Short Form-36 Domains Research Articles

OP0028 EARLY ACHIEVEMENT OF MINIMAL DISEASE ACTIVITY IN PSORIATIC ARTHRITIS IS ASSOCIATED WITH LONG-TERM IMPROVEMENTS IN QUALITY OF LIFE

BackgroundMinimal disease activity (MDA) is a treatment target in psoriatic arthritis (PsA) that takes both clinical manifestations (joints, skin and enthesis) and the patient perspective into account (1). In a previous study we have shown that achieving MDA in the first year is associated with better quality of life (QoL) regardless whether this was achieved early or late in the first year (2). However, the impact of achieving MDA within the first year on the long-term is lacking.ObjectivesTo compare quality of life at 1, 2 and 3 years between PsA patients who achieve MDA in the first year and those who do not.MethodsNewly diagnosed, DMARD naïve PsA patients with oligo- or polyarthritis and at least 3 years of follow-up, participating in the Dutch southwest Early PsA cohoRt (DEPAR) were included. In short the DEPAR is an observational cohort of newly diagnosed PsA (3). Study visits took place at 3, 6, 9, 12, 18, 24 and 36 months after diagnosis. Patients were categorized in three groups by achievement of MDA in the first year:Sustained MDA, includes patients who were in MDA at both their 9- and 12-month visit;Non-sustained MDA, includes patients who achieved MDA in the first year but did not sustain it at both 9- and 12-months;No MDA, includes patients who did not achieve MDA in the first year.To measure QoL at 1, 2 and 3 years the Short form-36 (SF-36) questionnaire was used. Descriptive statistics were used to compare QoL.ResultsWe included 243 patients (51% male) of whom 113 (47%) were classified as sustained MDA, 64 (26%) as non-sustained MDA and 66 (27%) as no MDA. At baseline, patients had a mean age of 52.7 years and median symptom duration of 9.3 months. Patients in the no MDA group seemed to be older, were more often female and had a longer symptom duration (Table 1). QoL of sustained MDA patients was comparable to the general Dutch population (4) after 1, 2 and 3 years of follow-up. However, patients who did not achieve MDA in the first year had a lower QoL compared to the sustained MDA group and these differences persist in the years thereafter (Figure 1). The physical as well as the mental QoL domains were worse in the no MDA group compared to the other groups.Table 1.Baseline characteristics of patients categorized by MDA groupSustained MDA (n=113)Non-sustained MDA (n=64)No MDA(n=66)Demographics Age (years)51.8 ± 1351.8 ± 1455.3 ± 13 Sex (male)69 (61)33 (52)21 (32) Symptom duration (months)8.5 (4-24)8.1 (3-28)12.9 (5-51)Disease activity Swollen joint count (66)3 (2-5)4 (1-6)4 (2-8) Tender joint count (68)3 (1-6)4 (2-8)8 (4-13) Psoriasis95 (84)58 (91)56 (85) BSA in case of psoriasis (%)3 (2-4)3.3 (1-6.5)3 (1.5-6) Enthesitis29 (26)28 (44)38 (58) LEI in case of enthesitis1 (1-2)2 (1-2)2 (1-4)HAQ0.38 (0.13-0.75)0.75 (0.5-1)1 (0.75-1.38)VAS global31 (15-56)46 (23-65)59 (50-77)VAS pain28 (12-52)50 (26-66)69 (53-80)Results are shown as mean ± standard deviation, n (%) or median (interquartile range). BSA: Body Surface Area; LEI: Leeds Enthesitis Index; HAQ: Health Assessment Questionnaire; VAS: visual analogue scale.Figure 1.(A) 1 year, (B) 2 year and (C) 3 year quality of life scores, measured with the SF-36 domains, for MDA groups and compared with the general Dutch population norms (4), (D) percentage of patients who use biologicals over time per MDA group.Over the years, treatment was intensified in all groups, with biologicals use after three years at 18%, 25% and 31% in the sustained MDA, non-sustained MDA and no MDA group, respectively.ConclusionFailure to achieve MDA in the first year after PsA diagnosis is associated with worse quality of life outcomes that persist over the years despite more intensified treatment.

Quality of life in Indian patients with functional dyspepsia: Translation and validation of the Hindi version of Short-Form Nepean Dyspepsia Index.

