Lower limb atherosclerotic disease causes various deteriorations of patients' health-related quality of life.

BACKGROUND: Lower limb atherosclerotic disease (LLAD) is a worldwide health problem. Approximately 100,000 Finns have LLAD. Currently, a large number of health-related quality of life (HRQoL) studies are available, but we still have scant comprehensive information of HRQoL of patients with LLAD. OBJECTIVES: The aim was to describe the HRQoL of women and men with LLAD in relation to the age- and sex-matched general population. In addition, the purpose was to study which demographic and relevant clinical and psychologic factors are connected with HRQoL of patients with LLAD. METHODS: Patients with LLAD (N = 180, 62 women and 118 men) were recruited to participate in this study in the Clinic of Surgery, Oulu University Hospital, from 2001 to 2004. The control sample consisted of an age- and sex-matched general population (N = 2126; 1081 women and 1045 men). The HRQoL of the women and men with LLAD was evaluated using the Nottingham Health Profile (NHP) instrument, in relation to an age- and sex-matched general population (N = 2126) as well as demographic and relevant clinical and psychologic factors. RESULTS: The HRQoL of men was significantly (P < .05) poorer on all dimensions of the NHP instrument in the age groups 55 to 74 years. HRQoL was also clearly affected in the youngest age group of men on the dimensions of pain (P < .05) and mobility (P < .05) and further in the oldest age group on the dimension of energy (P < .05). The HRQoL of women with LLAD was only significantly poorer (P < .05) on the dimension of pain in the age group of 65 to 74 years than the HRQoL of age-matched Finnish women. The most emphasized relationships between poor HRQoL and the demographic, relevant clinical and psychologic factors were male sex, lack of exercise, retirement, a short painless walking distance, other atherosclerotic disease, poor subjective health status, problems with ability to cope at home, problems with the treatment of illness, and sex life. Male patients with LLAD had poorer HRQoL than the corresponding female patients on the dimensions of energy (P = .023), emotional reaction (P = .050), social isolation (P = .028), and NHP total score (P = .023). Those who did not exercise regularly had poorer HRQoL on the dimensions of energy (P = .005), pain (P = .049), emotional reaction (P = .007), social isolation (P = .001), and physical mobility (P = .028) than those who did exercise regularly. CONCLUSIONS: The HRQoL of middle-aged men was significantly poorer than that of controls. Male sex, retirement, asymptomatic walking distance, other atherosclerotic disease, lack of exercise, and feeling incapable of performing daily activities are important causes of impaired HRQoL. Health care professionals should pay extra attention to the development of rehabilitation programs aimed at preventing patients with LLAD from experiencing a myriad of problems.     

Poor health-related quality of life of patients with indication for chronic cardiac pacemaker therapy

Background: Studies on health-related quality of life (HRQoL) of patients awaiting pacemaker (PM) implantation are scarce, or executed in specific patient subgroups (regarding age or specific cardiac rhythm disorders). The purpose of this study was to systematically assess the HRQoL in a large unselected cohort of patients with a conventional indication for PM therapy.
Methods: Pre-PM implantation HRQoL (measured with the SF-36 questionnaire, completed at hospital admission) of 818 consecutive Dutch patients included in the FOLLOWPACE study was compared with the HRQoL in a sample of the general Dutch population, and with several cohorts of patients with other conditions. Linear regression analysis was performed to analyze determinants of this HRQoL.
Results: Almost all SF-36 subscale scores were substantially and significantly lower in the PM patients compared to the general population, with P-values < 0.001 in all SF-36 subscales except for "pain" and "general health perception." In the PM patients, presence of comorbidities, gender, and age were significantly associated with the overall physical component summary score (mean 38.8 ± 27 standard deviation) whereas the overall mental component summary score (46.8 ± 27.0) was associated with gender and age.
Conclusion: The HRQoL of patients before first PM implantation is significantly lower than that of a general population and also various other patient populations. Physicians should be aware of this unfavorable condition and keep the time interval between the diagnosis of a cardiac rhythm disorder requiring PM implantation and the implantation procedure as short as possible.     

