Functional Outcomes in Patients with Chronic Nonmalignant Pain on Long‐Term Opioid Therapy

? Abstract Objectives: Although long‐term opioid therapy for chronic nonmalignant pain (CNMP) is widely accepted, it is controversial as to whether long‐term benefits outweigh detrimental side effects. This study examines the effect of long‐term opioid therapy on quality of life in terms of both physical and mental health in patients with CNMP. Methods: We retrospectively studied a cohort of patients with CNMP. With informed consent, data were collected prior to and at 6–36 months after the institution of opioid therapy in 67 patients with CNMP. The Short Form 36 (SF‐36) health survey was used to compare self‐reported measures of health‐related quality of life in nine subscales. Visual analog scale (VAS) for pain intensity scores, disability status, and ability to return to work were also assessed. The pre‐ and post‐therapy parameters were compared. Results: The average scores of self‐reported quality of life improved significantly in eight out of the nine parameters in the SF‐36 after at least 6 months of opioid therapy. The increase in reported scores was statistically significant for physical functioning, physical role, bodily pain, general health, validity, social functioning, emotional role, and mental health. No significant changes were observed in reported health transition, VAS pain scores, disability status, or return to work. Conclusions: We conclude that judicious use of opioid therapy may lead to improvement in perceived quality of life and certain aspects of functional capacity and daily activities in a highly selected group of patients with CNMP who have not responded to other therapeutic modalities for over 6 months. ?     

Physical activity six months after a myocardial infarction

In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged ≤ 65 years. The self-report question showed that < 40% of the patients were engaged in at least 30 min of physical activity every day. The pedometric physical activity data showed a daily mean number of steps of 6719. The self-report question was correlated with the pedometric registration data. Among myocardial infarction patients, physical activity 6 months after the acute heart attack was insufficient in the majority of patients, both when evaluated with a self-report question and when evaluated with a pedometer. Efforts to increase physical activity after myocardial infarction are warranted.     

心肌梗死患者重返工作后生活质量的现状调查

目的 对心肌梗死患者重返工作后的生活质量进行调查,分析影响生活质量的因素,为制订针对性的二级预防和干预措施提供借鉴。方法 采取便利抽样方法,采用一般资料调查表、医学结局研究简短量表-8、健康促进生活方式评定量表Ⅱ、医学应对方式量表和社会支持评定量表对郑州市3所医院326例已重返工作的心肌梗死患者进行问卷调查。结果 心肌梗死患者重返工作后生活质量总分为(28.03±2.55),在社会功能(2.48±1.09)、情感角色(2.22±0.87)和精神健康(2.38±0.88)方面得分较低,影响生活质量的因素为面对应对维度得分、屈服应对维度得分、年龄、重返工作时间、支架植入个数、家庭月收入、合并症、是否参与及完成心脏康复等(P<0.05)。结论 心肌梗死患者重返工作后的生活质量水平有待提高,应根据影响生活质量的因素开展针对性的干预,提高心肌梗死患者重返工作后的生活质量,从而帮助患者更好地回归社会。     

The effect of individual training and counselling programme for patients with myocardial infarction over patients’ quality of life

The aim of the present study was to identify the effect of individual training and counselling programme for patients having experienced myocardial infarction over patients’ quality of life. The sample was composed of 90 patients, 45 in the intervention and 45 in the control group, selected by sequential sampling from patients who had myocardial infarction for the first time. Data were collected between April and November 2008 by means of patient information form, Myocardial Infarction Dimensional Assessment Scale MIDAS, and Short Form SF‐36. In the intervention group, more improvement was observed in comparison with the control group in terms of quitting smoking, physical activity, body mass index, waist circumference (mean differences P = 0.000). A significant difference was observed in the third month of evaluation of both MIDAS and SF‐36 quality of life scales in comparison with the baseline values (P ≤ 0.000). The results indicated that individual training and counselling provided to patients having experienced acute myocardial infarction lead to improvement in quality of life and decrease risk factors by increasing behaviours that protect cardiac health. Such educational programmes should be applied to patients with acute myocardial infarction prior to discharge.     

