Search Results (3,196)

Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst stimulation (iTBS), a neuromodulatory approach, with the evidence-based LoveYourBrain Yoga program to enhance rehabilitation outcomes. In a six-week open-label trial, ten Veterans with mTBI + CP received weekly iTBS followed by yoga sessions. Pilot quantitative outcomes included quality of life (Traumatic Brain Injury Quality of Life [TBI-QoL]) and functional ability (Mayo Portland Adaptability Inventory-4 [MPAI-4]), assessed pre- and post-intervention, alongside qualitative semi-structured interviews and interdisciplinary clinical notes. Significant improvements were observed in TBI-QoL Fatigue (p = 0.021) and MPAI-4 Grief and Loss (p = 0.016), with clinically meaningful but non-significant gains in Ability and Adjustment. Qualitative findings revealed improved pain management and enhanced self-management, with participants describing better emotional regulation, more effective coping strategies, and stronger social connections. Some benefits were more evident in qualitative data than in standardized measures. These pilot findings suggest that combining iTBS with mind–body therapy may provide complementary tools for pain management and functional recovery in Veterans with mTBI + CP, supporting further investigation of integrated neuromodulation and behavioral interventions. Full article

Background: The Ketogenic Diet (KD) has been proposed as an adjunct to standard therapy for gliomas by targeting tumor glycolysis. We systematically reviewed evidence on KD interventions in patients with glioma across multiple outcomes. Methods: Following Cochrane guidelines, we searched MEDLINE, Embase, and Cochrane Library (until 1 February 2025) for studies on humans with glioma treated with any KD versus usual care or other diets. Outcomes included overall survival (OS) and progression-free survival (PFS), quality of life (QoL), biochemical markers (glucose, ketones, glucose–ketone index GKI), anthropometric measures, safety, and tolerability. All study designs were eligible. The quality of the studies was assessed with JBI tools. Data were narratively synthesized due to heterogeneity. The PROSPERO registration is CRD42024547388. Results: Twenty-three studies (306 patients) were included: two RCTs, 11 quasi-experimental studies, six case series, and four case reports. Dietary interventions included classic KD, modified KD, medium-chain triglyceride KD, and Modified Atkins Diet, sometimes combined with fasting. The overall dropout was 20.3%, mainly due to dietary restrictiveness, disease progression, adverse effects, or QoL concerns. Survival results were inconsistent: RCTs showed no significant OS/PFS differences versus controls, although exploratory analyses suggested better outcomes with lower glucose levels. Ketosis was commonly achieved; glucose reductions were variable, and GKI was rarely reported, with target values seldom reached outside fasting periods. Weight/BMI generally decreased modestly or remained stable; adverse events were mostly mild and tolerability was acceptable. Conclusions: Evidence for KDs in glioma patients is heterogeneous and limited. Although ketosis and safety are achievable, survival or QoL benefits remain unproven. Given the methodological challenges, the clinical complexity, and the promising potential of the Ketogenic Diet, further well-designed studies are needed to clarify its clinical utility in glioma treatment. Full article

Background: Problematic smartphone use may threaten student well-being, especially among nursing students who rely on smartphones for academic and clinical activities. This study estimated potential problematic smartphone use among Greek nursing students, examined its association with quality of life (QoL), and explored whether contextual factors modified these associations. Methods: A cross-sectional study was conducted among 331 nursing students in Greece from September to November 2025. Participants completed an anonymous online questionnaire including sociodemographic data, the Smartphone Addiction Scale–Short Version (SAS-SV), and the World Health Organization Quality of Life–BREF (WHOQOL-BREF). Results: The mean SAS-SV score was 29.30 ± 9.69, and 18.9% of students screened positive for potential problematic smartphone use. Mean overall QoL and general health satisfaction were 3.80 ± 0.78 and 3.97 ± 0.88, respectively. Higher SAS-SV scores were associated with lower physical, psychological, and environmental QoL, but not with social QoL. Years of study moderated only the association with environmental QoL. Conclusions: Problematic smartphone use was associated with poorer physical, psychological, and environmental QoL among Greek nursing students. These domain-specific findings extend existing evidence and support integrating digital well-being, self-regulation, and sleep-hygiene strategies into nursing education and student-support services. Full article