Peripheral neuropathic pain--a multidimensional burden for patients.

The present study was undertaken to assess the health-related quality of life (HRQoL) and burden of illness due to pain and its treatment for patients with peripheral neuropathic pain (PNP). It is the first step in finding reliable instruments/targets to evaluate treatment outcome in this patient population. Study population consisted of 126 patients suffering from neuropathic pain due to a peripheral nerve or root lesion, recruited from two multidisciplinary pain clinics. HRQoL was examined using Short Form 36 (SF-36) Health Survey and Nottingham Health Profile (NHP). Pain intensity in four categories (at rest and evoked by movement, touch and cold) was rated on a visual analogue scale (VAS). Degree of discomfort from pain and 25 symptoms related to pain and side-effects was also assessed. Reduction in workload due to pain was recorded, as was the pain relief from previous and current treatments and the reasons for discontinuing previous treatments. All dimensions in SF-36 and NHP were significantly impaired. SF-36 was a valid instrument for describing the impact of pain on the HRQoL of patients with PNP. NHP had a lower reliability but has other advantages that might be of importance. Many patients experienced poor pain relief from ongoing pain treatments. Most previous treatments were discontinued owing to lack of efficacy and/or severe side-effects. Many patients experienced a high intensity of at least one type of pain; median VAS for the highest pain intensity score of each patient (any type of pain) was 74/100. Besides pain, patients were most bothered by difficulty in sleeping, lack of energy, drowsiness, difficulty in concentrating and dry mouth. Employment status was reduced owing to pain in 52% of the patients. The intense pain, other troublesome symptoms, limited efficacy and tolerability of available treatments, together with the impaired health and reduced work status, amount to a substantial burden for patients with PNP.     

Peripheral neuropathic pain—a multidimensional burden for patients

The present study was undertaken to assess the health-related quality of life (HRQoL) and burden of illness due to pain and its treatment for patients with peripheral neuropathic pain (PNP). It is the first step in finding reliable instruments/targets to evaluate treatment outcome in this patient population. Study population consisted of 126 patients suffering from neuropathic pain due to a peripheral nerve or root lesion, recruited from two multidisciplinary pain clinics. HRQoL was examined using Short Form 36 (SF-36) Health Survey and Nottingham Health Profile (NHP). Pain intensity in four categories (at rest and evoked by movement, touch and cold) was rated on a visual analogue scale (VAS). Degree of discomfort from pain and 25 symptoms related to pain and side-effects was also assessed. Reduction in workload due to pain was recorded, as was the pain relief from previous and current treatments and the reasons for discontinuing previous treatments.All dimensions in SF-36 and NHP were significantly impaired. SF-36 was a valid instrument for describing the impact of pain on the HRQoL of patients with PNP. NHP had a lower reliability but has other advantages that might be of importance. Many patients experienced poor pain relief from ongoing pain treatments. Most previous treatments were discontinued owing to lack of efficacy and/or severe side-effects. Many patients experienced a high intensity of at least one type of pain; median VAS for the highest pain intensity score of each patient (any type of pain) was 74/100. Besides pain, patients were most bothered by difficulty in sleeping, lack of energy, drowsiness, difficulty in concentrating and dry mouth. Employment status was reduced owing to pain in 52% of the patients.The intense pain, other troublesome symptoms, limited efficacy and tolerability of available treatments, together with the impaired health and reduced work status, amount to a substantial burden for patients with PNP.     

