Monitoring health outcomes among patients with arthritis using the SF-36 Health Survey: overview

Outcomes of Twice Repeated High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Subacute Postherpetic Neuralgia: a Retrospective Single-Center Analysis

Background

The treatment of herpes zoster-related pain is challenging, and requires a variety of methods including pulse radio frequency modulation. Among them, single-time high-voltage long-term pulsed radiofrequency (HL-PRF) has been proved to be an effective treatment for subacute postherpetic neuralgia. However, it has the possibility of poor long-term curative effect and recurrence of neuralgia. In this study, we aim to identify the clinical efficacy and safety of twice repeated HL-PRF treatment in patients with subacute postherpetic neuralgia.

Design

We conducted a retrospective analysis of subacute postherpetic neuralgia patients who underwent HL-PRF treatment.

Setting

Pain Management Department of First Affiliated Hospital of Wannan Medical College.

Patients

We enrolled all patients with subacute postherpetic neuralgia, who underwent HL-PRF treatment from January 2023 to October 2023.

Measurements

The primary outcome variable was the visual Analog Scale (VAS) scores at 1, 4, 8, and 12 weeks after treatment. Secondary outcomes included Pittsburgh sleep quality index (PSQI), 36-item short-form health survey (SF-36) score, and total effective rate after treatment.

Results

A total of 63 patients were included in the analysis. Among them, 33 patients received single-time HL-PRF treatment (Group S) and 30 patients received twice repeated HL-PRF treatment (Group T). Pain scores, PSQI scores, and SF-36 score were reduced in both groups after treatment (P < 0.001). Compared to group S, the VAS scores, PSQI scores, anxiety scores, and depression scores were significantly lower at 1, 4, 8, and 12 weeks in group T. (P < 0.001). The total efficiency rate at 12 weeks after treatment of group T was statistically higher than that of group S (60.6% vs 86.7%, P < 0.05).

Conclusion

Twice repeated high-voltage long-duration PRF therapy demonstrates satisfactory efficacy in patients with subacute postherpetic neuralgia and is associated with no significant adverse reactions.

Efficacy and Safety of High-Voltage Pulsed Radiofrequency versus Standard-Voltage Pulsed Radiofrequency for Patients with Neuropathic Pain: A Literature Review and Meta-Analysis

Background

Neuropathic pain (NP) is recognized as one of the most difficult pain syndromes which lacks a safe, well-tolerated and effective treatment. Pulsed radiofrequency (PRF), a novel and minimally invasive interventions, has been introduced to alleviate various types of NP. Previous studies reported PRF with higher voltage could further improve the treatment efficacy. Therefore, we conducted this systematic review and meta-analysis to determine whether high-voltage PRF is superior to standard-voltage PRF for the treatment of NP patients.

Methods

Databases published from the date of inception until 15 March 2022 on PubMed/MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched for RCTs comparing high-voltage PRF and standard-voltage PRF in NP patients. The primary outcome measures were the efficiency rates of NP patients with high-voltage PRF or standard-voltage PRF treatment. Data analysis was conducted using the Review Manager software (RevMan V.5.3).

Results

Six RCTs involving 423 patients were included in our meta-analysis. Compared with standard-voltage PRF group, the high-voltage PRF group attained a higher efficiency rate at 1 month (P = 0.04; I2 = 0%), 3 months (P = 0.04; I2 = 0%), 6 months (P = 0.002; I2 = 0%) post-procedure respectively. There was no significant difference in the complications between the two groups.

Conclusion

Our study supported that high-voltage PRF attained more satisfactory efficacy than standard-voltage PRF without increased side effects. High-voltage PRF could be a promising, effective, minimally invasive technology for NP patients.

Comparison of Two Different Pulsed Radiofrequency Modes for Prevention of Postherpetic Neuralgia in Elderly Patients With Acute/Subacute Trigeminal Herpes Zoster

OBJECTIVE

Trigeminal postherpetic neuralgia (PHN) is often refractory to treatment. Pulsed radiofrequency (PRF) neuromodulation can help in preventing PHN after herpes zoster. This study aimed to compare the efficacy and safety of two different PRF modes on gasserian ganglion neuromodulation in elderly patients with acute/subacute trigeminal herpes zoster.

MATERIALS AND METHODS

A total of 120 elderly patients with acute or subacute (within past three months) trigeminal herpes zoster were randomized to receive either a single cycle of high-voltage, long-duration PRF (HL-PRF group; N = 60) or three cycles of standard PRF (S-PRF group; N = 60). Patients were followed up for six months after treatment. Visual analog scale (VAS) pain score, 36-Item Short Form Health Survey (SF-36) score, and pregabalin at baseline and at different time points during follow-up were recorded.

