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PubMed2003

The significance of coping as a therapeutic variable for the outcome of psychological therapy in schizophrenia.

Although there is now strong evidence confirming the efficacy of psychological therapies in schizophrenia, the therapeutic processes which they activate remain widely unknown. In order to effectively implement them in clinical practice, identification of these processes is essential. In a controlled study, the efficacy of a coping-oriented therapy approach for schizophrenia patients was tested. Furthermore, the study aimed at establishing preliminary hypotheses on the therapeutically relevant factors. Treatment effects were found in the prominence of psychopathology, the extent of cognizance of the disorder, and the level of social functioning. Moreover, a better psychopathological and social outcome as measured 12 and 18 months after completion of therapy was best predicted by the patients' mastery of active, problem-focused coping strategies immediately after completion of therapy. The findings underscore the clinical relevance of specific coping styles and corroborate the appropriateness of focusing on aspects of coping behavior in psychological interventions for schizophrenia patients.

Activities of Daily Living↗
PubMed1995

Long-term quality of life after ablative intraoral tumour surgery.

The aim of the present retrospective study was to determine the long-term quality of life of patients who had undergone intraoral tumour resection. 135 patients with a malignant tumour located in the floor of the mouth and the adjacent area were enrolled in the study. A standard questionnaire was used to determine the physical functional status, the psychological status and social functioning of cancer patients (Schipper et al., 1984). The results were related to the T-stage, the size and the location of the intraoral soft tissue defect, the mode of reconstruction and the postoperative interval. The results showed a significant correlation of the Functional Living Index-Cancer (FLIC) score with the Karnowsky-Index. The values were significantly lower in the higher T-stages. The location of the soft tissue defect, the type of soft tissue reconstruction and discontinuity resections of the mandible were crucial for postoperative quality of life, inasmuch as bilateral defects with loss of mandibular continuity and myocutaneous flap reconstructions showed significantly lower FLIC values. Reconstruction of mandibular continuity did not contribute to an increase in FLIC values. Dysphagia, reflux of food through the lips and nose during meals, decreased appetite and persistent pain significantly decreased the FLIC scores. It is concluded, that the FLIC is suitable for the determination of life quality in cancer patients since the score has shown the potential to reflect differences in postoperative life quality with regard to surgical procedures and functional sequelae.

Adult↗
PubMedDate not supplied

Self-assessment of general health status in patients with five common shoulder conditions.

The SF-36 Health Survey is a patient self-administered general health status evaluation designed to measure the impact of disease on an individual's perception of his or her health. Five hundred forty-four patients with five common shoulder conditions (anterior glenohumeral instability (149 patients), complete reparable rotator cuff tear (111 patients), adhesive capsulitis (100 patients), glenohumeral osteoarthritis (67 patients), and impingement (117 patients)) completed the SF-36 Health Survey before undergoing treatment. When compared with U.S. general population norms, the patients with each of these shoulder conditions had statistically significant decreases in their health for Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, Role-Emotional, and the Physical Component Summary as measured by the SF-36 Health Survey. Comparison with published data demonstrated that these shoulder conditions rank in severity (in terms of affecting a patient's perception of his or her general health) with five major medical conditions (hypertension, congestive heart failure, acute myocardial infarction, diabetes mellitus, and clinical depression). The data presented in this study should serve as a baseline to document the impact of shoulder musculoskeletal conditions and possibly to allow comparison among various methods of operative and nonoperative treatment.

Adolescent↗
PubMed2003

Early recovery of walking in children and youths after traumatic brain injury.

A consecutive series of 106 children and adolescents (mean age 10 years, 6 months; SD 4 years, 8 months) with recent traumatic brain injury admitted to a regional hospital-based rehabilitation program was assessed to determine the rate of walking recovery, and characteristics that distinguish between independent walkers, non-walkers, and device-assisted walkers at hospital discharge. Data were collected through a retrospective medical record review of patients admitted between 1994 and 2001. Mean hospital stays were 66.7 days (SD 88.5, range 7 to 140 days). All children (72 male, 34 female) had recent injuries (from 1 to 8 weeks after onset of traumatic brain injury) and were independent walkers before injury. Sixty-four children (60.4%) were discharged as independent walkers, 13 (12.3%) walked with the assistance of a device, and 29 (27.3%) were non-walkers. Non-walkers had a higher proportion of prolonged loss of consciousness, lower-extremity injury, impaired responsiveness, and lower-extremity spasticity than independent walkers. In addition, non-walkers had poorer discharge mobility and social function scores, longer average hospital stays, and a greater proportion of non-community discharges. Device-only walkers were older, more likely to be male, and had a higher proportion of lower-extremity injuries than independent walkers. Results highlight several demographic, clinical, and outcome variables that distinguish independent walkers from device-assisted walkers and non-walkers. These variables might help to determine the prognosis for ambulation, resource needs, and discharge plans for children and adolescents with traumatic brain injury after episodes of inpatient rehabilitation.

