Do worker's compensation patients with neck pain have lower SF-36 scores?

Poorer outcomes of treatment are reported in patients with spinal disorders who receive worker's compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between worker's compensation and SF-36 health status of patients with neck pain. The aim of our study was to compare the self-perceived health status of patients with neck pain receiving worker's compensation, with that of patients not receiving worker's compensation. A cross-sectional study was conducted on 2356 patients with neck pain who were evaluated at the 27 centers comprising the National Spine Network, between January 1998 and April 2000. The outcome measures used were the eight individual and two component scores of the SF-36 health survey. Of the 2356 patients, 171 (7%) were receiving worker's compensation. Bivariate analyses revealed seven individual scores (except General Health) and two summary scores of the SF-36 were significantly lower in patients receiving worker's compensation. After controlling for confounding covariates, worker's compensation status was a significant predictor of lower SF-36 scores for Physical Functioning ( P<0.05). The results of this study indicate that worker's compensation status is associated with poorer Physical Functioning in patients presenting with neck pain. Another significant finding of the study is that confounding factors can exert major effects on the SF-36 scores obtained on normal validated instruments.     

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

Introduction

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

Patients and methods

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

Results

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

Discussion

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

Self-assessed quality of life after acoustic neuroma surgery

OBJECT: The aim of this study was to determine if factors such as postoperative hearing, facial function, headaches, or other factors have an impact on self-assessed quality of life (QOL) after acoustic neuroma surgery. METHODS: The SF-36 and seven additional questions on the impact of surgery on the QOL were sent to 135 consecutive patients who had undergone acoustic neuroma surgery. The Spearman rho correlations were calculated for each of the eight categories of the SF-36 (general health, physical functioning, physical role limitations, emotional role limitations, mental health, energy/vitality, pain, social functioning). The results were correlated with patients' sex, age, persistent headache, years since surgery, postoperative hearing level, and facial function. The response rate was 74.8%. The transformed scores of the eight categories of the SF-36 were lower than age-matched healthy controls in approximately half of the categories. The strongest trend toward lower scores with statistical significance in two categories was persistent headaches. Some categories demonstrated trends toward lower scores with females or age older than 55 years. Postoperative hearing and facial functioning, and time since surgery showed no statistically significant impact on QOL measured by the SF-36. Responses to the additional questions indicate that hearing, facial function, and headache influenced people's feelings about surgery and had an impact on their return to work. CONCLUSIONS: The QOL scores are not consistently lower than population normative values compared with different normative studies. The strongest correlation was between the presence of persistent headache and QOL. Other correlations were not consistent in all categories, and few were statistically significant. These trends in some categories do not explain the difference seen between patients after acoustic neuroma surgery in this study and normal populations in other studies.     

Clinical impact of tamsulosin on generic and symptom-specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36-item Health Survey

AIM: To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. METHODS: A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. RESULTS: After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. CONCLUSIONS: Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.     

Surgery for large vestibular schwannomas: how patients and surgeons perceive quality of life

OBJECT: The aim of this study was to assess the consequences of total removal of a large vestibular schwannoma on the patient's symptoms and quality of life (QOL). METHODS: A questionnaire regarding preoperative and postoperative symptoms with measures of both daily and global QOL and a modified 36-Item Short Form Health Survey (SF-36) QOL instrument were sent to 103 patients who had undergone surgery via a retrosigmoid approach for total removal of a Grade III or IV vestibular schwannoma. In addition, 48 patients underwent follow-up clinical examinations to assess their conditions. Seventy-two of the 103 patients completed and returned the questionnaire. Forty-six (64%) of the schwannomas were Grade IV and 26 (36%) were Grade III. The patients' pre- and postoperative symptoms were similar to those reported in other studies. The patients' perceptions of facial movement were likely to be worse than the clinicians' estimation based on the House-Brackmann classification. All scores in the QOL categories were significantly reduced when compared with normative data. Patients with large vestibular schwannomas had lower scores in all SF-36 categories except pain compared with data from other studies. Psychological problems were the preponderant symptoms, and their presence was the most powerful predictive variable for global and daily QOL. CONCLUSIONS: Surgery for a large vestibular schwannoma has a significant impact on the patient's QOL. To improve QOL postoperatively, the patient should be prepared and well informed of the consequences of such a surgery on QOL. Clinicians must be aware that early involvement of a clinical psychologist may be very helpful.     

