Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain

Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain.

Objective

To examine the psychometric properties including test-retest reliability, construct validity, and minimum levels of detectable and clinically important change for the Neck Disability Index (NDI) and the numeric rating scale (NRS) for pain in a cohort of patients with neck pain.

Design

Single-group repeated-measures design.

Setting

Outpatient physical therapy (PT) clinics.

Participants

Patients (N=137) presenting to PT with a primary report of neck pain.

Interventions

Not applicable.

Main Outcome Measures

All patients completed the NDI and the NRS at the baseline examination and at a follow-up. At the time of the follow-up, all patients also completed the global rating of change, which was used to dichotomize patients as improved or stable. Baseline and follow-up scores were used to determine the test-retest reliability, construct validity, and minimal levels of detectable and clinically important change for both the NDI and NRS.

Results

Test-retest reliability was calculated using an intraclass correlation coefficient (ICC) (NDI ICC=.50; 95% confidence interval [CI], .25-.67; NRS ICC=.76; 95% CI, .51-.87). The area under the curve was .83 (95% CI, .75-.90) for the NDI score and .85 (95% CI, .78-.93) for the NRS score for determining between stable and improved patients. Thresholds for the minimum clinically important difference (MCID) for the NDI were 19-percentage points and 1.3 for the NRS.

Conclusions

Both the NDI and NRS exhibit fair to moderate test-retest reliability in patients with mechanical neck pain. Both instruments also showed adequate responsiveness in this patient population. However, the MCID required to be certain that the change in scores has surpassed a level that could be contributed to measurement error for the NDI was twice that which has previously been reported. Therefore the ongoing analyses of the properties of the NDI in a patient population with neck pain are warranted.     

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain.

Objective

To determine whether neck manipulation is more effective for neck pain than mobilization.

Design

Randomized controlled trial with blind assessment of outcome.

Setting

Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.

Participants

Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner.

Interventions

Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks.

Main Outcome Measure

The number of days taken to recover from the episode of neck pain.

Results

The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66-1.46).

Conclusions

Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.     

Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study

Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study.

Objective

To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin.

Design

A randomized, double-blind, placebo-controlled pilot study.

Setting

Outpatient physical medicine and rehabilitation clinic of a university-affiliated tertiary hospital.

Participants

A total of 29 subjects enrolled from among 45 screened patients. No subject withdrawal due to serious adverse events occurred.

Intervention

Subjects were evaluated at baseline, received a 1-time injection of either BTX-A (treatment group) or saline (control group), and were followed up at 2 weeks and at months 1, 2, 3, 4, and 6.

Main Outcome Measures

Visual analog scale (VAS) for pain, the Neck Disability Index (NDI), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36).

Results

Improvements in the VAS and NDI scores were seen in the treatment group but were not significant when compared with the controls. Statistically significant improvements for the treatment group were seen in the SF-36 bodily pain (at months 2 and 4) and mental health (at month 1) scales but not in the other scales, nor in the summary measures. No serious adverse events were reported.

Conclusions

Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic.     

A national framework for supporting improvements in the physiotherapy assessment and management of low back pain: the Scottish experience

Background

Similar to other countries worldwide, Scotland lacked a national view of whether the quality of the physiotherapy management of low back pain was compliant with national guidelines. Anecdotal evidence suggested that standards of care varied considerably despite the wide availability of clinical guidelines to clinicians.

Aim

To develop a framework that supports National Health Service (NHS) Scotland in providing consistently applied high-quality physiotherapy assessment and management of low back pain in line with guideline recommendations.

Design

Prospective, multicentred national study, data collection and improvement phase.

Setting

All NHS boards in Scotland (n = 14) plus two private provider sites.

Participants

One hundred and eighty-six individual NHS sites and two private providers of services to patients with low back pain.

Method

A national dataset was developed from evidence- and consensus-based guideline sources. All sites collected data (two 5-week periods) over 1 year (2008-2009) using a web-based database. This was interspersed by an improvement phase during which required improvements were considered and implemented. Issues were shared through a national network and national meeting.

