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Fontaine G, Poitras ME, Sasseville M, Pomey MP, Ouellet J, Brahim LO, Wasserman S, Bergeron F, Lambert SD. Barriers and enablers to the implementation of patient-reported outcome and experience measures (PROMs/PREMs): protocol for an umbrella review. Syst Rev 2024; 13:96. [PMID: 38532492 DOI: 10.1186/s13643-024-02512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Patient-reported outcome and experience measures (PROMs and PREMs, respectively) are evidence-based, standardized questionnaires that can be used to capture patients' perspectives of their health and health care. While substantial investments have been made in the implementation of PROMs and PREMs, their use remains fragmented and limited in many settings. Analysis of multi-level barriers and enablers to the implementation of PROMs and PREMs has been hampered by the lack of use of state-of-the-art implementation science frameworks. This umbrella review aims to consolidate available evidence from existing quantitative, qualitative, and mixed-methods systematic and scoping reviews covering factors that influence the implementation of PROMs and PREMs in healthcare settings. METHODS An umbrella review of systematic and scoping reviews will be conducted following the guidelines of the Joanna Briggs Institute (JBI). Qualitative, quantitative, and mixed methods reviews of studies focusing on the implementation of PROMs and/or PREMs in all healthcare settings will be considered for inclusion. Eight bibliographical databases will be searched. All review steps will be conducted by two reviewers independently. Included reviews will be appraised and data will be extracted in four steps: (1) assessing the methodological quality of reviews using the JBI Critical Appraisal Checklist; (2) extracting data from included reviews; (3) theory-based coding of barriers and enablers using the Consolidated Framework for Implementation Research (CFIR) 2.0; and (4) identifying the barriers and enablers best supported by reviews using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. Findings will be presented in diagrammatic and tabular forms in a manner that aligns with the objective and scope of this umbrella review, along with a narrative summary. DISCUSSION This umbrella review of quantitative, qualitative, and mixed-methods systematic and scoping reviews will inform policymakers, researchers, managers, and clinicians regarding which factors hamper or enable the adoption and sustained use of PROMs and PREMs in healthcare settings, and the level of confidence in the evidence supporting these factors. Findings will orient the selection and adaptation of implementation strategies tailored to the factors identified. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023421845.
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Affiliation(s)
- Guillaume Fontaine
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12 Ave N Building X1, Sherbrooke, QC, J1H 5N4, Canada
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS) du Saguenay-Lac-Saint-Jean du Québec, 930 Rue Jacques-Cartier E, Chicoutimi, QC, G7H 7K9, Canada
| | - Maxime Sasseville
- Faculty of Nursing, Université Laval, 1050 Av. de La Médecine, Québec, QC, G1V 0A6, Canada
- Centre de Recherche en Santé Durable VITAM, CIUSSS de La Capitale-Nationale, 2480, Chemin de La Canardière, Quebec City, QC, G1J 2G1, Canada
| | - Marie-Pascale Pomey
- Faculty of Medicine & School of Public Health, Université de Montréal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
- Centre de Recherche du Centre Hospitalier de L, Université de Montréal (CR-CHUM), 900 Saint Denis St., Montreal, QC, H2X 0A9, Canada
| | - Jérôme Ouellet
- Direction of Nursing, CIUSSS de L'Ouest de L'Île-de-Montréal, 3830, Avenue Lacombe, Montreal, QC, H3T 1M5, Canada
| | - Lydia Ould Brahim
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada
| | - Sydney Wasserman
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada
| | - Frédéric Bergeron
- Université Laval Library, Pavillon Alexandre-Vachon 1045, Avenue de La Médecine, Québec, Québec), G1V 0A6, Canada
| | - Sylvie D Lambert
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada
- St. Mary's Research Centre, CIUSSS de L'Ouest de L'Île-de-Montréal, 3777 Jean Brillant St, Montreal, QC, H3T 0A2, Canada
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Porsius JT, Ter Stege MHP, Selles RW, Slijper HP. Driving Factors of Recommending a Hand Surgery Clinic After Surgery. J Hand Surg Am 2024; 49:114-123. [PMID: 38099875 DOI: 10.1016/j.jhsa.2023.11.010] [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: 08/30/2022] [Revised: 10/20/2023] [Accepted: 11/01/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Since a patient's recommendation of a clinic to others is an important indicator of patient experience, more insight is needed into the underlying factors that motivate such recommendations. This retrospective cohort study assessed the relative contribution of the following: (1) patient-related characteristics, (2) treatment outcome, (3) satisfaction with treatment outcome, and (4) patients' experience with the process of care to patients' recommendation of a specific clinic after elective surgery. METHODS Patients of specialized outpatient hand surgery clinics (N = 6,895) reported the likelihood of recommending the clinic to friends or family 3-5 months after surgery by filling in the Net Promoter Score. Potential predictors of the Net Promoter Score were preoperative patient characteristics, patient-reported treatment outcomes, satisfaction with treatment outcome, and experience with several health care delivery domains. Linear regression analyses were used to examine the contribution of the predictors. RESULTS Mean age of the patients was 53 (SD, 14) years, 62.5% were women, and 62.5% were employed. Preoperative patient characteristics explained 1% of the variance in clinic recommendations. An additional 6% was explained by the treatment outcome, 21.6% by satisfaction with treatment outcome, and 33.8% by patients' experience with care delivery (total explained variance was 62.3%). The strongest independent predictors of clinic recommendations were positive experiences with the quality of the facilities and the communication skills of the physician. CONCLUSIONS Patient recommendations are more strongly driven by patients' experience with care delivery than by treatment outcome and patient characteristics. CLINICAL RELEVANCE In elective surgery, improving patient experiences is pivotal in boosting patient recommendation of the clinic.
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Affiliation(s)
- Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Marloes H P Ter Stege
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, the Netherlands.
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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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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Adames DNB, González-Lucena G, Ruales JIS, Cudos BG, Ginés-Cespedosa A. Outcome Assessment Performance of the SF-36, Manchester-Oxford Foot Questionnaire and AOFAS in Forefoot Reconstruction Surgery. J Foot Ankle Surg 2022; 61:248-252. [PMID: 34364761 DOI: 10.1053/j.jfas.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate the measurement properties of the Short Form 36 (SF-36) to detect real change after forefoot reconstruction surgery. Responsiveness and minimally important change estimates were compared with those from the Manchester-Oxford Foot Questionnaire (MOXFQ) and the American Orthopaedic Foot and Ankle Society (AOFAS) measures. Eighty-three patients awaiting surgery were recruited. Patients completed pre- and 12 months postoperative the SF-36 and the MOXFQ. A surgeon assessed the AOFAS scores. The responsiveness to change was determined using the effect size (ES), the minimal detectable change (MDC) and the minimal clinically important change. Two subscales of the SF-36 demonstrated significant improvement, bodily pain (BP) and mental health. Only the BP domain appeared the most responsive with an ES of 0.73. All domains of the MOXFQ and AOFAS produced much larger effect sizes (ES > 1.5). MDC values for the majority of the SF-36 domains fell within measurement error except for the BP domain. Fewer patients showed significant improvement when compared with the MOXFQ pain domain. In conclusion, the SF-36 measuring tool proved to be neither reliable nor responsive enough to detect real change after forefoot surgery. Though the BP domain appeared to be the most responsive, it failed to detect meaningful change when compared to the MOXFQ-Pain and the Visual Analogue Scale.
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Affiliation(s)
- Philip Berry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Stausberg J, Harkener S, Semler SC. Recent Trends in Patient Registries for Health Services Research. Methods Inf Med 2021; 60:e1-e8. [PMID: 33862662 PMCID: PMC8294939 DOI: 10.1055/s-0041-1724104] [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] [Indexed: 11/24/2022]
Abstract
Background
Patient registries are an established methodology in health services research. Since more than 150 years, registries collect information concerning groups of similar patients to answer research questions. Elaborated recommendations about an appropriate development and an efficient operation of registries are available. However, the scene changes rapidly.
Objectives
The aim of the study is to describe current trends in registry research for health services research.
Methods
Registries developed within a German funding scheme for model registries in health services research were analyzed. The observations were compared with recent recommendations of the Agency for Healthcare Research and Quality (AHRQ) on registries in the 21st century.
Results
Analyzing six registries from the funding scheme revealed the following trends: recruiting healthy individuals, representing familial or other interpersonal relationships, recording of patient-reported experiences or outcomes, accepting participants as study sites, active informing of participants, integrating the registry with other data collections, and transferring data from the registry to electronic patient records. This list partly complies with the issues discussed by the AHRQ. The AHRQ structured its ideas in five chapters, increasing focus on the patient, engaging patients as partners, digital health and patient registries, direct-to-patient registry, and registry networks.
Conclusion
For the near future, it can be said that the concept and the design of a registry should place the patient in the center. Registries will be increasingly linked together and interconnected with other data collections. New challenges arise regarding the management of data quality and the interpretation of results from less controlled settings. Here, further research related to the methodology of registries is needed.
