Short-Form Health Survey Mental Component Research Articles

Comparison of the Medium-term Outcomes of Anterior Lumbar Discectomy and Fusion with Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study.

Lumbar degenerative diseases (LDDs) with huge herniation in the left lateral recess or central canal present challenges for oblique lateral lumbar interbody fusion (OLIF) or endoscope-assisted OLIF procedures. Currently, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the primary approach for this issue. This study aims to provide a standardized technical description of the anterior lumbar discectomy and fusion (ALDF) and evaluate the medium-term clinical effectiveness of both ALDF and MIS-TLIF techniques. A retrospective review was performed on LDDs who underwent ALDF and MIS-TLIF surgery from January 2018 to January 2020. The evaluation encompassed various clinical outcomes, such as the visual analogue scale (VAS) scores for back pain and leg pain (VAS-back, VAS-leg), the Oswestry disability index (ODI), the 36-item short-form health survey mental component summary (SF-36 MCS), and the physical component summary (SF-36 PCS). Additionally, radiological parameters, including disc height (DH), segmental disk angle (SDA), lumbar lordosis (LL), and cross-sectional area (CSA), were assessed. Data including radiculopathy, estimated blood loss, operation time, time of getting out of bed, fusion rate, and complications were recorded. Student's independent samples t test and Pearson's chi-square test were used to compare the differences between groups. In total, 47 patients were treated by ALDF and 48 patients were treated by MIS-TLIF. The ALDF group exhibited statistically significant lower estimated blood loss and earlier time of getting out of bed compared to the MIS-TLIF group (p < 0.05). The ALDF group demonstrated lower VAS-back scores and a higher remission rate of low back pain 3 years after the surgery (p < 0.05). During the entire follow-up period, the ALDF group exhibited higher increases in DH and SDA compared to the MIS-TLIF group (p < 0.05). At 6 months, the fusion rate in the ALDF group was significantly higher than in the MIS-TLIF group (p < 0.05). The comparison revealed no statistically significant differences in complication rates between the two groups (p > 0.05). The ALDF could be considered as a viable surgical alternative for the treatment of LDDs that necessitate ventral neural direct decompression. ALDF exhibited favorable medium-term outcomes in patients with LDDs, displaying advantages in facilitating expedited recovery, enhancing radiographic outcomes, and elevating the remission rate of low back pain. Although ALDF presents slightly higher complication rates compared to MIS-TLIF, it does not adversely affect clinical outcomes.

Feasibility of an Intradialytic Combined Exercise Program Targeting Older Adults With End-Stage Renal Disease.

To assess the feasibility and clinical benefits of supervised, intradialytic exercise in older patients. Multicenter one-arm feasibility study. The main outcome was feasibility (ease of recruitment, dropout rate, adherence, affective valence, and adverse events). The secondary outcomes were physical capacity (five-repetition sit-to-stand, 60-s sit-to-stand tests, and grip strength), quality of life (36-Item Short-Form Health Survey), quality of sleep (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), and dialysis efficacy (Kt/V and urea reduction ratio). About 79% of the screened patients agreed to participate (n = 25, 73 [66-77]years). The dropout rate was high (32%), but adherence remained high among the participants who completed the study (94%). Improvements were found in the five-repetition sit-to-stand (p < .001), 60-ssit-to-stand tests (p = .028), 36-Item Short-Form Health Survey mental component score (p = .008), depressive symptoms (p = .006), and quality of sleep (p = .035). Supervised intradialytic exercise seems safe and beneficial in older patients.

Life-course impact of child maltreatment on midlife health-related quality of life in women: longitudinal mediation analysis for potential pathways

PurposeWe examined (1) if child maltreatment (CM) is associated with lower health-related quality of life (HRQoL) and fewer quality-adjusted life years (QALY) over a 9-year follow-up of midlife women and (2) if adulthood psychosocial mediators could explain these associations. MethodsWomen (n = 342) completed the Childhood Trauma Questionnaire. Longitudinal HRQoL and QALY outcomes measured at five study visits include 36-item Short-Form Health Survey mental component score and physical component score and the Short Form-6 Dimension health index. Aims 1 and 2 were investigated by generalized estimating equations and sequential structural nested mean models, respectively. ResultsTwenty percent reported 2+ CM types. Compared with women without CM, women who experienced 2+ CM types reported 5- and 4-points lower scores in mental component score and physical component score, respectively, and 28 fewer healthy days per year in QALY. Low optimism, sleep problems, and low social support each explained greater than 10% of the relationship between 2+ CM and HRQoL and QALY over time. ConclusionsCM is a life-course social determinant of HRQoL and QALY throughout midlife, particularly in women who experienced 2+ CM types. Several mediators are modifiable and could be targets of interventions to mitigate the negative impact of CM on midlife HRQoL and QALY in women.