Patients with functional dyspepsia (FD) have poor health-related quality of life (HRQOL), but Indian data are lacking. Also, there is non-availability of validated disease-specific questionnaire to assess HRQOL in Hindi-speaking patients withdyspepsia. We aimed to develop and validate a reliable translation of Short-Form Nepean Dyspepsia Index (SF-NDI) in Hindi, and assess the impact of FD on HRQOL in Indian patients. Cross-cultural adaptation of English version of SF-NDI, translation to Hindi, and adaptation of Hindi version were performed using standard procedures. English and Hindi versions were assessed against Short Form-36 (SF-36), examining for internal consistency, test-retest reliability, and validity. Total 211 FD patients (144 Hindi speaking, 67 English speaking) were enrolled (mean age 40.8 ± 11.7years; male:female = 115:96). Median total SF-NDI scores for both languages were 38.75 and 40.0, respectively. Test-retest reliability intraclass correlation coefficients were 0.85 (Hindi) and 0.89 (English). Internal consistency evaluation revealed Cronbach's α coefficient of 0.79-0.86 (Hindi) and 0.78-0.89 (English). SF-NDI sub-scales showed moderate to good correlation with various domains of SF-36 (content validity). There was significant (p < 0.001) decline of HRQOL in patients with severe dyspepsia relative to those with mild dyspepsia (construct validity). On multivariate analysis, factors independently associated with HRQOL were duration of symptoms and dyspepsia severity. Both English and Hindi versions of SF-NDI are reliable and valid for HRQOL assessment in Indian FD patients, and will be useful in future epidemiological and clinical studies. Indian FD patients have poor HRQOL, being worse in those with severe dyspepsia and longer duration of symptoms.

How does fibromyalgia affect sleep quality and quality of life in patients with metabolic syndrome?

Aim: In this study, we aimed to investigate the prevalence of fibromyalgia syndrome (FMS) in patients with metabolic syndrome (MetS) and its effects on sleep quality and quality of life (QoL).Methods: The study included a total of 84 (56 females, 28 males) patients with MetS, with a mean age of 57.5 (34–74) years and mean body mass index of 32.5 (25–48.9) kg/m2. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The FMS diagnosis was made based on the 2013 American College of Rheumatology Alternative Criteria. QoL and sleep quality were evaluated by the Short Form 36 (SF-36) and the Pittsburgh Sleep Quality Index, respectively.Results: All patients had diabetes mellitus and were obese or overweight. Of all patients, 73.8% had poor sleep quality and 51.2% had FMS. Patients with both MetS and FMS had a statistically significant female predominance (p<0.001). Impaired sleep was present in 62.9% of patients with both MetS and FMS and 37.1% of patients with MetS only (p<0.001). All SF-36 domain scores were statistically significantly lower in the MetS+FMS group than in the MetS group (p<0.001)Conclusion: The frequency of FMS is high in patients with MetS. Sleep quality and QoL are impaired in the presence of FMS or MetS alone. The co-presence of these conditions causes poorer sleep quality and worse QoL. FMS should be considered in the treatment and followup of patients with MetS.

Low health-related quality of life in adult individuals with multiple limb deficiencies compared with population-based reference values.

Knowledge on health-related quality of life (HRQoL) in multiple limb deficiencies (LDs) is limited. To investigate self-reported HRQoL in multiple LDs, assess differences between congenital LD and acquired LD and sex, and to evaluate associations between the types of LDs, demographic variables, and HRQoL. Cross-sectional cohort study. A total of 106 individuals with multiple limb deficiencies treated at the EX-Center were invited by mail to fill out the Short Form-36 survey. Responses from 62 participants, mean age ± SD 49.5 ± 14.2, showed that 43 had congenital LD and 19 had acquired LD. Responders reported reduced HRQoL in all Short Form-36 domains except Role-Emotional, compared with reference values (P < 0.05-<0.001). Individuals with a congenital LD reported worse Bodily Pain than acquired LD (P < 0.05), and women reported lower Physical Function than men (P < 0.05). Sick leave was negatively associated with physical composite score. Living in a rural area was positively associated with Mental Health (P < 0.01), and congenital LD was negatively associated with Vitality (P < 0.05). Individuals with multiple LDs in Sweden have lower HRQoL compared with reference values. There are significant associations between sick leave and physical function, rural living and mental health, and the type of LD and vitality.

