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El Miedany Y, El Gaafary M, Youssef S, El Aroussy N. Meaningful patient engagement in inflammatory arthritis: development of the Patient Motivation Questionnaire. Clin Rheumatol 2024; 43:1793-1801. [PMID: 28382403 DOI: 10.1007/s10067-017-3605-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
The objective of this study is to develop a questionnaire for evaluating the patient's "motivation" and assess the psychometric properties of that measure in patients with chronic inflammatory arthritis. Using Rasch analysis and questions item pool, content analysis, and semi-structured group discussion, the questionnaire was developed including 10-item scale (0-10 on VAS scale). Construct validity was assessed by correlating the questionnaire score to parameters of disease activity (DAS-28, ASDAS, and DAPSA scores), functional disability, quality of life, patient self-helplessness measure, as well as the patients' compliance to therapy. Reliability and comprehensibility and sensitivity to change were also assessed. The questionnaire was assessed in 432 RA, 415 psoriatic arthritis patients, and 232 ankylosing spondylitis patients. Dimensionality analysis revealed a 1-factor solution, explaining 98% of the total variance. It showed acceptable validity as it correlated significantly with disease activity measures: DAS-28: r = -0.85, ASDAS: r = -0.86, and DAPSA: r = -0.89. It also correlated significantly with functional disability score: r = -0.91, QoL: r = -0.90, as well as patient self-helplessness: r = -0.88. The questionnaire was reliable (Cronbach's alpha 0.958) and had no misfitting items. In addition, it was comprehensible (9.4) and sensitive to change (p < 0.01). The patient motivation score showed significant (p < 0.01) variation with the medication compliance. The measure is a patient-reported tool that is valid, reliable, comprehensible, and unidimensional scale that reflects the patients' motivation and engagement. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor management and monitor changes.
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Affiliation(s)
- Y El Miedany
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt.
- Darent Valley Hospital, Dartford, Kent, England, DA2 8DA, UK.
| | - Maha El Gaafary
- Public Health and Community Department, Ain Shams University, Cairo, Egypt
| | - Sally Youssef
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Nadia El Aroussy
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
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Campos PC, Silva ACRD, Fleury Cardoso R, Rodrigues VGB, Alves FL, Maciel EHB, Prates MCSM, Costa HS, Figueiredo PHS, Lima VP. Reliability and validity of the Patient Generated Index (PGI) in patients with chronic kidney disease (CKD) on dialysis, a new approach to quality of life. Disabil Rehabil 2024; 46:773-782. [PMID: 36705255 DOI: 10.1080/09638288.2023.2173314] [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: 05/13/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the test-retest reliability and validity of the Patient Generated Index (PGI) in individuals with Chronic Kidney Disease (CDK) undergoing hemodialysis. METHODS Through a non-experimental study with repeated measures, PGI was applied twice to assess internal consistency and test-retest reliability. Correlations with the Kidney Disease Quality of Life Short Form (KDQOL-SF), the Human Activity Profile (HAP) questionnaire, the Social Participation Scale, and the Glittre ADL Test were used. RESULTS 91 individuals with CKD were evaluated. There was high reliability for the PGI (ICC= 0.97) PGI correlated with KQDOL - SF in Functional Capacity r = 0.38 (p < 0.001), Emotional Well-Being r = 0.31 (p = 0.003), Social Aspect r = 0.22 (p = 0.036), Emotional Function r = 0.22 (p = 0.038) and Effect of Kidney Disease r = 0.21 (p = 0.042), and Physical scores r = 0.24 (p = 0.021)), Mental r = 0.21 (p = 0.05) and General r = 0.22 (p = 0.037) summarized. There was a significant correlation between PGI and HAP r = 0.40 (p < 0.001) and the Social Participation Scale r = -0.36 (p < 0.001). There was no correlation between the PGI and Glittre ADL scores r = 0.12 (p = 0.247). CONCLUSION In adults receiving hemodialysis, the PGI proved to be an accurate and reliable instrument for the assessment of the quality of life from the perspective of the patient.IMPLICATIONS FOR REHABILITATIONAlthough hemodialysis treatment is associated with increased survival and symptom control, there is a significant change in the patient's lifestyle.In order to provide a more focused view of the individual, the Patient Generated Index (PGI) was created to evaluate the quality of life.PGI is reliable and correlates with KQDOL - SF and the Social Participation Scale in this population.
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Affiliation(s)
- Patrícia Cardoso Campos
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Ana Caiane Rocha da Silva
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Renato Fleury Cardoso
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Vanessa Gomes Brandão Rodrigues
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
- Hemodialysis Unit of the Santa Casa de Caridade de Diamantina, Diamantina, Brazil
- School of Medicine, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Frederico Lopes Alves
- Hemodialysis Unit of the Santa Casa de Caridade de Diamantina, Diamantina, Brazil
- School of Medicine, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Emílio Henrique Barroso Maciel
- Hemodialysis Unit of the Santa Casa de Caridade de Diamantina, Diamantina, Brazil
- School of Medicine, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Maria Cecília Sales Mendes Prates
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
- Hemodialysis Unit of the Santa Casa de Caridade de Diamantina, Diamantina, Brazil
- School of Medicine, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Henrique Silveira Costa
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
- Department of Physiotherapy, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
- Department of Physiotherapy, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
| | - Vanessa Pereira Lima
- Postgraduate Program in Rehabilitation and Functional Performance, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
- Department of Physiotherapy, Federal University of Vales do Jequitinhonha and Mucuri, Diamantina, Brazil
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El Miedany Y, El Gaafary M, Toth M, Palmer D, Ali A, Bahlas S, Mahran S, Hassan W, Abu-Zaid MH, Saber S, Elwakil W. Beyond the symptoms: Personalizing giant cell arteritis care through multidimensional patient reported outcome measure. Semin Arthritis Rheum 2023; 63:152285. [PMID: 37944298 DOI: 10.1016/j.semarthrit.2023.152285] [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: 05/27/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Giant Cell Arteritis (GCA) is the commonest form of systemic vasculitis in people over the age of 50. Published research highlighted the lack of a disease-specific patient reported outcomes (PROMs) for GCA. OBJECTIVES To assess the validity, reliability and responsiveness to change of a devised disease specific patient self-reported outcome measures questionnaire for Giant Cell Arteritis (GCA). METHODS The GCA-PROMs was conceptualized based on frameworks outlined in the OMERACT developed core set of Outcome Measures for Large-Vessel Vasculitis and the guiding principles of the FDA guidance. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction was achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. RESULTS A total of 54 GCA patients completed the questionnaire. The GCA-PROMs questionnaire was reliable as demonstrated by a high standardized alpha (0.878-0.983). Content construct assessment of the GCA-PROMs functional disability and QoL revealed significant correlation (p< 0.01) with both HAQ and EQ-5D. Changes in functional disability, QoL showed significant (p< 0.01) variation with diseases activity status in response to therapy. CONCLUSIONS The developed GCA-PROMs questionnaire is a reliable and valid instrument for assessment of GCA patients. A stratified treatment regimen depending on the individual patient's risk factors as well as preferences and associated comorbidities is the best approach to tailored patient management.
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Affiliation(s)
- Y El Miedany
- Professor Canterbury Christ Church University, England; H. Senior Clinical Lecturer, King's College London, England.
| | - M El Gaafary
- Professor Community and Public Health, Ain Shams University, Cairo, Egypt
| | - M Toth
- H. Senior Clinical Lecturer, King's College London, England; Darent Valley Hospital, Kent, England
| | - D Palmer
- North Middlesex University Hospital, London, England
| | - Ayman Ali
- Darent Valley Hospital, Kent, England
| | - S Bahlas
- Professor of Internal Medicine/Rheumatology, College of Medicine, King Abdulaziz University, Saudi Arabia
| | - S Mahran
- Professor Rheumatology, Physical Medicine and Rehabilitation, Assiut University, Egypt
| | - W Hassan
- Professor Rheumatology and Rehabilitation, Benha University, Benha, Egypt
| | - M H Abu-Zaid
- Assistant Professor Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
| | - S Saber
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - W Elwakil
- Lectuer Rheumatology and Rehabilitation, Alexandria University, Alexanrdia, Egypt
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Components of a Behavior Change Model Drive Quality of Life in Community-Dwelling Older Persons. J Aging Phys Act 2023; 31:506-514. [PMID: 36669505 DOI: 10.1123/japa.2022-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/06/2022] [Accepted: 10/03/2022] [Indexed: 01/22/2023]
Abstract
This study aimed to inform a measurement approach for older persons who wish to engage in active living such as participating in a walking program. The Patient Generated Index, an individualized measurement approach, and directed and summative content analyses were carried out. A sample size of 204 participants (mean age 75 years; 62% women) was recruited; it generated 934 text threads mapped to 460 unique categories within 45 domains with similarities and differences for women and men. The Capability, Opportunity, Motivation, and Behaviors Model best linked the domains. The results suggest that older persons identify the need to overcome impaired capacity, low motivation, and barriers to engagement to live actively. These are all areas that active living programs could address. How to measure the outcomes of these programs remains elusive.