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Affiliation(s)
- Jürgen Stausberg
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
| | - Sonja Harkener
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
| | - Sebastian C Semler
- TMF Technology, Methods, and Infrastructure for Networked Medical Research, Berlin, Germany
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Vieira Cardoso D, Dubois-Ferrière V, Hannouche D, Lübbeke A, Perneger T. Development and psychometric performance of the French language version of the Manchester-Oxford Foot Questionnaire (MOXFQ). Foot Ankle Surg 2020; 26:902-906. [PMID: 31882344 DOI: 10.1016/j.fas.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Manchester-Oxford Foot Questionnaire (MOXFQ) is a 16-item patient-reported outcome measure (PROM) validated for use in patients with foot and ankle pathologies. It contains three sub-scores for pain, walking/standing and social interaction dimensions. The aim of this study was to develop a French language version of the MOXFQ and to assess its psychometric properties in patients affected by foot and ankle pathologies. METHODS According to guidelines, forward and backward independent translations were performed. The final French version was pre-tested in 45 patients. The French MOXFQ and the Short-form 36 Health Survey (SF-36) were filled in by 149 patients. A retest was performed in 39 patients. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by factor analysis, and through correlations of MOXFQ scales with SF-36 scales. RESULTS Internal consistency coefficients were high with Cronbach's alpha ranging from 0.79 and 0.94. Test-retest ICCs were between 0.74 and 0.93. No floor or ceiling effects were observed. The correlations between French MOXFQ and French SF-36 subscales were moderate ranging from -0.33 to -0.71. CONCLUSIONS The French translation of the MOXFQ revealed good psychometric properties. Our French version proved to be a reliable instrument which can be used for evaluation of patients with foot and ankle disorders. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Diogo Vieira Cardoso
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland.
| | - Victor Dubois-Ferrière
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Lübbeke
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Epidemiology, Geneva University Hospitals, Geneva, Switzerland
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Maempel JF, Clement ND, Duckworth AD, Keenan OJF, White TO, Biant LC. A Randomized Controlled Trial Comparing Traditional Plaster Cast Rehabilitation With Functional Walking Boot Rehabilitation for Acute Achilles Tendon Ruptures. Am J Sports Med 2020; 48:2755-2764. [PMID: 32816521 DOI: 10.1177/0363546520944905] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been a shift toward functional nonoperative rehabilitation in the treatment of Achilles tendon rupture (ATR) despite a shortage of studies directly comparing nonoperative functional rehabilitation with traditional nonoperative immobilization. PURPOSE To compare patient-reported outcome measures and functional outcomes for nonoperatively treated ATR with traditional cast immobilization or functional rehabilitation in a walking boot. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 2. METHODS In a single-center nonblinded study, 140 patients were randomized to compare treatment for acute ATR in (1) an immobilizing cast in reducing degrees of equinus over a 10-week period with 8 weeks of nonweightbearing mobilization or (2) a walking boot for 8 weeks with reducing equinus and immediate full weightbearing. Exclusion criteria were delayed presentation >2 weeks after injury, tendon reruptures, and latex allergy. Analysis was undertaken on an intention-to-treat basis. RESULTS A total of 69 patients (median age, 41 years [interquartile range, 33-50.5 years]) were randomized to walking boot treatment and 71 patients (41 [32-49]) to cast treatment. At 6 months, patients treated in a walking boot reported better Short Musculoskeletal Function Assessment (SMFA) dysfunction index (6.62 [2.21-12.50] vs 10.66 [4.96-13.42]; P = .050), SMFA bother index (7.29 [2.08-14.58] vs 10.42 [5.73-19.27]; P = .04), Achilles Tendon Total Rupture Score (71.5 [53.50-84.25] vs 54.0 [37-76]; P = .01), and Foot and Ankle Questionnaire core score (91 [81.89-97.55] vs 85 [78.25-92.09]; P = .04). At 1 year, there was no difference in SMFA dysfunction index (2.21 [0.74-5.88] vs 2.94 [1.47-6.62]; P = .25), SMFA bother index (2.08 [0-9.38] vs 5.21 [0.52-11.98]; P = .25), Achilles Tendon Total Rupture Score (92 [72.50-96] vs 87.5 [66.0-94.75]; P = .21), or Foot and Ankle Questionnaire core score (97.75 [89.46-99.00] vs 95.50 [90.88-97.50]; P = .18). Rerupture occurred in 5 and 11 patients (P = .075) and venous thromboembolism in 2 and 3 patients (P = .67) in the boot and cast groups, respectively. Fifteen patients in the boot group but none in the cast group had skin problems (P < .001). Patients treated in a boot returned to driving at a median 12 weeks (vs 13 weeks for cast; P = .045), but there was no difference in time to return to work (P = .48). CONCLUSION Functional rehabilitation with early weightbearing is a safe alternative to traditional immobilizing treatment for ATR, giving better early functional outcomes, albeit with a higher incidence of transient minor skin complications. REGISTRATION NCT02598843 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Julian F Maempel
- Royal Prince Alfred Hospital, Sydney, Australia.,University of Malta Medical School, Msida, Malta
| | | | - Andrew D Duckworth
- Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | | | - Tim O White
- Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Leela C Biant
- University of Manchester Medical School, Manchester, UK.,Manchester Orthopaedic Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Iliopoulos E, Hossain N, Freeman R, Vernois J, Bendall S. Development and validation of the unifying elective orthopaedic score (UnEOS). A pilot study. J Clin Orthop Trauma 2020; 11:S153-S157. [PMID: 31992937 PMCID: PMC6977529 DOI: 10.1016/j.jcot.2019.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) are increasingly valued in orthopaedics. There are already many site specific or pathology specific scores. These scores are usually validated for specific pathologies and can be complicated and time consuming to use. The aim of the present pilot study is to develop a new orthopaedic score for elective operations, which measures patient satisfaction simply and quickly, and is not limited to a single site or pathology. MATERIALS & METHODS The UnEOS questionnaire has 16 questions. Eleven questions relate to the three main dimensions (Symptoms, Function, Mental Status) and can be used both preoperatively and postoperatively. Five questions are added to the questionnaire at the postoperative mode, which form the satisfaction dimension. For this pilot study we enrolled all patients listed for surgery from our foot and ankle clinics. Each patient was asked to complete the UnEOS and FADI questionnaires. RESULTS A total of 181 questionnaires were collected from patients (aged 56.4 ± 14.8, range 20-85) with a variety of foot and ankle pathologies. Scores were obtained both pre- and post-operatively. The scale reliability was checked with the Cronbach's Alpha score, which was 0.87 for the UnEOS scale. Each subscale had good reliability with 0.73, 0.77 and 0.76 respectively (Symptoms, Function, Mental Status). The validity of the scale was checked using the Spearman's Rho correlation, which was strong between the UnEOS and the FADI score (0.79) and each subscale (0.7, 0.75 and 0.69 respectively). CONCLUSION The UnEOS score is a valid and easy to use PROM which is not limited by site or pathology. Further validation with other orthopaedic pathologies will lead to a Unified Elective Orthopaedic score.
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Affiliation(s)
- Efthymios Iliopoulos
- Corresponding author. Brighton and Sussex University Hospitals, NHS Trust, Brighton, UK.
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Maempel JF, Jenkins PJ, McEachan JE. The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release. J Hand Surg Eur Vol 2020; 45:147-152. [PMID: 31403874 DOI: 10.1177/1753193419866400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We studied whether mental health status is significantly correlated to patient reported functional outcomes and satisfaction after carpal tunnel release. Over a 7-year period, 809 patients completed Short Form-12 (SF-12) questionnaires which allowed calculation of the SF-12 mental component summary 1 year postoperatively, 780 (96%) completed a satisfaction questionnaire and 777 (96%) completed a QuickDisabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Median QuickDASH score was 55 preoperatively (interquartile range [IQR] 28) and 14 postoperatively (IQR 32). A total of 674 patients were satisfied. Patients with mental disability had worse QuickDASH scores (median 34, IQR 41) and a higher incidence of dissatisfaction (52/245, 21%) than those without mental disability (n = 9, IQR 20, 10%, both p < 0.001). Regression analyses indicated scores in the SF-12 mental component summary were significantly related to postoperative QuickDASH score (p < 0.001) and satisfaction (p = 0.02). We concluded that patients with mental disability report poorer outcomes and lower satisfaction rates; however, the majority still exhibit significant improvements and are satisfied. Level of evidence: II.
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Lungu DA, Pennucci F, De Rosis S, Romano G, Melfi F. Implementing successful systematic Patient Reported Outcome and Experience Measures (PROMs and PREMs) in robotic oncological surgery-The role of physicians. Int J Health Plann Manage 2019; 35:773-787. [PMID: 31793689 DOI: 10.1002/hpm.2959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/04/2023] Open
Abstract
Patient Reported Outcome and Experience Measures (PROMs and PREMs) play an increasingly important role in monitoring the quality of the oncological pathway. The aim of this study is to describe the case of five hospitals a year after the adoption of PROMs and PREMs for robotic oncological colorectal surgery in Tuscany and to investigate how the clinicians can impact the process of implementation and the efficacy of such measures. We used 14 months of data from the five robotic centers in Tuscany. Above all, the physician's personal motivation to improve the treatment of patients, the teamwork, and the possibility to use data for research purposes proved to be the essential factors for their engagement and the successful implementation of patient reported measures. Physicians play a key role in the adoption of systematic PROMs and PREMs. The higher their level of engagement, the higher the collection success, both in terms of number of patients enrolled and response rates. Moreover, the collection of patient reported measures may become part of physicians' daily practice and may lead to a change in their relationship and communication with patients, as clinicians accept to have their job reviewed and are not afraid to be evaluated by their patients.
