SF-36 Health Status Questionnaire Research Articles

Council tax valuation bands, socio-economic status and health outcome: a cross-sectional analysis from the Caerphilly Health and Social Needs Study

Council tax valuation bands (CTVBs) are a categorisation of household property value in Great Britain. The aim of the study was to assess the CTVB as a measure of socio-economic status by comparing the strength of the associations between selected health and lifestyle outcomes and CTVBs with two measures of socio-economic status: the National Statistics Socio-Economic Classification (NS-SEC) and the 2001 UK census-based Townsend deprivation index.MethodsCross-sectional analysis of data on 12,092 respondents (adjusted response 62.7%) to the Caerphilly Health and Social Needs Study, a postal questionnaire survey undertaken in Caerphilly county borough, south-east Wales, UK. The CTVB was assigned to each individual by matching the sampling frame to the local authority council tax register. Crude and age-gender adjusted odds ratios for each category of CTVB, NS-SEC and fifth of the ward distribution of Townsend scores were estimated for smoking, poor diet, obesity, and limiting long-term illness using logistic regression. Mean mental (MCS) and physical (PCS) component summary scores of the Short-Form SF-36 health status questionnaire were estimated in general linear models.ResultsThere were significant trends in odds ratios across the CTVB categories for all outcomes, most marked for smoking and mental and physical health status. The adjusted odds ratio for being a smoker in the lowest versus highest CTVB category was 3.80 (95% CI: 3.06, 4.71), compared to 3.00 (95% CI: 2.30, 3.90) for the NS-SEC 'never worked and long-term unemployed' versus 'higher managerial and professional' categories, and 1.61 (95% CI: 1.42, 1.83) for the most deprived versus the least deprived Townsend fifth. The difference in adjusted mean MCS scores was 5.9 points on the scale for CTVB, 9.2 for NS-SEC and 3.2 for the Townsend score. The values for the adjusted mean PCS scores were 6.3 points for CTVB, 11.3 for NS-SEC, and 2.5 for the Townsend score.ConclusionCTVBs assigned to individuals were strongly associated with the health and lifestyle outcomes modelled in this study. CTVBs are readily available for all residential properties and deserve further consideration as a proxy for socio-economic status in epidemiological studies in Great Britain.

Quality of life and dietary intake in elderly patients with dysphagia

M In patients with dysphagia, malnutrition is associated ith tissue wasting and impaired organ function, which eads to impaired morbidity and hospital stay [1]. Quality of ife is impaired in these patients. Kikafunda et al. [2] found hat a large percentage of older patients is malnourished, hich influences daily activities, especially mobility and eeding. The aim of this study was to describe the influence f nutritional status and oral dietary intake on quality of life n elderly patients with dysphagia. Thirty-nine patients with dysphagia were studied (mean age 1 10 y, 25 women and 14 men). Thirty patients had ysphagia from dementia (77%), five from acute cerebrovasular disease (13%), and four from head trauma (10%). Table presents dietary intake compared with recommended dietary llowances [3]. The SF-36 Health Status questionnaire showed score of 96.3 9.9 points. In the multivariate analysis with dependent variable (SF-36 score), only carbohydrate intake emained in the model that was adjusted by body mass index, lbumin, age, and sex (F 5.37, P 0.005), with an increase f 0.1 (95% confidence interval 0.01 to 0.191) SF-36 point ith each gram of carbohydrate intake. Quality of life is an important consideration in clinical utcome. A cross-sectional study [4] detected that consumpion of diets rich in fruits and vegetables is associated with igher levels of physical functioning and quality of life among lder cancer patients. This association remained unclear. In conclusion, quality of life was related to carbohydrate ntake. Further interventional studies will be designed by ur group to improve dietary intake and quality of life by sing oral supplementation. The aim is to detect the relation f quality of life to caloric intake and/or macronutrient istribution.

Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study

Little is known concerning the natural history of psychiatric morbidity, postoperative delirium, cognitive decline and health-related quality of life (HRQOL) in cardiac surgery patients and the impact of neurocognitive dysfunction on HRQOL after cardiac surgery with cardiopulmonary bypass (CPB). In a prospective study, we followed up for 1 year 30 of the original 34 patients who had undergone cardiac surgery with CPB. Patients were assessed preoperatively, before discharge, and at 1 year after surgery with the Structural Clinical Interview for DSM-IV and a series of neuropsychological tests. Psychometric scales were administered to evaluate cognitive functioning (Syndrom Kurztest), depressive symptomatology (Montgomery–Åsberg Depression Rating Scale), posttraumatic stress symptoms (Posttraumatic Stress Syndrome 10-Questions Inventory) and HRQOL (SF-36 Health Status Questionnaire). Delirium Rating Scale (DRS) was used daily over the course of intensive care unit treatment. Postoperative delirium developed in 11 of the 34 patients (mean DRS rating scale score±S.D.: 20.36±6.22, range: 14–31). Short-term consequences of cardiac surgery included adjustment disorder with depressed features ( n=11), posttraumatic stress disorder ( n=6), major depression ( n=6) and clinically relevant cognitive deficits ( n=13). At 12 months, the severity of depression and anxiety disorders improved and returned to the preoperative level, and 6 out of the 30 followed-up patients displayed cognitive deficits. Our patients' HRQOL SF-36 self-reports significantly improved compared with baseline quality of life data. However, 1-year overall lower cognitive function scores were associated with lower HRQOL. Cardiac surgery with CPB is associated with improvements in HRQOL relative to the preoperative period, but the presence of cardiac surgery-related cognitive decline impairing HRQOL is a complication for a subgroup of cardiac surgical patients in the long-term outcome.

Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population.

Heart failure and left ventricular systolic dysfunction (LVSD) are increasingly common disorders, with outcomes worse than many cancers. Evidence-based therapies, such as ACE inhibitors and beta-blockers, improve prognosis and symptoms, and reduce healthcare expenditure. However, despite the high prevalence and malignant prognosis, few studies have reported the impact of heart failure and LVSD on overall quality of life and, more crucially, have not researched the elderly or those in the community. All patients attending the Echocardiographic Heart of England Screening (ECHOES) study of the prevalence of heart failure and LVSD in the community were assessed by clinical history and examination, electrocardiogram and echocardiography, and also completed the SF36 health status questionnaire. Quality of life in patients found to have heart failure, LVSD, and other cardiac and medical conditions are compared with the randomly selected general population sample. Data are generalisable to the UK. 6162 people in the community were screened in the ECHOES study, of whom 5961 (97%) completed the SF36. The health perceptions of 3850 people aged 45 years or older selected randomly from the population were compared with those of 426 patients diagnosed as having definite heart failure. Those with heart failure had significant impairment of all the measured aspects of physical and mental health, in addition to declines in physical functioning. Significantly worse impairment was found in those with more severe heart failure by NYHA class: indeed, NYHA functional class was closely correlated to SF36 score. Patients with asymptomatic left ventricular dysfunction and patients rendered asymptomatic by treatment had similar scores to the random population sample. Those with heart failure reported more severe physical impairment of quality of life than people giving a history of chronic lung disease or arthritis, with less impact on mental health than patients reporting depression. Patients with heart failure have statistically significant impairment of all aspects of quality of life, not simply physical functioning. The physical (role and functioning) health burden was significantly greater than that suffered in other serious common chronic disorders, whether cardiac or other systems. Optimising treatment to improve NYHA class appears to improve perceptions of quality of life for patients with heart failure. Given the dramatic decline in quality of life with heart failure, this end-point should be a much more important target for healthcare interventions, especially treatments such as ACE inhibitors and beta-blockers that are shown to improve quality of life.

