SF-36 Scale Scores Research Articles

Correlation between pain response and improvements in patient-reported outcomes and health-related quality of life in duloxetine-treated patients with diabetic peripheral neuropathic pain.

ObjectiveWe assessed whether quality of life (QoL) improvement in duloxetine-treated patients with diabetic peripheral neuropathic pain (DPNP) correlates with the extent of pain relief.MethodsPooled data from three multicountry, double-blind, 12-week, placebo-controlled trials of duloxetine-treated (duloxetine 60 mg once daily; total number =335) patients with DPNP were analyzed. Based on improvement in 24-hour average pain scores, patients were stratified into four groups. Improvement in QoL, which was measured as the change from baseline in two patient-reported health outcome measures (Short Form [SF]-36 and five-dimension version of the EuroQol Questionnaire [EQ-5D]), was evaluated and compared among the four groups. Pearson’s correlation coefficient was calculated to assess the correlation between improvement in pain scores and improvement in QoL.ResultsThe group with more pain improvement generally showed greater mean change from baseline in all of the SF-36 scale scores and on the EQ-5D index. Pearson’s correlation coefficients ranged from 0.114 to 0.401 for the SF-36 scale scores (P<0.05), and it was 0.271 for the EQ-5D (P<0.001).ConclusionImprovement in pain scores was positively correlated with improvement in QoL and patient-reported outcomes in duloxetine-treated patients.

Comparison of the efficacy of total knee arthroplasty with different prostheses for knee valgus

Objective To compare the efficacy of fixed bearing(FB) and rotating bearing(RB) in total knee arthroplasty (TKA) for knee valgus. Methods Data of 203 cases with valgus knee deformity who had undergone TKA procedure from January 2007 to December 2013 were retrospectively analyzed. 181 cases were primary joint replacement. They were divided into FB group and RB group. 168 patients (168 knees) were followed-up for more than 2 years. 83 cases (83 knees) were in FB group, and 85 cases (85knees) were in RB group. There were 57 males and 111 females, aged from 40 to 79 years, with an average age of 59.3±7.2 years. Among them, 153 cases were osteoarthritis and 15 cases were rheumatoid arthritis. Activities of the knee, tibiofemoral angle on X-ray, Hospital for Special Surgery (Hospital for Special Surgery, HSS) knee score and the SF-36 scale scores were recorded before surgery and at the final follow-up. Results All patients were followed up for 24 to 84 months (average, 37.4 months). The average knee activities of the fixed bearing and rotating mobile bearing were from 72.8°±13.1°and 71.2°±12.8° before surgery to 106.5°±9.8°and 115.4°±7.9° at final follow-up. The average tibiofemoral angle on X-ray decreased from 16.8°±5.3° and 15.2°±4.7° preoperatively to 5.6°±2.3 and 5.2°±2.1° at the final follow-up. The HSS knee score improved from 47.5±7.1 points and 49.6±8.9 points to 89.1±4.6 points and 90.2±5.3 points at final follow-up. The SF-36 scale scores improved from 52.3±15.4 points and 50.1±17.9 points to 81.6±12.3 points and 82.2±14.5 points at the final follow-up. At the latest follow-up, except the Range of motion, there were no statistically significant in any other indicator between two groups. Two cases appeared postoperative deep venous thrombosis symptoms. One case had joint stiffness early, and the symptoms improved after strengthen functional exercise. No infections, delayed knee instability, implant loosening or subsidence was found during the follow-up. Conclusion For patients with mild to moderate knee valgus, both fixed and rotating bearing with same soft tissue balance technique can improve the knee function and correct the valgus deformity, and the recent results are satisfactory. Key words: Genu Valgum; Arthroplasty, replacement, knee; Prostheses and implants

Smoking and Health-Related Quality of Life (SF-36). A Population-Based Study in Campinas, SP, Brazil

