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Yu M, Harrison M, Bansback N. Can prediction models for hospital readmission be improved by incorporating patient-reported outcome measures? A systematic review and narrative synthesis. Qual Life Res 2024; 33:1767-1779. [PMID: 38689165 DOI: 10.1007/s11136-024-03638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To investigate the roles, challenges, and implications of using patient-reported outcome measures (PROMs) in predicting the risk of hospital readmissions. METHODS We systematically searched four bibliometric databases for peer-reviewed studies published in English between 1 January 2000 and 15 June 2023 and used validated PROMs to predict readmission risks for adult populations. Reported studies were analysed and narratively synthesised in accordance with the CHARMS and PRISMA guidelines. RESULTS Of the 2858 abstracts reviewed, 23 studies met predefined eligibility criteria, representing diverse geographic regions and medical specialties. Among those, 19 identified the positive contributions of PROMs in predicting readmission risks. Seven studies utilised generic PROMs exclusively, eleven used generic and condition-specific PROMs, while 5 focussed solely on condition-specific PROMs. Logistic regression was the most used modelling approach, with 13 studies aiming at predicting 30-day all-cause readmission risks. The c-statistic, ranging from 0.54 to 0.84, was reported in 22/23 studies as a measure of model discrimination. Nine studies reported model calibration in addition to c-statistic. Thirteen studies detailed their approaches to dealing with missing data. CONCLUSION Our study highlights the potential of PROMs to enhance predictive accuracy in readmission models, while acknowledging the diversity in data collection methods, readmission definitions, and model evaluation approaches. Recognizing that PROMs serve various purposes beyond readmission reduction, our study supports routine data collection and strategic integration of PROMs in healthcare practices to improve patient outcomes. To facilitate comparative analysis and broaden the use of PROMs in the prediction framework, it is imperative to consider the methodological aspects involved.
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Affiliation(s)
- Maggie Yu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, BC, Canada.
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Dai L, Liu Z, Zhou W, Zhang L, Miao M, Wang L, Hua H, Wang B, Ji G. Sijunzi decoction, a classical Chinese herbal formula, improves fatigue symptoms with changes in gut microbiota in chronic fatigue syndrome: A randomized, double-blind, placebo-controlled, multi-center clinical trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 129:155636. [PMID: 38640860 DOI: 10.1016/j.phymed.2024.155636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUD Chronic fatigue syndrome (CFS) severely impact patients' quality of life and lacks well-acknowledged drug therapy. Sijunzi decoction (SJZD), a classical Chinese herbal formula, has been widely used for spleen deficiency syndrome like fatigue in China. However, there is a lack of evidence on the efficacy of SJZD in treating CFS. PURPOSE To evaluate the efficacy and safety of SJZD for CFS. STUDY DESIGN A multi-center, double-blinded, randomized controlled trial. METHODS Participants with definite diagnoses of CFS and spleen deficiency syndrome were randomly assigned in 1:1 ratio to receive SJZD or placebo granules for 2 months. The primary outcome was the change of Chalder fatigue questionnaire (CFQ) scoring after treatment. Other outcomes included changes in short form-36 physical function (SF36-PF) score, spleen deficiency scale score, Euroqol Questionnaire-Visual Analogue Scale (ED-VAS) score, and clinical global impression (CGI) evaluating by corresponding questionnaires. Fecal metagenome sequencing was conducted to explore the potential mechanism of SJZD effect. RESULTS From June 2020 to July 2021, 105 of 127 participants completed the study at four hospitals in China. After a 2-month treatment, intention-to-treat (ITT) analysis found participants who received SJZD had larger reduction than placebo control (mean change 6.65 [standard deviation (SD) 6.11] points vs. 5.31 [SD 5.19] points; difference 1.34, 95 % confidence interval [CI] -0.65 to 3.33). Per-protocol (PP) analysis reported confirmative results with a significant difference between SJZD and placebo groups (2.24, 95 % CI 0.10 to 4.39). SJZD also significantly improved overall health status compared with placebo in per-protocol population (p = 0.009). No significant difference was found between groups in changes of SF36-PF, spleen deficiency scale scoring, and CGI. Fecal metagenome sequencing and correlation analyses indicated that the beneficial effect of SJZD may be related to the abundance change of Pediococcus acidilactici. No serious adverse event or abnormal laboratory test was found during the whole study. CONCLUSION Our results indicated that SJZD can improve fatigue symptom and overall health status in patients with CFS under good medication adherence. Potential therapeutic effects may be related to the regulation of gut microbiota. Large-scale trials with longer intervention period are encouraged to further support SJZD's application. CLINICAL TRIAL REGISTRATION (ID, ISRCTN23930966, URL = https://www.isrctn.com/ISRCTN23930966).
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Affiliation(s)
- Liang Dai
- Institute of Digestive Disease, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China; Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen 518036, China
| | - Zhidong Liu
- Institute of Digestive Disease, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China; State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, China
| | - Wenjuan Zhou
- Institute of Digestive Disease, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China; State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, China
| | - Li Zhang
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Minjie Miao
- Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214413, China
| | - Lei Wang
- Shanghai Changning Tianshan Hospital of Traditional Chinese Medicine, Shanghai 200051, China
| | - Haibing Hua
- Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214413, China
| | - Bing Wang
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Guang Ji
- Institute of Digestive Disease, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China; State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, China.
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Siewertsen M, Näslund-Koch C, Duus Johansen J, Simonsen AB, Nguyen TT, Zachariae C, Skov L, Loft N. Psychological burden, anxiety, depression and quality of life in patients with hand eczema: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024. [PMID: 38808968 DOI: 10.1111/jdv.20140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/21/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Living with hand eczema (HE) has been associated with impaired quality of life (QoL), having anxiety and depression but the magnitude of association is not clear. OBJECTIVES The aim of this systematic review and meta-analysis was to determine the psychological burden in terms of anxiety, depression and quality of life in patients with HE. METHODS Several databases were systematically searched. Weighted means with standard deviation (SD) were calculated for disease severity, QoL, depression and/or anxiety scores among patients with HE. For studies presenting QoL, depression and/or anxiety scores in patients with HE and in controls the weighted means were compared with an unpaired t-test. In studies reporting Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI), the correlation between HECSI and DLQI was estimated using Spearman's rank correlation (rs). RESULTS In total, 81 studies encompassing 17,835 patients with HE and 31,541 controls were included. The weighted mean DLQI was 10.66 (SD 8.93) corresponding to a moderate-to-large effect on QoL and a strong correlation (rs: 0.76, 95% CI:0.56-0.87) between DLQI and HECSI was observed. The mean EQ-5D-VAS was significantly lower in patients with HE compared with controls (68.03 (SD 10.52) vs. 80.63 (SD 1.17), p < 0.00001). Patients with HE had higher mean HADS (Hospital Anxiety and Depression Scale) anxiety score (7.4 vs. 5.8, p = 0.0008) than controls but not higher HADS depression score (6.5 vs. 5.7, p = 0.32). Only one study assessed risk of anxiety, depression and suicidal ideation showing an increased odds of all diseases among patients with HE compared with controls. CONCLUSION Hand eczema has a moderate-to-severe impact on quality of life with a strong correlation between disease severity and impact on quality of life. Patients with hand eczema have an impact on QoL comparable to other chronic diseases when measured with generic QoL scoring systems.
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Affiliation(s)
- Mie Siewertsen
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Charlotte Näslund-Koch
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jeanne Duus Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Anne Birgitte Simonsen
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Thi Thao Nguyen
- Unit of Social Medicine, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Loft
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
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Durojaiye OC, Kritsotakis EI. Evaluation of health-related quality of life in patients receiving outpatient parenteral antimicrobial therapy (OPAT) in a UK setting. Expert Rev Anti Infect Ther 2024:1-9. [PMID: 38511820 DOI: 10.1080/14787210.2024.2334059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Studies assessing the benefits of outpatient parenteral antimicrobial therapy (OPAT) have paid less attention to patient-centered factors such as patients' experiences and their health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS Prospective before-and-after quasi-experimental study enrolled adult patients receiving OPAT at a tertiary hospital in Derbyshire, UK, between October 2022 and October 2023. Consenting patients completed paired EQ-5D-3 L questionnaires before OPAT initiation and upon completion of therapy or 30 days after its commencement (whichever occurred first). Changes and predictors of change in HRQoL indicators and associations with clinical outcomes (treatment failure, adverse events, and 30-day unplanned readmission) were examined. RESULTS Health state index and visual analogue scale (EQ VAS) scores of 162 enrolled patients at baseline were significantly lower than the UK population averages, but the patients experienced significant improvements in both scores and in four EQ-5D dimensions (mobility, self-care, usual activities, and pain/discomfort). Baseline health index and EQ VAS scores were significant independent predictors of positive changes in HRQoL scores. CONCLUSIONS OPAT is associated with improved patient-reported quality of life and facilitates early return to work or school. Nevertheless, it is crucial to closely monitor patients with a lower baseline quality of life to optimize their overall OPAT experience.
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Affiliation(s)
- Oyewole Christopher Durojaiye
- Department of Microbiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
- Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Evangelos I Kritsotakis
- School of Medicine and Population Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
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Xu RH, Sun R, Tian L, Cheung AWL, Wong EL. Health-related quality of life in primary care patients: a comparison between EQ-5D-5L utility score and EQ-visual analogue scale. Health Qual Life Outcomes 2024; 22:2. [PMID: 38172916 PMCID: PMC10765691 DOI: 10.1186/s12955-023-02215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The EQ-VAS is an important component of the EQ-5D questionnaire. However, there is limited evidence comparing its performance to the EQ-5D utility score, which restricts its use in the population. This study aimed to EQ-5D-5L utility score and EQ-visual analogue scale (EQ-VAS) in primary care patients in Hong Kong (HK). METHODS Secondary data analysis was performed on the data collected from a cross-sectional survey to investigate patient engagement in HK. Participants were recruited through random sampling from a single general outpatient clinic. Trained investigators conducted face-to-face interviews with all eligible patients attending the clinic. Patients who were: 1) ≥ 18 years old, 2) have visited the clinic at least once in the last 6 months, 3) no cognitive problems, and 4) can speak and understand the local language. Pearson correlation was used to explore the association between EQ-5D utility and EQ-VAS score. Ordinary least squares regression and heteroscedastic Tobit regression models were adopted to analyze the EQ-VAS and EQ-5D utility data, respectively. RESULTS The analysis included data from 1,004 responses (response rate = 65%). Around 52.7% of participants were female, 25.9% completed tertiary or above education, and 75.1% living with chronic disease. The mean EQ-5D utility and EQ-VAS score were 0.92 (SD = 0.13) and 72.27 (SD = 14.69), respectively. A significant association was found between EQ-5D utility and EQ-VAS score, with coefficients ranging from 0.335 (participants who divorced) to 0.744 (participants living alone). Around 98.5% reported having no problems with 'Self-care', followed by 'Usual activities' (96.3%), 'Mobility' (91.5%) and 'Anxiety/depression' (79.9%). The correlation between EQ-VAS score and EQ-5D utility was positive for each dimension of the EQ-5D instrument (correlation coefficients ranged between 0.211 and 0.623). Age strongly influenced the magnitude and trajectory of EQ-VAS score and utility, as observed in the changes. The regression model showed that 'Mobility', 'Pain/discomfort', and 'Anxiety/depression' have considerable influence on EQ-VAS score. CONCLUSIONS This study compared the EQ-5D utility score and EQ-VAS in HK primary care setting. Although heterogeneity existed, the EQ-VAS and utility score are significantly correlated and reliable for evaluating health-related quality of life in this population.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China.
| | - Ruiqi Sun
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Lidan Tian
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Annie Wai-Ling Cheung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza Laiyi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Taroza S, Burkauskas J, Mickuviene N, Kazukauskiene N, Podlipskyte A. Psychometrics and validation of the EQ-5D-5L instrument in individuals with ischemic stroke in Lithuania. Front Psychol 2023; 14:1284859. [PMID: 38125861 PMCID: PMC10731357 DOI: 10.3389/fpsyg.2023.1284859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background Experiencing stroke is associated with deterioration in health-related quality of life (HRQL). One of the generic tools used for HRQL assessment is the EuroQol instrument of five dimensions and five levels (EQ-5D-5L), which has not yet been validated in Lithuania. This study aimed to evaluate validity, reliability, and factor structure of the EQ-5D-5L instrument in a sample of Lithuanian individuals at the end of the first week after experiencing ischemic stroke (IS). Methods The study had a cross-sectional design, including 134 individuals [61.9% men and 38.1% women; median (IQR) age was 66 years (59-73) years, in the final analysis]. Alongside the EQ-5D-5L, psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Assessment-7 (GAD-7); neurological impairment with the National Institutes of Health Stroke Scale (NIHSS); and functional independence with the Barthel index (BI). Confirmatory factor analysis (CFA) was performed for validation of the factor structure. Results The internal consistency of the EQ-5D-5L instrument was 0.81. A significant ceiling effect (17.2%) of the descriptive part of the EQ-5D-5L was detected. The convergent validity of the EQ-5D-5L descriptive system was confirmed, with significant correlations with the other scales used, except for the visual analog scale. The two-factor ("physical" and "emotional") model was confirmed by CFA, with acceptable fit [root mean square error of approximation (RMSEA) = 0.045, RMSEA 90% CI = 0.000-0.145; comparative fit indices (CFI) = 0.996; non-normal fit index (NFI) = 0.983; Tucker-Lewis Index (TLI) = 0.936; χ2/df = 1.27)]. Conclusion This study provides information on the psychometric properties of the EQ-5D-5L instrument in Lithuanian individuals, showing that the EQ-5D-5L descriptive system is a reliable and valid tool for HRQL assessment. The Lithuanian version of the descriptive part of the EQ-5D-5L instrument is best expressed as a two-factor model, estimating the physical and emotional dimensions of HRQL in individuals who have experienced IS.
