Predictors of health-related quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective

Background

In brain tumor (BT) patients, the association between health-related quality of life (HRQoL) and psychological characteristics remains largely unknown. We evaluated the association of personality traits, clinical factors, psychological distress symptoms, and cognitive state with HRQoL in BT patients.

Methods

On admission for BT surgery, 200 patients (69 % women; age 55.8?±?14.5 years) were evaluated for HRQoL (SF-36 scale), Big-Five personality traits (Ten-Item Personality Inventory), psychological distress symptoms (Hospital Anxiety and Depression Scale or HADS), cognitive function (Mini-Mental State Examination or MMSE) and clinical characteristics, including functional status (Barthel index or BI). The most common BT diagnoses were meningioma (39 %) and high-grade glioma (18 %).

Results

Only factors significantly associated with SF-36 domains in univariable regression analyses were included in their respective multivariable models and predicted from 6 %–49 % of the total variance of SF-36 scores. Greater TIPI emotional stability score was independently associated with greater SF-36 emotional well-being (β?=?0.23, p?<?0.001) and general health (β?=?0.18, p?=?0.01) scores, and greater TIPI consciousness score, with greater SF-36 emotional well-being score (β?=?0.13, p?=?0.02). HADS-anxiety and HADS-depression scores were the strongest independent determinants of all, except physical functioning, SF-36 scores (β-values range from 0.14 to 0.56; p values?≤?0.03). BI score was the strongest independent determinant of SF-36 physical functioning score (β?=?0.36, p?<?0.001). MMSE score was associated with all but emotional well-being and social functioning SF-36 scores.

Conclusions

Consciousness and emotional stability should be considered important personality-related determinants of HRQoL in BT patients. Psychological distress, functional disability, and cognitive impairment are also important predictors of HRQoL.     

Self-reported pad use per day reflects patient quality of life after pubovaginal sling surgery

Introduction and hypothesis

We hypothesized that self-reported pad use per day (PPD) after pubovaginal sling (PVS) correlated with postoperative quality of life (QOL) scores.

Methods

Two hundred fifteen women completed the incontinence impact questionnaire 7 (IIQ-7) and urogenital distress inventory 6 (UDI-6) before PVS and during follow-up. Starting 3 days before a visit, women recorded the number of protective urinary pad changes per day. Analysis of variance and Pearson correlation tests were used to determine if women reporting zero, one, or greater than or equal to two urinary pads per day after PVS had significantly different changes in baseline QOL scores.

Results

Over a mean 8.5 months follow-up after PVS, 131, 56, and 28 women reported zero, one, and greater than or equal to two pad changes/day. Each pad group showed progressively less improvement from baseline IIQ-7 and UDI-6 scores after PVS. Change in IIQ-7 and UDI-6 scores negatively correlated with PPD (p?<?0.0001).

Conclusions

Self-reported PPD after PVS reflects patient perception of urinary-specific QOL.     

Impact on Quality of Life After Pancreatoduodenectomy: A Prospective Study Comparing Preoperative and Postoperative Scores

Introduction

Few studies compare the direct impact of pancreatoduodenectomy (PD) on the patient??s quality of life (QOL). The effect of PD in QOL, comparing the preoperative vs. postoperative status, was analyzed.

Method

A prospective single-center study was performed. PD patients in a 2-year period were included. A general QOL instrument was applied preoperative, 1, 3, 6, and 12?months after surgery and compared with national norms.

Results

Thirty-seven patients were recruited. Twenty of 37 were female. Ampullary carcinoma 14/37, ductal adenocarcinoma in 9/37, and other malignant neoplasms 14/37 were diagnosed. Mortality was absent; 48.6?% had complications, 13.5?% required reoperation. Three (median) and 4 (mode) questionnaires were answered per individual. 85?% answered the last questionnaire. 4/37 had cancer related death before a year. Median follow-up was 29 (3?C72) months. QOL diminished a month after surgery, physical function (67 vs 40, p?p?p?=?0.001), physical pain (51 vs 71, p?=?0.01), social function (52 vs 63, p?=?0.014), vitality (54 vs 64, p?=?0.018), and emotional role (41 vs 69, p?=?0.006) improved significantly.

Discussion

PD has a favorable impact in quality of life as demonstrated by the improvement of most parameters assessed in the postoperative period.     

