Showing papers on "Quality of life published in 2006"
TL;DR: Exercise is an effective intervention to improve quality of life, cardiorespiratory fitness, physical functioning and fatigue in breast cancer patients and survivors and larger trials that examine the long-term benefits of exercise are needed for this patient group.
Abstract: Background: Physical exercise has been identified as a potential intervention to improve quality of life in women with breast cancer. We sought to summarize the available evidence concerning the effects of exercise on breast cancer patients and survivors. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsychINFO, CancerLit, PEDro and SportDiscus as well as conference proceedings, clinical practice guidelines and other unpublished literature resources. We included only randomized controlled trials that examined exercise interventions for breast cancer patients or survivors with quality of life, cardiorespiratory fitness or physical functioning as primary outcomes. We also extracted data on symptoms of fatigue, body composition and adverse effects. Results: Of 136 studies identified, 14 met all the inclusion criteria. Despite significant heterogeneity and relatively small samples, the point estimates in terms of the benefits of exercise for all outcomes were positive even when statistical significance was not achieved. Exercise led to statistically significant improvements in quality of life as assessed by the Functional Assessment of Cancer Therapy–General (weighted mean difference [WMD] 4.58, 95% confidence interval [CI] 0.35 to 8.80) and Functional Assessment of Cancer Therapy–Breast (WMD 6.62, 95% CI 1.21 to 12.03). Exercise also led to significant improvements in physical functioning and peak oxygen consumption and in reducing symptoms of fatigue. Interpretation: Exercise is an effective intervention to improve quality of life, cardiorespiratory fitness, physical functioning and fatigue in breast cancer patients and survivors. Larger trials that have a greater focus on study quality and adverse effects and that examine the long-term benefits of exercise are needed for this patient group.
1,017 citations
TL;DR: By 2030, the number of US adults with arthritis and its associated activity limitation is expected to increase substantially, resulting in a large impact on individuals, the health care system, and society in general.
Abstract: Objective
To update the projected prevalence of self-reported, doctor-diagnosed arthritis and arthritis-attributable activity limitations among US adults ages 18 years and older from 2005 through 2030.
Methods
Baseline age- and sex-specific prevalence rates of arthritis and activity limitation, using the latest surveillance case definitions, were estimated from the 2003 National Health Interview Survey, which is an annual, cross-sectional, population-based health interview survey of ∼31,000 adults. These estimates were used to calculate projected arthritis prevalence and activity limitations for 2005–2030 using future population projections obtained from the US Census Bureau.
Results
The prevalence of self-reported, doctor-diagnosed arthritis is projected to increase from 47.8 million in 2005 to nearly 67 million by 2030 (25% of the adult population). By 2030, 25 million (9.3% of the adult population) are projected to report arthritis-attributable activity limitations. In 2030, >50% of arthritis cases will be among adults older than age 65 years. However, working-age adults (45–64 years) will account for almost one-third of cases.
Conclusion
By 2030, the number of US adults with arthritis and its associated activity limitation is expected to increase substantially, resulting in a large impact on individuals, the health care system, and society in general. The growing epidemic of obesity may also significantly contribute to the future burden of arthritis. Improving access and availability of current clinical and public health interventions aimed at improving quality of life among persons with arthritis through lifestyle changes and disease self-management may help lessen the long-term impact.
889 citations
TL;DR: CBT is related to short-term effects on depression and anxiety and both short and long term effects on QOL and individual interventions were more effective than group.
Abstract: Objective: The purpose of this meta-analysis was to investigate the effects of cognitive behavioral therapy (CBT) and patient education (PE) on commonly reported problems (depression, anxiety, pain, physical functioning, and quality of life (QOL)) in adult cancer survivors. Methods: Meta analyses of randomized controlled trials of CBT and PE were conducted. MEDLINE, PSYCHINFO and the Cochrane Database were searched from 1993-2004. The effects of individual versus group interventions and short ( 8 months) term follow up are also reported. Results: Fifteen studies met quality criteria. The sample size was 1,492 adult cancer survivors with an age range of 18-84. 790 were randomly assigned to intervention groups and 702 to control groups. CBT varied in duration from 4 weekly one-hour sessions to 55 weekly two-hour sessions. PE ranged from a single 20-minute session to 6 weekly one-hour sessions. Follow up ranged from 1 week to 14 months. CBT was effective for depression (ES = 1.2; 95% CI = 0.22-2.19), anxiety (ES = 1.99; 95% CI = 0.69-3.31), and QOL
574 citations
TL;DR: QoL in "general" patients with AF as well as the effects that rate and/or rhythm-control interventions have on QoL are examined, suggesting that patients with atrial fibrillation have impaired QoO, and that QOL can be significantly improved through rate or rhythm- control strategies.