RESULTS

VAS and SF-36 scores declined significantly from baseline levels in both groups (p < 0.001). The scores were significantly lower in the HL-PRF group than in the S-PRF group at some time points (p < 0.05). The mean dose of pregabalin was significantly lower in the HL-PRF group than in the S-PRF group on days 3, 14, and 28 after treatment (p < 0.05). No serious adverse events occurred in either group.

CONCLUSION

HL-PRF neuromodulation of the gasserian ganglion appears to be more effective than S-PRF for preventing PHN in the elderly.

CLINICAL TRIAL REGISTRATION

ChiCTR2000038775.

The Clinical Efficacy of High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Pudendal Neuralgia: A Retrospective Study

BACKGROUND

Patients with pudendal neuralgia (PN) experience long-lasting chronic pain, hyperalgesia, and comorbid emotional disorders, such as depression and anxiety. Treatment via conventional pulsed radiofrequency (PRF) current carries a significantly high rate of failure.

OBJECTIVE

To determine the safety and clinical efficacy of high-voltage, long-duration PRF application to the pudendal nerve in patients with PN.

STUDY DESIGN

Observational retrospective design, self before-after controlled clinical trial.

MATERIALS AND METHODS

We analyzed the records of 70 patients of our hospital with diagnosed PN. Treatment consisted of PRF application to the pudendal nerve, using computed tomography guidance to target the pudendal nerve at the level of the ischial spine or ischial tuberosity of the affected side. PRF was applied with the following parameters: temperature 42 °C, frequency 2 Hz, pulse width 20 ms, field intensity ramped gradually from 40 to 90 V, duration 900 sec. The therapeutic effect was evaluated by collecting patient scores for the visual analog scale (VAS), SF-36 health survey questionnaire (SF-36), and patient health questionnaire (PHQ-9) before treatment and at 1-, 4-, and 12-week follow-ups after PRF treatment. Data were analyzed by paired t-test with p < 0.05 considered to be statistically significant.

RESULTS

VAS, SF-36, and PHQ-9 scores at 1, 4, and 12 weeks after high-voltage long-duration PRF treatment were significantly improved relative to their respective pretreatment baseline scores (p < 0.05 for all). The effective rate at 12 weeks after high-voltage long-duration PRF was up to 88.6%.

LIMITATIONS

A small sample size and lack of a control group.

CONCLUSIONS

High-voltage long-duration PRF provided significant short-term (at least 12 weeks) pain relief to most patients with PN; it also improved subjective measures of depression and quality of life over the same duration of time.

Effects of three frequencies of self-monitored blood glucose on HbA1c and quality of life in patients with type 2 diabetes with once daily insulin and stable control: a randomized trial

Objective

The optimal frequency of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes (T2DM) with stable glycemic control is unknown. This study investigated effects of 3 frequencies of SMBG on glycemic control and quality of life after 9 months in patients using one long-acting insulin injection a day. In an open-label, multi-center, primary-care, parallel (1:1:1) randomized trial in the Netherlands including patients with T2DM, HbA1c ≤ 58 mmol/mol (≤ 7.5%), stable glycemic control, treated with one insulin injection daily, three frequencies of 4-point glucose measurements (before meals and bedtime) were weekly (n = 22), every 2 weeks (n = 16) and monthly (n = 20) were compared.

Results

A total of 58 patients with T2DM were included by 38 general practitioners, which was lower then anticipated. There were no significant between group differences in HbA1c (mmol/mol); group C compared to A and B; − 2.7 (95% CI − 6.4, 1.0) and − 1.0 (95% CI − 4.9, 3.0) and quality of life. Baring in mind the lower than anticipated inclusion rate, there were no significant differences in HbA1c and quality of life between three different frequencies of SMBG in patients with stable glycemic control using one long-acting insulin injection.

Trial registration NCT01460459, registered 10-2011, recruitment between 05-2011 and 12-2011

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3138-7) contains supplementary material, which is available to authorized users.

Determinants of pain, disability, health-related quality of life and physical performance in patients with knee osteoarthritis awaiting total joint arthroplasty

PURPOSE

In patients suffering from knee osteoarthritis awaiting knee arthroplasty, to measure associations between several selected determinants and pain, disability, health-related quality of life and physical performance.

