Long-term results of peripheral arterial disease rehabilitation

PURPOSE: Although the Peripheral Arterial Disease Rehabilitation Program (PADRx) improves walking ability and quality of life over brief periods of follow-up, the long-term durability of results has not been established. This study examined functional status, walking ability, and quality of life in patients several months after completion of a 12-week PADRx. METHODS: Patients who completed a PADRx were eligible for participation. A Medical Outcomes Study 36-Item Short Form (SF-36), Walking Impairment Questionnaire (WIQ), and physical activity questionnaire were administered by telephone. A progressive treadmill test was performed on-site. RESULTS: Of 63 eligible patients, 14 were lost to follow-up, 11 refused participation, and four died. Thirty-four patients had completed PADRx 20 to 80 months previously (mean, 48.2 +/- 13.7 months), and completed the phone survey. Fifteen patients reported exercising a minimum of 60 min/wk for 3 months (EX group), and 19 had not exercised in the preceding 3 months (SED group). Self-reported SF-36 values were significantly different between the EX and SED groups for Physical Function (43.3 +/- 8.2 vs 34.2 +/- 7.8), Role-Physical Function (41.2 +/- 7.7 vs 32.8 +/- 9.2), and Bodily Pain (46.9 +/- 8.8 vs 38.9 +/- 7.1), as well as the Physical Composite (43.5 +/- 6.5 vs 34.0 vs 5.8) domains of the SF-36. Similarly the WIQ demonstrated significant differences in Walking Distance (46.8 +/- 36.2 vs 7.8 +/- 9.4), Walking Speed (47.5 +/- 32.6 vs 14.5 +/- 13.9), and Stair Climbing (60.6 +/- 36.6 vs 37.1 +/- 27.6), favoring the EX group. Sixteen patients, equally distributed between the EX and SED groups, completed the progressive treadmill test. Both groups had experienced improvement (P <.05) in claudication pain time and maximal walking time after completing the 12-week supervised program. The EX group maintained increased claudication pain time of 121% and maximum walking time of 109% over baseline, whereas the SED group values had returned to baseline (P <.05). CONCLUSIONS: Patients with claudication realize symptomatic and functional improvement with supervised exercise programs. Those who continue to exercise will potentially maintain these benefits and experience improved health-related quality of life.     

Correlation between ankle-brachial index, symptoms, and health-related quality of life in patients with peripheral vascular disease

OBJECTIVE: Improving health-related quality of life (HRQL) is the main goal of surgery to treat peripheral vascular disease (PVD); however, HRQL is rarely measured directly. Rather, most surgeons use other measures, such as patient symptoms and ankle-brachial index (ABI) to determine the need for intervention in PVD. The accuracy of these surrogates in representing HRQL has been untested. The purpose of this study was to determine the correlation of these measures with HRQL in patients undergoing evaluation for intervention in symptomatic PVD. METHODS: Patients (n=108) referred to the vascular surgery service with symptoms of PVD were enrolled in a prospective study of HRQL. Patients completed two validated HRQL questionnaires: the short form-36 (SF-36) and the Walking Impairment Questionnaire (WIQ). All patients had symptoms consistent with PVD, including claudication (n=69; 63.9%), ischemic rest pain (n=17; 15.7%), or tissue loss (n=22; 20.4%). ABI was measured at presentation. RESULTS: The mean ABI was 0.53 (range, 0.00-0.98). The maximal correlation between SF-36 score and ABI was reflected in the Physical Component Summary score (r=0.25). WIQ score also exhibited modest correlation with ABI, with maximal correlation noted for stair climbing (r=0.26). Both SF-36 and WIQ scores exhibited a highly significant association with symptoms. Patients with more severe symptoms, such as lifestyle-limiting claudication or limb-threatening ischemia, had lower HRQL scores compared with patients with non-lifestyle-limiting claudication. Multivariate analysis demonstrated that SF-36 and WIQ physical summary scores are better predicted by symptoms than by ABI (P<.01). CONCLUSIONS: HRQL in patients with PVD correlates weakly with ABI, but exhibits a closer association with vascular symptoms. However, neither variable fully expresses patient HRQL. These data suggest that sole reliance on these surrogates may not accurately reflect the effect of PVD on HRQL, or the potential benefit of vascular surgery in improving HRQL.     