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Ow N, Karp A, Ogeil J, Dilenge ME, Sébire G, Dahan-Oliel N, Kuspinar A, Mayo NE. Quality of life in Pediatric-Onset Multiple Sclerosis: Different disease course, different impact, different measurement approach needed. Mult Scler Relat Disord 2022; 63:103820. [DOI: 10.1016/j.msard.2022.103820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
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Mariappen U, Chew KT, Zainuddin AA, Mahdy ZA, Abdul Ghani NA, Grover S. Quality of life of adolescents with menstrual problems in Klang Valley, Malaysia: a school population-based cross-sectional study. BMJ Open 2022; 12:e051896. [PMID: 34983763 PMCID: PMC8728463 DOI: 10.1136/bmjopen-2021-051896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To describe the prevalence of menstrual problems (heavy menses bleeding, dysmenorrhoea and oligomenorrhoea) and its impact towards quality of life among adolescents in Klang Valley, Malaysia. DESIGN Cross-sectional study. SETTING Adolescent girls at secondary schools in the Klang Valley, Malaysia. POPULATION 729 adolescents aged between 13 and 18 years. METHOD A questionnaire survey using Menorrhagia Questionnaire and Paediatric Quality of Life-Teen Report Ages 13-18 (PedsQL). MAIN OUTCOME MEASURES Self reports of menstrual bleeding patterns, morbidities and effect on quality of life. RESULTS The prevalence of menstrual problems among adolescents was 63.9% in the Klang Valley. Adolescents with menstrual problems had significant lower mean total score of PedsQL (70.23±13.53 vs 76.36±14.93, p=0.001), physical health summary score (74.10±16.83 vs 79.00±15.86, p<0.001) and psychosocial health summary score (68.05±14.27 vs 73.21±13.09, p=0.001) compared with those without menstrual problem. Adolescents experiencing heavy menses bleeding had the lowest physical and emotional function. Those with oligomenorrhoea had the lowest social function, whereas those with dysmenorrhoea had the lowest school function. Cigarette smoking, alcohol and medical illness had lower health-related quality of life, whereas taking oral contraceptive pills for menstrual problems was associated with higher scores in these adolescents. CONCLUSION Menstrual problems among adolescents have a significant impact on their quality of life. It is probably wise to screen them at the school level, to identify those with low functional scores and to refer them for proper management at a tertiary adolescent gynaecology centre.
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Affiliation(s)
- Uma Mariappen
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Kah Teik Chew
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Ani Amelia Zainuddin
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Nur Azurah Abdul Ghani
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Sonia Grover
- Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia
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Lonner B, Castillo A, Jain A, Sponseller P, Samdani A, Kelly M, Ames C, Eaker L, Marrache M, Shah SA. The patient generated index and decision regret in adolescent idiopathic scoliosis. Spine Deform 2020; 8:1231-1238. [PMID: 32588338 DOI: 10.1007/s43390-020-00155-9] [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] [Received: 03/03/2020] [Accepted: 06/06/2020] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS AIS patients and their parents will have distinct perspectives regarding the impact of AIS on patients' lives. INTRODUCTION Current outcome assessment tools for AIS do not fully assess patient-specific disease impact and fail to distinguish between patient and parent perspectives. Patient Generated Index (PGI) has been used in other disease states to assess individual experiences. This study assesses PGI in operative AIS patients and their parents. DESIGN Level 1, prospective multi-center study. METHODS 44 AIS patient and parent pairs completed the PGI questionnaire comprised of three stages (S1, S2, S3) and decision regret (DR). S1 asks for five areas of the patient's life most affected by AIS and a 6th encompassing all other areas of their lives affected, S2 focuses on the magnitude of effect, S3 identifies desire to improve affected areas and DR if the surgery did not improve the specific area. S1 free responses were organized into 14 domains. Descriptive statistics were reported for stage scores; free-response format of PGI and DR limited ability for paired sample t test analysis. RESULTS Mean age at surgery was 14.3 years, 84% female, and mean major curve magnitude was 61°. The three most common patient-reported concerns prior to surgery were (in descending order): sports, general function, and general fitness. However, the three most common parent-reported concerns were (in descending order): general function, sports, and appearance. Patients reported self-esteem and parents reported physical appearance as the most affected domain (S2). Patients reported pain and self-esteem and parents reported sleep and self-esteem as main operative aspirations (S3). Decision regret was the highest for uncertainty of future health in patients and sleep in parents. CONCLUSION AIS patients and their parents reported different concerns and DR regarding surgical treatment. PGI provides insight into patient and parent views toward the disease as well as treatment aspirations.
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Affiliation(s)
- Baron Lonner
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Andrea Castillo
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Amit Jain
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Paul Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Amer Samdani
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - Michael Kelly
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Lily Eaker
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Majd Marrache
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Suken A Shah
- Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
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A qualitative inquiry into patients' perspectives on individualized priorities for treatment outcomes in inflammatory bowel diseases. Qual Life Res 2020; 29:2403-2414. [PMID: 32279196 DOI: 10.1007/s11136-020-02492-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Patients with inflammatory bowel diseases (IBD) experience a variety of symptoms and limitations due to their condition. While many outcome measures are available to assess IBD symptom level and disease activity, individual patients' preferences are usually not accounted for. Individualized outcome measures allow individual patients to select and weigh outcomes based on their relative importance, and have been developed in other medical disciplines. In this study, we explored IBD patients' perspectives on different strategies to prioritize IBD-specific health outcomes. METHODS Existing individualized measures were modified for relevance to IBD patients. We performed six focus groups, in which patients were asked to rate and weigh these measures in a series of exercises and to discuss the pros and cons of five different prioritization methods (Likert scale, ranking, selecting outcomes, distribute points, and using a rotating disk) using a semi-structured approach. A thematic analysis revealed key themes in the data. RESULTS Patients' thoughts could be grouped into four key themes with 2-4 subthemes each: (1) prioritizing outcomes; (2) differences between methods; (3) outcomes to include; and (4) practical use. Overall, it was challenging for many patients to prioritize outcomes. Among the different prioritization methods, the rotating disk was perceived as the most intuitive. Patients anticipated that this visualization would also help them communicate with their physician. CONCLUSION In a series of focus groups, a visual rotating disk was found to be an intuitive and holistic way to elicit the relative importance of different outcomes for individual IBD patients.
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Zidarov D, Zidarova-Carrié A, Visca R, Miller JM, Brecht K, Viens N, Ahmed S. Core patient-reported outcome domains for routine clinical care in chronic pain management: patients' and healthcare professionals' perspective. Qual Life Res 2020; 29:2007-2020. [PMID: 32125600 DOI: 10.1007/s11136-020-02459-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To identify a core patient-reported outcome (PRO) domain set to be used in routine clinical care in settings offering specialized and supra-specialized multidisciplinary care to individuals with chronic pain (CP). METHODS Two online cross-sectional surveys were administered: one with healthcare professionals (HCPs) and one with individuals with CP. Both surveys included domains of health-related quality of life (HRQoL) from the Patient-Reported Outcomes Measurement Information System (PROMIS) framework. The patients' survey also included the Patient Generated Index (PGI). Areas affected by CP identified in the PGI were mapped to The International Classification of Functioning, Disability and Health (ICF). RESULTS According to HCPs, the five most relevant HRQoL domains to be assessed in routine clinical care were pain interference, pain intensity, physical function, anxiety and depression. The five areas that were the most valued by individuals with CP were recreation and leisure; global mental function; work and employment; household tasks and walking and moving. In total, these represented 74% of all nominated areas. When triangulating both frameworks (ICF/PROMIS) and perspectives (HCPs/patients), 10 core PRO domains were identified: pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, ability to participate in social roles and activities, fatigue, sleep-related impairments and self-efficacy. CONCLUSIONS This study identified 10 core PRO domains covering the physical, psychological and social consequences of CP on an individual's life from the perspective of individuals with CP and HCPs. The results can help identify appropriate PRO measures to assess the outcomes of multidisciplinary interventions.
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Affiliation(s)
- Diana Zidarov
- Faculty of Medicine, School of Rehabilitation, Université de Montreal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, QC, Canada
| | | | - Regina Visca
- McGill Integrated University Health Network (RUIS) Centre of Expertise in Chronic Pain, Montreal, Canada
| | - J Marc Miller
- Clinique d'adaptation à la douleur chronique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Centre de réadaptation Lucie-Bruneau, Montreal, Canada
| | - Krista Brecht
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Natacha Viens
- Direction du soutien de l'autonomie des personnes âgées, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'île-de-Montréal, Montreal, Canada
| | - Sara Ahmed
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, QC, Canada.
- McGill Integrated University Health Network (RUIS) Centre of Expertise in Chronic Pain, Montreal, Canada.
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom. Sir William Osler, Montreal, QC, Canada.
