scholarly journals Health-related quality of life outcomes in complex adult spinal deformity surgery

2018 ◽  
Vol 28 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Max S. Riley ◽  
Keith H. Bridwell ◽  
Lawrence G. Lenke ◽  
Jonathan Dalton ◽  
Michael P. Kelly
Keyword(s):  
Mental Health ◽  
Neurological Deficit ◽  
Adult Spinal Deformity ◽  
Major Complication ◽  
Self Image ◽  
Related Quality ◽  
Health Related ◽  
Function Domain

OBJECTIVESignificant health-related quality of life (HRQOL) benefits have been observed for patients undergoing primary and revision adult spinal deformity (ASD) surgery. The purpose of this study was to report changes in HRQOL measures in a consecutive series of patients undergoing complex spinal reconstructive surgery, using Scoli-RISK-1 (SR-1) inclusion criteria.METHODSThis was a single-center, retrospective cohort study. The SR-1 inclusion criteria were used to define patients with complex ASD treated between June 1, 2009, and June 1, 2011. Standard preoperative and perioperative data were collected, including the Scoliosis Research Society (SRS)–22r instrument. The HRQOL changes were evaluated at a minimum 2-year follow-up. Standardized forms were used to collect surgery-related complications data for all patients. Complications were defined as minor, transient major, or permanent major. Patients who achieved a minimum 2-year follow-up were included in the analysis.RESULTSEighty-four patients meeting SR-1 criteria were identified. Baseline demographic and surgical data were available for 74/84 (88%) patients. Forty-seven of 74 (64%) patients met the additional HRQOL criteria with a minimum 2-year follow-up (mean follow-up 3.4 years, range 2–6.5 years). Twenty-one percent of patients underwent posterior fusion only, 40% of patients had a posterior column osteotomy, and 38% had a 3-column osteotomy. Seventy-five percent of patients underwent a revision procedure. Significant improvements were observed in all SRS-22r domains: Pain: +0.8 (p < 0.001); Self-Image: +1.4 (p < 0.001); Function: +0.46 (p < 0.001); Satisfaction: +1.6 (p < 0.001); and Mental Health: +0.28 (p = 0.04). With the exception of Mental Health, more than 50% of patients achieved a minimum clinically important difference (MCID) in SRS-22r domain scores (Mental Health: 20/47, 42.6%). A total of 65 complications occurred in 31 patients. This includes 29.8% (14/47) of patients who suffered a major complication and 17% (8/47) who suffered a postoperative neurological deficit, most commonly at the root level (10.6%, 5/47). Of the 8 patients who suffered a neurological deficit, 1 (13%) was able to achieve MCID in the SRS Function domain.CONCLUSIONSThe majority of patients experienced clinically relevant improvement in SRS-22r HRQOL scores after complex ASD surgery. The greatest improvements were seen in the SRS Pain and SRS Self-Image domains. Although 30% of patients suffered a major or permanent complication, benefits from surgery were still attained. Patients sustaining a neurological deficit or major complication were unlikely to achieve HRQOL improvements meeting or exceeding MCID for the SRS Function domain.

scholarly journals Prevalence and 11-year incidence of common eye diseases and their relation to health-related quality of life, mental health, and visual impairment

2021 ◽  
Author(s):  
Petri K. M. Purola ◽  
Janika E. Nättinen ◽  
Matti U. I. Ojamo ◽  
Seppo V. P. Koskinen ◽  
Harri A. Rissanen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Visual Impairment ◽  
Eye Diseases ◽  
Health Related Quality ◽  
Time Points ◽  
Related Quality ◽  
Health Related

Abstract Purpose To study the prevalence and incidence of the most common eye diseases and their relation to health-related quality of life (HRQoL), depression, psychological distress, and visual impairment in the aging population of Finland. Methods Our study was based on two nationwide health surveys conducted in 2000 and 2011. Eye disease status data were obtained from 7379 and 5710 individuals aged 30 + years, of whom 4620 partook in both time points. Both surveys included identical indicators of HRQoL (EuroQol-5 Dimension [EQ-5D], 15D), depression (Beck Depression Inventory [BDI]), psychological distress (General Health Questionnaire-12 [GHQ-12]), visual acuity, and self-reported eye diseases. We assessed the impact of known eye diseases on these factors, adjusted for age, gender, and co-morbidities. Results Prevalence of self-reported eye diseases was 3.1/2.7% for glaucoma, 8.1/11.4% for cataract, and 3.4/3.8% for retinal degeneration in 2000 and 2011, and the average incidence between 2000 and 2011 was 22, 109, and 35 /year/10,000 individuals, respectively. These eye diseases were associated with a significant decrease in EQ-5D and 15D index scores in both time points. BDI and GHQ-12 scores were also worsened, with some variation between different eye diseases. Impaired vision was, however, the strongest determinant of declined HRQoL. During the 11-year follow-up the effect of eye diseases on HRQoL and mental health diminished. Conclusion Declined HRQoL associated with eye diseases is more related to impaired vision than the awareness of the disease itself, and this declining effect diminished during the follow-up. Therefore, information directed to the public on the risks and prevention of blindness can and should be strengthened to prevent the deleterious effects of visual impairment.