536 citations
TL;DR: Physical more than mental health deteriorated with increasing multimorbidity, and perceived social support and self-perception of economic status were significantly related to all scales of the SF-36, which adversely affected HRQOL in primary-care adult patients.
Abstract: Previous studies about the association of multimorbidity and the health-related quality of life (HRQOL) in primary-care patients are limited because of their reliance on simple counts of diseases from a limited list of diseases and their failure to assess the severity of disease. We evaluated the association while taking into account the severity of the medical conditions based on the Cumulative Illness Rating Scale (CIRS) score, and controlling for potential confounders (age, sex, household income, education, self-perception of economic status, number of people living in the same dwelling, and perceived social support). We randomly selected 238 patients to construct quintiles of increasing multimorbidity (CIRS). Patients completed the 36-item Medical Outcomes study questionnaire (SF-36) to evaluate their HRQOL. Applying bivariate and multivariate linear regression analyses, we used the CIRS as either a continuous or a categorical (quintiles) variable. Use of the CIRS revealed a stronger association of HRQOL with multimorbidity than using a simple count of chronic conditions. Physical more than mental health deteriorated with increasing multimorbidity. Perceived social support and self-perception of economic status were significantly related to all scales of the SF-36 (p < 0.05). Increased multimorbidity adversely affected HRQOL in primary-care adult patients, even when confounding variables were controlled for.
505 citations
TL;DR: Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics.
Abstract: Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics Design Cluster randomised controlled trial with blinded assessment of outcome Setting 12 specialist nursing homes for people with dementia in London, Newcastle, and Oxford Participants Residents of the 12 nursing homes; numbers varied during the study period Intervention Training and support intervention delivered to nursing home staff over 10 months, focusing on alternatives to drugs for the management of agitated behaviour in dementia Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour (Cohen-Mansfield agitation inventory) in each home at 12 months Results At 12 months the proportion of residents taking neuroleptics in the intervention homes (230%) was significantly lower than that in the control homes (421%): average reduction in neuroleptic use 191% (95% confidence interval 05% to 377%) No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes Conclusions Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics
499 citations
TL;DR: The data from this randomised study support the use of SNB in patients with clinically node negative breast cancer.
Abstract: This study is the first large prospective RCT of sentinel node biopsy (SNB) compared with standard axillary treatment (level I-III axillary lymph node dissection or four node sampling), which includes comprehensive and repeated quality of life (QOL) assessments over 18 months. Patients (n = 829) completed the Functional Assessment of Cancer Therapy - Breast (FACT-B+4) and the Spielberger State/Trait Anxiety Inventory (STAI) at baseline (pre-surgery) and at 1, 3, 6, 12, and 18 months post-surgery. There were significant differences between treatment groups favouring the SNB group throughout the 18 months assessment. Patients in the standard treatment group showed a greater decline in Trial Outcome Index (TOI) scores (physical well-being, functional well-being and breast cancer concerns subscales in FACT-B+4) and recovered more slowly than patients in the SNB group (p 0.05). For 6 months post-surgery younger patients reported less favourable QOL scores (p < 0.001) and greater levels of anxiety (p < 0.01). In view of the benefits regarding arm functioning and quality of life, the data from this randomised study support the use of SNB in patients with clinically node negative breast cancer.
468 citations
TL;DR: It is shown that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma, and patients recognise deteriorating asthma control and adjust their medication during episodes of worsening, which represents a window of missed opportunity.
Abstract: This study examined the attitudes and actions of 3415 physician-recruited adults aged ≥ 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting β2-agonists. Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma. Despite being prescribed regular maintenance therapy, 74% of patients used short-acting β2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting β2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening. Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.
445 citations
TL;DR: Female patients appear to be more exposed to psychological impairment, which correlates well with some specific symptomatic aspects of the disease, such as dyspnea, which is more strongly correlated with depression in women than in men.
434 citations
TL;DR: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood if these factors are controlled.
