SF-36 PF Scores Research Articles

Six-year follow-up of participants in two clinical trials of rituximab or cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

In this six-year follow-up study, we used patient-reported outcome measures (PROMs) to compare values at baseline, at 18 months, and at six-year follow up from the CycloME and the RituxME trials. Based on the hypothesis that ME/CFS in a subgroup of patients is a variant of an autoimmune disease, we performed two clinical trials between 2014 and 2017. The RituxME trial was a randomized, double-blind and placebo-controlled phase III trial of 151 patients, assessing the B-cell depleting antibody rituximab. The CycloME trial was an open-label phase II trial of 40 patients using intravenous cyclophosphamide. Here we report six-year follow-up from both trials, using the Short Form 36 Physical Function (SF-36 PF) and DePaul short form (DSQ-SF) questionnaires. Of the patients available after six years, 75.7% of RituxME and 94.4% of CycloME patients participated. In the RituxME rituximab group, the mean SF-36 PF scores were 32.9 at baseline, 42.4 at 18 months and 45.5 at six years. In the placebo group, the mean SF-36 PF scores were 32.3 at baseline, 45.5 at 18 months and 43.1 at six years. In the CycloME trial, mean SF-36 PF increased from 35.4 at baseline to 54.4 at 18 months, and 56.7 at six years. At six-year follow-up, 44.1% of cyclophosphamide-, 27.6% of rituximab- and 20.4% of placebo-treated patients had an SF-36 PF ≥ 70, and further, 17.6%, 8.6% and 7.4% of the corresponding patient groups had an SF-36 PF ≥ 90, which is within normal range. In terms of worsening at six years, 5.9% of cyclophosphamide-treated, 10.3% of rituximab-, and 14.8% of placebo-treated patients had a drop in SF-36 PF of 20 points or more from baseline. There were no serious unexpected adverse reactions. After six years, 44.1% of the cyclophosphamide group scored an SF-36 PF of at least 70, and 17.6% of at least 90, suggesting that cyclophosphamide in a subgroup may modulate the disease course in a beneficial way. However, cyclophosphamide carries toxicity concerns and should not be used for ME/CFS patients outside clinical trials. Rather, these data should encourage efforts to better understand the disease mechanisms and to search for targeted and less toxic immune modulatory treatment for this patient group.

Association of sarcopenia defined by different skeletal muscle mass measurements with prognosis and quality of life in older patients with heart failure

BackgroundDiagnosing sarcopenia in heart failure (HF) patients is important, but how to assess skeletal muscle mass in HF patients with fluid retention is controversial. We aimed to examine the association between sarcopenia, defined by different skeletal muscle mass measurements, and clinical outcomes in older HF patients. MethodsWe included 546 older HF patients (≥ 65 years) who were assessed for sarcopenia at discharge (median age 77 years, 309 males). Sarcopenia was diagnosed using grip strength, usual gait speed, and skeletal muscle mass according to international criteria. We used mid-upper arm circumference (MUAC), mid-upper arm muscle circumference (MAMC), calf circumference (CC), and skeletal muscle mass index (SMI) assessed by bioelectrical impedance analysis to assess skeletal muscle mass and defined sarcopenia in each of these measurements. Prognostic outcomes were composite events (all-cause death and HF rehospitalization) and cardiovascular disease (CVD) events (CVD death and CVD rehospitalization). Quality of life (QOL) was assessed using the 36-item Short-Form Health Survey physical functioning (SF-36PF) score. ResultsThe sarcopenia defined by MUAC [hazard ratio (HR): 2.50; 95 % confidence interval (95 % CI): 1.64–3.81; p < 0.001] or MAMC (HR: 1.98; 95 % CI: 1.35–2.92; p = 0.001) were associated with higher composite event rates than the non-sarcopenia. The sarcopenia defined by MUAC (HR: 1.88; 95 % CI: 1.25–2.83; p = 0.002) or MAMC (HR: 1.70; 95 % CI: 1.16–2.49; p = 0.007) were associated with higher CVD event rates than the non-sarcopenia. The sarcopenia defined by CC or SMI were not associated with prognoses. The sarcopenia defined by MUAC, MAMC, or CC were associated with low SF-36PF scores (all p < 0.05). ConclusionsThese results suggest that a diagnosis of sarcopenia based on MUAC or MAMC rather than CC or SMI reflects prognosis and QOL in older HF patients.

Clinical Significance of Lateral Pedicle Screw Malposition in Lumbar Spine Fusion.

