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Lehmann J, Pilz MJ, Holzner B, Kemmler G, Giesinger JM. General population normative data from seven European countries for the K10 and K6 scales for psychological distress. Sci Rep 2023; 13:18389. [PMID: 37884547 PMCID: PMC10603032 DOI: 10.1038/s41598-023-45124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
The 10-item Kessler Psychological Distress scale (K10) and its 6-item short-form version (K6) measure psychological distress, particularly anxiety or depressive symptoms. While these questionnaire scales are widely used in various settings and populations, general population normative data are rarely available. To facilitate the interpretation of K10 and K6 scores, we provide normative general population data from seven European countries. We used an online survey to collect K10 data from general population samples in Austria, Italy, Germany, France, the Netherlands, Poland and Spain. We calculated the age- and sex-specific normative values separately for each country. For more specific estimates of K10 and K6 scores for individuals or groups, we also established a multivariable regression model based on socio-demographic and health data. In total, N = 7,087 adults participated in our study (51.6% women; mean age, 49.6 years). The mean K10 score in the total sample was 8.5 points (standard deviation, 7.3) on 0-40 points metric, with mean scores in individual countries ranging from 6.9 (the Netherlands) to 9.9 (Spain). Women showed higher scores than men and younger participants scored higher than older participants. Our study is the first to present normative K10 and K6 data from several European countries using a consistent sampling approach. These reference values will facilitate the interpretation of K10 and K6 scores in clinical research and practice and also highlight the variation in psychological distress levels across countries and groups according to their socio-demographic and health characteristics.
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Affiliation(s)
- J Lehmann
- Health Outcomes Research Unit, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 43, 6020, Innsbruck, Austria
| | - M J Pilz
- Health Outcomes Research Unit, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 43, 6020, Innsbruck, Austria
| | - B Holzner
- University Hospital of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - G Kemmler
- University Hospital of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - J M Giesinger
- Health Outcomes Research Unit, University Hospital of Psychiatry II, Medical University of Innsbruck, Innrain 43, 6020, Innsbruck, Austria.
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Schurr T, Loth F, Lidington E, Piccinin C, Arraras JI, Groenvold M, Holzner B, van Leeuwen M, Petersen MA, Schmidt H, Young T, Giesinger JM. Patient-reported outcome measures for physical function in cancer patients: content comparison of the EORTC CAT Core, EORTC QLQ-C30, SF-36, FACT-G, and PROMIS measures using the International Classification of Functioning, Disability and Health. BMC Med Res Methodol 2023; 23:21. [PMID: 36681808 PMCID: PMC9862545 DOI: 10.1186/s12874-022-01826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patient-reported physical function (PF) is a key endpoint in cancer clinical trials. Using complex statistical methods, common metrics have been developed to compare scores from different patient-reported outcome (PRO) measures, but such methods do not account for possible differences in questionnaire content. Therefore, the aim of our study was a content comparison of frequently used PRO measures for PF in cancer patients. METHODS Relying on the framework of the International Classification of Functioning, Disability and Health (ICF) we categorized the item content of the physical domains of the following measures: EORTC CAT Core, EORTC QLQ-C30, SF-36, PROMIS Cancer Item Bank for Physical Function, PROMIS Short Form for Physical Function 20a, and the FACT-G. Item content was linked to ICF categories by two independent reviewers. RESULTS The 118 items investigated were assigned to 3 components ('d - Activities and Participation', 'b - Body Functions', and 'e - Environmental Factors') and 11 first-level ICF categories. All PF items of the EORTC measures but one were assigned to the first-level ICF categories 'd4 - Mobility' and 'd5 - Self-care', all within the component 'd - Activities and Participation'. The SF-36 additionally included item content related to 'd9 - Community, social and civic life' and the PROMIS Short Form for Physical Function 20a also included content related to 'd6 - domestic life'. The PROMIS Cancer Item Bank (v1.1) covered, in addition, two first-level categories within the component 'b - Body Functions'. The FACT-G Physical Well-being scale was found to be the most diverse scale with item content partly not covered by the ICF framework. DISCUSSION Our results provide information about conceptual differences between common PRO measures for the assessment of PF in cancer patients. Our results complement quantitative information on psychometric characteristics of these measures and provide a better understanding of the possibilities of establishing common metrics.
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Affiliation(s)
- T Schurr
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Hospital of Psychiatry I, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria
| | - F Loth
- Professorship for Psychological Diagnostics and Intervention Psychology, Faculty of Philosophy and Education, Catholic University of Eichstätt-Ingolstadt, Ostenstraße 25, 85072 Eichstätt, Germany
| | - E Lidington
- Cancer Behavioural Science Unit, King’s College London, Guy’s Hospital, St Thomas Street, London, SE1 9RT UK
| | - C Piccinin
- Quality of Life Department, EORTC, Avenue E. Mounier, 83/11, 1200 Brussels, Belgium
| | - JI Arraras
- Medical Oncology Department, Hospital Universitario de Navarra, C/Irunlarrea 3, S31008 Pamplona, Spain
| | - M Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - B Holzner
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria
| | - M van Leeuwen
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - MA Petersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H Schmidt
- University Clinic and Outpatient Clinic for Radiotherapy and Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - T Young
- Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Rickmansworth Rd, GB- HA6 2RN Halle (Saale), UK
| | - JM Giesinger
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria
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Brunner C, Egle D, Ritter M, Kofler R, Pichler B, Sztankay M, Schneitter L, Giesinger J, Abdel Azim S, Oberguggenberger A. PRO Hair Safe Study: The patient’s perspective on the effects of scalp cooling on hair preservation. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01512-x] [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: 11/19/2022]
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Giesinger K, Giesinger JM, Hamilton DF, Rechsteiner J, Ladurner A. Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:635. [PMID: 34303341 PMCID: PMC8310599 DOI: 10.1186/s12891-021-04512-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/02/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). METHODS A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. RESULTS Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0-29.9 kg/m2, 27.0% BMI 30.0-34.9 kg/m2, 10.2% BMI 35.0-39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. CONCLUSIONS Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020-00,879).