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Dekeseredy P, Marsh R, Sedney CL. Using the "Patient Generated Index" in Spine Surgery in an Appalachian Population. THE WEST VIRGINIA MEDICAL JOURNAL 2019; 115:21-25. [PMID: 37637865 PMCID: PMC10457017 DOI: 10.21885/wvmj.2019.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
In most health care fields, outcomes are becoming increasingly scrutinized and may play a role in "pay for performance;" therefore, selecting the most appropriate outcomes measures for the populations being studied or treated has evolved into a key aspect of outcomes monitoring. One way to assess patient goals is to administer a "patient generated index" (PGI). The philosophical underpinning of the PGI is that the person living the life is the best judge of the quality of that life. The PGI has been utilized in low back pain, as well as in adult spinal deformity surgery, however, it has not been previously utilized in an Appalachian population. The PGI was administered by means of self-report to 80 new patients with back pain who presented for assessment in the neurosurgery clinic. Participants completed an acceptability survey and written comments as well as compliance were analyzed. Findings indicate that the PGI in its earliest form did not meet acceptable levels for use in this Appalachian subspecialist clinic setting. This study contributes to the growing body of knowledge on patient reported outcomes and more specifically, the importance of utilizing patient generated responses to map improvements in quality of life for patients over time.
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Affiliation(s)
- Patricia Dekeseredy
- WVU Medicine, One Medical Center Drive, PO Box 9183, Suite 4300 Health Science Center, Morgantown, West Virginia
| | - Robert Marsh
- West Virginia University Department of Neurosurgery
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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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Ellard DR, Underwood M, Achana F, Antrobus JH, Balasubramanian S, Brown S, Cairns M, Griffin J, Griffiths F, Haywood K, Hutchinson C, Lall R, Petrou S, Stallard N, Tysall C, Walsh DA, Sandhu H. Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial. Health Technol Assess 2018. [PMID: 28639551 DOI: 10.3310/hta21300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) 2009 guidelines for persistent low back pain (LBP) do not recommend the injection of therapeutic substances into the back as a treatment for LBP because of the absence of evidence for their effectiveness. This feasibility study aimed to provide a stable platform that could be used to evaluate a randomised controlled trial (RCT) on the clinical effectiveness and cost-effectiveness of intra-articular facet joint injections (FJIs) when added to normal care. OBJECTIVES To explore the feasibility of running a RCT to test the hypothesis that, for people with suspected facet joint back pain, adding the option of intra-articular FJIs (local anaesthetic and corticosteroids) to best usual non-invasive care is clinically effective and cost-effective. DESIGN The trial was a mixed design. The RCT pilot protocol development involved literature reviews and a consensus conference followed by a randomised pilot study with an embedded mixed-methods process evaluation. SETTING Five NHS acute trusts in England. PARTICIPANTS Participants were patients aged ≥ 18 years with moderately troublesome LBP present (> 6 months), who had failed previous conservative treatment and who had suspected facet joint pain. The study aimed to recruit 150 participants (approximately 30 per site). Participants were randomised sequentially by a remote service to FJIs combined with 'best usual care' (BUC) or BUC alone. INTERVENTIONS All participants were to receive six sessions of a bespoke BUC rehabilitation package. Those randomised into the intervention arm were, in addition, given FJIs with local anaesthetic and steroids (at up to six injection sites). Randomisation occurred at the end of the first BUC session. MAIN OUTCOME MEASURES Process and clinical outcomes. Clinical outcomes included a measurement of level of pain on a scale from 0 to 10, which was collected daily and then weekly via text messaging (or through a written diary). Questionnaire follow-up was at 3 months. RESULTS Fifty-two stakeholders attended the consensus meeting. Agreement informed several statistical questions and three design considerations: diagnosis, the process of FJI and the BUC package and informing the design for the randomised pilot study. Recruitment started on 26 June 2015 and was terminated by the funder (as a result of poor recruitment) on 11 December 2015. In total, 26 participants were randomised. Process data illuminate some of the reasons for recruitment problems but also show that trial processes after enrolment ran smoothly. No between-group analysis was carried out. All pain-related outcomes show the expected improvement between baseline and follow-up. The mean total cost of the overall treatment package (injection £419.22 and BUC £264.00) was estimated at £683.22 per participant. This is similar to a NHS tariff cost for a course of FJIs of £686.84. LIMITATIONS Poor recruitment was a limiting factor. CONCLUSIONS This feasibility study achieved consensus on the main challenges in a trial of FJIs for people with persistent non-specific low back pain. FUTURE WORK Further work is needed to test recruitment from alternative clinical situations. TRIAL REGISTRATION EudraCT 2014-000682-50 and Current Controlled Trials ISRCTN93184143. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 30. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David R Ellard
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - James Hl Antrobus
- South Warwickshire NHS Foundation Trust, Warwick Hospital, Warwick, UK
| | - Shyam Balasubramanian
- Pain Management Service, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Sally Brown
- University/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - Melinda Cairns
- Department of Allied Health Professions and Midwifery, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - James Griffin
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Social Science and Systems in Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kirstie Haywood
- Royal College of Nursing Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Charles Hutchinson
- Population Evidence and Technologies Room, Warwick Medical School, University of Warwick, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nigel Stallard
- Statistics and Epidemiology, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Colin Tysall
- University/User Teaching and Research Action Partnership (UNTRAP), University of Warwick, Coventry, UK
| | - David A Walsh
- Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Scheer JK, Keefe M, Lafage V, Kelly MP, Bess S, Burton DC, Hart RA, Jain A, Lonner BS, Protopsaltis TS, Hostin R, Shaffrey CI, Smith JS, Schwab F, Ames CP. Importance of patient-reported individualized goals when assessing outcomes for adult spinal deformity (ASD): initial experience with a Patient Generated Index (PGI). Spine J 2017; 17:1397-1405. [PMID: 28414170 DOI: 10.1016/j.spinee.2017.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Current metrics to assess patients' health-related quality of life (HRQOL) may not reflect a true change in the patients' specific perception of what is most important to them. PURPOSE This study aimed to describe the initial experience of a Patient Generated Index (PGI) in which patients create their own outcome domains. STUDY DESIGN This is a single-center prospective study. PATIENT SAMPLE Patients with adult spinal deformity (ASD) comprise the study sample. OUTCOME MEASURES Oswestry Disability Index (ODI), Short Form-36 (SF-36 Physical Component Score [PCS] and Mental Component Score [MCS]), Scoliosis Research Society-22r (SRS-22r), and PGI. METHODS Oswestry Disability Index, SF-36, SRS-22r, and PGI were administered preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 1 and 2 years. PGI correlations with ODI, SF-36, SRS total score, free-text frequency analysis of PGI exact response with text in ODI and SRS-22r questionnaires, and the responsiveness (effect size [ES]) of the HRQOL metrics were analyzed. No funding was used for this study and there are no conflicts of interest. RESULTS A total of 59 patients with 209 clinical encounters produced 370 PGI written response topics that included affect or emotions, relationships, activities of daily life, personal care, work, and hobbies. Mean preoperative PGI score was 18.6±13.5 (0-71.7 out of 100 [best]), and mean scores significantly improved at every postoperative time point (p<.05). Preoperative PGI scores significantly correlated with preoperative ODI (r=-0.28, p=.03), MCS (r=0.48, p<.01), and SRS total (r=0.57, p<.01). Postoperative PGI scores correlated with all HRQOL measures (p<.0001): ODI (r=-0.65), PCS (r=0.50), MCS (r=0.55), and SRS total (r=0.63). PGI responses exactly matched ODI and SRS-22r text at 47.8% and 35.4%, respectively, and at 63.2% and 58.9%, respectively, for categories. Patient Generated Index ES at a minimum of 1-year follow-up was -2.39, indicating substantial responsiveness (|ES|>0.8). Effect sizes for ODI, SRS-22r total, SF-36 PCS, and SF-36 MCS were 2.16, -2.06, -2.05, and -0.80, respectively. CONCLUSIONS The PGI is easy to administer and offers additional information about the patients' perspective not captured in standard HRQOL metrics. Patient Generated Index scores correlated with all of the standard HRQOL scores and were more responsive than ODI, SF-36, and SRS-22r, suggesting that the PGI may be a step closer to one HRQOL measure that better encompasses concerns and goals of the individual patients.
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Affiliation(s)
- Justin K Scheer
- School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA.
| | - Malla Keefe
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M779, San Francisco, CA 94143, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, 660 S Euclid Avenue, Campus Box 8233, St. Louis, MO 63110, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 4F, New York, NY 10003, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, 610 North Caroline Street, Suite 5243, Baltimore, MD 21287, USA
| | - Baron S Lonner
- Department of Orthopaedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, 10 Nathan D Perlman Pl, New York, NY 10003, USA
| | - Themistocles S Protopsaltis
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 4F, New York, NY 10003, USA
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd, Suite 810, Plano, TX 75093, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M779, San Francisco, CA 94143, USA
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Ammendolia C, Schneider M, Williams K, Zickmund S, Hamm M, Stuber K, Tomkins-Lane C, Rampersaud YR. The physical and psychological impact of neurogenic claudication: the patients' perspectives. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2017; 61:18-31. [PMID: 28413220 PMCID: PMC5381486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The patient perspective regarding the impact of neurogenic claudication (NC) has not been well studied. The objectives of this study were to determine what is most bothersome among patients with NC and how it impacts their lives and expectations with surgical and non-surgical treatment. METHODS Semi-structured telephone interviews were conducted, audio recorded and transcribed verbatim. A thematic analysis categorized key findings based on relative importance and impact on participants. RESULTS Twenty-eight individuals participated in this study. Participants were most bothered by the pain of NC, which dramatically impacted their lives. Inability to walk was the dominant functional limitation and this impacted the ability to engage in recreational and social activities. The most surprising finding was how frequently participants reported significant emotional effects of NC. CONCLUSIONS From a patients' perspective NC has a significant multidimensional effects with pain, limited walking ability and emotional effects being most impactful to their lives.
