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Item Variation of Minimum Clinically Important Difference by Age, Gender, Baseline Disability, and Change of Direction in Adult Spinal Deformity Population: Is It a Constant Value?(2021) Bahadir, Sinan; Yuksel, Selcen; Ayhan, Selim; Nabi, Vugar; Vila-Casademunt, Alba; Obeid, Ibrahim; Sanchez Perez-Grueso, Francisco Javier; Acaroglu, Emre; 0000-0003-0153-3012; 33259972; U-5409-2018BACKGROUND: The minimum clinically important difference (MCID), an important concept to evaluate the effectiveness of treatments, might not be a single "magical" constant for any given health-related quality of life (HRQoL) scale. Thus, we analyzed the effects of various factors on MCIDs for several HRQoL measures in an adult spinal deformity population. METHODS: Surgical and nonsurgical patients from a multicenter adult spinal deformity database who had completed pretreatment and 1-year follow-up questionnaires (Core Outcome Measures Index [COMI], Oswestry Disability Index [ODI], Medical Outcomes Study 36-item short-form questionnaire, 22-item Scoliosis Research Society Outcomes questionnaire, and an anchor question of "back health"erelated change during the previous year) were evaluated. The MCIDs for each HRQoL measure were calculated using an anchor-based method and latent class analysis for the overall population and subpopulations stratified by age, gender, and baseline scores (ODI and COMI) separately for patients with positive versus negative perceptions of change. RESULTS: Patients with a baseline ODI score of <20, 20- 40, and >40 had an MCID of 2.24, 11.35, and 26.57, respectively. Similarly, patients with a baseline COMI score of <2.75, 2.8-5.4, and >5.4 had an MCID of 0.59, 1.38, and 3.67 respectively. The overall MCID thresholds for deterioration and improvement were 0.27 and 2.62 for COMI, 2.23 and 14.31 for ODI, and 0.01 and 0.71 for 22-item Scoliosis Research Society Outcomes questionnaire, respectively. CONCLUSIONS: The results from the present study have demonstrated that MCIDs change in accordance with the baseline scores and direction of change but not by age or gender. The MCID, in its current state, should be considered a concept rather than a constant.Item The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery(2021) Nabi, Vugar; Ayhan, Selim; Yuksel, Selcen; Adhikari, Prashant; Vila-Casademunt, Alba; Pellise, Ferran; Perez-Grueso, Francisco Sanchez; Alanay, Ahmet; Obeid, Ibrahim; Kleinstueck, Frank; Acaroglu, Emre; 0000-0003-0153-3012; 34130379; U-5409-2018Study design: Retrospective cohort. Purpose: This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery. Conclusions: The results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery.Item Cross-cultural adaptation of the Nijmegen cochlear implant questionnaire into Turkish language: validity, reliability and effects of demographic variables(2021) Alniacik, Asuman; Cakmak, Eda; Oz, Okan; 0000-0002-6108-7029; 34837517Purpose The purpose of this study was to evaluate the validity and reliability of the Turkish version of the Nijmegen Cochlear Implant Questionnaire (Tr-NCIQ) and reveal the demographic factors contributing to the outcomes. Methods A group of 118 cochlear implant users aged between 18 and 70 years filled the Tr-NCIQ and the Turkish Hearing Handicapped Inventory for Adults (the Tr-HHI-Adult) via electronic survey. Cross-cultural adaptation of the Tr-NCIQ was performed. The reliability and validity of the questionnaire were evaluated utilizing internal consistency coefficient, split-half method, and predictive validity. Results The overall Cronbach's alpha coefficient of the scale was 0.91, and the Spearman-Brown coefficient was 0.91. A moderately significant and negative correlation was present between the basic sound perception, speech production, self-esteem, activity, and social interactions subdomain scores and the HHI-Adult scores. Patients with post-lingual onset of hearing loss had significantly better results than those with pre-lingual onset, in the advanced sound perception subdomain. In addition, bilateral cochlear implant users had better results than the unilateral and bimodal users in the speech production subdomain