Guoqing Diao

Factors predicting clinically significant fatigue in women following treatment for primary breast cancer

Cancer-related fatigue is common, complex, and distressing. It affects 70–100% of patients receiving chemotherapy and a significant number who have completed their treatments. We assessed a number of variables in women newly diagnosed with primary breast cancer (BrCa) to determine whether biological and/or functional measures are likely to be associated with the development of clinically significant fatigue (CSF). Two hundred twenty-three women participated in a study designed to document the impact of the diagnosis and treatment of primary breast cancer on function. Forty-four had complete data on all variables of interest at the time of confirmed diagnosis but prior to treatment (baseline) and ≥9xa0months post-diagnosis. Objective measures and descriptive variables included history, physical examination, limb volume, hemoglobin, white blood cell count, and glucose. Patient-reported outcomes included a verbal numerical rating of fatigue (0–10, a score of ≥4 was CSF), five subscales of the SF-36, Physical Activity Survey, and Sleep Questionnaire. At baseline, the entire cohort (nu2009=u2009223) and the subset (nu2009=u200944) were not significantly different for demographic, biological, and self-reported data, except for younger age (pu2009=u20090.03) and ER+ (pu2009=u20090.01). Forty-five percent had body mass index (BMI)u2009≥u200925, 52% were post-menopause, and 52% received modified radical mastectomy, 39% lumpectomy, 52% chemotherapy, 68% radiation, and 86% hormonal therapy. Number of patients with CSF increased from 1 at baseline to 11 at ≥9xa0months of follow-up. CSF at ≥9xa0months significantly correlated with BMIu2009≥u200925, abnormal white blood cell count, and increase in limb volume and inversely correlated with vigorous activity and physical function (pu2009<u20090.05). Fatigue increases significantly following the treatment of BrCa. Predictors of CSF include high BMI and WBC count, increase in limb volume, and low level of physical activity. These are remediable.

A Systematic Comparison Between Subjects With No Pain and Pain Associated With Active Myofascial Trigger Points

To determine whether standard evaluations of pain distinguish subjects with no pain from those with myofascial pain syndromes (MPS) and active myofascial trigger points (MTrPs) and to assess whether self‐reports of mood, function, and health‐related quality of life differ between these groups.

Exploratory Analysis of the Relationships between Aerobic Capacity and Self-Reported Fatigue in Patients with Rheumatoid Arthritis, Polymyositis, and Chronic Fatigue Syndrome

To determine if self‐reported levels of physical activity and fatigue are related to peak oxygen uptake (VO2peak) and whether these relationships differ among the patient groups (rheumatoid arthritis [RA], polymyositis [PM], and chronic fatigue syndrome [CFS]).

Comparison of activity level among patients with chronic liver disease

Purpose: To determine whether self-reported maximal and daily activity levels are impaired among patients with nonalcoholic fatty liver disease (NAFLD), hepatitis C (HCV) and hepatitis B (HBV). Methods: Clinicodemographic, diagnostic, self-report and standard laboratory data were obtained. Univariate, multivariate and regression analyses were performed comparing group maximal (Maximum Activity Score [MAS]) and daily activity scores (Adjusted Activity Score [AAS]), adjusted for age and gender. Results: Two hundred twenty-two patients completed activity-level self-reports (mean age [52.4u2009±u200910.0 years], BMI [28.3u2009±u20096.58], 31.2% NAFLD, 48.3% HCV, 20.3% HBV). On multivariate analysis, significantly higher MAS (p < 0.05) and AAS in HBV patients correlated with absence of cirrhosis, younger age, male gender (higher MAS) and lower BMI (higher AAS). Lowest activity levels were found primarily in obese patients (p < 0.009). Compared with population norms, NAFLD and HCV cohorts scored mildly disabled on MAS; the HBV cohort scored low normal. Mild disability on AAS was observed in patients with HBV; moderate disability in those with NAFLD, HCV. Conclusions: All groups had significantly lower activity levels than population norms. Nonobese patients showed significantly less disability than obese patients. Patients with NAFLD and HCV are likely to have lower levels than those with HBV without cirrhosis. This presents an additional risk factor for disability and mortality. Implications for Rehabilitation Hepatitis B (HBV), hepatitis C (HCV), and non-alcoholic fatty liver disease (NAFLD) patients had significantly lower activity levels than expected for their age and gender, as measured by the Human Activity Profile (HAP). Overweight and normal weight chronic liver disease (CLD) patients showed significantly less disability than obese chronic liver disease patients. Patients with NAFLD and HCV are likely to participate in low levels of activity that require fewer metabolic equivalents for completion, adding an additional risk factor for disability and mortality. Targeting low activity level in CLD patients, and decreasing BMI below the obesity threshold, may reduce disability and risk of mortality.