Utility of Anxiety/Depression Domain of EQ-5D to Define Psychological Distress in Spine Surgery

Prospective patient-reported outcomes (PROs) registries are central to emerging evidence-driven reform models. These registries entail significant operator and responder burden to capture PROs data. It is important to limit the number of PROs administered. We sought to determine whether the anxiety/depression domain of EQ-5D could be used to define preoperative psychological distress in patients undergoing elective spine surgery. Patients undergoing elective spine surgery and enrolled into a prospective registry were analyzed. The 12-Item Short-Form Health Survey Mental Component Summary, Zung depression scale, Modified Somatic Perception Questionnaire, and EQ-5D were completed. The anxiety/depression domain of EQ-5D was used to define psychological distress; responses were captured as 1) not anxious or depressed, 2) moderately anxious or depressed, or 3) extremely anxious or depressed. Univariate correlation and proportional odds logistic regression analyses were conducted. Of 2470 included patients undergoing elective spine surgery, 45% (n= 1109) reported no psychological distress, 47% (n= 1168) reported moderate psychological distress, and 8% (n= 193) reported extreme psychological distress on EQ-5D. Psychological distress on EQ-5D had positive correlation with Zung depression scale (P < 0.0001, r= 0.620) and Modified Somatic Perception Questionnaire (P < 0.0001, r= 0.450) and negative correlation with 12-Item Short-Form Health Survey Mental Component Summary (P < 0.0001, r=-0.662). In proportional odds logistic regression models, EQ-5D psychological distress had significant correlations with 12-Item Short-Form Health Survey Mental Component Summary (P < 0.0001, C-index= 0.831), Zung depression scale (P < 0.0001, C-index= 0.802), and Modified Somatic Perception Questionnaire (P < 0.0001, C-index= 0.711). The anxiety/depression domain of EQ-5D could be used to categorize preoperative psychological distress. Spine registries could use this information to potentially limit the number of validated PROs administered.

Effects of promoting daily physical activity on physical and mental health in older individuals.

[Purpose] A trial was conducted to examine the effects of promoting daily physical activity, tailored to specific living situations, on physical and mental health indicators in older adults. [Participants and Methods] Participants in the ‘Intervention’ group (N=21) wore accelerometers during the 12-week trial period, and for one week during preliminary and follow-up surveys. Based on their physical activity levels as measured by accelerometers, participants were given instructions to increase their daily physical activity. Participants in the ‘Control’ group (N=18) wore the accelerometer only during the preliminary and follow-up survey. [Results] Number of steps increased significantly in the intervention group and a significant decrease in light physical activity time was observed in the control group. No such decrease was observed in the intervention group. With regard to health-related quality of life, significant interactions were observed between groups based on the 36-Item Short-Form Health Survey Mental Component Summary score, and some sub-items. A combined analysis of both groups found a significant positive correlation between the change in light physical activity time and the Mental Component Summary score. [Conclusion] An increase in daily physical activity was considered to have a sustained bolstering effect on mental health.

The influence of fibromyalgia on achieving remission in patients with long-standing rheumatoid arthritis.

To investigate the influence of fibromyalgia (FM) on achieving remission defined on the basis of the Simplified Disease Activity Index (SDAI) remission criteria in patients with long-standing rheumatoid arthritis (RA). This observational longitudinal cohort consisted of long-standing RA patients being treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs). After 6months of follow-up, the patients fulfilling or not fulfilling the remission criteria were identified and compared with each other in terms of the presence of FM, neuropathic pain, and other comorbidities. At the end of the 6-month observation period, 24 of the 117 patients (20.4%) met the SDAI remission criteria. Logistic regression analysis showed that the modified Rheumatic Disease Comorbidity Index (mRDCI) (p=0.0001), the FM presence (p=0.0001), and the 36-item short-form health survey Mental Component Summary (SF-36 MCS) Score (p=0.0088) were the strongest predictors of not being in SDAI remission. None of the patients with concomitant FM (17.1%) achieved SDAI remission. In comparison with the non-FM patients, the patients with RA and FM patients had worse scores on the SF-36 MCS (p=0.011), on the sleep Visual Analogue Scale (VAS) (p=0.018), on the self-counts of tender joints (p=0.039), and on the PainDetect Questionnaire (PDQ) (p=0.001). To avoid over treatment, an assessment of FM should be considered in RA patients who do not fulfil the remission criteria.