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Affiliation(s)
- K Giesinger
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - J M Giesinger
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - D F Hamilton
- School of Health and Social Care, Edinburgh Napier Univ, ersity, Edinburgh, Scotland
| | - J Rechsteiner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - A Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
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Liebensteiner MC, Henninger B, Kittl C, Attal R, Giesinger JM, Kranewitter C. The anterolateral ligament and the deep structures of the iliotibial tract: MRI visibility in the paediatric patient. Injury 2019; 50:602-606. [PMID: 30391071 DOI: 10.1016/j.injury.2018.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/28/2018] [Revised: 09/24/2018] [Accepted: 10/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the visibility of both the anterolateral ligament (ALL) and the deep structures of the iliotibial tract (ITT) by means of MRI in paediatric patients. To determine reproducibility for such measurements. METHODS Knee MRI data from patients aged <18a without lesions of the capsule or ligaments, fractures, bone edemas, foreign material or motion artifacts were analyzed by two musculoskeletal radiologists separately and twice. The visibility of the different parts of the ALL was determined (femoral, meniscal, tibial parts). Similarly, the visibility of the different parts of the deep ITT was determined: deep attachments of the ITT to the distal femur (insertion near septum, supracondylar insertion and retrograde insertion) and capsulo-osseous layer of the ITT. RESULTS We studied 61 cases (36 female, 25 male). Age was 15 years (±2.3). Interobserver agreement was high. Cohen's Kappa was 0.864 (95%CI: 0.715-1.000) for the tibial part of the ALL and 1.0 for the femoral part of the ALL. For the deep attachments of the ITT to the distal femur Kappa was 0.828 (95%CI: 0.685-0.971). Regarding intraobserver agreement, Cohen's Kappa was 1.0 for the femoral part of the ALL and 0.955 (95%CI: 0.867-1.000) for the tibial part of the ALL. For the deep attachments of the ITT to the distal femur Cohen's Kappa was 0.896 (95%CI: 0.782-1.000). CONCLUSION On the basis of our findings it is concluded that the presence of the anterolateral structures of the knee can be determined by MRI in a pediatric population with substantial inter- and intraobserver agreement. This is true for both the ALL and the deep structures of the ITT. LEVEL OF EVIDENCE Diagnostic study - Level 3.
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Affiliation(s)
- M C Liebensteiner
- Dept. of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - B Henninger
- Dept. of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Kittl
- Dept. of Trauma, Hand and Reconstructive Surgery, Muenster University Hospital, Muenster, Germany
| | - R Attal
- Dept. of Trauma Surgery, Feldkirch Hospital, Feldkirch, Austria
| | - J M Giesinger
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - C Kranewitter
- Dept. of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Giesinger JM, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson AHRW, Howie CR, Hamilton DF. Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients' body mass index. Knee Surg Sports Traumatol Arthrosc 2018; 26:3257-3264. [PMID: 29417168 PMCID: PMC6208940 DOI: 10.1007/s00167-018-4853-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 05/12/2017] [Accepted: 01/29/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE This study investigated the impact of body mass index (BMI) on improvement in patient outcomes (pain, function, joint awareness, general health and satisfaction) following total knee arthroplasty (TKA). METHODS Data were obtained for primary TKAs performed at a single centre over a 12-month period. Data were collected pre-operatively and 12-month postoperatively with the Oxford Knee Score (OKS) measuring pain and function, the EQ-5D-3L measuring general health status, the Forgotten Joint Score-12 (FJS-12) measuring joint awareness and a single question on treatment satisfaction. Change in scores following surgery was compared across the BMI categories identified by the World Health Organization (< 25.0, 25.0-29.9, 30.0-34.9, 35.0-39.9 and ≥ 40.0). Differences in postoperative improvement between the BMI groups were analysed with an overall Kruskal-Wallis test, with post hoc pairwise comparisons between BMI groups with Mann-Whitney tests. RESULTS Of 402 patients [mean age 70.7 (SD 9.2); 55.2% women] 15.7% were normal weight (BMI < 25.0), 33.1% were overweight (BMI 25.0-29.9), 28.2% had class I obesity (BMI 30.0-34.9), 16.2% had class II obesity (BMI 35.0-39.9), and 7.0% had class III obesity (BMI ≥ 40.0). Postoperative change in OKS (n.s.) and EQ-5D-3L (n.s.) was not associated with BMI. Higher BMI group was associated with less improvement in FJS-12 scores (p = 0.010), reflecting a greater awareness of the operated joint during activity in the most obese patients. Treatment satisfaction was associated with BMI category (p = 0.029), with obese patients reporting less satisfaction. CONCLUSIONS In TKA patients, outcome parameters are influenced differently by BMI. Our study showed a negative impact of BMI on postoperative improvement in joint awareness and satisfaction scores, but there was no influence on pain, function or general health scores. This information may be useful in terms of setting expectations expectation in obese patients planning to undergo TKA. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- J M Giesinger
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - F L Loth