Long-Term Quality of Life after Ivor Lewis Esophagectomy for Esophageal Cancer

Background

Esophagectomy has a potentially high impact on physical, emotional, and social functions. The aim of this study was to assess long-term health-related quality of life (QOL) after esophageal cancer surgery.

Methods

We analyzed all patients who underwent an Ivor Lewis esophagectomy for resectable esophageal cancer in our hospital from 1999 to 2010. QOL was assessed using the European Organization for Research and Treatment of Cancer general questionnaire QLQ-C30 and esophagus-specific questionnaire QLQ-OES18.

Results

A total of 150 patients were operated in the surveyed 12-year period. At the time of analysis, 46 patients (31 %) were eligible for assessment, 97 patients (65 %) had died or experienced tumor recurrence, and seven patients (5 %) were lost to follow-up. Of the 46 eligible patients, 43 (94 %) returned the questionnaires. The median observation interval between the operation and QOL assessment was 40 (range 21–135) months. The QLQ-C30 mean score of global health status and general QOL was similar to that of a healthy reference population. Most of the QLQ-C30 mean scores of functional and symptom scales and QLQ-OES18 symptom scales showed a worse result than for a healthy reference population. The highest mean scores were reflux and eating problems.

Conclusions

In the long term, Ivor Lewis esophagectomy provides a generally good QOL for patients with esophageal cancer, which is comparable to a healthy reference population. However, some patients suffer from significant symptoms. Reflux and eating problems were the most relevant complaints. Dietary counseling is therefore important in the postoperative course.     

Predictors of Weight Loss at 1 Year After Laparoscopic Adjustable Gastric Banding and the Role of Presurgical Quality of Life

Background

There is uncertainty regarding preoperative predictors of a successful outcome for bariatric surgery (BarSurg), on which to determine appropriateness for such a procedure. Our aims were to identify preoperative clinical and psychosocial predictors of success following BarSurg and to explore the influence of body mass index (BMI) on these parameters.

Methods

Preoperative data, including Impact of Weight on Quality of Life—Lite (IWQOL-Lite) scores transformed to Health-Related Quality of Life (HRQOL) scores, were accrued from 76 morbidly obese adults awaiting BarSurg. Pre- and postoperative data were also accrued for 26 patients who had completed 1-year follow-up post-bariatric surgery (laparoscopic adjustable gastric banding—LAGB). Statistical analysis was performed to assess the relationships between preoperative HRQOL scores, preoperative BMI and excess weight loss 1 year following BarSurg (EWL-1 year).

Results

Preoperative BMI showed a significant independent, negative linear correlation with the public distress domain of preoperative quality of life (QOL) (r?=??0.368, p?=?0.001; β?=??0.245, p?=?0.009). Preoperative BMI had a significant, positive and independent association with EWL-1 year (r?=?0.499, p?=?0.009; β?=?0.679, p?=?0.015). Preoperative QOL scores had no association with EWL-1 year.

Conclusions

Preoperative BMI appears to predict EWL-1 year following restrictive bariatric surgery (LAGB). Preoperatively, patients with higher BMI appear to manifest greater public distress. Preoperative QOL scores, however, do not appear to have any predictive value for EWL-1 year post-LAGB. Preoperative BMI should therefore be employed as a predictor of EWL-1 year post-LAGB. Other measures of successful outcomes of bariatric surgeries (such as effects on QOL scores at 1 year) should be explored in future, larger and longer term studies.     

Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: An Asian Perspective

Background

Data on quality of life (QOL) after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is scarce in the Asian population. This study assesses QOL outcomes after CRS and HIPEC in an Asian cancer center.

Methods

Patients who completed CRS + HIPEC 6–18 months ago (27 patients) were enrolled in the study. QOL was measured via the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaires. The scores were compared with a group of 393 disease-free cancer patients, not on active treatment, who had ECOG scores of either 0 or 1. The 1-sample t test was used to compare differences in QOL scores between the 2 groups.