Introduction: Smoking persists as a global and relevant health problem being one of the major risk factors to non-communicable diseases and early death. Studies on the association between smoking and health related quality of life (HRQL) are scarce in Brazil and Latin America. The aim of this study was to analyze the HRQL according to smoking status on adults aged 20 to 59 years, living in Campinas, Brazil. Method: It is a population-based cross-sectional study, carried out with data from the Campinas Health Survey developed in 2008/2009. The dependent variables were the eight scales and the two components—physical (PCS) and mental component summary (MCS) of the instrument SF-36, version 2. Means and confidence intervals of the SF-36 scale scores and components were estimated according to smoking (never smokers, former smokers, current smokers) and nicotine dependence (mild, moderate, heavy). Results: The sample comprised 957 individuals (mean age of 37.5 years). Comparing with never smokers, smokers had lower score means in all SF-36 scales, except in physical functioning and role-physical; among the former smokers, lower scores were observed in vitality and mental health. A reduction of the MCS score was observed among smokers and former smokers among men; but in the female population, this reduction was observed only in smokers compared with never smokers. According to the nicotine dependence, it was observed an increasing reduction in MCS scores from mild, to moderate and heavy smokers. Conclusion: Smoking is significantly and negatively associated with HRQL in the studied population. The results point out the importance of the strategic policies against smoking, to reduce morbidity and premature death, but also to increase the quality of life and well-being. It is also important to consider the mental health dimension, since that best mental health can be relevant to promote healthier behaviors.

Anxiety, depression, social phobia, and quality of life in Turkish patients with acne and their relationships with the severity of acne

To investigate the psychiatric characteristics of acne vulgaris and the effects of the disease on quality of life. Materials and methods: We included 70 acne patients and 50 healthy controls. The Structured Clinical Interview for DSM-IV Axis I Disorders, Hospital Anxiety and Depression Scale, Liebowitz Social Anxiety Scale, Quality of Life Scale Short Form, and Acne Quality of Life Questionnaire were applied. Results: Anxiety and depression scores of the acne patients were significantly higher than those of the control group. In patients with acne, significantly higher levels of social anxiety were detected. Social anxiety levels of severe acne cases were significantly higher. Social phobia was the most common axis I disorder. According to the SF-36 scale, vitality, social functioning, and emotional role difficulty scores were significantly higher in acne patients. Conclusion: Especially when acne vulgaris is severe, psychiatric evaluation and psychotherapeutic interventions particularly aimed at social anxiety symptoms and social functioning should be important parts of the treatment plan.

Falls and health-related quality of life (SF-36) in elderly people—ISACAMP 2008

Falls are accidental events and harmful to the healthy elderly. Its consequence can lead to the disability and the death. Accordingly, it becomes important to assess the relation between falls and quality of life. This theme is little studied in Brazil and internationally, especially in areas with large population bases. Objective: To identify the association between occurrence of fall and health-related quality of life (HRQL) using the SF-36 according to gender, age and schooling, among the elderly population of Campinas/Brazil. Methods: A cross-sectional, population-based study, using data from ISACAMP 2008. The present study analyzed only the population with 60 years old or more, totaling 1432 elderly individuals. The dependent variables were the eight SF-36 scale, version 2. The main independent variables were the falls occurred in the last 12 months and the limitation in activities daily living due to the falls. Analysis were carried out with the simple and multiple linear regression model in order to determine the associations between the dependent and main independent variables, using svy commands of STATA 11.0. Results: The prevalence of falls in the last year was 6.3%. The elderly individuals who referred to fall in the last 12 months exhibited the lowest score in seven of eight SF-36 scales, comparing with non-fallers. The association between fall and HRQL was greater in the male population. The elderly individuals who are older (75 or more) and located in the lower schooling stratum, and experienced falls also exhibited the lowest SF-36 scale scores, in physical and social functioning. Stratifying falls, considering those who cause limitations and those who do not, can be observed with the lowest scores in physical functioning, role physical, role emotion and social functioning, and only in the stratum of people who have limitations in daily living. Conclusion: The occurrence of falls can cause important limitations in the elderly individuals, and the limitations are associated with the worst health condition and quality of life. It is important to consider that the fragile elderly, especially in physical, social functioning, with pain, and role physical, are most vulnerable to experience falls, principally those who cause limitation.

