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Singer S, Al-Ibraheem A, Pinto M, Iakovou I, Østhus AA, Hammerlid E, Locati LD, Gamper E, Ignacio J, Jordan SJ, Kiyota N, Buettner M, Engesser D, Canotilho R, Ioannidis G, Husson O, Gama RR, Fanetti G, Moss L, Inhestern J, Andry G, Fuehrer D, Kuliś D, Rimmele H, Sykiotis G. International Phase IV Field Study for the Reliability and Validity of the European Organisation for Research and Treatment of Cancer Thyroid Cancer Module EORTC QLQ-THY34. Thyroid 2023; 33:1078-1089. [PMID: 37450344 DOI: 10.1089/thy.2023.0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Purpose: The aim of this study was to validate the new European Organisation for Research and Treatment of Cancer Quality of Life Thyroid Cancer Module (EORTC QLQ-THY34). Methods: We enrolled 437 thyroid cancer patients from 17 countries. One group (n = 303), undergoing treatment or best supportive care, completed the questionnaires at three time points (before therapy [t1], 6 weeks later [t2], and 6 months after t2 [t3]). A second group (survivors ≥2 years after diagnosis, n = 134) completed it at a random baseline time point and a second time 1 week later. We determined internal consistency (using Cronbach's alpha), the scale structure (with confirmatory factor analysis), and discriminant validity (using known-group comparisons). Group 1 data were used to assess responsiveness and group 2 data to determine test-retest reliability using intra-class correlations (ICC). Results: All 34 items fulfilled the criteria to be kept in the questionnaire. Cronbach's alpha was >0.70 in 8 of the 9 multi-item scales. All standardized factor loadings exceeded 0.40, confirming the proposed scale structure. The ICC was >0.70 in all scales expressing good test-retest reliability. Differences in scale scores between patients with different histology were >5 points in all scales. In all but one of the pre-specified scales (Dry Mouth), changes over time were ≥|4| points between at least two time points. Conclusion: The EORTC QLQ-THY34 with its 9 multi-item and 8 single-item scales is a reliable and valid tool to measure quality of life in thyroid cancer patients and can be used in future trials and studies.
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Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
- University Cancer Centre, Mainz, Germany
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Ioannis Iakovou
- Department of Nuclear Medicine, Aristotle University, Thessaloniki, Greece
| | - Arild Andre Østhus
- ENT and Head and Neck Department, University Medical Centre Oslo, Oslo, Norway
| | - Eva Hammerlid
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laura Deborah Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eva Gamper
- Department of Nuclear Medicine and Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Psychiatry II, Medical University of Innsbruck, Austria
| | - Juan Ignacio
- Oncology Departments, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Susan J Jordan
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Matthias Buettner
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Deborah Engesser
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Rita Canotilho
- Instituto Português do Oncologia do Porto Francisco Gentil, Porto, Portugal
| | | | - Olga Husson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Giuseppe Fanetti
- Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
| | - Laura Moss
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, United Kingdom
| | - Johanna Inhestern
- Department of Otorhinolaryngology, Oberhavelkliniken, Hennigsdorf, Germany
| | - Guy Andry
- Surgery Department, Jules Bordet Institute, Brussels, Belgium
| | - Dagmar Fuehrer
- Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Center at WTZ, Member of ENDO-ERN and EURACAN, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dagmara Kuliś
- European Organisation for Research and Treatment of Cancer (EORTC), Quality of Life Department, Brussels, Belgium
| | - Harald Rimmele
- Bundesverband Schilddrüsenkrebs-Ohne Schilddrüse leben e. V., Berlin, Germany
| | - Gerasimos Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ramage JK, Friend E, Randell J, KING B, Fernandez Ortega P, McNamara MG, Kaltsas G, Falconi M, Cwikla J, Capdevila J, Grozinsky‐Glasberg S, Mandair D, Gamper E, Srirajaskanthan R, O Weickert M, Gray D. Development of a quality of life questionnaire for patients with pancreatic neuroendocrine tumours (the PANNET module). J Neuroendocrinol 2022; 34:e13097. [PMID: 35156246 PMCID: PMC9285342 DOI: 10.1111/jne.13097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/18/2022] [Indexed: 12/04/2022]
Abstract
Pancreatic neuroendocrine tumours (panNET) are heterogeneous neoplasms usually characterised by slow growth and secretion of hormones, which often cause symptoms. The effect of these symptoms on quality of life (QoL) has not previously been examined in detail. EORTC (European Organisation for Research and Treatment of Cancer) guidelines were followed in phases 1-3 to produce a potential module of questions usable for trials in panNET, focusing on three common types of panNET. For two less common types, a list of symptoms was constructed. Following an extensive literature search and phase 1a interviews with patients and healthcare workers, a long list of potential issues (169) was obtained. This list was shown to 12 patients from three countries in phase 1b interviews to check that no items were missed. The list was reduced to 57 issues. The list of issues was converted to questions, mainly from existing validated questions within the EORTC item library. The list of questions was then used in a phase 3 international study in eight countries using seven languages. A provisional module of 24 items is presented for use in nonfunctioning panNET, gastrinoma and insulinoma. This module increases knowledge concerning QoL in this condition and may be a useful adjunct in clinical trials. A phase 4 trial is being considered for validation of this questionnaire.
