Evaluation of health-related quality of life in patients with shoulder pain: are we doing the best we can?

This article provides an understanding of patient-based shoulder outcome tools and the conceptual framework of disablement models from which the patient-based outcome tools are based. To allow for the evaluation of function, disability, and health-related quality of life in patients suffering from shoulder pain and in particular those whose shoulders have high physical demands, the use of shoulder self-report patient-oriented outcome tools must become standard of practice. A wide variety of available outcome tools demonstrate acceptable levels of measurement properties and are appropriate for virtually every patient with a shoulder disorder.     

Improvements in self-reported and parent-proxy perceptions of adolescents’ health-related quality of life following a multidisciplinary obesity treatment program

Purpose

To evaluate the effects of a Multidisciplinary Obesity Treatment Program (PMTO) on parent-proxy perceptions and self-reported health-related quality of life (HRQoL) in overweight and obese adolescents.

Methods

Ninety-two overweight and obese adolescents aged 10–18 years were assigned to the PMTO. HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQLTM 4.0), administered to the adolescents and their parents/guardians at baseline and post-intervention. This intervention lasted 16 weeks and was based on cognitive behavioral therapy with the involvement of a psychologist, a nutritionist and exercise professionals.

Results

Adolescents reported improved physical [pre: 78.13 (21.1) to post: 84.38 (18.8); p < 0.001; effect size: 0.43], social [pre: 80.0 (30.0) to post: 85.0 (20.0); p = 0.033; effect size: 0.10], psychosocial [pre: 75.0 (22.8) to post: 76.67 (19.6); p = 0.013; effect size: 0.18], and total [pre: 75.0 (17.4) to post: 79.35 (16.8); p = 0.001; effect size: 0.28] domain scores. As for parent-proxy perceptions, improvements for all domains, except school domain, were noted (p < 0.05; effect sizes: from 0.26 to 0.34) post-intervention. At baseline, parents presented lower scores than the adolescents’ HRQoL for all domains (p < 0.05). However, following the intervention, parents only had lower scores than their children for the physical and total domains of the HRQoL scale.

Conclusions

In addition to improving HRQoL in the adolescents, the PMTO improved parent-proxy perceptions of their children’s HRQoL.

     

Effect of 8 months of whole-body vibration training on quality of life in elderly women

Whole-body vibration (WBV) training in elderly may improve muscle strength, muscle power and postural control. However, knowledge about the effect of WBV training in elderly on measures of health as a multidimensional construct (health-related quality of life, HRQoL) is scarce. The present study aimed to determine the effects of WBV training on HRQoL in elderly women. A total of 37 women (aged 82.4 ± 5.7 years) were recruited and were assigned to either the WBV group or to the control (CON) group. After 8 months of training, the WBV group showed non-significant changes on HRQoL and additional health-related outcomes (fall risk, life satisfaction or cognitive status). Our findings are in disagreement with previous studies of shorter duration (6 weeks), which reported positive significant changes in HRQoL in elderly people. Discrepancies among studies may be partly attributed to methodological differences, but the existence of publication bias in previous studies cannot be discarded.     

Is there an association between physical exercise and the quality of life of hypertensive patients?

CONTEXT: Quality of life of hypertensive patients (QOLHP) is associated with factors that are not always taken into account in the recommendations made by doctors. OBJECTIVE: To evaluate the association between QOLHP and physical exercise in an effectiveness approach, i.e. under the actual conditions of application of these treatments. METHODOLOGY: In a sample of 361 hypertensive patients registered in a primary care center in Tenerife, Spain, the QOLHP is measured using the PECVEC questionnaire. The main factor considered is physical exercise. In addition, we compiled a set of control variables: pharmacological and dietetic treatments, pathological, clinical, functional, psychological, social, lifestyle and demographic characteristic of the patients. We explored the association between all these factors and the QOLHP by adjusting multiple linear regression models. RESULTS: The PECVEC results were between 2.0 and 3.5, with an overall Cronbach's alpha reliability statistic of 0.88. From the sample, 58% of the patients engage in physical exercise, 75% maintain a anti-hypertension diet and 89% take hypertension medication. From all the treatments evaluated, only physical exercise is associated directly with all PECVEC scales, especially for women and patients over 65. CONCLUSIONS: Recommending the practice of physical exercise may be a useful tool for doctors to improve the QOLHP.     