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Affiliation(s)
- Carlo Ammendolia
- University of Toronto, Institute for Health Policy, Management and Evaluation, Faculty of Medicine
| | - Michael Schneider
- University of Pittsburgh, Department of Physical Therapy and Clinical and Translational Science Institute
| | - Kelly Williams
- University of Pittsburgh, Department of Behavioral and Community Health Sciences, Graduate School of Public Health
| | - Susan Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Health Services Research and Development Center of Innovation, 2C21 Building 2, Salt Lake City VA, Salt Lake City, UT
| | - Megan Hamm
- University of Pittsburgh, Department of Medicine, Center for Research on Health Care
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Division of Graduate Education & Research
| | | | - Y Raja Rampersaud
- University of Toronto, Division of Orthopaedic Surgery, University Health Network-Arthritis Program
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Responsiveness of SF-36 Health Survey and Patient Generated Index in people with chronic knee pain commenced on oral analgesia: analysis of data from a randomised controlled clinical trial. Qual Life Res 2016; 26:761-766. [PMID: 27995369 DOI: 10.1007/s11136-016-1484-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE (1) To assess the responsiveness of the Short Form 36 Health Survey (SF-36) and Patient Generated Index (PGI) in people with knee pain who were given oral analgesics; and (2) to perform content analysis of the SF-36 and PGI aiming to identify differences between the instruments and causes of different responsiveness. METHODS An observational study nested within a randomised controlled trial comparing oral paracetamol, ibuprofen or a combination of the two in 884 community-derived people with chronic knee pain. Each participant was given the SF-36 and PGI questionnaires to fill out at baseline, day 10, week 7 and week 13 after commencement on analgesia. Responsiveness was measured as a standardised response mean from baseline, and contents of the instruments were analysed. RESULTS The PGI showed the greater responsiveness to analgesics than the SF-36 throughout the study period. Only the Bodily Pain Score of the SF-36 showed comparable responsiveness to the PGI. The standardised response mean of the PGI at 13 weeks was 0.61 (95% CI 0.51-0.72), and that of the Bodily Pain Score of the SF-36 was 0.49 (95% CI 0.39-0.58). Content analysis of the PGI identified multiple areas which are not represented in the SF-36 which may help explain its performance. CONCLUSIONS Overall the PGI is more responsive than the SF-36 to commonly used oral analgesics taken for knee pain. The PGI is able to elicit areas of individualised health-related quality of life which are not captured by the SF-36.
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In support of an individualized approach to assessing quality of life: comparison between Patient Generated Index and standardized measures across four health conditions. Qual Life Res 2016; 26:601-609. [DOI: 10.1007/s11136-016-1480-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 01/08/2023]
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17
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Callaghan BG, Condie ME. A post-discharge quality of life outcome measure for lower limb amputees: test–retest reliability and construct validity. Clin Rehabil 2016; 17:858-64. [PMID: 14682557 DOI: 10.1191/0269215503cr689oa] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To adapt the Patient Generated Index (PGI) quality of life measure for use with lower limb amputees and to conduct a test–retest reliability and construct validity study on the adapted measure. Design: Repeat questionnaire interviews with a four-week interval administered by trained peers. Setting: Participants' homes. Subjects: Forty-two unilateral lower limb transfemoral amputees, 16 years of age or older and fluent in English, fitted with a prosthesis and discharged into the community for at least one year following postoperative rehabilitation therapy. Main results: An intraclass correlation coefficient of 0.48 ( p < 0.001) was achieved for the index reliability analyses. Intraclass correlation (ICC) values for the seven most commonly mentioned areas of life affected by the amputation and its treatment ranged from 0.40 to 0.92. Comparing the PGI with the SF-12 Health Survey physical and mental component summaries gave Pearson's correlation coefficients of 0.12 ( p < 0.5) and 0.56 ( p < 0.001) respectively. Multiple linear regression analysis showed the SF-12 physical and mental component scores explained 31.5% of the variability in PGI scores, however, the mental component scores alone explained 31.2%. Conclusions: The PGI was adapted and found to be moderately reliable in terms of repeatability during successive follow-up interviews. Testing its construct validity supported a stronger relationship between mental health and quality of life than between physical health and quality of life.
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Affiliation(s)
- B G Callaghan
- The National Centre for Training and Education in Prosthetics and Orthotics, University of Strathclyde, Glasgow, Scotland, UK.
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18
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Abstract
Aim: To review the role of Health Related Quality of Life (HRQL) assessments in the management of patients with venous ulceration. Method: A search of electronic databases and reference lists delivered numerous articles containing a variety of HRQL assessments for venous ulcer treatment. Synthesis: The salient points from the literature were collaborated in order to establish which outcome measures best reflect the quality of care delivered. The treatment of chronic venous leg ulceration is often prolonged and a permanent cure is frequently unattainable. An improvement in a patient's condition needs to be demonstrated in order to determine the benefit of a surgical treatment. The assessment of HRQL is increasingly recognised as a valuable surgical outcome measurement. Conclusion: The combination of ‘standard’ clinical outcome measures, the generic SF-36 and a specific ‘venous ulcer’ HRQL questionnaire can produce a more complete treatment outcome assessment in patients with venous ulceration.
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Affiliation(s)
- A. Howard
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, Charing Cross Hospital, London, UK
| | - A. H. Davies
- Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, Charing Cross Hospital, London, UK
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19
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Towards Tailored Patient's Management Approach: Integrating the Modified 2010 ACR Criteria for Fibromyalgia in Multidimensional Patient Reported Outcome Measures Questionnaire. ARTHRITIS 2016; 2016:5371682. [PMID: 27190648 PMCID: PMC4846760 DOI: 10.1155/2016/5371682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/16/2016] [Indexed: 11/18/2022]
Abstract
Objectives. To assess the validity, reliability, and responsiveness to change of a patient self-reported questionnaire combining the Widespread Pain Index and the Symptom Severity Score as well as construct outcome measures and comorbidities assessment in fibromyalgia patients. Methods. The PROMs-FM was conceptualized based on frameworks used by the WHO Quality of Life tool and the PROMIS. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction were achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. The questionnaire included the modified ACR criteria main items (Symptom Severity Score and Widespread Pain Index), in addition to assessment of functional disability, quality of life (QoL), review of the systems, and comorbidities. Every patient completed HAQ and EQ-5D questionnaires. Results. A total of 146 fibromyalgia patients completed the questionnaire. The PROMs-FM questionnaire was reliable as demonstrated by a high standardized alpha (0.886-0.982). Content construct assessment of the functional disability and QoL revealed significant correlation (p < 0.01) with both HAQ and EQ-5D. Changes in functional disability and QoL showed significant (p < 0.01) variation with diseases activity status in response to therapy. There was higher prevalence of autonomic symptoms, CVS risk, sexual dysfunction, and falling. Conclusions. The developed PROMs-FM questionnaire is a reliable and valid instrument for assessment of fibromyalgia patients. A phased treatment regimen depending on the severity of FMS as well as preferences and comorbidities of the patient is the best approach to tailored patient management.
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Aburub AS, Gagnon B, Rodríguez AM, Mayo NE. Agreement between personally generated areas of quality of life concern and standard outcome measures in people with advanced cancer. Support Care Cancer 2016; 24:3831-8. [PMID: 27067594 DOI: 10.1007/s00520-016-3204-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/01/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE People with advanced cancer experience different sequelae which have unique effects on quality of life (QOL). The patient-generated index (PGI) is a personalized measure that allows patients to nominate, rate, and value areas that have the most impact on QOL. Fatigue, pain, and aspects of physical function are among the top 10 areas with QOL impact. An area of validation that is lacking for the PGI is the extent to which spontaneously nominated areas of QOL that patients are concerned with, agree with ratings obtained from standard patient reported outcomes (PROs). METHODS Data from 192 patients were used to compare ratings on fatigue, pain, and physical function obtained from PGI to those from standard outcome measures. RESULTS Within one severity rating, agreement ranged from 32.1 to 76.9 % within the fatigue domain, 34.2 to 95.24 % for pain, and between 84.2 and 94.7 % for physical function. Of the 10 items where the PGI had the highest agreement, 7 came from the RAND-36. At the domain level, people nominating an area scored in the more impaired range on standard measures than people who did not. CONCLUSION PGI gives comparable information as do standard measures. IMPLICATIONS FOR CANCER PGI provides important information to guide clinical care of the patient and also produces a legitimate total score suitable for research.