MATERIAL AND METHODS

Validated self-reported measures were collected: (1) Western Ontario and McMaster Universities Osteoarthritis Index, (2) Lower Extremity Functional Scale (LEFS) and (3) Short-Form 36 (SF-36). Physical performance was also assessed with four validated performance tests. Demographic, socioeconomic, psychosocial and clinical characteristics of the participants were also measured. Multivariate regression analyses were used to evaluate potential associations.

RESULTS

Higher fear-avoidance beliefs, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse pain, function or HRQOL (p < 0.05) and explained 12%-35% of the variances of the self-reported measure scores. Pretest pain and change in pain during posttest, greater comorbidities, psychological distress and use of a walking aid were significantly associated with worse performance on the physical tests (p < 0.05) and explained 41%-59% of the variances of the different physical tests results.

CONCLUSIONS

Several determinants were significantly associated with worse pain, disability, health-related quality of life or physical performance. Several of these associations may be considered clinically important, including psychosocial determinants in relation to self-reported measures, but to physical performance as well. Implications for rehabilitation Knee osteoarthritis is a highly prevalent and disabling condition incurring important socioeconomic costs. Several modifiable determinants have been shown to contribute to pain and disability in individuals suffering from knee OA awaiting TKA. Recent studies demonstrated the efficacy of education and rehabilitation (prehabilitation) in individuals awaiting TKA.

Effects of a tele-prehabilitation program or an in-person prehabilitation program in surgical candidates awaiting total hip or knee arthroplasty: Protocol of a pilot single blind randomized controlled trial

Background

The accessibility for total joint arthroplasty often comes up against long wait lists, and may lead to deleterious effects for the awaiting patients. This pilot single blind randomized controlled trial aims to evaluate the impact of a telerehabilitation prehabilitation program before a hip or knee arthroplasty compared to in-person prehabilitation or to usual wait for surgery.

Methods/design

Thirty-six patients on a wait list for a total hip or knee arthroplasty will be recruited and randomly assigned to one of three groups. The in-person prehabilitation group (n = 12) will receive a 12-week rehabilitation program (2 sessions/week) including education, exercises of the lower limb and cardiovascular training. Patients in the tele-prehabilitation group (n = 12) will receive the same intervention using a telecommunication software. The control group (n = 12) will be provided with the hospital's usual documentation before surgery. The Lower Extremity Functional Scale (LEFS) will be the primary outcome measure taken at baseline and at 12 weeks. Secondary measures will include self-reported function and quality of life as well as performance tests. A mixed-model, 2-way repeated-measure ANOVA will be used to analyse the effects of the rehabilitation programs.

Discussion

This pilot study is the first to evaluate the feasibility and the impact of a telerehabilitation prehabilitation program for patients awaiting a total joint arthroplasty. The results of this pilot-RCT will set the foundations for further research in the fields of rehabilitation and tele-medicine for patients suffering from lower limb osteoarthritis.

Trial registration

ClinicalTrials.gov: NCT02636751.

Comparison of the short form-12 (SF-12) health status questionnaire with the SF-36 in patients with knee osteoarthritis who have replacement surgery

PURPOSE

To investigate whether the performance of the short form-12 (SF-12) health survey is comparable with the longer version SF-36 for measuring health-related quality of life over time in patients with knee osteoarthritis who have joint replacement surgery.

METHODS

Four hundred and seven patients with knee osteoarthritis completed the SF-36 before surgery and at a minimum of 12 months following knee replacement. SF-12 item responses were obtained from the responses given to the SF-36 questionnaire. Correlation coefficients were calculated between SF-12 and SF-36 physical component summary (PCS) and mental component summary (MCS) scores and the respective change in scores. Sensitivity to change was determined with the standardised response mean (SRM).

RESULTS

PCS and MCS scores were highly correlated between SF-12 and SF-36 versions for both preoperative and post-operative measures (r = 0.90-0.96, p < 0.0001). Change scores (post-operative-preoperative) were also highly correlated (PCS: r = 0.88, p < 0.001;

MCS

r = 0.93, p < 0.001). Sensitivity to change was large for the PCS scale (all SRMs >1.0). Correlations above 0.7 were found between change scores for each SF-36 and SF-12 subscale except General Health (r = 0.55).

CONCLUSIONS

The SF-12 summary measures and component scores replicate well with the SF-36 and show similar responsiveness to change. The SF-12 appears to be an adequate alternative for use in patients with knee osteoarthritis who undergo replacement surgery, and its brevity should be attractive for both clinicians and patients.

LEVEL OF EVIDENCE

I.

