1
|
Blomqvist A, Bäck M, Klompstra L, Strömberg A, Jaarsma T. Usability and feasibility analysis of an mHealth-tool for supporting physical activity in people with heart failure. BMC Med Inform Decis Mak 2024; 24:44. [PMID: 38347499 PMCID: PMC10860324 DOI: 10.1186/s12911-024-02452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Physical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial. METHODS A mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively. RESULTS Ten people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. FEASIBILITY Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves. CONCLUSIONS It was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.
Collapse
Affiliation(s)
- Andreas Blomqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Ahmed MA, Burnham J, Dwivedi G, AbuAsal B. Achieving big with small: quantitative clinical pharmacology tools for drug development in pediatric rare diseases. J Pharmacokinet Pharmacodyn 2023; 50:429-444. [PMID: 37140724 DOI: 10.1007/s10928-023-09863-x] [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: 03/04/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
Pediatric populations represent a major fraction of rare diseases and compound the intrinsic challenges of pediatric drug development and drug development for rare diseases. The intertwined complexities of pediatric and rare disease populations impose unique challenges to clinical pharmacologists and require integration of novel clinical pharmacology and quantitative tools to overcome multiple hurdles during the discovery and development of new therapies. Drug development strategies for pediatric rare diseases continue to evolve to meet the inherent challenges and produce new medicines. Advances in quantitative clinical pharmacology research have been a key component in advancing pediatric rare disease research to accelerate drug development and inform regulatory decisions. This article will discuss the evolution of the regulatory landscape in pediatric rare diseases, the challenges encountered during the design of rare disease drug development programs and will highlight the use of innovative tools and potential solutions for future development programs.
Collapse
Affiliation(s)
- Mariam A Ahmed
- Takeda Development Center Americas Inc, 125 Binney St, Cambridge, MA, 02142-1123, USA.
| | | | - Gaurav Dwivedi
- Takeda Development Center Americas Inc, 125 Binney St, Cambridge, MA, 02142-1123, USA
| | - Bilal AbuAsal
- US Food and Drug Administration, 10903, New Hampshire Ave, Silver Spring, MD, 20993, USA
| |
Collapse
|
3
|
Logan B, Viecelli AK, Johnson DW, Aquino EM, Bailey J, Comans TA, Gray LC, Hawley CM, Hickey LE, Janda M, Jaure A, Jose MD, Kalaw E, Kiriwandeniya C, Matsuyama M, Mihala G, Nguyen KH, Pascoe E, Pole JD, Polkinghorne KR, Pond D, Raj R, Reidlinger DM, Scholes-Robertson N, Varghese J, Wong G, Hubbard RE. Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals-a cluster randomised controlled trial. Trials 2023; 24:365. [PMID: 37254217 DOI: 10.1186/s13063-023-07363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. METHODS The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3-5/5D who are frail, measured by a Frailty Index (FI) of > 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index - Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. DISCUSSION This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial's findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. TRIAL REGISTRATION ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.
Collapse
Affiliation(s)
- B Logan
- Centre for Health Services Research, University of Queensland, Brisbane, Australia.