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Affiliation(s)
- Ala' S Aburub
- School of Physical and Occupational Therapy, Division of Clinical Epidemiology, McGill University Department of Medicine, 687 Pine Ave W, Ross Pavilion R4.29, Montreal, H3A 1A1, QC, Canada.
| | - B Gagnon
- Département de Médecine Familiale et de Médecine d'urgence, Centre de Recherche sur le Cancer, Universite Laval, Centre de recherche du CHU de Québec, 9 rue McMahon, Local Qc, G1R 2J6, Québec, 1899-6, Canada
| | - A M Rodríguez
- School of Rehabilitation Sciences, McGill University, 3654 Prom Sir-William-Osler, Montréal H3G 1Y5, Québec, Canada
| | - Nancy E Mayo
- School of Physical and Occupational Therapy, Division of Clinical Epidemiology, McGill University Department of Medicine, 687 Pine Ave W, Ross Pavilion R4.29, Montreal, H3A 1A1, QC, Canada
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Abstract
The field of quality-of-life (QOL) measurement grew out of attempts in the 1960s and 1970s to connect the ever-increasing levels of public expenditure on technology-based health care for chronic diseases with evidence of the benefits and harms to patients. Most of the concepts, methods, and standards for measuring QOL were derived from psychometrics, but the degree to which current tools adhere to these methods varies greatly. Despite the importance of QOL, patient-reported outcomes are not measured in most cardiovascular clinical trials. Lack of familiarity with QOL measures and their interpretation, and unrealistic expectations about the information these measures can provide, are obstacles to their use. Large clinical trials of revascularization therapy for coronary artery disease and medical treatments for heart failure show small-to-moderate QOL effects, primarily detected with disease-specific instruments. Larger treatment effects, seen in trials of device therapy for heart failure and ablation therapy for atrial fibrillation, have been detected with both generic and disease-specific instruments. A large gap remains between the parameters currently being measured in clinical research and the data needed to incorporate the 'patient's voice' into therapeutic decision-making.
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Affiliation(s)
- Daniel B Mark
- Duke Clinical Research Institute, 2400 Pratt Avenue, Room 0311, PO Box 17969, Durham, North Carolina 27715, USA
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Abstract
Demonstrating the effectiveness of health care interventions requires valid measurement of the impact, or outcome of those interventions. It is increasingly suggested that Quality of Life (QoL) is the ‘gold standard’ outcome internationally (Bowling 1995) and in Australasia (Mordue & Parkin, 1997). Although a number of QoL measures are now available, questions remain about the definition of the concept itself and the psychometric properties of those measures. A consequence of major concern is that health services research or clinical studies of healthcare interventions using inadequately defined outcomes or invalid measures will in turn produce results that lack validity. This paper explores a number of such issues concerning the concept of QoL and the way it is measured.
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Using a personalized measure (Patient Generated Index (PGI)) to identify what matters to people with cancer. Support Care Cancer 2015; 24:437-445. [DOI: 10.1007/s00520-015-2821-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/15/2015] [Indexed: 11/26/2022]
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Evaluation of the stages of completion and scoring of the Patient Generated Index (PGI) in patients with rheumatic diseases. Qual Life Res 2015; 24:2625-35. [DOI: 10.1007/s11136-015-1014-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
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Matteson KA, Scott DM, Raker CA, Clark MA. The menstrual bleeding questionnaire: development and validation of a comprehensive patient-reported outcome instrument for heavy menstrual bleeding. BJOG 2015; 122:681-9. [PMID: 25615842 DOI: 10.1111/1471-0528.13273] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and validate a patient-reported outcome measure for women with heavy menstrual bleeding (HMB). STUDY DESIGN Prospective cohort and cross-sectional studies. SETTING Outpatient women's health facility. POPULATION Women aged between 18 and 55 years with and without self-reported HMB. METHODS Using data from patients and clinicians, we developed a patient-reported outcome measure for HMB; the Menstrual Bleeding Questionnaire (MBQ). Participants in the validation studies completed demographic and general health questionnaires and either (1) bleeding and quality of life data collected daily on handheld computers and the MBQ after 1 month or (2) the MBQ at enrolment only. A subset of women also completed the Short-form-36 (SF-36) generic quality of life questionnaire. We performed psychometric analyses of the MBQ to assess its internal consistency as well as its content and concurrent validity and ability to discriminate between women with and without HMB. MAIN OUTCOME MEASURES Psychometric properties of the questionnaire. RESULTS Overall, 182 women participated in the MBQ validation studies. We found that the MBQ domains were internally consistent (Cronbach's α = 0.87-0.94). There was excellent correlation between daily bleeding-related symptom data and the MBQ completed at 1 month (ρ > 0.7 for all domains). We found low to moderate correlation between the MBQ scores and SF-36 scores (ρ = -0.15 to -0.45). The MBQ clearly discriminated between women with and without HMB (mean MBQ score = 10.6 versus 30.8, P < 0.0001). CONCLUSIONS The MBQ is a valid patient-reported outcome measure for HMB that has the potential to improve the evaluation of women with self-reported HMB in research and clinical practice.
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Affiliation(s)
- K A Matteson
- Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Contribution of symptom clusters to multiple sclerosis consequences. Qual Life Res 2014; 24:617-29. [DOI: 10.1007/s11136-014-0804-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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Wen Z, Li X, Lu Q, Brunson J, Zhao M, Tan J, Wan C, Lei P. Health related quality of life in patients with chronic gastritis and peptic ulcer and factors with impact: a longitudinal study. BMC Gastroenterol 2014; 14:149. [PMID: 25141760 PMCID: PMC4236548 DOI: 10.1186/1471-230x-14-149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 08/12/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The assessment of Health Related Quality of Life (HRQOL) has been applied as a significant outcome indicator for patients with chronic diseases. No HRQOL study, however, has looked at HRQOL in patients with chronic gastritis and peptic ulcers. This paper focuses on comparing HRQOL in patients with chronic gastritis and peptic ulcers and examining the factors that influence the HRQOL of such patients. Results can be used for making decisions in clinical trials as well as aiding individual management and preventive care of these diseases. METHODS The Chinese version of the SF-36 (CSF-36) was administered twice to 244 patients with chronic gastritis and peptic ulcers. Mean scores across the two disease groups were compared using t-tests, change over time was analyzed with paired samples t-tests, and factors predicting HRQOL were investigated using the univariate general linear model. RESULTS The mean domain scores of patients with chronic gastritis were lower than those for patients with peptic ulcers, with the exception of physical functioning. Both groups had lower HRQOL compared with population norms. Mean domain scores increased after treatment in both groups. HRQOL in patients with these two chronic diseases differed by age, education level, marriage, income, and gender, but their explanatory power was relatively low. CONCLUSION Quality of life of patients with chronic gastritis was lower than that of patients with peptic ulcers, which was lower than population norms. Quality of life in both patients groups was associated with socio-demographic risk factors.
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Affiliation(s)
| | | | | | | | | | | | - Chonghua Wan
- People's Hospital of Songgang, Baoan, Shenzhen, Guangdong 518105, China.
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Tang JA, Oh T, Scheer JK, Parsa AT. The current trend of administering a patient-generated index in the oncological setting: a systematic review. Oncol Rev 2014; 8:245. [PMID: 25992233 PMCID: PMC4419610 DOI: 10.4081/oncol.2014.245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/05/2014] [Accepted: 04/27/2014] [Indexed: 01/07/2023] Open
Abstract
The patient-generated index (PGI) is a more novel approach to evaluating health-related quality of life (HRQOL) that allows patients to formulate their own responses in an open-ended format in order to measure HRQOL based on each patient’s own stated goals and expectations. To date the use of PGI in the setting of patients diagnosed with cancer remains relatively less common compared to other health conditions. This systematic review primarily aims to identify current literature in which PGI has been used as a tool to assess quality of life in cancer patients. A systematic review using the MEDLINE database from January 1990 to July 2013 was performed with the following search terms to identify the implementation of PGI in oncology settings: (PGI OR patient generated index OR patient-generated OR patient-reported OR patient generated OR patient reported) AND (cancer OR oncology OR tumor OR neoplasm OR malignancy). Of the 2167 papers initially identified, 10 papers evaluated quality of life in oncology patients by collecting free-form responses from the patient, 4 of which actually used PGI. An overarching theme observed in these studies highlighted the concerns mentioned by patients that were not targeted or detected by standardized quality of life measures. While implementing the PGI may require slightly more investment of resources in the beginning, the potential implications of allowing patients to characterize their quality of life on their own terms are tremendous.
