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Selected AbstractsA Comparison of Clinically Important Differences in Health-Related Quality of Life for Patients with Chronic Lung Disease, Asthma, or Heart DiseaseHEALTH SERVICES RESEARCH, Issue 2 2005Kathleen W. Wyrwich Objective. On the eight scales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), Version 2, we compared the clinically important difference (CID) thresholds for change over time developed by three separate expert panels of physicians with experience in quality of life assessment among patients with chronic obstructive pulmonary disease (COPD), asthma, and heart disease. Study Design. We used a modified Delphi technique combined with a face-to-face panel meeting within each disease to organize and conduct the consensus process among the expert panelists, who were familiar with the assessment and evaluations of health-related quality of life (HRQL) measures among patients with the panel-specific disease. Principal Findings. Each of the expert panels first determined the magnitude of the smallest numerically possible change on each SF-36 scale, referred to as a state change, and then built their CIDs from this metric. All three panels attained consensus on the scale changes that constituted small, moderate, and large clinically important SF-36 change scores. The CIDs established by the heart disease panel were generally greater than the CIDs agreed on by the asthma and COPD panels. Conclusions. These panel-derived thresholds reflect possible differences in disease management among the represented panel-specific diseases, and are all greater than the minimal CID thresholds previously developed for the SF-36 scales among patients with arthritis. If confirmed among patients with the relevant diseases and those patients' physicians, these disease-specific CIDs could assist both researchers and practicing clinicians in the use and interpretation of HRQL changes over time. [source] Relationship between intensity of physical activity and health-related quality of life in Portuguese institutionalized elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2008Alexandrina Lobo Aims: Health-related quality of life (HRQOL) is considered to be the key goal for health promotion in older people. This study explores the relationship between HRQOL and objectively measured intensity of physical activity (PA) in institutionalized older adults. The analysis of the PA patterns of the subjects in relation to recommended levels of PA was also performed. Methods: One hundred and eighty-five residents of long-term care homes aged 65 years or more, volunteered for this study. The Medical Outcome Study Short Form 36-Item health survey (MOS SF-36) questionnaires and the uni-axial MTI Actigraph were used to assess HRQOL and PA, respectively. Participants were classified as less active, reasonably active and more active by tertile of moderated physical activity (MPA). Results: (i) The men represented a greater number of counts/h and min of MPA in all the tertile groups; (ii) men from the less active group had a significantly higher body mass index; (iii) women came third and exhibited less total activity even though they used this time in more intense activities; (iv) there was a higher significant correlation between MPA, physical function and negative association with body pain in relation to the time of institutionalization in both sexes but was more strongly visible in men; and (v) only men presented a significant positive association with physical health, mental health and vitality. Conclusion: Any intensity of PA seems to be better than no activity for HRQOL, but MPA confers greater benefits for the perception of physical function and body pain in the case of institutionalized elderly persons. [source] Outcomes Associated with Opioid Use in the Treatment of Chronic Noncancer Pain in Older Adults: A Systematic Review and Meta-AnalysisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2010Maria Papaleontiou MD This systematic review summarizes existing evidence regarding the efficacy, safety, and abuse and misuse potential of opioids as treatment for chronic noncancer pain in older adults. Multiple databases were searched to identify relevant studies published in English (1/1/80,7/1/09) with a mean study population age of 60 and older. Forty-three articles were identified and retained for review (40 reported safety and efficacy data, the remaining 3 reported misuse or abuse outcome data). The weighted mean subject age was 64.1 (mean age range 60,73). Studies enrolled patients with osteoarthritis (70%), neuropathic pain (13%), and other pain-producing disorders (17%). The mean duration of treatment