Five-Repetition Sit-to-Stand Test Performance in Healthy Individuals: Reference Values and Predictors From 2 Prospective Cohorts

Objective: The 5-repetition-sit-to-stand (5R-STS) test is an objective test of functional impairment- commonly used in various diseases, including lumbar degenerative disc diseases. It is used to measure the severity of disease and to monitor recovery. We aimed to evaluate reference values for the test, as well as factors predicting 5R-STS performance in healthy adults.Methods: Healthy adults ( > 18 years of age) were recruited, and their 5R-STS time was measured. Their age, sex, weight, height, body mass index (BMI), smoking status, education level, work situation and EuroQOL-5D Healthy & Anxiety category were recorded. Linear regression analysis was employed to identify predictors of 5R-STS performance.Results: We included 172 individuals with mean age of 39.4 ± 14.1 years and mean BMI of 24.0 ± 4.0 kg/m². Females constituted 57%. Average 5R-STS time was 6.21 ± 1.92 seconds, with an upper limit of normal of 12.39 seconds. In a multivariable model, age (regression coefficient [RC], 0.07; 95% confidence interval [CI], 0.05/0.09; p < 0.001), male sex (RC, -0.87; 95% CI, -1.50 to -0.23; p = 0.008), BMI (RC, 0.40; 95% CI, 0.10–0.71; p = 0.010), height (RC, 0.13; 95% CI, 0.04–0.22; p = 0.006), and houseworker status (RC, -1.62; 95% CI, -2.93 to -0.32; p = 0.016) were significantly associated with 5R-STS time. Anxiety and depression did not influence performance significantly (RC, 0.82; 95% CI, -0.14 to 1.77; p = 0.097).Conclusion: The presented reference values can be applied as normative data for 5R-STS in healthy adults, and are necessary to judge what constitutes abnormal performance. We identified several significant factors associated with 5R-STS performance that may be used to calculate individualized expected test times.

Medicina Integrativa y su Impacto en Calidad de Vida en Artritis Reumatoide. Reporte de Caso Clínico

La artritis reumatoidea (AR) es una enfermedad inflamatoria crónica de origendesconocido, que se caracteriza por ser una poliartritis simétrica y periférica, la cual causa dañoarticular y presenta manifestaciones extraarticulares generando dolor crónico y discapacidadfísica; estas últimas deterioran la calidad de vida del paciente y provocan una percepciónnegativa sobre su bienestar físico, emocional y social [1][2]. Se realizó un estudioobservacional descriptivo a modo de reporte de caso clínico de un paciente con diagnóstico deartritis reumatoidea quien se encontraba en manejo farmacológico alopático, a pesar de estotuvo empeoramiento de su sintomatología con aumento del dolor, signos inflamatorios locales,limitación de la movilidad, cambios negativos a nivel emocional, con pérdida de la autonomía ydetrimento de la calidad de vida. Se realizó manejo con enfoque integrativo con medicamentosinmunomoduladores, multicomponentes por un periodo de 2 meses: Traumeel, Zeel T,Lymphomyosot, Nuxeel Homaccord, Berbeel Homaccord, Discus compositum, Ubichinoncompositum y Gelsemium Homaccord, los cuales fueron administrados vía oral y mediante lacombinación de técnicas como la homeosiniatria y biopuntura, además se implementaroncambios en el estilo de vida. Se realizó la aplicación de las escalas: EuroQol-5D y Escalacuantitativa numérica (ECN) durante el seguimiento del paciente, con el fin de determinar elimpacto que tiene el tratamiento a nivel de las manifestaciones clínicas y la calidad de vida. Lacalificación del dolor describió una disminución de 10/10 en ECN a 4/10 en ECN. Según eltermómetro EuroQol-5D la autovaloración de su estado de salud pasó de 20/100 a 80/100.Además, se logró reducir los requerimientos de medicamentos alopáticos. Se pudo concluir queel uso de medicamentos biorreguladores y el enfoque individual e integral del paciente logrómejoría en los signos inflamatorios y en la calidad de vida del paciente.

Impacto en la calidad de vida con manejo biorregulador en un paciente con artritis reumatoide. Reporte de caso.

