Health-related quality of life and pressure ulceration assessment in patients treated in the community

Little is known of the impact of pressure ulceration on adult patients' health-related quality of life. The purpose of this study was to determine the impact pressure ulceration has on pressure ulcer patients cared for in the community. A case control study design was used by drawing a random sample from patients receiving community nursing care, stratified by the presence of pressure ulceration. In all, 75 patients with pressure ulcers were compared with 100 controls without ulcers using the four-point ulcer grading scale described by United Kingdom consensus guidelines. Patients were interviewed using the Short Form-36 (SF-36) questionnaire and activities of daily living assessed using the modified Barthel scale. Patients with pressure ulcers had significantly poorer physical function (mean difference (d) = 37.6, 95% CI 28.6-46.6, p < 0.001) and social functioning (d = 33.9, 95 % CI 24.0-43.9, p < 0.001) than published age- and sex-matched normative data from the United Kingdom. The difference between cases and controls was much smaller in these domains, with neither approaching statistical significance. After adjustment for age and gender, scores for bodily pain were poorer in patients with no ulceration (d = -10.5, 95% CI - 20.6 to - 0.4, p = 0.042) indicating greater pain in these patients compared with the cases with ulceration. Activities of daily living determined by the modified Barthel scale showed reduced self-care (d = -7.6, 95% CI -12.5 to - 2.7, p = 0.010) and mobility (d = -9.2, 95% CI -14.6 to - 3.8, p = 0.001) in patients with pressure ulceration. The overall ability to perform these activities was also significantly poorer in this group (d = -16.3, 95% CI -27.3 to -5.3, p = 0.004). While patients with pressure ulceration experience some deficits in their health-related quality of life compared with a normal population, these differences are similar to those experienced by other patients receiving community nursing care.     

Cardiff Wound Impact Schedule: the development of a condition-specific questionnaire to assess health-related quality of life in patients with chronic wounds of the lower limb

The purpose of this study was to develop and validate a questionnaire to measure the impact of chronic wounds (leg ulcers and diabetic foot ulcers) on patient health-related quality of life (HRQoL) and identify areas of patient concern. The Cardiff Wound Impact Schedule (CWIS) was created following a three-stage process. Stage 1 included a focus group (n=10) and a series of semi-structured interviews (n=13) to generate items for the questionnaire. Stage 2 involved piloting the 28-item questionnaire on 124 patients (64.5% with leg ulceration and 35.5% with diabetic foot ulceration): data from this stage were analysed using factor analysis. The reliability, validity and reproducibility of the resulting scale were assessed in Stage 3, a 3-month follow-up study of 135 patients in which patients completed the CWIS and the SF-36. Factor analysis identified three domains of HRQoL: physical symptoms and daily living, social life and well-being. There were no significant differences in scores across the wound types. Internal consistency was good (alpha=0.77-0.96) as was reproducibility (P<0.001). The CWIS was able to discriminate between those with healed ulcers and active ulcers (P<0.01). Construct validity was demonstrated by strong correlations between related items on CWIS and SF-36 (P<0.01-P<0.0001). The data suggest that CWIS has high internal consistency and the ability to discriminate between health states and good reproducibility. CWIS is a valid tool for studying the impact of chronic wounds of the lower leg on HRQoL. CWIS allows clinicians to identify items of patient concern, which can then be used to negotiate options of care most suited to individual patients.     

A cross-sectional study in Kerman, Iran, on the effect of diabetic foot ulcer on health-related quality of life