Quality of life of adults with unhealed and healed diabetic foot ulcers

BACKGROUND: Diabetic foot ulcers cause major treatment morbidity and cost of care. This study evaluated quality of life in patients with unhealed and healed diabetic foot ulcers. METHODS: This was a cross-sectional study of adult diabetic patients (age 45 years or older) treated in a tertiary care foot clinic who had foot ulcers within the preceding 2 years. Patients with other diabetic complications or conditions that would potentially affect quality of life were excluded. Two patient groups of comparable age, gender distribution, and duration of diabetes were studied: 57 patients with unhealed ulcers (minimum duration, 6 months) and 47 patients with healed ulcers. Telephone interviews were done using the Short Form 12 (SF-12) (both groups) and a Cardiff Wound Impact Scale (CWIS) (unhealed ulcer group). RESULTS: The mean SF-12 Physical Component Summary score was significantly lower for the group with unhealed ulcers (unhealed, 35 +/- 8 points; healed, 39 +/- 10 points; p = 0.04); these scores for both groups were significantly lower than published Short Form 36 (SF-36) scores for general, diabetic, and hypertensive populations. The mean SF-12 Mental Component Summary scores of the groups did not differ significantly from each other or from published population scores. CWIS responses showed that patients with unhealed ulcers were frustrated with healing and had anxiety about the wounds, resulting in marked negative impact on the average Well-being Component Score (35 +/- 6 points). CONCLUSIONS: Individuals with diabetic foot ulcers experience profound compromise of physical quality of life, which is worse in those with unhealed ulcers.     

Osseointegrated trans-femoral amputation prostheses: prospective results of general and condition-specific quality of life in 18 patients at 2-year follow-up

This is the first report on prospective outcome for individuals treated with bone-anchored trans-femoral amputation prostheses (OI-prostheses) using the method of osseointegration. The aim was to analyze general and condition-specific health related quality of life (HRQL) at 2-year follow-up as compared to the preoperative situation. The study population consists of the first 18 consecutively treated patients (8 male/10 female, mean age 45 years) in a clinical investigation with amputations mainly caused by trauma and tumour. At inclusion the mean time since the amputation was 15 years (10 months - 33 years). Two self-report questionnaires were answered preoperatively and at follow-up: the SF-36 Health Survey (SF-36) and the Questionnaire for persons with a Transfemoral Amputation (Q-TFA). At follow-up 17/18 patients used the OI-prosthesis; one did not due to pain and loosening of the implant. Four of the scales of the SF-36 (Physical Functioning, Role Functioning Physical, Bodily Pain and Physical Component Score) and all four scores of Q-TFA (Prosthetic Use, Prosthetic Mobility, Problems and Global Health) were statistically significantly improved at follow-up showing superior general physical HRQL, increased prosthetic use, better prosthetic mobility, fewer problems and a better global amputation situation. Thus, osseointegrated prostheses represent a promising development in the rehabilitation of individuals with transfemoral amputation and increase their quality of life.     

