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BACKGROUND: Numerous studies associate metabolic syndrome (MetS) with poor life quality, depression, and anxiety. Aerobic exercise training has proven its value in promoting health among subjects with MetS. We aimed to evaluate the changes in health-related quality of life (HRQOL), motivation for physical activity, and the levels of anxiety and depression in subjects with MetS after individualized aerobic training. METHODS: A total of 140 subjects with MetS (53.2±6.8-years, 55%-female) were analyzed after the random assignment to the intervention (n=84) or the control group (n=56). Only the intervention group participated in the 8-week HR targeted aerobic training program, which consisted of exercises on a cycle ergometer for 30-40 min/day, 5 days/week. In all study participants HRQOL, motivation for physical activity, anxiety and depression levels were evaluated by the Medical Outcomes Study 36-Item Short-Form Health Survey, the Exercise Motivations Inventory-2, and the Hospital Anxiety and Depression scale before and after 8 weeks. RESULTS: After 8 weeks, self-reported physical functioning significantly increased only in the intervention group (p=0.01). The scores of mental health-summary and role limitations due to emotional problems also improved in subjects with MetS, who participated in the aerobic training program (p

Symptom and functional assessment is challenging in geriatric oncology care. This multicenter cross-sectional study examined the use of a multiple-symptom assessment tool, the MD Anderson Symptom Inventory (MDASI), on Chinese patients with cancer aged 65 years and older.Patient-rated symptoms and functioning were assessed using MDASI and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire.The most severe symptoms were fatigue and poor appetite. The older group (75-84 years old, n = 224) reported a more severe difficulty remembering (effect size [ES] 0.32; P.001), shortness of breath (ES 0.20; P = .020), and interference with general activity (ES 0.14; P = .027), with significantly worse physical functioning (ES -0.33; P.001) and cognitive functioning on the European Organization for Research and Treatment of Cancer quality-of-life questionnaire (ES 0.20; P .001) than the younger group (65-74 years old, n = 555). For MDASI measures of the core symptoms and total interference with daily activity, Cronbach α coefficients were 0.90 and 0.93, respectively, for the younger group; and 0.93 and 0.94 for the older group, respectively. Moderate to severe (score ≥4) interference with general activity and walking on MDASI accurately indicated poor performance status (area under the curve 0.8089 and 0.7969, respectively) and lack of independence status of Activities of Daily Living (area under the curve 0.7993 and 0.8304, respectively).MDASI is psychometrically reliable, valid, and clinically sensitive for the measuring symptom burden and functional status of Chinese patients with cancer aged 65 years and older. MDASI could be adopted to measure multiple symptoms and physical functioning outcomes in geriatric oncology practice as well as for research on treatment benefits.

Introduction This study compared the relative efficacy of aerobic training to resistance training on physical functioning in older breast cancer survivors and determined whether benefits could be maintained by transitioning to unsupervised home-based training. Materials and methods Early-stage, post-treatment, older (≥65 years) breast cancer survivors (n = 114; mean age 72 years) were randomized to 12 months of supervised aerobic (n = 37), resistance (n = 39) or stretching (active control; n = 38) training followed by 6 months of unsupervised home-based training. Outcomes included aerobic capacity by 6-min walk distance (6MWD; m), maximal upper and lower body strength (1-repetition maximum; kg); physical function by short physical performance battery (SPPB), SF-36 and Late Life Function and Disability Instruments. Results Over 12-months of supervised exercise, all groups improved in muscle strength and SPPB scores, but resistance trained women also improved 6MWD. Improvements in upper and lower body strength in the resistance group were significantly greater than those in the stretching control (+2.5 kg vs. +1.8 kg; p = 0.05) and aerobic groups (+8.3 kg vs +2.7 kg; p = 0.047), respectively, with trends for greater improvements in 6MWD (+57.9 m vs. +22.5 m; p = 0.057) and self-report physical function (+4.8 vs. -4.4; 0.066) in resistance trained women versus controls. Compared to values at 12 months, there were no changes during unsupervised training in any measure within or between groups, except for self-reported advanced lower extremity function which improved in the resistance group and fell in the aerobic group (+1.3 vs. -3.1; p = 0.043). Discussion Supervised exercise can improve strength and physical functioning among older breast cancer survivors. Resistance training may lead to better improvements compared to aerobic or flexibility training, whether in a supervised or unsupervised setting. Clinicaltrials.gov NCT00662103

Background Adolescent depression can severely interfere with age-appropriate and lifetime development and functionality. Physical functioning in daily life (as a means of individual support) as well as social support from family and friends have been shown to enhance adolescent resilience against depression. By applying a multisystemic model of resilience, this study investigates how these resources reciprocally influence each other and how they interact with depression over time. Methods Longitudinal data (three assessments over three years) from the Resilient Youth in Stressed Environments project was analyzed using panel network analysis to investigate short- and long-term uni- and bidirectional effects. The sample consisted of N = 500 adolescents from Canada (mean age = 18.49, SD = 3.01, 56.40% young women) at the first assessment. Results Depression seemed to fluctuate, while the resources showed significant stability over the course of the study. Perceived family and friend support were not significantly influenced by depression while they had significantly negative temporal effects on depression. Only physical functioning showed a negative feedback loop, notably with somatic symptoms of depression. Family and friend support shared a reinforcing feedback loop, while physical functioning was not related to either type of support. Limitations Future studies should address the low average of depressive symptomatology and subjective, global measures of social support. Conclusions The resources show potential time-dependent effects: symptom-specific resources need to be applied in the short-term, while a pool of multisystemic resilience resources seems necessary over the long-term to increase the resilience to depression among adolescents.

Summary Background & aims Healthy diet has been associated with decreased mortality, but its impact on survival without disability is less clear. We aimed to investigate the association between the Nordic Prudent Diet Pattern (NPDP) and dementia- and disability-free survival, and to assess its interaction with other healthy lifestyle behaviors. Methods Within the Swedish National Study on Aging and Care-Kungsholmen, 2290 dementia- and disability-free adults aged ≥60 were followed up to 12 years to detect survival free from dementia (standard criteria) and disability (Katz's Activities of Daily Living). NPDP index was assessed at baseline with a 98-item food frequency questionnaire (characterized mainly by more frequent intakes of vegetable, fruit, cooking, cereals, whole grains, fish, and water) and was further categorized into tertiles (low, moderate, or high). Information on lifestyle factors was collected via baseline questionnaire. A favorable (vs unfavorable) lifestyle profile was determined based on smoking status, social network and physical activity. Data were analyzed using Cox proportional hazard regression models and Laplace regression. Results During the follow-up, 1074 participants survived without dementia and disability (614 died, 518 became disabled, and 84 developed dementia). Compared to low NPDP adherence, the hazard ratio (HR) of high NPDP adherence was 1.19 (95% CI 1.04–1.34) for dementia- and disability-free survival. High NPDP adherence prolonged lifespan without mental and physical disability by an average of 1.24 years (95% CI 0.11–2.37). Further, among participants with high NPDP adherence, a favorable lifestyle profile was associated with an even higher HR (1.96, 95% CI 1.52–2.42) of dementia- and disability-free survival, corresponding to an average of 3.80 (95% CI 2.25–5.35) years longer life compared to those with low NPDP adherence and an unfavorable lifestyle profile. Conclusion High adherence to NPDP prolongs survival with good mental and physical function for more than one year, and this could increase to almost four years with a favorable lifestyle.