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Affiliation(s)
| | | | | | - Barbara KING
- Hampshire Hospitals NHS Foundation TrustBasingstokeUK
| | | | - Mairéad G. McNamara
- Division of Cancer SciencesUniversity of Manchester/The Christie NHS Foundation TrustManchesterUK
| | | | - Massimo Falconi
- Pancreatic Surgery UnitPancreas Translational & Clinical Research CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | | | - Jaume Capdevila
- Vall D’Hebron University HospitalVall Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | | | | | - Eva Gamper
- Medical University of InnsbruckInnsbruckAustria
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Finch AP, Gamper E, Norman R, Viney R, Holzner B, King M, Kemmler G. Estimation of an EORTC QLU-C10 Value Set for Spain Using a Discrete Choice Experiment. Pharmacoeconomics 2021; 39:1085-1098. [PMID: 34216380 PMCID: PMC8352836 DOI: 10.1007/s40273-021-01058-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND The EORTC QLU-C10D is a preference-based measure derived from the EORTC QLQ-C30. For use in economic evaluations, country-specific value sets are needed. This study aimed to generate an EORTC QLU-C10 value set for Spain. METHODS A sample of the Spanish general population completed an online discrete choice experiment. An attribute-balanced incomplete block design was used to select 960 choice tasks, with a total of 1920 health states. Each participant was randomly assigned 16 choice sets without replacement. Data were modelled using generalized estimating equations and mixed logistic regressions. RESULTS A total of 1625 panel members were invited to participate, 1010 of whom were included in the study. Dimension decrements were generally monotonic with larger disutilities at increased severity levels. Dimensions associated with larger decrements were physical functioning and pain, while the dimension with the smallest decrement was sleep disturbances. The PITS state (i.e. worst attainable health) for the Spanish population is - 0.043. CONCLUSIONS This study generated the first Spanish value set for the QLU-C10D. This can facilitate cost-utility analyses when applied to data collected with the EORTC QLQ-C30.
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Affiliation(s)
- Aureliano Paolo Finch
- Research Centre on Health and Social Care Management (CERGAS), Bocconi University, Via Sarfatti 25, S1 4DT, Milan, Italy.
- Health Values Research and Consultancy, Amsterdam, The Netherlands.
| | - Eva Gamper
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation (CHERE), UTS Business School, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Madeleine King
- School of Psychology, University of Sydney, Sydney, Australia
| | - Georg Kemmler
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
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Büttner M, Locati LD, Pinto M, Araújo C, Tomaszewska IM, Kiyota N, Vidhubala E, Brannan C, Hammerlid E, Husson O, Salem D, Ioannidis G, Gamper E, Arraras JI, Andry G, Inhestern J, Theurer J, Taylor K, Singer S. Quality of Life in Patients With Hypoparathyroidism After Treatment for Thyroid Cancer. J Clin Endocrinol Metab 2020; 105:5904489. [PMID: 32918085 DOI: 10.1210/clinem/dgaa597] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Surgical complications such as hypoparathyroidism (HPT) or vocal cord palsy are seldom assessed when the quality of life (QOL) in thyroid cancer patients is investigated. The aim of this study was to measure the QOL difference in thyroid cancer survivors with and without HPT. METHODS Participants for this analysis were enrolled in 13 countries from a study that pilot-tested a thyroid cancer-specific QOL instrument. They were included if they had been diagnosed with thyroid cancer at least 9 months previously. QOL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) and some items on HPT symptoms (eg, tingling in fingers or toes). HPT status and other clinical data were extracted from the patients' medical charts. Comparisons of QOL domains between patients with and without HPT were performed using Mann-Whitney U test. The occurrence of HPT-related symptoms was compared using chi-square tests. Multiple ordinal regression analysis was performed to evaluate factors that might affect QOL. RESULTS Eighty-nine patients participated in this study, 17 of whom were considered to have HPT. Patients in the HPT group reported significantly reduced QOL in 9 of the 15 scales of the EORTC QLQ-C30 compared to patients without HPT. Regression analysis showed that HPT was independently negatively associated with various scales of the QLQ-C30. Both groups showed a high prevalence of typical HPT symptoms. CONCLUSION Thyroid cancer patients with HPT report significantly impaired QOL compared to thyroid cancer survivors without HPT. The assessment of HPT should be considered when measuring QOL in thyroid cancer patients.
