A randomized clinical trial of a wellness intervention for women with multiple sclerosis

OBJECTIVE: To examine the effects of a wellness intervention program for women with multiple sclerosis (MS) on health behaviors and quality of life (QOL). DESIGN: Randomized clinical trial. SETTING: Community setting in the southwestern United States. PARTICIPANTS: Convenience sample of 113 women with physician-confirmed MS (mean age, 45.79y). INTERVENTIONS: The 2-phase intervention program included lifestyle-change classes for 8 weeks, then telephone follow-up for 3 months. Participants were followed over an 8-month period. MAIN OUTCOME MEASURES: A series of self-report instruments to measure barriers, resources, self-efficacy for health behaviors, health promotion behaviors, and health-related QOL were completed at baseline, 2 months (after the classes), 5 months (after telephone follow-up), and at 8 months. Principal outcomes measures were health-promoting behaviors (scores on the Health Promoting Lifestyle Profile II) and QOL (scores on the Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] scales). RESULTS: Hierarchical linear modeling techniques revealed a statistically significant group by time effect for self-efficacy for health behaviors, health-promoting behaviors, and the mental health and pain scales of the SF-36. CONCLUSION: These data provide initial support for the positive effects of wellness interventions to improve health behaviors and selected dimensions of QOL for women with MS.     

老年人社会支持情况与生活质量的关系

背景:美国简明健康测量量表中文版与中国老年人生活质量调查表,哪个更能反映中国老年人的社会支持情况与其生活质量的相关性?目的:分析和探讨老年人社会支持情况对其生活质量的影响。设计:随机抽样,以人群为基础的横断面调查研究。地点、对象和方法:采用社会支持评定量表(socialsupportreviewques-tionnaire,SSRS,MOSSF-36)和老年人生活质量调查表对苏州市167名离退休人员进行自评调查。主要观察指标:苏州市167名离退休人员SSRS,MOSSF-36,老年人生活质量调查评定结果。结果:用MOSSF-36量表测出的生活质量中的活力和精神健康与该老年人群的社会支持情况的主观支持相关,其余均与社会支持情况不相关。中国老年人生活质量调查表测出的生活质量总分和家庭和睦、社会交往、生活满意度与该老年人群的社会支持情况显著正相关,其中生活质量总分和家庭和睦、社会交往、生活满意度与主观支持显著正相关;家庭和睦、居住条件和生活满意度与客观支持显著正相关;心理卫生与支持利用度显著正相关。结论:对于中国老年人的社会支持情况是与其生活质量密切相关的因素,中国老年人生活质量调查表在社会支持方面较SF-36中文版量表更敏感、更明显。     

Effects of a Thoracic Mobility and Respiratory Exercise Program on Pulmonary Function and Functional Capacity in Older Adults

The purposes of this study were to describe a home exercise program (HEP) consisting of respiratory exercise and stretching thoracic muscles and to determine how regular participation in this program affected pulmonary function, chest wall excursion, physical function, and quality of life in community-dwelling older adults. Thirty-seven volunteers (mean age 80.5 years) participated in a twice daily HEP for 6 weeks. Twenty-two subjects completed the program. Pulmonary function, chest wall excursion (CWE), the 6-minute walk test (6MWT), the physical performance test (PPT), and RAND SF-36 quality of life survey (SF-36) were administered before and after the exercise program. Increases in CWE, 6MWT, and PPT were statistically significant. In conclusion, community-dwelling older adults participating in a 6-week stretching and respiratory exercise program demonstrated improved CWE and function.     

Longitudinal study of a health education program for Japanese women in menopause

In this longitudinal intervention study, a 6 week health education program consisting of lectures and exercises was implemented for 39 Japanese menopausal women. The effects of the program were assessed by measuring their exercise participation, climacteric symptoms, and quality of life immediately before, 6 weeks after, and 1 year after the program. The Simplified Menopausal Index was used to assess the climacteric symptoms and the Medical Outcomes Study 36-Item Short-Form Health (SF-36) Survey was used to assess the quality of life. Significant improvements were observed in the subscale score for general health perception and the summary score for the physical component summary in the SF-36 Survey. Favorable results also were found for women without a previous exercise habit before the program but who participated in regular exercise 1 year after the program. No improvements were observed in the climacteric symptoms. We concluded that our program was effective for menopausal women in spite of the intervention period being relatively short.     