Results

Data from 2147 patients showed improvements in the documented physiotherapy management of low back pain over the two cycles. All participants developed and implemented remedial action plans based on the results of the first cycle.

Conclusion

It is possible to implement a framework, which is led nationally but driven and owned locally, supporting physiotherapists in an active programme of locally determined improvement. However, although process and outcome are linked, the direct impact of this initiative on patient outcome is not known.     

Prevalence and Impact of Pain in Multiple Sclerosis: Physical and Psychologic Contributors

Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors.

Objective

To characterize the prevalence and impact of pain in veterans with multiple sclerosis (MS) and to assess their association with demographic, biologic, and psychologic variables.

Design

Cross-sectional cohort study linking computerized medical record information to mailed survey data.

Setting

Veterans Health Administration (VHA).

Participants

Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Items assessing pain intensity, pain interference, and physical and mental health functioning.

Results

Ninety-two percent of participants reported bodily pain within the prior 4 weeks, with 69% of the total sample indicating pain of moderate or higher intensity. Eighty-five percent indicated that pain caused functional interference during the past 4 weeks, with 71% of the total sample reporting pain-related interference that was moderate or greater. No significant sex or race differences emerged for the pain indices. A significant but modest relationship between increasing age and pain interference emerged (r=.05, P<.01); however, age was not significantly related to pain intensity. Multivariate regression analyses identified pain intensity (β=.73), physical health functioning (β=-.07), and mental health functioning (β=-.13) variables as significant, unique contributors to the prediction of pain interference. The interaction of pain intensity and physical functioning was also significant but of minimal effect size (β=-.03).

Conclusions

Pain is highly prevalent and causes substantial interference in the lives of veterans with MS. The functional impact of pain in veterans with MS is influenced by pain intensity, physical health, and emotional functioning. Clinical practice should take each of these domains into consideration and reflect a biopsychosocial conceptualization.     

Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study

Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective, case series study.

Objective

To determine outcomes after administration of a prone lumbar traction protocol.

Design

Prospective, longitudinal, case series.

Setting

Suburban, chiropractic practice.

Participants

A total of 296 subjects with low back pain (LBP) and evidence of a degenerative and/or herniated intervertebral disk at 1 or more levels of the lumbar spine. We excluded patients involved in litigation and those receiving workers’ compensation.

Intervention

An 8-week course of prone lumbar traction, using the vertebral axial decompression (VAX-D) system, consisting of five 30-minute sessions a week for 4 weeks, followed by one 30-minute session a week for 4 additional weeks.

Main Outcome Measures

The numeric pain rating scale and the Roland-Morris Disability Questionnaire (RMDQ) were completed at preintervention, discharge (within 2 weeks of the last visit), and at 30 days and 180 days after discharge. Intention-to-treat strategies were used to account for those subjects lost to follow-up.

Results

A total of 250 (84.4%) subjects completed the treatment protocol. On the 30-day follow-up, 247 (83.4%) subjects were available; on the 180-day follow-up, data were available for 241 (81.4%) subjects. We noted significant improvements for all postintervention outcome scores when compared with preintervention scores (P<.01).

Conclusions

Traction applied in the prone position using the VAX-D for 8 weeks was associated with improvements in pain intensity and RMDQ scores at discharge, and at 30 and 180 days after discharge in a sample of patients with activity-limiting LBP. Causal relationships between these outcomes and the intervention should not be made until further study is performed using randomized comparison groups.     

Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis

Douglas C, Wollin JA, Windsor C. Illness and demographic correlates of chronic pain among a community-based sample of people with multiple sclerosis.

Objective

To investigate the prevalence, nature, and correlates of pain among a community-based sample with multiple sclerosis (MS).

Design

A cross-sectional survey and structured pain interview.

Setting

Community.

Participants

People with MS (N=219) recruited through systematic sampling from a randomly ordered MS society membership database.

Interventions

Not applicable.