We aim to determine the effect of a fixed-dose combination (FDC) of tiotropium/olodaterol on Physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) in a real world setting.COPD patients were prospectively enrolled to evaluate the effect of a FDC of tiotropium/olodaterol inhaler therapy via the Respimat® Soft Mist™ inhaler (SMI) on the physical functioning scale (PF-10), and the general condition of the patient as assessed by the physician (Physician's Global Evaluation, PGE), and the patient's satisfaction after 6 weeks of treatment. The primary end-point was the percentage of patients with therapeutic success at 6th week follow-up, defined as a ≥10-points increase in the standardised PF-10 score from baseline.A total of 257 patients from 57 sites were enrolled, and 234 completed the follow up. After 6 weeks of treatment, 155 out of 234 patients (66.2%) showed therapeutic success in the physical functioning score, coupled with significant improvement in PGE score: 78 (33.3%) patients with good/excellent PGE score at baseline, increasing to 172 (73.5%) at 6th week (p0.0001). The patient's satisfaction was excellent: 77.2% reporting to be satisfied/very satisfied with the treatment, 79.9% with inhaling and 79.0% with the handling of SMI device. 1.6% of patients reported an investigator-defined drug-related adverse event.Treatment of COPD patients with a FDC of tiotropium/olodaterol SMI for 6 weeks resulted in significant improvements in the patients' condition as assessed by patients and physicians, with no new safety findings.

Objective Integration of patient-identified goals is a critical element of shared decision-making and patient-provider communication. There is limited information on the goals of patients with multiple medical conditions and high healthcare utilization. We aimed to identify and categorize the goals described by “high-need, high-cost” (HNHC) older patients and their caregivers. Methods Using conventional content analysis, we used data from interviews conducted with 17 HNHC older patients (mean age 72.5 years) and 4 caregivers. Results HNHC older patients and their caregivers used language such as “hopes, wishes, and wants” to describe their goals, which fell into eight categories: alleviating discomfort, having autonomy and control, decreasing treatment burden, maintaining physical functioning and engagement, leaving a legacy, extending life, having satisfying and effective relationships, and experiencing security. Conclusion Our results contribute to knowledge of goals of HNHC patients and provides guidance for improving the patient-provider relationship and communication between HNHC older patients and their healthcare providers. Practice implications Our findings can inform provider efforts to assess patient goals and engage high-need, high-cost older patients in shared decision-making. Further, this study contributes to an improved understanding of HNHC older patients to support continued development of effective care models for this population.

This longitudinal case-control study aims to 1) compare symptoms and functioning in otherwise healthy adolescents with versus without a parent with chronic pain (Parent CP+/Parent CP−) 2) test adolescent sex as a moderator of the relation between parent CP group and child functioning, and 3) determine changes in adolescent pain over 1 year. Adolescents (n = 140; ages 11–15) completed tests of pain responsivity and physical function, as well as self-report measures assessing pain characteristics, somatic symptoms, and physical and psychosocial functioning. Self-reported pain and somatic symptoms were reassessed 1 year later. Adolescents in the Parent CP+ group reported greater pain, somatic symptoms, and worse physical health than Parent CP− youth. Parent CP+ youth performed worse on all tests of physical function. Some observed effects were stronger for girls than boys. There were no differences between groups on pain responsivity. Both groups reported increased pain and somatic symptoms from baseline to 1-year follow-up, with the Parent CP+ group reporting the highest level of symptoms at both time points. This study highlights the potential impact of parental pain status on children, particularly daughters, and is the first to document objective physical functioning differences in youth at risk for developing chronic pain. Perspective Adolescents who have a parent with chronic pain demonstrate higher pain and lower physical function than adolescents who have a parent without chronic pain. Group differences in pain and somatic symptoms persist over 1 year. Family based interventions are needed for comprehensive pain prevention and treatment.

Low back pain is the primary cause of adult disability worldwide and if poorly managed can precipitate the unnecessary use of opioids, diminish physical functioning, and lead to comorbid conditions interfering with patient quality of life. Providers who collaborate with a spinal interventionalist can effectively manage acute and chronic low back pain, improve physical functioning, and reduce the use of opioid analgesics. The implementation of specific spinal interventions, adjuvant analgesics, and collaboration with a multidisciplinary team can promote health and wellness for 1 of the most prevalent and debilitating global health conditions.

Predicting personalized outcome after arthroplasty improves shared decision-making. The aim of this paper was to determine predictors of functional outcome measured by the Hip disability and Osteoarthritis Outcome Score - Physical function Shortform (HOOS-PS) or Knee injury and Osteoarthritis Outcome Score - Physical function Shortform (KOOS-PS) in patients undergoing total hip (n = 79) or total knee arthroplasty (n = 90) respectively. Patients were assessed at baseline and following arthroplasty. A multiple regression analysis showed that the included variables predicted the change score in HOOS-PS limited (F (8,66) = 3.139, p = 0.005, adjusted R2 = 0.188) and the KOOS-PS not significantly (F (8,73) = 0.837, p = 0.573, adjusted R2 = −0.016). Concluding, baseline characteristics cannot be used for personalized prediction using the KOOS-PS and HOOS-PS.

Introduction Osteoarthritis (OA) is one of the most common and fast-growing chronic diseases among older adults. The aim of this study was to assess the effect of acupressure therapy on pain, stiffness, and physical functioning of a knee affected by osteoarthritis. Methods A single-blind pilot randomized control trial was conducted on 51 older adults with OA of the knee living in one of 3 nursing homes. Nursing homes were randomly allocated to one of three study groups; acupressure therapy, placebo, and routine care. The intervention group received acupressure therapy on eight acupoints. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and the separate WOMAC subscales were used to evaluate pain, stiffness and physical functioning of knees. Results A one-way ANOVA revealed that WOMAC index was not significantly different at the baseline between the three groups (P = 0.296). After intervention, ANOVA showed significant differences between groups in regard to total WOMAC index, pain and physical dysfunction (p Conclusion Acupressure may be an effective intervention for reducing the pain, stiffness, and improving the function of knees with osteoarthritis.