Estudio de tipo observacional transversal donde se evalúa la respuesta clínica del paciente conartritis reumatoidea (AR) al manejo con medicamentos inmunomoduladores,multicomponentes: Traumeel, Zeel T, Lymphomyosot, Nuxeel Homaccord, BerbeelHomaccord, Discus compositum, Ubichinon compositum y Gelsemium Homaccord, mediantecombinación de diferentes técnicas como la homeosiniatria, acupuntura y la vía oral,implementando cambios en el estilo de vida, por un período de 2 meses. Observándose mejoríaen los signos inflamatorios y calidad de vida del paciente. Las mediciones de las variables sehicieron a través de la aplicación las escalas: EuroQol-5D y Escala cuantitativa numérica(ECN). La calificación del dolor describió una disminución de 10/10 en ECN a 4/10 en ECN.Según el termómetro EuroQol-5D la autovaloración de su estado de salud pasó de 20/100 a80/100. Además, se logró reducir los requerimientos de medicamentos alopáticos.

Impacto en la calidad de vida con manejo biorregulador en un paciente con artritis reumatoide. Reporte de casos clínico

Estudio de tipo observacional transversal donde se evalúa la respuesta clínica del paciente con artritis reumatoidea (AR) al manejo con medicamentos inmunomoduladores, multicomponentes: Traumeel, Zeel T, Lymphomyosot, Nuxeel Homaccord, Berbeel Homaccord, Discus compositum, Ubichinon compositum y Gelsemium Homaccord, mediante combinación de diferentes técnicas como la homeosiniatria, acupuntura y la vía oral, implementando cambios en el estilo de vida, por un período de 2 meses. Observándose mejoría en los signos inflamatorios y calidad de vida del paciente. Las mediciones de las variables se hicieron a través de la aplicación las escalas: EuroQol-5D y Escala cuantitativa numérica (ECN). La calificación del dolor describió una disminución de 10/10 en ECN a 4/10 en ECN. Según el termómetro EuroQol-5D la autovaloración de su estado de salud pasó de 20/100 a 80/100. Además, se logró reducir los requerimientos de medicamentos alopáticos.

MEJORANDO LA CALIDAD DE VIDA EN LA ENFERMEDAD DE PARKINSON DESDE LA MEDICINA BIORREGULADORA DE SISTEMAS, UNA NUEVA PERSPECTIVA, REPORTE DE CASO CLINICO

Sabemos que la enfermedad de Parkinson, es el trastorno neurodegenerativo más frecuente, después de la enfermedad de Alzheimer y que su principal factor de riesgo es la edad avanzada. Dicha enfermedad supone cada vez más un reto de salud pública en nuestras sociedades occidentales progresivamente envejecidas.(1) Esta se caracteriza clínicamente por la presencia de la tríada motora: acinesia o lentitud de movimientos, temblor de reposo y rigidez, por ello ha sido clásicamente considerada y estudiada como un trastorno motor; Sin embargo, en las últimas décadas, ha aumentado el reconocimiento de manifestaciones no motoras como la apatía, el deterioro cognitivo o los síntomas disautonómicos entre otros.(1) Según la Asociación Europea de la Enfermedad de Parkinson el 94 % de los pacientes sufre anomalías motoras, el 84 % síntomas depresivos y en un 65 % trastornos cognitivos, Estas diferencias fisiopatológicas están influenciadas por factores genéticos, emocionales y epigenéticos, que se expresan en una inflamación crónica de bajo grado ,asociado directamente a una mayor degeneración de las células neuronales ; ésta combinación supone para el paciente una progresiva disminución en su calidad de vida. Se presenta el caso de un paciente de 78 años de edad con diagnóstico de enfermedad de Parkinson desde hace 17 años, en manejo médico convencional por especialistas en neurología, con pobre respuesta al tratamiento , con deterioro clínico y con alteración importante de su calidad de vida, que al momento de su valoración inicial, aplicando la escala de calidad de vida Euroqol 5D mostraba un puntaje 6.74 % , y en el termómetro de calidad de vida de esta misma escala 20 puntos % , con una severidad según la escala Hoehn y Yahr tambien de calidad de vida , en estadio 5, indicando (necesita ayuda para todo permanece sentado o acostado) , y por el índice de Katz que evalúa la independencia de un enfermo para realizar actividades de la vida diaria por calculadora virtual registrando los items obtenidos . 5 puntos ( incapacidad severa) , se inicio tratamiento desde la medicina biorreguladora de sistemas, aplicando como conceptos la detoxificación básica y central , la inmunomodulación y la regulación del eje hipotálamo hipófisis adrenal (HHA) con medicamentos como Galium Heel, Cerecomp Compositum, Traumeel S , Neurexan entre otros. por vía oral y endovenosa; después de 3 meses de tratamiento se logra evidenciar en el paciente una mejoría notable de sus síntomas clínicos siendo muy evidente en el temblor , rigidez , agitación psicomotora , demostrado por cambios en los resultados de las escalas ;en la escala Euroqol 5D mejorando en un 62.43 % en su calidad de vida , 50 puntos % en el termometro de calidad de vida de esta misma escala y ; pasando a un estadio 3 en la escala de Hoehn y Yahr (alteración bilateral leve o moderada con cierta inestabilidad postural), y obteniendo en el índice de Katz un puntaje de 3 puntos ; además se logro reducir la dosis de medicación antihipertensiva .Con este caso clínico podemos sugerir que el uso de medicamentos biorreguladores en dosis bajas multiobjetivo y multicomponente favorecen el proceso de autorregulación de redes desreguladas en la Enfermedad de Parkinson como son el sistema linfático " glinfático", la red neuroendocrina ,mitocondrial y modulando la inflamación crónica de bajo grado; logrando disminuir la severidad de los síntomas , la limitación funcional y mejorando la calidad de vida .

