Browsing by Subject "Functional Status"

Now showing 1 - 3 of 3
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    ItemOpen Access
    Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients.
    (Spine, 2021-04) Lafage, Renaud; Ang, Bryan; Schwab, Frank; Kim, Han Jo; Smith, Justin S; Shaffrey, Christopher; Burton, Douglas; Ames, Christopher; Mundis, Gregory; Hostin, Richard; Bess, Shay; Klineberg, Eric; Passias, Peter; Lafage, Virginie; on behalf of the International Spine Study Group (ISSG)

    Study design

    Retrospective review of prospective multicenter database.

    Objective

    The aim of this study was to investigate how preoperative mental status affects preoperative and postoperative disability and health scores in adult spinal deformity (ASD) patients.

    Summary of background data

    The relationship between health-related quality of life (HRQOL) and depression has previously been documented. However, the influence of depression on clinical outcomes among ASD patients is not well understood.

    Methods

    ASD patients with minimum 2-year follow-up were stratified based on preoperative mental health measured by Short Form 36 (SF-36) mental component score (MCS). Patients with MCS in the 25th and 75th percentile of the cohort were designated as having low and high MCS, respectively. After matching by preoperative demographics and deformity, pre- and post-HRQOL were compared between the two groups. Further analysis was performed to identify individualized questions on the SF-36 that could potentially screen for patients with low MCS.

    Results

    Five hundred thirteen patients were assessed (58.4 years' old, 79% women, mean MCS 45.5). Thresholds for low and high MCS cohorts were 35.0 and 57.3, respectively. After matching by preoperative alignment, low MCS patients had worse Oswestry Disability Index (ODI) (52.3 ± 17.0 vs. 35.7 ± 14.6, P < 0.001) and Scoliosis Research Society-22R scores for all domains (all P < 0.001) compared to high MCS patients. Similar results were maintained at 2-year postop, with low MCS patients having a worse ODI (35.2 ± 20.2 vs. 19.7 ± 18.6, P < 0.001) and MCS (42.4 ± 13.5 vs. 58.6 ± 7.1, P < 0.001). Despite similar preoperative Physical Component Score (PCS), low MCS patients were less likely to reach MCID for PCS (46.1% vs. 70.6%, P < 0.01) and had a lower satisfaction at 2-year follow-up (3.88 ± 1.07 vs. 4.39 ± 0.94, P < 0.001). Questions 5a, 9d, and 9f on the SF-36 were found to be independent predictors of low MCS.

    Conclusion

    ASD patients with low MCS are more likely to experience functional limitations before and after surgery and are less likely to be satisfied postoperatively, even when similar clinical goals are achieved. Incorporating psychological factors may assist in decision making.Level of Evidence: 3.
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    ItemOpen Access
    Outcome at 1 year in patients with femoral shaft fractures treated with intramedullary nailing or skeletal traction in a low-income country: a prospective observational study of 187 patients in Malawi.
    (Acta orthopaedica, 2020-12) Chokotho, Linda; Wu, Hao-Hua; Shearer, David; Lau, Brian C; Mkandawire, Nyengo; Gjertsen, Jan-Erik; Hallan, Geir; Young, Sven
    Background and purpose - Intramedullary nailing (IMN) is underutilized in low-income countries (LICs) where skeletal traction (ST) remains the standard of care for femoral shaft fractures. This prospective study compared patient-reported quality of life and functional status after femoral shaft fractures treated with IMN or ST in Malawi. Patients and methods - Adult patients with femoral shaft fractures managed by IMN or ST were enrolled prospectively from 6 hospitals. Quality of life and functional status were assessed using EQ-5D-3L, and the Short Musculoskeletal Function Assessment (SMFA) respectively. Patients were followed up at 6 weeks, 3, 6, and 12 months post-injury. Results - Of 248 patients enrolled (85 IMN, 163 ST), 187 (75%) completed 1-year follow-up (55 IMN, 132 ST). 1 of 55 IMN cases had nonunion compared with 40 of 132 ST cases that failed treatment and converted to IMN (p < 0.001). Quality of life and SMFA Functional Index Scores were better for IMN than ST at 6 weeks, 3 and 6 months, but not at 1 year. At 6 months, 24 of 51 patients in the ST group had returned to work, compared with 26 of 37 in the IMN group (p = 0.02). Interpretation - Treatment with IMN improved early quality of life and function and allowed patients to return to work earlier compared with treatment with ST. Approximately one-third of patients treated with ST failed treatment and were converted to IMN.
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    Relationship of physical function with quality of life in older patients with acute heart failure.
    (Journal of the American Geriatrics Society, 2021-07) Aladin, Amer I; Whellan, David; Mentz, Robert J; Pastva, Amy M; Nelson, M Benjamin; Brubaker, Peter; Duncan, Pamela; Reeves, Gordon; Rosenberg, Paul; Kitzman, Dalane W

    Background

    Older patients with acute decompensated heart failure (ADHF) have severely impaired physical function (PF) and quality of life (QOL). However, relationships between impairments in PF and QOL are unknown but are relevant to clinical practice and trial design.

    Methods

    We assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. PF measures included Short Physical Performance Battery (SPPB) and 6-min walk distance (6MWD). Disease-specific QOL was assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). General QOL was assessed by the Short Form-12 (SF-12) and EuroQol-5D-5L. PF was evaluated as a predictor of QOL using stepwise regression adjusted for age, sex, race, and New York Heart Association class.

    Results

    Participants were 72 ± 8 years, 54% women, 55% minority race, 52% with reduced ejection fraction, and body mass index 33 ± 9 kg/m2 . Participants had severe impairments in PF (6MWD 185 ± 99 m, SPPB 6.0 ± 2.5 units) and disease-specific QOL (KCCQ Overall Score 41 ± 21 and Physical Score 47 ± 24) and general QOL (SF-12 Physical Score 28 ± 9 and EuroQol Visual Analog Scale 57 ± 23). There were modest, statistically significant correlations between 6MWD and KCCQ Overall, KCCQ Physical Limitation, and SF-12 Physical Scores (r = 0.23, p < 0.001; r = 0.30, p < 0.001; and r = 0.24, p = 0.001, respectively); and between SPPB and KCCQ Physical and SF-12 Physical Scores (r = 0.20, p = 0.004, and r = 0.19, p = 0.007, respectively). Both 6MWD and SPPB were correlated with multiple components of the EuroQol-5D-5L. 6MWD was a significant, weak predictor of KCCQ Overall Score and SF-12 Physical Score (estimate = 0.05 ± 0.01, p < 0.001 and estimate = 0.05 ± 0.02, p = 0.012, respectively). SPPB was a significant, weak predictor of KCCQ Physical Score and SF-12 Physical Score (estimate = 1.37 ± 0.66, p = 0.040 and estimate = 0.54 ± 0.25, p = 0.030, respectively).

    Conclusion

    In older, hospitalized ADHF patients, PF and QOL are both severely impaired but are only modestly related, suggesting that PF and QOL provide complementary information and assessment of both should be considered to fully assess clinically meaningful patient-oriented outcomes.