Evaluation of quality of life in brachial plexus injury patients after reconstructive surgery.

To evaluate the subjective satisfaction of brachial plexus injury (BPI) patients after surgery based on the medical outcomes study 36-item short form health survey (SF-36) and to correlate their SF-36 scores with upper extremity functions. Four items were assessed statistically for 30 patients: SF-36 scores after BPI surgery were compared with Japanese standard scores; the correlation between SF-36 scores and objective joint functions; difference in SF-36 scores between each type of BPI; and influence of each joint function on the SF-36 scores. The SF-36 subscale: PF--physical functioning, RP--role-physical, BP--bodily pain, and the summary score PCS--physical component summary, were significantly inferior to the Japanese standard scores. SF-36 is more sensitive to shoulder joint function than to elbow and finger joint functions. Little correlation was found between SF-36 scores and objective evaluations of joint functions. Greater effort is needed to improve the quality of life (QOL) of BPI patients. This study showed that SF-36 is not sensitive enough to evaluate regional conditions. A region- or site-specific questionnaire is required to evaluate upper extremity surgery.     

Sexual Function and Quality of Life in Women after Elective Aortic Surgery

The incidence of sexual dysfunction in women after open aortic reconstruction is unknown. Additionally, previous studies of quality of life (QOL) following aortic surgery include small numbers of women compared to those of men. The purpose of this study was to determine the effects of elective aortic surgery on sexual function (SF) and QOL in women. Two validated questionnaires, the Female Sexual Function Index (FSFI) and Short Form 36 (SF-36), were mailed to all women who underwent elective aortic reconstruction between 1995 and 2000. Comparisons were made between preoperative (baseline) SF, 1-year postoperative SF, and SF within the 4 weeks preceding receipt of the questionnaire. The SF-36 responses were compared to national norms. Of the 182 women who underwent elective aortic reconstruction, only 122 patients (67%) were alive and able to complete the questionnaires. Of 56 patients (46%) who had sexual partners, 21 (38%) returned both questionnaires and 22 patients returned only the SF-36 portion. There were no differences in desire, arousal, lubrication, orgasm, satisfaction, or pain scores. There was a trend toward poorer baseline sexual function in claudicants in all domains, with the pain domain reaching significance (p = 0.03). Previous hysterectomy did not affect sexual function (p > 0.05). Following aortic surgery, patients had a significant decrease in the role-physical (p = 0.03), social functioning (p = 0.01), role-emotional (p < 0.001), and mental health domains (p < 0.001) compared to national norms. There were no differences in QOL scores between claudicants and aneurysm patients or married and nonmarried patients. Sexual function is maintained in women undergoing open reconstructive aortic surgery. Patients with occlusive disease tend to have poorer preoperative sexual function than aneurysm patients. Compared to national norms, QOL is worse in women after aortic surgery.Presented at the Western Vascular Society 18th Annual Meeting Resident Forum, Big Island, HI, September 20, 2003.     

SF-36 health status of workers compensation cases with spinal disorders.

BACKGROUND CONTEXT: Poorer outcomes of treatment are reported in patients with spinal disorders who receive workers compensation. The reason for their suboptimal outcomes is unclear. No study has examined the relationship between workers compensation and the Short Form Health Survey (SF-36) health status of patients with spinal disorders. PURPOSE: To compare the self-perceived health status of spinal disorder patients receiving workers compensation with those not receiving workers compensation. STUDY DESIGN/SETTING: A cross-sectional study on 18,389 patients who were evaluated in the 28 centers comprising the National Spine Network. PATIENT SAMPLE: The study data were derived from patients when first evaluated for back or neck pain between January 1998 and April 2000. OUTCOME MEASURES: The outcome measures used were the eight individual and two component scores of the SF-36. METHODS: All first-visit patients enrolled in the National Spine Network from January 1998 to April 2000 were reviewed. Eight individual scores and two component scores of the SF-36 were compared. RESULTS: Of the 18,389 patients, 1,535 (8%) were receiving workers compensation. Bivariate analyses showed all eight individual scores, and two summary scores of the SF-36 were significantly lower (p<.0001) in patients receiving workers compensation. After controlling for confounding covariates, workers compensation status was a significant predictor of lower SF-36 scores for General Health (p<.0001), Physical Functioning (p<.0001), Role Physical (p<.01), Social Functioning (p<.05), and Mental Health (p<.05). CONCLUSIONS: Workers compensation status is associated with poorer physical and mental health of patients with spinal disorders. Because the workers compensation group is younger, has a shorter duration of symptoms, and fewer comorbid medical problems, the lower SF-36 scores most likely reflect psychological factors and not ill health per se. The lower SF-36 scores may also reflect premorbid personality differences in the workers compensation patients, compared with those not receiving workers compensation. SF-36 is a validated tool that can be used to objectively identify the patient at risk for delayed recovery. Future treatment protocols should pay special attention to improve the health-related quality of life, especially general health and physical functioning of spinal patients receiving workers compensation.     

