Introduction of the quality of life concept in practical medicine

The modern stage of medical development requires a multidisciplinary approach to studying the impact of treatment on human life. The social aspects are of great importance because the goal of treatment is to preserve or/and improve life. Therefore, the term "quality of life" is increasingly used in the world medical literature. The objectification of this indicator and its adaptation in practical medicine is a priority task. The concept of "quality of life" first appeared in 1958. In the future, this concept was developed in a research carried out by a group of professors at MIT (Massachusetts Institute of Technology) under Prof. R. Bauer in 1966. These researches initiated the quality of life study. In 1996, the WHO developed a definition of quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. The purpose of studying the quality of life in the medical field was to introduce treatment protocols and standardize medical care. An important criterion for evaluating the quality of treatment was to compare changes in the patient’s quality of life before and after using a particular medical protocol. The main methods of studying changes in the patient’s quality of life were the use of special questionnaires. The most common general-purpose questionnaires for assessing changes in quality of life are SF-36, WHOQoL-100, Sickness Impact Profile, Nottingham Health Profile, EuroQoL-5D, EORTC QLQ-C30. In Ukraine, as of 2020, there is no local questionnaire for either general or specialized purposes. But there are translations of the main questionnaires, for example, SF-36, EORTC QLQ-C30. Developing own questionnaire that fully complies with the standards of the MAPI Research Institute requires multi-center and multidisciplinary research. The study of changes in the quality of life is an integral part of a comprehensive analysis of new methods of the diagnosis, treatment and prevention of diseases. Analysis of changes in the quality of life using different approaches to treatment is possible provided that general and special purpose questionnaires and available clinical data are used. Using advanced statistical processing of the questionnaire survey allows you to increase the reliability of the research. There is a need to develop own specialized adapted nosological questionnaires for quality of life analysis. Assessment of the quality of life should become one of the main criteria for the effectiveness of medical care, as well as an independent indicator of the condition of patients during medical and social expertise, determining the prognosis, treatment tactics, and developing rehabilitation programs.

Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

O001. Juvenile-onset spondyloarthritis: a study of 54 cases in Senegal

Background Juvenile onset spondyloarthritis (JoSpA), also known as enthesitis-related arthritis (ERA), accounts for approximately 10-20% of all juvenile idiopathic arthritis (JIA) and affects four times more boys than girls. It’s characterized by frequent arthritis of the lower limbs and strongly associated with presence of HLA-B27. In sub-Saharan Africa, SpA is considered as a rare disease where the frequency of HLA-B27 is &lt; 1% in the population. However, an interesting exception is found in the Fula ethnic group of Gambia, where the prevalence of HLA-B27 was estimated at 6% to 7.8%. This ethnic group is also present in Senegal Aims: To determine the epidemiological, clinical, Para clinical, therapeutic and disease course aspects of JoSpA in Senegal. Methods A retrospective observational study, was conducted in rheumatology department of Aristide Le Dantec Hospital, between January 2012 and December 2020. Two hundred and fifteen JIA cases were collated, 54 were JoSpA fulfilling the ILAR classification criteria of ERA, with age of onset of symptoms ≤ 16 years. Exclusion criteria were: psoriasis or history of psoriasis, presence of rheumatoid factor and presence of systemic arthritis. Disease activity was assessed by activity indexes (BASDAI and ASDAS), functional impact by BASFI, and Quality of Life by Nottingham Health Profile (NHP). Results A total of 54 patients (29 males and 25 females with a sex ratio M/F of 1.16) were included in the study. The mean age at onset of symptoms was 12.4 years, mean age at diagnosis was 23.2 years. 34 (63%) patients were of Fula ethnicity. The inaugural symptomatology was exclusively peripheral in 33 cases (61.1%), axial and peripheral in 23 cases (42.6%). At the time of diagnosis, arthritis was located in the lower limbs in 92.1% of cases, where knee involvement was predominant in 30 (55.6%) cases, followed by hip involvement in 17 (31.5%) cases. Axial involvement was present in 46 cases (85.2%), dominated by sacroiliac pain/ buttock pain in 73.9%, followed by low back pain in 52.1%. Entheseal involvement was present in 30 cases, dominated by Achilles enthesitis and plantar fasciitis in 83.3%. Involvement of the anterior chest wall was found in 12 patients. Uveitis was present in 3 patients. Biological inflammatory syndrome was found in 55.5% of cases, with a mean CRP level of 17.1mg/l. Search for HLA-B27 was carried out in 34 patients, 25 were HLA-B27 positive (73.5%). Among HLA-B27 positive patients, 21 (84%) were of Fula ethnicity. On radiography, sacroiliitis was present in 29 patients, and 8 had coxitis. On admission, the mean BASDAI and ASDAS-CRP were 4.66/10 and 2.98 respectively, mean BASFI was 4.36/10. NHP showed impairment of all items, especially the concepts of energy, pain, sleep and physical mobility. Treatment was based on: NSAIDs (42 patients, 79.6%), methotrexate (30 patients, 55.5%), sulfasalazine (8 patients, 14.8%), oral steroids (15 patients, 27.7%), intra-articular joint steroid injections (6 patients), hip replacement surgery (2 patients), and functional rehabilitation (5 patients). The evolution was favorable, after 6 months of treatment, mean BASDAI and BASFI were 2.47/10 and 2.19/10 respectively. Conclusion In our study, JoSpA affects both girls and boys. The prevalence of HLA-B27 was 73.5% of cases, especially in the Fula ethnic group. The disease is considered as a source of significant functional impact and impairment of quality of life. The treatment was based mainly on conventional treatment. Evolution was globally favorable after treatment. Further epidemiological studies are needed to obtain reliable prevalence rates and to better understand our findings.

