Usual Activities Research Articles

Changes in health-related quality of life in common variable immunodeficiency: an eight-year journey, including the COVID-19 pandemic

ABSTRACT Background Personalized medicine requires the assessment of the impact of health care interventions on Health-Related Quality of Life. Research design and methods We run an observational study of HRQoL in 140 CVID patients with biannual assessments over 8 years using a disease-specific tool, the CVID_QoL, and the GHQ questionnaires. Factors influencing changes in HRQoL scores were identified using multiple linear regression models with a stepwise procedure. Results Infections frequency, female gender, and chronic enteropathy were associated with worse global CVID_QoL scores. The presence of permanent organ damage and older age contributed to the perception of being at risk of health deterioration, while chronic enteropathy was associated with fatigue. The presence of permanent organ damage was also associated with perceived difficulties in usual activities. The frequency of infections was the main risk factor for difficulties in long-term planning and perceptions of vulnerability. Before COVID-19, improved HRQoL scores were associated with reduced respiratory infections and changes in immunoglobulin replacement route and setting. The COVID-19 pandemic caused a sudden deterioration in all HRQoL dimensions, and a further deterioration in the emotional dimension was observed during the pandemic period. Patients who died during the study had worse CVID_QoL scores at all time points, confirming that HRQoL performance is strongly related to patient outcome. Conclusions Periodic HRQoL assessments are needed to capture relevant issues that change over time in patients affected by long-term chronic conditions such CVID, possibly identifying areas of intervention.

Bayesian Networks for Prescreening in Depression: Algorithm Development and Validation.

Identifying individuals with depressive symptomatology (DS) promptly and effectively is of paramount importance for providing timely treatment. Machine learning models have shown promise in this area; however, studies often fall short in demonstrating the practical benefits of using these models and fail to provide tangible real-world applications. This study aims to establish a novel methodology for identifying individuals likely to exhibit DS, identify the most influential features in a more explainable way via probabilistic measures, and propose tools that can be used in real-world applications. The study used 3 data sets: PROACTIVE, the Brazilian National Health Survey (PesquisaNacionalde Saúde [PNS]) 2013, and PNS 2019, comprising sociodemographic and health-related features. A Bayesian network was used for feature selection. Selected features were then used to train machine learning models to predict DS, operationalized as a score of ≥10 on the 9-item Patient Health Questionnaire. The study also analyzed the impact of varying sensitivity rates on the reduction of screening interviews compared to a random approach. The methodology allows the users to make an informed trade-off among sensitivity, specificity, and a reduction in the number of interviews. At the thresholds of 0.444, 0.412, and 0.472, determined by maximizing the Youden index, the models achieved sensitivities of 0.717, 0.741, and 0.718, and specificities of 0.644, 0.737, and 0.766 for PROACTIVE, PNS 2013, and PNS 2019, respectively. The area under the receiver operating characteristic curve was 0.736, 0.801, and 0.809 for these 3 data sets, respectively. For the PROACTIVE data set, the most influential features identified were postural balance, shortness of breath, and how old people feel they are. In the PNS 2013 data set, the features were the ability to do usual activities, chest pain, sleep problems, and chronic back problems. The PNS 2019 data set shared 3 of the most influential features with the PNS 2013 data set. However, the difference was the replacement of chronic back problems with verbal abuse. It is important to note that the features contained in the PNS data sets differ from those found in the PROACTIVE data set. An empirical analysis demonstrated that using the proposed model led to a potential reduction in screening interviews of up to 52% while maintaining a sensitivity of 0.80. This study developed a novel methodology for identifying individuals with DS, demonstrating the utility of using Bayesian networks to identify the most significant features. Moreover, this approach has the potential to substantially reduce the number of screening interviews while maintaining high sensitivity, thereby facilitating improved early identification and intervention strategies for individuals experiencing DS.

Patient-Reported Outcomes in COVID-19 Treatment with Monoclonal Antibodies Reveal Benefits in Return to Usual Activities.