Background: Lung transplant recipients often live for years with residual respiratory symptoms and psychological distress, but the pathways through which these factors affect quality of life (QoL) are not fully understood. We examined how transplant-specific pulmonary symptom burden and psychological distress relate to generic and transplant-specific QoL in long-term lung transplant recipients. Methods: In this cross-sectional study, 76 adult lung transplant recipients from a single center completed the Lung Transplant Quality of Life (LT-QoL) questionnaire, EQ-5D-5L, SF-36, St George’s Respiratory Questionnaire (SGRQ), and Hospital Anxiety and Depression Scale (HADS). A composite psychological distress index was derived from HADS-Anxiety, HADS-Depression, and the LT-QoL Anxiety/Depression and Health Distress subscales. Associations were examined using Pearson correlations, hierarchical linear regression (adjusting for age, sex, and time since transplant), and statistical mediation models examining psychological distress as a potential mediator between pulmonary symptoms and QoL outcomes. Results: Pulmonary symptom burden (LT-QoL Pulmonary Symptoms) was in the low–moderate range yet showed robust correlations with poorer generic, transplant-specific, and respiratory-specific QoL (|r| up to 0.82). The psychological distress index demonstrated good internal consistency (α = 0.84) and was strongly associated with worse EQ-5D, SF-36, and LT-QoL General QoL scores. In regression models, pulmonary symptoms and psychological distress independently predicted SF-36 overall QoL (R² = 0.55), whereas psychological distress was the stronger predictor of the EQ-5D Index Value. Statistical mediation analyses were consistent with partial mediation of the association between pulmonary symptoms and SF-36 and the EQ-5D Index Value, while effects on the EQ-VAS and LT-QoL General QoL were largely direct. Conclusions: Even modest pulmonary symptom burden and psychological distress are tightly linked to QoL years after lung transplantation. Routine follow-up should include brief assessment of both domains, and integrated care models that combine optimization of pulmonary status with targeted psychological support may be needed to preserve long-term QoL in lung transplant recipients. Full article

Sarcoidosis is a multisystem disease characterised by a heterogeneous clinical presentation and variable disease course. Despite low mortality, the burden of sarcoidosis extends beyond organ involvement, with many patients reporting significant impairment in quality of life (QoL). Fatigue, chronic cough, and small fibre neuropathy (SFN) are among the most prevalent and debilitating symptoms reported by patients, often demonstrating poor correlation with conventional markers of disease activity and frequently persisting despite apparent disease control. This review examines the impact of sarcoidosis on QoL and highlights the limitations of traditional assessment tools, including imaging and pulmonary function testing, in capturing the full extent of disease burden. The role of patient-reported outcome measures (PROMs) is discussed, including generic instruments and sarcoidosis-specific tools such as the King’s Sarcoidosis Questionnaire (KSQ), Sarcoidosis Health Questionnaire (SHQ), and Sarcoidosis Assessment Tool (SAT), alongside symptom-specific measures targeting fatigue, neuropathic symptoms, and cough. Current and emerging management strategies aimed at improving QoL are reviewed, including immunosuppressive therapies, biologic agents, and non-pharmacological interventions. Despite increasing recognition of QoL as a key outcome, its integration into clinical trials remains inconsistent. Incorporating PROMs into routine clinical practice and research is essential to enable comprehensive assessment and support patient-centred care. Greater emphasis on QoL outcomes may improve therapeutic decision-making and overall disease management in sarcoidosis. Full article

