The RAND-36 measure of health-related quality of life

A Randomized, Controlled Trial Evaluating Perioperative Risk-stratification and Risk-based, Protocol-driven Management After Elective Major Cancer Surgery

OBJECTIVE

To evaluate the efficacy of risk-based, protocol-driven management versus usual management after elective major cancer surgery to reduce 30-day rates of postoperative death or serious complications (DSCs).

BACKGROUND

Major cancer surgery is associated with significant perioperative risks, which result in worse long-term outcomes.

METHODS

Adults scheduled for elective major cancer surgery were stratified/randomized to risk-based escalating levels of care, monitoring, and comanagement versus usual management. The primary study outcome was a 30-day rate of DSC. Additional outcomes included complications, adverse events, health care utilization, health-related quality of life (HRQOL), and disease-free survival and overall survival.

RESULTS

Between August 2014 and June 2020, 1529 patients were enrolled and randomly allocated to the study arms; 738 patients in the intervention arm and 732 patients in the control arm were eligible for analysis. Thirty-day rate of DSC with the intervention was 15.0% (95% CI: 12.5%-17.6%) versus 14.1%, (95% CI: 11.6%-16.6%) with usual management ( P = 0.65). There were no differences in 30-day rates of complications or adverse events (including return to the operating room), postoperative length of stay, rate of discharge to home, or 30, 60, or 90-day HRQOL or rates of hospital readmission or receipt of antineoplastic therapy between the study arms. At a median follow-up of 48 months, overall survival ( P = 0.57) and disease-free survival ( P = 0.91) were similar.

CONCLUSIONS

Risk-based, protocol-driven management did not reduce the 30-day rate of DSC after elective major cancer surgery compared with usual management, nor did it improve postoperative health care utilization, HRQOL, or cancer outcomes. Trials are needed to identify cost-effective, tailored perioperative strategies to optimize outcomes after major cancer surgery.

Social Mobility and Health-Related Quality of Life Trajectory Classes Among Older Women and Men

OBJECTIVES

Changes in socioeconomic status (SES) during life may impact health in old age. We investigated whether social mobility and childhood and adulthood SES are associated with trajectories of health-related quality of life (HrQoL) over a 17-year period.

METHODS

We used data from the Helsinki Birth Cohort Study (n = 2003, 46% men, mean age 61.5 years). Social mobility was derived from childhood SES, obtained from healthcare records, and register-based adulthood SES.

RESULTS

Logistic regression models showed that lower adulthood SES was associated with lower physical HrQoL trajectories. Among men low (OR 3.95, p < .001), middle (OR 2.20, p = .006), and declining lifetime SES (OR 2.41, p = .001) were associated with lower physical HrQoL trajectories compared to men with high SES. Socioeconomic status was not associated with mental HrQoL trajectories.

DISCUSSION

Declining SES during life course may have negative health consequences, while improving SES is potentially as beneficial as high SES to later-life health among men.

Quality of life in chiropractic students pre- and post-COVID-19 lockdowns utilizing the Short-Form Health Survey-36

OBJECTIVE

To compare previously recorded quality of life scores of students at the New Zealand College of Chiropractic using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to those after New Zealand (NZ) COVID lockdowns.

METHODS

Previously recorded students' SF-36 questionnaires were collected before (2019) and after (2022) the lockdowns. Student populations were independent at each time point (pre- and post-lockdown) and were compared between 2019 and 2022 using unpaired Wilcoxon tests and to similarly aged and NZ normative data.

RESULTS

Two hundred seventy-six pre-COVID (51.1% female) and 120 post-COVID (60.8% female) data sets were returned. All pre-COVID years and scores were significantly higher or comparable with reference data (p ≤ .050). Post-COVID scores dropped below pre-COVID and reference data-with the largest drops seen in emotional wellbeing, emotional role limitations, social, and fatigue domains (p < .05 - p < .001). Only post-COVID physical functioning was comparable with pre-COVID or reference data (p > .050).

CONCLUSION

This study suggests that before COVID New Zealand College of Chiropractic perceived their quality of life as the same or better than the average New Zealander or similarly aged person. After COVID, most quality of life scores dropped substantially with emotional, social, and fatigue-related domains showing the greatest decline.

Laparoscopic inguinal hernia repair with self-fixated meshes: a randomized controlled trial

BACKGROUND

Laparoscopic inguinal hernia surgery leads to rapid recovery and low complication rates. An alternative to fixate the mesh is using a self-fixated mesh.

METHODS

From April 2021 to June 2024, we conducted a randomized controlled trial comparing self-adhesive mesh (Adhesix™) with self-gripping mesh (Progrip™) in laparoscopic inguinal hernia surgery (TAPP and TEP). Adult patients scheduled for day surgery were included in the study with a 1-year follow up. The primary endpoint was the number of analgesics (Paracetamol or Ibuprofen) used during the first post-operative week. Secondary outcomes were pain-related issues, complications, and recurrence rate.

RESULTS

A total of 174 patients participated; 90 received Adhesix™ (group A) and 84 Progrip™ (Group P). Forty-six (26.4%) patients had recurrent hernia, 68 (39.1%) had unilateral and 60 (34.5%) had bilateral primary hernias. A total of 156 (90%) patients completed follow up. The number of analgesics during the first post-operative week was comparable between groups (P 22.9, A 21.2 tablets, p = 0.461). Group P used more analgesics during day 1, after which no difference was observed. In general, all participants used analgesics after surgery regularly for 10.8 days (SD 10.6) and occasionally for 15.9 days (SD 16.9). Time to return to work and normal activities was 16.1 days (SD 10.8) and 16.6 days (SD 9.6), respectively. More patients in group P reported moderate or severe pain (numeric rating scale > 3) during exercise 3 months after surgery (P 15.4%, A 3.1%, p = 0.035), although no difference was observed at 1 year after surgery. Both groups had significantly improved quality of life measures in physical aspects of the RAND-36 Item Health Survey after 3 months. Two recurrences, one in each group (1.1%) occurred.

CONCLUSION

The use of Adhesix was non-inferior to Progrip in laparoscopic surgery. Surgery using either mesh led to rapid recovery and improved quality of life. This trial was registered in ClinicalTrials.gov (NCT05091853).

Weight-Bearing Versus Non-Weight-Bearing After Ankle Fracture: A Systematic Review and Meta-Analysis of Patient-Reported Outcome

BACKGROUND

Ankle fractures commonly affect mobility and quality of life. Although unstable fractures typically require surgery, post-treatment protocols vary widely, including both surgical and conservative approaches. This systematic review and meta-analysis evaluated the effects of early weight-bearing after ankle fracture treatment on functional outcomes and quality of life.

METHODS

Following the PRISMA guidelines and the PICOS strategy, we performed a meta-analysis across multiple databases (PubMed, Embase, Scopus, and Cochrane Library). Analysis was conducted using Review Manager 5.4, calculating the mean and standard mean differences with 95% confidence intervals (CIs).

RESULTS

Eleven studies (n = 939) showed favorable outcomes with weight-bearing. Significant functional improvements were observed at 6 weeks (MD 7.88, 95% CI 3.14-12.61), 3 months (MD 5.79, 95% CI 4.41-7.17), and 12 months (MD 4.74, 95% CI 3.01-6.46). RAND scores favored the weight-bearing group at 6 weeks (SMD 0.48, 95% CI 0.26-0.70) and 12 months (SMD 0.31, 95% CI 0.07-0.55), with no significant differences at 3 months (SMD 0.18, 95% CI -0.10-0.46).

CONCLUSION

The outcomes obtained indicated statistically significant differences in favor of the early weight-bearing group regarding ankle function and quality of life.

Pain and functional limitations in knee osteoarthritis are reflected in the fatty acid composition of plasma extracellular vesicles

This study investigated relationships between fatty acid (FA) profiles of extracellular vesicles (EVs) and cartilage degradation, functional limitations, pain, and psychological well-being in knee osteoarthritis (KOA). Fasting plasma was collected from controls (n = 10), end-stage KOA patients at baseline (n = 12) and at 3 and 12 months (n = 11 and 9) after joint replacement surgery, and from KOA synovial fluid (SF) at baseline (n = 10). EVs were isolated with the exoEasy Maxi Kit or size-exclusion chromatography, and EV FAs were analyzed with gas chromatography-mass spectrometry. Articular cartilage loss was determined by magnetic resonance imaging, and knee pain and function were assessed through questionnaires and physiatric and neuromuscular examinations. The associations of these data with EV FA proportions were tested with the univariate analysis of variance adjusted for age and body adiposity. Higher proportions of 16:1n-7, 18:1n-7, and total monounsaturated FAs in plasma EVs were associated with less severe KOA symptoms, while higher 24:1n-9, total saturated FAs, and ratios of arachidonic acid to long-chain n-3 polyunsaturated FAs (PUFAs) were linked to KOA pain, independent of age and body adiposity. In SF EVs, higher product/precursor ratios of n-6 PUFAs were associated with increased joint stiffness, and higher total dimethyl acetals were linked to physical disability. EV FAs emerged as significant indicators of knee pain and function. The results can be utilized to discover novel biomarkers for KOA and may have implications for targeted prevention and treatment of KOA symptoms by using EVs with a specific FA cargo.

