SF-36 Physical Function Scale Research Articles

Behavioral and health outcomes from the NRG Oncology/NSABP B-36 trial comparing two different adjuvant therapy regimens for early-stage node-negative breast cancer.

The NSABP B-36 compared four cycles of doxorubicin and cyclophosphamide (AC) with six cycles of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC-100) in node-negative early-stage breast cancer. A sub-study within B-36, focusing on symptoms, quality of life (QOL), menstrual history (MH), and cardiac function (CF) was conducted. Patients completed the QOL questionnaire at baseline, during treatment, and every 6months through 36months. FACT-B Trial Outcome Index (TOI), symptom severity, and SF-36 Vitality and Physical Functioning (PF) scales scores were compared between the two groups using a mixed model for repeated measures analysis. MH was collected at baseline and subsequently assessed if menstrual bleeding occurred within 12months prior to randomization. Post-chemotherapy amenorrhea outcome was examined at 18months and was defined as lack of menses in the preceding year. Logistic regression was used to test for association of amenorrhea and treatment. CF assessment was done at baseline and 12months. Correlation analysis was used to address associations between changes in baseline and 12-month PF and concurrent CF changes measured by LVEF. FEC-100 patients had statistically significantly lower TOI scores during chemotherapy (P = 0.02) and at 6months (P < 0.001); lower Vitality score at 6months (P < 0.01), and lower PF score during the first year than AC patients. There were no statistically significant QOL score differences between the two groups beyond 12months. No significant differences in symptom severity between the two groups were observed. Rates of amenorrhea were significantly different between FEC-100 and AC (67.4% vs. 59.1%, P < 0.001). There was no association between changes in LVEF and PF (P = 0.38). Statistically significant QOL differences between the two groups favored AC; however, the magnitude was small and unlikely to be clinically meaningful. There was a clinical and statistically significant difference in risk for amenorrhea, favoring AC. NCT00087178; Date of registration: 07/08/2004.

Retrolisthesis and lumbar disc herniation: a postoperative assessment of outcomes at 8-year follow-up

BACKGROUND CONTEXTLumbar disc herniation and retrolisthesis have been shown to be significant degenerative changes that can be associated with back pain. Current literature has shown evidence that retrolisthesis is associated with similar baseline function in patients with L5–S1 disc herniation, but worse postoperative outcomes 2 years after lumbar discectomy. However, literature comparing long-term postoperative outcomes at 8-year follow-up in patients with L5–S1 disc herniation with retrolisthesis is lacking. PURPOSEThe purpose of the present study is to compare long-term postoperative outcomes at 8-year follow-up in patients with retrolisthesis and L5–S1 disc herniations to patients with L5–S1 disc herniations without retrolisthesis. STUDY DESIGNRetrospective review of prospectively collected data from the Spine Patients Outcomes Research Trial (SPORT) database. PATIENT SAMPLESixty-five patients who underwent lumbar discectomy for L5–S1 disc herniations with 8-year follow-up from the SPORT. OUTCOME MEASURESShort Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index, Sciatica Bothersomeness Index, and reoperation rate. METHODSBaseline surgical parameters, length of stay, complication rates, reoperation rates, and outcome measures were recorded in the SPORT database. Follow-up data were collected at 6 weeks, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, 6 years, 7 years, and 8 years. Retrolisthesis was defined as posterior subluxation ≥8%. Patients with and without retrolisthesis were compared using a mixed-effects model of longitudinal regression. Outcomes were calculated as time-weighted averages over 8 years. Reoperation rates were compared using the log-rank test based on time to first reoperation. RESULTSOne hundred-twenty five patients met inclusion criteria for the present study, including 29 patients with retrolisthesis (23.3%) and 96 patients who did not have retrolisthesis (76.7%). The greatest difference in clinical outcome measures was found at 2 years postoperatively. This was the only point at which both the Short Form-36 Bodily Pain scale (SF-36 BP) and PF showed significant differences between the retrolisthesis and nonretrolisthesis group. At 3 years, SF-36 BP was significantly lower in patients with retrolisthesis (39.9 vs. 52, p=.046).At 8-year follow-up, the presence of retrolisthesis in patients undergoing L5–S1 discectomy was not associated with worse outcome measure scores based on the area under the curve analysis for any metric investigated (SF-36 BP 41.4 vs. 47.1, p=.18; SF-36 Physical Function scale 38.9 vs. 45.4, p=.12; Oswestry Disability Index −39.4 vs. −34.8, p=.23; −11.6 vs. −10.4, p=.25) or a difference in reoperation rate (retrolisthesis group 10%, nonretrolisthesis group 17%, p=.41). CONCLUSIONSWhile retrolisthesis can contribute to low back pain and dysfunction in patients undergoing lumbar discectomy for L5–S1 herniated nucleus pulposus in early follow-up, no significant difference was found in postoperative outcomes after 3 years. Additionally, retrolisthesis was not found to be associated with different reoperation rates at 8 years postoperatively.

Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure

Physical rehabilitation in the intensive care unit (ICU) may improve the outcomes of patients with acute respiratory failure. To compare standardized rehabilitation therapy (SRT) to usual ICU care in acute respiratory failure. Single-center, randomized clinical trial at Wake Forest Baptist Medical Center, North Carolina. Adult patients (mean age, 58 years; women, 55%) admitted to the ICU with acute respiratory failure requiring mechanical ventilation were randomized to SRT (n=150) or usual care (n=150) from October 2009 through May 2014 with 6-month follow-up. Patients in the SRT group received daily therapy until hospital discharge, consisting of passive range of motion, physical therapy, and progressive resistance exercise. The usual care group received weekday physical therapy when ordered by the clinical team. For the SRT group, the median (interquartile range [IQR]) days of delivery of therapy were 8.0 (5.0-14.0) for passive range of motion, 5.0 (3.0-8.0) for physical therapy, and 3.0 (1.0-5.0) for progressive resistance exercise. The median days of delivery of physical therapy for the usual care group was 1.0 (IQR, 0.0-8.0). Both groups underwent assessor-blinded testing at ICU and hospital discharge and at 2, 4, and 6 months. The primary outcome was hospital length of stay (LOS). Secondary outcomes were ventilator days, ICU days, Short Physical Performance Battery (SPPB) score, 36-item Short-Form Health Surveys (SF-36) for physical and mental health and physical function scale score, Functional Performance Inventory (FPI) score, Mini-Mental State Examination (MMSE) score, and handgrip and handheld dynamometer strength. Among 300 randomized patients, the median hospital LOS was 10 days (IQR, 6 to 17) for the SRT group and 10 days (IQR, 7 to 16) for the usual care group (median difference, 0 [95% CI, -1.5 to 3], P = .41). There was no difference in duration of ventilation or ICU care. There was no effect at 6 months for handgrip (difference, 2.0 kg [95% CI, -1.3 to 5.4], P = .23) and handheld dynamometer strength (difference, 0.4 lb [95% CI, -2.9 to 3.7], P = .82), SF-36 physical health score (difference, 3.4 [95% CI, -0.02 to 7.0], P = .05), SF-36 mental health score (difference, 2.4 [95% CI, -1.2 to 6.0], P = .19), or MMSE score (difference, 0.6 [95% CI, -0.2 to 1.4], P = .17). There were higher scores at 6 months in the SRT group for the SPPB score (difference, 1.1 [95% CI, 0.04 to 2.1, P = .04), SF-36 physical function scale score (difference, 12.2 [95% CI, 3.8 to 20.7], P = .001), and the FPI score (difference, 0.2 [95% CI, 0.04 to 0.4], P = .02). Among patients hospitalized with acute respiratory failure, SRT compared with usual care did not decrease hospital LOS. clinicaltrials.gov Identifier: NCT00976833.

The physical functioning and mental health of informal carers: evidence of care-giving impacts from an Australian population-based cohort.

