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Antonini A, Gentile G, Giglio M, Marcante A, Gage H, Touray MML, Fotiadis DI, Gatsios D, Konitsiotis S, Timotijevic L, Egan B, Hodgkins C, Biundo R, Pellicano C. Acceptability to patients, carers and clinicians of an mHealth platform for the management of Parkinson's disease (PD_Manager): study protocol for a pilot randomised controlled trial. Trials 2018; 19:492. [PMID: 30217235 PMCID: PMC6138904 DOI: 10.1186/s13063-018-2767-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parkinson's disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_Manager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_Manager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_Manager for clinical decision making and the acceptability of the system in clinical practice. METHODS/DESIGN This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson's disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson's diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_Manager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_Manager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_Manager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_Manager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework. DISCUSSION Information gathered will inform further development of the PD_Manager system and a larger effectiveness trial. TRIAL REGISTRATION ISRCTN Registry, ISRCTN17396879 . Registered on 15 March 2017.
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Affiliation(s)
- Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy.,IRCCS San Camillo Hospital, Venice, Italy
| | | | | | - Andrea Marcante
- Department of Neuroscience, University of Padua, Padua, Italy.,IRCCS San Camillo Hospital, Venice, Italy
| | - Heather Gage
- Surrey Health Economics Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Morro M L Touray
- Surrey Health Economics Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
| | - Dimitrios I Fotiadis
- Department of Materials Science, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Dimitris Gatsios
- Department of Materials Science, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Spyridon Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lada Timotijevic
- Department of Psychology, University of Surrey, Guildford, England
| | - Bernadette Egan
- Department of Psychology, University of Surrey, Guildford, England
| | - Charo Hodgkins
- Department of Psychology, University of Surrey, Guildford, England
| | | | - Clelia Pellicano
- Fondazione Santa Lucia IRCCS, Via Ardeatina 306, 00179, Rome, Italy.,Department of Neuriscience, Mental Health and Sensory Organs, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy
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102
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The relationship of neighbourhood-level material and social deprivation with health-related quality of life. Qual Life Res 2018; 27:3265-3274. [PMID: 30069793 DOI: 10.1007/s11136-018-1962-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine the relationship of neighbourhood-level material and social deprivation with health-related quality of life, measured by the EQ-5D-5L, in the general adult population. METHODS A sample of 11,835 adults living in Alberta, Canada was drawn from three combined annual Health Quality Council of Alberta Satisfaction and Experiences with Health Care Services surveys from 2012 to 2016. Neighbourhood-level material and social deprivation indices were derived using the Pampalon index and the 2006 Canadian census. The EQ-5D-5L dimensions, index and VAS scores were compared across the deprivation indices quintiles in the overall sample and by participants' sub-groups. Differences were tested using ANOVA or Chi-square test as appropriate. Multivariate linear regression models were conducted to examine the independent association of material and social deprivation with the EQ-5D-5L index and VAS scores, and multinomial logistic regression models with each of the EQ-5D-5L dimensions. RESULTS Respondents in higher material or social deprivation categories had lower EQ-5D-5L index and VAS scores than those in the least deprived categories. Additionally, respondents with higher material deprivation were more likely to report problems on mobility, usual activities, and pain/discomfort; those with higher social deprivation were more likely to report problems on mobility, self-care, usual activities, and anxiety/depression. CONCLUSION Higher neighbourhood-level material and social deprivation is significantly associated with lower health-related quality of life in the general adult population. Examining the factors leading to this inequity in health between individuals living in the least and most deprived neighbourhoods is imperative to mitigating these inequities.
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103
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Grobet C, Marks M, Tecklenburg L, Audigé L. Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review. Arch Orthop Trauma Surg 2018; 138:953-961. [PMID: 29654354 DOI: 10.1007/s00402-018-2933-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The EuroQol-5 Dimension (EQ-5D) is the most widely used generic instrument to measure quality of life (QoL), yet its application in upper extremity orthopaedics as well as its measurement properties remain largely undefined. We implemented a systematic literature review to provide an overview of the application of EQ-5D in patients with upper extremity disorders and analyse its measurement properties. MATERIALS AND METHODS We searched Medline, EMBASE, Cochrane and Scopus databases for clinical studies including orthopaedic patients with surgical interventions of the upper extremity who completed the EQ-5D. For all included studies, the use of EQ-5D and quantitative QoL data were described. Validation studies of EQ-5D were assessed according to COSMIN guidelines and standard measurement properties were examined. RESULTS Twenty-three studies were included in the review, 19 of which investigated patients with an intervention carried out at the shoulder region. In 15 studies, EQ-5D assessed QoL as the primary outcome. Utility index scores in non-trauma patients generally improved postoperatively, whereas trauma patients did not regain their recalled pre-injury QoL levels. EQ-5D measurement properties were reported in three articles on proximal humerus fractures and carpal tunnel syndrome. Positive ratings were seen for construct validity (Spearman correlation coefficient ≥ 0.70 with the Short Form (SF)-12 or SF-6D health surveys) and reliability (intraclass correlation coefficient ≥ 0.77) with intermediate responsiveness (standardised response means: 0.5-0.9). However, ceiling effects were identified with 16-48% of the patients scoring the maximum QoL. The methodological quality of the three articles varied from fair to good. CONCLUSIONS For surgical interventions of the upper extremity, EQ-5D was mostly applied to assess QoL as a primary outcome in patients with shoulder disorders. Investigations of the measurement properties were rare, but indicate good reliability and validity as well as moderate responsiveness in patients with upper extremity conditions.
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Affiliation(s)
- Cécile Grobet
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Linda Tecklenburg
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland
| | - Laurent Audigé
- Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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104
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Ombler F, Albert M, Hansen P. How Significant Are "High" Correlations Between EQ-5D Value Sets? Med Decis Making 2018; 38:635-645. [PMID: 29877163 DOI: 10.1177/0272989x18778295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The calculation of quality-adjusted life years, as used for cost-utility analysis, depends on the availability of value sets representing people's preferences with respect to health-related quality of life (HRQoL). A value set consists of HRQoL index values for all health states representable by the particular descriptive system used, of which the EQ-5D (EuroQoL, 5 Dimensions) is by far the most widely used. High correlation coefficients for EQ-5D value sets derived from different samples-across countries and/or using different valuation techniques-are conventionally interpreted as evidence that the people in the respective samples have similar HRQoL preferences. However, EQ-5D value sets-for both versions of the system (EQ-5D-3L and EQ-5D-5L)-contain many inherent rankings of health state values by design. By calculating correlation coefficients for value sets created from random data, we demonstrate that "high" coefficients are artifacts of these inherent rankings, such as median Pearson's r = 0.783 for the EQ-5D-3L and 0.850 for the EQ-5D-5L instead of zero. Therefore, high correlation coefficients do not necessarily constitute evidence of meaningful associations in terms of similar HRQoL preferences. After calculating significance levels based on our simulations-available as an online resource for other researchers-we find that many high coefficients are not as significant as conventionally interpreted, whereas other coefficients are not significant. These "high" but insignificant correlations are in fact spurious.
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Affiliation(s)
- Franz Ombler
- Department of Computer Science, University of Otago, Dunedin, New Zealand
| | - Michael Albert
- Department of Computer Science, University of Otago, Dunedin, New Zealand
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
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105
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Wong ELY, Shah K, Cheung AWL, Wong AYK, Visser M, Stolk E. Evaluation of Split Version and Feedback Module on the Improvement of Time Trade-Off Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:732-741. [PMID: 29909879 DOI: 10.1016/j.jval.2017.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/16/2017] [Accepted: 10/15/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND EQ-5D-5L valuation studies previously reported many inconsistent responses in time trade-off (TTO) data. A number of possible elements, including ordering effects of the valuation tasks, mistakes at the sorting question, and interviewers' (learning) effects, may contribute to their inconsistency. OBJECTIVES This study aimed to evaluate the effect of two modifications on consistency of TTO data in The Netherlands (NL) and Hong Kong (HK): (1) separating the valuation of the Better than Dead (BTD) and Worse than Dead (WTD) states; and (2) Implementation of feedback (FB) module by offering an opportunity to review TTO responses. METHODS A crossover design with two study arms was used to test the effect of the modifications. In each jurisdiction, six interviewers were involved where half the interviewers started using the standard version, and the other half started with the split version. Each version was switched after every 25 (NL) or 30 (HK) interviews until 400 interviews were completed. RESULTS In the NL and HK, 404 and 403 respondents participated, respectively. With the use of the FB module, the proportion of respondents with inconsistent responses was lowered from 17.8% to 10.6% (P < 0.001) in NL and from 31.8% to 22.3% (P = 0.003) in HK. The result of separating the valuation of BTD and WTD states was not straightforward because it reduced the inconsistency rate in NL but not in HK. CONCLUSIONS The results support implementation of the FB module to promote the consistency of the data. The separation of the BTD and WTD task is not supported.