Adolescent↗
PubMed2004

The impact of visual impairment and use of eye services on health-related quality of life among the elderly in Taiwan: the Shihpai Eye Study.

To evaluate the effect of impaired vision on health-related quality of life (HRQoL), the authors administered the Medical Outcomes Survey Short-Form 36 (SF-36) to the elderly in a metropolitan Taiwanese community and assessed their visual impairment status. A structured questionnaire was used for door-to-door data collection. Interviewers also collected information on demographics, medical history, and HRQoL. Those who were interviewed were invited to the study hospital for a detailed eye examination. An eye examination, including presenting visual acuity and best-corrected visual acuity, was conducted by ophthalmologists. Presenting visual acuity and best-corrected visual acuity were measured in the better eye. Impaired vision was defined as presenting visual acuity in the better-seeing eye worse than 6/12 (or 20/40) and was used to evaluate the correlation to HRQoL. A total of 1361 subjects at least 65 years of age participated in both the interview and eye examination. Internal-consistency and test-retest reliability of the eight scales were high. Based on the separate multiple regression model, after controlling for all other covariates, subjects in contact with vision services offered by an ophthalmologist had more positive scores on general health perceptions (beta = 4.29; p < 0.001), vitality/energy (beta = 2.73; p < 0.001), and mental health (beta = 2.06; p = 0.01). Impaired vision was associated with significantly lower scores in physical functioning (beta = -3.62; p < 0.001) and social functioning scales (beta = -3.25; p = 0.015). The findings suggest that visual impairment is associated with lower quality of life and use of eye care services is associated with higher quality of life.

Aged↗
PubMed2003

Aerobic exercise as additive palliative treatment for a patient with advanced hepatocellular cancer.

Aerobic exercise is known to improve biopsychosocial outcomes in cancer patients. Currently, exercise is not regarded as a quality-of-life intervention for patients with advanced cancer. The aim of this case study was to determine the feasibility and effects of an aerobic exercise programme for a patient with advanced hepatocellular cancer. After written informed consent, a 55-year-old male patient with advanced hepatocellular carcinoma participated in an aerobic exercise programme of precise intensity, duration and frequency, consisting of ergometer cycling 2 times a week, carried out for a period of 6 weeks. Exercise testing and a 6-min walk were performed, and the patient's quality of life was assessed. The feasibility, safety and beneficial effects of the programme were proven for this patient. At the end of the exercise programme, peak work capacity had increased by 20.3%. The patient has experienced an improvement in physical performance, which was underlined by the 6-min walk. Quality of life has been improved (physical functioning, vitality, mental health, role functioning/emotional, social functioning). Knowledge about the benefits of aerobic exercise for patients suffering from advanced cancer is not yet widespread. Nevertheless, aerobic exercise initiated and executed with appropriate care may serve as a useful additional means of palliative treatment in some patients with advanced cancer.

Carcinoma, Hepatocellular↗
PubMed2000

Functional outcome in knee osteoarthritis after treatment with hylan G-F 20: a prospective study.

OBJECTIVE: To assess functional change in patients with knee osteoarthritis (OA) after treatment with intra-articular hyaluronic acid (Hylan G-F 20; Synvisc). DESIGN: Prospective case series with 6-month follow-up. SETTING: Outpatient community orthopedic practice. PARTICIPANTS: Eighty-four consecutive patients referred to private orthopedic group with symptoms and radiographic evidence of unilateral or bilateral knee OA who had either failed or could not tolerate the side effects of conservative treatment. Sixty-one patients completed the study. Nineteen patients were lost to follow-up. Four patients withdrew from study due to subsequent knee arthroplasty. INTERVENTION: Three weekly injections of Hylan G-F 20 into one or both (if bilaterally symptomatic) knees (110 knees total). OUTCOME MEASURE: SF-36 Health Survey was completed before treatment and 6 months after treatment. RESULTS: Statistically significant improvement (p < .001) in Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, and Role-Emotional categories on 6-month follow-up survey. Age and percent above ideal body weight were not significant predictors of functional change. CONCLUSION: Efficacy of intra-articular injection of Hylan G-F 20 for knee OA 6 months after injection is demonstrated in several categories of the SF-36, indicating a measurable improvement in overall functioning in these patients.