Results

A total of 27 patients were analyzed, of which 22 (81 %) were females. Median age was 51 years (15–59 years). CRS + HIPEC were performed for ovarian cancer in 15 patients (55 %), appendiceal carcinoma in 5 patients (19 %), and colorectal carcinoma in 4 patients (15 %). The median intraoperative peritoneal carcinomatosis index (PCI) score was 15 (2–31) while the completeness of CC score was 0 and 1 in 25 and 2 patients, respectively. The median duration after CRS + HIPEC was 10 months (6–16 months). Global health status and functional and symptom scores were largely similar between patients after CRS + HIPEC and the control group. Cognitive functioning scores and fatigue scores were significantly better in the group after CRS + HIPEC (p = 0.014 and 0.04).

Conclusions

QOL after CRS and HIPEC can be equivalent to that of well-functioning, disease-free cancer patients.     

Impact of Surgery on Quality of Life in Patients with Hepatocellular Carcinoma

Background

Liver resection is the mainstay of curative treatment for localized hepatocellular carcinoma (HCC). However, the impact of surgery for HCC on quality of life (QOL) has not been well assessed.

Methods

Health-related QOL was assessed using the Short Form-36 questionnaire in 108 patients who underwent a liver resection for HCC between January 2004 and January 2008. The QOL assessment was scheduled before and every 3 months after the operation. Patients were divided into two groups based on patient-, tumor-, and surgery-related variables. The physical component summary (PCS) and mental component summary (MCS) were compared between the two groups.

Results

Altogether, 69 patients (64 %) completed the consecutive QOL assessments until 6 months after surgery. At 3 months, the PCS scores were significantly lower for women and for patients who had undergone thoracotomy than among men (p = 0.010) and patients who had not undergone thoracotomy (p = 0.048), respectively. No significant differences in any of the PCS scores were observed at 6 months. No significant differences in the MCS scores were observed between the groups throughout the investigation, and improvement relative to the preoperative status was observed at 6 months.

Conclusions

Physical impairments in the QOL after surgery had returned to the baseline at 6 months, and the postoperative mental QOL improved relative to the preoperative state. The surgical candidates were expected to have a satisfactory QOL regardless of the preoperative status and surgical outcomes. A thoracoabdominal approach had a transient negative impact on the physical health status.     

Cancer or No Cancer: The Influence of Trait Anxiety and Diagnosis on Quality of Life With Breast Cancer and Benign Disease: A Prospective, Longitudinal Study

Background

High trait anxiety (HTA) causes an impaired quality of life (QOL) and fatigue in women with breast cancer (BC) and benign breast disease (BBD). We examined whether the lowered QOL was determined solely by the personality characteristic HTA or by the combination of personality and diagnosis.

Methods

In a prospective longitudinal study, women with BC (n = 152), BBD (n = 205), or gallstone disease (GD) before laparoscopic cholecystectomy (n = 128) were included. Questionnaires concerning trait anxiety (baseline), fatigue, and QOL were completed at baseline and at 6 months. Multivariate linear regression analysis was performed to analyze the predictors for QOL at 6 months.

Results

At 6 months QOL scores were increased in the GD group, especially in women without HTA. For women without HTA, in the BBD group the scores for fatigue and physical QOL had improved at 6 months, whereas in the BC group physical QOL and fatigue was impaired. Women with HTA scored unfavorably on fatigue and QOL. HTA was the most important factor influencing QOL.

Conclusions

The course of QOL and fatigue during follow-up were significantly different for each diagnosis. Particularly HTA had a negative impact on QOL and fatigue. Especially the combination HTA and BC caused impaired QOL and fatigue. We recommend identifying women with BC and HTA and offer them a tailor-made follow-up protocol.     

Predicting Psychosocial Outcomes Using a Brief Measure of Quality of Life in a Sample of People with Spinal Cord Injury

Background:

Spinal cord injury (SCI) significantly impacts an individual’s quality of life (QOL). A brief and subjective measure of QOL is necessary to monitor the progress and outcomes of SCI rehabilitation.

Objective:

To determine whether this measure of QOL was associated with clinically important physical and psychosocial outcomes in a sample of people with SCI, to determine how people with SCI scored on this measure of QOL, and to determine whether people with SCI scored differently than nondisabled individuals on the QOL scale.

Methods:

Participants were 134 people with SCI (65% male; 35% female) and 227 nondisabled people (35% male; 65% female). Participants were assessed on a number of psychosocial and physiological variables at a large urban university and rehabilitation center. Variables examined were QOL, life satisfaction, depression, social interaction, pain, fatigue, and level of functioning.

