Medical Outcomes Study Short Form Research Articles

#831 Associations of quality of life with hospitalization for infection and subsequent death in hemodialysis patients: Osaka Dialysis Complication Study

Abstract Background and Aims Health-related quality of life (HRQOL) as self-reported health status is known to predict mortality in hemodialysis (HD) patients. Infection is one of the major causes for death in those patients, although limited studies have examined possible associations of HRQOL with infection-related outcomes. In the present study, we examined the associations of HRQOL scores with all-cause mortality, hospitalization for infection, and subsequent death in HD patients. Method Patients for this study were selected from the Osaka Dialysis Complication Study (ODCS) which is a prospective cohort study from 2012 to 2017 including a total of 1696 HD patients. HRQOL was assessed by Medical Outcomes Study short form 36 (SF-36) questionnaire to determine scores of the physical component summary (PCS) and the mental component summary (MCS) at baseline, and patients were divided into tertiles of them. The key outcomes were all-cause mortality, hospitalization for infection, and subsequent death after infection. Association was analyzed with Cox proportional hazards models or Fine-Gray models to estimate hazard ratios (HRs) with the highest tertile of PCS or MCS (T3) as referent. Models were unadjusted and adjusted for potential confounders including major demographic factors, traditional cardiovascular risk factors, and the factors related to chronic kidney disease-mineral and bone disorder (CKD-MBD), protein energy wasting and inflammation, and renal anemia. Results We analyzed data from 1464 patients, and we identified 384 all-cause deaths, 321 hospitalizations for infections, and 143 subsequent deaths following infection. Risk of all-cause death was the highest in the lowest PCS tertile in unadjusted model, and this association remained significant in multivariable-adjusted models. In addition, a lower PCS was significantly predictive of a higher risk of both hospitalization for infection in models unadjusted and adjusted for demographic variables, but not significant in a model adjusted for all confounders. However, risk of death after hospitalization for infection was significantly higher in the lowest PCS tertile in unadjusted and in multivariable-adjusted models, compared with the highest PCS tertile. In contrast, MCS was not associated with all-cause mortality, hospitalization for infection, or death following hospitalization for infection. Conclusion A low PCS was associated with both hospitalization for infection and subsequent death after infection in HD patients, but it was more closely associated with the latter. This study revealed that HRQOL, particularly its physical component, is an independent predictor of infection-related outcomes in this population.

Collaborative Care for Injured Older Adults

Older adults with recent injuries can have impaired long-term biopsychosocial function and may benefit from interventions adapted to their needs. To determine if a collaborative care intervention, Trauma Medical Home (TMH), improved the biopsychosocial function of older patients in the year after injury. This was a single-blinded, randomized clinical trial conducted at 4 level I trauma centers in Indianapolis, Indiana, and Madison, Wisconsin. Between October 2017 and October 2021, patients aged 50 years and older with an Injury Severity Score (ISS) of 9 or greater and without traumatic brain or spinal cord injury were enrolled. Exclusions were significant brain injury or a spinal cord injury with a persistent neurologic deficit at the time of enrollment, extensive burns, pregnancy, incarceration, neurodegenerative disease, visual or auditory impairment that would preclude study participation, a life expectancy of less than 1 year, significant alcohol or drug use history, and acute stroke during admission. Of 10 276 patients screened, 430 were randomized and 299 completed 12-month follow-up. Data were analyzed from March to July 2023. Intervention patients received 6 months of TMH delivered by a nurse care coordinator guided by an interdisciplinary team (trauma surgeon, pulmonary critical care and geriatrician physicians, nurses, and psychologist) in partnership with primary care. The care coordinator used standard protocols to monitor and treat biopsychosocial symptoms. Primary outcomes were Medical Outcome Study Short Form-36 (SF-36) score and Short Physical Performance Battery (SPPB) score at 12 months. Secondary outcomes were Patient Health Questionnaire-9 (PHQ-9) score, the Generalized Anxiety Disorder scale-7 (GAD-7) score, and health care utilization. A total of 429 participants (228 [53.1%] female; mean [SD] age, 69.3 [10.8] years; mean [SD] ISS, 12.3 [4.6]) completed baseline assessments and were randomized. Follow-up was 76% (n = 324) at 6 months and 70% (n = 299) at 12 months. There were no differences between the TMH and usual care groups at 12 months in SF-36 Physical Component Summary score (mean [SD], 40.42 [12.82] vs 39.18 [12.43]), SF-36 Mental Component Summary score (mean [SD], 53.92 [10.02] vs 53.21 [10.82]), or SPPB score (mean [SD], 8.00 [3.60] vs 8.28 [3.88]). Secondary outcomes were also no different. Planned subgroup analysis revealed patients with baseline symptoms of anxiety or depression (high GAD-7 and PHQ-9 scores) experienced improvement in the Mental Component Summary score when randomized to the TMH intervention. The TMH intervention did not significantly influence quality of life, depressive and anxiety symptoms, or physical function of older adults with injury at 12 months. Subgroup analysis showed positive impact in patients with a high burden of anxiety and depression symptoms at enrollment. Collaborative care interventions may improve long-term outcomes of select patients, but further research is needed. ClinicalTrials.gov Identifier: NCT03108820.