Lifestyle differentiation among older adults: exploring the links between individuals’ behaviours, socio-demographic characteristics, health and wellbeing in later life

The association between everyday activities, health and subjective wellbeing in older adults has mostly been examined using different activities as separate variables. Which activities are likely to come together in individuals’ daily time-use patterns, or in what context, has not yet been analysed. This study looks at a broad range of spontaneously reported activities, their location and social context to identify latent behavioural classes. The data used in the study came from a sample of 200 non-institutionalised adults aged 65 and above. Activity data were collected using the Experience Sampling Method. Generalised structural equation modelling was used to identify the classes. Three distinctive behavioural classes, representing different lifestyles, emerged: passive domiciliary, active functional and social recreational. They constituted 30, 53 and 17 per cent of the sample, respectively. Class membership was related to individuals’ age, education and selected dimensions of health measured using the Nottingham Health Profile: energy levels and emotional response. There was consistency between the objectively measured class and an individual's subjective assessment of their physical and emotional health. While both class membership and subjective wellbeing were associated with health, the relationship between class and wellbeing was weak and fully explained by socio-demographic and health-related variables.

Validity and reliability of the Mini-Osteoarthritis Knee and Hip Quality of Life scale in Turkish population

Objectives: This study aims to investigate the validity and reliability of the Turkish version of the Mini-Osteoarthritis Knee and Hip Quality of Life (Mini-OAKHQoL) scale developed to assess the quality of life (QoL) in patients with knee and/or hip osteoarthritis. Patients and methods: Between May 2018 and May 2020, a total of 83 patients (11 males, 72 females; mean age: 58.1±10.0 years; range, 39 to 81 years) with knee and/or hip osteoarthritis were included. Demographic, clinical, and survey data (Mini-OAKHQoL, Nottingham Health Profile, Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne Index, and Visual Analog Scale of pain intensity) were recorded. Missing data, floor effect, and ceiling effect were calculated. For reliability analysis, internal consistency and test-retest reliability were discovered. Face, content, convergent, and divergent validities were applied. Results: Among the patients, 52 (62.65%) had knee osteoarthritis, 26 (31.32%) had hip osteoarthritis, and five (6.02%) had both. Mini-OAKHQoL had a good face and content validity. The average item completion rate was 96.9%, with the time needed to perform was about 4 min. None of the subscales of Mini-OAKHQoL presented floor or ceiling effect, with a good range of responses. The Cronbach alpha coefficients and intraclass correlation coefficient (ICC) analysis of the subscales ranged from 0.927 to 0.676 and 0.987 to 0.843, respectively. Regarding convergent validity, the physical activities, mental health, and pain subscales of Mini-OAKHQoL had moderate to high correlations with the topic-related subset of the other QoL surveys. There were no or weak correlations between Mini-OAKHQoL and non-QoL parameters, indicating its divergent validity. Conclusion: The Turkish version of Mini-OAKHQoL is a valid, reliable, simple, practical, accurate, completable, comprehensive, and disease-specific self-report instrument to assess QoL in patients with knee and/or hip osteoarthritis.

The Effectiveness of Client-Centered Intervention With Telerehabilitation Method After Total Knee Arthroplasty

There is known to be a decrease in quality of life and perceived occupational performance and satisfaction following total knee arthroplasty (TKA). This study was planned to examine the effectiveness of a client-centered (CC) intervention with the telerehabilitation (TR) method on the quality of life, perceived occupational performance, and satisfaction after TKA. A total of 38 patients who had undergone TKA were randomly assigned to the CC and control groups. A 12-day intervention program was applied to the CC group. The Nottingham Health Profile (NHP) and Canadian Occupational Performance Measure (COPM) were applied before and after intervention. The 12-day intervention showed a strong effect on all parameters in the CC group ( p<.001). In the postintervention comparisons, a significant difference was found in favor of the CC group ( p < .001). CC interventions with the TR method can be used in post-TKA interventions.