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Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
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Silveira Bianchim M, Crane E, Jones A, Neukirchinger B, Roberts G, Mclaughlin L, Noyes J. The implementation, use and impact of patient reported outcome measures in value-based healthcare programmes: A scoping review. PLoS One 2023; 18:e0290976. [PMID: 38055759 DOI: 10.1371/journal.pone.0290976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/08/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Value-Based Healthcare (VBHC) focuses on the value of patient outcomes and is achieved by ensuring resources already available are managed to realise the best possible individual and population health outcomes. Patient reported outcome measures (PROMs) measure the impact of illnesses from the patient perspective. We conducted a scoping review to understand how PROMs were implemented and used, and their impact in the context of VBHC. METHODS Arksey and O'Malley's overarching framework supplemented by principles from mixed-methods Framework Synthesis were used. CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, Web of Science, Google Scholar and reference lists were searched. An a priori data extraction framework was created using the review question and objectives as key domains against which to extract data. Mixed-methods data were organised, integrated and preserved in original format and reported for each domain. RESULTS Forty-three studies were included with 60,200 participants. Few studies reported a well-developed programme theory and we found little robust evidence of effect. PROMs were universally considered to have the potential to increase patient satisfaction with treatment and services, enhance patient awareness of symptoms and self-management, and improve health outcomes such as quality of life and global health status. Evidence is currently limited on how PROMs work and how best to optimally implement PROMs to achieve the target outcome. Implementation challenges commonly prevented the realisation of optimal outcomes and patients generally needed better and clearer communication about why PROMs were being given and how they could optimally be used to support their own self-management. CONCLUSION PROMSs have yet to demonstrate their full potential in a VBHC context. Optimal PROMs implementation is poorly understood by clinicians and patients. Future studies should explore different models of PROM implementation and use within VBHC programmes to understand what works best and why for each specific context, condition, and population.
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Affiliation(s)
| | - Ellie Crane
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Anwen Jones
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | | | - Gareth Roberts
- Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Leah Mclaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
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Short H, Al Sayah F, Churchill K, Keogh E, Warner L, Ohinmaa A, Johnson JA. The use of EQ-5D-5L as a patient-reported outcome measure in evaluating community rehabilitation services in Alberta, Canada. Health Qual Life Outcomes 2023; 21:125. [PMID: 37978502 PMCID: PMC10657124 DOI: 10.1186/s12955-023-02207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The purpose of this study was to describe the characteristics and health-related quality of life (HRQL) of patients accessing community rehabilitation services in Alberta, Canada, using routinely collected EQ-5D-5L data, and explore factors associated with the impact of these services. METHODS A retrospective, longitudinal, observational design was used. Patients completed the EQ-5D-5L and demographic questions at intake and end of rehabilitation care. Change in EQ-5D-5L dimensions from intake until end of rehabilitation was examined using the Pareto Classification of Health Change. Change scores were calculated for the EQ-5D-5L index, VAS, and total sum scores. Change groups in the EQ-5D-5L index and VAS scores, were defined by minimally important differences of 0.04 and 7.0, respectively. One level change was considered important for the total sum score. Effect size of the change in index, VAS, and total sum scores was also examined. Chi-squared tests were conducted to examine whether change in EQ-5D-5L varied by age, gender, region, and having anxiety/depression at intake. RESULTS Three service programs were examined; pulmonary rehabilitation (n = 542), group-based community exercise (n = 463), and physiotherapy for bone and joint care (n = 391). At intake, HRQL in all programs was lower than that of the general Alberta population norms and improved by end of rehabilitation. The mean (SD) change in index, VAS, and total sum scores were 0.02 (0.13), 6.0 (18.3), and - 0.5 (2.4) in pulmonary rehabilitation, 0.06 (0.13), 6.6 (18.7), - 1.2 (2.4) in community exercise, and 0.13 (0.16), 1.2 (0.9), and - 2.8 (2.8) in physiotherapy, respectively. Based on change of the index score, 24% deteriorated, 38% improved, and 38% had no change in pulmonary rehabilitation; 17% deteriorated, 51% improved, and 32% had no change in community exercise; 5% deteriorated, 72% improved, and 23% had no change in physiotherapy. Similar trends were seen in the VAS and total sum scores. Older age, urban region, and having anxiety/depression at intake were associated with positive change in EQ-5D-5L. CONCLUSIONS The results of this study are intended to inform program/service level decisions by describing the characteristics and HRQL of patients accessing community rehabilitation, as well as the predictors of change in health status, which will help direct future program growth and service changes.
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Affiliation(s)
- Hilary Short
- School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Katie Churchill
- Department of Rehabilitation Medicine, Allied Health Professional Practice and Education, Alberta Health Services, Edmonton, AB, Canada
| | - Eileen Keogh
- Allied Health Professional Practice and Education, Alberta Health Services, Suite 300, 10216 - 124 Street, Edmonton, AB, T5N 4A3, Canada
| | - Lisa Warner
- Allied Health Professional Practice and Education, Alberta Health Services, Calgary, AB, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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Färber G, Marx J, Scherag A, Saqer I, Diab M, Sponholz C, Doenst T. Risk stratification for isolated tricuspid valve surgery assisted using the Model for End-Stage Liver Disease score. J Thorac Cardiovasc Surg 2023; 166:1433-1441.e1. [PMID: 35431033 DOI: 10.1016/j.jtcvs.2021.11.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Isolated tricuspid valve surgery is perceived as high-risk. This perception is nurtured by patients who often present with substantial liver dysfunction, which is inappropriately reflected in current surgical risk scores (eg, the Society of Thoracic Surgeons [STS] score has no specific tricuspid model). The Model for End-Stage Liver Disease (MELD) has was developed as a measure for the severity of liver dysfunction. We report scores and outcomes for our patient population. METHODS We calculated STS, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (ESII), and MELD scores for all of our patients who received isolated tricuspid valve surgery between 2011 and 2020 (n = 157). We determined the MELD score, stratified patients into 3 groups (MELD <10: low, n = 53; 10 to <20: intermediate, n = 78; ≥20: high, n = 26) and describe associated outcomes. RESULTS Patients were 72 ± 10 years old and 43% were male. Mean STS score was 4.9 ± 3.5% and ESII was 7.2 ± 6.6%. Mortality was 8.9% at 30 days and 65% at latest follow-up (95% CI, 51%-76%). Median follow-up was 4.4 years (range, 0-9.7 years). Although ESII and STS score accurately predicted 30-day mortality at low MELD scores (observed to expected [O/E] for ESII score = 0.8 and O/E for STS score = 1.0) and intermediate MELD (O/E for ESII score = 0.7, O/E for STS score = 1.0), mortality was underestimated at high MELD (O/E for ESII score = 3.0, O/E for STS score = 4.7). This subgroup also had higher incidence of new-onset hemodialysis. Besides MELD category, recent congestive heart failure, endocarditis, and hemodialysis were also associated with 30-day mortality. CONCLUSIONS For isolated tricuspid valve regurgitation, classic surgical risk stratification with STS or ESII scores failed to predict perioperative mortality if there was evidence of severe liver dysfunction. Preoperative MELD assessment might be useful to assist in proper risk assessment for isolated tricuspid valve surgery.
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Affiliation(s)
- Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Jonas Marx
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences (IMSID), Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ibrahim Saqer
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Critical Care Medicine, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Gustafsson K, Kvist J, Eriksson M, Rolfson O. What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA? A Register-based Study. Clin Orthop Relat Res 2023; 481:1732-1742. [PMID: 37159269 PMCID: PMC10427049 DOI: 10.1097/corr.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Some patients report long-term pain or no improvement in health-related quality of life (HRQoL) or are dissatisfied after THA. However, factors associated with these poorer patient-reported outcomes after surgery are inconsistent and have typically been studied in the late phase of hip osteoarthritis (OA) among patients already eligible for surgery. Earlier identification of risk factors would provide time to address modifiable factors, helping to improve patients' pain, HRQoL, and satisfaction after surgery and reduce the burden on orthopaedic clinics by referring patients who are better prepared for surgery. QUESTIONS/PURPOSES We analyzed data from patients with hip OA referred to a first-line OA intervention program in primary healthcare at a stage when they had not been referred for THA, and asked: (1) What percentage of patients who proceed to THA report lack of improvement in pain, lack of improvement in HRQoL as measured by the EQ-5D, or are not satisfied with surgery 1 year after THA? (2) What associations exist between baseline factors at referral to this first-line OA intervention program and these poorer patient-reported outcomes 1 year after THA? METHODS We included 3411 patients with hip OA (mean age 67 ± 9 years, 63% [2160 of 3411] women) who had been referred for first-line OA interventions between 2008 and 2015 and subsequently underwent THA for OA. All patients were initially identified through the Swedish Osteoarthritis Register, which follows and evaluates patients in a standardized national first-line OA intervention program. Then, we identified those who were also registered in the Swedish Arthroplasty Register with a THA during the study period. We included only those with complete patient-reported outcome measures for pain, HRQoL, and satisfaction preoperatively and 1-year postoperatively, representing 78% (3411 of 4368) of patients, who had the same baseline characteristics as nonrespondents. Multiple logistic regression was used to assess the associations between 14 baseline factors and the aforementioned patient-reported outcomes of pain, HRQoL, and satisfaction 1 year after THA, adjusted for all included factors. RESULTS Five percent (156 of 3411) of the study population lacked improvement in pain, 11% (385 of 3411) reported no improvement in HRQoL, and 10% (339 of 3411) reported they were not satisfied with surgery 1 year after THA. Charnley Class C (multiple-joint OA or another condition that affects the ability to walk) was associated with all outcomes: lack of improvement in pain (OR 1.84 [95% CI 1.24 to 2.71]; p = 0.002), lack of improvement in HRQoL (OR 1.83 [95% CI 1.42 to 2.36]; p < 0.001), and not being satisfied (OR 1.40 [95% CI 1.07 to 1.82]; p = 0.01). Older age was associated with a lack of improvement in pain (OR per year 1.03 [95% CI 1.01 to 1.05]; p = 0.02), lack of improvement in HRQoL (OR per year 1.04 [95% CI 1.03 to 1.06]; p < 0.001), and not being satisfied (OR per year 1.03 [95% CI 1.01 to 1.05]; p < 0.001). Depression was associated with a lack of improvement in pain (OR 1.54 [95% CI 1.00 to 2.35]; p = 0.050) and with not being satisfied (OR 1.50 [95% CI 1.11 to 2.04]; p = 0.01) but not with a lack of improvement in HRQoL (OR 1.04 [95% CI 0.76 to 1.43]; p = 0.79). Having four or more comorbidities was associated with a lack of improvement in HRQoL (OR 2.08 [95% CI 1.39 to 3.10]; p < 0.001) but not with a lack of improvement in pain and not being satisfied. CONCLUSION The results of this study showed that older age, Charley Class C, and depression in patients with first-line OA interventions were risk factors associated with poorer outcomes regarding pain, HRQoL, and satisfaction after THA. Screening patients with hip OA for depression early in the disease course would provide increased time to optimize treatments and may contribute to better patient-reported pain, HRQoL, and satisfaction after future THA. Further research should focus on identifying the optimal time for surgery in patients with depression, as well as what targeted interventions for depression can improve outcome of surgery in these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Kristin Gustafsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Marit Eriksson
- Futurum - the Academy for Health and Care, Region Jönköping County, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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McFarland AM, Manoukian S, Mason H, Reilly JS. Impact of surgical-site infection on health utility values: a meta-analysis. Br J Surg 2023:7193941. [PMID: 37303251 PMCID: PMC10361680 DOI: 10.1093/bjs/znad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/25/2023] [Accepted: 04/29/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Surgical-site infections (SSIs) are recognized as negatively affecting patient quality of life. No meta-analysis of SSI utility values is available in the literature to inform estimates of this burden and investment decisions in prevention. METHODS A systematic search of PubMed, MEDLINE, CINAHL, and the National Health Service Economic Evaluation Database was performed in April 2022 in accordance with PROSPERO registration CRD 42021262633. Studies were included where quality-of-life data were gathered from adults undergoing surgery, and such data were presented for those with and without an SSI at similar time points. Two researchers undertook data extraction and quality appraisal independently, with a third as arbiter. Utility values were converted to EuroQol 5D (EQ-5D™) estimates. Meta-analyses were conducted using a random-effects model across all relevant studies, with subgroup analyses on type and timing of the SSI. RESULTS In total, 15 studies with 2817 patients met the inclusion criteria. Six studies across seven time points were used in the meta-analysis. The pooled mean difference in EQ-5D™ utility in all studies combined was -0.08 (95 per cent c.i. -0.11 to -0.05; prediction interval -0.16 to -0.01; I2 = 40 per cent). The mean difference in EQ-5D™ utility associated with deep SSI was -0.10 (95 per cent c.i. -0.14 to -0.06; I2 = 0 per cent) and the mean difference in EQ-5D™ utility persisted over time. CONCLUSION The present study provides the first synthesized estimate of SSI burden over the short and long term. EQ-5D™ utility estimates for a range of SSIs are essential for infection prevention planning and future economic modelling.
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Affiliation(s)
- Agi M McFarland
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Sarkis Manoukian
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Glasgow Caledonian University Yunus Centre for Social Business, Glasgow
| | - Helen Mason
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Glasgow Caledonian University Yunus Centre for Social Business, Glasgow
| | - Jacqui S Reilly
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Health and Safeguarding Health through Infection Prevention (SHIP) Research Group, Glasgow
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13
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Cai Q, Fu K, Jia W, Li X, He H, Yao Z, Chen X, Dong Y, Wang Q, Kang B, Qian B, Chen S, Zhang C. In-hospital waiting time to surgery and functional outcomes in geriatric hip fractures: a directed acyclic graph-based preplanned analysis from a prospective multicenter cohort study. Int J Surg 2023; 109:1612-1619. [PMID: 37039039 PMCID: PMC10389213 DOI: 10.1097/js9.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The early recovery of hip function after hip fracture surgery values more attention, especially for patients with delayed surgery of longer than 48 h. We aim to evaluate the associations of in-hospital surgical waiting time with the functional outcomes [Harris Hip Score (HHS), Parker Mobility Score (PMS), and EuroQol 5 dimensions VAS (visual analogue scale) score (EQ-5D VAS)] in elderly patients who sustained hip fractures. MATERIALS AND METHODS Data on sociodemographic and clinical factors were prospectively collected using a multicenter hip fracture registry system. Participants in the cohort underwent a 12-month follow-up investigation. After adjusting potential confounders identified by the directed acyclic graphs, the associations between surgical waiting time longer than 48 h and functional outcomes were estimated by log-binomial regression and multivariable linear regression models with generalized estimating equations. RESULTS Of 863 survival participants with available functional data at 12 months after surgery, an increased risk was obtained from receiving surgery after 48 h and the poor functional outcomes (HHS<80: relative risk (RR)=1.56, 95% CI: 1.00-2.51; PMS<7: RR=1.49, 95% CI: 1.13-2.01; EQ-5D VAS<80: RR=1.97, 95% CI: 1.57-2.47). In-hospital waiting time greater than 48 h were time-invariantly associated with lower PMS during recovery (-0.44 units 95% CI: -0.70 to -0.18). In addition, delayed surgery was time-varying associated with HHS and EQ-5D VAS. CONCLUSIONS The associations between in-hospital waiting time and postoperative functional score suggest that delayed surgery can lead to poor functional outcomes, especially in patients waiting longer than 72 h from injury. Delayed surgery mainly impacted hip function and mobility recovery with a slower speed in early recovery of the first 3 months. More attention should be paid to mechanisms behind the associations between delayed surgery on general healthy status.