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Affiliation(s)
- Daniel Adrian Lungu
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Pennucci
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina De Rosis
- Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
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PROMs in post-mastectomy care: Patient self-reports (BREAST-Q™) as a powerful instrument to personalize medical services. Eur J Surg Oncol 2019; 46:1034-1040. [PMID: 31812290 DOI: 10.1016/j.ejso.2019.11.504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
One of the goals of immediate breast reconstruction (IBR) is to satisfy the patient's outcome. Recent studies therefore tended to focus on the patient's perception of the care and on the impact on quality of life using patients-reported-outcome-measures (PROMs), able to measure the health status directly without the clinician's interposition. We present a preliminary prospective study on 333 patients who underwent mastectomy with IBR in a two-year period, in a single Italian centre, using a dedicated PROMs, the BREAST-Q™, to determine the patient's satisfaction. We studied two groups of IBR: Group A (two-step with tissue-expander) and Group B (one-step: prosthesis/mesh) and conducted a pre- and post-operative comparison for each group to evaluate score-gain over time, and a group-score comparison to determine whether differences were significant between reconstruction types. Two-hundred-and-nine were actually enrolled and 132 completed all the questionnaires. The response rate was 62.8% and the compliance rate (completion of all the questionnaires) was 63.1%. In both groups all the analyzed domains worsened comparing the pre and post-operative period; the differences were statistically significant only for physical and sexual-wellbeing. In the comparison between the two groups, none of the detected differences reached the statistical significance. According to our experience, we can state that PROMs could improve the health concept redefining the variables to be monitored even if data is still insufficient to draw any definitive conclusion. PROMs can help surgeons and patients decide the most appropriate surgery for a particular patient-profile and to identify those who require further support.
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Associations between interim patient-reported outcome measures and functional status at discharge from rehabilitation for non-specific lumbar impairments. Qual Life Res 2019; 29:439-451. [PMID: 31571028 DOI: 10.1007/s11136-019-02314-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Identify impact of frequency and timing of interim Patient-Reported Outcome Measures (PROMs) assessments during episodes of care for rehabilitation services in outpatient clinical settings on functional status (FS) outcomes at discharge for patients with low back pain. METHODS FS outcomes of patients who had no interim PROMs were compared to outcomes of six patient groups defined by interim timing (early, mid, late) and frequency (1, 2 or more). For each comparison, patients were matched using propensity score matching for variables known to be associated with FS outcomes and for episode duration (days) and number of visits. FS was assessed using the lumbar computerized adaptive test (LCAT) where scores range from 0 to 100 with higher scores representing better physical function. RESULTS A sample of 140,336 patients was considered for matching (mean age = 58 [SD = 17] range 18-89; 60% females) with 83,101 patients (59%) having no interim PROMs. Patients who had only one interim PROM, administered during early (first 2 weeks), mid (weeks 3-4), or late (week 5 or later) timing, had 4.6, 2.7, and 1.0 additional FS score points at discharge compared to those without an interim PROM, respectively (p < 0.001). Having two or more interim PROMs was associated with an additional 1.2 FS points compared to having only one interim assessment, but only if the first interim was administered early. CONCLUSIONS Optimal utilization of interim PROM assessment during clinical practice to enhance treatment outcomes was related to administering the first interim PROM within the first 2 weeks after the initial evaluation.
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Stirling P, Jenkins PJ, Clement ND, Duckworth AD, McEachan JE. The Net Promoter Scores with Friends and Family Test after four hand surgery procedures. J Hand Surg Eur Vol 2019; 44:290-295. [PMID: 30567459 DOI: 10.1177/1753193418819686] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Friends and Family Test, a variant of the Net Promoter Score, was adapted for the National Health Service to evaluate overall patient satisfaction and how likely patients are to recommend an intervention. It ranges from -100 to 100. Positive scores indicate good performance. This study quantifies the scores in 810 patients at a mean of 14 months following four common procedures. The score was 83 for trigger finger release ( n = 103), 68 for carpal tunnel decompression ( n = 467), 62 for surgery for Dupuytren's disease ( n = 224) and 44 for ganglia excision ( n = 16). Our study indicates that these procedures are highly valued and are recommended by patients according to the Friends and Family Test. The results of the Friends and Family Test correlated well with postoperative functional improvement and satisfaction. We conclude from this study that a compound score based on the Friends and Family Test is a useful addition to traditional measures of patient satisfaction. Level of evidence: II.
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Petousis P, Naeim A, Mosleh A, Hsu W. Evaluating the Impact of Uncertainty on Risk Prediction: Towards More Robust Prediction Models. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1461-1470. [PMID: 30815191 PMCID: PMC6371325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Risk prediction models are crucial for assessing the pretest probability of cancer and are applied to stratify patient management strategies. These models are frequently based on multivariate regression analysis, requiring that all risk factors be specified, and do not convey the confidence in their predictions. We present a framework for uncertainty analysis that accounts for variability in input values. Uncertain or missing values are replaced with a range of plausible values. These ranges are used to compute individualized risk confidence intervals. We demonstrate our approach using the Gail model to evaluate the impact of uncertainty on management decisions. Up to 13% of cases (uncertain) had a risk interval that falls within the decision threshold (e.g., 1.67% 5-year absolute risk). A small number of cases changed from low- to high-risk when missing values were present. Our analysis underscores the need for better communication of input assumptions that influence the resulting predictions.
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Affiliation(s)
- Panayiotis Petousis
- Medical Imaging & Informatics, Department of Radiological Sciences and Bioengineering
| | - Arash Naeim
- Department of Medicine, David Geffen School of Medicine
| | - Ali Mosleh
- B. John Garrick Institute for the Risk Sciences, Samueli School of Engineering University of California, Los Angeles, CA
| | - William Hsu
- Medical Imaging & Informatics, Department of Radiological Sciences and Bioengineering
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Maempel JF, Ting JZ, Gaston P. Assessing the Outcome of Hip Arthroscopy for Labral Tears in Femoroacetabular Impingement Using the Minimum Dataset of the British Non-arthroplasty Hip Register: A Single-Surgeon Experience. Arthroscopy 2018; 34:2131-2139. [PMID: 29730220 DOI: 10.1016/j.arthro.2018.02.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to assess changes in British Non-arthroplasty Hip Register (NAHR) minimum dataset (MDS) patient-reported outcome measures (PROMs) after hip arthroscopy for femoroacetabular impingement (FAI) and define the relation between these and patient satisfaction. Secondary aims included exploring the impact of patient characteristics (age, sex, and social deprivation status) on MDS PROMs and satisfaction and determining the Net Promoter Score for hip arthroscopy for FAI. METHODS Preoperative data were collected from the NAHR, and postoperative data were collected through the NAHR, by mail, and by telephone survey. Correlations between satisfaction, International Hip Outcome Tool 12 (iHOT-12), and EQ-5D scores were explored. RESULTS A consecutive series of 89 primary hip arthroscopy procedures for FAI in 88 patients is reported. Patients reported improvements in the iHOT-12 score (mean, 34.08; 95% confidence interval [CI], 27.88 to 40.28; P < .001), EQ-5D index score (+0.124; 95% CI, 0.063 to 0.185; P < .001), and EQ-5D visual analog scale (VAS) (+4.49; 95% CI, -1.56 to 10.54; P = .061) after hip arthroscopy for FAI. Satisfaction was predicted by both change in iHOT-12 score (Spearman r [rs] = 0.54, P < .001) and absolute postoperative iHOT-12 score (rs = 0.78, P < .001), change in EQ-5D index score (rs = 0.42, P < .001) and absolute postoperative EQ-5D index score (rs = 0.70, P < .001), and change in EQ-5D VAS score (rs = 0.30, P = .012) and absolute postoperative EQ-5D VAS score (rs = 0.59, P < .001); and the strength of correlation was greater with the absolute postoperative score than with the change in score for all 3. Sex, age, and social deprivation status did not predict postoperative PROMs (P ≥ .15) or satisfaction (P ≥ .32). The postoperative iHOT-12 score correlated strongly with EQ-5D index (rs = 0.90, P < .001) and EQ-5D VAS (rs = 0.81, P < .001) scores. The Net Promoter Score for hip arthroscopy for FAI was 70.31. CONCLUSIONS This study showed significant improvements in hip-specific function (iHOT-12) and health-related quality of life (EQ-5D), as measured by the NAHR MDS, in patients undergoing hip arthroscopy for FAI. Satisfaction rates were high (75.7%) and correlated strongly with hip-specific and general health PROMs. Satisfied patients were more likely to be willing to undergo similar surgery in the future. Self-reported postoperative hip function correlated very strongly with general health-related quality of life. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Julian F Maempel
- Department of Trauma & Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
| | | | - Paul Gaston
- Department of Trauma & Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
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Fleischmann M, Vaughan B. The challenges and opportunities of using patient reported outcome measures (PROMs) in clinical practice. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2018.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Tran MG, Sut MK, Collie J, Neves JB, Al-Hayek S, Armitage JN, Couturier DL, Wiseman OJ. Development of a Disease-Specific Ureteral Calculus Patient Reported Outcome Measurement Instrument. J Endourol 2018; 32:548-558. [DOI: 10.1089/end.2017.0795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maxine G.B. Tran
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, United Kingdom
- Specialist Center for Kidney Cancer, Department of Urology, Royal Free Hospital, London, United Kingdom
| | - Michal K. Sut
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
- Department of Urology, Peterborough City Hospital, Peterborough, United Kingdom
| | - Jane Collie
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
| | - Joana B. Neves
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, United Kingdom
- Specialist Center for Kidney Cancer, Department of Urology, Royal Free Hospital, London, United Kingdom
| | - Samih Al-Hayek
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
| | - James N. Armitage
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
| | | | - Oliver J. Wiseman
- Department of Urology, Addenbrooke's Hospital, Cambridge University, Cambridge, United Kingdom
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Maempel JF, Mackenzie SP, Stirling PHC, McCann C, Oliver CW, White TO. Tram system related cycling injuries. Arch Orthop Trauma Surg 2018; 138:643-650. [PMID: 29368177 DOI: 10.1007/s00402-018-2890-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Understanding of tram-system related cycling injuries (TSRCI) is poor. The aim of this study was to report the spectrum of injuries, demographics and social deprivation status of patients. Secondary aims included assessment of accident circumstances, effects of TSRCI on patients' confidence cycling, together with time off work and cycling. METHODS A retrospective review of patients presenting to emergency services across all hospitals in Edinburgh and West Lothian with tram related injuries between May 2009 and April 2016 was undertaken. Medical records and imagining were analysed and patients were contacted by telephone. RESULTS 191 cyclists (119 males, 72 females) were identified. 63 patients sustained one or more fractures or dislocations. Upper limb fractures/dislocations occurred in 55, lower limb fractures in 8 and facial fractures in 2. Most patients demonstrated low levels of socioeconomic deprivation. In 142 cases, the wheel was caught in tram-tracks, while in 32 it slid on tracks. The latter occurred more commonly in wet conditions (p = 0.028). 151 patients answered detailed questionnaires. Ninety-eight were commuting. 112 patients intended to cross tramlines and 65 accidents occurred at a junction. Eighty patients reported traffic pressures contributed to their accident. 120 stated that their confidence was affected and 24 did not resume cycling. Female gender (p < 0.001) and presence of a fracture/dislocation (p = 0.012) were independent predictors of negative effects on confidence. Patients sustaining a fracture/dislocation spent more time off work (median 5 days vs 1, p < 0.001) and cycling (median 57 days vs 21, p < 0.001). CONCLUSIONS TSRCI occur predominantly in young to middle-aged adults with low levels of socioeconomic deprivation, most commonly when bicycle wheels get caught in tram-tracks. They result in various injuries, frequently affecting the upper limb. Traffic pressures are commonly implicated. Most patients report negative effects on confidence and a sizeable minority do not resume cycling. TSRCI can result in significant loss of working and cycling days.