Informal carers represent a substantial proportion of the population in many countries and health is an important factor in their capacity to continue care-giving. This study investigated the impact of care-giving on the mental and physical health of informal carers, taking account of contextual factors, including family and work. We examined health changes from before care-giving commenced to 2 and 4years after, using longitudinal data from the Household Income and Labour Dynamics in Australia survey. The sample comprised 424 carers and 424 propensity score-matched non-carers. Health was self-assessed, measured with the SF-36 Health Survey Mental Health (MH) and Physical Functioning (PF) scales. Care-giving was classified as non-carer, low (<5hours/week), moderate (5-19hours/week) and high (20 or more hours/week). PF and MH change scores were regressed on baseline scores, care-giving, covariates (including work, family and socio-demographic characteristics) and interactions to identify impacts for subgroups. The physical and mental health impacts differed by gender, and care-giving hours and carer work hours were important contextual factors. Deterioration in both PF and MH was worse for females after 2years and deterioration in MH was worse for males after 4years. Among carers aged 40-64years, there was a 17-point decline in PF (P=0.009) and a 14-point decline in MH (P<0.0001) after 2years for female high caregivers working full-time and 9.3 point improvement (P=0.02) for non-working male high caregivers. Change was not significant for non-carers. The study found that not all carers suffer adverse health impacts; however, the combination of high levels of care-giving with workforce participation can increase the risk of negative physical and mental health effects (particularly in female carers). Working carers providing high levels of care represent a vulnerable subgroup where supportive and preventive services might be focused.

変形性膝関節症罹患者に対する運動療法は治療開始150日を超えても有効か？&amp;mdash;システマティックレビュー&amp;mdash;

Objective : We performed a systematic review to investigate improvements in body function and structure, activity, and health-related quality of life from exercise programs of >150 days' duration in patients with knee osteoarthritis (OA). Methods : We collected data on randomized controlled trials (RCTs) comparing the effects of exercise intervention with those of either nonintervention or psychoeducational intervention in patients with knee OA. Data were collected on pain, stiffness, muscle strength, range of motion, flexibility, maximal oxygen uptake, proprioception, time to climb a flight of stairs, disability as assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC), walking distance (e.g., 6-min walking-distance test), walking time (e.g., time to walk arbitrary distances), walking velocity, and health-related quality of life assessed using the SF-36® Health Survey (SF-36). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to determine the quality of the evidence. Results: Forty-one RCTs were identified. Outcomes that were significantly affected by exercise programs of >150 days were knee flexion muscle strength at a functional level, time to climb a flight of stairs and walking distance at activity level, and SF-36 General Health, Physical Functioning, Role-Physical, and Bodily Pain scales. The quality of evidence for these outcomes was moderate to high. Conclusion : In patients with knee OA, improvements in body function, activity, and health-related quality of life can be maintained with exercise programs of >150 days' duration, and these findings are supported by a moderate to high level of evidence.

Combining Cognitive-Behavioral Therapy and Milnacipran for Fibromyalgia

To evaluate the feasibility of a randomized-controlled trial and to obtain estimates of the effects of combined cognitive-behavioral therapy (CBT) and milnacipran for the treatment of fibromyalgia. Fifty-eight patients with fibromyalgia were randomized to 1 of the 3 treatment arms: (1) combination therapy (n = 20); (2) milnacipran+education (n = 19); and (3) placebo+CBT (n = 19). Patients received either milnacipran (100 mg/d) or placebo. Patients also received 8 sessions of phone-delivered CBT or educational instructions, but only from baseline to week 9. Assessments were conducted at baseline, week 9, and 21. The primary endpoints were baseline to week 21 changes in weekly average pain intensity and physical function (SF-36 physical function scale). Compared with milnacipran, combination therapy demonstrated a moderate effect on improving SF-36 physical function (SE = 9.42 [5.48], P = 0.09, effect size = 0.60) and in reducing weekly average pain intensity (mean difference [SE] = -1.18 [0.62], P = 0.07, effect size = 0.67). Compared with milnacipran, CBT had a moderate to large effect in improving SF-36 physical function (mean difference [SE] = 11.0 [5.66], P = 0.06, effect size = 0.70). Despite the presence of concomitant centrally acting therapies, dropout rate was lower than anticipated (15% at week 21). Importantly, at least 6 out of the 8 phone-based therapy sessions were successfully completed by 89% of the patients; and adherence to the treatment protocols was > 95%. In this pilot study, a therapeutic approach that combines phone-based CBT and milnacipran was feasible and acceptable. Moreover, the preliminary data supports conducting a fully powered randomized-controlled trial.