Psychiatric and Psychosocial Outcome of Orthotopic Liver Transplantation

Background: The study aimed to explore the prevalence of psychiatric disorders among orthotopic liver transplantation (OLT) recipients, and to investigate how psychiatric morbidity was linked to health-related quality of life (HRQOL). Methods: We recruited 75 patients who had undergone OLT a median of 3.8 years previously (range = 5–129 months). Psychiatric morbidity was assessed using the Structural Clinical Interview for the DSM-III-R. Psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptomatology (HAMD₁₇), posttraumatic stress symptoms (PTSS-10), social support (SSS), and HRQOL (SF-36 Health Status Questionnaire). Treatment characteristics were obtained from medical records. Results: 22.7% (n = 17) of our sample had a current or probable psychiatric diagnosis according to DSM-III-R: 2.7% full posttraumatic stress disorder (PTSD) (n = 2), 2.7% major depressive disorder (MDD) comorbid to full PTSD (n = 2), 1.3% MDD comorbid to partial PTSD (n = 1), and 16% partial PTSD (n = 12). Patients with PTSD symptoms demonstrated lower cognitive performance, higher severity of depressive symptoms and more unfavorable perception of social support. OLT-related PTSD symptomatology was associated with maximal decrements in HRQOL. The duration of intensive care treatment, the number of medical complications, and the occurrence of acute rejection were positively correlated with the risk of PTSD symptoms subsequent to OLT. Conclusion: OLT-related PTSD symptomatology impairing HRQOL is a complication for a subgroup of OLT recipients. Health-care providers should be aware of the possible presence of PTSD in OLT survivors.

A patient-oriented health status measure in outpatient rehabilitation.

The purpose of this study was to assess the utility of a patient-centered health status measurement tool in multiple outpatient rehabilitation clinics and to characterize health status before and after an outpatient physical therapy intervention as part of that assessment. Six outpatient rehabilitation clinics voluntarily agreed to incorporate a standardized patient-centered health status questionnaire into everyday practice. Patients completed the SF-36 health status questionnaire before initiating treatment and again at discharge. Only nonsurgical patients without comorbidities were enrolled. Voluntary application of the SF-36 on a small scale was achieved over a period of 3-4 mo. All health concepts improved except general health perceptions. The results suggest that (1) a standard patient-oriented health status questionnaire can be incorporated into outpatient rehabilitation clinics, and useful information can be derived regarding outcomes; (2) careful administrative coordination is necessary to optimize follow-up and decrease burden on both patients and clinicians; (3) although improvements in health status were demonstrated, small sample sizes and the lack of control groups prevents conclusions regarding the effectiveness of physical therapy treatment; and (4) the magnitude of effect sizes suggests that controlled studies could be performed by clinicians partnering with researchers to improve outpatient rehabilitation.

Anxiety, depression and functional capacity in older women with mitral valve stenosis.

Mitral valve stenosis can lead to a range of symptoms that affect daily life. As many of the people with this problem are elderly, the difficulties resulting from age can be exacerbated by illness. A pilot descriptive study was designed to examine the differences in anxiety, depression and functional capacity in women with mitral valve stenosis who were aged over 60 years when compared to a similar group of volunteers who did not have any cardiac disease. Measurement was undertaken using the Hospital Anxiety and Depression scale, the SF-36 Health Status questionnaire and the Functional Limitations Profile. Forty women were recruited to the study: 20 women with mitral valve stenosis and 20 volunteers. Each person was asked to complete the three questionnaires on one occasion only. Non-parametric statistics were used for analysis. Patients fared worse than volunteers with significant differences between groups in respect of anxiety (P = 0.03), depression (P = 0.02) and overall function (P < 0.001), but not in physical (P = 0.52) or mental health (P = 0.32). Future research could focus on strategies that would help alleviate anxiety and depression and improve functional capacity in older women with mitral valve stenosis.

The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study

Survivors of acute respiratory distress syndrome (ARDS) are at risk for long-lasting cognitive decline due to hypoxemia, sepsis and/or psychological sequelae associated with aggressive supportive care in the intensive care unit (ICU). We conducted an exploratory study to assess cognitive performance in long-term survivors of ARDS and to investigate how cognitive functioning is related to employment status and health-related quality of life (HRQOL). At median time of 6.0 years after ICU discharge, forty-six ARDS survivors were tested with SKT, a short cognitive performance test for assessing deficits of memory and attention. A measure of HRQOL (SF-36 Health Status Questionnaire) was also administered, and in a brief psychiatric interview, employment status was rated. 23.9% (n=11) of the patients showed cognitive impairments. However, no extreme and severe cognitive deficits were recorded. They primarily revealed low levels of cognitive function in various tasks assessing attention skills. Disability was found in 41.3% (n=19) of the patients. All ARDS survivors with cognitive deficits were disabled, whereas only 22.9% (n=8) of the cognitively not impaired patients gave evidence of disability. The SF-36 values of the ARDS survivors indicated impaired health status on seven out of eight domains when compared to normative population data. Patients with cognitive deficits described the lowest HRQOL with major limitations in the domains role-physical and social functioning when compared to patients without cognitive impairments. In conclusion, long-term ARDS survivors exhibit impaired health status and the presence of cognitive deficits is associated with disability and considerable impairments in HRQOL. More detailed psychiatric research is required to establish the etiology of these cognitive impairments.

