Objective To assess the appropriateness of Barthel Index (BI) and Modified Rankin Scales (MRS) used as long-term outcome measures in a stroke data register and to investigate the correlation between cutoff points of the two scales in different stroke patients with and without disability. Methods Nine hundred and twelve patients were registered prospectively. BI and MRS were evaluated at the end of 1, 3, 6 and 12 months after stroke onset. The distribution, ceiling effects and floor effects of the two scales were evaluated. A logistic regression model was established to investigate correlation of cutoff points of BI and MRS. Results There were a total of 2 829 evaluation points of BI and MRS. The percentages of patients reaching the maximum scores of BI at the end of 3, 6 and 12 months (54.8％, 62.2％ and 68.3％, respectively) were higher than those of MRS. There was significant correlation between the two scales (Spearman’s correlation coefficient 0.887, P＜0.05), when MRS scores of ≤1 and ≤2 were taken as cutoff points, the corresponding cutoff points of BI score were ≥90 and ≥85, respectively. Conclusions BI has significant ceiling effects when used as long-term outcome measurement in a stroke data register. There was significant correlation between BI and MRS scores. In future clinical studies, an MRS score ≤2 or BI score ≥85 could be used as cutoff points in predicting stroke patients with and without disability.
ObjectiveTo compare the disability conditions in different elderly populations in Sichuan province in order to get baseline data for further analyses in the future. MethodFrom October 2011 to August 2012, face-to-face interviews were performed by trained investigators in different elderly populations from urban communities, rural communities, acute care wards and rehabilitation wards. The main content of the investigation was the Elderly Disability Assessment Scale (EDAS). ResultsTotally, 1406 subjects were interviewed, among which, 1387 subjects completed the questionnaires. The response rate was 98.7%. The mean age of the participants was (73.8±8.2) years old. Elderly people dwelling in rural areas had a highest disability rate (81.4%), while the correspondent rate in subjects in acute care wards, rehabilitation wards, and urban community were 79.2%, 64.5%, and 53.8%, respectively (P<0.001). In each population, the disability rate increased with age. In the whole sample, most disabled subjects were of mild disability (80.5%). However, those in acute care wards or rehabilitation wards were more likely to have severe or profound disability. ConclusionsThe disability rate and the severity of disability increase with age in different elderly populations in Sichuan province, although most of them are of mild disability. The disability rate is conspicuously higher in the elderly dwelling in rural areas.
ObjectiveTo systematically review the disease burden and epidemiological characteristics of diabetes mellitus in Chinese population, and to provide references for health resources allocation and health policy making. MethodsDatabases such as PubMed, EMbase, CNKI, VIP and WanFang Data were searched for studies investigating disease burden of diabetes mellitus in Chinese population up to January 1st, 2014. According to the inclusion and exclusion criteria, two researchers screened literature, exacted data, and assessed methodological quality of included studies. Statistical analysis was performed with the data of diabetes associated population, mortality and disease burden were analyzed. ResultsA total of 39 studies were included, one of which was not included for further qualitative analysis due to low quality. The results of qualitative analysis involving 38 studies showed that, since 1980, the prevalence of diabetes increased rapidly in China, especially in the younger age group. The disease burden of woman was higher than that of man; it was slightly higher in the city than in the countryside; but the gap between urban and rural areas was gradually narrowed. Disease burdens in Eastern, Central and Western regions orderly decreased, all of which were all at high levels. ConclusionThe disease burden of diabetes mellitus in China is seriously high and the prevention and control work is very hard. It is necessary to rationally and effectively allocate health resources based on different health demands in different regions among urban-rural and age groups; to reduce the burden in the elderly; and to pay more attention to the young age population at the same time. Besides, the emphasis of prevention should be placed on suppressing the increase of prevalence of diabetes mellitus and reducing disease burden due to its complications.
Objective To explore the clinical efficacy and safety of percutaneous kyphoplasty (PKP) in the treatment of Kummell disease. Methods We retrospectively analyzed the clinical data of 11 patients with Kummell disease treated by PKP between January 2013 and January 2016. There were 8 males and 3 females with an average age of 72.3 years old ranging from 64 to 78. The injured vertebra was located at T11 in 2 patients, T12 in 3, and L1 in 6. All the patients suffered from lower back pain for 2.5-15.0 months averaging 7.6 months. Preoperative CT and MRI examinations showed that there were clear signs of intravertebral vacuum cleft and abnormal fluid signals. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the height and kyphotic angle of the injured vertebral body were measured to evaluate the clinical outcomes before and after surgery. Results Follow-up was conducted for all 11 patients. Cement leakage occurred in 4 patients with no symptoms. The vertebral height, Cobb angel of the injured vertebra, VAS and ODI improved significantly after surgery and during the latest follow-up. Compared with those parameters after surgery, only VAS score was different during the latest follow-up. Conclusion PKP is safe and effective in the treatment of Kummell disease.