Targeting the underlying causes of undernutrition. Cost-effectiveness of a multifactorial personalized intervention in community-dwelling older adults: A randomized controlled trial.

Undernutrition in old age is associated with increased morbidity, mortality and health care costs. Treatment by caloric supplementation results in weight gain, but compliance is poor in the long run. Few studies targeted underlying causes of undernutrition in community-dwelling older adults. This study aimed to evaluate the cost-effectiveness of a multifactorial personalized intervention focused on eliminating or managing the underlying causes of undernutrition to prevent and reduce undernutrition in comparison with usual care. A randomized controlled trial was performed among 155 community-dwelling older adults receiving home care with or at risk of undernutrition. The intervention included a personalized action plan and 6 months support. The control group received usual care. Body weight, and secondary outcomes were measured in both groups at baseline and 6 months follow-up. Multiple imputation, linear regression and generalized estimating equation analyses were used to analyze intervention effects. In the cost-effectiveness analyses regression models were bootstrapped to estimate statistical uncertainty. This intervention showed no statistically significant effects on body weight, mid-upper arm circumference, grip strength, gait speed and 12-Item Short-Form Health Survey physical component scale as compared to usual care, but there was an effect on the 12-Item Short-Form Health Survey mental component scale (0-100) (β=8.940, p=0.001). Borderline significant intervention effects were found for both objective and subjective physical function measures, Short Physical Performance Battery (0-12) (β=0.56, p=0.08) and ADL-Barthel score (0-20) (β=0.69, p=0.09). Societal costs in the intervention group were statistically non-significantly lower than in the control group (mean difference-274; 95% CI-1111; 782). Cost-effectiveness acceptability curves showed that the probability of cost-effectiveness was 0.72 at a willingness-to-pay of 1000€/kg weight gain and 0.80at a willingness-to-pay of 20,000€/quality-adjusted life year gained. This multifactorial personalized intervention showed a statistically non-significant effect and was not cost-effective on body-weight compared to usual care. We observed consistently beneficial treatment effects in the intervention group on all outcomes measures. NTR5184 (www.trialregister.nl).

Real-life assessment of the multidimensional nature of dyspnoea in COPD outpatients.

Dyspnoea is a prominent symptom of chronic obstructive pulmonary disease (COPD). Recent multidimensional dyspnoea questionnaires like the Multidimensional Dyspnea Profile (MDP) individualise the sensory and affective dimensions of dyspnoea. We tested the MDP in COPD outpatients based on the hypothesis that the importance of the affective dimension of dyspnoea would vary according to clinical characteristics.A multicentre, prospective, observational, real-life study was conducted in 276 patients. MDP data were compared across various categories of patients (modified Medical Research Council (mMRC) dyspnoea score, COPD Assessment Test (CAT) score, Global Initiative for Chronic Obstructive Lung Disease (GOLD) airflow obstruction categories, GOLD "ABCD" categories, and Hospital Anxiety and Depression Scale (HADS)). Univariate and multivariate regressions were conducted to explore factors influencing the affective dimension of dyspnoea. Cluster analysis was conducted to create homogeneous patient profiles.The MDP identified a more marked affective dimension of dyspnoea with more severe mMRC, CAT, 12-item Short-Form Health Survey mental component, airflow obstruction and HADS. Multivariate analysis identified airflow obstruction, depressive symptoms and physical activity as determinants of the affective dimension of dyspnoea. Patients clustered into an "elderly, ex-smoker, severe disease, no rehabilitation" group exhibited the most marked affective dimension of dyspnoea.An affective/emotional dimension of dyspnoea can be identified in routine clinical practice. It can contribute to the phenotypic description of patients. Studies are needed to determine whether targeted therapeutic interventions can be designed and whether they are useful.

Relationships Among Daytime Napping and Fatigue, Sleep Quality, and Quality of Life in Cancer Patients.