Results:

Participants with SCI reported more low QOL scores and fewer high QOL scores than the nondisabled group. For participants with SCI, QOL was positively related to life satisfaction and social interaction and negatively related to pain, fatigue, and depression.

Conclusions:

Participants with SCI scored lower on the QOL measure than those without a disability, although the difference was not clinically significant. QOL was unrelated to level of functioning; people may still experience a high QOL despite their physical limitations. Depression and social interaction were significantly related to QOL and should be secondary targets for intervention following SCI rehabilitation.Key words: depression, disability, life satisfaction, pain, quality of life, social interaction, spinal cord injuriesQuality of life (QOL) can be defined as the quality of a person’s overall experiences of living. Individuals differ on what values they place on work, leisure activities, relationships with other people, intimacy with a spouse or partner, or participation in sports. Perhaps no other impairment impacts a person’s QOL as much as a spinal cord injury (SCI).¹ After the medical and functional problems are addressed in rehabilitation, individuals begin to think about how they can regain much of their previous lifestyle and QOL. There are substantial barriers in the physical and social environments that stand in the way of higher QOL, including medical issues; difficulties in constructing a suitable home environment; and challenges in keeping the family together, supporting oneself, and dealing with the subtle and not-so-subtle attitudes of others.² These problems and barriers can result in psychological issues, the most common of which is depression.³ It is not surprising that individuals find it difficult to regain a positive level of QOL after SCI.Considering that there are approximately 270,000 people currently living with SCI in the United States, with 12,000 new cases of SCI each year,⁴ the topic of QOL is important to the persons with SCI, their families, and to the clinicians who treat them. However, there is little agreement on the definition of QOL and therefore on its measurement. Most measures of QOL are either too long for clinicians to use in practice or are not measures of QOL itself, but rather are measures of life satisfaction, health status, or well-being. For example, The World Health Organization’s⁵ QOL measure, WHOQOL-BREF, is primarily a life satisfaction measure, and it takes more than 1 hour to administer. Even the SF-36,⁶ which many people inaccurately accept and use as a measure of QOL, is actually a measure of health status, according to the author.Experts in both QOL and SCI, including Dijkers⁷ and Tate,⁸ have argued that there is a need for a subjective measure of QOL that can be used to monitor a person’s progress of rehabilitation and as a measurable outcome of rehabilitation programs. Clinical practice requires brief measures that are reliable and valid and that can be incorporated into progress notes about the patient. This clinically oriented article addresses the issue of whether a brief measure of QOL can stand up to the rigors of scientific standards while still predicting clinically important outcomes of SCI and whether it is suitable for the practitioner as well as for persons with SCI.This article addresses 3 objectives. The first objective was to determine whether this measure of QOL was associated with clinically important physical and psychosocial outcomes in a sample of people with SCI. The second objective was to determine how people with SCI scored on this measure of QOL. The third objective was to determine whether people with SCI scored differently than nondisabled individuals on a subjective, single-item QOL scale.     

Prospective analysis of health-related quality of life and clinical evaluations in patients with anterior cruciate ligament injury undergoing reconstruction

Introduction

This study aimed to evaluate the treatment outcome of patients with anterior cruciate ligament (ACL) injury using the patient-based quality of life (QOL) survey SF-36, and investigate the correlation with conventional objective assessment methods. Our hypothesis that SF-36 is a useful assessment method for QOL in patients with ACL injury, and this assessment clarifies the concord and the discord between doctor-based objective assessment.

Patients and methods

A prospective study was conducted on patients who underwent ligament reconstruction. Eighty-one patients with a mean age of 27.4?years were analyzed. Clinical evaluations comprising SF-36 survey, Lysholm scoring, and anterior tibial translation measurement were conducted before as well as after surgery. The changes over time and the correlation between these evaluation methods were analyzed.

Results

All SF-36 subscales were significantly improved after surgery. Regarding QOL of patients with ACL injury, the preoperative scores of all the subscales except vitality and mental health were lower than the national standard values, while the postoperative scores of all subclasses were not different from the national standards. A correlation was found between Lysholm score and all SF-36 subscale scores except general health before surgery, but a correlation was observed only with physical functioning, bodily pain and role emotional at 6?months after surgery, and with physical functioning, role physical, bodily pain and vitality at 12?months. No correlation between SF-36 scores and distance of anterior tibial translation was observed both before and after surgery.

