Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation

2020 ◽  
Vol 36 (08) ◽  
pp. 606-615
Author(s):  
Halley Darrach ◽  
Pooja S. Yesantharao ◽  
Sarah Persing ◽  
George Kokosis ◽  
Hannah M. Carl ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Upper Extremity ◽  
Nonoperative Management ◽  
Multivariable Analysis ◽  
Sociodemographic Factors ◽  
Surgical Patients ◽  
Linear Modeling ◽  
Secondary Lymphedema ◽  
Nonsurgical Management

Abstract Background Postmastectomy secondary lymphedema can cause substantial morbidity. However, few studies have investigated longitudinal quality of life (QoL) outcomes in patients with postmastectomy lymphedema, especially with regard to surgical versus nonoperative management. This study prospectively investigated QoL in surgically versus nonsurgically managed patients with postmastectomy upper extremity lymphedema. Methods This was a longitudinal cohort study of breast cancer-related lymphedema patients at a single institution, between February 2017 and January 2020. Lymphedema Quality of Life Instrument (LyQLI) and RAND-36 QoL instrument were used. Mann–Whitney U and Fisher's exact tests were used for descriptive statistics. Wilcoxon's signed-rank testing and linear modeling were used to analyze longitudinal changes in QoL. Results Thirty-two lymphedema patients were recruited to the study (20 surgical and 12 nonsurgical). Surgical and nonsurgical cohorts did not significantly differ in clinical/demographic characteristics or baseline QoL scores, but at the 12-month time point surgical patients had significantly greater LyQLI overall health scores than nonsurgical patients (79.3 vs. 58.3, p = 0.02), as well as higher composite RAND-36 physical (68.5 vs. 38.3, p = 0.04), and mental (77.0 vs. 52.7, p = 0.02) scores. Furthermore, LyQLI overall health scores significantly improved over time in surgical patients (60.0 at baseline vs. 79.3 at 12 months, p = 0.04). Besides surgical treatment, race, and age were also found to significantly impact QoL on multivariable analysis. Conclusion Our results suggest that when compared with nonoperative management, surgery improved QoL for chronic, secondary upper extremity lymphedema patients within 12-month postoperatively. Our results also suggested that insurance status may have influenced decisions to undergo lymphedema surgery. Further study is needed to investigate the various sociodemographic factors that were also found to impact QoL outcomes in these lymphedema patients.

Fecal Incontinence: Nonsurgical Management

2018 ◽  
Author(s):  
Madeleine Blank ◽  
Lilian Chen
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Pelvic Floor ◽  
Nonoperative Management ◽  
Disease Process ◽  
The United States ◽  
Pelvic Floor Physical Therapy ◽  
Nonsurgical Management ◽  
Accidental Bowel Leakage

Fecal incontinence is the uncontrolled passage of feces or flatus. It is a debilitating and often unrecognized condition whose prevalence is increasing with our aging population and often carries significant stigmata associated with decreased quality of life. It is also one of the leading causes of nursing home admissions in the United States. The etiology of fecal incontinence is multifactorial, with many risk factors contributing to this disease process. Treatment may be challenging and needs to be individualized. In this review, we discuss the initial evaluation of the patient presenting with fecal incontinence, adjunctive testing modalities, and nonoperative management. This review contains 6 figures, 2 tables and 50 references Key words: accidental bowel leakage, biofeedback, bowel incontinence, fecal incontinence, pelvic floor physical therapy, pelvic floor retraining

Fecal Incontinence: Nonsurgical Management

2017 ◽  
Author(s):  
Madeleine Blank ◽  
Lilian Chen
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Pelvic Floor ◽  
Nonoperative Management ◽  
Disease Process ◽  
The United States ◽  
Pelvic Floor Physical Therapy ◽  
Nonsurgical Management ◽  
Accidental Bowel Leakage

Fecal incontinence is the uncontrolled passage of feces or flatus. It is a debilitating and often unrecognized condition whose prevalence is increasing with our aging population and often carries significant stigmata associated with decreased quality of life. It is also one of the leading causes of nursing home admissions in the United States. The etiology of fecal incontinence is multifactorial, with many risk factors contributing to this disease process. Treatment may be challenging and needs to be individualized. In this review, we discuss the initial evaluation of the patient presenting with fecal incontinence, adjunctive testing modalities, and nonoperative management. This review contains 6 figures, 2 tables and 50 references Key words: accidental bowel leakage, biofeedback, bowel incontinence, fecal incontinence, pelvic floor physical therapy, pelvic floor retraining

Association between multimodality measures of aortic stenosis severity and quality-of-life improvement outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Michael A Catalano ◽  
Shahryar G Saba ◽  
Bruce Rutkin ◽  
Greg Maurer ◽  
Jacinda Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Replacement ◽  
Multivariable Analysis ◽  
Calcium Score ◽  
Post Intervention ◽  
Transcatheter Aortic Valve