上海金山社区老年人生活状况的调查分析

目的调查上海金山社区老年人生活状况,并分析其影响因素。方法 2013年9—12月选择上海市金山区12个城镇社区年龄≥60岁的老年人1 050例,采用简明健康调查问卷(SF-36量表),调查其生活状况,并用单因素方差分析影响因素。结果年龄、婚姻、文化、子女、经济、体检及2周患病情况对老年人生活状况有极显著影响(P0.01),是否患有慢性病与老年人健康状况显著相关(P0.05)。结论上海金山社区老年人生活状况受多种人口学因素及疾病因素影响。提示需关注社区老年人,改善生活状况,加强慢性病管理,对提高其生活状况有重要意义。     

Health-related quality of life in low-income older African Americans

This study examined the relationships among comorbid conditions, symptom stress, depression, functional status and health-related quality of life (HRQOL) in low-income older African Americans with chronic diseases. A convenience sample of 83 older African American adults living in subsidized housing for elders participated in the study. Data were collected in face-to-face interviews. Participants reported lower scores on HRQOL than the SF-36 norms for age 60 or older in the general U.S. population. Comorbid conditions, symptom distress, depression, and functional status significantly predicted both the physical (F = 38.92, p < .001) and mental (F = 23.21, p < .001) health components of HRQOL, accounting for 63% of variance in the SF-36 physical health score and 55% of the variance in the SF-36 mental health score. The findings suggested that developing interventions to assist older African Americans to better manage their symptoms and depression are of prime importance for improving HRQOL.     

Assessing the mental health of rural older adults in public housing facilities: a comparison of screening tools

This pilot study assessed the prevalence of mental health disorders and cognitive impairment among rural older adults living in a public housing facility and compared screening tools in this setting. Interviews were completed with 20 of the 38 residents older than 60 years. Survey instruments included the following: Primary Care Evaluation of Mental Disorders (PRIME-MD), Medical Outcomes 36-item Short-Form Health Survey (SF-36), Montgomery-Asberg Depression Rating Scale (MADRS), Mini-Mental State Exam (MMSE), and Global Assessment Scale (GAS). Depressive disorders were identified in 50% (n = 10) of participants and included major depression (25%), minor depression (20%), and dysthymia (5%). Cognitive impairment was identified in 15% (n = 3) of participants. Comparative analysis of instruments administered showed high correlations among the PRIME-MD, MADRS, GAS, and SF-36. The screening instruments identified for depression and cognitive impairment can be used reliably by nurses in this setting.     

Health-Related Quality of Life in Low-Income Older African Americans

This study examined the relationships among comorbid conditions, symptom stress, depression, functional status and health-related quality of life (HRQOL) in low-income older African Americans with chronic diseases. A convenience sample of 83 older African American adults living in subsidized housing for elders participated in the study. Data were collected in face-to-face interviews. Participants reported lower scores on HRQOL than the SF-36 norms for age 60 or older in the general U.S. population. Comorbid conditions, symptom distress, depression, and functional status significantly predicted both the physical (F = 38.92, p < .001) and mental (F = 23.21, p < .001) health components of HRQOL, accounting for 63% of variance in the SF-36 physical health score and 55% of the variance in the SF-36 mental health score. The findings suggested that developing interventions to assist older African Americans to better manage their symptoms and depression are of prime importance for improving HRQOL.     

Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study

The objectives of this pilot study were to assess the feasibility of recruitment and adherence to an eight-session mindfulness meditation program for community-dwelling older adults with chronic low back pain (CLBP) and to develop initial estimates of treatment effects. It was designed as a randomized, controlled clinical trial. Participants were 37 community-dwelling older adults aged 65 years and older with CLBP of moderate intensity occurring daily or almost every day. Participants were randomized to an 8-week mindfulness-based meditation program or to a wait-list control group. Baseline, 8-week and 3-month follow-up measures of pain, physical function, and quality of life were assessed. Eighty-nine older adults were screened and 37 found to be eligible and randomized within a 6-month period. The mean age of the sample was 74.9 years, 21/37 (57%) of participants were female and 33/37 (89%) were white. At the end of the intervention 30/37 (81%) participants completed 8-week assessments. Average class attendance of the intervention arm was 6.7 out of 8. They meditated an average of 4.3 days a week and the average minutes per day was 31.6. Compared to the control group, the intervention group displayed significant improvement in the Chronic Pain Acceptance Questionnaire Total Score and Activities Engagement subscale (P=.008, P=.004) and SF-36 Physical Function (P=.03). An 8-week mindfulness-based meditation program is feasible for older adults with CLBP. The program may lead to improvement in pain acceptance and physical function.     

Enhancing function in older adults with chronic low back pain: a pilot study of endurance training

OBJECTIVES: To assess the effectiveness of a bicycle endurance program in older adults with chronic low back pain (CLBP) and to identify correlates of exercise adherence. DESIGN: Prospective cohort. SETTING: Residential facilities and a tertiary care hospital. PARTICIPANTS: Adults with CLBP aged 55 years and older. Of 29 subjects who agreed to participate, 3 (10%) were deemed ineligible at baseline. Nineteen subjects (73%) were women, and the median age was 72 years. INTERVENTIONS: Subjects were assessed at baseline and at 6 and 12 weeks by using standardized questionnaires, physical examination, and endurance testing by a physical therapist. Subjects received a bicycle and instructions to exercise 3 times a week for 12 weeks at a set wattage. A trained rescarcher collected exercise data weekly.Main outcome measures The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the lumbar spinal stenosis symptom severity and function scales, and kilocalories were used to assess change. RESULTS: At baseline, subjects were moderately impaired (mean SF-36 physical function score, 52.6). Eighteen (65%) completed the trial. At 12 weeks, physical functioning (SF-36) improved by 11%, mental health (Mental Health Inventory 5-Item Questionnaire) improved by 14%, and CLBP symptoms decreased by 8%. Reasons for withdrawing included illness, family issues, and bicycle-related discomfort. CONCLUSIONS: The bicycle program was safe and effective for improving functional status and well-being.     

Home care and quality of life three years after stroke]

INTRODUCTION: Stroke is the most disabling chronic disease among adults. The assessment of quality of life is of great importance to improve the management of patients with stroke sequelae returning to the community. METHOD: A total of 93 patients and their referring clinicians were contacted. Quality of life of patients three years after stroke was assessed by use of the Short-Form Health Survey (SF-36). RESULTS: Thirteen patients died during this period. Fifty participated in the study. The average age was 66.8 years. The patients who died were older and had an initial greater impairment after stroke than survivors. In most of the cases, a life plan, built during the inpatient rehabilitation period, could be achieved. Just six patients had to change their way of life during the three years after stroke. A total of 44% of the patients needed human assistance for basic daily living activities. Patients with stroke had lower scores on the SF-36 than their healthy peers. All subscale scores differed for patients with stroke, as compared with health peers. Initial disability, the occurrence of falls, age and urinary incontinence at the time of the study indicated poor prognosis. DISCUSSION: Our results are close to those previously published: a great number of people who survive stroke live with sequelae that requires assistance in the home and have decreased quality of life. These results stress the importance of follow-up by a rehabilitation team to prevent altered quality of life, with a special care to urinary incontinence and falls, especially in old people with abundant sequelae of stroke.     