Background Exercise-based interventions have become part of the standard of care in rehabilitation programs for cardiovascular risk reduction and the promotion of a healthy lifestyle. The systematic review describes the current state of knowledge of the effects of preoperative exercise training (prehabilitation) on perioperative clinical outcomes in patients undergoing cardiac and vascular interventions. Methods Studies were systematically searched within 14 databases from inception to October 2016. Only studies that assessed a preoperative exercise program in adult patients undergoing cardiac or vascular interventions with clinical or patient-centered endpoints were included in the review. Two independent reviewers selected studies for inclusion, extracted data, and assessed quality using Cochrane Collaboration's tool for RCTs11111111111111111 and ROBINS-I tool for nonrandomized studies. Results Nine studies met our inclusion criteria and were stratified for qualitative analyses by cardiac (n = 7) and vascular (n = 2) procedures. Prehabilitation was associated with decreased length of stay, reduced postoperative complications, improved objective physical functioning, and improved subjective quality of life (SF-36 physical and mental health domains) measures in patients undergoing cardiac and vascular procedures. Given the amount of heterogeneity that was present in the designs, populations, and comparators among the included studies, we were unable to statistically pool data across trials. Conclusions Our qualitative findings suggest that prehabilitation may improve clinical outcomes, physical performance, and health-related quality-of-life measures in patients undergoing cardiac and vascular surgery procedures.

Introduction Multiple sclerosis (MS) is a chronic autoimmune disease affecting the myelinated axons of the central nervous system causing neurological deterioration. People living with MS have a poor quality of life (QOL) because of the symptoms caused by the disease and there are various types of treatments to manage the symptoms aside from medication. Objective This meta-analysis examines the effect of exercise, yoga and physiotherapy on the physical, mental and social QOL among individuals living with MS. Setting A systematic review with meta-analysis was conducted using PubMed, Medline, and Scopus from 1990 to 2017. The standard mean difference scores were computed in each study for the domains of physical, mental and social functioning. Results Eighteen studies met the inclusion criteria for this meta-analysis. Aerobic exercise was effective in improving satisfaction with physical functioning,d = 0.35 (95% CI = 0.08 to 0.62), mental functioning d = 0.42 (95% CI = 0.11 to 0.72), and social functioning d = 0.42 (95% CI = 0.15 to 0.69). Physiotherapy was also found to be effective for physical functioning d = 0.50 (95% CI 0.19 to 0.80), mental functioning d = 0.44 (95% CI 0.14 to 0.75) and social functioning d = 0.60 (95% CI 0.21 to 0.90). However yoga and combination of exercises did not have a significant effect on any of the QOL domains. Conclusion These findings suggest that aerobic exercise and physiotherapy improves the satisfaction of MS patients with their physical, mental and social functioning and may be included as normal practice in the treatment of MS.

OBJECTIVES: Older breast cancer survivors (BCS) consistently report more functional limitations than women without cancer, but whether or not these differences remain when using objective measures of physical functioning and the correlates of these measures is unknown. METHODS: Cross-sectional study comparing older (≥60 years old) BCS (n=84) to similarly aged women without cancer (n=40). Patient-reported physical function was assessed by the SF-36 physical function (SF-36PF) subscale and the Late Life Function & Disability Instrument (LLFDI). Objective measures included the short Physical Performance Battery (sPPB), usual walk speed (m/s), chair stand time (sec) and, grip strength (kg). Potential predictors included age, comorbidities, symptom severity, fatigue and skeletal muscle index (SMI; kg/m(2)). RESULTS: Patient-reported physical function was significantly lower in BCS than controls using SF-36PF (47.3±0.1 vs. 52.9±4.0, p

Objectives: To determine the proportion of participants of a running program for novice runners that discontinued running and investigate the main reasons to discontinue and characteristics associated with discontinuation.Design: Prospective cohort study.Methods: The study included 774 participants of Start to Run, a 6-week running program for novice runners. Before the start of the program, participants filled-in a baseline questionnaire to collect information on demographics, physical activity and perceived health. The 26-weeks follow-up questionnaire was used to obtain information on the continuation of running (yes/no) and main reasons for discontinuation. To determine predictors for discontinuation of running, multivariable logistic regression was performed.Results: Within 26 weeks after the start of the 6-week running program, 29.5% of the novice runners (n = 225) had stopped running. The main reason for discontinuation was a running-related injury (n = 108, 48%). Being female (OR 1.74; 95% CI 1.13-2.68), being unsure about the continuation of running after the program (OR 2.06; 95% CI 1.31-3.24) and (almost) no alcohol use (OR 1.62; 95%CI 1.11-2.37) were associated with a higher chance of discontinuation of running. Previous running experience less than one year previously (OR 0.46; 95% CI 0.26-0.83) and a higher score on the RAND-36 subscale physical functioning (OR 0.98; 95% CI 0.96-0.99) were associated with a lower chance of discontinuation.Conclusions: In this group of novice runners, almost one-third stopped running within six months. A running-related injury was the main reason to stop running. Women with a low perceived physical functioning and without running experience were prone to discontinue running. (C) 2018 Published by Elsevier Ltd on behalf of Sports Medicine Australia.

Evidence supports that the physical disablement process starts earlier than previously thought, in midlife when women still have many years to live. Physical activity participation and interventions have been successful in preventing disability in older adults and may be promising for maintaining function at younger ages. Changing the conversation to more relevant topics in midlife, like positive changes in body composition, sleep, and improved mood, may move the dial on participation, as midlife women do not meet guidelines for physical activity. Exploring the role of reproductive aging beyond chronologic aging may provide gender-specific insights on both disablement and participation.

Objectives: Activity-related travel behaviour is a prerequisite for participation. Knowledge about key factors influencing activity-related travel behaviour is necessary, in order to define guidelines for interventions to optimize this behaviour. The present study 1. investigated to which degree the activity-related travel behaviour in Multiple Sclerosis (MS) does decrease with increasing ambulatory dysfunction and 2. assessed the impact of health condition and contextual factors on activity-related travel behaviour in MS. Methods: A convenience sample of 108 persons with MS was studied, distinguished in three disability subgroups based on Disease Steps (DS). Health condition was assessed by standardized clinical tests about physical, cognitive and psychosocial functioning. Contextual factors (personal and environmental) were collected. Activity-related travel diaries and GPS tracking devices were used to investigate activity-related travel behaviour in terms of number of trips and transport modes used. The influence of health condition measures and contextual factors with activityrelated travel behaviour measures was analyzed using Spearman correlations and multiple linear regressions. Results: 1. Activity-related travel behaviour in MS decreased significantly with increasing ambulatory dysfunction. Significant changes were found regarding travel modes, number, type and planning of activities. 2. Activity-related travel behaviour in MS correlated with both health condition measures and contextual factors. A limited number of standardized tests of health condition and contextual factors (driving ability, household size) can predict activity-related travel behaviour in MS. Conclusions: Both health condition (mostly physical functioning) and contextual factors are predictive for activity-related travel behaviour in MS. Multi-disciplinary teams should include counselling on living situation and on advice regarding environmental factors. Policy makers should be recommended to integrate medical and other services in the community. The studywasfinanciallysupportedbyaPhDfellowshipfromtheResearchcouncilofHasseltUniversity(BOF-grant) The authors want to thank all PwMS for their voluntary participation. We also acknowledge Veronik Truyens and Greet Adriaenssens, heads of paramedical services of the Rehabilitation Center Overpelt and De Mick Rehabilitation Center Brasschaat, respectively, for facilitation of the study and patient recruitment; as well as vzw Lidwina for facilitation of patient recruitment.