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Affiliation(s)
- Qianying Cai
- Department of Orthopedic Surgery, Shanghai Institute of Microsurgery on Extremities
| | - Kai Fu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Weitao Jia
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Xiaolin Li
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Haiyan He
- Department of Orthopedic Surgery, Shanghai Institute of Microsurgery on Extremities
| | - Zhenjun Yao
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University
| | - Xiaodong Chen
- Department of Orthopedic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Yuqi Dong
- Department of Orthopedics Trauma, Department of Orthopedics, Renji Hospital, School of Medicine
| | - Qiugen Wang
- Department of Trauma and Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University
| | - Bin Kang
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute, Shanghai Jiao Tong University School of Medicine
- Shanghai Clinical Research Promotion and Development Center, Shanghai Shen Kang Hospital Development Center, Shanghai
| | - Shengbao Chen
- Department of Orthopedic Surgery, Shanghai Institute of Microsurgery on Extremities
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
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14
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Xiao M, Kristensen SR, Marti J, Mossialos E. The impact of patient safety incidents during hip and knee replacements on patients' health related quality of life: a before and after study using longitudinal data linked to patient-reported outcome measures. Int J Surg 2023; 109:1085-1093. [PMID: 37026831 PMCID: PMC10389309 DOI: 10.1097/js9.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/30/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The burden of patient safety incidents (PSIs) is often characterized by their impact on mortality, morbidity, and treatment costs. Few studies have attempted to estimate the impact of PSIs on patients' health-related quality of life (HRQoL) and the studies that have made such estimates primarily focus on a narrow set of incidents. The aim of this paper is to estimate the impact of PSIs on HRQoL of patients undergoing elective hip and knee surgery in England. PATIENTS AND METHODS A unique linked longitudinal data set consisting of patient-reported outcome measures for patients with hip and knee replacements linked to Hospital Episode Statistics (HES) collected between 2013/14 and 2016/17 was examined. Patients with any of nine US Agency for Healthcare Research and Quality (AHRQ) PSI indicators were identified. HRQoL was measured using the general EuroQol five dimensions questionnaire (EQ-5D) before and after surgery. Exploiting the longitudinal structure of the data, exact matching was combined with difference in differences to estimate the impact of experiencing a PSI on HRQoL and its individual dimensions, comparing HRQoL improvements after surgery in similar patients with and without a PSI in a retrospective cohort study. This design compares the change in HRQoL before and after surgery in patients who experience a PSI to those who do not. RESULTS The sample comprised 190 697 and 204 649 observations for patients undergoing hip replacement and knee replacement respectively. For six out of nine PSIs, patients who experienced a PSI reported improvements in HRQoL that were 14-23% lower than those who did not experience a PSI during surgery. Those who experienced a PSI were also more likely to report worse health states after surgery than those without a PSI on all five dimensions of HRQoL. CONCLUSION PSIs are associated with a substantial negative impact on patients' HRQoL.
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Affiliation(s)
- Mimi Xiao
- School of Public Health, Development Research Center of Medical Science and Society, Chongqing Medical University, Chongqing, P.R. China
| | - Søren Rud Kristensen
- DaCHE - Danish Centre for Health Economics Department of Public Health, University of Southern Denmark, Odense, Denmark
- Patient Safety Translational Research Centre, Centre for Health Policy, Institute of Global Health Innovation, Imperial College London
| | - Joachim Marti
- Patient Safety Translational Research Centre, Centre for Health Policy, Institute of Global Health Innovation, Imperial College London
- Health Economics and Policy Unit, Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
| | - Elias Mossialos
- Patient Safety Translational Research Centre, Centre for Health Policy, Institute of Global Health Innovation, Imperial College London
- Department of Health Policy, London School of Economics and Political Science, London, UK
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15
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Johansson KS, Kornholt J, Bülow C, Petersen TS, Perrild H, Rungby J, Christensen MB. Physician-led medication reviews in polypharmacy patients treated with at least 12 medications in a type 2 diabetes outpatient clinic: A randomised trial. Diabet Med 2023; 40:e15052. [PMID: 36681891 DOI: 10.1111/dme.15052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/25/2022] [Accepted: 01/19/2023] [Indexed: 01/23/2023]
Abstract
AIMS Medication reviews can be used to promote appropriate pharmacotherapy and negate the harmful consequences of polypharmacy. This study aimed to evaluate the effect of physician-led medication reviews and increased cross-sectoral communication as a supplement to standard care in a type 2 diabetes outpatient clinic. METHODS This pragmatic randomised clinical trial enrolled patients with type 2 diabetes treated with at least 12 medications. The subjects were randomised to either standard care (standard care consultation at the outpatient clinic) or standard care plus a medication review consultation and increased cross-sectoral communication. The primary outcome was the number of medications used after six months. Health-related quality of life was quantified using the EuroQoL 5-dimension 5-level (EQ5D-5 L) questionnaire. RESULTS We recruited 50 participants with a median age of 72 (IQR 67-75) years. The mean number of medications per patient changed from 17.9 to 14.3 in the intervention group and 17.6 to 17.2 in the control group (rate ratio 0.81). The reasons for discontinuations were medication no longer indicated (60%), safety issues (20%), efficacy issues (15%) or patient preferences (5%). There was a significant difference in the change in health-related quality of life (EQ5D-5 L index score) in favour of the intervention (0.111, 95% CI 0.001 to 0.221). CONCLUSIONS Physician-led medication reviews and increased cross-sectoral communication in patients with type 2 diabetes treated with at least 12 medications reduced the number of medications used and improved health-related quality of life. Implementing and further investigating similar interventions as standard care seems reasonable.
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Affiliation(s)
- Karl Sebastian Johansson
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jonatan Kornholt
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Cille Bülow
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tonny Studsgaard Petersen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Perrild
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jørgen Rungby
- Department of Endocrinology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Herlev and Gentofte, Center for Clinical Metabolic Research, Copenhagen University Hospital, Gentofte, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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16
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Tan JM, Halford GRJ, Lukin M, Kohler F. Recommendations from the ISPO lower-limb COMPASS: Patient-reported and performance-based outcome measures. Prosthet Orthot Int 2023; 47:13-25. [PMID: 36629556 PMCID: PMC9945573 DOI: 10.1097/pxr.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Outcome measures (patient-reported and performance-based) are used widely but not uniformly within the clinical setting for individuals with lower-limb absence (LLA). The need for more detailed information by funding bodies, service planners and providers, and researchers requires the systematic and routine use of outcome measures. Currently, there is no consensus on which outcome measure(s) should be used for individuals with LLA. The aim of the International Society of Prosthetics and Orthotics (ISPO) lower-limb Consensus Outcome Measures for Prosthetic and Amputation Services (COMPASS) was to produce a recommended list of outcome measures to be actively promoted for routine use within clinical practice before and after an episode of care. METHODS Between May and June 2021, 46 users, clinicians, researchers, managers, and policymakers working in the field of LLA and prosthetic users met virtually. Consensus participants were first asked to complete an online survey with questions based on the results from a systematic review and the outcomes from an expert panel. A modified Delphi technique was used to determine outcome measures for use in routine clinical practice. This paper discusses the ISPO lower-limb COMPASS process from which recommendations were made. RESULTS The ISPO lower-limb COMPASS resulted in the following 6 recommendations: (1) Amputee Mobility Predictor, Timed Up and Go, Two-Minute Walk Test, Prosthetic Evaluation Questionnaire-Residual Limb Health, Prosthetic Evaluation Questionnaire-Utility, and Trinity Amputation and Prosthesis Experience Scales-Revised, which make up the ISPO lower-limb COMPASS ; (2) Comprehensive High-Level Activity Mobility Predictor and Six-Minute Walk Test are 2 additional outcome measures recommended for higher-activity-level individuals with LLA, which make up the COMPASS+ ; (3) Patient-Specific Function Scale makes up the COMPASS Adjunct ; (4) a generic health-related quality of life outcome measure such as the European Quality of Life-5D-5L or Patient-Reported Outcomes Measurement Information System-29 item can be used to supplement the COMPASS; (5) outcome measures suited to low- and middle-income countries need to be developed with a focus on activities such as sitting cross-legged, kneeling, squatting, and other culturally important mobility-related activities; and (6) translation, validation, and open sharing of translated outcome measures included in the COMPASS, COMPASS+, and COMPASS Adjunct occurs. CONCLUSION The above recommendations represent the current status of knowledge on outcome measures for LLA based on research and international consensus and hence, will change over time. This work has been developed for clinicians and researchers to improve knowledge on outcome measures to guide clinical decision-making and future research initiatives.
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Affiliation(s)
- Jade M. Tan
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Gregory R. J. Halford
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
| | - Martina Lukin
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- School of Clinical Medicine, Medicine & Health, University of New South Wales, Sydney, Australia
- Clinical Directorate Aged Care and Rehabilitation, South Western Sydney Local Health District, Liverpool, Australia
- Rehabilitation Medicine, Braeside Hospital, Braeside Hospital, HammondCare Health, Sydney, Australia
| | - Friedbert Kohler
- School of Clinical Medicine, Medicine & Health, University of New South Wales, Sydney, Australia
- Clinical Directorate Aged Care and Rehabilitation, South Western Sydney Local Health District, Liverpool, Australia
- Rehabilitation Medicine, Braeside Hospital, Braeside Hospital, HammondCare Health, Sydney, Australia
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17
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Kaur MN, Gallo L, Wang Y, Rae C, McEvenue G, Semple J, Johnson N, Savard K, Pusic AL, Coon D, Klassen AF. Health State Utility Values in Patients Undergoing Chest Masculinization Surgery. J Plast Reconstr Aesthet Surg 2023; 81:26-33. [PMID: 37068381 DOI: 10.1016/j.bjps.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Chest masculinization surgery is the most common gender-affirming procedure performed in transgender and gender-diverse individuals. While evidence on the health-related quality of life (HRQL) impact of chest masculinization is starting to emerge, data on health state utility values (HSUVs) associated with the surgery is largely missing. The objectives of this study were to estimate the HSUVs using EQ-5D for patients seeking chest masculinization surgery and assess the determinants of EQ-5D score at 6 months postoperatively. METHODS Patients seeking chest masculinization at a single community plastic surgery clinic by 2 surgeons completed 3 patient-reported outcome measures - EQ-5D-3L, Patient Health Questionnaire (PHQ)-9, and BODY-Q Chest module - preoperatively and postoperatively at 6 weeks and 6-months. Friedman test was used to assess the differences in PROM scores at the 3 timepoints. Simple and backward stepwise regression analyses of 6-month postoperative EQ-5D scores were performed. RESULTS A total of 113 patients (mean [SD] age, 25.7 [6.9] years) were included. The mean [SD] EQ-5D scores at preoperative, postoperative 6 weeks and 6 months were 0.81 [0.15], 0.84 [0.15] and 0.87 [0.12], respectively. Postoperatively, problems were most frequently reported in the dimensions "pain/discomfort" and "anxiety/depression". Preoperative PHQ-9 score was a predictor of 6-month postoperative EQ-5D scores following simple (p < 0.01) and backward stepwise linear regression analysis (p < 0.01). CONCLUSION Chest masculinization was associated with an improvement in overall HRL at 6 months postoperatively; however, this did not achieve statistical significance. Preoperative depression severity was a significant determinant of postoperative HRL. Consequently, additional support must be offered to patients who have a higher level of preoperative depression.
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Affiliation(s)
- Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA.
| | - Lucas Gallo
- Department of Surgery, Division of Plastic Surgery, McMaster University, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Yi Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Charlene Rae
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Giancarlo McEvenue
- Doctor Giancarlo Plastic Surgery Clinic, 4600 Linton Blvd, Suite 310, Delray Beach, FL 33445, USA
| | - John Semple
- Division of Plastic Surgery, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada M5S 1B2
| | - Natasha Johnson
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Kinusan Savard
- Fleming College, 599 Brealey Dr, Peterborough, ON, Canada K9J 7B1
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA
| | - Devin Coon
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
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18
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Yoganathan A, Sandinha T, Shamdas M, Diafas A, Steel D. Patient-reported outcome measures in vitreoretinal surgery: a systematic review. Eye (Lond) 2023; 37:391-401. [PMID: 35550605 PMCID: PMC9905525 DOI: 10.1038/s41433-022-02073-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022] Open
Abstract
This review article systematically reviews the use of Patient Reported Outcome Measures (PROMs) in Vitreoretinal surgery, with the aim of recommending a preferred PROM-tool for use in clinical practice. Vitreoretinal surgery lags behind other ophthalmic subspecialties in the adoption of PROMs as a core outcome measure of success post-operatively. Current outcomes rely heavily on post-operative Best Corrected Visual Acuity (BCVA) and anatomical success on imaging modalities such as Ocular Coherence Tomography (OCT), despite the link between each of these measures and patient satisfaction being uncertain. We systematically reviewed the available literature in March 2021, in accordance with PRISMA guidelines, searching six databases: MEDLINE, EMBASE, Web of Science, APA PsycINFO, SCOPUS and Cochrane Library. Critical appraisal of PROM-tools was facilitated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. We identified 14 eligible original research papers that used PROMs as a primary or secondary outcome of success post-operatively in patients having undergone vitreoretinal surgery. Eight different generic and vision-related PROM-tools were identified as being used in vitreoretinal studies, none of which were vitreoretinal-disease-specific. Our review article considers whether generic-health PROMs (e.g., EQ5D) or vision-related PROMs (e.g. NEI VFQ-25) are precise or responsive enough following vitreoretinal surgery to have a meaningful impact on clinical or research practice. We also consider the importance of standardisation of clinical outcomes in vitreoretinal clinical trials.