| | - A K Viecelli
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - D W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - E M Aquino
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - J Bailey
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - T A Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - L C Gray
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - C M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - L E Hickey
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - M Janda
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - A Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M D Jose
- Renal Unit, Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - E Kalaw
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - C Kiriwandeniya
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - M Matsuyama
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - G Mihala
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - K H Nguyen
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - E Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - J D Pole
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - K R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - D Pond
- School of Rural Medicine, University of New England, Armidale, Australia
- Wicking Centre, University of Tasmania, Hobart, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - R Raj
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Nephrology, Launceston General Hospital, Launceston, Australia
| | - D M Reidlinger
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - N Scholes-Robertson
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - J Varghese
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - G Wong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - R E Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
4
|
Murray LT, Howell TA, Matza LS, Eremenco S, Adams HR, Trundell D, Coons SJ. Approaches to the Assessment of Clinical Benefit of Treatments for Conditions That Have Heterogeneous Symptoms and Impacts: Potential Applications in Rare Disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:547-553. [PMID: 36455827 DOI: 10.1016/j.jval.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Evaluating the clinical benefit of interventions for conditions with heterogeneous symptom and impact presentations is challenging. The same condition can present differently across and within individuals over time. This occurs frequently in rare diseases. The purpose of this review was to identify (1) assessment approaches used in clinical trials to address heterogeneous manifestations that could be relevant in rare disease research and (2) US Food and Drug Administration (FDA)-approved labeling claims that used these approaches. METHODS A targeted literature review was conducted examining peer-reviewed publications and FDA-approved labeling claims from January 2002 to July 2020, focusing on claims incorporating clinical outcome assessments. Approaches were then assessed for their potential application in rare diseases. RESULTS A total of 6 assessment approaches were identified: composite or other multicomponent endpoints, multidomain responder index, most bothersome symptom (MBS), goal attainment scaling, sliding dichotomy, and adequate relief. A total of 59 FDA-approved labeling claims associated with these approaches were identified: composite or other multicomponent endpoints (n=49), MBS (n=9), and adequate relief (n=1). A total of 10 FDA-approved labeling claims, all using multicomponent endpoints, were identified for rare diseases. CONCLUSIONS Multicomponent, MBS, and adequate relief have been included in FDA-approved labeling claims. Multicomponent endpoints, including composite endpoints, were the most frequent way to address heterogeneous manifestations of both common and rare diseases. MBS may be acceptable to regulators, whereas multidomain responder index is unlikely to be. The goal attainment scaling and adequate relief approaches may have potential utility in rare disease trials, assuming the theoretical and statistical challenges inherent in each approach are managed.
Collapse
|
5
|
Sales CMD, Ashworth M, Ayis S, Barkham M, Edbrooke-Childs J, Faísca L, Jacob J, Xu D, Cooper M. Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: Position paper. J Clin Psychol 2023; 79:596-621. [PMID: 35194799 DOI: 10.1002/jclp.23319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/07/2022]
Abstract
Idiographic patient-reported outcome measures (I-PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem-based, and seven goal-based, I-PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I-PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient-centered approach. However, there are several challenges for I-PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I-PROM score. Based on the current state of the literature, we recommend that I-PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I-PROM data.
Collapse
Affiliation(s)
- Célia M D Sales
- Faculty of Psychology and Education Sciences (FPCEUP), Center for Psychology at the Universidade do Porto (CPUP), University of Porto, Porto, Portugal
| | - Mark Ashworth
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Salma Ayis
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Julian Edbrooke-Childs
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Luís Faísca
- FCHS & Center for Research in Health Technologies and Information, Universidade do Algarve, Faro, Portugal
| | - Jenna Jacob
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Dan Xu
- Zhejiang University of Technology, Hangzhou, China
| | - Mick Cooper
- Department of Psychology, University of Roehampton, London, UK
| |
Collapse
|
6
|
Roberts MA, Abery BH. A person-centered approach to home and community-based services outcome measurement. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1056530. [PMID: 36817716 PMCID: PMC9929050 DOI: 10.3389/fresc.2023.1056530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
In the United States, over 2.5 million people with disabilities are recipients of supports through the Center for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) program. Recent decades have seen a growing focus on providing HCBS in a person-centered manner thereby supporting outcomes that are both important for and to the person. HCBS outcome measurement, however, has not kept pace with advancements in person-centered thinking as it relates to providing supports to people with disabilities. The concept of person-centered outcome measurement has been inadequately defined and is frequently misunderstood including by those in the measurement field. The authors first operationally define person-centered measurement and establish its importance within the context of HCBS and the recent CMS's Final Settings Rule. The important role that person-centered measurement has to play in quality improvement efforts in this area is then explored. A discussion is subsequently provided as to the challenges that are faced in person-centered measurement specific to the disability field. In addition to further conceptualizing and defining this form of measurement, recommendations are provided for moving the field forward.