Retrospective cohort study. Our objective was to determine whether lateral pedicle screw breach affects fusion rates and patient-reported outcomes in lumbar fusion surgery. Although lateral pedicle screw malposition is considered relatively benign, few studies have focused specifically on clinical outcomes or fusion rates associated with lateral screw malposition. Twelve-month postoperative computed tomography scans were reviewed for lateral breach, severity of breach, and fusion status. Patients with lateral breach were compared with patients with no breach. Outcome measures included Numerical Pain Rating Scale for back and leg pain, Oswestry Disability Index, and SF-36 physical function (SF-36 PF). Multivariable linear and logistic regression and were adjusted for age, procedure, level, and/or baseline pain score. Forty-five patients (31%) demonstrated 1 or more lateral breaches as compared with 99 patients without breach. After adjusting for baseline scores and fusion level, patients with 2 or more screw breaches experienced SF-36 PF score improvements that were 3.43 points less ( P =0.016) than patients with no lateral breach. After adjusting for baseline Numerical Pain Rating Scale, there was also a significant decrease in the odds of achieving minimally clinical important difference in back pain relief in these patients. There was no observed effect of lateral breach on the odds of successful fusion. The current study did not observe an association between laterally malpositioned pedicle screws and nonunion. However, results are consistent with a negative effect on SF-36 PF scores and self-reported back pain at 12 months.

SARC-F predicts poor motor function, quality of life, and prognosis in older patients with cardiovascular disease and cognitive impairment

ObjectivesWe investigated whether SARC-F scores were associated with motor function, quality of life (QOL) related to physical function, and prognosis in older patients with cardiovascular disease (CVD) and cognitive impairment. MethodsThis was a retrospective cross-sectional cohort study. The study population consisted of 408 patients with CVD (≥60 years old) who completed the SARC-F questionnaire and Mini-Cog, a cognitive function test, at discharge. Sarcopenia was defined as a total SARC-F score ≥ 4 points. Patients who were cognitively-preserved (Mini-Cog score ≥ 3 points) were excluded. Patients completed the handgrip strength, leg strength, usual gait speed, 6-minute walking distance, short physical performance battery score, and 36-item Short-Form Health Survey Physical Functioning (SF-36PF) tests before discharge. Associations of SARC-F with physical function, QOL, and prognoses (i.e., composite of all-cause death and emergency CVD rehospitalization and the number of CVD rehospitalizations) were investigated. ResultsSarcopenia (SARC-F score ≥ 4 points) was associated with poorer motor function test outcomes and SF-36PF scores (all P < 0.001). The correlations remained significant after adjusting for comorbidities (e.g., anemia, prior heart failure, and renal dysfunction). Sarcopenia was also associated with a poorer prognosis (hazard ratio: 1.574; 95 % confidence interval [CI], 1.011–2.445) and an increased risk of CVD rehospitalization (incidence rate ratio: 1.911; 95 % CI, 1.312–2.782) after adjusting for comorbidities. Conclusions and implicationsIn older patients with CVD and cognitive impairment, the SARC-F questionnaire may be a simple and inexpensive tool for identifying patients with decreased motor function and a poor prognosis.

Sustained physical activity in peripheral artery disease: Associations with disease severity, functional performance, health-related quality of life, and subsequent serious adverse events in the LITE randomized clinical trial.

This study investigated cross-sectional associations of peripheral artery disease (PAD) severity (defined by the ankle-brachial index (ABI)) and amounts of daily sustained physical activity (PA) (defined as > 100 activity counts per minute lasting 5 consecutive minutes or more). This study also investigated associations of amounts of daily sustained PA with 6-minute walk (6MW) distance and the Short Form-36 physical functioning domain (SF-36 PF) score in cross-sectional analyses and with serious adverse events (SAEs) in longitudinal analyses of people with PAD. PA was measured continuously for 10 days using a tri-axial accelerometer at baseline in 277 participants with PAD randomized to the LITE clinical trial. In regression analyses, each 0.15 lower ABI value was associated with a 5.67% decrease in the number of daily bouts of sustained PA (95% CI: 3.85-6.54; p < 0.001). Every additional bout of sustained PA per day was associated with a 4.56-meter greater 6MW distance (95% CI: 2.67-6.46; p < 0.0001), and a 0.81-point improvement in SF-36 PF score (95% CI: 0.34-1.28; p < 0.001). Participants with values of daily bouts of sustained PA below the median had higher rates of SAEs during follow-up, compared to participants above the median (41% vs 24%; p = 0.002). In conclusion, among participants with PAD, lower ABI values were associated with fewer bouts of daily sustained PA. A greater number of bouts of daily sustained PA were associated with better 6MW performance and SF-36 PF score, and, in longitudinal analyses, lower rates of SAEs. Clinicaltrials.gov ID: NCT02538900.