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Affiliation(s)
- Anusha Yoganathan
- Department of Eye and Visual Science, University of Liverpool, Merseyside, UK
| | - Teresa Sandinha
- Department of Eye and Visual Science, University of Liverpool, Merseyside, UK.
- Department of Ophthalmology, St Paul's Eye Unit, Royal Liverpool University Hospital, Merseyside, UK.
| | - Mohith Shamdas
- Department of Ophthalmology, St Paul's Eye Unit, Royal Liverpool University Hospital, Merseyside, UK
| | - Asterios Diafas
- Department of Ophthalmology, St Paul's Eye Unit, Royal Liverpool University Hospital, Merseyside, UK
| | - David Steel
- Department of Eye and Visual Science, University of Liverpool, Merseyside, UK
- Sunderland Eye Infirmary, Sunderland, UK
- Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK
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19
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Snowdon DA, McGill S, Altmann C, Brooks K, Everard T, Le Fevre K, Andrew NE. Client and service factors associated with changes in health-related quality of life following community rehabilitation. Disabil Rehabil 2023; 45:512-522. [PMID: 35179439 DOI: 10.1080/09638288.2022.2037747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify client and service factors associated with changes in health-related quality of life following community rehabilitation. METHODS We conducted a retrospective observational cohort study within a community rehabilitation program. Health-related quality of life was measured using the EuroQol five Dimensions, five response level version (EQ-5D-5L). Our primary outcome was the Visual Analogue Scale (VAS) rating of overall health. Analyses were stratified by diagnostic group: traumatic orthopaedic, elective orthopaedic, neurological, medical, and other. The association between client and service factors and discharge VAS scores, adjusted for baseline scores were determined using multivariable regression. RESULTS EQ-5D-5L data were available for 981 of 1350 participants. Treatment intensity was associated with a seven-point increase (β = 7.22, 95%CI 2.28-12.2, p = 0.004) in VAS scores for traumatic orthopaedic participants. For neurological participants, there was a positive interaction between comorbidities and intensity of therapy (β = 7.9, 95%CI 2.75-13.1, p = 0.003), indicating that greater therapy intensity in those with higher comorbidity scores was associated with an improvement in VAS scores. Age was negatively associated with VAS scores for traumatic orthopaedic participants and socioeconomic status was positively associated with VAS scores for elective orthopaedic participants. CONCLUSIONS Treatment intensity is a modifiable service factor that may positively influence health-related quality of life.Implications for rehabilitationIn addition to providing information on client progress towards attainment of individual treatment goals, routine collection of patient reported outcome measures within a community rehabilitation program can elicit information that can inform rehabilitation service improvement.Clients of a community rehabilitation program with a neurological or medical condition demonstrate the least improvement in overall health profile and may require additional rehabilitation or supports.Across all diagnostic groups, problems with anxiety and depression were least likely to improve following receipt of community rehabilitation. Improving access to psychological services and associated referral pathways in community rehabilitation services could improve these outcomes.Initiatives aimed at increasing intensity of therapy such as targeted triage and resource allocation, may improve health-related quality of life for clients of a community rehabilitation program with traumatic orthopaedic conditions.For clients with a neurological condition, initiatives aimed at increasing intensity of therapy may improve health-related quality of life in more complex patients with comorbid health conditions.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
| | - Scott McGill
- Community Rehabilitation Program, Rosebud, Australia
- Community Rehabilitation Program, Mornington, Australia
| | | | | | - Tori Everard
- Community Rehabilitation Program, Rosebud, Australia
| | - Kate Le Fevre
- Community Rehabilitation Program, Rosebud, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
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20
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Puttasiddaiah PM, Morris S, Costello RC, Whittet HB. Paediatric quality-of-life following adenotonsillectomy: an evaluation of T14 paediatric throat disorder quality-of-life outcomes according to operative indication. Ann R Coll Surg Engl 2023; 105:68-71. [PMID: 35446710 PMCID: PMC9891077 DOI: 10.1308/rcsann.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Adenotonsillectomy is the most common surgical intervention for obstructive sleep apnoea (OSA) or recurrent tonsillitis. The Paediatric Throat Disorder Quality of Life Outcome (T14) questionnaire is a validated tool completed by parents to compare the outcome of surgery by measuring the pre- and postoperative scores. This study was undertaken to evaluate the quality-of-life outcome in children undergoing surgical intervention for recurrent tonsillitis and/or OSA. METHODS This was a prospective, uncontrolled study of 117 children who underwent adenotonsillectomy and tonsillectomy at a single tertiary ear, nose and throat department. An analysis of pre- and postoperative T14 paediatric throat disorder quality-of-life outcomes was undertaken at 12 months. RESULTS Of the 117 children, 105 were included in the study sample; 75 with recurrent tonsillitis, 8 with OSA and 22 with both tonsillitis and OSA. All children had an improved T14 score postoperatively. The greatest change in pre- and postoperative T14 score was observed in the tonsillitis and OSA combined group (mean change -29.36, p<0.001). However, an improvement in T14 score was also noted in the tonsilitis (-24.453, p<0.001) and OSA groups (-14.25, p<0.001). CONCLUSIONS This study found a statistically significant improvement in the T14 quality-of-life score at 12 months postoperatively in children undergoing adenotonsillectomy. This demonstrates improved parental perception of their child's symptoms for all operative indications of adenotonsillectomy.
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Affiliation(s)
| | - S Morris
- Swansea Bay University Health Board, UK
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21
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Hegde S, Sreeram S, Bhat KR, Satish V, Shekar S, Babu M. Evaluation of post-COVID health status using the EuroQol-5D-5L scale. Pathog Glob Health 2022; 116:498-508. [PMID: 35129097 PMCID: PMC9639560 DOI: 10.1080/20477724.2022.2035623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
SARS-CoV-2 has had a lasting effect on the overall health of recovered patients, called 'long COVID'. Currently, there is a lack of a validated standard questionnaire to assess post-COVID health status. A retrospective observational study involving the recovered COVID patients admitted to a secondary care hospital in India between June to December 2020 (n = 123), was conducted using the EuroQol-5D-5L scale at discharge, 4 weeks and 8 weeks post-discharge. A significant difference in anxiety/depression scores was found (χ2 = 65.6, p < 0.000) among the 3 categories of time (discharge, 4 weeks and 8 weeks). The anxiety/depression dimension scores showed a significant change (p < 0.0001) between discharge and 8 weeks, using paired t-test. Age had a significant relationship with the anxiety/depression dimension at 4 weeks (OR = 5.617, 95% CI = 1.0320-30.5746, p < 0.05). A significant difference was found using Kruskal-Wallis rank-sum test on mean index scores (χ2 = 60.0, p < 0.000) among the three categories of time (discharge, 4 weeks and 8 weeks). There was a statistically significant difference of time on EQ Index scores as determined by one-way repeated measures ANOVA (F(2,375) = 18.941, p = <0.00001). Our study found time to have a statistically significant impact on the mean index scores, level sum scores and dimension scores. Smoking was found to be significantly associated with usual activity scores at 4 weeks. The most remarkable changes occurred in the anxiety/depression dimension. Overall, there was a general trend of health improvement.
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Affiliation(s)
| | | | | | - Vaishnavi Satish
- Department of Community Medicine, Kasturba Medical College and Hospital, Mangalore, India
| | | | - Mahesh Babu
- Department of Ophthalmology, KVG Medical College and Hospital, Sullia, India,CONTACT Mahesh Babu Department of Ophthalmology, Kvg Medical College and Hospital, Sullia, D.K., Karnataka, India
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22
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Janssen MF, Buchholz I, Golicki D, Bonsel GJ. Is EQ-5D-5L Better Than EQ-5D-3L Over Time? A Head-to-Head Comparison of Responsiveness of Descriptive Systems and Value Sets from Nine Countries. PHARMACOECONOMICS 2022; 40:1081-1093. [PMID: 35930137 PMCID: PMC9550755 DOI: 10.1007/s40273-022-01172-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The aim of this study was to compare the responsiveness of EQ-5D-3L (3L) with EQ-5D-5L (5L) descriptive systems and value sets in two independent samples (rehabilitation and stroke patients). METHODS Descriptive system results were compared cross-sectionally, and descriptive responsiveness was tested by calculating changed level responses ('moves') from baseline to follow-up, proportion of improved patients, Paretian Classification of Health Change (PCHC), and probability of superiority (PS). Responsiveness of values based on nine country-specific value sets was assessed by standardized response mean (SRM) and standardized effect size (SES). Relative efficiency of 5L over 3L was assessed by calculating ratios of the SRM and SES statistics. RESULTS Descriptive comparisons confirmed earlier evidence and showed a consistent overestimation of health problems in 3L. Descriptive responsiveness improved with 5L in terms of moves per respondent, proportions of improved patients and PS, whereas PCHC showed mixed results. Better value responsiveness statistics were observed for 5L in rehabilitation patients for all value sets. In stroke patients, 3L showed better responsiveness statistics compared with 5L. Relative efficiency results were moderately to strongly better with 5L for rehabilitation, and slightly to moderately better with 3L for stroke. CONCLUSIONS Descriptive results were the main driver of 3L-5L responsiveness differences. Responsiveness of 3L was influenced by the 'confined to bed' label and the overestimation bias of 3L, which affected all responsiveness results. This may impact quality-adjusted life-year (QALY) estimations, leading to over- or underestimations of QALYs gained, depending on the condition and condition severity. QALY calculations based on 5L data will result in more accurate estimates.
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Affiliation(s)
- Mathieu F. Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Gouke J. Bonsel
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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23
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Yapp LZ, Scott CEH, Howie CR, MacDonald DJ, Simpson AHRW, Clement ND. Meaningful values of the EQ-5D-3L in patients undergoing primary knee arthroplasty. Bone Joint Res 2022; 11:619-628. [PMID: 36047008 PMCID: PMC9533244 DOI: 10.1302/2046-3758.119.bjr-2022-0054.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The aim of this study was to report the meaningful values of the EuroQol five-dimension three-level questionnaire (EQ-5D-3L) and EuroQol visual analogue scale (EQ-VAS) in patients undergoing primary knee arthroplasty (KA). METHODS This is a retrospective study of patients undergoing primary KA for osteoarthritis in a university teaching hospital (Royal Infirmary of Edinburgh) (1 January 2013 to 31 December 2019). Pre- and postoperative (one-year) data were prospectively collected for 3,181 patients (median age 69.9 years (interquartile range (IQR) 64.2 to 76.1); females, n = 1,745 (54.9%); median BMI 30.1 kg/m2 (IQR 26.6 to 34.2)). The reliability of the EQ-5D-3L was measured using Cronbach's alpha. Responsiveness was determined by calculating the anchor-based minimal clinically important difference (MCID), the minimal important change (MIC) (cohort and individual), the patient-acceptable symptom state (PASS) predictive of satisfaction, and the minimal detectable change at 90% confidence intervals (MDC-90). RESULTS The EQ-5D-3L demonstrated good internal consistency with an overall Cronbach alpha of 0.75 (preoperative) and 0.88 (postoperative), respectively. The MCID for the Index score was 0.085 (95% confidence interval (CI) 0.042 to 0.127) and EQ-VAS was 6.41 (95% CI 3.497 to 9.323). The MICCOHORT was 0.289 for the EQ-5D and 5.27 for the EQ-VAS. However, the MICINDIVIDUAL for both the EQ-5D-3L Index (0.105) and EQ-VAS (-1) demonstrated poor-to-acceptable reliability. The MDC-90 was 0.023 for the EQ-5D-3L Index and 1.0 for the EQ-VAS. The PASS for the postoperative EQ-5D-3L Index and EQ-VAS scores predictive of patient satisfaction were 0.708 and 77.0, respectively. CONCLUSION The meaningful values of the EQ-5D-3L Index and EQ-VAS scores can be used to measure clinically relevant changes in health-related quality of life in patients undergoing primary KA.Cite this article: Bone Joint Res 2022;11(9):619-628.
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Affiliation(s)
- Liam Z Yapp
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Deborah J MacDonald
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Hamish R W Simpson
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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24
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Parkin DW, Do Rego B, Shaw R. EQ-5D-3L and quality of life in total knee arthroplasty (TKA) patients: beyond the index scores. J Patient Rep Outcomes 2022; 6:91. [PMID: 36040553 PMCID: PMC9428084 DOI: 10.1186/s41687-022-00497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background Many patient reported outcome measures (PROMs) generate single number index scores that summarise responses to different questions within a questionnaire. Although these are valuable as unambiguous indicators of ill-health and changes in health, further information can be gained from examining the questionnaire responses themselves. This has additional importance since the patients’ reports are those responses and not the index scores. This paper reanalyses data from two prospective multicentre clinical studies assessing patients’ quality of life before and after total knee arthroplasty (TKA) using the EQ-5D-3L. Patients who completed EQ-5D-3L questionnaires at 3 time periods were included from 4 countries (USA, UK, Australia, New Zealand) operated on by the same surgeons using two different knee replacement systems. Descriptive analyses included levels within EQ-5D dimensions and profiles (combinations of dimensions and levels) at baseline and follow-up, including changes over time and differences between implants. Regression analysis quantified the relationship between the profiles and the EQ VAS.
Results Problems with mobility, usual activities and pain & discomfort, in that order, were most frequent for pre-operative patients. There were large improvements in every dimension after surgery, but the time that this was observed differed: for mobility, self-care and anxiety & depression, most of the improvement occurred during the first 10 months; for usual activities and pain & discomfort, over 11–22 months. Analysing profiles, 85% of patients experienced an unequivocal improvement, 5.9% had no change, 3.5% worsened and 5.5% a mixed change at 11–22 months follow-up. Anxiety & depression had the greatest impact on EQ VAS scores; while mobility and usual activities were also important; usual activities was particularly important post-surgery.