- University of Innsbruck, Innsbruck, Austria
| | - D J MacDonald
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - K Giesinger
- Department of Orthopaedics, Kantonsspital, St. Gallen, St Gallen, Switzerland
| | - J T Patton
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - A H R W Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - C R Howie
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - David F Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Biedermann R, Riccabona J, Giesinger JM, Brunner A, Liebensteiner M, Wansch J, Dammerer D, Nogler M. Results of universal ultrasound screening for developmental dysplasia of the hip: a prospective follow-up of 28 092 consecutive infants. Bone Joint J 2018; 100-B:1399-1404. [PMID: 30295526 DOI: 10.1302/0301-620x.100b10.bjj-2017-1539.r2] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to analyze the incidence of the different ultrasound phenotypes of developmental dysplasia of the hip (DDH), and to determine their subsequent course. PATIENTS AND METHODS A consecutive series of 28 092 neonates was screened and classified according to the Graf method as part of a nationwide surveillance programme, and then followed prospectively. Abnormal hips were followed until they became normal (Graf type I). Type IIb hips and higher grades were treated by abduction in a Tübinger orthosis until normal. Dislocated hips underwent closed or open reduction. RESULTS Overall, 90.2% of hips were normal at birth. Type IIa hips (8.9%) became normal at a median of six weeks (interquartile range (IQR) 6 to 9). Type IIc and IId hips (0.67%) became normal after ten weeks (IQR 7 to 13). There were 19 type lll and eight type lV hips at baseline. There were 24 closed reductions and one open reduction. No late presentations of DDH were detected within the first five years of life. CONCLUSION The incidence of DDH was eight per 1000 live births. The treatment rate was 1% (n = 273). The rate of first operations on the newborn hip was 0.86, and rate of open surgery was 0.04. The cumulative rate of open surgery was 0.07. The authors take the view that early identification and treatment in abduction of all dysplastic hips in early childhood reduces the rate of open reduction and secondary DDH-related surgery later in life. Cite this article: Bone Joint J 2018;100-B:1399-1404.
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Affiliation(s)
- R Biedermann
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - J Riccabona
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - J M Giesinger
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - A Brunner
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - M Liebensteiner
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - J Wansch
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - D Dammerer
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - M Nogler
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
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Loth FL, Liebensteiner MC, Giesinger JM, Giesinger K, Bliem HR, Holzner B. What makes patients aware of their artificial knee joint? BMC Musculoskelet Disord 2018; 19:5. [PMID: 29310652 PMCID: PMC5759839 DOI: 10.1186/s12891-017-1923-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Joint awareness was recently introduced as a new concept for outcome assessment after total knee arthroplasty (TKA). Findings from qualitative and psychometric studies suggest that joint awareness is a distinct concept especially relevant to patients with good surgical outcome and patients at late follow-up time points. The aim of this study was to improve the understanding of the concept of joint awareness by identifying situations in which patients are aware of their artificial knee joint and to investigate what bodily sensations and psychological factors raise a patient’s awareness of her/his knee. In addition, we evaluated the relative importance of patient-reported outcome parameters that are commonly assessed in orthopaedics. Methods Qualitative interviews were conducted with patients being at least 12 months after TKA. The interviews focused on when, where and for what reasons patients were aware of their artificial knee joint. To evaluate the relative importance of ‘joint awareness’ after TKA among nine commonly assessed outcome parameters (e.g. pain or stiffness), we collected importance ratings (‘0’ indicating no importance at all and ‘10’ indicating high importance). Results We conducted interviews with 40 TKA patients (mean age 69.0 years; 65.0% female). Joint awareness was found to be frequently triggered by kneeling on the floor (30%), climbing stairs (25%), and starting up after resting (25%). Patients reported joint awareness to be related to activities of daily living (68%), specific movements (60%), or meteoropathy (18%). Sensations causing joint awareness included pain (45%) or stiffness (15%). Psychological factors raising a patient’s awareness of his/her knee comprised for example feelings of insecurity (15%), and fears related to revision surgeries, inflammations or recurring pain (8%). Patients’ importance ratings of outcome parameters were generally high and did not allow differentiating clearly among them. Conclusions We have identified a wide range of situations, activities, movements and psychological factors contributing to patients’ awareness of their artificial knee joints. This improves the understanding of the concept of joint awareness and of a patient’s perception of his/her artificial knee joint. The diversity of sensations and factors raising patient’s awareness of their joint encourages taking a broader perspective on outcome after TKA.