The relationships among napping and sleep quality, fatigue, and quality of life (QOL) in cancer patients are not clearly understood. The aim of the study was to determine whether daytime napping is associated with nighttime sleep, fatigue, and QOL in cancer patients. In total, 187 cancer patients were recruited. Daytime napping, nighttime self-reported sleep, fatigue, and QOL were assessed using a questionnaire. Objective sleep parameters were collected using a wrist actigraph. According to waking-after-sleep-onset measurements, patients who napped during the day experienced poorer nighttime sleep than did patients who did not (t = -2.44, P = .02). Daytime napping duration was significantly negatively correlated with QOL. Patients who napped after 4 PM had poorer sleep quality (t = -1.93, P = .05) and a poorer Short-Form Health Survey mental component score (t = 2.06, P = .04) than did patients who did not. Fatigue, daytime napping duration, and sleep quality were significant predictors of the mental component score and physical component score, accounting for 45.7% and 39.3% of the variance, respectively. Daytime napping duration was negatively associated with QOL. Napping should be avoided after 4 PM. Daytime napping affects the QOL of cancer patients. Future research can determine the role of napping in the sleep hygiene of cancer patients.

Relationship of preinjury depressive symptoms to outcomes 3 mos after complicated and uncomplicated mild traumatic brain injury.

This study examines the effect of preinjury depressive symptoms on outcomes 3 mos after complicated and uncomplicated cases of mild traumatic brain injury. Preinjury depressive symptoms, experienced in the 30 days before injury, as measured by retrospective self-report, were assessed within the first 2 wks after injury. The outcome measures assessed at 3 mos after injury included affective/behavioral, cognitive, and physical problems and health-related quality-of-life. There were 177 patients who completed both the baseline and 3-mo follow-up interviews. The sample was categorized by severity of depressive symptoms in the month before injury as normal, mild, or moderate-severe. Compared with those reporting no preinjury depressive symptoms, persons reporting moderate-severe depressive symptoms had significantly worse outcomes on the Affective and Behavioral and the Cognitive subscales of the Head Injury-Family Interview Problem Checklist and on the 36-item Short-Form Health Survey Mental Component Summary score. The group reporting mild preinjury depressive symptoms scored worse on a measure of cognitive symptoms compared with those with no preinjury depressive symptoms. There was no interaction between preinjury depressive symptoms and severity of the mild traumatic brain injury (complicated or uncomplicated) for any of the outcomes. Moderate to severe depressive symptoms in the month before injury seems to be a possible risk factor for poor affective/behavioral, cognitive, and mental health-related quality-of-life outcomes at 3 mos after mild traumatic brain injury. Clinicians and researchers should consider the impact of preinjury depression on the recovery process to provide at-risk patients adequate treatment soon after injury.

Functional and social limitations after facial palsy: expanded and independent validation of the Italian version of the facial disability index.

The Facial Disability Index (FDI) is widely used for self-assessment of functional impairment and quality of life in patients with facial palsy. The study aim was to complete the validation of the FDI by generating an Italian version (IT-FDI) and evaluating its clinimetric properties. This was a longitudinal, observational measurement study. The questionnaire was translated, cross-culturally adapted, and administered to 100 consecutive participants (outpatients) with facial palsy. The clinical severity of facial palsy, impairments in physical and social function, and quality of life were evaluated with the Sunnybrook Facial Grading System, IT-FDI, and 12-Item Short-Form Health Survey. The IT-FDI showed excellent test-retest reliability for every item and for total scores (intraclass correlation coefficients of .93 and .84 for physical function subscale and social/well-being function subscale, respectively). The IT-FDI confirmed the high internal consistency of the original version, with theta coefficients of .82 for the physical function subscale and .78 for the social/well-being function subscale. The physical function subscale correlated with the Sunnybrook Facial Grading System composite score (r=.44), and the social/well-being function subscale correlated with the 12-Item Short-Form Health Survey mental component (r=.55). The IT-FDI confirmed the good responsiveness of the original version, as expressed by effect size, standardized response mean, and responsiveness ratio of, respectively, 1, 1.03, and 1.21 for the physical function subscale and 0.75, 0.83, and 1.15 for the social/well-being function subscale. Responsiveness was evaluated with a limited number of participants. The results demonstrated the test-retest reliability for all items of the FDI and confirmed its internal consistency, construct validity, and responsiveness with an independent and larger clinical subset. This study completes the validation of the FDI and provides the first validated questionnaire in Italian for assessment of disability and quality of life specifically in patients with facial palsy.