Collapse
|
7
|
Logan B, Jegatheesan D, Viecelli A, Pascoe E, Hubbard R. Goal attainment scaling as an outcome measure for randomised controlled trials: a scoping review. BMJ Open 2022; 12:e063061. [PMID: 35868829 PMCID: PMC9316030 DOI: 10.1136/bmjopen-2022-063061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES (1) Identify the healthcare settings in which goal attainment scaling (GAS) has been used as an outcome measure in randomised controlled trials. (2) Describe how GAS has been implemented by researchers in those trials. DESIGN Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews approach. DATA SOURCES PubMed, CENTRAL, EMBASE and PsycINFO were searched through 28 February 2022. ELIGIBILITY CRITERIA English-language publications reporting on research where adults in healthcare settings were recruited to a randomised controlled trial where GAS was an outcome measure. DATA EXTRACTION AND SYNTHESIS Two independent reviewers completed data extraction. Data collected underwent descriptive statistics. RESULTS Of 1,838 articles screened, 38 studies were included. These studies were most frequently conducted in rehabilitation (58%) and geriatric medicine (24%) disciplines/populations. Sample sizes ranged from 8 to 468, with a median of 51 participants (IQR: 30-96). A number of studies did not report on implementation aspects such as the personnel involved (26%), the training provided (79%) and the calibration and review mechanisms (87%). Not all trials used the same scale, with 24% varying from the traditional five-point scale. Outcome attainment was scored in various manners (self-report: 21%; observed: 26%; both self-report and observed: 8%; and not reported: 45%), and the calculation of GAS scores differed between trials (raw score: 21%; T score: 47%; other: 21%; and not reported: 66%). CONCLUSIONS GAS has been used as an outcome measure across a wide range of disciplines and trial settings. However, there are inadequacies and inconsistencies in how it has been applied and implemented. Developing a cross-disciplinary practical guide to support a degree of standardisation in its implementation may be beneficial in increasing the reliability and comparability of trial results. PROSPERO REGISTRATION NUMBER CRD42021237541.
Collapse
Affiliation(s)
- Benignus Logan
- Medicine Service Line, Redcliffe Hospital, Redcliffe, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Dev Jegatheesan
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Kidney Disease Research, The University of Queensland-Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Australasian Kidney Trials Network, Faculty of Medicine, The University of Queensland-Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Elaine Pascoe
- Australasian Kidney Trials Network, Faculty of Medicine, The University of Queensland-Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| |
Collapse
|
8
|
Osteopathic Treatment and Evaluation in the Clinical Setting of Childhood Hematological Malignancies. Cancers (Basel) 2021; 13:cancers13246321. [PMID: 34944939 PMCID: PMC8699143 DOI: 10.3390/cancers13246321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Children: adolescents, and young adults who are affected by hematological malignancies and who are undergoing intensive phases of cancer treatment including hematopoietic stem cell transplantation, experience diminished functional ability. This study was aimed at assessing if osteopathic treatment and evaluation can be used when an 11-week precision-based exercise program is run inside the hospital. Our results support that osteopathy plus precision-based intervention could be a desirable support in the clinical prise en charge of these children and adolescents. Osteopathy is a safe method for the evaluation of clinical conditions and requires strong multidisciplinary synergy between pediatricians and exercise physiologists. Abstract Children: adolescents, and young who are adults affected with hematological malignancies (CAYA-H) and who are undergoing intensive phases of cancer treatment, including hematopoietic stem cell transplantation (HSCT), experience diminished functional ability. This study was aimed at assessing the feasibility, efficacy, safety, and satisfaction of an osteopathic intervention in CAYA-H attending an 11-week precision-based exercise program (PEx). All of the participants were given 4–10 treatments according to the prescription ordered by the sports medicine doctor in charge of the PEx, and the following outcomes were assessed: (1) spinal column range of motion (ROM) by palpation; (2) lower and upper limb joints ROM by a goniometer; (3) orthostatic posture by plumb line assessment; (4) chest and abdomen mobility by inspection and palpation; (5) cranial-sacral rhythmic impulse (CRI) by palpation; and (6) adverse effects. Goal attainment scaling (GAS) was used to identify the accomplishment of a desired clinical result. Moreover, HSCT patients who were affected with graft-versus-host disease and/or osteonecrosis had their joints assessed in terms of ROM as tools to monitor the effectiveness of immunosuppressive treatment. A total of 231 CAYA-H were identified, and 104 participated in the study (age 10.66 ± 4.51 yrs; 43% F). PEx plus osteopathy reached positive GAS scores by improving the ROMs of the spinal column and/or limbs (81% and 78%, respectively), chest and abdomen mobility (82%), and CRI (76%). Only minor reversible adverse effects were noticed during the study. Together, our data seem to initiate a new course where osteopathy could be useful in evaluating structural edges due to the clinical history of each CAYA-H. Given the contributions that were obtained by the GAS scores, osteopathic treatment seems to reveal interesting potential that can be targeted in the future.