Objective To develop the short version of the elderly disability assessment scale (EDAS-SF), and to evaluate its validity and reliability. Methods We conducted a face-to-face investigation in five rural communities in Suining and three urban communities in Chengdu city for elderly adults. We consulted gerontologists and rehabilitation physicians through an internet survey. Proper items were selected from the EDAS according to the results from the following statistical methods: critical ration, Cronbach’s α, correlation coefficient and exploratory factor analysis. Based on these work, the EDAS-SF was developed. The Cronbach’s α was used to assess the internal reliability and confirmatory factor analysis (CFA) to assess the construct validity of the EDAS-SF. Results A totally of 916 elderly adults were surveyed, among which, 887 finished the questionnaire, accounting for 96.8%. The mean age of the studied population was 70.8±6.9 years old. Finally, seven items were chosen for the EDAS-SF which included mental function, organ function, communication, activity, self-care, family function, economic and social function. The Cronbach’s α of the scale was 0.836. Except for the " economy and social function” dimension and the " communication” dimension, the Cronbach’s α of other dimensions were higher than 0.8. EDAS-SF was proved to have good internal reliability. In addition, the CFA indicated that the theoretical model of the EDAS-SF was well fit to the data of the checking sample, which meant EDAS-SF had good construct validity. Conclusion The current study develops the short version of elderly disability assessment scale. The internal reliability and construct validity of the EDAS-SF are good.
ObjectivesTo systematically review the health utility scores and disability weights of liver cancer and related diseases in China.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were electronically searched to collect the studies of health utility scores and disability weights of liver cancer and related diseases in China from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 9 studies were included which covered 10 related diseases, among which chronic hepatitis B, compensated cirrhosis, decompensated cirrhosis and liver cancer were the mostly reported. The overall quality was adequate, and EQ-5D was the most common tool in these studies. Results of meta-analysis showed that healthy utility scores of the four common diseases were 0.789 (0.735, 0.843), 0.734 (0.693, 0.776), 0.647 (0.627, 0.666) and 0.636 (0.508, 0.765), respectively. Measures from EQ-5D were 0.825 (0.762, 0.868), 0.761 (0.731, 0.791), 0.643 (0.620, 0.666) and 0.620 (0.473, 0.766), respectively. In addition, the corresponding median (range) utility scores of the four diseases were found to be 0.758 (0.520–0.950), 0.716 (0.570–0.900), 0.538 (0.260–0.662) and 0.541(0.310–0.720). Only one disability weight study was concluded (0.360–0.900 reported for liver cancer).ConclusionIn Chinese population, current evidences on health utility of liver cancer and related diseases are limited, particularly data on disability weights. Utility values from meta-analysis seems more optimistic and centralized than those from descriptive analysis. Different survey tools yield varying outcomes, and attentions should be addressed to their application. The decrease of heath utility scores with the severity of liver disease suggests that early prevention, early diagnosis and treatment can save more years of life with enhanced quality.
ObjectivesTo systematically review the disease burden and epidemiological characteristics of tuberculosis in the Chinese population, and to provide reference for health resources allocation and health policy making.MethodsDatabases such as PubMed, EMbase, CNKI, VIP and WanFang Data were searched for studies investigating disease burden of tuberculosis in Chinese population from inception to August 1st, 2017. Two researchers independently screened literature, exacted data and assessed methodological quality of included studies. Statistical analysis was performed on data of tuberculosis associated population, mortality and disease burden.ResultsA total of 40 studies were included. The results of qualitative analysis showed that, since 1990, the prevalence of tuberculosis and its disease burden in China decreased year by year. However, the disease burden per patient and the total economic burden in China showed an increasing trend, and the economical disease burden increased 1.6 times from 1993 to 2003. The disease burden of men was higher than that of women, and it was higher in the countryside than in the city. In 2004, the ratio of YLL per thousand people in rural and urban areas was 2.18, and the ratio was 1.29 in 2014. Additionally, the disease burden decreased gradually in western, central and eastern regions. In 2014, compared with 2004, YLL decreased by 1.11, while the central and eastern regions were 0.48 and 0.25, respectively. The gap between the gender, the urban and rural areas and the regions was not as significant as in previous.ConclusionsThe disease burden of tuberculosis in China is seriously high and the tuberculosis prevention and control work should take into consideration the epidemiological characteristics of tuberculosis and the trends of the disease burden. It is necessary to rationally and effectively implement health intervention programs and allocate health resources based on different health demands in different regions and age groups to reduce the morbidity and mortality, and to pay more attention to drug-resistant tuberculosis. Besides, the emphasis of prevention should be placed on reducing disease burden in the elderly and strengthening prevention in the young population.