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Affiliation(s)
- J F Maempel
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - S P Mackenzie
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - P H C Stirling
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, UK
| | - C McCann
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - C W Oliver
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, UK.,Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - T O White
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh, EH16 4SA, UK
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Ologunde R, McLeod NMH. Use of patient-reported outcome measures in oral and maxillofacial trauma surgery: a review. Br J Oral Maxillofac Surg 2018; 56:371-379. [PMID: 29650475 DOI: 10.1016/j.bjoms.2018.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/21/2018] [Indexed: 11/15/2022]
Abstract
In the UK, about one person/100/year sustains a facial injury, so trauma surgery accounts for a considerable part of the caseload in oral and maxillofacial surgery (OMFS). Patient-reported outcome measures (PROM) allow for patient-centred assessment of postoperative outcomes, but to our knowledge, most research in OMFS trauma does not currently include them. To investigate their use, we searched Medline to find relevant studies that reported outcomes from inception in January 1879 to August 2016. Those not in the English language and those that did not report operations were excluded. We retrieved 416 articles, of which 21 met the inclusion criteria (five randomised controlled trials and 16 cohort studies) yielding 16 outcome measures. Most of these had been devised by authors (eight studies), four studies reported use of the Geriatric Oral Health Assessment Index, and three the Nasal Obstruction Symptom Evaluation. Most were used in studies on mandibular surgery (n=13), followed by those on nasal and facial surgery (n=3 each). There is a great heterogeneity in the use of these assessments in OMF trauma. In view of their increasing importance compared with simpler objective measures that may not be relevant to the patients' own perception, more research is needed to establish which of them can be used to measure the QoL of patients treated for OMF trauma.
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Affiliation(s)
- R Ologunde
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - N M H McLeod
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Comments on the Assessment of Nasal Obstruction With Rhinomanometry and Subjective Scales and Outcomes of Surgical and Medical Treatment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Morris S, Booth J. Shaping conservative spinal services with the Spine Tango Registry. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:543-553. [PMID: 29388090 DOI: 10.1007/s00586-018-5484-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 01/21/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE This study reports the results of a registry data collection project within a secondary care spinal osteopathy service. METHODS Clinical and demographic data were collected using the Spine Tango Conservative registry data collection tool. Outcomes were assessed using the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Neck Disability Index (NDI), COMI Low Back Conservative (COMI-LBC), COMI Neck Conservative (COMI-NC) and EQ5D. Global treatment outcome (GTO), satisfaction with care and therapeutic complications were reported using the Spine Tango Patient Self Assessment form (STPSA). The correlation of GTO and PROM change scores was analysed using Spearman's rank correlation coefficient. RESULTS 262 patients presented during the study period. 100% of patients had chronic spinal pain and 98.8% had previously received other interventions for the same episode. Mean (standard deviation) improvements by PROM: NPRS low back 2.1 (2.5); NPRS neck 2.3 (2.3); COMI-LBC 2.1 (2.2); COMI-NC 2.0 (1.7); ODI 10.5 (12.1); NDI 14.5 (12.2); EQ5D 0.2 (0.3). 83.2% of patients reported that osteopathy had 'helped a lot' or 'helped'. 96.2% of patients were 'very satisfied' or 'satisfied' with care. There were no serious therapeutic complications. CONCLUSIONS The secondary care spinal osteopathy service demonstrated high satisfaction, few therapeutic complications and positive outcomes on all PROMs. Registry participation has facilitated robust clinical governance and the data support the use of osteopaths to deliver a conservative spinal service in this setting. Registry data collection is a significant administrative and clinical task which should be structured to minimise burden on patients and resources. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Samuel Morris
- Spinal Outpatient's Department, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK.
| | - James Booth
- Spinal Outpatient's Department, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
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Larrosa F, Samara L, Esteller E, Dura M, Escamilla Y, Alberti A, Rosell R, Hopkins C. Cross-cultural adaptation and validation of the Spanish version of the Paediatric Throat Disorders Outcome Test (T-14). Clin Otolaryngol 2017; 43:598-603. [DOI: 10.1111/coa.13029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- F. Larrosa
- Department of Otorhinolaryngology-Head and Neck Surgery; Hospital Alt Penedes; Barcelona Spain
- Department of Otorhinolaryngology-Head and Neck Surgery; Hospital Quiron Teknon; Barcelona Spain
| | - L. Samara
- Department of Otorhinolaryngology-Head and Neck Surgery; Hospital Parc Taulí; Universitat Autonoma de Barcelona; Sabadell Spain
| | - E. Esteller
- Department of Otorhinolaryngology-Head and Neck Surgery; Hospital General de Catalunya; Universitat Internacional de Catalunya; Barcelona Spain
| | - M.J. Dura
- Hospital Universitari Germans Trias i Pujol; Badalona Spain
| | - Y. Escamilla
- Department of Otorhinolaryngology-Head and Neck Surgery; Hospital Parc Taulí; Universitat Autonoma de Barcelona; Sabadell Spain
| | - A. Alberti
- Department of Otorhinolaryngology-Head and Neck Surgery; Hospital Alt Penedes; Barcelona Spain
| | - R. Rosell
- Department of Otorhinolaryngology-Head and Neck Surgery; Hospital Parc Taulí; Universitat Autonoma de Barcelona; Sabadell Spain
| | - C. Hopkins
- ENT Department of Guy's; St Thomas' Hospital; London UK
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Larrosa F, Alobid I. Comments on the assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:124. [PMID: 29033122 DOI: 10.1016/j.otorri.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Francisco Larrosa
- Servicio de Otorrinolaringología, Hospital Comarcal de l'Alt Penedès, Vilafranca del Penedès, Barcelona, España.
| | - Isam Alobid
- Unidad de Rinología y Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, España
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Samara L, Esteller E, Dura MJ, Guirao M, Cardesin A, Stewart M, Larrosa F. Adaptation and validation of the Spanish version of the Tonsil and Adenoid Health Status Instrument. Laryngoscope 2017; 128:1469-1475. [DOI: 10.1002/lary.26923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/14/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Laura Samara
- Department of Otorhinolaryngology–Head and Neck SurgeryHospital Parc Taulí, Sabadell/Universitat Autonoma de BarcelonaBarcelona Spain
| | - Eduard Esteller
- Department of Otorhinolaryngology–Head and Neck SurgeryHospital General de Catalunya/Universitat Internacional de CatalunyaBarcelona Spain
| | - Maria J. Dura
- Hospital Universitari Germans Trias i PujolBadalona Spain
| | - Miquel Guirao
- Department of Otorhinolaryngology–Head and Neck SurgeryHospital Alt PenedesBarcelona Spain
| | - Alda Cardesin
- Department of Otorhinolaryngology–Head and Neck SurgeryHospital Parc Taulí, Sabadell/Universitat Autonoma de BarcelonaBarcelona Spain
| | - Michael Stewart
- Department of Otolaryngology–Head and Neck SurgeryNew York–Presbyterian Hospital/Weill Cornell Medical CollegeNew York New York U.S.A
| | - Francisco Larrosa
- Department of Otorhinolaryngology–Head and Neck SurgeryHospital Alt PenedesBarcelona Spain
- Department of Otorhinolaryngology–Head and Neck SurgeryHospital Quiron TeknonBarcelona Spain
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Self-Monitoring Symptoms in Glaucoma: A Feasibility Study of a Web-Based Diary Tool. J Ophthalmol 2017; 2017:8452840. [PMID: 28546876 PMCID: PMC5435987 DOI: 10.1155/2017/8452840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/07/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose. Glaucoma patients annually spend only a few hours in an eye clinic but spend more than 5000 waking hours engaged in everything else. We propose that patients could self-monitor changes in visual symptoms providing valuable between clinic information; we test the hypothesis that this is feasible using a web-based diary tool. Methods. Ten glaucoma patients with a range of visual field loss took part in an eight-week pilot study. After completing a series of baseline tests, volunteers were prompted to monitor symptoms every three days and complete a diary about their vision during daily life using a bespoke web-based diary tool. Response to an end of a study questionnaire about the usefulness of the exercise was a main outcome measure. Results. Eight of the 10 patients rated the monitoring scheme to be “valuable” or “very valuable.” Completion rate to items was excellent (96%). Themes from a qualitative synthesis of the diary entries related to behavioural aspects of glaucoma. One patient concluded that a constant focus on monitoring symptoms led to negative feelings. Conclusions. A web-based diary tool for monitoring self-reported glaucoma symptoms is practically feasible. The tool must be carefully designed to ensure participants are benefitting, and it is not increasing anxiety.
