Correlated physical and mental health composite scores for the RAND-36 and RAND-12 health surveys: can we keep them simple?

Changes in health related quality of life in mothers with inflammatory joint disease from year 2000 to 2020 - a comparative cross-sectional study

Objectives

More knowledge about health related quality of life (HRQoL) among mothers with inflammatory joint disease (IJD) is needed to understand the complex challenges for this group of patients. The overall aim of this study was to investigate changes in HRQoL among mothers with IJD from year 2000 to year 2020.

Methods

This study had a comparative cross-sectional design with two study groups 20 years apart, year 2000 (n = 77) and year 2020 (n = 197). Patients were identified from RevNatus, a Norwegian nationwide medical quality register (2020 cohort) and from a national centre for pregnancy and rheumatic disease (2000 cohort). Mothers with the diagnoses of rheumatoid arthritis, juvenile idiopathic arthritis, axial spondyloarthritis and psoriatic arthritis with children aged 0-6 were included. Data on HRQoL were self-reported and assessed by the RAND-36 (SF-36) questionnaire, along with data on educational status, number of children, months since last childbirth and eight questions on experienced motherhood limitations and experienced anxiety and distress for the children. Descriptive statistics were performed using the Mann-Whitney U-test, the Pearson chi-squared test and independent samples t-test. Multivariable linear regression were used to investigate changes and association between the RAND36 (SF-36) scores and the two study groups and possible confouders.

Results

The 2020 cohort had significantly higher scores on bodily pain (p < 0.001), physical function (p < 0.001), and role physical (p = 0.01) scales compared to the 2000 cohort, indicating better health. There were no significant differences between the two cohorts in the mental health (MH) (p = 0.81), vitality (p = 0.09), general health (p = 0.06), social function (p = 0.83), and role emotional (p = 0.93) scales. Compared to the calculated norm scores, the 2020 cohort had significantly lower scores on all scales (p < 0.01) except on the MH scale (p = 0.37).

Conclusion

Mothers with IJD were affected in most dimensions of RAND-36 (SF-36) both in year 2000 and year 2020. The findings emphasize the importance of understanding the intrusiveness of being a mother with IJD despite the improved medical treatment options over the last 20 years.

The Caregiver Pathway Intervention Can Contribute to Reduced Post-Intensive Care Syndrome Among Family Caregivers of ICU Survivors: A Randomized Controlled Trial

OBJECTIVES

Explore short-term effects of "The Caregiver Pathway," an intervention for family caregiver follow-up, on Post-Intensive Care Syndrome symptoms among families (PICS-F).

DESIGN

A randomized controlled trial.

SETTING

A medical ICU at a Norwegian University Hospital.

PARTICIPANTS

One hundred ninety-six family caregivers of critically ill patients randomized to an intervention (n = 101) or control group (n = 95).

INTERVENTIONS

"The Caregiver Pathway" four-step model offers individual and structured follow-up, including: 1) mapping family caregivers' needs and concerns with an assessment tool followed by a conversation with an ICU nurse within the first days at the ICU, 2) a supportive card when leaving the ICU, 3) offer for the family caregivers to receive a phone call after ICU patient discharge, and 4) a follow-up conversation within 3 months.

MEASUREMENTS AND MAIN RESULTS

Data were collected at baseline and after 3 months and analyzed using linear regression. No significant effects were detected when comparing all participants completing 3-month outcome measurements (n = 144). A subgroups analysis stratified on patient survival, however, showed statistically significant effect for family caregivers of patients surviving the ICU stay receiving the intervention compared with controls. Caregivers of surviving patients reported improved symptoms related to post-traumatic stress disorder, measured by Impact of Event Scale-Revised (B = -8.2 [95% CI, -14.2 to -2.2]; p = 0.008), anxiety (B = -2.2 [95% CI, -4.0 to -0.5]; p = 0.014), and depression (B = -1.5 [95% CI, -2.9 to -0.1]; p = 0.035); measured by the Hospital Anxiety and Depression Scale, subscore physical functioning in health-related quality of life (B = 9.7 [95% CI, 0.3-19.0]; p = 0.043); measured by Short Form 12-Item Health Survey; and hope (B = 2.4 [95% CI, 0.4-4.3]; p = 0.017) and measured by the Herth Hope Index. At 3-month, the model did not appear to improve the outcomes for family caregivers of nonsurviving patients.