An evaluation of quality of life in patients who underwent orthotopic bladder replacement after cystectomy: comparison of ileal neobladder versus colon neobladder

OBJECTIVE: The objective of this study was to determine whether the quality of life (QOL) in patients who underwent orthotopic bladder replacement after radical cystectomy was affected by the intestinal segment used for the creation of a neobladder. MATERIALS AND METHODS: A total of 52 patients who underwent radical cystectomy for bladder cancer were included in this study; i.e., 24 patients with an ileal neobladder and 28 patients with a sigmoid neobladder. QOL was evaluated using the SF-36 health-related QOL survey and a questionnaire designed to evaluate the continent status. RESULTS: The mean follow-up periods for patients with an ileal and a sigmoid neobladder was 40.2 and 43.1 months, respectively. The SF-36 survey revealed that patients with colon neobladder had a significantly higher score for role-emotional functioning than those with ileal neobladder, while there was no significant difference in the remaining seven scores between patients with ileal and colon neobladders; however, general health and social functioning in patients with both types of neobladder appeared to be significantly lower than those in the general population in the United States. The results of the questionnaire analyzing the continent status were also similar between these two groups, including the desire to urinate, the incidence of both day- and nighttime urinary leakage, the frequency of pad exchange, and the concern of urine odor. CONCLUSIONS: Six of the eight scales concerning health-related QOL were favorable with both patients with ileal and colon neobladders, and the health-related QOL in orthotopic neobladder patients except for role-emotional functioning was not affected by the segment of the intestine used for neobladder construction. Moreover, no significant differences were observed in the QOL associated with continent status between these two groups. Therefore, patients with both types of orthotopic neobladder were generally satisfied with their health-related as well as disease-specific QOL.     

SF-36量表用于国人脊髓型颈椎病的信度分析及其与神经功能的相关性研究

目的:评估SF-36量表用于国人脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者健康相关生活质量(quality of life,QOL)的信度,并验证术后疗效评价中,生活质量评价与神经功能评估的一致性。方法:本研究前瞻性收集了接受手术治疗的脊髓型颈椎病患者142例,男84例,女58例,年龄60.0±10.9岁。所有患者均接受手术治疗。分别于术前、术后3个月、术后1年和术后2年以上末次随访时分别使用改良日本骨科协会评分法(modified Japanese Orthopaedic Association,mJOA)评分和健康状况调查简表(SF-36量表)进行神经功能和生活质量评估,并与正常人群的常模进行对比。使用克隆巴赫系数(Cronbachα)分析SF-36量表八个维度的信度,并进一步分析在术后不同随访时间节点SF-36各维度与神经功能评价的相关性。根据患者各项评分的变化趋势,分析患者的康复峰值时间。结果:术前CSM患者SF-36量表8个维度中,除“精神健康”维度外,其余7各维度较健康成年人常模均存在显著功能缺陷。SF-36量表各维度的Cronbachα介于0.73~0.85之间(Cronbachα:生理功能=0.85、生理职能=0.83、躯体疼痛=0.80、整体健康=0.81、活力=0.81、社会功能=0.79、情感职能=0.73、精神健康=0.75)。术后3个月时,mJOA评分的改善仅与患者SF-36量表中生理功能和躯体疼痛两个维度得分有显著相关性(相关系数R:生理功能=0.32,躯体疼痛=0.20;P<0.05);术后1年时,mJOA评分的改善与SF-36量表中生理功能、整体健康、社会功能和情感职能四个维度有显著相关性(相关系数R:生理功能=0.39,整体健康=0.24,社会功能=0.22,情感职能=0.19;P<0.05);在术后2年以上末次随访时,mJOA评分的改善与SF-36量表中生理功能、活力和情感职能三个维度显著相关(相关系数R:生理功能=0.38,活力=0.20,情感职能=0.20;P<0.05)。SF-36量表的生理总评分和心理总评分分别在17.7个月和18.9个月达到峰值。结论:SF-36量表各维度的信度较高,是一项可靠的评估CSM患者健康相关生活质量的方法。在术后不同随访期的疗效评估中,SF-36量表各维度与神经功能改善评估的一致性不尽相同:在术后恢复早期,mJOA评分的改善与SF-36量表中的生理相关维度显著相关;随着术后恢复期延长,mJOA评分的改善则与生理、心理相关维度均显著相关。     

Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty

Background contextMultilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach.PurposeTo elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study.Study designA prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty.Patient sampleIn total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3–C6 and C3–C7).Outcome measuresSelf-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales.MethodsComparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables.ResultsPosterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group.ConclusionsOur study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.     

Robotic techniques improve quality of life in patients undergoing atrial septal defect repair

BACKGROUND: Minimally invasive cardiac surgery has emerged as an alternative to conventional, open surgery. Although most studies of robotically assisted cardiac surgery have reported morbidity and mortality, few have addressed outcome measures, such as pain and quality of life, which was the aim of this study. METHODS: Eleven patients with atrial septal defects (ASD), and five patients with patent foramen ovale, underwent repair using the Da Vinci system (Intuitive Surgical, Mountain View, CA). The Medical Outcomes Study Short Form Survey (SF-36), along with two additional questions, were administered to these patients on postoperative day 30, along with a similar number of patients who underwent ASD repair by mini-thoracotomy or sternotomy. Quality of life endpoints included bodily pain, vitality, mental health, general health, physical function, and social function. RESULTS: Robotic patients demonstrated significantly higher scores in 6 of the eight variables (p < 0.05). There was no significant difference in intensive care unit or overall hospital stay among the groups (p = NS). Robotic patients returned to work after 40.2 +/- 30.2 days, mini-thoracotomy patients after 45.6 +/- 27.9 days, and sternotomy patients after 51.7 +/- 40.2 days (p = 0.767). There were no significant differences in SF-36 scores between patients who underwent mini-thoracotomy and sternotomy approaches. CONCLUSIONS: Closure of an ASD can be performed safely and effectively via an endoscopic approach. Robotic technology minimized the degree of invasiveness, hastened postoperative recovery, and improved quality of life, although length of hospital stay was unchanged.     

胰十二指肠切除术后患者生活质量的随访研究

目的评估患者接受胰十二指肠切除术（PD）后的生活质量（QOL）,以指导其远期治疗。方法采用普通症状问卷表和中文版SF-36量表评估自2002年1月至2003年12月于我院普外科行PD的18例患者（PD组）的生活质量,并与相应手术日行腹腔镜胆囊切除术（1aparoacopic cholecystectomy,LC）的18例患者（LC组）进行病例对照分析。结果SF-36量表调查显示,与LC组相比,PD组在SF-36总分及总体生理健康分值上无明显降低,而PD组的总体心理健康分值低于LC组。SF-36量表各维度评估显示：在生理功能、生理职能、躯体疼痛、总体健康、社会功能5个维度的生活质量评估中,PD组较LC组有所下降;而在活力、情感职能和精神健康3个维度的生活质量评估中,PD组与LC组比较无明显降低。症状问卷显示,腹泻和疾病复发是影响PD组总体生理健康分值的因素;而体重减轻和失业是影响其总体心理健康分值的因素。结论PD组QOL水平并无明显减低,其总体QOL水平与LC组无显著性差异。体重减轻、失业、疾病复发及慢性胰源性腹泻是影响PD后QOL水平的因素。     

The characteristics of chronic pain after non-traumatic,non-compressive myelopathy: Focus on neuropathic pain

Objectives: The aim of this study was to assess the characteristics of neuropathic pain after non-traumatic, non-compressive (NTNC) myelopathy and find potential predictors for neuropathic pain.

Design: We analyzed 54 patients with NTNC myelopathy. The Short Form McGill Pain Questionnaire (SF-MPQ) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to assess pain. Health-related QOL was evaluated by the Short Form 36-item (SF-36) health survey.

