolled 46. To date, 26 (56%) participants have completed the study, 6 (13%) dropped out, and 14 (30%) are pending completion. The mean [SD] age was 63 [12] years, with 50% female and 90% African American. After 12 weeks, the mean 6MWD increased by 15.7 m from a baseline of 336.0 m in the HBET arm (n=13) and decreased by 6.6 from a baseline of 310.2 m in the UC arm (n=13). The between-group difference was 22.4 [95% CI -11.8 – 56.6] m; p=0.19). The WIQ stair climbing score changed by -10.9 in the UC arm vs. 7.1 in the HBET arm (between group difference 17.9 [95% CI 1.1-34.8]; p=0.04), while the other WIQ sub-scores were more similar between groups. The 12-week changes in SF-36 scores were not different by group. Conclusion: In this preliminary analysis, the HBET arm showed within-group improvements in 6MWD and symptoms after 12 weeks, but most changes were not significantly different when comparing them with the UC arm. Future analyses are pending and will provide the necessary statistical power for a more precise measure of the treatment effects.

Predicting sarcopenia in community-dwelling older adults through comprehensive physical fitness tests

BackgroundSarcopenia is typically assessed through hand grip strength, walking speed, and chair stand tests. However, it has been inadequately examined in terms of other physical fitness (PF) components in community-dwelling older adults. Thus, in this study, we explored factors influencing the risk of sarcopenia in community-dwelling older adults. In addition, we analyzed the clinicodemographic characteristics of older adults with or without sarcopenia and investigated the effect of sex on their PF.MethodsThis cross-sectional study included 745 older adults from a community health promotion program in Taiwan. Their clinicodemographic characteristics were recorded. PF was assessed through various tests, such as hand grip strength evaluation, 8-foot up-and-go test (8-UGT), 2-min step test, and 6-m walk test. PF and factors influencing sarcopenia risk were compared between older adults with sarcopenia (sarcopenia group) and those without it (nonsarcopenia group). A logistic regression model was performed to identify key factors associated with sarcopenia. Its predictive performance was evaluated by calculating the area under the receiver operating characteristic curve (ROC) curve.ResultsRegardless of sex, the sarcopenia group performed worse in almost all components of PF—for example, upper and lower limb muscular strength and endurance, cardiopulmonary fitness, and balance—than did the nonsarcopenia group. However, for men, no significant between-group difference was observed in flexibility. The logistic regression model indicated age (odds ratio [OR]: 1.107), sex (OR: 2.881), Mini Nutritional Assessment—Short Form scores (OR: 0.690), and performance in 8-UGT (OR: 1.346) as factors influencing the risk of sarcopenia. The model exhibited excellent discriminative ability in predicting sarcopenia, as indicated by an area under the curve value of 0.867 (95% confidence interval: 0.827–0.906; p < 0.05).ConclusionOlder adults without sarcopenia tend to outperform those with sarcopenia in almost all PF measures, regardless of sex. Older age, male sex, low Mini Nutritional Assessment—Short Form scores, and poor performance in 8-UGT are associated with a high risk of sarcopenia.