Home-Based Exercise Enhances Health-Related Quality of Life in Persons With Spinal Cord Injury: A Randomized Controlled Trial

Objective

To assess the influence of a home-based exercise intervention on indices of health-related quality of life (HRQOL) in persons with spinal cord injury (SCI).

Impact of Primary Care�CBased Disease Management on the Health-Related Quality of Life in Patients With Type 2 Diabetes and Comorbidity

OBJECTIVE

This study examined the effectiveness of the German diabetes disease management program (DMP) for patients with varying numbers of other medical conditions with respect to their health-related quality of life (HRQoL).

RESEARCH DESIGN AND METHODS

A questionnaire, including the HRQoL-measured EQ-5D, was mailed to a random sample of 3,546 patients with type 2 diabetes (59.3% female). The EQ-5D score was analyzed by grouping patients according to those on a DMP and those receiving routine care.

RESULTS

The analysis showed that participation in the DMP (P < 0.001), the number of other medical conditions (P < 0.001), and the interaction between the DMP and the number of other conditions (P < 0.05) had a significant impact on the EQ-5D score.

CONCLUSIONS

Our findings suggest that the number of other medical conditions may have a negative impact on the HRQoL of patients with type 2 diabetes. The results demonstrate that the German DMP for type 2 diabetes may help counterbalance this effect.Previous research showed that the presence of other medical conditions had a negative impact on health-related quality of life (HRQoL) for patients with type 2 diabetes (1,2,3). In Germany, a special disease management program (DMP) has been in place throughout the country since 2003, aiming to better structure and coordinate the care of patients with type 2 diabetes. This primary care–based continuous program comprises elements of the Chronic Care Model and is accessible for all patients with type 2 diabetes (4,5). This study aimed to examine the effectiveness of the German diabetes DMP for patients with varying numbers of other medical conditions with respect to their HRQoL.     

Health-Related Profile and Quality of Life Among Nursing Home Residents: Does Pain Matter?

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents’ demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents’ physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents’ pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.     

Is Higher Serum Total Cholesterol Level Associated With Better Long-Term Functional Outcomes After Noncardioembolic Ischemic Stroke?

Pan S-L, Lien I-N, Chen TH. Is higher serum total cholesterol level associated with better long-term functional outcomes after noncardioembolic ischemic stroke?

Objective

To investigate the prognostic effects of the serum total cholesterol (TC) levels on long-term functional outcomes in patients with first-time noncardioembolic ischemic stroke.

Design

Cohort study.

Setting

Referral center.

Participants

Patients (N=109) with first-time ischemic stroke.

Interventions

Not applicable.

Main Outcome Measure

Serial Barthel Index (BI) scores at onset; 2 weeks; and 1, 2, 4, and 6 months after stroke. We analyzed the impact of the serum TC level and other clinical factors on the repeated measurements of BI scores at these 6 time points by using a linear mixed regression model.

Results

Taking correlation across repeated measurement of BI scores, the TC level, baseline BI, follow-up time, and infarct size were identified as significant predictors for serial BI scores. Higher TC levels correlated with better functional outcomes. A 1-unit (mmol/L) increase in the TC caused a 3.12 (95% confidence interval [CI], .79-5.46) increase in the BI score after controlling for other clinical factors such as age, baseline functional status, and size of infarct. An elevation of 1 unit of baseline BI led to a .49 increase (95% CI, .38-.59) per unit in subsequent BI scores. A small infarct (<1cm) had higher BI scores than larger infarct by 9.09 (95% CI, 2.03-16.16).

Conclusions

The serum TC level measured at the acute stage of noncardioembolic ischemic stroke is an independent predictor for long-term functional outcomes.     