QUALITY OF LIFE OF PATIENTS TREATED BY VALVE-SPARING AORTIC ROOT REPLACEMENT

The aim. To determine the effectiveness of David valve-preserving operation in comparison with Bentall operation based on the analysis of patients' quality of life after operations. Materials and methods. The study included 107 patients who underwent planned and urgent surgical treatment at the Heart Institute of the Ministry of Health of Ukraine from 2015 to 2023. The patients were divided into two groups depending on the type of surgical intervention: group A consisted of 53 patients (49,11±1,54 years; 47 (88,68%) males), who underwent the David procedure (valve-sparing replacement of aortic root and ascending aorta), group B – 55 patients (52,36±1,56 years; 53 (96,36%) males), who underwent Bentall surgery (replacement of the valve, root and ascending part of the aorta). The quality of life was assessed before the operation for each group, and in the long-term period after operation. The quality of life of the patients of both groups was compared. It was assessed using the Medical Outcomes Study Short Form 36 (MOS SF-36) questionnaire. Results. The obtained data indicated that the average preoperative values of quality of life indicators of patients of both groups with different types of aneurysm correction were significantly different from ideal health. The performed operations significantly improved the assessment of the quality of life. When comparing the quality of life in the remote period of the patients of both groups, the indicators were significantly better in group A. We noticed that the patients of group A had a significantly better psycho-social component, which probably influenced the assessment of other scales. Group A patients had statistically better all indicators of quality of life after surgery comparing with group B patients. Group B patients complained about the sound of the artificial aortic valve prosthesis, sometimes the occurrence of minor nosebleeds and the need for frequent visits of the doctor to monitor blood "thinning" indicators. Conclusions. The obtained results indicate a positive change in the quality of life in patients of both groups. When David operation is performed for aortic root and ascending aortic aneurysms, the quality of life is significantly better than in patients after Bentall operation. We recommend performing David operations at the highly specialized cardiac centers.

Клапанозбережне протезування кореня аорти: результати операції Девіда І

The aim – to determine the long-term results and quality of life of patients who underwent David І valve-sparing operation.Materials and methods. The one-center study included 53 patients who underwent planned and urgent David I procedure (valve-sparing replacement of the aortic root and ascending aorta) from 2015 to 2023. The mean age of the 53 patients (among them, 47 (88.68 %) males) was 49.11 ± 1.54 years. We analyzed basic characteristics of the patients, intraoperative and postoperative data. The quality of life was assessed before and in the long-term period after operations by the Medical Outcomes Study Short Form 36 (MOS SF-36) questionnaire.Results and discussion. An average duration of the follow-up period was 2.59 ± 0.27 years ranging from 1.0 to 9.0 years. Overall in-hospital mortality and 30-day mortality was 1.89 % (n 1). Estimated 5-year survival rate was 95.7 ± 1.45 % for all patients. The average duration of the operations was 291.23 ± 12.67 minutes, the total duration of artificial blood circulation was 170.28 ± 8.77 minutes, aorta clamping time – 122.02 ± 5.92 minutes. The mean duration of stay in the hospital was 13.81 ± 0.54 days, intensive care unit – 2.94 ± 0.03 days. The number of patients extubated up to 8 hours after surgery was 48 patients (90.57 %). The performed operation significantly improved the indicators. Patients positively perceived the information about the absence of an artificial heart valve and need of concomitant use of anticoagulants. The patients had a good psycho-social component, which probably affected the assessment of other scales.Conclusions. Patients after David I operation have a low overall in-hospital mortality and 30-day mortality, with a short period of time in intensive care unit and hospital at all. Long-term results in indicator of 5-year survival are excellent. The operation significantly improves quality of life parameters.

Perceived Stress Mediates Associations Between Grit and Health-Related Quality of Life.