Results: Out of 48 patients with pain, 16 (33.3%) patients experienced neuropathic pain. Mean age was significantly lower in patients with neuropathic pain than in patients with non-neuropathic pain (39.1?±?12.5 vs. 49.8?±?9.3, P?=?0.002). There were no statistically significant differences in the other variables including sex, etiology of myelopathy, pain and QOL scores between the two groups. A binary logistic regression revealed that onset age under 40, and non-idiopathic etiology were independent predictors of the occurrence of neuropathic pain. Both SF-MPQ and LANSS scores were significantly correlated with SF-36 scores, adjusted by age, sex, presence of diabetes mellitus, and current EDSS scores (r?=?–0.624, P?Conclusion: Neuropathic pain must be one of serious complications in patients with NTNC myelopathy and also affects their quality of life. Onset age and etiology of myelopathy are important factors in the development of neuropathic pain in NTNC myelopathy.     

Postoperative quality of life of patients treated for asymptomatic unruptured intracranial aneurysms

OBJECT: The aim of this study was to assess the quality of life (QOL) of patients who underwent surgery for asymptomatic unruptured intracranial aneurysms (UIAs). METHODS: The authors assessed QOL in 149 patients who had undergone microsurgical clipping of asymptomatic UIAs. They surveyed these patients using universal methods such as the 36-Item Short Form Health Survey (SF-36) for health-related QOL and the Hospital Anxiety and Depression Scale for anxiety and depression assessments. RESULTS: The patients' mean scores for each of the eight domains of SF-36 were comparable to those of a Japanese reference population. Analysis of data from the average-QOL and low-QOL subgroups showed that the low-QOL group contained a higher number of patients with preexisting heart diseases and restricted activities of daily living. Operative procedures and complications did not affect QOL. CONCLUSIONS: Because 86% of the patients who underwent surgery manifested a QOL similar to the reference population, the authors suggest that elective surgery for asymptomatic UIAs is a reasonable treatment, especially in patients who are troubled by the risk of rupture. Postoperative decreases in QOL are not invariably attributable to the operation or its associated complications, but may be correlated with other chronic disorders. To select the appropriate treatment for asymptomatic UIAs, neurosurgeons and patients need information on the expected postoperative QOL.     

Health-related quality of life after radical prostatectomy or radiotherapy

PURPOSE: We compared general and disease specific health related quality of life (QOL) after surgery and radiotherapy for prostate cancer. MATERIALS AND METHODS: We performed a retrospective survey of patients treated between 1992 and 2001. General and disease specific health related QOL were assessed by the SF-36 and the University of California-Los Angels Prostate Cancer Index (UCLA PCI). We mailed questionnaires of QOL survey and obtained from 143 and 73 men who treated surgery and radiotherapy. The median ages of surgery and radiation group were 70.9 and 79.2 years old, and the median periods after treatment were 2.7 and 2.0 years, respectively. RESULTS: Physical function, role physical, social functioning and mental health were higher score in surgery group than radiation group, however, general health perceptions was higher in radiation group among SF-36. Surgery group had worse urinary function and better sexual function compared with radiation group. Multi-variable analysis showed that scores of social functioning, mental health and sexual function were most influenced by each modality, the scores of physical function, role physical, urinary function and sexual bother were most influenced by age, and the score of general health perceptions and body pain was most influenced by the existence of recurrence. CONSIDERATION: This cross-sectional survey cleared the differences of QOL after surgery and radiotherapy, and the influences of each modality. However, because of difference in background of each group, longitudinal investigation will need to aid patients in the decision making process.     

Does condition‐specific quality of life correlate with generic health‐related quality of life and objective incontinence severity in women with stress urinary incontinence?

AIMS: We examined the impact of stress urinary incontinence (SUI) on health-related quality of life (QOL) and evaluated the relationships between incontinence-specific QOL and objective disease severity. METHODS: A total of 158 women (mean age 49.9) suffering from SUI were included in the study. The Medical Outcomes Study Short Form-36 (SF-36) and the King's Health Questionnaire (KHQ) were used to assess QOL in the patient and control groups. RESULTS: The SF-36 scores did not show any significant differences between the two groups except for one domain (physical functioning, P = 0.005). The patient KHQ scores were significantly lower than those of the controls (P < 0.001 for all domains). The scores of the KHQ domains correlated with those of the SF-36 domains, but the relationship was low to moderate, ranging from -0.033 to -0.686. However, they did not correlate with Valsalva leak point pressure (VLPP). When patients were divided into the low VLPP group (n = 60) and the higher VLPP group (n = 98), statistically significant differences were found between the groups for general health domains of the SF-36 (P = 0.010) and of the KHQ (P = 0.027). No statistically significant differences were found in other domains of both questionnaires. CONCLUSIONS: The generic QOL instrument is not a sensitive tool for measuring QOL in women with SUI. In addition, our findings suggest that objective disease severity is not associated with generic or incontinence-specific QOL.     