Discussion

The QOL of patients with ACL injury as assessed by SF-36 improved significantly after reconstruction surgery. The mental health subscales of SF-36 correlate with Lysholm score before surgery suggesting that apart from the physical impairment, lowered mental health is also an important clinical issue in patients with ACL injury.     

Genitourinary symptoms and their effects on quality of life in women with uterine myomas

Introduction and hypothesis

This study was designed to determine the presence of genitourinary symptoms and their effects on quality of life (QOL) in women with uterine myomas.

Methods

A total of 145 women with ultrasonography (US) diagnosis of anterior myoma were divided into two groups according to myoma size: (1) those ≤5 cm (n?=?75), and (2) those >5 cm (n?=?70). The control group comprised previously matched 94 women with a normal-appearing uterus on US. Study participants answered the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Pelvic examination was performed, and urinary symptoms were recorded. The chi-square test and Fischer’s exact test were used to compare qualitative data. The Kruskal–Wallis test and Dunn’s test were used to compare groups. Statistical significance was set at P <0.05.

Results

The frequency of genitourinary symptoms was significantly higher in women with myomas, including stress urinary incontinence (SUI), urgency, frequency, urge urinary incontinence (UUI), and dyspareunia. SUI and mixed urinary incontinence (MUI) were the most common symptoms associated with myoma size. Total UDI-6 scores were significantly higher in women with myomas than in control patients (P?<?0.0001). UDI scores associated with UI and obstructive symptoms were higher in women with myomas >5 cm than in other women. IIQ scores regarding physical activity, travel, and emotional health were significantly higher in women with myomas >5 cm than in other women (P?<?0.001).

Conclusions

Urinary tract dysfunction is associated with anterior myomas, increasing in association with myoma size, and significantly affects QOL.     

Impact on quality of life after ring pessary use for pelvic organ prolapse

Introduction and hypothesis

The purpose of this study was to evaluate symptoms associated with pelvic organ prolapse (POP) and quality of life (QOL) improvement in patients who continue ring pessary use at 1?year.

Methods

Seventy-seven symptomatic POP patients had successful fitting, and 64 patients (83.1%) continued use at 1?year. The Thai version of Prolapse Quality of Life (P-QOL) questionnaire was used to evaluate symptoms associated with POP and impact on QOL. A higher score represents a greater impairment on the QOL, whereas a lower score represents a better QOL.

Results

Mean age was 66.7?±?8.6?years, median parity was 4 (range 0–10), 59 patients (92.2%) were menopausal, and none had received hormone treatment. Only nine patients (14.1%) were sexually active. Most patients were in the advanced stage of POP—32.8% stage 3 and 29.7% stage 4. Improvement of prolapse symptoms and voiding difficulty were reported in 100% and 85.7% of the patients, respectively. Among patients who had lower urinary tract symptoms at pre-treatment, about half of patients improvement in frequency, urgency, and urgency urinary incontinence. Only 9.1% of the patients had improvement in stress urinary incontinence (SUI), and 23.8% of the patients reported new onset of SUI (de novo SUI). The median score from all P-QOL domains except personal relationships were significantly decreased after 1?year of ring pessary use. The median total scores at baseline and at 1?year were 40 and 8, respectively (P?Conclusions Ring pessary is an effective non-surgical treatment to alleviate symptoms associated with POP. It can improve QOL in symptomatic POP patients.     

Improvement of bowel dysfunction with sacral neuromodulation for refractory urge urinary incontinence

Introduction and hypothesis

Sacral nerve stimulation (SNS) is approved for urologic indications in the USA and, recently, fecal incontinence. This study described concomitant bowel dysfunction and improvements in bowel and urinary symptoms and quality of life (QOL) in women with refractory urge urinary incontinence (UUI) receiving SNS.

Methods

Women (N?=?36) with refractory UUI receiving SNS were prospectively enrolled. Surveys and exams were completed at baseline and follow-up, with symptom and QOL scores measured using validated scales (0–100, none–worst).

Results

A total 24 women were followed up at a median of 4.0?months post-implantation. Of these, 20 (83%) had bowel dysfunction, 13 (54%) used bowel medications at baseline, and 11 (45%) continued them after SNS. The mean/median urinary (54.8 to 32.6) and bowel (23.4 to 14.1) symptom scores improved significantly, as did urinary (64.2 to 14.3) but not bowel (2.4 to 0.0) QOL scores.