Background and purpose Physical activity can improve the mental and physical functioning of older people. This study investigated the impact of Tai Chi exercise on the quality of life of older men. Materials and methods This randomized controlled clinical trial was conducted on 132 older men in an urban area of Iran. The subjects were randomly assigned into two groups: a Tai Chi intervention group and a control group (n = 66 per group). Quality of life was evaluated using the Leiden-Padua quality of life questionnaire before and after the intervention. Data analysis was performed using analytical statistics via the SPSS software. Results After eight weeks of Tai Chi exercise, the mean scores of quality of life in different areas demonstrated a statistically significant difference between the two groups (p < 0 0.05). Conclusion This study illustrated that the 8-week Tai Chi intervention had a positive effect on the quality of life in older men.

Owing to significant medical advances, it is now estimated that more than 90% of persons born with congenital heart disease (CHD) will reach adulthood. Medically appropriate physical activity represents an opportunity to improve physical functioning as well as quality of life and psychosocial outcomes. By reviewing published CHD research and clinical recommendations, herein we first summarize how adults with CHD are known to be less physically active and have reduced exercise capacity compared with healthy peers. Cardiopulmonary exercise testing is important for routine clinical management and before the onset of an exercise program. Physiological anomalies are common in adults with CHD, although very few necessitate activity restrictions, and positive results from exercise training have been demonstrated. In recent decades, the focus has thus shifted from restriction of exercise to promotion of exercise. Adults with CHD also face unique psychosocial challenges associated with living with a chronic cardiac condition, many of which may influence exercise behaviours. However, much less is known about participation of adults with CHD in cardiac rehabilitation (CR) programs, which differ from exercise training in their comprehensive, interdisciplinary approach to management of chronic disease and that might be uniquely poised to meet the physical and psychosocial needs of adults with CHD. Initial CR outcomes have been positive and with no reported adverse events. This review summarizes the unique physical and psychosocial considerations that may guide the provision of CR to adults with CHD.

Low distress tolerance (DT), the capacity to withstand aversive emotional or physical states, is associated with adverse psychological and physical functioning. However, we know relatively little about the psychological processes through which low DT results in poor functioning. The present study examined the effects of DT on cognitive appraisals of stress using an experimental stress-induction paradigm in 136 undergraduates. We hypothesized (1) lower DT predicts lower challenge appraisal and higher threat appraisal, and (2) these relationships are strengthened for those with higher trait anxiety. Results partially supported Hypothesis 1 : Lower DT predicted higher threat appraisal, but not challenge appraisal. A significant interaction effect was found between DT and trait anxiety in predicting challenge appraisal, but the relationship was opposite from the direction predicted in Hypothesis 2 , such that individuals with very high trait anxiety and lower DT made higher challenge appraisals. Future research should further examine the relations of DT, trait anxiety, and stress appraisals with respect to psychological well-being in young adults.

Resilience is the capacity of a system, enterprise or a person to maintain its core purpose and integrity in the face of dramatically changed circumstances. In human physiology, resilience is the capacity of adaptively overcoming stress and adversity while maintaining normal psychological and physical functioning. In this review, we investigate the resilient strategies of sleep. First, we discuss the concept of brain resilience, highlighting the modular structure of small-world networking, neuronal plasticity and critical brain behavior. Second, we explore the contribution of sleep to brain resilience listing the putative factors that impair sleep quality and predict susceptibility to sleep disorders. The third part details the manifold mechanisms acting as guardians of sleep, i.e., homeostatic, circadian and ultradian processes, sleep microstructure (K-complexes, delta bursts, arousals, cyclic alternating pattern, spindles), gravity, muscle tone and dreams. Mapping and pooling together the guardians of sleep in a dynamic integrated framework might lead towards an objective measure of sleep resilience and identify effective personalized strategies (biological, pharmacological, behavioral) to restore or protect the core properties of healthy sleep.

This paper examines the consequences of disability, identifying for the first time, the separate impacts of onsets and recoveries from disability on both employment status and hours worked using panel data from Indonesia. We find that changes in physical functioning have no affect hours worked among the employed. However, we find that onsets of physical limitations lead to an increase in the probability of leaving employment, while recoveries increase the probability of returning to work. We also find a larger effect among self-employed workers compared to salaried workers. These results overall point towards a need for social protection policies with a focus on health, disability, and employment in Indonesia.

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing prospective cohort study in a representative sample of Dutch older persons. In previous LASA studies, lower serum 25-hydroxyvitamin D (25(OH)D) values, as assessed by a competitive protein binding assay or radioimmunoassay, have been associated with decreased physical functioning, falls and fractures. Recently, serum 25(OHD) values in LASA were standardized using the Vitamin D Standardization Program (VDSP) protocol as part of the European ODIN project. In the current manuscript, the influence of standardizing serum 25(OH)D values will be discussed using the associations with physical functioning, falls and fractures as examples.

Highlights Patient-reported outcomes (PRO) in atrial fibrillation (AF) differ by sex. We compared general and disease-specific PRO in women and men with AF. Comorbidity, treatment, and social factors did not change differences. Modification of such factors by sex also did not change differences in PRO. Sex-specific assessment of PRO is essential to improve how women experience AF., Background Women have worse patient-reported outcomes in atrial fibrillation (AF) than men, but the reasons remain poorly understood. We investigated how comorbid conditions, treatment, social factors, and their modification by sex would attenuate sex-specific differences in patient-reported outcomes in AF. Methods In a cohort with prevalent AF we measured patient-reported outcomes with the Short-Form-12 (SF-12, an 8-domain quality of life measure), and the AF Effect on QualiTy of Life (AFEQT), an instrument specific to AF, both with range 0-100 and higher scores indicating superior outcomes. We examined sex-specific differences in patient-reported outcomes in multivariable-adjusted regression analyses incorporating demographics, comorbid conditions, treatment, social factors, and their sex-based modification. Results In 339 individuals (age 72±10, 45% women), women (vs. men) reported worse physical functioning on the SF-12 (49.7±39.0 versus 65.0±34.0), social functioning (69.8±31.8 versus 79.7±25.8), and mental health (67.4±20.2 versus 75.0±18.6). These differences were attenuated with adjustment for comorbid conditions and depression. Women had worse composite AFEQT scores (73.8±18.4 versus 78.5±16.6) and symptoms and treatment scores than men with differences remaining significant after multivariable adjustment. There were not significant interactions by sex and the array of covariates when examining differences in patient-reported outcomes between women and men. Conclusions We identified sex-specific differences in patient-reported outcomes assessed with general and AF-specific measures. Compared to men, women with AF reported worse overall health-related quality of life, even after consideration of both relevant covariates and their modification by sex. Our research indicates the importance of consideration of sex-based inequities when evaluating patient-reported outcomes in AF.