Main Outcome Measures

Pain presence or absence, pain intensity (numeric rating scales), pain quality (McGill Pain Questionnaire), pain location(s) and extent (pain drawing), pain duration and frequency, provoking and relieving pain factors, and pain management techniques.

Results

Pain was common with some 67.1% of the sample reporting pain during the 2 weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these subjects experience chronic pain conditions characterized by moderate-to-severe pain intensity. Among those with pain, 75% reported pain in 3 or more locations, with participants reporting an average of 4.0±1.8 distinct pain sites. Women and people with more severe MS-related disability were significantly more likely to report both the presence of pain and greater pain intensity. In contrast, being in a married or in a de facto relationship and longer time since MS diagnosis were significantly associated with lower pain intensity.

Conclusions

Given the high prevalence and nature of pain experienced by people with MS, health care providers need to approach pain with a priority similar to that given to other MS-related problems such as mobility and functional independence. Women and people with more severe MS-related disability appear to be at particular risk for significant pain problems and therefore these groups warrant particular attention, such that routine clinical assessment should trigger routine pain assessment.     

Interexaminer reliability of supine leg checks for discriminating leg-length inequality

Objective

The purpose of this study was to quantify interexaminer reliability of a standardized supine leg check procedure used to screen for leg-length inequality.

Methods

Two doctors of chiropractic used a standardized supine leg check procedure to examine 50 volunteers for leg-length inequality. The order of examination was randomized. The side and magnitude of leg-length inequality were determined to the nearest 1/8 in. Subjects and examiners were blinded. Interexaminer reliability was assessed with a Bland-Altman plot, tolerance table of absolute differences, a quadratic weighted κ statistic for quantitative scores, and a Gwet's first-order agreement coefficient for dichotomous ratings.

Results

The quadratic weighted κ statistic to quantify the reliability of the rating scale was 0.44 (95% confidence interval, 0.21-0.67), indicating moderate reliability. The 2 examiners agreed exactly 32% of the time, within 1/8 in 58% of the time, within 3/16 in 72% of the time, and within 3/8 in 92% of the time. The Bland-Altman plot revealed possible heterogeneity in reliability that requires additional study. The examiners agreed on the presence of a leg-length inequality of at least 1/8 in in 40 (80%) of 50 subjects (first-order agreement coefficient, 0.76), suggesting good agreement for this diagnostic category.

Conclusion

The examiners showed moderate reliability in assessing leg-length inequality at 1/8-in increments and good reliability in determining the presence of a leg-length inequality.     

The Immediate Effects of Mobilization Technique on Pain and Range of Motion in Patients Presenting With Unilateral Neck Pain: A Randomized Controlled Trial

Kanlayanaphotporn R, Chiradejnant A, Vachalathiti R. The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial.

Objective

To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms.

Design

Triple-blind, randomized controlled trial.

Setting

Outpatient physical therapy, institutional clinic.

Participants

Patients (N=60), 2 physical therapists, and 1 assessor involved in this study.

Interventions

The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM.

Main Outcome Measures

Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment.

Results

After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement (P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement (P=0.002).

Conclusions

The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization.     

Factor structure and concurrent/convergent validity of the modified somatic perception questionnaire and pain beliefs instrument

Objective

Our goal was to create a parsimonious combination of the Modified Somatic Perception Questionnaire (MSPQ) and the Pain Beliefs Screening Instrument (PBSI) through factorial structural analysis and to investigate the associations of the new scale (if unique) to disability, health condition, and quality of life report in patients with neck and low back pain scheduled for spine fusion surgery.

Methods

Factor analysis was used to refine all items within the 2 scales to 4 distinct factors: (1) somatic complaints of the head/neck, (2) somatic complaints of the gastrointestinal symptom, (3) pain beliefs and fear, and (4) self perception of serious problems. Each factor was assessed for concurrent validity with other well-established tools including the Deyo comorbidity index, the Short Form (SF)-36 mental and physical component subscales, and the Oswestry and Neck Disability Indices (ODI/NDI).

