Is global quality of life reduced before fracture in patients with low-energy wrist or hip fracture? A comparison with matched controls

<p>Abstract</p> <p>Background</p> <p>The aims of the study were (i) to examine global quality of life (GQOL) before fracture in patients with low-energy wrist or hip fracture compared with an age- and sex-matched control group, and (ii) to identify relationships between demographic variables, clinical fracture variables, and health- and global-focused quality of life (QOL) prior to fracture.</p> <p>Methods</p> <p>Patients with a low-energy fracture of the wrist (n = 181) or hip (n = 97) aged ≥ 50 years at a regional hospital in Norway and matched controls (n = 226) were included. The participants answered retrospectively, within two weeks after the fracture, a questionnaire on their GQOL before the fracture occurred using the Quality of Life Scale (QOLS), and health-focused QOL using the Short Form-36, physical component summary, and mental component summary scales. A broad range of clinical data including bone density was also collected. ANOVA and multiple linear regression analysis were used to analyse the data.</p> <p>Results</p> <p>Osteoporosis was identified in 59% of the hip fracture patients, 33% of the wrist fracture patients, and 16% of the controls. After adjusting GQOL scores and the three sub-dimensions for known covariates (sociodemographics, clinical fracture characteristics, and health-focused QOL), the hip patients reported significantly lower scores compared with the controls, except for the sub-dimension of personal, social, and community commitment (p = 0.096). Unadjusted and adjusted GQOL scores did not differ between the wrist fracture patients and controls. Sociodemographics (age, sex, education, marital status), clinical fracture variables (osteoporosis, falls, fracture group) and health-focused QOL explained 51.4% of the variance in the QOLS, 35.2% of the variance in relationship and marital well-being, 59.3% of the variance in health and functioning, and 24.9% of the variance of personal, social, and community commitment.</p> <p>Conclusion</p> <p>The hip fracture patients had lower GQOL before the fracture occurred than did controls, even after adjusting for known factors such as sociodemographics, clinical variables and health-focused QOL. The findings suggest that by identifying patients with low GQOL, in addition to other known risk factors for hip fracture, may raise the probability to target preventive health care activities.</p

Associations between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>In patients with suspected coronary artery disease (CAD), the overall aim was to analyse the relationships between disease severity and both mental and physical dimensions of health related quality of life (HRQOL) using a modified version of the Wilson and Cleary model.</p> <p>Methods</p> <p>Using a cross-sectional design, 753 patients (74% men), mean age 62 years, referred for elective cardiac catheterisation were included. The measures included 1) physiological factors 2) symptoms (disease severity, self-reported symptoms, anxiety and depression 3) self-reported functional status, 4) coping, 5) perceived disease burden, 6) general health perception and 7) overall quality of life. To analyse relationships, we performed linear and ordinal logistic regressions.</p> <p>Results</p> <p>CAD and left ventricular ejection fraction (LVEF) were significantly associated with symptoms of angina pectoris and dyspnea. CAD was not related to symptoms of anxiety and depression, but less depression was found in patients with low LVEF. Angina pectoris and dyspnea were both associated with impaired physical function, and dyspnea was also negatively related to social function. Overall, less perceived burden and better overall QOL were observed in patients using more confronting coping strategy.</p> <p>Conclusion</p> <p>The present study demonstrated that data from cardiac patients to a large extent support the suggested model by Wilson and Cleary.</p

The complexity of the relationship between chronic pain and quality of life: a study of the general Norwegian population

The aims of this paper were to evaluate the relationship between chronic pain and global quality of life (GQOL) and to explore the effect of possible confounders, mediators, and moderators such as selected demographic variables, chronic illnesses, stress-related symptoms, fatigue, and subjective health of the relationship between chronic pain and GQOL. We used a cross-sectional design, including 1,893 respondents from a population of 4,000 of Norwegian citizens, aged 19–81 years, who were randomly drawn from the National Register by Statistics Norway in November 2000 (48.5%). Pain duration of more than 3 months was categorized as having chronic pain. The Quality of Life Scale, the Fatigue Severity Scale, and the Posttraumatic Stress Scale were used as our main dependent and independent variables, respectively. A series of multiple regression analyses (GLM in SPSS) were applied using GQOL as the dependent variable, entering subsets of independent variables in a theoretically predefined sequence. In the total model, there was no significant relationship between chronic pain and GQOL. The model explained 39% of the variance in GQOL. For direct effect sizes, stress-related symptoms were related most strongly to GQOL, followed by subjective health, fatigue, chronic illnesses, and selected demographic variables. These findings support the assumption of a complex and indirect relationship between chronic pain and GQOL

Quality of life in female myocardial infarction survivors: a comparative study with a randomly selected general female population cohort