This study describes the impact of diabetic foot ulcers (DFUs) on health-related quality of life (HRQoL) using a generic instrument including 8 domains. Data were obtained from 54 patients with DFU who were compared with 78 patients who had diabetes without foot ulcer. HRQoL was measured using the Iranian version of Medical Outcome Study-Short Form (SF-36). The fasting plasma glucose, creatinine, glycosylated hemoglobin (HbA1c), and urine microalbumin as well as ankle-brachial pressure index (ABI) were measured for all participants in the 2 groups. In all, 51.9% of patients with DFU had ABI scores of <0.9 compared with only 11.8% of the control group (P < .001). No differences were found in any of the treatment characteristics (oral/insulin therapy) between the 2 groups (case/control). HRQoL evaluated by the SF-36 questionnaire, in particular in the areas of physical function, is lower in patients with diabetes with foot ulcers compared with patients with diabetes without foot ulcers (41.04 ± 22.69 vs 56.67 ± 25.57; P < .01). After adjusting by sex, 2 domains of physical functioning and bodily pain as well as the total HRQoL score in patients with DFU were lower than in patients with diabetes (P < .001). This study showed that physical functioning and bodily pain along with total score of HRQoL were important aspects that were lower in patients with DFU than in patients with diabetes. Gender was considered as a confounding factor, which was omitted in multivariate analysis.     

Health-related quality of life one month after thrombolysis or primary PCI in patients with ST-elevation infarction. A DANAMI-2 sub-study

OBJECTIVES: To evaluate the health-related quality of life (HRQoL) following Primary percutaneous coronary intervention (PCI) or thrombolytic treatment for ST-elevation myocardial infarction (STEMI). DESIGN: A questionnaire based study on patients randomised in the DANAMI-2 study to Primary PCI or thrombolysis for STEMI. A total of 1 351 patients (93.2% response rate) randomised in the DANAMI-2 study completed the HRQoL questionnaire one month after the infarction. RESULTS: With respect to the primary end-points (SF-36 physical component score, angina pectoris, and dyspnoea), patients randomised to primary PCI scored better on the SF-36 physical component score (PCS) (p=0.007), and reported significantly less angina pectoris (p=0.010) and dyspnoea (p=0.010). Higher scores among PCI patients were also found on the SF-36 scales physical functioning (p=0.015), role-physical (p=0.017), and general health (p=0.009). CONCLUSION: The results in this study support the hypothesis that primary PCI is superior to thrombolysis in treating STEMI, not only in clinical outcome, but also in quality of life outcome.     

Predictors of health-related quality of life in hypertensive recipients following renal transplantation

BACKGROUND: Health-related quality of life (HRQoL) improves after renal transplantation. However, it is unclear which variables are the strongest determinants of HRQoL following renal transplantation. In this study, we wanted to assess whether antihypertensive medication, donor type, human leukocyte antigen (HLA)-compatibility or other variables could predict HRQoL 6-12 months after transplantation. METHODS: The study was a follow up of 124 patients recruited to a single center, randomized, double-blind clinical trial, comparing the effects of lisinopril and nifedipine in hypertensive renal transplant recipients. HRQoL was assessed with the Short Form 36 (SF-36) questionnaire. Bivariate and multiple linear regression analysis were used to assess the relationship between potential predictors and the physical component summary (PCS) and mental component summary (MCS) scales of the SF-36. RESULTS: Average scores 6-12 months after transplantation did not differ between patients randomized to lisinopril or nifedipine, or between cadaveric and living donor recipients on any of the eight SF-36 scales, or the two summary scales. In multivariate analyses, recipient age (p = 0.01) and cold ischemia time >14.5 h (p = 0.04) were independent predictors of the PCS score. Recipient age (p = 0.05), 2-4 HLA-AB mismatches (p = 0.05) and donor age (p = 0.03) were independent predictors of the MCS score. CONCLUSIONS: There was no evidence of differences in HRQoL according to lisinopril or nifedipine, or living vs. cadaveric donor transplantation. HRQoL was significantly reduced with longer cold ischemia time and more than one HLA-AB mismatches, after adjusting for age. These donor kidneys related issues need confirmation.     