Validity in clinical research: a review of basic concepts and definitions☆

This is the first in a series of papers broadly titled ‘Research Without Tears’ that will discuss fundamental and sometimes controversial areas of research methods. In general, papers in this section aim to inform or update the readership of theoretical and practical issues for research in the clinical sciences. Some of the review papers will be conceptual in nature whilst others may address specific topics related to research design and data handling. It is hoped that this will facilitate the individuals and teams to complete and disseminate their research. Another important aim of these papers will be to try to demystify the chosen topics for those people whose role is not exclusively research orientated.The aim of this specific review paper is to address the concept of validity in clinical research. This article will be followed, firstly, by a review paper that will investigate the topic of reliability in clinical research, and then by an original research article that places the determination of validity and reliability within a specific clinical context. The current paper will initially define key components of validity with regard to the general aims of research and the research design. This will include definitions of internal, external and ecological validity. Threats to internal and external validity will be discussed, as will remedies to these treats through the application of appropriate sampling and design. This paper will then investigate the narrower concept of the validity of the measuring tool or process. A brief definition will be followed by a discussion of the processes by which validity may be determined. Future papers will address other issues of relevance to the readership. The Editorial Board welcomes any specific ideas and/or submissions.     

Health-related quality of life in the Royal Norwegian Navy: does officer rank matter?

The health-related quality of life of Royal Norwegian Navy officers was compared with that of the general population and the association between health-related quality of life and the rank of the officers was estimated in a cross-sectional survey of 1,316 male officers, 25 to 62 years of age, in September 2002. Standardized scores for the SF-36 Health Survey were used for the comparison with the general population, and the mean raw scores for the eight SF-36 subscales were used for the association within the Navy study population. The health-related quality of life of the Navy officers was similar to that of the general population of Norway when adjusted for age, gender, having a job, and educational level. Higher military rank among male Navy officers was associated with better health-related quality of life when adjusted for age but not when adjusted for other sociodemographic variables and lifestyle factors. Physical activity seemed to be the most important positive lifestyle factor.     

Individuals with multiple sclerosis who participate in a 6-week group exercise programme ��show an improvement in their quality of life and fatigue��

Background

Neurorehabilitation exercise programmes designed for individuals with multiple sclerosis (MS) are usually carried out in gyms with specific facilities and expensive equipment. However, little is known about the effects of other training programmes which do not need special equipment. This pilot study aimed to determine whether patients suffering from MS show an improved quality of life (QoL) and diminished level of fatigue perception after participating in a group-based callisthenic exercise programme.

Methods

A total of 26 individuals (17 women, 9 men, mean age 44.4 years) completed the study. Outcome assessments of fatigue were made with the Fatigue Impact Scale (FIS) and of QoL with the Functional Assessment of Multiple Sclerosis (FAMS) scale. Results: The results obtained showed a significant difference on both scales after the programme (p<0.05 for FIS and p<0.01 for FAMS).

Conclusion

Our findings seem to indicate that callisthenic exercise programmes can be beneficial for individuals with MS. Further research with larger samples is needed.     

Peace,justice and disabled women’s advocacy: Tamil women with disabilities in rural post-conflict Sri Lanka

This article draws on grounded qualitative research with rural Tamil women who acquired a disability during the civil war in Sri Lanka and conceptualizes an intersectionality-peace framework. Three main themes were developed from the interviews: narratives of conflict, survival outcomes of social assistance and mobilization of cross-ethnic relationships. With the support of a local women’s disability advocacy organization, Tamil women with disabilities were enabled to overcome social stigma and claim a positive identity as women with disabilities. The organization’s focus on realizing disability rights created new opportunities for these highly marginalized rural women. The women were also supported to form cross-ethnic relationships with women who similarly faced multiple oppressions. These relationships transformed the women into ‘agents of peace’, using their newfound disability identity to foster cross-ethnic dialogue and create safe spaces in the post-conflict context.     