This study examined the relationship between negative and positive perceptions of media sources during wartime and posttraumatic stress disorder (PTSD) symptoms among older adults with varying levels of physical functioning. We examined perception of media sources as stressful or helpful, PTSD symptoms and physical functioning among 170 older adults (mean age = 66.87) four months after the 2014 Israel-Gaza conflict. After controlling for previous PTSD symptoms, the number of media sources perceived as stressful was positively related to PTSD symptoms, particularly among respondents with low physical functioning. The number of helpful media sources was unrelated to PTSD symptoms. The findings suggest that stressful media is especially maladaptive for older adults with low physical functioning, who are at a higher risk of being homebound. Moreover, favorable perception of media was not beneficial for older adults in the specific context of PTSD symptoms. Helping older adults regulate their perceptions regarding the media may restrict their negative outcomes.

The purpose of this study was to examine the importance of midlife physical activity on physical functioning in later life. Data are from 1771 Study of Women’s Health Across the Nation (SWAN) participants, aged 42–52 (46.4 ± 2.7) years at baseline (1996–97). Latent class growth analysis was used to identify physical activity trajectory groups using reported sports and exercise index data collected at seven time-points from baseline to Visit 13 (2011–13); objective measures of physical functioning performance were collected at Visit 13. The sports and exercise index (henceforth: physical activity) is a measure of moderate to vigorous intensity physical activity during discretionary periods of the day. Multivariable linear regression analyses were used to model each continuous physical performance measure as a function of the physical activity trajectory class. Across midlife, five physical activity trajectory classes emerged, including: lowest (26.2% of participants), increasing (13.4%), decreasing (22.4%), middle (23.9%), and highest (14.1%) physical activity. After full adjustment, women included in the middle and highest physical activity groups demonstrated ≥5% better physical functioning performance than those who maintained low physical activity levels (all comparisons; p < 0.05). Statistically significant differences were also noted when physical activity trajectory groups were compared to the increasing physical activity group. Results from the current study support health promotion efforts targeting increased (or maintenance of) habitual physical activity in women during midlife to reduce future risk of functional limitations and disability. These findings have important public health and clinical relevance as future generations continue to transition into older adulthood.

Bothersome and multisite pain are common and strongly associated with low physical functioning in older adults. Although these associations are well established in cross-sectional studies, few population-based studies have examined the impact of pain on physical functioning over time. Accordingly, we sought to determine the associations of pain characteristics with longitudinal trajectories of performance-based measures of physical capacity in older adults. Data on 6,783 community-dwelling adults aged ≥65 years who participated in the 2011-2017 National Health and Aging Trends Study were analyzed. Physical capacity was measured annually using the Short Physical Performance Battery. Group-based trajectory modeling was used to identify groups with similar longitudinal patterns of physical capacity. Baseline pain characteristics included report of bothersome pain in the past month, activity-limiting pain, location of pain, and pain medication use. Multinomial logistic regression was used to examine associations of pain characteristics with trajectories of physical capacity, adjusting for demographic and health characteristics. The cohort was 57% female, 68% white, and 58% were ≥75 years. Four distinct physical capacity trajectories were identified: “persistently low” (12% of cohort), “low, declining” (16%), “moderate, declining” (29%), and “persistently high” (43%). Participants who reported bothersome pain, activity-limiting pain, greater number of pain sites, and more frequent pain medication use at baseline were significantly more likely to demonstrate either “persistently low” or a declining physical capacity trajectory. For example, compared to those not reporting bothersome pain participants who reported bothersome pain were 79% (adjusted relative risk [RR]=1.79 [95%CI:1.26-2.55]), 75% (RR=1.75 [95%CI:1.42-2.16]), and 24% (RR=1.24 [95%CI:1.01-1.51]) more likely to have a “persistently low”, “low declining”, and “moderate declining” physical capacity trajectory, respectively. Among older adults in the US, bothersome pain and other pain characteristics were significantly associated with poor and worsening trajectories of physical capacity over a 6-year period. National Institute on Aging/NIH U01AG032947 and Scan Design Foundation.

Background: Immune thrombocytopenia (ITP) is a benign childhood disease. The aim of this study was to assess Health Related Quality of Life (HRQoL) among chronic ITP children in Vietnam. Methods: A case - control study was conducted from January 2020 to April 2021. Case group consisted of 56 children with chronic ITP aged from 2 to 18 years and their parents selected in the Department of Nephrology-Hematology – Endocrinology, Haiphong Children's Hospital, Hai Phong city. Controls included 170 healthy children matched with the patients on sex, and age recruited from schools in the same city. The validated Vietnamese version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scale was used to assess QoL of the participants. Results: The mean HRQoL physical, emotional, social, school functioning domains and total scores of the chronic ITP patients were significantly lower compared with that of the controls (p

Objectives Sleep disorders (SDs), particularly problems with falling asleep or daytime sleepiness, have negative impact on health and longevity. Sleep deprivation is also associated with a decline in physical functioning (PF) that mediates the ability to perform activities of daily living. But it remains unknown if deterioration in PF can predict the risk of having a SD. Therefore, the purpose of the present study is to assess the risk of SD associated with PF status in the US adult population. Study design Cross-sectional study design with data from the National Health and Nutrition Examination Survey from year 2005 to year 2014. Methods PF limitation is assessed by reported difficulty in performing 10 tasks selected from PF questionnaire. SD is identified by subjective description of presence of doctor diagnosed SD. Also, five categories of comorbidities that caused difficulty in carrying out these tasks were created. Results The adults with self-reported PF limitation have 41% higher odds of having a SD (odds ratio [OR] = 1.41, 95% confidence interval [CI] = 1.22–1.59). Moreover, participants having cognitive problems and cardiovascular and pulmonary disorders as secondary conditions that cause difficulty in PF have 145% and 28% higher odds (OR = 2.45 and 1.28; 95% CI = 2.01–3.01 and 1.08–1.53, respectively) of having a SD. Also, females have a 27% lower odds of having a SD than males (OR = 0.73, 95% CI = 0.63–0.83). Conclusion Risk for SD is associated with increasing level of functional disability. We advocate the importance of engagement in physical activities to prevent or delay the onset of SD.