Conclusions The value of analysing patients’ responses to PROMs questionnaires without using summary scores was confirmed. The results add further detail to existing knowledge about the health problems that TKA patients experience before surgery, improvements after surgery, residual problems that some have, and the time at which improvements are experienced. This was a small study, but its methods may be easily replicated in other studies that use the EQ-5D-3L. It may also be possible to adapt them for other PROMs. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00497-0.
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25
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Brajković A, Bićanić LA, Strgačić M, Orehovački H, Ramalho-de-Oliveira D, Mucalo I. The Impact of Pharmacist-Led Medication Management Services on the Quality of Life and Adverse Drug Reaction Occurrence. PHARMACY 2022; 10:pharmacy10050102. [PMID: 36136835 PMCID: PMC9498323 DOI: 10.3390/pharmacy10050102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of this research was to assess the impact of comprehensive medication management (CMM) services on patients’ health-related quality of life (HRQoL) and frequency of adverse drug reactions (ADRs) in older patients with cardiovascular diseases (CVDs). A prospective, pre- and post-intervention study with a one-year follow-up was conducted at the Health Care Centre Zagreb—Centre (HCZC). The Euro-Quality of Life Questionnaire 5 Dimensions 5 Levels (EQ-5D-5L) was used to measure the HRQoL at baseline (initial visit at the HCZC) and 12 months following CMM services. The ADRs collected at the initial assessment of the CMM services and throughout follow-up consultations were analyzed according to the occurrence mechanism, seriousness, expectedness and distribution of the Preferred Term according to the System Organ Class. Following the CMM intervention, 65 patients reported significant improvement in dimensions “self-care” (p = 0.011) and “usual activities” (p = 0.003), whereas no significant change was found in the “mobility” (p = 0.203), “pain/discomfort” (p = 0.173) and “anxiety/depression” (p = 0.083) dimensions and the self-rated VAS scale (p = 0.781). A total of 596 suspected ADR reports were found, the majority at patients’ initial assessment (67.3%), with a mean ± SD of 9.2 ± 16.9 per patient. The CMM services significantly reduced the rate of suspected ADRs, namely 2.7 ± 1.7 ADRs per patient at the initial assessment vs. 1.0 ± 1.5 ADRs per patient at the last consultation (p < 0.001). The obtained results indicate that CMM services may improve patients’ HRQoL. Additionally, as CMM services diminished the proportion of ADRs following 1-year patient follow-up, they may serve as a viable solution for safety management.
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Affiliation(s)
- Andrea Brajković
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Lucija Ana Bićanić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Marija Strgačić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Djenane Ramalho-de-Oliveira
- Centre for Pharmaceutical Care Studies, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Iva Mucalo
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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26
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Sprave T, Verma V, Fabian A, Rühle A, Baltas D, Grosu AL, Nicolay NH. Cost effectiveness and health-related quality of life of chemoradiotherapy versus radiation therapy alone in elderly head and neck cancer patients. Strahlenther Onkol 2022; 198:1008-1015. [PMID: 35833963 PMCID: PMC9581829 DOI: 10.1007/s00066-022-01975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022]
Abstract
Purpose Radiotherapy (RT) constitutes a mainstay in the treatment of elderly patients with head and neck cancer (HNC), but use of simultaneous chemoradiotherapy (CRT) remains controversial. We have conducted a prospective analysis based on real-world patient data to examine the health-related quality of life (HRQoL) and cost effectiveness (CE) of CRT vs. RT in elderly HNC patients. Methods Eligible participants ≥ 65 years treated in a large tertiary cancer center between July 2019 and February 2020 who completed the validated EQ-5D-5L questionnaire (health state index [HI] and visual analog scale [VAS]) before and after RT were included. CE referred to direct medical costs, including diagnosis-related group (DRG)-based billings for inpatients and uniform assessment standard (EBM)-based costs for outpatients. The primary endpoint was cost (euros [€]) per quality-adjusted life year (QALY). The incremental cost-effectiveness ratios (ICERs) were calculated. Costs and QALYs were not discounted for short overall survival (OS). Results Baseline HRQoL was 0.878 (±0.11) in the CRT group and 0.857 (±0.17) in the RT group. Upon completion of therapy, HRQoL amounted to 0.849 (±0.14) in the CRT and 0.850 (±0.13) in the RT group. The mean treatment-related cost in the CRT cohort was €22,180.17 (±8325.26) vs. €18,027.87 (±26,022.48) in the RT group. The corresponding QALYs amounted to 2.62 in the CRT and 1.91 in the RT groups. The ICER was €5848.31. Conclusion This is the first analysis from the German health care system demonstrating that the addition of chemotherapy to RT for selected elderly HNC patients is cost effective and not associated with a significant HRQoL decline.
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Affiliation(s)
- Tanja Sprave
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Alexander Fabian
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Kiel, Kiel, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany. .,German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
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27
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Gargula S, Simon F, Célérier C, Couloigner V, Leboulanger N, Loundon N, Denoyelle F. French adaptation and validation of parents' evaluation of aural/oral performance of children (PEACH) scale in children. Int J Audiol 2022:1-7. [PMID: 35533092 DOI: 10.1080/14992027.2022.2059714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Hearing loss can seriously impact children's quality of life. Disease-specific questionnaires are required to optimise medical care. This study aims to translate, adapt and validate the French version of the PEACH score for the auditory performance of children. DESIGN This is a controlled, prospective study, conducted between April and October 2020. The translation was conducted using a forward-backward technique, and statistical validation was conducted with a test and re-test, on a patient population and a control population. STUDY SAMPLE Patients were included if they were 1-11 years old, and had at least 30 dB hearing loss in one ear. The mean age was 6 years for the 39 patients and 3.9 years for the 34 controls. RESULTS Reproducibility, measured by Spearman's coefficient between global scores of the test and re-test was 0.78 (p < 0.001). The test was internally consistent (Cronbach's alpha was 0.89) and item per item construct validity was satisfactory. The ROC curve showed a moderate area under the curve (0.74 p < 0.001) with 67% sensitivity and 73% specificity. CONCLUSIONS The French PEACH had good statistical properties, although a brief 13-item questionnaire, and can be used for evaluation of the disease-specific quality of life for young children with hearing loss.
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Affiliation(s)
- Stéphane Gargula
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Charlotte Célérier
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Natalie Loundon
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Mei YX, Zhang ZX, Wu H, Hou J, Liu XT, Sang SX, Mao ZX, Zhang WH, Yang DB, Wang CJ. Health-Related Quality of Life and Its Related Factors in Survivors of Stroke in Rural China: A Large-Scale Cross-Sectional Study. Front Public Health 2022; 10:810185. [PMID: 35450122 PMCID: PMC9016152 DOI: 10.3389/fpubh.2022.810185] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Stroke is a major health threat and the leading cause of mortality and disability in China. The aims of this study were to identify the possible influencing factors of health-related quality of life (HRQoL) and its domain-specific contents in stroke patients in rural areas in China. Methods A total of 1,709 stroke patients aged 36–79 years from the baseline data of Henan Rural Cohort study (n = 39,259) were included in the cross-sectional study. The Chinese version of the European Quality of Life Five Dimension (including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) Five Level Scale (EQ-5D-5L) and visual analog scale (VAS) were used to evaluate HRQoL in stroke patients. Tobit regression models, generalized linear models and binary logistic regression models were constructed to determine potential influencing factors of the EQ-5D utility index, as well as influencing factors of each domain and VAS score. Results The mean utility index and VAS scores of stroke patients were 0.885 (SD, 0.204), and 68.39 (SD, 17.31), respectively. Pain/discomfort (PD, 35.2%) and mobility (MO, 30.4%) were the most frequently reported issues. Regression models revealed that illiterate; a low monthly income; low physical activity intensity; and diabetes, anxiety, depression, or poor sleep quality were significantly associated with lower utility index and VAS scores among stroke patients. In addition, patients with stroke who were older, female, drinking, smoking, and consuming a high-fat diet, had a higher BMI, and lived with a stroke for a longer time, were also significantly associated with different dimensions of the EQ-5D. Conclusion Patients with stroke in rural areas in China had a low HRQoL. Factors associated with the EQ-5D utility index as well as each domain and VAS score, need to be considered by health providers in rural areas. Patients with stroke in rural areas need to be included in national basic public medical services and managed systematically by medical institutions.
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Affiliation(s)
- Yong-Xia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China.,The People's Hospital of Hebi, Hebi, China
| | - Zhen-Xiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hui Wu
- School of Public Health, Xinxiang Medical University, Xinxiang, China.,School of Public Health, Tianjin Medical University, Tianjin, China.,Henan Province General Medical Educations and Research Center, Xinxiang, China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiao-Tian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Sheng-Xiang Sang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhen-Xing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wei-Hong Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | | | - Chong-Jian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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MOHAMMAD HR, JUDGE A, MURRAY DW. A matched comparison of cementless unicompartmental and total knee replacement outcomes based on the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Acta Orthop 2022; 93:478-487. [PMID: 35611477 PMCID: PMC9131198 DOI: 10.2340/17453674.2022.2743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The main treatments for severe medial compartment knee arthritis are unicompartmental (UKR) and total knee replacement (TKR). UKRs have higher revision rates, particularly for aseptic loosening, therefore the cementless version was introduced. We compared the outcomes of matched cementless UKRs and TKRs. PATIENTS AND METHODS The National Joint Registry was linked to the English Hospital Episode Statistics and Patient Reported Outcome Measures (PROMs) databases. 10,552 cementless UKRs and 10,552 TKRs were propensity matched and regression analysis used to compare revision/reoperation risks. 6-month PROMs were compared. UKR results were stratified by surgeon caseload into low- (< 10 UKRs/year), medium- (10 to < 30 UKRs/year), and high-volume (≥ 30 UKRs/year). RESULTS 8-year cementless UKR revision survival for the 3 respective caseloads were 90% (95% CI 87-93), 93% (CI 91-95), and 96% (CI 94-97). 8-year reoperation survivals were 76% (CI 71-80), 81% (CI 78-85), and 84% (CI 82-86) respectively. For TKR the 8-year implant survivals for revision and reoperation were 96% (CI 95-97) and 81% (CI 80-83). The HRs for the 3 caseload groups compared with TKR for revision were 2.0 (CI 1.3-2.9), 2.0 (CI 1.6-2.7), and 1.0 (CI 0.8-1.3) and for reoperation were 1.2 (CI 1.0-1.4), 0.9 (CI 0.8-1.0), and 0.6 (CI 0.5-0.7). 6-month Oxford Knee Score (OKS) (39 vs. 37) and EQ-5D (0.80 vs. 0.77) were higher (p < 0.001) for the cementless UKR. INTERPRETATION Cementless UKRs have higher revision and reoperation rates than TKR for low-volume UKR surgeons, similar reoperation but higher revision rates for mid-volume surgeons, and lower reoperation and similar revision rates for high-volume surgeons. Cementless UKR also had better PROMs.
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Affiliation(s)
- Hasan R MOHAMMAD
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford,Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Westbury-on-Trym, UK
| | - Andrew JUDGE
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford,Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Southmead Hospital, Westbury-on-Trym, UK
| | - David W MURRAY
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford
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Noto S, Wake M, Mishiro I, Hammer-Helmich L, Ren H, Moriguchi Y, Fujikawa K, Fernandez J. Health-Related Quality of Life Over 6 Months in Patients With Major Depressive Disorder Who Started Antidepressant Monotherapy. Value Health Reg Issues 2022; 30:127-133. [PMID: 35405582 DOI: 10.1016/j.vhri.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/03/2021] [Accepted: 12/30/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Major depressive disorder (MDD) is increasing worldwide and is associated with impaired quality of life (QOL). This study aimed to assess the QOL and its association with cognitive symptoms in patients with MDD who started antidepressant monotherapy. METHODS Data from the PERFORM (Prospective Epidemiological Research on Functioning Outcomes Related to Major Depressive Disorder) study were analyzed. A descriptive epidemiological analysis on EQ-5D-5L utility score, the level of each dimension, and the EuroQoL visual analog scale value was conducted at 4 visits during 6 months' follow-up. The association between cognitive complaints and changes in QOL measures was analyzed using multivariate linear regression analysis. RESULTS The median EQ-5D-5L utility score improved from 0.67 at baseline to 0.82 at month 6. Although the proportion of patients reporting level 1 (no problem) in every dimension of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression increased over time, less than half of the patients achieved level 1 in pain/discomfort and depression/anxiety, which were closely related to depression and usual activities at month 6. Patients with no cognitive complaints or no history of MDD at baseline showed greater improvement in EQ-5D-5L utility scores and EuroQoL visual analog scale value for measuring QOL than those with these characteristics. CONCLUSIONS Treatment over 6 months improved QOL in patients with MDD although there remained room for improvement in dimensions of usual activities, pain/discomfort, and depression/anxiety. Cognitive complaints or history of MDD at baseline predicted less improvement in QOL at 6 months. Any history of MDD might delay improvement in QOL after treatment.
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Affiliation(s)
- Shinichi Noto
- Department of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan.
| | - Mayumi Wake
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Izumi Mishiro
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | | | | | | | - Keita Fujikawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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Teni FS, Rolfson O, Devlin N, Parkin D, Nauclér E, Burström K. Longitudinal study of patients' health-related quality of life using EQ-5D-3L in 11 Swedish National Quality Registers. BMJ Open 2022; 12:e048176. [PMID: 34992101 PMCID: PMC8739074 DOI: 10.1136/bmjopen-2020-048176] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare problems reported in the five EQ-5D-3L dimensions and EQ VAS scores at baseline and at 1-year follow-up among different patient groups and specific diagnoses in 11 National Quality Registers (NQRs) and to compare these with the general population. DESIGN Longitudinal, descriptive study. PARTICIPANTS 2 66 241 patients from 11 NQRs and 49 169 participants from the general population were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Proportions of problems reported in the five EQ-5D-3L dimensions, EQ VAS scores of participants' own health and proportions of participants and mean/median EQ VAS score in the Paretian Classification of Health Change (PCHC) categories. RESULTS In most of the included registers, and the general population, problems with pain/discomfort were the most frequently reported at baseline and at 1-year follow-up. Mean EQ VAS score (SD) ranged from 45.2 (22.4) among disc hernia patients to 88.1 (15.3) in wrist and hand fracture patients at baseline. They ranged from 48.9 (20.9) in pulmonary fibrosis patients to 83.3 (17.4) in wrist and hand fracture patients at follow-up. The improved category of PCHC, improvement in at least one dimension without deterioration in any other, accounted for the highest proportion in several diagnoses, corresponding with highest improvement in mean EQ VAS score. CONCLUSIONS The study documented self-reported health of several different patient groups using the EQ-5D-3L in comparing with the general population. This demonstrated the important role of patient-reported outcomes in routine clinical care, to assess and follow-up health status and progress within different groups of patients. The EQ-5D-3L descriptive system and EQ VAS have an important role in providing a 'common denominator', allowing comparisons across NQRs and specific diagnoses. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT04359628).