Does a telephone follow‐up intervention for patients discharged with acute myocardial infarction have long‐term effects on health‐related quality of life? A randomised controlled trial

Aims. An earlier combined proactive and reactive telephone follow‐up intervention for acute myocardial infarction patients after discharge from hospital showed positive effects after six months. The aim of the present study was to assess whether the intervention has long‐term effects up to 18 months after discharge. Design. A prospective randomised controlled trial with 18 months follow‐up. Method. The trial was conducted with 288 patients allocated to a telephone follow‐up intervention group (n = 156) or control group (n = 132). The primary endpoint was health‐related quality of life using the SF‐36. Secondary endpoints included smoking and exercise habits, return to work and rehospitalisation due to chest pain. Results. There were significant improvements over time on most dimensions of health‐related quality of life in both the intervention and control group to US norm population levels on most SF‐36 dimensions and summary scores. The intervention group showed no overall significant improvement beyond six months in the physical or mental summary scores, but there was a significant effect for those aged 70 or above. Although there was a promising effect for rehospitalisation due to chest pain, no significant differences were found between the groups on the secondary endpoints after six months. Conclusion. This study demonstrated that despite positive short‐term effects at six months, the telephone follow‐up intervention had no long‐term effects on health‐related quality of life or secondary endpoints. However, the potential for improvement beyond six months was less than anticipated reflecting a reduced morbidity among acute myocardial infarction patients. Relevance to clinical practice. Telephone follow‐up after discharge from hospital is an easy implementable follow‐up intervention enabling individualised provision of information and support in a time often experienced as stressful by patients. Our study indicates that six months is an adequate support period. Despite positive results six months after discharge no significant added long‐term effects of telephone follow‐up, compared to usual care were found in this study.     

Mokken scaling of the Myocardial Infarction Dimensional Assessment Scale (MIDAS)

Aims The purpose of this study was to examine the hierarchical and cumulative nature of the 35 items of the Myocardial Infarction Dimensional Assessment Scale (MIDAS), a disease‐specific health‐related quality of life measure. Method Data from 668 participants who completed the MIDAS were analysed using the Mokken Scaling Procedure, which is a computer program that searches polychotomous data for hierarchical and cumulative scales on the basis of a range of diagnostic criteria. Results Fourteen MIDAS items were retained in a Mokken scale and these items included physical activity, insecurity, emotional reaction and dependency items but excluded items related to diet, medication or side‐effects. Item difficulty, in item response theory terms, ran from physical activity items (low difficulty) to insecurity, suggesting that the most severe quality of life effect of myocardial infarction is loneliness and isolation. Conclusions Items from the MIDAS form a strong and reliable Mokken scale, which provides new insight into the relationship between items in the MIDAS and the measurement of quality of life after myocardial infarction.     

The effects of gender and age on health-related quality of life following kidney transplantation

Aims and objectives. To evaluate whether gender, age and their interaction affect health‐related quality of life and overall health status following kidney transplantation. Background. Some investigators have examined the main effects of gender and/or age on health‐related quality of life following kidney transplantation, but the potential interaction effect of these measures on this outcome has not been reported. Design. This was a cross‐sectional, single‐centre study, based in one US geographic area. Methods. Self‐report survey data were provided by adult kidney transplant recipients using the SF‐36 Health Survey (SF‐36) and a visual analogue scale of overall health. SF‐36 physical and mental component summary and individual scales and overall health were measured prospectively at one time point post‐transplant. All adult patients were eligible to participate and rolling enrolment was employed. Statistical effects were tested using analysis of covariance (controlling for time post‐transplant). Results. Subjects (n = 138) included 66 women and 72 men. There were no effects of gender, age group, or their interaction on MCS or overall health scores (all p ≥ 0·12). Physical component summary scale data demonstrated: (i) a significant effect of gender (p = 0·025); (ii) a statistically marginal effect of age group (p = 0·068); and (iii) a statistically marginal gender by age group interaction effect (p = 0·066). Women reported poorer scores on the SF‐36 physical functioning (p = 0·049), role physical (p = 0·014) and bodily pain scales (p = 0·028). There was an effect of age group on physical functioning (p = 0·005), with younger patients reporting higher scores. Conclusions. Women report lower scores on several physical measures and may experience a greater reduction with age in physical health‐related quality of life than men. Physical functioning declines with age following kidney transplantation. Relevance to clinical practice. Findings may help healthcare professionals to develop gender‐ and age‐specific interventions to optimize health‐related quality of life of kidney transplant patients.     