scholarly journals Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up

2021 ◽  
pp. 219256822110091
Author(s):  
Yu-Cheng Yao ◽  
Han Jo Kim ◽  
Mathieu Bannwarth ◽  
Justin Smith ◽  
Shay Bess ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Operating Time ◽  
Patient Demographics ◽  
Lowest Instrumented Vertebra ◽  
Related Quality ◽  
Health Related

Study Design: Retrospective cohort study. Objective: To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. Methods: A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels—groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. Results: Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. Conclusions: Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.

scholarly journals Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255077
Author(s):  
Hala Allabadi ◽  
Abdulsalam Alkaiyat ◽  
Tamer Zahdeh ◽  
Alaa Assadi ◽  
Aya Ghanayim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Stress Disorder ◽  
Cardiac Patients ◽  
Ptsd Symptoms ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Background The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings. Materials and methods For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline. Results The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship was largely mediated by depressive and anxiety symptoms. It was not materially altered by adjustment for socio-demographic, clinical, and lifestyle factors. Discussion Our findings suggest that individuals with a combination of PTSD and depression, or anxiety are potentially faced with poor HRQL as a longer-term outcome of their cardiac disease. In Palestine, psychological disorders are often stigmatized; however, integration of mental health care with cardiac care may offer an entry door for addressing psychological problems in the population. Further studies need to assess the effective mental health interventions for improving quality of life in cardiac patients.

scholarly journals Long-term mental wellbeing and functioning after surgery for cauda equina syndrome

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255530
Author(s):  
James E. Hazelwood ◽  
Ingrid Hoeritzauer ◽  
Alan Carson ◽  
Jon Stone ◽  
Andreas K. Demetriades
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Cauda Equina ◽  
Mental Wellbeing ◽  
Physical Dysfunction ◽  
Related Quality ◽  
Health Related

Introduction Cauda Equina Syndrome (CES) can cause persisting life-changing dysfunction. There is scarce literature regarding the long-term assessment of CES symptoms, and rarer still is the impact of these symptoms on mental wellbeing investigated. This study assessed the long-term patient reported mental wellbeing outcomes of post-operative CES patients. Methods Patients who underwent surgery for CES between August 2013 and November 2014 were identified using an ethically approved database. They then completed validated questionnaires over the telephone assessing their mental and physical functioning (Short-Form 12 Questionnaire), generating the Physical Component Summary (PCS) and Mental Component Summary (MCS). Bladder, bowel and sexual function were also assessed using validated questionnaires. MCS scores were compared to both the Scottish mean and previously published cut-offs indicating patients at risk of depression. Correlations of MCS with bladder, bowel, sexual and physical dysfunction were examined and multifactorial regression to predict MCS from these variables analysed. Independent t-tests assessed the mean difference in MCS between patients presenting with incomplete CES (CES-I) and CES with retention (CES-R) and between those with radiologically confirmed and impending CES. Results Forty-six participants with a mean follow-up time of 43 months completed the study. The mean (±SD) MCS was 49 (±11.8) with 22% demonstrating poor mental health related quality of life in comparison to the Scottish mean. Overall, 37% had scores consistent with being at risk for depression with in the last 30 days, and 45% within the last 12 months. MCS was significantly correlated with Urinary Symptoms Profile (USP) score (-0.608), NBDS score (-0.556), ASEX score (-0.349) and PCS score (0.413) with worse bladder, bowel, sexual and physical dysfunction associated with worse MCS score. Multifactorial regression analysis demonstrated both urinary (USP score p = 0.031) and bowel function (NBDS score p = 0.009) to be significant predictive variables of mental health related quality of life. There were no significant mean differences in MCS between those presenting with CES-I and CES-R or those with radiologically complete and impending CES. Discussion This study demonstrates a high frequency of being at risk for depression in patients with CES and identifies outcome measures (physical, sexual and more so bladder and bowel dysfunction) associated with poorer mental wellbeing. Our large cohort and long follow-up highlight that CES patients should be considered at risk of depression, and the need to consider mental health outcomes following CES surgery.