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Suk M, Daigl M, Buckley RE, Lorich DG, Helfet DL, Hanson B. Outcomes after orthopedic trauma. J Orthop Surg (Hong Kong) 2017; 25:2309499016684089. [PMID: 28134049 DOI: 10.1177/2309499016684089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical orthopedic research needs better ability to assess patient expectations with regard to orthopedic trauma surgery outcomes. The aim of this study was to investigate to which extent patient expectations prior to surgery could be met after surgery. METHODS Patients (≥18 years) with surgical ankle fractures were prospectively recruited at 5 orthopedic trauma clinics in the United States (USA), Canada, and Brazil and followed up for 12 months. Patients were asked to complete a previously validated trauma expectation factor (TEF) questionnaire prior to surgery and a trauma outcome measure (TOM) 1 year after surgery. RESULTS At 1 year, 155 patients had provided complete records. Almost half (49%; 76/155) had a 1-year TOM score equaling or exceeding their preoperative TEF score (95% CI: 41-57%). The remaining scores failed to meet patient expectations. TOM scores matched or exceeded patient expectations for 33% of patients in the USA and 47% in Canada, but for 69% in Brazil ( p = 0.001 (USA); p = 0.024 (Canada)). This geographical effect was attributable to higher patient expectations in North America as compared to Brazil (average TEF scores: 36 (North America) versus 31 (Brazil); p < 0.001). Patients with lower household income or smokers were more likely to be satisfied with their treatment ( p = 0.02 and p = 0.05, respectively). Furthermore, patients with severe type C fractures had better rates of satisfaction (62%) than patients with simpler B (50%) or type A fractures (33%) ( p = 0.01 [C type versus A type]). CONCLUSIONS Orthopedic surgeons have difficulty in meeting or exceeding presurgical patient expectations of long-term outcomes for ankle fracture surgery. This study provides evidence that culture, geography, and surgeon-patient communication have considerable influence on patient expectations.
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Affiliation(s)
- Michael Suk
- 1 Geisinger Health System, Danville, PA, USA
| | - Monica Daigl
- 2 AO Foundation, AO Clinical Investigation and Documentation, Duebendorf, Switzerland
| | | | | | | | - Beate Hanson
- 5 Clinical Research, Smith and Nephew, Zurich, Switzerland
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Greenhalgh J, Dalkin S, Gooding K, Gibbons E, Wright J, Meads D, Black N, Valderas JM, Pawson R. Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05020] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Sonia Dalkin
- Department of Public Health, Northumbria University, Newcastle upon Tyne, UK
| | - Kate Gooding
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Judy Wright
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - David Meads
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Orthodontic therapists – has their introduction affected outcomes? Br Dent J 2016; 221:421-424. [DOI: 10.1038/sj.bdj.2016.735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 11/08/2022]
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Babatunde O, Forsyth J. Lifestyle exercises for bone health and health-related quality of life among premenopausal women: a randomised controlled trial. Glob Health Promot 2016; 23:63-71. [DOI: 10.1177/1757975914568901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/06/2014] [Indexed: 11/17/2022]
Abstract
Purpose: Growing evidence supports engagement in physical exercise throughout life for optimal bone health. However, promotion of physical exercise among premenopausal women presents significant challenges, which are yet to be addressed in the design of many bone-health exercise regimes. As a deviation from traditional, facility-based, supervised, long-duration and intense exercise regimes, the efficacy of short-duration, practical, lifestyle physical exercises for improving bone health and quality of life was examined. Methods: Premenopausal women ( N = 96, mean age 22.25 ± 3.5 years; mean BMI 23.43 ± 3.5 kg/m2) participated in a 6-month randomised trial of lifestyle physical exercises for the intervention group and sham exercises for the control group. The participants’ scores on the outcome measure SF-36 was accessed pre- and post-intervention and compared with general population norms according to the SF-36 scoring manual. Paired t-tests were used to examine changes within trial arms from baseline to post-intervention, while analysis of covariance was performed to examine the effect of the lifestyle exercise programme on quality of life of premenopausal women. Results: Compared to 51% at baseline, 63% of the participants were either at or above the general population norm for general health, and the percentage of participants who were below the population health norm for mental health was reduced from 46% at baseline to 38% post-exercise intervention. Comparable improvements in quality of life were found in both trial arms post-participation in the bone-health promotion programme. Conclusions: Bone-health exercises, when implemented as easily adoptable, lifestyle physical activity, may also enhance the quality of life of premenopausal women. Hence, a practical lifestyle approach to exercise may offer a much-needed public health strategy for bone-health promotion among women.
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Affiliation(s)
- Opeyemi Babatunde
- Research Institute for Primary Care & Health Sciences, Keele University, UK
| | - Jacky Forsyth
- School of Psychology, Sport and Exercise, Faculty of Health Science, Staffordshire University, Stoke-on-Trent, UK
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Erskine S, Hopkins C, Clark A, Anari S, Kumar N, Robertson A, Sunkaraneni S, Wilson J, Carrie S, Kara N, Ray J, Smith R, Philpott C. SNOT-22 in a control population. Clin Otolaryngol 2016; 42:81-85. [DOI: 10.1111/coa.12667] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/27/2022]
Affiliation(s)
- S.E. Erskine
- Norwich Medical School; University of East Anglia; Norwich UK
- ENT Department; James Paget University Hospital NHS Foundation Trust; Great Yarmouth UK
| | - C. Hopkins
- ENT Department; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - A. Clark
- Norwich Medical School; University of East Anglia; Norwich UK
| | - S. Anari
- ENT Department; Heart of England NHS Foundation Trust; Birmingham UK
| | - N. Kumar
- Otolaryngology, Head & Neck Surg; ENT Department; Writington, Wigan and Lee NHS Foundation Trust; Wigan UK
| | - A. Robertson
- ENT Department; Southern General Hospital; Glasgow UK
| | - S. Sunkaraneni
- ENT Department; Royal Surrey County Hospital; Guildford UK
| | - J.A. Wilson
- Otolaryngology, Head & Neck Surgery; Institute of Health & Society; Newcastle University; Newcastle upon Tyne UK
| | - S. Carrie
- ENT Department; Freeman Hospital; Newcastle upon Tyne UK
| | - N. Kara
- ENT Department; Royal Hallamshire Hospital; Sheffield UK
| | - J. Ray
- ENT Department; Darlington Memorial Hospitals NHS Foundation Trust; Darlington UK
| | - R. Smith
- Norwich Medical School; UEA; Norwich UK
| | - C.M. Philpott
- Norwich Medical School; University of East Anglia; Norwich UK
- ENT Department; James Paget University Hospital NHS Foundation Trust; Great Yarmouth UK
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Hamilton DF, Giesinger JM, Patton JT, MacDonald DJ, Simpson AHRW, Howie CR, Giesinger K. Making the Oxford Hip and Knee Scores meaningful at the patient level through normative scoring and registry data. Bone Joint Res 2015; 4:137-44. [PMID: 26311163 PMCID: PMC4561372 DOI: 10.1302/2046-3758.48.2000524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objectives The Oxford Hip and Knee Scores (OHS, OKS) have been demonstrated
to vary according to age and gender, making it difficult to compare
results in cohorts with different demographics. The aim of this
paper was to calculate reference values for different patient groups
and highlight the concept of normative reference data to contextualise an
individual’s outcome. Methods We accessed prospectively collected OHS and OKS data for patients
undergoing lower limb joint arthroplasty at a single orthopaedic
teaching hospital during a five-year period.
T-scores were calculated based on the OHS and OKS distributions. Results Data were obtained from 3203 total hip arthroplasty (THA) patients
and 2742 total knee arthroplasty (TKA) patients. The mean age of
the patient was 68.0 years (sd 11.3, 58.4% women) in the
THA group and in 70.2 (sd 9.4; 57.5% women) in the TKA
group. T-scores were calculated for age and gender subgroups by
operation. Different T-score thresholds are seen at different time
points pre and post surgery. Values are further stratified by operation (THA/TKA)
age and gender. Conclusions Normative data interpretation requires a fundamental shift in
the thinking as to the use of the Oxford Scores. Instead of reporting
actual score points, the patient is rated by their relative position
within the group of all patients undergoing the same procedure.