Comparison of Short Form-36 Health Survey and Nottingham Health Profile in moderate to severe patients with COPD

Objective  To compare the health-related quality of life (HRQoL) assessed by Short Form-36 Health Survey (SF-36) and Nottingham Health Profile (NHP) on the basis of lung function and exercise capacity parameters in patients with moderate to severe chronic obstructive pulmonary disease (COPD).
Methods and materials  The investigation was a prospective, quality-of-life survey and cross-sectional study of 130 consecutive COPD patients. The NHP and SF-36 as generic HRQoL instruments, the Chronic Respiratory Disease questionnaire (CRQ) as a disease-specific HRQoL instrument and 6-minute walking test, severity of dyspnea, leg fatigue and lung function, were the measurements and instruments used in the study.
Results  It was determined that the subscales of both questionnaires were generally related with the FEV₁, walking distance, CRQ, severity of dyspnea and leg fatigue values ( P  < 0.05). The much higher correlation coefficient was determined between these parameters and NHP compared with the SF-36. Only NHP was found to be correlated with the age, body mass index and smoking consumption ( P  < 0.05).
Conclusions  The stronger relation of NHP with the clinical and physical parameters of the patients compared with that of SF-36 may be associated with the increased sensitivity of NHP to the clinical state owing to the increasing respiratory symptoms of our old patients with moderate to severe obstruction and/or the more intelligible and easy-to-respond nature of NHP compared with SF-36.     

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

Objective The purpose of the current study was to assess, in patients scheduled for primary total knee replacement (TKR), the effects of pre‐surgery waiting time on pain and functional limitations related to the knee joint undergoing surgery, on health‐related quality of life (HRQoL) and on contralateral knee pain 6 months after surgery. Method A total of 141 patients scheduled for TKR were recruited from three hospitals in Quebec City, Canada, and followed up until 6 months after surgery. Pre‐surgery wait, defined as the time between enrolment on the pre‐surgery waiting list and surgery, was considered in four categories (≤3, >3–6, >6–9, >9 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC). HRQoL was measured with the SF‐36. Results Mean pre‐surgery waiting time was 184 (SD: 120.8) days. Six months after TKR, a significant difference was seen between the four groups of pre‐surgery wait in terms of HRQoL SF‐36 role physical [F(3, 136) = 2.74, P = 0.046] and contralateral knee WOMAC pain [F(3, 136) = 5.78, P = 0.0009] scores. Participants with the longest pre‐surgery wait (>9 months) showed the worst scores 6 months after TKR. Conclusions Longer pre‐surgery waiting time had a negative clinically important impact on HRQoL and contralateral knee pain 6 months after surgery.     

Demographic Characteristics of Patients with Severe Neuropathic Pain Secondary to Failed Back Surgery Syndrome

Background: Neuropathic pain commonly affects the back and legs and is associated with severe disability and psychological illness. It is unclear how patients with predominantly neuropathic pain due to failed back surgery syndrome (FBSS) compare with patients with other chronic pain conditions. Aims: To present data on characteristics associated with FBSS patients compared with those with complex regional pain syndrome, rheumatoid and osteoarthritis, and fibromyalgia. Methods: The PROCESS (Prospective Randomized Controlled Multicenter Trial of the Effectiveness of Spinal Cord Stimulation, ISRCTN 77527324) trial randomized 100 patients to spinal cord stimulation (n = 52) plus conventional medical management (CMM) or CMM alone (n = 48). Baseline patient parameters included age, sex, time since last surgery, employment status, pain location and severity (visual analogue scale), health‐related quality of life (HRQoL), level of disability, medication, and nondrug therapies. Reference population data was drawn from the literature. Results: At baseline, patients in the PROCESS study had a similar age and gender profile compared with other conditions. PROCESS patients suffered from greater leg pain and had lower HRQoL. PROCESS patients treatment cost was higher and they commonly took opioids, while antidepressants and nonsteroidal anti‐inflammatory drugs were more often used for other conditions. Prior to baseline, 87% of patients had tried at least 4 different treatment modalities. Conclusions: Patients suffering from chronic pain of neuropathic origin following FBSS often fail to obtain adequate relief with conventional therapies (eg, medication, nondrug therapies) and suffer greater pain and lower HRQoL compared with patients with other chronic pain conditions. Neuropathic FBSS patients may require alternative and possibly more (cost‐) effective treatments, which should be considered earlier in their therapeutic management.     