Results

The PBSI was fairly to moderately correlated with assessment tools of quality of life (SF-36) and disability assessment (ODI/NDI). Some of the items in the factor 1 from the MSPQ were slightly associated with the Deyo comorbidity index but not with the ODI/NDI.

Conclusions

The items from the MSPQ failed to associate with measures of quality of life and disability and thus may provide only marginal value when assessing the multidimensional aspects associated with neck and low back pain. The PBSI has moderate correlation with disability assessments. Neither tool was found to strongly correlate with disability measures or with SF-36 scales (mental and physical component subscales). Additional tools may be needed to further identify the dimensions associated with chronic pain patients.     

Smoking among veterans with multiple sclerosis: prevalence correlates, quit attempts, and unmet need for services

Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence, correlates, quit attempts, and unmet need for services.

Objective

To describe the prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS).

Design

Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999.

Setting

Veterans Health Administration (VHA).

Participants

Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking.

Interventions

Not applicable.

Main Outcome Measures

Items assessing smoking, quit attempts, and unmet need for smoking services.

Results

Among all survey respondents with MS, 28.5% (95% confidence interval [CI], 26.9-30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6-62.1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1-66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity.

Conclusions

Smoking among veterans with MS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation.     

Clinical Outcomes for Patients Classified by Fear-Avoidance Beliefs and Centralization Phenomenon

Werneke MW, Hart DL, George SZ, Stratford PW, Matheson JW, Reyes A. Clinical outcomes for patients classified by fear-avoidance beliefs and centralization phenomenon.

Objectives

To (1) determine the prevalence of pain pattern classification subgroups (centralization, noncentralization, and not classified) observed during the initial evaluation of patients experiencing high versus low Fear-Avoidance Beliefs Questionnaire for physical activity (FABQ-PA) scores, (2) examine the association between discharge pain intensity and functional status (FS) outcomes based on FABQ-PA and pain pattern subgroups, and (3) compare minimal clinically important improvement for FS and pain intensity for FABQ-PA and pain pattern classification subgroups.

Design

Observational cohort design.

Setting

Suburban hospital-based outpatient rehabilitation clinic.

Participants

Consecutive patients with low back syndromes (N=238, mean ± SD, 59.1±17.0y; minimum=20, maximum=91).

Interventions

Interventions were designed to match patient classification by fear-avoidance level and pain pattern.

Main Outcome Measures

Two outcome measures were assessed: patient self-reported FS and pain intensity. FS was assessed by using computerized adaptive testing methods. Maximal pain intensity was assessed by using an 11-point numeric pain scale: 0 (no pain) to 10 (worst imaginable pain).

Results

There were no differences (χ₂²=3.7, P=.16) in proportion of patients classified by pain pattern experiencing high or low fear-avoidance beliefs. After controlling for the effect of available risk-adjustment variables, only dual-level classification subgroups, symptom acuity, payer type, and intake FS or pain intensity were associated with discharge FS or pain outcomes. The highest proportion of patients achieving minimal clinically important improvement in pain and FS were reported by the following patient subgroup: centralization and low fear.

Conclusions

Pain pattern and FABQ-PA characteristics impacted rehabilitation outcomes. We recommend that both factors be considered when managing patients with low back pain in an effort to optimize rehabilitation outcomes.     

The association between a lifetime history of a work-related neck injury and future neck pain: a population based cohort study

Objective

The purpose of this study was to investigate the association between a lifetime history of a work-related neck injury and the development of troublesome neck pain in the general population.

Methods

We formed a cohort of randomly sampled Saskatchewan adults with no or mild neck pain in September 1995. At baseline, participants were asked if they had ever injured their neck at work. Six and 12 months later, participants were asked if they had troublesome neck pain defined as grades II to IV on the Chronic Pain Grade Questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of work-related neck injury and the onset of troublesome neck pain while controlling for age and sex.