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Affiliation(s)
- Fitsum Sebsibe Teni
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Nancy Devlin
- Health Economics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
- Office of Health Economics, London, UK
| | - David Parkin
- Office of Health Economics, London, UK
- City University of London, London, UK
| | - Emma Nauclér
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Region Stockholm, Stockholm, Sweden
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MOHAMMAD HR, JUDGE A, MURRAY DW. A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England's National PROM collection programme. Acta Orthop 2022; 93:164-170. [PMID: 34981127 PMCID: PMC8815428 DOI: 10.2340/17453674.2021.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Total knee replacement (TKR) can be implanted with or without bone cement. It is currently unknown how the functional outcomes compare. Therefore, we compared the patient-reported outcome measures (PROMS) of both fixation methods. Patients and methods - We performed a propensitymatched comparison of 14,404 TKRs (7,202 cemented and 7,202 cementless) enrolled in the National Joint Registry and the English National PROMs collection programme. Subgroup analyses were performed in different age groups (1) < 55 years; (2) 55-64 years; (3) 65-74 years; (4) ≥ 75 years. Results - The 6-month postoperative Oxford Knee Score (OKS) was significantly (p < 0.001) higher for cemented TKR (35, SD 9.7) than cementless TKR (34, SD 9.9). The OKS was also significantly higher for the cemented TKR in all age groups, except the 55-64-year group. A significantly higher proportion of cemented TKRs had an excellent OKS (≥ 41) compared with cementless (32% vs. 28%, p < 0.001) and a lower proportion of poor (< 27) scores (19% vs. 22%, p = 0.001). This was also observed for all age subgroups. There were no significant differences in EQ-5D points gained postoperatively between the groups respectively (0.31 vs. 0.30, p = 0.1). Interpretation - Cemented TKRs had a greater proportion of excellent OKS scores and lower proportion of poor scores both overall and across all age groups. However, the absolute differences are small and below the minimally clinically important difference, making both fixation types acceptable. Currently the vast majority of TKRs are cemented and the results from this study suggest that this is appropriate.
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Affiliation(s)
- Hasan R MOHAMMAD
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford
| | - Andrew JUDGE
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK
| | - David W MURRAY
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Nuffield Orthopaedic Centre, Oxford
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Harenwall S, Heywood-Everett S, Henderson R, Godsell S, Jordan S, Moore A, Philpot U, Shepherd K, Smith J, Bland AR. Post-Covid-19 Syndrome: Improvements in Health-Related Quality of Life Following Psychology-Led Interdisciplinary Virtual Rehabilitation. J Prim Care Community Health 2021; 12:21501319211067674. [PMID: 34939506 PMCID: PMC8721676 DOI: 10.1177/21501319211067674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is increasingly recognized as having significant long-term impact on physical and mental health. The Primary Care Wellbeing Service (PCWBS) in Bradford District Care NHS Foundation Trust (BDCFT) is a psychology-led specialist interdisciplinary team of health professionals specializing in persistent physical symptoms (PPS) and Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) with an emphasis on holistic integrated care. The PCWBS quickly recognized the risk of the long-term effects of COVID-19, particularly for social, health and care staff, and developed a 7-week virtual rehabilitation course which was piloted in October 2020. The “Recovering from COVID” course takes a whole system, biopsychosocial approach to understanding COVID-19 and post-viral fatigue (PVF) and is delivered by an interdisciplinary team consisting of a clinical psychologist, physiotherapist, occupational therapist, dietitian, speech and language therapist, assistant psychologist, and a personal support navigator with support from a team administrator. The course focuses on understanding PVF, sleep optimization, nutrition, swallowing, activity management, energy conservation, stress management, breathing optimization, managing setbacks, and signposting to appropriate resources and services. Since the pilot, PCWBS has delivered 7 courses to support over 200 people suffering from post-COVID-19 syndrome. One hundred and forty-nine individuals that enrolled on the “Recovering from COVID” course completed the EQ-5D-5L to assess Health-related quality of life (HRQoL) across 5 dimensions, including problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Subsequently, 76 individuals completed these measures at the end of the rehabilitation course showing that patient ratings were significantly improved. In response to the NIHR recommendation for rapid evaluation of different service models for supporting people with post-COVID-19 syndrome, this data offers hope that rehabilitation is effective in reversing some of the problems faced by people living with the long-term effects of COVID-19.
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Affiliation(s)
- Sari Harenwall
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | | | | | - Sherri Godsell
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Sarah Jordan
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Angela Moore
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ursula Philpot
- Bradford District Care NHS Foundation Trust, Bradford, UK.,Leeds Beckett University, Leeds, UK
| | - Kirsty Shepherd
- Bradford District Care NHS Foundation Trust, Bradford, UK.,University of Bradford, Bradford, UK
| | - Joanne Smith
- Bradford District Care NHS Foundation Trust, Bradford, UK
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34
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Mohammad HR, Judge A, Murray DW. A matched comparison of the patient-reported outcome measures of 38,716 total and unicompartmental knee replacements: an analysis of linked data from the National Joint Registry of England, Northern Ireland and Isle of Man and England's National PROM collection programme. Acta Orthop 2021; 92:701-708. [PMID: 34309481 PMCID: PMC8635544 DOI: 10.1080/17453674.2021.1956744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The surgical treatment options for severe knee osteoarthritis are unicompartmental (UKR) and total knee replacement (TKR). For patients, functional outcomes are more important than revision rate. We compared the patient-reported outcome measures (PROMs) of both implant types using a large PROMs dataset.Patients and methods - We analysed a propensity-matched comparison of 38,716 knee replacements (19,358 UKRs and 19,358 TKRs) enrolled in the National Joint Registry and the English National PROM collection programme. Subgroup analyses were performed in different age groups.Results - 6-month postoperative Oxford Knee Score (OKS) for UKR and TKR were 38 (SD 9.4) and 36 (SD 9.4) respectively. A higher proportion of UKRs had an excellent OKS (≥ 41) compared with TKR (47% vs 36%) and a lower proportion of poor OKS (< 27) scores (13% vs. 16%). The 6-month OKS was higher in all age groups for UKR compared with TKR, with the difference increasing in older age groups. The mean 6-month EQ-5D score was 0.78 (SD 0.25) and 0.75 (SD 0.25) respectively. The improvement in EQ-5D resulting from surgery was higher for UKR than TKR both overall and in all age groups. All comparisons were statistically significant (p < 0.05).Interpretation - UKR had a greater proportion of excellent OKS scores and lower proportion of poor scores than TKR. Additionally, the quality of life was higher for UKR compared with TKR. These factors should be balanced against the higher revision rate for UKR when choosing which procedure to perform.
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Affiliation(s)
- Hasan R Mohammad
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK,Correspondence: Hasan R MOHAMMAD Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Shah N. Effects of Systemic Enzyme Supplements on Symptoms and Quality of Life in Patients with Pulmonary Fibrosis-A Pilot Study. MEDICINES (BASEL, SWITZERLAND) 2021; 8:68. [PMID: 34822365 PMCID: PMC8624573 DOI: 10.3390/medicines8110068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Current FDA-approved antifibrotic treatments for Idiopathic Pulmonary Fibrosis slow down disease progression but have little impact on symptoms or quality of life in patients. This study was conducted to evaluate the effects of systemic enzymes in relieving symptoms associated with PF and improving quality of life. METHODS an open-label, prospective study on subjects with a confirmed diagnosis of PF was conducted as proof-of-concept. The subjects (n = 13) received the oral systemic enzyme supplements Serracor-NK and Serra Rx for 12 weeks and completed Health-Related Quality of Life (HRQL) questionnaires. The effect of this regimen was examined by comparing the end-of-treatment questionnaire scores with baseline values. RESULTS significant improvement was seen in 61.5% of subjects, as assessed by the WHO well-being index; an improvement in scores was seen in 84.6% of the subjects, as assessed by the UCSD Shortness of Breath Questionnaire, with 38.4% of the subjects showing minimal clinically important difference; the supplementation was found to be efficacious in 69.2%, 84.6%, 69.2% and 61.5% of the subjects, as assessed by the Saint George's Respiratory Questionnaire total, symptom, activity, and impact scores, respectively. CONCLUSIONS Serracor-NK and Serra Rx improve symptoms, as well as mental and physical wellbeing and HRQL in patients with PF.
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Affiliation(s)
- Neha Shah
- Pulmonary Fibrosis NOW, Chino, CA 91710, USA
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36
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Gutierrez-Delgado C, Galindo-Suárez RM, Cruz-Santiago C, Shah K, Papadimitropoulos M, Feng Y, Zamora B, Devlin N. EQ-5D-5L Health-State Values for the Mexican Population. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:905-914. [PMID: 34173957 PMCID: PMC8545780 DOI: 10.1007/s40258-021-00658-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To generate a value set for the Mexican adult general population to support and facilitate the inclusion of quality-adjusted life years (QALYs) into the health technology assessment process of the Mexican healthcare authorities. METHODS A representative sample of the Mexican adult population stratified by age, sex and socio-economic status was used. Following version 2.0 of the EuroQol EQ-5D-5L valuation protocol, trained interviewers guided participants in completing composite time trade-off (cTTO) and discrete-choice experiment (DCE) tasks included in the EQ-VT software. Generalized least squares, Tobit and Bayesian models were used for cTTO data. The choice of value set model was based on criteria that included: theoretical considerations, parsimony, logical ordering of coefficients, and statistical significance. RESULTS Based on quality control criteria and interviewer judgment, 1000 out of 1032 participants provided useable responses. Participants' demographic characteristics were similar to the 2010 Mexican Population Census and followed the socioeconomic structure defined by the Mexican Association of Marketing Research and Public Opinion Agencies (AMAI). The predicted index values in the final cTTO model (a heteroscedastic censored model with Bayesian estimation) ranged from - 0.5960 to 1, with 19.7% of all predicted health state scores less than 0 (i.e., worse than dead). CONCLUSION This study has generated the first value set representing the stated preferences of the Mexican adult population for use in estimating QALYs. The resulting EQ-5D-5L value set is technically robust and will facilitate health economic analyses as well as quality-of-life studies.
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Affiliation(s)
- Cristina Gutierrez-Delgado
- Faculty of Sciences, National Autonomous University of Mexico, Mexico City, Mexico
- Economic Analysis Unit, Secretariat of Health, Mexico City, Mexico
| | | | - Cesar Cruz-Santiago
- General Health Council, Mexico City, Mexico
- ISPOR Chapter Mexico, Mexico City, Mexico
| | | | | | - Yan Feng
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | - Nancy Devlin
- Office of Health Economics, London, UK
- Centre for Health Policy, University of Melbourne, Melbourne, VIC Australia
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Polistena B, Rigante D, Sicignano LL, Verrecchia E, Manna R, d’Angela D, Spandonaro F. Survey about the Quality of Life of Italian Patients with Fabry Disease. Diseases 2021; 9:diseases9040072. [PMID: 34698147 PMCID: PMC8544536 DOI: 10.3390/diseases9040072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 01/03/2023] Open
Abstract
Fabry disease (FD) is a genetic disease included in the group of lysosomal storage disorders, caused by X-linked deficiency of the enzyme alpha-galactosidase A. The aim of this study was to evaluate different aspects related to the quality of life (QoL) of a multicentre cohort of Italian patients with FD. An observational survey was conducted to measure health-related quality of life (HR-QoL) in FD patients using the CAPI (Computer-Assisted Personal Interview) method: 106 patients (mostly women) responded to the questionnaire. Geographically, 53.7% of patients lived in northern Italy, 18.9% in central Italy and 27.4% in southern Italy or the Islands. All data were collected through a five-dimensional EuroQoL questionnaire referring to functional aspects (mobility, personal care, routine activities) and perception of physical/mental well-being (pain or discomfort, anxiety or depression). A descriptive analysis of responses was performed; FD patients were compared in terms of QoL with subjects suffering from other chronic diseases, such as Crohn’s disease, chronic hepatitis, cirrhosis and multiple sclerosis. Difficulty in normal daily activities was reported by 47.2% of FD patients. About one third of subjects also had mobility difficulties. Feelings of loneliness and isolation were reported by 33.3% of those being 60–69 years old. Anxiety was equally reported in both oldest and youngest patients (66.7%), while depression, relational problems, fear of other people’s judgement increased along with age, reaching 66.7% in the over-70-years group. Male patients were largely troubled about the risk of physical disability, particularly those aged 60 years or over. Furthermore, FD patients had a poorer QoL than people suffering from other chronic inflammatory disorders. Our study upholds that FD patients have a poor QoL, as already known, negatively impacting psychic well-being and social activities. Our survey has also found a worse QoL in FD patients compared with other severe chronic disorders.
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Affiliation(s)
- Barbara Polistena
- Department of Economic and Finance, University of Rome Tor Vergata, C.R.E.A. Sanità, via Columbia n. 2, 00133 Rome, Italy; (D.d.); (F.S.)
- Correspondence:
| | - Donato Rigante
- Department of Life Sciences and Global Health, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy
| | - Ludovico Luca Sicignano
- Rare diseases and Periodic Fever Research Center, Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.L.S.); (E.V.); (R.M.)
| | - Elena Verrecchia
- Rare diseases and Periodic Fever Research Center, Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.L.S.); (E.V.); (R.M.)
| | - Raffaele Manna
- Rare diseases and Periodic Fever Research Center, Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.L.S.); (E.V.); (R.M.)
| | - Daniela d’Angela
- Department of Economic and Finance, University of Rome Tor Vergata, C.R.E.A. Sanità, via Columbia n. 2, 00133 Rome, Italy; (D.d.); (F.S.)
| | - Federico Spandonaro
- Department of Economic and Finance, University of Rome Tor Vergata, C.R.E.A. Sanità, via Columbia n. 2, 00133 Rome, Italy; (D.d.); (F.S.)