Housing insecurity, financial hardship and mental health

We examine the impact of housing insecurity on mental health. We use missed rental payments due to a shortage of money as a direct measure of housing insecurity and a difference-in-differences framework that allows us to differentiate the effect of housing insecurity from the effect of experiencing financial hardship more generally. We find that housing insecurity causes a decline in mental health. Further analysis reveals two important dimensions of heterogeneity: the duration of prior financial hardship and the intensity of housing insecurity. Renters in prolonged financial hardship and those who experience high levels of housing insecurity (defined as missing a rental payment and having a high rent to income ratio), experience the largest negative impacts on their mental health.

Examining recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life in COVID-19 patients treated in ICU: a Swedish prospective cohort study

PURPOSE

To investigate the recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life, as well as potential interaction effects, in individuals with COVID-19 treated in an intensive care unit (ICU).

METHODS

This prospective cohort study included patients with confirmed COVID-19 infection, treated in an ICU. Clinical assessments and self-ratings of functioning, disability and health were performed > 1 month and > 12 months after discharge from hospital.

RESULTS

Among the 65 included individuals (mean age 56.6, SD 11) significant improvements in physical and psychological function were observed over time, although not reaching population norms. Cognition remained unchanged (MoCA median 27, IQR 4). At the 12-month follow-up, physical limitations in activity (RAND-36) were found to be associated with dyspnea (mMRC-Dyspnea), mental and physical fatigue (MFI-20), and walking endurance (6-minute walk test) (r2 0.509 p < 0.001). Role limitations due to physical health (RAND-36) was found to be associated with physical and mental fatigue (MFI-20) and pain (r2 0.530 p < 0.001).

CONCLUSION

Despite improvements in functioning and health in this group of predominantly younger age recovery did not reach population norms. These results highlight persistent impairments and activity limitations that may necessitate long-term healthcare interventions.

Differences in health related quality of life among older migrants and nonmigrants in India

Increasing age with migration status might have a double risk of vulnerability to poor health outcomes. There is a lack of population-based studies on health-related quality of life (HRQoL) of older migrants in India. This study compares the HRQoL between older migrants and non-migrant populations in India and examines the role of migration-related factors. The Longitudinal Ageing Study in India (LASI) Wave-I data was used, and older persons aged 60 and above were selected for the study, which included 30,158 final samples. The HRQoL was measured based on a EuroQol Five-Dimension (EQ-5D) measure. The study used univariate and bivariate analysis to examine HRQoL differences between migrants and non-migrants, and logistic regression analysis was used to examine the association between HRQoL and migration status and other correlates of older persons. Over half of the older persons (55.9%) were growing older at destination places in India. The migrants showed a higher prevalence of poor HRQoL (44.5%) than non-migrants (34.8%). Further, the adjusted logistic regression result shows that migrants were likelier to have poor HRQoL [AOR 1.15; CI 1.09-1.22] than non-migrants. The migrants with 0-9 years of duration and migration at age 60 and above were significantly more likely to have poor HRQoL [AOR 1.20; CI 1.03-1.39] and [AOR 1.20; CI 1.04-1.39], respectively, than non-migrants. Moreover, the origin-destination place of migrants was also found to be significantly associated with poor HRQoL compared to non-migrants. The findings of our study reveal that persons with migration status had lower HRQoL than non-migrants. Some migration-related factors were significantly associated with HRQoL among migrants. However, this study predicts that migrants especially need separate health policies as they are in poorer health conditions than non-migrants. Policymakers should focus on the determinants of migrant health to achieve the goal of healthy ageing for all in India.

Changes in physical function in older women with endometrial cancer with or without adjuvant therapy

OBJECTIVE

To evaluate changes in physical function (PF) for older women with endometrial cancer (EC) + / - adjuvant therapy in the Women's Health Initiative Life and Longevity after Cancer cohort.

MATERIALS AND METHODS

This study examined women ≥ 70 years of age with EC with available treatment records. Change in PF was measured using the RAND-36 and compared between groups using Wilcoxon rank-sum tests. Multivariable median regression was used to compare the changes in scores while adjusting for confounding variables.

RESULTS

Included in the study were 287 women, 150 (52.3%) women who did not receive adjuvant therapy and 137 (47.7%) who received adjuvant therapy. When comparing PF scores, there was a statistically significant difference in the median percent change in functional decline, with a greater decline in those who received adjuvant therapy (- 5.9% [- 23.5 to 0%]) compared to those who did not (0 [- 18.8 to + 6.7%]), p = 0.02). Results were not statistically significant after multivariable adjustment, but women who underwent chemotherapy had a greater percent change (median ∆ - 13.8% [- 35.5 to 0%]) compared to those who received radiation alone (median ∆ - 5.9% [- 31.3 to 0%]) or chemotherapy and radiation (median ∆ - 6.5% [- 25.8 to + 5.7%].

CONCLUSIONS

Older women with EC who received adjuvant therapy experienced greater change in PF than those who did not receive adjuvant therapy, particularly women who received chemotherapy. These results were not statistically significant on multivariate analysis.

IMPLICATIONS FOR CANCER SURVIVORS

EC survivors may experience changes in PF because of chemotherapy and/or radiation therapy. Additional supportive care may need to be provided to older women to mitigate functional decline.

The humanistic burden of immunoglobulin A nephropathy on patients and care-partners in the United States

PURPOSE

This cross-sectional survey study quantified the humanistic burden of immunoglobulin A nephropathy (IgAN), in terms of physical and mental health-related quality of life (HRQoL) and work productivity, among adults with primary IgAN and their care-partners.

METHODS

HRQoL was assessed (01/31/22 - 05/31/23) with validated tools including the KDQoL-36 (with SF-12), GAD-7 (anxiety), PHQ-9 (depression), and WPAI: SHP (work productivity). Participant characteristics and total/domain scores were summarized; selected outcomes were compared to an external, kidney disease-free cohort.

RESULTS

117 adults with IgAN and their care-partner pairs, and one adult without a care-partner, were included. The mean ages of patients and care-partners were 38.0 (SD: 8.6) and 40.2 (11.8) years, respectively; 55.9% and 43.6% were female. Mean physical and mental SF-12 scores for patients were 46.7 (SD: 8.0) and 41.9 (9.2), respectively, and 50.7 (7.3) and 43.7 (10.24) for care-partners. Both SF-12 components for patients, and the mental component for care-givers, were significantly worse compared to the US general population. Among patients, 27.1% had moderate/severe anxiety and 49.2% reported at least moderate depression. Compared to external controls, patients experienced significantly higher severity of anxiety (6.6 vs. 5.4) and depression (8.1 vs. 6.6; both p < 0.0001). Among care-partners, 13.7% experienced moderate anxiety and 37.8% experienced moderate/moderately-severe depression. Among employed individuals, both groups reported IgAN-related absenteeism (8.8-9.4%), presenteeism (25.1-25.9%), and overall work impairment (30.4-30.5%).

CONCLUSION

US adults with IgAN and their care partners experience impairments to mental and physical HRQoL and heightened levels of depression and anxiety, underscoring the need for effective IgAN therapies and care-partner support.

Virtual motivational interviewing for physical activity among older adults: A non-randomised, mixed-methods feasibility study

The objective of this study was to evaluate the feasibility of Virtual Motivational Interviewing (VIMINT) for improving physical activity among community-dwelling older adults. A feasibility study using a mixed-method single-group pre- and post-design. Each participant received five sessions of motivational interviewing (MI) through the Zoom platform. Feasibility and acceptability were assessed through recruitment, attrition and retention rates; adherence; satisfaction; counsellors' competency; and interviews with participants and counsellors. Other outcomes including physical activity were assessed at baseline, post- and 2-month follow-up. Eight participants were recruited; the mean age was 68.9 ± 3.9 years. The retention rate was 88%, 92.5% of the sessions were attended, and the participants' satisfaction score was 24.14 ± 7.3/32. The counsellors were rated as "good" and "fair" in relational and technical components, respectively. The categories derived from qualitative analysis were session composition, acceptability of outcome measures, positive impact of the VIMINT study and suggestions to improve future studies. The findings showed that VIMINT intervention should be feasible and acceptable for older adults. Evidence from this study provides relevant information that will guide the planning of future studies investigating the effectiveness of virtual MI on physical activity among community-dwelling older adults.

Health-related quality of life in patients with liver cirrhosis following adjunctive nurse-based care versus standard medical care: a pragmatic, multicentre, randomised controlled study

OBJECTIVES

Patients have difficulties in understanding how to manage their liver cirrhosis. This highlights a need for support in comprehending health-related information, which remains largely lacking within liver cirrhosis care. Involvement of registered nurses (RNs) in outpatient liver cirrhosis care has potential to improve quality of care and reduce patient mortality. However, the benefits of nursing care on patients' health-related quality of life (HRQoL) are scarcely studied. This study compared HRQoL in patients receiving either standard medical outpatient care or adjunctive, nurse-led care. The risk of malnutrition, decompensation events and mortality were also compared between the two study groups.

METHODS

This was a pragmatic, multicentre, randomised trial, which enrolled 167 patients with liver cirrhosis. The primary outcome measure, HRQoL, was assessed using the RAND-36 questionnaire. The physical component summary (PCS) and the mental component summary (MCS) scores of RAND-36 were compared, using linear mixed-effects models for repeated measures, at 12 and 24 months.

RESULTS

83 patients received standard medical care, and 84 patients received adjunctive, nurse-led care for 24 months. Due to unforeseen circumstances, the final study population of 167 participants was less than the intended 500. Group comparisons were non-significant of the PCS and MCS scores (-1.1, p=0.53 and -0.7, p=0.67, respectively), malnutrition (p=0.62) and decompensation events (p=0.46), after 24 months. However, mortality was three times higher in the control group compared with the intervention group (12 vs 4, p=0.04) after 24 months.

