Quality of life and the high-dependency unit

An exercise trial for wheelchair users: project workout on wheels

There is growing interest in promoting health for people with disabilities, yet evidence regarding community-based interventions is sparse. This paper describes the design details of a randomized controlled trial (RCT) that will test the effectiveness of a multi-component behaviorally based, intervention to promote exercise adoption (over 6 months) and maintenance (up to one year) among wheelchair users and includes descriptive data on participant characteristics at baseline. Participants were randomly assigned to either a staff-supported intervention group or a self-guided comparison group. The primary study aim is to assess the effectiveness of the multi-component behaviorally based intervention for promoting physical activity adoption and maintenance. The RCT will also assess the physical and psychosocial effects of the intervention and the complex interplay of factors that influence the effectiveness of the intervention. Therefore, the primary outcome derives from participant reports of weekly exercise (type, frequency, duration) over 52 weeks. Secondary outcomes collected on four occasions (baseline, 3 months, 6 months, 12 months) included physiological outcomes (VO(2) peak, strength), disability-related outcomes (pain, fatigue, participation), and psychosocial outcomes (exercise self-efficacy, exercise barriers, quality of life, depression, mood). This study will provide evidence regarding the effectiveness of a multi-component behaviorally based intervention for promoting exercise adoption among people with mobility impairments that necessitate wheelchair use.

Responsividade dos instrumentos de avaliação de qualidade de vida de Ferrans e Powers: uma revisão bibliográfica

Este estudo objetivou realizar uma revisão bibliográfica sobre a responsividade ou sensibilidade às mudanças dos instrumentos de avaliação de qualidade de vida de Ferrans & Powers (IQVFP), nas versões genérica e específica. Os artigos foram localizados por meio das bases de dados Pubmed/Medline, Lilacs e SciELO e no próprio sítio eletrônico das autoras, utilizando as palavras-chaves: quality of life, responsiveness, sensitivity to change, Ferrans and Powers Index, measure tool. Dos 31 artigos encontrados, 20 foram acessados na íntegra. Quanto aos objetivos, 85% relacionavam QV e intervenções e 15% sobre responsividade, sendo a maioria desenvolvida com pacientes cardíacos (11/ 55%). Dentre os três estudos sobre responsividade, em dois foram testadas as propriedades psicométricas de confiabilidade e responsividade. O outro tratava de revisão de literatura. Concluiu-se que o número de pesquisas que testou a responsividade dos instrumentos de IQVFP é reduzido, havendo necessidade de novos estudos que avaliem essa propriedade de medida.

Somatically ill persons' self-nominated quality of life domains: review of the literature and guidelines for future studies

OBJECTIVE

To review which domains somatically ill persons nominate as constituting their QoL. Specific objective is to examine whether the method of enquiry affect these domains.

METHODS

We conducted two literature searches in the databases PubMed/Medline, CINAHL and Psychinfo for qualitative studies examining patients' self-defined QoL domains using (1) SEIQoL and (2) study-specific questions. For each database, two researchers independently assessed the eligibility of the retrieved abstracts and three researchers subsequently classified all QoL domains.

RESULTS

Thirty-six eligible papers were identified: 27 studies using the SEIQoL, and nine presenting data derived from study-specific questions. The influence of the method of enquiry on patients' self-nominated QoL domains appears limited: most domains were presented in both types of studies, albeit with different frequencies.

CONCLUSIONS

This review provides a comprehensive overview of somatically ill persons' self-nominated QoL domains. However, limitations inherent to reviewing qualitative studies (e.g., the varying level of abstraction of patients' self-defined QoL domains), limitations of the included studies and limitations inherent to the review process, hinder cross-study comparisons. Therefore, we provide guidelines to address shortcomings of qualitative reports amenable to improvement and to stimulate further improvement of conducting and reporting qualitative research aimed at exploring respondents' self-nominated QoL domains.

Short- and long-term outcomes of older patients in intermediate care units

OBJECTIVE

To evaluate short- and long-term outcomes of elderly patients (>or=65 years) treated at an intermediate care unit (IMCU) and to identify outcome predictors.

DESIGN AND SETTING

Prospective observational study in the IMCU of a university teaching hospital.

PARTICIPANTS

We studied 412 patients over 8 months, classified into three groups: under 65years (control group, n=158), 65-80 (n=186), and >80 (n=68).

MEASUREMENTS

At admission: APACHE II, TISS-28 first day, Charlson Index, diagnosis, and prior Barthel Index.

OUTCOME MEASURES

in-hospital mortality, length of stay, discharge destination, and 2-year mortality and readmissions. Data analysis included multivariate logistic regression and receiver operating characteristics area under the curve (ROC AUC).

RESULTS

No statistically significant differences between groups were observed in hospital mortality (14.1%), discharge to a long-term facility (2.7%), or 2-year readmissions (1.2+/-2.1). However, hospital stay was longer in patients aged 65-80years (14 vs.10 days) and 2-year mortality was higher in those 65 or over (34% vs.10.6%). In the overall series in-hospital mortality was predicted by APACHE II, first-day TISS-28, and diagnosis (ROC AUC 0.81), and 2-year mortality by Charlson Index and age (ROC AUC 0.77). In the elderly patients 2-year mortality was predicted by Charlson and Barthel indices (ROC AUC 0.70).

CONCLUSIONS

Illness severity and therapeutic intervention at admission to IMCU were predictors of short-term mortality, whereas the strongest predictor of long-term mortality was comorbidity. Our results suggest that comprehensive assessment of elderly patients at admission to IMCUs may improve outcome prediction.