P.219 The effect of peri-operative adverse events on long-term patient reported outcomes after lumbar spine surgery

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.

Quality of Life among Patients with Chronic Venous Disease (CVD) as Measured by the VEINES-QOL/SYM and the EuroQol-5D-5L Questionnaires, A Descriptive-Comparative Design Study

Objective: To determine the efficacy (sensitivity, specificity, and accuracy) of the VeinesQol/Sym with metric statements fewer than the EQ5D in detecting the quality of life of patients with Chronic Venous Disease (CVD) before and after treatment. Methods: This is a descriptive-comparative design in collecting the necessary data to arrive at conclusions that respond to the specific questions of the study in 2 private hospitals. The responses gathered from patients through EQ5D and VeinesQol/Sym, before and after they received treatment were utilized in describing and comparing the efficacy of the health questionnaires. Data were further subjected to a comparative analysis to elaborate the efficacy of the VeinesQol/Sym. Results: A total of 114 CVD patients completed the study after the exclusion of 13 patients due to failure to follow up after eight weeks of treatment. The study showed that VeinesQol/Sym and EQ5D has similar efficacy in determining quality of life of CVD patients. However, VeinesQol/Sym has higher accuracy (84.96% vs 76.99%), higher sensitivity (87.85% vs 83.87%), detects greater level of impairment in mobility, anxiety/depression, pain and discomfort, disruptions in usual activity and lower quality of current state of health condition than EQ5D Conclusion: With the responses to the metric statements of the indicators of quality life in both VeinesQol/Sym and EQ5D, VeinesQol/Sym was found to have a greater efficacy in establishing the accurate status of quality of life of patients with CVD than the EQ5D.

Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients

Objective: Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied.Methods: Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-year data were included. Modified Japanese Orthopaedic Association (mJOA) score categorized BL myelopathy (mJOA = 18 excluded), with moderate myelopathy mJOA being 12 to 17 and severe myelopathy being less than 12. BL deformity severity was categorized using the mismatch between T1 slope and cervical lordosis (TS-CL), with CL being the angle between the lower endplates of C2 and C7. Moderate deformity was TS-CL less than or equal to 25° and severe deformity was greater than 25°. Categorizations were combined into 4 groups: group 1 (G1), severe myelopathy and severe deformity; group 2 (G2), severe myelopathy and moderate deformity; group 3 (G3), moderate myelopathy and moderate deformity; group 4 (G4), moderate myelopathy and severe deformity. Univariate analyses determined whether myelopathy or deformity had greater impact on outcomes.Results: One hundred twenty-eight CD patients were included (mean age, 56.5 years; 46% female; body mass index, 30.4 kg/m2) with a BL mJOA score of 12.8 ± 2.7 and mean TS-CL of 25.9° ± 16.1°. G1 consisted of 11.1% of our CD population, with 21% in G2, 34.6% in G3, and 33.3% in G4. At BL, Neck Disability Index (NDI) was greatest in G2 (p = 0.011). G4 had the lowest EuroQol-5D (EQ-5D) (p < 0.001). Neurologic exam factors were greater in severe myelopathy (p < 0.050). At 1-year, severe deformity met minimum clinically important differences (MCIDs) for NDI more than moderate deformity (p = 0.002). G2 had significantly worse outcomes compared to G4 by 1-year NDI (p = 0.004), EQ-5D (p = 0.028), Numerical Rating Scale neck (p = 0.046), and MCID for NDI (p = 0.001).Conclusion: Addressing severe deformity had increased clinical weight in improving patient-reported outcomes compared to addressing severe myelopathy.