This study aimed to assess the effects of a monoclonal antibody (mAb) combination on symptoms, daily function, and overall health-related quality of life. We analyzed patient-reported outcomes data from symptomatic outpatients in a phase1/2/3 trial. Patients with confirmed SARS-CoV-2 infection and ≥ 1 risk factor for severe COVID-19 received mAb treatment (casirivimab plus imdevimab 1200mg) or placebo. Prespecified exploratory assessments included time to sustained symptoms resolution, usual health, and return to usual activities (assessed daily for 29days). The trial was conducted from September 2020 to February 2021, prior to widespread COVID-19 vaccination programs and Omicron-lineage variants against which casirivimab + imdevimab is not active. In this analysis 736 outpatients received mAb and 1341 received placebo. Median time to sustained symptoms resolution was consistently shorter with mAb versus placebo (≥ 2consecutive days: 14 vs 17days, [nominal p = 0.0017]; ≥ 3 consecutive days: 17vs 21days, [nominal p = 0.0046]). Median time to sustained return to usual health and usual activities were both consistently shorter with mAb versus placebo (≥ 2 consecutive days: 12vs 15days [nominal p = 0.0001] and 9 vs 11days [nominal p = 0.0001], respectively; ≥ 3 consecutive days: 14 vs 18days [nominal p = 0.0003] and 10 vs 13days [nominal p = 0.0041], respectively). mAb treatment against susceptible SARS-CoV-2 strains improved how patients feel and function, as evidenced by shortened time to sustained symptoms resolution and return to usual health and activities. Future studies are warranted to assess the patient experience with next generation mAbs. GOV: Registration number, NCT04425629; Submission date June 11, 2020.

Hearing Loss, Hearing Aids, and Functional Status

Hearing loss may contribute to poor functional status via cognitive impairment and social isolation. Hearing aids may play a protective role by attenuating these downstream outcomes. However, population-based evidence is lacking. To examine the association of hearing loss and hearing aids with functional status. This cross-sectional (2016-2017) and longitudinal (2016-2022) analysis of data from the Atherosclerosis Risk in Communities cohort study included older, community-dwelling adults with complete data. Data were analyzed from June to December 2023. The better-hearing ear's pure tone average (BPTA) at speech frequencies (0.5-4 kHz) was modeled categorically (no [BPTA ≤25 dB], mild [26-40 dB], and moderate or greater hearing loss [>40 dB]). Hearing aid use was self-reported. Difficulties in activities of daily living (ADLs; eg, dressing and eating), instrumental activities of daily living (IADLS; eg, household chores and meal preparation), and heavier tasks (eg, walking a quarter of a mile) were self-reported at visit 6. The ability to perform usual activities, walk a half mile, walk up and down stairs, and do heavy housework without help were collected in follow-up surveys. Linear and logistic regression models were used that were adjusted for sociodemographic and health covariates. Among 3142 participants (mean [SD] age, 79.3 [4.6] years; 1828 women [58.2%]), 1013 (32.2%) had no hearing loss, 1220 (38.8%) had mild hearing loss, and 909 (29.0%) had moderate or greater hearing loss. Moderate or greater hearing loss was cross-sectionally associated with difficulty in 1 or more ADLs (odds ratio [OR], 1.27; 95% CI, 1.02-1.58), IADLs (OR, 1.34; 95% CI, 1.05-1.71), and heavier tasks (OR, 1.29; 95% CI, 1.04-1.62) compared with no hearing loss. Over time (mean [SD] follow-up, 1.9 [1.8] years), moderate or greater hearing loss was associated with a faster decline in the number of activities participants were able to do (β = -0.07 per year; 95% CI, -0.09 to -0.06) and greater odds of reporting inability to do 1 or more of the 4 activities (OR, 1.14; 95% CI, 1.05-1.24). Hearing aid users and nonusers did not differ. The results of this study suggest that moderate or greater hearing loss was associated with functional difficulties and may contribute to a faster decline in function longitudinally independent of sociodemographic and health covariates. Hearing aids did not change the association among those with hearing loss.

Estimating an EQ-5D-Y-3L Value Set for Brazil.

The EQ-5D-Y-3L is a generic measure of health-related quality of life in children and adolescents. Although the Brazilian-Portuguese EQ-5D-Y-3L version is available, there is no value set for it, hampering its use in economic evaluations. This study aimed to elicit a Brazilian EQ-5D-Y-3L value set based on preferences of the general adult population. Two independent samples of adults participated in an online discrete choice experiment (DCE) survey and a composite time trade-off (cTTO) face-to-face interview. The framing was "considering your views for a 10-year-old child". DCE data were analyzed using a mixed-logit model. The 243 DCE predicted values were mapped into the observed 28 cTTO values using linear and non-linear mapping approaches with and without intercept. Mapping approaches' performance was assessed to estimate the most valid method to rescale DCE predicted values using the model fit (R2), Akaike Information Criteria (AIC), root mean squared error (RMSE), and mean absolute error (MAE). A representative sample of 1376 Brazilian adults participated (DCE, 1152; cTTO, 211). The linear mapping without intercept (R2 = 96%; AIC, - 44; RMSE, 0.0803; MAE, - 0.0479) outperformed the non-linear without intercept (R2 = 98%; AIC, - 63; RMSE, 0.1385; MAE, - 0.1320). Utilities ranged from 1 (full health) to - 0.0059 (the worst health state). Highest weights were assigned to having pain or discomfort (pain/discomfort), followed by walking about (mobility), looking after myself (self-care), doing usual activities (usual activities), and feeling worried, sad, or unhappy (anxiety/depression). This study elicited the Brazilian EQ-5D-Y-3L value set using a mixed-logit DCE model with a power parameter based on a linear mapping without intercept, which can be used to estimate the quality-adjusted life-years for economic evaluations of health technologies targeting the Brazilian youth population.