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Affiliation(s)
- Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
- University Cancer Centre, Mainz, Germany
| | - Laura D Locati
- Head & Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Cláudia Araújo
- Service of Surgical Oncology, Instituto Português do Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - E Vidhubala
- Nellai Cancer Care Center, Tirunelveli, Tamil Nadu, India
| | - Christine Brannan
- Mount Vernon Cancer Centre, East & North Herts NHS Trust, Northwood, London, UK
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olga Husson
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Dina Salem
- Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Eva Gamper
- Department of Nuclear Medicine, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Psychiatry II Medical University of Innsbruck, Innsbruck, Austria
| | | | - Guy Andry
- Surgery Department, Jules Bordet Institute, Brussels, Belgium
| | - Johanna Inhestern
- Clinic of Otorhinolaryngology, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Juliane Theurer
- Department of Surgery, University Medical Center Mainz, Mainz, Germany
| | - Katherine Taylor
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
- University Cancer Centre, Mainz, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
- University Cancer Centre, Mainz, Germany
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Oberguggenberger A, Meraner V, Sztankay M, Hilbert A, Hubalek M, Holzner B, Gamper E, Kemmler G, Baumgartner T, Lackinger I, Sperner-Unterweger B, Mangweth-Matzek B. Health Behavior and Quality of Life Outcome in Breast Cancer Survivors: Prevalence Rates and Predictors. Clin Breast Cancer 2017; 18:38-44. [PMID: 29017754 DOI: 10.1016/j.clbc.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Health behavior (HB) has been identified as contributing to breast cancer (BC) disease outcome. The present study was subjected to gain more in-depth insight into breast cancer survivors' (BCS) HB and its associations with patient quality of life (QOL) outcome. We investigated HB focusing on eating disturbances comparing the latter with a reference population sample (PS). MATERIALS AND METHODS The research cohort included 303 BCS completing a comprehensive patient-reported-outcome assessment on HB (eating disturbances, exercise, substance use) and QOL. Data from an age- and education-matched reference PS (n = 303) on eating disturbances were included. RESULTS Overall, 30% of BCS were overweight; 11.7% of BCS (2-11 years after diagnosis, mean = 5.2 years) reported eating disturbances compared with 5% of PS (P < .05). Approximately three-fourths of BCS indicated they exercise regularly, one-fourth smoke regularly, and 30% consume alcohol. Lower consumption of analgesics and tranquilizers, higher frequency of exercise, lower eating concern (EDE-Q), younger age, and lower body mass index were significant predictors for better physical QOL. Lower eating and shape concern were next to age-identified predictive for better psychological QOL. DISCUSSION Obesity and eating disturbances are a considerable HB problem in women with a history of BC. Considering that HB is predictive for long-term QOL in BCS, routine counseling on HB should be integrated into survivorship care to increase patient education and contribute to behavioral changes.