Grit, characterized by passion and perseverance in the pursuit of long-term goals, may be associated with enhanced quality of life and reduced levels of perceived chronic stress. We hypothesized that reduced levels of perceived stress may mediate the association between facets of grit (i.e., Perseverance and Consistency) and healthy functioning. We conducted two studies, one with college students and one with community adults, to test this hypothesis (cumulative N = 600). In both studies, facets of grit were assessed using the Short Grit Scale, levels of perceived chronic stress were assessed via the Perceived Stress Scale, and health-related quality of life was measured using selected questions from the Medical Outcome Study Short Form-36. Consistent with our hypothesis, perceived stress levels significantly mediated the relation between Grit-Perseverance and health-related quality of life in both college students and community adults. Our data suggest that individuals with high Grit-Perseverance experience lower perceived stress, which may result in improved health-related quality of life. Additionally, perceived stress partially mediated the relation between Grit-Consistency and health-related quality of life, but only in community adults. These novel findings suggest that the association between Grit-Perseverance and perceived chronic stress may differ for college students and community adults. Overall, our work indicates that perceived stress may be a key mediator through which facets of grit are related to healthy functioning in college students and community adults.

Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation

BackgroundInternal and external fixation are common surgical procedures for treating fractures. However, the impact of different surgical approaches (including internal and external fixations) on patients’ psychological status and Quality of Life (QoL) is rarely examined. Herein, we aimed to investigate the effects of internal and external fixation on anxiety, depression, insomnia, and overall mental and physical health in Distal Radius Fractures (DRF) patients.MethodsWe performed a retrospective study on 96 fracture patients who underwent internal fixation (57 patients) or external fixation (39 patients). The Visual Analog Scale (VAS), the Hospital Anxiety and Depression Scale (HADS), the Athens Insomnia Scale (AIS), and the Medical Outcomes Study Short Form 36 (SF-36) questionnaire were used to assess the patients’ pain, anxiety, depression, sleep, and QoL before surgery and at seven days, one month, and three months post-surgery.ResultsThe VAS scores were significantly lower in the Internal Fixation Group (IFG) than in the External Fixation Group (EFG) on the seventh day and one month postoperatively (P < 0.05). Although both groups showed no significant anxiety, depression, or insomnia before surgery (P > 0.05), the EFG showed significantly higher HADS-A, HADS-D, and AIS scores than the IFG at seven days and one and three months postoperatively (P < 0.05). Additionally, changes in HADS-A, HADS-D, and AIS scores were most significant at day seven post-surgery in the EFG (P < 0.05). Furthermore, no significant difference was found between the two groups in the average Physical Component Summary (PCS) and Mental Component Summary (MCS) scores before surgery (P > 0.05). However, both groups showed positive changes in PCS and MCS scores at postoperative day seven and one and three months postoperatively, with the IFG having significantly higher average PCS and MCS scores compared to the EFG (P < 0.05).ConclusionCompared to external fixation, internal fixation did not significantly impact patients’ emotions regarding anxiety and depression in the early postoperative period, and physical and mental health recovery was better during the postoperative rehabilitation period. Furthermore, when there are no absolute indications, the impact on patients’ psychological well-being should be considered as one of the key factors in the treatment plan during surgical approach selection.

Long-term burden of informal caregiver 7-years after severe childhood traumatic brain injury in the traumatisme grave de l’Enfant (TGE) study

ABSTRACT Objective To investigate reported burden by the Primary Family Caregiver (PFC) 7-years after severe pediatric traumatic brain injury in the TGE (Traumatisme Grave de l’Enfant) longitudinal study. Methods Subjective burden was estimated with the Zarit Burden Inventory (ZBI) in 36 PFC (parents), who rated their own health status (Medical Outcome Study Short Form-12), family functioning and their child’s level of care and needs (Pediatric/Adult Care And Needs Scale [PCANS/CANS]). Data collection included: child and PFC sociodemographic characteristics, injury-related factors, ‘objective’ (e.g. overall level of disability: Glasgow Outcome Scale – Extended, GOS-E/GOS-E-Peds) and ‘subjective’ outcomes (e.g. participation, behavior, executive functions, quality of life and fatigue). Results 25% of PFC reported mild-moderate burden, and 19% moderate-severe burden. Higher burden correlated with worse outcomes in all ‘subjective’ PFC-rated outcomes, and with self-reported participation. The ZBI correlated strongly with CANS/PCANS and GOS-E/GOS-E-Peds. Overall level of disability and PFC-reported executive functioning explained 62% of the ZBI variance. For equal levels of disability, burden was higher when PFC reported a ‘negative’ picture of their child. Conclusion Significant PFC-reported burden 7-years post-injury was associated with overall disability and ‘subjective’ PFC-rated outcomes. Factors influencing parental burden in the long term should be identified and psychological support implemented over time.