CONCLUSIONS

"The Caregiver Pathway" intervention was associated with reduced symptoms of PICS-F in family caregivers of surviving ICU patients compared with controls.

Ocular Damage Index, Ocular Pain and Subjective Visual Rating in Patients with Behçet's Uveitis: A Study of Impact on Health-Related Quality of Life

PURPOSE

The aim of our study is to assess subjective disease burden parameters (SVR and OP) as well as objective ones (BCVA and ODI) as predictors of HRQoL in Egyptian patients with BD uveitis.

METHODS

Ninety-six patients with BD uveitis were recruited in this cross-sectional study from the Rheumatology Department, Cairo University Hospital. HRQoL was assessed using RAND-36 item health survey 1.0, subjective visual rating (SVR) was measured on a 6-point Likert scale. Ocular pain (OP) was rated on a numeric rating scale. The Ocular Damage Index (ODI) was calculated using the ocular domain of the BD damage index. Linear regression was performed to determine predictors of HRQoL metrics.

RESULTS

SVR predicted Vitality (β = 0.15, p = 0.004), Emotional Well-being (EW) (β = 0.13, p = 0.005), General Health (β = 0.18, p = 0.012) and Mental Component Summary (β = 0.22, p = 0.002). OP predicted Social Function (β = -3.18 p < 0.001), General Health (β = -1.55, p = 0.004), Physical Component Summary (β = -2.00, p = 0.007) and Mental Component Summary (β = -1.53, p = 0.005). BCVA predicted Physical Function (β = 31.1, p = 0.02) and Emotional Well-being (β = 7.94, p = 0.01). ODI failed to predict any HRQoL metrics. ODI was independent predictor of legal blindness adjusted for uveitis duration and severity. Legally blind patients had worse HRQoL metrics than patients with better vision.

CONCLUSION

In BD uveitis patients, subjective disease burden parameters were more informative about HRQoL metrics than objective ones. Longitudinal studies are needed to elucidate the utility of ODI as an outcome measure in BD uveitis.

PRECIS

In Behcet's uveitis patients, health-related quality of life was related to visual outcome, ocular pain, and subjective visual rating. Ocular damage was an independent predictor of legal blindness, adjusted for uveitis duration and severity.

Sedentary patterns and health outcomes in the oldest-old: a latent profile analysis

Background

Sedentary behavior is most prevalent among those aged 80 years and above, referred to as the oldest-old. Current literature emphasizes the significance of sedentary behavior patterns, but further evidence is required to understand how these patterns relate to specific health outcomes and to identify at-risk profiles for tailored interventions in the oldest-old. Therefore, the aim of this study was to identify profiles of adults aged 80+ years based on their sedentary patterns and health outcomes, and to examine associations between profiles and socio-demographics.

Methods

A cross-sectional study was conducted in Flanders (Belgium) from February 2021 to December 2022 recruiting 90 older adults (80+) through convenience sampling, employing word of mouth, social media and local service centers. Latent profile analysis identified device-based sedentary patterns and assessed their associations with physical and cognitive functioning, mental health-related quality of life (QoL), and social isolation. Associations of these profiles with socio-demographic factors were analyzed.

Results

Three distinct profiles were identified: (1) the 'cognitively and physically frail' profile, (2) the 'healthy' profile and (3) the 'lower mental health-related QoL' profile. Those in the 'cognitively and physically frail' profile exhibited the least favorable sedentary pattern, and had a higher likelihood of residing in a nursing home. No significant differences were found for the other socio-demographic variables, being age, sex, educational degree and family situation.

Conclusions

Three distinct profiles in the oldest-old population, based on cognitive and physical functioning, mental health-related QoL, and sedentary behavior patterns, were identified. Lower physical and cognitive functioning was associated with unhealthy sedentary patterns. Further research with larger samples is crucial to uncover potential links between socio-demographics and at-risk subgroups, enhancing our understanding of sedentary behavior and geriatric health outcomes in this population.

Intensive Lifestyle Intervention for Cardiometabolic Prevention Implemented in Healthcare: Higher Risk Predicts Premature Dropout

Aims

Patient characteristics and treatment setting are potential predictors of premature dropout from lifestyle interventions, but their relative importance is unknown.

Methods

From the quality registry of the unit for behavioral medicine, Umeå University hospital, we identified 2589 patients who had been enrolled in a multimodal lifestyle intervention for cardiometabolic risk reduction between 2006 and 2015. Baseline characteristics predicting dropout before 1-year follow-up were selected by a stepwise logistic regression algorithm.