Factor analysis of a health-promoting lifestyle profile (HPLP): Application to older adults in Mainland China

This research reports preliminary psychometric properties, especially the factor structure, of a Chinese version of a health-promoting lifestyles profile designed for older adults; and examines the distribution of the health-promoting behavioral patterns – both for the purpose of developing culturally sensitive health advancement strategies for Chinese seniors. Responses to this questionnaire were used to measure health-promoting behaviors in a random sample of 1012 elderly Chinese from thirty communities in Xi’an Shaanixi-Province. DesignFactor analysis relied on polychoric correlations with ordinal categorical data were used to evaluate reliability and validity of a revised Chinese version of the health-promoting lifestyles profile (HPLP-C). Because this revised version was used to assess elderly adults, we termed it the HPLP-CE. This factor analysis supported a six-factor model of the original HPLP-C scale. Confirmatory factor analysis indicated a good fit, with factors explaining 88.1% of the common variance of the HPLP-CE scores. Cronbach's α coefficients were 0.91 for the revised instrument, and ranged from 0.67 to 0.88 for six dimensions. The split-half reliability was 0.92, while the test–retest reliability was 0.68. Relationships between HPLP-CE, perceived health status, SF-36 scale scores, and associations with selected demographic variables were significantly positive. ConclusionsWe concluded that this revised scale, based on the 40-item HPLP-C, was considered suitable for measuring health-promoting lifestyles of older adults in China. Mental and inner self-reflection planes were the most salient factors for assessing health-promoting behaviors of seniors. Such factors need to be considered if preventive programs are to be designed to promote seniors’ health.

Prevalence of fibromyalgia in France: a multi-step study research combining national screening and clinical confirmation: The DEFI study (Determination of Epidemiology of FIbromyalgia)

BackgroundFibromyalgia is a common disease, but little is known on its real prevalence in France. This epidemiological study aimed to assess fibromyalgia (FM) prevalence in the French metropolitan population, based on a multi-step sampling analysis, combining national screening and clinical confirmation by trained specialists.Methodsa sampling method on the entire national territory was used: patients over 18 years of age accepting to take part in the study were contacted by telephone using the LFES Questionnaire, a screening test for FM. The, for patients detected by the LFESQ, a visit with a FM-trained rheumatologist was proposed to confirm FM, based on 1990 ACR criteria. Each detected patient completed the following self-questionnaires: SF36, HADS, stress VAS, Co-morbidities and Regional pain score.Results3081 patients were contacted in 5 representative French regions, of which 232 patients were screened for FM. A fibromyalgia diagnosis was then confirmed by rheumatologist in 20 cases (17 female and 3 male, 56.9 ± 13.2 years). The final estimated FM prevalence was 1.6 (CI95: 1.2%; 2.0%). No significant difference was detected between the patients accepting (CS+) and refusing (CS-) rheumatologist visit for the SF36 score, regional pain score, stress VAS scale and co-morbidities. In patients detected for FM by the LFESQ, we found a statistically significant decrease in quality of life and a statistically significant increase in stress level in patients with a confirmed diagnosis (FM+) (6.3 ± 1.9) compared to patients with an invalidated diagnosis (FM-) (4.4 ± 2.8; p = 0.007). The study also demonstrated a significant association, independently of ACR criteria, between the diagnosis of FM and several factors such as regional pain score > 10, elevated stress level, low SF36 scale score and presence of gastro-intestinal disorder co-morbidities.ConclusionFibromyalgia is a common condition; the 1.6% prevalence calculated in the French population in our study corroborates the figures published in the European literature. Our results also suggest that criteria such as regional pain score, stress level or SF36 quality of life, could represent useful tools in fibromyalgia diagnosis.