AB0505 Enhanced improvement in physical functioning with secukinumab treatment among RA patients: An application of IRT methodology

BackgroundThe effectiveness of rheumatoid arthritis (RA) treatment in improving physical functioning is most often measured using the HAQ-DI and SF-36v2 physical functioning (PF) scales. Items of the HAQ-DI assess lower...

Effectiveness of pre-operative physiotherapy-based programmes on outcomes following total knee arthroplasty: a systematic review and meta-analysis

Background: The rates of total knee arthroplasty (TKA) procedures have increased over the last 30 years. Prehabilitation has been advocated to enhance strength and functional capability in order to optimize post-operative rehabilitation.Objectives: A systematic review was conducted to determine the effectiveness of pre-operative physiotherapy-based interventions on outcomes following TKA.Methods: Searches of multiple databases of published (MEDLINE, EMBASE, CINAHL, AMED, the Cochrane library database and the PEDro database) and unpublished literature were conducted. All randomized and non-randomized controlled trials assessing pre-operative physiotherapy or exercise training were eligible. The PEDro scale was used to assess methodological quality.Results: Eleven trials including 656 participants were included. There were no statistically significant differences between groups for function as measured by the Western Ontario and McMaster Universities Osteoarthritis function scale, the SF-36 physical function scale, the Hospital for Special Surgery knee rating scale, pain scores, range of motion or length of stay (P>0·05). Of those studies reporting on objective measures of function, five out of eight studies reported no significant difference with the inclusion of pre-operative rehabilitation (P>0·05). Interventions based on neuromuscular electrical stimulation or proprioception in the intervention group demonstrated improvements in sit-to-stand and stair climbing/descending ability (P≤0·05) at 12 weeks after TKA.Conclusion: Pre-operative physiotherapy-based interventions can improve sit-to-stand, stair climbing/descending ability and standing balance post-TKA but do not have a significant effect on self-reported function, self-reported pain levels, range of motion or length of stay in the short-term. However, this should be viewed with caution, since the evidence-base presented with some major methodological limitations.

Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function

Background contextThe presence of retrolisthesis has been associated with the degenerative changes of the lumbar spine. However, retrolisthesis in patients with L5–S1 disc herniation has not been shown to have a significant relationship with worse baseline pain or function. Whether it can affect the outcomes after discectomy, is yet to be established. PurposeThe purpose of this study was to determine the relationship between retrolisthesis (alone or in combination with other degenerative conditions) and postoperative low back pain, physical function, and quality of life. This study was intended to be a follow-up to a previous investigation that looked at the preoperative assessment of patient function in those with retrolisthesis and lumbar disc herniation. Study designCross-sectional study. Patient samplePatients enrolled in SPORT (Spine Patient Outcomes Research Trial) who had undergone L5–S1 discectomy and had a complete magnetic resonance imaging scan available for review (n=125). Individuals with anterolisthesis were excluded. Outcome measuresTime-weighted averages over 4 years for the Short Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index (ODI), and Sciatica Bothersomeness Index (SBI). MethodsRetrolisthesis was defined as a posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 to 3 and collectively classified as vertebral end plate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy was classified jointly as posterior degenerative changes. Longitudinal regression models were used to compare the time-weighted outcomes over 4 years. ResultsPatients with retrolisthesis did significantly worse with regard to bodily pain and physical function over 4 years. However, there were no significant differences in terms of ODI or SBI. Similarly, retrolisthesis was not a significant factor in the operative time, blood loss, lengths of stay, complications, rate of additional spine surgeries, or recurrent disc herniations. Disc degeneration, modic changes, and posterior degenerative changes did not affect the outcomes. ConclusionsAlthough retrolisthesis in patients with L5–S1 disc herniation did not affect the baseline pain or function, postoperative outcomes appeared to be somewhat worse. It is possible that the contribution of pain or dysfunction related to retrolisthesis became more evident after removal of the disc herniation.

Assessment of response shift using two structural equation modeling techniques.