Self-reported functional ambulation is related to physical mobility status in polio survivors; a cross-sectional observational study.

The condensed 3-level version of the self-reported ambulation classification by Perry is a validated, simple-to-use instrument in clinical practice to classify functional ambulation. To further validate the clinical meaning of the classification for polio survivors, we compared physical mobility status across 3 functional ambulation categories and investigated the relation between physical mobility and functional ambulation category. We investigated a convenience sample of 140 individuals with polio [mean (SD) age 59.4 (12.1) years; 74 men] who were able to walk at least indoors. For indicators of physical mobility status, we assessed the walked distance (m) and walking energy cost (Jkg-1m-1) during a 6-min walk test at a comfortable speed. Furthermore, self-reported physical functioning and fatigue were assessed with the 36-item Short Form Health Survey physical functioning scale (SF36-PF) and Fatigue Severity Scale (FSS), respectively. Self-reported functional ambulation was classified as household walker, limited community walker or full community walker. The mean (SD) walked distance, energy cost, and SF36-PF and FSS scores significantly differed between household walkers (n=48) and limited community walkers (n=63) [275 (67) m; 6.35 (1.80) Jkg-1m-1; 27.7 (13.5), 5.53 (1.06), respectively, and 323 (73) m; 5.49 (1.50) Jkg-1m-1; 40.1 (15.1); 4.81 (1.38) (P<0.018)] and full community walkers (n=29) [383 (66) m; 4.68 (0.85) Jkg-1m-1; 63.9 (18.5), 3.85 (1.54) (P<0.001)], with significant differences also present between limited and full community walkers (P<0.05). Walked distance and SF36-PF score were significantly associated with functional ambulation level, determining 46% of the variance in ambulation level. The simple, self-reported classification of functional ambulation in 3 levels is clinically meaningful for polio survivors because it consistently corresponds to differences in objective and self-reported indicators of physical mobility and, as such, can be used to better manage rehabilitation treatment.

Physiological and neuropsychological features of adaptation to training in conditions of Western Ural among foreign students from India

Aim. To study the physiological and neuropsychological features of adaptation to training in conditions of Western Ural among foreign students from India.&#x0D; Materials and methods. The object of study – first-year foreign students from India and Russian students of E.A. Vagner Perm State Medical University (52 and 47 persons, respectively). There were studied the parameters of physical development and cardiovascular system, including those with loading, as well as hypoxia tolerance tests. The following indices were calculated: body mass index (BMI), Robinson and Kerdo index, cardiac performance index (CPI), strength index (SI). The health level was calculated by G.L. Apanasenko. Peculiar features of students’ neuropsychical status were studied using the following surveys: Spilberger-Hanin Anxiety Scale to determine personal and situational anxiety, Beck Depression Inventory (BDI), scale for assessment of depression symptoms CES-D, scale for assessment of quality of life SF-36 with subscales, Epworth Sleepiness Scale, asthenia scale MFI-20, CAM (cenesthesia, activity, mood).&#x0D; Results. Among Indian students, dispersion of BMI values and lower dynamometry indices were established. Hypoxia tolerance in the groups was similar. Kerdo index values in the group of Indian students showed a tendency to vagotonia, in the control group – to normotonia. No significant differences in other indices were registered. Health level in the studied groups was in “dangerous” zone regarding the risk for development of chronic noninfectious diseases, especially in the group of Indian students. The situational anxiety level by Spilberg 1 scale, and depression level by CES-D scale were reliably higher in the group of foreign students (p &lt; 0.0001). SF-36 PF and SF-36 GH scores in Indian students were reliably lower versus Russian. Psychical component of health by SF-36 MH subscale was significantly higher in Russian students.&#x0D; Conclusions. Among first-year students from India, who study at Perm State Medical University, there is observed a complex adaptive syndrome, which needs to be taken into account and corrected to prevent deadaptation disorders and raise progress in studies as well as quality of life and health status.

36-Item Short Form Survey (SF-36) Versus Gait Speed As Predictor of Preclinical Mobility Disability in Older Women: The Women's Health Initiative.