Prevalence and characteristics of chronic musculoskeletal pain in Japan

BackgroundThis cross-sectional study was conducted to obtain epidemiologic data on chronic musculoskeletal pain in the Japanese people, and with it a better understanding of the actual conditions and problems involved. MethodsA questionnaire covering basic information, chronic musculoskeletal pain, daily life, quality of life, and social loss was prepared and mailed to 11507 individuals aged 18 years or older. Subjects were selected randomly nationwide in accordance with the demographic composition of Japan. ResultsThe prevalence of chronic musculoskeletal pain was 15.4%. The prevalence was highest in people in their 30s to 50s. Pain occurred most frequently in the low back, neck, shoulder, and knee. Among symptomatic subjects, 42% sought treatment, by visiting a medical institution (19%), taking folk remedies (20%), or both (3%). Treatment was generally prolonged, with 70% of those treated reporting treatment durations of more than a year. Although 69% reported that their symptoms had improved, 30% reported unchanged or aggravated symptoms and dissatisfaction with treatment. Among symptomatic subjects, a high percentage of both men and women had lost jobs, left school, been absent from work or school, or had changed jobs. Basic activities of daily living (ADL) were disturbed in men, and the instrumental ADL (IADL) score was low in women. SF-36 scale scores were significantly lower in every area for subjects with chronic pain. ConclusionsChronic musculoskeletal pain does not necessarily improve even with prolonged treatment. It adversely affects daily life and both physical and mental health. Because those suffering pain often increasingly need assistance in daily activities, people around them are also affected. The therapeutic system and treatment procedures for chronic musculoskeletal pain merit prompt review.

Physical and Psychosocial Recovery in the Year After Primary Treatment of Breast Cancer

The 2000 National Institutes of Health Consensus Conference on Adjuvant Therapy of Breast Cancer recommended chemotherapy for all women with invasive cancer greater than 1 centimeter. Studies of long-term breast cancer survivors have found poorer quality of life (QOL) in women who received adjuvant chemotherapy. The aim of this article is to characterize physical and psychosocial recovery as a function of chemotherapy receipt in the year after medical treatment completion. Prospective longitudinal survey data (RAND SF-36 and Breast Cancer Prevention Trial [BCPT] Symptom Scales) collected from 558 women with breast cancer enrolled on the Moving Beyond Cancer (MBC) psychoeducational intervention trial were compared according to receipt of chemotherapy. MBC study enrollment occurred within 4 weeks after the end of primary treatment (eg, surgery, chemotherapy, radiation). Self-report questionnaire data collected at enrollment and at 2, 6, and 12 months thereafter were examined, controlling for intervention and with propensity score adjustment for imbalance of covariates. Outcome analyses were carried out by fitting linear mixed models by using SAS PROC MIXED. Longitudinal SF-36 scale scores did not differ by chemotherapy treatment exposure, and both groups improved significantly (P < .01) in the year after primary treatment ended. However, adjuvant chemotherapy treatment was associated with significantly more severe physical symptoms, including musculoskeletal pain (P = .01), vaginal problems (P < .01), weight problems (P = .01), and nausea (P = .03). Physical and psychosocial functioning improved significantly after breast cancer treatment, independent of receipt of adjuvant chemotherapy. Women who received chemotherapy experienced more severe and persistent physical symptoms that should be more effectively managed as part of survivorship care.

Health‐related quality of life in adults with sickle cell disease (SCD): A report from the comprehensive sickle cell centers clinical trial consortium

Adults with Sickle Cell Disease (SCD) experience multiple disease-related complications, but few studies have examined relationships between these events and health-related quality of life (HRQOL). We determined the number and type of previous or co-occurring SCD-related complications and their reported HRQOL in a cohort of 1,046 adults from the Comprehensive Sickle Cell Centers (CSCC). Participants had a median age of 28.0 years (48% male, 73% SS or Sβ⁰ thalassemia) and had experienced several SCD-related complications (mean 3.8 ± 2.0), which were influenced by age, gender, and hemoglobinopathy type (P < 0.0001). In multivariate models, increasing age reduced all SF-36 scales scores (P < 0.05) except mental health, while female gender additionally diminished physical function and vitality scale scores (P < 0.01). Of possible complications, only vaso-occlusive crisis, asthma, or avascular necrosis diminished SF-36 scale scores. Chronic antidepressants usage predominantly diminished scores on bodily pain, vitality, social functioning, emotional role, and mental health scales, whereas chronic opioid usage diminished all scale scores (P < 0.01). Our study documents substantial impairment of HRQOL in adults with SCD that was influenced by only a few of many possible medical complications. It suggests that more effective treatments of persistent pain and depression would provide the largest HRQOL benefit.