Conclusions

Bowel dysfunction is common in women with refractory UUI. SNS improves urinary symptoms and QOL, but improvement in bowel symptoms does not translate into significant QOL changes.     

Spinal cord ischemia after endovascular aortic repair versus open surgical repair for descending thoracic and thoracoabdominal aortic aneurism

Purpose

Thoracic endovascular aortic repair (TEVAR) an emerging less invasive alternative to surgery, is now being increasingly employed, but spinal cord ischemia (SCI) is still a threat with this procedure. Delayed paraplegia has been frequently observed after TEVAR, suggesting there may be different courses of SCI between TEVAR and the conventional open surgical repair (OSR) of thoracic and thoracoabdominal aneurysms. Therefore, we conducted a study to investigate the risk factors for and the course of SCI after TEVAR and OSR.

Methods

We studied a series of 414 OSR and 94 TEVAR patients prospectively. Postoperative motor function, sensory disturbance, and bladder disturbance were assessed daily to evaluate the course of SCI. Previously reported risk factors for SCI were investigated.

Results

Spinal cord ischemia occurred in 6 patients (6.4 %) in the TEVAR group, and in 18 patients (4.3 %) in the OSR group, resulting in no significant difference (p = 0.401). A greater percentage of patients (n = 4, 66.7 %) with SCI in the TEVAR group had a delayed onset, compared with 16.7 % (n = 3) in the OSR group (p = 0.038). The rate of recovery of walking function after SCI and the incidence of sensory disturbance and bladder dysfunction was similar in the two groups. Multivariate analysis demonstrated that, in the TEVAR group, the stent length of aortic coverage was a significant risk factor for SCI.

Conclusion

The incidence of SCI was similar in the OSR and TEVAR groups, but delayed SCI occurred more frequently in the TEVAR group. Except for the delayed onset of SCI, SCI showed a similar course of recovery in the two groups.     

Effects of reduction in shoulder pain on quality of life and community activities among people living long-term with SCI paraplegia: a randomized control trial

Objective/background

People with spinal cord injury (SCI) paraplegia can develop shoulder problems over time, which may also cause pain. Shoulder pain may complicate or interfere with a person''s daily activities, social events, and their overall quality of life (QOL). The purpose of this study was to examine changes in social interaction and QOL after an exercise treatment for shoulder pain in people with SCI paraplegia.

Design

Fifty-eight participants with SCI paraplegia who were also experiencing shoulder pain were selected and randomized to either an exercise treatment or a control group. Participants in the treatment group participated in a 12-week, at-home, exercise and movement optimization program designed to strengthen shoulder muscles and modify movements related to upper extremity weight bearing.

Methods

Participants filled out self-report measures at baseline, 12 weeks later at the end of treatment, and at a 4-week follow-up.

Outcome measures

The Wheelchair User''s Shoulder Pain Index (WUSPI), the Social Interaction Inventory (SII), and the Subjective Quality of Life Scale.

Results

From the baseline to the end of treatment, repeated-measures analysis of variance revealed a significant interaction between WUSPI and SII scores, P < 0.001, and between WUSPI and QOL scores, P < 0.001.

Conclusion

Reductions in shoulder pain were related to significant increases in social participation and improvements in QOL. However, increases in social participation did not significantly affect improvements in QOL.     

Evaluation of health-related quality of life in patients candidate for spine and other musculoskeletal surgery

Introduction

Despite the high prevalence of musculoskeletal diseases, in Spain there are few data about how these conditions affect the quality of life of individuals. The objective of this study was to assess the quality of life (QOL) of patients candidate for orthopedic surgical treatment using an age–gender adjusted method of QOL scores.

Materials and methods

The SF-36 Health Survey was administered to 538 patients candidate for surgery between surgical treatment was classified in four groups (lumbar disease, cervical disease, knee arthroplasty, and hip arthroplasty). Associated morbidities were collected retrospectively for all cases using the Charlson co-morbidity index. Univariate, bivariate, and multivariate statistical analyses were done to compare the four groups to each other, to the general population mean, and to the age and gender-adjusted population mean.