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Affiliation(s)
- Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | | | - Annie W L Cheung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Amy Y K Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Martijn Visser
- Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Elly Stolk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; EuroQol Executive Office, Rotterdam, The Netherlands
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106
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Giesberts B, Ennion L, Hjelmstrom O, Karma A, Lechler K, Hekman E, Bergsma A. The modular socket system in a rural setting in Indonesia. Prosthet Orthot Int 2018; 42:336-343. [PMID: 29153044 PMCID: PMC5960840 DOI: 10.1177/0309364617741917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prosthetic services are inaccessible to people living in rural areas. Systems like the modular socket system have the potential to be fabricated outside of the prosthetic workshop. OBJECTIVES This study aimed to evaluate the patient's performance and satisfaction with the use of the modular socket system, and the technical feasibility of its implementation in a rural setting. STUDY DESIGN A quantitative longitudinal descriptive study design was followed. METHODS A total of 15 persons with a lower limb amputation were fitted with the modular socket system and followed over 4-6 months. Performance was measured using a 2-min walk test, 10-m walk test and mobility and function questionnaire. Satisfaction was measured by the Socket Fit Comfort Score, Prosthesis Evaluation Questionnaire and EuroQoL 5 Dimensions 5 Levels. Notes on technical feasibility were taken at the moment of fitting ( t0), at 1-3 months post fitting ( t1) and at the end evaluation at 4-6 months post fitting ( t2). RESULTS Performance did not change between t0 and t2. The comfort of the socket fit reduced between t0 and t2. Satisfaction with prosthesis and general health status stayed constant over time. The average fitting-time for the modular socket system was 6.4 h. CONCLUSION The modular socket system can be considered a useful alternative for use in rural settings. Clinical relevance The use of the modular socket system is feasible and can improve accessibility to prosthetic technology in rural areas. Experienced prosthetic users were satisfied with the performance and the device. The shorter manufacturing time and use of only hand-held tools makes it an ideal alternative for use in remote and rural settings.
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Affiliation(s)
- Bob Giesberts
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands,Bob Giesberts, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands.
| | - Liezel Ennion
- Department of Physiotherapy, University of the Western Cape, Bellville, South Africa
| | | | - Agusni Karma
- Department of Prosthetic and Orthotic, Polytechnic of Health, Indonesian Ministry of Health, Jakarta, Indonesia
| | | | - Edsko Hekman
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Arjen Bergsma
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands,Movendi Foundation, The Netherlands
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107
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Ludwig K, Graf von der Schulenburg JM, Greiner W. German Value Set for the EQ-5D-5L. PHARMACOECONOMICS 2018; 36:663-674. [PMID: 29460066 PMCID: PMC5954069 DOI: 10.1007/s40273-018-0615-8] [Citation(s) in RCA: 294] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVES The objective of this study was to develop a value set for EQ-5D-5L based on the societal preferences of the German population. As the first country to do so, the study design used the improved EQ-5D-5L valuation protocol 2.0 developed by the EuroQol Group, including a feedback module as internal validation and a quality control process that was missing in the first wave of EQ-5D-5L valuation studies. METHODS A representative sample of the general German population (n = 1158) was interviewed using a composite time trade-off and a discrete choice experiment under close quality control. Econometric modeling was used to estimate values for all 3125 possible health states described by EQ-5D-5L. The value set was based on a hybrid model including all available information from the composite time trade-off and discrete choice experiment valuations without any exclusions due to data issues. RESULTS The final German value set was constructed from a combination of a conditional logit model for the discrete choice experiment data and a censored at -1 Tobit model for the composite time trade-off data, correcting for heteroskedasticity. The value set had logically consistent parameter estimates (p < 0.001 for all coefficients). The predicted EQ-5D-5L index values ranged from -0.661 to 1. CONCLUSIONS This study provided values for the health states of the German version of EQ-5D-5L representing the preferences of the German population. The study successfully employed for the first time worldwide the improved protocol 2.0. The value set enables the use of the EQ-5D-5L instrument in economic evaluations and in clinical studies.
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Affiliation(s)
- Kristina Ludwig
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | | | - Wolfgang Greiner
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
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108
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Buchholz I, Janssen MF, Kohlmann T, Feng YS. A Systematic Review of Studies Comparing the Measurement Properties of the Three-Level and Five-Level Versions of the EQ-5D. PHARMACOECONOMICS 2018; 36:645-661. [PMID: 29572719 PMCID: PMC5954044 DOI: 10.1007/s40273-018-0642-5] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Since the introduction of the five-level version of the EQ-5D (5L), many studies have comparatively investigated the measurement properties of the original three-level version (3L) with the 5L version. OBJECTIVE The aim of this study was to consolidate the available evidence on the performance of both instruments. METHODS A systematic literature search of studies in the English and German languages was conducted (2007-January 2018) using the PubMed, EMBASE, and PsycINFO (EBSCO) databases, as well as the EuroQol Research Foundation website. Data were extracted and assessed on missing values, distributional properties, informativity indices (Shannon's H' and J'), inconsistencies, responsiveness, and test-retest reliability. RESULTS Twenty-four studies were included in the review. Missing values and floor effects (percentage reporting the worst health state) were found to be negligible for both 3L and 5L (< 5%). From 18 studies, inconsistencies ranged from 0 to 10.6%, although they were generally well below 5%, with 9 studies reporting the most inconsistencies for Usual Activities (mean percentage 4.1%). Shannon's indices were always higher for 5L than for 3L, and all but three studies reported lower ceiling effects ('11111') for 5L than for 3L. There is mixed and insufficient evidence on responsiveness and test-retest reliability, although results on index values showed better performance for 5L on test-retest reliability. CONCLUSION Overall, studies showed similar or better measurement properties of the 5L compared with the 3L, and evidence indicated moderately better distributional parameters and substantial improvement in informativity for the 5L compared with the 3L. Insufficient evidence on responsiveness and test-retest reliability implies further research is needed.
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Affiliation(s)
- Ines Buchholz
- Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany.
| | - Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Thomas Kohlmann
- Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany
| | - You-Shan Feng
- Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany
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Burns RM, Wolstenholme J, Jawad S, Williams N, Thompson M, Perera R, Hay AD, Heneghan C, Little P, Moore M, Hayward G. Economic analysis of oral dexamethasone for symptom relief of sore throat: the UK TOAST study. BMJ Open 2018; 8:e019184. [PMID: 29705751 PMCID: PMC5931286 DOI: 10.1136/bmjopen-2017-019184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat. DESIGN A UK-based, multicentre, two arm, individually randomised, double blind trial. SETTING AND POPULATION Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. INTERVENTION a single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit. MAIN OUTCOME Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost-utility analysis performed on an intention-to-treat cohort adopting a health payers perspective. RESULTS Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: the quality-adjusted life year difference was -0.00005 (95% CI -0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was -£6440 (95% CI -£132 151 to £126 335) and the median ICER was -£304 (IQR-£5816 to £3877); suggesting considerable uncertainty. CONCLUSIONS AND RELEVANCE The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice. TRIAL REGISTRATION NUMBER ISRCTN17435450; Post-results.
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Affiliation(s)
- Richeal M Burns
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sena Jawad
- Department of Medicine, Imperial College London, Neonatal Data Analysis Unit, London, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Rafael Perera
- Primary Health Care, University of Oxford, Oxford, UK
| | - Alastair D Hay
- School of Social and Community Medicine, University of Bristol, Bristol, Bristol, UK
| | | | - Paul Little
- Southampton Medical School, University of Southampton, Southampton, UK
| | | | - Gail Hayward
- Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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Cost-effectiveness of benign Wirsung duct strictures treatment in chronic pancreatitis. Wideochir Inne Tech Maloinwazyjne 2018; 13:17-26. [PMID: 29643954 PMCID: PMC5890842 DOI: 10.5114/wiitm.2018.72578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/29/2017] [Indexed: 01/22/2023] Open
Abstract
Introduction Chronic pancreatitis (CP) is an important problem for modern medicine, the healthcare system (Poland – NFZ) and the national insurance system (Poland – ZUS). The chronic nature of the disease, the lack of targeted treatment and the low mortality rate lead to an accumulation of patients who demand expensive treatment, both conservative and invasive. Rising costs in health care are forcing the need for a more cost-effective method of treatment. Aim The primary aim of this study was to perform a retrospective calculation of costs in both surgical and endoscopic treatment, hospital stay, healthcare, and public insurance of patients suffering from chronic pancreatitis. Parallel quality of life analysis was performed. It was possible to develop a cost-effective therapeutic algorithm for patients with an uncomplicated stricture of Wirsung’s duct within the Polish health care system. Results In Poland, the hospital costs of endoscopic treatment of patients with chronic pancreatitis were higher than those of the surgical treatment group despite both resulting in a similar life quality. Conclusions From a cost-effectiveness perspective, it was shown that surgical intervention is a more cost-effective therapy than endotherapy. Furthermore, patients with benign stricture of the main pancreatic duct in chronic pancreatitis should not be treated with endotherapy for longer than 12 months.