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Affiliation(s)
- Anne Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria.
| | - Verena Meraner
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Hubalek
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa Baumgartner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Isabelle Lackinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Mangweth-Matzek
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
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Oberguggenberger A, Martini C, Huber N, Fallowfield L, Hubalek M, Daniaux M, Sperner-Unterweger B, Holzner B, Sztankay M, Gamper E, Meraner V. Self-reported sexual health: Breast cancer survivors compared to women from the general population - an observational study. BMC Cancer 2017; 17:599. [PMID: 28854893 PMCID: PMC5577863 DOI: 10.1186/s12885-017-3580-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Cancer survivorship is of increasing importance in post-treatment care. Sexual health (SH) and femininity can be crucial issues for women surviving cancer. We aimed to determine a more complete understanding of the contribution that a breast cancer (BC) diagnosis and its treatment exert on patients’ follow-up SH. For this purpose, self-reported levels and predictors of SH in breast cancer survivors (BCS) were compared with those of women with no previous or current BC (WNBC). Methods BCS and WNBC underwent a comprehensive, cross-sectional patient-reported outcome (PRO) assessment. Validated PRO instruments were used to measure SH, body image, anxiety and depression and menopausal symptoms. Assessments were performed within the routine clinical setting. Instruments used were the Sexual Interest and Desire Inventory - Female, Sexual Activity Questionnaire, Body Image Scale, Hospital Anxiety and Depression Scale and the Menopause-Specific Quality of Life Questionnaire. Results One hundred five BCS (average time since diagnosis of 3 years) and 97 WNBC with a mean age of 49 years completed the assessment. SH was significantly worse in BCS compared to WNBC (p = 0.005; BCS SIDI-F mean = 24.9 vs. WNBC mean = 29.8). 68.8% of BCS and 58.8% of WNBC met criteria of a hypo-active sexual desire disorder. Higher depressive symptoms, higher age and lower partnership satisfaction were predictive for poorer SH in BCS. Conclusion SH problems are apparent in BCS and differ significantly from those seen in the general population. Consequently, BC survivorship care should include interventions to ameliorate sexual dysfunction and provide help with depressive symptoms and partnership problems, which are associated with poor BCS SH.
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Affiliation(s)
- Anne Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria.
| | - Caroline Martini
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
| | - Nathalie Huber
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
| | - Lesley Fallowfield
- Sussex Health Outcomes, Research & Education in Cancer (SHORE-C), University of Sussex, Brighton, BN1 9PX, UK
| | - Michael Hubalek
- Breast Center, County Hospital Schwaz, Swarovskistraße 1-3, 6130, Schwaz, Austria
| | - Martin Daniaux
- Department of Radiology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
| | - Eva Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
| | - Verena Meraner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, 6020, Innsbruck, Austria
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7
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Norman R, Kemmler G, Viney R, Pickard AS, Gamper E, Holzner B, Nerich V, King M. Order of Presentation of Dimensions Does Not Systematically Bias Utility Weights from a Discrete Choice Experiment. Value Health 2016; 19:1033-1038. [PMID: 27987630 DOI: 10.1016/j.jval.2016.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Discrete choice experiments (DCEs) are increasingly used to value aspects of health. An issue with their adoption is that results may be sensitive to the order in which dimensions of health are presented in the valuation task. Findings in the literature regarding order effects are discordant at present. OBJECTIVES To quantify the magnitude of order effect of quality-of-life (QOL) dimensions within the context of a DCE designed to produce country-specific value sets for the EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D), a new utility instrument derived from the widely used cancer-specific QOL questionnaire, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. METHODS The DCE comprised 960 choice sets, divided into 60 versions of 16 choice sets, with each respondent assigned to a version. Within each version, the order of QLU-C10D QOL dimensions was randomized, followed by life duration in the last position. The DCE was completed online by 2053 individuals in France and Germany. We analyzed the data with a series of conditional logit models, adjusted for repeated choices within respondent. We used F tests to assess order effects, correcting for multiple hypothesis testing. RESULTS Each F test failed to reject the null hypothesis of no position effect: 1) all QOL order positions considered jointly; 2) last QOL position only; 3) first QOL position only. Furthermore, the order coefficients were small relative to those of the QLU-C10D QOL dimension levels. CONCLUSIONS The order of presentation of QOL dimensions within a DCE designed to provide utility weights for the QLU-C10D had little effect on level coefficients of those QOL dimensions.