Quality of Life Scores Remained Different among the Genotypic Groups of Patients with Suspected Hemochromatosis, Even after Treatment Period.

Background: Hemochromatosis is a genetic condition of iron overload caused by deficiency of hepcidin. In a previous stage of this study, patients with suspected hemochromatosis had their quality of life (QL) measured. We observed that QL scores differed among genotypic groups of patients. In this reported final phase of the study, the aims were to compare QL scores after a treatment period of approximately 3 years and to analyze a possible association of the serum ferritin values with QL scores. Methods: Sixty-five patients were enrolled in this final phase and divided into group 1 (patients that showed primary iron overload and homozygous genotype for the HFE p.Cys282Tyr mutation) and group 2 (other kinds of genotypes). Short Form 36 (SF-36) was performed and consisted of eight domains with a physical and also a mental component. Results: Both groups had a significant decrease in serum ferritin concentrations: group 1 had a variation from 1844 ± 1313 ng/mL to 281 ± 294 ng/mL, and group 2 had a variation from 1216 ± 631 ng/mL to 236 ± 174 ng/mL. Group 1 had a smaller mean value for these six SF-36 domains compared with group 2, indicating a worse QL. Conclusions: In this final stage, six domains demonstrated a difference among genotypic groups (role emotional and mental health, adding to the four of the initial phase), reassuring the impact of the identified genotype on the QL of hemochromatosis patients. Furthermore, despite that both patient groups demonstrated similar and significant decreases in serum ferritin values, no association was found between the decrease in this biological parameter and the SF-36 domains.

Arthroscopic Bankart repair improves upper limb exercise capacity, shoulder function and quality of life.

Anterior glenohumeral instability is an important cause of shoulder disability. The aim of the present study was to investigate arm exercise capacity in patients with anterior glenohumeral instability before and after arthroscopic Bankart repair and to compare the results with those of healthy controls. The patient group included a total of 11 males between the ages of 18 and 40 years. The control group consisted of 13 healthy males with an age range of 23 to 41 years. An incremental arm crank exercise test was performed to determine upper limb exercise capacity, as expressed by peak oxygen consumption (VO2peak). The shoulder function of the patients was evaluated by the Western Ontario Shoulder Instability Index (WOSI), and the quality of life was assessed with the Short Form-36 (SF-36). All evaluations were performed preoperatively, and at the postop 3rd and 6th months. The patient group had lower VO2peak and exhaustion duration at the preoperative assessment (p = 0.025 and p = 0.007, respectively). SF-36 domains were lower in patients (p < 0.05). There were significant differences in VO2peak between preoperative and postop 6th-month measurements and between postop 3rd and 6th-month measurements (p < 0.001 and p = 0.001, respectively). The total WOSI score increased from preoperative 50.27% to 57.77% at the postop 3rd month, and to 65.56% at the final follow-up. Although improvements were detected in all SF-36 domains at postop follow-ups, they were not statistically significant except role limitations due to the physical problems domain (p = 0.006). There were no significant differences between controls and patients at the postop 3rd and 6th months with regard to exercise test parameters except the peak rating of perceived exertion. Shoulder function, exercise capacity, and quality of life were lower in the patient group and improved after arthroscopic Bankart repair. Clinicians should use the exercise capacity assessment for the evaluation of the recovery of shoulder function after providing stabilization.

Clinical effects of suprascapular nerve block in addition to intra-articular corticosteroid injection in the early stages of adhesive capsulitis: A singleblind, randomized controlled trial.