Post-COVID syndrome: Clinical pattern and impact on health related quality of life

Background COVID-19 management has changed from just dealing with a novel respiratory viral illness to unraveling the mystery of a systemic disease. This study aimed to assess clinical pattern for post-COVID survivors and impact on quality of life. Methods 115 Patients suffering from COVID-19 affection were recruited in this study. The assessment included clinical history with special attention to symptoms attributable to post-COVID manifestations. Evaluation for presence of insomnia, anxiety and depression were done using insomnia severity index (ISI), Hamilton’s anxiety (HAM-A) and depression rating scales (HAM-D), respectively. Laboratory investigations included complete blood count (CBC), kidney function test, liver function test, C-reactive protein (CRP), and inflammatory markers including ESR, CRP and Ferritin level. EQ-5D-5L and EQ visual analogue scale (EQ-VAS) were used to assess participants’ overall health status and quality of life. Results COVID-19 patients suffered from cough (76%), fever (72.9%), fatigue (72.9%), dyspnea (69.8%) and muscle/joint pain (66.1%) as the most distressing symptoms during period of acute infection. Regarding post-COVID syndrome (PCS); Dyspnea (32.2%), fatigue (26.1%), muscle/joint pain (22.6%), loss of taste (16.5%) and loss of smell (15.7%) were the most prevalent at 3 month evaluation. 46.9% patients developed manifestations attributable to post-COVID syndrome. Fever, cough, loss of smell and taste, fatigue, anxiety and insomnia persisted significantly for longer periods among severe cases (Group 2). EQ-5D-5L domains were significantly impaired among severe COVID patients. Significant positive correlation noticed between age and increased duration of dyspnea, muscle/joint pains and depression. Also, CT chest severity scores showed significant correlation with dyspnea, fatigue, muscle/joint pains (P=0.023, 0.012 and <0.001; respectively). Conclusion High prevalence of Post-COVID syndrome is a challenge to health care resources. PCS directly impacts mobility, self-care, usual activities, pain perception and anxiety and therefore is associated with lower quality of life among post-COVID patients.

Comparison of Postoperative Morbidity Between Two Tension-Free Hernioplasty Techniques: With Mesh versus Without Mesh

Introduction. Although inguinal hernia surgery is the most common surgical procedure worldwide, the best surgical method is still not universally accepted. The Lichtenstein technique is considered the gold standard, although it also has its limitations. Therefore, there is still a need for new techniques, such as the Desarda technique. The aim of this article is to evaluate and compare the postoperative morbidity of two tension-free techniques for inguinal canal pla-stic surgery with and without the use of mesh. Methods. This prospective randomized clinical study was conducted at the Clinic for General and Abdominal Surgery of the Clinical Center of the University of Sarajevo from January 2017 to December 2022. The study included 60 patients with primary inguinal hernia who met the predefi ned inclusion and exclusion criteria and were randomly allocated into two equal groups: 30 patients operated on by the Desarda technique and 30 patients operated on by the Lichten-stein technique. Results: The following parameters showed a statistically signifi cant diff erence in favor of the Desarda operative technique: shorter hospitalization, lower level of postoperative pain, faster achievement of early physical activity, lesser amount of analgesic consumption, earlier return to regular daily and work activities, and absence of chronic inguinal pain. Postoperative morbidity was more frequent in the Lichtenstein group, but likely due to the small sample size, this diff e-rence remained statistically insignifi cant. Conclusion: Patients operated on by the Desarda method exhibited signifi cantly lower levels and frequencies of postoperative pain, faster postoperative recovery, and return to usual daily and work activities.

Dynamics of Long-Term Quality of Life After Treatment for Esophageal Cancer: A Community-Based Patient Study.

