***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the responsiveness and minimal important change ( MIC ) of Evaluation of Ankylosing Spondylitis Quality of Life ( EASi-QoL ) , a reliable and valid patient-reported measure of AS-specific quality of life with four domains : physical function ( PF ) , disease activity ( DA ) , emotional well-being ( EWB ) and social participation ( SP ) . METHODS A total of 1000 UK AS patients received a postal question naire including EASi-QoL. Comparative responsiveness of EASi-QoL was assessed against measures reflecting similar health domains in patients self-reporting an improvement in their AS-specific health at 6 months on a health transition question . Effect size ( ES ) statistics were calculated for all measures and MIC was determined for EASi-QoL. Comparative responsiveness was determined in a r and omized trial of AS patients receiving etanercept ( ETN ) 50 mg weekly or SSZ 3 g daily . RESULTS Of 470 patients , 80 responding at 6 months reported health improvement . Responsiveness ( ES ) for EASi-QoL domains was superior or similar to comparator measures : DA 0.72 vs BASDAI 0.58 ; SP 0.52 vs SF-36 social functioning 0.29 ; PF 0.32 vs BASFI 0.28 and SF-36 PF 0.24 ; EWB 0.40 vs HADS-anxiety 0.13 , HADS-depression 0.21 and SF-36 mental health 0.35 . ES for the ASQoL was 0.40 . Superior ES was seen in those improving somewhat . In the r and omized trial , all EASi-QoL domains had superior responsiveness to comparator measures following ETN treatment . Following SSZ treatment , all EASi-QoL domains were highly responsive , but BASDAI and BASFI was more responsive than EASi-QoL(DA ) and ( PF ) , respectively . CONCLUSION In patients reporting improvement during routine clinical practice or following treatment with ETN or SSZ , EASi-QoL domains have superior or comparable responsiveness than comparable measures Objective : To investigate in ankylosing spondylitis ( AS ) whether the newly developed World Health Organisation Disability Assessment Schedule II ( WHODAS II ) is a useful instrument for measuring disability , to assess its responsiveness in relation to other traditional disease specific instruments , and to identify factors that are associated with both short term and long term scores on the WHODAS II . Methods : Patients with AS from a r and omised controlled trial assessing the efficacy of spa treatment ( n=117 ) and from a five year longitudinal observational study ( n=97 ) participated . The patients completed several question naires , including the WHODAS II . After a three week course of spa treatment , 31 patients again completed all question naires to assess responsiveness . To determine to what degree the WHODAS II reflects some AS oriented measures on disease activity , functioning , and quality of life , correlation coefficients between the WHODAS II and these other question naires were calculated . Responsiveness was calculated by the effect size ( ES ) and st and ardised response mean ( SRM ) . Linear regression analysis was performed to explore which factors might be associated with short term changes on the WHODAS II and to investigate ( in the observational study ) which factors of WHODAS II might predict disability five years later . Results : Mean score on the WHODAS II was 23.9 ( SD 15.5 ( range 0.0−76.1 ) ) . Scores on the WHODAS II were significantly correlated with all disease specific question naires measured ( all p<0.001 ) . The WHODAS II showed a comparable short term responsiveness score ( SRM 0.41 ; ES 0.39 ) . In regression analysis these short term changes on the WHODAS II were significantly associated with changes in functioning ( β coefficient 4.25 , 95 % confidence interval ( 95 % CI ) 1.24 to 7.26 , p=0.007 ) . In the observational study , disease activity ( β coefficient 0.35 , 95 % CI 0.17 to 0.53 , p<0.000 ) as well as functioning ( β coefficient 0.23 , 95 % CI 0.09 to 0.38 , p=0.002 ) seemed to significantly predict disability ( WHODAS II ) after five years . Conclusion : The WHODAS II is a useful instrument for measuring  disability in AS in that it accurately reflects disease specific instruments and that it shows similar responsiveness scores . In AS , a short term change on the WHODAS II is associated with a change in physical