Background: Occupational moral injury is associated with nurses’ psychological well-being, yet evidence linking it to professional quality of life remains limited, and no validated Greek version of the Occupational Moral Injury Scale (OMIS) has been available. Methods: A cross-sectional study was conducted among 301 nurses from two public hospitals in Greece. Using convenience sampling, 350 questionnaires were distributed, yielding an 86.0% response rate. Participants completed the Occupational Moral Injury Scale (OMIS) and the Professional Quality of Life Scale Version 5 (ProQOL-V). The OMIS was translated and culturally adapted into Greek through a forward–backward translation process, and its validity and reliability were assessed using confirmatory factor analysis and internal consistency testing. Results: The Greek OMIS demonstrated excellent internal consistency (Cronbach’s α = 0.95). CFA provided preliminary support for the proposed factorial structure, although model fit indices indicated a marginal-to-moderate fit (CFI = 0.887, TLI = 0.866, SRMR = 0.070 and GFI 0.902). Participants reported relatively high compassion satisfaction (M = 37.30, SD = 7.35) and moderate levels of burnout (M = 23.36, SD = 5.06) and secondary traumatic stress (M = 22.13, SD = 7.28). Betrayal was negatively associated with compassion satisfaction (r = −0.151, p = 0.009) and positively associated with burnout (r = 0.427, p < 0.001) and secondary traumatic stress (r = 0.366, p < 0.001). Regression analyses showed that dimensions of moral injury were associated with burnout, secondary traumatic stress, and compassion satisfaction, with betrayal showing the strongest associations. Conclusions: Occupational moral injury was associated with poorer professional quality of life, underscoring the need for organizational support, ethical resources, and clinical supervision to promote healthcare professionals’ well-being and resilience. Full article

Background/Objectives: Primary Sjögren’s syndrome (pSS) is a chronic autoimmune rheumatic disease that clinically presents with symptoms of xerostomia and xerophthalmia, as well as a wide range of other symptoms that may affect patients’ daily functioning and life satisfaction. The main purpose of this study was to assess their health-related quality of life (HRQoL) using both general and disease-specific questionnaires. Methods: This cross-sectional observational research with prospective data collection was conducted at the Rheumatology Clinic of the University Clinical Centre of Kragujevac. Participants were divided into two groups: patients with oral manifestations (oral manifestations group) and those presenting with xerostomia only, without other oral lesions or symptoms (xerostomia-only group). A complete clinical examination of the patient’s oral cavity was performed by one doctor of dental medicine. HRQoL was evaluated using various generic and disease-specific instruments. Results: A total of 80 participants were included in the study, of whom 40 were in the oral manifestations group and 40 in the xerostomia-only group. Patients with oral manifestations had significantly higher scores across all PSS-QoL domains compared with the xerostomia-only group (p < 0.001). A statistically significant difference in the total EQ-5D result was detected between groups (0.7 (0.3) vs. 0.8 (0.1), p < 0.001). In multivariable regression analysis (R² = 0.921), the ESSPRI score (β = 0.418, p < 0.001) and the presence of oral manifestations (β = −1.155, p < 0.001) were significant independent predictors of impaired HRQoL, while disease activity showed no significant association (p = 0.895). Conclusions: Patients with primary Sjögren’s syndrome presenting with oral manifestations have poorer HRQoL compared with participants with xerostomia only. Symptom burden, including dryness, pain, fatigue, and oral manifestations, may be associated with decreased HRQoL, in contrast to disease activity. Full article