Understanding and Assessing the Impact of Alcoholism on Quality of Life: A Systematic Review of the Content Validity of Instruments Used to Assess Health-Related Quality of Life in Alcoholism

Alcoholism has the potential to impact on the quality of life (QOL) of an 'alcoholic,' their family, and friends in both the short and long term. Consequently, increasing significance has been placed on understanding health issues from the patient's perspective, evaluating the patient's subjective experience of his/her symptoms (as well as any treatment), and the impact of these on his/her QOL.The objective of this review was to identify and evaluate the content validity of measures used to assess health-related QOL (HR-QOL) in alcoholism (alcohol abuse and alcohol dependence).Systematic searches of Scopus (1990-2007) were conducted using terms synonymous with alcoholism combined with terms associated with measuring HR-QOL. A total of 618 abstracts were identified, detailing the use of 16 generic patient-reported outcome measures to assess HR-QOL in alcoholism. Upon further examination of item content, seven measured generic health status and nine assessed generic QOL or life satisfaction (with varying definitional criteria and domain focus).The SF-36 and EQ-5D, in particular, have been used widely, but were misinterpreted frequently as measures of HR-QOL rather than health status. One alcohol-specific measure was identified: the AlQoL 9, a scale that some have claimed to epitomize alcohol-related QOL. However, the AlQoL 9 was developed by reducing the SF-36 (French version) to the nine items most relevant to alcoholism. The methodology for determining the relevance of the existing items of the SF-36 was comprehensive but the adapted measure does not include assessment of additional concepts (such as sleep and social isolation) of particular importance for alcohol-related QOL.There is a lack of research and assessment of HR-QOL in alcoholism and alcohol abuse, and our assessment of the content validity of existing measures used to date suggests that many are likely to be inadequate. Given the insufficiencies of generic measures and the limited applicability of the AlQoL 9, there is a need for an alcoholism-specific QOL measure that focuses on the domains that are most salient to people with such problems. Individuals need to be given the opportunity to determine the extent to which their QOL is impaired by alcoholism based upon their own criteria for what constitutes good HR-QOL. Only then will we be able to assess the full impact of alcoholism (and its treatment) on QOL.     

Measuring the Psychosocial Dimensions of Quality of Life in Patients With Advanced Cancer: Psychometrics of the German Quality of Life at the End of Life-Cancer-Psychosocial Questionnaire

Context

Quality of life (QoL) is a central focus of care in advanced cancer. Specialized instruments, such as the Quality of Life at the End of Life-Cancer (QUAL-EC), may be useful to assess psychosocial issues associated with QoL unique to this population.

What Is the Quality of Life for Survivors of Cardiac Arrest? A Prospective Study

Objective: To evaluate the quality of life of survivors of in-hospital and out-of-hospital cardiac arrest, and to correlate quality of life with clinically important parameters. Methods: Cohort followed at least six months after hospital discharge. Eligible patients had survived to hospital discharge after sudden cardiac arrest in 1) EDs, wards, and intensive care units of five university hospitals and 2) all locations outside hospitals in two midsized cities. Of 126 patients discharged alive, 30 died before they could be interviewed. Of the 96 patients remaining, 86 (90% of available patients, 68% of survivors to discharge) completed the interview. Quality of life was assessed with the Health Utilities Index Mark 3, which describes health as a utility score on a scale from perfect health (equal to 1.0) to death (equal to 0.) Results: Mean age (±SD) of interviewed survivors was 65 ± 14 years, and 47 (55%) were male; mean time between collapse and initiation of CPR was 2.2 ± 2.6 minutes. Mean utility was 0.72 (±0.22). Utilities were significantly higher among patients who had a shorter duration of resuscitation (mean ? 0.81 for those who received less than 2 minutes of CPR, 0.76 for those who received 3 to 10 minutes, and 0.65 for others, p ? 0.05, r²? 0.07). Mean utilities of survivors were worse than those of the general population (mean ? 0.85 ± 0.16, p < 0.01) and those whose activities were not limited by chronic disease (mean ? 0.91 ± 0.08, p < 0.01). Conclusions: Although overall survival was poor, most survivors had acceptable health-related quality of life. Therefore, concerns about poor quality of life are not a valid reason to abandon efforts to improve the health care system's response to victims of sudden cardiac arrest. Further research is necessary to identify effective strategies for improving both survival and quality of life after cardiac arrest.     

Effect of Functional Status on Survival in Patients With Stroke: Is Independent Ambulation a Key Determinant?