Adjuvants, Immunologic↗
PubMed2005

Quality of life after unilateral acoustic neuroma surgery via middle cranial fossa approach.

CONCLUSIONS: Patients with acoustic neuroma experienced reduced quality of life (QOL) after surgery. Individual factors did not have a significant effect on QOL. In the future, QOL should be a basic factor in the outcome evaluation of different therapeutic regimens in the treatment of acoustic neuroma. OBJECTIVE: To measure the QOL of patients who underwent unilateral acoustic neuroma surgery via the middle cranial fossa approach. MATERIAL AND METHODS: The Short Form-36 (SF-36) Health Survey and a self-designed disease-specific questionnaire were used during follow-up examinations to assess health-related QOL. The pure-tone average was used to specify hearing ability. Facial nerve function was described using the House-Brackmann grading system. A total of 28 male and 14 female patients who underwent surgery between 1997 and 2001 were included in the study. RESULTS: Patients' QOL scores revealed significant reductions in QOL in comparison to normative German QOL data. Gender, age, tumor size or location and clinical symptoms such as hearing loss and restricted facial nerve function did not have an effect on QOL. The SF-36 scales physical functioning, role functioning-physical, bodily pain, general health, social functioning and role functioning-emotional demonstrated significant QOL reductions.

Adult↗
PubMed1995

Social aspects of treatment of depression.

Epidemiological studies of depression have shown a consistent, clinical syndrome across different societies, most of the symptoms being included in DSM-III-R. It is an illness associated with considerable impairment of social function, and in DSM-IV social or occupational dysfunction is included as a criterion for diagnosis. There is also an increased suicide risk which has to be taken into account when selecting treatment. Most depression is treated in general practice, where treatment has tended to be of short duration. The usefulness of tricyclic antidepressants in limited by their toxicity in overdose and their unwanted side effects, which lead to the overuse of health care facilities, reduce compliance, and have social and quality of life consequences particularly in long-term treatment. On these measures the selective serotonin reuptake inhibitors offer a preferred choice of treatment in view of their improved safety and tolerability profile.

Antidepressive Agents, Tricyclic↗
PubMed2002

Factor structure of the Multnomah Community Ability Scale.

More and more, Intensive Community Treatment programs in Canada use questionnaires to evaluate the health and social functioning of individuals suffering from a severe mental illness. However, seldom are these tools subject to psychometric analyses to establish their validity on independent samples. This article presents the results of the validation of the French version of the Multnomah Community Ability Scale. Confirmatory factor analyses were carried out to assess the factorial structure. The factor structure, four dimensions with three items, emerging from a first sample was replicated with data from a different sample of clients. Moreover, these four dimensions respect the initial factor solution of the Multnomah Community Ability Scale, which are a) interference with functioning, b) adjustment to living, c) social competence, and d) behavior problems. The study shows the structural validity of this brief questionnaire, which could be useful both for clinical and research settings to evaluate the effectiveness of interventions.

Activities of Daily Living↗
PubMed2001

Laryngeal preservation with supracricoid partial laryngectomy results in improved quality of life when compared with total laryngectomy.