Prevention of supine hypotensive syndrome in pregnant women undergoing computed tomography – A national survey of current practice

AimSupine hypotensive syndrome (SHS) can occur in women in the second half of pregnancy due to compression of the aorta and inferior vena cava by the gravid uterus. This results in a decrease in cardiac output with effects ranging from transient asymptomatic hypotension to cardiovascular collapse. SHS can be easily avoided by left lateral tilt positioning. We undertook a nationwide survey to assess the awareness amongst senior computed tomography (CT) radiographers of the potential risk of SHS in women in this patient group, and to identify the extent to which preventative practices and protocols are in place.Methods and materialsA questionnaire was sent to superintendent CT radiographers at all acute NHS Trusts in England and Wales examining awareness of the risk of SHS and the preventative practices and protocols currently used.ResultsCompleted questionnaires were received from 64% institutions. Of respondents who scan women in this patient group, only 44% were aware of the risk of SHS. No institution had a written protocol specifying positioning of women in this patient group. Seventy-five percent of institutions never employed oblique positioning. Eighty-five percent felt that specific guidelines from the Society of Radiographers or Royal College of Radiologists would be helpful.ConclusionCurrent awareness and practices for preventing this easily avoidable but potentially harmful condition are inadequate. Central guidance would be welcomed by a large majority of respondents.     

Improving muscular endurance with the MVe Fitness Chair™ in breast cancer survivors: A feasibility and efficacy study

ObjectivesTo assess the feasibility and efficacy of delivering Pilates exercises for resistance training to breast cancer survivors using the MVe Fitness Chair?.DesignPilot randomized controlled trial.MethodsTwenty-six female breast cancer survivors were randomized to use the MVe Fitness Chair? (n = 8), traditional resistance training (n = 8), or a control group (no exercise) (CO) (n = 10). The MVe Fitness Chair? and traditional resistance training groups completed 8 weeks of exercise. Muscular endurance was assessed pre and post-test for comparisons within and between groups using push ups, curl ups, and the Dynamic Muscular Endurance Test Battery for Cancer Patients of Various Ages.ResultsFeasibility of the MVe Fitness Chair? was good, evidenced by over 80% adherence for both exercise groups and positive narrative feedback. Significant improvements in muscular endurance were observed in the MVe Fitness Chair? (p < 0.002) and traditional resistance training groups (p < 0.001), but there were no differences in improvement between the MVe Fitness Chair? and traditional resistance training groups (p < 0.711) indicating that Pilates and traditional resistance training may be equally effective at improving muscular endurance in this population.ConclusionsThe MVe Fitness Chair? is feasible for use in breast cancer survivors. It appears to promote similar improvements in muscular endurance when compared to traditional resistance training, but has several advantages over traditional resistance training, including cost, logistics, enjoyment, and ease of learning.     

Longitudinal evaluation of patients with cancer in the oral tongue, tonsils, or base of tongue--does interstitial radiation dose affect quality of life?

PURPOSE: To evaluate health-related quality of life (HRQL) in patients with oral tongue, tonsil, or base of tongue cancer in a prospective longitudinal study and explore correlations between HRQL scores and interstitial radiation dose, dose rate, and volume of implant. METHODS AND MATERIALS: Ninety patients with oral tongue cancer (n=30) and tonsil or base of tongue cancer (n=60) were assessed with the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and the European Organization of Research and Treatment of Cancer Head and Neck module at diagnosis, and after 3, 12, and 36 months of starting treatment. RESULTS: The HRQL of all patients decreased during treatment. Most HRQL scores returned to baseline values after 3 years; however, 60% of patients with oral tongue cancer and 80% with tonsil and base of tongue cancer reported problems with dry mouth and half of the patients with tonsil and base of tongue cancer reported problems with swallowing solid food at the 3-year followup. No correlations between brachytherapy quality indices and HRQL scores were found. CONCLUSIONS: Patients with oral tongue, tonsil, or base of tongue cancer reported significant problems with dry mouth and swallowing solid food throughout this 3-year followup study.     