The aim of this study was to evaluate the short and long-term effects of the combination of suprascapular nerve block (SSNB) and intra-articular corticosteroid injection (IAI) on pain, shoulder range of motion (ROM), disability, and quality of life in the management of patients with adhesive capsulitis (AC). Forty patients (ages 30-70 years) who were diagnosed with AC stages 1 and 2 were randomlyassigned to one of two groups: Group-1 received IAI and SSNB combination, while group-2 only-IAI. Both groups started a three-week rehabilitation program after the intervention. The Shoulder Pain and Disability Index (SPADI), Numeric Rating Scale (NRS), active and passive shoulder ROMs, and the Short Form 36(SF-36) were assessed by a physiatrist who was blinded to the allocation at baseline and three weeks, three months, and twelve months. The NRS and shoulder ROMs were also examined in the first hour. Nineteen patients from each group with mean ages of 55.84±2.19 (15 females, 4 males) and51.79 ± 1.58 (14 females, 5 males) were included. Within the groups, SPADI and NRS scores were decreased, while active and passive ROMs and the physical function, physical role, and bodily pain domains of SF-36 were increased by time (P < 0.05). Between the groups, the change in NRS value and active flexion in the first hour was more remarkable in group 1 (P < 0.05). No significant difference between outcome measurements was found at the 3rd week, 3rd month, and 12th month (P > 0.05). SSNB as an adjunct to IAI in AC positively affected the immediate pain relief and functional improvement after the intervention; however, it did not yield any additional benefit in the short and long-terms. Level I, Therapeutic Study.

Evaluation of psychosocial functioning in the acute treatment term of major depressive disorder: A 16-week multi-centered follow-up study.

Major depressive disorder is the leading cause of non-fatal burden, and disability in adulthood. Even though depression is well-treated in the acute term,psychosocial functioning does not get back to the premorbid level most of the time. In this present study, it is aimed to evaluate the outcome of the acute term treatment of major depressive disorder in terms of psychosocial functioning. The study is an open-label, observational, multi-center follow-up study for four months of patients with major depressive disorder according to DSM-5. Patients were evaluated with Montgomery Asberg Depression Rating Scale (MADRS), Sheehan Disability Scale (SDS) and Short Form-36 (SF-36) at the beginning, and at the 2., 4., 8., 12. and 16.weeks. 100 patients were invited to the study and 56 patients completed the study.As a result of the treatment, the mean MADRS and SDS scores decreased significantly. All domains of SF-36 were improved significantly with the treatment. Unfortunately patients suffering from MDD could not reach the normative data,especially on the domains of social functioning, role emotional, pain, and general health perception. Treatment outcomes show that SNRI users presented higher scores on the domains of pain and physical functioning. However SSRI users showed better outcomes on the domains of mental health and vitality. Our research corroborated that even patients gain symptomatic remission in MDD treatment, psychosocial dysfunction persists. It is also concluded that different antidepressant options may act differently on treatment outcomes.

Does Video-Assisted Thoracoscopic Surgery with Bullectomy and Partial Pleurectomy for Primary Spontaneous Pneumothorax Impair Health-Related Quality of Life and Pulmonary Function?

Background: Video-assisted thoracoscopic surgery (VATS) with partial pleurectomy is an established treatment for primary spontaneous pneumothorax (PSP). However, postoperative pulmonary function and health-related quality of life (HR-QoL) after VATS–bullectomy with partial pleurectomy (VBPP) have not been elucidated. Methods: Eligible patients were assessed for HR-QoL using the Short-Form 36 (SF-36) health survey. Pulmonary function (PF) was evaluated by spirometry. We compared the results of the VBPP cohort with the German national norms, and with a similar cohort of patients successfully treated by chest tube (CT) only. Results: A total of 25 VBPP patients completed the SF-36 health survey, of whom 15 presented for PF assessment. Between the VBPP and CT groups, the mean forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratio were not statistically significantly different. However, in both groups, FVC, FEV1, and FEV1/FVC were above the lower limit of normal (LLN), suggesting no restrictive or obstructive patterns. Compared with the sex- and age-matched normal German population, patients who underwent VBPP displayed a similar physical component summary score and a significantly decreased mental component summary score. Interestingly, comparison of the SF-36 domains between the VBPP and CT groups showed no statistical difference. Conclusion: VBPP is a suitable surgical treatment for PSP, with no apparent adverse impacts on pulmonary or physical function. However, psychological distress and measures to counteract its impact should be considered.