A challenge to the cross-cultural validity of the SF-36 health survey: factor structure in Māori, Pacific and New Zealand European ethnic groups

This paper reports on a principal component factor analysis of the SF-36 health status questionnaire in the three major ethnic groups in New Zealand (New Zealand Europeans, Māori and Pacific). The SF-36 is hypothesised to have a two-dimensional structure with distinct (weakly correlated) mental and physical health components, and support for this structural model has generally been found cross-nationally. However, in Māori and Pacific models of health mental and physical dimensions are not generally seen as separable, or independently functioning. This raises the possibility that the questionnaire’s hypothesised structural model would not be supported among Māori and Pacific ethnic groups. This study evaluated that possibility. The results of the analysis showed a similar factor structure among New Zealand Europeans, and younger Māori (<45 years) to that reported by Ware et al. for Western European countries. Among Pacific people and older Māori (45 years and over), however, the factor structure did not clearly differentiate physical and mental health components. Implications are discussed both specific to the SF-36 (and in particular the use of principal component summary scores), and more generally for the cross-cultural validity of self-reported health status measures.

Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome.

We performed a follow-up cohort analysis in order to delineate the correlation between pulmonary function (PF) and health-related quality of life (HRQL) in patients after ARDS. Follow-up cohort study. A 20-bed ICU of a university teaching hospital. A cohort of 50 long-term survivors of ARDS. Measurements of PF (FVC, FEV1, TLC, D(LCO)) and HRQL (SF-36 Health Status Questionnaire) were made 5.5 years (median value) after discharge from the ICU. Impairments in PF (defined as PF results below 80% of the predicted value) were frequent but generally mild. Twenty patients had a single PF impairment (with limitations in FEV1/FVC ratio in 12 patients being the most common), four patients had two (with D(LCO) and FEV1/FVC ratio impairment the most common) and three patients had pathologic results in three PF tests (FEV1/FVC ratio, TLC and capillary pO2 during exercise in one case, FVC, TLC and capillary pO2 during exercise in the second patient and FVC, TLC and D(LCO) in the third). Compared to normal controls, survivors of ARDS showed impairments in all SF-36 health dimensions (p < 0.001). Patients with multiple (> 1) PF impairments described the lowest HRQL with major limitations in all SF-36 categories (p < 0.037) including physical and mental summary scores (36.5 vs 46.9, p = 0.037 and 31.3 vs 51.4, p = 0.003) when compared to patients with no or only one PF impairment. Long-term survivors of ARDS have a significant reduction in HRQL and the presence of multiple PF impairments is associated with maximal decrements in HRQL.

Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment

Objectives: Health-related quality of life and patient satisfaction have become important end points in cardiac surgery. Post-traumatic stress disorder has been described in patients with life-threatening heart disease. In this study, we investigated the occurrence of post-traumatic stress disorder in a sample of patients after cardiac surgery and compared health-related quality of life and patient satisfaction between patients with and without evidence of post-traumatic stress disorder. Methods: We studied 80 patients serially admitted to the intensive care unit after cardiac surgery (bypass grafting, n = 51; aortic valve replacement, n = 29). Health-related quality of life was assessed with the use of the SF-36 Health Status Questionnaire. Post-traumatic stress disorder was measured with a previously validated instrument (the Post-Traumatic Stress Syndrome 10-Questions Inventory), and 20 different aspects of life satisfaction were quantified on a scale ranging from 0 to 10. For measurements of health-related quality of life and post-traumatic stress disorder, age- and gender-comparable healthy individuals, as well as patients with cardiovascular diseases, served as control groups. Results: Patients who had cardiac surgery described high life satisfaction summary scores (156 of a maximum of 200 points) and only small impairments in physical and mental SF-36 summary scores when compared with healthy control groups (median reduction 7.15, P <.05). Patients with evidence of post-traumatic stress disorder (n = 15) reported the lowest SF-36 mental health summary scores when compared with patients without stress disorder (38.3 vs 48.4, P =.004) and rated their life satisfaction lower (121.5 vs 162.0, P =.002). Conclusions: Patients who have had cardiac surgery demonstrate a high life satisfaction with an acceptable degree of physical and mental health-related quality of life. Impairments in psychosocial function and life satisfaction were found in a subgroup of patients with evidence of post-traumatic stress disorder. (J Thorac Cardiovasc Surg 2000;120:505-12)