It is proposed that this form of transformation is beneficial (a)
for more appropriately comparing different patient cohorts and (b)
informing an individual patient how they are progressing compared
with others of their age and gender. Cite this article: Bone Joint Res 2015;4:137–144
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Affiliation(s)
- D F Hamilton
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - J M Giesinger
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - J T Patton
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - D J MacDonald
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - A H R W Simpson
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - C R Howie
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - K Giesinger
- Kantonsspital St. Gallen, Rorschacherstrasse 95, CH- 9000 St. Gallen, Switzerland
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Zhang Z, Adappa ND, Chiu AG, Doghramji LJ, Cohen NA, Palmer JN. Biofilm-forming bacteria and quality of life improvement after sinus surgery. Int Forum Allergy Rhinol 2015; 5:643-9. [PMID: 25763837 DOI: 10.1002/alr.21505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/23/2014] [Accepted: 01/06/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND It remains unclear how much chronic rhinosinusitis (CRS) patients with bacterial biofilms can benefit from functional endoscopic sinus surgery (FESS). We aimed to evaluate whether biofilm-forming bacteria was associated with quality of life (QOL) improvement after FESS. METHODS This retrospective cohort study included adult CRS patients who underwent FESS from 2008 to 2011. Sinus samples were taken to evaluate for biofilm-formation in vitro using a modified Calgary Biofilm Detection Assay. QOL was measured before FESS, and 1-month, 3-month, and 6-month after FESS using 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Patients' characteristics and medications were collected. Clinical significant QOL change was defined as a difference of at least 0.5 standard deviation (SD) of baseline SNOT-22 score in the reference group. RESULTS A total of 156 patients had complete data, and 15% had biofilm-forming bacteria (n = 24). Patients with biofilm-forming bacteria had significantly worse preoperative SNOT-22 scores compared to patients without biofilm-forming bacteria (48 ± 20 vs 38 ± 23, p = 0.048). Both groups had clinically significant QOL improvement after FESS, and the differences in their 1-month (23 ± 19 vs 17 ± 20) and 3-month (27 ± 18 vs 18 ± 19) post-FESS SNOT-22 scores were not significant. However, patients with biofilm-forming bacteria demonstrated significantly less QOL improvement than patients without biofilm-forming bacteria from pre-FESS to 6-month post-FESS visits after adjusting for clinical factors (35 ± 25 vs 14 ± 15; β-coefficient = 0.71; 95% confidence interval [CI], 0.13 to 1.28; p = 0.016). CONCLUSION CRS patients with biofilm-forming bacteria demonstrated clinically significant QOL improvement following FESS, but the degree of improvement was decreased overtime and became significantly worse than patients without biofilm-forming bacteria by 6-month follow-up. This QOL worsening was independent of other risk factors for CRS.
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Affiliation(s)
- Zi Zhang
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | | | - Laurel J Doghramji
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.,Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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Hamilton DF, Lane JV, Gaston P, Patton JT, Macdonald DJ, Simpson AHRW, Howie CR. Assessing treatment outcomes using a single question: the net promoter score. Bone Joint J 2014; 96-B:622-8. [PMID: 24788496 DOI: 10.1302/0301-620x.96b5.32434] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Satisfaction with care is important to both patients and to those who pay for it. The Net Promoter Score (NPS), widely used in the service industries, has been introduced into the NHS as the 'friends and family test'; an overarching measure of patient satisfaction. It assesses the likelihood of the patient recommending the healthcare received to another, and is seen as a discriminator of healthcare performance. We prospectively assessed 6186 individuals undergoing primary lower limb joint replacement at a single university hospital to determine the Net Promoter Score for joint replacements and to evaluate which factors contributed to the response. Achieving pain relief (odds ratio (OR) 2.13, confidence interval (CI) 1.83 to 2.49), the meeting of pre-operative expectation (OR 2.57, CI 2.24 to 2.97), and the hospital experience (OR 2.33, CI 2.03 to 2.68) are the domains that explain whether a patient would recommend joint replacement services. These three factors, combined with the type of surgery undertaken (OR 2.31, CI 1.68 to 3.17), drove a predictive model that was able to explain 95% of the variation in the patient's recommendation response. Though intuitively similar, this 'recommendation' metric was found to be materially different to satisfaction responses. The difference between THR (NPS 71) and TKR (NPS 49) suggests that no overarching score for a department should be used without an adjustment for case mix. However, the Net Promoter Score does measure a further important dimension to our existing metrics: the patient experience of healthcare delivery.
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Affiliation(s)
- D F Hamilton
- University of Edinburgh, Department of Orthopaedics and Trauma, Edinburgh, EH16 4SB, UK
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Weenink JW, Braspenning J, Wensing M. Patient reported outcome measures (PROMs) in primary care: an observational pilot study of seven generic instruments. BMC FAMILY PRACTICE 2014; 15:88. [PMID: 24884544 PMCID: PMC4029823 DOI: 10.1186/1471-2296-15-88] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/17/2014] [Indexed: 11/24/2022]
Abstract
Background Patient reported outcome measures (PROMs) have been introduced in studies to assess healthcare performance. The development of PROMs for primary care poses specific challenges, including a preference for generic measures that can be used across diseases, including early phases or mild conditions. This pilot study aimed to explore the potential usefulness of seven generic measures for assessing health outcomes in primary care patients. Methods A total of 300 patients in three general practices were invited to participate in the study, shortly after their visit to the general practitioner. Patients received a written questionnaire, containing seven validated instruments, focused on patient empowerment (PAM-13 or EC-17), quality of life (EQ-5D or SF-12), mental health (GHQ-12), enablement (PEI) and perceived treatment effect (GPE). Furthermore, questions on non-specific symptoms and number of GP contacts were included. After 4 weeks patients received a second, identical, questionnaire. Response and missing items, total scores and dispersion, responsiveness, and associations between instruments and other measures were examined. Results A total of 124 patients completed the questionnaire at baseline, of whom 98 completed it both at baseline and 4 weeks later (response rate: 32.7%). The instruments had a full completion rate of 80% or higher. Differences between baseline and follow up were significant for the EQ-5D (p = 0.026), SF-12 PCS (p = 0.026) and the GPE (p = 0.006). A strong correlation (r ≥ 0.6) was found between the SF-12 MCS and GHQ-12, at both baseline measurement and after four weeks. Other observed associations between instruments were moderately strong. No strong correlations were found between instruments and non-specific symptoms or number of GP contacts. Conclusions The present study is among the first to explore the use of generic patient-reported outcome measures in primary care. It provides several leads for developing a generic PROM questionnaire in primary care as well as for potential limitations of such instruments.
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Affiliation(s)
- Jan-Willem Weenink
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, P,O, Box 9101, 6500 HB Nijmegen, the Netherlands.
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Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, Jenkinson C. Minimally important change was estimated for the Manchester-Oxford Foot Questionnaire after foot/ankle surgery. J Clin Epidemiol 2014; 67:697-705. [PMID: 24709030 DOI: 10.1016/j.jclinepi.2014.01.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To ascertain the smallest amounts of change for the three Manchester-Oxford Foot Questionnaire (MOXFQ) domains that are likely to be clinically meaningful and beyond measurement error for conditions affecting the foot/ankle. Estimates were compared with those from the Short-Form 36 (SF-36). STUDY DESIGN AND SETTING A prospective observational study of 671 consecutive patients undergoing foot or ankle surgery at an orthopedic hospital. Before and 9 months after surgery, patients completed the MOXFQ and SF-36; transition items (anchor) asked about perceived changes in foot/ankle pain or problems since the surgery. RESULTS Four hundred ninety-one patients completed pre- and postoperative questionnaires. Anchor-based minimal clinically important change (MCIC) values were ~13 points for each of the MOXFQ Walking/standing (W/S), Pain, and Social Interaction (S-I) domains [and greater than the standard error of measurement (SEM)]. MCIC values for all SF-36 domains fell within the SEM. Between-group MCIDs for the MOXFQ were W/S, 16.2; Pain, 9.9; S-I, 9.3. Distribution-based minimal detectable change (MDC90) values for the MOXFQ were ~11, ~12, and ~16 score points for the W/S, Pain, and S-I scales, respectively. CONCLUSION This article provides information for aiding the interpretability of MOXFQ outcomes data and for planning future studies. The SF-36 is not recommended as a primary outcome for foot/ankle surgery.
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Affiliation(s)
- Jill Dawson
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK; Department of Sport & Health Sciences, Oxford Brookes University, Jack Straw's Lane, Oxford OX3 OFL, UK.
| | - Irene Boller
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Helen Doll
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Grahame Lavis
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Robert Sharp
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Paul Cooke
- Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
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Iyasere O, Brown EA. Determinants of quality of life in advanced kidney disease: time to screen? Postgrad Med J 2014; 90:340-7. [DOI: 10.1136/postgradmedj-2013-132251] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Roberts AJ, Etherington J. The functional activity assessment: a validated PROM, unreliable in the hands of clinicians. J ROY ARMY MED CORPS 2013; 159:287-90. [PMID: 23720512 DOI: 10.1136/jramc-2013-000056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the validity of the clinician-assessed version of a military occupational outcome measure (the functional activity assessment; FAA) and to compare the validity with the self-assessed version. METHODS The relationship between the clinician-assessed FAA and the SF-36 and Physical Workload Questionnaire was examined in 192 service personnel with musculoskeletal injuries. Concurrent validity was checked by comparing actual medical category with the FAA. RESULTS Clinicians preferentially chose an FAA grade of 2 (56% of all grades). The clinician-assessed FAA was significantly correlated with all measured variables in the expected direction. The performance of the regression models did not fully support construct validity. The discriminative ability of the models was poor. CONCLUSIONS The clinician-assessed FAA is a less valid measure than its self-assessed counterpart. Use of the patient-reported FAA outcome measure is recommended.