To characterize the pattern of post-treatment quality of life (QoL) for esophageal cancer (EC) survivors and construct models predicting their long-term QoL. On the basis of a randomized trial in an EC high-risk region in China, we interviewed 363 EC survivors and 25,245 permanent residents matched with the survivors on age, sex, and township as the baseline. QoL was measured using three-level version of European Quality of Life 5-Dimensions instrument. We constructed piecewise mixed models estimating the QoL of EC survivors that varied by age, sex, patient type, hospital level, and therapy to ascertain QoL determinants. The post-treatment QoL of EC survivors dropped by 15.7% within the first year and recovered by 9.3% between 1 and 9 years compared with the baseline. Therapy was found to be a determinant of QoL, and a series of therapy-specific models were fitted accordingly, which all showed the pattern of decreasing rapidly and recovering gradually. Endoscopic treatment had the least impact on post-treatment QoL (7.5% drop within 5 years) compared with esophagectomy (12.2% drop within 1 year) and chemoradiotherapy (37.8% drop within 2 years). The usual activities dimension showed the greatest impairment among those patients (34.4% drop within 1 year). This community-based study described the long-term QoL trajectory for EC survivors after different therapeutic modalities and constructed models to predict therapy-specific QoL at different time points after treatment. It provided new insights into decision making in treatment for EC from the perspective of QoL protection, offering a convenient tool for estimating quality-adjusted life-years.

EDUCATION AND PROFESSIONAL TRAINING OF PUBLIC SERVANTS IN THE AGE OF ARTIFICIAL INTELLIGENCE

Society is evolving in an era of speed, where the population is eager for knowledge, especially technology, everything that means digitization and especially artificial intelligence. In the context where E-governance has gained momentum, and the use of artificial intelligence in carrying out usual activities is becoming a common aspect, the public services provided by authorities and public institutions must be correlated to meet the needs of society, citizens and the business environment .Considering these aspects, through this paper we propose to explore the need for education on certain topics, the professional training of public servants, but also the particular importance of an effective human resources management.Adapting the administrative system and public development policies to the global changes taking place and to European standards is vital for national well-being. Implicitly, the professional training of public servants, in order to perfect or acquire the necessary capacity and skills, is imperative.

Health-Related Quality of Life during 26-Week Intervention with the New Nordic Renal Diet.

The New Nordic Renal Diet (NNRD) is a whole-food approach, tailored to meet recommended guidelines in patients with moderate chronic kidney disease (stage 3b-4). The NNRD improved various metabolic and physiological endpoints during a 26-week randomized controlled study. Here, we examined the effect of dietary intervention on health-related quality of life (HRQoL). Sixty participants were recruited (NNRD group n = 30, control group n = 30) and 58 completed the study. During the intervention, the NNRD group received food boxes, and recipes once a week. The control group continued their habitual diet. HRQoL was examined at baseline and at the end of the intervention using the validated EuroQol-5D-5L, including a 5-point scale Likert questionnaire at the end of the intervention. Assessed by the EuroQol-5D-5L questionnaire, the NNRD group experienced a reduction in pain/discomfort during the intervention by 26% [-0.44 points (95% CI; -0.73, -0.16)], compared with no change in the control group [0.25 points (95% CI; -0.02, 0.53)] and a between-group difference of -0.70 points (95% CI; -1.03, -0.37, p < 0.001). A larger decrease of body fat mass was associated with a larger decrease in pain/discomfort (p = 0.014). In addition, the NNRD group reported an overall improvement in conducting usual daily activities by 23% [-0.30-point (95% CI; -0.50, -0.11)], while no change was seen in the control group [-0.02 points (95% CI; -0.21, 0.17)], with a between-group difference -0.28 points (95% CI; -0.51, -0.06, p = 0.014). A larger decrease in 24 h urine phosphorus excretion, used as a marker of compliance, was associated with a larger improvement in conducting usual daily activities (p = 0.036). The NNRD group had a clinically relevant improvement in various HRQoL outcomes.

STUDYING ATTITUDES TO DEPRESSION AMONG STUDENTS

Depression is a serious mental illness, when it occurs, the ability to work is sharply reduced and motor problems arise lethargy, impaired thinking, decreased mood. Depression is accompanied by low self-esteem, loss of taste to life, interest in usual activities. Being a mental disorder, depression manifests itself as pathological affect. It is perceived by people and patients as a manifestation of laziness, bad character, selfishness and pessimism. It should be noted that a depressive state is not just a bad mood, but a psychosomatic disease in which specialist intervention required. Overthinking or intrusive thoughts depression or anxiety or any mental problem isn't just a disorder, it can happen to us because of various reasons.

Prevalence and associated factors of premenstrual dysphoric disorder among high school students in Finote Selam town, northwest Ethiopia.