Correlation between ankle brachial index, symptoms, and health-related quality of life in patients with peripheral vascular disease

Introduction: In the absence of quality of life measurement, other measures such as ABIs and patient symptoms provide a basis for determining the need for invasive therapy for patients with peripheral vascular disease (PVD). The accuracy of these surrogates in representing HRQL is, however, untested. The purpose of this study was to determine the correlation of these measures to HRQL. Methods: 115 PVD patients (114 male:1 female; median-age 64yrs) referred for vascular evaluation, were enrolled in an IRB-approved, prospective study. All patients completed Short Form-36 (SF-36) and Walking Impairment Questionnaire (WIQ- validated, PVD specific HRQL measure). 102 patients had measurement of ABIs and all had documented PVD symptoms. Pearsons correlation and student’s t test were used to examine univariate associations. Linear regression was used to assess the significance of the association of ABIs or symptoms in explaining the variance in HRQL scores. Results: The average ABI was 0.54 (0.00-0.98). The maximal correlation between SF-36 and ABIs was Physical Component Summary score (r = 0.29, p = 0.003). WIQ scores also exhibited modest correlation with ABIs (maximal correlation noted [r = 0.30, p = 0.002] for stair climbing). Both SF-36 and WIQ exhibited a highly significant association with symptoms: in all cases patients with surgical indications (lifestyle-limiting claudication or chronic critical limb-ischemia) had reduced HRQL scores compared with non-surgical patients (non-lifestyle-limiting claudication). Multivariate analysis suggested that in each case, SF-36 and WIQ summary scores were better predicted by symptoms than ABI’s (see table). Conclusions: HRQL in PVD patients correlates weakly with ABIs, but exhibits a closer association with vascular symptoms. This suggests that sole reliance on ABIs may not accurately reflect the impact of PVD on HRQL, or the potential benefit of vascular surgery in improving HRQL.     

重症急性胰腺炎远期疗效及健康相关生命质量分析

目的评估重症急性胰腺炎（severe acute pancreatitis,SAP）患者的远期疗效及健康相关生命质量,分析其影响因素。方法回顾性分析2003年1月至12月出院的98例SAP患者相关病历资料,应用SF-36量表及自制问卷表进行自评式调查,观察其健康相关生命质量及远期疗效。并与普通人群健康相关生命质量进行比较,作相关影响因素的单因素方差分析。自制问卷表单独分析。结果98例SAP患者中,病历资料完整59例,死亡2例,不能完成量表1例,无应答6例,收回有效问卷50例,应答率89．8％。SF-36量表生理功能、生理职能、情感职能、身体疼痛、活力、精神健康、社会功能和总体健康8个维度的得分分别为：（83±15）分、（62±42）分、（69±36）分、（80．4-15）分、（69±19）分、（72±15）分、（75±18）分和（65±18）分。与普通人群比较,生理职能和社会功能两项与普通人群间差异有统计学意义（P〈0．05）。其余6项与普通人群差异无统计学意义（P〉0．05）。影响生理健康总分的变量有治疗方式、住院时间、住院费用造成的经济负担。影响心理健康总分的变量有性别和住院费用造成的经济负担。结论SAP患者的健康相关生命质量与普通人群相近,远期疗效及生命质量良好,其影响因素主要有性别、治疗方法、住院时间及经济状况。     

Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery

No results on long-term outcome in terms of health-related quality of life (HRQL) have previously been presented for patients treated for adolescent idiopathic scoliosis. A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before the age of 21, either with distraction and fusion using Harrington rods [surgical treatment group (ST), n=156; 145 females and 11 males] or with a brace [brace treatment group (BT), n=127; 122 females and 5 males] were followed at least 20 years after completion of the treatment. Ninety-four percent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM'S questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination including radiography and clinical examination. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. The results showed no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly, reduced physical function using the SF-36 subscales, SF-36/Physical Component Summary (PCS) score as well as the Oswestry Disability Back Pain Questionnaire compared to the controls. Neither the mental subscales and the Mental Component Summary (MCS) score of SF-36 nor the PGWB index showed any significant difference between the groups. Forty-nine percent of ST, 34% of BT and 15% of controls admitted limitation of social activities due to their back [P<0.001 ST vs controls, P=0.0010 BT vs controls, and n.s. (P=0.024) ST vs BT], mostly due to difficulties with physical participation in activities or self-consciousness about appearance. Pain was a minor reason for limitation. No correlation was found between the outcome scores and curve size after treatment, curve type, total treatment time or age at completed treatment. Patients treated for adolescent idiopathic scoliosis were found to have approximately the same HRQL as the general population. A minority of the patients (4%) had a severely decreased psychological well-being, and a few (1.5%) were severely physically disabled due to the back.     

Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients.

OBJECTIVE: The malnutrition-inflammation score (MIS) is a scoring system that measures malnutrition and inflammation. We sought to explore its associations with depression, sleep disturbance, and quality of life. DESIGN: This was a cross-sectional study. SETTING: This study took place at the Baskent University Outpatient Hemodialysis Unit (Ankara, Turkey). PATIENTS: We enrolled 67 hemodialysis patients (male/female, 34/33; age, 47.7 +/- 11.4 years [mean +/- SD]; hemodialysis duration, 103.7 +/- 59.1 months [mean +/- SD]). INTERVENTION: We retrospectively recorded patients' monthly clinical and laboratory findings from the previous 6 months. The same physician calculated MIS scores. We interviewed all patients, and each completed a Beck Depression Inventory (BDI) assessment. We used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep, and the Medical Outcomes Study 36-item short form (SF-36) questionnaire to evaluate health-related quality of life. MAIN OUTCOME MEASURES: The main outcome measures involved the univariate and multivariate relationships of the MIS with BDI, PSQI, and SF-36. RESULTS: Patients with PSQI scores of < or = 5 ("good sleepers") had lower MIS scores than did poor sleepers (6.8 +/- 2.5 vs. 8.8 +/- 3.2, P < .05). Patients with moderate-to-severe depression (BDI score > or = 19) had higher MIS scores (9.0 +/- 3.2 vs. 6.5 +/- 2.5, P = .005) and higher PSQI scores (7.6 +/- 2.1 vs. 4.7 +/- 1.8, P = .001), compared with patients with BDI scores < 19. Increased MIS scores were correlated with increased comorbidity (P = .01) and poor SF-36 scores (P = .009). CONCLUSION: Increased MIS is significantly associated with the presence of depression, sleep disorders, and poor quality of life. This close relationship may help establish the MIS as an important determinant of the increased morbidity and mortality of hemodialysis patients.     

Responsiveness of the foot function index, AOFAS clinical rating systems, and SF-36 after foot and ankle surgery

BACKGROUND: There is uncertainty regarding which outcomes tools should be used to report the results of treatment for patients with foot and ankle disorders. This study compared the responsiveness of the Foot Function Index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Systems, and Medical Outcomes Study Short Form-36 (SF-36) in patients with foot and ankle surgery. METHODS: Twenty-five patients were recruited at a tertiary referral foot and ankle practice. The mean age of the patient sample was 40 years (range 21 to 69) and 19 were women (76%). Thirteen patients (52%) had conditions affecting the ankle, hindfoot, or midfoot, while 12 patients (48%) had conditions affecting the forefoot. Patients completed packets preoperatively and 6-months postoperatively which included informed consent forms, the FFI, the AOFAS, and the SF-36 questionnaires. Standardized response means (SRM) and effect sizes (ES) were used as the measures of responsiveness and were calculated for the AOFAS scores, the three domains of the FFI, the eight SF-36 sub-scales, and the two SF-36 summary scales. RESULTS: The standardized response mean (SRM) for the AOFAS scores was 1.10 and the effect size (ES) was 1.12. The SRM for the three FFI domains ranged from -0.39 to -0.83, while the ES ranged from -0.55 to -0.86. The SRM for the SF-36 ranged from 0.09 to 0.72 (ES ranged from 0.09 to 0.77) with the highest values occurring with the Bodily Pain sub-scale (SRM 0.72, ES 0.77) and Physical Component Summary scale (SRM 0.76, ES 0.68). CONCLUSIONS: This study demonstrated increased responsiveness of foot and ankle specific outcomes tools compared to the SF-36. However, the Bodily Pain sub-scale and Physical Component Summary scale of the SF-36 had levels of responsiveness approaching those of the FFI and AOFAS Systems after foot and ankle surgery. This suggests that the SF-36 may be used alone to monitor the outcomes in these patients without sacrificing adequate sensitivity to clinical change.     