OBJECTIVES/HYPOTHESES: Study 1: To assess the oncologic outcome following supracricoid partial laryngectomy (SCPL). Study 2: To compare the quality of life (QOL) following SCPL to total laryngectomy (TL) with tracheoesophageal puncture (TEP). Study 3: To analyze whole organ TL sections to determine the percentage of lesions amenable to SCPL STUDY DESIGN: Study 1: A retrospective review of patients who underwent SCPL. Study 2: A non-randomized, prospective study using QOL instruments to compare patients who underwent either SCPL or TL Study 3: A retrospective histopathologic study of TL specimens assessed for the possibility of performing an SCPL. METHODS: Study 1: Twenty-five patients with carcinoma of the larynx underwent SCPL between June 1992 and June 1999. Various rates of oncologic outcome were calculated. Study 2: Thirty-one patients participated in the QOL assessment. This included the SF-36 general health status measure, the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, and the University of Michigan Voice-Related Quality of Life (VRQOL) instrument. Study 3: Ninety surgical specimens were obtained and studied from the total laryngectomy cases in the Tucker Collection. Multiple sites were evaluated for the presence of carcinoma A computer program was written to classify whether the patient was amenable to SCPL. RESULTS: Study 1: The overall local control rate was 96% (24/25). The local control rate following SCPL with cricohyoidoepiglottopexy (CHEP) was 95% (20/21). The local control rate following SCPL with cricohyoidopexy (CHP) was 100% (4/4). Study 2: The SCPL had significantly higher domain scores than TL and TEP in the following categories for the SF-36: physical function, physical limitations, general health, vitality, social functioning, emotional limitations, and physical health summary. The significantly higher domains for the SCPL when compared with the TL and TEP for the HNQOL were eating and pain. Finally, when voice-related QOL was assessed with the V-RQOL, the domains of physical functioning and the total score were significantly better with SCPL when compared with TL and TEP. Study 3: Forty of 90 (44%) laryngeal whole organ specimens were determined to be resectable by SCPL. In 16 (18%) specimens, the patients could have undergone SCPL with CHEP and in 24 (27%) specimens the patients could have undergone SCPL with CHP. Among the 40 (44%) specimens determined to be able to have undergone SCPL, 19 were glottic (1 T1, 15 T2, 3 T3) and 21 were supraglottic (9 T2, 12 T3). CONCLUSIONS: 1) A review of the literature and an analysis of the data in this study indicate that excellent local control may be expected following SCPL. 2) The QOL following SCPL, as measured by three validated QOL instruments, is superior to TL with TEP. 3) A histologic assessment of whole organ sections of TL specimens indicates that many patients who have been subjected to TL may have been candidates for SCPL. 4) If the indications and contraindications are rigorously adhered to, SCPLs are reasonable alternatives to TL in selected cases.

Adult↗
PubMed2006

Quality of life of cancer survivors after physical and psychosocial rehabilitation.

As the number of newly diagnosed cancer patients and the survival rates of cancer increase, more and more cancer patients are facing distressing physical and psychosocial problems as a result of their cancer and its treatment. To address these problems, a 12-week rehabilitation group program for cancer patients (all cancer types), combining physical exercise and psycho-education, was tested in a longitudinal cohort study (n=658). At baseline, participants reported a low quality of life, measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) (range 0-100). Halfway through the intervention significant improvements were found in all domains, except cognitive functioning. At the end of rehabilitation, participants had reached significant improvements on all outcome variables: in global quality of life (from 63.0 to 71.9), emotional functioning (from 66.2 to 74.4), cognitive functioning (from 70.5 to 74.4) and fatigue level (reduction from 49.8 to 41.8) while, moreover, non-breast cancer patients showed clinically relevant improvement in physical functioning (from 67.3 to 80.4) and social functioning (from 63.4 to 79.4) and non-working patients showed a clinically relevant improvement in role functioning (from 57.0 to 69.6).

Adult↗
PubMed2002

Change in quality of life in patients with permanent cardiac pacemakers: a six-month follow-up study.

The purpose of this study was to investigate the quality of life (QOL) in patients before and after permanent pacemaker implantation. A follow-up study design was adopted and purposive sampling was applied to recruit subjects from two medical centers in Taipei City. Subjects were interviewed before pacemaker implantation. Follow-up interviews were conducted at second, fourth, and sixth month after pacemaker implantation. There were 42 subjects enrolled in this study. These subjects had moderate QOL (62.4 +/- 15.9 on a scale of 97) before pacemaker implantation and the QOL improved significantly after pacemaker implantation(p <.05). The QOL improvement reached a peak at the end of the fourth month and the scores decreased at the end of the sixth month vs. the fourth month (p <.05). They had significant improvement in general well-being, sleeping, appetite, physical activity, and physical symptoms (p <.05), but not in cognitive function, social participation, work capability and sexual function (p >.05). Subjects with spouses as their main caregivers had significantly better improvement in QOL after pacemaker implantation. Subjects perceptions of distress from arrhythmia were the most significant determinant in their QOL pre and post pacemaker implantation. The findings suggest that aggressively resolving arrhythmia distress is important for improving QOL.

Activities of Daily Living↗
PubMed1990

Social cognition and impaired social interaction in people with severe learning difficulties.

Social skills training has focused on 'performance' or overt behaviour, rather than on the other components of successful social functioning: motivation and goals, analysis of social information, and performance feedback, Some basic aspects of this 'analysis' or 'social cognition' component were compared in a preliminary study of 25 teenagers and young adults with severe learning difficulties, whose social interaction was categorized as either 'impaired' or 'appropriate'. As predicted from the literature on autistic children, there were no differences between the groups on tasks involving recognition of the visual aspects of the concept of self or perceptual role-taking. It is suggested that social impairments do not reflect social cognitive abilities which are 'lower level' (i.e. can be solved on the basis of information available to the senses). Contrary to expectations, on the four individual tasks of affective role-taking, which is 'higher level', since it requires inferences to be made about the inner emotional state of another person, the differences between the groups were not significant. However, the results were in the predicted direction, and when scores on the tasks were combined, the overall performance of the socially impaired group was significantly poorer (P less than 0.05). It is suggested that the results from this aspect of social cognition might be attributed either to methodological difficulties or to differences between autistic children and the present sample. The clinical implications of the findings of the study are discussed.