Validation of Bengali Modified Barthel Index in aged patients of Bangladesh

Functional independence is an integral part for reflection of quality of living. Many scales have been utilised for it and the Barthel Index (BI) is one of them, which later modified on 10 activities having the score range of 0-20. English version of the Modified Barthel Index (MBI) is widely used to measure disability also in Bangladesh and an important tool for assessment of activities of daily living in aged patients. However, a validated and culturally adapted Bengali version of MBI has not been produced yet. This study describes the validation and reliability into Bengali of the modified 10-item version of MBI, and reports the procedures for testing its validity and reliability. For validation process a two phased study was conducted based on data from aged patients in out and in patient department of Bangabandhu Sheikh Mujib Medical University. After pre-testing of the Bengali version of MBI (B-MBI) among 30 aged patients in phase-1 of the study whereas total 129 patients were submitted to the adapted scale for testing its acceptability and internal consistency in second phase. The internal consistency by Cronbach’s alpha resulted equal to 0.880. The score was also tested against the Bengali adapted SF-36 (Short Form-36) to compare with physical functioning and mental health domains. It yielded Spearman’s correlation coefficient (rS) 0.787 (p&lt;0.001)), indicating strong positive correlation of B-MBI with physical functioning part and a weak correlation (rs=0.191; p=0.031) was found with mental health domain of SF-36. Reliability was evaluated on 124 cases as 5 participants were missed for re-test; at test-retest was ICC=0.961 (95%IC: p&lt;0.001). This study provides a new tool for professionals in Bangladesh to measure functional disability in aged patients both in inpatient and outpatient department of hospitals and also in the health and social care settings along the continuum of care. Asian J. Med. Biol. Res. 2021, 7 (3), 238-248

Outcome Assessment Performance of the SF-36, Manchester-Oxford Foot Questionnaire and AOFAS in Forefoot Reconstruction Surgery

The purpose of this study was to investigate the measurement properties of the Short Form 36 (SF-36) to detect real change after forefoot reconstruction surgery. Responsiveness and minimally important change estimates were compared with those from the Manchester-Oxford Foot Questionnaire (MOXFQ) and the American Orthopaedic Foot and Ankle Society (AOFAS) measures. Eighty-three patients awaiting surgery were recruited. Patients completed pre- and 12 months postoperative the SF-36 and the MOXFQ. A surgeon assessed the AOFAS scores. The responsiveness to change was determined using the effect size (ES), the minimal detectable change (MDC) and the minimal clinically important change. Two subscales of the SF-36 demonstrated significant improvement, bodily pain (BP) and mental health. Only the BP domain appeared the most responsive with an ES of 0.73. All domains of the MOXFQ and AOFAS produced much larger effect sizes (ES > 1.5). MDC values for the majority of the SF-36 domains fell within measurement error except for the BP domain. Fewer patients showed significant improvement when compared with the MOXFQ pain domain. In conclusion, the SF-36 measuring tool proved to be neither reliable nor responsive enough to detect real change after forefoot surgery. Though the BP domain appeared to be the most responsive, it failed to detect meaningful change when compared to the MOXFQ-Pain and the Visual Analogue Scale.

Atrial Fibrillation Impact Questionnaire (AFImpact): Validity and reliability of the Turkish version.

Guidelines recommend measuring and addressing health-related quality of life in the management of atrial fibrillation (AF); however, a disease-specific questionnaire is lacking for the Turkish language. Our aim was to translate and adapt the Atrial Fibrillation Impact Questionnaire (AFImpact) into Turkish and to explore its psychometric properties. This cross-sectional study was conducted in two phases, including the translation and cultural adaptation of AFImpact into Turkish language and the analysis of psychometric properties of the translated questionnaire. 98 patients diagnosed with AF were evaluated using the Turkish version of AFImpact, Short Form-36 (SF-36) and Pittsburg Sleep Quality Index (PSQI). Reliability, validity, and factor structure of the Turkish version of AFImpact was explored. Cronbach's alpha coefficients for vitality, emotional distress, and sleep domains of AFImpact was 0.956, 0.955, and 0.819, respectively, indicating good-to-excellent internal consistency. No significant difference was detected between the initial and retest scores, and intraclass correlation coefficients of each domain varied between 0.991 and 0.996, indicating excellent test-retest reliability. Each domain of AFImpact highly correlated with similar domains of SF-36 and PSQI, having correlation coefficients between -0.484 and -0.699. AFImpact was able to discriminate between the patients in different functional classes, confirming know-groups validity. Factor analysis revealed AFImpact had the same factorial structure as the original questionnaire. The Turkish version of AFImpact is a valid and reliable questionnaire for evaluating health-related quality of life in patients with AF.