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Affiliation(s)
- Jessica A Tang
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University , Chicago, IL, USA
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Fraser IS, Langham S, Uhl-Hochgraeber K. Health-related quality of life and economic burden of abnormal uterine bleeding. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.4.2.179] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ahmed S, Ring L. Influence of response shift on evaluations of change in patient-reported outcomes. Expert Rev Pharmacoecon Outcomes Res 2014; 8:479-89. [DOI: 10.1586/14737167.8.5.479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Using existing data to identify candidate items for a health state classification system in multiple sclerosis. Qual Life Res 2013; 23:1445-57. [PMID: 24338161 DOI: 10.1007/s11136-013-0604-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 02/03/2023]
Abstract
PURPOSE In multiple sclerosis (MS), the use of preference-based measures is limited to generic measures such as Health Utilities Index Mark 2 and 3, the EQ-5D and the SF-6D. However, the challenge of using such generic preference-based measures in people with MS is that they may not capture all domains of health relevant to the disease. Therefore, the main aim of this paper is to describe the development of a health state classification system for MS patients. The specific objectives are: (1) to identify items best reflecting the domains of quality of life important to people with MS and (2) to provide evidence for the discriminative capacity of the response options by cross-walking onto a visual analog scale of health rating. METHODS The data come from an epidemiologically sampled population of people with MS diagnosed post-1994. The dataset consisted of 206 items relating to impairments, activity limitations, participation restrictions, health perception and quality of life. Important domains were identified from the responses to the Patient Generated Index, an individualized measure of quality of life. The extent to which the items formed a uni-dimensional, linear construct was estimated using Rasch analysis, and the best item was selected using the threshold map. RESULTS The sample was young (mean age 43) and predominantly female (n = 140/189; 74%). The P-PBMSI classification system consisted of five items, with three response levels per item, producing a total of 243 possible health states. Regression coefficient values consistently decreased between response levels and the linear test for trend were statistically significant for all items. The linear test for trend indicated that for each item the response options provided the same discriminative ability within the magnitude of their capacity. A scoring algorithm was estimated using a simple additive formula. The classification system demonstrated convergent validity against other measures of similar constructs and known-groups validity between different clinical subgroups. CONCLUSION This study produced a health state classifier system based on items impacted upon by MS, and demonstrated the potential to discriminate the health impact of the disease.
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Mayo NE, Bayley M, Duquette P, Lapierre Y, Anderson R, Bartlett S. The role of exercise in modifying outcomes for people with multiple sclerosis: a randomized trial. BMC Neurol 2013; 13:69. [PMID: 23809312 PMCID: PMC3706216 DOI: 10.1186/1471-2377-13-69] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/30/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the commonly known benefits of exercise and physical activity evidence shows that persons Multiple Sclerosis (MS) are relatively inactive yet physical activity may be even more important in a population facing functional deterioration. No exercise is effective if it is not done and people with MS face unique barriers to exercise engagement which need to be overcome. We have developed and pilot tested a Multiple Sclerosis Tailored Exercise Program (MSTEP) and it is ready to be tested against general guidelines for superiority and ultimately for its impact on MS relevant outcomes. The primary research question is to what extent does an MS Tailored Exercise Program (MSTEP) result in greater improvements in exercise capacity and related outcomes over a one year period in comparison to a program based on general guidelines for exercise among people with MS who are sedentary and wish to engage in exercise as part of MS self-management. METHODS/DESIGN The proposed study is an assessor-blind, parallel-group, randomized controlled trial (RCT). The duration of the intervention will be one year with follow-up to year two. The targeted outcomes are exercise capacity, functional ambulation, strength, and components of quality of life including frequency and intensity of fatigue symptoms, mood, global physical function, health perception, and objective measures of activity level. Logistic regression will be used to test the main hypothesis related to the superiority of the MSTEP program based on a greater proportion of people making a clinically relevant gain in exercise capacity at 1 year and at 2 years, using an intention-to-treat approach. Sample size will be 240 (120 per group). DISCUSSION The MS community is clearly looking for interventions to help alleviate the disabling sequelae of MS and promote health. Exercise is a well-known intervention which has known benefits to all, yet few exercise regularly. For people with MS, the role of exercise in MS management needs to be rigorously assessed to inform people as to how best to use exercise to reduce disability and promote health. TRIAL REGISTRATION Clinical Trials.gov: NCT01611987.
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Affiliation(s)
- Nancy E Mayo
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
| | - Mark Bayley
- UHN - Toronto Rehabilitation Institute, University Centre, 550 University Avenue, Toronto, ON M5G 2A2, Canada
| | - Pierre Duquette
- Centre hospitalier de l’Université de Montréal, 1560 Sherbrooke Street E, Montreal, Quebec H2L 4M1, Canada
| | - Yves Lapierre
- Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
| | - Ross Anderson
- Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC H2W 1S4, Canada
| | - Susan Bartlett
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC H3A 1A1, Canada
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de Achaval S, Kallen MA, Mayes MD, Lopez-Olivo MA, Suarez-Almazor ME. Use of the Patient-generated Index in systemic sclerosis to assess patient-centered outcomes. J Rheumatol 2013; 40:1337-43. [PMID: 23772081 DOI: 10.3899/jrheum.120978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the content and construct validity of an individualized patient-reported instrument, the Patient-generated Index (PGI), in patients with systemic sclerosis (SSc), and to compare its performance to that of other instruments and to the Patient-reported Outcomes Measurement Information System (PROMIS) framework. METHODS Patients identified the 5 most important life areas affected by SSc, which we categorized into domains of the PROMIS framework (mental, physical, and social). Correlations were obtained between PGI and the Health Assessment Questionnaire (HAQ), the Medical Outcomes Study Short Form-36 (SF-36), and the Symptom Burden Index (SBI) scores. RESULTS Sixty-two patients with SSc completed the PGI: 87% women, 69% white, mean age 53 years, mean disease duration 8 years, and 63% with diffuse disease. A total of 258 individual life area responses were recorded: 54% in social health (social function and relationship subcomponents); 28% in physical health (physical function, symptoms, general physical health); and 19% in mental health (consisting largely of the affect subcomponent). Patient PGI responses were categorized into 6 of the 7 subcomponents of the PROMIS framework; substance use/alcohol was not identified. Statistically significant correlations ranging in absolute value from 0.26 to 0.50 were observed between the PGI and the HAQ, SF-36 summary component scores, and the large majority of SF-36 subscales and SBI components. CONCLUSION The PGI is a personalized instrument that adequately assessed a wide range of health-related quality of life outcomes within the PROMIS framework. The PGI captured additional constructs not yet defined within the framework that are important for patients with SSc.
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Affiliation(s)
- Sofia de Achaval
- University of Texas MD Anderson Cancer Center, Department of General Internal Medicine, Houston, Texas 77030, USA
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Hogan M, Nangle N, Morrison TG, McGuire BE. Evaluation of thePatient Generated Indexas a measure of quality-of-life in people with severe traumatic brain injury. Brain Inj 2013; 27:273-80. [DOI: 10.3109/02699052.2012.743177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Klokkerud M, Grotle M, Lochting I, Kjeken I, Hagen KB, Garratt AM. Psychometric properties of the Norwegian version of the Patient Generated Index in patients with rheumatic diseases participating in rehabilitation or self-management programmes. Rheumatology (Oxford) 2013; 52:924-32. [DOI: 10.1093/rheumatology/kes401] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tavernier SS, Totten AM, Beck SL. Assessing content validity of the patient generated index using cognitive interviews. QUALITATIVE HEALTH RESEARCH 2011; 21:1729-1738. [PMID: 21859908 DOI: 10.1177/1049732311420169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The effects of cancer and its treatment on quality of life contribute to patient and clinician decisions. Health-related quality of life (HRQL) is a subjective concept, leading to variation in its definition. This presents challenges when measuring HRQL and evaluating interventions. The designers of the Patient Generated Index (PGI) addressed these challenges by having individuals identify areas of their lives affected by illness and treatment, then report on these self-defined areas. We used cognitive interviews to collect information about patient understanding of the PGI, the response processes used to complete the PGI, and how well the PGI reflected participant HRQL. Interview data support the content validity of the PGI in comprehensively defining and adequately sampling participant HRQL as an individualized construct. Findings also support our recommendation to revise PGI formatting to reduce response errors. We make recommendations to reduce the cognitive demands the PGI places on respondents.
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Tavernier SS, Beck SL, Clayton MF, Pett MA, Berry DL. Validity of the Patient Generated Index as a quality-of-life measure in radiation oncology. Oncol Nurs Forum 2011; 38:319-29. [PMID: 21531682 DOI: 10.1188/11.onf.319-329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate psychometric properties of an instrument designed to measure individualized health-related quality of life (HRQOL). DESIGN Repeated measures of self-reported quality of life. SETTING An outpatient radiation therapy department in the western part of the United States. SAMPLE 86 adults with cancer receiving their first course of radiation therapy. METHODS The Patient Generated Index (PGI), the National Comprehensive Cancer Network's Distress Thermometer (DT), and the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core-30 (QLQ-C30). MAIN RESEARCH VARIABLES Convergent validity, responsiveness, sensitivity, and response shift. FINDINGS PGI scores were inversely correlated with scores on the DT (r = -0.49, -0.55, -0.44; p < 0.001), as well as the role (r = 0.31, 0.4, 0.38; p < 0.01), emotional (r = 0.33, 0.41, 0.33; p < 0.01), social functioning (r = 0.27, 0.49, 0.42; p < 0.05), pain (r = -0.29, -0.39, -0.39; p < 0.01), and fatigue (r = -0.35, -0.25, -0.47; p < 0.05) QLQ-C30 subscales at all measurement times. The PGI was responsive to those reporting high or low DT scores (t = 4.42, 3.32, 2.9; p < 0.05). A small-to-moderate effect size was detected in those who had an increase (effect size = 0.51) or decrease (effect size = 0.38) in HRQOL over time. Participants reconceptualized HRQOL over time. CONCLUSIONS Data supported the PGI as a valid measure of individualized HRQOL. IMPLICATIONS FOR NURSING The PGI potentially provides a more patient-centered measure of HRQOL in patients with cancer. Additional testing is needed in larger, more diverse groups.