Abstract: Objectives: To investigate whether longstanding illnesses, social context, and current socioeconomic circumstances predict quality of life. Design: Secondary analysis of wave 1 of the English longitudinal study of aging. Missing data were imputed and multiple regression analyses conducted. Setting: England, 2002 Participants: Nationally representative sample of non-institutionalised adults living in England (n = 11 234, 54.5% women, age 65.1 (SD 10.2) years). Main outcome measure: Quality of life as measured by CASP-19, a 19 item Likert scaled index. Results: The quality of life was reduced by depression (β −0.265), poor perceived financial situation (β −0.157), limitations in mobility (β −0.124), difficulties with everyday activities (β −0.112), and limiting longstanding illness (β −0.112). The quality of life was improved by trusting relationships with family (β 0.105) and friends (β 0.078), frequent contacts with friends (β 0.059), living in good neighbourhoods (β 0.103), and having two cars (β 0.066). The regression models explained 48% variation in CASP-19 scores. There were slight differences between age groups and between men and women. Conclusions: Efforts to improve quality of life in early old age need to address financial hardships, functionally limiting disease, lack of at least one trusting relationship, and inability to move out of a disfavoured neighbourhood. There is the potential for improved quality of life in early old age (the third age) if these factors are controlled.
430 citations
TL;DR: A meta-analysis on published QOL articles on response shift finds that a definitive conclusion on the clinical significance of response shift cannot currently be drawn from existing studies, and recommends a standardized approach for reporting results of future response shift research to advance the field and to facilitate interpretation and comparisons across studies.
Abstract: When individuals experience changes in their health states, they may alter their internal standards, values, or conceptualization of quality of life (QOL). Such ‘response shifts’ can affect or distort QOL outcome measurement, which is of particular concern when evaluating medical or psychosocial interventions. Although clinicians and researchers acknowledge the occurrence of response shifts, little is known about the magnitude and clinical significance of those effects. To fill this gap in knowledge about response shift phenomena, we performed a meta-analysis on published QOL articles on response shift. Extensive literature searches and multiple contacts with researchers yielded a collection of 494 articles for potential reviewing. We retained only published longitudinal studies that measured response shift, resulting in 26, of which 19 reported the requisite data for computing an effect size (ES). We calculated and compared the ESs for each study with regard to potential moderator variables: the QOL domains measured, disease group investigated, sample size, and response shift method used. We rated studies for quality to allow ES weighting. When we examined ES absolute values, we found that ES magnitude was small, with the largest ESs detected for fatigue, followed by global QOL, physical role limitation, psychological well-being, and pain (mean |ESweighted| = 0.32, 0.30, 0.24, 0.12, and 0.08, respectively). ESs varied considerably in direction. Aggregating raw ES scores over all studies led to positive and negative values canceling each other out (mean directional ESweighted = 0.17, 0.02, −0.01, 0.06, and 0.02, respectively). We found little evidence of an effect for the moderator variables examined. A definitive conclusion on the clinical significance of response shift cannot currently be drawn from existing studies. For a number of reasons, ES estimates were primarily based on then-test results, a method that is not without criticism, such as its susceptibility to recall bias. We recommend a standardized approach for reporting results of future response shift research to advance the field and to facilitate interpretation and comparisons across studies.
TL;DR: Findings show that religious coping plays an important role for the QOL of patients and the types of religious coping strategies used are related to better or poorer QOL.
Abstract: Background: For patients confronting a life-threatening illness such as advanced cancer, religious coping can be an important factor influencing their quality of life (QOL). Objective: The study's main purpose was to examine the association between religious coping and QOL among 170 patients with advanced cancer. Both positive religious coping (e.g., benevolent religious appraisals) and negative religious coping (e.g., anger at God) and multiple dimensions of QOL (physical, physical symptom, psychological, existential, and support) were studied. Design: Structured interviews were conducted with 170 patients recruited as part of an ongoing multi-institutional longitudinal evaluation of the prevalence of mental illness and patterns of mental health service utilization in advanced cancer patients and their primary informal caregivers. Measurements: Patients completed measures of QOL (McGill QOL questionnaire), religious coping (Brief Measure of Religious Coping [RCOPE] and Multidimensional Measure of Religio...
TL;DR: In this study, saw palmetto did not improve symptoms or objective measures of benign prostatic hyperplasia and there was no significant difference between the saw Palmetto and placebo groups in the change in AUASI scores.