Abstract Aims Up to 40% of patients with aortic stenosis (AS) present with discordant grading of AS severity based on common transthoracic echocardiography (TTE) measures. Our aim was to evaluate the utility of TTE and multi-detector computed tomography (MDCT) measures in predicting symptomatic improvement in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods and results A retrospective review of 201 TAVR patients from January 2017 to November 2018 was performed. Pre- and post-intervention quality-of-life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Pre-intervention measures including dimensionless index (DI), stroke volume index (SVI), mean transaortic gradient, peak transaortic velocity, indexed aortic valve area (AVA), aortic valve calcium score, and AVA based on hybrid MDCT-Doppler calculations were obtained and correlated with change in KCCQ-12 at 30-day follow-up. Among the 201 patients studied, median KCCQ-12 improved from 54.2 pre-intervention to 85.9 post-intervention. In multivariable analysis, patients with a mean gradient >40 mmHg experienced significantly greater improvement in KCCQ-12 at follow-up than those with mean gradient ≤40 mmHg (28.1 vs. 16.4, P = 0.015). Patients with MDCT-Doppler-calculated AVA of ≤1.2 cm2 had greater improvements in KCCQ-12 scores than those with computed tomography-measured AVA of >1.2 cm2 (23.4 vs. 14.1, P = 0.049) on univariate but not multivariable analysis. No association was detected between DI, SVI, peak velocity, calcium score, or AVA index and change in KCCQ-12. Conclusion Mean transaortic gradient is predictive of improvement in quality-of-life after TAVR. This measure of AS severity may warrant greater relative consideration when selecting the appropriateness of patients for TAVR.

scholarly journals Pain Assessment: Benefits of Using Pain Scales for Surgical Patients in South Bohemian Hospitals

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 171
Author(s):  
Vera Olisarova ◽  
Valerie Tothova ◽  
Martin Cerveny ◽  
Vendula Dvorakova ◽  
Petr Sadilek
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Pain Assessment ◽  
Exploratory Study ◽  
Surgical Patients ◽  
The South ◽  
Pain Scales ◽  
Emotional Component ◽  
Attention To Pain

Pain is a medical and nursing problem that is common in surgical departments. Inadequate pain management can lead to patient distress, as well as extending the period in which the patient’s quality of life is reduced. The standardized SF-MPQ-2 questionnaire provides nurses with the opportunity to assess pain within a broader context. The aim of this descriptive and exploratory study was to describe the state of pain assessment in surgical patients in the South Bohemian Region and to highlight the benefits of using a standardized tool for proper pain assessment. The research was carried out using a quantitative survey within the South Bohemian Region (Czech Republic). The participants in the study were nurses working in surgical departments in hospitals in the region as well as hospitalized patients. The results show that nurses pay slightly more attention to pain assessments than doctors. We know that, generally, pain decreases with time after surgery. Nonetheless, returning pain, as well as continuous pain, can occur, both of which have an emotional component. The results of this study are directed at nurses and include a call for more effective pain management through improved assessment.

115 The Impact of Burn Injury on Upper Extremity Prosthesis Users

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S77-S77
Author(s):  
Jill M Cancio ◽  
Matthew Borgia ◽  
Leopoldo C Cancio ◽  
Linda Resnik
Keyword(s):  
Quality Of Life ◽  
Upper Extremity ◽  
Performance Testing ◽  
Hospital Length Of Stay ◽  
Shoulder Abduction ◽  
Phantom Pain ◽  
Assessment Procedure ◽  
Full Time ◽  
The Impact