全髋关节置换术后病人健康相关生存质量评估

[目的]评价Harris评分在全髋关节置换术疗效评估中的局限性。[方法]对2005年9月~2006年1月47例(50髋)接受全髋关节置换术的病人进行6个月的前瞻性研究。在术前和术后6个月均对病人进行Harris评分和评估健康相关生存质量的SF-36简明健康状况调查量表(MOS36-item Short Form Health Survey,SF-36)评分,并分析Harris评分和SF-36各项评分之间的相关性。[结果]病人术后6个月的Harris评分和SF-36各项评分均较术前有统计学意义上的差异(P<0.001),但SF-36各项评分的改善程度并不一致。Harris评分和SF-36生理功能(PF)和躯体疼痛(BP)项评分有相关性(r>0.4,P<0.001),但与SF-36其它方面评分无明显相关性(r<0.4),或无相关性(P>0.05)。[结论]虽然Harris评分能较好地评估全髋关节置换术对改善病人生理功能和缓解疼痛的疗效,但对于评价病人健康相关生存质量和其它方面的改善还存在局限性。因此,有必要将SF-36评分引入到全髋关节置换术的疗效评估中。     

Improved Patient-Reported Quality of Life and Hip Function After Cementless 1-Stage Revision of Chronic Periprosthetic Hip Joint Infection

BackgroundLimited information is available on health-related quality of life (HRQoL) and patient-reported hip function following treatment for a chronic periprosthetic hip joint infection. The purpose of this study is to evaluate changes in HRQoL and patient-reported hip function 2 years following a cementless 1-stage revision for chronic periprosthetic hip joint infection.MethodsPatients (n = 52) enrolled in a previously published clinical study on cementless 1-stage revision in chronic periprosthetic hip joint infection prospectively answered the EuroQol-5D, Short-Form Health Survey 36 (SF-36), and Oxford Hip Score preoperatively and at 3, 6, 12, and 24 months follow-up. Results were compared to age-matched and gender-matched population norm.ResultsA significant improvement in HRQoL and patient-reported hip function appeared in the first 3 months after surgery and reached a plateau after 6 months. The patients statistically reached age-matched and gender-matched population norm after 3 to 12 months follow-up on most items, except for Physical Functioning and Social Functioning on the SF-36. The largest effect sizes were found for Oxford Hip Score at 1.8 and for Role Limitation, Physical and Bodily Pain on the SF-36 at 1.5 and 1.6, respectively.ConclusionPatients treated with a cementless 1-stage revision for chronic periprosthetic hip joint infection experienced a marked increase in HRQoL and patient-reported hip function, and matched population norms on many parameters.     

Quality of life of patients operated on for lumbar stenosis: a long-term follow-up

Summary Background. We evaluated a sample of 28 patients surgically treated for lumbar stenosis (LS) four years after the first evaluation (length of the first follow-up mean 44.6 months, range 15–88) in order to evaluate the long-term follow-up of Quality of Life (QoL) after surgical treatment as LS may greatly impair the patients’ QoL. We previously assessed QoL in 30 patients operated on for LS four years before, by performing a retrospective follow-up through the Short-Form 36 Health Survey (SF-36). Methods. In this current study we performed a phone call evaluation administering the SF-36 and the official Italian version of the North American Spine Society (NASS) lumbar spine outcome assessment instrument. Findings. With regard to the SF-36 results at long term follow-up we observed a significant improvement of Physical Function, Bodily Pain, Mental Health and the Physical Composite Score with respect to the first follow-up. Conversely, Vitality worsened. Regarding the results of NASS an improvement of neurological symptoms was observed. Comparison of SF-36 mean scores in the current LS sample vs. the Italian normal population at the same age, showed similar QoL pattern. Conclusions. The long-term follow-up showed that patients operated on for LS continue to improve their QoL pattern even between the 4th and the 8th year after surgery.     