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Affiliation(s)
- F L Loth
- Institute of Psychology, University of Innsbruck, A-6020, Innsbruck, Austria
| | - M C Liebensteiner
- Department for Orthopaedic Surgery, Medical University Innsbruck, A-6020, Innsbruck, Austria
| | - J M Giesinger
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), A-6020, Innsbruck, Austria
| | - K Giesinger
- Department of Orthopaedics and Traumatology, Kantonspital St. Gallen, CH-9007, St. Gallen, Switzerland
| | - H R Bliem
- Institute of Psychology, University of Innsbruck, A-6020, Innsbruck, Austria
| | - B Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
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Affiliation(s)
- D F Hamilton
- University of Edinburgh, Orthopeadics, FU413 Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - J M Giesinger
- Innsbruck Institute of Patient Centered Outcome Research, 6020 Innsbruck, Austria
| | - K Giesinger
- Department of Orthopaedic Surgery and Traumatology, Senior Consultant Knee Surgeon, Kantonsspital St Gallen, St Gallen, Switzerland
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Loth FL, Holzner B, Sztankay M, Bliem HR, Raoufi S, Rumpold G, Giesinger JM. Cancer patients' understanding of longitudinal EORTC QLQ-C30 scores presented as bar charts. Patient Educ Couns 2016; 99:2012-2017. [PMID: 27506581 DOI: 10.1016/j.pec.2016.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/16/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate cancer patients' understanding of graphical presentations of longitudinal EORTC QLQ-C30 scores. METHODS We conducted semi-structured interviews with brain tumour patients participating in routine patient-reported outcome (PRO) monitoring. We assessed understanding of longitudinal quality of life (QOL) profiles, presented as bar charts objectively and with self-ratings. In addition, patients' opinions on congruency of the QOL scores with their self-perceived health status were evaluated. RESULTS We recruited 40 brain tumour patients (57.5% female; mean age 52.7, SD 13.7). In total, 90% of patients rated the graphs as easy to understand. Accordingly, almost all questions on assessing understanding objectively were answered correctly by at least 80% of the patients. More than 95% indicated that the displayed QOL scores matched their personal perception of symptom burden and functional health in the observed period. CONCLUSION Patients are able to understand their QOL results when presented graphically and are able to interpret important changes. Displayed QOL scores obtained with the EORTC QLQ-C30 are consistent with the patients' personal perception of physical and emotional functioning, pain and fatigue. PRACTICE IMPLICATIONS Knowledge about patients' understanding of graphically displayed QOL results contributes to creation of optimal evidence-based feedback on the patients' present QOL and its trajectory.
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Affiliation(s)
- F L Loth
- Medical University of Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck, Austria; Leopold-Franzens-University of Innsbruck, Institute of Psychology, Innsbruck,Austria.
| | - B Holzner
- Medical University of Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck, Austria.
| | - M Sztankay
- Medical University of Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck, Austria; Leopold-Franzens-University of Innsbruck, Institute of Psychology, Innsbruck,Austria.
| | - H R Bliem
- Leopold-Franzens-University of Innsbruck, Institute of Psychology, Innsbruck,Austria.
| | - S Raoufi
- Institute of Psychology, Leopold-Franzens-University of Innsbruck, Institute of Psychology, Innsbruck, Austria.
| | - G Rumpold
- Medical University of Innsbruck, Department of Medical Psychology, Innsbruck, Austria.
| | - J M Giesinger
- Medical University of Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Innsbruck, Austria.
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Hamilton DF, Giesinger JM, MacDonald DJ, Simpson AHRW, Howie CR, Giesinger K. Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty. Bone Joint Res 2016; 5:87-91. [PMID: 26965167 PMCID: PMC4852794 DOI: 10.1302/2046-3758.53.2000480] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To assess the responsiveness and ceiling/floor effects of the Forgotten Joint Score -12 and to compare these with that of the more widely used Oxford Hip Score (OHS) in patients six and 12 months after primary total hip arthroplasty. METHODS We prospectively collected data at six and 12 months following total hip arthroplasty from 193 patients undergoing surgery at a single centre. Ceiling effects are outlined with frequencies for patients obtaining the lowest or highest possible score. Change over time from six months to 12 months post-surgery is reported as effect size (Cohen's d). RESULTS The mean OHS improved from 40.3 (sd 7.9) at six months to 41.9 (sd 7.2) at 12 months. The mean FJS-12 improved from 56.8 (sd 30.1) at six months to 62.1 (sd 29.0) at 12 months. At six months, 15.5% of patients reached the best possible score (48 points) on the OHS and 8.3% obtained the best score (100 points) on the FJS-12. At 12 months, this percentage increased to 20.8% for the OHS and to 10.4% for the FJS-12. In terms of the effect size (Cohen's d), the change was d = 0.10 for the OHS and d = 0.17 for the FJS-12. CONCLUSIONS The FJS-12 is more responsive to change between six and 12 months following total hip arthroplasty than is the OHS, with the measured ceiling effect for the OHS twice that of the FJS-12. The difference in effect size of change results in substantial differences in required sample size if aiming to detect change between these two time points. This has important implications for powering clinical trials with patient-reported measures as the primary outcome.Cite this article: Dr D. F. Hamilton. Responsiveness and ceiling effects of the Forgotten Joint Score-12 following total hip arthroplasty. Bone Joint Res 2016;5:87-91. DOI: 10.1302/2046-3758.53.2000480.
