title: The effects of spinal cord stimulation on quality of life in patients with therapeutically chronic refractory angina pectoris.
abstract: Objective. For patients with refractory angina pectoris, spinal cord stimulation (SCS) is a beneficial and safe adjuvant therapy. However, it has not yet been established whether SCS alters the quality of life (QoL) in these patients. Methods. In this study, 26 consecutive patients (age 61.3 ± 7.0 years, 13 females, angina duration 12.7 ± 6.0 years) were recruited. Social, mental, and physical aspects of QoL were determined by Nottingham Health Profile (NHP I), depression scale (CES-D), scoring of angina pectoris attacks and short-acting nitroglycerine intake, pain score on the Visual Analog Scale (VAS), perceived health percentage, Satisfaction With Life scale (SWLS), and one-aspect Linear Analog Self Assessment scale (LASA). QoL outcomes at baseline were compared with reference values from healthy subjects. Within-group changes and magnitude of changes (effect size, ES) were assessed after 3 months and 1 year of SCS. Results. Compared to healthy subjects, the patients had significantly worse scores at baseline on NHP, SWLS, and LASA. After 3 months of SCS, NHP I aspect pain (ES = 1.39), AP-score (ES = 0.85), perceived health percentage (ES =- 0.80), NTG-use (ES = 1.08) and VAS-score (ES = 1.13) were all significantly improved (p < 0.05). After 3 months, moderate changes were observed; however, they were not statistically significant on the NHP-aspects "emotion" (ES = 0.57) and "sleep" (ES = 0.56). At the 1-year follow-up, significant and substantial improvements were found on NHP-I aspects: pain, energy, emotional reactions, social isolation, sleep, and physical mobility (p < 0.05) with changes that can be interpreted as large (ES > 0.80). Conclusion. QoL in patients with refractory angina pectoris is poor. Both pain and health aspects of QoL improved significantly after 3 months of SCS. Social, mental, and physical aspects of QoL were found improved after 1 year of SCS.
authors.affiliation: Faculty of Medical Sciences, Departments of                    Cardiology,                    Rehabilitation/Physical Therapy, and                    Neurosurgery, University Hospital of Groningen, and                    Northern Center for Health Care Research, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.
authors.forename: N C
authors.initials: NC
authors.lastname: Vulink
authors.forename: D M
authors.initials: DM
authors.lastname: Overgaauw
authors.forename: G A
authors.initials: GA
authors.lastname: Jessurun
authors.forename: I A
authors.initials: IA
authors.lastname: Tenvaarwerk
authors.forename: T J
authors.initials: TJ
authors.lastname: Kropmans
authors.forename: C P
authors.initials: CP
authors.lastname: van der Schans
authors.forename: B
authors.initials: B
authors.lastname: Middel
authors.forename: M J
authors.initials: MJ
authors.lastname: Staal
authors.forename: M J
authors.initials: MJ
authors.lastname: Dejongste