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111
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Buckner TW, Witkop M, Guelcher C, Sidonio R, Kessler CM, Clark DB, Owens W, Frick N, Iyer NN, Cooper DL. Impact of hemophilia B on quality of life in affected men, women, and caregivers-Assessment of patient-reported outcomes in the B-HERO-S study. Eur J Haematol 2018; 100:592-602. [DOI: 10.1111/ejh.13055] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | - Robert Sidonio
- Emory University and Children's Healthcare of Atlanta; Atlanta GA USA
| | | | | | - Wendy Owens
- Hemophilia Federation of America; Washington DC USA
| | - Neil Frick
- National Hemophilia Foundation; New York NY USA
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Wong ELY, Ramos-Goñi JM, Cheung AWL, Wong AYK, Rivero-Arias O. Assessing the Use of a Feedback Module to Model EQ-5D-5L Health States Values in Hong Kong. THE PATIENT 2018; 11:235-247. [PMID: 29019161 PMCID: PMC5845074 DOI: 10.1007/s40271-017-0278-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND An international valuation protocol exists for obtaining societal values for each of the 3125 health states of the five-level EuroQol-five dimensions (EQ-5D-5L) questionnaire. A feedback module (FM) that can be related to theoretical models used in behavioral economics was recently included in this protocol. OBJECTIVES Our objective was to assess the impact of using an FM to estimate an EQ-5D-5L value set in Hong Kong. METHODS EQ-5D-5L health states were elicited using a composite time trade-off (C-TTO) and a discrete-choice (DC) experiment. Use of the FM according to participant characteristics and the impact of the FM on the number of inconsistent C-TTO responses were assessed. We employed a main-effects hybrid model that combined data from both elicitation techniques. RESULTS In total, 1014 individuals completed the survey. The sample was representative of the general Chinese Hong Kong population in terms of sex, educational attainment, marital status, and most age groups but not for employment status. The use of the FM reduced the number of C-TTO inconsistencies. Participant characteristics differed significantly between those who used and did not use the FM. The model without a constant resulted in logical consistent coefficients and was therefore selected as the model to produce the value set. The predicted EQ-5D-5L values ranged from -0.864 to 1. CONCLUSIONS The use of an FM to allow participants to exclude C-TTO responses reduced the number of inconsistent responses and improved the quality of the data when estimating an EQ-5D-5L value set in Hong Kong.
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Affiliation(s)
- Eliza L Y Wong
- The JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Annie W L Cheung
- The JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Amy Y K Wong
- The JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
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Gabbay MB, Ring A, Byng R, Anderson P, Taylor RS, Matthews C, Harris T, Berry V, Byrne P, Carter E, Clarke P, Cocking L, Edwards S, Emsley R, Fornasiero M, Frith L, Harris S, Huxley P, Jones S, Kinderman P, King M, Kosnes L, Marshall D, Mercer D, May C, Nolan D, Phillips C, Rawcliffe T, Sardani AV, Shaw E, Thompson S, Vickery J, Wainman B, Warner M. Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer study). Health Technol Assess 2018. [PMID: 28648148 DOI: 10.3310/hta21350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression and debt are common in the UK. Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer) aimed to assess the clinical effectiveness and cost-effectiveness of the addition of a primary care debt counselling advice service to usual care for patients with depression and debt. However, the study was terminated early during the internal pilot trial phase because of recruitment delays. This report describes the rationale, methods and findings of the pilot study, and implications for future research. OBJECTIVES The overarching aim of the internal pilot was to identify and resolve problems, thereby assessing the feasibility of the main trial. The specific objectives were to confirm methods for practice recruitment and the ability to recruit patients via the proposed approaches; to determine the acceptability of the study interventions and outcome measures; to assess contamination; to confirm the randomisation method for main trial and the level of participant attrition; and to check the robustness of data collection systems. DESIGN An adaptive, parallel, two-group multicentre randomised controlled pilot trial with a nested mixed-methods process and economic evaluation. Both individual- and cluster (general practice)-level were was used in the pilot phase to assign participants to intervention or control groups. SETTING General practices in England and Wales. PARTICIPANTS Individuals were included who were aged ≥ 18 years, scored ≥ 14 on the Beck Depression Inventory II and self-identified as having debt worries. The main exclusion criteria were being actively suicidal or psychotic and/or severely depressed and unresponsive to treatment; having a severe addiction to alcohol/illicit drugs; being unable/unwilling to give written informed consent; currently participating in other research including follow-up phases; having received Citizens Advice Bureau (CAB) debt advice in the past year; and not wanting debt advice via a general practice. INTERVENTIONS The participants in the intervention group were given debt advice provided by the CAB and shared biopsychosocial assessment, in addition to treatment as usual (TAU) and two debt advice leaflets. The participants in the control group were given advice leaflets provided by the general practitioner and TAU only. MAIN OUTCOME MEASURES (1) Outcomes of the pilot trial - the proportion of eligible patients who consented, the number of participants recruited compared with target, assessment of contamination, and assessment of patient satisfaction with intervention and outcome measures. (2) Participant outcomes - primary - Beck Depression Inventory II; secondary - psychological well-being, health and social care utilisation, service satisfaction, substance misuse, record of priority/non-priority debts, life events and difficulties, and explanatory measures. Outcomes were assessed at baseline (pre-randomisation) and at 4 months post randomisation. Other data sources - qualitative interviews were conducted with participants, clinicians and CAB advisors. RESULTS Of the 238 expressions of interest screened, 61 participants (26%) were recruited and randomised (32 in the intervention group and 29 in the control group). All participants provided baseline outcomes and 52 provided the primary outcome at 4 months' follow-up (14.7% dropout). Seventeen participants allocated to the intervention saw a CAB advisor. Descriptive statistics are reported for participants with complete outcomes at baseline and 4 months' follow-up. Our qualitative findings suggest that the relationship between debt and depression is complex, and the impact of each on the other is compounded by other psychological, social and contextual influences. CONCLUSIONS As a result of low recruitment, this trial was terminated at the internal pilot phase and was too small for inferential statistical analysis. We recommend ways to reduce this risk when conducting complex trials among vulnerable populations recruited in community settings. These cover trial design, the design and delivery of interventions, recruitment strategies and support for sites. TRIAL REGISTRATION Current Controlled Trials ISRCTN79705874. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 35. See the NIHR Journals Library website for further project information. Mark Gabbay and Adele Ring are part-funded by NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) North West Coast and Richard Byng and Rod S Taylor, Vashti Berry and Elizabeth Shaw part-funded by NIHR CLAHRC South West Peninsula.
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Affiliation(s)
- Mark B Gabbay
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Adele Ring
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Richard Byng
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | | | - Tirril Harris
- Department of Health Service and Population Research, King's College London, London, UK
| | - Vashti Berry
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Paula Byrne
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Elliot Carter
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Pam Clarke
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Laura Cocking
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Suzanne Edwards
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Richard Emsley
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mauro Fornasiero
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Lucy Frith
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Peter Huxley
- Centre for Mental Health and Society, School of Social Sciences, Bangor University, Bangor, UK
| | - Siw Jones
- Citizens Advice Bureau, Liverpool, UK
| | - Peter Kinderman
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Liv Kosnes
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Daniel Marshall
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Dave Mercer
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Carl May
- Faculty of Life Sciences, University of Southampton, Southampton, UK
| | | | - Ceri Phillips
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Tim Rawcliffe
- Lancashire Care NHS Foundation Trust, Lancashire, UK
| | | | - Elizabeth Shaw
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Sam Thompson
- Department of Health Services Research, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jane Vickery
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Brian Wainman
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Mark Warner
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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Syrios J, Pappa E, Volakakis N, Grivas A, Alafis J, Manioudaki S, Tzouda V, Korogiannos A, Rapti C, Koufopoulos N, Nikolaidou A, Kanavou E, Alexopoulos A, Koumarianou A. Real-World Data on Health-Related Quality of Life Assessment in Patients With Breast Cancer Receiving Subcutaneous Trastuzumab. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223418758031. [PMID: 29511355 PMCID: PMC5826003 DOI: 10.1177/1178223418758031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/18/2018] [Indexed: 01/03/2023]
Abstract
Purpose Trastuzumab, a humanized anti-human epidermal growth factor receptor 2 (anti-HER2) antibody delivered intravenously, has revolutionized the treatment of patients with breast cancer overexpressing HER2 protein. Recently, a newer subcutaneous formulation was shown to have comparable efficacy to the initial intravenous trastuzumab. In this study, we aimed to evaluate the impact of subcutaneous trastuzumab on the health-related quality of life (HRQoL) of patients diagnosed with early or metastatic HER2-overexpressing breast cancer. Methods Patients were provided with the EORTC QLQ-C30 (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) and the BR-23 questionnaires. The scoring of questionnaires and patient's sociodemographic and clinicopathologic characteristics were recorded and analyzed by descriptive and correlation statistics employing t test and 2-way analysis of variance. Results A total of 163 patients agreed to participate in the study. About 90 of 163 patients (55.21%) received subcutaneous trastuzumab and 21 patients intravenous trastuzumab (12.88%). A control group of 52 HER2+ patients received chemotherapy without trastuzumab (31.90%). Patients receiving subcutaneous trastuzumab were older and of more advanced disease stage compared with those receiving chemotherapy (58.5 vs 51 years, 39.8% vs 28.8% advanced disease). In univariate analysis, subcutaneous trastuzumab was associated with less nausea and vomiting (P = .002) but worse cognitive function (P = .013) and dyspnea (P = .042). Patients who have received >8 cycles of subcutaneous trastuzumab reported less diarrhea (P = .049) and systemic therapy side effects (P = .015). Multivariate analysis showed that patients without comorbidity receiving subcutaneous trastuzumab had less treatment side effects, less upset by hair loss, and higher emotional functioning. Of note, mastectomy and subcutaneous trastuzumab were associated with improved role functioning (P = .021). In metastatic disease, no negative impact of subcutaneous trastuzumab on HRQoL was found. Conclusions The administration of subcutaneous trastuzumab improved certain symptoms and did not adversely affect most of the assessed functional scales. Particularly, in the metastatic setting, subcutaneous trastuzumab had no negative impact on HRQoL.