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Affiliation(s)
- D F Hamilton
- Department of Orthopaedics, University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK.
| | - J M Giesinger
- Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - D J MacDonald
- Department of Orthopaedics, University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - A H R W Simpson
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - C R Howie
- Department of Orthopaedics, University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - K Giesinger
- Department of Orthopaedics, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
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Wintner LM, Giesinger JM, Zabernigg A, Rumpold G, Sztankay M, Oberguggenberger AS, Gamper EM, Holzner B. Evaluation of electronic patient-reported outcome assessment with cancer patients in the hospital and at home. BMC Med Inform Decis Mak 2015; 15:110. [PMID: 26699708 PMCID: PMC4690412 DOI: 10.1186/s12911-015-0230-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 06/23/2015] [Accepted: 12/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PRO) provide a more comprehensive picture of patients' quality of life than do mere physicians' ratings. Electronic data collection of PRO offers several advantages and allows assessments at patients' homes as well. This study reports on patients' personal internet use, their attitudes towards electronic and web-based PRO assessment (clinic-ePRO and home-ePRO) and the feasibility of these two assessment modes. METHODS At the Medical University of Innsbruck and Kufstein County Hospital, cancer patients who participated in clinic-ePRO/home-ePRO were asked to complete a comprehensive evaluation form on their personal internet usage, attitudes towards and the feasibility of routine clinic-ePRO/home-ePRO with the Computer-based Health Evaluation System (CHES) software. RESULTS In total, 113 patients completed the evaluation form for clinic-ePRO (Ø 45 years, SD 14) and 45 patients for home-ePRO (Ø 58 years, SD 10; 33.1 per cent inclusion rate for this sample). Most patients expressed willingness to complete routine clinic-ePRO assessments in the future (94.7 per cent of clinic-ePRO patients and 84.4 per cent of home-ePRO patients) and to discuss their data with attending physicians (82.2 per cent, home-ePRO patients only). Overall, patients preferred the software over paper-pencil questionnaires (67.2 per cent of clinic-ePRO patients and 60 per cent of home-ePRO patients) and experienced it as easy to use. Only a few minor suggestions for improvement were made (e.g. adjustable font sizes). CONCLUSIONS The use of clinic-ePRO/home-ePRO was in general shown to be feasible and well accepted. However, to be more inclusive in the implementation of clinic-ePRO/home-ePRO, educational programs concerning their particular benefit in oncology practice potentially could enhance patients' attitudes towards, and consequently their acceptance of and compliance with electronic PRO assessments.
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Affiliation(s)
- L M Wintner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr.35, Innsbruck, 6020, Austria. .,Leopold-Franzens-University of Innsbruck, Innrain 52, Innsbruck, 6020, Austria.
| | - J M Giesinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr.35, Innsbruck, 6020, Austria
| | - A Zabernigg
- Department of Internal Medicine Kufstein County Hospital, Endach 27, Kufstein, 6330, Austria
| | - G Rumpold
- Department of Medical Psychology, Medical University of Innsbruck, Schöpfstraße 23a, Innsbruck, 6020, Austria
| | - M Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr.35, Innsbruck, 6020, Austria.,Leopold-Franzens-University of Innsbruck, Innrain 52, Innsbruck, 6020, Austria
| | - A S Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr.35, Innsbruck, 6020, Austria
| | - E M Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr.35, Innsbruck, 6020, Austria
| | - B Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr.35, Innsbruck, 6020, Austria
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13
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Hamilton DF, Giesinger JM, Patton JT, MacDonald DJ, Simpson AHRW, Howie CR, Giesinger K. Making the Oxford Hip and Knee Scores meaningful at the patient level through normative scoring and registry data. Bone Joint Res 2015; 4:137-44. [PMID: 26311163 PMCID: PMC4561372 DOI: 10.1302/2046-3758.48.2000524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objectives The Oxford Hip and Knee Scores (OHS, OKS) have been demonstrated
to vary according to age and gender, making it difficult to compare
results in cohorts with different demographics. The aim of this
paper was to calculate reference values for different patient groups
and highlight the concept of normative reference data to contextualise an
individual’s outcome. Methods We accessed prospectively collected OHS and OKS data for patients
undergoing lower limb joint arthroplasty at a single orthopaedic
teaching hospital during a five-year period.
T-scores were calculated based on the OHS and OKS distributions. Results Data were obtained from 3203 total hip arthroplasty (THA) patients
and 2742 total knee arthroplasty (TKA) patients. The mean age of
the patient was 68.0 years (sd 11.3, 58.4% women) in the
THA group and in 70.2 (sd 9.4; 57.5% women) in the TKA
group. T-scores were calculated for age and gender subgroups by
operation. Different T-score thresholds are seen at different time
points pre and post surgery. Values are further stratified by operation (THA/TKA)
age and gender. Conclusions Normative data interpretation requires a fundamental shift in
the thinking as to the use of the Oxford Scores. Instead of reporting
actual score points, the patient is rated by their relative position
within the group of all patients undergoing the same procedure.