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Affiliation(s)
- Andrew J Roberts
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, UK
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Giesinger JM, Kuster MS, Behrend H, Giesinger K. Association of psychological status and patient-reported physical outcome measures in joint arthroplasty: a lack of divergent validity. Health Qual Life Outcomes 2013; 11:64. [PMID: 23601140 PMCID: PMC3639925 DOI: 10.1186/1477-7525-11-64] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/16/2013] [Indexed: 11/12/2022] Open
Abstract
Background Patient-reported outcome measures have become a well-recognised part of outcome assessment in orthopaedic surgery. These questionnaires claim to measure joint-specific dimensions like pain, function in activities of daily living, joint awareness or stiffness. Interference of the patient’s psychological status with these orthopaedic questionnaires however may make accurate interpretation difficult. Methods We recruited 356 patients after unilateral, primary THA or TKA and performed a postal survey including the Brief Symptom Inventory (psychological distress measure), the Catastrophising Scale (from the Coping Strategies Questionnaire), the WOMAC score (Western Ontario and McMaster Universities Osteoarthritis Index) and the Forgotten Joint Score – 12 (FJS-12). Associations between the different questionnaires were determined calculating Pearson correlation coefficients. Two multiple linear regression models were used to investigate the impact of socio-demographic variables, clinical variables and of the psychological scales (BSI and Catastrophising Scale) separately for the WOMAC score and the FJS-12. Results WOMAC-Total score showed strong correlation to Catastrophising (r = 0.79), BSI-Somatisation (r = 0.63) and BSI-GSI (r = 0.54). The FJS-12 demonstrated modest to strong correlation with Catastrophising (r = −0.60), BSI-Somatisation (r = −0.49) and the BSI-GSI (Global Severity Index) (r = −0.44). BSI-GSI and Catastrophising explained 54.3% of variance in a multivariate regression model for the WOMAC score. The same two scales explained 30.0% of variance for the FJS-12. Conclusions There is a strong relationship between psychological status and orthopaedic outcome. The scale names of orthopaedic outcome measures suggest to measure specific dimensions like pain, stiffness, function or joint awareness. In fact they largely include patient’s psychological status indicating poor divergent validity.
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Affiliation(s)
- Johannes M Giesinger
- Department of Orthopaedic Surgery, Kantonsspital St, Gallen, Rorschacherstrasse 95, CH- 9000 St, Gallen, Switzerland
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Hamilton DF, Gaston P, Simpson AHRW. Is patient reporting of physical function accurate following total knee replacement? ACTA ACUST UNITED AC 2013; 94:1506-10. [PMID: 23109630 DOI: 10.1302/0301-620x.94b11.30081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to determine the association between the Oxford knee score (OKS) and direct assessment of outcome, and to examine how this relationship varied at different time-points following total knee replacement (TKR). Prospective data consisting of the OKS, numerical rating scales for 'worst pain' and 'perceived mean daily pain', timed functional assessments (chair rising, stairs and walking ability), goniometry and lower limb power were recorded for 183 patients pre-operatively and at six, 26 and 52 weeks post-operatively. The OKS was influenced primarily by the patient's level of pain rather than objective functional assessments. The relationship between report of outcome and direct assessment changed over time: R2 = 35% pre-operatively, 44% at six weeks, 57% at 26 weeks and 62% at 52 weeks. The relationship between assessment of performance and report of performance improved as the patient's report of pain diminished, suggesting that patients' reporting of functional outcome after TKR is influenced more by their pain level than their ability to accomplish tasks.
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Affiliation(s)
- D F Hamilton
- University of Edinburgh, Department of Orthopaedics, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
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Development of a danish language version of the manchester foot pain and disability index: reproducibility and construct validity testing. PAIN RESEARCH AND TREATMENT 2013; 2013:284903. [PMID: 23533748 PMCID: PMC3606795 DOI: 10.1155/2013/284903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/01/2013] [Indexed: 11/17/2022]
Abstract
Introduction. The Manchester Foot Pain and Disability Index (MFPDI) is a 19-item questionnaire for the assessment of disability caused by foot pain. The aim was to develop a Danish language version of the MFPDI (MFPDI-DK) and evaluate its reproducibility and construct validity. Methods. A Danish version was created, following a forward-backward translation procedure. A sample of 84 adult patients with foot pain was recruited. Participants completed two copies of the MFPDI-DK within a 24- to 48-hour interval, along with the Medical Outcomes Study Short Form 36 (SF-36), and a pain Visual Analog Scale (VAS). Reproducibility was assessed using the intraclass correlation coefficient (ICC) and 95% limits of agreement (Bland-Altman plot). Construct validity was evaluated with Pearson's Rho, using a priori hypothesized correlations with SF-36 subscales and VASmean. Results. The MFPDI-DK showed very good reliability with an ICC of 0.92 (0.88-0.95). The 95% limits of agreement ranged from -6.03 to 6.03 points. Construct validity was supported by moderate to very strong correlations with the SF-36 physical subscales and VASmean. Conclusion. The MFPDI-DK appears to be a valid and reproducible instrument in evaluating foot-pain-related disability in Danish adult patients in cross-sectional samples. Further research is needed to test the responsiveness of the MFPDI-DK.
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Suk M, Daigl M, Buckley RE, Paccola CAJ, Lorich DG, Helfet DL, Hanson B. TEFTOM: A Promising General Trauma Expectation/Outcome Measure-Results of a Validation Study on Pan-American Ankle and Distal Tibia Trauma Patients. ISRN ORTHOPEDICS 2013; 2013:801784. [PMID: 24967116 PMCID: PMC4045348 DOI: 10.1155/2013/801784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/30/2013] [Indexed: 11/17/2022]
Abstract
Background. In orthopedics, there is no instrument specifically designed to assess patients' expectations of their final surgery outcome in general trauma populations. We developed the Trauma Expectation Factor Trauma Outcome Measure (TEFTOM) to investigate the fulfilment of patients' expectations one year after surgery as a measure of general trauma surgical outcomes. The aim of this paper was to assess the psychometric characteristics of this new general trauma outcome measure. Methods. The questionnaire was tested in 201 ankle and distal tibia fracture patients scheduled for surgery. Patients were followed up for twelve months. The TEFTOM questionnaire was evaluated for its criterion validity, internal consistency, reproducibility, and responsiveness. Results. TOM showed good criterion validity against the American Academy of Orthopaedic Surgeons Foot and Ankle Scale (Pearson's correlation coefficient = 0.69-0.77). Internal consistency was acceptable for TEF (Cronbach's alpha = 0.65-0.76) and excellent for TOM (Cronbach's alpha = 0.76-0.85). Reproducibility was moderate to very good (intraclass coefficient correlation (ICC) ≥0.67) for TEF and very good (ICC ≥0.92) for TOM. TOM also proved to be responsive to changes in patients' condition over time (Wald test; P < 0.001). Conclusions. TEFTOM is a promising tool for measuring general trauma outcomes in terms of patients' expectation fulfilment that proved to be valid, internally consistent, reproducible, and responsive to change.
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Affiliation(s)
- Michael Suk
- Orthopaedic Trauma Service, College of Medicine Jacksonville, University of Florida, 655 West Eight St, 2nd Floor ACC, Jacksonville, FL 32209, USA
| | - Monica Daigl
- Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600 Duebendorf, Switzerland
| | - Richard E. Buckley
- Department of Surgery, Foothills Medical Centre, University of Calgary, AC 144A, 1403 29th Street NW, Calgary, AB, Canada T2N 2T9
| | - Cleber A. J. Paccola
- Department of Orthopaedics and Trauma Surgery, Ribeirão Preto School of Medicine, São Paulo University, São Paolo, Brazil
| | - Dean G. Lorich
- Orthopaedic Trauma Service, New York Presbyterian University Hospital of Columbia and Cornell, 525 East 68th Street, New York, NY 10065-4870, USA
| | - David L. Helfet
- Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021-4898, USA
| | - Beate Hanson
- Clinical Investigation and Documentation, AO Foundation, Stettbachstrasse 6, 8600 Duebendorf, Switzerland
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Moores KL, Jones GL, Radley SC. Development of an instrument to measure face validity, feasibility and utility of patient questionnaire use during health care: the QQ-10. Int J Qual Health Care 2012; 24:517-24. [DOI: 10.1093/intqhc/mzs051] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Staniszewska S, Haywood KL, Brett J, Tutton L. Patient and Public Involvement in Patient-Reported Outcome Measures. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 5:79-87. [DOI: 10.2165/11597150-000000000-00000] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Dawson J, Boller I, Doll H, Lavis G, Sharp R, Cooke P, Jenkinson C. Responsiveness of the Manchester-Oxford Foot Questionnaire (MOXFQ) compared with AOFAS, SF-36 and EQ-5D assessments following foot or ankle surgery. ACTA ACUST UNITED AC 2012; 94:215-21. [PMID: 22323689 DOI: 10.1302/0301-620x.94b2.27634] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The responsiveness of the Manchester-Oxford Foot Questionnaire (MOXFQ) was compared with foot/ankle-specific and generic outcome measures used to assess all surgery of the foot and ankle. We recruited 671 consecutive adult patients awaiting foot or ankle surgery, of whom 427 (63.6%) were female, with a mean age of 52.8 years (18 to 89). They independently completed the MOXFQ, Short-Form 36 (SF-36) and EuroQol (EQ-5D) questionnaires pre-operatively and at a mean of nine months (3.8 to 14.4) post-operatively. Foot/ankle surgeons assessed American Orthopaedic Foot and Ankle Society (AOFAS) scores corresponding to four foot/ankle regions. A transition item measured perceived changes in foot/ankle problems post-surgery. Of 628 eligible patients proceeding to surgery, 491 (78%) completed questionnaires and 262 (42%) received clinical assessments both pre- and post-operatively. The regions receiving surgery were: multiple/whole foot in eight (1.3%), ankle/hindfoot in 292 (46.5%), mid-foot in 21 (3.3%), hallux in 196 (31.2%), and lesser toes in 111 (17.7%). Foot/ankle-specific MOXFQ, AOFAS and EQ-5D domains produced larger effect sizes (> 0.8) than any SF-36 domains, suggesting superior responsiveness. In analyses that anchored change in scores and effect sizes to patients' responses to a transition item about their foot/ankle problems, the MOXFQ performed well. The SF-36 and EQ-5D performed poorly. Similar analyses, conducted within foot-region based sub-groups of patients, found that the responsiveness of the MOXFQ was good compared with the AOFAS. This evidence supports the MOXFQ's suitability for assessing all foot and ankle surgery.