Family support for physical activity post‐myocardial infarction: A qualitative study exploring the perceptions of cardiac rehabilitation practitioners

Physical activity post‐myocardial infarction has numerous health benefits, yet uptake through cardiac rehabilitation is poor. Whilst family support can facilitate patients' recovery, little is known about the role family may play in supporting physical activity for post‐myocardial infarction patients. This qualitative study used semistructured interviews with 14 cardiac rehabilitation practitioners to explore their perceptions about the role of the family in supporting post‐myocardial infarction patients' physical activity. Data were transcribed verbatim and analyzed thematically. Three familial roles were identified: “family as a second pair of ears,” “family as physical activity regulators,” and “family as social support.” A fourth theme, “factors that influence family support,” described how family health beliefs and perceptions could influence the physical activity support provided. Practitioner perceptions suggest families play an important role in post‐myocardial infarction patients' physical activity, which is enhanced when families personally value physical activity. Integrating the family into cardiac rehabilitation may help facilitate physical activity‐related interactions and promote positive engagement for patients.     

Perceptions of illness and its development in patients with multiple sclerosis: a prospective cohort study

Title. Perceptions of illness and its development in patients with multiple sclerosis: a prospective cohort study. Aim. This paper is a report of a study to examine the degree to which socio‐demographic variables, clinical variables and health‐related quality of life are related to perceptions of disease severity and changes in disease severity in patients with multiple sclerosis. Background. Studies have shown that patients with multiple sclerosis report lower quality of life than the general population. Method. Questionnaires measuring health‐related quality of life and perceived multiple sclerosis severity were mailed twice, 1 year apart, in May/June of 2000 and 2001, (t₁ and t₂), to patients with confirmed multiple sclerosis in Oslo, Norway (n = 502). Clinical data about disease onset and course were retrieved from the Oslo City Multiple Sclerosis Registry. Findings. Among the 313 (62·4%) people who responded at both times, those with primary progressive disease course reported higher perceived multiple sclerosis severity (P < 0·001), more mental health problems (P = 0·004) and lower physical functioning (P < 0·001) than those with a relapsing remitting/secondary progressive disease course. Patients with primary progressive disease course reported higher mean scores for multiple sclerosis severity at t₂ than at t₁. Multivariate regression analysis showed that social functioning was the only factor with statistically significant relationships to perceived multiple sclerosis severity among all sub‐domains of health‐related quality of life or personal factors. However, physical impairment was also independently related to patients’ ratings of changes in multiple sclerosis severity during the year and illness severity 1 year later. Conclusion. In addition to patients’ physical impairment, healthcare workers should pay special attention to issues related to their social functioning.     

Long-term exercise maintenance, physical activity, and health-related quality of life after cardiac rehabilitation

OBJECTIVE: The purpose of this study was to determine exercise maintenance rate, leisure-time objective physical activity level, and health-related quality of life in relation to exercise maintenance over the 6-mo period after a supervised 5-mo recovery-phase cardiac rehabilitation program in acute myocardial infarction patients. The study also investigated whether exercise maintenance resulted in reproducible health-related quality-of-life outcomes comparable with those of the Japanese normal population. DESIGN: This observational study comprised 109 acute myocardial infarction patients (89 men, 20 women; mean age, 63.5 +/- 10.1 yrs). Physiologic outcomes (peak oxygen uptake, handgrip, and knee-extension strength) measured at 1 and 6 mos after acute myocardial infarction onset were compared. Completed exercise maintenance and health-related quality-of-life questionnaires and results of electronic pedometer recordings to evaluate leisure-time objective physical activity level were assessed 6 mos after cardiac rehabilitation. RESULTS: The mean period from acute myocardial infarction to evaluation of outcomes was 18.8 +/- 3.4 mos. Ninety of 109 patients (82.6%) continued exercise for >6 mos after cardiac rehabilitation (exercise group); 19 patients (17.4%) quit exercise after cardiac rehabilitation (nonexercise group). Improvement in physiologic outcomes was noted at 6 mos vs. those at 1 mo, but outcomes were not significantly different between groups. The exercise group performed significantly better than the nonexercise group for leisure-time objective physical activity level and scored significantly higher than the nonexercise group for seven of eight health-related quality of life measures, attaining scores similar to those of the Japanese normal population. CONCLUSIONS: At >18 mos after acute myocardial infarction, the exercise maintenance rate in our patients remains high, and exercise maintenance may be one of the factors contributing to improvement of health-related quality of life and leisure-time objective physical activity level.     