One-year prospective health-related quality-of-life outcomes in patients treated with conservative method, endovascular treatment or open surgery for symptomatic lower limb atherosclerotic disease.

BACKGROUND: There are no many reports on the long-term impacts of different treatments of lower limb atherosclerotic disease (LLAD) on patients' health behaviour, clinical outcome and health-related quality of life (HRQoL). AIMS: The purpose of this study was to follow up the HRQoL of LLAD patients before and after the conservative, endovascular or surgical treatment. METHODS: Patients who were treated conservatively (64 patients), scheduled for endovascular treatment (85 patients), or for elective surgery (31 patients) filled in the Nottingham Health Profile (NHP) questionnaire before treatment and 12 months after. The patients' background data were recorded, and their resting ankle-brachial pressure (ABI) was measured at baseline and 12 months later. RESULTS: Smoking increased statistically significantly (p=0.031) in the group of conservatively treated patients. The ABI and asymptomatic walking distance scores of the patients treated with endovascular (p=0.000/p=0.000) and surgical (p=0.000/p=0.000) procedures improved statistically significantly. Conservatively treated patients reported improvement of sleep (p=0.047) and emotional reactions (p=0.032). The patients with endovascular treatment reported improved emotional reactions (p=0.016), energy (p=0.027) and less social isolation (p=0.050). The surgically treated patients reported improvement of pain (p=0.001), mobility (p=0.048), sleep (p=0.030) and emotional reactions (p=0.007). CONCLUSION: Deterioration of any clinical characteristics or HRQoL was not observed after any of the treatment modalities. Surgery gave LLAD patients a good clinical outcome and HRQoL for at least a year, whereas patients who were treated with endovascular and especially conservative treatment gained limited benefits.     

Relationship between quality of life and functional status of young adults and adults with cerebral palsy

Purpose.?The aim of this study was investigate the relation between health related quality of life (HRQoL) and functional status in young adult or adult cerebral palsied individuals.

Methods.?The study included 45 cerebral palsied subjects who were divided into two groups as young adults (n?=?21, group 1) and adults (n?=?24, group 2), over the age 15 years. Gross Motor Function Classification System (GMFCS), Functional Independence Measurement (FIM), Physical Mobility Scale (PMS), Nottingham Health Profile (NHP), Visual Analogue Scale (VAS) were used as outcome measures.

Results.?In group 1, GMFCS and PMS scores were significantly correlated with total the total score of FIM (p?<?0.05). Although total FIM, PMS, LS and GMFCS scores were not correlated with the total NHP score (p?>?0.05), pain subscale of NHP was significantly correlated with self care and mobility subscales of FIM (p?<?0.05). Also, self care, mobility, locomotion subscales and total score of FIM were highly correlated with the physical activity subscale of NHP (p?<?0.05). In group 2, our findings were also similar to those of young adults when the relations between total NHP score and total FIM, PMS, LS and GMFCS were investigated (p?>?0.05) and also some subscales of FIM and NHP presented high correlations in between. In addition, there were significant differences between the groups in GMFCS, LS and locomotion and self care subscales of FIM (p?<?0.05).

Conclusion.?Although HRQoL in young cerebral palsied individuals seems to be more effected by parameters related to physical condition, in cerebral palsied adults psychological and emotional aspects may be more important indicators related to HRQoL. For that reasons, more population specific measures have to be developed for in-depth analysis of these factors.     

A telephone survey of day-surgery eye patients

The objective of this research study was to evaluate the nursing care processes and patient satisfaction with the new day-surgery services. Forty-five adult day-surgery eye Patients were selected at random to take part in a telephone survey. The response rate was 84·4% (38). Patients were contacted 48 hours post-surgery to obtain their view of the entire surgical experience. The research result found that the majority of the patients were satisfied with the day-surgery services. The main problems experienced by patients were long waiting times to see the doctor during pre-operation assessment, unsatisfactory journeys to and from theatre, and difficulty in remembering verbal advice. Twenty-eight (73·6%) of the day-surgery patients would prefer day-surgery again for a similar operation, but 10 (26·3%) would prefer a longer stay in hospital. The main implications for practice are that realistic assessment time should be allocated to reduces waiting time, verbal advice should be accompanied by written leaflets or audio-tape, and patients should be encouraged to make an informed choice about day or in-patient surgery. A Regular survey of day-surgery eye patients should be part of a general audit.     