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Affiliation(s)
- Richard Norman
- School of Public Health, Curtin University, Bentley, Western Australia, Australia.
| | - Georg Kemmler
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Eva Gamper
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Virginie Nerich
- INSERM, Unit 1098, University of Franche-Comté, Besançon, France; Department of Pharmacy, University Hospital of Besançon, Besançon, France
| | - Madeleine King
- Psycho-Oncology Cooperative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Oberguggenberger A, Sztankay M, Morscher RJ, Sperner-Unterweger B, Weber I, Hubalek M, Kemmler G, Zschocke J, Martini C, Egle D, Dünser M, Gamper E, Meraner V. Psychosocial outcomes and counselee satisfaction following genetic counseling for hereditary breast and ovarian cancer: A patient-reported outcome study. J Psychosom Res 2016; 89:39-45. [PMID: 27663109 DOI: 10.1016/j.jpsychores.2016.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/02/2016] [Accepted: 08/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We investigated the psychosocial consequences of genetic counseling and testing (GCT) for hereditary breast and ovarian cancer (HBOC) at follow-up in a "real-life" sample of counselees at an Austrian tertiary care center. METHODS The study cohort included counselees who had undergone genetic counseling for HBOC and completed a follow-up self-report questionnaire battery on psychosocial outcomes (quality of life, psychological distress, satisfaction with counseling and decisions). For comparison of distress, we recruited a reference sample of breast cancer survivors (BCS; n=665) who had not requested GCT in the same setting. RESULTS Overall, counselees did not exhibit increased levels of anxiety and depression when compared to BCS. No specific follow-up deleterious psychosocial consequences were detected among the former group. Of the 137 counselees, 22.6% and 9.8% experienced clinically relevant levels of anxiety and depression, respectively, at an average follow-up time of 1.8years. However, both anxiety and depression significantly decreased with time and were alike between counselees with and without cancer diagnosis. Follow-up cancer worry seems to be significantly higher among counselees who had not undergone genetic testing or were undecided about it than among counselees who had been tested. CONCLUSION Our results strongly support GCT as part of routine care for patients with HBOC. The risk factors of increased distress in specific subgroups of counselees, such as recent cancer diagnosis or uncertainty about testing, warrant further exploration and specific attention in clinical routines. Particularly, the psychological needs of undecided counselees warrant ongoing attention and potential follow-ups.
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Affiliation(s)
- Anne Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Raphael Johannes Morscher
- Division of Human Genetics, Medical University of Innsbruck, Austria; Research Program for Receptor Biochemistry and Tumor Metabolism, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ingrid Weber
- Division of Human Genetics, Medical University of Innsbruck, Austria
| | - Michael Hubalek
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Zschocke
- Division of Human Genetics, Medical University of Innsbruck, Austria
| | - Caroline Martini
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martina Dünser
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Meraner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
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Hüfner K, Oberguggenberger A, Kohl C, Geisler S, Gamper E, Meraner V, Egeter J, Hubalek M, Beer B, Fuchs D, Sperner-Unterweger B. Levels in neurotransmitter precursor amino acids correlate with mental health in patients with breast cancer. Psychoneuroendocrinology 2015; 60:28-38. [PMID: 26112459 DOI: 10.1016/j.psyneuen.2015.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 12/19/2022]
Abstract
Breast cancer is the most common cancer among females. Approximately 30% of cancer patients develop depression or depressive adaptation disorder within 5 years post diagnosis. Low grade inflammation and subsequent changes in neurotransmitter levels could be the pathophysiological link. In the current study we investigated the association of neurotransmitter precursor amino acids with a diagnosis of depression or state anxiety in 154 subjects suffering from breast cancer (BCA(+)), depression (DPR(+)), both or neither. Sociodemographic parameters, severity of depressive symptoms, and state anxiety (ANX) were recorded. Neopterin, kynurenine/tryptophan and phenylalanine/tyrosine were analysed by HPLC or ELISA. Significantly higher serum neopterin values were found in DPR(+) patients (p = 0.034) and in ANX(+) subjects (p = 0.008), as a marker of Th1-related inflammation. The phenylalanine/tyrosine ratio (index of the catecholamine pathway) was associated with the factors "breast cancer" and "depression" and their interaction (all p < 0.001); it was highest in the DPR(+)BCA(+) group. The kynurenine/tryptophan ratio (index of the serotonin pathway) was significantly associated with the factors "breast cancer" and "state anxiety" and their interaction (p < 0.001, p = 0.026, p = 0.02, respectively); it was highest in the ANX(+)BCA(+) group. In BCA(+) patients kynurenine/tryptophan ratios correlated with severity of state anxiety (r = 0.226, p = 0.048, uncorrected) and phenylalanine/tyrosine ratios with severity of depressive symptoms (r = 0.376, p < 0.05, corrected). In conclusion, levels of neurotransmitter precursor amino acids correlate with mental health, an effect which was much more pronounced in BCA(+) patients than in BCA(-) subjects. Aside from identifying underlying pathophysiological mechanisms, these results could be the basis for future treatment studies: in BCA(+) patients with depression the use of serotonin-noradrenaline reuptake inhibitors might be recommended while in those with predominant anxiety selective serotonin reuptake inhibitors might be the treatment of choice.