Importance of achieving Scoliosis Research Society–22r minimal clinically important difference for improving patient satisfaction after adult spinal deformity surgery

2021 ◽  
pp. 1-9
Author(s):  
Hideyuki Arima ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tomohiro Banno ◽  
...  
Keyword(s):  
Mental Health ◽  
Multivariate Analysis ◽  
Patient Satisfaction ◽  
Adult Spinal Deformity ◽  
Research Society ◽  
Scoliosis Research Society ◽  
Self Image ◽  
Related Quality ◽  
Health Related ◽  
And Function

OBJECTIVE Achievement of minimal clinically important differences (MCIDs) in the Scoliosis Research Society–22r (SRS-22r) subdomains represents surgical efficacy. However, whether achievements of MCIDs in SRS-22r domains are associated with long-term satisfaction in patients with adult spinal deformity (ASD) is unclear. This study aimed to elucidate factors affecting patient satisfaction after thoracopelvic corrective fusion surgery in patients with ASD. METHODS Data obtained in 187 patients with ASD who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis between 2010 and 2017 and underwent follow-up for 2 years were retrospectively reviewed. The authors investigated the likelihood of achieving MCIDs in the function, pain, self-image, mental health, and subtotal domains 2 years after surgery. The following MCID values were used: function, 0.90; pain, 0.85; self-image, 1.05; mental health, 0.70; and subtotal, 1.05. Multivariate analysis was performed to evaluate factors associated with patient satisfaction 2 years after surgery. RESULTS The average satisfaction scores in the group that achieved MCID and the group that did not were as follows: 3.97 and 3.37 for function (p < 0.001), 3.66 and 3.51 for pain (p = 0.221), 3.84 and 3.06 for self-image (p < 0.001), 3.82 and 3.28 for mental health (p < 0.001), and 3.96 and 3.30 for subtotal (p < 0.001), respectively. Except for the pain domain, the group that achieved MCIDs showed greater satisfaction than the group that did not achieve MCIDs. On multivariate analysis, factors related to postoperative satisfaction were achievement of SRS-22r self-image (standardization coefficient 0.322, p < 0.001) and function (standardization coefficient 0.179, p = 0.026) MCIDs. Perioperative complications and revision surgery were not related to patient satisfaction. CONCLUSIONS Multivariate analysis demonstrated that achievement of MCIDs in SRS-22r self-image and function domains was significantly associated with postoperative satisfaction. Given that patients with poor preoperative health-related quality of life are more likely to achieve MCIDs in SRS-22r domains, surgeons should carefully consider whether to operate on patients with relatively good baseline health-related quality of life when making surgical decisions.

scholarly journals The Bariatric Interprofessional Psychosocial Assessment Of Suitability Scale (BIPASS): Predictive Validity for Outcomes 1 And 2 Years Following Bariatric Surgery

2021 ◽  
Author(s):  
Molly Atwood
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Psychosocial Assessment ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Bariatric surgery is the most effective intervention for severe obesity; however, many patients demonstrate insufficient and/or unsustained weight loss, and unsatisfactory psychosocial functioning in the longer-term. Although it is well established that attendance at postsurgical follow-up appointments is integral to sustained weight loss, nonadherence to follow-up is common. Consequently, presurgical psychosocial evaluations are conducted in order to identify patients at high risk of poor outcomes. Yet, no consensus has been established regarding a standardized protocol for the assessment of variables relevant to surgical outcomes, and bariatric programs vary widely in their interpretation of psychosocial risk. In addition, there is a paucity of research examining the predictive utility of psychosocial evaluations. The Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASSTM), a novel psychosocial evaluation tool, was developed to address these issues. The purpose of the present study was to contribute to the validation of the BIPASS tool via two aims: 1) by examining the psychometric properties of the BIPASS, and; 2) by examining the ability of the BIPASS tool to predict outcomes 1 and 2 years following bariatric surgery, including weight loss and weight regain, quality of life, psychiatric symptoms, and adherence to postsurgical follow-up appointments. The BIPASS was applied retrospectively to the charts of 200 consecutively referred patients of the Toronto Western Hospital Bariatric Surgery Program (TWH-BSP). Factor analysis of BIPASS items revealed a two-factor structure, reflecting “Mental Health” and “Patient Readiness” subscales. Internal consistency for the BIPASS Total and subscale scores ranged from poor to good, and inter-rater reliability was excellent. Higher BIPASS scores significantly predicted higher binge eating symptomatology, and lower physical and mental health-related quality of life at 1 year postsurgery. The BIPASS did not predict any outcome variables at 2 years postsurgery, or adherence to postsurgical follow-up appointments. Findings suggest that the BIPASS can be used to identify patients at increased risk of problematic eating and poor health-related quality of life early in the postsurgical course, thereby facilitating appropriate interventions.

scholarly journals 35. Health-related quality of life in COVID-19 survivors after 12 months, a prospective cohort study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S25-S26
Author(s):  
Sebastiaan Siegerink ◽  
Marië Nijpels ◽  
Sander Albers ◽  
Frédérique Jurgens ◽  
Felix K Pettai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Control Group ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Healthy Control ◽  
One Year