Long-term quality of life outcome after spondylodiscitis treatment

BACKGROUND CONTEXTSpondylodiscitis is the most common spinal infection of which the incidence has increased and the peak prevalence is between 50 and 70 years of age. Spondylodiscitis is often a complication of a distant infection. Early diagnosis can be challenging, and although improvements in diagnostic techniques and modern therapy have diminished the mortality of the disease, current literature about the outcome of spondylodiscitis is scarce. PURPOSETo evaluate the long-term clinical outcome of patients who suffered from spondylodiscitis. STUDY DESIGNA two-center cross-sectional study. PATIENT SAMPLEPatients with spondylodiscitis in two large teaching hospitals in the Netherlands between 2003 and 2017. OUTCOME MEASURESVisual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) for function, and Short Form 36 (SF-36) for general quality of life of spondylodiscitis patients. METHODEligible patients were identified from electronic patient databases and completed multiple patient reported outcome measures after obtaining informed consent. General demographic and clinical information (age, sex, medical history) were extracted from the patient records. SF-36 domain scores of spondylodiscitis patients were compared with a nationwide population sample. RESULTS183 patients were treated for spondylodiscitis; additional questionnaires were received from 82 patients. After a median follow-up of 63 months, the overall mortality was 28%. The mean VAS for back pain was 3.5, and the mean ODI score was 22. In all SF-36 domains a significantly lower score was found in the spondylodiscitis group compared with a normative national Dutch cohort. There was a strong correlation between back pain and ODI scores (ρ=0.81, p<.05). CONCLUSIONSOur study confirms that spondylodiscitis is a disease causing a profound impact on back pain, function and quality of life. The results suggest that chronic back pain is a debilitating problem, as it has an extensive influence on daily activities and social and psychological well-being, causing significant disability.

Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery: A Prospective Cohort Study.

Introduction:Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery.Methods:Adults undergoing cancer surgery were eligible for inclusion (2017–2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined.Results:Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22–0.78], P < 0.001) and physical role limitations (0.41, 95% confidence interval [0.05–0.77], P = 0.024). Patients expected better HRQL than they experienced.Conclusions:Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.

Early Recovery Following Total and Unicompartmental Knee Arthroplasty Assessed Using Novel Patient-Reported Measures

BackgroundThe early postoperative recovery period following unicompartmental (UKA) and total knee arthroplasty (TKA) is an important area for research with increasingly sensitive metrics and new technologies. This study uses 2 recently developed patient-reported scores to compare the recovery following UKA and TKA. MethodsTwo consecutive cohorts of 37 UKAs and 33 TKAs completed the Oxford Arthroplasty Early Recovery Score (OARS) and the Oxford Arthroplasty Early Change Score (OACS) on days 1, 2, 3, 7, 14, and week 6. The Short Form-36 version 2 was also completed on weeks 1, 2, and 6. Improvements within cohorts and comparisons between cohorts were assessed. ResultsFor both UKA and TKA the speed of recovery was rapid early on and then progressively decreased. At all time points, the UKA cohort reported similar or significantly better scores than the TKA cohort. The overall OARS (P < .001) showed that UKA recovered, shown as improvement on the OARS, 2-3 times faster than TKA. OARS subscales demonstrated that UKA had better Function/Mobility (P = .003) particularly early in the recovery, and better Nausea/Feeling Unwell (P < .001) and Fatigue/Sleep (P = .009) later in the recovery. UKA also had less pain at 2 weeks (P = .03). There was no significant difference between UKA and TKA OACS. UKA had significantly better scores in 3 of the 8 Short Form-36 domains, with the largest difference being in Role-Emotional (P = .003). ConclusionThe OARS is useful for the assessment of postoperative recovery. This study provides direct evidence that recovery following UKA is better and 2-3 times faster than following TKA. All differences may be explained by the less invasive nature of UKA.

Biological Therapy in Patients with Rheumatoid Arthritis in a Tertiary Center in Portugal: A Cross-Sectional Study.