Results

Better physical health and older age predicted full participation, with odds ratios for premature dropout (ORs) of .44 (95% confidence interval (CI) .31-.63), and .47 (95% CI .34-.65) in the highest compared to the lowest quartile, respectively. Odds of premature dropout were also lower among female participants, .71 (95% CI .58-.89). Premature dropout was predicted by higher BMI, snuffing tobacco, and smoking, with ORs of 1.53 (95% CI 1.13-2.08) in the highest compared to the lowest quartile of BMI, 1.37 (95% CI 1.03-1.81) comparing snuff user with non-users and 2.53 (95% CI 1.79-3.61) comparing smokers with non-smokers. Odds ratio for premature dropout among inpatients compared with outpatients was .84 (95% CI .68-1.04).

Conclusion

Higher risk at baseline predicts premature dropout.

The relationship between resting metabolic rate and quality of life is moderated by age and body composition in women: a cross-sectional study

BACKGROUND

Health-related quality of life (HRQOL) is related to body composition, which is also related to resting metabolic rate (RMR). RMR can be increased by exercise and diet interventions that are not dependent on changes in body composition, so a link between RMR and HRQOL may provide interventions that directly improve HRQOL in women.

METHODS

One hundred twenty women (median age 63.5 [IQR: 53.0-71.0] years) completed one-time measurement of body composition (multi-frequency bioelectrical impedance), RMR (handheld calorimetry), and HRQOL (RAND-36). Physical (PCS) and mental (MCS) composite scores were calculated for the RAND-36. Pearson correlations were used to identify relationships between RMR, body composition, and HRQOL. Variables at the p < .01 level were entered into multiple regression models.

RESULTS

Median body mass index was 26.1 [IQR: 23.2-30.9] kg/m2 and median lean mass index was 16.1 [IQR: 14.6-17.3] kg/m2. Body composition consisted of fat mass (median 27.2 [IQR: 20.3-34.7] kg) and lean mass (median 42.7 [IQR: 38.2-46.9] kg). Median RMR was 1165.0 [IQR: 1022.5-1380.0] kcal/day. Median HRQOL scores were PCS (84.0 [IQR: 74.0-93.0]) and MCS (85.0 [IQR: 74.3-90.0]). RMR was not directly related to PCS, but was directly and negatively related to MCS (p = .002). RMR was significantly and positively related to body composition (lean mass: p < .001; fat mass: p < .001), body mass index (p = .005), and lean mass index (p < .001); but only fat mass (PCS: p < .001; MCS: p < .001) and body mass index (PCS: p < .001; MCS: p < .001) were related to HRQOL, although the relationship was negative. In addition, age was found to be significantly negatively related to RMR (p < .001) and PCS (p = .003). Regression models confirmed the moderating influence of age and body composition on the relationship between RMR and HRQOL. RMR, age, fat mass, and body mass index explained 24% (p < .001) of variance in PCS; and RMR, fat mass, and body mass index explained 15% (p < .001) of variance in MCS.

CONCLUSION

In women, the relationship between RMR and HRQOL is moderated by age and body composition. Understanding these pathways will allow clinicians and researchers to direct interventions more effectively.

The Effect of Spacer Treatment of Infected Hip and Knee Arthroplasties on Patients' Mental Health: A Narrative Review of the Literature

BACKGROUND

The gold standard treatment for periprosthetic joint infections is the two-stage revision that includes the spacer placement before definitive reimplantation. The management of PJI affects patients' joint function and, subsequently, their mental health. Even though significant advances have been achieved, little to no attention has been paid to the psychological implications. So, based on standardized patient-reported outcome measures (PROMs), this study aimed to clarify the effect of spacer treatment of infected hip and knee arthroplasties on patients' mental health.

METHODS

We performed research on the literature on PJIs in the English language using the MEDLINE database with the search strings "spacer" OR "spacers" AND "hip" OR "knee" AND "SF-12" OR "SF-36" OR "EQ-5" OR "mental" OR "depression" OR "anxiety." The reference lists of selected articles were also hand-searched for any additional articles.

RESULTS

A total of 973 published papers were extracted, and 9 papers were finally included. A total of 384 patients who underwent spacer placement for PJI were identified. Of these 384 patients, 54% were female. The mean age ranged from 62 to 78.2 years. Of the11 papers identified for this review, 4 analyzed only hip spacers, including 119 patients; 4 only knee spacers, evaluating 153 patients; while a single study included 112 patients for both joints.