Results

Our cohort included 866 individuals at risk for developing troublesome neck pain. Of those, 73.8% (639/866) were followed up at 6 months, and 63.0% (546/866), at 1 year. We found a positive association between a history of a work-related neck injury and the onset of troublesome neck pain (age- and sex-adjusted hazard rate ratio [HRR], 2.4; 95% confidence interval, 1.3-4.7).

Conclusion

Our analysis suggests that a lifetime history of work-related neck injury is associated with an increased risk of troublesome neck pain. Occupational neck injuries can lead to recurrent episodes of neck pain.     

Correlation of Body Composition and Low Back Pain Severity in a Cross-Section of US Veterans

Objective

Back pain is more prevalent in the obese, but whether back pain severity is directly correlated to obesity in veterans is unknown. We sought to determine if there was a correlation between body composition and low back pain severity in a sample of veterans. The hypothesis was that veterans with higher body mass index values would report higher low back pain severity scores.

Psychometric Properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in Patients With Shoulder Pain

Mintken PE, Cleland JA, Whitman JM, George SZ. Psychometric properties of the Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in patients with shoulder pain.

Objective

To investigate the reliability and validity of 2 commonly used measures of pain related fear in patients with shoulder pain.

Design

A preplanned secondary analysis of a prospective single-arm trial involving a repeated-measures design.

Setting

Outpatient physical therapy clinics.

Participants

Patients (N=80) with a primary report of shoulder pain.

Intervention

All patients completed the outcome measures at baseline and at follow-up.

Main Outcome Measures

Patients completed a modified Fear-Avoidance Beliefs Questionnaire (FABQ), the 11-item version of Tampa Scale of Kinesiophobia (TSK-11), and the Shoulder Pain and Disability Index (SPADI) at baseline and at a 48-hour follow-up. Patients were dichotomized as improved or stable at follow-up based on the Global Rating of Change.

Results

Factor analysis indicated 3 stable factors for the FABQ and 1 stable factor for the TSK-11. Shoulder specific scoring for the FABQ and TSK-11 were used in subsequent analyses. Test-retest reliability intraclass correlation coefficient (ICC) was substantial for the FABQ and the TSK-11. The FABQ correlated significantly with SPADI pain and disability scores, while the TSK-11 correlated significantly only with SPADI pain scores. The shoulder-specific FABQ-W (work beliefs subscale) was a better than chance predictor of missing days of work during the 48-hour study period.

Conclusions

The modified FABQ and TSK-11 may be appropriate for use in patients with shoulder pain. Shoulder-specific scoring of these measures resulted in substantial test-retest reliability, and the FABQ correlated with the SPADI for pain and disability. The FABQ also showed potential for prediction of short-term work loss in this sample. Pain-related fear may be an important variable in patients with shoulder pain and merits future consideration in longitudinal studies.     

Self-reported driving habits in subjects with persistent whiplash-associated disorder: relationship to sensorimotor and psychologic features

Pereira MJ, Jull GA, Treleaven JM. Self-reported driving habits in subjects with persistent whiplash-associated disorder: relationship to sensorimotor and psychologic features.

Objectives

To study self-reported driving habits after whiplash injury and to determine any relation among self-reported driving habits, selected sensorimotor impairments, and psychologic features.

Design

Repeated-measures, case-controlled.

Setting

Tertiary institution.

Participants

Subjects (n=30) with chronic whiplash and 30 asymptomatic controls.

Interventions

Not applicable.

Main Outcome Measures

The Driving Habits Questionnaire (composite driving tasks score), Neck Disability Index (NDI), 28-item General Health Questionnaire (GHQ-28), Impact of Events Scale−Revised (IES-R), Tampa Scale for Kinesiophobia, cervical range of motion, cervical joint position error, and smooth pursuit neck torsion test.

Results

Subjects in the whiplash group had equal driving exposure and driving spaces (distances, locations) compared with control subjects but reported significantly more driving difficulty with most driving tasks (P<.01). There were no significant correlations between the composite driving tasks score and any of the sensorimotor impairments, but there were significant and moderate correlations between the composite driving task score and both pain and disability (NDI score, .518) and anxiety (GHQ-28 score, .518; IES-R score, .524).