Background: The available evidence highlights that low back pain (LBP) can be categorized into neuropathic or nociceptive pain, according to mechanical- or lesion/disease-related issues. Both types of pain are associated with increased psychological and sleep problems and well-being. However, little is known about how a specific type of LBP pain (neuropathic vs. nociceptive) has an impact on these lifestyle factors. Therefore, the main purpose of the study was to examine the differences in depression and anxiety symptoms, quality of life (QoL) and quality of sleep in patients with LBP. Materials and Methods: In this cross-sectional study, we included 150 patients [mean ± standard deviation (SD) age: 46.54 ± 13.36 years; height: 178.06 ± 10.80 cm; weight: 85.26 ± 15.53 kg; body mass index (BMI): 26.77 ± 3.63 kg/m²; 45.0% women] from three centers in Bosnia and Herzegovina and Croatia between July and October 2025. All patients suffered from chronic LBP confirmed by computerized tomography (CT). The classification of pain was conducted using the Leeds Assessment of Neuropathic Symptoms and Signs (LANNS), the Douleur Neuropathique 4 (DN4) and the PainDETECT (PD-Q) questionnaires. Positive scores in all three questionnaires denoted neuropathic pain. Factors of depression (Beck’s Depression Inventory), anxiety [Hamilton Anxiety Rating Scale (HARS)], QoL (SF-36 scale) and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were also collected. Results: After adjusting for sociodemographic covariates, neuropathic patients reported higher depression [F_1,149 = 7.790, p = 0.006, partial eta squared (ηp²) = 0.051] and anxiety level scores (F_1,149 = 8.140, p = 0.005, ηp² = 0.053), lower QoL (F_1,149 = 19.088, p < 0.001, ηp² = 0.116) and poorer sleep quality (F_1,149 = 19.654, p < 0.001, ηp² = 0.119). Conclusions: In summary, this study shows that neuropathic patients with LBP are more depressed and anxious, and have lower levels of QoL and poorer sleep quality, in comparison to nociceptive patients. The findings suggest that these lifestyle factors need to be considered when establishing the appropriate rehabilitation and management of LBP. Full article

Advancing age, while a natural trajectory, often leads to several age-related diseases (ARDs) and impacts the quality of life (QOL) of the elderly. The World Health Organization (WHO) predicts that the incidence of ARDs is only going to increase over the next couple of decades. Musculoskeletal (MSK) diseases associated with advancing age are a major global health burden and are closely associated with cellular senescence, inflammaging and immunosenescence. To target these, a clear pathway with well-defined biomarkers that can then be translated into clinical applications is needed. Clearly defined biomarkers will bring us one step closer to dissecting age-related MSK changes, tracking these changes with advancing age, predicting these MSK ARDs and thus providing a platform towards healthy aging, disease-free life in the elderly and longevity. This review outlines our current knowledge in the field, discusses the current knowns and unknowns, provides an overview of the anti-aging strategies, and finally encourages its readers to consider approaches to help converge biomarkers of aging for clinical translation using next-generation technologies. Full article

Background/Objectives: Patellofemoral pain (PFP) is a persistent knee disorder that impacts quality of life (QoL). Although holistic assessments are needed, no specific tools exist regarding QoL in PFP. The Knee Quality of Life 26-item questionnaire (KQoL-26), covering physical and psychosocial dimensions, could be useful but has not been adapted for Spanish speakers. This study aimed to cross-culturally adapt KQoL-26 into Spanish and assess its psychometric properties regarding PFP, including validity and reliability. Methods: This cross-cultural adaptation followed COSMIN recommendations. The cultural and linguistic adaptation of KQoL-26 included 104 subjects with PFP, involving 145 affected knees. Inclusion criteria: symptomatic PFP, aged between 16 and 55, and being native Spanish speakers. Validity (structural, construct, and external), reliability (internal consistency, test–retest, and agreement), discriminant ability, and feasibility were assessed. Results: Factor Analysis identified five dimensions. Convergent validity demonstrated a strong correlation between KQoL-26 and Knee Injury and Osteoarthritis Outcome Score for Patellofemoral pain and osteoarthritis, Kujala Score, Fulkerson Scale, and the Physical Component Summary of 12-item Short Form, while weak correlations with descriptive data supported discriminant validity. The questionnaire demonstrated high internal consistency (Cronbach’s α = 0.949) and test–retest reliability (ICC = 0.949), with adequate agreement parameters. No floor or ceiling effects were observed. Regarding feasibility, KQoL-26 was understandable and completed by all participants. Conclusions: The Spanish KQoL-26 is a valid, reliable, and feasible QoL assessment tool for Spanish speakers with PFP. Its use may support both clinical decision-making and research in this population group by providing a comprehensive assessment of patient-reported outcomes. Full article

