Short Form-36 Bodily Pain Scores Research Articles

Prognostic factors of nonsurgical intervention outcomes for patients with frozen shoulder: a retrospective study

Purpose This study aimed to investigate the correlation between mental and physical health-related quality of life and the outcomes of conservative treatment in patients with frozen shoulder (FS). Methods This was a two-center retrospective study. It included 84 consecutive patients who underwent a 3-month treatment comprising education, physical therapy, and corticosteroid-anesthetic injections. Changes in range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) scores, measured at baseline and after 3 months, were selected as dependent variables. Data on age, sex, Body Mass Index, duration of symptoms, dominant affected limb, and Short Form-36 (SF-36) subscales were gathered at baseline and investigated as prognostic factors. Backward stepwise regression models were used to identify significant associations. Results At 3-month follow-up, all the patients showed significant improvement. Higher SF-36 General Health, Mental Health and Social Functioning scores at baseline were associated with a greater beneficial change in ROM and SPADI. In contrast, lower SF-36 Bodily Pain and Role Emotional scores were found to be associated with greater improvement. Conclusion The study findings indicate that the self-perceived mental and physical health of patients have a significant impact on both subjective and objective clinical outcomes and healthcare professionals should take these aspects into account. Level of Evidence Prognostic Level II

Prospective investigation of Oswestry Disability Index and short form 36 subscale scores related to sagittal and coronal parameters in patients with degenerative lumbar scoliosis.

This study investigated relationships of Oswestry Disability Index (ODI) and Short Form 36 (SF-36) total and subscale scores with global spinal parameters in patients with degenerative lumbar scoliosis (DLS). This was a prospective single-center study of 126 consecutive patients with DLS. Disability was evaluated using the ODI and SF-36 total and subscale scores. Sagittal and coronal parameters were measured. Pearson's correlation analysis was performed to determine relationships between disability and radiographic parameters. The study population included 76 women and 15 men (mean age, 70.2 ± 8.4years). Mean Cobb angle was 18.9° ± 8.0°. The ODI total score and SF-36 physical component score were only correlated with coronal parameters. ODI pain intensity, personal care, lifting, sitting, and sex life domains were only correlated with coronal parameters. The walking, standing, social life, and traveling domain scores were correlated with coronal and sagittal parameters. The SF-36 bodily pain and vitality domain scores were only correlated with coronal parameters. The SF-36 physical function domain score was correlated with both coronal and sagittal parameters. Among the clinical and radiographic parameters, the personal care score and the coronal vertical-axis had the strongest correlation (r = 0.425), although the r2 value was only 0.18. ODI total score and most of the subscale scores were significantly, but weakly correlated with coronal parameters. Sagittal parameters were only correlated with some of the ODI and SF-36 subscale scores. Analysis using ODI and SF-36 subscale scores may aid in understanding and treatment of disability in patients with DLS.

Discrete Trajectories of Resolving and Persistent Pain in People With Rheumatoid Arthritis Despite Undergoing Treatment for Inflammation: Results From Three UK Cohorts

Rheumatoid arthritis (RA) is an example of human chronic inflammatory pain. Modern treatments suppress inflammation, yet pain remains a major problem for many people with RA. We hypothesized that discrete RA subgroups might display favorable or unfavorable pain trajectories when receiving treatment, and that baseline characteristics will predict trajectory allocation. Growth mixture modelling was used to identify discrete trajectories of Short Form-36 bodily pain scores during 3 years in 3 RA cohorts (Early RA Network (n = 683), British Society for Rheumatology Biologics Register Biologics (n = 7,090) and nonbiologics (n = 1,720) cohorts. Logistic regression compared baseline predictor variables between trajectories. The role of inflammation was examined in a subgroup analysis of people with normal levels of inflammatory markers after 3 years. The mean Short Form-36 bodily pain scores in each cohort improved but remained throughout 3 years of follow-up of >1 standard deviation worse than the UK general population average. Discrete persistent pain (59–79% of cohort participants) and resolving pain (19–27%) trajectories were identified in each cohort. In Early RA Network, a third trajectory displaying persistently low pain (23%) was also identified. In people with normal levels of inflammatory markers after 3 years, 65% were found to follow a persistent pain trajectory. When trajectories were compared, greater disability (adjusted odds ratio = 2.3–2.5 per unit baseline Health Assessment Questionnaire score) and smoking history (adjusted odds ratio = 1.6–1.8) were risk factors for persistent pain trajectories in each cohort. In conclusion, distinct trajectories indicate patient subgroups with very different pain prognosis during treatment for RA. Inflammation does not fully explain the pain trajectories, and noninflammatory factors as well as acute phase response predict which trajectory an individual will follow. Targeted treatments additional to those which suppress inflammation might reduce the long-term burden of arthritis pain. PerspectiveImmunosuppression decreases inflammation in RA, but pain outcomes are less favorable. Discrete persistent and resolving pain trajectories were identified after treatment, both in early and established RA. Smoking and greater disability at baseline predicted persistent pain. Identifying patient subgroups with a poor pain prognosis could enable adjunctive treatment to improve outcomes.