Measuring the Functional Status and Well-Being of Patients with Migraine Headache

SYNOPSIS
Objective: Compare adult migraineurs' health related quality of life to adults in the general U.S. population reporting no chronic conditions, and to samples of patients with other chronic conditions. Methods: Subjects (n=845) were surveyed 2–6 months after participation in a placebo-controlled clinical trial and asked to complete a questionnaire including the SF-36 Health Survey, a migraine severity measurement scale and demographics. Results were adjusted for severity of illness and comorbidities. Scores were compared with responses to the same survey by the U.S. sample and by patients with other chronic conditions. Results: Response rate was 67%. After adjustment for comorbid conditions, SF-36 scale scores were significantly (P 0.001 ) lower in migraineurs, relative to age and sex-adjusted norms for the U.S. sample with no chronic conditions. Some health dimensions were more affected by migraine than other chronic conditions, while other dimensions were less affected by migraine. Measures of bodily pain, role disability due to physical health and social functioning discriminated best between migraineurs, the U.S. sample, and patients with other chronic conditions. Patients reporting moderate, severe and very severe migraines scored significantly (P £ 0.001 ) lower on five of the eight SF-36 scales than the U.S. sample. Conclusions: Migraine has a unique, significant quality of life burden.     

梅尼埃病患者生存质量与疾病不确定感的相关性分析

目的 调查梅尼埃病患者的疾病不确定感与生存质量情况,并探讨两者的相关性。 方法 选取门诊及病房的140例梅尼埃病患者为研究对象,采用Mishel疾病不确定感量表(MUIS)和简明健康状况调查表(SF-36)进行横断面调查。 结果 ①梅尼埃病患者MUIS平均得分为(118.52±15.15)分。②梅尼埃病患者SF-36量表各维度的评分均明显低于常模组(P<0.01)。③不明确性、复杂性、信息缺乏及不确定感总分与SF-36各维度评分均呈显著的负相关(P＜0.05);不可预测维度与精力和社会功能呈低度正相关,与其他维度评分无显著的相关性。结论 梅尼埃病患者存在中度不确定感,且生存质量明显降低,患者疾病不确定感状态与生存质量呈负相关。     

社会支持与老年高血压病患者生活质量的研究

目的:探讨社会支持与老年高血压病患者生活质量的相关关系。方法:采用健康状况调查问卷和社会支持评定量表对103例老年高血压病患者及100例健康老年体检者的生活质量及社会支持进行评定,并对两者的相关关系进行统计学分析。结果:老年高血压病患者的生活质量及社会支持评分均低于正常人群(P<0.05,P<0.01),除患者机体功能状态外,社会支持与生活质量各维度之间呈显著正相关(P<0.05,P<0.01)。结论:社会支持可从心理层面影响老年高血压病患者的生活质量。     

Quality of life after participation in a rural phase II cardiac rehabilitation program

The purpose of this study was to explore the effectiveness of a cardiac rehabilitation program (phase II) in improving participants' quality of life (QOL). Existing data collected previously by a not-for-profit rural community hospital using the SF-36 tool were analyzed. The secondary data consisted of precardiac and post-cardiac rehabilitation SF-36 scores for 121 phase II participants. All the 8 subscale post scores of the SF-36 were higher when compared to the pre-rehabilitation scores. In this non-controlled trial, results suggest that participation in rural cardiac rehabilitation programs may improve patients' perceptions of QOL and health.     

Activity,participation, and quality of life 6 months poststroke

OBJECTIVES: To estimate the extent of activity and participation of individuals 6 months poststroke and their influence on health-related quality of life (QOL) and overall QOL, information that would be useful in identifying services that stroke patients would need in the community. DESIGN: Inception cohort study. SETTING: Ten acute care hospitals in metropolitan areas of the province of Quebec. PARTICIPANTS: Persons with first-ever stroke, either ischemic or hemorrhagic. In parallel, a population-based sample of community-dwelling individuals without stroke, frequency matched in age and city district, were also recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Stroke subjects were interviewed by telephone at 6-month intervals for 2 years of follow-up. The community-dwelling individuals without stroke were also followed. RESULTS: A total of 434 persons were interviewed approximately 6 months poststroke. Their average age +/- standard deviation was 68.4+/-12.5 years; the average age of the 486 controls was 61.7+/-12.4 years. The stroke group scored on average 90.6/100 on the Barthel Index; 39% reported a limitation in functional activities, 54% reported limitations with higher-level activities of daily living such as housework and shopping, and 65% reported restrictions in reintegration into community activities. By using the Medical Outcomes 36-Item Short-Form Health Survey (SF-36), persons with stroke rated their physical health 7 points lower than healthy peers; also, 7 of the 8 subscales of the SF-36 were affected by stroke. CONCLUSION: Almost 50% of the community-dwelling stroke population lived with sequelae of stroke such that, unless there was a full-time and able-bodied caregiver at home, they needed some form of home help. A large proportion also reported lack of meaningful activity, indicating a need for organized support groups for people with stroke; otherwise, boredom will lead to depression and worsening of function, affect, health status, and QOL.     