Health‐related quality of life among adult patients with moderate and severe von Willebrand disease

Summary. Background: von Willebrand Disease (VWD) is the most frequent inherited bleeding disorder. It is unknown how this disorder affects quality of life. Objectives: This nationwide multicenter cross‐sectional study determined health‐related quality of life (HR‐QoL) in adult patients with moderate or severe VWD, and assessed whether bleeding severity and type of VWD are associated with HR‐QoL. Methods: HR‐QoL was assessed using the Short Form (SF)‐36, and bleeding severity was measured using the Bleeding Score (BS). Results: Five hundred and nine patients participated; 192 males and 317 females, median age and range 45 (16–87) and 47 (16–84) years, respectively. Compared with the general population, HR‐QoL in VWD patients was lower in the vitality domain (61 vs. 66 P < 0.001 for females, 67 vs. 72 P < 0.001 for males). Patients with the most severe bleeding phenotype (highest quartile BS, BS > 17) had a lower HR‐QoL in eight domains than patients with a less severe bleeding type (lowest quartile BS, BS < 7) in the univariate analysis. After adjustment for age, gender, co‐morbidity and employment/educational status, a more severe bleeding phenotype was associated with lower scores on the domains of physical functioning, role limitations due to physical functioning, bodily pain, general health, social functioning and physical component summary. Conclusions: HR‐QoL is lower in VWD patients compared with the general population. HR‐QoL is strongly associated with bleeding phenotype.     

Changes in hope and health‐related quality of life in couples following acute myocardial infarction: a quantitative longitudinal study

Scand J Caring Sci; 2013; 27; 295–302 Changes in hope and health‐related quality of life in couples following acute myocardial infarction: a quantitative longitudinal study Background: Acute myocardial infarction (AMI) is a life‐changing event that affects both the patient and the family and can have an influence on hope as well as HRQoL during the recovery period. Aims: To compare self‐rated scores of hope and health‐related quality of life (HRQoL) 1, 7, 13 and 25 months, after an AMI with regard to (i) differences across time, and (ii) differences between patients and their partners. Design: Explorative and longitudinal study. Methods: In this nonrandomized study, Short Form 36 Health Questionnaire (SF‐36) and Herth Hope Index‐Swedish (HHI‐S) questionnaires were completed by thirteen post‐AMI patients and their partners. Data were collected on four occasions. Results: In general, hope as well as HRQoL scores increased over time. A 2 (groups) × 4 (times) anova for mixed design showed significant changes in mental as well as in physical health over time but no significant effect of group on mental or physical health. Calculation of the minimum detectable change (MDC‐index) for HHI‐S and SF‐36 revealed that scores between data collection points were not stable. Conclusion: Our results show that although hope and HRQoL scores increased, only a few of the changes were statistically significant. Neither HHI‐S nor SF‐36 seems to measure stable states. Changes in hope and HRQoL levels may be due to participants striving to adapt to the current situation. Relevance to clinical practice: These results can be used in the training of nursing staff to enhance their understanding of the significance of a family‐centred approach after an AMI.     

Health status and quality of life of elderly persons with severe hemophilia born before the advent of modern replacement therapy

Summary. Background: More and more people with severe hemophilia reach an old age thanks to an effective treatment. There is no information on the health status and quality of life of elderly people with hemophilia born at a time when replacement therapy was hardly available. Methods: Italian patients with severe hemophilia, aged ≥65 years and hence born in 1942 or earlier, were compared with elderly men without bleeding disorders matched for age, sex, geography and social status. The following aspects were evaluated: concomitant illness, orthopedic status, physical functioning and cognitive status. Measurements of generic and disease‐specific health‐related quality of life were also obtained, together with the presence or absence of depression. Results: Thirty‐nine patients, aged 65–78 years, were investigated; 33 had hemophilia A. All patients had started regular treatment on demand only when they were already 25–30 years of age. Patients were compared with 43 men without hemophilia, aged 65–79 years. More patients with hemophilia had chronic hepatitis B and C, HIV infection and hypertension. On the other hand, their elderly peers without hemophilia were more frequently hypercholesterolemic and had more cardiovascular diseases. Most hemophiliacs had arthropathy and worse values for physical functioning, but their cognitive status was similar to that of elderly non‐hemophiliacs. Hemophiliacs reported greater depression and lower health‐related quality of life. Conclusions: Elderly patients with hemophilia have more co‐morbidities and problems in daily living, but similar cognitive status as age‐matched non‐hemophilic peers. They have more chronic viral infections and hypertension but fewer cardiovascular diseases. These observations should help to optimize health care delivery in this increasing and neglected population of people with hemophilia.     