Mobile Critical Care Recovery Program for Survivors of Acute Respiratory Failure

Over 50% of Acute Respiratory Failure (ARF) survivors experience cognitive, physical, and psychological impairments that negatively impact their quality of life (QOL). To evaluate the efficacy of a post-intensive care unit (ICU) program, the Mobile Critical Care Recovery Program (m-CCRP) consisting of a nurse care coordinator supported by an interdisciplinary team, in improving the QOL of ARF survivors. This randomized clinical trial with concealed outcome assessments among ARF survivors was conducted from March 1, 2017, to April 30, 2022, with a 12-month follow-up. Patients were admitted to the ICU services of 4 Indiana hospitals (1 community, 1 county, 2 academic), affiliated with the Indiana University School of Medicine. A 12-month nurse-led collaborative care intervention (m-CCRP) supported by an interdisciplinary group of clinicians (2 intensivists, 1 geriatrician, 1 ICU nurse, and 1 neuropsychologist) was compared with a telephone-based control. The intervention comprised longitudinal symptom monitoring coupled with nurse-delivered care protocols targeting cognition, physical function, personal care, mobility, sleep disturbances, pain, depression, anxiety, agitation or aggression, delusions or hallucinations, stress and physical health, legal and financial needs, and medication adherence. The primary outcome was QOL as measured by the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), with scores on each component ranging from 0-100, and higher scores indicating better health status. In an intention-to-treat analysis among 466 ARF survivors (mean [SD] age, 56.1 [14.4] years; 250 [53.6%] female; 233 assigned to each group), the m-CCRP intervention for 12 months did not significantly improve the QOL compared with the control group (estimated difference in change from baseline between m-CCRP and control group: 1.61 [95% CI, -1.06 to 4.29] for SF-36 PCS; -2.50 [95% CI, -5.29 to 0.30] for SF-36 MCS. Compared with the control group, the rates of hospitalization were higher in the m-CCRP group (117 [50.2%] vs 95 [40.8%]; P = .04), whereas the 12-month mortality rates were not statistically significantly lower (24 [10.3%] vs 38 [16.3%]; P = .05). Findings from this randomized clinical trial indicated that a nurse-led 12-month comprehensive interdisciplinary care intervention did not significantly improve the QOL of ARF survivors after ICU hospitalization. These results suggest that further research is needed to identify specific patient groups who could benefit from tailored post-ICU interventions. ClinicalTrials.gov Identifier: NCT03053245.

Using Myofascial Therapy to Improve Psychological Outcomes, Quality of Life, and Sexual Function in Women with Chronic Pelvic Pain—A Case Series

(1) Background: Chronic pelvic pain represents a prevalent condition afflicting women. Research has highlighted the presence of psychological distress and sexual dysfunction in these individuals. Regrettably, myofascial pelvic pain often goes unnoticed and untreated despite its integral role in chronic pelvic pain. (2) Methods: By employing a longitudinal case series design, we studied eighteen women afflicted with chronic pelvic pain. Over a 12-week period, these participants underwent 15 sessions of myofascial therapy. Data encompassing sociodemographic particulars, the Hospital Anxiety and Depression Scale, the Medical Outcomes Study Short Form 12 questionnaire, and the Female Sexual Function Index were collected at baseline, 12 weeks post-intervention, and again at the 24-week mark. (3) Results: After a span of 12 weeks subsequent to the intervention, the participants demonstrated noteworthy enhancements (p &lt; 0.001) in their depression and anxiety scores, their overall Mental Component scores in the Medical Outcomes Study Short Form 12, as well as sexual function. Importantly, these gains were sustained at the 24-week juncture post-therapy. (4) Conclusions: The findings stemming from our prospective case study underscore the potential utility of myofascial therapy for women grappling with chronic pelvic pain. This form of intervention yields significant advancements in alleviating anxiety, depression, health-related quality of life, and sexual function.