The presence of concomitant intra-articular injuries and bone bruise does not affect pre-operative knee pain and symptoms in patients undergoing anterior cruciate ligament reconstruction.

Increased knee pain at the time of anterior cruciate ligament (ACL) reconstruction may predict increased pain post-operatively, a prolonged recovery and a more difficult rehabilitation. The main objective of our study was to identify preoperative factors, such as concomitant intra-articular injuries and bone bruises, that may be associated with increased knee pain and symptoms in patients undergoing ACL reconstruction. Patient data was queried from our institution's prospectively maintained ACL reconstruction registry. Two-hundred and seventy patients who underwent primary ACL reconstruction within 3 months of injury were included in the study. Predictors such as demographic characteristics (age, body mass index and gender) and injury characteristics (mechanism of injury, meniscal injury, chondral injury and bone bruise) were recorded. The association between the pre-operative knee injury and Osteoarthritis Outcome Score (KOOS) pain and symptom subscales and the Short Form-36 (SF-36) bodily pain subscale, and the predictors were assessed using logistic regression for categorical variables and linear regression for continuous variables. The mean age of our patient group was 25.4years with 211 out of 270 (78%) being males. Bone bruise was present in 243 patients (90%), meniscal injury in 165 (61%) patients and chondral injury in 40 (15%) patients. The presence of bone bruise, meniscal injury or chondral injury was not significantly associated with worse preoperative KOOS pain and symptom and SF-36 bodily pain scores. Other factors that were not associated were demographic characteristics (age, BMI and gender) and mechanism of injury. The presence of bone bruise and concomitant intra-articular injuries does not affect pre-operative knee pain and symptoms in patients undergoing ACL reconstruction within 3 months of injury. This knowledge would aid the surgeon in pre-operative counselling, and prognostication of post-operative pain and rehabilitation after ACL reconstruction.

Influence of Endometriosis Pain on Quality of Life: Assessing Specific Pain Scales from Both Short Form 36 and Endometriosis Health Profile 30

To assess the correlation between intensity of the major painful symptoms of deep infiltrating endometriosis (DIE) with pain scales from both Short Form 36 (SF36) and Endometriosis Health Profile 30 (EHP30). Sectional observational study. Public teaching hospital. Women with DIE diagnosed by nuclear magnetic resonance (n = 65; ages 20 to 53y). Exclusion criteria: incapability to answer the questionnaires, self-reported symptomatic pathologies/traumas or refuse. Anamnesis and patient self-reported scores from SF36 (bodily pain) and EHP30 (pain) quality of life (QoL) questionnaires. From July 2010 to March 2012, in parallel to preoperative evaluation for cytoreductive laparoscopy, patients answered Brazilian validated versions of both questionnaires to estimate different domains of QoL; scales were standardized from 0 (worst) to 100 (best QoL). Besides, endometriosis pain intensity was quantified by an analog scale (0-10). Median scores and percentiles 5 and 95 for major symptoms were: dyspareunia (4.0; 0.0-10.0), dysmenorrhea (8.0;0.0-10.0), hypogastric pain (3.4;0.0-10.0), dyschezia (0.0;0.0-7.0) and menstrual dyschezia (0.4;0.0-10.0). Analysis was performed with SPSS 15.0 for Windows; significant if P<0.05. Shapiro-Wilk test showed non-normal distribution of QoL scales. Nonparametric correlation was expressed with Spearman coefficient and p value. As expected, there was significant correlation between EHP30 and SF36 pain scores (0.378; 0.001), dyspareunia (-0.437; <0.001), dysmenorrhea (-0.389; 0.001), hypogastric pain (-0.437; <0.001) and menstrual dyschezia (-0.260; 0.035); while correlation with dyschezia was close to significance (-0.226; 0.070). On the other hand, despite significant negative correlation with dyspareunia (-0.373; 0.002) and hypogastric pain (-0.418; <0.001), SF36 bodily pain scores showed no significant correlation with dysmenorrhea (-0.128; 0.311), dyschezia (-0.180; 0.151) and menstrual dyschezia (-0.193; 0.121). Data suggest that a specific tool (EHP30) should be preferred to assess the influence of endometriosis pain on QoL because SF36 bodily pain scale showed no significant correlation with dysmenorrhea (one of the most important painful symptom in endometriosis).