Assessment of health-related quality of life in patients with lymphedema of the lower limb

The purpose of this study was to examine the use of a number of tools in the evaluation of health-related quality of life in patients with lower limb lymphedema, and to determine the consequences of cancer history and concurrent leg ulceration. Patients in one health trust having lower limb lymphedema were identified and interviewed at entry and after 24 weeks. The short form-36 (SF-36), modified Barthel scale, McGill short form pain questionnaire, and Euroqol were administered at both time points. Of the 164 (median age=76.9 years, 70.7% women) patients who comprised the study population, 15.2% had a history of cancer and 30.4% had coexisting current leg ulceration. Internal consistencies were high for all scales (Cronbach's alpha >0.80). There were high ceiling effects for a number of SF-36 scores, and high floor effects in these and the McGill short form pain questionnaire, scales. Despite these limitations, there was strong evidence that treatment led to significant improvements in six of eight scores of the SF-36, three of three scores of the McGill short form pain questionnaire and the modified Barthel scale (all p<0.05). The improvement in physical functioning was significantly greater for patients who entered the study with a leg ulcer (mean different=9.1, 95% confidence interval 2.1-16.1, p=0.011). Patients treated with compression bandaging had significantly greater improvements for physical functioning (10.2) than those treated with compression hosiery (-1.5) or no treatment (-2.0), p=0.001. Of the tools assessed, the SF-36, appears to be the most appropriate for use in this patient group.     

Differences in health-related quality of life between elderly and younger patients on hemodialysis

BACKGROUND: It has been demonstrated that elderly patients have a great capacity of adaptation to renal replacement therapy (RRT). The aim of this study was to assess the health-related quality of life (HRQoL) of a cohort of patients at 3 and 12 months after the start of hemodialysis, searching for differences between elderly (aged>or=65 years) and younger (aged <65 years) patients. METHODS: This was a longitudinal prospective study of 93 patients starting RRT. HRQoL was assessed using the SF-36 health survey and the physical symptom dimension of the Kidney Disease Questionnaire (KDQ) at 3 and 12 months from the start of RRT. Physical component summary (PCS), mental component summary (MCS) and standardized scores, in which a lower score indicated lower HRQoL, by age and sex were obtained. RESULTS: Mean (SD) age was 66 years (12.26 years). At 3 months, differences between younger patients and elderly ones were statistically significant in the general health dimension, and at 12 months in physical functioning, role physical, general health dimensions and PCS, indicating less loss of HRQoL in elderly patients. At 3 months it was found that the functional state measured on the Karnofsky scale was independently associated with PCS (p=0.003), and hematocrit to MCS (p=0.036). At 1 year, PCS was independently associated with age (p=0.043) and Karnofsky score (p=0.039). CONCLUSIONS: Using scores standardized by age and sex, elderly patients had less loss of HRQoL in the physical aspects, than younger patients at 1 year from the start of hemodialysis.     

Health-related quality of life during the first year after severe brain trauma with and without polytrauma

OBJECTIVE: The increasing number of patients surviving severe traumatic brain injury (sTBI) but with significant sensorimotor and neuropsychological deficits is a challenge to rehabilitation medicine. So far, most research initiatives have focused on mortality rates, physiological or economic parameters to estimate therapeutic effects of rehabilitation strategies. Investigations on health-related quality of life (HRQoL) after TBI with and without concomitant polytrauma are rare compared to other disorders. DESIGN/PATIENTS: A prospective study was conducted to investigate HRQoL using the SF-36 questionnaire in 49 patients with sTBI (Glasgow Coma Scale < 9 for more than 24 hours) with and without concomitant polytrauma 6 and 12 months after injury. RESULTS: The SF-36 score profiles 6 and 12 months after trauma were similar. Scores 12 months after trauma, however, were higher in 7/8 dimensions indicating an improvement over time. Similar observations were made for physical and mental sum scores. There was no difference in the SF-36 scoring pattern between the patients with isolated TBI and the patients with concomitant polytrauma, except for physical functioning after 12 months. CONCLUSION: While there is significant overall improvement of HRQoL over time, sTBI appears to bear major influence on post-traumatic HRQoL and outcome.     