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Affiliation(s)
- John Syrios
- Oncology Department, Hygeia & Mitera Hospital, Marousi, Greece
| | - Evelina Pappa
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
| | - Nikolaos Volakakis
- 2nd Department of Medical Oncology, "St. Savvas" Cancer Hospital, Athens, Greece
| | - Anastasios Grivas
- Department of Medical Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | - John Alafis
- 2nd Department of Medical Oncology, "St. Savvas" Cancer Hospital, Athens, Greece
| | - Sofia Manioudaki
- 2nd Department of Medical Oncology, "St. Savvas" Cancer Hospital, Athens, Greece
| | - Vasiliki Tzouda
- Oncology Department, Hygeia & Mitera Hospital, Marousi, Greece
| | | | - Cleopatra Rapti
- 2nd Department of Medical Oncology, "St. Savvas" Cancer Hospital, Athens, Greece
| | | | | | | | | | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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115
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Umbehr MH, Bachmann LM, Poyet C, Hammerer P, Steurer J, Puhan MA, Frei A. The German version of the Expanded Prostate Cancer Index Composite (EPIC): translation, validation and minimal important difference estimation. Health Qual Life Outcomes 2018; 16:36. [PMID: 29458434 PMCID: PMC5819270 DOI: 10.1186/s12955-018-0859-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No official German translation exists for the 50-item Expanded Prostate Cancer Index Composite (EPIC), and no minimal important difference (MID) has been established yet. The aim of the study was to translate and validate a German version of the EPIC with cultural adaptation to the different German speaking countries and to establish the MID. METHODS We translated and culturally adapted the EPIC into German. For validation, we included a consecutive subsample of 92 patients with localized prostate cancer undergoing radical prostatectomy who participated the Prostate Cancer Outcomes Cohort. Baseline and follow-up assessments took place before and six weeks after prostatectomy in 2010 and 2011. We assessed the EPIC, EORTC QLQ-PR25, Feeling Thermometer, SF-36 and a global rating of health state change variable. We calculated the internal consistency, test-retest reliability, construct validity, responsiveness and MID. RESULTS For most EPIC domains and subscales, our a priori defined criteria for reliability were fulfilled (construct reliability: Cronbach's alpha 0.7-0.9; test-retest reliability: intraclass-correlation coefficient ≥ 0.7). Cross-sectional and longitudinal correlations between EPIC and EORTC QLQ-PR25 domains ranged from 0.14-0.79, and 0.06-0.5 and 0.08-0.72 for Feeling Thermometer and SF-36, respectively. We established MID values of 10, 4, 12, and 6 for the urinary, bowel, sexual and hormonal domain. CONCLUSION The German version of the EPIC is reliable, responsive and valid to measure HRQL in prostate cancer patients and is now available in German language. With the suggested MID we provide interpretation to what extent changes in HRQL are clinically relevant for patients. Hence, study results are of interest beyond German speaking countries.
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Affiliation(s)
- Martin H. Umbehr
- Department of Urology, City Hospital Triemli of Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
- Horten Centre of patient orientated research and knowledge transfer, University of Zurich, Zurich, Switzerland
| | | | - Cedric Poyet
- Department of Urology, University Hospital of Zurich, Zurich, Switzerland
| | - Peter Hammerer
- Clinic of Urology, Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Johann Steurer
- Horten Centre of patient orientated research and knowledge transfer, University of Zurich, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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116
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Parry SW, Bamford C, Deary V, Finch TL, Gray J, MacDonald C, McMeekin P, Sabin NJ, Steen IN, Whitney SL, McColl EM. Cognitive-behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial - the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study. Health Technol Assess 2018; 20:1-206. [PMID: 27480813 DOI: 10.3310/hta20560] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Falls cause fear, anxiety and loss of confidence, resulting in activity avoidance, social isolation and increasing frailty. The umbrella term for these problems is 'fear of falling', seen in up to 85% of older adults who fall. Evidence of effectiveness of physical and psychological interventions is limited, with no previous studies examining the role of an individually delivered cognitive-behavioural therapy (CBT) approach. OBJECTIVES Primary objective To develop and then determine the effectiveness of a new CBT intervention (CBTi) delivered by health-care assistants (HCAs) plus usual care compared with usual care alone in reducing fear of falling. Secondary objectives To measure the impact of the intervention on falls, injuries, functional abilities, anxiety/depression, quality of life, social participation and loneliness; investigate the acceptability of the intervention for patients, family members and professionals and factors that promote or inhibit its implementation; and measure the costs and benefits of the intervention. DESIGN Phase I CBTi development. Phase II Parallel-group patient randomised controlled trial (RCT) of the new CBTi plus usual care compared with usual care alone. SETTING Multidisciplinary falls services. PARTICIPANTS Consecutive community-dwelling older adults, both sexes, aged ≥ 60 years, with excessive or undue fear of falling per Falls Efficacy Scale-International (FES-I) score of > 23. INTERVENTIONS Phase I Development of the CBTi. The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting. Phase II RCT. The CBTi was delivered by HCAs weekly for 8 weeks, with a 6-month booster session plus usual care. MAIN OUTCOME MEASURES These were assessed at baseline, 8 weeks, 6 months and 12 months. Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months. Secondary outcome measures These comprised falls, injuries, anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], quality of life, social participation, loneliness and measures of physical function. There were process and health-economic evaluations alongside the trial. RESULTS Four hundred and fifteen patients were recruited, with 210 patients randomised to CBTi group and 205 to the control group. There were significant reductions in mean FES-I [-4.02; 95% confidence interval (CI) -5.95 to -2.1], single-item numerical fear of falling scale (-1.42; 95% CI -1.87 to 1.07) and HADS (-1; 95% CI -1.6 to -0.3) scores at 12 months in the CBTi group compared with the usual care group. There were no differences in the other secondary outcome measures. Most patients found the CBTi acceptable. Factors affecting the delivery of the CBTi as part of routine practice were identified. There was no evidence that the intervention was cost-effective. CONCLUSIONS Our new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services. There was no impact on other measures. FURTHER WORK Further work should focus on a joint CBTi and physical training approach to fear of falling, more rational targeting of CBTi, the possibility of mixed group and individual CBTi, and the cost-effectiveness of provision of CBTi by non-specialists. TRIAL REGISTRATION Current Controlled Trials ISRCTN78396615. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 56. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steve W Parry
- Institute of Cellular Medicine, Newcastle University, c/o Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Vincent Deary
- Department of Health Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy L Finch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jo Gray
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Claire MacDonald
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Peter McMeekin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Neil J Sabin
- Department of Clinical Psychology, Newcastle Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - I Nick Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sue L Whitney
- Department of Otolaryngology, Pittsburgh University, Philadelphia, PA, USA
| | - Elaine M McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
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Palmer S, Cramp F, Clark E, Lewis R, Brookes S, Hollingworth W, Welton N, Thom H, Terry R, Rimes KA, Horwood J. The feasibility of a randomised controlled trial of physiotherapy for adults with joint hypermobility syndrome. Health Technol Assess 2018; 20:1-264. [PMID: 27365226 DOI: 10.3310/hta20470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) is a heritable disorder associated with laxity and pain in multiple joints. Physiotherapy is the mainstay of treatment, but there is little research investigating its clinical effectiveness. OBJECTIVES To develop a comprehensive physiotherapy intervention for adults with JHS; to pilot the intervention; and to conduct a pilot randomised controlled trial (RCT) to determine the feasibility of conducting a future definitive RCT. DESIGN Patients' and health professionals' perspectives on physiotherapy for JHS were explored in focus groups (stage 1). A working group of patient research partners, clinicians and researchers used this information to develop the physiotherapy intervention. This was piloted and refined on the basis of patients' and physiotherapists' feedback (stage 2). A parallel two-arm pilot RCT compared 'advice' with 'advice and physiotherapy' (stage 3). Random allocation was via an automated randomisation service, devised specifically for the study. Owing to the nature of the interventions, it was not possible to blind clinicians or patients to treatment allocation. SETTING Stage 1 - focus groups were conducted in four UK locations. Stages 2 and 3 - piloting of the intervention and the pilot RCT were conducted in two UK secondary care NHS trusts. PARTICIPANTS Stage 1 - patient focus group participants (n = 25, three men) were aged > 18 years, had a JHS diagnosis and had received physiotherapy within the preceding 12 months. The health professional focus group participants (n = 16, three men; 14 physiotherapists, two podiatrists) had experience of managing JHS. Stage 2 - patient participants (n = 8) were aged > 18 years, had a JHS diagnosis and no other musculoskeletal conditions causing pain. Stage 3 - patient participants for the pilot RCT (n = 29) were as for stage 2 but the lower age limit was 16 years. INTERVENTION For