Normative Comparison of Patient-Reported Outcomes in Patients With Noninfectious Uveitis

To compare vision-related functioning and health-related quality of life of patients with noninfectious intermediate or posterior uveitis with those of the US general population and normal-vision reference groups. Secondary analysis of health-related quality of life measures administered at baseline to patients with noninfectious intermediate or posterior uveitis participating in the HURON trial, a 26-week, multicenter, masked, randomized, sham-controlled trial of a dexamethasone intravitreal implant (n=224) was performed. Patient-reported outcome measures included the National Eye Institute Visual Function Questionnaire-25, the 36-Item Short-Form Health Survey, the Short Form-6 Dimensions, and the EuroQol-5D. The National Eye Institute Visual Function Questionnaire-25 scores from the HURON uveitis population were compared with published National Eye Institute Visual Function Questionnaire-25 scores from a normal-vision reference group (n=122). The 36-Item Short-Form Health Survey, Short Form-6 Dimensions, and EuroQol-5D scores were compared with the US general population using data from the National Health Measurement Study (n=3844) and the Medical Expenditure Panel Survey (n=955). Compared with a normal-vision population, the HURON uveitis population had clinically significant impairments across all National Eye Institute Visual Function Questionnaire-25 subscales and the composite score, with all subscale score differences exceeding 10 points (P< .001). The HURON uveitis population had significantly lower 36-Item Short-Form Health Survey mental component summary and Short Form-6 Dimensions scores compared with a US general population sample (P< .001). No significant differences were found for the 36-Item Short-Form Health Survey physical component summary and EuroQol-5D scores between the uveitis and US general population samples. Compared with the US general population and normal-vision reference groups, noninfectious intermediate or posterior uveitis results in meaningful reductions in mental health outcomes, health-related quality of life, and vision-related functioning. clinicaltrials.gov Identifier:NCT00333814.

Clinical Implications

HomeHypertensionVol. 60, No. 6Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Dec 2012https://doi.org/10.1161/HYP.0b013e31827adfa9Hypertension. 2012;60:1367NHE3-Inhibition in the Gut and Hypertension (page 1560)High intestinal sodium absorption is 1 mechanism of hypertension and constipation. The sodium-proton-exchanger subtype 3 (NHE3) is an important mediator of sodium absorption in the gut. SAR218034 is an orally nonabsorbable specific NHE3 inhibitor. Inhibition of intestinal NHE3 by SAR218034 increased feces sodium-excretion and reduced urinary sodium-excretion, while absolute sodium balance and serum sodium-concentration was not changed. Reduced intestinal sodium absorption by SAR218034-treatment was associated with increased feces water content and reduction in systolic blood pressure. Angiotensin-converting enzyme inhibition by ramipril plus NHE3 inhibition resulted in an additive blood pressure lowering effect. Selective inhibition of NHE3-mediated sodium absorption in the gut has the potential to reduce high blood pressure and can be safely combined with angiotensin-converting enzyme inhibitor treatment. In addition, NHE3 inhibition in the gut may display a laxative effect in elderly patients suffering from constipation. These results show that SAR218034 inhibiting intestinal NHE3-mediated sodium absorption has potential as a representative of a new class of antihypertensive drugs. Intestinal NHE3 inhibitors may be particularly useful as an adjunct to other therapies. The real potential of the NHE3 inhibitor is to help accomplish a truly low salt-intake from the gut, because it is difficult to sufficiently reduce salt in the human diet.Quality of Life After Renal Denervation (page 1479)Recent studies have demonstrated the effectiveness of radiofrequency ablation of the renal sympathetic nerves in reducing blood pressure in patients with treatment resistant hypertension. In this issue of Hypertension, Lambert et al present data indicating that subjective health-related quality of life, as assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey, is markedly diminished in patients with treatment resistant hypertension. Three months after renal denervation, the 36-Item Short-Form Health Survey mental component summary score improved, with the change being driven by increases in the vitality, social function, role emotion, and mental health domains. No change occurred in the physical component summary score. The changes in 36-Item Short-Form Health Survey scores were not related to the magnitude of blood pressure reduction. Although the authors could not exclude the possibility of a placebo effect, the potential mechanisms underlying their observations are intriguing. Preclinical studies have demonstrated that sensory renal afferent nerves can influence the firing rate of medullary and hypothalamic neurones and that renal afferent denervation prevents the development of hypertension and an increase in norepinephrine turnover in the posterior and lateral hypothalamic nuclei and the locus coeruleus. The majority of brain norepinephrine is located in the locus coeruleus, which, together with its hypothalamic and amygdala projections, is linked with behavioral responses involving autonomic activation. Whether the improvement in health-related quality of life that occurred after renal denervation is sustained and has a biological basis associated with reduction in sympathetic tone remains unknown but does merit further attention.Blood Pressure Tracking Over the Life Course (page 1393)Although prior studies have shown that blood pressure steadily increases with age, there are limited longitudinal data characterizing the pattern of blood pressure tracking over the life course. Furthermore, the extent to which risk factors influence blood pressure tracking is not well understood. Therefore, we used multilevel modeling to analyze blood pressure measurements performed serially, over a period of up to 28 years, in participants of the Framingham Heart Study. On the basis of data collected from >21 700 person-observations, we observed that risk factors such as greater body mass index and higher heart rate were associated with an increase in all component measures of blood pressure. However, dyslipidemia was primarily associated with increased mean arterial pressure, a measure of steady-state load, whereas diabetes mellitus and smoking were predominantly associated with higher pulse pressure, representing pulsatile load. Notably, age-related increases in pulse pressure were more pronounced in women compared with men overall. The differential impact of select risk factors on elevation in the individual components of blood pressure underscores distinct regulation of these measures over the life course. Further research is needed to investigate the mechanisms underlying these observations and, in turn, the extent to which targeted interventions may attenuate the typical trajectory of blood pressure progression with aging. Previous Back to top Next FiguresReferencesRelatedDetails December 2012Vol 60, Issue 6 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/HYP.0b013e31827adfa9 Originally publishedDecember 1, 2012 PDF download Advertisement