Clinical outcomes in rheumatoid arthritis have greatly improved with therapeutic advances. Despite the availability of substantial clinical trial evidence, there is a lack of real-life data. The aim of this study was to assess disease status and quality of life in an outpatient population treated with biological disease-modifying anti-rheumatic drugs. Cross-sectional study recalling all patients ever treated in our unit with biological disease-modifying antirheumatic drugs. Clinical and demographic data, compliance, disease activity, functional status, joint deformities, and comorbidities were documented, and patients queried on occupational status, education, marital status and generic health related quality of life questionnaires. Recall was attended by 77 of the original 94 patients. At recall, median age was 63 years old, 82% of the patients were female and the median disease duration was 12 years. Biological therapy was started at a median of four years following disease onset. According to the disease activity score (DAS28), the percentage of patients with high, moderate, low disease activity or remission changed from 50, 45, 0 and 5 (pre-therapy) to 11, 37, 25 and 26 at recall, respectively; functional status was significantly improved. Seventy-five per cent of the patients retained the original treatment with good compliance. Lower Short Form-36 domain scores accompanied a low EQ-5D-3L score. Deceased patients (n = 6) had a lower estimated 10-year survival rate. In this group, biological therapy was discontinued at a higher frequency during follow-up. A high disease activity and a high HAQ disability index characterized most patients at pre-bDMARD onset. Despite therapy switches and regular follow-up, a significant percentage of patients still presented with moderate disease activity, functional impairment and a poor health-related quality of life.

The impact of symptoms on daily life as perceived by patients with Charcot-Marie-Tooth type 1A disease

IntroductionIn Charcot-Marie-Tooth type 1A (CMT1A) patients, daily life is mainly influenced by mobility and ambulation dysfunctions. The aim of our work was to evaluate the perception of disturbances that mostly impact on daily life in CMT1A patients and its difference on the basis of age, gender, disability, and quality of life.MethodsForty-one CMT1A patients underwent neurological assessment focused on establishing clinical disability through the Charcot-Marie-Tooth Neuropathy Score (CMTNS) and quality of life through the Short Form-36 (SF-36) questionnaire. We identified from CMT disturbances 5 categories [weakness in lower limbs (WLL), weakness in upper limbs (WUL), skeletal deformities (SD), sensory symptoms (SS), balance (B)] and patients classified the categories from the highest to the lowest impact on daily life (1: highest; 5: lowest). Ranking of the 5 categories, in the overall sample and in the different subgroups (dividing by gender, median of age and disease duration, CMTNS, domains of SF-36), was obtained and differences among subgroups were assessed using a bootstrap approach.ResultsRank analysis showed that WLL was the most important disturbance on daily life whereas WUL had the lowest impact. In the older CMT1A group, the most important disturbance on daily life was B that was also the most relevant disturbance in patients with a greater disability. SD influenced daily life in younger patients. SS had less impact on daily life, with the exception of patients with a milder disability.DiscussionOur findings demonstrated that the perception of disturbances that mostly impact on CMT1A patients’ daily life changes over the lifetime and with degree of disability.

Impact of Completion Lymphadenectomy on Quality of Life for Head and Neck Cutaneous Melanoma.

Recent randomized data suggest that completion lymph node dissection after a positive sentinel lymph node biopsy (SLNB) improves locoregional control but does not improve survival for melanoma patients. Locoregional recurrences of head and neck cutaneous melanoma (HNCM) may result in significant morbidity. A better understanding of morbidity is thus important to inform decisions about whether to pursue completion neck dissection (ND). Cross-sectional study. Academic tertiary care hospital. Clinical data were collected for patients with HNCM seen between 2016 and 2019 who were at least 1-year disease free. Each patient completed the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS), Neck Dissection Impairment Index, and SF-36 (Short Form-36). Scores were compared by surgical treatment: wide local excision (WLE) only, SLNB, and ND. Univariate and multivariable regression was performed. Of 474 patients, 140 returned questionnaires (29.5% response rate; WLE, n = 49; SLNB, n = 76; ND, n = 15). No significant differences in SLANSS or Neck Dissection Impairment Index scores were found between the WLE and SLNB groups. SLANSS scores differed by 2 SD (P = .001) in the ND cohort, which had a 36% rate of neuropathy. Neck impairment was worse by 1 SD (P = .01) in the ND cohort. No differences were found in SF-36 domains. Neuropathy and neck impairment are components of morbidity after ND. These risks must be balanced with potential morbidity of locoregional recurrence in HNCM.