It is proposed that this form of transformation is beneficial (a)
for more appropriately comparing different patient cohorts and (b)
informing an individual patient how they are progressing compared
with others of their age and gender. Cite this article: Bone Joint Res 2015;4:137–144
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Affiliation(s)
- D F Hamilton
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - J M Giesinger
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - J T Patton
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - D J MacDonald
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - A H R W Simpson
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - C R Howie
- University of Edinburgh, FU413, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH164SB, UK
| | - K Giesinger
- Kantonsspital St. Gallen, Rorschacherstrasse 95, CH- 9000 St. Gallen, Switzerland
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Zabernigg A, Holzner B, Giesinger J, Wintner L, Gamper EM, Huber C. Korrelation zwischen Komorbiditäten und Lebensqualität bei Patient(Inn)en mit Bronchialkarzinom unter Chemotherapie. Pneumologie 2015. [DOI: 10.1055/s-0035-1551920] [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: 10/23/2022]
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15
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Malik P, Gasser RW, Moncayo RC, Kandler C, Koudouovoh-Tripp P, Giesinger J, Sperner-Unterweger B. Bone mineral density and bone metabolism in patients with major depressive disorder without somatic comorbidities. Prog Neuropsychopharmacol Biol Psychiatry 2013; 44:58-63. [PMID: 23380173 DOI: 10.1016/j.pnpbp.2013.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/25/2013] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been linked with accelerated bone loss leading to the development of low bone mineral density (BMD). Several mechanisms have been discussed as causative factors, e.g. lifestyle, selective serotonin reuptake inhibitor (SSRI) intake, or the influence of proinflammatory cytokines. METHODS In a cross-sectional study of in-patients with a current episode of MDD, without somatic comorbidities, we determined various parameters of bone metabolism, inflammatory parameters and parameters of depression. BMD was measured by dual x-ray absorptiometry. RESULTS Of 50 patients, only one had low BMD in any of the measure sites. Body mass index (BMI) correlated positively with Z-scores. 83.3% of the examined patients had elevated osteoprotegerin (OPG) levels. SSRI intake did not have an effect on BMD. BMD in the femoral neck was significantly lower in smokers. We also found a positive correlation between the level of physical activity and osteocalcin levels. CONCLUSIONS In our sample, young to middle-aged, somatically healthy, and acutely depressed patients with a history of MDD showed no reduction of BMD. This could be due to compensatory mechanisms, as suggested by elevated OPG levels. Physical activity and high BMI could also have served as protective factors. Still, as patients with MDD often suffer from comorbidities or take medication with a negative effect on bone, this population should be appreciated as a high-risk group for the development of osteopenia and osteoporosis.
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Affiliation(s)
- P Malik
- Department of Biological Psychiatry, Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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16
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Wintner L, Zabernigg A, Pall G, Giesinger J, Sztankay M, Hilbe W, Holzner B. Stabile Lebensqualität während Chemotherapie bei Lungenkrebs-PatientInnen. Pneumologie 2013. [DOI: 10.1055/s-0033-1345080] [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: 10/26/2022]
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17
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Strobl EM, Oberguggenberger A, Meraner V, Beer B, Giesinger J, Kemmler G, Oberacher H, Sperner-Unterweger B, Holzner B, Marth C, Hubalek M. Hat der CYP 2D6 Genotyp Einfluss auf Nebenwirkungen und Adherence? Prämenopausale Brustkrebs-Patientinnen unter Tamoxifen-Therapie. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1336791] [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: 10/27/2022] Open
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18
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Berger A, Oberguggenberger A, Sztankay M, Meraner V, Beer B, Oberacher H, Giesinger J, Kemmler G, Egle D, Gamper EM, Sperner-Unterweger B, Holzner B, Marth C, Hubalek M. Wird die Toxizität einer adjuvanten Therapie mit Aromataseinhibitoren unterschätzt? Zusätzliche Informationen durch Patientinnen Feedback Fragebögen. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1336792] [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: 10/27/2022] Open
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19
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Ritter M, Egle D, Oberguggenberger A, Nehoda R, Sztankay M, Meraner V, Giesinger J, Sperner-Unterweger B, Holzner B, Beer B, Oberacher H, Marth C, Hubalek M. Profitieren adipöse Frauen weniger von der adjuvanten endokrinen Therapie mit Aromataseinhibitoren? Der Zusammenhang von BMI und den Plasmaspiegeln von Aromataseinibitoren, dargestellt in einer umfangreichen Studie. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1336793] [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: 10/27/2022] Open
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20
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Mayrbäurl B, Wintner LM, Giesinger JM, Himmelfreundpointner T, Burgstaller S, Holzner B, Thaler J. Chemotherapy line-associated differences in quality of life in patients with advanced cancer. Support Care Cancer 2011; 20:2399-405. [PMID: 22205549 DOI: 10.1007/s00520-011-1355-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/12/2011] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to investigate quality of life (QOL) differences between patients receiving first, second, or third-line palliative chemotherapy (CT).Furthermore, QOL was also compared to a sex- and age-matched sample of healthy controls. METHODS Patients with different metastatic cancers receiving palliative CT were approached to complete the EORTC QLQ-C30 questionnaire by means of touch-screen computers before the start of CT, after 3 cycles and at the end of cytostatic treatment. RESULTS One hundred four patients were recruited for QOL assessment (56.9% of patients in first, 22.5% second and 20.6% third- or above-line palliative CT). Compared to healthy controls, they suffered from substantial QOL impairments in all EORTC QLQ-C30 sub-domains. In regard to CT lines, patients with first-line CT reached better scores in emotional and social functioning than second-line patients and less financial difficulties than third-line patients. Despite the high level of impairment in the patient sample, electronic data collection proved to be feasible and well accepted. CONCLUSIONS The results indicate that patients receiving third- or above-line palliative CT are confronted with stronger QOL impairments than first- and second-line patients. Supported by its feasibility and acceptance of by patients, electronic QOL data capture is an attractive method to screen for symptoms and track their course within clinical routine.