Association Between Lower Extremity Performance and Health-Related Quality of Life in Elderly Mexican Americans

OBJECTIVE

To examine the longitudinal association between levels of lower extremity performance (LEP) and health-related quality of life (HRQoL) in older Mexican Americans aged 72 years or older participating in the Hispanic Established Population for the Epidemiological Study of the Elderly (2000-2006).

METHOD

LEP was measured in 621 non-institutionalized participants with the Short Physical Performance Battery (SPPB). Participants were divided into high (SPPB score 10-12), intermediate (SPPB score 7-9), and low (SPPB score 0-6) groups based on LEP. HRQoL was assessed using the Medical Outcomes Study Short Form (SF-36), which includes a Physical Composite Scale (PCS) and a Mental Composite Scale (MCS).

RESULTS

Participants in the high LEP group had slower rates of decline in the PCS, and those in the intermediate LEP group had slower rates of decline in the MCS score over time.

DISCUSSION

Increased LEP was associated with slower rates of decline in physical and mental HRQoL in older Mexican Americans.

Patellar tendon properties and lower limb function in rheumatoid arthritis and ankylosing spondylitis versus healthy controls: a cross-sectional study

Objective. Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) lead to inflammation in tendons and peritendinous tissues, but effects on biomechanical tendon function are unknown. This study investigated patellar tendon (PT) properties in stable, established RA and AS patients. Methods. We compared 18 RA patients (13 women, 59.0 ± 2.8 years, mean ± SEM) with 18 age- and sex-matched healthy controls (58.2 ± 3.2 years), and 12 AS patients (4 women, 52.9 ± 3.4 years) with 12 matched controls (54.5 ± 4.7 years). Assessments with electromyography, isokinetic dynamometry, and ultrasound included quadriceps muscle force and cross-sectional area (CSA), PT stiffness, and PT CSA. Additionally, measures of physical function and disease activity were performed. Results. PT stiffness and physical function were lower in RA and AS patients compared to healthy controls, without a significant difference in force production. PT CSA was significantly larger leading to reduction in Young's modulus (YM) in AS, but not in RA. Conclusion. The adverse changes in PT properties in RA and AS may contribute to their impaired physical function. AS, but not RA, leads to PT thickening without increasing PT stiffness, suggesting that PT thickening in AS is a disorganised repair process. Longitudinal studies need to investigate the time course of these changes and their response to exercise training.

Determinants of pain, functional limitations and health-related quality of life six months after total knee arthroplasty: results from a prospective cohort study

Background

Total knee arthroplasty (TKA) is an effective procedure. However, for some patients, the outcomes are not satisfactory. Identification of TKA determinants could help manage these patients more efficiently. The purpose of this study was to identify pre- and perioperative determinants of pain, functional limitations and health-related quality of life (HRQoL) 6 months after TKA.

Methods

138 participants were recruited from 3 hospitals in Quebec City, Canada and followed up until 6 months after surgery. Data were collected through review of the subjects’ medical files and structured telephone interviews before and 6 months after TKA. Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Independent variables included demographic, socioeconomic, psychosocial, clinical and surgical characteristics of participants as well as data on health services utilization. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores.

Results

Higher preoperative pain, cruciate retaining implants and the number of complications were significantly associated with worse pain 6 months after TKA (p < 0.05) and explained 11% of the variance of the WOMAC pain score. Higher preoperative functional limitations, being single, separated, divorced or widowed, being unemployed or retired and the number of complications were significantly associated (p < 0.05) with worse functional limitations 6 months after TKA and explained 16% of the variance of the WOMAC function score. Lower preoperative HRQoL, contralateral knee pain, higher psychological distress and comorbidities were significantly associated (p < 0.05) with worse HRQoL 6 months after TKA and explained 23% of the variance of the SF-36 physical functioning score.

Conclusions

Several variables were found to be significantly associated with worse outcomes 6 months after TKA and may help identify patients at risk of poorer outcome. The identification of these determinants could help manage patients more efficiently and may help target patients who may benefit from extensive rehabilitation.

Do patients achieve normal gait patterns 3 years after total knee arthroplasty?

STUDY DESIGN

Longitudinal cross-sectional study.

BACKGROUND

In the early stages after total knee arthroplasty (TKA), quadriceps strength of the operated limb decreases and is substantially less than that of the nonoperated limb. This asymmetry in strength is related to asymmetrical movement patterns that increase reliance on the nonoperated limb. Over time, quadriceps strength in the operated limb increases but remains less than that in age-matched controls without knee pathology, whereas the quadriceps strength in the nonoperated limb gradually decreases. The purpose of this study was to investigate the changes in quadriceps strength and function of both limbs up to 3 years after TKA and to evaluate change in interlimb kinematic and kinetic parameters over time compared to that in age-matched individuals without knee pathology.