Comparison of EuroQol-5D-3L and Short Form-6D Utility Scores in Family Caregivers of Colorectal Cancer Patients: A Cross-Sectional Survey in China

Objective: To compare the EuroQol-5D-3L (EQ-5D-3L) and the Short Form-6D (SF-6D) utility scores in family caregivers (FCs) of colorectal cancer (CRC) patients.Method: This study was performed on FCs of CRC patients from three primary cancer centers in the capital city of the Heilongjiang province. The participants (FCs) who were enrolled, filled the EQ-5D-3L, along with the SF-6D questionnaire. Two tools were compared for their distribution, discriminant validity, agreement, and convergent validity along with known-groups validity.Result: Two hundred ninety-two FCs of CRC patients were enrolled. The score distribution of the SF-6D along with the EQ-5D-3L were not normal. A ceiling impact was seen in 31.8% of the FCs for EQ-5D-3L; however, none for the SF-6D. Good associations (Spearman’s rho = 0.622, p &lt; 0.01) and intraclass correlation coefficient (ICC 0.637 and average ICC 0.778) between the two scores were observed. The EQ-5D-3L yielded higher utility scores in contrast with the SF-6D in the better health subclass. The SF-6D distinguished better between excellent and good health statuses, with better effect size and relative efficiency statistics. Both tools showed good known-groups validity.Conclusion: The utility scores of SF-6D were remarkably lower relative to that of the EQ-5D-3L, but the difference may be clinically insignificant. However, the SF-6D may be superior because of the lack of ceiling impact. SF-6D exhibited a better convergent validity along with discrimination validity of excellent health condition and improved known-groups validity efficiency.

Baseline Characteristics of Patients With Cavernous Angiomas With Symptomatic Hemorrhage in Multisite Trial Readiness Project

Background and Purpose: Brain cavernous angiomas with symptomatic hemorrhage (CASH) have a high risk of neurological disability from recurrent bleeding. Systematic assessment of baseline features and multisite validation of novel magnetic resonance imaging biomarkers are needed to optimize clinical trial design aimed at novel pharmacotherapies in CASH. Methods: This prospective, multicenter, observational cohort study included adults with unresected, adjudicated brain CASH within the prior year. Six US sites screened and enrolled patients starting August 2018. Baseline demographics, clinical and imaging features, functional status (modified Rankin Scale and National Institutes of Health Stroke Scale), and patient quality of life outcomes (Patient-Reported Outcomes Measurement Information System-29 and EuroQol-5D) were summarized using descriptive statistics. Patient-Reported Outcomes Measurement Information System-29 scores were standardized against a reference population (mean 50, SD 10), and one-sample t test was performed for each domain. A subgroup underwent harmonized magnetic resonance imaging assessment of lesional iron content with quantitative susceptibility mapping and vascular permeability with dynamic contrast-enhanced quantitative perfusion. Results: As of May 2020, 849 patients were screened and 110 CASH cases enrolled (13% prevalence of trial eligible cases). The average age at consent was 46±16 years, 53% were female, 41% were familial, and 43% were brainstem lesions. At enrollment, ≥90% of the cohort had independent functional outcome (modified Rankin Scale score ≤2 and National Institutes of Health Stroke Scale score <5). However, perceived health problems affecting quality of life were reported in >30% of patients (EuroQol-5D). Patients had significantly worse Patient-Reported Outcomes Measurement Information System-29 scores for anxiety ( P =0.007), but better depression ( P =0.002) and social satisfaction scores ( P =0.012) compared with the general reference population. Mean baseline quantitative susceptibility mapping and permeability of CASH lesion were 0.45±0.17 ppm and 0.39±0.31 mL/100 g per minute, respectively, which were similar to historical CASH cases and consistent across sites. Conclusions: These baseline features will aid investigators in patient stratification and determining the most appropriate outcome measures for clinical trials of emerging pharmacotherapies in CASH.