Premenstrual dysphoric disorder (PMDD) is the most prevalent but neglected psychiatric disorder, with somatic symptoms that are severe enough to markedly affect usual daily activities and have a negative impact on mental health and quality of life by affecting female patients' behavior and cognition. Studies regarding premenstrual dysphoric disorder and associated factors among high school students in low- and middle-income countries are limited. Therefore, the aim of this study was to assess the prevalence and associated factors of PMDD among high school students, and this is pivotal in further investigation. A school-based cross-sectional study was conducted from March 25 to April 17, 2023 using a simple random-sampling technique to select a sample of 564 participants. Premenstrual dysphoric disorder was assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Self-administered standardized questionnaires were used to collect data. A total of 548 study participants participated, with a 97.2% response rate. The prevalence of premenstrual dysphoric disorder among high school students was found to be 33.03% (95%CI: 29.20-37.09). In a multivariable analysis, irregular menstruation cycle (AOR = 4.242, 95%CI = 2.182-8.246), depression (AOR = 5.272, 95%CI = 2.779-10.002), having greater than 4 days of menstruation bleeding duration (AOR = 2.138, 95%CI = 1.105-4.138), and high perceived stress (AOR = 3.468, 95%CL = 1.217-9.880) were the factors significantly associated with premenstrual dysphoric disorder. The overall prevalence of PMDD which was one-third among high school students was high. Moreover, long duration of menstruation bleeding, depressive symptoms, irregular menstruation cycle, and high perceived stress were significant factors in PMDD. Therefore, it needs early screening and intervention in primary healthcare settings, especially for those who have high perceived stress, having depression, having a long duration of menstruation bleeding, and having an irregular menstruation cycle, so as to have good academic achievement and psychological wellbeing.

Factors associated with self-rated health in people with late-stage parkinson’s and cognitive impairment

PurposeTo investigate the contributors to self-rated health in people with late-stage Parkinson’s disease (PD) and cognitive impairment.MethodsA secondary analysis of baseline data from the international Care of Late-Stage Parkinsonism (CLaSP) cohort study was conducted. Participants with PD and either dementia or mild cognitive impairment or MMSE < 24/30 in the absence of major depression were included if they had completed the EQ-5D-3L assessment (n = 277). Factors associated with self-rated health (EQ-5D-3L Index and Visual Analogue Scale) were investigated through multivariable linear regression.ResultsMore severe PD (motor and non-motor) was associated with worse self-rated health. The EQ-5D-3L dimensions of Mobility, Self-Care and Usual Activities were almost universally affected; the latter two particularly severely. Being unable to perform usual activities or having moderate to extreme anxiety or depression were significantly associated with EQ-5D-3L Visual Analogue Scale, suggesting these are particularly valued. Worse motor impairment and function and the non-motor symptom domains of mood, perception, sexual function, and miscellaneous (e.g., pain) were associated with worse self-rated health, whereas greater burden of gastrointestinal symptoms was associated with better self-rated health in multivariate analysis. Better self-rated health was associated with recent PD nurse consultation, and higher doses of dopaminergic medication.ConclusionImprovement of activities of daily living, mood and anxiety should be prioritised in clinical practice, with consideration of perception and sexual function in this population. Recent nurse consultations and higher antiparkinsonian doses are associated with better self-rated health, suggesting there is no room for a therapeutic nihilism in this population of people within a complex phase of PD.

(055) A RETROSPECTIVE ANALYSIS ON THE BENEFITS OF AN OVER-THE-COUNTER COMBINATION OF ASPIRIN, ACETAMINOPHEN, AND CAFFEINE (AAC) IN MENSTRUAL MIGRAINE