CONCLUSIONS

In this study, adjunctive nurse-led care was not superior to standard medical outpatient care regarding HRQoL, risk of developing malnutrition or decompensation. However, RN involvement contributed to early identification of decompensation and reduced mortality.

TRIAL REGISTRATION NUMBER

NCT02957253.

Changes in Leisure-Time Physical Activity and Sedentary Time and Their Associations With Psychological Distress: An Occupational Cohort Study

BACKGROUND

Physical inactivity and sedentary behavior are associated with mental ill-health. We examined changes in leisure-time physical activity (LTPA) and sedentary time, and their associations with psychological distress in an occupational cohort.

METHODS

We used phase 1 survey data, collected among the employees of the City of Helsinki, Finland, aged 19-39 years in 2017, and phase 2 follow-up survey from 2022 (n = 1914 participants, 75% women). A 4-category variable (High→High, Low→High, High→Low, and Low→Low) was constructed for both LTPA and sedentary time to reflect the change over time. The 21-item Depression, Anxiety and Stress Scale was used to measure psychological distress. Logistic regression analysis estimated odds ratios (ORs) and their 95% CIs, adjusting for sociodemographic factors, working conditions, health-related factors, and physician-diagnosed mental disorders at phase 1.

RESULTS

Repeated low LTPA was associated with anxiety (OR = 2.03; 95% CI, 1.44-2.85), depressive (OR = 1.69; 95% CI, 1.22-2.36), and stress (OR = 2.22; 95% CI, 1.58-3.12) symptoms after adjusting for gender and age, compared with repeated high LTPA. The associations remained after full adjustments in anxiety (OR = 1.57; 95% CI, 1.08-2.30) and stress (OR = 1.92; 95% CI, 1.32-2.78) symptoms. Additionally, a change from high to low LTPA was associated with anxiety (OR = 1.47; 95% CI, 1.05-2.04) symptoms after full adjustments.

CONCLUSION

Repeated low levels of LTPA are associated with anxiety and stress symptoms. No consistent associations between sitting time and psychological distress could be confirmed. Considering the increasing levels of psychological distress in recent years, particularly among younger adults, it is essential to explore effective countermeasures through large interventions or prospective study designs.

A role for proprioceptors in sngception

Proprioceptors are primary mechanosensory neurons to monitor the status of muscle contraction and/or body position (1). Although proprioceptors are known as non-nociceptive mechanoreceptors, they also express the pro-nociceptive acid-sensing ion channel 3 (ASIC3) (2-5). To probe the role for proprioceptors in sensing acidosis (or sngception) (6), we found that genetic deletion of Asic3 in proprioceptors but not in nociceptors abolished acid-induced chronic hyperalgesia in mice. Chemo-optogenetically activating proprioceptors resulted in hyperalgesic priming that favored chronic pain induced by acidosis. In humans, intramuscular acidification induced acid perception but not pain. Conversely, in a spinal cord-injured patient who lost pain sensation in the right leg, proprioception and sngception were remaining somatosensory functions, associated with the spinal dorsal column. Together, evidence from both mouse and human studies suggests a role for proprioceptors in sngception.

Joint trajectories of physical activity, health, and income before and after statutory retirement: A 22-year follow-up

BACKGROUND

Health behaviors, health, and income change during aging. However, no previous studies have examined, how they develop together over the transition to statutory retirement. We aimed to examine their joint development and to identify the determinants of any distinct trajectories.

METHODS

We studied former employees of the City of Helsinki, Finland, who transitioned to full statutory retirement between 2000 and 2022 (n = 5209, 80% women). We examined five repeated questionnaire surveys to identify any joint developmental patterns in the key indicators of healthy aging and well-being-leisure-time physical activity, health measured by general health perceptions, and household income, over a follow-up of 22 years. We used joint group-based trajectory analysis to identify latent developmental groups. The social and health-related determinants of trajectory group membership are reported as average marginal effects.

RESULTS

We found four distinct joint trajectory groups. Group 1 (22.6%) had consistently poor general health perceptions, less physical activity than the recommended amount, and low income. In Group 2 (34.2%), general health perceptions were first good but then declined, and income was low but slightly increasing. Group 3 (12.3%) had good general health perceptions, a very high level of physical activity, but fluctuating income. In Group 4 (30.9%), general health perceptions were first good but then declined, physical activity was at the recommended level, and income was sharply increasing. People with obesity had a 22 percentage-point (21-24) higher predicted probability of belonging to Group 1 than people with normal weight. They were also more likely to report low education and more physician-diagnosed chronic diseases and mental disorders.

CONCLUSIONS

We identified distinct trajectories in physical activity, general health perceptions, and income over a follow-up of over 20 years. The majority of those who had transitioned to statutory retirement had good general health perceptions but varying levels of physical activity and income. As not all those with a low income had a low level of physical activity or poor general health perceptions, public health interventions should target distinct groups with the most adverse risk factor profiles, to narrow health inequalities during aging.

Evaluation of the Content Validity of the COVID-19 Symptoms Daily Diary

Introduction

The COVID-19 Symptoms Daily Diary (CSDD) is a patient-reported outcome measure designed to assess the severity of core COVID-19 symptoms in clinical trials. The preliminary version of the CSDD was developed based on regulatory guidance and the hallmark COVID-19 symptoms identified by the CDC. This study aimed to evaluate CSDD content validity, to determine whether it is fit for the purpose of supporting efficacy endpoints in clinical trials of treatments for COVID-19. This research also sought to evaluate the appropriateness of a newly developed Pre-COVID-19 Symptoms Questionnaire.

Methods

A targeted literature review was completed to evaluate the relevance of concepts included in the diary and to identify any important symptoms that may have been missing. Hybrid (concept elicitation and cognitive debriefing) semistructured qualitative interviews were then conducted across 3 iterative rounds with 30 adults in the United States recently diagnosed with COVID-19.

Results

The CSDD included concepts that were most frequently reported by interview participants, including those identified as most bothersome and most important to treat. During cognitive debriefing, participants described the diary concepts as salient and reported the instructions, recall period, and response options as clear and appropriate. Only 2 of 15 CSDD items were modified across 3 interview rounds; specifically, definitions for the vomiting and diarrhea frequency items were clarified for consistent interpretation and response. Interview participants also reported general ease in understanding and responding to the Pre-COVID-19 questionnaire, with feedback resulting in only minor changes to the reference period and instructions.

Conclusion

The findings of the current study provide strong evidence for the content validity of the CSDD and the appropriateness of each of the items assessed. This rigorous evaluation (aligned with regulatory guidance) indicates that the CSDD is fit for the purpose of supporting efficacy endpoints in planned clinical trials evaluating medications for COVID-19 treatment.

Physical functioning trajectories over statutory retirement: a finnish occupational cohort study

BACKGROUND

The association of workload and performance with physical functioning is recognised among the ageing public sector workforce. The characteristics of working conditions and social- and health-related factors associated with physical functioning after statutory retirement are still unknown. Also, previous studies on changes in physical functioning have not used a person-oriented approach. We examined physical functioning trajectories over statutory retirement and how social- and health-related factors are associated with them. Our aim was to identify distinct developmental trajectories of physical functioning over statutory retirement and to examine how social- (age, gender, marital status, education) and health-related (physical workload, self-reported sleep problems, alcohol consumption, smoking, fruit and vegetable (F&V) consumption, leisure-time physical activity (LTPA), and body mass index (BMI)) factors before retirement were associated with the identified trajectories.

METHODS

We used data from the Helsinki Health Study cohort. Participants consisted of 2736 employees of the City of Helsinki, Finland who retired during the follow-up. Growth mixture modelling was used to identify physical functioning trajectories and multinominal regression analyses to examine associations of social- and health-related factors with them.

RESULTS

Three distinct developmental patterns in physical functioning before and after retirement were found among ageing and retired employees. Lower educational level, sleep problems, physical inactivity, and obesity were associated with the trajectory groups of 'fast decreasing' and 'slowly increasing', compared to the 'stable high' trajectory.

CONCLUSION

The results suggest that poor social- and health-related factors are key risk factors associated with declining and lower-level physical functioning over the retirement period. Supporting healthy lifestyles among older employees might maintaining good physical functioning until retirement and beyond.

Effectiveness of digital health applications on the quality of life in patients with overweight or obesity: a systematic review

BACKGROUND

Globally, more than half of the adult population is overweight, including those who are obese, which increases the risk of premature death and reduces quality of life (QoL). Technologies such as digital health applications (DiHA) can potentially improve clinical outcomes (e.g., health status, illness duration, QoL) or patient-related factors (e.g., therapy monitoring, adherence, health literacy). To date, there is no systematic review addressing the effectiveness of DiHA on the QoL in patients with overweight or obesity.

OBJECTIVE

The objective was to investigate the impact of DiHA on QoL in overweight or obese patients.

METHODS

A systematic literature search was conducted in MEDLINE via PubMed, Cochrane Library, and Embase via Ovid in 2023, supplemented by additional manual searches. The eligibility criteria included patients with overweight and/or obesity who used a digital intervention independently and without interaction with a healthcare professional. The outcome of interest was QoL. As potentially eligible trials had to demonstrate effectiveness, only randomized controlled trials (RCT) were included as the minimum evidence standard. The study screening (title-abstract, full-text) was conducted independently by two researchers using pre-specified eligibility criteria. CONSORT-EHEALTH checklist was used for data extraction of qualitative and quantitative data (study characteristics and study results) and the Cochrane Risk of Bias Tool (version 2) for quality assessment independently by two researchers.