Demonstration of two types of fatigue in subjects with chronic liver disease using factor analysis

PurposeThe purpose of this investigation was to determine if it was possible to separate fatigue self-reports into two distinct types of fatigue symptom clusters in research subjects with chronic liver disease (CLD). It was hypothesized that when items from the Medical Outcomes Study Short-Form (SF-36v2) are combined with items from the Fatigue Severity Scale (FSS), these distinct factors will emerge.MethodsConfirmatory and exploratory factor analyses from data collected in a prospective, natural history study of CLD patients were conducted. Items were selected from the SF-36v2 and the FSS for entry into the factor analyses. In order to establish convergent and discriminant validity, derived factor scores were correlated with subscale scores of the Human Activity Profile (HAP), Mental Component Score (MCS) from the SF-36v2, and the Emotional Functioning Subscale of the Chronic Liver Disease Questionnaire (CLDQ-EF).Results106 participants with CLD were included (50% female; age: 51u2009±u200910). Two factors were identified. The factors included one that clustered around questions addressing fatigue related to physical activity (peripheral fatigue) and the other to the questions addressing generalized fatigue that did not require physical tasks to produce the fatigue (central fatigue). The standardized factor loadings of all items were greater than 0.6 on their underlying constructs. Moreover, all factor loadings are significant at pu2009<u20090.01. Peripheral fatigue was related to HAP (ru2009=u20090.26, ru2009=u20090.24, pu2009<u20090.01), as was central fatigue (ru2009=u2009−0.34, ru2009=u2009−0.33, pu2009<u20090.01). Central fatigue was related to MCS and CLDQ-EF (ru2009=u2009−0.60; ru2009=u2009−0.63, pu2009<u20090.01), whereas peripheral fatigue was not (ru2009=u20090.07, pu2009>u20090.40). We then tested the original scales to determine if the newly created factors correlated better with the validity measures. The full FSS did not correlate as well as the newly created central fatigue scale, while the original peripheral fatigue scale (the SF-36v2 physical functioning) was more related to HAP than the newly created scale.ConclusionsIn individuals with CLD, two separate factors pertaining to fatigue were identified. This recognition of the multifaceted nature of fatigue may help increase the specificity of self-reports of fatigue and lead to treatments that can specifically address the underlying factors contributing to fatigue.

Relationship between Depressive Symptoms and Cardiovascular Disease Risk Factors in African American Individuals

Objective. To examine the relationship between depressive symptoms and cardiovascular disease (CVD) risk factors in a group of African American individuals. Design. A nonrandom sample of 253 (age 43.7 ± 11.6 years; 37% male) African American individuals was recruited by advertisements. Data were obtained by validated questionnaires, anthropometric, blood pressure, and blood sample measurements. Results. Regression analyses were performed to assess the relationship between depressive symptoms and CVD risk factors controlling for socioeconomic status indicators. These analyses demonstrated that those with higher levels of depressive symptoms had larger waist-to-hip ratios, higher percent body fat, higher triglycerides, and were more likely to be smokers. Conclusions. It has been well documented that higher levels of depressive symptoms are associated with higher CVD risk. However, this evidence is derived primarily from samples of predominantly Caucasian individuals. The present investigation demonstrates that depressive symptoms are related to CVD risk factors in African American individuals.

Quantification of Muscle Tissue Properties by Modeling the Statistics of Ultrasound Image Intensities Using a Mixture of Gamma Distributions in Children With and Without Cerebral Palsy: Quantitative Ultrasound Muscle Characterization

To investigate whether quantitative ultrasound (US) imaging, based on the envelope statistics of the backscattered US signal, can describe muscle properties in typically developing children and those with cerebral palsy (CP).

Poster 42 Differentiation of Central and Peripheral Fatigue in Breast Cancer Survivors