the pilot RCT (stage 3) the advice intervention was a one-off session, supplemented by advice booklets. All participants could ask questions specific to their circumstances and receive tailored advice. Participants were randomly allocated to 'advice' (no further advice or physiotherapy) or 'advice and physiotherapy' (an additional six 30-minute sessions over 4 months). The physiotherapy intervention was supported by a patient handbook and was delivered on a one-to-one patient-therapist basis. It aimed to increase patients' physical activity through developing knowledge, understanding and skills to better manage their condition. MAIN OUTCOME MEASURES Data from patient and health professional focus groups formed the main outcome from stage 1. Patient and physiotherapist interview data also formed a major component of stages 2 and 3. The primary outcome in stage 3 related to the feasibility of a future definitive RCT [number of referrals, recruitment and retention rates, and an estimate of the value of information (VOI) of a future RCT]. Secondary outcomes included clinical measures (physical function, pain, global status, self-reported joint count, quality of life, exercise self-efficacy and adverse events) and resource use (to estimate cost-effectiveness). Outcomes were recorded at baseline, 4 months and 7 months. RESULTS Stage 1 - JHS is complex and unpredictable. Physiotherapists should take a long-term holistic approach rather than treating acutely painful joints in isolation. Stage 2 - a user-informed physiotherapy intervention was developed and evaluated positively. Stage 3 - recruitment to the pilot RCT was challenging, primarily because of a perceived lack of equipoise between advice and physiotherapy. The qualitative evaluation provided very clear guidance to inform a future RCT, including enhancement of the advice intervention. Some patients reported that the advice intervention was useful and the physiotherapy intervention was again evaluated very positively. The rate of return of questionnaires was low in the advice group but reasonable in the physiotherapy group. The physiotherapy intervention showed evidence of promise in terms of primary and secondary clinical outcomes. The advice arm experienced more adverse events. The VOI analysis indicated the potential for high value from a future RCT. Such a trial should form the basis of future research efforts. CONCLUSION A future definitive RCT of physiotherapy for JHS seems feasible, although the advice intervention should be made more robust to address perceived equipoise and subsequent attrition. TRIAL REGISTRATION Current Controlled Trials ISRCTN29874209. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Shea Palmer
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Fiona Cramp
- Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Emma Clark
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | | | - Sara Brookes
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | | | - Nicky Welton
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Howard Thom
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Rohini Terry
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
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Oremus M, Sharafoddini A, Morgano GP, Jin X, Xie F. A Computer-Assisted Personal Interview App in Research Electronic Data Capture for Administering Time Trade-off Surveys (REDCap): Development and Pretest. JMIR Form Res 2018; 2:e3. [PMID: 30684429 PMCID: PMC6334703 DOI: 10.2196/formative.8202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality of life. Software apps exist to administer the TTO task; however, most of these apps are poorly documented and unavailable to researchers. Objective To fill the void, we developed an online app to administer the TTO task for a research study that is examining general public proxy health-related quality of life estimates for persons with Alzheimer’s disease. This manuscript describes the development and pretest of the app. Methods We used Research Electronic Data Capture (REDCap) to build the TTO app. The app’s modular structure and REDCap’s object-oriented environment facilitated development. After the TTO app was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease of use. Results Feedback from the pretest group was positive. Minor modifications included clarity enhancements, such as rearranging some paragraph text into bullet points, labeling the app to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease. Conclusions We developed an online app to administer the TTO task. Other researchers may access and customize the app for their own research purposes.
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Affiliation(s)
- Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Anis Sharafoddini
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Xuejing Jin
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Program for Health Economics and Outcome Measures, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Program for Health Economics and Outcome Measures, Hamilton, ON, Canada.,Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Chang SF, Lin PC, Yang RS, Yang RJ. The preliminary effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life among older people with sarcopenia. BMC Geriatr 2018; 18:17. [PMID: 29343219 PMCID: PMC5773163 DOI: 10.1186/s12877-018-0712-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/09/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies have shown that sarcopenia easily leads to difficulty moving, disability, and poor quality of life. However, researches on the use of whole-body vibration for older adults with sarcopenia living in institutions have been lacking. Therefore, the main objective of the present study was to investigate the effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life of older adults with sarcopenia living in institutions. METHODS This study adopted a quasi-experimental, single-group, pretest-posttest design. The whole-body vibration intervention was performed over a 3-month period, in which the older adults trained 3 times per week; each training lasted 60 s with a break of 30 s for 10 repetitions. The older adults' skeletal muscle mass index, physical fitness and quality of life before and after the intervention of the whole-body vibration was collected. Concerning the statistical methods adopted, nonparametric method-based tests were employed. RESULTS According to the results of analysis, after the intervention of the 12-week whole-body vibration, the skeletal muscle mass index (z = - 3.621, p = 0.000), physical fitness on standing on one foot (z = - 2.447, p = 0.014), shoulder-arm flexibility (z = - 3.159, p = 0.002), 8-ft up and go test (z = - 2.692, p = 0.009), hand grip strength (z = - 3.388, p = 0.009), and five repeated sit-to-stand tests (z = - 2.936, p = 0.003), all improved significantly. Furthermore, concerning the quality of life of the older adults in the pretest and posttest, the improvements were statistically significant (z = - 2.533, p = 0.011). CONCLUSIONS The study results showed the effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life of sarcopenic older people living in institutions and could serve as a crucial reference to health care professionals.
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Affiliation(s)
- Shu-Fang Chang
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming Te Road, Pei-Tou, Taipei, 112 Taiwan, Republic of China
| | - Pei-Chen Lin
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming Te Road, Pei-Tou, Taipei, 112 Taiwan, Republic of China
| | - Rong-Sen Yang
- Department of Orthopaedics, National Taiwan University & Hospital, No.7, Chung-Shan S. Rd, Taipei, Taiwan, Republic of China
| | - Rea-Jeng Yang
- Department of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming Te Rd., Peitou, Taipei City, 112 Taiwan, Republic of China
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Ragusa R, Bertino G, Bruno A, Frazzetto E, Cicciu F, Giorgianni G, Lupo L. Evaluation of health status in patients with hepatitis c treated with and without interferon. Health Qual Life Outcomes 2018; 16:17. [PMID: 29343250 PMCID: PMC5773186 DOI: 10.1186/s12955-018-0842-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/05/2018] [Indexed: 12/15/2022] Open
Abstract
Background The evolution of technology in healthcare has increased the health care’s costs and, the universal healthcare systems, in developed countries, need to ensure proper allocation of resources. Thus, the major issue is assessing the effectiveness of new medical technologies. The evaluation of quality of life in response to new treatments has become a key indicator in chronic conditions for which medical interventions are evaluated not only in terms of increasing the number of expected life years but also in terms of increasing quality of life. The aim of this observational study was to verify whether a simple instrument (EQ-5D-5 L) can capture variations in health-related quality of life (HRQoL) and allow us to evaluate the impact of different drug treatment protocols in patients with hepatitis C virus (HCV) on daily activities. Methods Sixty six patients with HCV were consecutively enrolled in the Hepatology Unit at the University Hospital of Catania “G. Rodolico”. Sixteen patients received new direct-acting-antiviral agents (DAAs) plus pegylated alpha interferon (Peg-α-IFN) protocol (Group A) and 50 DAAs IFN free protocol (Group B). The EQ-5D-5 L® questionnaire and visual analog scale (VAS) were given to both groups to calculate coefficient’s utility. We used the EQ-5D-5 L Crosswalk Index Value Calculator to obtain the utility EQIndex and both parametric and non parametric tests for the statistical analysis. Results The biopsy taken at the beginning of treatment showed comparable cell damage in both groups. The difference in the VAS results was negative for patients who received protocols containing IFN (indicating decreased quality of life),whereas it was positive in patients treated with IFN-free protocols. The baseline EQIndex did not reveal any differences between the two treatment groups. The post-treatment EQIndex was statistically better in the groups that received IFN-free therapy. Conclusions When innovative treatments are introduced into clinical practice, assessing quality of life is mandatory to determine their benefits. The instruments used in the present study are effective in detecting the areas in which improvement has occurred. These instruments can be easily managed by general practitioners for follow up of progression of the disease and referred to the specialist.