METHODS

Fourteen individuals after TKA and 14 healthy individuals matched for age, weight, height, and sex participated in the study. Outcome measures included kinematics, kinetics, quadriceps strength, and functional performance.

RESULTS

In participants who underwent TKA, quadriceps strength was significantly different between limbs at 3 months and 1 year after TKA, but not at 3 years after TKA. In this group, there was also a significant improvement in self-reported function between 3 months and 1 year after TKA, but a significant decrease between years 1 and 3 for the physical component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey. In the TKA group, there were few interlimb differences in joint kinematics and kinetics 3 years after TKA, which may be attributed to a combination of worsening in the nonoperated limb, as well as improvement in the operated limb. Differences between participants without knee pathology and those 3 years after TKA still existed for kinematic, kinetic, and spatiotemporal variables.

CONCLUSION

As interlimb differences in quadriceps strength decrease after TKA, there are concomitant symmetrical improvements in temporospatial and kinetic gait parameters. The symmetry 3 years after TKA in quadriceps strength is primarily the result of progressive weakness in the nonoperated limb.

The relative importance of psychosocial factors in arthritis: findings from 10,509 Australian women

OBJECTIVE

To determine the relative importance of psychosocial factors in arthritis diagnosis in an ageing cohort of Australian women.

METHODS

This study focused on 10,509 women from the 1946-1951 cohort who responded to questions on arthritis in the fifth mailed population-based survey of the Australian Longitudinal Study on Women's Health conducted in 2007.

RESULTS

Arthritis was characterised by widespread psychosocial concerns, particularly relating to chronic stress and poor mental health. Univariate analyses revealed that in comparison to women without stress, women with moderate/high stress levels had a 2.5-fold increase in reporting arthritis. Experiencing ongoing negative interpersonal life events concerning illness of a family member/close friend and relationship difficulties was also associated with a 1.4-fold increase in the reporting of arthritis. Likewise, significantly reduced levels of optimism and perceived social support were noted (all associations p<.001). Psychiatric diagnosis was also associated with a two-fold increase in having arthritis (p<.001). Following adjustment for behavioural, demographic and health-related characteristics, anxiety was the only psychosocial factor associated with arthritis (OR=1.4, 95% CI=1.2, 1.7; p<.001).

CONCLUSION

This study examined, epidemiologically, the relative importance of psychosocial factors in arthritis in an ageing cohort of Australian women. The findings from this population-based study indicate that women with arthritis are more likely to report a range of psychosocial-related problems, particularly with regard to chronic stress perception and anxiety. Longitudinal analyses are required to examine the processes by which stress and psychosocial factors may contribute to arthritis risk and poor adaptation in terms of health-related quality of life.

The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery

OBJECTIVE

The purpose of the current study was to assess, in patients scheduled for primary total knee replacement (TKR), the effects of pre-surgery waiting time on pain and functional limitations related to the knee joint undergoing surgery, on health-related quality of life (HRQoL) and on contralateral knee pain 6 months after surgery.

METHOD

A total of 141 patients scheduled for TKR were recruited from three hospitals in Quebec City, Canada, and followed up until 6 months after surgery. Pre-surgery wait, defined as the time between enrolment on the pre-surgery waiting list and surgery, was considered in four categories (≤3, >3-6, >6-9, >9 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC). HRQoL was measured with the SF-36.

RESULTS

Mean pre-surgery waiting time was 184 (SD: 120.8) days. Six months after TKR, a significant difference was seen between the four groups of pre-surgery wait in terms of HRQoL SF-36 role physical [F(3, 136) = 2.74, P = 0.046] and contralateral knee WOMAC pain [F(3, 136) = 5.78, P = 0.0009] scores. Participants with the longest pre-surgery wait (>9 months) showed the worst scores 6 months after TKR.

CONCLUSIONS

Longer pre-surgery waiting time had a negative clinically important impact on HRQoL and contralateral knee pain 6 months after surgery.