Background and objectives Atopic dermatitis is one of the most common skin disorders in children and it can negatively affect both children and their families. The purpose of this study was to investigate the effect of atopic dermatitis on quality of life related to maternal health and maternal obsessive compulsive symptoms. Methods A cross-sectional study was conducted in the pediatric and dermatology polyclinics. The SCORAD index was used for determining the severity of disease, and the Maudsley Obsessive Compulsive Inventory (MOCI) and SF-36 form were applied to the participants’ mothers. Results A total of 120 children and their mothers participated the study. Comparing the atopic dermatitis group and the healthy control group, no statistically significant differences were seen in terms of MOCI and SF-36 scores, except for the physical functioning subscore. Conclusion The results showed that having a child with atopic dermatitis and the severity of the disease do not influence their mothers in terms of obsessive-compulsive symptoms and health-related quality of life, except for physical functioning scores.

Physical impairments and activity restrictions cause significant morbidity after surgery for sarcoma. Yet objective assessment of key components of balance, gait and physical activity (PA), using valid and reliable outcome measures, is lacking in routine clinical practice.We therefore performed a systematic review to identify studies quantifying balance, gait and PA in clinically useful ways, after treatment for lower extremity sarcoma.Relevant articles quantifying balance, gait and PA in patients who underwent surgery for lower extremity bone or soft tissue sarcoma were identified from Medline, Embase, Scopus, and Web of Science up to February 2016. Results were compiled by principal research findings, objective measures used, their ability to detect differences between important clinical groups, change over time and reliability.Eighteen articles were included. Surgery had a significant impact on outcomes (p 0.05). A wide range of measures and concerns about accuracy of measurement were noted, as gait and PA measures did not discriminate between distinct clinical groups such as limb sparing surgery and amputation, and did not detect changes over time. Few studies investigated reliability (n = 1) and sensitivity to change (n = 4).There is a deficit of studies quantifying balance, gait and PA in patients with lower extremity sarcoma. Studies did not use consistent, valid and reliable instruments. There is an urgent need to develop novel objective measures of physical functioning in this patient group to encourage evidence-based clinical care.

Objective Identify the trajectories of physical and mental functioning among spouse caregivers of patients with cancer over the first five years post-diagnosis and variables associated with low or deteriorating functioning. Methods Caregivers completed a survey at 6 months and 1, 2, 3.5, and 5 years post-patient diagnosis, including the SF-12 for quality of life (QOL). SF-12 Mental Component Summary (MCS, n = 299) and Physical Component Summary (PCS, n = 300) scores were analyzed using SAS. Results Five trajectories for PCS were identified, the top three were: (a) high PCS (53.0%); (b) steady decline in PCS (17.0%); and (c) steady increase, but remaining below population norm (16.7%). Five trajectories for MCS were also identified, the top two being: (a) high MCS (45.8%) and (b) MCS comparable to population norm (27.8%). Variables associated with low or deteriorating QOL included depression, social support, coping, burden, and/or unmet needs. Conclusions This is the first study to document spouse caregivers’ QOL over the first five years post-patient diagnosis. Although many participants experienced high functioning, almost a third reported low or deteriorating mental or physical functioning. Practice implications Variables associated with low or deteriorating mental and physical functioning can be targeted in future interventions.

The well-being of older adults is frequently tied to support from their adult children. Here, we assess whether the education of adult offspring is associated with changes to older parents' short- and long-term health in Mexico, a rapidly aging context with historically limited institutional support for the elderly. Educational expansion over the past half century, however, provides older adults with greater resources to rely on via the education of their children. Using longitudinal data from the Mexican Health and Aging Study (2001–2012), we find that offspring education is not associated with short-term changes in parents' physical functioning, but is associated with increased parental longevity, net of children's financial status and transfers. In addition, we find that mothers' longevity is more sensitive to offspring education than fathers. Our findings add to a growing body of literature that urges policy-makers to consider the multi-generational advantages of expanding educational opportunities in Mexico.

Background Although current research supports the use of active video games (AVGs) in rehabilitation, the evidence has yet to be systematically reviewed or synthesized. The current project systematically reviewed literature, summarized findings, and evaluated the effectiveness of AVGs as a therapeutic tool in improving physical, psychological, and cognitive rehabilitative outcomes among older adults with chronic diseases. Methods Seven databases (Academic Search Complete, Communication & Mass Media Complete, ERIC, PsycINFO, PubMed, SPORTDiscus, and Medline) were searched for studies that evaluated the effectiveness of AVG-based rehabilitation among older patients. The initial search yielded 946 articles; after evaluating against inclusion criteria and removing duplicates, 19 studies of AVG-based rehabilitation remained. Results Most studies were quasi-experimental in design, with physical functioning the primary outcome investigated with regard to the use of AVGs in rehabilitation. Overall, 9 studies found significant improvements for all study outcomes, whereas 9 studies were mixed, with significant improvements on several study outcomes but no effects observed on other outcomes after AVG-based treatments. One study failed to find any benefits of AVG-based rehabilitation. Conclusion Findings indicate AVGs have potential in rehabilitation for older patients, with several randomized clinical trials reporting positive effects on rehabilitative outcomes. However, existing evidence is insufficient to support the advantages of AVGs over standard therapy. Given the limited number of studies and concerns with study design quality, more research is warranted to make more definitive conclusions regarding the ability of AVGs to improve rehabilitative outcomes in older patients.

Objectives Emerging evidence suggests that the prevalence rates of poor functioning and of disability are increasing among middle-aged individuals. Visual impairment is associated with poor functioning among older adults but little is known about the impact of vision on functioning during midlife. The objective of this study was to assess the impact of visual impairment on future physical functioning among middle-aged women. Study design In this longitudinal study, the sample consisted of 483 women aged 42 to 56 years, from the Michigan site of the Study of Women’s Health Across the Nation. Main outcome measures At baseline, distance and near vision were measured using a Titmus vision screener. Visual impairment was defined as visual acuity worse than 20/40. Physical functioning was measured up to 10 years later using performance-based measures, including a 40-foot timed walk, timed stair climb and forward reach. Results Women with impaired distance vision at baseline had 2.81 centimeters less forward reach distance (95% confidence interval (CI): −4.19, −1.42) and 4.26 s longer stair climb time (95% CI: 2.73, 5.79) at follow-up than women without impaired distance vision. Women with impaired near vision also had less forward reach distance (2.26 centimeters, 95% CI: −3.30, −1.21) than those without impaired near vision. Conclusion Among middle-aged women, visual impairment is a marker of poor physical functioning. Routine eye testing and vision correction may help improve physical functioning among midlife individuals.