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Van Egmond JC, Hesseling B, Verburg H, Mathijssen NMC. Short-term functional outcome after fast-track primary total knee arthroplasty: analysis of 623 patients. Acta Orthop 2021; 92:602-607. [PMID: 33977863 PMCID: PMC8519557 DOI: 10.1080/17453674.2021.1925412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Early functional outcome after total knee arthroplasty (TKA) has been described before, but without focus on the presence of certain functional recovery patterns. We investigated patterns of functional recovery during the first 3 months after TKA and determined characteristics for non-responders in functional outcome.Patients and methods - All primary TKA in a fast-track setting with complete patient-reported outcome measures (PROMs) preoperatively, at 6 weeks, and 3 months postoperatively were included. Included PROMs were Oxford Knee Score (OKS), Knee disability and Osteoarthritis Outcome Score Physical Function Short-Form (KOOS-PS), and EuroQol 5 dimensions (EQ-5D) including the self-rated health Visual Analogue Scale (VAS). Patients with improvement on OKS less than the minimal clinically important difference (MCID) were determined as non-responders at that time point. Characteristics between groups of responders and non-responders in functional recovery were tested for differences: we defined 4 groups a priori, based on the responder status at each time point.Results - 623 patients were included. At 6 weeks OKS, KOOS-PS, and EQ-5D self-rated health VAS were statistically significant improved compared with preoperative scores. The mean improvement was clinically relevant at 6 weeks for KOOS-PS and at 3 months for OKS. Patient characteristics in non-responders were higher BMI and worse scores on EQ-5D items: mobility, self-care, usual activities, and anxiety/depression.Interpretation - Both statistically significant and clinically relevant functional improvement were found in most patients during the first 3 months after primary TKA. Presumed modifiable patient characteristics in non-responders on early functional outcome were BMI and anxiety/depression.
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Affiliation(s)
- Jeroen C Van Egmond
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands,Correspondence:
| | - Brechtje Hesseling
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands
| | - Hennie Verburg
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands
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Lindqvist Bagge AS, Wesslau H, Cizek R, Holmberg CJ, Moncrieff M, Katsarelias D, Carlander A, Olofsson Bagge R. Health-related quality of life using the FACT-M questionnaire in patients with malignant melanoma: A systematic review. Eur J Surg Oncol 2021; 48:312-319. [PMID: 34600786 DOI: 10.1016/j.ejso.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since there are no formal definition of health-related quality of life (HRQOL) there may be a lack of coherence and understanding of how to interpret HRQOL-data. The aim of this study is to summarize HRQOL-results that have used the FACT-M questionnaire in patients with melanoma, and specifically to summarize FACT-M between tumor stage. METHODS This review was conducted in accordance with the PRISMA guidelines. INCLUSION CRITERIA original studies on cutaneous melanoma between 2005 and 2020, written in English, containing "Functional Assessment of Cancer Therapy Melanoma" OR "Functional Assessment of Cancer Therapy M" OR FACT-M OR FACT/M OR FACTM OR "FACT M" OR FACT-melanoma OR "FACT Melanoma" together with FACT-M numbered data and basic patient characteristics, using the databases Scopus, Web of Science, PubMed and PsycINFO. RESULTS 16 articles describing 14 patient cohorts published 2008-2020 were included. The majority of the studies did not report subscale scores in accordance with FACT-M guidelines. The results did indicate that FACT-M total scores were inversely correlated with AJCC stage. Subscale analysis demonstrated varying degrees of correlation with AJCC stage. The Melanoma Surgery Subscale score was lowest in stage III patients, probably reflecting more advanced surgical procedures in this group of patients. CONCLUSIONS Though this review is based on a questionnaire limited to the assessment of melanoma patients, it highlights the universal need for clinical studies to describe their selected HRQOL-questionnaires, its definition of HRQOL and its dimensions, as well as comply with the questionnaire's guidelines when reporting HRQOL-data.
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Affiliation(s)
- Ann-Sophie Lindqvist Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Psychology, Gothenburg University, Gothenburg, Sweden.
| | - Hanna Wesslau
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Roza Cizek
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Carl Jacob Holmberg
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Marc Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital, Norwich, UK
| | - Dimitrios Katsarelias
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Carlander
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; SOM Institute. University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Cubi-Molla P, Buxton M, Devlin N. Allocating Public Spending Efficiently: Is There a Need for a Better Mechanism to Inform Decisions in the UK and Elsewhere? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:635-644. [PMID: 34105080 PMCID: PMC8187139 DOI: 10.1007/s40258-021-00648-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 05/13/2023]
Abstract
In the UK few if any regular processes explicitly address comparisons of value for money between spending in different government departments, despite the existence of mechanisms that could in principle achieve that. This leaves a very important gap in evidence and means that decisions about public spending allocations are likely to miss opportunities to improve social welfare from existing budgets. Greater attention to the development of methods and evidence to better inform the allocation of public sector spending between departments is therefore urgently needed. We identify a number of possible approaches to this-some of which are being used in different countries-and highlight their strengths and weaknesses. We propose a new, pragmatic approach that incorporates a generic descriptive system to measure the disparate outcomes produced by public sector activities in a commensurate manner. Discrete-choice experiments could be used to generate evidence of the relative importance placed on different aspects of public sector outcomes by members of the general public. The proposed approach would produce evidence on value for money across departments, and the generation of evidence on public preferences to support that.
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Affiliation(s)
- Patricia Cubi-Molla
- Office of Health Economics, 7th Floor Southside, 105 Victoria Street, London SW1E 6QT, London, UK.
- City, University of London, London, UK.
| | | | - Nancy Devlin
- Office of Health Economics, 7th Floor Southside, 105 Victoria Street, London SW1E 6QT, London, UK
- City, University of London, London, UK
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Teni FS, Rolfson O, Devlin N, Parkin D, Nauclér E, Burström K. Variations in Patients' Overall Assessment of Their Health Across and Within Disease Groups Using the EQ-5D Questionnaire: Protocol for a Longitudinal Study in the Swedish National Quality Registers. JMIR Res Protoc 2021; 10:e27669. [PMID: 34448726 PMCID: PMC8433865 DOI: 10.2196/27669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND EQ-5D is one of the most commonly used questionnaires to measure health-related quality of life. It is included in many of the Swedish National Quality Registers (NQRs). EQ-5D health states are usually summarized using "values" obtained from members of the general public, a majority of whom are healthy. However, an alternative, which remains to be studied in detail, is the potential to use patients' self-reported overall health on the visual analog scale (VAS) as a means of capturing experience-based perspective. OBJECTIVE The aim of this study is to assess EQ VAS as a valuation method with an experience-based perspective through comparison of its performance across and within patient groups, and with that of the general population in Sweden. METHODS Data on nearly 700,000 patients from 12 NQRs covering a variety of diseases/conditions and nearly 50,000 individuals from the general population will be analyzed. The EQ-5D-3L data from the 12 registers and EQ-5D-5L data from 2 registers will be used in the analyses. Longitudinal studies of patient-reported outcomes among different patient groups will be conducted in the period from baseline to 1-year follow-up. Descriptive statistics and analyses comparing EQ-5D dimensions and observed self-assessed EQ VAS values across and within patient groups will be performed. Comparisons of the change in health state and observed EQ VAS values at 1-year follow-up will also be undertaken. Regression models will be used to assess whether EQ-5D dimensions predict observed EQ VAS values to investigate patient value sets in each patient group. These will be compared across the patient groups and with the existing Swedish experience-based VAS and time trade-off value sets obtained from the general population. RESULTS Data retrieval started in May 2019 and data of patients in the 12 NQRs and from the survey conducted among the general population have been retrieved. Data analysis is ongoing on the retrieved data. CONCLUSIONS This research project will provide information on the differences across and within patient groups in terms of self-reported health status through EQ VAS and comparison with the general population. The findings of the study will contribute to the literature by exploring the potential of self-assessed EQ VAS values to develop value sets using an experience-based perspective. TRIAL REGISTRATION ClinicalTrials.gov NCT04359628; https://clinicaltrials.gov/ct2/show/NCT04359628. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27669.
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Affiliation(s)
- Fitsum Sebsibe Teni
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Nancy Devlin
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
- Office of Health Economics, London, United Kingdom
| | - David Parkin
- Office of Health Economics, London, United Kingdom
- City, University of London, London, United Kingdom
| | - Emma Nauclér
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Health Care Services, Region Stockholm, Stockholm, Sweden
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Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol. LANCET REGIONAL HEALTH-EUROPE 2021; 8:100186. [PMID: 34386785 PMCID: PMC8343377 DOI: 10.1016/j.lanepe.2021.100186] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background This study sought to establish the long-term effects of Covid-19 following hospitalisation. Methods 327 hospitalised participants, with SARS-CoV-2 infection were recruited into a prospective multicentre cohort study at least 3 months post-discharge. The primary outcome was self-reported recovery at least ninety days after initial Covid-19 symptom onset. Secondary outcomes included new symptoms, disability (Washington group short scale), breathlessness (MRC Dyspnoea scale) and quality of life (EQ5D-5L). Findings 55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age. Interpretation Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females. Funding National Institute for Health Research, UK Medical Research Council, Wellcome Trust, Department for International Development and the Bill and Melinda Gates Foundation.
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Sabah SA, Alvand A, Knight R, Beard DJ, Price AJ. Patient-Reported Function and Quality of Life After Revision Total Knee Arthroplasty: An Analysis of 10,727 Patients from the NHS PROMs Program. J Arthroplasty 2021; 36:2887-2895.e7. [PMID: 33840536 DOI: 10.1016/j.arth.2021.03.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of the study was to investigate changes in patient-reported outcome measures (PROMs) after revision total knee arthroplasty (rTKA). METHODS A total of 10,727 patients undergoing elective rTKA were recruited from the UK National Health Service PROMs data set from 2013 to 2019. PROMs were collected at baseline and six months to assess joint function (Oxford Knee Score, OKS) and quality of life (EQ-5D). Associations with a change in the OKS (COKS) were investigated through multiple linear regression. RESULTS The mean COKS was 12.4 (standard deviation 10.7) points. A total of 6776 of 10,329 (65.6%) patients demonstrated increase in the OKS above the minimal important change of 7.5 points. The median change in the EQ-5D utility was 0.227 (interquartile range 0.000 to 0.554). A total of 4917 of 9279 (53.0%) patients achieved a composite endpoint of improvement greater than the minimal important change for joint function and 'better' QoL as per the Paretian analysis. A total of 7477 of 10,727 (69.7%) patients reported satisfaction with rTKA. A total of 7947 of 10,727 (74.1%) patients felt surgery was a success. A total of 4888 of 10,632 (46.0%) patients reported one or more adverse events. A higher preoperative OKS was associated with a lower COKS (coefficient -0.63 [95% confidence interval -0.67 to -0.60]). Other factors associated with a lower COKS were postoperative complication(s), age under 60 years, longer duration of knee problems, patients who identified as disabled, problems in EQ-5D dimensions of anxiety/depression and self-care, comorbid conditions (circulatory problems, diabetes, and depression), and earlier year of procedure in the data set. CONCLUSION Two-thirds of patients experienced a meaningful improvement in joint function after rTKA. However, there was a high frequency of patient-reported complications. These findings may enable better informed discussion of the risks and benefits of discretionary rTKA.
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Affiliation(s)
- Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK; Nuffield Orthopaedic Centre, Oxford, UK
| | - Ruth Knight
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK; Nuffield Orthopaedic Centre, Oxford, UK
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Rivano Fischer M, Schult ML, Löfgren M, Stålnacke BM. Do quality of life, anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive-behavioural therapy-based programmes. J Int Med Res 2021; 49:3000605211027435. [PMID: 34275375 PMCID: PMC8293856 DOI: 10.1177/03000605211027435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive-behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes. METHODS We used a retrospective multicentre pretest-posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions. RESULTS Neither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres. CONCLUSIONS These findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.
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Affiliation(s)
- Marcelo Rivano Fischer
- Rehabilitation Medicine, Health Sciences Department, Lund University, Lund, Sweden.,Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden
| | - Marie-Louise Schult
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Monika Löfgren
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Britt-Marie Stålnacke
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
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Ladha KS, Cuthbertson BH, Abbott TEF, Pearse RM, Wijeysundera DN. Functional decline after major elective non-cardiac surgery: a multicentre prospective cohort study. Anaesthesia 2021; 76:1593-1599. [PMID: 34254670 DOI: 10.1111/anae.15537] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
Self-reported postoperative functional recovery is an important patient-centred outcome that is rarely measured or considered in research and decision-making. We conducted a secondary analysis of the measurement of exercise tolerance before surgery (METS) study for associations of peri-operative variables with functional decline after major non-cardiac surgery. Patients who were at least 40 years old, had or were at risk of, coronary artery disease and who were scheduled for non-cardiac surgery were recruited. Primary outcome was a reduction in mobility, self-care or ability to conduct usual activities (EuroQol 5 dimension) from before surgery to 30 days and 1 year after surgery. A decline in at least one function was reported by 523/1309 (40%) participants at 30 days and 320/1309 (24%) participants at 1 year. Participants who reported higher pre-operative Duke Activity Status indices more often reported functional decline 30 days after surgery and less often reported functional decline 1 year after surgery. The odds ratios (95%CI) of functional decline 30 days and 1 year after surgery with moderate or severe postoperative complications were 1.46 (1.02-2.09), p = 0.037 and 1.44 (0.98-2.13), p = 0.066. Discrimination of participants who reported functional decline 30 days and 1 year after surgery were poor (c-statistic 0.61 and 0.63, respectively). In summary, one quarter of participants reported functional decline up to one postoperative year.