Adolescent↗
PubMed1985

Depressive neurosis. A long-term prospective and retrospective follow-up study of former inpatients.

The results of a 7-year follow-up study of 50 former psychiatric inpatients with a diagnosis of depressive neurosis (ICD 300.4) who met the RDC criteria for Major Depression are reported. The follow-up assessment of the patients included the use of standardized social, psychological and psychopathological instruments. In addition, the course of illness as well as the utilization of medical services and periods of working disability were evaluated. The results indicate a rather unfavourable course and outcome in terms of symptoms for approximately 40% of the sample, including six patients who had committed suicide after index discharge. Almost 40% of the sample showed mild chronic symptoms with persistent impairments in social functioning especially in the area of social interaction, whereas only 20% of the sample were classified as satisfactorily improved or completely remitted.

Adult↗
PubMed1995

Predictive validity of subtypes of chronic affective disorders derived by cluster analysis.

This study aimed to examine the predictive validity of the cluster-analytically derived 3 subtypes of chronic affective disorders that were proposed on the basis of cross-sectional symptoms and were shown to have some external validity with regard to psychosocial characteristics. Two-year naturalistic follow-up data were available for 38 (97%) of the original 39 patients with chronic affective disorders. The 3 subtypes, which were named psychotic subtype, late-onset female subtype and depressive personality subtype in the previous analyses, did not differ in their depressive severity or social functioning upon entry. In the course of the 2-year follow-up, however, there were significant differences in the Global Assessment of Functioning scores as well as the social adaptation in the economic sphere according to the Social Adjustment Scale-Self Report. All these indices revealed the psychotic subtype to have the worst outcome, followed by the depressive personality subtype, and the late-onset female subtype fared best.

Adult↗
PubMed1993

Young adult chronic patients: empirical results on subgroups and age.

The discussion about young adult chronic patients (YACPs) started in the literature in the early eighties. However, the insufficient operationalization of the YACP concept provoked some criticism. The aim of the present study was to examine whether there were operational differences between YACPs and older chronic patients, as well as between hypothesized subgroups. The results show, as expected, that the differences between YACPs and older patients correlate with age. But only the 'high-energy, high-demand' subgroup differs not only from the other YACPs but also from the older chronic patients concerning psychopathology, social functioning and their interaction with the social environment. After 35 they grow out of their typical behavior which is strongly determined by traits of borderline and antisocial personality disorder. The stigmatizing YACP label should therefore be replaced by a more precise description such as 'young long-term patients with borderline or antisocial personality traits'.

Adolescent↗
PubMed2003

The development and preliminary validation of a Preference-Based Stroke Index (PBSI).

BACKGROUND: Health-related quality of life (HRQL) is a key issue in disabling conditions like stroke. Unfortunately, HRQL is often difficult to quantify in a comprehensive measure that can be used in cost analyses. Preference-based HRQL measures meet this challenge. To date, there are no existing preference-based HRQL measure for stroke that could be used as an outcome in clinical and economic studies of stroke. The aim of this study was to develop the first stroke-specific health index, the Preference-based Stroke Index (PBSI). METHODS: The PBSI includes 10 items; walking, climbing stairs, physical activities/sports, recreational activities, work, driving, speech, memory, coping and self-esteem. Each item has a 3-point response scale. Items known to be impacted by a stroke were selected. Scaling properties and preference-weights obtained from individuals with stroke and their caregivers were used to develop a cumulative score. RESULTS: Compared to the EQ-5D, the PBSI showed no ceiling effect in a high-functioning stroke population. Moderately high correlations were found between the physical function (r = 0.78), vitality (r = 0.67), social functioning (r = 0.64) scales of the SF-36 and the PBSI. The lowest correlation was with the role emotional scale of the SF-36 (r = 0.32). Our results indicated that the PBSI can differentiate patients by severity of stroke (p < 0.05) and level of functional independence (p < 0.0001). CONCLUSIONS: Content validity and preliminary evidence of construct validity has been demonstrated. Further work is needed to develop a multiattribute utility function to gather information on psychometric properties of the PBSI.

Aged↗