The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury

A subset of mild traumatic brain injury (mTBI) patients experience post-concussion symptoms. When a cluster of post-concussion symptoms persists for over three months, it is referred to as post-concussion syndrome (PCS). Little is known about the association between PCS and Health-Related Quality of Life (HRQoL) after mTBI. The aims of this study were to assess the implications of PCS on HRQoL six months after mTBI and the relationship between PCS and HRQoL domains. A prospective observational cohort study was conducted among a sample of mTBI patients. Follow-up postal questionnaires at six months after emergency department (ED) admission included socio-demographic information, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and HRQoL measured with the 36-item Short-Form Health Survey (SF-36) and the Perceived Quality of Life Scale (PQoL). In total, 731 mTBI patients were included, of whom 38.7% were classified as suffering from PCS. Patients with PCS had significantly lower scores on all SF-36 domains, lower physical and mental component summary scores and lower mean PQoL scores compared to patients without PCS. All items of the RPQ were negatively correlated to all SF-36 domains and PQoL subscale scores, indicating that reporting problems on any of the RPQ symptoms was associated with a decrease on different aspects of an individuals’ HRQoL. To conclude, PCS is common following mTBI and patients with PCS have a considerably lower HRQoL. A better understanding of the relationship between PCS and HRQoL and possible mediating factors in this relationship could improve intervention strategies, the recovery process for mTBI patients and benchmarking.     

The negative impact of chronic rhinosinusitis on the health-related quality of life among adult patients with cystic fibrosis

BackgroundWith improved survival in cystic fibrosis (CF) patients, it is crucial to evaluate the impact of chronic co-morbidities such as chronic rhinosinusitis (CRS). The objectives were 1) To determine the prevalence of CRS with a large series of CF patients 2) To evaluate the impact of CRS on the Health-Related Quality of Life (HRQoL) of CF patients and 3) To compare CRS-specific, CF-specific and general HRQoL instruments.MethodsConsecutive CF patients from the Toronto Adult Cystic Fibrosis Centre were recruited between March 2018 and January 2020. Participants completed the 22-Item Nasal Outcome Test (SNOT-22), Cystic Fibrosis Questionnaire-Revised for adolescents and adults over 14 years of age (CFQ-R), Cystic Fibrosis Quality of Life Evaluative Self-administered Test (CF-QUEST) and the 36-Item Short Form Survey (SF-36). HRQoL scores were correlated using Spearman's correlation coefficients.ResultsOut of 195 patients eligible for analysis, the prevalence of CRS with positive endoscopic findings was 42.6% (95% confidence interval: 35.5–49.8%). CRS patients reported significantly lower HRQoL with higher SNOT-22 scores and lower scores in the respiratory domain of CFQ-R and physical health domains of CF-QUEST and SF-36. The physical (ρ= ?0.63) and mental (ρ= ?0.66) domains of SF-36 and CF-QUEST (ρ= ?0.76) had a strong correlation with SNOT-22. Higher scores of SNOT-22 nasal subdomains correlated with lower scores of SF-36, CFQ-R and CF-QUEST.ConclusionCRS is a prevalent co-morbidity of CF patients, which significantly reduces HRQoL. SNOT-22, CFQ-R, CF-QUEST and SF-36 were strongly correlated. Severity of sinonasal symptoms have a strong correlation with HRQoL in CF patients.     

Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery

Background: The effect of gastric bypass on the health-related quality of life (HRQoL) of morbidly obese patients was investigated in a cross-sectional study. Methods: A postoperative group of 78 patients on average 13.8 years after gastric bypass was compared with a preoperative control group of 110 patients. The SF-36 was used to assess HRQoL. In preoperative patients, the SF-36 was self-administered, while in the postoperative group, telephone interviews were conducted. In the postoperative sample, multiple stepwise linear regression analyses were carried out to examine putative predictors of the physical (PCS) and the mental (MCS) composite scores of the SF-36. Results: Significant differences between the preand postoperative group were found for all subscales except Mental Health, in favor of the postoperative group. On average 13.8 years after gastric bypass, most of the sub-scales were similar to the US norm values. However, the Bodily Pain and the overall Physical Composite scale (PCS) scores were lower (more impaired) in the postoperative group compared with the US norms. Female patients, patients who were hospitalized since the surgery, and those who had lost less weight had more impaired values on the PCS and patients who reported binge-eating disorder (BED) at follow-up had more impaired values on the Mental Composite Scale (MCS) of the SF-36. Conclusion: HRQoL was significantly better in postoperative gastric bypass patients in comparison to a sample of preoperative patients. However, HRQoL, specifically the physical domain of the SF-36, was more impaired in long-term follow-up patients compared with US norm values. The reoccurrence of BED after surgery negatively influenced the mental domain of the SF-36.     