To compare the value of clinically measured gait speed with that of the self-reported Medical Outcomes Study 36-item Short-Form Survey Physical Function Index (SF-36 PF) in predicting future preclinical mobility disability (PCMD) in older women. Prospective cohort study. Forty clinical centers in the United States. Women aged 65 to 79 enrolled in the Women's Health Initiative Clinical Trials with gait speed and SF-36 assessed at baseline (1993-1998) and follow-up Years 1, 3, and 6 (N = 3,587). Women were categorized as nondecliners or decliners based on changes (from baseline to Year 1) in gait speed and SF-36 PF scores. Logistic regression models were used to estimate incident PCMD (gait speed <1.0 m/s) at Years 3 and 6. Area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of SF-36 PF with that of measured gait speed. Slower baseline gait speed and lower SF-36 PF scores were associated with higher adjusted odds of PCMD at Years 3 and 6 (all P < .001). For gait speed, decliners were 2.59 times as likely to have developed PCMD as nondecliners by Year 3 and 2.35 times as likely by Year 6. Likewise, for SF-36, decliners were 1.42 times as likely to have developed PCMD by Year 3 and 1.49 times as likely by Year 6. Baseline gait speed (AUC = 0.713) was nonsignificantly better than SF-36 (AUC = 0.705) at predicting PCMD over 6 years (P = .21); including measures at a second time point significantly improved model discrimination for predicting PCMD (all P < .001). Gait speed identified PCMD risk in older women better than the SF-36 PF did, although the results may be limited given that gait speed served as a predictor and to define the PCMD outcome. Nonetheless, monitoring trajectories of change in mobility are better predictors of future mobility disability than single measures.

Changes in physical functioning among men and women aged 50-79 years in Germany: an analysis of National Health Interview and Examination Surveys, 1997-1999 and 2008-2011.

BackgroundThis study examines changes in physical functioning among adults aged 50-79 years in Germany based on data from two German National Health Interview and Examination Surveys conducted in 1997–1999 (GNHIES98) and 2008–2011 (DEGS1).MethodsUsing cross-sectional data from the two surveys (GNHIES98, n = 2884 and DEGS1, n = 3732), we examined changes in self-reported physical functioning scores (Short Form-36 physical functioning subscale (SF-36 PF)) by sex and age groups (50–64 and 65–79 years). Covariables included educational level, living alone, nine chronic diseases, polypharmacy (≥5 prescribed medicines), body mass index, sports activity, smoking and alcohol consumption. Multimorbidity was defined as ≥2 chronic diseases. Multivariable models were fitted to examine consistency of changes in physical functioning among certain subgroups and to assess changes in mean SF-36 PF scores, adjusting for changes in covariables between surveys.ResultsMean physical functioning increased among adults aged 50–79 years between surveys in unadjusted analyses, but this change was not as marked among men aged 65–79 years who experienced rising obesity (20.6 to 31.5%, p = 0.004) and diabetes (13.0 to 20.0%, p = 0.014). Prevalence of multimorbidity and polypharmacy use increased among men and women aged 65–79 years. In sex and age specific multivariable analyses, changes in physical functioning over time were consistent across subgroups. Gains in physical functioning were explained by improved education, lower body mass index and improved health-related behaviours (smoking, alcohol consumption, sports activity) in women, but less so among men.ConclusionsPhysical functioning improved in Germany among adults aged 50–79 years. Improvements in the population 65–79 years were less evident among men than women, despite increases in multimorbidity prevalence among both sexes. Changes in health behaviours over time differed between sexes and help explain variations in physical functioning. Targeted health behaviour interventions are indicated from this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0377-0) contains supplementary material, which is available to authorized users.

Does Further Education in Adulthood Improve Physical and Mental Health among Australian Women? A Longitudinal Study.