CONCLUSIONS

Patients with the spacer are living in a state of mental upset, albeit better than the preoperative state. Clinical improvement with the review is not assured. The alteration of mental state turns out not to be transient for all the patients.

Health-related quality of life during the COVID-19 pandemic: The impact of restrictive measures using data from two Dutch population-based cohort studies

OBJECTIVES

We describe health-related quality of life during the COVID-19 pandemic in the general Dutch population and correlations with restrictive measures.

METHODS

Data were obtained from 18-85 year-old participants of two population-based cohort studies (February 2021-July 2022): PIENTER Corona (n = 8,019) and VASCO (n = 45,413). Per cohort, mean scores of mental and physical health and health utility from the SF-12 were calculated by age group, sex and presence of a medical risk condition. Spearman correlations with stringency of measures were calculated.

RESULTS

Both cohorts showed comparable results. Participants <30 years had lowest health utility and mental health score, and highest physical health score. Health utility and mental health score increased with age (up to 79 years), while physical health score decreased with age. Women and participants with a medical risk condition scored lower than their counterparts. Fluctuations were small over time but most pronounced among participants <60 years, and correlated weakly, but mostly positively with measure stringency.

CONCLUSIONS

During the Dutch COVID-19 epidemic, health utility and mental health scores were lower and fluctuated strongest among young adults compared to older adults. In our study population, age, sex and presence of a medical risk condition seemed to have more impact on health scores than stringency of COVID-19 non-pharmaceutical interventions.

Feasibility and acceptability of design and conduct of a registry-based randomised clinical trial evaluating eVIS as a digital support for physical activity in interdisciplinary pain rehabilitation programs: A randomised pilot study

Background

Patients with chronic pain often struggle to engage in physical activity despite its health benefits. The eVISualisation of physical activity and pain intervention (eVIS) was developed to support adherence to physical activity plans in Interdisciplinary Pain Rehabilitation Programs (IPRPs) by visualising activity, pain levels, pain interference, and pharmacological use. This pilot study assesses the feasibility and acceptability of trial design and trial conduct of a registry-based randomised clinical trial (R-RCT).

Method

This randomised clinical pilot study included the first 10% (n = 39, mean age 43.5, 74.4% females) of the R-RCT sample (n≈400). Participants with non-cancer chronic pain from six IPRP units were randomly assigned to either the intervention group (IPRP + eVIS, n = 19) or the control group (IPRP, n = 20). Feasibility and acceptability were evaluated using pre-defined criteria on recruitment- and data collection procedures (e.g., inclusion rates, representativeness, adverse events), physiotherapists' ratings of trial design and conduct (e.g., acceptability, feasibility), and outcome data characteristics and completeness (e.g., adherence, data accessibility).

Results

Recruitment was largely feasible, though attrition differences and the need for refined eligibility screening were noted. Physiotherapists cited time and implementation challenges. Both groups had satisfactory data completeness, but the control group showed lower adherence to daily reporting in the final third of the study. The intervention group had greater improvements in physical health, with 19.5% more participants achieving the minimum clinically important difference (≥3) on the physical component summary scale (PCS). No adverse events occurred.

Conclusion

With minor adjustments, the R-RCT design is mostly feasible, though some challenges to feasibility were identified and addressed.

The Subglottic Stenosis 6 Questionnaire: A Novel Quality-of-Life Survey Validated to Predict Need for Intervention in Patients With Idiopathic Subglottic Stenosis

BACKGROUND

Idiopathic subglottic stenosis (iSGS) is a recurrent, chronic disease defined by fibroinflammatory narrowing of the subglottic airway. A key challenge in treatment is monitoring disease progression, which may be debilitating and unpredictable in its timing.

RESEARCH QUESTION

Can the Subglottic Stenosis 6 (SGS-6) questionnaire be validated as a novel quality-of-life (QOL) instrument to monitor breathing, disease progression, and disease severity proactively in patients with iSGS?

STUDY DESIGN AND METHODS

Panel data from 51 patients with iSGS were collected from January 2012 through June 2022, representing 1,684 patient encounters including routine office visits and treatment encounters. Subjective QOL scores (including the novel SGS-6 and established RAND-36 and EuroQol Five Dimensions [EQ-5D] Visual Analog Scale) and objective pulmonary function test (PFT) results were collected at each visit. Subjective SGS-6 QOL scores were repeated within 1 week of initial reporting. Panel regression analyses were performed to assess the relationship between SGS-6 scores, PFT results, and a patient's need for intervention. Minimal clinically important differences (MCIDs) for SGS-6 and peak expiratory flow percentage (PEF%) were assessed using receiver operating characteristic (ROC) curve analysis and a patient's need for intervention as the external anchor.