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Affiliation(s)
- B Mayrbäurl
- Department of Internal Medicine IV, Clinical Centre Wels-Grieskirchen, Wels, Austria.
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21
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Singer S, Kuhnt S, Zwerenz R, Eckert K, Hofmeister D, Dietz A, Giesinger J, Hauss J, Papsdorf K, Briest S, Brown A. Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients. Br J Cancer 2011. [PMID: 21750551 DOI: 10.1038/bjc.2011.251; 10.1038/bjc.2011.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this longitudinal study was to determine age- and sex-standardised prevalence rates of cancer-related fatigue in different groups of patients. METHODS This was a prospective study in a cohort of N=1494 cancer patients investigating fatigue at three time points t1-t3 (t1: admission to hospital, t2: discharge, t3: half a year after t1). Fatigue was measured with the Multidimensional Fatigue Inventory. Age- and sex-adjusted norms were derived from a representative community sample of N=2037, using a cutoff at the 75th percentile. RESULTS At admission to the hospital, 32% of the patients were classified as fatigued. At discharge, the overall prevalence rate was 40%, and at half a year after t1, prevalence was 34%. Fatigue prevalence rates differed according to tumour stage, site, age, and sex of the patients. CONCLUSION The prevalence rates provided by this study can be used for the planning of research and clinical routine.
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Affiliation(s)
- S Singer
- Department of Health Psychology and Applied Diagnostics, University of Wuppertal, Wuppertal, Germany.
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22
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Egle D, Oberguggenberger A, Achleitner R, Sztankay M, Meraner V, Giesinger J, Sperner-Unterweger B, Holzner B, Beer B, Oberacher H, Marth C, Hubalek M. Do obese women benefit less from adjuvant endocrine therapy with aromatase inhibitors? Preliminary analysis on the association of BMI and aromatase inhibitor plasma levels. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11118] [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: 11/20/2022] Open
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23
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Hubalek M, Oberguggenberger A, Meraner V, Beer B, Giesinger J, Oberacher H, Sperner-Unterweger B, Marth C. Abstract P4-02-04: Impact of CYP2D6 Genotype and Side-Effects on Adherence Rates to Tamoxifen in Premenopausal Breast Cancer Patients. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Only few studies have investigated the issue of breast cancer patients’ adherence to tamoxifen therapy and factors influencing adherence behavior. Especially in the context of different CYP2D6 genotypes adherence to tamoxifen has not been extensively studied yet. Variations in the CYP2D6 genotype, as well as patients taking inhibitors of CYP2D6 (e.g. antidepressants) contribute to different side effects and adherence rates to adjuvant tamoxifen.
Materials and Methods: 106 premenopausal breast cancer patients who met inclusion criteria were consecutively included in the study at the outpatient unit of the Department of Gynecology, Innsbruck Medical University. Within their routine after care appointment patients completed a comprehensive PRO assessment including the FACT-B/ES, the HADS and a self-report questionnaire on adherence behavior (SMAQ). The multi-method approach comprised the Simplified Medication Adherence Questionnaire, a semi-structured interview, physicians’ ratings and blood levels for tamoxifen metabolites. Additionally, the CYP2D6 genotype was determined in all patients participating in this part of the study.
Results: 19% patients were poor metabolizer (PM), 51% intermediate metabolizer (IM), 29% extensive metabolizer (EM) and 7% ultra-rapid metabolizer (UM). Significant group differences with regard to tamoxifen and endoxifen serum concentrations were found between the metabolization groups (p=0.044). UMs had the lowest tamoxifen and highest endoxifen concentrations. Only 3.2% of the patients analyzed had no measurable tamoxifen concentrations in their serum. All non-compilant patients were from the extensive metabolizer group. However, during follow-up 25% (2/6) of patients with UM genotype, 13% (4/30) with EM genotype, 1% (1/50) with IM genotype and 0% (0/19) with the PM genotype discontinued their tamoxifen therapy due to therapy related side effects. In addition anti-depressants were more frequently prescribed in the extensive metabolizer group leading to lower levels of the active metabolite endoxifen. Conclusion: A trend towards higher hot flashes was observed in the EM and UM group. We did not find significant differences in QOL between
CYP2D6 metabolizing groups. Trend level significance was found for global QOL (on a descriptive level) physical well-being and emotional well-being. Non-adherence to tamoxifen therapy is more frequent in patients with CYP2D6 EM and UM genotype. These preliminary data may explain part of the current controversy over CYP2D6 genotype predicting response to tamoxifen and suggest that patients most likely to benefit from tamoxifen are paradoxically most likely to stop their tamoxifen therapy prematurely.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-02-04.