Convalescence after laparoscopically assisted vaginal hysterectomy

Objective To compare convalescence in women following laparoscopically assisted vaginal hysterectomy and following total abdominal hysterectomy. Design A prospective comparative study. Subjects 72 women who underwent hysterectomy. Main outcome measure Physical functioning score according to the SF-36 Health Status Questionnaire at, 1 and 6 weeks postoperatively. Results The physical functioning scores were similar, both preoperatively and at 1 week after the operation, in women who had laparoscopically assisted vaginal hysterectomy (n = 35) and in those who had conventional total abdominal hysterectomy (n = 37). However 6 weeks after operation, women who had undergone laparoscopically assisted vaginal hysterectomy had significantly higher physical functioning scores (26, range 19–30 vs. 22, range 14–30; P = 0.041), and significantly less reduction in physical functioning score relative to baseline than the conventional hysterectomy group (3% vs 13%; P = 0.031). Conclusion Women appear to recover more quickly after laparoscopically assisted vaginal hysterectomy than after total abdominal hysterectomy.

The Health-Related Quality-of-Life of Never Smokers, Ex-smokers, and Light, Moderate, and Heavy Smokers

Background. Health related quality-of-life is recog nized as an important health outcome measure; how ever, it may also have a significant application in smok ing reduction and cessation programs.Methods. Representative population data (n = 3010) was used to compare the quality-of-life status of differ ent smoking categories with never smokers.Results. Statistically significant differences in mean quality-of-life scores, as measured by the SF-36 health status questionnaire, were observed between never smokers, as the reference group, ex-smokers, all smok ers, and light, moderate, and heavy smokers. Heavy smokers also scored significantly lower than both other groups of smokers, scoring as low as the 29th percentile of the population on the general health di mension and lower than the 36th percentile of the pop ulation on all the mental health dimensions.Conclusions. The design of public health smoking cessation programs should consider the varying char acteristics of different segments of the smoking popu lation. The advantages of improved quality-of-life may strengthen the argument for encouraging heavier smokers to become light smokers as a precursor to total cessation.

The effect of oestrogen supplementation on post‐menopausal urinary stress incontinence: a double‐blind placebo‐controlled trial

To investigate the effect of hormone replacement therapy on post-menopausal urinary stress incontinence. Double-blind, placebo-controlled, randomised trial. University associated teaching hospital. Post-menopausal women with genuine stress incontinence, not taking hormone replacement therapy. Randomisation to six months therapy with oestradiol valerate 2 mg daily or placebo. Assessment prior to treatment and upon study completion with the SF-36 health status questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, a one week urinary diary, one hour perineal pad test, cystometry and urethral profilometry. Sixty-seven women consented to participate, 33 were randomised to receive oestradiol. Mean age was 63 years. Five women failed to undergo repeat assessment, three of whom were receiving oestrogen. Six women receiving oestradiol experienced breakthrough bleeding during the six months and were subsequently treated with additional monthly progestogen. No significant effect of oestrogen over placebo was observed for any subjective or objective clinical outcome. This trial is one of the largest controlled studies yet reported, with the longest duration of treatment. No improvement in post-menopausal stress incontinence was demonstrated after six months therapy with oestradiol. This concurs with another study reported recently; it seems unlikely that oestrogen has a significant role to play in this condition.

Self reported health status and magnetic resonance imaging findings in patients with low back pain.