ObjectiveWe analyzed whether further education in young adult and mid-life [adult educational mobility] influences physical functioning and depressive symptoms in women.Methods14247 women born 1973–78 (younger cohort) and 13715 women born 1946–51 (mid-aged cohort) from the Australian Longitudinal Study on Women’s Health were followed for 14–16 years. Measures were the Short-Form 36 Health Survey physical functioning subscale (SF-36 PF) and Centre for Epidemiologic Studies 10-item Depression Scale (CESD-10). Linear mixed modelling, accounting for time varying covariates, assessed the influence of further education on physical functioning and depressive symptoms over time. Sensitivity analysis to assess the impact of missing data was conducted using multiple imputation.ResultsCompared to younger women with a pre-existing high level of education, women gaining further education (up to age 39 years) from low levels had lower SF-36 PF scores (poorer physical functioning) (fully adjusted beta estimates (95%CIs) -1.52 (-2.59, -0.44)) while those gaining further education from middle to high levels showed equivalent SF-36 PF scores (-0.08 (-0.61, 0.44)). A similar pattern was shown for CESD-10 scores (0.78 (0.29, 1.25); -0.02 (-0.26, 0.21), respectively) where higher scores represented more depressive symptoms. For mid-age women, further education from a middle to high level resulted in equivalent SF-36 PF scores (-0.61 (-1.93,0.71)) but higher CESD-10 scores (0.49 (0.11, 0.86)), compared to highly educated women.ConclusionWomen who delay further education until they are aged between their 40s and 60s can improve or maintain their physical functioning but may have missed the critical time to minimise depressive symptomatology. Public health policy should focus on encouraging women to upgrade their educational qualifications earlier in life in order to potentially offset the negative associations between their initial lower socio-economic position class of origin and their mental health.

Using the Haemophilia Joint Health Score for assessment of teenagers and young adults: exploring reliability and validity

Outcome assessment in haemophilia is important to assess results of prophylactic treatment. Recently, the Haemophilia Joint Health Score (HJHS) was developed to assess early joint damage in children with haemophilia. Thus, the aim of this study was to assess reliability and explore validity of the HJHS in teenagers and young adults with haemophilia. Twenty-two patients with haemophilia (mean age 20.4, range 14-30, including 15 severe) were assessed by the HJHS1.0, Haemophilia Activities List (HAL), SF36 and self-evaluation was performed using a Visual Analogue Scale (VAS) scale. A subset of 12 patients were assessed by three physiotherapists to establish interobserver reliability (intraclass correlation coefficient: ICC). Total HJHS1.0 scores were calculated without overall global gait. Validity was explored by the assessment of Pearson's correlation with all outcome parameters and recent Pettersson scores. Overall outcome was good, with median HJHS score of 5.5 of a maximum 144 (range 0-34), median patients' VAS of 96.5 and maximum scores for HAL and SF36 physical functioning for the majority of patients. Pettersson scores were low (median 3.5 of 78, N = 18). Interobserver reliability was good (ICC 0.84), with limits of agreement of ±7.2 points. ICC was unaffected by different score calculation methods. Exploration of validity in 22 patients showed weak correlations of HJHS scores with patients' VAS (0.33) and HAL (-0.40) and strong correlations with SF36-PF (-0.66) and Pettersson scores (0.86). These results suggest that interobserver reliability of the HJHS1.0 in teenagers and young adults with limited joint damage is excellent. Preliminary data on validity were similar or better than those in children.

Repeatability and validity of a standardised maximal step-up test for leg function-a diagnostic accuracy study

BackgroundObjectively assessed physical performance is a strong predictor for morbidity and premature death and there is an increasing interest in the role of sarcopenia in many chronic diseases. There is a need for robust and valid functional tests in clinical practice. Therefore, the repeatability and validity of a newly developed maximal step up test (MST) was assessed.MethodsThe MST, assessing maximal step-up height (MSH) in 3-cm increments, was evaluated in 60 healthy middle-aged subjects, 30 women and 30 men. The repeatability of MSH and the correlation between MSH and isokinetic knee extension peak torque (IKEPT), self-reported physical function (SF-36, PF), patient demographics and self-reported physical activity were investigated.ResultsThe repeatability between occasions and between testers was 6 cm. MSH (range 12-45 cm) was significantly correlated to IKEPT, (r = 0.68, P < 0.001), SF-36 PF score, (r = 0.29, P = 0.03), sex, age, weight and BMI. The results also show that MSH above 32 cm discriminates subjects in our study with no limitation in self-reported physical function.ConclusionsThe standardised MST is considered a reliable leg function test for clinical practice. The MSH was related to knee extension strength and self-reported physical function. The precision of the MST for identification of limitations in physical function needs further investigation.