Health-related quality of life one month after thrombolysis or primary PCI in patients with ST-elevation infarction. A DANAMI-2 sub-study.

Objectives. To evaluate the health-related quality of life (HRQoL) following Primary percutaneous coronary intervention (PCI) or thrombolytic treatment for ST-elevation myocardial infarction (STEMI). Design. A questionnaire based study on patients randomised in the DANAMI-2 study to Primary PCI or thrombolysis for STEMI. A total of 1?351 patients (93.2% response rate) randomised in the DANAMI-2 study completed the HRQoL questionnaire one month after the infarction. Results. With respect to the primary end-points (SF-36 physical component score, angina pectoris, and dyspnoea), patients randomised to primary PCI scored better on the SF-36 physical component score (PCS) (p?=?0.007), and reported significantly less angina pectoris (p?=?0.010) and dyspnoea (p?=?0.010). Higher scores among PCI patients were also found on the SF-36 scales physical functioning (p?=?0.015), role-physical (p?=?0.017), and general health (p?=?0.009). Conclusion. The results in this study support the hypothesis that primary PCI is superior to thrombolysis in treating STEMI, not only in clinical outcome, but also in quality of life outcome.     

Influence of erectile dysfunction on health related quality of life of male kidney transplant patients

The objective of the present study was to investigate if a psychological adaptation capacity exists in kidney transplant bearers, even with ageing, in relation to erectile dysfunction (ED). We studied ED using IIEF-5 and health-related quality of life (HRQoL) using the SF-36 Health Survey, in a large sample of male renal transplant patients (n=242), searching for the influence of ED on HRQoL. Patients included 199 patients (82%); the median age was 52 y (43-62); 106 patients (54.9%) presented ED. These patients were divided into four groups according to median age. SF-36 scores were worse for ED vs non-ED patients in the first three age groups, but not in age group 4. SF-36 Mental Component Summary was similar for patients with ED and without ED in all age groups. We confirm the hypothesis that a psychological adaptation occurs in renal transplant patients in all age groups, when suffering ED.     

Health-related quality of life in different stages of renal failure

Measures of health-related quality of life (HRQoL) have a significant predictive value on patient survival and hospitalizations, especially in patients with chronic kidney disease (CKD). In this review, some of the major studies performed in patients with different stages of renal failure are presented. The most used instrument for measuring HRQoL is the Short form health survey questionnaire (SF-36). Patients with predialysis CKD had higher SF-36 scores than a large cohort of hemodialysis (HD) or peritoneal dialysis (PD) patients, but lower scores than those reported for the adult population. Kidney transplantation offers better HRQoL than dialysis. Hemoglobin level predicted both physical and mental domain scores of the SF-36. HRQoL of HD and PD patients were compared in only a few studies, mostly because these studies are difficult to interpret. PD patients generally have lower comorbidity scores at the onset of end-stage renal disease (ESRD), independent of other factors influencing modality selection. Comorbid medical conditions are common in patients with ESRD, and are an important contributing factor to clinical outcomes and quality of life. Depression occurs in about 20-30% of dialysis patients. This is important because of the negative impact depression has on quality of life, but also because depression is now established as a factor that can significantly affect morbidity and mortality in ESRD patients. Sexual life satisfaction showed marked deterioration in all age groups. Patients aged over 65 scored significantly better than younger patients on dialysis stress scales, and were generally more satisfied with life. Longitudinal studies are needed to define periods at risk for decline in HRQoL during progression of CKD.     

Quality of sleep and health-related quality of life in haemodialysis patients.