The role of psycho-emotional factors in assessing the prognosis of different types of myocardial infarction

Aim. To study the features of psycho-emotional status and its clinical and prognostic significance in patients with type 1 and 2 myocardial infarction (MI).Material and methods. Of the 1293 patients hospitalized at the District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery" with a diagnosis of acute coronary syndrome, 277 (21,4%) patients with confirmed MI were consecutively included in the observational study. There were 194 (15,0%) patients with type 1 MI (MI1) and 83 (6,4%) with type 2 MI (MI2). MI types were determined based on the IV Universal Definition of Myocardial Infarction (UDMI). During the hospital period, type D personality was identified using the Russian version of the Type D scale-14 (DS-14), while the presence and severity of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). Follow-up was conducted through outpatient visits, telephone or email interviews for 12 months after discharge. Patients' adherence to drug therapy was assessed using 8-item Morisky Medication Adherence Scale, and quality of life (QoL) using Short Form Medical Outcomes Study (SF-36) questionnaire.Results. During the hospital period, in the group of patients with MI2, patients with type D personality were more often identified compared with MI1 (30 (36,1%) vs 55 (28,3%), p&lt;0,05). Patients with MI2 had a significantly higher subclinical level of anxiety (34 (41,0%) vs 43 (22,2%), p=0,002), expressed level of anxiety (10 (12,1%) vs 12 (6,2%), p=0,011), as well as a significant level of depression (13 (15,7%) vs 14 (7,2%), p=0,03). At the same time, in patients with type D, regardless of MI type, subclinical levels of anxiety and depression were significantly expressed (63 (74,1%) vs 14 (7,3%) (p&lt;0,001) and 58 (68,2%) vs 25 (13,0%) (p&lt;0,001)). There were no significant differences in inhospital complications between the MI1 and MI2 groups depending on type D personality. After 12-month follow-up, patients with the distressed personality type had higher rate of all-cause death (5 (7,2%) vs 5 (1,6%), p&lt;0,05 without type D), rehospitalization for decompensated heart failure (8 (11,5%) vs 9 (4,8%), p=0,04). Patients with type D were less adherent to drug therapy compared to patients without type D (30 (43,4%) vs 9 (4,8%) p=0,001, respectively), and they had lower QoL scores.Conclusion. Type D personality, the presence of anxiety and depression, high all-cause mortality and rehospitalization rate of decompensated heart failure were more often observed in MI2 compared to MI1, as well as in patients with type D, regardless of MI type. Low adherence to drug therapy and poor quality of life, regardless of MI type, were also associated with the type D personality.

The effectiveness of using pulsed electromagnetic fields for osteoarthritis of the knee joint

BACKGROUND: Osteoarthritis is one of the most common forms of pathology of the musculoskeletal system with significant impairment of motor function, which is one of the main causes of disability in the population.&#x0D; AIM: This study was aimed at testing the effectiveness of the portable device "ALMAG+" with pulsed electromagnetic fields in the treatment of pain in patients with osteoarthritis of the knee joint.&#x0D; MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial included patients with radiographic evidence of knee osteoarthritis and persistent pain greater than 40 mm on a visual analogue scale (VAS). The study included daily treatment with pulsed electromagnetic fields from the ALMAG+ device for 1 month in 60 patients with knee osteoarthritis. The primary outcome measure was reduction in pain intensity assessed by VAS and WOMAC scales. Secondary outcomes included the 36-item Short Form Medical Outcomes Study version 2 (SF-36 v2) quality of life, pressure pain threshold, and changes in non-steroidal anti-inflammatory drug/analgesic use.&#x0D; RESULTS: Sixty-six patients were enrolled in the study, and 60 completed the study. After 1 month of treatment, pulsed electromagnetic fields caused a significant reduction in pain VAS and WOMAC scores compared to placebo. In addition, patients receiving pulsed electromagnetic fields improved pain tolerance, which was reflected in changes in pain threshold, and physical condition. We obtained a significant and statistically significant effect of the organized pulsed electromagnetic fields factor on VAS pain scores (F=47.6; p=0.00006); assessments of the severity of pain, joint function and stiffness on the scales of the WOMAC questionnaire also significantly changed under the influence of the pulsed electromagnetic fields factor (F=14.7; p=0.001). 26% of patients in the pulsed electromagnetic fields group discontinued non-steroidal anti-inflammatory drug/analgesic therapy. No adverse events were identified during treatment.&#x0D; CONCLUSION: These results suggest that pulsed electromagnetic fields therapy is effective in relieving pain in patients with knee osteoarthritis and also affects pain threshold, stiffness, and physical functioning. In the future, it is desirable to conduct larger studies, including those comparing the effectiveness of pulsed electromagnetic fields therapy with standard pharmacological approaches for osteoarthritis.

Predictors of Dizziness and Hearing Disorders in People with Long COVID.

