Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease.

PURPOSE: How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD). METHODS: In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4 weeks, and 130 at 4 months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George's Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed. RESULTS: At 4 weeks and 4 months, changes in disease-specific QOL (st. ß = -0.35, p < 0.001, partial (p) R (2) = 11-12 %), depression (st. ß = -0.32 to -0.36, p < 0.001, pR (2) = 9-12 %), and anxiety (st. ß = -0.21 to -0.40, p < 0.02-0.001, pR (2) = 4-15 %) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4 months (st. ß = 0.21, p = 0.02, pR (2) = 4 %), but not with changes in depression. CONCLUSIONS: Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.

Similarities and differences in the experience of fatigue among people living with fibromyalgia, multiple sclerosis, ankylosing spondylitis and stroke.

AIMS AND OBJECTIVES: To elucidate the experience of fatigue across several long-term illnesses, focusing on the similarities and differences. BACKGROUND: Fatigue is common to many long-term illnesses, but it has been studied mainly within the context of a single illness; qualitative studies comparing the experience and its impact on daily life across different long-term illnesses are lacking. DESIGN: Qualitative design. METHODS: A secondary analysis was conducted of five original interview studies involving 95 persons with ankylosing spondylitis, fibromyalgia, multiple sclerosis or stroke. RESULTS: Similarities and differences concerning experiences of fatigue were found across the studied long-term illnesses. All patients expressed the perception of having an unfamiliar body. Fatigue was also commonly expressed as unpredictable, uncontrollable and invisible to others. Differences were related to a constant versus a varying condition, a sudden and an uncontrollable sleepiness, a mutual reinforcement with pain and increased stress sensitivity. A lack of energy and a need for sleep and rest were common experiences, as was the impact on social relationships. There were also similarities regarding how the patients managed their daily life. The search for practical solutions and attitude adjustment differed with the fatigue characteristics. All patients felt a lack of understanding and disbelief from others. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Fatigue is commonly expressed by patients with long-term illnesses. Variations in experience are related to the type of diagnosis. The disparity between experiences influences how patients managed and adjusted to the conditions of everyday life. The illness-specific characteristics of fatigue warrant increased clinical awareness and may allow professionals to offer adequate information and establish effective methods of managing the condition. The feeling of invisibility and difficulty describing the experience of fatigue in particular highlights this need.

Shoulder function and active motion deficit in patients with rheumatoid arthritis.

PURPOSE: To discover whether there are differences between patients with RA with and without active motion deficit in the shoulder (passive ROM greater than active ROM) concerning disease characteristics and shoulder function, and examine the role of active motion deficit in explaining limitations of shoulder function in daily life. METHODS: This cross-sectional study included 123 patients with RA having shoulder pain. Disease activity and duration of shoulder pain and disease were registered, active and passive shoulder ROM, pain and muscle strength were measured. Shoulder function in daily life was assessed by Disability of the Arm, Shoulder and Hand (DASH). RESULTS: Patients with active motion deficit (36%) had statistical significant worse scores on disease activity, shoulder pain, muscle strength, and DASH function than those without active motion deficit (p ≤ 0.05). No differences between the groups were found for duration of shoulder pain or disease (p > 0.05). Active motion deficit, passive ROM, muscle strength and pain explained 33.7% of the variation in the DASH function score. CONCLUSION: Active motion deficit in the shoulder seems frequent in patients with RA. Together with passive ROM, muscle strength and pain, active motion deficit explained about one-third of the limitations in shoulder function in daily life.

Troubled bodies--troubled men: a narrative analysis of men's stories of chronic muscle pain.

PURPOSE: To examine how men present themselves as patients with chronic pain and how the men's subjective experience of pain interplay with dominant norms of masculinity. METHOD: The material consists of qualitative interviews with 10 Norwegian men on rehabilitation from chronic neck pain. The data is subjected to narrative analysis combined with a gender-sensitive perspective. FINDINGS: The men's accounts of chronic pain were narrated as a series of events, displaying physical impairments and demanding work and troubled private affairs. Through rich descriptions of presumably objective facts, like heredity, physical injury and the character of the men's work, and comparatively little information about the men's personal experiences of pain and distress, a rational and self-controlled masculinity is displayed. However, extrapolation of the analysis also brought out how human suffering, such as chronic headaches, the losing of control and of oneself, is narrated in the men's stories. CONCLUSION: Men's stories of chronic muscle pain display a subtle balance between following dominant norms of masculinity, such as being rational and in self-control, and a need to express vulnerability as human beings. We argue that health care professionals should be sensitive to the dynamics of subjectivities and cultural norms of gender within patients' illness stories.

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

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