function . At the group level , disease activity and physical functioning may predict disability after five years Abstract Ankylosing spondylitis ( AS ) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability . Aquatic ( water-based ) exercise may have a beneficial effect in various musculoskeletal conditions . The aim of this study was to compare the effectiveness of aquatic exercise interventions with l and -based exercises ( home-based exercise ) in the treatment of AS . Patients with AS were r and omly assigned to receive either home-based exercise or aquatic exercise treatment protocol . Home-based exercise program was demonstrated by a physiotherapist on one occasion and then , exercise manual booklet was given to all patients in this group . Aquatic exercise program consisted of 20 sessions , 5 × per week for 4 weeks in a swimming pool at 32–33 ° C . All the patients in both groups were assessed for pain , spinal mobility , disease activity , disability , and quality of life . Evaluations were performed before treatment ( week 0 ) and after treatment ( week 4 and week 12 ) . The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test . Paired t test was used for comparison of pre- and posttreatment values within groups . A total of 69 patients with AS were included in this study . We observed significant improvements for all parameters [ pain score ( VAS ) visual analog scale , lumbar flexion/extension , modified Schober test , chest expansion , bath AS functional index , bath AS metrology index , bath AS disease activity index , and short form-36 ( SF-36 ) ] in both groups after treatment at week 4 and week 12 ( p < 0.05 ) . Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS ( p < 0.001 ) and bodily pain ( p < 0.001 ) , general health ( p < 0.001 ) , vitality ( p < 0.001 ) , social functioning ( p < 0.001 ) , role limitations due to emotional problems ( p < 0.001 ) , and general mental health ( p < 0.001 ) subparts of SF-36 were better in aquatic exercise group . It is concluded that a water-based exercises produced better improvement in pain score and quality of life of the patients with AS compared with home-based exercise OBJECTIVE The objective of the EPISER study was to estimate the prevalence of rheumatoid arthritis ( RA ) , low back pain , h and and knee osteoarthritis ( OA ) , and fibromyalgia in the adult Spanish population , and to assess the impact of these diseases on function and quality of life , and use of health and social re sources . METHODS 2998 subjects aged 20 years or above were r and omly selected by stratified multistage cluster sampling from the censuses of 20 municipalities .  Trained rheumatologists carried out structured visits at which subjects were asked about rheumatic symptoms and sociodemographic characteristics , completed vali date d instruments for measuring function ( HAQ ) and  quality of life  ( SF-12 ) , and underwent a st and ardised physical examination . Cases were defined by previously vali date d criteria . RESULTS The estimated prevalences with 95 % confidence intervals were as follows : RA lifetime cumulative : 0.5 % ( 0.3 to 0.9 ) ; low back pain : 14.8 % ( 12.2 to 17.4 ) ; symptomatic knee OA : 10.2 % ( 8.5 to 11.9 ) ; h and OA : 6.2 % ( 5.9 to 6.5 ) ; fibromyalgia : 2.4 % ( 1.5 to 3.2 ) . Most conditions significantly impaired function and quality of life . CONCLUSIONS The EPISER study has internal and external validity for application of the results to the adult Spanish population . The diseases studied affect a significant proportion of the population , with various degrees of impact on disability and quality of life result ing in a significant number of physician visits , work disability , and medication use OBJECTIVE To identify risk factors for functional limitations in patients with ankylosing spondylitis ( AS ) of at least 20 years ' duration . METHODS Patients with AS for > or = 20 years were enrolled in the cross-sectional component of the Prospect i ve Study of Outcomes in AS . All patients had clinical evaluations and completed question naires on functional limitations and potential risk factors . Functional limitations were assessed using the Bath Ankylosing Spondylitis Functional Index ( BASFI ; score range 0 - 100 , higher scores indicate