studies was 4 weeks (range 1.5,156 weeks), and only five (12%) lasted longer than 12 weeks. In meta-analyses, effect sizes were ,0.557 (P<.001) for pain reduction, ,0.432 (P<.001) for physical disability reduction, and 0.859 (P=.31) for improved sleep. The effect size for the Medical Outcomes Study 36-item Health Survey was 0.191 (P=.17) for the physical component score and ,0.220 (P=.04) for the mental component score. Adults aged 65 and older were as likely as those younger than 65 to benefit from treatment. Common adverse events included constipation (median frequency of occurrence 30%), nausea (28%), and dizziness (22%) and prompted opioid discontinuation in 25% of cases. Abuse and misuse behaviors were negatively associated with older age. In older adults with chronic pain and no significant comorbidity, short-term use of opioids is associated with reduction in pain intensity and better physical functioning but poorer mental health functioning. The long-term safety, efficacy, and abuse potential of this treatment practice in diverse populations of older persons remain to be determined. [source] Less is more, or almost as much: A 15-item quality-of-life instrument for myasthenia gravisMUSCLE AND NERVE, Issue 2 2008Ted M. Burns MD Abstract We describe the process whereby a recently developed myasthenia gravis (MG)-specific quality-of-life (QOL) instrument was reduced from 60 items to 15 items while maintaining potential usefulness in the clinic and in prospective treatment trials. In data from a recently completed prospective trial of mycophenolate mofetil (MMF) in MG, the MG-QOL15 correlated as highly as the 60-item MG-QOL for physical and social domains of the 36-item health survey of the Medical Outcomes Study Short Form (SF-36). Correlation coefficients for the MG-QOL15 were similar to the 60-item MG-QOL for the Quantitative Myasthenia Gravis (QMG), MG-specific Manual Muscle Testing (MG-MMT), and the MG-specific Activities of Daily Living (MG-ADL) scores at week 0 and for change in scores from week 0 to week 12 in the MMF trial. Using the physician global impression at week 12 of the trial as the "gold standard," the MG-QOL15 demonstrated high sensitivity. Because the MG-QOL15 instrument can be quickly and easily administered and interpreted, it is a potential QOL measure for treatment trials and the clinical evaluation of patients with MG. Muscle Nerve, 2008 [source] The Effect of Comorbidity and Socioeconomic Status on Sexual and Urinary Function and on General Health-Related Quality of Life in Men Treated with Radical Prostatectomy for Localized Prostate CancerTHE JOURNAL OF SEXUAL MEDICINE, Issue 4 2008Pierre I. Karakiewicz MD ABSTRACT Introduction., Different treatments for localized prostate cancer (PCa) may be associated with similar overall survival but may demonstrate important differences in health-related quality of life (HRQOL). Therefore, valid interpretation of cancer control outcomes requires adjustment for HRQOL. Aim., To assess the effect of comorbidity and socioeconomic status (SES) on sexual and urinary function as well as general HRQOL in men treated with radical prostatectomy (RP) for PCa. Methods., We sent a self-addressed mail survey, composed of the research and development short form 36-item health survey, the PCa-specific University of California at Los Angeles (UCLA) Prostate Cancer Index (PCI), as well as a battery of items addressing SES and lifetime prevalence of comorbidity, to 4,546 men treated with RP in Quebec between 1988 and 1996. Main Outcome Measures., The association between comorbidity, SES, and HRQOL was tested and quantified using univariable and multivariable linear regression models. Results., Survey responses from 2,415 participants demonstrated that comorbidity and SES are strongly related to sexual, urinary, and general HRQOL in univariable and multivariable analyses. In multivariable models, the presence of comorbid conditions was associated with significantly worse HRQOL, as evidenced by lower scale scores by as much as 17/100 points in general domains, and by as much as 10/100 points in PCa-specific domains. Favorable SES characteristics were related to higher general (up to 9/100 points) and higher PCa-specific (up to 8/100 points) HRQOL scale scores. Conclusions., Comorbidity and SES are strongly associated with sexual, urinary and general HRQOL. Karakiewicz PI, Bhojani N, Neugut A, Shariat SF, Jeldres C, Graefen M, Perrotte P, Peloquin F, and Kattan MW. The effect of comorbidity and socioeconomic status on sexual and urinary function and on general health-related quality of life in men treated with radical prostatectomy for localized prostate cancer. J Sex Med 2008;5:919,927. [source] |