IMU-augmented Patient-related Outcome Measure for Knee Arthroplasty Patients

Qol-P-03 - Quality of life in patients with mycosis fungoides and Sézary syndrome: a review of the literature

Estimation of knee contact force (KCF) during gait provides essential information to evaluate knee joint function. Machine learning has been employed to estimate KCF because of the advantages of low computational cost and real-time. However, the existing machine learning models do not adequately consider gait-related data's temporal-dependent, multidimensional, and highly heterogeneous nature. This study is aimed at developing a multisource fusion recurrent neural network to predict the medial condyle KCF. First, a multisource fusion long short-term memory (MF-LSTM) model was established. Then, we developed a transfer learning strategy based on the MF-LSTM model for subject-specific medial KCF prediction. Four subjects with instrumented tibial prostheses were obtained from the literature. The results showed that the MF-LSTM model could predict medial KCF to a certain high level of accuracy (the mean of ρ = 0.970). The transfer learning model improved the prediction accuracy (the mean of ρ = 0.987). This study shows that the MF-LSTM model is a powerful and accurate computational tool for medial KCF prediction. Introducing transfer learning techniques could further improve the prediction performance for the target subject. This coupling strategy can help clinicians accurately estimate and track joint contact forces in real time.

Computational models that predict in vivo joint loading and muscle forces can potentially enhance and augment our knowledge of both typical and pathological gaits. To adopt such models into clinical applications, studies validating modeling predictions are essential. This study created a full-body musculoskeletal model using data from the "Sixth Grand Challenge Competition to Predict in vivo Knee Loads." This model incorporates subject-specific geometries of the right leg in order to concurrently predict knee contact forces, ligament forces, muscle forces, and ground contact forces. The objectives of this paper are twofold: (1) to describe an electromyography (EMG)-driven modeling methodology to predict knee contact forces and (2) to validate model predictions by evaluating the model predictions against known values for a patient with an instrumented total knee replacement (TKR) for three distinctly different gait styles (normal, smooth, and bouncy gaits). The model integrates a subject-specific knee model onto a previously validated generic full-body musculoskeletal model. The combined model included six degrees-of-freedom (6DOF) patellofemoral and tibiofemoral joints, ligament forces, and deformable contact forces with viscous damping. The foot/shoe/floor interactions were modeled by incorporating shoe geometries to the feet. Contact between shoe segments and the floor surface was used to constrain the shoe segments. A novel EMG-driven feedforward with feedback trim motor control strategy was used to concurrently estimate muscle forces and knee contact forces from standard motion capture data collected on the individual subject. The predicted medial, lateral, and total tibiofemoral forces represented the overall measured magnitude and temporal patterns with good root-mean-squared errors (RMSEs) and Pearson's correlation (p2). The model accuracy was high: medial, lateral, and total tibiofemoral contact force RMSEs = 0.15, 0.14, 0.21 body weight (BW), and (0.92 < p2 < 0.96) for normal gait; RMSEs = 0.18 BW, 0.21 BW, 0.29 BW, and (0.81 < p2 < 0.93) for smooth gait; and RMSEs = 0.21 BW, 0.22 BW, 0.33 BW, and (0.86 < p2 < 0.95) for bouncy gait, respectively. Overall, the model captured the general shape, magnitude, and temporal patterns of the contact force profiles accurately. Potential applications of this proposed model include predictive biomechanics simulations, design of TKR components, soft tissue balancing, and surgical simulation.

Quality of Life Scores Improve with Increasing Hemoglobin but Optimal Thresholds Vary According to Transfusion Dependence and Clinical Risk Scores: A Canadian Cross Sectional Study of 689 Patients with 2969 Measurements