RESULTS

Seven RCT conducted in Europe and the United States were included in this systematic review with a total sample size of N = 946. Observation periods were heterogeneous and ranged from 3 to 24 months. The evaluated interventions consisted of websites or apps, all of which included nutrition and physical activity features, and functioned independently with minimal or no involvement of a healthcare professional. All studies showed a high risk of bias, no statistically significant improvement and no effects regarding QoL using different validated questionnaires.

CONCLUSIONS

This systematic review provides a comprehensive analysis of DiHA effectiveness on QoL in patients with overweight or obesity. Overall, there is heterogeneity regarding the operationalization of QoL and the examined interventions have no statistically significant impact on QoL. Comparable systematic reviews show that digital interventions have the potential to improve the QoL of these patients, but further RCT and high-quality studies are needed to assess the impact of DiHA on QoL.

TRIAL REGISTRATION

PROSPERO CRD42023408994.

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 course of physical fitness and nutritional status in patients following prehabilitation before esophageal cancer surgery: Results from the PRIOR study

INTRODUCTION

This study evaluates the course of physical fitness and nutritional status during curative therapy for esophageal cancer, after implementation of a prehabilitation program. Additionally, the impact of baseline physical fitness level and severe postoperative complications on the course of individual patients were explored.

MATERIALS AND METHODS

This multicenter, observational cohort study included patients with esophageal cancer following curative treatment. Prehabilitation, consisting of supervised exercise training and nutritional counseling was offered as standard care to patients after neoadjuvant therapy, prior to surgery. Primary outcome measures included change of exercise capacity, hand grip strength, self-reported physical functioning, Body Mass Index, and malnutrition risk from diagnosis to 2-6 months postoperatively. Analyses over time were performed using linear mixed models, and linear mixed regression models to investigate the impact of baseline level and severe postoperative complications.

RESULTS

Hundred sixty-eight patients were included (mean age 65.9 ± 8.6 years; 78.0 % male). All parameters (except for malnutrition risk) showed a decline during neoadjuvant therapy (p < .05), an improvement during prehabilitation (p < .005) and a decline postoperatively (p < .001), with a high heterogeneity between patients. Change in the outcomes from baseline to postoperatively was not different for patients with or without a severe complication. Better baseline physical fitness and nutritional status were significantly associated with a greater decline postoperatively (p < .001).

CONCLUSION

This study demonstrates a notable decline during neoadjuvant therapy, that fully recovers during prehabilitation, and a subsequent long lasting decline postoperatively. The heterogeneity in the course of physical fitness and nutritional status underlines the importance of individualized monitoring.

Emerging adults' financial stress and self-rated health: Meaning in life as a moderator

Objective: The primary objective of the study was to examine associations between financial stress and self-rated health (mental and physical), with presence of and search for meaning in life as moderator variables. The secondary objective was to examine the association between presence of meaning and self-rated health, with search for meaning as a moderator. Participants and methods: The sample included 166 emerging adults (ages 18-32, mean age 22.55) recruited from a university setting (n = 87) and online platform (n = 79). To examine the proposed moderating effects, two hierarchical multiple regression models were conducted using secondary data. Results: For the primary objective, presence of meaning did not moderate the association between financial stress and self-rated health (mental or physical). Search for meaning strengthened the negative association between financial stress and physical health, exacerbating the negative health impacts associated with financial stress. However, search for meaning did not moderate the association between financial stress and mental health. For the secondary objective, search for meaning moderated the association between presence of meaning and physical health such that a negative presence-physical health association emerged at high levels of search, and a positive presence-physical health association emerged at low levels of search. Conclusion: Presence of meaning was not a protective factor in the association between financial stress and self-rated health, perhaps because average presence of meaning was lower than average search for meaning in this sample. Search for meaning was a risk factor for adverse physical health when financial stress was high or presence of meaning was low. Future research should examine in which contexts (e.g., different stressors, cultures) meaning in life dimensions emerge as risk versus protective factors.

Central sensitization in alcohol use disorder: correlates of pain, addiction and health-related quality of life

BACKGROUND

Central sensitization is an important mechanism underlying many chronic pain conditions. Chronic pain and alcohol use disorder (AUD) are highly comorbid. Despite great scientific interest in brain mechanisms linking chronic pain and AUD, progress has been impeded by difficulty assessing central sensitization in AUD.

OBJECTIVE

The present study is the first to employ a validated surrogate measure to describe central sensitization in a clinical sample with AUD.

METHODS

Participants with AUD (n = 99) were recruited from an academic addiction treatment center. A well-established surrogate measure of central sensitization, The American College of Rheumatology Fibromyalgia Survey Criteria (ACRFMS) was administered. Participants also responded to questions about quality of life (RAND-36), and AUD. Descriptive analyses and Spearman's rho correlations were performed.

RESULTS

Chronic pain and evidence of central sensitization were prevalent. Greater central sensitization was associated with worse health-related quality of life. Participants higher in central sensitization expressed greater endorsement of pain as a reason for AUD onset, maintenance, escalation, treatment delay, and relapse.

CONCLUSION

The present study bolsters prior assertions that AUD and chronic pain might compound one another via progressive sensitization of shared brain circuitry. These results may inform future mechanistic research and precision AUD treatment.

Sickness absence trajectories among young and early midlife employees with psychological distress: the contributions of social and health-related factors in a longitudinal register linkage study

PURPOSE

Psychological distress has been associated with sickness absence (SA), but less is known about whether there are distinct patterns in the development of SA among people with psychological distress. We examined trajectories of short- and long-term SA among employees with psychological distress and how social and health-related factors are associated with them.

METHODS

We used the employer's register data on all-cause short- (≤ 10 working days) and long-term (> 10 working days) SA with a two-year follow-up. We prospectively linked the Helsinki Health Study survey data on 19-39-year-old employees of the City of Helsinki, Finland, in 2017, to the SA data. We included 1060 participants (81% women) who reported experiencing psychological distress, measured by the emotional wellbeing scale of RAND-36. Survey responses of age; gender; education; marital status; social support, procedural and interactional organisational justice, and bullying at work; physical activity; diet; tobacco and alcohol use; prior SA; and the level of psychological distress were included as exposures. Group-based trajectory modelling and multinomial logistic regression were used for the analyses.

RESULTS

We identified four short-term SA trajectories: 'low' (n = 379, 36% of participants), 'descending' (n = 212, 20%), 'intermediate' (n = 312, 29%), and 'high' (n = 157, 15%); and two long-term SA trajectories: 'low' (n = 973, 92%) and 'high' (n = 87, 8%). A higher education, fewer prior SA, and lower levels of psychological distress were associated with the 'low' short- and long-term SA trajectories.

CONCLUSION

SA trajectories differ among employees with psychological distress. Early intervention and support are needed among employees with mental health symptoms to prevent future SA.

Improvement in Health-Related Quality of Life and Symptoms Following Lipedema Liposuction: A Longitudinal Study

BACKGROUND

Lipedema is a chronic fat disorder characterized by disproportionate fat deposition in the lower limbs, leading to pain, mobility issues and reduced health related quality of life (HRQoL).There is growing evidence that liposuction of the excess fat not only reduces soft tissue pain but also improves HRQoL. The published data, however, remain limited, and there are no studies of liposuction in the UK lipedema population. This study aimed to evaluate the effectiveness of liposuction on HRQoL and symptoms in UK lipedema patients using 2 HRQoL instruments and a Lipedema Symptom Scale.

PATIENT AND METHODS

Lipedema patients undergoing liposuction between January 2016 and December 2021 completed Short-Form Health Survey (SF-36), World Health Organization Quality-of-Life Assessment (WHOQOL-BREF), and 17-question Lipedema Symptom Scale preoperatively and postoperatively. Paired t test was used to compare the preoperative and postoperative mean scores of the different domains of the SF-36 and WHOQOL-BREF and preoperative and postoperative mean scores for the lipedema symptom scale. Paired t test was also used to compare preoperative and postoperative SF-36 scores to age-matched normative data for the English population to assess the extent of HRQoL improvement relative to the general population.

RESULTS

Seventy-six women were included in the study with a mean age of 46.4 ± 12 years. Mean follow-up (interval between first liposuction surgery and postoperative completion of the instruments) was 25.3 ± 23.2 months. There was significant improvement in all SF-36 and WHOQOL-BREF domains postoperatively ( P < 0.001). Compared with age-matched normative data, postoperative SF-36 scores remained lower in physical functioning, social functioning, and general health. Postoperative results also showed a highly significant improvement ( P < 0.001) across all 17 items of the Lipedema Symptom Scale.

CONCLUSION

This longitudinal study indicates liposuction is an effective treatment for improving HRQoL and symptoms in lipedema patients, although it may not completely restore HRQoL to normative levels. Limitations include potential selection bias, sampling bias, and the need for longer follow-up. The findings support liposuction as a first-line treatment for lipedema and could inform decision-making for both patients and policymakers.

Plant food consumption and emotional well-being: the Helsinki Health Study among 19-39-year-old employees

BACKGROUND AND OBJECTIVES

Associations between fruit and vegetable consumption and mental health have been observed, but studies comparing different types of plant foods are sparse. This study among Finnish municipal employees examined associations of the consumption of a range of different plant foods with emotional well-being (EWB).