more limitations ) and the  Health Assessment Question naire for the Spondylarthropathies ( HAQS )  . Risk factors included demographic characteristics , duration of AS , smoking status , number of comorbid medical conditions , recalled level of recreational activity in teens and twenties , occupational physical activity throughout life ( rated 1 = little , 2 = moderate , 3 = heavy , and weighted by the number of years in each job ) , and history of AS in a first-degree relative . RESULTS The 326 patients ( 74 % men ) had a mean + /- SD age of 55.0 + /- 10.7 years , a mean duration of AS symptoms of 31.7 + /- 10.2 years , and a mean BASFI score of 40.7 + /- 25.6 . BASFI scores increased with higher lifetime occupational physical activity ( r = 0.31 ; P < 0.0001 ) , the number of comorbid conditions ( r = 0.25 ; P < 0.0001 ) , and the duration of AS ( r = 0.12 ; P = 0.04 ) . BASFI scores were higher among current smokers compared with former/nonsmokers ( 55.5 versus 38.9 ; P = 0.0002 ) , and among nonwhites compared with whites ( 49.9 versus 39.3 ; P = 0.02 ) . In multivariable analyses , lifetime occupational physical activity , current smoking , education level , number of comorbid conditions , and family history were significantly associated with BASFI scores . The same risk factors were associated with the HAQS . CONCLUSION Functional limitations in patients with AS for > /=20 years are greater among those with a history of more physically dem and ing jobs , more comorbid conditions , and among smokers , and are less severe among those with higher levels of education and a family history of AS Background We evaluated the psychometric characteristics of the Short Form 36 ( SF-36 ) Health Survey and the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue subscale in patients with ankylosing spondylitis ( AS ) . Methods We analyzed clinical and patient-reported outcome ( PRO ) data collected during 12-week , double-blind , placebo-controlled periods of two r and omized controlled trials comparing adalimumab and placebo for the treatment of active AS . The Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Functional Index , and other clinical measures were collected during the clinical trial . We evaluated internal consistency/reliability , construct validity , and responsiveness to change for the SF-36 and FACIT-Fatigue . Results The SF-36 ( Cronbach alpha , 0.74 - 0.92 ) and FACIT-Fatigue ( Cronbach alpha , 0.82 - 0.86 ) both had good internal consistency/reliability . At baseline , SF-36 and FACIT-Fatigue scores correlated significantly with Ankylosing Spondylitis Quality of Life scores ( r = -0.36 to -0.66 and r = -0.70 , respectively ; all p < 0.0001 ) . SF-36 scores varied by indicators of clinical severity , with greater impairment observed for more severe degrees of clinical activity ( all p < 0.0001 ) . FACIT-Fatigue scores correlated significantly with SF-36 scores ( r = 0.42 to 0.74 ; all p < 0.0001 ) and varied by clinical severity ( p < 0.05 to p < 0.0001 ) . Conclusions The SF-36 is a reliable , valid , and responsive measure of health-related quality of life and the FACIT-Fatigue is a brief and psychometrically sound measure of the effects of fatigue on patients with AS . These PROs may be useful in evaluating effectiveness of new treatments for AS.Trial Registration Clinical Trials.gov : NCT00085644 and OBJECTIVES --To gain population norms for the short form 36 health survey question naire ( SF36 ) in a large community sample and to explore the question naire 's internal consistency and validity . DESIGN --Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness . SETTING --The sample was drawn from computerised registers of the family health services authorities for Berkshire , Buckinghamshire , Northamptonshire , and Oxfordshire . SAMPLE --13,042 r and omly selected subjects aged 18 - 64 years . MAIN OUTCOME MEASURE 
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Besides , the physical component summary was lower than the mental component summary .
BASDAI and BASFI were negatively associated with some domains of the SF-36 significantly .
Patients with AS had a substantial impaired HRQoL in comparison with the general population .
Conclusions AS could adversely affect the HRQoL of patients .