Ten-Year Results of Unicompartmental Knee Arthroplasty in Patients With Psychological Distress

BackgroundAlthough the influence of psychological distress on the outcomes of total knee arthroplasty has been described extensively, its effect on unicompartmental knee arthroplasty (UKA) is poorly defined. Furthermore, most studies in arthroplasty literature had short follow-ups of ≤1 year. We investigated the influence of psychological distress on long-term patient-reported outcomes and analyzed the change in mental health after UKA in a cohort with minimum 10 years of follow-up.MethodsProspectively collected data of 269 patients undergoing UKA in 2004-2007 were reviewed. Patients were stratified into those with psychological distress (36-item Short-Form health survey [SF-36] Mental Component Summary [MCS] <50, n = 111) and those without (SF-36 MCS ≥50, n = 158). Clinical outcomes were obtained preoperatively, at 2 years, and 10 years. Multiple regression was used to control for age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, and baseline scores. The rate of expectation fulfillment and satisfaction was compared.ResultsPsychologically distressed patients had poorer Knee Society Knee Score, Function Score, Oxford Knee Score, and SF-36 Physical Component Summary preoperatively, at 2 years, and 10 years. However, an equal proportion in each group attained the minimal clinically important difference for each score. Distressed patients had a comparable rate of satisfaction (91% vs 95%, P = .136) but lower fulfillment of expectations (89% vs 95%, P = .048). The percentage of distressed patients declined from 41% to 35% at follow-up. The mean SF-36 MCS improved by 6.9 points.ConclusionAlthough psychologically distressed patients had relatively greater pain and poorer function preoperatively and up to 10 years after UKA, a similar proportion of them experienced a clinically meaningful improvement in patient-reported outcomes.     

Barrett食管伴滑动性食管裂孔疝腹腔镜治疗疗效观察

目的探究合并滑动性食管裂孔疝的Barrett食管患者经腹腔镜下治疗后生活质量和食管黏膜病变的改善情况。 方法回顾性收集首都医科大学宣武医院胃食管反流中心2016年1月至2020年12月诊断为Barrett食管伴滑动性食管裂孔疝患者23例，接受腹腔镜食管裂孔疝修补+胃底折叠术，于术前和术后12周时行胃镜、胃食管反流病自测量表（Gerd Q）评分、反流症状指数（RSI）评分、健康调查量表36（SF-36）调查问卷，评估患者术后生活质量和食管黏膜改善情况。 结果23例伴滑动性食管裂孔疝的Barrett患者术后12周随访显示3例患者黏膜病变部分消退。患者术后GerdQ、RSI相较术前均有明显改善（GerdQ：5.78±1.54 vs 11.65±1.50，P=0.00；RSI：9.70±1.92 vs 18.57±3.01，P=0.00），SF-36量表仅在生理功能方面改善不明显（85.87±4.16 vs 86.43±3.12，P=0.31），生理职能、情感职能、活力、精神健康、社会功能、躯体疼痛和总体健康方面均明显改善（生理职能：66.43±6.13 vs 35.48±2.86，P=0.00；情感职能：73.74±4.91 vs 65.22±2.58，P=0.00；活力：56.96±3.80 vs 50.30±4.56，P=0.00；精神健康：62.09±4.89 vs 53.26±2.07，P=0.00；社会功能：81.39±4.42 vs 74.00±3.59，P=0.00；躯体疼痛：80.00±6.84 vs 75.30±10.27，P=0.00；总体健康：69.17±5.68 vs 60.17±4.61，P=0.00）。 结论腹腔镜食管裂孔疝修补+胃底折叠术对伴滑动性食管裂孔疝的Barrett食管患者生活质量和黏膜病变均有一定改善。     