Introduction: Cochlear implantation is a well-established treatment for adults with bilateral postlingual deafness. In recent years, increasing research attention has focused on its use in patients with single-sided deafness (SSD) with or without tinnitus. Restoration of binaural auditory input through cochlear implantation may partially reestablish binaural processing. Methods: We conducted a narrative review of the literature focusing on studies examining the basic mechanisms associated with hearing impairment in SSD, as well as cochlear implantation outcomes in this population, including hearing performance, tinnitus suppression, and quality of life (QoL). We also reviewed comparative studies between cochlear implants (CIs) and alternative hearing devices, along with current candidacy criteria and the challenges associated with cochlear implantation in this patient group. Results: Current evidence suggests that CIs can provide significant benefits in this population, including tinnitus reduction or suppression, improved speech perception in both quiet and noise, enhanced sound localization, and better disease-specific and overall QoL. Furthermore, numerous studies—despite some variability in outcomes—indicate that CIs may offer superior performance compared with alternative options, such as contralateral routing of signals hearing aids (CROS-HAs) and bone-conduction devices, particularly in terms of speech perception, localization, tinnitus control, and aspects of QoL. Nevertheless, appropriate candidacy criteria and key challenges—most notably device non-use—should be carefully considered when evaluating cochlear implantation in this patient population. Conclusions: Further research is required to address these challenges and to advance a more personalized approach to cochlear implantation in individuals with SSD, with the aim of optimizing outcomes and reducing cochlear implant non-use. Full article

Background: Diabetes mellitus (DM) is a metabolic disease with an increasing global prevalence. It is characterized by chronic and systemic complications. Due to these complications, DM significantly impacts patients’ health-related quality of life (HRQoL). One of the most critical complications of DM is diabetic foot ulcers (DFUs), which have serious consequences for patients and healthcare systems. Objective: This study aimed to investigate variables potentially associated with HRQoL in patients with DFUs presenting to our wound care unit. Methods: This prospective cross-sectional study was conducted from February to May of 2023 at the Wound Care Unit of the General Surgery Department at Eskişehir City Hospital. A total of 209 patients who agreed to participate were included in the study. Data were collected via a structured questionnaire developed based on the literature, which included the Diabetic Foot Ulcer Scale–Short Form (DFS-SF). We used the Kolmogorov–Smirnov test, univariate analyses (Mann–Whitney U and Kruskal–Wallis tests), and multiple linear regression. Results: In the multivariate analysis, receipt of foot care education (p < 0.001), frequency of hospital applications due to DFU (p = 0.008), and Wagner classification (p = 0.012) were found to be predictors of HRQoL for DFUs (Adjusted R² = 0.206, F = 4.365, p < 0.001). Conclusions: To maintain a high HRQoL among DFU patients, they should immediately apply to specialized Wound Care Units, receive education, especially regarding early diagnosis and treatment, and receive multidisciplinary management for DFU. Full article

Background: Glioblastoma (used to be called glioblastoma multiforme—GBM) is the most common and aggressive brain tumor, having the lowest overall survival rate. Initial focal neurological deficits are primarily attributable to surrounding edema; however, as tumor invasion progresses, these deficits become more pronounced and permanent. The standard treatment for newly diagnosed glioblastoma is represented by cytoreductive neurosurgery followed by the Stupp Protocol. Postoperative recovery of the patient with glioblastoma is a long-term process that should include, for overall more acceptable outcomes, neurorehabilitation. This review aims to bring together evidence from neuro-oncology, neurosurgery, and neurorehabilitation in order to better understand the factors associated with recovery, functional status, and quality of life (QoL) after glioblastoma surgery. Our work also aimed to update the related knowledge base and to attempt to optimize the related protocols in patients with operated cerebral glioblastoma. Methods: For these purposes, we conducted a systematic literature review to assess the current state of research referring to the above-mentioned topic. We have used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA—widely recognized internationally) methodology. We used, in this respect, specific keyword combinations/“syntaxes” for searching literature in the domain, in four international databases. Results: Following PRISMA screening, 14 studies met the predefined eligibility criteria. Additional manual reference screening and complementary searches identified further relevant publications, resulting in a total of 22 included articles. Together, the reviewed work addressed a diverse range of topics relevant to postoperative glioblastoma management, including the potential role of multidisciplinary rehabilitation, cognitive interventions, neuromodulation approaches, and functional assessment strategies in improving postoperative outcomes and QoL in glioblastoma patients, while emphasizing that this interdisciplinary domain warrants more extended approaches. Discussion and Conclusions: Despite the relatively limited and largely exploratory available information, neurorehabilitation may contribute to improved functional outcomes and QoL in patients with glioblastoma. Full article