Collapse
|
9
|
Backward Running on a Negative Slope as a Treatment for Achilles Tendinopathy in Runners: A Feasibility Pilot Study. J Sport Rehabil 2021; 30:1197-1202. [PMID: 34438365 DOI: 10.1123/jsr.2020-0500] [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: 11/29/2020] [Revised: 04/05/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Achilles tendinopathy (AT) is a common musculoskeletal injury among runners. Eccentric exercises are considered first-line treatment. However, during the early stages of rehabilitation, patients are usually instructed to stop running. Backward running (BR) on a negative slope provides a similar eccentric load while enabling ongoing physical activity; thus, it may be suggested as an alternative treatment. OBJECTIVES To determine the feasibility of a BR program as a treatment option for AT in runners. DESIGN Prospective, single-arm feasibility study. SETTING Outpatient clinic. PATIENTS Recreational runners diagnosed with AT and referred to the Meuhedet Health Services Physical Therapy Clinic in Jerusalem, Israel, from September 2019 to February 2020. INTERVENTION The patients completed a 5-week (9 sessions) rehabilitation program of supervised BR on a negatively inclined treadmill. MAIN OUTCOME MEASURES Compliance with the program was evaluated by calculating the percentage of patients who completed the full protocol with no adverse events. Personal running-related goals were set before the program and were assessed following rehabilitation using the goal attainment scaling method. Forward-running time until the onset of relevant Achilles tendon pain, and the Victorian Institute of Sports Assessment Scale-Achilles were measured at baseline (T0), before treatment session 6 (T1), and after the last session (T2). RESULTS Among the 15 patients recruited, 14 (93%), average age 48.8 (10.4) years (86% males), completed the full protocol with no adverse events. Almost all participants (85.7%) achieved their running-related functional goals. Postintervention, the median forward-running time increased from 52.5 (92.5) to 900 (522.5) seconds (P = .008, effect size = .858), and the median Victorian Institute of Sports Assessment Scale-Achilles score improved by 28 points (P = .003, effect size = .881). CONCLUSIONS BR on a negative slope may be a feasible treatment method for runners suffering from AT. Future randomized control trials are required to further validate the efficacy of this method.