DATA AND METHODS

We used survey data from the Helsinki Health Study conducted in 2017 among 19-39-year-old employees of the City of Helsinki, Finland (N = 5898, response rate 51.5%, 80% women). Consumption of plant foods, including fruit, berries, fresh and cooked vegetables and wholegrain bread, was measured by a food frequency questionnaire and dichotomised into daily/non-daily consumption. The EWB scale of the RAND-36 questionnaire was dichotomised, with the lowest quartile indicating 'poor EWB' and the three higher quartiles indicating 'good EWB'. We used logistic regression for analysing the associations between plant food consumption and EWB. Analyses were sex-stratified and age, socioeconomic circumstances and psychosocial working conditions were adjusted for.

RESULTS

Prevalence of daily consumption of plant foods varied from 25% for berries and cooked vegetables to 70% for fresh vegetables. Daily consumption was associated with good EWB among both women and men. The strongest age-adjusted association was found for fresh vegetables, with women (OR 1.48, 95% CI 1.27-1.74) and men (OR 1.86, CI 1.37-2.52) with daily consumption having clearly higher odds of good EWB compared to non-daily consumers. Associations slightly attenuated but mostly remained after adjusting for socioeconomic circumstances and working conditions.

CONCLUSIONS

More frequent plant food consumption was associated with good EWB. Thus, the results support the need for interventions that investigate whether the promotion of plant food consumption could show potential mental health benefits among employees.

Predictors for pain and functioning in patients with plantar fasciopathy one year after inclusion in a treatment trial in specialist care

BACKGROUND

Plantar fasciopathy is common, is characterized by heel pain and is associated with decreased functioning and health-related quality of life. While many recover from this condition, a considerable number of people experience persistent heel pain. This study seeks to evaluate predictors for pain and function twelve months after inclusion in a treatment trial in specialist care.

METHODS

Secondary analysis was conducted on 200 patients with plantar fasciopathy included in a randomized controlled trial and followed for twelve months. Baseline demographics and clinical characteristics were included as possible predictors. Univariate and multivariable linear regression models were applied to identify predictors for foot pain (Numeric rating scale) and function (Foot Function Index revised short form) at 12-month follow-up.

RESULTS

Unilateral heel pain, lower physical activity level and higher number of repetitions in the clinical heel-rise test were identified as statistically significant predictors for reduced pain. Unilateral heel pain, shorter duration of heel pain and being married/cohabitating were predictors for better functioning.

CONCLUSIONS

Unilateral heel pain as opposed to bilateral heel pain, was the most consistent positive predictor for the outcomes pain and function in plantar fasciopathy at 12-month follow-up. Hence, patients with bilateral PF may need extended assessment and treatment. Other predictors varied among outcomes. These findings may be used to improve clinical management of patients with persistent PF.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03472989. Date of registration 2018-03-20.

Long-term trajectories of physical activity behavior in adults with physical disabilities and/or chronic diseases following rehabilitation: the prospective cohort study ReSpAct 2.0

PURPOSE

This study aimed to identify trajectories of physical activity behavior from discharge up to 6-8 years after rehabilitation among adults with physical disabilities and/or chronic diseases, and to determine modifiable determinants associated with trajectory membership.

MATERIAL AND METHODS

390 Adults with physical disabilities and/or chronic diseases participated in the Rehabilitation, Sports and Active lifestyle (ReSpAct) 2.0 study with measurements at 3-6 weeks before discharge (T0), and 14 (T1), 33 (T2), and 52 weeks (T3), and 6-8 years (T4) after discharge from rehabilitation. Physical activity behavior and its determinants were assessed using questionnaires. Latent class growth modeling was used to identify trajectories of physical activity behavior. Associations between determinants at T0 and trajectory membership were analyzed using logistic regression analyses.

RESULTS

Three trajectories of physical activity behavior were identified: a moderately active (n = 297; baseline total physical activity: 1370 (770:2070) min/week), highly active (n = 71; baseline total physical activity: 2950 (1945:3475) min/week), and increasingly active (n = 22; baseline total physical activity: 1755 (461:2415) min/week) trajectory. Barriers regarding physical activity (OR = 0.71, 95%CI 0.53-0.95) and perceived fatigue (OR = 0.75, 95%CI 0.57-0.98) were significantly associated with trajectory membership in univariable models, corrected for age and sex.

CONCLUSIONS

Targeting barriers regarding physical activity and perceived fatigue early in rehabilitation seem crucial for membership of a trajectory resulting in a more favorable development of physical activity behavior after rehabilitation.

Cognition, Depression, Pain, and Exercise Motives as Predictors of Longitudinal Profiles of Physical Activity During a Seven-Year Follow-Up Among Older Adults

This study investigated longitudinal physical activity (PA) profiles over 7 years in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Cognition, depression, pain, and PA motives were included as determinants of the PA profiles. The 1259 participants, aged 60-77 years at baseline, were randomized into either a control group receiving general health advice, or an intervention group offered a comprehensive 2-year multidomain intervention including physical exercise, diet advice, cognitive training, and vascular risk factor management. The participants reported weekly moderate-intensity PA at baseline and 1, 2, 5, and 7 years after the baseline. Those providing PA data at two or more time points were included (n = 1188). Longitudinal PA profiles were determined using latent class growth analysis, and their associations with baseline determinants via multinomial logistic regression analysis. Interaction terms were added to investigate whether the intervention modified these associations. Six PA profiles were identified: Very high-stable (6%), High-stable (22%), Moderate-declining (47%), Moderate-steeply declining (5%), Low-increasing (9%), and Constantly low (12%). Participants in the intervention group and those motivated by distal and proximal benefits of exercise were likelier to maintain high PA level. Conversely, depressive symptoms and pain were predictors of Constantly low profile. Results show that high baseline PA was generally maintained, while greater variability in PA changes was observed among initially less active participants.

Association of unemployment and increased depressive symptoms with all-cause mortality: follow-up study of a cardiovascular prevention programme

Unemployment has been associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. However, factors behind this association remain unsettled. A primary care CVD prevention programme was conducted in two Finnish towns in 2005-07. Of the participants (n = 4450), a cohort of apparently healthy CVD risk subjects belonging to the labour force (n = 1487) was identified. Baseline depressive symptoms were assessed by Beck's Depression Inventory. Data on employment status and mortality were obtained from official statistics. The effect of employment status and depressive symptoms on all-cause mortality after a median follow-up of 15 years was estimated in models adjusted for age, sex, body mass index, non-high-density lipoprotein cholesterol, physical activity, alcohol use, current smoking, glucose metabolism, and hypertension. In comparison to employed non-depressive subjects, fully adjusted hazard ratio (HR) for all-cause mortality was 3.53 (1.90-6.57) in unemployed subjects with increased depressive symptoms, 1.26 (0.68-2.34) in unemployed non-depressive subjects, and 1.09 (0.63-1.90) in employed depressive subjects. Factors independently associated with mortality were unemployment with increased depressive symptoms [HR 3.56 (95% CI 1.92-6.61)], screen-detected diabetes [HR 2.71 (95% CI 1.59-4.63)], current smoking [HR 1.77 (95% CI 1.19-2.65)], and higher age [HR 1.10 (95% CI 1.05-1.15)]. Unemployment in itself was not associated with all-cause mortality. If unemployment was accompanied with increased depressive symptoms, risk of death was significantly elevated.

Trajectories of satisfaction with work-family reconciliation among midlife employees: the role of family-related factors and quality of life

We studied the developmental trajectories of satisfaction with work-family reconciliation (WFS) and their associations with family-related factors and quality of life measures among municipal employees. The study was based on the Helsinki Health Study of municipal employees of the City of Helsinki in 2001-02 and its follow-up surveys in 2007, 2012, and 2017. Employees aged 40-50 at baseline and working at all timepoints were analysed (n = 1681, 84% women). Growth Mixture Models were applied to identify trajectories of WFS (dissatisfied vs. satisfied). Associations of family-related and quality-of-life factors (physical functioning and emotional well-being) with the WFS trajectories were studied using log-binomial regression models, adjusting for sociodemographic and lifestyle variables. Two WFS trajectories, low (women 45%; men 53%) and high were identified. In a fully adjusted model among women, having ≥1 children aged 0-6 years was associated with increased odds of belonging to the low WFS trajectory (OR 1.52, 95% CI 1.19-1.95). Among men, having ≥1 children aged 7-18 was associated with decreased odds (0.39, 0.19-0.80). High emotional well-being was inversely associated with the low WFS trajectory among both genders (women 0.32, 0.23-0.45; men 0.20, 0.09-0.46). High physical functioning (0.59, 0.42-0.83) was inversely associated with the low WFS trajectory among women only. Less than half of the women and more than half of the men participants belonged to a low WFS trajectory, which associated with the age of children in the family and quality-of-life measures.

Inflammation is associated with pain and fatigue in older adults

Introduction

Increasing evidence suggests that inflammation may play a pivotal role in the development of chronic pain and fatigue in aging individuals. This study investigated the relationship between three inflammatory markers (IL-6, CRP, and TNFα) and pain and fatigue, both cross-sectionally and longitudinally, in a sample of older adults from the Saint Louis Personality and Aging (SPAN) study.