To identify response shift using two structural equation modeling (SEM) techniques. Hypertensive patients (n=909) with coronary artery disease (CAD) completed SF-36 surveys at both baseline and 1-year follow-up. Response shift was identified using Oort and Schmitt SEM techniques. The type of response shift linked to changes in various parameters of the SEM measurement model is defined differently for both SEM approaches. Effect sizes were calculated for the impact of response shift on the change of SF-36 domain scores when using the Oort approach. Both Oort and Schmitt SEM approaches identified response shift only in the SF-36 physical functioning (PF) scale. The effect size of recalibration on the change of PF domain scores when using the Oort approach was -0.12. This study showed that hypertensive patients with CAD experienced a response shift over a 1-year period. Both the SEM approaches identified response shift (uniform recalibration using the Oort approach and recalibration using the Schmitt approach); however, both approaches use different parameters to define and test response shift. We found that either the variation in analytic methods or the sample used may influence the identification and type of response shift.

An investigation of the validity of six measures of physical function in people awaiting joint replacement surgery of the hip or knee

Objective: To assess and compare the validity of six physical function measures in people awaiting hip or knee joint replacement. Design: Eighty-two people awaiting hip or knee replacement were assessed using six physical function measures including the WOMAC Function scale, SF-36 Physical Function scale, SF-36 Physical Component Summary scale, Patient Specific Functional Scale, 30-second chair stand test, and 50-foot timed walk. Validity was assessed using a head-to-head comparison design. Results: Convergent validity was demonstrated with significant correlations between most measures (Spearman’s rho 0.22 to 0.71). The Patient Specific Functional Scale had the lowest correlations with other measures of physical function. Discriminant validity was demonstrated with low correlations between mental health and physical function scores (Spearman’s rho −0.12 to 0.33). Only the WOMAC Function scale, 30-second chair stand test, and 50-foot timed walk demonstrated known groups validity when scores for participants who walked with a gait aid were compared with those who did not. Standardized response means and Guyatt’s responsiveness indexes indicated that the SF-36 was the least responsive measure. Conclusions: For those awaiting joint replacement surgery of the hip or knee, the current investigation found that the WOMAC Function scale, 30-second chair stand test, and 50-foot timed walk demonstrated the most evidence of validity. The Patient Specific Functional Scale might complement other measures by capturing a different aspect of physical function.

Sedentary Behavior and Physical Function Decline in Older Women: Findings from the Women's Health Initiative.

Sedentary behavior is associated with deleterious health outcomes. This study evaluated the association between sedentary time and physical function among postmenopausal women in the Women's Health Initiative Observational Study. Data for this prospective cohort study were collected between 1993–1998 (enrollment) and 2009, with an average of 12.3 follow-up years. Analyses included 61,609 women (aged 50–79 years at baseline). Sedentary time was estimated by questionnaire; physical function was measured using the RAND SF-36 physical function scale. Mixed-model analysis of repeated measures was used to estimate the relationship of sedentary time exposures and changes in physical function adjusting for relevant covariates. Compared to women reporting sedentary time of ≤6 hours/day, those with greater amounts of sedentary time (>6–8 hours/day, >8–11 hours/day, >11 hours/day) reported lower physical function between baseline and follow up (coefficient = −0.78, CI = −0.98, −0.57, −1.48, CI = −1.71, −1.25, −3.13, and CI = −3.36, −2.89, respectively P < 0.001). Sedentary time was strongly associated with diminished physical function and most pronounced among older women and those reporting the greatest sedentary time. Maintaining physical function with age may be improved by pairing messages to limit sedentary activities with those promoting recommended levels of physical activity.

Long-term quality of life after breast cancer: a French registry-based controlled study

Population-based studies on quality of life (QOL) of long-term breast cancer survivors are quite recent and insufficient attention has been paid to the effect of time since diagnosis. We compared long-term QOL of population-based breast cancer survivors 5, 10, and 15 years after diagnosis with that of healthy controls. Breast cancer survivors were randomly selected from three population-based cancer registries (Bas-Rhin, Calvados and Doubs, France) along with healthy controls, stratified for age and place of residence, randomly selected from electoral rolls. Participants completed five self-administered questionnaires: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), Short Form-36 (SF-36), Spielberger State-Trait Anxiety Inventory (STAI), Multidimensional Fatigue Inventory (MFI) and a life conditions questionnaire. An analysis of variance was used to compare QOL scores of breast cancer survivors by period (5, 10, or 15 years) of diagnosis with those of controls, adjusted for sociodemographic data and comorbidities. Six hundred and fifty-two cases and 1,188 controls participated in the study. For many QOL scales, scores were significantly different between cancer survivors and controls. A clinically significant difference was evidenced for the fatigue scales, the SF36 physical functioning, role-physical, and role-emotional scales, with more favorable results for controls. Differences decreased with time and 15-year cancer survivors were generally not different from controls. Scores were particularly influenced by age and mean household income. More efforts should be made, specifically during the first 5 to 10 years after diagnosis, to help women with breast cancer to overcome their impairment in QOL.

Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program.

IntroductionSignificant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery.MethodsA multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge.ResultsOf the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects (P = 0.84) or group by time interactions (P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores.ConclusionsThis individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention.Trial registrationAustralia and New Zealand Clinical Trials Register ACTRN12605000166673

Patient-Level Minimal Clinically Important Difference Based on Clinical Judgment and Minimally Detectable Measurement Difference

A proof of concept case study. To introduce and evaluate a method for identifying what constitutes a minimal clinically important difference (MCID) in the SF-36 Physical Function scale at the patient level. MCID has become increasingly important to researchers interested in evaluating patient care. Over the last 30 years, an array of approaches for assessing MCID has evolved with little consensus on which approach applies in any given situation. Three approaches for estimating standard errors of measurement (se) and a 30% change approach for establishing MCID were evaluated for the physical function (PF) scale with SPORT patients in the intervertebral disc herniations cohort. MCIDs for each se approach were then developed based on (1) these standard errors and (2) clinically relevant factors including: (a) baseline PF score and (b) acceptable risk for type I error. RESULTS.: Intervertebral disc herniations patients (N = 996) identified from the SPORT database met inclusion criteria. The se for the classic test theory (CTT)-based test level approach was 9.66. CTT-score-level and IRT-pattern-level standard errors varied depending on the score, and ranged between (2.73-7.17) and (5.96-16.2), respectively. As predicted, CTT-score-level se values were much smaller than IRT-pattern-level se values at the extreme scores and IRT-pattern-level se values were slightly smaller than CTT score-level se values in the middle of the distribution. Across follow-up intervals, the CTT-score-based approach consistently demonstrated greater sensitivity for identifying patients who were improved or worsened. Comparisons of CTT-based-score-level se and 30% improvement rule MCID estimates were as hypothesized: MCID values for 30% gains demonstrated substantially lower sensitivity to change for baseline PF scores in the 0 to 50 range but were similar to CTT-score-level-based MCIDs when baseline scores were above 50. The CTT-based-score-level approach for establishing MCID based on the clinical relevance of the baseline PF score and the tolerance for erroneously accepting an observed change as reliable provided the more sensitive and theoretical compelling approach for estimating MCID at the patient level, which in turn will provide fundamentally important to the clinician regarding treatment efficacy at the patient level.

Successful Treatment of Lumbar Discogenic Pain Using Intradiscal Biacuplasty in Previously Discectomized Disc

Discogenic back pain is frequently present in patients after discectomy. Here, we describe a case of young woman, previously discectomized, who was treated by a novel annuloplasty procedure, intradiscal biacuplasty (IDB). The improvement in functional capacity and pain scores were profound 12 months after the IDB. Visual analog pain scores (0-10) changed from 5 to 3. Oswestry scale showed functional improvement from 52%, or severe disability, to 14%, or minimal disability, and the SF-36 physical function scale score changed from 55 to 95. IDB may be an effective treatment for patients with discogenic pain from previously discectomized discs.

Clinical Trial of Wellness Training

This randomized controlled trial examined benefits of adding active health promotion to basic primary care (BPC) services for SMI adults. It compared BPC with BPC plus wellness training (WT), a 12 months intervention promoting individual skills in self-management. Three hundred nine participants enrolled during short-term residential treatment completed baseline assessments and were assigned to treatment groups, before discharge. Outcomes of perceived health status (SF-36), global assessment of function, and ratings of self-efficacy were assessed at follow-up interviews at 6, 12, and 18 months. The intent-to-treat analysis employed multilevel regression to examine differences by group on outcomes across time, controlling for health related covariates. The WT group showed significantly better outcomes on the SF-36 physical functioning and general health scales. Findings affirm ability of SMI adults to benefit from active health promotion.