Prevalence and predictors of return to work in hospitalised trauma patients during the first year after discharge: A prospective cohort study

ObjectiveThe aim of the study was to investigate the proportion of patients who return to work and predictors of return to pre-injury level of work participation the first year after trauma. MethodsA prospective single-centre study of 188 patients aged 18–65 years with different degrees of injury severity was carried out in a trauma referral centre. All patients were working or studying full or part time before the injury. The first assessments were performed a median time of 27 days after discharge. Participation in work/education was measured 3 and 12 months after the first assessment with self-report questionnaires. The Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) were independent measures of anxiety, depression and post-traumatic stress symptoms (PTS) at baseline and 3 months. The Life Orientation Test Revised (LOT-R) measured optimism and pessimism at baseline. Predictors of return to work were identified by multiple logistic regression analysis. ResultsAfter one year, 131 patients (70%) had returned to the same level of participation in work or education; 95 (50%) had returned at 3 months. Independent predictors of return to work after 3 months were low age, low Injury Severity Score (ISS) score, not needing ventilator treatment and low score for depression symptoms, adjusted for gender (Nagelkerke R square 0.38). Low ISS, absence of serious head injury, low HADS depression score and an optimistic life orientation remained significant predictors of return to work at the same level after 12 months (Nagelkerke R square 0.38). In addition, good physical function (SF-36 PF score>65) at 3 months was an independent predictor of return to work at 12 months in the 93 patients who had not returned to work at 3 months. ConclusionIndependent predictors of return to work at 3 months were low age, low ISS and absence of depression symptoms. At 12 months, independent predictors of return to work were low ISS, low depression score and an optimistic life orientation.To promote early return to work, trauma patients might be screened for depression symptoms and pessimism, and intervention or treatment provided for those in need.

Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction

BackgroundComorbidities negatively affect prognosis more strongly in heart failure with preserved (HFpEF) than with reduced (HFrEF) ejection fraction. Their comparative impact on physical impairment in HFpEF and HFrEF has not been evaluated so far.Methods and resultsThe frequency of 12 comorbidities and their impact on NYHA class and SF-36 physical functioning score (SF-36 PF) were evaluated in 1,294 patients with HFpEF and 2,785 with HFrEF. HFpEF patients had lower NYHA class (2.0 ± 0.6 vs. 2.4 ± 0.6, p < 0.001) and higher SF-36 PF score (54.4 ± 28.3 vs. 54.4 ± 27.7, p < 0.001). All comorbidities were significantly (p < 0.05) more frequent in HFrEF, except hypertension and obesity, which were more frequent in HFpEF (p < 0.001). Adjusting for age and gender, COPD, anemia, hyperuricemia, atrial fibrillation, renal dysfunction, cerebrovascular disease and diabetes had a similar (p for interaction > 0.05) negative effect in both groups. Obesity, coronary artery disease and peripheral arterial occlusive disease exerted a significantly (p < 0.05) more adverse effect in HFpEF, while hypertension and hyperlipidemia were associated with fewer (p < 0.05) symptoms in HFrEF only. The total impact of comorbidities on NYHA (AUC for prediction of NYHA III/IV vs. I/II) and SF-36 PF (r 2) in multivariate analyses was approximately 1.5-fold higher in HFpEF, and also much stronger than the impact of a 10% decrease in ejection fraction in HFrEF or a 5 mm decrease in left ventricular end-diastolic diameter in HFpEF.ConclusionThe impact of comorbidities on physical impairment is higher in HFpEF than in HFrEF. This should be considered in the differential diagnosis and in the treatment of patients with HFpEF.

A questionnaire assessment of physical function in hyperlipidemic patients

A spectrum of myopathic manifestations has been recognized as associated with lipid lowering drug therapy (LLT), but their effect on quality of life and physical functioning is uncertain. We conducted a prospective cohort study in which physical functioning was the dependent variable, in patients with and without exposure to LLT. Consecutive patients attending a risk reduction clinic were invited to participate in a questionnaire study which included demographic data, muscular symptoms, the SF-36 Physical Function Score (PF), and the modified Health Assessment Questionnaire (mHAQ). Laboratory and co-morbidity data was recorded. Of 117 consecutive patients invited to participate, 112 consented. Of these, 81 were receiving statins and/or fibrates as LLT and 31 were participating in a non-pharmacologic therapeutic program (NPT) of diet and exercise therapy. The mean age for the total population was 56.7 years (20-78): the LLT group 58.6 and NPT group 51.9 years. Women comprised 53% of the LLT group and 58% of the NPT. No significant differences in baseline lipid profiles, CK level, BMI, waist measurement, gender, cigarette smoking, alcohol consumption, non-steroidal anti-inflammatory drugs or acetaminophen use, frequency of myalgias, SF-36 PF or mHAQ scores were observed between groups. On comparison of gender groups, we observed that men receiving LLT had significantly better SF- 36 PF (p = 0.037) than men on NPT. There were no differences in SF-36 PF or mHAQ scores between groups for females. We found no adverse effects of LLT on physical functioning or quality of life. Indeed, men treated with LLT had significantly better SF-36 PF scores than men treated non-pharmacologically.