The authors present a prospective study of quality of life (SF-36) and MRI findings in patients with low back pain (LBP). Disc herniation and nerve root compression contribute to LBP and poor quality of life. However, significant proportions of asymptomatic subjects have disc herniation and neural compromise. Little is known about the influence of disc abnormalities and neural compression on quality of life in symptomatic patients. The purpose of this study was to assess the relationship between the extent of disc abnormality, neural impingement and quality of life. A total of 317 consecutive patients with LBP referred for MRI completed an SF-36 health status questionnaire immediately before imaging and again 6 months later. Patients were grouped according to the most extensive disc abnormality and any neural compromise reported at MRI. The relationship between symptoms, radiological signs and SF-36 scores was assessed. Eighty percent (255/317) and 65% (205/317) of patients completed the initial and 6-month SF-36, respectively. Thirty-six percent of patients (115/317) had one or more herniated discs and 44% (140/317) had neural impingement. There was little relationship between the extent of disc abnormality and quality of life. Patients with radiological evidence of neural impingement reported better general health (P < 0.01). SF-36 scores improved at 6 months in four dimensions, but general health deteriorated (P < 0.01). Patients with neural impingement had improved pain scores at 6 months (P < 0.05). The study results showed that the pain and dysfunction caused by disc herniation and neural compromise are not sufficiently distinct from other causes of back pain to be distinguished by the SF-36. Whilst neural compromise may be the best radiological feature distinguishing patients who may benefit from intervention, it cannot predict quality of life deficits in the diffuse group of patients with LBP.

Gesundheitsbezogene Lebensqualität

Treatment of severe acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) can be lifesaving but requires maximal use of intensive care resources over prolonged periods of time, resulting in high costs. Little is known about the health-related quality of life (HRQL) in long-term survivors. This case-controlled retrospective study was designed to assess the health-related quality of life in long-term survivors of ARDS and ECMO-therapy. 14 long-term survivors of ARDS (APACHE II score = 24, Lung Injury Score = 3.25, median values) treated using ECMO between 1992 and 1995 (median time interval between data collection and discharge from the ICU 16 months) and 14 ARDS-patients conventionally treated during the same period (group I) were identified and completed the SF-36 Health Status Questionnaire (Medical Outcome Trust, Boston, USA). 14 healthy subjects (group II) were drawn at random from a large data base generated to provide normal values for the SF-36 in a German population. All three groups were comparable with respect to sex and age. Long-term survivors of ECMO-therapy reported significant reductions in physical functioning when compared with patients treated by mechanical ventilation alone (group I, -12.5%, p < 0.05) and with healthy controls (group II, -50%, p < 0.05) and showed a higher incidence of chronic physical pain (+5% and +24%, respectively, p < 0.05). There were no differences with regard to the mental health dimensions of the SF-36 (e.g. vitality, mental health index or social functioning) between ECMO-patients and all controls. Nine patients (64.3%) from the ECMO group versus all patients treated conventionally (group I) had full-time employment (p = 0.46, Chi2 test). The majority of long-term survivors of ECMO-treatment show good physical and social functioning, including a high rate of employment. The more aggressive approach of ECMO-therapy and a possibly more severe underlying disease process may explain impairments in health-related quality of life outcomes after ECMO-treatment. Despite these limitations, long-term survivors of ECMO-therapy are able to reach a highly satisfactory health-related quality of life.

Screening for pain in knee osteoarthritis: which question?

To compare three questions on knee pain with respect to determined prevalence and associations with disability and structural change. Postal survey to 4057 men and women aged 40-79 years. Knee pain was defined by three questions: (A) "Have you ever had pain in or around the knee on most days for at least a month? If so, have you experienced any pain during the last year?" (B) "Have you had pain within the last year in or around the knee that occurred on most days for at least a month?" (C) "Have you had knee pain on most days of the last month?" [American College of Rheumatology (ACR) criteria for knee osteoarthritis]. Disability was assessed with the SF-36 health status questionnaire. Radiographs (AP weight bearing and skyline) were obtained on a proportion (n = 459) and graded for maximum osteophyte in any compartment. Prevalence of knee pain for questions A, B, and C were 28.3%, 25.3%, and 19.3% respectively. Highest rates of disability were observed for question C (71.3% compared with 60.9% for question A). There was no major difference between questions in terms of percentage with > or = grade 1 osteophyte or > or = grade 2 osteophyte. Sensitivity and specificity of each question for > or = grade 1 osteophyte did vary, with question A being most sensitive but least specific (58.7% and 59.1%) and question C most specific (72.7%) but least sensitive (45.4%). Estimates of knee pain and disability are influenced by even minor changes in question content. The ACR criteria question may be a better predictor of disability but is relatively insensitive for use in the community.