Abstract Introduction Burns with upper extremity (UE) amputation present a unique rehabilitation challenge. The purpose of this study of UE amputees who are active prosthesis users was to compare outcomes for those with and without burns. Methods This is part of a larger nationwide study of U.S. military members and veterans with UE amputations. In-person data were collected at 5 sites. An therapist measured passive and active range of motion (PROM, AROM); administered the Quick Disability of the Arm, Shoulder, and Hand; Community Reintegration of Injured Service Members-Computer Adaptive-Test; Trinity Amputation and Prosthetic Experience Scale; health-related quality of life (VR-12); Activities Measure for Upper Extremity Amputees; Southampton Assessment Procedure; 9-Hole Peg Test; and Jebsen-Taylor Hand Function Test (JTHF); and recorded residual and phantom pain; timing of prosthesis receipt; and current prosthesis use. The IRB approved this study. Results Data were collected on 126 individuals with UE amputation, of whom 105 had data on etiology and were included. Of these, 13 (12.4%) had burns (B) vs non-burn (NB). The majority were unilateral amputees (69% B, 90% NB). Most were transradial (TR) amputees (B 84.6%, NB 66.3%) as opposed to transhumeral (TH). A minority received their prosthetics within the first 3 months post-amputation (11.1% B, 28.8% NB) (p=0.15). Average age was 57.6 (SD 15.6) years for NB and 53.0 (20.6) years for B. Mean time since amputation was 22.5 (18.0) years for NB and 25.2 (17.3) years for B. The following non-significant differences in outcomes between B and NB were observed. Thirty-nine percent of B were employed full-time vs 18.9% of NB (p=0.15). The primary prosthesis was, for NB, a body-powered prosthesis (66.7%); for B, myoelectric (50%) or body-powered (50%). For unilateral UE amputees, there were no differences between B and NB on performance testing for dexterity and functional tasks or in self-reported disability, quality of life or prevalence or intensity of pain. B trended towards more moderate to severe PROM deficits with shoulder forward flexion (TH B 50%, TH NB 23.1% [p=0.444]; TR B 20%, TR NB 5.6% [p=0.197]) and shoulder abduction (TH B 50%, TH NB 26.9% [p=0.497]; TR B 30%, TR NB 16.4% [p=0.376]). Also, TR amputees with burns trended towards more PROM deficits with elbow flexion (B 20%, NB 6.9% [p=0.212]) and elbow extension (B 20%, NB 8.6% [p=0.272]). AROM deficits also trended greater in B. Conclusions We did not observe differences in physical function, pain levels, or quality of life between those with and without burns. Further studies with larger samples are needed, to include analysis of burn location, burn size, hospital length of stay, and rehabilitation care.

EVALUATION OF QUALITY OF LIFE IN BRACHIAL PLEXUS INJURY PATIENTS AFTER RECONSTRUCTIVE SURGERY

Hand Surgery ◽  
2006 ◽  
Vol 11 (03) ◽  
pp. 103-107 ◽  
Author(s):  
Izuru Kitajima ◽  
Kazureru Doi ◽  
Yasunori Hattori ◽  
Semih Takka ◽  
Emmanuel Estrella
Keyword(s):  
Quality Of Life ◽  
Brachial Plexus ◽  
Upper Extremity ◽  
Brachial Plexus Injury ◽  
Short Form ◽  
Bodily Pain ◽  
Summary Score ◽  
Joint Function ◽  
Sf 36

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.

Effect of Upper Extremity Nerve Damage on Activity Participation, Pain, Depression, and Quality of Life

2009 ◽  
Vol 34 (9) ◽  
pp. 1682-1688 ◽  
Author(s):  
Ryan Bailey ◽  
Vicki Kaskutas ◽  
Ida Fox ◽  
Carolyn M. Baum ◽  
Susan E. Mackinnon
Keyword(s):  
Quality Of Life ◽  
Upper Extremity ◽  
Nerve Damage ◽  
Activity Participation

scholarly journals Myofascial Massage for Chronic Pain and Decreased Upper Extremity Mobility After Breast Cancer Surgery

2018 ◽  
Vol 11 (3) ◽  
pp. 4-9 ◽  
Author(s):  
Jeanne Massingill, LMT, MLD, CST, KT, NMT ◽  
Cara Jorgensen, LMT ◽  
Jacqueline Dolata, MBA ◽  
Ashwini R. Sehgal, MD
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Chronic Pain ◽  
Upper Extremity ◽  
Outcome Measures ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Mobility Limitations ◽  
And Control

Background: Chronic localized pain and decreased upper extremity mobility commonly occur following breast cancer surgery and may persist despite use of pain medication and physical therapy.Purpose: We sought to determine the value of myofascial massage to address these pain and mobility limitations.Setting: The study took place at a clinical massage spa in the U.S. Midwest. The research was overseen by MetroHealth Medical Center’s Institutional Review Board and Case Center for Reducing Health Disparities research staff.Participants: 21 women with persistent pain and mobility limitations 3–18 months following breast surgery.Research Design: We conducted a pilot randomized controlled trial where intervention patients received myofascial massages and control patients received relaxation massages.Intervention: Intervention participants received 16 myofascial massage sessions over eight weeks that focused on the affected breast, chest, and shoulder areas. Control participants received 16 relaxation massage sessions over eight weeks that avoided the affected breast, chest, and shoulder areas. Participants completed a validated questionnaire at the beginning and end of the study that asked about pain, mobility, and quality of life.Main Outcome Measures: Outcome measures include change in self-reported pain, self-reported mobility, and three quality-of-life questions.Results: At baseline, intervention and control participants were similar in demographic and medical characteristics, pain and mobility ratings, and quality of life. Compared to control participants, intervention participants had more favorable changes in pain (-10.7 vs. +0.4, p < .001), mobility (-14.5 vs. -0.8, p < .001), and general health (+29.5 vs. -2.5, p = .002) after eight weeks. All intervention and control participants reported that receiving massage treatments was a positive experience.Conclusions: Myofascial massage is a promising treatment to address chronic pain and mobility limitations following breast cancer surgery. Further work in several areas is needed to confirm and expand on our study findings.

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