Background and Objectives: Individuals report persistent symptoms after becoming infected by SARS-CoV-2 (COVID-19) that last for >4 weeks (long-COVID syndrome). Dizziness and hearing loss have been reported among long-COVID symptoms. However, little is known about the potential predictors of dizziness and hearing loss in individuals with long COVID. This study aimed to explore the presence and correlates of dizziness and hearing loss in a sample of people with long-COVID syndrome. Materials and Methods: Individuals aged 18 years and older who were infected with COVID-19 at least 8 weeks prior to the start of the study were included if they were not diagnosed with dizziness or hearing loss before getting COVID-19. Demographics and COVID-19-related information were collected. Participants completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence (ABC) scale, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), and Medical Outcomes Study Short Form 12 (SF-12). Finally, hearing was assessed using pure-tone audiometry (PTA) in a subsample. Results: Two hundred and nine individuals (66% female) with a mean (SD) age of 27 (9) participated in the study. Perceived dizziness and hearing loss were reported in 26 and 15.3% of the sample, respectively. Logistic regression was conducted to identify potential predictors of dizziness and hearing loss separately. After controlling for age and severity of dizziness, female sex and high fatigue severity were associated with an increased likelihood of reporting dizziness (R2 = 31%). The severity of dizziness and neurological symptoms during the acute stage of COVID-19 were associated with an increased likelihood of reporting hearing loss (R2 = 10.4%) after controlling for age. Conclusions: Dizziness and hearing loss present in long COVID and can be disabling. Females with high levels of fatigue should be questioned about persistent dizziness. Hearing loss should be considered in individuals with neurological symptoms and severe dizziness as a consequence of long COVID.

Minimally Invasive Transverse Distal Metatarsal Osteotomy for Hallux Valgus Correction: Is there a Difference in Outcome Between Moderate and Severe Deformities?

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: We compared the radiological and clinical outcomes of moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon. Methods: Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) greater than 40° or preoperative first-to-second intermetatarsal angle (1–2 IMA) greater than 16°; the moderate group was defined as having an HVA less than 40° and a 1–2 IMA less than 16°. Pre- and postoperative measurements of the HVA, 1–2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The Visual Analogue Scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey-36 Physical Component Summary were used to assess clinical outcomes. Results: Both groups showed significant improvements in all radiologic parameters postoperatively with the degrees of correction greater in the severe group than in the moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups. Conclusion: This study showed that short-term radiographic results for patients with either moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. MITO with screw fixation is a satisfactory surgical option for patients with HV deformities.

Efficacy of Tuina in chronic low back pain with anxiety: study protocol for a randomised controlled trial

IntroductionChronic low back pain (cLBP) is one of the largest and most frequent public health problems worldwide. Tuina is a physical therapy commonly used in China to treat musculoskeletal diseases....

Trends in Racial and Ethnicity Disparities in the Health-Related Quality of Life in Older Adults with Breast Cancer: A SEER-MHOS National Database Study

To examine racial and ethnic disparities in Health-Related Quality of Life (HRQOL) in older adults with breast cancer, both pre- and post-diagnosis. Using the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) database, we included patients > 65 years old with breast cancer diagnosed from 1998-2019, who had completed the Health Outcomes Survey within 24 months pre- and post-diagnosis, and who had a reported ethnicity of non-Hispanic White (W), non-Hispanic Asian or Pacific Islander (API), non-Hispanic Black or African American (B), or Hispanic (H). HRQOL data was measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the Medical Outcomes Study Short Form-36 and the Veterans RAND 12-Item Health Survey instruments. Univariable (UVA) and multivariable (MVA) linear regression models were fitted for MCS, PCS, and TCS (composite MCS and PCS) as response variables to assess for potential disparities between races and ethnicities. MVA models were adjusted for sex, age, marital status, education, income, number of comorbidities, limitations in activities of daily living, national region, histology, and treatment type (in post-diagnosis cohort only). We identified 1,008 in the pre-diagnosis cohort (56.6% stage I, 29.8% stage II, 9.3% stage III, and 4.3% stage IV) and 991 patients in the post-diagnosis cohort (58.3% stage I, 28.6% stage II, 9.3% stage III, 3.8% stage IV). On UVA, differences in mean scores of TCS, PCS, and MCS, respectively, were found among W, API, B, and H patients in both pre-diagnosis and post-diagnosis cohorts (pre-diagnosis - TCS: 93.4, 93.0, 87.0, 86.3; PCS: 40.3, 40.0, 37.0, 37.5; MCS: 53.1, 52.9, 50.0, 48.7; post-diagnosis - TCS: 90.8, 90.3, 84.3, 83.5; PCS: 38.5, 39.2, 36.8, 34.5; MCS: 52.3, 51.1, 49.8, 46.8; all p < .001). A drop in PCS, MCS, and TCS scores numerically was observed for all groups. Among patients in the pre-diagnosis cohort who would be diagnosed with stage IV breast cancer, race was found to be a predictor of PCS with overall significance (p = 0.04) within MVA linear regression. Specifically, on the local test, compared to B, W had higher pre-diagnosis PCS scores (+13.32, p = 0.03). Race was not found to be a predictor in PCS, MCS, or TCS scores otherwise. Among older patients who would be diagnosed with stage IV breast cancer, W had better physical HRQOL as compared to B patients' pre-diagnosis. The decrease in numerical HRQOL scores of the physical domain in all groups post-diagnosis highlights the potential negative physical impact breast cancer has on patients, demonstrating the need for determining the proper resources and support to improve physical HRQOL following diagnosis.