Quality of life and sexual function after a pregnancy complicated by placenta accreta spectrum.

Little is known about the impact of Placenta Accreta Spectrum (PAS) on quality of life (QoL). This study aims to explore QoL and sexual function after a pregnancy complicated by PAS. Women who experienced a pregnancy complicated by PAS were invited to complete an online survey. Two validated surveys were completed: Short Form 36 (SF-36) and Female Sexual Function Index (FSFI). The mean scores were calculated and were compared between women by pregnancy outcomes. Continuous variables were presented as mean (standard deviation (SD)) and were compared to assess for significance between groups using independent t-test and one-way analysis of variance. Categorical variables were compared using χ2 test. A total of 142 women responded to the survey. For the SF-36, physical health was significantly higher for women at 24-36months postpartum compared to those from 0-6months postpartum for physical functioning (mean difference 21.9 (95% confidence interval (CI) 10.2, 33.5), role limitation due to physical function (mean difference 32.1 (95% CI 9.4, 54.7)) and pain (mean difference 15.5 (95% CI 3.4, 30.9)). For the mental health domains, only vitality improved at 24-36months compared to the first sixmonths postpartum (mean difference 12.8 (95% CI 0.2, 25.5)). The mean FSFI score was 24.8 (±5.8), lower than the critical score of 26.5 indicating sexual dysfunction, and 56.8% (n=75), scored less than 26.5. Women after a pregnancy complicated by PAS had high scores on the physical health domains of SF-36. The mental health scores were lower for all women regardless of time since birth.

Effects of craniosacral therapy and sensorimotor training on pain, disability, depression and quality of life of patients with nonspecific chronic low back pain: a randomized clinical trial

Background: Craniosacral therapy (CST) and sensorimotor training (SMT) are two recommended interventions for nonspecific chronic low back pain (NCLBP). This study compares the effects of CST and SMT on pain, functional disability, depression and quality of life in patients with NCLBP.&#x0D; Methodology: A total of 31 patients with NCLBP were randomly assigned to the CST group (n=16) and SMT (n=15). The study patients received 10 sessions of interventions during 5 weeks. Visual analogue scale (VAS), Oswestry disability index (ODI), Beck depression inventory-II (BDI-II), and Short Form-36 (SF-36) questionnaires were used at baseline (before the treatment), after the treatment, and 2 months after the last intervention session. Results were compared and analyzed statistically.&#x0D; Results: Both groups showed significant improvement from baseline to after treatment (p &lt; 0.05). In the CST group, this improvement continued during the follow-up period in all outcomes (p &lt; 0.05), except role emotional domain of SF-36. In the SMT group, VAS, ODI and BDI-II increased during follow-up. Also, all domains of SF-36 decreased over this period. Results of group analysis indicate a significant difference between groups at the end of treatment phase (p &lt; 0.05), except social functioning.&#x0D; Conclusions: Results of our research confirm that 10 sessions of craniosacral therapy (CST) or sensorimotor training (SMT) can significantly control pain, disability, depression, and quality of life in patients with NCLBP; but the efficacy of CST is significantly better than SMT.&#x0D; Key words: Craniosacral therapy; Sensorimotor training; Nonspecific chronic low back pain; Quality of life&#x0D; Citation: Ghasemi C, Amiri A, Sarrafzadeh J, Dadgoo M. Effects of craniosacral therapy and sensorimotor training on pain, disability, depression and quality of life of patients with nonspecific chronic low back pain: a randomized clinical trial. Anaesth. pain intensive care 2021;25(2):189-198. DOI: 10.35975/apic.v25i2.1458&#x0D; Abbreviations: CST=Craniosacral therapy; SMT=Sensorimotor training; NCLBP=Nonspecific chronic low back pain; VAS=Visual analogue scale; ODI=Oswestry disability index, BDI-II=Beck depression inventory-II, and SF-36=Short Form-36; CSF=cerebral spinal fluid; CSS=craniosacral system; PRM=primary respiratory movements&#x0D; Received: 27 June 2020, Reviewed: 24 July 2020, Accepted: 27 July 2020