Assessment of the performance of the Brazilian Portuguese Nottingham Health Profile in adult growth hormone deficiency and pulmonary hypertension

Background: The Nottingham Health Profile (NHP) is a generic measure of perceived distress that has been used widely as an outcome measure in clinical practice and trials. The availability of two Brazilian datasets provided the opportunity to assess the psychometric performance of the NHP in different populations - adult growth hormone deficiency (GHD) and pulmonary hypertension (PH). The purpose of the study was to see how valuable the NHP could be in assessing outcomes in diseases where no disease-specific measures are available. Methods: Secondary analyses were performed with NHP data. Patients diagnosed with adult GHD or PH were administered the NHP during clinic visits on two occasions, two weeks apart. A disease-specific measure of quality of life (QoL) was also administered to the relevant sample of patients on each occasion. Results: The psychometric properties of the NHP were good for both disease groups. As expected, both samples reported high scores on energy level, the PH sample scored high on physical functioning and the GHD sample on emotional reactions. For both samples, most of the NHP sections were able to distinguish between groups of respondents with different ratings of perceived general health. While most sections of the NHP were relatively highly correlated with the QoL measures, pain and sleep did not seem to be important predictors of QoL in either of the samples. Conclusions: The use of the NHP in adult GHD and PH populations in Brazil is not recommended as there are high-quality disease-specific measures available for each disease. However, where no disease-specific measures are available, the NHP can provide good descriptive information of the impact of disease on different patient populations.

CLINICAL OUTCOMES COMPARING TWO PROSTHETIC KNEE DESIGNS IN INDIVIDUALS WITH UNILATERAL TRANSFEMORAL AMPUTATION IN TURKEY

BACKGROUND: Clinical outcome assessments provide important input for the rehabilitation of individuals with transfemoral amputation. Differences in prosthetic knee designs may influence clinical outcomes. OBJECTIVE(S): The aim of this study was to compare functional mobility, balance, prosthetic satisfaction and quality of life in individuals with unilateral transfemoral amputation with microprocessor-controlled (MPK) and non-microprocessor knee designs (Non-MPK). METHODOLOGY: The study included ten experienced MPK (Rheo Knee) users (Group 1) and ten experienced Non-MPK (Total Knee® 2000) users (Group 2). For mobility; the 6 Minute Walk Test (6MWT), for balance; the Berg Balance Scale (BBS), Single Leg Stand Test (SLST) and Four Square Step Test (FSST), for quality of life; the Nottingham Health Profile (NHP) and for prosthetic satisfaction; the Satisfaction with Prosthesis Questionnaire (SATPRO) were administered. FINDINGS: 6MWT results of the MPK group were significantly higher than Non-MPK group (p <0.05). In the MPK group a strong negative correlation was found between the FSST and the 6MWT (r= -0.661, p=0.038). No statistically significant differences were found between the groups (p>0.05) comparing balance, prosthesis satisfaction and quality of life values. CONCLUSION: The findings will inform about the patient’s prognosis and the expected clinical outcomes when prescribing an MPK or an Non-MPK. Individuals with unilateral transfemoral amputation covered longer distances using an MPK compared to Non-MPK. Layman's Abstract Individuals living with an amputation above the knee are limited in mobility which effects their quality of life. Specific prosthetic knee designs may have a long-term impact on the quality of life. This study showed that prosthetic users can walk further with the Rheo knee as compared to those who are using the Total Knee® 2000. However, both groups seemed to be equally happy with their quality of life, equally satisfied with their prosthesis, and their balance capabilities appeared to be similar. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35297/28053 How To Cite: Yazgan A, Kutlutürk S, Lechler K. Clinical outcomes comparing two prosthetic knee designs in individuals with unilateral transfemoral amputation in Turkey. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.8. https://doi.org/10.33137/cpoj.v4i1.35297 Corresponding Author: Ayse Yazgan,1) Össur Turkey Academy, Istanbul, Turkey; 2) İstanbul Medipol University Orthotics - Prosthetics Master of Science Program, Istanbul, Turkey.E-Mail: [email protected] ORCID ID: https://orcid.org/0000-0003-0744-503X

Occupational balance and quality of life in mothers of children with cerebral palsy

Introduction Occupational balance (OB) is an important concept in occupational therapy and is considered as an essential component of health and well-being. The aim of this study was to show differences in OB and quality of life (QoL) between mothers of children with cerebral palsy (CP) and typically developing children. Methods Thirty-six mothers of children with CP and 36 mothers of typically developing children participated in the study. The mothers’ OB was evaluated using the Turkish Occupational Balance Questionnaire-11 (OBQ11-T), and their QoL was evaluated with the Nottingham Health Profile (NHP). Results The OBQ11-T, total score, and the item ‘balance between obligatory and voluntary occupations’ score differed significantly between the groups ( p < 0.05). There were also significant differences in NHP’s aspects of emotional reaction, social isolation, and sleep scores between the groups ( p < 0.05). A negative correlation was detected between OBQ11-T total and NHP total scores in mothers of children with CP ( p < 0.01). Conclusion This study demonstrates that occupational therapists should pay attention to balance between obligatory and voluntary occupations to promote occupational balance. Also, QoL in mothers of children with CP should be evaluated. Therefore, occupational therapists should implement interventions to increase them when necessary for mothers of children with CP.