Predicting quality-of-life outcomes following total joint arthroplasty: Limitations of the SF-36 health status questionnaire

A group of 114 patients undergoing total hip and knee arthroplasty were evaluated to assess the effect of total joint arthroplasty on quality of life, as measured by the SF-36 Health Status Questionnaire, and to determine the predictive relationship between preoperative and postoperative scores. A highly significant improvement was seen comparing preoperative with postoperative scores at 2 years for physical function, social function, physical role function, emotional role function, mental health, energy, and pain. Despite a significant change in health status ( P ≤ .001), no change was seen in the patient's health perception ( P = .61). Regression analysis failed to indicate a predictive relationship between preoperative and postoperative scores for any scale. Total joint arthroplasty dramatically improves the quality of life and function of patients afflicted with arthritis; however, because of the poor ability of the SF-36 to predict postoperative improvement on an individual basis, it cannot be used alone to determine treatment selection.

Initial health status of patients at outpatient physical therapy clinics.

The purpose of this study was to characterize the health status of individuals upon initiation of treatment in outpatient physical therapy clinics. Six outpatient clinical sites participated in the study. Three clinics were hospital based, and three clinics were privately owned by physical therapists. Patients who were referred with muscular, skeletal, or peripheral nerve involvement and who were not postoperative were included in the study. One hundred nine patients completed the SF-36 health status questionnaire, which assessed eight health concepts: physical function, role physical (ie, limitations in role functioning such as duties in the home or at work due to physical problems), bodily pain, vitality, social function, role emotional (ie, limitations in role functioning due to emotional problems), mental health, and general health. Patients referred for treatment to hospital-based or privately owned clinics had similar ages and diagnoses. No differences in health status were found between patients to be treated at hospital-based clinics and those to be treated at privately owned clinics, or between male and female patients. Only physical functioning scores were lower in patients with lower-quarter (lumbar or lower-extremity) disorders versus patients with upper-quarter (cervical or upper-extremity) disorders. All health concept scores, except general health, were found to differ from previously published normative data on the US population. A subgroup of patients seeking outpatient physical therapy had lower health concept scores than did the general population in not only the physical domain of health but also the psychological and social domains. These data reinforce the concept that physical impairment interacts with the emotional and social aspects of health. In addition, the health concept scores of our sample as compared with other patient groups who have responded to the SF-36 revealed some similarities and some marked differences. The results suggest that these types of data will provide practicing clinicians, as well as third-party payers and policy-makers, with a greater understanding of the severity of the patient's condition. Because the SF-36 provides information on health not routinely assessed by physical therapists, it may be a useful screening tool. [Mossberg KA, McFarland C. Initial health status of patients at outpatient physical therapy clinics.

Comparative outcomes of total joint arthroplasty

A prospective pre- and postoperative general health/quality-of-life factor comparison, using the Rand SF-36 Health Status Questionnaire (TyPE Specification, Quality Quest [Health Outcomes Institute, Minneapolis, MN]), was carried out on a consecutive series of patients with diagnosed osteoarthritis undergoing total hip and knee arthroplasty between March 1991 and March 1994. Study groups consisted of 85 total hip arthroplasty patients, 93 total knee arthroplasty patients, and 65 single-stage bilateral total knee arthroplasty patients, all treated at the same specialty hospital, under the care of three senior orthopaedic surgeons. The average patient age was 69 years. Significant improvements in quality-of-life measures including physical functioning, social functioning, role functioning/physical problem, role functioning/emotional problem, mental health, energy/fatigue, pain, and change in health were noted in all hip and knee arthroplasty patients 6 months, 1 year, and 2 years after surgery ( P < .05). There appeared to be no significant differences in quality-of-life measures between hip and knee arthroplasty patients. Results therefore indicate that total hip and knee arthroplasty significantly improve the functional status and quality of life among patients suffering from osteoarthritis.