Patient-reported health-related quality of life up to three years after the treatment with permanent brachytherapy: Outcome of the large-scale,prospective longitudinal study in Japanese–Prostate Cancer Outcome Study by Permanent I-125 Seed Implantation (J-POPS)

PurposeTo evaluate long-term health-related quality of life (HRQOL) impact of I-125 permanent seed implantation (PI) in Japanese patients with localized prostate cancer.Materials and MethodsThis is a longitudinal, prospective study of 2353 patients who enrolled in the nationwide Japanese–Prostate Cancer Outcome Study by Permanent I-125 Seed Implantation (J-POPS) from July 2005 to June 2007. HRQOL was measured before and after treatment (3, 12, 24, and 36 months) using the Medical Outcomes Study 8-items Short-Form Health Survey (SF-8) and the Expanded Prostate Cancer Index Composite Japanese version questionnaire.ResultsOf the total of 1511 patients who returned anonymized HRQOL questionnaires to Translational Research Center for Medical Innovation, 1079 underwent PI alone (PI group) and 432 underwent combined PI and external beam radiation therapy (EBRT) treatment (EBRT combination therapy group). The mental component summary score of SF-8 was improved at 12, 24, and 36 months compared with the pretreatment level. Although the urinary summary score at 3 months in the PI group was significantly lower than that in the EBRT combination therapy group, which recovered thereafter and was comparable to the score of the EBRT combination therapy group. The bowel summary score in the PI group was significantly higher than that in the EBRT combination therapy group at 12, 24, and 36 months.ConclusionThis longitudinal, large-scale prospective study indicated that the general HRQOL for PI was almost maintained 3 years after treatment. These results provide important information for patients with localized prostate cancer, who may select to receive I-125 brachytherapy.     

Examination of the external and internal load indicators’ association with overuse injuries in professional soccer players

Objectives

Research in professional soccer focusing on the relevance of external and internal load indicators for injury prevention is scarce. This study examined the relationship between load indicators and overuse injuries.

Sensitivity and reliability of language laterality assessment with a free reversed association task—a fMRI study

Objective

The aim of the study was to evaluate the sensitivity and reliability of assessing hemispheric language dominance with functional magnetic resonance imaging (fMRI) using a ‘free reversed association task.’

Methods

Thirty-nine healthy subjects (13 dextrals, 13 sinistrals and 13 bimanuals) underwent two repeated fMRI sessions. In the active phases sets of words were presented via headphones, and an associated target item was named. During the baseline phases a standard answer was given after listening to unintelligible stimuli. Data were preprocessed with SPM, and then laterality indices (LI) and reliability coefficients (RC) were calculated.

Results

Extensive frontal, temporal and parietal activations were found. Seventy-eight percent of the subjects showed left-hemispheric dominance, 5% showed right-hemispheric dominance, and 17% had bilateral language representations. The incidence of right-hemispheric language dominance was 4.3 times higher in a left-hander with a handedness quotient (HQ) of ?90 than in a right-hander with a HQ of +90. The RC was 0.61 for combined ROIs (global network). Strong correlations were found between the two session LIs (r?=?0.95 for the global network).

Conclusion

‘Free reversed association’ is a sensitive and reliable task for the determination of individual language lateralization. This suggests that the task may be used in a clinical setting.     

“Rectal cancer survival: A retrospective analysis of MRI features and their association with prognosis”

PurposeTo assess rectal cancer aggressiveness using magnetic resonance (MR) imaging features and to investigate their relationship with patient prognosis.Materials and methodsClinical information and Pelvic MR scans of 106 consecutive patients with primary rectal cancer (RC) were analyzed. Clinical symptoms, age, sex, tumor location, and patient´s survival were recorded. The variables investigated by MR were: depth or mural/extramural tumor involvement, distance to mesorectal margin, lymph node involvement, vascular, peritoneal or sphincter complex infiltration. The association between imaging features and disease-free survival (DFS) was also assessed using a Kaplan-Meier model. Differences between survival curves were tested for significance using the Mantel-Cox LogRank test.ResultsThe final study population was 106 patients (65 males, 41 females). The median age was 69.5 years (range, 39-92 years). No significant differences were found between death risk and sex, age or tumor location (p>0,05). However, the relative risk (RR) of tumor mortality increased significantly with the presence of the variables: vascular infiltration (×5), T4 tumors (× 4.57), N2 lymph node involvement (more than 3 affected nodes × 4.11) and mesorectal fascia involvement (× 3,77).ConclusionTumor extension, number of pathological lymph nodes, mesorectal fascia involvement and vascular infiltration values obtained on initial MR imaging staging showed a significant difference for disease-free survival in RC at six years of control.