Collapse
|
10
|
Stanley J, Howlett SE, Dunn T, Rockwood K. The Clinician's Interview-Based Impression of Change (Plus caregiver input) and goal attainment in two dementia drug trials: Clinical meaningfulness and the initial treatment response. Alzheimers Dement 2021; 17:856-865. [PMID: 33928754 DOI: 10.1002/alz.12242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The Clinician's Interview-Based Impression of Change Plus caregiver input (CIBIC-Plus) has been widely used in dementia drug trials to evaluate cognition, behavior, and function. New trials of symptomatic drugs forecast renewed interest in this measure. METHODS To test its clinical meaningfulness, we examined how CIBIC-Plus performed in two cholinesterase inhibitor trials compared to goal attainment scaling Scale (GAS) scores, a patient-reported outcome measure. RESULTS Net goal attainment was seen for all but one GAS domains in subjects who improved on the CIBIC-Plus. Subjects who improved initially on CIBIC-Plus scores were likely to remain improved across all other outcomes for each trial's duration, except for Disability Assessment for Dementia scores. DISCUSSION The initial response to treatment, as assessed by CIBIC-Plus, remained stable for most outcome measures. Even small CIBIC-Plus improvement changes are associated with clinically meaningful change as assessed by GAS. Other tests detect decline better than improvement.
Collapse
Affiliation(s)
| | - Susan E Howlett
- DGI Clinical Inc., Halifax, Nova Scotia, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Taylor Dunn
- DGI Clinical Inc., Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- DGI Clinical Inc., Halifax, Nova Scotia, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
11
|
Georgy E. Stroke early supported discharge: the impact of patients' characteristics and clinical profile on rehabilitation goal attainment and clinical outcomes. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Stroke early supported discharge services were introduced to provide a comprehensive stroke specialist therapy input, while reducing cost of acute care. Early supported discharge services resulted in better health-related outcomes. A consensus has not yet been established regarding specific early supported discharge patient characteristics and clinical profile. The main aim of this study was to establish evidence to support the development of an early supported discharge patient profile (demographics and clinical) and eligibility criteria to enable early supported discharge services achieve their purposes of reducing post-stroke disability and institutionalisation rates. This article outlines the relationship between early supported discharge patients' clinical profiles and clinical outcomes, in terms of disability, goal attainment and institutionalisation rates. Methods A retrospective review of data was implemented to determine whether specific early supported discharge patients' clinical profiles and characteristics correlate with clinical outcomes. Data were collected for patients admitted to the Suffolk Stroke Early Supported Discharge Service between August and October 2016, comprising patients' demographics and clinical profiles, including stroke type, Barthel Index and Modified Rankin Scale. Performance data were collected at the end of the early supported discharge service including therapy frequency and intensity, as well as clinical outcomes including the Goal Attainment Scale. Results Data were collected for 53 patients. Data were analysed for all patients in three groups: goals not achieved; goals achieved; and goals achieved to a higher level), according to the Goal Attainment Scale. A Chi-square test showed no significant difference with regard to sex and stroke side (P=0.27). Analysis of variance revealed no significant difference in age. Conversely, results showed a significant association between goal attainment and the stroke subtype, severity and length of hospital stay. Conclusions Specific clinical characteristics and disease profiles correlate with functional outcomes and could influence goal attainment and functional status. A specific patient cohort seems to benefit the most from early supported discharge services in terms of optimised functional outcomes and recovery.
Collapse
Affiliation(s)
- Ehab Georgy
- Suffolk Stroke Early Supported Discharge Team, Suffolk Stroke Early Supported Discharge, Norfolk Community Health and Care NHS Trust, Bury St Edmunds, UK
| |
Collapse
|
12
|
Paul F, Silván CV. Effect of nabiximols on Goal Attainment Scale scores in patients with treatment-resistant multiple sclerosis spasticity. Neurodegener Dis Manag 2021; 11:143-153. [PMID: 33641348 DOI: 10.2217/nmt-2020-0060] [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] [Indexed: 01/17/2023] Open
Abstract
Background: Nabiximols oromucosal spray (Sativex®) is an approved add-on treatment option for moderate-to-severe treatment-resistant multiple sclerosis (MS) spasticity. Materials & methods: This prospective, observational, noninterventional, 3-month follow-up pilot study assessed the evolution of patient-selected goal attainment scale (GAS) item scores and of MS spasticity and associated symptoms during nabiximols treatment. Results: In the full analysis set (n = 21), the mean (SD) overall unweighted GAS score increased from 32.1 (3.4) at baseline to 43.6 (14.6) at month 3 (p = 0.0060), constituting a clinically meaningful change. Slight improvements were observed in MS spasticity and most associated symptoms. Nabiximols improved walking ability and was well tolerated. Conclusion: The study provides proof-of-concept that GAS methodology can be applied to MS management in daily practice.