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Affiliation(s)
- R Ragusa
- Health Technology Assessment Committee, University Hospital "G. Rodolico", Via Rosso di San Secondo 3, 95128, Catania, Italy.
| | - G Bertino
- Hepatology Unit-Department of clinical and Experimental Medicine, University Hospital "G. Rodolico", Catania, Italy
| | - A Bruno
- Science of Health Professions Technical Diagnostic, University of Catania, Catania, Italy
| | - E Frazzetto
- School of Specialization in Internal Medicine, University of Catania, Catania, Italy
| | - F Cicciu
- School of Specialization in Hygiene, University of Catania, Catania, Italy
| | - G Giorgianni
- School of Specialization in Hygiene, University of Catania, Catania, Italy
| | - L Lupo
- Medical Statistic - Department of Medical and Surgical Sciences and advanced technologies, University of Catania, Catania, Italy
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121
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Eneqvist T, Nemes S, Bülow E, Mohaddes M, Rolfson O. Can patient-reported outcomes predict re-operations after total hip replacement? INTERNATIONAL ORTHOPAEDICS 2018; 42:273-279. [PMID: 29299650 DOI: 10.1007/s00264-017-3711-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We investigated if patient-reported outcomes (PROMs) one year after total hip replacement (THR) can predict the risk of re-operation using data from the Swedish Hip Arthroplasty Register. METHODS A total of 75,899 patients with THR due to osteoarthritis operated in 2002-2014 were included. We used Kaplan-Meier and Cox regression to investigate the relationship between one-year post-operative PROMs and risk of re-operation (all types of further hip surgery). The predictive power of the model and post-operative PROMs were evaluated by concordance index (C). RESULTS Kaplan-Meier estimates for not being re-operated at eight years was 95.5% (95%CI; 95.3-95.8). Cox regression analyses showed that all PROMs, except for EQ-VAS, were associated with re-operation. The full model had a concordance index of 0.68. Satisfaction (C = 0.65) and pain (C = 0.65) in isolation had the highest predictive power. CONCLUSIONS Worse PROMs predicted higher risk of re-operation. Therefore, we believe PROMs may be helpful in identifying patients at risk for re-operation and timely address their problems.
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Affiliation(s)
- Ted Eneqvist
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden. .,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Szilárd Nemes
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Bülow
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Sågbladsgatan 11, 41680, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Cramer P, Fraser G, Santucci-Silva R, Grosicki S, Dilhuydy MS, Janssens A, Loscertales J, Rule S, Goy A, Traina S, Chan EKH, Diels J, Sengupta N, Mahler M, Salman M, Howes A, Chanan-Khan A. Improvement of fatigue, physical functioning, and well-being among patients with severe impairment at baseline receiving ibrutinib in combination with bendamustine and rituximab for relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma in the HELIOS study. Leuk Lymphoma 2018; 59:2075-2084. [DOI: 10.1080/10428194.2017.1416364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Graeme Fraser
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Ann Janssens
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Javier Loscertales
- Hematology Department, Hospital Universitario La Princesa, IIS-IP, Madrid, Spain
| | - Simon Rule
- Plymouth University Medical School, Plymouth, UK
| | - Andre Goy
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Joris Diels
- Janssen EU HEMAR Statistics & Modelling, Beerse, Belgium
| | | | | | | | - Angela Howes
- Janssen Research & Development, High Wycombe, UK
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Feng Y, Devlin NJ, Shah KK, Mulhern B, van Hout B. New methods for modelling EQ-5D-5L value sets: An application to English data. HEALTH ECONOMICS 2018. [PMID: 28833854 DOI: 10.1002/hec.3560/full] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Value sets for the EQ-5D-5L are required to facilitate its use in estimating quality-adjusted life years. An international protocol has been developed to guide the collection of stated preference data for this purpose and has been used to generate EQ-5D-5L valuation data for England. The aim of this paper is report the innovative methods used for modelling those data to obtain a value set. Nine hundred and ninety-six members of the English general public completed time trade-off (TTO) and discrete choice experiment (DCE) tasks. We estimate models, with and without interactions, using DCE data only, TTO data only, and TTO/DCE data combined. TTO data are interpreted as both left and right censored. Heteroskedasticity and preference heterogeneity between individuals are accounted for. We use Bayesian methods in the econometric analysis. The final model is chosen based on the deviance information criterion (DIC). Censoring and taking account of heteroskedasticity have important effects on parameter estimation. For DCE data only, TTO data only, and DCE/TTO data combined, models with parameters for all dimensions and levels perform best, as judged by the DIC. Taking account of heterogeneity improves fit, and the multinomial model reports the lowest DIC. This paper presents approaches that suit observed characteristics of EQ-5D-5L valuation data and recognise respondents' preference heterogeneity. The methods described are potentially relevant to other value set studies.
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Affiliation(s)
- Yan Feng
- Office of Health Economics, London, UK
| | - Nancy J Devlin
- Office of Health Economics, London, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Brendan Mulhern
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Ben van Hout
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Feng Y, Devlin NJ, Shah KK, Mulhern B, van Hout B. New methods for modelling EQ-5D-5L value sets: An application to English data. HEALTH ECONOMICS 2018; 27:23-38. [PMID: 28833854 PMCID: PMC5836982 DOI: 10.1002/hec.3560] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 03/25/2017] [Accepted: 06/23/2017] [Indexed: 05/19/2023]
Abstract
Value sets for the EQ-5D-5L are required to facilitate its use in estimating quality-adjusted life years. An international protocol has been developed to guide the collection of stated preference data for this purpose and has been used to generate EQ-5D-5L valuation data for England. The aim of this paper is report the innovative methods used for modelling those data to obtain a value set. Nine hundred and ninety-six members of the English general public completed time trade-off (TTO) and discrete choice experiment (DCE) tasks. We estimate models, with and without interactions, using DCE data only, TTO data only, and TTO/DCE data combined. TTO data are interpreted as both left and right censored. Heteroskedasticity and preference heterogeneity between individuals are accounted for. We use Bayesian methods in the econometric analysis. The final model is chosen based on the deviance information criterion (DIC). Censoring and taking account of heteroskedasticity have important effects on parameter estimation. For DCE data only, TTO data only, and DCE/TTO data combined, models with parameters for all dimensions and levels perform best, as judged by the DIC. Taking account of heterogeneity improves fit, and the multinomial model reports the lowest DIC. This paper presents approaches that suit observed characteristics of EQ-5D-5L valuation data and recognise respondents' preference heterogeneity. The methods described are potentially relevant to other value set studies.
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Affiliation(s)
- Yan Feng
- Office of Health EconomicsLondonUK
| | - Nancy J. Devlin
- Office of Health EconomicsLondonUK
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Brendan Mulhern
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
- Centre for Health Economics Research and EvaluationUniversity of Technology SydneySydneyNSWAustralia
| | - Ben van Hout
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Kempton CL, Recht M, Neff A, Wang M, Buckner TW, Soni A, Quon D, Witkop M, Boggio L, Gut RZ, Cooper DL. Impact of pain and functional impairment in US adults with haemophilia: Patient-reported outcomes and musculoskeletal evaluation in the pain, functional impairment and quality of life (P-FiQ) study. Haemophilia 2017; 24:261-270. [DOI: 10.1111/hae.13377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - M. Recht
- Oregon Health & Science University; Portland OR USA
| | - A. Neff
- Cleveland Clinic; Cleveland OH USA
| | - M. Wang
- University of Colorado School of Medicine; Aurora CO USA
| | - T. W. Buckner
- University of Colorado School of Medicine; Aurora CO USA
| | - A. Soni
- Center for Inherited Blood Disorders; CHOC Children's Hospital/UC Irvine; Orange CA USA
| | - D. Quon
- Orthopaedic Hemophilia Treatment Center; Orthopaedic Institute for Children; Los Angeles CA USA
| | - M. Witkop
- Munson Medical Center; Traverse City MI USA
| | - L. Boggio
- Rush University Medical Center; Chicago IL USA
| | - R. Z. Gut
- Novo Nordisk Inc.; Plainsboro NJ USA
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Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L in psoriasis patients. Qual Life Res 2017; 26:3409-3419. [DOI: 10.1007/s11136-017-1699-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 01/04/2023]
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Endarti D, Riewpaiboon A, Thavorncharoensap M, Praditsitthikorn N, Hutubessy R, Kristina SA. A Comparison of EQ-5D-3L Index Scores Using Malaysian, Singaporean, Thai, and UK Value Sets in Indonesian Cervical Cancer Patients. Value Health Reg Issues 2017; 15:50-55. [PMID: 29474178 DOI: 10.1016/j.vhri.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To gain insight into the most suitable foreign value set among Malaysian, Singaporean, Thai, and UK value sets for calculating the EuroQol five-dimensional questionnaire index score (utility) among patients with cervical cancer in Indonesia. METHODS Data from 87 patients with cervical cancer recruited from a referral hospital in Yogyakarta province, Indonesia, from an earlier study of health-related quality of life were used in this study. The differences among the utility scores derived from the four value sets were determined using the Friedman test. Performance of the psychometric properties of the four value sets versus visual analogue scale (VAS) was assessed. Intraclass correlation coefficients and Bland-Altman plots were used to test the agreement among the utility scores. Spearman ρ correlation coefficients were used to assess convergent validity between utility scores and patients' sociodemographic and clinical characteristics. With respect to known-group validity, the Kruskal-Wallis test was used to examine the differences in utility according to the stages of cancer. RESULTS There was significant difference among utility scores derived from the four value sets, among which the Malaysian value set yielded higher utility than the other three value sets. Utility obtained from the Malaysian value set had more agreements with VAS than the other value sets versus VAS (intraclass correlation coefficients and Bland-Altman plot tests results). As for the validity, the four value sets showed equivalent psychometric properties as those that resulted from convergent and known-group validity tests. CONCLUSIONS In the absence of an Indonesian value set, the Malaysian value set was more preferable to be used compared with the other value sets. Further studies on the development of an Indonesian value set need to be conducted.