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Affiliation(s)
- M Hubalek
- Medical University Innsbruck, Austria
| | | | - V Meraner
- Medical University Innsbruck, Austria
| | - B Beer
- Medical University Innsbruck, Austria
| | | | | | | | - C. Marth
- Medical University Innsbruck, Austria
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Hubalek M, Oberguggenberger A, Meraner V, Giesinger J, Kemmler G, Sperner-Unterweger B, Beer B, Oberacher H, Marth C, Holzner B. Abstract PD08-02: The Impact of Patient Reported Outcomes (PRO) on the Evaluation of Therapy Related Side-Effects and the Improvement of Adherence to Endocrine Treatment in Breast Cancer Patients. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd08-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Long term treatment regimen with significant side effects may diminish a patient's quality of life (QOL) and consequently undermine adherence. Endocrine treatment for breast cancer causes various side effects, which can lead to early discontinuation of this effective therapy. Current knowledge on patients’ quality of life (QOL) impairments caused by endocrine therapy originates from clinicians’ impressions and expert ratings. This runs the risk of underestimating the effects of endocrine therapy on patients’ quality of life. Patient reported outcome (PRO) may provide higher accuracy and may therefore essentially contribute to medication evaluation and clinical decision making. In this study, we report on the patient reported outcome (PRO) related to endocrine therapy in early breast cancer.
Methods: Pre-and postmenopausal breast cancer outpatients treated with aromatase inhibitors (AIS) or tamoxifen were approached at their routine control appointment with the treating physician. We conducted a comprehensive PRO assessment comprising the following scales: FACT-B/+ES and HADS (high scores indicate high symptoms). In a short, semi-structured interview data on patients’ general medication intake behavior were collected focusing on the intake of complementary and alternative medicine (CAM)
Results: We analyzed PRO data of 240 patients undergoing endocrine treatment. 66.6% received AI therapy, 71.9% were postmenopausal. We found high levels of symptom burden in this study group: 55.9% had moderate to severe bone pain, 47.8% menopausal symptoms and 49.1% loss of sex drive. Postmenopausal women in the AI group had significantly more symptoms on the endocrine subscale (mean 24.25 vs. 16.42, p=0.045), significantly more anxiety (mean 8.8 vs. 5.11, p=0.036) and depression (mean 8.75 vs. 3.86, p=0.011). In the tamoxifen group premenopausal patients scored significantly higher on all scales. Moreover, patients who used complementary substances had a significant lower physical well-being (22.70 vs. 24.39, p=0.007) and more endocrine symptoms (22.63 vs. 16.30, p=0.004).
Conclusion:The results of our study show a significantly higher assessment of physical side-effects and psychosocial burden on part of the patients than implied by clinicians’ reports and expert ratings. PRO data may therefore provide a more accurate measure for symptom burden and contribute to individualized clinical decision making. It is an important tool to detect and effectively treat therapy related side effect to ultimately preserve adherence to endocrine treatment. According to our findings, it appears mandatory to incorporate PRO data in individualized clinical decision making to arrive at a more accurate assessment of symptom burden.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD08-02.
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Affiliation(s)
- M Hubalek
- Medical University Innsbruck, Austria
| | | | - V Meraner
- Medical University Innsbruck, Austria
| | | | - G Kemmler
- Medical University Innsbruck, Austria
| | | | - B Beer
- Medical University Innsbruck, Austria
| | | | - C Marth
- Medical University Innsbruck, Austria
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Meraner V, Oberguggenberger A, Giesinger J, Hubalek M, Beer B, Schubert B, Sperner-Unterweger B, Holzner B. 377 Patient-reported outcomes in breast cancer patients undergoing endocrine therapy (PRO-BETh): adherence rates and symptom burden over the disease trajectory. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70403-1] [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: 10/19/2022] Open
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26
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Kemmler G, Zabernigg A, Gattringer K, Rumpold G, Giesinger J, Sperner-Unterweger B, Holzner B. A new approach to combining clinical relevance and statistical significance for evaluation of quality of life changes in the individual patient. J Clin Epidemiol 2009; 63:171-9. [PMID: 19615857 DOI: 10.1016/j.jclinepi.2009.03.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 03/04/2009] [Accepted: 03/30/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Empirical investigation of formerly proposed criteria for relevant changes of health-related quality of life (QOL) regarding their use for monitoring changes in the individual patient. Suggestion of a new criterion trying to overcome the drawbacks of former criteria. STUDY DESIGN AND SETTING QOL data were collected longitudinally in 160 cancer patients receiving chemotherapy at an oncological outpatient unit, giving rise to a total of 975 QOL assessments. QOL was measured using the European Organization on Research and Treatment of Cancer Quality of Life Core Questionnaire. Several formerly suggested criteria of relevant change (distribution based, anchor based) were compared in terms of both prevalence and statistical significance of the resulting relevant changes. RESULTS When considering criteria of relevant change suggested in the literature, high proportions (average: 42.3-48.3%) of reputedly relevant changes were found. The majority of these changes (average: 55.8-62.2%) were statistically insignificant. Combination of an increased threshold for clinical relevance with the concept of statistical significance resulted in a more meaningful change criterion. CONCLUSION Formerly recommended thresholds of relevant change in QOL appear to be unduly low when focusing on the individual patient. A modified criterion is therefore suggested for this case. However, more research is needed for validation and refinement of the proposed criterion.
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Affiliation(s)
- G Kemmler
- Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Tyrol 6020, Austria.
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Brass H, Schleiffer T, Giesinger J. [Takayasu aortic arteritis]. Med Klin (Munich) 1992; 87:155-7. [PMID: 1349725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- H Brass
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen
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