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Affiliation(s)
- J Dawson
- University of Oxford, Department of Public Health, Old Road Campus, Oxford OX3 7LF, UK.
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Burton M, Walters SJ, Saleh M, Brazier JE. An evaluation of patient-reported outcome measures in lower limb reconstruction surgery. Qual Life Res 2011; 21:1731-43. [PMID: 22179990 DOI: 10.1007/s11136-011-0090-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the measurement properties (acceptability, validity, reliability and responsiveness), of the MOS 36-Item Short-Form Health Survey (SF-36), the EQ-5D, the Short-Form McGill Pain Questionnaire (SF-MPQ) and the Musculoskeletal Functional Assessment Instrument (MFA), in patients who have undergone limb reconstruction surgery (LRS). METHODS Four instruments measuring patient-reported outcome were completed at baseline and 12 months from surgery. RESULTS 101 LRS patients were recruited with 95 responding at baseline and 71 at a 12-month follow-up. Response rates at baseline were over 94%. In three instruments, there was evidence of floor or ceiling effect, the exception being the EQ-5D. Cronbach's α statistics of internal consistency reliability were acceptable at ≥ 0.80 for all dimensions of the MFA, the SF-MPQ PRI(S) and seven of the SF-36 dimensions. When comparing mean changes in scores between baseline and 12 months, the most responsive measure was the SF-36 with an average Standardised Response Mean of 0.48 for those who reported their health as better. Statistically significant differences were observed between the health change groups ('worse', 'better' and 'same') for four dimensions of the SF-36, the two summary scores and the SF-6D. CONCLUSIONS Variation and poor performance of some of the instruments resulted in a recommendation of using the SF-36 and the SF-6D for LRS patients.
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Affiliation(s)
- M Burton
- Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, Collegiate Campus, Sheffield S10 2BP, UK.
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Wray J, Brown K, Marino BS, Franklin R. Medical Test Results Do Not Tell the Whole Story. World J Pediatr Congenit Heart Surg 2011; 2:566-75. [DOI: 10.1177/2150135111416017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Children born today with congenital heart disease (CHD) are likely to reach adulthood, even those with complex disease. As survival rates have increased, attention has focused on the longer-term morbidity associated with CHD and its treatment, but this has largely addressed the physical and physiological outcomes rather than psychosocial morbidity and health-related quality of life (QoL). The purpose of this article is to outline the arguments in favor of routine evaluation of health-related QoL, describe how such measurements might be used, and the barriers and challenges associated with the collection of the data. Finally, a strategy is suggested for the routine collection and use of health-related QoL data with children and adolescents with CHD.
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Affiliation(s)
- Jo Wray
- Centre for Nursing and Allied Health Research, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Kate Brown
- Centre for Nursing and Allied Health Research, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Rodney Franklin
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Bolland BJRF, Culliford DJ, Maskell J, Latham JM, Dunlop DG, Arden NK. The effect of hip and knee arthroplasty on oral anti-inflammatory use and the relationship to body mass index: results from the UK general practice research database. Osteoarthritis Cartilage 2011; 19:29-36. [PMID: 21034838 DOI: 10.1016/j.joca.2010.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 09/22/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the use of oral anti-inflammatory drugs in the year before and the 2 years after primary total hip (THR) or knee (TKR) replacement, and whether this varies according to Body mass Index (BMI). DESIGN 28,068 THR's and 24,364 TKR's, with five matched controls per case were identified from the General Practitioner Research Database. Anti-inflammatory usage was categorized into "zero coverage" - no prescribed anti-inflammatory medication and ">80% coverage" - prescribed anti-inflammatory medication for greater than 80% of the days in the year. Secondary subset analysis was performed according to BMI. RESULTS 1 year post-surgery the proportion of cases on >80% coverage reduced from 21% (95%confidence interval (CI): 20-22%) to 8% (95%CI: 7-10%) for THR and 21% (95%CI: 20-22%) to 13% (95%CI: 11-14%) for TKR, with no ongoing reduction at 2 years. Zero coverage increased at one and both time points. The proportion of THR's on >80% coverage increased with BMI pre-op. The magnitude in reduction post-op was similar across all BMI groups. The proportion of TKR's on >80% coverage pre-op was greatest in extreme BMI categories. The magnitude in reduction post-op was similar across all BMI groups. CONCLUSION THR/TKR's reduce the need for anti-inflammatory medication with most benefit observed in the first post-operative year. Increasing BMI affects anti-inflammatory use both in the general population and those undergoing THR/TKR surgery but without strong evidence of a detrimental effect on the benefits of pain relief.
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Affiliation(s)
- B J R F Bolland
- Southampton General Hospital, Southampton University Hospital Trust, Tremona Road, Southampton, United Kingdom
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Rees JL, Dawson J, Hand GCR, Cooper C, Judge A, Price AJ, Beard DJ, Carr AJ. The use of patient-reported outcome measures and patient satisfaction ratings to assess outcome in hemiarthroplasty of the shoulder. ACTA ACUST UNITED AC 2010; 92:1107-11. [PMID: 20675755 DOI: 10.1302/0301-620x.92b8.22860] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We have compared the outcome of hemiarthroplasty of the shoulder in three distinct diagnostic groups, using survival analysis as used by the United Kingdom national joint registers, patient-reported outcome measures (PROMs) as recommended by Darzi in the 2008 NHS review, and transition and satisfaction questions. A total of 72 hemiarthroplasties, 19 for primary osteoarthritis (OA) with an intact rotator cuff, 22 for OA with a torn rotator cuff, and 31 for rheumatoid arthritis (RA), were followed up for between three and eight years. All the patients survived, with no revisions or dislocations and no significant radiological evidence of loosening. The mean new Oxford shoulder score (minimum/worst 0, maximum/best 48) improved significantly for all groups (p < 0.001), in the OA group with an intact rotator cuff from 21.4 to 38.8 (effect size 2.9), in the OA group with a torn rotator cuff from 13.3 to 27.2 (effect size 2.1) and in the RA group from 13.7 to 28.0 (effect size 3.1). By this assessment, and for the survival analysis, there was no significant difference between the groups. However, when ratings using the patient satisfaction questions were analysed, eight (29.6%) of the RA group were 'disappointed', compared with one (9.1%) of the OA group with cuff intact and one (7.7%) of the OA group with cuff torn. All patients in the OA group with cuff torn indicated that they would undergo the operation again, compared to ten (90.9%) in the OA group with cuff intact and 20 (76.9%) in the RA group. The use of revision rates alone does not fully represent outcome after hemiarthroplasty of the shoulder. Data from PROMs provides more information about change in pain and the ability to undertake activities and perform tasks. The additional use of satisfaction ratings shows that both the rates of revision surgery and PROMs need careful interpretation in the context of patient expectations.
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Affiliation(s)
- J L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford OX3 7LD, UK.
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Kayes NM, McPherson KM. Measuring what matters: does 'objectivity' mean good science? Disabil Rehabil 2010; 32:1011-9. [PMID: 20384538 DOI: 10.3109/09638281003775501] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE While the limitations of self-report measures are clearly acknowledged, less apparent is attention to the potential limitations of their 'objective' counterparts leading to the assumption that objectivity results in more robust and scientifically valid measurement tools. This article aims to: (1) test this assumption; (2) consider the implications of advocating for a measure on the basis of its objectivity; (3) propose an alternative approach to measure selection. KEY FINDINGS AND IMPLICATIONS A critical evaluation of one 'objective' measure highlights a number of potential limitations suggesting that the apparent willingness to adopt 'objective' measures with little questioning may be misguided. The possible implications of this are discussed and include a risk to the advancement of, and capacity for, knowledge in rehabilitation; or worse, of making clinical decisions based on erroneous conclusions. CONCLUSIONS Characterising a measure on the basis of objectivity (or not) assumes an overly simplistic dichotomy that is unhelpful and perhaps misleading. We argue that assessing whether a measure is fit for purpose and makes mathematical sense is the key consideration. Indeed, in some cases, using both an 'objective' measure and a subjective rating scale may be appropriate and the only way of truly capturing the phenomenon of interest.
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Affiliation(s)
- Nicola M Kayes
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand.
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