Background: A growing consensus among speech-language pathologists that treatment goals should be significant to the consumer and society has spurred clinicians to address stroke survivors' quality of life (QOL) as a possible target for remediation. Use of formal measures to detect decreased QOL presumes that test performance of aphasic patients is different from that of non-brain-injured (NBI) adults. Treatment directed towards decreased QOL presupposes that its symptoms are attributable to a diagnosis of aphasia. Differential performance for chronically aphasic and NBI adults on two QOL measures has been established. However, relationships between residual language and/or communication deficits and QOL have not been confirmed. Aims: We examined relationships between residual language and/or communication deficits and QOL to determine whether, within NBI adult and chronically aphasic adult groups, there are significant relationships between language impairment and QOL measures; whether there are significant relationships between communication activity limitation and QOL measures; and, whether the strengths of these relationships differ between groups. Methods & Procedures: A total of 18 NBI controls and 18 adults with chronic aphasia were administered two language impairment tests (WAB, PICA), two communication activity limitation assessments (CADL-2, ASHA FACS), and two QOL measures (WHOQOLBREF, PWI). Correlation analyses were used to examine relationships between residual language and/or communication deficits and QOL. Outcome & Results: Although chronically aphasic adults scored significantly lower on all measures than did NBI adults, language-based disability generally was not significantly related with QOL in either group. Within the NBI group, only one language impairment and one QOL measure were significantly related. Within the chronically aphasic group, there were no significant relationships between language impairment and QOL measures, and there were no significant between-groups differences in the strengths of these relationships. Within either group, there were no significant relationships between communication activity limitation and QOL measures. Furthermore, there were no significant between-groups differences in the strengths of these relationships. Conclusions: The results of this investigation may be interpreted to suggest that decreased QOL in chronically aphasic adults is not closely related with language-based disablement. Thus, speech therapy that directly targets QOL in aphasic patients may not be justified. However, the use of correlational analysis limits the ability to rule out viable, alternative hypotheses or to account for misinterpretation due to measurement error. To examine relationships between language-based disablement, other undetermined factors, and QOL, further study, using larger sample sizes and causal modelling techniques, is recommended.

Although several studies have determined quality of life in patients with lung cancer, there is still little information about the use of generic questionnaires [e.g. the 36-item Short Form health survey (SF-36)] and utility questionnaires [e.g. the EuroQOL instrument (EQ-5D)] in this disease. To (i) measure quality of life and utility in patients with non-small cell lung cancer (NSCLC) using the SF-36 and the EuroQOL questionnaires; (ii) to evaluate the impact of some clinical variables on quality of life and utility; (iii) to assess the correlation between the measurements produced by the 2 questionnaires. Cross-sectional study. 95 patients from 15 Italian hospitals with NSCLC (93% male, mean age 62 years) completed both questionnaires. The mean scores for the 8 domains of the SF-36 ranged from 20.8 (physical role) to 63.0 (social functioning). The mean physical and mental summed scores of the SF-36 were 36.8 [standard deviation (SD) 9.8] and 43.0 (SD 11.5), respectively. The EuroQOL mean score was 0.58 (SD 0.32) in the self-classifier (SC) version and 0.58 (SD 0.20) in the visual analogue scale (VAS) version. Among the clinical variables that affected quality of life and utility, the presence of metastasis had the greatest impact: patients with metastasis had statistically significantly lower scores for 2 domains of the SF-36 (physical functioning, p = 0.009; bodily pain, p = 0.016), for the physical component summed score of the SF-36 (p = 0.015) and for both utility estimates (EuroQOL-SC, p = 0.027; EuroQOL-VAS, p = 0.038) than patients without metastasis. Both the SC and VAS EuroQOL scores showed a statistically significant correlation with each of the 8 domains of the SF-36. The scores for both the SF-36 and the EuroQOL in patients with NSCLC were considerably worse (relative differences ranging from -8 to -73%) than the corresponding values (normative data) previously reported for healthy individuals. Our study quantified the degree to which quality of life is impaired in patients with NSCLC, showed that the presence of metastasis had an important role, and indicated a strong correlation between the measurements produced by the 2 questionnaires. The EuroQOL measurements obtained from these patients will aid evaluation of the cost-utility ratio for NSCLC therapies.

Objectives Evaluate relationships between changes in dermatologic assessments and quality of life (QoL) measures; quantify dermatologic symptom severity impacts on QoL in patients with psoriatic arthritis (PsA) treated with tofacitinib. Methods Data were from two phase III studies; patients received tofacitinib 5 or 10 mg twice daily (BID), adalimumab 40 mg every other week, or placebo advancing to tofacitinib 5 or 10 mg BID at Month 3. Repeated measures longitudinal models assessed relationships between dermatologic assessments (predictors) Itch Severity Item (ISI), Physician’s Global Assessment of Psoriasis (PGA-PsO), and Patient’s Global Joint and Skin Assessment-Visual Analog Scale-Psoriasis question (PGJS-VAS-PsO), and QoL measures (outcomes) Dermatology Life Quality Index (DLQI) and Short Form-36 Health Survey Version 2 (SF-36v2). Models included one predictor and one outcome. Results Direct, approximately linear relationships existed between predictors and outcomes. ISI/PGA-PsO/PGJS-VAS-PsO improvements from baseline of ≥3/≥2/≥40-mm VAS corresponded with clinically meaningful DLQI improvements; improvements from baseline of ≥4/≥3/≥40-mm VAS generally corresponded with clinically meaningful improvements across component scores and all SF-36v2 domains. Conclusions Substantial links exist between dermatologic symptoms and QoL in patients with PsA, potentially informing patient-centered care and research. Rheumatologists should be aware of dermatologic manifestations and QoL impacts in patients with PsA. ClinicalTrials.gov NCT01877668; NCT01882439