ObjectiveTo explore the effect of a new rehabilitation intervention model based on International Classification of Functioning, Disability and Healthy (ICF) concept in perioperative treatment on patients with adolescent idiopathic scoliosis (AIS).MethodsFrom June 2017 to January 2019, AIS patients with Cobb angle below 80° were randomly divided into experimental group and control group by the method of randomized block design. The patients in the control group received routine perioperative rehabilitation intervention, while the patients in the experimental group received rehabilitation mode intervention based on ICF concept. The therapeutic effect of the two groups including functional and activity dimensions was observed.ResultsA total of 40 patients were included, with 20 in each group. Two patients withdrew the control group. On the fourth day after surgery, the total score of Modified Barthel Index (50.55±8.87 vs. 18.99±5.63; t=13.264, P<0.001) and Scoliosis Research Society-22 (SRS-22) (3.68±0.13 vs. 3.27±0.11; t=10.355, P<0.001) in the experimental group were all better than those in the control group. In the SRS-22 scores, statistically significant differences in comparison of function (2.79±0.29 vs. 1.90±0.48; t=6.884, P<0.001), and self image (3.91±0.27 vs. 3.38±0.32; t=5.539, P<0.001) between the two groups were found. There was no statistically significant difference in pain indicators and muscle strength between the two groups in the two postoperative evaluations (P>0.05). ConclusionsThe treatment based on the concept of ICF can improve the daily living ability in the short term with the safe and acceptable premise. The concept of stimulating patient autonomy, improving patient independence, and promoting social treatment, may improve the overall state of the patients.
ObjectiveTo explore the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and interlaminar fenestration discectomy in the treatment of lumbar (L) 5-Sacral (S) 1 lumbar disc herniation (LDH).MethodsLDH patients were retrospectively included from January 2016 to Januray 2018. And the patients were divided into the PEID group and the fenestration group according to their choice of different surgical methods. The operation time, intra-operative blood loss, and bed rest time in the two groups were recorded. The preoperative and postoperative [1 week, 1 month, 3 months, and last follow-up (>12 months)] Visual Analogue Score (VAS) of the lumbago and leg pain between the two groups were compared; the preoperative and postoperative [1 week, and last follow-up (>12 months)] Oswestry Disability Index (ODI) and also the postoperative [(>12 months)] therapeutic effect (modified MacNab) between the two groups were compared.ResultsA total of 66 patients were included, with 31 in the PEID group and 35 in the fenestration group. There was no significant difference in age, gender and course of disease between the two groups (P>0.05). There were leakage of cerebrospinal fluid and transient lumbago, leg pain and numbness, which were worse than those before operation in the PEID group (1 and 1 patient, respectively) and the fenestration group (2 and 3 patients, respectively). There were statistically significant differences between the PEID group and the fenestration group, in the operative time [(90.65±9.98) vs. (66.23±16.50) minutes], intra-operative blood loss [(51.77±18.64) vs. (184.29±78.38) mL], and bed time [(2.87±0.92) vs. (7.49±1.20) d] (t=−7.365, t’=−9.697, t=−17.374, P<0.001). There was no significant difference in the preoperative VAS score (lumbar-leg pain) and ODI index, and the ODI index at each postoperative time point, between the two groups (P>0.05). VAS score (lumbago) and VAS score (leg pain) in the PEID group at each postoperative time point were lower than those in the fenestration group (P<0.05); VAS scores (leg pain) at other time points were not statistically significant between the two groups (P > 0.05). VAS (lumbar-leg pain) score and ODI index at each postoperative time point were lower than those before the surgery. The was no statistically significant difference in the PEID group (90.32%) and fenestration group (85.71%) in the excellent rate (χ2=0.328, P=0.713).ConclusionsPEID has less surgical trauma, less bleeding, short bed rest, fast recovery, and better relief of postoperative lumbago symptoms. It is worthy of further promotion in clinical work.
ObjectivesTo systematically review approaches to derive disability weights (DWs) based on EQ-5D instrument.MethodsPubMed, EMbase, Web of Science, CNKI and WanFang Data databases were electronically searched to collect studies on the approaches to derive disability weights based on EQ-5D from inception to June 1st, 2019. Two reviewers independently screened literature, extracted the basic information and evaluated risk of bias of included studies. Then, systematic review on approaches to derive DWs based on EQ-5D instrument was performed.ResultsA total of 18 studies were included, which were published between 2003 and 2018. The included studies involved a variety of diseases, mostly focusing on quality of life and the burden of disease. The approaches to derive DWs based on EQ-5D health instrument were as follows: DWs=health utility scoreNormal or Control−health utility scoreDisease (7 studies), DWs=1−VAS score/100 (6 studies), DWs=1−health utility scoreDisease (3 studies), linear regression model (1 study), and mapping (1 study).ConclusionsAmong all the included studies using EQ-5D-based disability weight measurement methods involves a variety of diseases, with relatively low comparability. More methodological studies are from abroad. Among all the applied approaches, DWs equally to health utility scoreNormal or Control minus health utility scoreDisease is the most commonly used.