Measuring health-related quality of life for persons with mobility impairments: an enabled version of the short-form 36 (SF-36E)

Examine psychometric properties of the SF-36 and SF-36E for mobility-impaired individuals and assess whether the SF-36E yields higher health-related quality-of-life scores. We altered the SF-36 Physical Function scale by substituting the word "go" for "walk" and "climb" and changed the stem to reflect function using assistive devices. We compared responses between versions for 201 individuals with disabilities (n = 95 wheelchair users, n = 48 other device users, 58 = no device users). Both surveys yielded reliable scores, but floor and ceiling effects occurred with both versions. Confirmatory factor analyses demonstrate good fit for the SF-36 and SF36E, but were compromised by low sample size. Respondents demonstrated significantly better Role Physical, Bodily Pain, and Vitality on the SF-36E, but worse General Health. The World Health Organization framework, the International Classification of Functioning, Disability, and Health (ICF) suggests that it is important to know both what one can do without assistance (capacity) and what one can do with assistance (performance). Results suggest that the SF-36E successfully measures performance among mobility-impaired individuals, including wheelchair users. However, further validation studies of the SF-36 and SF-36E are warranted with samples of individuals with disabilities.

Evaluation of functional results according to Body Mass Index in patients with acute non-specific low back pain

Objective: The aim of our study was to detect the factors which might affect the recovery of the patients with Acute Non-Specific Low Back Pain (ANSLBP) according to their Body Mass Index (BMI), and to determine the effects of these factors on disability and the perceived functional level with quality of life. Design: A retrospective study. Patients: Ninety-three patients were included in the study, and separated as three groups according to BMI (normal weight group, Grade1 obesity group, Grade 2 obesity group). Methods: Acute Low Back Pain Screening Questionnaire (ALBPSQ) and SF-36 Physical Functioning Scale (PFS) were used in the evaluation of the patients. Results: The ALBPSQ and SF-36 PFS results of our patients in all three groups before and after the treatment were found to be significant in the direction of positive scores ( p< 0.05). When the SF-36 PFS scores and the total scores of ALBPSQ were compared among the groups according to the increase of the obesity, there existed a significant difference ( p< 0.05). Between the ALBPSQ and SF-36 PFS scores, in the three groups correlation was determined in the negative direction. Conclusion: With the treatment applied to our patients, pain and disability with the quality of life showed positive differences, but the results were observed to be affected unfavorably through the increase of obesity based on the functional status and decrease in the quality of life.

The effects of gender and age on health‐related quality of life following kidney transplantation

To evaluate whether gender, age and their interaction affect health-related quality of life and overall health status following kidney transplantation. Some investigators have examined the main effects of gender and/or age on health-related quality of life following kidney transplantation, but the potential interaction effect of these measures on this outcome has not been reported. This was a cross-sectional, single-centre study, based in one US geographic area. Self-report survey data were provided by adult kidney transplant recipients using the SF-36 Health Survey (SF-36) and a visual analogue scale of overall health. SF-36 physical and mental component summary and individual scales and overall health were measured prospectively at one time point post-transplant. All adult patients were eligible to participate and rolling enrolment was employed. Statistical effects were tested using analysis of covariance (controlling for time post-transplant). Subjects (n = 138) included 66 women and 72 men. There were no effects of gender, age group, or their interaction on MCS or overall health scores (all p >or= 0.12). Physical component summary scale data demonstrated: (i) a significant effect of gender (p = 0.025); (ii) a statistically marginal effect of age group (p = 0.068); and (iii) a statistically marginal gender by age group interaction effect (p = 0.066). Women reported poorer scores on the SF-36 physical functioning (p = 0.049), role physical (p = 0.014) and bodily pain scales (p = 0.028). There was an effect of age group on physical functioning (p = 0.005), with younger patients reporting higher scores. Women report lower scores on several physical measures and may experience a greater reduction with age in physical health-related quality of life than men. Physical functioning declines with age following kidney transplantation. Findings may help healthcare professionals to develop gender- and age-specific interventions to optimize health-related quality of life of kidney transplant patients.