Objective: To investigate the association between seat elevator (SE) procurement and changes in functional mobility for clients recommended new equipment with SEs. Design: A retrospective analysis was conducted on clients recommended new equipment with SEs. Demographics, procurement data, and Functional Mobility Assessment (FMA) scores were obtained. Clients were divided into 4 groups, based on SE status before and after receiving new equipment: SE to SE (clients with prior SEs who received new SEs); no SE (NSE) to SE; SE to NSE; and NSE to NSE. Analysis was performed on 3 groups (NSE to NSE group was excluded due to insufficient sample). Setting: Assistive Technology clinic. Participants: 83 clients had data from both time points. Age range was 13 to 88 years. Participants were 41.0% female and 59.0% male. Interventions: Procuring new equipment with or without SEs. Main Outcome Measures: Groups were compared with regard to baseline demographics using ANOVA, Chi-square, and Fishers Exact tests. Within each group, Wilcoxon Rank Sum Analyses were used to compare two time points with respect to FMA individual items (on reach and transfer) and total FMA scores. Results: The 3 groups were not significantly different with regard to age, gender, or diagnosis. In the SE to NSE group, a significant decrease in FMA reach score was seen (P 1⁄4 .026). In the SE to SE group, a significant increase in FMA reach score, FMA transfer score, and total FMA was seen (P 1⁄4 .001, P 1⁄4 .002, P 1⁄4 .001, respectively). In the NSE to SE group, a significant increase in FMA reach score and total FMA was seen (P 1⁄4 .041, P 1⁄4 .049, respectively). Conclusions: Because SEs are often denied by insurance, more research is needed on SEs. This is one of the first studies to show that SEs may have a beneficial effect on reach, transfers, and overall functional mobility. Level of Evidence: Level III

Dry-Needling is Effective in Treating Active Myofascial Trigger Points in Subjects with Chronic Myofascial Pain: A Prospective Trial

Disclosures: A. Reddy, No Disclosures: I Have Nothing To Disclose. Objective: Development of functional assessment tool for chronic pain patients that provides practitioners with a common outcome evaluation to quantify patients’ progress during a pain management program. It was hypothesized that the functional assessment tool developed will show objective evidence of decreased physical capabilities by patients with chronic pain relative to healthy participants’ outcomes. Design: Case-control study. Setting: Outpatient pain treatment center. Participants: 31 healthy control participants and 104 chronic pain patients. Interventions: Literature review performed initially to assimilate various individual functional tests into a single comprehensive assessment tool which was named, Marianjoy Pain Functional Assessment Tool (MPFAT). Collection of data was obtained utilizing MPFAT on healthy control subjects and initial assessments of chronic pain patients enrolled in a comprehensive pain management program. Main Outcome Measures: The MPFAT outcomes were based upon subject’s assessment of initial self physical ability, visual analog pain score, 6 minute walk test, fast walking 10 meters, handgrip strength, sit to stand repetitions, lifting adjustable weighted object, step-ups, subject’s estimate of perceived exertion, and assessment of pain behavior using Modified University of Alabama-Birmingham Pain Behavior Scale. T-tests and Chi-Square were used for comparison between healthy control subjects and chronic pain patients’ initial assessments. Results or Clinical Course: All performance outcomes measured by the MPFAT showed significant (p<.05) decrease in baseline physical function of chronic pain patients compared to healthy control subjects, with exception of hand grip strength. Most significant mean differences were noted by chronic pain patients’ lower 6 minute walk test, fast walking 10 meters, sit to stand repetitions, and lifting adjustable weighted object compared to healthy controls. Conclusions: Framework provided by MPFAT showed objective evidence of physical decline in the chronic pain patient study group as hypothesized. Thus, it may be plausible for the MPFAT to be further used in other pain management program settings to objectively track patient progress.

Poster 229: Fatigue and Physical Performance in Subjects With Chronic Liver Disease

eters (SF-36). Design: The following assessments were administered to 449 obese patients: RolandMorris Disability Questionnaire (RMDQ), Disabilities of the Arm, Shoulder and Hand (DASH), the Western Ontario and McMaster Universities index (WOMAC), SF-12 questionnaire, Short Physical Performance Battery (SPPB), SIO-Obesity correlated Disability Test (TSDOC). Subjects were also requested to execute the 6-minute walking test (6MWT). The TSD-OC is composed by 7 sections (pain; stiffness; activities of daily living and indoor mobility; housework; outdoor activities; occupational activities; social life) and a total of 36 items. The patient is requested to subjectively assess disability for each item by means of a visual analog scale. Setting: Multicentric study coordinated by the SIO and involving 16 center in Italy. Participants: 449 obese subjects (30.5% M, 69.5% F; mean age 51.1 14 years). Results: No significant correlations between BMI and RMDQ, DASH, WOMAC, SF-12 (PCS-12 and MCS-12); a high correlation between BMI and TSDOC, both for the global score and for some items: “pain while carrying loads” (rho 0.47), “difficulty at work” (rho 0.51), “need to be often absent from work” (rho 0.46). Conclusions: Disability in obesity is peculiar and standardized assessments commonly used in rehabilitation settings fail to characterize it. Our study demonstrates that high BMI values are correlated to the global TSDOC score, indicating overall disability. TSD-OC may represent an important instrument to establish the rehabilitation needs in patients with obesity-related disability, to plan appropriate rehabilitation programs and to evaluate their effectiveness