Patient-reported quality of life after abdominal aortic aneurysm surgery: a prospective comparison of endovascular and open repair

PURPOSE: This study evaluated and compared changes over time in health-related quality of life reported by patients with infrarenal abdominal aortic aneurysm (AAA) undergoing elective endovascular (EVAR) and open aneurysm (OR) repair. METHODS: A prospective, nonrandomized cohort of 76 patients (62 men, 14 women; age range, 42 to 89 years) undergoing elective, infrarenal AAA repair (EVAR, n = 43; OR, n = 33) at two university teaching hospitals during a 15-month period were administered the Medical Outcomes Study Short-Form 36-item (SF-36) health survey preoperatively and then 1 week, 1 month, and 6 months postoperatively. Patient demographics, procedural details, postoperative follow-up data, and SF-36 scores were compared between groups. RESULTS: Both groups had total SF-36 scores that were significantly lower than preoperative scores at 1 week and 1 month after surgery but were not significantly different from the preoperative scores at 6 months (OR 66.2 +/- 21.1 to 72.3 +/- 19.8, P > .1; and EVAR 61.0 +/- 17.7 to 58.7 +/- 19.4, P > .1). Six-month total SF-36 scores were significantly higher in the OR group compared with the EVAR group (mean 72.3 +/- 19.8 OR vs 58.7 +/- 19.4 EVAR; P = .009). In the postoperative period, a significant drop occurred in mean scores in six of the eight domains of the SF-36 in the OR patients (physical function, PF; role physical, RP; bodily pain, BP; vitality, VT; social function, SF; role emotional, RE) and five domains for EVAR patients (PF, RP, BP, SF, RE). In two domains, RE and PF, scores returned to baseline values significantly sooner in EVAR patients than in OR patients (RE, EVAR 1 month vs OR 6 months; and PF, EVAR 1 month vs OR 6 months). In the VT domain, no significant postoperative drop occurred in the EVAR group, but in the OR group, mean scores were significantly lower at 1 week and 1 month compared with preoperative values. In the domains of general health and mental health, no significant drop occurred in SF-36 score postoperatively in either group. CONCLUSIONS: Patient reported health-related quality of life after infrarenal AAA repair is significantly impaired in the early postoperative period but returns to baseline by 6 months in patients treated with EVAR and OR. Patients having EVAR had significantly more rapid return to preoperative scores in selected domains of the SF-36. Even though EVAR is associated with shorter and less invasive perioperative hospital course and fewer postoperative complications, EVAR patients had lower quality of life scores 6 months after surgery than OR patients.     

Radical surgery: effect on quality of life and pain in chronic rhinosinusitis.

OBJECTIVES: Despite effective medical therapy and repetitive endoscopic sinus surgery in the treatment of chronic rhinosinusitis, there still remains a small group of patients without improvement of symptoms. This study evaluates the effect of radical surgery on quality of life and pain in these patients with recalcitrant disease. STUDY DESIGN: A prospective, questionnaire-based study was conducted in 23 patients who underwent Denker's procedure for refractory chronic rhinosinusitis. Quality of life and pain were evaluated before surgery and 12 months and 2 years after surgery with the SF-36 and McGill Pain Questionnaire. RESULTS: Seven of the eight mean scores of the SF-36 postoperatively improved after surgery, with statistical significance for Role Physical (RP) P=0.048. Bodily pain showed a strong tendency to significance. Results of the McGill Pain Questionnaire show a significant improvement in most of the subscores after surgery implying less pain. CONCLUSION: Radical surgery improves the physical burden of chronic rhinosinusitis and pain experience in patients with therapy resistant chronic rhinosinusitis.     