Phase II trial of low-dose continuous (metronomic) treatment of temozolomide for recurrent glioblastoma

The prognosis for patients with recurrent glioblastomas (GBMs) is dismal, with a median survival of 3-6 months. We performed a phase II trial of low-dose continuous (metronomic) treatment using temozolomide (TMZ) for recurrent GBMs. TMZ-refractory patients with GBM who experienced disease recurrence or progression during or after the cyclic treatment schedule of TMZ after surgery and standard radiotherapy were eligible. This phase II trial included 2 cohorts of patients. The initial cohort, comprising 10 patients, received TMZ at 40 mg/m(2) everyday. After this regimen seemed safe and effective, the metronomic schedule was changed to 50 mg/m(2) everyday. The second cohort, comprising 28 patients, received TMZ at 50 mg/m(2) everyday. The 6-month progression-free survival in all 38 patients was 32.5% (95% CI: 29.3%-35.8%) and the 6-month overall survival was 56.0% (95% CI: 36.2%-75.8%). One patient developed a grade III neutropenia, grade II thrombocytopenia in 3 patients, and grade II increase of liver enzyme (GOT/GPT) in 3 patients. Of all patients included in this study, 4 patients were withdrawn from this study because of side effects including sustained hematological disorders, cryptococcal infection, and cellulitis. In a response group, quality of life measured with short form-36 was well preserved, when compared with the pretreatment status. Metronomic treatment of TMZ is an effective treatment for recurrent GBM that is even refractory to conventional treatment of TMZ and has acceptable toxicity.

Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: less is more

BACKGROUND

Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate on standing. beta-Blockade is an appealing treatment approach, but conflicting preliminary reports are conflicting. We tested the hypothesis that propranolol will attenuate the tachycardia and improve symptom burden in patients with POTS. In protocol 1, a low dose (20 mg) was compared with placebo, and the dose response was assessed in protocol 2.

METHODS AND RESULTS

In protocol 1, patients with POTS (n=54) underwent acute drug trials of propranolol 20 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, heart rate, and symptoms were assessed while the patients were seated and after standing for up to 10 minutes before and hourly after the study drug. Supine (P<0.001) and standing (P<0.001) heart rates were significantly lower after propranolol compared with placebo. The symptom burden improvement from baseline to 2 hours was greater with propranolol than placebo (median, -4.5 versus 0 arbitrary units; P=0.044). In protocol 2, 18 patients with POTS underwent similar trials of high-dose (80 mg) versus low-dose (20 mg) propranolol. Although the high dose elicited a greater decrease than the low dose in standing heart rate (P<0.001) and orthostatic tachycardia (P<0.001), the improvement in symptoms at 2 hours was greater with low-dose propranolol (-6 versus -2 arbitrary units; P=0.041).

CONCLUSIONS

Low-dose oral propranolol significantly attenuated tachycardia and improved symptoms in POTS. Higher-dose propranolol did not further improve, and may worsen, symptoms.

Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life

Background

Recent evidences show that education and rehabilitation while waiting for knee replacement have positive effects on the patients' health status. Identification of factors associated with worse pain, function and health-related quality of life (HRQoL) while waiting for surgery could help develop pre-surgery rehabilitation interventions that target specifically these factors and prioritize patients that may benefit the most from them. The objectives of this study were to measure pain, stiffness, function and HRQoL in patients at enrolment on waiting lists for knee replacement and to identify demographic, clinical, socioeconomic and psychosocial characteristics associated with these outcomes.

Methods

This study is part of a broader study measuring the effects of pre-surgery wait in patients scheduled for knee replacement. From 02/2006 to 09/2007, 197 patients newly scheduled for total knee replacement were recruited from the waiting lists of three university hospitals in Quebec City, Canada. Pain, stiffness and function were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the SF-36 Health Survey. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores.

Results

The scores of all eight HRQoL physical and mental domains of the SF-36 were significantly lower than aged matched Canadian normative data (p < 0.05). Contralateral knee pain, higher psychological distress, higher body mass index (BMI) and the use of a walking aid were significantly associated with worse function (p < 0.05) and contributed to 22% of the variance of the WOMAC function score (multiple r = 0.47). A higher BMI, the use of a walking aid, contralateral knee pain and advanced age were significantly associated with worse physical function (p < 0.05) and contributed to 17% of the variance of the SF-36 HRQoL physical functioning score (multiple r = 0.41).

Conclusion

Patients waiting for knee replacement have poor function and HRQoL. Characteristics that were found to be associated with these outcomes could help develop pre-surgery rehabilitation program and prioritize patients that may benefit the most from them. Such programs could include interventions to reduce psychological distress, therapeutic exercises targeting both knees and weight loss management.

Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

Background

The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery.

Methods

Longitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM.

Results

On average, large effect sizes (ES≥0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20–0.49) to moderate (0.50–0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low.

Conclusion

Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.