Changes in Objective and Self-Reported Measures of Physical Capacity After an Intervention in Obese Older Women

The aim of this study was to determine if objective and self-reported measures of physical capacity are two equivalent methods to detect changes following an intervention in obese older women. 36 obese women aged between 55 and 75 years participated in a 3-month study with the aim of improving physical capacity by caloric restriction and/or resistance training. Physical capacity was measured objectively with 10 different tests and self-reported with the SF-36 physical functioning score (SF-36 PF score). Then the performance-to-objective tests were computed using quartiles to provide a baseline global physical capacity score. The mean percentage of change of the 10 tests as well as the SF-36 PF score were also calculated after the study. Body composition was measured by dual-energy X-ray (DXA) absorptiometry. The baseline global physical capacity score and the SF-36 PF score were significantly correlated at baseline (r = 0.43; P < 0.01). Eight out of the 10 objective tests of physical capacity improved after the intervention, while no improvement was observed for the SF-36 PF score. On average, percentage of change in physical capacity was 4.1 ± 5.9% for the SF-36 PF score and 11.1 ± 2.9% for the objective measures. However, no significant correlation was observed between percentage of changes between the two approaches after the intervention (r = 0.32; P = 0.07). Based on these results, the method used to quantify physical capacity after an intervention may have major implications on the outcomes. The methods used should be carefully analyzed in regard to the objective of the study.

Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication

Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease (PAD) without intermittent claudication have been established as beneficial. To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication. Randomized controlled clinical trial performed at an urban academic medical center between April 1, 2004, and August 8, 2008, involving 156 patients with PAD who were randomly assigned to supervised treadmill exercise, to lower extremity resistance training, or to a control group. Six-minute walk performance and the short physical performance battery. Secondary outcomes were brachial artery flow-mediated dilation, treadmill walking performance, the Walking Impairment Questionnaire, and the 36-Item Short Form Health Survey physical functioning (SF-36 PF) score. For the 6-minute walk, those in the supervised treadmill exercise group increased their distance walked by 35.9 m (95% confidence interval [CI], 15.3-56.5 m; P < .001) compared with the control group, whereas those in the resistance training group increased their distance walked by 12.4 m (95% CI, -8.42 to 33.3 m; P = .24) compared with the control group. Neither exercise group improved its short physical performance battery scores. For brachial artery flow-mediated dilation, those in the treadmill group had a mean improvement of 1.53% (95% CI, 0.35%-2.70%; P = .02) compared with the control group. The treadmill group had greater increases in maximal treadmill walking time (3.44 minutes; 95% CI, 2.05-4.84 minutes; P < .001); walking impairment distance score (10.7; 95% CI, 1.56-19.9; P = .02); and SF-36 PF score (7.5; 95% CI, 0.00-15.0; P = .02) than the control group. The resistance training group had greater increases in maximal treadmill walking time (1.90 minutes; 95% CI, 0.49-3.31 minutes; P = .009); walking impairment scores for distance (6.92; 95% CI, 1.07-12.8; P = .02) and stair climbing (10.4; 95% CI, 0.00-20.8; P = .03); and SF-36 PF score (7.5; 95% CI, 0.0-15.0; P = .04) than the control group. Supervised treadmill training improved 6-minute walk performance, treadmill walking performance, brachial artery flow-mediated dilation, and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication. Lower extremity resistance training improved functional performance measured by treadmill walking, quality of life, and stair climbing ability. clinicaltrials.gov Identifier: NCT00106327.

Comparison of the Indian version of Health Assessment Questionnaire Score and Short Form 36 Physical Function Score in rheumatoid arthritis using Rasch analysis