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Affiliation(s)
- K S Ladha
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - B H Cuthbertson
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - T E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - R M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - D N Wijeysundera
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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Feng YS, Jiang R, Pickard AS, Kohlmann T. Combining EQ-5D-5L items into a level summary score: demonstrating feasibility using non-parametric item response theory using an international dataset. Qual Life Res 2021; 31:11-23. [PMID: 34236579 PMCID: PMC8800896 DOI: 10.1007/s11136-021-02922-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 01/31/2023]
Abstract
Background The EQ-5D-5L is a well-established health questionnaire that estimates health utilities by applying preference-based weights. Limited work has been done to examine alternative scoring approaches when utility weights are unavailable or inapplicable. We examined whether the Mokken scaling approach can elucidate 1) if the level summary score is appropriate for the EQ-5D-5L and 2) an interpretation of such a score. Methods The R package “mokken” was used to assess monotonicity (scaling coefficients H, automated item selection procedure) and manifest invariant item ordering (MIIO: paired item response functions [IRF], HT). We used a rich dataset (the Multiple Instrument Comparison, MIC) which includes EQ-5D-5L data from six Western countries. Results While all EQ-5D-5L items demonstrated monotonicity, the anxiety/depression (AD) item had weak scalability (Hi = 0.377). Without AD, scalability improved from Hs = 0.559 to Hs = 0.714. MIIO revealed that the 5 items can be ordered, and the ordering is moderately accurate in the MIC data (HT = 0.463). Excluding AD, HT improves to 0.743. Results were largely consistent across disease and country subgroups. Discussion The 5 items of the EQ-5D-5L form a moderate to strong Mokken scale, enabling persons to be ordered using the level summary score. Item ordering suggests that the lower range of the score represents mainly problems with pain and anxiety/depression, the mid-range indicates additional problems with mobility and usual activities, and middle to higher range of scores reveals additional limitations with self-care. Scalability and item ordering are even stronger when the anxiety/depression item is not included in the scale. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02922-1.
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Affiliation(s)
- You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5 72076, Tübingen, Germany. .,Institute for Community Medicine, University of Greifswald, Greifswald, Germany.
| | - Ruixuan Jiang
- Center for Observational and Real-World Evidence, Merck & Co, Kenilworth, NJ, USA
| | - A Simon Pickard
- College of Pharmacy, University of Illinois At Chicago, Chicago, IL, USA
| | - Thomas Kohlmann
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
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Baker E, Battle C, Banjeri A, Carlton E, Dixon C, Ferry J, Hopkins P, Jones R, Murrells T, Norton C, Patient L, Rasheed A, Skene I, Tabner A, Tunnicliff M, Young L, Xyrichis A, Lee G. Prospective observational study to examine health-related quality of life and develop models to predict long-term patient-reported outcomes 6 months after hospital discharge with blunt thoracic injuries. BMJ Open 2021; 11:e049292. [PMID: 34244278 PMCID: PMC8268921 DOI: 10.1136/bmjopen-2021-049292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study aimed to examine the long-term outcomes and health-related quality of life in patients with blunt thoracic injuries over 6 months from hospital discharge and develop models to predict long-term patient-reported outcomes. DESIGN A prospective observational study using longitudinal survey design. SETTING The study recruitment was undertaken at 12 UK hospitals which represented diverse geographical locations and covered urban, suburban and rural areas across England and Wales. PARTICIPANTS 337 patients admitted to hospital with blunt thoracic injuries were recruited between June 2018-October 2020. METHODS Participants completed a bank of two quality of life surveys (Short Form-12 (SF-12) and EuroQol 5-Dimensions 5-Levels) and two pain questionnaires (Brief Pain Inventory and painDETECT Questionnaire) at four time points over the first 6 months after discharge from hospital. A total of 211 (63%) participants completed the outcomes data at 6 months after hospital discharge. OUTCOMES MEASURES Three outcomes were measured using pre-existing and validated patient-reported outcome measures. Outcomes included: Poor physical function (SF-12 Physical Component Score); chronic pain (Brief Pain Inventory Pain Severity Score); and neuropathic pain (painDETECT Questionnaire). RESULTS Despite a trend towards improving physical functional and pain at 6 months, outcomes did not return to participants perceived baseline level of function. At 6 months after hospital discharge, 37% (n=77) of participants reported poor physical function; 36.5% (n=77) reported a chronic pain state; and 22% (n=47) reported pain with a neuropathic component. Predictive models were developed for each outcome highlighting important data collection requirements for predicting long-term outcomes in this population. Model diagnostics including calibration and discrimination statistics suggested good model fit in this development cohort. CONCLUSIONS This study identified the recovery trajectories for patients with blunt thoracic injuries over the first 6 months after hospital discharge and present prognostic models for three important outcomes which after external validation could be used as clinical risk stratification scores.
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Affiliation(s)
- Edward Baker
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Emergency Department, King's College Hospital, London, UK
| | - Ceri Battle
- Welsh Institute of Biomedical and Emergency Medicine Research, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Abhishek Banjeri
- Emergency Department, Buckingham Healthcare NHS Trust, Amersham, UK
| | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Christine Dixon
- Emergency Department, Surrey and Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Jennifer Ferry
- Department of Anesthetics, Aneurin Bevan Health Board, Newport, UK
| | - Philip Hopkins
- Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Robert Jones
- Emergency Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Trevor Murrells
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Lee Patient
- Emergency Department, St George's Healthcare NHS Trust, London, UK
| | - Ashraf Rasheed
- General Surgery, Aneurin Bevan Health Board, Newport, UK
| | - Imogen Skene
- Emergency Department, Barts Health NHS Trust, London, UK
| | - Andrew Tabner
- Emergency Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Malcolm Tunnicliff
- Emergency Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Louise Young
- Emergency Department, Imperial College Healthcare NHS Trust, London, UK
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Gerry Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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48
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Gargula S, Luscan R, Drummond D, Denoyelle F, Couloigner V, Leboulanger N, Simon F. French translation and validation of the Sinus and Nasal Quality of Life Survey (SN-5) in children. Int J Pediatr Otorhinolaryngol 2021; 145:110706. [PMID: 33862327 DOI: 10.1016/j.ijporl.2021.110706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Chronic rhinosinusitis (CRS) is a frequent, quality-of-life (QOL) impairing disease in pediatrics. The SN-5 is a reliable, sensitive and reproductible QOL questionnaire, validated in English for evaluation of CRS disease-specific QOL in children. This study aims to adapt and validate the French version of this test. METHODS The SN-5 score was adapted into French language through a forward-backwards translation process, and validated through a monocentric prospective controlled study. Inclusion criteria were 2-12 years of age, CRS symptoms for at least 12 weeks, or absence of sino-nasal symptom for controls. Reproducibility was assessed through Spearman's correlation between initial answers and a re-test conducted 15 days later. Internal consistency was measured through Cronbach's alpha, construct validity through Spearman's correlation between items, discriminative ability through Mann-Whitney tests. RESULTS 40 patients and 37 controls filled the score between November 2019 and March 2020. Retest was returned by 35 patients and 35 controls. Mean cases age was 8.5 ± 2.6 years old. 26 patients had primary CRS, 10 had cystic fibrosis, 4 had ciliary dyskinesia. All had diffuse disease. Mean SN-5 overall score was 3.63/7 ± 6.4 for CRS patients and 1.89/7 ± 0.9 for controls (p < 0.001). Test-retest coefficient was 0.84 (0.70-0.92; p < 0.001), Cronbach's alpha was 0.83 for CRS patient. Item per item construct validity was good to excellent. CONCLUSIONS The French version of the SN-5 showed good statistical properties, with good test-retest reliability, internal consistency, structural validity and discriminative ability between CRS and control patients.
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Affiliation(s)
- Stéphane Gargula
- Université de Paris, Faculté de Médecine, F-75006, Paris, France; Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France.
| | - Romain Luscan
- Université de Paris, Faculté de Médecine, F-75006, Paris, France; Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
| | - David Drummond
- Université de Paris, Faculté de Médecine, F-75006, Paris, France; Department of Paediatric Pulmonology, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
| | - Françoise Denoyelle
- Université de Paris, Faculté de Médecine, F-75006, Paris, France; Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
| | - Vincent Couloigner
- Université de Paris, Faculté de Médecine, F-75006, Paris, France; Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
| | - Nicolas Leboulanger
- Université de Paris, Faculté de Médecine, F-75006, Paris, France; Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
| | - François Simon
- Université de Paris, Faculté de Médecine, F-75006, Paris, France; Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France
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49
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Trigg A, Brohan E, Cocks K, Jones A, Tahami Monfared AA, Chabot I, Meier G, Campbell R, Li H, Ngo LY. Health-related quality of life in pediatric patients with partial onset seizures or primary generalized tonic-clonic seizures receiving adjunctive perampanel. Epilepsy Behav 2021; 118:107938. [PMID: 33839450 DOI: 10.1016/j.yebeh.2021.107938] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE Study 311 (E2007-G000-311; NCT02849626) was a Phase 3, multicenter, open-label single-arm study of adjunctive perampanel oral suspension in pediatric patients (aged 4 to <12 years) with partial-onset seizures (POS) (with/without secondarily generalized tonic-clonic seizures [SGTCS]) or primary generalized tonic-clonic seizures (PGTCS). Health-related quality of life (HRQoL) was an exploratory endpoint initially analyzed through simple descriptive summaries. The aim of this post hoc analysis was to provide a more thorough assessment of HRQoL. METHODS This analysis focused on EQ-5D-Y data collected at Baseline, Week 23, and Week 52. Individual dimensions, visual analog scale (VAS) and summed misery index (MI) were evaluated at all visits and compared by seizure type (POS versus SGTCS versus PGTCS), age (4 to <7 versus 7 to <12), and use of concomitant enzyme-inducing antiepileptic drugs (EIAEDs) (yes versus no). Paretian Classification of Health Change (PCHC) analysis summarized the proportion of patients who showed improvement or deterioration in HRQoL. Waterfall plots assessed changes in EQ-5D-Y scores by treatment-emergent adverse events (TEAEs) and by reduction in seizure frequency. Health state utility values associated with differing seizure frequency states were estimated using a linear mixed model. RESULTS One hundred and fifteen patients completed EQ-5D-Y at relevant study visits (Seizure type: POS n = 84 [of which 21 had SGTCS], PGTCS n = 31; Age: 4 to <7 years n = 30, 7 to <12 years n = 85; Concomitant EIAEDs: Yes n = 35, No n = 80). Completion rates out of those expected to complete EQ-5D-Y were high at both timepoints (84.4% at Week 23 and 97.2% at Week 52). Overall, VAS/MI remained stable over time (did not exceed minimal important difference); this was similar according to seizure type, age, and EIAED usage. In patients with 'no problems' on any EQ-5D-Y dimension at Baseline, nearly all retained their full health at Week 23 (94.7%), and all retained it at Week 52 (100.0%). PCHC analysis showed fewer patients with POS experienced deterioration in EQ-5D-Y than patients with PGTCS at Week 23 (24.1% versus 42.1%). Not experiencing a TEAE, or remaining seizure-free, was associated with improvements in VAS score at Week 23 compared to those experiencing TEAEs or seizures, respectively. Health state utility values (HSUVs) were estimated as follows: seizure free (LS Mean 0.914 [95% CIs 0.587, 1.240]), ≥1 seizure per year (0.620 [0.506, 0.734]), ≥1 seizure per month (0.596 [0.338, 0.855]), ≥1 seizure per week (0.284 [-0.014, 0.582]). CONCLUSIONS An in-depth analysis of EQ-5D-Y data allowed for a more nuanced exploration of HRQoL than previous descriptive summaries. Our findings provide evidence that perampanel as adjunctive therapy did not result in deterioration of patient HRQoL. The association between TEAEs or remaining seizure-free and HRQoL warrants further exploration. Increasing seizure frequency was associated with decreasing HSUVs; these can inform cost-effectiveness modeling of perampanel and other therapies aiming to reduce seizure frequency in pediatric patients.
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Affiliation(s)
- Andrew Trigg
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK.
| | - Elaine Brohan
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Kim Cocks
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Amy Jones
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, UK
| | - Amir A Tahami Monfared
- Eisai Inc., Woodcliff Lake, NJ, USA; McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada
| | - Isabelle Chabot
- Faculty of Pharmacy, Montreal University, Montreal, QC, Canada
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50
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Robertson AO, Horvat-Gitsels LA, Cortina-Borja M, Rahi JS. Distribution and associations of vision-related quality of life and functional vision of children with visual impairment. Br J Ophthalmol 2021; 106:1325-1330. [PMID: 33827860 DOI: 10.1136/bjophthalmol-2020-318473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are increasingly used in paediatric ophthalmology. However, little is known about the distribution of PROM scores among children and young people with visual impairment. AIM To investigate the distributions and predictors of scores on the VQoL_CYP (measuring vision-related quality of life) and FVQ_CYP (measuring functional vision). METHODS Children and young people aged 8-18 years, with visual impairment/blindness (logarithm of the minimum angle of resolution (LogMAR) worse than 0.48 in the better eye, and/or eligible visual field restriction) completed the VQoL_CYP and FVQ_CYP at home or Great Ormond Street Hospital, London, UK. Associations between VQoL_CYP and FVQ_CYP scores and sociodemographic and clinical factors were analysed using multiple linear regression models. RESULTS Among 93 participants, VQoL_CYP scores ranged from 36.6 to 78.2 (mean=57.9, SD=8.1). FVQ_CYP scores ranged from 23.5 to 70.3 (mean=48.3, SD=10.1). Only 0.4% of the variation in VQoL_CYP scores was explained, with no associations with the variables of interest. By contrast, 21.6% of the variation in FVQ_CYP scores was explained, with a gradient of worse acuity (p<0.001) and female gender (p=0.04) associated with worse self-rated functional vision. Age, ethnicity, time of onset and stability/progression of visual impairment were not associated. DISCUSSION Self-rated vision-related quality of life and functional vision are not readily predicted from sociodemographic or clinical characteristics that ophthalmologists measure/record. Routine use of PROMs in clinical practice can offer important insights. Use in research can provide valuable measures of effectiveness of interventions. The reference values provided will aid interpretation in both settings.
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Affiliation(s)
- Alexandra O Robertson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lisanne A Horvat-Gitsels
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Ulverscroft Vision Research Group, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jugnoo S Rahi
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK .,Ulverscroft Vision Research Group, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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