RESULTS

Each one-point increase in SGS-6 score (of a maximum of 27) was associated with a 3.26% decrease in PEF%, a 1.93-point decrease in RAND-36 Physical Health composite score, a 1.27-point decrease in RAND-36 Mental Health composite score, and a 0.88-point decrease in EQ-5D Visual Analog Scale score. The intracorrelation coefficient for the SGS-6 composite score is 0.838 (95% CI, 0.770-0.888). Compared with patient baselines, SGS-6 scores were 4.66 points greater at the time of intervention with an MCID of 2.25 from a patient's baseline. The area under the ROC curve for SGS-6 and a patient's intervention point was 0.81.

INTERPRETATION

iSGS disease severity can be modeled using the SGS-6 questionnaire, offering physicians and patients a potentially new method of tracking disease progression and need for intervention remotely.

Experiences and results from using a novel clinical feedback system in routine stoma care nurse follow-up of patients with an ostomy: a longitudinal study

BACKGROUND

A faecal or urinary ostomy may be lifesaving. However, it involves significant bodily change, and the adjustment process to life with an ostomy includes a broad spectre of physical and psychosocial challenges. Thus, new interventions are needed to improve adaptation to living with an ostomy. This study aimed to examine experiences and outcomes using a new clinical feedback system with patient-reported outcome measures in ostomy care.

METHODS

In this longitudinal explorative study, 69 ostomy patients were followed by a stoma care nurse in an outpatient clinic, using a clinical feedback system postoperatively at 3, 6 and 12 months. The patients responded electronically to the questionnaires before each consultation. The Generic Short Patient Experiences Questionnaire was used to measure patient experiences and satisfaction with follow-up. The Ostomy Adjustment Scale (OAS) measured adjustment to life with an ostomy, and the Short Form-36 (SF-36) assessed the patient's health-related quality of life. Longitudinal regression models with time as an explanatory (categorical) variable were used to analyse changes. The STROBE guideline was applied.

RESULTS

The patients were satisfied with their follow-up (96%). Especially, they felt they received sufficient and individualised information, were involved in treatment decisions, and benefited from the consultations. The OAS subscale scores for 'daily activities', 'knowledge and skills' and 'health' improved over time (all p < 0.05), as did the physical and mental component summary scores of the SF-36 (all p < 0.05). Effect sizes of changes were small (0.20-0.40). Sexuality was the most challenging factor reported.

CONCLUSIONS

The clinical feedback system could be helpful because outpatient follow-ups for ostomy patients may be more tailored when clinicians use clinical feedback systems. However, further development and testing are needed.

Prolonged electrocardiography registration does not lead to increased diagnosis of atrial fibrillation in pulmonary embolism patients, but sex affects generic health-related quality of life: Findings from a randomized clinical trial

BACKGROUND

Pulmonary embolism (PE) is the third most common cause of cardiovascular death. Atrial fibrillation (AF) is the most common arrhythmia and is commonly detected in patients after embolic stroke. In this study, we set out to study if undiagnosed AF could be detected in patients with PE. In survivors of PE, persisting symptoms and exercise limitations are common. The disease burden of PE on quality of life (QoL) has received scarce attention. The primary aim was to study the prevalence of AF in patients with newly diagnosed PE. The secondary aim was to study QoL in PE patients.

METHODS

Patients with newly diagnosed acute PE were randomized 1:1 to long-term electrocardiogram (ECG) screening for AF (handheld ECG or ECG patch) or standard-of-care. The study participants were asked to complete RAND-36 questionnaires upon inclusion.

RESULTS

In total 89 PE patients (mean age 74.6 years) were included, and 40 out of these patients were randomized to AF screening. The study was terminated early due to futility when analysis 1 year after inclusion did not find any patients with newly detected AF.RAND-36 showed that QoL was affected in PE patients. Interestingly, sex differences were found; women had a significantly lower QoL in the dimensions of vitality (P = .006), general health (P = .039), and mental health (P = .041).

CONCLUSION

Screening for AF in PE patients did not yield a significant proportion of new cases. QoL is more affected in female patients with PE, and increased awareness of this is suggested.