Collapse
Affiliation(s)
- Friedemann Paul
- Experimental & Clinical Research Center & NeuroCure Clinical Research Center, Max Delbrueck Center for Molecular Medicine & Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | |
Collapse
|
13
|
Shogren KA, Dean EE, Burke KM, Raley SK, Taylor JL. Goal Attainment Scaling: A Framework for Research and Practice in the Intellectual and Developmental Disabilities Field. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:7-21. [PMID: 33543273 DOI: 10.1352/1934-9556-59.1.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/17/2020] [Indexed: 06/12/2023]
Abstract
Goal setting and attainment is often a targeted outcome in the intellectual and developmental disabilities field; however, standardizing the measurement of attainment of individualized goals is challenging. The purpose of this article is to introduce a four-domain framework that provides a series of questions to research and evaluation teams in planning for the use of goal attainment scaling (GAS) as an outcome measure at the individual or aggregate level. We intend to stimulate discussion and ongoing work to further systematize how GAS is used in (a) intervention research to establish evidence-based practices and (b) practice to assess the extent to which interventions and supports lead to intended outcomes. The goal is to promote a clear planning process to inform data collection on individualized goal attainment outcomes that are rooted in goals and outcomes valued by people with intellectual and developmental disabilities.
Collapse
Affiliation(s)
| | - Evan E Dean
- Karrie A. Shogren and Evan E. Dean, University of Kansas
| | | | | | | |
Collapse
|
14
|
Giovannetti ER, Clair CA, Jennings LA, Sandberg SF, Bowman A, Reuben DB, Scholle SH. Standardised approach to measuring goal-based outcomes among older disabled adults: results from a multisite pilot. BMJ Qual Saf 2020; 30:157-166. [PMID: 33037142 DOI: 10.1136/bmjqs-2019-010742] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Older adults with complex care needs face trade-offs in determining the right course of treatment. The Centers for Medicare and Medicaid Services identified 'Care is personalized and aligned with patient's goals' as a key meaningful measures category, yet existing quality measures typically assess disease-specific care and may not effectively evaluate what is most important to older adults and family members. Measures based on individualised goals and goal-based outcomes have been proposed as an alternative but are not routinely assessed or implemented. OBJECTIVES We tested two approaches to assessing goal-based outcomes that allow individuals to set goals based on their own priorities and measure progress-(1) goal attainment scaling and (2) existing, validated patient-reported outcome measures (PROM). METHODS A prospective cohort study of feasibility in seven sites (33 clinicians) of the two approaches with 229 individuals. We calculated performance on a measure of achievement of individually identified goals. RESULTS Both approaches were successfully implemented in a non-randomly selected population, and a goal-based outcome could be calculated for 189 (82%) of participants. Most individuals met their goal-based outcome (73%) with no statistical difference between the goal attainment scaling approach (74%) and the patient-reported outcomes approach (70%). Goals were heterogeneous ranging from participating in activities, health management, independence and physical health. Clinicians chose to use goal attainment scaling (n=184, 80%) more often than PROMs (n=49, 20%) and rated the goal attainment scaling approach as useful for providing patient care. CONCLUSION Goal-based outcomes have the potential to both improve the way healthcare is provided and fill a critical gap in value-based payment.