Inflammatory bowel diseases (IBD) are chronic disorders affecting psychological well-being, quality of life (QOL), social interactions, and close interpersonal relationships of patients affected. The attachment theory provides a theoretical framework to evaluate the quality of close interpersonal relationships in the context of chronic disorders. The aims of this study were to compare the attachment dimensions between IBD patients and healthy controls and to evaluate the impact of these dimensions on QOL in IBD patients. One hundred three consecutive IBD outpatients (70 with Crohn's disease and 33 with ulcerative colitis) were recruited in the IBD Unit of the University of Bologna. They were clinically evaluated and filled out the questionnaire Short Form health survey-36 (SF-36), assessing QOL, and the attachment style questionnaire (ASQ), assessing attachment dimensions. One hundred three matched healthy subjects filled out the same questionnaires and represented the control group. IBD patients exhibited worst scores in the QOL measures (both physical and mental health) and in the attachment dimensions Relationships as secondary and Preoccupation with relationships. In IBD, the significant predictors of physical health were disease activity and disease type, while the significant predictors of mental health were disease activity and type, surgery, and the attachment dimensions Confidence and Preoccupation with relationships. Compared to controls, in IBD patients, the close interpersonal relationships are characterized by attachment insecurity that, in turn, is a significant predictor of QOL. These findings suggest plausible insights for psychological interventions in IBD patients with deterioration in QOL.

P0166 Presence of stoma nurse and quality of life of colorectal cancer patients with fecal ostomy in the early postoperative phase

In this review we present an overview of quality of life (QOL) and QOL measures in neuromuscular disorders. We discuss the characteristics of QOL measures used in neuromuscular research, highlighting differences between generic versus disease-specific and global versus health-related QOL instruments. The phenomenon of response shift is reviewed. Commonly used QOL instruments are reviewed for amyotrophic lateral sclerosis, muscle diseases, myasthenia gravis, and polyneuropathy. We also review some of what is known about QOL for patients with these neuromuscular disorders.

From the perspective of health care practitioners, the most useful clinical trials are those that assess the effectiveness of a drug, that is, determine how well the drug works under conditions of actual clinical practice. Clinical trials designed to determine effectiveness should use outcome measures that have the greatest clinical significance for practitioners, with the goal of maximizing generalizability and addressing practical questions about the risks, benefits, and costs of an intervention in routine clinical practice 1. Here we would like to emphasize the importance of social functioning and quality of life (QOL) as outcome variables in clinical trials in patients with schizophrenia. Recent research has shown that atypical antipsychotics improve QOL in patients with schizophrenia 2. However, studies that incorporate QOL in the assessment of long-term effectiveness are limited and inconsistent. Fleischhacker and Goodwin summarize the results of the Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS) 3, which employed the Quality of Life Scale 4 as the primary outcome measure for evaluating the effectiveness of treatment. The CUtLASS found no disadvantage of first-generation antipsychotics in comparison to non-clozapine second-generation antipsychotics. Similarly, in a double-blind, randomized controlled trial, Rosenheck et al 5 reported that measures of effectiveness demonstrated no advantage for olanzapine compared with haloperidol in overall QOL. In contrast, a naturalistic observational study on patients with schizophrenia undergoing usual care indicated that ziprasidone treatment resulted in improved satisfaction with general activity as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire 6. When measuring QOL in patients taking antipsychotics, it is important to acknowledge that a variety of factors may influence QOL outcomes: these include side effects and daily dosage of the antipsychotic, depressive and negative symptoms, duration of treatment, and subjective tolerability. In a naturalistic comparative study, Ritsner et al 7 found no significant difference in general QOL between patients using atypical vs. typical antipsychotics. However, after adjusting for daily dosage, duration of treatment, and subjective tolerability, QOL measures indicated that atypical antipsychotics (olanzapine and risperidone) were superior to typical ones. Some randomized controlled trials of antipsychotics have used a social functioning scale as an outcome measure, such as the Social and Occupational Functioning Assessment Scale 8 - 9, the Medical Outcomes Study Short-Form 36 Health Survey 10, or the Personal and Social Performance scale (PSP) 11. However, these trials have largely involved short-term interventions, limiting their ability to detect meaningful changes in the social functioning of patients. We are currently undertaking a randomized, controlled, open-label clinical trial in Korea to evaluate improvement in social functioning in patients with schizophrenia or schizoaffective disorder. The study compares long-acting injectable vs. oral risperidone using a hybrid model to assess both efficacy and effectiveness after one year of treatment. Primary outcome measures in this study are the PSP and the Social Functioning Scale. The scales used to assess social functioning and QOL in clinical trials must be appropriate to the study population and the clinical condition, and should measure several dimensions of social functioning and QOL. Furthermore, we need to develop scales that measure functioning independently from symptoms, and that are sensitive to changes over the course of the illness.