Femoral replacement for salvage of periprosthetic fracture around a total hip replacement

A total of 20 patients with a mean age of 72 (range: 36-91) were managed with replacement of the proximal (15) or total (5) femur for salvage of a periprosthetic femoral fracture with bone loss. A mean 12.5 years had elapsed between primary total hip replacement and surgery and the mean follow-up was 48 months (range: 12-116 months). Clinical outcome was assessed using the Toronto Extremity Salvage Score (mean: 68, range: 32-98) and Short Form 36 (SF-36; mean Physical Component Score (PCS): 53, range: 44-62; mean Mental Component Score (MCS): 51, range: 41-64). No prostheses were radiologically loose. There were six major complications; three patients suffered a postoperative dislocation; two patients had persistent deep infection (present preoperatively); and one patient suffered a fracture of their femur distal to the femoral stem of a proximal femoral replacement. Endoprosthetic replacement of the femur is a reasonable salvage option for patients with periprosthetic fracture and bone loss, with good clinical results. It allows immediate weight bearing and does not rely on bony union for success.     

Age and angina as predictors of quality of life after myocardial infarction: a prospective comparative study.

OBJECTIVES: The objectives were to compare quality of life (QoL) after first myocardial infarction with an age- and sex-adjusted normative population and to test whether the 1-month QoL had predictive properties. DESIGN: QoL was assessed by self-administered questionnaires (SF-36 and Cardiac Health Profile) 1, 3 and 6 months after index-event. Participants were 60 consecutive patients (20% women) with a mean age of 58 +/- 7.4 years. RESULTS: Patients > or =59 years improved in Physical (PCS) and Mental Component Summary (MCS), scoring comparable to community norms at 6 months. However, patients <59 years improved in PCS but not in MCS. and scored significantly below community norms in both PCS (x = 44.7, CI 40.6-48.7 vs x = 50.3, CI 49.3-51.4) and MCS (x = 45.9, Cl 41.8-49.9 vs. x = 51.3, CI 50.3-52.4) at 6 months. Predictors for MCS were age (p = 0.025) and Vitality (p = 0.020) both positively related to QoL. Predictors for PCS were Physical Function (p = 0.003) and CCS score (p < 0.001) where angina grade was negatively related to QoL. CONCLUSION: Because of impaired mental recovery in younger post-infarction patients, their need of special attention in the rehabilitation process must not be overlooked.     

Relationship between objective measures of peripheral arterial disease severity to self-reported quality of life in older adults with intermittent claudication

OBJECTIVES: The aim of this study was to determine the relation between functional measures of peripheral arterial disease (PAD) severity with both disease-specific and generic self-reported health-related quality-of-life (HR-QOL) measures, as well as the relation between the two types of HR-QOL measures. METHODS: This was a cross-sectional observation of participants from the community and primary care or vascular surgery clinics in an academic Veterans Administration medical center. Eighty patients with symptomatic Fontaine stage II PAD provided physiologic measures and self-response questionnaires. Objective measures included the ankle-brachial index (ABI), time to maximum claudication pain on a graded exercise test, and a 6-minute floor-walking distance. Self-reports included the Walking Impairment Questionnaire (WIQ), a disease-specific HR-QOL measure and the Medical Outcomes Study (MOS) Short-Form 36 (SF-36), a generic HR-QOL measure. RESULTS: Patients (mean age 70 +/- 8 [+/- SD] and 85% men) exhibited moderate-to-severe PAD by objective measures of ABI (0.65 +/- 0.19) and time in minutes to maximal claudication on a graded exercise test (7:54 +/- 4:58). Significant correlations were found between these measures and the WIQ distance, MOS-Physical Function, and MOS-Role Limitations due to physical dysfunction. The SF-36 and the WIQ subscales were significantly correlated. CONCLUSION: In older PAD patients with intermittent claudication, objective measures of disease severity are correlated with a self-reported, disease-specific and generic HR-QOL.