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Affiliation(s)
- K Hüfner
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - A Oberguggenberger
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - C Kohl
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - S Geisler
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - E Gamper
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - V Meraner
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - J Egeter
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - M Hubalek
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - B Beer
- Institute of Legal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - D Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - B Sperner-Unterweger
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Duan H, Gamper E, Becherer A, Hoffmann M. Quality of life aspects in the management of thyroid cancer. Oral Oncol 2015; 51:S1-5. [PMID: 25920747 DOI: 10.1016/j.oraloncology.2015.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/10/2015] [Accepted: 03/18/2015] [Indexed: 11/26/2022]
Abstract
While there is agreement that quality of life (QoL) is a central aim of medical treatment, the methods of its evaluation as well as its role in the patient's overall treatment experience are under continuous scrutiny. Different perspectives on patients' QoL have emerged; from the treating physician, from the psychologist, and naturally from the patient him/herself. This article provides insights into each of these views within the context of thyroid cancer where, as a consequence of increasing incidence and decreasing mortality rates, QoL aspects deserve close attention. Physicians often find themselves in situations where they perform a balancing act between what they know is best from a somatic point of view and learning about what is best for the individual patient. For psychologists in the field of oncology, a main area of interest is the incorporation of the patient's perspective into research by using patient-reported outcomes (PROs) which include QoL assessment. PROs can also be used in clinical practice as a way to start a conversation about symptoms and QoL aspects that perhaps patients might not volunteer, and this allows physicians to address QoL issues more directly. Patients usually appreciate being asked about all aspects of QoL, and need sound information about how their QoL might be affected by the disease and its treatment. By examining and understanding the different perspectives on QoL, and how QoL differs in patients with thyroid cancer compared with other cancers, it is hoped that the QoL can be enhanced in this particular patient group.
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Affiliation(s)
- H Duan
- Medical University of Vienna, Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Vienna, Austria
| | - E Gamper
- Innsbruck Medical University, Univ.-Clinic for Nuclear Medicine, Univ.-Clinic for Psychiatry and Psychotherapy, Innsbruck, Austria
| | - A Becherer
- Academic Teaching Hospital Feldkirch, Dept. of Nuclear Medicine, Feldkirch, Austria
| | - M Hoffmann
- Medical University of Vienna, Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Vienna, Austria.
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Singer S, Arraras JI, Chie WC, Fisher SE, Galalae R, Hammerlid E, Nicolatou-Galitis O, Schmalz C, Verdonck-de Leeuw I, Gamper E, Keszte J, Hofmeister D. Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H&N35: a methodological review. Qual Life Res 2012. [PMID: 23188134 DOI: 10.1007/s11136-012-0325-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The EORTC QLQ-H&N35 (H&N35) is widely used to measure quality of life in head and neck cancer patients. The aims of this study were to obtain insight into a) the languages in which the H&N35 has been used and the psychometric properties in those languages, b) the study designs, and c) its acceptance by patients and investigators. METHODS A systematic literature review was performed searching for all original papers that had used at least one item of the H&N35. Identified papers were read and the information about methodological issues abstracted statistically analysed. RESULTS A total of 136 papers were identified. The H&N35 was administered in 19 different languages in 27 countries. The study design was cross-sectional in the majority of studies (53 %), prospective cohort studies (31 %), phase-II-trials (7 %), phase-III-trials (6 %) and case-control studies (1 %). The scales with the highest percentages of missing values were Sexuality (11.5 %) and Speech (7 %). The median Cronbach's alpha of the multi-item scales ranged from 0.61 (Senses) to 0.93 (Sexuality). Construct validity was rarely investigated. On average, 12 scales (range 0-18) of the instrument were used by the investigators. The scale most often used was swallowing (in 85 % of studies) and least often used was Weight Gain (39 %). CONCLUSION The H&N35 is widely used throughout the world, mainly in observational studies, and has demonstrated robust psychometric features in different languages. However, some methodological problems reported imply that the instrument can be improved in some areas.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany,