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Bouwsma EVA, Hesley GK, Woodrum DA, Weaver AL, Leppert PC, Peterson LG, Stewart EA. Comparing focused ultrasound and uterine artery embolization for uterine fibroids-rationale and design of the Fibroid Interventions: reducing symptoms today and tomorrow (FIRSTT) trial. Fertil Steril 2011; 96:704-10. [PMID: 21794858 DOI: 10.1016/j.fertnstert.2011.06.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/22/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To present the rationale, design, and methodology of the Fibroid Interventions: Reducing Symptoms Today and Tomorrow (FIRSTT) study. DESIGN Randomized clinical trial. SETTING Two academic medical centers. PATIENT(S) Premenopausal women with symptomatic uterine fibroids. INTERVENTION(S) Participants are randomized to two U.S. Food and Drug Administration-approved minimally invasive treatments for uterine leiomyomas: uterine artery embolization and magnetic resonance-guided focused ultrasound. MAIN OUTCOME MEASURE(S) The primary endpoint is defined as the need for an additional intervention for fibroid symptoms following treatment. Secondary outcomes consist of group differences in symptom alleviation, recovery trajectory, health-related quality of life, impairment of ovarian reserve, treatment complications, and the economic impact of these issues. RESULT(S) The trial is currently in the phase of active recruitment. CONCLUSION(S) This randomized clinical trial will provide important evidence-based information for patients and health care providers regarding optimal minimally invasive treatment approach for women with symptomatic uterine leiomyomas. CLINICAL TRIAL REGISTRATION NCT00995878.
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Affiliation(s)
- Esther V A Bouwsma
- Center for Uterine Fibroids, Mayo Clinic, Rochester, Minnesota; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55901, USA
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Dworkin RH, Peirce-Sandner S, Turk DC, McDermott MP, Gibofsky A, Simon LS, Farrar JT, Katz NP. Outcome measures in placebo-controlled trials of osteoarthritis: responsiveness to treatment effects in the REPORT database. Osteoarthritis Cartilage 2011; 19:483-92. [PMID: 21396467 DOI: 10.1016/j.joca.2011.02.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 02/11/2011] [Accepted: 02/14/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment response in randomized clinical trials (RCT) of osteoarthritis (OA) has been assessed by multiple primary and secondary outcomes, including pain, function, patient and clinician global measures of status and response to treatment, and various composite and responder measures. Identifying outcome measures with greater responsiveness to treatment is important to increase the assay sensitivity of RCTs. OBJECTIVE To assess and compare the responsiveness of different outcome measures used in placebo-controlled RCTs of OA. SEARCH STRATEGY The Resource for Evaluating Procedures and Outcomes of Randomized Trials database includes placebo-controlled clinical trials of pharmacologic treatments (oral, topical, or transdermal) for OA identified from a systematic literature search of RCTs published or publicly available before August 5, 2009, which was conducted using PubMed, the Cochrane collaboration, publicly-available websites, and reference lists of retrieved publications. DATA COLLECTION AND ANALYSIS Data collected included: (1) pain assessed with single-item ratings and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale; (2) patient and clinician global measures of status, improvement, and treatment response; (3) function assessed by the WOMAC function subscale; (4) stiffness assessed by the WOMAC stiffness subscale; and (5) the WOMAC and Lequesne Algofunctional Index composite outcomes. Measures were grouped according to the total number of response categories (i.e., <10 categories or ≥10 categories). The treatment effect (difference in mean change from baseline between the placebo and active therapy arms) and standardized effect size (SES) were estimated for each measure in a meta-analysis using a random effects model. RESULTS There were 125 RCTs with data to compute the treatment effect for at least one measure; the majority evaluated non-steroidal anti-inflammatory drugs (NSAIDs), followed by opioids, glucosamine and/or chondroitin, and acetaminophen. In general, the patient-reported pain outcome measures had comparable responsiveness to treatment as shown by the estimates of treatment effects and SES. Treatment effects and SESs were generally higher for patient-reported global measures compared with clinician-rated global measures but generally similar for the WOMAC and Lequesne composite measures. CONCLUSIONS Comparing different outcome measures using meta-analysis and selecting those that have the greatest ability to identify efficacious treatments may increase the efficiency of clinical trials of treatments for OA. Improvements in the quality of the reporting of clinical trial results are needed to facilitate meta-analyses to evaluate the responsiveness of outcome measures and to also address other issues related to assay sensitivity.
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Affiliation(s)
- R H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Treatment Satisfaction in Osteoarthritis and Chronic Low Back Pain: The Role of Pain, Physical and Emotional Functioning, Sleep, and Adverse Events. THE JOURNAL OF PAIN 2011; 12:416-24. [DOI: 10.1016/j.jpain.2010.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 07/16/2010] [Accepted: 07/26/2010] [Indexed: 11/22/2022]
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Abresch RT, Carter GT, Han JJ, McDonald CM. New clinical end points in rehabilitation medicine: tools for measuring quality of life. Am J Hosp Palliat Care 2010; 26:483-92. [PMID: 19923631 DOI: 10.1177/1049909109352656] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Traditional clinical end points in rehabilitation medicine have centered on objective measures of human performance, including quantitative muscle strength testing, functional independence measurements (FIM), and timed motor performance (TMP). However, it is now increasingly recognized that health-related quality of life (HRQoL) is a valid clinical end point. Health-related quality of life is a broad concept involving an individual's physical health, psychological state, personal beliefs, and interpersonal and social support relationships. The goals for this article are to show the value of performing HRQoL measurements and briefly describe methods used to assess quality of life (QoL).
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Affiliation(s)
- Richard T Abresch
- Department of Physical Medicine and Rehabilitation, University of California at Davis, Sacramento, CA 95616, USA.
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Speight J, Reaney MD, Barnard KD. The use of hypothetical scenarios and importance weightings when measuring the impact of diabetes on quality of life. A response to Broseet al. Diabet Med 2009. [DOI: 10.1111/j.1464-5491.2009.02853.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wong M, Rietzschel J, Mulherin D, David C. Evaluation of a multidisciplinary outpatient pain management programme based at a community hospital. Musculoskeletal Care 2009; 7:106-120. [PMID: 19051202 DOI: 10.1002/msc.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate a multidisciplinary cognitive behavioural therapy pain management programme (PMP) based at a small community hospital. METHODS Patients attending the PMP were assessed at three intervals (pre-training, and 18 and 44 weeks post-training) using a set of seven questionnaires. Information about their general practitioner (GP) and consultant visits was recorded at pre-training and final follow-up visits. Questionnaires were completed and additional personal information recorded before patients attended their appointments. RESULTS Between 1997 and 2006, 163 patients completed at least six sessions out of the eight-week programme. Of these, 70 who had completed at least one questionnaire outcome measure at the three assessment intervals, and 83 who had provided information on their GP and consultant visits at pre-training and final follow-up, were included in the analyses. The results showed that patients reported being more confident in coping with their pain (pain self-efficacy questionnaire) at 18 weeks post-training and their improvement was sustained at the final follow-up. They were significantly less depressed (hospital and anxiety depression scale [HADS]) and reported a large improvement in their quality of life (modified patient generated index) at the final follow-up. They also reported a significant reduction in pain-related GP and consultant visits at their final follow-up. Although there were improvements in the Tampa scale of kinesiophobia, anxiety (HADS-Anx) and sickness impact profile scores, these were not statistically significant. CONCLUSION The result of the evaluation indicated that this PMP, delivered in a community hospital setting, made some significant differences to patients with intractable chronic pain conditions.
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Affiliation(s)
- Mei Wong
- Department of Physical Health Psychology, Cannock Chase Hospital, UK.