Abstract: Background Saw palmetto is used by over 2 million men in the United States for the treatment of benign prostatic hyperplasia and is commonly recommended as an alternative to drugs approved by the Food and Drug Administration. Methods In this double-blind trial, we randomly assigned 225 men over the age of 49 years who had moderate-to-severe symptoms of benign prostatic hyperplasia to one year of treatment with saw palmetto extract (160 mg twice a day) or placebo. The primary outcome measures were changes in the scores on the American Urological Association Symptom Index (AUASI) and the maximal urinary flow rate. Secondary outcome measures included changes in prostate size, residual urinary volume after voiding, quality of life, laboratory values, and the rate of reported adverse effects. Results There was no significant difference between the saw palmetto and placebo groups in the change in AUASI scores (mean difference, 0.04 point; 95 percent confidence interval, –0.93 to 1.01), maximal urinary flow rate...
TL;DR: Findings indicate that all aspects of QOL are markedly affected in individuals with OCD and are associated with OCD severity (particularly obsessional severity) and depression severity.
TL;DR: A “steering” away from fatty foods after LGBP may be an important mechanism of action in gastric bypass, and energy expenditure developed as expected postoperatively.
Abstract: There are as yet no indications of decrease in the global obesity epidemic.1 The etiology is probably multifactorial, to which a genetic disposition together with unlimited access to high calorie foods and a lifestyle promoting physical inactivity contribute. Morbidity and mortality are strongly correlated to the level of obesity,2–4 and the list of diseases with a causal factor in obesity continues to expand. Obesity surgery is the only option that has been demonstrated to result in efficient, sustained long-term weight loss in the treatment of severe obesity.5
Most authors use the amount of weight loss (or percent excess weight loss [%EWL]) as the only tool to evaluate the efficacy of bariatric surgical procedures. Generally, there is a strong correlation between the level of weight loss and improvements in metabolic risk factors and quality of life (QoL).6,7 However, there is limited knowledge about the differences between the surgical options (restrictive, malabsorptive, and combined) in the crucial task of reducing the metabolic risk and thereby contribute to curing morbidity and preventing mortality.
Previous studies of the difference between Roux-en-Y Gastric bypass (GBP) and the restrictive bariatric procedures, such as vertical banded gastroplasty (VBG), have reported a superior outcome in terms of weight loss and a better dietary pattern after GBP.8–12 Studies of body composition have demonstrated a reduction of body fat as well as a decrease in lean tissue mass (LTM) following bariatric surgery.13–16 The question of whether or not higher energy expenditure than expected could be a contributing factor to weight loss after obesity surgery has been disputed in previous studies.17–20 No study has to our knowledge prospectively compared changes in body composition and/or energy expenditure related to dietary intake in a randomized clinical trial between different bariatric surgical techniques. Based on a prospective randomized trial, we have recently reported that laparoscopic GBP (LGBP) resulted in a weight reduction that was clearly superior to the effect of laparoscopic vertical banded gastroplasty (LVBG). Furthermore, remedial surgical interventions were more frequent following LVBG.21
The patients enrolled in the above mentioned clinical trial21 were also examined with regard to other outcome variables not directly related to the operative procedures. In this paper, we report the results concerning effects on body composition, energy expenditure and dietary intake.
TL;DR: In this paper, the authors compared outcomes of three different rectocele repair techniques: posterior colporrhaphy, site-specific repair, and porcine small intestinal submucosa graft augmentation.
TL;DR: A structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment, and control participants experienced a significant decrease in their QOL.
Abstract: Purpose The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. Patients and Methods Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. Results Of the 103 participants, overall QOL at week 4 was ...
TL;DR: This study examines HRQOL and its association with depressive symptoms and perceived social support in African‐American and white youth pursuing weight management treatment.