Should aggregate scores of the Medical Outcomes Study 36-item Short Form Health Survey be used to assess quality of life in knee and hip osteoarthritis? A national survey in primary care

OBJECTIVE

To assess the relevance of using the aggregate physical component score (PCS) and mental component score (MCS) of the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) for patients with knee and hip osteoarthritis (OA).

METHODS

We conducted a cross-sectional national survey in a primary care setting in France. A total of 1474 general practitioners enrolled 4183 patients with hip or knee OA. Construct validity of PCS and MCS was assessed by convergent and divergent validity and factor analysis.

RESULTS

Records of 4133 patients (98.8%) were analyzed (2540 knee, 1593 hip OA). PCS mean scores were 32.0+/-8.4 and 31.8+/-8.4 and MCS scores 47.1+/-11.0 and 46.8+/-11.1, for knee and hip OA, respectively. Acceptable convergent and divergent validity was observed, and correlation between PCS and MCS mean scores was low (r=0.14). However, factor analysis performed on the eight subscale scores failed to support the use of PCS and MCS aggregate scores. It extracted two factors which were similar for both OA types and differed from the a priori stratification. Scores for two subscales usually attributed to MCS - emotional role and social functioning - were shared between factors, and scores for another subscale - general health perception - usually belonging to the PCS was in the mental component factor.

CONCLUSIONS

Our results suggest that aggregate scores from the PCS and MCS of the SF-36 as they are currently defined may not be optimal for used in hip and knee OA patients to assess health-related quality of life.

Neuroticism, Side Effects, and Health Perceptions Among HIV-Infected Individuals on Antiretroviral Medications

Side effects from antiretroviral therapy (ART) for HIV disease can deter treatment, impact quality of life, and impede medication adherence. Individual differences in neuroticism may account for variations in the experience of side effects and perceptions of health status. Cross-sectional assessments were conducted with 258 HIV-infected participants with confirmed HIV infection and current ART regimen. Structural equation modeling (SEM) was used to evaluate a model of self-reported ART side effect frequency and severity and perceived health status, as related to symptoms of neuroticism. Symptoms of neuroticism were associated with greater reports of ART side effects and poorer perceived health but unrelated to reported CD4 count and viral load. A structural model was supported in which greater symptoms of neuroticism are linked to poorer perceived health through greater side effect frequency and severity. Individual differences in symptoms of neuroticism can explain variations in side effect reporting and consequential impairments in perceived health in the context of HIV treatment. Identification and intervention with individuals high in symptoms of neuroticism may be warranted to alleviate side effect-related concerns and maximize treatment benefit.

Parsimonious and efficient assessment of health-related quality of life in osteoarthritis research: validation of the Assessment of Quality of Life (AQoL) instrument

BACKGROUND

The Assessment of Quality of Life (AQoL) utility instrument was psychometrically developed for the general population. This study aimed to explore its potential as an osteoarthritis (OA) outcome measure.

METHODS

WOMAC, Lequesne index, SF-36, Visual analogue scales and the AQoL were administered to 222 people with OA. The ability of each questionnaire to detect differences between groups was based on (i) self-rated health (SRH) and, (ii) differences between people on an orthopedic waiting list (WL) vs people with OA in the community (C). Comparisons included effect size, relative efficiency and receiver operator characteristic curves.

RESULTS

All instruments detected differences between groups; however no one instrument exhibited superior efficiency. The AQoL demonstrated strong psychometric properties.

CONCLUSION

The AQoL has equivalent performance to comparator questionnaires commonly used in OA research and would be a useful adjunct to well-established disease specific scales. The AQoL has important advantages; brevity (12 items), facilitates comparisons between disease groups, and delivers a utility score that can be used in health economic evaluations.

Validity of self-administered quality of well-being scale in musculoskeletal disease

OBJECTIVE

To evaluate the self-administered Quality of Well-Being (QWB-SA) Scale for patients with rheumatic diseases.

METHODS

Family medicine patients (n = 562) and rheumatology patients (n = 334) were assessed using the following tools: QWB-SA, Health Assessment Questionnaire (HAQ), Arthritis Impact Measurement Scales (AIMS), and Rapid Assessment of Disease Activity in Rheumatology (RADAR).

RESULTS

Patients with arthritis had significantly lower QWB-SA scores and significantly higher HAQ scores than family medicine patients with and without adjustment for covariates. The QWB-SA was significantly associated with quartiles from the RADAR, AIMS, and HAQ, providing evidence for the validity of the generic measure in patients with arthritis. Discriminant function analysis was used to create an arthritis-specific scoring system for the QWB-SA. Analyses demonstrated systematic relationships between the Quality of Well-Being arthritis composite and the disease-specific RADAR, AIMS, and HAQ.