Chiu H-T, Wang Y-H, Jeng J-S, Chen B-B, Pan S-L. Effect of functional status on survival in patients with stroke: is independent ambulation a key determinant?ObjectiveTo investigate the effect of functional status, measured using the Modified Rankin Scale (MRS), at 3 months after stroke on survival in patients with stroke.DesignCohort study.SettingReferral medical center.ParticipantsPatients with stroke (N=1032).InterventionsNot applicable.Main Outcome MeasureSurvival after stroke.ResultsThe Kaplan-Meier survival curves stratified by the 3-month MRS score showed 2 clear groups of patients with 3-month MRS scores of 0 to 3 (able to walk without assistance) and 4 or 5 (unable to walk without assistance). Accordingly, we grouped the patients into a high function (HF) group (3-month MRS≦3) and a low function (LF) group (3-month MRS≧4). Multiple Cox regression analysis showed that the LF group had significantly poorer survival (adjusted hazard ratio=4.69; 95% confidence interval [CI], 2.89–7.60; P<.001) than the HF group. Other significant risk factors of higher mortality were older age, history of diabetes mellitus, and heart disease.ConclusionsThis study showed a significant influence of the 3-month MRS score on stroke survival. Moreover, independent ambulation may be a major determinant of a favorable survival prognosis. This finding suggests a potential role of rehabilitation in promoting stroke survival by maximizing ambulation function.     

Is the Fear Avoidance Model Associated With the Reduced Level of Aerobic Fitness in Patients With Chronic Low Back Pain?

Smeets RJ, van Geel KD, Verbunt JA. Is the fear avoidance model associated with the reduced level of aerobic fitness in patients with chronic low back pain?

Objectives

To compare aerobic fitness of patients with chronic low back pain (CLBP) against healthy controls and to assess whether variables of the fear avoidance model are associated with loss of aerobic fitness.

Design

A case-comparison study.

Setting

Rehabilitation centers.

Participants

Patients with CLBP (n=223), and normative data from healthy subjects (n=18,082).

Interventions

Not applicable.

Main Outcome Measures

Maximal oxygen uptake (V?o₂max) was estimated on the basis of a modified submaximal Åstrand bicycle test performed by patients with CLBP (observed level of aerobic fitness) and compared with the normative data of healthy controls matched for age, sex, and level of sport activity (expected level of aerobic fitness). Pain (visual analog scale); disability (Roland Disability Questionnaire); pain-related fear (Tampa Scale for Kinesiophobia); depression (Beck Depression Inventory); catastrophizing (Pain Catastrophizing Scale); and the level of activity during sport, work/household, and leisure time (Baecke Physical Activity Questionnaire) were assessed. Multiple linear regression analysis was performed with the difference of the observed and expected level of aerobic fitness as dependent variable and putative influential factors including those of the fear avoidance model as independent variables.

Results

V?o₂max could be calculated in 175 (78%) of the patients. Both men and women with CLBP had significant lower V?o₂max than expected (10.3mL/kg lean body mass (LBM)×min⁻¹ and 6.5mL/kg LBM×min⁻¹, respectively; P<.001). The levels of activity during leisure time and work/household were significantly associated with this reduced level of aerobic fitness. However, the variables of the fear avoidance model were not.

Conclusions

Most patients with CLBP-associated disability have a lower level of aerobic fitness, but this is not associated with fear avoidance.     

Is Rural School-Aged Children's Quality of Life Affected by Their Responses to Asthma?

The unpredictable nature of asthma makes it stressful for children and can affect their quality of life (QOL). An exploratory analysis of 183 rural school-aged children's data was conducted to determine relationships among demographic factors, children's responses to asthma (coping and asthma self-management), and their QOL. Coping frequency, asthma severity, and race/ethnicity significantly predicted children's asthma-related QOL. Children reported more frequent coping as asthma-related QOL worsened (higher scores). Children with more asthma severity had worse asthma-related QOL. Post hoc analyses showed that racial/ethnic minorities reported worse asthma-related QOL scores than did non-Hispanic Whites.     

Radioprotectants: Adding Quality of Life to Survivorship?