This study estimates multilevel mixed effects models of three retrospective measures of childhood health – self-rated childhood health, exposure to parental smoking growing up, and missing school for 30 or more consecutive days due to a health event – on levels and changes in physical functioning at age 50 and beyond. Using data from 15 waves of the Household, Income and Labour Dynamics in Australia survey, the results show that variation in the level of later-life physical functioning is associated with childhood health. Poor childhood health however is not associated with the rate of physical functioning decline. Respondents who reported poor childhood health and were migrants to Australia from a non-English speaking country reported better physical functioning in later life, compared with non-Indigenous Australian-born respondents who reported poor childhood health. In contrast, women who reported poor self-rated childhood health reported worse physical functioning compared with men who reported poor self-rated childhood health. These findings are robust to the inclusion of a range of measures of childhood and adult characteristics and circumstances. These results suggest that Australia, with arguably a strong and supportive health care system as compared with the U.S., may mitigate the accumulation of disadvantages to those who reported poor childhood health. We note that though functional health differences due to childhood health are not exacerbated in later life, neither are they eliminated., Highlights • Poor childhood health is associated with worse physical functioning in later life. • This association is stronger for women, as compared with men. • Association weaker for migrants non-English speaking countries, vs. native-born.

Item does not contain fulltext INTRODUCTION: Performance status (PS) is an established prognostic factor in patients with advanced cancer and is usually scored by the treating physician. The EORTC QLQ-C30 questionnaire as reported by cancer patients is a validated tool to assess quality of life (QoL). Subjectivity plays a role in both assessments, and data on a direct comparison are scarce. METHODS: We compared the prognostic value for overall survival (OS) of the WHO PS to the baseline physical function scale of the EORTC QLQ-C30 (QLQ-C30 PF) in a prospective randomised phase 3 trial in advanced colorectal cancer (ACC), the CAIRO study. Patients were divided into two groups based on the baseline QLQ-C30 PF. QLQ-C30 PF was considered 'good' if the score was more than 66.7% and 'poor' if 66.7% or less. Results were validated in a subsequent phase 3 study in ACC, the CAIRO2 study. RESULTS: The median OS for patients with a 'good' QLQ-C30 PF and a 'poor' PF in patients with WHO PS 0 was 20.3 months (n = 300) and 10.4 months (n = 44), in patients with WHO PS 1 16.8 months (n = 125) and 10.1 months (n = 63), and in patients with WHO PS 2 16.2 months (n = 11) and 9.9 months (n = 12), respectively. In a Cox regression model which included other prognostic factors, 'good' versus 'poor' QLQ-C30 PF was significantly prognostic for OS (0.57 95% confidence interval: 0.46-0.72), but not WHO PS. These results were confirmed in the CAIRO2 study. CONCLUSIONS: We demonstrate in ACC patients that PF, as assessed by patients using the EORTC QLQ-C30, is superior in terms of prognostic value to WHO PS as scored by physicians. Our data support to include the results of baseline EORTC QLQ-C30 PF instead of WHO PS as a stratification parameter in oncology trials.

Objective We previously reported a pilot randomized controlled trial in gynecologic cancer survivors (GCS) suggesting that wall climbing is safe, feasible, and improves objective physical functioning. Here, we report the effects of wall climbing on posttraumatic growth, quality of life, and symptoms. Methods GCS (N = 35) were randomized to either an 8-week wall climbing intervention (WCI; n = 24) or usual care (UC; n = 11). The primary efficacy outcome was posttraumatic growth assessed by the Posttraumatic Growth Inventory. Secondary outcomes included health-related quality of life assessed by the Short Form-36 (SF-36). Results Analyses of covariance revealed a statistically significant or borderline significant effect favoring WCI over UC for the posttraumatic growth subscales of new possibilities (d = + 0.70; p = 0.065) and personal strength (d = + 0.76; p = 0.049) as well as the SF-36 mental health subscale (d = +0.61; p = 0.077) and the mental health component score (d = +0.80; p = 0.063). Conversely, a statistically significant or borderline significant effect favoring UC over WCI was found for the SF-36 bodily pain subscale (d = −0.50; p = 0.063) and the physical health component score (d = −0.58; p = 0.038). Conclusions This phase I/II study suggests that wall climbing may improve some aspects of posttraumatic growth and mental health in GCS but may also cause some bodily pain and reduced physical health. Larger phase II and III trials are needed to fully describe the potentially complex benefits and harms of wall climbing in GCS.

Objective:Cognitive behaviour therapy (CBT) reduces fatigue and disability in chronic fatigue syndrome (CFS). However, outcomes vary between studies, possibly because of differences in patient characteristics, treatment protocols, diagnostic criteria and outcome measures. The objective was to compare outcomes after CBT in tertiary treatment centres in the Netherlands (NL) and the United Kingdom (UK), using different treatment protocols but identical outcome measures, while controlling for differences in patient characteristics and diagnostic criteria.Methods:Consecutively referred CFS patients who received CBT were included (NL: n = 293, UK: n = 163). Uncontrolled effect sizes for improvement in fatigue (Chalder Fatigue Questionnaire), physical functioning (SF-36 physical functioning subscale) and social functioning (Work and Social Adjustment Scale) were compared. Multiple regression analysis was used to examine whether patient differences explained outcome differences between centres.Results:Effect sizes differed between centres for fatigue (Cohen's D NL = 1.74, 95% CI = 1.52–1.95; UK = 0.99, CI = 0.73–1.25), physical functioning (NL = 0.99, CI = 0.81–1.18; UK = 0.33, CI = 0.08–0.58) and social functioning (NL = 1.47, CI = 1.26–1.69; UK = 0.61, CI = 0.35–0.86). Patients in the UK had worse physical functioning at baseline and there were minor demographic differences. These could not explain differences in centre outcome.Conclusion:Effectiveness of CBT differed between treatment centres. Differences in treatment protocols may explain this and should be investigated to help further improve outcomes.

Background Most research on domestic abuse and disability has focused on women with disabilities, while research on abuse against men with disabilities and their risk factors is virtually non-existent. Objective The purpose of this research is to understand domestic abuse experienced by people with disabilities by investigating its prevalence and risk factors. Method This research used the National Survey on Persons with Disabilities (2011) . Using a stratified sampling method, 5259 respondents were identified to make up the final sample. Ordered logistic regression was used to verify risk factors for abuse. Results Risk factors for women with disabilities are age, educational attainment level, ADL, experiences of discrimination, awareness of disability discrimination, external support, and satisfaction with number of friends. Risk factors for men with disabilities are region, experiences of discrimination, awareness of disability discrimination, external support, and satisfaction with number of friends. For both women and men with disabilities, more experience of discrimination, greater awareness of disability discrimination, less external support, and less satisfaction with number of friends are associated with a higher likelihood of having experiences of abuse. Men with disabilities living in rural areas have a higher risk of abuse than those living in cities. Younger women, women with lower educational attainment, and those with lower physical functioning are more likely to have experienced abuse. Conclusions Based on these findings, the authors make recommendations designed to protect people with disabilities from domestic abuse.