Abstract: ZELLER, MEG H. AND AVANI C. MODI. Predictors of health-related quality of life in obese youth. Obesity. 2006; 14:122-130. Objective: Recent literature has documented the psychosocial consequences of pediatric obesity, including poor health-related quality of life (HRQOL). The present study examines HRQOL and its association with depressive symptoms and perceived social support in African-American and white youth pursuing weight management treatment. Research Methods and Procedures: Study participants were 166 obese youth (mean = 12.7 years, 70% females, 57% African American, mean BMI = 37.0) referred to a pediatric weight management program. Parents of participants completed a demographics form and the parent-proxy Pediatric Quality of Life Inventory (PedsQL). Youth completed the Children's Depression Inventory, PedsQL, and Perceived Social Support Scale for Children. Results: HRQOL scores were quite impaired relative to published norms on healthy youth (p < 0.001). Approximately 11 % of the sample met criteria for clinically significant depressive symptoms. Simultaneous regression analyses revealed that depressive symptoms, perceived social support from classmates, degree of overweight, and socioeconomic status seem to be strong predictors of HRQOL. Discussion: Obesity has a clear impact on HRQOL regardless of respondent (e.g., parent, youth) or racial group. It is likely that assessing and treating depressive symptoms and fostering social support in the context of pediatric intervention have implications for both improved HRQOL and weight management outcomes.
TL;DR: Eerrlotinib not only improves survival in previously treated patients with NSCLC, but also improves tumor-related symptoms and important aspects of QOL.
Abstract: Purpose This report describes the quality of life (QOL) findings of a randomized placebo controlled study of erlotinib, an epidermal growth factor receptor inhibitor, in patients with non‐small-cell lung cancer (NSCLC). Patients and Methods This double-blind phase III trial randomly assigned 731 patients with NSCLC who had progressed after prior chemotherapy to erlotinib 150 mg daily or placebo, with survival as the primary study outcome. QOL was assessed by European Organisation for Research and Treatment of Cancer QLQ-C30 and the lung cancer module QLQ-LC13. The primary end points for QOL analysis were time to deterioration of three common lung cancer symptoms: cough, dyspnea, and pain. Results Survival was significantly longer (hazard ratio, 0.70; P .0001) in the erlotinib arm. Compliance with QOL was 87% at baseline and more than 70% during treatment. Patients receiving erlotinib had significantly longer median time to deterioration for all three symptoms (4.9 v 3.7 months for cough [P .04]; 4.7 v 2.9 months for dyspnea [P .04], and 2.8 v 1.9 months for pain [P .03]). QOL response analyses showed that 44%, 34%, and 42% of patients receiving erlotinib had improvement in these three symptoms, respectively. This was accompanied by a significant improvement in the physical function (31% erlotinib v 19% placebo, P .01), and global QOL (35% v 26%, P .0001). Patients with complete or partial response were more likely to have improvement in the QOL response than patients with stable or progressive disease (P .01).
TL;DR: Four relatively distinct patient subgroups were identified based on patients experiences with four highly prevalent and related symptoms; the subgroup of patients who reported low levels of all four symptoms reported the best functional status and QOL.
Abstract: PURPOSE/OBJECTIVES: To identify subgroups of outpatients with cancer based on their experiences with the symptoms of fatigue, sleep disturbance, depression, and pain; to explore whether patients in the subgroups differed on selected demographic, disease, and treatment characteristics; and to determine whether patients in the subgroups differed on two important patient outcomes: functional status and quality of life (QOL). DESIGN: Descriptive, correlational study. SETTING: Four outpatient oncology practices in northern California. SAMPLE: 191 outpatients with cancer receiving active treatment. METHODS: Patients completed a demographic questionnaire, Karnofsky Performance Status scale, Lee Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies Depression Scale, Multidimensional Quality-of-Life Scale Cancer, and a numeric rating scale of worst pain intensity. Medical records were reviewed for disease and treatment information. Cluster analysis was used to identify patient subgroups based on patients symptom experiences. Differences in demographic, disease, and treatment characteristics as well as in outcomes were evaluated using analysis of variance and chi square analysis. MAIN RESEARCH VARIABLES: Subgroup membership, fatigue, sleep disturbance, depression, pain, functional status, and QOL. FINDINGS: Four relatively distinct patient subgroups were identified based on patients experiences with four highly prevalent and related symptoms. CONCLUSIONS: The subgroup of patients who reported low levels of all four symptoms reported the best functional status and QOL. IMPLICATIONS FOR NURSING: The findings from this study need to be replicated before definitive clinical practice recommendations can be made. Until that time, clinicians need to assess patients for the occurrence of multiple symptoms that may place them at increased risk for poorer outcomes.
TL;DR: ARDS survivors in different clinical settings experience similar decrements in QOL, and the precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.