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

Background

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

Methods

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

Results

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

Conclusions

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

Quality of life of patients with diabetes mellitus. An overview of research in primary health care in the Nordic countries

OBJECTIVE: A review of articles on health-related quality of life (HRQoL) among diabetes patients in primary health care in the Nordic countries. DESIGN: Search in PubMed and related sources. Used MeSH terms were: "Diabetes Mellitus", "Quality of Life", "Primary Health Care", and "Scandinavia" or "Denmark", "Finland", "Iceland", "Norway", or "Sweden". RESULTS: In total, 19 relevant articles were found, 9 from Finland and 10 from Sweden. HRQoL questionnaires used were from the Medical Outcomes Study, i.e. the SWED-QUAL in seven, SF-20 in four and SF-36 in one, NHP in two, GQL in two, GHQ in one, and own questionnaires in two. HRQoL was moderately affected in diabetic patients, with macrovascular diseases, especially coronary heart disease, and non-vascular diseases as the most consistently found and strongest predictors. Weaker predictors were microvascular complications, age, sex, metabolic level, and education. Other groups at higher risk of worse HRQoL were diabetes patients with psychiatric disorders, especially depression, and foreign-born patients. Good continuity of care was associated with better HRQoL. CONCLUSION: Diabetes affects the HRQoL through macrovascular complications and associated non-vascular comorbidity, and also by adding to the total burden of disease. Future research areas include transcultural and ethnic aspects, and effects of lifestyle interventions.     

Social Participation and Health Related Quality of Life in Early and Established Rheumatoid Arthritis Patients

Social participation has been recognized as one of the key variables to be addressed in disability research yet few studies addressed the association between restriction in participation and quality of life in the context of rheumatoid arthritis. The aim of this study was to explore the associations between restrictions in social participation and health related quality of life (HRQoL) in early and established group of rheumatoid arthritis (RA) patients. Two samples with early (n?=?97; age?=?53?±?12.3 years; disease duration?=?2.8?±?1.2 years; 76 % women) and established (n?=?143; age?=?58?±?10.3 years; disease duration?=?16.1?±?3.6 years; 86 % women) RA patients were collected. Respondents completed questionnaires on pain (NHP), fatigue (VAS), functional disability (HAQ), depression (HADS), social participation restrictions (Participation scale) and health related quality of life (SF-36). Data were analyzed using stepwise regression models controlling for the relevant variables. Perceived social participation restrictions in the group of early patients were found to be negatively associated with the mental health component of the HRQoL (β?=??0.192; p?≤?0.05) and in the established RA group with the physical health component of the HRQoL (β?=??0.271; p?≤?0.001). These results generally suggest the importance of social participation with regard to HRQoL in RA.     

The prevalence of postoperative pain in a cross-sectional group of patients after day-case surgery in a university hospital

OBJECTIVES: Although a great variety of surgical procedures are performed on an ambulatory basis, little is known about postoperative pain experience at home after ambulatory surgery. This study was performed to assess the prevalence and course of postoperative pain in the early postoperative period after ambulatory surgery. METHODS: Over a period of 4 months, 648 patients who underwent day-case surgery were included in our study. Data were collected with interviews and questionnaires. Pain intensity was measured using a visual analog scale (VAS) during 4 days after surgery. Side effects of anesthesia and analgesia techniques were also recorded. RESULTS: On the day of the operation, 26% of the patients had moderate to severe pain (defined as mean VAS >40 mm). Mean VAS-scores were greater than 40 mm in 21% on postoperative day (POD) 1, in 13% on POD 2, in 10% on POD 3, and in 9% on POD 4. Operations of nose and pharynx, abdominal operations, plastic surgery of the breasts, and orthopedic operations were the most painful procedures during the first 48 hours. DISCUSSION: This study showed that an important number of patients still experience moderate to severe pain in the postoperative period after day-case surgery even after a 4-day period. Furthermore, the type of operation should be considered when planning postoperative analgesia for ambulatory surgery.     

