Return to work and health-related quality of life up to 1 year in patients hospitalized for COVID-19: the CO-FLOW study.

BACKGROUND: Currently, evidence about the long-term consequences of COVID-19 on return to work and health-related quality of life (HRQoL) is limited. We evaluated return to work and its associations with baseline characteristics and physical and mental recovery over time in patients up to 1 year after hospitalization for COVID-19. Secondly, we aimed to evaluate the association between return to work and health-related quality of life (HRQoL). METHODS: CO-FLOW, a multicenter prospective cohort study, enrolled adult participants hospitalized for COVID-19, aged ≥ 18 years within 6 months after hospital discharge. Return to work and HRQoL were collected at 3, 6, and 12 months after hospital discharge using the iMTA Productivity Cost Questionnaire and the 36-Item Short Form Health Survey, respectively. Data were collected between July 1, 2020, and September 1, 2022. Generalized estimating equations with repeated measurements were used to assess outcomes over time. RESULTS: In the CO-FLOW study, 371 participants were employed pre-hospitalization. At 3, 6, and 12 months post-discharge, 50% (170/342), 29% (92/317), and 15% (44/295) of participants had not returned to work, and 21% (71/342), 21% (65/317), and 16% (48/295) only partially, respectively. ICU admission (adjusted odds ratio (95% confidence interval): 0.17 (0.10 to 0.30), p < 0.001), persistent fatigue (0.93 (0.90 to 0.97), p < 0.001), female sex (0.57 (0.36 to 0.90), p = 0.017), and older age (0.96 (0.93 to 0.98), p < 0.001) were independently associated with no return to work. ICU patients required a longer time to return to work than non-ICU patients. Patients who did not return or partially returned to work reported lower scores on all domains of HRQoL than those who fully returned. CONCLUSIONS: One year after hospitalization for COVID-19, only 69% of patients fully returned to work, whereas 15% did not return and 16% partially returned to work. No or partial return to work was associated with reduced HRQoL. This study suggests that long-term vocational support might be needed to facilitate return to work. TRIAL REGISTRATION: World Health Organization International Clinical Trials Registry Platform NL8710.

Dutch Dataset Pain Rehabilitation in daily practice: Content, patient characteristics and reference data.

BACKGROUND: No core set of measurement tools exists to collect data within clinical practice. Such data could be useful as reference data to guide treatment decisions and to compare patient characteristics or treatment results within specific treatment settings. METHODS: The Dutch Dataset Pain Rehabilitation was developed which included the six domains of the IMMPACT core set and three new domains relevant in the field of rehabilitation (medical consumption, patient-specific goals and activities/participation). Between 2010 and 2013 the core set was implemented in 32 rehabilitation facilities throughout the Netherlands. RESULTS: A total of 8200 adult patients with chronic pain completed the core set at first consultation with the rehabilitation physician. Adult patients (18-90 years) suffering from a long history of pain (38% >5 years) were referred. Patients had high medical consumption and less than half were working. Although patients were referred with diagnosis of low back pain or neck or shoulder pain, a large group (85%) had multisite pain (39% 2-5 painful body regions; 46% >5 painful body regions). Scores on psychosocial questionnaires were high, indicating high case complexity of referred patients. Reference data for subgroups based on gender, pain severity, pain locations and on pain duration are presented. CONCLUSIONS: The data from this clinical core set can be used to compare patient characteristics of patients of other treatment setting and/or scientific publications. As treatment success might depend on case complexity, which is high in the referred patients, the advantages of earlier referral to comprehensive multidisciplinary treatment were discussed. SIGNIFICANCE: A detailed description of case complexity of patients with chronic pain referred for pain rehabilitation. Insight in case complexity of patients within subgroups on the basis of gender, pain duration, pain severity and pain location. These descriptions can be used as reference data for daily practice in the field of pain rehabilitation and can be used to evaluate, monitor and improve rehabilitation care in care settings nationwide as well as internationally.

Social functioning in adulthood: Understanding long-term outcomes of adolescents with chronic pain/fatigue treated at inpatient rehabilitation programs.

BACKGROUND: Chronic pain and fatigue are both common complaints in childhood and adolescence and often persist over time. The aim of the study was to investigate whether chronic pain/fatigue persists during adulthood and how former patients function and participate in society as adults. METHODS: This historical cohort study used questionnaires to gather the data. Predictors for social participation in adulthood were also identified. Differences in functioning and health care use between young adults with current pain/fatigue complaints and those without were also discussed. RESULTS: Ninety-four young adults responded; their mean age was 26.6 years and 91.5% were women. The average time since treatment was 10.2 years. 63.4% reported ongoing or new pain/fatigue complaints. 72.0% had a paid job; of those who worked, 22.1% reported taking sick leave in the past month. 78.7% of them reported having one or more chronic diseases. A higher level of pain/fatigue measured pre-treatment was identified as a predictor for more impaired social participation in adulthood. Young adults with current pain/fatigue complaints reported more healthcare utilization, lower levels of physical functioning and limitations in daily activities due to physical problems. CONCLUSIONS: A considerable number of these young adults still have pain/fatigue complaints in adulthood. More pain/fatigue pre-treatment during adolescence predict impaired functioning in the work-educational domain in young adulthood. WHAT DOES THIS STUDY ADD?: This study examines the social participation of young adults who suffered from severe chronic pain/fatigue during adolescence. Predictors for social participation are reported, as are the differences between young adults with and without persistent pain/fatigue complaints.