Results

234 men and 304 women whose mean age was 58.78 years (19–89) were assessed. Patients candidate for some kind or lumbar surgery had the worst scores in all physical and mental scales as compared to the other disease groups. Patients candidate for knee arthroplasty, had the best quality of life scores in all scales, compared to the other disease groups. Medical conditions had no influence over the summary measures.

Conclusion

Presenting the results of SF-36 in standard deviations from the age- and gender-adjusted population mean (T values) leads to a better appreciation of the differences between the various diseases. Patients candidate for surgery of the lumbar spine had a worse QOL, while the QOL in patients candidate for knee arthroplasty was the least affected.     

Does the impact of urinary incontinence on quality of life differ based on age?

Introduction and hypothesis

The purpose of this study was to evaluate if the impact of urinary incontinence (UI) on quality of life (QOL) differs between women based on age.

Methods

A retrospective review of patients presenting for the management of UI was performed. Patients with UI and their corresponding degree of bother were identified by their responses to validated questionnaires. Distributions of comorbidities and types of UI were presented as frequencies and compared between age cohorts with a chi-square test. Mean scale scores were assessed for normality and a one-way analysis of variance with a post hoc Scheffé’s test was used to compare the scores.

Results

Of 765 patients meeting inclusion criteria, 22.4 % were <45, 28.9 % were 45–55, and 48.8 % were >55 years of age. Women older than 55 were significantly more likely to have urge UI and mixed UI than their counterparts (p?<?0.001). Women <45 and 45–55 were more negatively impacted in their ability to perform physical activities compared to women >55 (p?=?0.004), whereas women >55 were significantly less likely to feel frustrated by their incontinence than women <45 (p?=?0.022). However, there was no significant difference in overall impact of incontinence among groups (p?=?0.585).

Conclusions

UI equally impacts the functional and psychological QOL in women regardless of age. UI in women <55 results in a greater negative impact on level of physical activity, whereas women <45 are significantly more frustrated.     

Home-Based Functional Electrical Stimulation Cycling Enhances Quality of Life in Individuals with Spinal Cord Injury

Background:

With advances in medicine and increased survival rates, the focus of health care after spinal cord injury (SCI) has evolved from extending life to increasing independence and quality of life (QOL). Because enhancing QOL is an ultimate goal of the rehabilitation process, research involving the improvement of QOL is of great importance.

Objective:

The purpose of this study was to determine the effects of a home-based functional electrical stimulation lower extremity cycling (FES-LEC) program on the QOL of persons with SCI.

Design:

Eleven veterans with posttraumatic C4-T11 AIS A-C SCI participated in 8 weeks of 3 times weekly home-based FES-LEC. QOL was assessed using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Tests were completed by all participants prior to and after the 8-week FES-LEC program.

Results:

There were significant increases in the physical and environmental domain QOL scores. There were nominal nonsignificant increases in the psychological and social domain QOL scores.

Conclusions:

The results of this study provide evidence that home-based FES-LEC 3 times per week for 8 weeks has the potential to result in QOL improvements.Key words: cycling, electrical stimulation quality of life, spinal cord injuryWith medical advances over the past century, there has been a dramatic increase in life-span of those with spinal cord injury (SCI).¹ This has changed the focus of health care after SCI from extending life to increasing independence and quality of life (QOL).² Chappell and Wirz³ state that enhancing QOL is the ultimate goal of rehabilitation, and the overall processes of optimizing physical function and independence comprise 2 of the many components of enhancing the QOL of persons with SCI. The US Surgeon General reports that physical activity is an important factor in promoting QOL. Persons with SCI have been shown to have decreased QOL after injury,^4–6 thus research measuring the effects of physical activity on the QOL of persons with SCI is necessary.The World Health Organization (WHO) defines QOL as the individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. This concept takes into account the effect of physical health, psychological state, level of independence, social relationships, personal beliefs, and relationship to pertinent environmental features.⁷ One intervention that has been associated with the enhancement of QOL is physical activity.⁸ White and colleagues⁹ studied the effects of leisure time physical activities on community-dwelling older adults and found that physical activity and QOL were linked through selfefficacy, whereby physical activities that produce a positive experience and positive feedback are most likely to improve QOL. The study of the relationship between QOL and physical activity for persons with SCI is a more recent undertaking, thus there are relatively few studies that have targeted the psychological effects of regular physical activity in persons with SCI. Hicks et al² studied the effects of an upper body resistance training program using arm ergometry twice weekly for 9 months on the QOL of 34 individuals with SCI. Results showed positive QOL factors; the exercise group reported significantly less stress, fewer depression symptoms, and greater satisfaction with their physical functioning. The results also showed a nonsignificant increase in satisfaction in the selfperceived physical appearance of the exercise group relative to the control group. Fitzwater,¹⁰ a general medical practitioner and FES researcher, provided a personal view as a self-exerciser reporting the perception of improved body image and a preference for functional electrical stimulation lower extremity cycling (FES-LEC) over hand and arm activities. Our group has recently reported case reports utilizing a home-based FES-LEC program. Two older male adults with motor complete tetraplegia participated in FES-LEC 3 times per week for 9 weeks and 6 months, respectively. The results in both case reports showed improvements in perceived body image and self-esteem.^11,12 However, information concerning the effects of exercise, particularly FES-LEC on QOL of those with SCI, remains limited. The purpose of this study was to determine the effects of an Internetconnected home-based FES cycling program on the QOL (physical, psychological, social, and environmental health) of persons with SCI.     