Health-related quality of life after bladder preservation therapy for muscle invasive bladder cancer

Objective:   To assess health-related quality of life (QOL) of bladder cancer patients following bladder preservation therapy (BPT).
Methods:   Eighty patients with muscle-invasive bladder cancer had been treated between January 1992 and July 2005 at our institutions with BPT consisting of transurethral resection, intra-arterial chemotherapy and radiotherapy. Among them, 48 were alive and free from recurrence at the time of survey and were asked to participate. A total of 168 patients who had been treated for superficial bladder cancer in the same period were used as a control group. Three questionnaires, namely the International Prostate Symptom Score (IPSS), the SF-36, and the Expanded Prostate Cancer Index Composite (EPIC) were used.
Results:   Thirty-three patients in the BPT group (68.8%) and 128 patients in the control group (76.2%) answered the QOL survey. There was no significant difference in age, gender and other clinical factors among these two groups. No significant difference was found between the groups according to IPSS. The QOL score of BPT was lower than that of the control group in the SF-36, but there was no significant difference without body pain ( P  = 0.047). There was a tendency toward a diminished physical functioning ( P  = 0.053) and role-physical ( P  = 0.064) in BPT. The EPIC scores for urinary function, especially storage and voiding symptoms, and bowel function were significantly lower in the BPT group. At multivariable analysis, body pain and bowel function were associated with the type of treatment.
Conclusion:   Although some of the QOL outcome parameters after BPT were found to be lower than the control group, these differences were not significant. Overall, patients retaining their bladder had an acceptable health related QOL.     

Surveying quality of life in patients with Fabry disease by the SF-36 scale

Objective To test the availability of the SF-36 scale for the Chinese patient with Fabry disease (FD), the quality of life(QOL) and its probable influence factors were analyzed. Methods The data were obtained from 50 healthy volunteers and 57 patients with FD enrolled in nephrology department of Ruijin hospital from Jan, 2003 to Jan, 2013. The SF-36 scale was used to evaluate the QOL of patients and to compare the difference between the patientsandcontrols. Furthermore, the influencing factors were estimated by multiple linear regressions. Results Between the patientsandcontrols, the differences of 8 dimensionalitiy's scores had statistical significance, which claimed that the reaction was sensitive. Especially, in the patient group, the Pearson correlation coefficient among each domain of the SF-36 was lower than its Cronbach's α coefficient (0.934), which indicated good internal consistency reliability. The two common factors were much the same to the theory assume, which illustrated the construct validity was available. Even the acceptability of the patient’ group at 100% proved the scale was appropriate for patients with FD. In addition, in role-physical (RP) and bodily pain (BP) , the scores of the male patients were less than the females (P﹤0.01), declared that the QOL of the males was inferior to the females. In the physical function (PF) and the mental health (MH), the scores of the patients with angiokeratoma were less than the group without it, so the patients who had evident clinical symptoms more likely contributed to depression. Using multiple linear regression, age, gender and clinical types were chosen into regression equation by stepwise regression, and the main potential predictor was age. Conclusions The SF-36 scale applies to evaluate the QOL of patients with FD. It is critical to concern and manage the QOL of FD patients, especially in their mental health aspect.     

内镜与显微镜经鼻蝶窦垂体瘤术后生存质量研究

目的比较内镜与显微镜经蝶垂体瘤术后生存质量,为全面评估手术疗效提供依据。方法 2006年6月～2011年9月对105例垂体瘤分别施行内镜和显微镜经蝶手术,采用SF-36、HADS、MFI-20生存质量量表对41例内镜经蝶垂体瘤手术（内镜组）和64例显微镜经蝶垂体瘤手术（显微镜组）进行比较。结果 SF-36提示内镜组总体健康指数（71.6±21.9）分明显高于显微镜组（59.8±21.7）分（t=2.706,P=0.008）;HADS提示2组焦虑指数无明显差异（t=0.518,P=0.615）,抑郁指数亦无明显差异（t=0.128,P=0.899）;MFI-20提示内镜组一般疲劳程度（10.2±4.3）分与显微镜组（11.3±5.3）分差异无显著性（t=-1.114,P=0.268）。结论内镜经蝶垂体瘤手术比显微镜经蝶垂体瘤手术使患者获得更满意的生存质量。