CONCLUSIONS

Evidence supports the validity of the QWB-SA for patients with rheumatic diseases. QWB-SA items can be used to calculate an arthritis-specific score. The QWB-SA can be used to gain generic information for cost-utility analysis and disease-specific outcomes information for patients with arthritis.

Use of the reliable change index to evaluate clinical significance in SF-36 outcomes

The SF-36 Health Survey is the most widely used self-report measure of functional health. It is commonly used in both randomized controlled trials (RCT) and non-controlled evaluation of medical or other health services. However, determining a clinically significant change in SF-36 outcomes from pre-to-post-intervention, in contrast to statistically significant differences, is often not a focus of medical outcomes research. We propose use of the Reliable Change Index (RCI) in combination with SF-36 norms as one method for researchers, provider groups, and health care policy makers to determine clinically significant healthcare outcomes when the SF-36 is used as a primary measure. The RCI is a statistic that determines the magnitude of change score necessary of a given self-report measure to be considered statistically reliable. The RCI has been used to determine clinically significant change in mental health and behavioral medicine outcomes research, but is not widely applied to medical outcomes research. A usable table of RCIs for the SF-36 has been calculated and is presented. Instruction and a case illustration of how to use the RCI table is also provided. Finally, limitations and cautionary guidelines on using SF-36 norms and the RCI to determine clinically significant outcome are discussed.

The determination and measurement of functional disability in rheumatoid arthritis

Although functional outcome is frequently discussed and written about, it is often not clear what functional outcome is and how it can be measured. This paper introduces the concept of latent and observed measures of functional disability, and distinguishes between disability as a process measure and disability as an outcome measure. Using the Health Assessment Questionnaire as the main functional outcome measure in rheumatoid arthritis, we propose and discuss several methods for determining disability, and describe the implications of altering the disability course.

The SF-36 Arthritis-Specific Health Index (ASHI): I. Development and cross-validation of scoring algorithms

An arthritis-specific health index (ASHI) for the SF-36 Health Survey was developed by studying its responsiveness to changes in clinical indicators of arthritis severity. Longitudinal data from 1,076 patients participating in four placebo-controlled trials were analyzed. All had at least a 6-month history of moderate to severe osteoarthritis or rheumatoid arthritis of the knee or hip. All had undergone a washout period of 3 to 14 days before baseline assessment to bring about a flare state in osteoarthritis or rheumatoid arthritis symptoms. Their average age was 60 years and 72% were female. Change scores for the eight-scale SF-36 health profile (acute version) and five arthritis-specific measures of disease severity (knee pain on weight bearing, time to walk 50 feet, physician global evaluation of symptom severity and impact, patient global evaluation of symptom severity and impact, and pain intensity visual analogue scale) were computed by subtracting scores before treatment from scores at two-week follow-up. Canonical correlation methods were used to derive weights for changes in SF-36 scales to score a single index (ASHI) that maximized its correlation with changes in the set of five clinical measures of arthritis severity. The weights used to score the ASHI were cross-validated in a 25% holdout group (N = 144) from the first two osteoarthritis trials and in two additional osteoarthritis and rheumatoid arthritis trials (N = 530). Only one SF-36 canonical variate (ASHI) correlated significantly (F = 4.69, P < 0.0001) with the clinical canonical variate that served as the "criterion" measure of change in the severity of arthritis. Changes in the ASHI and clinical canonical variate were substantially correlated in the developmental sample (r = 0.628, P < 0.0001) and on cross-validation (r = 0.629, P < 0.0001). The clinical canonical variate correlated highly (r = 0.75-0.88) with changes in all but one of the five clinical measures (50-foot walk; r = 0.41). The pattern of correlations between changes in SF-36 scales and the ASHI indicated that ASHI is primarily a measure of bodily pain (r = 0.92) and other aspects of physical and role functioning and well-being (r = 0.69 for Role-Physical, r = 0.68 for Physical Functioning, r = 0.52 for Social Functioning, and r = 0.51 Vitality). The patterns of correlations between SF-36 scales and the ASHI were very similar across developmental and cross-validation samples. This research demonstrates the feasibility and generalizability of a single ASHI scored from changes in responses to the SF-36 Health Survey. The generic SF-36 health profile, which has already been shown to be useful in comparing arthritis with other diseases and treatments, can also be scored specifically to make it more useful in studies of osteoarthritis and rheumatoid arthritis.