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12
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Oberguggenberger AS, Sztankay M, Beer B, Schubert B, Meraner V, Oberacher H, Kemmler G, Giesinger J, Gamper E, Sperner-Unterweger B, Marth C, Holzner B, Hubalek M. Adherence evaluation of endocrine treatment in breast cancer: methodological aspects. BMC Cancer 2012; 12:474. [PMID: 23066928 PMCID: PMC3519669 DOI: 10.1186/1471-2407-12-474] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 09/25/2012] [Indexed: 01/01/2023] Open
Abstract
Background Current studies on adherence to endocrine therapy in breast cancer patients suffer from methodological limitations due to a lack of well-validated methods for assessing adherence. There is no gold standard for measuring adherence. The aim of our study was to compare four different approaches for evaluating adherence to anastrozole therapy for breast cancer with regard to concordance between methods. Methods Outpatients with early breast cancer treated with anastrozole completed the multi-method assessment of adherence. We implemented a self-report scale (the Simplified Medication Adherence Questionnaire), physician- ratings, refill records and determination of anastrozole serum concentration. Results Comparison of the four approaches using Spearman rank correlation revealed poor concordance across all methods reflecting weak correlations of 0.2-0.4. Considering this data incomparability across methods, we still observed high adherence rates of 78%-98% across measures. Conclusion Our findings contribute to the growing body of knowledge on the impact that methodological aspects exert on the results of adherence measurement in breast cancer patients receiving endocrine treatment. Our findings suggest that the development and validation of instruments specific to patients receiving endocrine agents is imperative in order to arrive at a more accurate assessment and to subsequently obtain more precise estimates of adherence rates in this patient population.
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Affiliation(s)
- Anne S Oberguggenberger
- Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
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Abstract
BACKGROUND Since patients with thyroid cancer have a very good prognosis overall, clinicians may often assume that their quality of life is comparable to the general population. We hypothesized that quality of life of thyroid cancer patients is lower compared with the general population while controlling the effect of age and gender. METHODS At the beginning of their stay at an inpatient rehabilitation clinic, a cohort of n=121 patients with thyroid cancer were assessed using the quality of life core questionnaire of the European Organisation for Research and Treatment of Cancer (QLQ-C30). Data for comparison were derived from a representative German community sample with n=2037. RESULTS The patients reported significantly more problems than the community sample participants independent of gender and age effects in all but two domains, namely constipation and diarrhea. The strongest effects of the group (patients vs. general population) were found in the following domains: insomnia (B=-43.7, p<0.001), fatigue (B=-38.0, p=<0.001), and role functioning (B=29.7, p=<0.001). Significant interactions between age and group occurred in the social functioning, role functioning, fatigue, nausea/vomiting, and financial difficulties domains. Quality of life was unrelated to the stage of the disease, except in the physical function and global health status domains. CONCLUSIONS At the beginning of inpatient rehabilitation, patients with thyroid cancer often experience more problems than controls from community samples, independent of their age and gender. Clinicians should be aware of the fact that quality of life is not directly related to the severity of the cancer prognosis.
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Affiliation(s)
- Susanne Singer
- Department of Health Psychology and Applied Psychodiagnostics, University of Wuppertal, Wuppertal, Germany.