Abstract Introduction • Migraine affects approximately 15% of the general population globally. It is an episodic headache disorder that produces a wide spectrum of pain and associated disability. • Women are 3 times more likely than men to experience migraine headache. More than 60% of women with migraine experience attacks that occur in association with the menstrual periods. • Although some women experience migraine exclusively during the perimenstrual period others have attacks both during the perimenstrual period and at other times of the month. Menstrual migraine is thought to be more severe and disabling and less responsive to non-drug treatments than is non-menstrual migraine Objective Since menstrual migraine is an important health issue for women, we wanted to examine whether AAC is more effective than placebo in relieving menstruation associated migraine and improving the quality of life (QoL) of patients. Methods The study population selected for this analysis were adapted from a pooled analysis of women associated with menstrual migraine [Clin Therapeutics 21(3) 475, 1999]. A total of 185 women with menstrual associated migraine, of which 85 took one dose of AAC (aspirin/acetaminophen/caffeine – 250 mg/250 mg/65 mg) and 100 took placebo were included in this study. The data was analyzed using SAS Windows version 9.4. All post-rescue medication severity scores were assigned either the baseline value or the last recorded value whichever was most severe. Post-rescue medication pain relief scores were classified as “no relief”. Results It was observed that the intensity of the headache pain was reduced to mild or none (1) within 30 min in 20% (AAC treated) vs (10% in placebo). Within 1 hour in 40% (AAC treated) vs (14% placebo) (p&amp;lt;=0.001) treated patients and the pain relief lasted for at least six hours. The quality of life (able to perform all or usual activities with minimal or no additional effort) also improved within 1 hour in 48.2% (AAC treated patients) vs 28% (placebo) (p&amp;lt;=0.005) and within 3 hour in 68.2% AAC treated patients vs 40% (placebo) (p&amp;lt;=0.001). In addition, in terms of relative change (%) difference, there was a 19% improvement in QoL with a 24.6% reduction in pain intensity within 1 hour. At 3 hours the QoL scores improved to 38.1% with a reduction in pain intensity of 41.1% that lasted till 6 hours in AAC treated patients vs placebo. Conclusions This post- hoc pooled analysis provides evidence that a single dose of AAC provides significant benefits in relieving menstrual migraine associated pain relief and improves quality of life of patients in their ability to perform usual activities with minimal or no additional effort. Disclosure Yes, this is sponsored by industry/sponsor: Haleon Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Haleon.

Prospective Registration Study for Establishing Minimal Clinically Important Differences in Patients Undergoing Surgery for Spinal Metastases.

Multicenter, prospective registry study. To clarify minimal clinically important differences (MCIDs) for surgical interventions for spinal metastases, thereby enhancing patient care by integrating quality of life assessments with clinical outcomes. Despite its proven usefulness in degenerative spinal diseases and deformities, the MCID remains unexplored regarding surgery for spinal metastases. This study included 171 (out of 413) patients from the multicenter "Prospective Registration Study on Surgery for Metastatic Spinal Tumors" by the Japan Association of Spine Surgeons. These were evaluated preoperatively and at 6 months postoperatively using the Face Scale, EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), including the Visual Analog Scale, and performance status. The MCIDs were calculated using an anchor-based method, classifying participants into the improved, unchanged, and deteriorated groups based on the Face Scale scores. Focusing on the improved and unchanged groups, the change in the EQ-5D-5L values from before to after treatment was analyzed, and the cutoff value with the highest sensitivity and specificity was determined as the MCID through receiver operating characteristic curve analysis. The validity of the MCIDs was evaluated using a distribution-based calculation method for patient-reported outcomes. The improved, unchanged, and deteriorated groups comprised 121, 28, and 22 participants, respectively. The anchor-based MCIDs for the EQ-5D-5L index, EQ-Visual Analog Scale, and domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were 0.21, 15.50, 1.50, 0.50, 0.50, 0.50, and 0.50, respectively; the corresponding distribution-based MCIDs were 0.17, 15,99, 0.77, 0.80, 0.78, 0.60, and 0.70, respectively. We identified MCIDs for surgical treatment of spinal metastases, providing benchmarks for future clinical research. By retrospectively examining whether the MCIDs are achieved, factors favoring their achievement and risks affecting them can be explored. This could aid in decisions on surgical candidacy and patient counseling. II.

Health-related quality of life and associations with general characteristics among older patients with overweight and obesity

Objectives: To assess health-related quality of life (HRQoL) and associations with general characteristics among older people with overweight and obesity. Subjects and Methods: A cross-sectional study on 220 older patients with overweight and obesity examined and treated at National Geriatric Hospital from January to May 2023. HRQoL were assessed using the EQ–5D– 5L questionnaire. General information and classification of obesity were also collected. Results: Of the total 220 participants, the proportion of patients with difficulties in aspects such as mobility was 57.3%; self- care is 48.6%; usual activities is 55.5%; pain/ discomfort is 65% and anxiety/depression is 49.5%. The results showed that HRQoL in women was significantly lower than in men in terms of pain/discomfort and anxiety/ depression (p&lt;0.05). People living in urban areas have better HRQoL than those living in rural areas in terms of usual activities with p&lt;0.05. People living in rural areas have lower EQ-VAS health self-assessment scores than those living in urban areas, which is statistically significant with p&lt;0.05. Between groups with the different numbers of hospital stays in the past year, there was a significant difference in almost all aspects of HRQoL (p&lt;0.05) except for pain/discomfort. The more hospital stays, the lower the HRQoL, especially the lower the EQ - VAS score (p &lt; 0.001). Conclusion: About 50% of the participants self-rated as having problems with one of the aspects of HRQoL among older patients with overweight and obesity. Our results highlighted that aspects of quality of life EQ - 5D are related to gender, living area, and number of hospitalization in the past year among this population.