Methods

SPAN study participants provided blood samples at two in-person sessions approximately 2 years apart for the analysis of the inflammatory biomarkers IL-6, CRP, and TNFα. Pain and fatigue were assessed using the RAND-36 Health Status Inventory. Correlations (with false discovery rate correction for multiple testing) and follow-up linear regressions including potentially confounding demographic (e.g., annual household income) and health (e.g., BMI, medication use) covariates were used to estimate cross sectional and longitudinal associations. Analytic ns ranged from 533 to 815.

Results

Cross-sectional analyses revealed that higher IL-6 and CRP were associated with greater reported pain and fatigue, even after accounting for covariates (βs > .098, ps < .05). TNFα was associated with greater fatigue only (β = .100, p = .012). Longitudinally, CRP and IL-6 predicted future pain and fatigue, although only the relationship between CRP and future fatigue survived the inclusion of covariates (β = .104, p = .022). Both pain and fatigue predicted higher levels of IL-6 and CRP approximately 2 years later, although only the associations with IL-6 survived the inclusion of covariates (βs > .12, ps < .01).

Discussion

Our study adds to a growing body of literature showing that inflammation is associated with greater pain and fatigue in older adults. Our longitudinal data showing temporal bidirectional associations is consistent with evidence from non-human animal models that heightened inflammation causally contributes to fatigue and also suggests that the experience of pain and fatigue may contribute to inflammation. It will be important for future work to identify how lifestyle factors associated with pain and fatigue (e.g., physical activity) may contribute to these associations.

Fibromyalgia is associated with increased odds of prior pain-precipitated relapse among non-treatment-seeking individuals with opioid use disorder

BACKGROUND/OBJECTIVES

Chronic pain is an opioid use disorder (OUD) treatment barrier and associated with poor outcomes in OUD treatment including relapse. Fibromyalgia is a chronic pain condition related to central nervous system substrates that overlap with the brain disease model of OUD. We know of no studies that have looked at non-treatment seeking individuals, to see if fibromyalgia might represent a barrier to OUD treatment. Given many non-treatment-seeking individuals previously attempted recovery before experiencing relapse, and chronic pain is a known precipitant of relapse, fibromyalgia might be a currently unappreciated modifiable factor in OUD relapse and, potentially, a barrier to treatment reengagement among those not currently seeking treatment. This study aimed to determine if fibromyalgia is associated with greater odds of agreeing that 'I have tried to stop using opioids before, but pain caused me to relapse' among non-treatment seeking individuals with OUD.

METHODS

This cross-sectional study recruited non-treatment-seeking individuals with OUD (n = 141) from a syringe service program. Ordinal logistic regression was used to determine if the presence of fibromyalgia increased the odds of agreement with prior pain-precipitated relapse.

RESULTS

Fibromyalgia was identified in 35% of study participants and associated with 125% greater odds of strongly agreeing that pain had previously caused them to relapse, even after accounting for relevant covariates, including age, sex, depression, anxiety, OUD severity, and pain severity.

CONCLUSIONS

This study provides early evidence that the presence of fibromyalgia may be associated with increased odds of pain-precipitated OUD relapse.

Fear and Impact of COVID-19 Among Post-Infected Adults: Types and Associations with Quality of Life and Post-Traumatic Stress Symptoms

Survivors of COVID-19 are susceptible to diminished health-related quality of life (HRQoL) and adverse psychological health, which may be exacerbated by their experiences of fear and the impact of the pandemic itself. This study aims to identify distinct fear and impact patterns related to the COVID-19 pandemic among survivors through latent profile analysis (LPA) and examine the associations of fear and impact patterns with post-traumatic stress symptoms (PTSS) and HRQoL. A total of 5,890 Vietnamese COVID-19 survivors completed the COVID-19 Impact Battery- Disability Scale (CIB-D), the Fear of COVID-19 Scale (FCoV-19 S), the Impact of Event Scale-Revised for PTSS, and the 36-Item Short Form Survey (SF-36) for HRQoL. Four distinct groups of fear and impact were identified: "Fearful and highly impacted" (26.8%), "moderately impacted yet not fearful" (22.9%), "less impacted and less fearful" (18.6%), and "mildly impacted and neutral" (31.7%). Survivors who were "less impacted and less fearful" exhibited significantly higher HRQoL scores (regression coefficient, B: 10.9; 95% confidence interval (CI): 10.0 - 11.7), both in terms of physical (B: 12.0; 95%CI: 11.1 - 12.9) and mental health (B: 19.4; 95%CI: 9.6 - 11.1), and lower PTSS levels (B: -24.5; 95%CI: -25.8 - -23.3) compared to those who were "highly impacted and fearful". It is imperative to acknowledge the intricate association between fear, impact, and mental health to comprehensively address the diverse needs of this distinct population post-COVID-19. These findings provide insights for designing interventions and support mechanisms for COVID-19 survivors.

A Hearing Intervention and Health-Related Quality of Life in Older Adults: A Secondary Analysis of the ACHIEVE Randomized Clinical Trial

Importance

Health-related quality of life is a critical health outcome and a clinically important patient-reported outcome in clinical trials. Hearing loss is associated with poorer health-related quality-of-life in older adults.

Objective

To investigate the 3-year outcomes of hearing intervention vs health education control on health-related quality of life.

Design, Setting, and Participants

This secondary analysis of a randomized clinical trial included participants treated for hearing loss at multiple US centers between 2018 and 2019 with 3-year follow-up completed in 2022. Eligible participants were aged 70 to 84 years, had untreated hearing loss, and were without substantial cognitive impairment. Participants were randomized (1:1) to hearing intervention or health education control and followed every 6 months.

Intervention

Hearing intervention (provision of hearing aids and related technologies, counseling, education) or health education control (individual sessions covering topics relevant to chronic disease, disability prevention).

Main Outcomes and Measures

Three-year change in the RAND-36 physical and mental health component scores over 3 years. The 8 individual domains of health-related quality-of-life were additionally assessed. Outcomes measured at baseline and at 6-month, 1-year, 2-year, and 3-year follow-ups. Intervention effect sizes estimated using a 2-level linear mixed effects model under the intention-to-treat principle.

Results

A total of 977 participants were analyzed (mean [SD] age, 76.8 [4.0] years; 523 female [53.5%]; 112 Black [11.5%], 858 White [87.8%]; 521 had a Bachelor's degree or higher [53.4%]), with 490 in the hearing intervention and 487 in the control group. Over 3 years, hearing intervention (vs health education control) had no significant association with physical (intervention, -0.49 [95% CI, -3.05 to 2.08]; control, -0.92 [95% CI, -3.39 to 1.55]; difference, 0.43 [95% CI, -0.64 to 1.51]) or mental (intervention, 0.38 [95% CI, -1.58 to 2.34]; control, -0.09 [95% CI, -1.99 to 1.81]; difference, 0.47 [95% CI, -0.41 to 1.35]) health-related quality of life.

Conclusions and Relevance

In this secondary analysis of a randomized clinical trial, hearing intervention had no association with physical and mental health-related quality-of-life over 3 years among older adults with hearing loss. Additional intervention strategies may be needed to modify health-related quality among older adults with hearing loss.

Trial Registration

ClinicalTrials.gov Identifier: NCT03243422.

Health-related quality of life of people with type 1 diabetes: An IMI2 SOPHIA post hoc analysis of FUTURE and ADJUNCT-ONE

AIM

To characterize and stratify health-related quality of life in individuals with type 1 diabetes (T1D) using body mass index (BMI) and clustering analysis.

MATERIAL AND METHODS

Baseline data on individuals with T1D were pooled from two studies. A post hoc analysis of health-related quality of life, measured using the 36-item Short-Form questionnaire, was performed, referenced to the 2010 US general population. Descriptive statistics were presented for the pooled cohort and per BMI category. K-means clustering was performed. One-way analysis of variance was conducted to examine differences in clinical characteristics between clusters.

RESULTS

The pooled cohort consisted of 2256 individuals with T1D (age: 45.4 ± 15.0 years, BMI: 26.2 ± 4.6 kg/m2, diabetes duration: 22.7 ± 13.5 years). All quality-of-life domains were slightly lower than 50(the general population's mean), except for vitality. Individuals with a BMI ≥30 kg/m2 reported lower scores for bodily pain, physical functioning, general health, and vitality. A first cluster with a high and a second cluster with a low quality of life were identified, with significant differences in the mental (Cluster 1: 53.8 ± 6.8 vs. Cluster 2: 39.5 ± 10.7; p < 0.001) and physical component summary scores (Cluster 1: 49.6 ± 6.3 vs. Cluster 2: 35.2 ± 12.0; p < 0.001), which exceeded differences found between BMI categories.

CONCLUSIONS

In our population of people living with T1D, higher BMI may have adversely impacted physical domains of quality of life, but larger differences between the high- and low-quality-of-life cluster indicate that more factors play a role.

The effect of exercise training in people with pre-dialysis chronic kidney disease: a systematic review with meta-analysis

BACKGROUND

Chronic kidney disease (CKD) is a global health issue with high mortality and economic costs. Exercise has potential benefits for pre-dialysis CKD management. This review examines the impact of exercise on CKD patients not on dialysis, focusing on improvement in various health parameters. Findings aim to inform the role of exercise in pre-dialysis CKD care.

METHODS

A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus, up to August 31, 2023, used key terms relating to pre-dialysis CKD and exercise. We pooled randomized controlled trials (RCTs) comparing exercise with usual care and conducted meta-analyses based on a random effects inverse variance model with the effect measure of mean difference.