脑卒中后情感障碍患者的生存质量及其影响因素分析

目的:探讨脑卒中后情感障碍患者的生存质量及影响因素。方法:对入住本院康复科的脑卒中患者在出院前进行汉密尔顿抑郁量表和焦虑量表评定,确定128例脑卒中后情感障碍患者。采用健康调查简表(SF-36)对128例脑卒中后情感障碍患者在出院前和出院后6个月进行测量并做一般情况问卷调查,分析生存质量状况及其相关影响因素。结果:脑卒中后情感障碍患者生存质量明显降低,生存质量评定的8个维度平均得分(42.81±20.14)分。出院6个月后各维度平均得分均较出院时有一定提高,其中生理功能,生理职能,躯体疼痛,总体健康,精力5项维度评分提高差异有显著性意义(P0.05),但情感职能、社会职能、精神健康3项维度评分提高无显著性差异。影响生存质量评分的共同因素有性别、配偶状况、子女状况、生活护理、日常生活活动能力、认知状况、是否接受社区康复治疗(P0.05)。结论:脑卒中后情感障碍的生存质量与家庭状况、日常生活活动能力、认知功能密切相关,亲人的关爱与照护、社区康复的介入对生存质量改善起积极作用。     

Comparison of Telecommunication, Community, and Home-Based Tai Chi Exercise Programs on Compliance and Effectiveness in Elders at Risk for Falls

Wu G, Keyes L, Callas P, Ren X, Bookchin B. Comparison of telecommunication, community, and home-based Tai Chi exercise programs on compliance and effectiveness in elders at risk for falls.

Objective

To compare the adherence to and effectiveness of Tai Chi exercise program through a live, interactive, telecommunication-based exercise (Tele-ex) with that of a similar program through a community center-based exercise (Comm-ex) and a home video-based exercise (Home-ex) among community-dwelling elders who are at risk for falls.

Design

Three groups randomized controlled trial with pretests and posttests.

Setting

Exercise programs were community-based, and the outcome measures were laboratory-based.

Participants

Adults (N=64) age 65+ years with positive fall history in the previous year and/or significant fear of falling.

Intervention

A 24-form, Yang-style Tai Chi for 15 weeks, 3 hours a week.

Main Outcome Measures

Exercise compliance, number of falls, fear of falling (Activities-specific Balance Confidence [ABC] score), self-perceived health (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]), Timed Up & Go (TUG), single leg stance (SLS), and body sway during quiet stance (medial-lateral foot center of pressure [ML-COP]).

Results

Tele-ex and Comm-ex groups demonstrated significantly higher exercise attendance and in-class practice time than the Home-ex group (P<.01) and significant reductions in the mean number of falls and injurious falls (P<.01). There were significant improvements posttraining in SLS, ABC, ML-COP, and Physical Health subscore of the SF-36 (P<.05). Both Tele-ex and Comm-ex groups demonstrated larger improvements than the Home-ex group in TUG, ML-COP, and the Social Function, Mental Health, and Physical Health subscores of the MOS SF-36.

Conclusion

Compared with the Home-ex, the Tele-ex and Comm-ex groups are better in exercise compliance, fall reduction and balance and health improvements. Tele-ex is an effective, affordable, and acceptable choice of exercise for elders.