BACKGROUND: Sleep complaints are common in haemodialysis patients. In the general population, insomnia impacts negatively on health-related quality of life (HRQoL). The objective of this study was to examine the association between quality of sleep and HRQoL in haemodialysis patients independent of known predictors of HRQoL. METHODS: Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and HRQoL was measured using the Medical Outcomes Study 36-item Short Form (SF-36) in 89 haemodialysis patients. RESULTS: Sixty-three (71%) subjects were 'poor sleepers' (global PSQI >5). The SF-36 mental component summary (MCS) and physical component summary (PCS) correlated inversely with the global PSQI score (MCS, r = -0.28, P < 0.01; PCS, r = -0.45, P < 0.01). The PCS score also correlated with age (r = -0.24, P = 0.02), haemoglobin (r = 0.21, P = 0.048) and comorbidity (r = -0.40, P < 0.01), and mean PCS was lower in depressed subjects (26.2 vs 35.9, P = 0.02). Subjects with global PSQI >5 had a higher prevalence of depression, lower haemoglobin and lower HRQoL in all SF-36 domains. The global PSQI score was a significant independent predictor of the MCS and PCS after controlling for age, sex, haemoglobin, serum albumin, comorbidity and depression in multivariate analysis. CONCLUSIONS: Poor sleep is common in dialysis patients and is associated with lower HRQoL. We hypothesize that end-stage renal disease directly influences quality of sleep, which in turn impacts on HRQoL.     

Health-related quality of life (HRQOL) in Japanese osteoporotic patients and its improvement by elcatonin treatment

Health-related quality of life (HRQOL; QOL hereafter) was evaluated in Japanese osteoporotic patients using three questionnaires; the SF-36 (MOS 36-Item Short-Form Health Survey; generic, profile-type), the EQ-5D (Euro Qol-5 Dimensions; generic, preference-based), and the JOQOL (Japanese Osteoporosis Quality of Life 1999; disease-targeted). The eight subscales and two summary scores of the SF-36 were impaired in these patients even after correction for age and sex. The scores on the EQ-5D and JOQOL correlated well with the subscales of the SF-36 that represent the physical aspects of physical function and bodily pain, which suggests that physical aspects are important determinants of overall QOL status in osteoporotic patients. Although the QOL scores did not correlate with bone mineral density, they were markedly influenced by the presence of vertebral fractures. In particular, the presence of two or more vertebral fractures greatly decreased the QOL scores. We then evaluated the QOL scores before and after treatment. The patients were either given calcium supplementation alone or calcium plus once-weekly elcatonin (Elcitonin, Asahi Kasei Pharma, Tokyo, Japan) injection. Elcatonin treatment markedly improved diverse aspects of the QOL, whereas calcium alone did not. The current data suggest that osteoporosis, especially in the presence of vertebral fracture, is associated with compromised QOL, and therapeutic intervention for osteoporosis should be evaluated in terms of QOL, as well as in terms of increases in bone mineral density and fracture prevention.     

Twelve-month self-reported quality of life after retropubic radical prostatectomy: a prospective study with Rand 36-Item Health Survey (Short Form-36)

OBJECTIVES: To evaluate the health-related quality of life (HRQoL) in patients undergoing retropubic radical prostatectomy (RRP) for clinically localized prostate cancer. PATIENTS AND METHODS: From February 2002 to September 2003 all patients undergoing RRP in our department were invited to participate in the study; the data from 75 of them comprised the present analysis. For evaluating HRQoL the RAND 36-Item Health Survey (SF-36) was used. RESULTS: Comparing the baseline scores of the SF-36 domains to those at 3, 6 and 12 months, there was a statistically significant difference in 'physical function', 'role limitations due to physical health problems', 'role limitations due to emotional problems', and 'energy/fatigue'. There were no statistically significant changes in the follow-up values for the other scales of the questionnaire. However, the baseline scores overlapped the 12-month follow-up values for all the SF-36 scales. The mean SF-36 scores reported by incontinent patients were lower than those of the continent patients, although this trend was not statistically significant. At the 12-month follow-up some variables were independent predictors of lower mean scores of some SF-36 scales, i.e. age >65 years, education level less than secondary school, pathological extracapsular extension of cancer and erectile dysfunction. CONCLUSION: At 1 year after RRP, HRQoL levels in each of the SF-36 domains overlapped those of the baseline in >80% of patients. The age, educational level of patients, local extension of the tumour, and erectile dysfunction could significantly affect the HRQoL scores.     