Background: Hormone therapy (HT) is an effective treatment for relieving menopausal symptoms; however, its association with health-related quality of life (HRQoL) in Asian populations remains insufficiently characterized. Objective: The aim of this study was to examine the association between HT use and HRQoL dimensions in postmenopausal Korean women using nationally representative data from 2005, 2007, 2008, and 2009. Methods: In this cross-sectional study, we analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2005, 2007, 2008, and 2009. Postmenopausal women aged 40–65 years were included (n = 2460). HRQoL was assessed using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument. Survey-weighted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association between HT use and each EQ-5D dimension, adjusting for age. Results: Of the 2460 participants, 464 (18.9%) were HT users. HT use was significantly more common among women with higher education levels (p < 0.001) and higher household income (p < 0.001). The weighted mean EQ-5D index was significantly higher among HT users (0.911, 95% CI: 0.902–0.921) than non-users (0.894, 95% CI: 0.889–0.900; p < 0.05). In age-stratified analyses, significant differences were observed between women aged <55 years (p < 0.05) and those aged ≥60 years (p < 0.05). The EQ-5D index was positively associated with HT duration in women aged <55 and ≥60 years (p for trend < 0.05). In age-adjusted, dimension-specific analyses, HT use was associated with lower odds of reporting problems across all five EQ-5D dimensions (all p < 0.001), with the strongest association observed for usual activities (OR = 0.719, 95% CI: 0.715–0.722). Conclusions: In this nationally representative sample of postmenopausal Korean women, HT use was associated with more favorable HRQoL outcomes, particularly in the usual activities domain, with patterns varying by age and BMI subgroups. These findings support individualized menopausal counseling that incorporates quality-of-life considerations into clinical decision-making. Full article

Background/Objectives: Carotid body tumour (CBT) resection carries substantial haemorrhage and cranial neuropathy risks. While preoperative embolisation mitigates these, its impact on patient-reported outcomes (PROMs) and quality of life (QoL) remains underexplored. Evaluate the preoperative embolisation’s impact on postoperative QoL using the 36-Item Short Form Health Survey (SF-36) questionnaire. Methods: A retrospective cohort study (68 patients) compared Preoperative Embolisation (Group E, n = 24) and Primary Resection (Group NE, n = 44), adjusting for confounders via multivariate linear regression. Results: Group E featured larger, more complex tumours. Despite this structural burden, intraoperative bleeding was significantly lower in Group E (median 300, Interquartile Range (IQR) 150–400 vs. 400 mL, IQR 350–500; p = 0.012). Group E reported lower overall median SF-36 scores (59.5 vs. 70 points; p = 0.002); however, multivariate analysis confirmed that embolisation was not an independent negative QoL predictor (b = −0.52, p = 0.852), whereas Shamblin grade III was associated with diminished well-being (b = −7.42, p = 0.012). Domain analysis revealed selective restrictions driven by acute somatic and emotional stress: Physical Functioning (p = 0.002), Bodily Pain (p = 0.007), General Health (p = 0.003), Vitality (p = 0.016), and Role Emotional (p = 0.010). Age stratification revealed a non-linear trend, validated via ANOVA (p = 0.013): working-age patients (<60 years) exhibited significantly lower SF-36 scores (61.2 ± 11.4 points) than the intermediate (p = 0.034) and elderly (p = 0.011) subgroups (>70 years; 72.8 ± 5.1 points). Conclusions: Preoperative embolisation optimises hemodynamic control and surgical safety without independently compromising long-term well-being. Postoperative QoL is heavily modulated by age-dependent generational psychosocial baselines rather than structural morbidity metrics alone. Full article