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16
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Beer S, Aschbacher B, Manoglou D, Gamper E, Kool J, Kesselring J. Robot-assisted gait training in multiple sclerosis: a pilot randomized trial. Mult Scler 2007; 14:231-6. [DOI: 10.1177/1352458507082358] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate feasibility and perform an explanatory analysis of the efficacy of robot-assisted gait training (RAGT) in MS patients with severe walking disabilities (Expanded Disability Status Scale [EDSS] 6.0—7.5) in a pilot trial. Methods Prospective, randomized, controlled clinical trial comparing RAGT with conventional walking training (CWT) in a group of stable MS patients ( n = 35) during an inpatient rehabilitation stay, 15 sessions over three weeks. All patients participated additionally in a multimodal rehabilitation program. The primary outcome measure was walking velocity and secondary measures were 6-minwalking distance, stride length and knee-extensor strength. All tests were performed by an external blinded assessor at baseline after three weeks and at follow-up after six months. Additionally, Extended Barthel Index (EBI) at entry and discharge was assessed (not blinded), and acceptance/convenience of RAGT rated by patients (Visual Analogue Scale [VAS]) was recorded. Results Nineteen patients were randomly allocated to RAGT and 16 patients to CWT. Groups were comparable at baseline. There were 5 drop-outs (2 related directly to treatment) in the RAGT group and 1 in the CWT group, leaving 14 RAGT patients and 15 CWT patients for final analysis. Acceptance and convenience of RAGT as rated by patients were high. Effect sizes were moderate to large, although not significant, for walking velocity (0.700, 95% CI -0.089 to 1.489), walking distance (0.401, 95% CI - 0.370 to 1.172) and knee-extensor strength (right: 1.105, 95% CI 0.278 to 1.932, left 0.650, 95% CI -0.135 to 1.436) favouring RAGT. Prepost within-group analysis revealed an increase of walking velocity, walking distance and knee-extensor strength in the RAGT group, whereas in CWT group only walking velocity was improved. In both groups outcome values returned to baseline at follow-up after six months ( n = 23). Conclusions Robot-assisted gait training is feasible and may be an effective therapeutic option in MS patients with severe walking disabilities. Effect size calculation and prepost analysis suggest a higher benefit on walking velocity and knee-extensor strength by RAGT compared to CWT. Due to several limitations, however, our results should be regarded as preliminary. Post hoc power calculation showed that two groups of 106 patients are needed to demonstrate a significant moderate effect size of 0.4 after three weeks of RAGT. Thus, further studies with a larger number of patients are needed to investigate the impact of this new treatment option in MS patients. Multiple Sclerosis 2008; 14: 231—236. http://msj.sagepub.com
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Affiliation(s)
- S. Beer
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317 Valens, Switzerland,
| | - B. Aschbacher
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317 Valens, Switzerland
| | - D. Manoglou
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317 Valens, Switzerland
| | - E. Gamper
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317 Valens, Switzerland
| | - J. Kool
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317 Valens, Switzerland
| | - J. Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317 Valens, Switzerland
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Fischer S, Bitter M, Caraccia M, Dülk M, Gamper E, Vogt W, Gini E, Melchior H, Hunziker W. All-optical sampling with a monolithically integrated Mach-Zehnder interferometer gate. Opt Lett 2001; 26:626-628. [PMID: 18040404 DOI: 10.1364/ol.26.000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
An all-optical sampler consisting of a polarization-independent monolithic Mach-Zehnder interferometer with integrated semiconductor optical amplifiers and a temporal resolution of 1 ps is presented. As an example, a simple 320-Gbit/s pattern has been successfully sampled, demonstrating the functionality of this scheme for high-bit-rate waveform characterizations in light-wave systems.
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Wiese S, Gamper E, Winkelmann H, Büchner B, Abd-Elmeguid M, Micklitz H, Takabatake T. Enhanced 119Sn Mössbauer quadrupole interactions below the magnetic phase transition of UPt2Sn. Physica B: Condensed Matter 1997; 230-232:95-97. [DOI: 10.1016/s0921-4526(96)00557-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Schnelle W, Büchner B, Gamper E, Stein M, Fernández-Díaz MT, Odier P. Thermal properties at the low-temperature structural and magnetic phase transitions in Pr2NiO4 crystals. Phys Rev B Condens Matter 1996; 54:9970-9976. [PMID: 9984733 DOI: 10.1103/physrevb.54.9970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Winkelmann H, Gamper E, Büchner B, Braden M, Revcolevschi A, Dhalenne G. Giant anomalies of the thermal expansion at the spin-Peierls transition in CuGeO3. Phys Rev B Condens Matter 1995; 51:12884-12887. [PMID: 9978080 DOI: 10.1103/physrevb.51.12884] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Abstract
Rennet whey protein concentrates have excellent nutritional properties, but their use in fluid food systems is impaired by the poor heat stability of the protein. Heating whey protein concentrated solutions at neutral pH caused up to 70% losses in solubility. In the absence of added calcium, protein coagulation occurred. near the iso-electric zone whereas in the presence of .03 M calcium chloride, similar protein coagulation occurred in the whole pH range (pH 2 to pH 12). Tryptic hydrolysis of the protein increased the heat stability of whey protein concentrates considerably.
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Jäger, Gamper E, Lauche, Mertens VE. Metastasen. J Cancer Res Clin Oncol 1929. [DOI: 10.1007/bf01619159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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