Measuring the health status burden in hemodialysis patients using the SF-36® health survey

The SF-36, a generic measure of 8 domains of health-related quality of life (HRQOL), has been widely used to examine HRQOL of end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). The current study synthesizes existing literature to examine which SF-36 domains capture the largest burden in this patient population. A literature search of published studies that presented descriptive statistics for baseline SF-36 scale scores from HD patients was conducted. Disease burden was estimated by comparing HD patients' SF-36 scores to those from either a control group or a general population normative sample taken from the same country. For each study, Cohen d effect sizes for between-sample differences were calculated for each scale. Twenty-six articles that matched set criteria were identified. Estimation of differences between HD patients and comparison groups showed that the SF-36 physical functioning scale yielded the largest weighted mean effect size across studies (d = 1.46), followed by the general health (d = 1.29) and role physical (d = 1.21) scales. Among the eight domains of the SF-36, physical functioning, general health, and role physical scales best captured disease burden for HD patients. The disease burden negatively impacts physical HRQOL more strongly than mental HRQOL.

Factors associated with health-related quality of life among Belgrade University students

The aims of the study were to evaluate health-related quality of life (HRQoL) among students of University of Belgrade (Serbia) and to identify factors that might have associated with their HRQoL including relationship with depression. Between April and June, 2009, 1624 students were enrolled in the cross-sectional study. HRQoL was assessed by using SF-36 questionnaire and general depressive status by Beck Depression Inventory (BDI). In statistical analysis, ANOVA (Bonferroni adjustment), χ(2) test, and correlation analysis were performed. In our study, the highest SF-36 scale score was obtained for Physical Functioning. All SF-36 domains significantly (P < 0.01) negatively correlated with BDI. Students of medical sciences had the lowest scores in almost all SF-36 domains. Students who lived with parents had statistically significantly higher scores of majority of SF-36 domains. The total SF-36 score significantly correlated with average monthly family income (P = 0.002). Smokers and non-smokers significantly differed in the total SF-36 score (P = 0.001). Based on the comparison across the physical activity categories, there is a clear pattern of differences in the total SF-36 scores (P = 0.001). Our findings indicate that multiple factors are adversely associated with students' HRQoL. Appropriate health education programs to target modifiable risk factors may improve students' HRQoL.

Qualidade de vida de portadores de dores crônicas em tratamento com acupuntura

Pain is a signal of alert, common in sickness and with negative impact in people's life that search for alternative ways of relief. Acupuncture is used because of its analgesic effect. It was questioned if quality of life (QL) changes after acupuncture's beginning. The study aimed to analyse people’s QL after acupuncture treatment to chronic pain relief. It was a descriptive-analytical study carried out in an acupunture clinic of Goiânia-GO, Brazil, in January/February 2006. Data were collected using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The answers were analysed by descriptive statistics and obtaining each SF-36 scale's score average. Most of the 35 interviewed individuals were female, catholic, with high school level. Pain's principal points were vertebral spine, limbs, joints and head. The highest scores were obtained in the General Health Scale (67.48), Mental Health Scale (65.94) and Physical Functioning Scale (65.57). The smallest scores were in Role-Physical Scale (42.14) and Bodily Pain Scale (47.54). Everyone asserted pain relief and changes in QL after acupuncture use. The highest scores indicate that the individual perception of QL of these people is positive despite pain limitations. They consider themselves healthy, living with pain in the possible manner. The smallest scores indicate areas where is necessary immediate professional intervention to enhance QL of people with chronic pain. Future studies may be conducted to amplify sample and to better understand the magnitude of the multidimensional quality of life variables. Key words: Quality of Life; Acupuncture; Pain; Nursing.