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Affiliation(s)
- Dwi Endarti
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Naiyana Praditsitthikorn
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Bangkok, Thailand; Bureau of AIDS, TB and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia
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Ricco JB, Illuminati G, Belmonte R. [Resection of recurrent neck cancers with replacement of the carotid artery]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:282-289. [PMID: 28964387 DOI: 10.1016/j.jdmv.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/14/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The management of patients with recurrent neck cancer invading the carotid artery is controversial. The aim of this study was to evaluate the overall survival and healthy survival years (QALY) as well as the patency of carotid revascularization after enbloc tumor resection followed by complementary radiotherapy. METHODS From 2000 to 2016, 42 consecutive patients with recurrent neck cancer invading the carotid artery underwent resection of the tumor associated with reconstruction of the carotid artery with a PTFE prosthesis (n=31) or with a saphenous vein graft (n=11). In 11 cases, resection was associated with musculocutaneous flap coverage. The primary tumor was a squamous cell carcinoma of the larynx (20 patients) or of the pharynx (9 patients), undifferentiated carcinoma of unknown origin (10 patients) and anaplastic thyroid carcinoma (3 patients). All patients had postoperative radiotherapy (50-70Gy) supplemented in 16 of them by chemotherapy. Nine patients had metastatic dissemination at the time of reoperation with a recurrent tumor ulcerated to the skin in 5 of them. RESULTS The combined 30-day mortality and stroke rate was nil. Postoperative morbidity included dysphagia (n=8), vocal cord paralysis (n=6), late wound healing delay (n=2), transient mandibular claudication (n=1) and partial necrosis of the musculocutaneous flap (n=1). No infection and no thrombosis of the bypass were observed during follow-up [median: 31 months, range: 8-167 months]. Twenty-one patients (50%) died from the consequences of the spread of cancer, which had become metastatic, but without local recurrence. The 5-year survival rate was 50.9±8.3%. The median healthy survival year (QALY) was 3.38 [95% CI: 1.70-4.54] with a significant difference between patients without metastasis at the time of reoperation [n=33; QALY=4.02] and those with metastases [n=9; QALY=0.43; P=0.005]. Healthy life expectancy was also significantly longer in patients with laryngeal cancer [n=20, QALY=4.95] compared to patients with other types of tumors [n=22, QALY=1.67; P=0.032]. CONCLUSION In the absence of metastases, enbloc resection of recurrent neck cancers invading the carotid artery improves the duration and quality of patient survival.
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Affiliation(s)
- J-B Ricco
- Service de chirurgie vasculaire, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
| | - G Illuminati
- Metodologia Chirurgica di Interesse Vascolare, Universita degli Studi di Roma "La Sapienza", Dipartimento di Scienze Chirurgiche, Viale del Policlinico, 00161 Roma, Italie
| | - R Belmonte
- Service de chirurgie vasculaire, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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Abstract
PURPOSE The EuroQol 5-Dimension (EQ-5D) is a widely used health status instrument for cost-utility analysis of healthcare interventions. Recently, its 5-Level version (EQ-5D-5L) and a protocol for conducting valuation of its health states were developed. We propose four approaches for estimating the sample size for EQ-5D-5L valuation according to the standardized procedures of the protocol. METHODS The first approach is for estimating mean health state utility values with a desired precision level using a regression model. The second approach, empirical in nature, determines a sample size based on mean absolute error in predicting health state values using a large-scale reference study. The last two approaches are for assessing the significance of regression coefficients of health state descriptors and to estimate the regression coefficients with a desired precision for predicting health state utility values. RESULTS Using data from a Singaporean study, we estimated parameters that are useful for sample size determination, including the design effect. Each of the approaches was illustrated with examples and pragmatic recommendations were provided. CONCLUSIONS Capitalizing on the EQ-5D-5L valuation protocol, we proposed four sample size estimation approaches which can help to decide an appropriate sample size for a value set study.
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Abstract
Supplemental Digital Content is available in the text. Background: The EQ-5D instrument is the most widely used preference-based health-related quality of life questionnaire in cost-effectiveness analysis of health care technologies. Recently, a version called EQ-5D-5L with 5 levels on each dimension was developed. This manuscript explores the performance of a hybrid approach for the modeling of EQ-5D-5L valuation data. Methods: Two elicitation techniques, the composite time trade-off, and discrete choice experiments, were applied to a sample of the Spanish population (n=1000) using a computer-based questionnaire. The sampling process consisted of 2 stages: stratified sampling of geographic area, followed by systematic sampling in each area. A hybrid regression model combining composite time trade-off and discrete choice data was used to estimate the potential value sets using main effects as starting point. The comparison between the models was performed using the criteria of logical consistency, goodness of fit, and parsimony. Results: Twenty-seven participants from the 1000 were removed following the exclusion criteria. The best-fitted model included 2 significant interaction terms but resulted in marginal improvements in model fit compared to the main effects model. We therefore selected the model results with main effects as a potential value set for this methodological study, based on the parsimony criteria. The results showed that the main effects hybrid model was consistent, with a range of utility values between 1 and −0.224. Conclusion: This paper shows the feasibility of using a hybrid approach to estimate a value set for EQ-5D-5L valuation data.
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Including Health Economic Analysis in Pilot Studies: Lessons Learned from a Cost-Utility Analysis within the PROSPECTIV Pilot Study. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2017. [DOI: 10.5301/grhta.5000269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kotecha D, Calvert M, Deeks JJ, Griffith M, Kirchhof P, Lip GY, Mehta S, Slinn G, Stanbury M, Steeds RP, Townend JN. A review of rate control in atrial fibrillation, and the rationale and protocol for the RATE-AF trial. BMJ Open 2017; 7:e015099. [PMID: 28729311 PMCID: PMC5588987 DOI: 10.1136/bmjopen-2016-015099] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/29/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Atrial fibrillation (AF) is common and causes impaired quality of life, an increased risk of stroke and death as well as frequent hospital admissions. The majority of patients with AF require control of heart rate. In this article , we summarise the limited evidence from clinical trials that guides prescription, and present the rationale and protocol for a new randomised trial. As rate control has not yet been shown to reduce mortality, there is a clear need to compare the impact of therapy on quality of life, cardiac function and exercise capacity. Such a trial should concentrate on the long-term effects of treatment in the largest proportion of patients with AF, those with symptomatic permanent AF, with the aim of improving patient well-being. DESIGN AND INTERVENTION The RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial will enrol 160 participants with a prospective, randomised, open-label, blinded end point design comparing initial rate control with digoxin or bisoprolol. This will be the first head-to-head randomised trial of digoxin and beta-blockers in AF. PARTICIPANTS Recruited patients will be aged ≥60 years with permanent AF and symptoms of breathlessness (equivalent to New York Heart Association class II or above), with few exclusion criteria to maximise generalisability to routine clinical practice. OUTCOME MEASURES The primary outcome is patient-reported quality of life, with secondary outcomes including echocardiographic ventricular function, exercise capacity and biomarkers of cellular and clinical response. Follow-up will occur at 6 and 12 months, with feasibility components to inform the design of a future trial powered to detect a difference in hospital admission. The RATE-AF trial will underpin an integrated approach to management including biomarkers, functions and symptoms that will guide future research into optimal, personalised rate control in patients with AF. ETHICS AND DISSEMINATION East Midlands-Derby Research Ethics Committee (16/EM/0178); peer-reviewed publications. TRIAL REGISTRATION Clinicaltrials.gov: NCT02391337; ISRCTN: 95259705. Pre-results.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
- Cardiology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Michael Griffith
- Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
- Cardiology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Gregory Yh Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Samir Mehta
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gemma Slinn
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Mary Stanbury
- (Lead for the Patient and Public Involvement panel), Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
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133
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Smith BE, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Selfe J, Smith TO, Logan P. Study protocol: a mixed methods feasibility study for a loaded self-managed exercise programme for patellofemoral pain. Pilot Feasibility Stud 2017; 4:24. [PMID: 28748107 PMCID: PMC5520346 DOI: 10.1186/s40814-017-0167-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patellofemoral pain (PFP) is one of the most common forms of knee pain in adults under the age of 40, with a prevalence of 23% in the general population. The long-term prognosis is poor, with only one third of people pain-free 1 year after diagnosis. The biomedical model of pain in relation to persistent PFP has recently been called into question. It has been suggested that interventions for chronic musculoskeletal conditions should consider alternative mechanisms of action, beyond muscles and joints. Modern treatment therapies should consider desensitising strategies, with exercises that target movements and activities patients find fearful and painful. High-quality research on exercise prescription in relation to pain mechanisms, not directed at specific tissue pathology, and dose response clearly warrants further investigation. Our primary aim is to establish the feasibility and acceptability of conducting a definitive RCT which will evaluate the clinical and cost-effectiveness of a loaded self-managed exercise programme for people with patellofemoral pain. Method This is a single-centred, multiphase, sequential, mixed-methods trial that will evaluate the feasibility of running a definitive large-scale randomised controlled trial of a loaded self-managed exercise programme versus usual physiotherapy. Initially, 8–10 participants with a minimum 3-month history of PFP will be recruited from an NHS physiotherapy waiting list and interviewed. Participants will be invited to discuss perceived barriers and facilitators to exercise engagement, and the meaning and impact of PFP. Then, 60 participants will be recruited in the same manner for the main phase of the feasibility trial. A web-based service will randomise patients to a loaded self-managed exercise programme or usual physiotherapy. The loaded self-managed exercise programme is aimed at addressing lower limb knee and hip weakness and is positioned within a framework of reducing fear/avoidance with an emphasis on self-management. Baseline assessment will include demographic data, average pain within the last week (VAS), fear avoidance behaviours, catastrophising, self-efficacy, sport and leisure activity participation, and general quality of life. Follow-up will be 3 and 6 months. The analysis will focus on descriptive statistics and confidence intervals. The qualitative components will follow a thematic analysis approach. Discussion This study will evaluate the feasibility of running a definitive large-scale trial on patients with patellofemoral pain, within the NHS in the UK. We will identify strengths and weaknesses of the proposed protocol and the utility and characteristics of the outcome measures. The results from this study will inform the design of a multicentre trial. Trial registration ISRCTN35272486.