and then the bimodal users in the self-esteem subdomain. There was no effect of age, duration of implant use, age at implantation, and the daily usage of cochlear implant (CI) on the quality-of-life outcomes. Conclusion The Tr-NCIQ is a reliable and valid tool to evaluate the subjective quality of life in CI users. In addition, as a standardized instrument, it can be easily self-administered both in clinical practice and for research purposes.Item The reliability and validity of the Turkish version of the oxford shoulder instability score(2020) Sonmezer, Emel; Yosmaoglu, Hayri Baran; Dogan, Celal Deha; 0000-0001-7356-8500; 30326748Background: The aim of this study was to adapt the Oxford Shoulder Instability Score to Turkish culture and test its reliability and validity. Methods: This study included 118 patients with shoulder instability. Confirmatory factor analyses, and correlation coefficient between Oxford Shoulder Instability Score and Short Form 36 were calculated in order to test construct validity. Internal consistency was tested using Cronbach's alpha. Pearson correlation were calculated to test reliability. Differential item functioning analysis was performed to detect whether items exhibited differences according to gender. Results: Confirmatory factor analysis indicating the single structure of the Oxford Shoulder Instability Score was confirmed. Cronbach's alpha was calculated as 0.87 for the whole scale. There were positive and strong correlations between the first and follow-up assessments (r = 0.86, p < 0.01). The Turkish version of OSIS showed moderate and significant correlations with domains of the SF-36 in general. Results also showed that there was no item exhibiting differential item functioning analysis in the Turkish version of Oxford Shoulder Instability Score. Conclusion: The Turkish version of the Oxford Shoulder Instability Score is a reliable, valid, reproducible and practical tool. It can be used for patients with shoulder disorders and is recommended for clinical use.Item Neuropsychological Changes and Health-related Quality of Life in Patients with Asymptomatic Primary Hyperparathyroidism(2017) Iyidir, Ozlem Turhan; Yilmaz, Banu Aktas; Toruner, Fusun Balos; Degertekin, Ceylan Konca; Kaya, Burhaneddin; Cakir, Nuri; 0000-0001-5305-6807; K-7904-2019Purpose: Data about neuropsychological impairment and health-related quality of life (HRQOL) in patients with asymptomatic primary hyperparathyroidism (APHPT) is limited. We aimed to investigate the HRQOL, neuropyschological impairment, including depression, anxiety in patients with APHPT who have mildly elevated serum calcium (Ca) levels. Material and Method: Thirty-seven patients with APHPT and 37 controls were included. The Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), and the General Health Questionnaire were administered in all patients, HRQOL was investigated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Results: Serum levels of Ca and parathyroid hormone (PTH) were significantly higher in patients than in controls [(10.92 +/- 0.66 vs. 9.49 +/- 0.66, p= 0.016, and 133 (34-736) vs. 52.95 (25-75.50), p< 0.001), respectively]. The levels of serum vitamin D were lower in patients than in controls [12.85 (4.0-62.50) vs. 20.30 (5.90-55.00), p= 0.041)]. The patient group had higher BDI scores than controls (12.49 +/- 10.34 vs. 7.46 +/- 5.33, p= 0.011). Patients with APHPT showed lower scores in SF-36 mental health (60.55 +/- 20.75 vs. 69.62 +/- 14.31, p= 0.034), SF-36 physical functioning (55.83 +/- 27.30 vs. 75.67 +/- 24.18, p= 0.002), SF-36 social functioning (66.32 +/- 27.69 vs. 82.08 +/- 14.89, p= 0.003), and SF-36 emotional role functioning (42.55 +/- 37.85 vs. 69.30 +/- 35.43, p= 0.003). The patients showed higher STAI-1 scores (39.95 +/- 11.52 vs. 34.70 +/- 8.01, p= 0.026). We observed that STAI-1 score positively correlated with serum Ca level (r= 0.391; p= 0.018); and PTH (r= 0.341; p= 0.042). Discussion: Our study demonstrated that patients with APHPT have more depressive and anxiety symptoms and lower HRQOL. Our results suggest that HRQOL and neuropsychological changes should also be considered during the clinical follow-up of patients with APHT.