Background: A substantial burden associated with MI has been reported. Thus, how survivors experience their quality of life (QOL) is now being given increasing attention. However, few studies have involved women and a comparison with the general population. The aims of this study were to determine the QOL of female MI survivors, to investigate whether their QOL differed from that of the general population, and to evaluate the clinical significance of the findings. Methods: Two cross-sectional surveys were performed; on female MI survivors and the general Norwegian population. The MI survey included women aged 62–80 years, three months to five years after their MI. One hundred and forty-five women responded, yielding a response rate of 60%. A subset of women in the same age range (n = 156) was drawn from a study of 1893 randomly selected Norwegian citizens. QOL was measured in both groups with the World Health Organization Quality of Life Instrument Abbreviated (WHOQOL-BREF). Results: The majority (54%) of the female MI survivors presented with ST-elevation in their ECG, 31% received thrombolysis, and 38% had reduced left ventricular ejection fraction. Female MI survivors reported significantly lower satisfaction with general health (p = 0.020) and overall QOL (p = 0.017) than women from the general population. This was also the case for the physical and environmental QOL domains (p < 0.001), but not for the psychological and social relationship domains. Estimated effect sizes between the two groups of participants ranged from 0.1 to -0.6. Conclusion: The burden of MI significantly affects the physical health of elderly women. Still, female MI survivors fare as well as the general female population on psychosocial QOL domains. Action should be taken not only to support women's physical needs but also to reinforce their strengths in order to maintain optimal QOL

‘Belonging’. ‘Patients' experiences of social relationships during pulmonary rehabilitation

rehabilitatio

Two-year changes in quality of life in elderly patients with low-energy hip fractures. A case-control study

<p>Abstract</p> <p>Background</p> <p>The long-term effect of hip fracture on health-related quality of life (HRQOL) and global quality of life (GQOL) has not been thoroughly studied in prospective case-control studies.</p> <p>Aims</p> <p>a) to explore whether patients with low-energy hip fracture regain their pre-fracture levels in HRQOL and GQOL compared with changes in age- and sex-matched controls over a two year period; b) to identify predictors of changes in HRQOL and GQOL after two years.</p> <p>Methods</p> <p>We examined 61 patients (mean age = 74 years, <it>SD </it>= 10) and 61 matched controls (mean age = 73 years, <it>SD </it>= 8). The Short Form 36 assessed HRQOL and the Quality of Life Scale assessed GQOL. Paired samples <it>t </it>tests and multiple linear regression analyses were applied.</p> <p>Results</p> <p>HRQOL decreased significantly between baseline and one-year follow-up in patients with hip fractures, within all the SF-36 domains (<it>p </it>< 0.04), except for social functioning (<it>p </it>= 0.091). There were no significant decreases within the SF-36 domains in the controls. Significantly decreased GQOL scores (<it>p </it>< 0.001) were observed both within patients and within controls between baseline and one-year follow-up. The same pattern persisted between baseline and two-year follow-up, except for the HRQOL domain mental health (<it>p </it>= 0.193). The patients with hip fractures did not regain their HRQOL and GQOL. Worsened physical health after two years was predicted by being a patient with hip fracture (B = -5.8, <it>p </it>< 0.001) and old age (B = -1.0, <it>p </it>= 0.015), while worsened mental health was predicted by co-morbidity (B = -2.2, <it>p </it>= 0.029). No significant predictors of differential changes in GQOL were identified.</p> <p>Conclusion</p> <p>A hip fracture has a long-term impact on HRQOL and is a strong predictor of worsened physical health. Our data emphasize the importance of preventing hip fracture in the elderly to maintain physical health. This knowledge should be included in decision-making and health care plans.</p

No long-term impact of low-energy distal radius fracture on health-related quality of life and global quality of life: a case-control study

<p>Abstract</p> <p>Background</p> <p>Changes in patient-reported outcomes like health related quality of life (HRQOL) and global quality of life (GQOL) in patients with low-energy distal radius fracture might be related to fracture, or be within the normal range of variation in an elderly population. Hence, the present study aims to examine: Whether patients with low-energy distal radius fracture attain their pre-fracture levels in HRQOL and GQOL one year after the fracture and compare these levels with age- and sex-matched controls; and whether objective factors predict changes in HRQOL and GQOL during the same one year period.</p> <p>Methods</p> <p>We examined 160 patients and 169 age- and sex matched controls, respectively (mean ± SD) 67 ± 9 and 66 ± 9 years of age. HRQOL was assessed by the Modified Health Assessment Questionnaire (MHAQ) and the Short–Form 36 (SF-36). The Quality of Life Scale (QOLS) assessed GQOL. Paired sample t-tests and multiple linear regression analyses were applied.</p> <p>Results</p> <p>After one year no differences were found in HRQOL (assessed as arm functions, physical health and mental health) compared to pre-fracture level in the patient group. Both patients with distal radius fracture and controls reported a reduced GQOL after one year (p < 0.001). Low-energy distal radius fracture did not predict worsened HRQOL or GQOL one year after inclusion, and few predictors of changes were identified. Worsened arm function was predicted by low BMI (B = -0.20, p = 0.019) at baseline, worsened physical health was predicted by low education (B = 1.37, p = 0.017) at baseline, and living with someone predicted worsened mental health (B = 2.85, p = 0.009)</p> <p>Conclusion</p> <p>Patients with a distal radius fracture seem to manage well despite the fracture, and distal radius fracture is not an independent predictor of worsened HRQOL and GQOL.</p