Abstract: To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors.
A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results. Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15–26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than ± 9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge. ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.
TL;DR: A broader understanding of the frequency and effects of neurological injury from cardiac surgery and its implications for patients in both the short term and the long term should be able to give personalised treatments and thus preserve both their quantity and quality of life.
TL;DR: The findings support a social cognitives model of physical activity’s relationship with QOL, which influenced self-efficacy and QOL through physical and mental health status, which in turn influenced global QOL.
Abstract: Background: Physical activity has been positively linked to quality of life (QOL) in older adults. Measures of health status and global well-being represent common methods of assessing QOL outcomes, yet little has been done to determine the nature of the relationship of these outcomes with physical activity.Purpose: We examined the roles played by physical activity, health status, and self-efficacy in global QOL (satisfaction with life) in a sample of older Black and White women.Method: Participants (N = 249, M age = 68.12 years) completed multiple indicators of physical activity, self-efficacy, health status, and QOL at baseline of a 24-month prospective trial. Structural equation modeling examined the fit of 3 models of the physical activity and QOL relationship.Results: Analyses indicated that relationships between physical activity and QOL, self-efficacy and QOL were all indirect. Specifically, physical activity influenced self-efficacy and QOL through physical and mental health status, which in turn influenced global QOL.Conclusions: Our findings support a social cognitives model of physical activity’s relationship with QOL. Subsequent tests of hypothesized relationships across time are recommended.
TL;DR: Pooled analyses revealed that, for chronic low back pain, specific stabilisation exercise was superior to usual medical care and education but not to manipulative therapy, and no additional effect was found when specific stabilised exercise was added to a conventional physiotherapy program.
Abstract: The aim of this study was to conduct a systematic review of the efficacy of specific stabilisation exercise for spinal and pelvic pain. Randomised clinical trials evaluating specific stabilisation exercise were identified and retrieved. Outcomes were disability, pain, return to work, number of episodes, global perceived effect, or health-related quality of life. A single trial reported that specific stabilisation exercise was more effective than no treatment but not more effective than spinal manipulative therapy for the management of cervicogenic headache and associated neck pain. Single trials reported that specific stabilisation exercise was effective for pelvic pain and for prevention of recurrence after an acute episode of low back pain but not to reduce pain or disability associated with acute low back pain. Pooled analyses revealed that, for chronic low back pain, specific stabilisation exercise was superior to usual medical care and education but not to manipulative therapy, and no additional effect was found when specific stabilisation exercise was added to a conventional physiotherapy program. A single trial reported that specific stabilisation exercise and a surgical procedure to reduce pain and disability in chronic low back pain were equally effective. The available evidence suggests that specific stabilisation exercise is effective in reducing pain and disability in chronic but not acute low back pain. Single trials indicate that specific stabilisation exercise can be helpful in the treatment of cervicogenic headache and associated neck pain, pelvic pain, and in reducing recurrence after acute low back pain.
TL;DR: Poor glycemic control in peridatric T1DM is associated with lower SES and depression, and the probability of depression increases as gly glucose control worsens.
TL;DR: Multivariate regression showed that those with active IBD had higher levels of distress, health anxiety, and perceived stress, lower social support, well-being and mastery, and poorer disease-specific QOL, relative to those with inactive disease.
TL;DR: The prevalence of depression in end-stage renal disease patients on hemodialysis and the sensitivity, specificity, positive, and negative likelihood ratios (+LR and -LR) of self-report scales were examined using the physician-administered Structured Clinical Interview for Depression (SCID) as the comparison.
TL;DR: QOL’s relationship with disability is complex, displaying non-linearity and interacting with patient characteristics, which has implication for QOL research methodology and provides insight into factors affecting patients’ perceptions of well-being.