Abstract Background The long-term effects of COVID-19 are still unknown. This study aims to assess the impact of COVID-19 among survivors after one year. Methods All confirmed COVID-19 cases who presented at OLVG hospital in Amsterdam during the first wave of the COVID-19 pandemic were invited to participate in our prospective observational cohort study. The participants were divided into three subgroups: patients not admitted, admitted to the general ward and admitted to the ICU. Questionnaires were sent at 3, 6 and 12 months after presentation. We used the Research and Development – 36-item health survey, the Hospital Anxiety and Depression Scale and the PTSS Checklist for DSM-5. We compared the RAND-36 scores at the timepoints with a Dutch healthy control population in 2020 and between the three subgroups using the Kruskal-Wallis test and the Mann-Whitney U test. Results Of the 466 confirmed cases, 75 patients died of COVID-19, 64 patients were lost to follow up and 12 patients were excluded because they were unable to complete the questionnaires due to mental illness or cognitive impairment, they moved back to their home country or refused to participate. Of the remaining 315 patients, 182 (57.8%) completed the questionnaires at 3 months. Subsequently, 163 patients provided informed consent for follow up. At 6 and 12 months, 98 (60.1%) and 131 (80.4%) completed the survey. The average score of all domains at 3 months was 58, compared to 79 at twelve months and 81 in the control group. There was a statistically significant increase from 3 and 12 and 6 and 12 months (figure 1). At twelve months participants recovered to levels of the healthy control group (N=459), except for the ICU group, who still experienced bodily pain and decreased physical function. The improvement was most noticeable in the domains of social functioning, role limitations – physical and role limitations – emotional. The percentage of patients with abnormal total HADS scores (cutoff at 16) and PCL5- scores (cutoff at 33) at 3 months decreased from 27.8 to 22.1% and 18.9 to 7.6% at 12 months, respectively (figure 2 and 3). Figure 1. RAND-36: Health-related quality of life after COVID-19 of all patients. Blue line is after 3 months, orange line is after 6 months, green line is after 12 months, yellow line is healthy control. The p-value in the right-upper corner shows statistical significant difference between all total scores, the asterisks indicate significance between groups. PF = physical functioning; SF = social functioning; RP = role limitations–physical; RE = role limitations–emotional; MH = mental health; VT = vitality; BP = pain; GH = general health; HC = health change. Figure 2 The blue column is after 3 months, the orange after 6 months and the green after 12 months. The numbers above the columns are percentages per group. Figure 3 The blue column is after 3 months, the orange after 6 months and the green after 12 months. The numbers above the columns are percentages per group. Conclusion Although, COVID-19 may cause a decreased health-related quality of life and impaired mental health, this study shows important recovery up to normal levels after one year. Disclosures All Authors: No reported disclosures

scholarly journals Clinical Utility of a Structured Program to Reduce the Risk of Health-Related Quality of Life Impairment after Discharge from Intensive Care Unit: A Real-World Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Angelica Venni ◽  
Francesca Ioia ◽  
Silvia Laviola ◽  
Francesca Frigieri ◽  
Alessandra Pieri ◽  
...  
Keyword(s):  
Mental Health ◽  
Intensive Care ◽  
Health Status ◽  
Mental Health Status ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Structured Program

Background. Postdischarge deterioration in health-related quality of life (HRQoL) is a major clinical issue for patients after an intensive care unit (ICU) hospitalization. A significant proportion of these patients is known to develop a progressive worsening of mental and physical performance—the so-called post-intensive care syndrome (PICS). Aim. We aimed at exploring the effects of a structured program for the management of ICU patients, aimed at improving postdischarge HRQoL and reducing the risk of PICS. Methods. A total of 159 patients hospitalized in our ICU with a length of stay >72 hours were enrolled in an institutional management protocol including specific recommendations: adequate sedation and analgesia protocols, to ensure a valid delirium prevention strategy, and to provide a planned midterm after discharge. The main endpoint was the occurrence of PICS at the 6-month follow-up visitation, defined as an abnormal physical or mental score in the SF-12 questionnaire in the presence of clinical evidence of new or worsening impairment in physical, cognitive, or mental health status. An additional questionnaire was administered, to assess the effects of ICU-related memories. Results. Most patients positively rated their health at the 6-month follow-up and had no significant impairment in physical or mental health status. The mean normalized values of the physical and mental component of the SF-12 score were 46 ± 11 and 48 ± 14, suggesting a normal physical and mental health status in most patients. Twenty-nine patients (18.2%) showed evidence of PICS. Similar good results were found by the questionnaire of memories. In multivariable analysis, no variable was found to predict the risk of PICS in our population. Conclusion. In this real-world analysis that lacks a control group, patients who used a program aimed at minimizing the risk of HRQoL deterioration and PICS reported a good perception of their state of health with a relatively low prevalence of PICS.

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