Comparative effectiveness of alternative clinical pathways for primary hip and knee joint replacement patients: a pragmatic randomized, controlled trial

Total hip replacement (THR) and total knee replacement (TKR) (arthroplasty) surgery for end-stage osteoarthritis (OA) are ideal candidates for optimization through an algorithmic care pathway. Using a comparative effectiveness study design, we compared the effectiveness of a new clinical pathway (NCP) featuring central intake clinics, dedicated inpatient resources, care guidelines and efficiency benchmarks vs. the standard of care (SOC) for THR or TKR. We compared patients undergoing primary THR and TKR who received surgery in NCP vs. SOC in a randomised controlled trial within the trial timeframe. 1,570 patients (1,066 SOC and 504 NCP patients) that underwent surgery within the study timeframe from urban and rural practice settings were included. The primary endpoint was improvement in Western Ontario and McMaster University osteoarthritis index (WOMAC) overall score over 12 months post-surgery. Secondary endpoints were improvements in the physical function (PF) and bodily pain (BP) domains of the Short Form 36 (SF-36). NCP patients had significantly greater improvements from baseline WOMAC scores compared to SOC patients after adjusting for covariates (treatment effect=2.56; 95% confidence interval (CI) [1.10-4.01]). SF-36 BP scores were significantly improved for both hip and knee patients in the NCP (treatment effect=3.01, 95% CI [0.70-5.32]), but SF-36 PF scores were not. Effects of the NCP were more pronounced in knee patients. While effect sizes were small compared with major effects of the surgery itself, an evidence-informed clinical pathway can improve health related quality of life (HRQoL) of hip and knee arthroplasty patients with degenerative joint disorder in routine clinical practice for up to 12 months post-operatively. CLINICALTRIALS.GOV IDENTIFIER: NCT00277186.

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain

Background context Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear. Purpose To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician–directed usual care (UC) in the treatment of AM-LBP. Study design/setting A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic. Patient sample Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT). Outcome measures Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks. Methods Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician–directed UC, the components of which were recorded. Results Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27). Conclusions This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician–directed UC in the treatment of patients with AM-LBP. Compared to family physician–directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.

286 The Extent of Resection and Insulin-Dependent Diabetes But Neither Preoperative Chemotherapy Nor (Chemotherapy-Induced) Liver Injury Influence Morbidity After Surgery for Hepatic Colorectal Metastases

OBJECTIVE: Laparoscopic Heller myotomy (LHM) provides more durable relief of achalasia symptoms than endoscopic pneumatic dilation or botulinum toxin injection. The role of pre-operative endoscopic therapy in surgical candidates is controversial. We investigated the association between multiple pre-operative endoscopic interventions and objective and subjective outcomes after LHM for achalasia. METHODS: Patients undergoing first-time LHM for achalasia between November 2001 and January 2008 were included. Demographics, comorbidities, pre-operative therapy, operative details, and clinical follow-up were obtained by chart review. Gastrointestinal (GI) symptom profile and health-related quality of life (HRQOL) was assessed pre-operatively using the GERD Symptom Assessment Scale (GSAS) and Short Form-36 (SF-36), respectively. Patients were classified on the number of preoperative endoscopic interventions: zero or one intervention (group 1) versus two or more interventions (group 2). Outcomes were assessed at a median of 22 months post-operatively using mailed GSAS, SF-36, and achalasia-specific questionnaires. The primary outcome of interest was surgical failure, defined as requiring additional surgical or interventional endoscopic therapy. Secondary outcomes of interest included gastroparesis and changes in GI symptoms and HRQOL. RESULTS: 134 patients met inclusion criteria; 88 (66%) were in group 1 and 46 (34%) in group 2. At the time of operation, patients in group 2 had a longer duration of symptoms (median 36 vs. 21mos., p=0.0026) and higher ASA classification (40% vs. 19% ASA 3-4, p=0.009) than those in group 1. No perioperative leaks or deaths occurred in either group. Group 1 patients reported significant improvements in SF-36 bodily pain, energy, social function, and general health scores, while HRQOL in group 2 remained unchanged. Five patients (3.7%) were diagnosed with symptomatic gastroparesis post-operatively. Surgical failure rate was 14.2%, and was higher in group 2 vs. group 1 (28.3% vs. 6.8%, p=0.001). On logistic regressionmodelingwith adjustment for confounders, having >1 pre-operative endoscopic intervention was found to be a significant independent predictor of surgical failure (OR=5.26, 95% C.I. 1.61-17.17, p=0.006). CONCLUSIONS: Multiple pre-operative endoscopic interventions are independently associated with a higher surgical failure rate after LHM for achalasia, suggesting that repeated interventions should be reserved only for patients who fail surgical therapy or are not surgical candidates. Potential associations between endoscopic intervention, gastroparesis, and LHM need further study.