Treatments of coronary artery disease improve quality of life in the long term

BACKGROUND: Cardiovascular diseases are currently the most common cause of death worldwide. This trend has been predicted to continue until 2020. The effects of treatments by bypass operation or angioplasty on the long-term health-related quality of life (HRQoL) in patients with coronary artery disease (CAD) have not been adequately studied. OBJECTIVE: To measure the HRQoL and its changes during 8 years of follow-up after a treatment intervention. METHODS: The primary study series consisted of 280 patients, of whom 100 underwent coronary artery bypass grafting (CABG), 100 had percutaneous transluminal coronary angioplasty (PTCA), and 80 were prescribed medication. At 1 year, 81 CABG patients, 74 PTCA patients, and 64 patients in the medication group responded. In the final analysis after 8 years, 63 CABG patients, 57 PTCA patients, and 34 patients in the medication group remained. HRQoL surveys were conducted 1 and 8 years after the treatment interventions. HRQoL was measured using the Nottingham Health Profile (NHP), which has been tested and evaluated in Finland. RESULTS: CABG patients had a statistically significantly better HRQoL 8 years after the operation than at baseline on the dimensions of mobility (p <.001), energy (p =.003), and pain (p =.031). PTCA patients had a statistically significantly better HRQoL 8 years after the intervention on the dimensions of emotional reactions (p =.002), pain (p =.003), mobility (p =.004), and energy (p =.005). A significant impairment on the dimension of sleep had taken place during the 8 years follow-up after PTCA (p =.018). No significant changes were seen in the HRQoL of the patients on medication at either 1 or 8 years. DISCUSSION: The need for treatment and primary and secondary prevention of CAD will increase in the future, especially in the case of high-risk patients. The present findings indicate that CABG and PTCA continue to significantly improve CAD patients' HRQoL 8 years after the intervention.     

心理干预对子宫肌瘤患者术后生活质量的影响

目的 探讨心理干预对子宫肌瘤患者术后生活质量的影响.方法 将320例子宫肌瘤患者按随机数字表法随机分为干预组160例和非干预组160例,2组全子宫切除、次全子宫切除、子宫肌瘤剔除、血管介入治疗各40例.对干预组的患者进行手术前、后的综合心理干预,采用Olson婚姻质量调查问卷及诺丁汉健康量表对干预组和非干预组手术前、后生活质量及婚姻质量进行评估.结果 手术前干预组和非干预组间诺丁汉健康量表生活质量评分和Olson婚姻质量各项记分差异均无统计学意义(P均>0.05).手术后,非干预组中全子宫切除组的生活质量评分较术前升高、婚姻质量评分较术前降低(P<0.05或P<0.01),次全子宫切除组、肌瘤剔除组及血管介入治疗组的生活质量评分较术前明显降低,婚姻质量评分较术前升高(P<0.05或P<0.01).手术后,干预组中全子宫切除组、次全子宫切除组、肌瘤剔除组及血管介入治疗组的生活质量评分均较非干预组降低,婚姻质量评分较非干预组升高(P<0.05或P<0.01).2组患者手术前后卵巢功能均正常,手术前后女性激素各项指标比较差异均无统计学意义(P均>0.05).结论 手术前后综合心理干预有利于提高子宫肌瘤患者术后的生活质量.     