Responsiveness of the Child Health Questionnaire-Parent Form in adolescents with non-specific chronic pain or fatigue.

BACKGROUND: The Child Health Questionnaire (CHQ) is a widely used instrument for measuring health-related quality of life covering both the physical and psychosocial domain. This study examined the responsiveness of the Dutch CHQ 50-item Parent Form (PF50) in a sample of adolescents with chronic non-specific pain and/or fatigue. METHOD: Five different methods were used to calculate the responsiveness for the physical (PhS) and psychosocial (PsS) subscale of the CHQ-50: standardized response mean (SRM), pooled effect sizes (ESs), standard error of measurement of agreement (SEMagreement ), minimal detectable change (MDC) and the area under the receiver operating characteristics (ROC) curve. For data analysis, the population was divided into two groups based on the parent's global perceived effect of treatment: a changed group (A) and an unchanged group (B). RESULTS: The responsiveness analyses were performed including 92 adolescents (88.0% girls; mean age 16.4 years). The SRMs are 2.89 and 1.01 for the PhS and PsS, respectively. Large ESs are found for group A (PhS = 3.30; PsS = 1.16). The method used for calculating SEMagreement results in a score of PhS = 18.92 and PsS = 11.39. The MDCs of PhS and PsS are 52.45 and 31.57, respectively. The area under the ROC curve (AUC) for PhS = 0.79 and for PsS = 0.64, and the corresponding optimal cut-off points are 21.1 and 7.0. CONCLUSION: Using the methods SRM, ES and AUC, the responsiveness of the CHQ-PF50 in adolescents with non-specific chronic pain or fatigue treated in a rehabilitation clinic is adequate for the physical scale and moderate for the psychosocial scale.

Outcome of atrial fibrillation ablation: assessment of success.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with a prevalence in the general population of approximately 1%. Catheter ablation has emerged from being a highly experimental procedure to one of the most common ablation performed in many electrophysiology laboratories throughout the world. The stability of sinus rhythm restored by catheter ablation is important not only for comparison of different ablation techniques, but also for guiding anticoagulation and possible antiarrhythmic drug treatment. It has been shown that asymptomatic AF after ablation is at least as common as before the ablation. Rhythm assessment is therefore a key component of post AF ablation follow-up. A variety of electrocardiogram (ECG) monitoring techniques is available. Besides of technical characteristics such as the number of recording leads and further signal processing, these techniques differ mainly in the duration of ECG recordings and the involvement of the patient. Intermittent rhythm monitoring techniques include standard 12-lead ECG, Holter-ECG of various duration, patient activated external loop ECG recorder as well as patient activated transtelephonic ECG monitor. Continuous ECG represents the gold standard for rhythm monitoring recording and can be achieved by means of a pacemaker, implan-table defibrillator or implantable cardiac ECG monitor.

Routing through the health care system and level of functioning of lower limb amputees.

OBJECTIVES: To describe the routing through the health care system and the level of functioning of a consecutive series of lower limb amputees at a general Dutch hospital. METHODS: A descriptive cohort study (medical records examination) with a follow-up interval of 11.7 months. All 124 major lower limb amputations (ankle to hip) between 1 July 1989 and 31 December 1992 are included in the study: 123 patients, average age 73.8 years, 96% vascular disease. Amputation levels are 55.3% transfemoral, 12.2% knee disarticulation and 32.5% transtibial. At follow-up two patients are missing. RESULTS: Before admission to hospital 75.6% of patients are able to walk and 79.9% live independently. Discharge destinations from hospital are 22.5% home, 42.3% inpatient rehabilitation and 32.4% nursing home. At follow-up, 59% of surviving patients have a prosthesis, 47.7% are able to walk and 70.5% live independently. Mortality after one year is 28.5%. Poor preoperative walkers seem to die more often within the first year and have less chance of being fitted with a prosthesis. Poor walkers, older than 75, with diabetes mellitus and a transfemoral amputation seem to stay more often in a nursing home after one year. DISCUSSION: Although the results are largely comparable with other studies, there appear to be differences in age, amputation level and course and duration of treatment. The predicting factors found here may help the rehabilitation specialist in advising on the best moment and level of amputation and course of treatment.