Testing the stability of a family resilience model at 2 and 5 years after traumatic brain injury or spinal cord injury: A longitudinal study.

Recent studies have tested models of resilience and caregiver adjustment in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). Few studies have examined the role of adaptive variables over time. Conduct a longitudinal study to test a model of caregiver resilience with caregiver outcomes at 2- and 5-years post-injury. Caregivers of relatives with TBI or SCI were surveyed at 2 years (Time 1) and 5 years (Time 2) post-injury. Stability of the resilience model across the 2 time-points was tested using structural equation modeling with multi-group analysis. Measures included resilience related variables (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Social Support Survey) and outcome variables (Caregiver Burden Scale, General Health Questionnaire-28, Medical Outcome Study Short Form -36 [SF-36] and Positive and Negative Affect Scale). In total, 100 caregivers were surveyed at both 2 and 5 years (TBI =77, SCI =23). Scores for resilience (Time 1, 75.9 SD 10.6; Time 2, 71.5 SD 12.6) and self-efficacy (Time 1, 32.51 SD 3.85; Time 2, 31.66 SD 4.28) showed significant minor declines, with other variables remaining stable. The resilience model for the pooled responses (Time 1+ Time 2) demonstrated a good fit (Goodness of Fit Index [GFI]=0.971; Incremental Fit Index [IFI]=0.986; Tucker-Lewis Index [TLI]=0.971; Comparative Fit Index [CFI]=0.985 and Root Mean Square Error of Approximation [RMSEA]=0.051). Multi-group analysis then compared Time 1 to Time 2 responses and found that a variant (compared to invariant) model best fitted the data, with social support having stronger associations with mental health and positive affect at Time 2 than Time 1. Hope reduced from Time 1 to Time 2. The model suggests that resilience-related variables can play an important role in positive caregiver adjustment over time.

Health service use after moving on from permanent supportive housing

PurposeStudies have shown positive housing retention and quality of life outcomes in moving on initiatives (MOIs). However, less is known about how movers’ health service use changes post-move. This paper aims to explore physical and mental health service use over time for participants in New York City’s MOI program.Design/methodology/approachThis paper uses data collected at baseline, 12-months post move and 24-months post move to explore patterns in mental and physical health service use and their association with mental and physical health status for participants (N = 41). Health status was measured with the Medical Outcomes Study Short Form Survey Instrument.FindingsThree mental health service use patterns emerged: service use at all time points, inconsistent service use across time points and no service use at any time point. Significant group differences in mental health were found at baseline and 12 months. Two physical health service use patterns emerged: service use at all three time points and inconsistent service use across time points. Significant group differences were found in mental health at 12 and 24 months.Originality/valueThis study showed that physical and mental health service use varied slightly over time for participants, with the majority of service use being for outpatient/non-acute care. The findings also point to possible relationships between service use and mental health status. Positive and negative implications of these findings are framed within the broader context of PSH and MOI goals.

Developing a common metric using current scales for assessing functioning in patients with knee osteoarthritis.

Various scales exist to assess different domains of functioning in knee osteoarthritis (OA). This study aimed to explore whether it is possible to develop a common metric (CM) from the frequently used scales to assess functioning in knee OA. The methodological study evaluated 411 patients (81 males, 330 females; mean age: 61.8±10.5 years; range, 41 to 88 years) with knee OA. Data from the Health Assessment Questionnaire, Oxford Knee Score, Medical Outcomes Study Short Form 36, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Arthritis Index, and the Nottingham Health Profile were used, and the items focusing on self-care, mobility, and domestic activity domains based on the activities and participation component of the International Classification of Functioning, Disability, and Health were included. Concurrent calibration was performed to combine the items of the scales. The CM parameters were estimated using the Rasch measurement model. Reliability was assessed using the person separation index. The CM was utilized to generate a transformation table to convert the scale scores to each other based on the reference metric score. Each scale fitted the Rasch model. Item invariance was achieved for the CM (p=0.775). The CM had a person separation index of 0.827. Age, sex, and disease duration did not cause difference in item functions. The CM satisfied the assumptions of unidimensionality and local independence. A reliable CM was created from the commonly used scales to measure functioning in individuals with knee OA. Thus, clinicians and researchers can refer to the transformation table to directly compare scores of those scales and use them interchangeably.