RESULTS

Of 1162 identified studies, 37 RCTs met the inclusion criteria including 1248 participants. Significant improvements were identified for peak VO2, mean difference [MD] (2.66 mL/kg/min; 95% confidence interval [CI] 1.48, 3.83; p < 0.00001); the 6-min walk (MD 58.83 m; 95% CI 35.26, 82.41; p < 0.00001), timed up and go (standardised mean difference - 0.35; 95% CI - 0.54, - 0.15; p = 0.0006), 2-min step (MD 57.48 steps; 95% CI 27.80, 87.16; p = 0.0001), and sit to stand tests (MD 4.55 repetitions; 95% CI 1.49, 7.60; p = 0.004); short form [SF]-36 general health (MD 4.26; 95% CI 0.04, 8.47; p = 0.05); SF-36 mental component summary (MD 1.84; 95% CI 0.18, 3.51; p = 0.03); estimated glomerular filtration rate (MD 2.19 mL/min/1.73 m2; 95% CI 0.97, 3.50; p = 0.001); serum cystatin-C (MD - 0.06 mg/L; 95% CI - 0.11, - 0.02; p = 0.004); resting heart rate (MD - 1.97 bpm; 95% CI - 3.84, - 0.11; p = 0.04); triglycerides (MD - 12.97mg/dL; 95% CI - 17.30, - 8.63; p < 0.00001); glycosylated haemoglobin (MD - 0.25%; 95% CI - 0.50, - 0.01; p = 0.04); waist circumference (MD - 3.12 cm; 95% CI - 4.37, - 1.86; p < 0.00001); and interleukin-6 (MD - 2.24 pg/mL; 95% CI - 3.87. - 0.61; p = 0.007).

CONCLUSIONS

Analysis revealed improvements in aerobic capacity, functional ability, quality of life, estimated glomerular filtration rate, serum cystatin-C, resting heart rate, waist circumference, triglyceride, glycosylated haemoglobin, and interleukin-6 levels.

Dietary Intervention Favorably Influences Physical Functioning: The Women's Health Initiative Randomized Dietary Modification Trial

BACKGROUND

In the Women's Health Initiative Dietary Modification randomized trial, the dietary intervention reduced breast cancer mortality by 21% (P = .02) and increased physical activity as well.

OBJECTIVE

Therefore, the aim was to examine whether or not these lifestyle changes attenuated age-related physical functioning decline.

DESIGN

In a randomized trial, the influence of 8 years of a low-fat dietary pattern intervention was examined through 20 years of cumulative follow-up.

PARTICIPANTS AND SETTING

From 1993 to 1998, 48,835 postmenopausal women, ages 50 to 79 years with no prior breast cancer and negative baseline mammogram were randomized at 40 US clinical centers to dietary intervention or usual diet comparison groups (40 out of 60). The intervention significantly reduced fat intake and increased vegetable, fruit, and grain intake.

MAIN OUTCOME MEASURES

In post hoc analyses, physical functioning, assessed using the RAND 36-Item Short Form Health Survey, evaluated quality or limitations of 10 hierarchical physical activities. Longitudinal physical functioning, reported against a disability threshold (when assistance in daily activities is required) was the primary study outcome.

STATISTICAL ANALYSES PERFORMED

Semiparametric linear mixed effect models were used to contrast physical functioning trajectories by randomization groups.

RESULTS

Physical functioning score, assessed 495,317 times with 11.0 (median) assessments per participant, was significantly higher in the intervention vs comparison groups through 12 years of cumulative follow-up (P = .001), representing a reduction in age-related functional decline. The intervention effect subsequently attenuated and did not delay time to the disability threshold. Among women in the dietary intervention vs comparison groups, aged 50 to 59 years, who were physically inactive at entry, a persistent, statistically significant, favorable influence on physical functioning with associated delay in crossing the disability threshold by approximately a year was seen (P value for interaction = .007).

CONCLUSIONS

In the Women's Health Initiative Dietary Modification randomized trial, a dietary intervention that significantly reduced breast cancer mortality also significantly reduced age-related functional decline through 12 years, which was attenuated with longer follow-up.

Patient-reported data on the severity of Von Willebrand disease

INTRODUCTION

The severity of Von Willebrand disease (VWD) is currently based on laboratory phenotype. However, little is known about the severity of the patient's experience with the disease. The most recent VWD guidelines highlight the need for patient-reported outcomes (PROs) in VWD.

AIM

The study aimed to investigate the patient-perspective on VWD severity and to identify key factors that determine the severity of disease experienced by patients.

MATERIALS AND METHODS

Patients participated in a nationwide cross-sectional study on VWD in the Netherlands (WiN-study). Patients filled in a questionnaire containing questions on the experienced severity of VWD (4-point scale), bleeding score (BS) and quality of life (QoL).

RESULTS

We included 736 patients, median age of 41.0 years (IQR 23.0-55.0) and 59.5% were women. A total of 443 had type 1, 269 type 2 and 24 type 3 VWD. Self-reported severity of VWD was categorized as severe (n = 52), moderate (n = 171), mild (n = 393) or negligible (n = 120). Classification by historically lowest FVIII:C levels < 0.20 IU/mL as a proxy for severe VWD aligned with patient-reported severity classification with a 72% accuracy. Type 3 VWD (OR = 4.02, 95%CI: 1.72-9.45), higher BS (OR = 1.09, 95%CI: 1.06-1.11), female sex (OR = 1.36, 95%CI: 1.01-1.83), haemostatic treatment in the year preceding study inclusion (OR = 1.53, 95%CI: 1.10-2.13) and historically lowest VWF:Act levels (OR = 0.26, 95%CI: 0.07-1.00) were independent determinants of patient-reported severity.

CONCLUSION

This study shows that patient-reported data provide novel insights into the determinants of experienced disease severity. Our findings highlight the need for studies on PROs with validated questionnaires to assess the burden of VWD.

Decrease in Primary Caregivers' Quality of Life During the Care of a Relative with Palliative Care Needs: A Prospective Longitudinal Study

BACKGROUND/OBJECTIVES

The quality of life is a complex concept that is insufficiently assessed in clinical practice. It is influenced by different factors, as follows: the individual's characteristics, personal values and beliefs, physical and mental state, and relationship to other members of their community. The quality of life of the primary caregiver influences their health and the quality of their care interventions. This study aims to investigate how the quality of life of caregivers changes during palliative patients' care.

METHODS

This is a prospective longitudinal study that assesses the different aspects of the quality of life of primary caregivers who care for patients with palliative needs. The tool used in this study was the Medical Outcomes Scale-Short Form 36 (MOS-SF36).

RESULTS

This study included 140 caregivers, of which 63 were involved in the care of patients with cancer and 77 were involved in the care of patients with non-oncological diseases. Almost 9 out of 10 caregivers were a family member of the patient and over two-thirds of these were women. The caregivers of patients with non-malignant diseases had a decreased quality of life in the following aspects: limitations in their usual role due to emotional problems, social functioning, energy, and their perception of their general health. In the group of oncological patients, the caregivers displayed limitations in their daily role due to physical health, emotional problems, and social functioning.

CONCLUSIONS

The large number of responsibilities, the long time spent caring, and the uncertainty about the evolution of the disease as well as the marginalization and lack of time for oneself are some of the elements that increase caregiver burden. Along with this, the quality of life of caregivers decreases significantly in different aspects, such as physical, psycho-emotional, and social, with the perception of deteriorating general health.

Exploration of the relationship between general health-related problems and subclinical coronary artery disease: a cross-sectional study in a general population

OBJECTIVE

To explore associations between general health-related problems and subclinical coronary artery disease (CAD), determined by CT coronary calcium score (CT-CCS), in a general population.

DESIGN

A cross-sectional design.

SETTING

This study was performed in a prospective population-based cohort, examining the health and health-related behaviour of individuals living in the Northern Netherlands.

PARTICIPANTS

The initial cohort comprised 6763 participants ≥45 years of age who underwent CT-scanning. Participants were included for the current analysis if they filled in three validated questionnaires (Symptomatic Checklist-90, Research and Development Survey-36 and Reviving the Early Diagnosis of CardioVascular Diseases questionnaire (RED-CVD)) and did not have a history of cardiovascular disease. The final analysis included 6530 participants.

PRIMARY OUTCOME MEASURE

Backward-stepwise and forward-stepwise logistic regression analyses were performed to determine associations between general health-related problems and subclinical CAD (CCS≥100 and ≥300).

RESULTS

The median age was 53 years (25th, 75th percentile: 48, 58); 57% were women. CRCS≥100 was found in 1236 (19%) participants, 437 (12%) in women and 799 (29%) men and CCS≥300 in 643 (9.9%) participants of which 180 (4.8%) were women and 463 (16.6%) men. In univariate analysis, in women the expectation of health to worsen (OR=1.13, 95% CI: 1.05 to 1.21), and in men reduced exercise intolerance (OR=1.14, 95% CI: 1.06 to 1.23) were associated with CCS≥100. The total RED-CVD score in women (OR=1.06, (95% CI: 1.05 to 1.08) and men (OR=1.07, 95% CI: 1.06 to 1.09), and in men also reduced exercise intolerance (OR=1.15, 95% CI: 1.06 to 1.25) and headache (OR=0.55, 95% CI: 0.38 to 0.79) were associated with CCS≥300. In multivariate analyses, only general health expectation in women was still significantly associated with subclinical CAD (CCS≥300) (OR=1.92, 95% CI: 1.56 to 2.37).

