Functional recovery following musculoskeletal injury in hospital workers.

BACKGROUND: Hospital workers are at high risk of work-related musculoskeletal disorders (WRMSDs), but outcomes following such injuries have not been well studied longitudinally. AIMS: To ascertain functional recovery in hospital workers following incident WRMSDs and identify predictors of functional status. METHODS: Cases (incident WRMSD) and matched referents from two hospitals were studied at baseline and at 2 year follow-up for health status [SF-12 physical component summary (PCS)], lost workdays, self-rated work effectiveness and work status change (job change or work cessation). Predictors included WRMSD and baseline demographics, socio-economic status (SES), job-related strain and effort-reward imbalance. Logistic regression analysis tested longitudinal predictors of adverse functional status. RESULTS: The WRMSD-associated risk of poor (lowest quartile) PCS was attenuated from a baseline odds ratio (OR) of 5.2 [95% confidence interval (CI) 3.5-7.5] to a follow-up OR of 1.5 (95% CI 1.0-2.3) and was reduced further in multivariate modelling (OR = 1.4; 95% CI 0.9-2.2). At follow-up, WRMSD status did not predict significantly increased likelihood of lost workdays, decreased effectiveness or work status change. In multivariate modelling, lowest quintile SES predicted poor PCS (OR = 2.0; 95% CI 1.0-4.0) and work status change (OR = 2.5; 95% CI 1.1-5.8). High combined baseline job strain/effort-reward imbalance predicted poor PCS (OR = 1.7; 95% CI 1.1-2.7) and reduced work effectiveness (OR = 2.6; 95% CI 1.6-4.2) at follow-up. CONCLUSIONS: Baseline functional deficits associated with incident WRMSDs were largely resolved by 2 year follow-up. Nonetheless, lower SES and higher combined job strain/effort-reward imbalance predicted adverse outcomes, controlling for WRMSDs.

Use of the Health Utilities Index with stroke patients and their caregivers.

BACKGROUND AND PURPOSE: Few studies currently assess the health-related quality of life of individuals following a stroke. One of the major challenges of assessing quality of life is the high likelihood that after a stroke a patient will not be able to complete such an assessment. One practical solution is to have a family caregiver complete the assessment on behalf of these individuals. This current pilot study examined the interrater reliability of having family caregivers complete the Health Utilities Index (HUI) on behalf of stroke patients. METHODS: A total of 74 patients who experienced an ischemic stroke and 37 family caregivers completed the interviewer-administered HUI (data were available for 33 pairs). The HUI is designed to produce a single summary measure of health-related quality of life, the global multiattribute utility score, as well as descriptive information on each of its attributes. Interrater reliability was measured by evaluating the percent agreement, Cohen's kappa statistics, intraclass correlation coefficients (ICCs), Pearson's R correlations, and paired t tests between the patient and caregiver responses. RESULTS: In most instances interrater reliability was acceptable, with values suggesting moderate to high agreement. The mean global multiattribute utility scores for the HUI 2 were identical for patients and caregivers (0.64 +/- 0.29), with an ICC of .72. A preponderance of patients reported decrements in several attributes of the HUI. CONCLUSIONS: These data indicate a substantial decrement in functioning in stroke patients and suggest that family caregivers can complete the HUI reliably when patients are unable to do so.

Assessing health-related quality-of-life and health state preference in persons with obesity: a validation study.

The objective of this study was to assess the reliability, validity and responsiveness of a new health-related quality-of-life (HRQOL) measure containing global and obesity-specific domains and an obesity-specific health state preference (HSP) assessment. A total of 417 obese and 'normal' weight individuals completed these assessments. Internal consistency and test-retest reliability were demonstrated, with Cronbach's alpha, intraclass correlation coefficient and kappa values well above the acceptable level for most scales. Construct validity hypotheses were confirmed by examining scale correlations. The normal weight individuals reported statistically significantly better functioning and well-being on the majority of the HRQOL scales and HSP than obese individuals. Guyatt's statistic of responsiveness was moderate to high for all the scales and items in the weight-loss and weight-gain groups; however, many of the scales and items in the weight-stable group also displayed responsiveness. The results of this study support the reliability and validity of these assessments. However, further testing is needed to evaluate the responsiveness of both assessments in a weight-stable group.

Invasive cervical carcinoma: role of MR imaging in pretreatment work-up--cost minimization and diagnostic efficacy analysis.

PURPOSE: To examine the cost and efficacy of diagnostic work-up in patients with invasive cervical cancer. MATERIALS AND METHODS: In 246 patients with invasive cervical cancer, all diagnostic tests performed before treatment were recorded. Patients were divided into two groups: those who underwent magnetic resonance (MR) imaging as the initial study (n = 105) and those who did not (n = 141). A list of 1995 Medicare global payments was used to measure cost. Bayesian analysis (likelihood ratios derived from a literature search) was performed for bladder, rectal, parameterial, and nodal involvement in stage Ib disease. RESULTS: Significantly fewer procedures and fewer invasive studies were performed in the MR imaging group. Net cost savings for the MR imaging group was $401 for all patients and $449 for patients with stage Ib disease. For stage Ib disease, the 0% pretest probability of bladder or rectal invasion does not justify the routine use of barium enema examination, cystoscopy, or proctoscopy. The increase in predictive values for parameterial and nodal disease was highest for MR imaging when tumor size was at least 2 cm. CONCLUSION: Guidelines for the pretreatment work-up of clinical stage Ib cervical cancer need revision. MR imaging should be used as an adjunct to clinical evaluation.