OBJECTIVES: To explore the use of radioprotectants in oncology and their affect on quality of life (QOL). DATA SOURCES: Textbooks, manuals, and journals in radiation oncology and cancer nursing. CONCLUSION: Many studies have shown that the use of amifostine has decreased the intensity and severity of treatment-related side effects as well as improving QOL. However, more research is needed in the development of newer agents and refining older agents. IMPLICATIONS FOR NURSING PRACTICE: With the advent of combined modality treatments, overall response and survival benefit has increased as well as enhanced toxicities affecting one's QOL. Agents such as radioprotectants and advances in supportive care have assisted in minimizing treatment-related side effects. Strides toward providing quality, compassionate care remain the goal of oncology nurses, while enhancing the QOL for cancer patients.     

Do Performance Measures of Strength,Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

Objective

To investigate the extent to which physical performance measures of strength, balance, and mobility taken at discharge from inpatient stroke rehabilitation can predict health-related quality of life (HRQoL) and community reintegration after 6 months.

Is Satisfaction a Valid Concept in the Assessment of Quality of Life of People with Intellectual Disabilities? A Review of the Literature

The present review examines the definitions of quality of life (QoL) which have developed over the past 3 decades and which reflect the increased awareness of the need to take into account individuals' own perceptions of their life. The concept of satisfaction is frequently used as an important subjective variable in QoL studies, despite the evidence of stability of satisfaction over individuals and over time, which suggests that it should be a measure insensitive to change. This evidence is examined and the idea of such stability being an adaptive psychological mechanism is considered. The use of satisfaction as a measure of QoL in people with intellectual disabilities (IDs) is discussed. The methodological difficulties encountered in assessing the subjective experiences of people with IDs are also discussed. Finally, it is argued that there is a strong argument for the abandonment of measures of QoL in general, and subjective ones in particular, for people with IDs. An alternative approach is suggested.     

Is the Life Space Assessment Applicable to a Palliative Care Population? Its Relationship to Measures of Performance and Quality of Life

ContextThe spatial environments that palliative care patients frequent for business and leisure constrict as their disease progresses and their physical functioning deteriorates. Measuring a person's movement within his or her own environment is a clinically relevant and patient-centered outcome because it measures function in a way that reflects actual and not theoretical participation.ObjectivesThis exploratory study set out to test whether the Life-Space Assessment (LSA) would correlate with other commonly used palliative care outcome measures of function and quality of life.MethodsThe baseline LSA, Australia-modified Karnofsky Performance Status Scale (AKPS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative (EORTC QLQ-C15-PAL) scores from two large clinical trials were used to calculate correlation coefficients between the measures. Convergent validity analysis was undertaken by comparing LSA scores between participants with higher (≥70) and lower (≤60) AKPS scores.ResultsThe LSA was correlated significantly and positively with the AKPS, with a moderate correlation coefficient of 0.54 (P < 0.001). There was a significant weak negative correlation between the LSA and the EORTC QLQ-C15-PAL, with a small coefficient of −0.22 (P = 0.027), but a strong correlation between the LSA and the EORTC QLQ-C15-PAL item related to independent activities of daily living (r = −0.654, P < 0.01). A significant difference in the LSA score between participants with higher (≥70) and lower (≤60) AKPS scores t(97) = −4.35, P < 0.001) was found.ConclusionThe LSA appears applicable to palliative care populations given the convergent validity and capacity of this instrument to differentiate a person's ability to move through life-space zones by performance status. Further research is required to validate and apply the LSA within community palliative care populations.     

Is Social Anxiety Associated With Both Interpersonal Avoidance and Interpersonal Dependence?

We tested the hypothesis that social anxiety is associated with both interpersonal avoidance and interpersonal dependency. Specifically, we predicted that dependence would be evident in developmentally salient close relationships upon which socially anxious people may rely. One hundred sixty-eight young people undergoing the transition to adulthood completed self-report measures of anxiety and interpersonal patterns. Results indicated that both dependent and avoidant interpersonal styles in romantic relationships, but not other relationships, were uniquely associated with social anxiety. These results remained when controlling for depressive symptoms, anxiety sensitivity, and trait anxiety. Our findings illustrate that social anxiety is not characterized solely by interpersonal avoidance as current conceptualizations suggest. Implications for models and treatment of social anxiety are discussed.