Evaluating the Health-Related Quality of Life in Patients with COPD and Chronic Heart Failure Post-Hospitalization after COVID-19 Using the EQ-5D and KCCQ Questionnaires.

Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) frequently coexist, significantly impacting health-related quality of life (HRQoL). This study evaluated HRQoL in patients with CHF, COPD, or both, three months post-COVID-19 discharge using EQ-5D and KCCQ questionnaires to guide targeted healthcare interventions. We conducted a cross-sectional study at "Victor Babes" Hospital in Timisoara, enrolling 180 patients who had recovered from COVID-19 (60 in each group including CHF, COPD, and both conditions). HRQoL was assessed via EQ-5D and KCCQ. Significant disparities in HRQoL measures were noted across the groups. Patients with both CHF and COPD reported the worst outcomes, especially in terms of hospital stay lengths due to COVID-19 (11.63 days) and initial oxygen saturation levels (88.7%). HRQoL improvements from discharge to three months post-discharge were significant, with EQ-5D mobility scores improving notably across all groups (CHF and COPD: 2.87 to 2.34, p = 0.010). KCCQ results reflected substantial enhancements in physical limitation (CHF and COPD: 38.94 to 58.54, p = 0.001) and quality of life scores (CHF and COPD: 41.38 to 61.92, p = 0.0031). Regression analysis revealed that dual diagnosis (CHF and COPD) significantly impacted usual activities and quality of life (β = -0.252, p = 0.048; β = -0.448, p = 0.017), whereas the initial severity of COVID-19 was a significant predictor of worse HRQoL outcomes (β = -0.298, p = 0.037; β = -0.342, p = 0.024). The presence of both CHF and COPD in patients recovering from COVID-19 was associated with more severe HRQoL impairment compared with either condition alone. These findings emphasize the need for specialized, comprehensive post-COVID-19 recovery programs that address the complex interplay among chronic conditions to optimize patient outcomes and enhance quality of life.

Examining health-related quality of life in ambulatory adult patients with chronic heart failure: insights from Malaysia using EQ-5D-5L.

Health-related quality-of-life (HRQoL) data for the chronic heart failure (HF) population in Malaysia are lacking. Using EQ-5D-5L, this study intended to describe their HRQoL, identify predictors of worse HRQoL, and derive EQ-5D-5L index scores for use in economic evaluations. A cross-sectional survey was conducted between April and September 2023 to collect EQ-5D-5L, sociodemographic, and clinical data from outpatients with HF across seven public specialist hospitals in Malaysia. Multivariable logistic and linear regression models were used to identify independent predictors of reported problems in the EQ-5D-5L dimensions, and predictors of index scores and EQ-VAS, respectively. EQ-5D-5L data from 424 outpatients of multi-ethnic background (mean age: 57.1years, 23.8% female, mean left ventricular ejection fraction: 35.7%, 89.7% NYHA class I-II) were collected using either Malay, English, or Chinese, achieving a 99.8% completion rate. Nearly half of the respondents reported issues in the Mobility, Usual Activities, and Pain/Discomfort dimensions. Mean EQ-5D-5L index was 0.820, lower than the general population, and significantly lower with NYHA class III-IV (0.747) versus NYHA class I (0.846) and NYHA class II (0.805). Besides NYHA class, independent predictors of worse HRQoL included Indian ethnicity, living alone, lower education, unemployment due to ill-health, and proxy-reported HRQoL, largely aligning with existing literature. Community-dwelling Malaysians with HF reported poorer HRQoL compared to the general population. The observed disparities in HRQoL among HF patients may be linked to specific patient characteristics, suggesting potential areas for targeted interventions. HRQoL assessment using EQ-5D-5L proves feasible and should be considered for routine implementation in local clinics.

Comparing the EQ-5D-5L and stroke impact scale 2.0 in stroke patients: an analysis of measurement properties