Hip flexion range of motion and physical function in hip osteoarthritis: Mediating effects of hip extensor strength and pain

Hip flexion range of motion (ROM), hip extensor strength (torque production), and hip pain are important correlates of physical function in individuals with hip osteoarthritis (OA). However, the relationships among these variables remain unclear. The purpose of this study was to examine whether hip extensor strength and hip pain mediate the association between hip flexion ROM and physical function. Participants were 100 adults (mean age 62 years) with radiographically confirmed hip OA. Passive hip flexion ROM was measured using a digital inclinometer, and isometric hip extensor strength was measured using a force transducer. Self-report measures of physical function and pain were assessed by the Short Form 36 (SF-36) questionnaire, and physical performance was assessed by the gait speed, step test, and stair climb test. Multiple mediation analyses, adjusted for demographic and anthropometric measures, revealed that the association between hip flexion ROM and SF-36 physical function scores was fully mediated by SF-36 bodily pain scores and hip extensor strength. Hip extensor strength mediated the hip flexion effects on gait speed and step test performance, while the SF-36 bodily pain scores mediated the hip flexion stair performance association. In individuals with symptomatic hip OA, hip pain and hip extensor strength mediated the influence of hip flexion ROM on physical function. These results suggest that interventions to improve the range of hip motion may be clinically indicated.

Comparison of Health-Related Quality of Life Between Patients with End-Stage Ankle and Hip Arthrosis

End-stage ankle arthrosis is one of the leading causes of chronic disability in North America. Information on this condition is limited. The amount of pain and the reduction in health-related quality of life and function have not been quantified with use of universal outcome measures. The purpose of the present study was to compare the extent of pain, loss of function, and health-related quality of life in two cohorts of patients waiting for the surgical treatment of end-stage ankle or hip arthrosis. One hundred and thirty patients with end-stage ankle arthrosis who were awaiting total ankle arthroplasty or ankle arthrodesis were recruited through a Canadian Orthopaedic Foot and Ankle Society multicenter study. All patients prospectively completed the Short Form-36 (SF-36) generic outcome instrument. This cohort was compared with a similar cohort of 130 patients with end-stage hip arthrosis, randomly selected from an existing prospective joint replacement database, who had completed an SF-36 questionnaire prospectively from 2000 to 2005. In both groups, the scores for all SF-36 subscales were approximately two standard deviations below normal population scores. Patients with ankle arthrosis had significantly worse mental component summary scores (p < 0.05), role-physical scores (p < 0.05), and general health scores (p < 0.05). Patients with hip arthrosis reported significantly lower physical function scores (p < 0.05), although the SF-36 physical component summary score was not significantly different between the two groups. The SF-36 physical component summary, bodily pain, vitality, role-emotional, social functioning, and mental health subscale scores were equally affected in both cohorts. The mental and physical disability associated with end-stage ankle arthrosis is at least as severe as that associated with end-stage hip arthrosis.

Functional limitations and well-being in injured municipal workers: a longitudinal study.

Two instruments, the Health Assessment Questionnaire (HAQ) and the Short Form-36 (SF-36), were used to document both the immediate and short-term effects of workplace injuries in municipal workers. Telephone interviews were conducted up to 3 months following the injury. One hundred fourteen subjects agreed to participate in the study; 90 workers completed at least one useable interview. The relationship between functional limitation and lost days was evaluated using Cox proportional hazards models. At 3 months following the onset of injury, SF-36 scores for physical function, role-physical, and bodily pain differed significantly from population norms. Using one standard deviation of change, statistically significant hazard ratios were seen in subjects with lower SF-36 physical component summary, physical function, and bodily pain scores, and higher HAQ disability and fatigue scores. Functional limitations persisted in workers after relatively minor workplace injuries despite a 91% return to work rate.

Case study research designs: their place in chiropractic: Waalen JK. J Can Chirop Assoc 1992; 36: 29–32

Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician–directed usual care (UC) in the treatment of AM-LBP.A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician–directed UC, the components of which were recorded.Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician–directed UC in the treatment of patients with AM-LBP. Compared to family physician–directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.