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.     

Pain affects health-related quality of life in kidney transplant recipients

BACKGROUND: Chronic pain is prevalent in end-stage renal disease patients undergoing chronic hemodialysis. We do not fully know the intensity of chronic pain experienced by kidney recipients in comparison to those on chronic hemodialysis and healthy controls. Moreover, the effect of chronic pain on kidney recipients' health-related quality of life (HRQoL) is yet to be comprehensively addressed. We designed this study to find an answer to these questions. METHODS: In this case control study, we studied 205 kidney recipients, 69 hemodialysis patients, and 100 healthy controls, who were matched for age, sex, monthly family income, and educational level. The patients were evaluated for the intensity of chronic pain by Visual Analogue Scale (VAS). HRQoL was measured with Short Form 36 (SF-36) in the kidney recipients. Chronic pain intensity was compared in the study groups, and in the kidney recipients the correlation between SF-36 subscores and severity of pain was assessed. RESULTS: Severity of pain in the kidney recipients was lower than the hemodialysis patients, but more than the healthy controls (P=.001). The VAS pain score negatively correlated with the scores of SF- 36 total (r=-.329, P=01), mental health (r=-.190, P=07), physical health (r=-.275, P=.001), physical function (r=-.339, P=.001), role limitation due to physical problems (r=-.478, P=.001), role limitation due to emotional problems (r=-.326, P=.001), and bodily pain (r=-.894, P=.001). DISCUSSION: The intensity of chronic pain experienced by the kidney recipients is less than that experienced by patients under chronic hemodialysis, but higher than healthy subjects. Focusing on chronic pain as a cause of post-renal transplantation morbidity is expected to improve post-renal transplantation quality of life.     

The effect of long saphenous vein stripping on quality of life

PURPOSE: Long saphenous vein (LSV) stripping in the treatment of varicose veins may reduce the recurrence of varices but may also increase morbidity rates. The effect of stripping on health-related quality of life (HRQoL) is unknown. The aim of this study was to examine the effect of LSV surgery, with and without successful stripping, on HRQoL. METHODS: This prospective study comprises 102 consecutive patients who underwent varicose vein surgery that included attempted stripping of the LSV to the knee. HRQoL was assessed before surgery and at 4 weeks, 6 months, and 2 years after surgery with the Aberdeen varicose vein severity score (AVSS; disease-specific) and the Short-Form 36 (SF-36; generic). Patients defined as stripped were those in whom complete thigh stripping to the knee was confirmed with postoperative duplex scanning at 2 years. Patients defined as incompletely stripped were those in whom any LSV remnant was found in the thigh after surgery. Deep venous reflux (DVR) was defined as reflux of 0.5 seconds or more in at least the popliteal vein. RESULTS: Sixty-six of 102 patients (65%) provided complete HRQoL data at all four time points. At baseline, there was no significant difference between patients who were stripped (n = 25) and incompletely stripped (n = 41) in terms of AVSS, SF-36, age, gender, DVR, or CEAP grade. Significantly more patients in the incompletely stripped group underwent surgery for recurrent disease (29/41, 71%, versus 8/25, 32%; P =.002, with chi(2) test). Both groups gained significant improvements in AVSS scores for as much as 2 years. After adjustment for recurrent disease, stripping conferred additional benefit in terms of AVSS at 6 months (median [interquartile range]) (9 [4 to 16] versus 15 [9 to 24]; P =.031) and 2 years (7 [2 to 10] versus 9 [5 to 15]; P =.014), which was statistically significant in patients without preoperative DVR but not significant in patients with preoperative DVR. SF-36 scores were not affected by stripping. CONCLUSION: LSV surgery leads to a significant improvement in disease-specific HRQoL for as much as 2 years. In patients without DVR, stripping to the knee confers additional benefit.