Determinants of functional performance in long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD).
This study examined factors accounting for functional performance limitations in 100 long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD). Functional performance, measured by the SF-36 physical component summary score, was substantially lower (mean=36.8+/-10.7) than the US population norm of 50 (P<0.001). The most severe decrements were in physical function (mean=38.8+/-10.9) and physical role function (mean=37.88+/-11.88); 68% of respondents exceeded the five-point threshold of minimum clinically important difference below the norm on these subscales. Controlling for age and gender, six variables explained 56% of the variance in functional performance: time since cGVHD diagnosis, cGVHD severity, intensity of immunosuppression, comorbidity, functional capacity (distance walked in 2 min, grip strength, and range of motion), and cGVHD symptom bother (F=11.26; P<0.001). Significant independent predictors of impaired performance were intensive systemic immunosuppression, reduced capacity for ambulation, and greater cGVHD symptom bother (P<0.05). Symptom bother had a direct effect on functional performance, as well as an indirect effect partially mediated by functional capacity (Sobel test, P=0.004). Results suggest two possible mechanisms underlying impaired functional performance in survivors with cGVHD and underscore the importance of testing interventions to enhance functional capacity and reduce symptom bother.
Mitchell
S A
SA
Nursing Research, Clinical Center, National Institutes of Health, Bethesda, MD 20852, USA. mitchlls@mail.nih.gov
Leidy
N Kline
NK
Mooney
K H
KH
Dudley
W N
WN
Beck
S L
SL
LaStayo
P C
PC
Cowen
E W
EW
Palit
P
P
Comis
L E
LE
Krumlauf
M C
MC
Avila
D N
DN
Atlam
N
N
Fowler
D H
DH
Pavletic
S Z
SZ
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006086:Graft vs Host Disease / Q000503:physiopathology*; D018737:Hand Strength / Q000502:physiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D017741:Survivors; D014184:Transplantation, Homologous; D055815:Young Adult