The Association of Neurocognitive Decline and Other Variables With Return to Work,Hobbies, and Activities of Daily Living After Coronary Artery Bypass Graft Surgery

ABSTRACT

Purpose: Coronary artery bypass graft (CABG) surgery is an integral method of palliative treatment for coronary artery disease. Despite many advances in surgical techniques, some patients continue to have neurocognitive deficits after surgery. The impact of these deficits on the patient's ability to return to work (RTW), daily activities of life, and hobbies has not been evaluated fully. The goal of this research project is to describe variables associated with the patients’ ability to RTW and necessary and essential activities. Methods: Sixty-three subjects who had CABG surgery with cardiopulmonary bypass (CPB) and who participated in neurocognitive testing preoperatively and postoperatively were interviewed by telephone 7–8 years after CABG surgery. Information was obtained on functional status measured by the Nottingham Health Profile (NHP), symptoms of depression measured by the Center for Epidemiological Studies Depression Scale, RTW status, and ability to participate in hobbies and activities of daily living (ADL) after CABG surgery. Bivariate and multivariate analyses were used to describe the relationship of neurocognitive, clinical, and social variables to RTW, hobbies, and ADL. Results: The ability to return to hobbies and ADL did not vary between individuals who experienced neurocognitive decline and those who did not (p = 0.755). Age and presence of angina were significantly associated with difficulty in returning to work (p = 0.009, p = 0.042). Higher scores on the Center for Epidemiological Studies Depression Scale after surgery were significantly associated with higher NHP scores (p = 0.000) and presence of shortness of breath (p = 0.000). Presence of angina (p = 0.035) was significantly associated with higher scores on the NHP. Conclusions: The relationship of neurocognitive decline after CABG surgery with RTW and activities remains unclear. Studies with larger sample size will further elucidate these relationships.     

Quality of life after complicated elective surgery requiring intensive care

Objective To evaluate outcomes of patients admitted to the ICU for complications after elective surgery and to assess perceived quality of life (pQOL) in survivors.Design Two-year prospective case-control study.Setting Twelve-bed ICU in a university-affiliated hospital.Patients Patients admitted to the ICU for a complication following elective surgery were included. Six months after discharge, pQOL was assessed using the Nottingham Health Profile (NHP). Results were compared to those of matched controls without complications.Interventions NoneMeasurements and results Of the 182 patients, 124 were alive after 6 months, among whom 116 had 6-month data and 104 of these had matched controls. Overall pQOL as assessed by the global NHP score was similar in both groups (median, 0.82 and 0.87 in cases and controls; P=0.24). NHP subscores showed significantly worse pain (P=0.03) and physical impairment (P=0.02) in the ICU patients. In the multivariate analysis, pQOL was better in patients with cancer as the reason for surgery (P=0.05). Severity of illness at inclusion had no influence on subsequent pQOL, but cardiovascular dysfunction was associated with decreased energy (P=0.04).Conclusions Although overall pQOL was satisfactory after 6 months, patients admitted to the ICU for postoperative complications had worse pain and physical impairment than controls. Whether these outcomes could be improved by early physiotherapy and aggressive pain management deserves investigation.     

Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke.

OBJECTIVE: To measure the effects of Bobath-based (BB) therapy on depression, shoulder pain and health-related quality of life (HRQoL) of patients during one year after stroke. DESIGN: In a prospective, non-randomized design, the use of BB therapy was compared with a more task-oriented therapy and no BB therapy. SUBJECTS: A total of 324 patients in 12 hospitals. METHODS: Patients in the intervention group received BB therapy, whereas patients in the control group received no BB therapy and a more task-oriented therapy. HRQoL was measured using the SF-36; depression was measured with the Center of Epidemiological Studies Depression Scale and shoulder pain was measured with the Visual Analogue Scale at discharge, 6 and 12 months. Linear and logistic regression analyses were performed. RESULTS: No effects of BB therapy on HRQoL or shoulder pain were found. After one year fewer patients were depressed in the BB group (30%) than in the non-BB group (43%); the adjusted odds ratio was 0.6 (95% confidence interval 0.3-1.0). CONCLUSION: BB therapy did not have any effect on HRQoL or shoulder pain in stroke patients. Healthcare professionals should reconsider the use of BB therapy in the care of stroke patients.