Cardiac rehabilitation program participation and outcomes after myocardial infarction.

Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.     

Effectiveness of a community‐based nurse‐led lifestyle‐modification intervention for people with serious mental illness and metabolic syndrome

The development of metabolic syndrome negatively affects the quality of life of people with serious mental illness. Experts agree on the need to evaluate the physical health of patients and intervene in modifiable risk factors, with emphasis on the promotion of healthy lifestyles. Interventions should include nutritional counselling and physical activity. This 24‐week randomized trial evaluated the effects of a community‐based nurse‐led lifestyle‐modification intervention in people with serious mental illness meeting metabolic syndrome criteria, and its impact on health‐related quality of life and physical activity. Sixty‐one participants from two community mental health centres were randomly assigned to the intervention or control group. The intervention consisted of weekly group sessions, with 20 min of theoretical content and 60 min of nurse‐led physical activity. Postintervention results between groups showed no differences in weight, waist circumference, fasting glucose, and systolic blood pressure. Differences in body mass index, triglyceride concentrations, and diastolic blood pressure were found to be significant (P = 0.010, P = 0.038, and P = 0.017). Participants who performed the intervention reported an increase in physical activity, which did not occur in the control group (P = 0.035), and also reported better health status (P < 0.001). Our intervention showed positive effects reducing participants’ cardiovascular and metabolic risks and improving their physical activity and quality of life. To our knowledge, this is the first clinical trial led and carried out by mental health nurses in community mental health centres which takes into account the effects of a lifestyle intervention on every metabolic syndrome criterion, health‐related quality of life, and physical activity.     

Work status and chronic low back pain: exploring the international classification of functioning,disability and health

Purpose.?Exploring which variables are related to work status in patients with chronic low back pain (CLBP), classified according to the International Classification of Functioning, Disability and Health (ICF).

Method.?Ninety-two patients with CLBP filled out questionnaires inquiring after health status, impairments in body functions/structures, limitations in activities of daily living (ADL), participation in work, environmental and personal factors. Additionally, patients performed tests to measure physical fitness and performance of work-related activities. Univariate analyses were performed to investigate whether differences exist between working and non-working patients. Logistic linear regression analysis was performed to explain work status from the variables of functioning.

Results.?Non-working patients had a lower self-reported physical and mental health, lower physical fitness, more self-reported limitations in ADL, lower education, more depressive symptoms and higher psycho neuroticism than working patients. Self-reported physical and mental health and educational level correctly classified 84.5% of the patients as working or non-working. Performance of work-related activities was not significantly related with work-status.

Conclusions.?The relation between work status and CLBP is multidimensional, as was illustrated by using the bio-psychosocial model of the ICF. Patients with a low educational level, a low self-reported physical or mental health were more likely to be non-working. Self-reported limitations and physical and mental health are more important in explaining work status than objective measurements of performance.     

Quality of life and well‐being of people receiving haemodialysis treatment in Scotland: A cross‐sectional survey

End‐stage renal disease is a complex, progressive and debilitating illness that affects patients’ quality of life, physical and mental health, well‐being, social functioning and emotional health. A cross‐sectional survey was carried out in renal dialysis centres in Scotland to assess patients’ health status and the impact of haemodialysis treatment on quality of life and well‐being. Participants scored considerably lower than the UK general population in all domains of health‐related quality of life, although mental health components were nearer to general population norms than physical health components. However, nearly half of the participants achieved a score on a general well‐being questionnaire that was indicative of stress and anxiety. Increasing age was associated with better overall mental health but worse physical functioning. Increasing levels of hope and support were associated with improved general well‐being.