Objective The health assessment questionnaire (HAQ) has been modified by many investigators to suit the culture and lifestyle of Indian population and these have been validated using traditional approaches. The goal of this study was to further validate the Indian version of HAQ published in 2002 by modern psychometric analysis, specifically by examining fit of the scale's data to the Rasch measurement model. Methods A cross-sectional study was performed on 46 patients with rheumatoid arthritis (RA) from a single center in western India. Demographic characteristics, pain score and global perception of health were recorded on visual analogue scale. Functional outcome was assessed with the Indian HAQ and Short Form 36 physical function (SF 36-PF). Rasch analysis was performed to examine the property of various measures and to compare them on a common scale. Result The mean age ± SD was 45 ± 14.19 years and mean duration was 35.5 ± 52 months. 82.6% were women. The Indian HAQ highly correlated with SF 36-PF ( r = 0.812, P < 0.001). Both the indices showed a moderate correlation with fatigue, pain, global health perception as well as disease activity scores (DAS28). Both the indices satisfied the Rasch model and were unidimensional with adequate person separation and reliability. Nine out of the 12 items in Indian HAQ were fitting in the Rasch model while in SF 36-PF scale nine out of 10 were fitting in the Rasch model. Three items in the HAQ (a) sitting cross-legged, (b) bending, and (c) lifting a cup were not fitting in the Rasch model, while one item of SF 36 ‘walking one block’, was not fitting in the Rasch model. 2.2% of patients assessed by Indian HAQ had 0 score (floor effect), while none had 3 score (ceiling effect), while 15.2% had maximum SF 36-PF score (ceiling effect) while none had 100 score (floor effect). Conclusion Both Indian HAQ and SF 36-PF provide unidimensional measure of physical functioning in RA. SF 36-PF has significant psychometric advantage over Indian HAQ in RA in our cohort.

Relative Contributions of Adiposity and Muscularity to Physical Function in Community‐dwelling Older Adults

To determine the relative contributions of adiposity and muscularity to multi-dimensional performance-based and perceived physical function in older adults living independently. Data from 109 women and men, aged 60 or older, with low serum dehydroepiandrosterone (DHEA) sulfate levels were included in this cross-sectional analysis of baseline measures from a single-site, randomized, controlled trial of DHEA replacement therapy. Physical function was determined by means of performance on the 100-point Continuous Scale-Physical Functional Performance (CS-PFP) test and by self-reporting using the physical function subscale of the Medical Outcomes Short Form-36 (SF36PF). Body composition was measured by dual-energy X-ray absorptiometry (DXA). Linear regression analyses were used to determine the contributions of body mass index (BMI; kg body mass/m2), fat index (FI; kg fat/m2), and appendicular skeletal muscle index (ASMI; kg muscle/m2) to the CS-PFP and SF36PF scores, adjusted for age and sex. Age-adjusted regression analyses indicated that FI, but not ASMI, was a significant (P<0.001) determinant of CS-PFP (R2=0.54) and SF36PF (R2=0.37). When adjusted for age and sex, BMI was nearly as good a predictor of CS-PFP (R2=0.50) and SF36PF (R2=0.34) as FI. Adiposity was a stronger predictor of measured and self-reported physical function than was muscularity in older adults living independently. BMI, adjusted for sex, is a reasonable substitute for adiposity in the prediction of physical function.

Self-Perceived Functionality Correlates With Power Predicted Using a 30s Chair Stand Test

As individuals age, their capacity to produce power becomes increasingly indicative of their level of functionality and therefore likelihood of remaining independent. Identifying individuals who are approaching the threshold of power production at which they are likely to lose functionality would allow health professionals to intervene before serious injury or loss of independence occurs. The SF-36 is a thoroughly documented and validated survey on 8 health constructs that can be easily administered by the subject in less than 15 minutes, which makes it a test that can be easily integrated into a normal health visit. PURPOSE: To determine if self-perceived functionality, as measured by the SF-36 physical function score (SF-36PF), which is the sum of the physical and general health items of the SF-36, correlates with an elderly person′s lower body power output as computed from performance on a 30s chair stand test. METHODS: 47 members of an extended care facility completed SF-36 questionnaires via an interview format and responses on the physical and general health items were selected for our analysis. Subjects were instructed to perform chair rises at maximum speed for 30 seconds or until volitional fatigue. The test was performed with the participant′s arms held across the chest. For a stand to be counted, the subject was required to touch the chair at the bottom of the repetition and reach a fully upright position. Peak lower body power was predicted using our regression equation, which used body mass and number of stands as the predictor variables. Scores from the SF-36PF were correlated with the predicted peak power figures using Pearson′s r. RESULTS: There was a significant correlation between the SF-36PF score and the peak power predicted by the 30s chair stand test (r=.40, p<0.01) as defined by critical values for Pearson′s r. CONCLUSIONS: These results suggest that power is a major dictate of self-rated physical function in the elderly, and that the power formula developed in our laboratory for use with the 30s chair stand test may be an important diagnostic tool to use in preparing an effective exercise prescription.