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Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, Peirce-Sandner S, Bhagwat D, Everton D, Burke LB, Cowan P, Farrar JT, Hertz S, Max MB, Rappaport BA, Melzack R. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain 2009; 144:35-42. [PMID: 19356853 DOI: 10.1016/j.pain.2009.02.007] [Citation(s) in RCA: 442] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 02/11/2009] [Accepted: 02/12/2009] [Indexed: 01/22/2023]
Abstract
The objective of the present research was to develop a single measure of the major symptoms of both neuropathic and non-neuropathic pain that can be used in studies of epidemiology, natural history, pathophysiologic mechanisms, and treatment response. We expanded and revised the Short-form McGill Pain Questionnaire (SF-MPQ) pain descriptors by adding symptoms relevant to neuropathic pain and by modifying the response format to a 0-10 numerical rating scale to provide increased responsiveness in longitudinal studies and clinical trials. The reliability, validity, and subscale structure of the revised SF-MPQ (SF-MPQ-2) were examined in responses from 882 individuals with diverse chronic pain syndromes and in 226 patients with painful diabetic peripheral neuropathy who participated in a randomized clinical trial. The data suggest that the SF-MPQ-2 has excellent reliability and validity, and the results of both exploratory and confirmatory factor analyses provided support for four readily interpretable subscales-continuous pain, intermittent pain, predominantly neuropathic pain, and affective descriptors. These results provide a basis for use of the SF-MPQ-2 in future clinical research, including clinical trials of treatments for neuropathic and non-neuropathic pain conditions.
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Affiliation(s)
- Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA.
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Responsiveness of a patient specific outcome measure compared with the Oswestry Disability Index v2.1 and Roland and Morris Disability Questionnaire for patients with subacute and chronic low back pain. Spine (Phila Pa 1976) 2008; 33:2450-7; discussion 2458. [PMID: 18824951 DOI: 10.1097/brs.0b013e31818916fd] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort. OBJECTIVE The aim of this study was to compare the responsiveness of a patient specific outcome measure with the Oswestry Disability Index v2.1 (ODI) and the Roland and Morris Disability Questionnaire (RMDQ) for patients with mild to moderate subacute and chronic low back pain. SUMMARY OF BACKGROUND DATA Patient specific outcome measures allow individuals to select and rate the relative importance of activities they consider of greatest relevance. However, there is a paucity of research reporting the responsiveness of these measures for patient with back pain. METHODS Two hundred and one patients were assessed at baseline and 12 months using the patient specific activity questionnaire (PSAQ), the ODI, the RMDQ, and a transition rating scale. The latter was used to categorize patients into 3 groups (better, same or worse). Effect size statistics, receiver operating characteristic curves and 1-way between groups analysis of variance were used in the analysis. RESULTS All instruments were able to detect improvements in back pain as measured by the transition rating scale. In this improved group effect sizes were large for the PSAQ (1.08 to 1.31) and ODI (-0.88 to -1.00) but only moderate for the RMDQ (-0.70 to -0.74). In the deteriorated group effect sizes were moderate to large for the ODI (0.61 to 1.16) and RMDQ (0.69 to 1.25), but small for the PSAQ (-0.16 to -0.26). The areas under receiver operator characteristic curves for the ODI, PSAQ, and RMDQ, respectively were: 0.75 (95% CI 0.68 to 0.82), 0.75 (95% CI 0.68 to 0.82) and 0.69 (95% CI 0.61 to 0.76). CONCLUSION The PSAQ was highly responsive to change in patients who report improvement in back symptoms but unlike the ODI and RMDQ was unable to detect deterioration. Overall, the ODI was more responsive than either the PSAQ or the RMDQ.
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Abnormal uterine bleeding: a review of patient-based outcome measures. Fertil Steril 2008; 92:205-16. [PMID: 18635169 DOI: 10.1016/j.fertnstert.2008.04.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 04/11/2008] [Accepted: 04/11/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To summarize and evaluate the patient-based outcome measures (PBOMs) that have been used to study women with abnormal uterine bleeding (AUB). DESIGN Systematic review. SETTING Original articles that used at least one PBOM and were conducted within a population of women with AUB. PATIENT(S) Women with AUB. INTERVENTION(S) The titles, abstracts, and studies were systematically reviewed for eligibility. The PBOMs used in eligible studies were summarized. Essential psychometric properties were identified, and a list of criteria for each property was generated. MAIN OUTCOME MEASURE(S) "Quality" of individual PBOMs as determined using the listed criteria for psychometric properties. RESULT(S) Nine hundred eighty-three studies referenced AUB and patient-reported outcomes. Of these, 80 studies met the eligibility criteria. Fifty different instruments were used to evaluate amount of bleeding, bleeding-related symptoms, or menstrual bleeding-specific quality of life. The quality of each of these instruments was evaluated on eight psychometric properties. The majority of instruments had no documentation of reliability, precision, or feasibility. There was no satisfactory evidence that any one instrument completely addressed all eight psychometric properties. CONCLUSION(S) Studies of women with AUB are increasingly using PBOMs. Many different PBOMs were used; however, no single instrument completely addressed eight important measurement properties.
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PAWAR A, KRISHNAN R, DAVIS K, BOSMA K, KULKARNI R. Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders. Haemophilia 2008; 14:579-83. [DOI: 10.1111/j.1365-2516.2008.01652.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Syme G, Rowe P, Martin D, Daly G. Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of VMO selective training versus general quadriceps strengthening. ACTA ACUST UNITED AC 2008; 14:252-63. [PMID: 18436468 DOI: 10.1016/j.math.2008.02.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 02/06/2008] [Accepted: 02/18/2008] [Indexed: 11/29/2022]
Abstract
This study was a prospective single blind randomised controlled trial to compare the effects of rehabilitation with emphasis on retraining the vastus medialis (VMO) component of the quadriceps femoris muscle and rehabilitation with emphasis on general strengthening of the quadriceps femoris muscles on pain, function and Quality of Life in patients with patellofemoral pain syndrome (PFPS). Patients with PFPS (n=69) were recruited from a hospital orthopaedic clinic and randomised into three groups: (1) physiotherapy with emphasis on selectively retraining the VMO (Selective); (2) physiotherapy with emphasis on general strengthening of the quadriceps femoris muscles (General); and (3) a no-treatment control group (Control). The three groups were then compared before and after an eight-week rehabilitation period. The Selective and General groups demonstrated statistically significant and 'moderate' to 'large' effect size reductions in pain when compared to the Control group. Both the Selective and General groups displayed statistically significant and 'moderate' and 'large' effect size improvements in subjective function and Quality of Life compared to the Control group. Knee flexion excursion during the stance phase of gait, demonstrated that there were no statistical significant differences and only 'trivial' to 'small' effect size differences between the Selective or General groups and the Control group. A large number of PFPS patients can experience significant improvements in pain, function and Quality of Life, at least in the short term, with quadriceps femoris rehabilitation, with or without emphasis on selective activation of the VMO component. Both approaches would seem acceptable for rehabilitating patients with PFPS. It may be appropriate to undertake exercises involving selective activation of the vastus medialis early in the rehabilitation process, however, clinicians should not overly focus on selective activation before progressing rehabilitation, especially in more chronic cases with significant participation restrictions.
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Affiliation(s)
- G Syme
- Department of Orthopaedic Surgery, St. John's Hospital in Howden, Livingston, United Kingdom.
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Witham MD, Fulton RL, Wilson L, Leslie CA, McMurdo MET. Validation of an individualised quality of life measure in older day hospital patients. Health Qual Life Outcomes 2008; 6:27. [PMID: 18423029 PMCID: PMC2373778 DOI: 10.1186/1477-7525-6-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 04/18/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To test the ease of use, reliability, responsiveness and construct validity of the Patient Generated Index, an individualised quality of life score, in older people attending a Medicine for Older People Day Hospital. METHODS Prospective longitudinal study in patients attending a specialist Medicine for Older People Day Hospital in Scotland. The Patient Generated Index was administered at baseline, one week later, and at the end of Day Hospital attendance. Functional Limitations Profile, Hospital Anxiety and Depression Score, Barthel index and global subjective impressions of change were also collected and compared with baseline scores and change in Patient Generated Index scores. Reliability was assessed using intraclass correlation coefficients in subjects reporting no change in global quality of life; responsiveness was assessed using effect size and Guyatt coefficients in subjects reporting change in global quality of life. External validity was assessed via correlation with measures of physical function, comorbid disease and psychological state. RESULTS 75 patients were enrolled, mean age 81 years. Mean completion time was 5.0 minutes at baseline. Reliability was moderate (intraclass correlation coefficient 0.72) but there were weak and inconsistent responses to change (effect sizes 0.02 to 0.15; Guyatt responsiveness coefficient 0.29). Patient Generated Index scores correlated with Functional Limitation Profile scores (r = 0.51, p < 0.001), baseline anxiety score (r = -0.25, P = 0.039) and baseline depression score (r = -0.37, P = 0.002) but displayed only weak, non-significant correlation with number of comorbid diseases (r = -0.22, P = 0.07), number of medications (r = -0.21, P = 0.08) and Barthel score (r = 0.09, p = 0.45). CONCLUSION The Patient Generated Index appears moderately reliable and easy to complete, but is poorly responsive to change, limiting its usefulness in clinical practice or research.
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Affiliation(s)
- Miles D Witham
- Section of Ageing and Health, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Roberta L Fulton
- Section of Ageing and Health, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Lucy Wilson
- Section of Ageing and Health, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Carolyn A Leslie
- Section of Ageing and Health, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
| | - Marion ET McMurdo
- Section of Ageing and Health, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK
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