BackgroundStroke has evolved to become a chronic disease and a major public health challenge. To adequately capture the full disease burden of stroke patients, the assessment of health-related quality of life (HRQoL) and thus the performance of respective measures is increasingly relevant. The aim of this analysis was to compare the measurement properties of two self-report instruments, the EQ-5D-5L and the Stroke Impact Scale 2.0.MethodsThe data used for the analysis was derived from a quasi-experimental case management study for mildly to moderately affected incident stroke and transient ischemic attack (TIA) patients aged ≥ 18 in Germany. Data was collected patient-individually at 3, 6 and 12 months after initial stroke. The EQ-5D-5L and SIS 2.0 were compared in terms of feasibility, ceiling and floor effects, responsiveness and known-groups validity (Kruskal-Wallis H and Wilcoxon rank-sum test).ResultsA response for all three follow-ups is available for n = 855 patients. The feasibility of the EQ-5D-5L is determined as good (completion rate: 96.4–96.6%, ≥ one item missing: 3.2 − 3.3%), whereas the SIS 2.0 is moderately feasible (overall completion rate: 44.9–46.1%, ≥ one item missing in domains: 4.7 − 28.7%). The SIS 2.0 shows substantial ceiling effects in comparable domains (physical function: 10.4 − 13%, others: 3.5–31.3%) which are mainly larger than ceiling effects in the EQ-5D-5L index (17.1–21.5%). In terms of responsiveness, the EQ-5D-5L shows small to moderate change while the SIS 2.0 presents with moderate to large responsiveness. The EQ-5D-5L index, mobility, usual activities and Visual Analogue Scale show known-groups validity (p < 0.05). Content-related domains of the SIS 2.0 show known-groups validity as well (p < 0.05). However, it is compromised in the emotion domain in both measures (p > 0.05).ConclusionsThe EQ-5D-5L seems to be slightly more suitable for this cohort. Nonetheless, the results of both measures indicate limited suitability for TIA patients. Large-scale studies concerning responsiveness and known-groups validity are encouraged.Trial registrationThe study was registered in the German Clinical Trials Register, retrospective registration on 21.09.2022. Registration ID: DRKS00030297.

Time From Hospital Arrival Until Endovascular Thrombectomy and Patient-Reported Outcomes in Acute Ischemic Stroke

The time-benefit association of endovascular thrombectomy (EVT) in ischemic stroke with patient-reported outcomes is unknown. To assess the time-dependent association of EVT with self-reported quality of life in patients with acute ischemic stroke. Data were used from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, which tested the effect of nerinetide on functional outcomes in patients with large vessel occlusion undergoing EVT and enrolled patients from March 1, 2017, to August 12, 2019. The ESCAPE-NA1 trial was an international randomized clinical trial that recruited patients from 7 countries. Patients with EuroQol 5-dimension 5-level (EQ-5D-5L) index values at 90 days and survivors with complete domain scores were included in the current study. Data were analyzed from July to September 2023. Hospital arrival to arterial puncture time and other time metrics. EQ-5D-5L index scores were calculated at 90 days using country-specific value sets. The association between time from hospital arrival to EVT arterial-access (door-to-puncture) and EQ-5D-5L index score, quality-adjusted life years, and visual analog scale (EQ-VAS) were evaluated using quantile regression, adjusting for age, sex, stroke severity, stroke imaging, wake-up stroke, alteplase, and nerinetide treatment and accounting for clustering by site. Using logistic regression, the association between door-to-puncture time and reporting no or slight symptoms (compared with moderate, severe, or extreme problems) was determined in each domain (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression) or across all domains. Time from stroke onset was also evaluated, and missing data were imputed in sensitivity analyses. Among 1105 patients in the ESCAPE-NA1 trial, there were 1043 patients with EQ-5D-5L index values at 90 days, among whom 147 had died and were given a score of 0, and 1039 patients (mean [SD] age, 69.0 [13.7] years; 527 male [50.7%]) in the final analysis as 4 did not receive EVT. There were 896 survivors with complete domain scores at 90 days. There was a strong association between door-to-puncture time and EQ-5D-5L index score (increase of 0.03; 95% CI, 0.02-0.04 per 15 minutes of earlier treatment), quality-adjusted life years (increase of 0.29; 95% CI, 0.08-0.49 per 15 minutes of earlier treatment), and EQ-VAS (increase of 1.65; 95% CI, 0.56-2.72 per 15 minutes of earlier treatment). Each 15 minutes of faster door-to-puncture time was associated with higher probability of no or slight problems in each of 5 domains and all domains concurrently (range from 1.86%; 95% CI, 1.14-2.58 for pain or discomfort to 3.55%; 95% CI, 2.06-5.04 for all domains concurrently). Door-to-puncture time less than 60 minutes was associated higher odds of no or slight problems in each domain, ranging from odds ratios of 1.49 (95% CI, 1.13-1.95) for pain or discomfort to 2.59 (95% CI, 1.83-3.68) for mobility, with numbers needed to treat ranging from 7 to 17. Results were similar after multiple imputation of missing data and attenuated when evaluating time from stroke onset. Results suggest that faster door-to-puncture EVT time was strongly associated with better health-related quality of life across all domains. These results support the beneficial impact of door-to-treatment speed on patient-reported outcomes and should encourage efforts to improve patient-centered care in acute stroke by optimizing in-hospital processes and workflows.