Effect of depression and neuropathic pain using questionnaires on quality of life in patients with low back pain; cross-sectional retrospective study

Purpose

The present study investigated the percentage of low back pain (LBP) patients who have depressive symptoms and neuropathic pain and analyzed the effects of these on the quality of life (QOL) in these patients.

Methods

Of the 650 new patients with LBP that visited the hospital between June 2012 and December 2013, 309 patients who completed questionnaires to assess LBP and QOL were included in the study. The questionnaire included demographic items, the self-rated depression scale (SDS)-Zung, the Japanese version of the PainDETECT questionnaire (PDQ-J), numerical pain rating scale (NRS), and QOL assessments. The patients were divided into two groups according to their SDS-Zung scores: a nondepressed group with SDS scores <40 and a depressed group with SDS-Zung scores ≥50.

Results

One hundred twenty-five patients (40.5 %) were classified as nondepressed and 63 (20.4 %) as depressed. The mean PDQ-J score was higher in depressed patients than in nondepressed patients. The frequency of neuropathic pain was greater in depressed patients, with neuropathic pain observed in 17 of the 63 (27 %) depressed LBP patients and 11 of the 125 (9 %) nondepressed LBP patients. The SDS-Zung and PDQ-J scores of LBP patients were correlated significantly (r = 0.261, p < 0.001). Depressed patients had higher pain NRS scores and lower QOL scores compared with nondepressed patients.

Conclusions

Both the depressed patients and those with neuropathic LBP had a higher level of pain, greater pain-related disability, and poorer QOL compared with nondepressed patients. This is the first study to use the SDS-Zung and PDQ-J screening questionnaires to estimate the presence of neuropathic pain associated with depressive symptoms in LBP patients and to evaluate the impact of these on QOL.

     

Patienten nach Primärtherapie eines klinisch lokal begrenzten Prostatakarzinoms

Background

Radical prostatectomy (RP) and percutaneous radiotherapy (RT) are viable options for the primary treatment of localized prostate cancer (PC). Given the comparable efficacy of both modalities quality of life (QOL) has been suggested as an additional decision criterion. In recent years several validated instruments have been introduced to assess QOL. Most of them allow for patient-based rating of QOL.

Aim

Herein, we aim to compare QOL after RP and RT in our own cohort of patients in Tübingen using validated questionnaires.

Methods

In total, 165 patients who had been treated for PC in Tübingen were enrolled. Of those 100 men had RP and 65 had RT. The validated QOL questionnaires EORTC QLQ-C30 and EORTC QLQ-PR 25 were used for assessment. Statistical analyses focused on analyses of variance.

Results

Concordant to previous studies it could be shown that RP mainly creates voiding problems most importantly urinary incontinence but also erectile dysfunction. After RT, patients mainly complained about disturbed bowel function including diarrhea and proctitis as well as about urgency and frequency. RP patients had better PF2 Scale values than RT patients (p= 0.00357143). On DI scales RT patients yielded significantly poorer values than the RP group (p= 0.003333).

Conclusion

Our data comply well with those from other international centers. QOL is an important yet underestimated variable in oncological research. Our investigations underline the importance of an interdisciplinary approach for the successful management of PC.