Conclusions

Persons with chronic whiplash have greater self-reported driving difficulty than controls, which appears to relate more to reported levels of pain and disability and psychologic stress than laboratory measures of features of cervical sensorimotor control.     

Longitudinal Changes in the Health-Related Quality of Life During the First Year After Traumatic Brain Injury

Lin M-R, Chiu W-T, Chen Y-J, Yu W-Y, Huang S-J, Tsai M-D. Longitudinal changes in the health-related quality of life during the first year after traumatic brain injury.

Objective

To track the health-related quality of life (HRQL) at discharge and at 6 and 12 months after a traumatic brain injury (TBI) and examine factors associated with changes in each HRQL domain.

Design

Longitudinal cohort study.

Setting

Using codes of the International Classification of Diseases, eligible participants who had a newly diagnosed TBI were identified from discharge records of 4 hospitals in northern Taiwan. Information on the HRQL and injury-related characteristics at the initial and 2 follow-up assessments was collected by extracting medical records and conducting telephone interviews.

Participants

Subjects (N=158) participated in the initial assessment, and 147 and 146, respectively, completed the follow-up assessments at 6 and 12 months after injury.

Interventions

Not applicable.

Main Outcome Measure

The brief version of the World Health Organization Quality of Life (WHOQOL-BREF) with 4 domains of physical capacity, psychologic well being, social relationships, and environment.

Results

Scores on all WHOQOL-BREF domains except social relationships greatly improved over the first 6 months and showed continued improvement at 12 months after injury. The domain scores of the WHOQOL-BREF at discharge were significantly associated with the preinjury HRQL level, marital status, alcohol consumption at the time of injury, Glasgow Outcome Scale (GOS) level, cognition, activities of daily living, social support, and depressive status. However, after adjusting for these baseline differences, only the GOS level and depressive status significantly influenced longitudinal changes in the psychologic and social domains over the 12-month period. Changes in the physical and environmental domains were not significantly associated with any characteristics of the study.

Conclusions

During the first year after a TBI, the magnitude of HRQL recovery differed across different HRQL domains. Many factors may have significant associations with the initial domain scores of HRQL after TBI; however, only a few factors can significantly influence longitudinal changes in the HRQL.     

Exercise and Quality of Life Among People With Multiple Sclerosis: Looking Beyond Physical Functioning to Mental Health and Participation in Life

Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life.

Objective

To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction.

Design

Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999.

Setting

Veterans Health Administration.

Participants

Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency.

Results

Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9-30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties).

Conclusions

Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.     

Validating the six-minute walk test as a measure of recovery after elective colon resection surgery

Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of recovery after elective colon resection surgery.

Objective

To provide evidence for construct and longitudinal validity of the six-minute walk test (6MWT) as a measure of postsurgical recovery.

Design

Data from a randomized clinical trial.

Setting

A major teaching hospital in a Canadian urban city.

Participants

Patients (N=63) undergoing elective colon resection.

Interventions

Not applicable.

Main Outcome Measures

Functional walking capacity was measured using the 6MWT at before surgery and at 3 and 6 weeks after surgery.

Results

At 3 weeks, 26 (41%) patients recovered to baseline or greater on the 6MWT distance, and 37 (59%) were at baseline or better by 6 weeks postdischarge. At all time points, the 6MWT distance correlated with age, the American Society of Anesthesiologists (ASA) score of surgical risk, albumin, the physical function subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the physical component summary score of the SF-36. Baseline 6MWT distance correlated with postoperative 6MWT recovery, and baseline SF-36 and ASA were associated with postoperative recovery. Patients with intraoperative complications had a clinically relevant lower 6MWT than those without complications at all time points.

Conclusions

This study provides evidence for construct validity and sensitivity to change for the 6MWT as a measure of surgical recovery.