Collapse
Affiliation(s)
- Erin R Giovannetti
- Health Economics and Aging Research, MedStar Health Research Institute, Baltimore, Maryland, USA
| | | | - Lee A Jennings
- Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Shana F Sandberg
- National Opinion Research Center-Bethesda MD Office, Bethesda, Maryland, USA
| | - Angelia Bowman
- National Committee for Quality Assurance, Washington, DC, USA
| | - David B Reuben
- Geriatrics, David Geffen School of Medicine, Los Angeles, California, USA
| | - Sarah H Scholle
- National Committee for Quality Assurance, Washington, DC, USA
| |
Collapse
|
15
|
Goal attainment scaling as an outcome measure in rare disease trials: a conceptual proposal for validation. BMC Med Res Methodol 2019; 19:227. [PMID: 31801463 PMCID: PMC6894223 DOI: 10.1186/s12874-019-0866-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Goal Attainment Scaling (GAS) is an instrument that is intended to evaluate the effect of an intervention by assessing change in daily life activities on an individual basis. However, GAS has not been validated adequately in an RCT setting. In this paper we propose a conceptual validation plan of GAS in the setting of rare disease drug trials, and describe a hypothetical trial where GAS could be validated. METHODS We have used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) taxonomy to deduce which measurement properties of GAS can be evaluated, and how. As individual GAS scores cannot be interpreted outside the context of a RCT, the validation of GAS needs to be done on trial as well as on individual level. RESULTS The procedure of GAS consists of three steps. For the step of goal selection (step 1) and definition of levels of attainment (step 2), face validity may be assessed by clinical experts. For the evaluation of the goal attainment (step 3), the inter and intra rater reliability can be evaluated on an individual level. Construct validity may be evaluated by comparison with change scores on other instruments measuring in the same domain as particular goals, if available, and by testing hypotheses about differences between groups. A difference in mean GAS scores between a group who received an efficacious intervention and a control group is an indication of well-chosen goals, and corroborates construct validity of GAS on trial level. Responsiveness of GAS cannot be evaluated due to the nature of the construct being assessed. CONCLUSION GAS may be useful as an instrument to assess functional change as an outcome measure in heterogeneous chronic rare diseases, but it can only be interpreted and validated when used in RCTs with blinded outcome assessment. This proposed theoretical validation plan can be used as a starting point to validate GAS in specific conditions.
Collapse
|
16
|
Rietkerk W, Uittenbroek RJ, Gerritsen DL, Slaets JPJ, Zuidema SU, Wynia K. Goal planning in person-centred care supports older adults receiving case management to attain their health-related goals. Disabil Rehabil 2019; 43:1682-1691. [PMID: 31589075 DOI: 10.1080/09638288.2019.1672813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Care for older adults should preferably be provided in a person-centred way that includes goal planning. The aim of the present cohort study is to gain an insight into the results of goal planning, in a person-centred care setting for community-living older adults. MATERIALS AND METHODS Within Embrace, a person-centred and integrated care service, older adults set goals with the aim to improve health-related problems. For every goal, they rated severity scores ranging from 0 (no problem) to 10 (extremely severe): a baseline score, a target score and, within one year, an end score to evaluate these goals. The differences between baseline and end scores (goal progress) and target and end scores (goal attainment), and the percentage of goals attained were calculated and compared between health-related domains (i.e., mental health, physical health, mobility, and support). RESULTS Among 233 older adults, 836 goal plans were formulated of which 74% (95% Confidence Interval: 71-77) were attained. Goals related to physical health were the most likely to be attained and goals for mobility and pain the least likely. CONCLUSIONS Older adults are able to attain health-related goals through collaborative goal planning. We recommend future integrated care programmes for older adults to incorporate goal-planning methods to achieve person-centred care.IMPLICATIONS FOR REHABILITATIONOlder adults experiencing frailty or complex care needs and receiving individual support within an integrated care setting are able to formulate and attain goals using goal planning with severity scores.Goal plans of community-living older adults mostly aim at improving health-related problems concerning physical health, mobility, or support.Goals related to physical health are the most likely to be attained, while goals for mobility and pain are the least likely to be attained.
Collapse
Affiliation(s)
- Wanda Rietkerk
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ronald J Uittenbroek
- Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Joris P J Slaets
- Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|