Evaluation of Mood Disorder Patients in a Primary Care Practice

THE PURPOSE OF THIS RETROSPECTIVE, DESCRIPTIVE STUDY WAS TO EVALUATE PRIMARY CARE PATIENTS DIAGNOSED WITH A MOOD DISORDER ON THE BASIS OF THE FOLLOWING: (1) comorbid medical illnesses, (2) risk factors for mood disorders and longitudinal presence of symptoms, (3) presence of affective temperament, and (4) functional status and quality of life. Patients (N = 35) were a convenience sample diagnosed in the Mood Disorder Clinic (MDC), a family practice site-based mental health treatment consultation service. All study patients were assessed using a semistructured interview and diagnosed according to DSM-IV-TR criteria. Data were collected using both chart review and secondary analysis of a computerized touch-screen mood disorders database that included the 36-item Short-Form Medical Outcomes Study Health Survey (SF-36) and an affective temperament survey. The study was conducted from January 2000 through August 2000. A total of 62 comorbid medical illnesses were present in this group of patients; only 2 patients had no comorbid illnesses. Psychiatric diagnoses included 25 cases (78.1%) of bipolar depression, 5 cases (15.6%) of unipolar or dysthymic depression, and 2 cases (6.3%) of nonmood or anxiety disorders. All patients (100%) had a positive family history for mood disorders or substance abuse. Twenty-four patients (70.6%) had onset of their depressive symptoms prior to age 21, and 11 patients (35.5%) had a positive history of sexual abuse. Affective temperaments were positive in the 30 patients who completed this section. SF-36 scale scores were predominantly below national norms. The medical comorbidities in our study were expected; the positive family and individual histories for risk along with low SF-36 scores reflect the severity and chronicity of mood disorders in this population.

Validation and calibration of the SF-36 health transition question against an external criterion of clinical change in health status

Cross-sectional surveys depend on retrospective health transition questions (HTQ) to estimate recent changes in health status. This paper assesses the validity of the SF-36 HTQ and calibrates its categories against change assessed prospectively on the SF-36 domain scales in a sub-group known to have experienced clinically important changes in health status. Adults (n = 9,649) from a longitudinal population survey completed the SF-36 in 2001 and 2002. Prospective measures were calculated as mean changes in SF-36 scale scores adjusted for age and gender, and also expressed as standardised response means. Comparison groups were those who had developed a long-term health condition since the last interview and the HTQ response categories for those who had not developed any new conditions. Those with a new condition and those without a new condition but who described their health as "somewhat worse" than a year ago had comparable declines in health status on all domain scales except role physical, where those with a new condition experienced a greater decline. This analysis demonstrates the validity and limitations of the HTQ as a measure of change in population studies. The calibration is useful for interpreting the meaning of the HTQ categories at the group level but not at the individual level.

Validity of the EuroQoL (EQ-5D) Instrument in a Greek General Population

Objectives The main purpose of this study was to assess the construct validity of the Greek EQ-5D instrument in measuring health-related quality of life, as well as to address the issues of concurrent validity, internal consistency reliability, and sensitivity. Methods A stratified, representative sample (n = 1388) of the Greek general population was approached for interview (response rate 72.4%). The survey included the EQ-5D, the SF-36, and questions on sociodemographic and clinical characteristics of the sample. Results The EQ-5D dimensions, the EQ visual analog scale, and the UK-based utility index were capable of distinguishing between groups of respondents, in the expected manner, on the basis of sex, age, education, socioeconomic status, self-reported health problems, and health services utilization, thus providing evidence of construct validity. Convergent and divergent validity of the EQ-5D descriptive system were supported by expected relationships with SF-36 scale and summary scores. Additionally, reporting a problem in a given EQ dimension was generally associated with lower SF-36 scores, supporting concurrent validity. Internal consistency reliability and sensitivity were also satisfactorily demonstrated. Conclusions The results provide initial support for the construct validity of the EQ-5D in Greece, and, in conjunction to future studies addressing test–retest reliability and responsiveness, they support administering the instrument in health status studies, which in turn can contribute to transnational comparisons.

Health-related quality of life among general practice patients with differing chronic diseases in Germany: Cross sectional survey