Minimally Invasive Transverse Distal Metatarsal Osteotomy (MITO) for Hallux Valgus Correction: Early Outcomes of Mild to Moderate vs Severe Deformities.

We compared the radiological and clinical outcomes of mild to moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon. Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) >40 degrees or preoperative first-to-second intermetatarsal angle (1-2 IMA) >16 degrees; the mild to moderate group was defined as having an HVA <40 degrees and a 1-2 IMA <16 degrees. Pre- and postoperative measurements of the HVA, 1-2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The visual analog scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey-36 physical component summary were used to assess clinical outcomes. A total of 116 feet were included in this study and median follow-up period of 29.0 months (range, 24-52 months). Both groups showed significant improvements in all radiologic parameters postoperatively, with the degrees of correction greater in the severe group than in the mild to moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups. This study showed that short-term radiographic results for patients with either mild to moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. In this series, we found MITO with screw fixation to be a satisfactory surgical option for patients with mild to severe HV deformities. Level III, retrospective comparative study.

PARAMETERS OF THE QUALITY OF LIFE OF WOMEN WITH HIP ARTHROPLASTY IN THE POSTPARTUM PERIOD (ABDOMINAL DELIVERY) AS A CRITERION FOR THE EFFECTIVENESS OF A PHYSICAL THERAPY PROGRAM

Abstract. Purpose: to determine the parameters of the quality of life of women with an endoprosthetic hip joint in the postpartum period as a criterion for the effectiveness of the physical therapy program.&#x0D; Methods. In the course of the study, 9 women aged 28.5±1.6 years were examined 1 month after childbirth, which took place by caesarean section. The developed program of physical therapy lasted 1 month (from the end of the first month after childbirth). In her process, therapeutic exercises for the trunk, upper and lower limbs were used; functional training to improve movements related to child care, Proprioceptive Neuromuscular Facilitation of lower limbs, back, trunk; massage of lower limbs, back. We took into account movement restrictions associated with an incompletely formed scar after cesarean section and with the presence of an endoprosthesis (excessive bending, rotation of the hip joint); accordingly, they created safe movement strategies related to child care (lifting, carrying) and transporting a baby carriage. Individual determination of short- and long-term goals of rehabilitation contributed to the improvement of psycho-emotional mood and increased compliance of women. The effectiveness of the tested program was evaluated using the standard SF-36 quality of life questionnaire («Medical outcomes study short form»).&#x0D; Results. During the initial examination, all women with hip arthroplasty in the postpartum period were found to have a deterioration in the quality of life according to the SF-36. Overloading of elements of the musculoskeletal system during pregnancy and changes in the biomechanics of a woman's body, which causes certain physical discomfort, is justified by hormonal and physical processes.During repeated testing, the effectiveness of the physical therapy program was confirmed by its positive impact on both scales - physical and mental functioning. The difference between the results of Physical health at the initial and repeated examination according to the Physical Functioning scale in the examined women was 41.9%, Role-Physical – 39.4%, Bodily Pain – 26.0%, General Health – 42.2%. Accordingly, for all subscales of Physical health, a statistically significant improvement in the condition of women was obtained compared to the initial parameters (р&lt;0.05). The improvement of Mental health in comparison with the primary result on the Vitality scale in the examined women was 26.9%, Social Functioning - 60.3%, Role-Emotional - 32.5%; Mental Health - 49.9%. Therefore, a statistically significant improvement in the condition of women compared to the initial parameters was obtained for all subscales of Mental health (р&lt;0.05).&#x0D; Conclusions. In women with an endoprosthetic hip joint in the postpartum period (abdominal delivery), a significant decrease in the physical and mental components of quality of life, determined by the SF-36 questionnaire, was found. The use of physical therapy (therapeutic exercises, functional training, massage taking into account the limitations of the abdominal wall scar and the functionality of the endoprosthesis) caused a statistically significant (p&lt;0.05) improvement in the condition of the examined women in all subscales of SF-36 - physical and role functioning, pain intensity , general state of health, vitality, social functioning, influence of emotional state on role functioning; self-assessment of mental health.