Purpose To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke. Methods We conducted a systematic search and meta-analysis of randomized controlled trials (RCTs) of chronic stroke rehabilitation interventions published from 2008 to 2020 in English or French. Of the 6476-screened articles collated from four databases, 15 RCTs were included and analyzed. We performed a meta-regression with the total training time as dependent variable in order to have a better understanding of how did the training dosage affect the effect sizes. Results Treadmill walking training was more effective on balance and motor functions (standardized mean difference (SMD)=0.70[0.02, 1.37], p = 0.04) and 0.56[0.15, 0.96], p = 0.007 respectively). Overground walking training improved significantly walking endurance (SMD = 0.38[0.16, 0.59], p < 0.001), walking speed (MD = 0.12[0.05, 0.18], p < 0.001), participation (SMD = 0.35[0.02, 0.68], p = 0.04) and quality of life (SMD = 0.46[0.12, 0.80], p = 0.008). Aquatic training improved balance (SMD = 2.41[1.20, 3.62], p < 0.001). The Meta-regression analysis did not show significant effect of total training time on the effect sizes. Conclusion Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke. Implications for rehabilitation Treadmill walking training is effective for improving balance and motor functions. Overground walking training improved significantly walking endurance, walking speed, participation and quality of life. Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in patient with chronic stroke.

Quality of life (QOL) is increasingly recognized as the main target of currently available dementia care. Its assessment has grown exponentially in the dementia field, but few studies have examined predictive factors for QOL taking caregiver variables into account. We examined patient and caregiver factors related to the QOL of dementia patients. The study design was cross-sectional. 161 couples of community residing dementia patients and their primary caregivers were interviewed. QOL was measured by the ADRQL, a proxy-rated, dementia-specific QOL instrument. Demographic factors were collected and clinical characteristics assessed using validated scales. In univariate analyses several patient and caregiver characteristics appeared associated with patient QOL. In multivariate analyses, independent predictors of worse patient QOL were behavioral and depressive symptoms of dementia patients, dependency in basic activities of daily living, poorer cognitive function, use of antipsychotic medication, caregiver burden, and caregiver not being an adult child. The adjusted R2 of the final, seven-factor model was 0.598. QOL for a person with dementia is a complex issue that is associated with several patient and caregiver factors. Efforts to improve patients' QOL should be addressed for both patients and caregivers. The measurement of QOL should be included, when possible, as a standard measurement tool, in everyday dementia clinical practice.

Stigma has been associated with health-related outcomes such as medication adherence and quality of life (QOL) in patients with tuberculosis (TB); however, the mechanisms via which TB-related stigma interferes with specific outcomes are unclear. This study aimed to determine whether depressive symptoms were one of the mechanisms that mediated the associations between TB-related stigma and both medication adherence and QOL in patients with TB. A cross-sectional survey was conducted between October 1, 2013, and March 31, 2014, in Hubei Province, central China, and data were collected from 1,342 patients with TB, using a structured questionnaire that measured TB-related stigma, depressive symptoms, medication adherence, and QOL. Multiple imputation was used to account for missing data. Structural equation modeling was performed to assess the mediating effect of depressive symptoms on the associations of TB-related stigma with medication adherence and QOL. Mediation analyses showed that depressive symptoms partially mediated the association between TB-related stigma and medication adherence (standardized indirect effect = -0.16, 95% bias-corrected confidence interval [CI] [-0.19, -0.13], P < 0.01). Moreover, depressive symptoms fully mediated the association between TB-related stigma and QOL (standardized indirect effect = -0.17, 95% bias-corrected CI [-0.21, -0.14], P < 0.01). The results suggest that depressive symptoms played a key role in the relationships among TB-related stigma, medication adherence, and QOL in patients with TB. Therefore, the alleviation of depressive symptoms could be an important strategy for improving medication adherence and QOL in patients with TB.

Expanded Prostate Cancer Index Composite for Clinical Practice: Development and Validation of a Practical Health Related Quality of Life Instrument for Use in the Routine Clinical Care of Patients With Prostate Cancer