Social engagement activities can help older adults maintain mental and physical functioning levels. This study examined the long-term effects of the intergenerational picture-book reading program "REPRINTS" (Research of Productivity by Intergenerational Sympathy) on older adults.After baseline assessment, participants were allowed to decide which condition they wanted to participate in: the REPRINTS intervention or control group involving only assessments. REPRINTS participants participated in group activities that involved playing a hand game and reading picture books to children at kindergartens, elementary schools, and public childcare centers, once every one-two weeks. A follow-up assessment, which focused on functional capacity (i.e., instrumental activities of daily living, intellectual activity, and social function), was conducted after seven years. The analysis included responses from 62 REPRINTS (mean age [SD]=66.2 [5.7]) and 100 control-group participants (mean age [SD]=68.0 [4.7]).A logistic regression analysis examining intervention effects revealed that control-group participants were more likely to reduce intellectual activity and interactions with children compared to REPRINTS participants (p=.013 and .003, respectively). Furthermore, the REPRINTS group maintained greater functional reach compared to the control group (p.001). However, the REPRINTS group was likely to stay indoors more often, compared to the control group (p=.045).The present study indicates that the REPRINTS intergenerational program has long-term, positive effects that help maintain and promote intellectual activity, physical functioning, and intergenerational exchange, although the effect of the increasing amount of physical activity is unclear.

Obesity appears to be associated with reduced physical performance, but comprehensive assessments of physical functioning are lacking in subjects with severe obesity, in particular in comparison with subjects without obesity. This precludes an objective assessment of the degree of impairment.To compare motor skills and cardiopulmonary fitness between subjects with severe obesity (OB) (i.e., candidates for bariatric surgery) and control subjects without obesity (non-OB).Cantonal Hospital, Switzerland.Flexibility, movement speed, balance, maximal isometric strength, and cardiopulmonary fitness were tested in 45 OB (body mass index: 42.6±.9 kg/m(2); age: 35±1.7 years; 33 women) and 32 non-OB (body mass index: 23±.4 kg/m(2); age: 38.5±2.1 years; 25 women) subjects.In comparison with the non-OB group, the OB group showed reduced shoulder flexibility (P.001) but comparable hamstrings flexibility (P = .3). Speed-related tasks (i.e., timed up-and-go test and timed lying-to-standing test) indicated that the OB group was slower than the non-OB group (all P.007). Strength-related tasks indicated a greater absolute back muscle and knee-extensor strength (all P.002) in the OB group with no difference in knee-flexor strength (both P.8). However, when related to weight, the OB group showed reduced maximal strength (all P.002). Bicycle spiroergometry indicated that absolute oxygen consumption at peak exercise and at the anaerobic threshold did not differ between groups (both P.06). Related to weight, however, values were lower in the OB than in the non-OB group (both P.001).Data indicate a differential pattern of functional impairment in bariatric surgery candidates compared with subjects without obesity. These findings might help to establish tailored intervention protocols to improve physical performance in such subjects.

Context: MF is a chronic myeloproliferative neoplasm (MPN) that can be accompanied by substantial symptom burden, diminished quality-of-life (QoL), and reduced survival. Objective: To report PROs in patients with lower-risk MF at time of enrollment in the MOST study. Design: MOST is a prospective, longitudinal, multicenter, noninterventional, observational study ( NCT02953704 ). Patients: Eligible adults had low-risk MF, using DIPSS risk categorization, or intermediate-1 risk by age alone (INT-1 age alone). Context: MF is a chronic myeloproliferative neoplasm (MPN) that can be accompanied by substantial symptom burden, diminished quality-of-life (QoL), and reduced survival. Objective: To report PROs in patients with lower-risk MF at time of enrollment in the MOST study. Design: MOST is a prospective, longitudinal, multicenter, noninterventional, observational study ( NCT02953704 ). Patients: Eligible adults had low-risk MF, using DIPSS risk categorization, or intermediate-1 risk by age alone (INT-1 age alone). Main outcome measures: PROs were assessed during usual-care visits every 6 months over 36 months of observation. Patient-reported symptom burden was assessed using the MPN-SAF; TSS was calculated. Health-related QoL was evaluated using the EORTC QLQ-C30 v3.0. Data were summarized descriptively; correlations between PROs and treatment modalities were not assessed. Results: Of 233 pts with lower-risk MF enrolled in MOST between November 29, 2016 and March 29, 2019, 125 with ≥1 PRO assessment at enrollment were included in this analysis (median age, 68 years; median duration from MF diagnosis to enrollment, 2.1 years; INT-1 age alone risk, 58%; full/part-time employment at diagnosis and enrollment, 46% and 33%, respectively). 124 patients completed the MPN-SAF at enrollment. Mean (SD) TSS was 18.1 (15.1) and was higher in women vs men (20.4 [15.8] vs 16.0 [14.2], respectively); 36% of pts had TSS ≥ 20. Fatigue was the highest mean (SD) individual symptom score (3.9 [2.7]) and the most commonly reported severe symptom (score ≥ 7; 22%). 123 patients completed the EORTC QLQ-C30 at enrollment. The highest mean (SD) symptom scale score was fatigue (30.2 [24.0]). The mean (SD) global health status/QoL score was 71.4 (21.0); functional scores ranged from 76.5 (21.3) for emotional functioning to 83.1 (16.1) for physical functioning. Conclusions: Despite having anticipated longer survival, patients with lower-risk MF reported high symptom burden and reduced QoL at the time of enrollment in MOST. Fatigue was the most common and most severe symptom. Future analyses from MOST will enhance understanding of symptom burden in patients with MF and its impact on QoL.

Objective The somatosensory amplification theory considers symptom focusing and somatosensory amplification as important perpetuating factors of persistent physical symptoms. We investigated whether symptom focusing and somatosensory amplification were associated with symptom severity and mental and physical functioning over a three-year period in patients with persistent physical symptoms (PPS). Methods Baseline, 6-, 12-, 24- and 36-months follow-up data from the PROSPECTS study, a prospective cohort consisting of 325 patients with PPS, were used. We applied longitudinal mixed model analyses to investigate if symptom focusing (CBRQ Symptom Focusing Subscale) and somatosensory amplification (Somatosensory Amplification Scale) at baseline were associated with symptom severity (PHQ-15), mental and physical functioning (RAND-36 MCS and PCS) over three years, using all measurements. Results Symptom focusing was associated with increased symptom severity and lower mental and physical functioning over time. Somatosensory amplification at baseline was associated with increased symptom severity and lower mental and physical functioning over time. Effect sizes were small. Associations with baseline symptom focusing decreased over time, associations with baseline somatosensory amplification were more stable. There was no interaction effect of both constructs, but they partly overlapped. Conclusion This is the first study to show that over an extended period, symptom focusing and somatosensory amplification are associated with symptom severity and lower mental and physical functioning in patients with PPS. These results support the impact of both symptom focusing and somatosensory amplification on the perpetuation of symptoms and lowered mental and physical functioning in individuals with PPS.