Abstract: Objectives: (1) Evaluate the impact of the patient charateristics of disability, gender and employment status on health-related quality of life (HRQOL) in multiple sclerosis (MS) and (2) Characterize the functional relationship between HRQOL and disability overall, and by gender and employment status. Methods: We assessed the HRQOL of 215 MS outpatients in our clinic using the MSQOL-54 and Fatigue Severity Scale (FSS), and that of 172 healthy controls, using the SF-36 (a subset of MSQOL-54). We compared QOL between MS subgroups defined by disability, gender and employment, and computed the linear and non-linear relationships between disability level measured by the Expanded Disability Status Scale (EDSS) and MSQOL-54 dimensions. Results: QOL of MS patients measured by SF-36 is lower than controls, varying by QOL dimension with the greatest difference emerging for physical aspects of the disease. The relationship of physical disability, measured by EDSS, and all 14 MSQOL-54 dimensions and FSS is negative; for 12 of the 14 dimensions and FSS it is also non-linear. Non-linearity is most pronounced among women, who show a weak EDSS/QOL relatioship at higher levels of physical disability, suggesting women better able to “psychologically buffer” the debilitating aspects of MS. While employed have higher QOL than unemployed, the former are more affected by physical disability. Conclusions: Multiple attributes, including disability, gender and employment status, affect QOL. QOL’s relationship with disability is complex, displaying non-linearity and interacting with patient characteristics. This has implication for QOL research methodology and provides insight into factors affecting patients’ perceptions of well-being.
TL;DR: Treatment of IBD‐associated anemia with iron may lead to improvement in patients' QOL, and increases in Hb improved QOL scores in IBD patients independent of change in disease activity.
Abstract: Background: Anemia commonly complicates inflammatory bowel disease (IBD). In patients with chronic renal failure, the treatment of anemia with iron ± erythropoietin improves both quality of life (QOL) and cognitive function (CF). The same drugs are effective in treating severe anemia in IBD, but there is no evidence to direct the treatment of mild anemia. Concern exists that the use of iron may exacerbate inflammation in patients with IBD. The present study examined the association between changes in hemoglobin (Hb) in a population of IBD patients and changes in QOL and CF independent of change in disease activity (DA). Subsidiary aims were to assess whether the use of iron was associated with worsening DA.
Methods: A cohort of 50 patients with IBD (29 Crohn's disease and 21 ulcerative colitis) took part. Iron replacement was given to 21 patients with low Hb. Measures of QOL, CF, DA, and Hb were recorded at baseline and at 6 months.
Results: The iron-treated group had lower Hb and higher DA scores compared with the non-iron-treated group at baseline. In a hierarchical regression model, changes in DA accounted for 13% (P = 0.17) and changes in Hb accounted for 18% (P = 0.005) of the variance in change in SF-36 and 12% (P = 0.23) and 17% (P = 0.009) in the Inflammatory Bowel Disease Questionnaire. In this pilot study, although no associations were identified between changes in Hb or DA and CF, increases in Hb improved QOL scores in IBD patients independent of changes in DA. We found no similar effect with CF, but again, the sample size was small. We found no evidence that iron therapy causes worsening of DA.
Conclusions: Treatment of IBD-associated anemia with iron may lead to improvement in patients' QOL.
TL;DR: Parents' perceptions of QoL for children with FAP were lower than their children's self-reported scores, highlighting the clinical significance of FAP and providing insight into one facet of the disease's biopsychosocial etiology.
Abstract: OBJECTIVE. Children with chronic abdominal pain of nonorganic origin, termed functional abdominal pain (FAP), experience school absences and social withdrawal and report impaired physical ability. The aim of this study was to assess patients9 and parents9 perceptions of health-related quality of life (QoL) for children with FAP. METHODS. Between October 2002 and November 2003, 209 children (including 125 girls; age: 11.2 ± 3.5 years) and 209 parents were recruited from a pediatric referral center. At the time of their initial evaluations, participants completed a validated, health-related QoL instrument (Pediatric Quality of Life Inventory), which was scored on a scale of 0 (poor) through 100 (best). Children with FAP (n = 65) and their families were compared with control groups of healthy children (n = 46) and children with histologically proven inflammatory bowel disease (IBD) (n = 42) or gastroesophageal reflux disease (GERD) (n = 56). RESULTS. Children with FAP had self-reported QoL scores (score: 78) that were similar to those for children with GERD (score: 80) or IBD (score: 84). Children with FAP had lower QoL scores than did healthy children (score: 88). Parents of children with FAP reported lower QoL scores, compared with their children9s scores (scores: 70 vs 78). CONCLUSIONS. Children with FAP reported lower QoL, compared with their healthy peers, and had the same QoL scores as did children with IBD or GERD. Parents9 perceptions of QoL for children with FAP were lower than their children9s self-reported scores. These findings highlight the clinical significance of FAP and may provide insight into one facet of the disease9s biopsychosocial etiology.