Is health-related quality of life associated with the risk of low-energy wrist fracture: a case-control study

<p>Abstract</p> <p>Background</p> <p>Some risk factors for low-energy wrist fracture have been identified. However, self-reported measures such as health-related quality of life (HRQOL) have not been examined as potential risk factors for wrist fracture. The aims of this study were to compare HRQOL prior to a low-energy wrist fracture in elderly patients (≥ 50 years) with HRQOL in age- and sex-matched controls, and to explore the association between HRQOL and wrist fracture after adjusting for known risk factors for fracture such as age, weight, osteoporosis and falls.</p> <p>Methods</p> <p>Patients with a low-energy wrist fracture (n = 181) and age- and sex-matched controls (n = 181) were studied. Shortly after fracture (median 10 days), patients assessed their HRQOL before fracture using the Short Form 36 (SF-36). Statistical tests included <it>t </it>tests and multivariate logistic regression analysis.</p> <p>Results</p> <p>Several dimensions of HRQOL were significantly associated with wrist fracture. The direction of the associations with wrist fracture varied between the different sub-dimensions of the SF-36. After controlling for demographic and clinical variables, higher scores on <it>general health </it>(odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.10–1.56), <it>bodily pain </it>(OR = 1.18, 95% CI = 1.03–1.34) and <it>mental health </it>(OR = 1.39, 95% CI = 1.09–1.79) were related to an increased chance of being a wrist fracture patient rather than a control. In contrast, higher scores on <it>physical role limitation </it>(OR = 0.87, 95% CI = 0.79–0.95) and <it>social function </it>(OR = 0.65, 95% CI 0.53–0.80) decreased this chance. Significant associations with wrist fracture were also found for living alone (OR = 1.91, 95% CI 1.07–3.4), low body mass index (BMI) (OR = 0.92, 95% CI 0.86–0.98), osteoporosis (OR = 3.30, 95% CI 1.67–6.50) and previous falls (OR = 2.01, 95% CI 1.16–3.49).</p> <p>Conclusion</p> <p>Wrist fracture patients perceive themselves to be as healthy as the controls before fracture. Our data indicate that patients with favourable and unfavourable HRQOL measures may be at increased risk of wrist fracture.</p

The predictive value of post-traumatic stress disorder symptoms for quality of life: a longitudinal study of physically injured victims of non-domestic violence

<p>Abstract</p> <p>Background</p> <p>Little is known about longitudinal associations between post-traumatic stress disorder (PTSD) and quality of life (QoL) after exposure to violence. The aims of the current study were to examine quality of life (QoL) and the predictive value of post-traumatic stress disorder (PTSD) for QoL in victims of non-domestic violence over a period of 12 months.</p> <p>Methods</p> <p>A single-group (n = 70) longitudinal design with three repeated measures over a period of 12 months were used. Posttraumatic psychological symptoms were assessed by using the Impact of Event Scale, a 15-item self-rating questionnaire comprising two subscales (intrusion and avoidance) as a screening instrument for PTSD. The questionnaire WHOQOL-Bref was used to assess QoL. The WHOQOL-BREF instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. Results of the analysis were summarized by fitting Structural Equation Modelling (SEM).</p> <p>Results</p> <p>For each category of PTSD (probable cases, risk level cases and no cases), the mean levels of the WHOQOL-Bref subscales (the four domains and the two single items) were stable across time of assessment. Individuals who scored as probable PTSD or as risk level cases had significantly lower scores on the QoL domains such as physical health, psychological health, social relationships and environmental than those without PTSD symptoms. In addition, the two items examining perception of overall quality of life and perception of overall health in WHOQOL showed the same results according to PTSD symptoms such as QoL domains. PTSD symptoms predicted lower QoL at all three assessments. Similarly PTSD symptoms at T1 predicted lower QoL at T2 and PTSD symptoms at T2 predicted lower QoL at T3.</p> <p>Conclusion</p> <p>The presence of PTSD symptoms predicted lower QoL, both from an acute and prolonged perspective, in victims of non-domestic violence. Focusing on the individual's perception of his/her QoL in addition to the illness may increase the treatment priorities and efforts.</p