Efficacy of a Brief Screening Tool to Identify Medical Students in Distress

To determine whether the Medical Student Well-Being Index (MSWBI) can serve as a brief assessment tool to identify medical students in severe psychological distress. The authors used data from 2,248 medical students at seven U.S. medical schools who responded to a 2007 survey to explore the accuracy of the MSWBI in identifying medical students with three outcomes: low mental quality of life (QOL; defined by having a Medical Outcomes Study Short-Form Health Survey mental component summary score ≥1/2 standard deviation below that of the age- and gender-matched population norm), suicidal ideation, or serious thoughts of dropping out. The authors confirmed their analyses using data from a separate sample of 2,682 students evaluated in 2009. Students with low mental QOL, suicidal ideation, or serious thoughts of dropping out were more likely to endorse each individual MSWBI item and a greater number of total items than were students without such distress (all P < .001). The likelihood ratio for low mental QOL among students with MSWBI scores <4 was 0.47 as compared with 4.79 for those with scores ≥4. At an MSWBI threshold score of ≥4, the MSWBI's sensitivity and specificity for identifying students with low mental QOL or recent suicidal ideation/serious thoughts of dropping out were both ≥90%. On multivariable logistic regression, all MSWBI items were independently associated with at least one outcome. The MSWBI is a useful brief screening tool to help identify students with severe distress.

Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial

Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Objective To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee. Design Randomized, single-blind, before-after trial. Setting Physiotherapy gymnasium and hydrotherapy pool. Participants Patients awaiting elective hip or knee joint replacement surgery. Interventions Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment. Main Outcome Measures Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale. Results Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes. Conclusions While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.

Depressive Symptoms, Satisfaction With Health Care, and 2-Year Work Outcomes in an Employed Population

The relationship of depressive symptoms, satisfaction with health care, and 2-year work outcomes was examined in a national cohort of employees. A total of 6,239 employees of three corporations completed surveys on health and satisfaction with health care in 1993 and 1995. This study used bivariate and multivariate analyses to examine the relationships of depressive symptoms (a score below 43 on the Medical Outcomes Study Short-Form Health Survey mental component summary), satisfaction with a variety of dimensions of health care in 1993, and work outcomes (sick days and decreased effectiveness in the workplace) in 1995. The odds of missed work due to health problems in 1995 were twice as high for employees with depressive symptoms in both 1993 and 1995 as for those without depressive symptoms in either year. The odds of decreased effectiveness at work in 1995 was seven times as high. Among individuals with depressive symptoms in 1993, a report of one or more problems with clinical care in 1993 predicted a 34% increase in the odds of persistent depressive symptoms and a 66% increased odds of decreased effectiveness at work in 1995. There was a weaker association between problems with plan administration and outcomes. Depressive disorders in the workplace persist over time and have a major effect on work performance, most notably on "presenteeism," or reduced effectiveness in the workplace. The study's findings suggest a potentially important link between consumers' perceptions of clinical care and work outcomes in this population.