CONCLUSION

Only a few general health-related problems were associated with the presence of subclinical CAD in the general population, however, these problems showed no strong association. Therefore, using health-related symptoms does not seem useful to pre-select for CT-CCS.

TRIAL REGISTRATION NUMBER

CCMO Register, NL17981.042.07 and NL58592.042.16.

Comparison of SF-36 and RAND-36 in Cardiovascular Diseases: A Reliability Study

Background/Objectives: Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. Health-related quality of life is crucial to assess the impact of cardiovascular diseases and to guide therapeutic strategies. The Short Form 36 Health Survey and the RAND 36-Item Health Survey questionnaires are common tools for measuring health-related quality of life in patients with cardiovascular disease, but their reliability may vary according to the population studied. The aim of this study is to compare the reliability of the SF-36 and the RAND-36 in a population with cardiac pathology, addressing the question of which of these instruments offers a more consistent and useful measurement in this specific group. Methods: A cross-sectional observational study was carried out at the University Hospital of Burgos (Spain). A total of 413 patients with cardiovascular pathology referred to the Cardiac Rehabilitation Unit were included. Patients with incomplete data or who did not participate in the program were excluded. Internal consistency (Cronbach's alpha), item-total correlation and reliability, and a half-and-half analysis were performed. Results: Both questionnaires showed similar and adequate reliability for patients with cardiovascular pathology. Internal consistency, as measured with Cronbach's alpha, was above 0.80 for most dimensions, supporting its robustness. Significant inter-item and inter-dimension correlations were found in both scales, except in some specific cases in the dimension 'Physical Functioning'. The half-and-half analysis confirmed the good reliability of both scales. Conclusions: Both the SF-36 and the RAND-36 are highly reliable tools for assessing health-related quality of life in patients with cardiovascular disease. The results may have significant implications for clinical practice, helping in the selection of health-related quality of life monitoring instruments and in the evaluation of the efficacy of therapeutic interventions.

Comparative responsiveness of the PROMIS-29 and SF-36 instruments in individuals with chronic musculoskeletal pain

BACKGROUND

Chronic musculoskeletal pain (CMP) impacts Health-Related Quality of Life (HRQoL). Several questionnaires are widely used for evaluating the HRQoL, such as Patient Reported Outcomes Measurement Information System 29-item Health Profile (PROMIS-29) and 36-Item Short Form Health Survey (SF-36). This study aimed to assess and compare the responsiveness of PROMIS-29 and SF-36 in individuals with CMP.

METHODS

The prospective study collected data from 215 patients with CMP. The participants completed both questionnaires at baseline and a 4-week follow-up with the global perceived effect (GPE) scale. The internal and external responsiveness methods evaluated the responsiveness of the instruments. The effect size (ES) and standardized response mean (SRM) assessed the internal responsiveness. External responsiveness was measured by Spearman's correlation coefficients (r) and area under the receiver operating curve (AUC). The responsiveness of the PROMIS-29 and SF-36 were compared in similar constructs.

RESULTS

The PROMIS-29 demonstrated responsiveness as moderate in fatigue (ES = -0.79, SRM = -0.64), moderate to large in pain interference (ES = -0.94, SRM = -0.64), and large effect in pain intensity subscale (ES = -1.25, SRM = -1.16). The SF-36 bodily pain exhibited moderate responsiveness (ES = 0.73, SRM = 0.60). Spearman's correlation showed moderate between GPE and change scores of PROMIS-29 physical function (r = 0.31), fatigue (r = -0.36), pain intensity (r = 0.45), and weak between GPE and changes score of SF-36 (r = 0.15-0.26). Besides, the AUC of the PROMIS-29 fatigue, and pain intensity scale were 0.701 and 0.725, respectively, indicating superior discriminative ability.

CONCLUSIONS

The PROMIS-29 and SF-36 were the most responsive in assessing the pain domain for physical health and PROMIS-29 fatigue domain for mental health among individuals with CMP. The PROMIS-29 demonstrated superior results compared to the SF-36. Other domains related to HRQoL could be considered in other assessment instruments.

Using network analysis to provide evidence for brain health as a unified construct relevant to aging with HIV

PURPOSE

Brain health is a dynamic state involving cognitive, emotional, and motor domains. Measuring brain health is a challenge owing to the uncertainty as to whether it is one or many constructs. This study aimed to contribute evidence for brain health as a unified construct by estimating the strength of relationships between and among patient-reported items related to the brain health construct in a population with brain vulnerability owing to HIV.

METHODS

Data for this cross-sectional analysis came from a Canadian cohort of people aging with HIV. The sample included 710 men recruited between 2014 and 2016 from five Canadian cities. A network analysis was conducted with 30 items selected from the brain-related domains of fatigue, cognition, depression, sleep, anxiety, and motivation. Node centrality measures were used to determine the most critical items in the network.

RESULTS

The network showed small-world properties, that is, most nodes can be reached from other nodes with few hops," indicating strong connectivity. The most central symptoms were "How much do you enjoy life?" and "How often do you have negative feelings?".

CONCLUSION

The small-world properties of the network structure indicate that brain health items are interconnected and may be influenced by shared underlying factors. The centrality indices suggest that items related to enjoyment of life and negative feelings may be particularly important for understanding brain health in this population. Future research should aim to replicate these findings in larger and more diverse samples to confirm their robustness and generalizability.

Association between objectively measured protein intake and muscle status, health-related quality of life, and mortality in hemodialysis patients

BACKGROUND

Protein intake is known to be associated with muscle mass, health-related quality of life (HRQoL), and mortality in patients with stage 5 chronic kidney disease undergoing dialysis. However, most studies evaluated protein intake based on 24 h dietary recall or food frequency questionnaire, and these methods are prone to bias. Therefore, this study aimed to evaluate the association of objectively measured protein intake with muscle mass and strength, HRQoL, and mortality.

METHODS

Dietary protein intake was calculated based on the combined (urinary and dialysate) urea excretion rate according to the Maroni formula and indexed to body weight. Muscle mass was calculated based on the combined dialysate and urinary creatinine excretion rate, and muscle strength was assessed by handgrip strength. HRQoL was based on the Short Form 36. Linear and Cox regression were used for the analyses.

RESULTS

We included 59 hemodialysis patients (mean age 65 ± 15 years, 37% female, median hemodialysis vintage 15 [6-39] months). Mean protein intake was 0.82 ± 0.23 g/kg/day, and 76% had a low protein intake (<1.0 g/kg/day). Higher protein intake was independently associated with higher muscle mass (Standardized beta (St. β) [95% confidence interval (95%CI) = 0.56 [0.34 to 0.78]) and higher scores on the physical functioning domain of HRQoL (St. β [95%CI] = 0.49 [0.25 to 0.73]), but not with muscle strength (St. β [95%CI] = 0.17 [-0.10 to 0.43]). During a median follow-up of 21.6 [8.6-36.6] months, 16 (27.1%) patients died. Higher protein intake was associated with lower mortality risk (hazard ratio [95%CI] = 0.34 [0.16-0.73]). This association remained significant after adjustment for potential confounders.

CONCLUSIONS

Protein intake is independently associated with muscle mass, physical functioning domain of HRQOL, and mortality. Clinicians and dietitians should closely monitor the protein intake of hemodialysis patients.

Measuring what matters to older persons for active living: part I content development for the OPAL measure across four countries

AIMS

Many older persons do not think of themselves as "patients" but as persons wishing to live as actively as possible for as long as possible. However, most health-related quality of life (HRQL) measures were developed for use with clinical populations. The aim of this project was to fill that gap and to develop, for international use, a measure of what matters to older persons as they age and seek to remain as active as possible, Older Persons for Active Living (OPAL).

METHODS

For content development, interviews about active living were conducted with older persons from Canada, USA, UK, and the Netherlands in English, French, Spanish and Dutch, respectively with subsequent thematic analysis and harmonization.

RESULTS

Analyses of transcripts from 148 older persons revealed that active living was a "way of being" and not merely doing activities. Saturation was reached and a total of 59 content areas were identified. After grouping similar "ways" together and after conducting a consensus rating of importance, 19 unique and important "ways" remained. In some languages, formulating was challenging for three of the 19, resulting in changes to two English words and dropping two other words, yielding a final list of 17 "ways of being" with harmonized wording in 4 languages.

CONCLUSION

This study underscores the significance of listening to older adults and highlights the importance of considering linguistic and cultural nuances in measure development.

Patient-reported function, quality of life and prosthesis wear in adults born with one hand: a national cohort study

We invited individuals aged above 16 years with a congenital transverse reduction deficiency at and above the wrist born in Norway between 1970 and 2006 to complete the short version of the Disabilities of the Arm, Shoulder and Hand Outcome Measure, the 5-Level EuroQoL-5-Dimension instrument, the RAND 36-Item Short Form Health Survey and a single-item questionnaire on arm function, appearance, pain and prosthesis wear. Of 154 eligible participants, 58 (38%) responded. Their scores were not different from the general population. All had been offered prostheses, and 56 (97%) had been fitted at a median age of 1 year (interquartile range 0-2.8). Of the participants, 37 (64%) were still prosthesis wearers, while 21 (36%) were non-wearers or using gripping devices only. Prosthesis wearers had higher levels of 'vitality' as assessed by the RAND-36 and rated their arm appearance higher, but there were no other score differences, indicating that prosthesis rejection is not associated with worse functional outcomes.Level of evidence: III.