BackgroundThis study was carried out to compare the HRQoL of patients in general practice with differing chronic diseases with the HRQoL of patients without chronic conditions, to evaluate the HRQoL of general practice patients in Germany compared with the HRQoL of the general population, and to explore the influence of different chronic diseases on patients' HRQoL, independently of the effects of multiple confounding variables.MethodsA cross-sectional questionnaire survey including the SF-36, the EQ-5D and demographic questions was conducted in 20 general practices in Germany. 1009 consecutive patients aged 15–89 participated. The SF-36 scale scores of general practice patients with differing chronic diseases were compared with those of patients without chronic conditions. Differences in the SF-36 scale/summary scores and proportions in the EQ-5D dimensions between patients and the general population were analyzed. Independent effects of chronic conditions and demographic variables on the HRQoL were analyzed using multivariable linear regression and polynomial regression models.ResultsThe HRQoL for general practice patients with differing chronic diseases tended to show more physical than mental health impairments compared with the reference group of patients without. Patients in general practice in Germany had considerably lower SF-36 scores than the general population (P < 0.001 for all) and showed significantly higher proportions of problems in all EQ-5D dimensions except for the self-care dimension (P < 0.001 for all). The mean EQ VAS for general practice patients was lower than that for the general population (69.2 versus 77.4, P < 0.001). The HRQoL for general practice patients in Germany seemed to be more strongly affected by diseases like depression, back pain, OA of the knee, and cancer than by hypertension and diabetes.ConclusionGeneral practice patients with differing chronic diseases in Germany had impaired quality of life, especially in terms of physical health. The independent impacts on the HRQoL were different depending on the type of chronic disease. Findings from this study might help health professionals to concern more influential diseases in primary care from the patient's perspective.

Differences in health‐related quality of life between older nursing home residents without cognitive impairment and the general population of Norway

To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65-102 years with at least six months' residence and a representative population sample of 1137 Norwegian citizens aged 65-102 years. All nursing home residents had a Clinical Dementia Rating Scale score > or =0.5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23.2 and mean general population 62.9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. This study highlights the role of nurses and other health professionals in ensuring that nursing home residents have opportunities to improve their health-related quality of life.

Testing the SF-36 in Parkinson's disease

Rating scales are increasingly the primary outcome measures in clinical trials. However, clinically meaningful interpretation of such outcomes requires that the scales used satisfy basic requirements (scaling assumptions) within the data. These are rarely tested. The SF-36 is the most widely used patient-reported rating scale. Its scaling assumptions have been challenged in neurological disorders but remain untested in Parkinson's disease (PD). We therefore tested these by analyzing SF-36 data from 202 PD patients (54% men; mean age 70) to determine if it was legitimate to report scores for the eight SF-36 scales and its two summary measures of physical and mental health, and if those scores were reliable and valid. Results supported generation of the eight SF-36 scale scores and their reliabilities were generally good (> or = 0.74 in all but one instance). However, we found limitations that question the meaningfulness of four scales and other limitations that restrict the ability of four scales to detect change in clinical trials (floor/ceiling effects, 19.6-46.2 %). The two SF-36 summary measures were not found to be valid indicators of physical and mental health. This study demonstrates important limitations of the SF-36 and provides the first evidence-based guidelines for its use in PD. The limitations of the SF-36 demonstrated here may explain some unexpected findings in previous studies. However, the main implication is a general one for the clinical research community regarding requirements for reporting rating scale endpoints. Specifically, investigators should routinely provide scale evaluations based on data from within major clinical trials.

Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.1

BackgroundThe SF-36 and SF-12 summary scores were derived using an uncorrelated (orthogonal) factor solution. We estimate SF-36 and SF-12 summary scores using a correlated (oblique) physical and mental health factor model.MethodsWe administered the SF-36 to 7,093 patients who received medical care from an independent association of 48 physician groups in the western United States. Correlated physical health (PCSc) and mental health (MCSc) scores were constructed by multiplying each SF-36 scale z-score by its respective scoring coefficient from the obliquely rotated two factor solution. PCSc-12 and MCSc-12 scores were estimated using an approach similar to the one used to derive the original SF-12 summary scores.ResultsThe estimated correlation between SF-36 PCSc and MCSc scores was 0.62. There were far fewer negative factor scoring coefficients for the oblique factor solution compared to the factor scoring coefficients produced by the standard orthogonal factor solution. Similar results were found for PCSc-12, and MCSc-12 summary scores.ConclusionCorrelated physical and mental health summary scores for the SF-36 and SF-12 derived from an obliquely rotated factor solution should be used along with the uncorrelated summary scores. The new scoring algorithm can reduce inconsistent results between the SF-36 scale scores and physical and mental health summary scores reported in some prior studies.(Subscripts C = correlated and UC = uncorrelated)