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Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK.,Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department (Level 3), London Road Community Hospital, Derby, DE1 2QY UK
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, UK
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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134
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Ó Céilleachair A, O'Mahony JF, O'Connor M, O'Leary J, Normand C, Martin C, Sharp L. Health-related quality of life as measured by the EQ-5D in the prevention, screening and management of cervical disease: A systematic review. Qual Life Res 2017; 26:2885-2897. [PMID: 28653217 DOI: 10.1007/s11136-017-1628-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Cost-effectiveness analyses (CEAs) of screening can be highly sensitive to the health-related quality of life (HRQoL) effects of screen tests and subsequent treatment. Accordingly, accurate assessment of HRQoL is essential. We reviewed the literature regarding HRQoL in cervical prevention and management in order to appraise the current evidence regarding this important input to CEA. METHODS We searched the MEDLINE, Scopus and EconLit databases for studies that estimated HRQoL in cervical cancer prevention and management published January 1995-December 2015. The primary inclusion criterion was for studies that assess HRQoL using the EQ-5D. Data were abstracted from eligible studies on setting, elicitation group, sample size, elicitation instruments, health state valuations, study design and follow-up. We assessed the quality and comparability of the studies with a particular focus on the HRQoL reported across states and groups. RESULTS Fifteen papers met the inclusion criteria. Most used patient elicitation groups (n = 11), 2 used the general public and 2 used a mix of both. Eight studies were cross-sectional and seven were longitudinal. Six studies used both the EQ-5D-3L and the EQ-VAS together with other measures of overall HRQoL or condition-specific instruments. Extensive heterogeneity was observed across study characteristics. CONCLUSIONS Our results reveal the challenges of sourcing reliable estimates of HRQoL for use in CEAs of cervical cancer prevention and treatment. The EQ-5D appears insufficiently sensitive for some health states. A more general problem is the paucity of HRQoL estimates for many health states and their change over time.
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Affiliation(s)
- A Ó Céilleachair
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland.
| | - J F O'Mahony
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | - M O'Connor
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland
| | - J O'Leary
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - C Normand
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | - C Martin
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - L Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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135
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Carroll AE, Saha C, Ofner S, Downs SM. Valuing health for oneself versus one's child or elderly parent. J Health Psychol 2017; 24:1965-1975. [PMID: 28810465 DOI: 10.1177/1359105317712574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to determine if adults value health states or are willing to accept risk differently for themselves than for their children or elderly parents. Participants (701) were asked to rate four hypothetical health states for themselves using both the standard gamble and time trade-off methodologies. They then did the same assessments for a real or hypothetical child as well as an elderly parent. Participants were willing to take more risk or trade more years of life to avoid bilateral vision loss and mental impairment for themselves than they were for their children and elderly parents.
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136
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Petrou S, Kim SW, McParland P, Boyle EM. Mode of Delivery and Long-Term Health-Related Quality-of-Life Outcomes: A Prospective Population-Based Study. Birth 2017; 44:110-119. [PMID: 27862265 DOI: 10.1111/birt.12268] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Relatively little is known about the effects of mode of delivery on long-term health-related quality-of-life outcomes. Furthermore, no previous study has expressed these outcomes in preference-based (utility) metrics. METHODS The study population comprised 2,161 mothers recruited from a prospective population-based study in the East Midlands of England encompassing live births and stillbirths between 32+0 and 36+6 weeks' gestation and a sample of term-born controls. Perinatal data were extracted from the mothers' maternity records. Health-related quality-of-life outcomes were assessed at 12 months postpartum, using the EuroQol Five Dimensions (EQ-5D) measure with responses to the EQ-5D descriptive system converted into health utility scores. Descriptive statistics and multivariable analyses were used to estimate the relationship between the mode of delivery and health-related quality-of-life outcomes. RESULTS The overall health-related quality-of-life profile of the women in the study cohort mirrored that of the English adult population as revealed by national health surveys. A significantly higher proportion of women delivering by cesarean delivery reported some, moderate, severe, or extreme pain or discomfort at 12 months postpartum than women undergoing spontaneous vaginal delivery. Multivariable analyses, using the Ordinary Least Squares estimator revealed that, after controlling for maternal sociodemographic characteristics, cesarean delivery without maternal or fetal compromise was associated with a significant EQ-5D utility decrement in comparison to spontaneous vaginal delivery among all women (-0.026; p = 0.038) and among mothers of term-born infants (-0.062; p < 0.001). Among mothers of term-born infants, this result was replicated in models that controlled for all maternal and infant characteristics (utility decrement of -0.061; p < 0.001). The results were confirmed by sensitivity analyses that varied the categorization of the main exposure variable (mode of delivery) and the econometric strategy. CONCLUSIONS Among mothers of term-born infants, cesarean delivery without maternal or fetal compromise is associated with poorer long-term health-related quality of life in comparison to spontaneous vaginal delivery. Further longitudinal studies are needed to understand the magnitude, trajectory, and underpinning mechanisms of health-related quality-of-life outcomes following different modes of delivery.
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137
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Wapenaar M, Patel AS, Birring SS, Domburg RTV, Bakker EW, Vindigni V, Sköld CM, Cottin V, Vancheri C, Wijsenbeek MS. Translation and validation of the King's Brief Interstitial Lung Disease (K-BILD) questionnaire in French, Italian, Swedish, and Dutch. Chron Respir Dis 2017; 14:140-150. [PMID: 28019103 PMCID: PMC5720224 DOI: 10.1177/1479972316674425] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
No disease-specific instruments exist in Dutch, French, Italian, and Swedish to measure health status in idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs). The King's Brief Interstitial Lung Disease (K-BILD) is a 15-item validated questionnaire assessing health status in patients with ILD. The aim of this study was to translate and validate the K-BILD to French, Italian, Swedish, and Dutch versions. The K-BILD was translated following a forward-backward multistep procedure and tested in structured patient interviews. Subsequently, 195 outpatients with ILD were asked to complete K-BILD, St. George's Respiratory Questionnaire (SGRQ), and Euroqol EQ-5D-5L (EQ5D), twice, 2 weeks apart. Internal consistency, concurrent validity, and repeatability were determined. No major difficulties occurred in the translation processes. The K-BILD was considered comprehensible and relevant by patients. One hundred seventy-six patients (108 IPF and 68 other ILDs) completed the translated K-BILD. Internal consistency was good for all K-BILD modules (Cronbach's α 0.70-0.93). Concurrent validity of K-BILD was strong compared with SGRQ ( r = -0.86) and EQ5D ( r = 0.68), low with transfer capacity of the lung for carbon monoxide corrected for hemoglobin ( r = 0.33) and with forced vital capacity ( r = 0.35). The K-BILD and its domains were repeatable over 2 weeks; intraclass correlation coefficients were 0.86-0.93 ( n = 159). Known groups validity showed K-BILD was able to discriminate between patients based on severity of disease. K-BILD's validity and reliability for patients with IPF was similar to that of other ILDs. The French, Italian, Swedish, and Dutch translated K-BILD questionnaires were well-received by patients and demonstrated excellent validity comparable to the original English K-BILD.
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Affiliation(s)
- Monique Wapenaar
- 1 Department of Pulmonary Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Amit S Patel
- 2 Department of Respiratory Medicine, King's College Hospital, London, UK
| | - Surinder S Birring
- 3 Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Ron T van Domburg
- 4 Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Eric Wp Bakker
- 5 Division Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Virginia Vindigni
- 6 Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - C Magnus Sköld
- 7 Karolinska Institute, Department of Medicine Solna and Centre for Molecular Medicine, Respiratory Medicine Unit, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Vincent Cottin
- 8 Department of Respiratory Medicine, Louis Pradel Hospital, Lyon 1 University, Lyon, France
| | - Carlo Vancheri
- 6 Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Marlies S Wijsenbeek
- 1 Department of Pulmonary Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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138
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van Manen MJ, van 't Spijker A, Tak NC, Baars CT, Jongenotter SM, van Roon LR, Kraan J, Hoogsteden HC, Wijsenbeek MS. Patient and partner empowerment programme for idiopathic pulmonary fibrosis. Eur Respir J 2017; 49:49/4/1601596. [DOI: 10.1183/13993003.01596-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/15/2017] [Indexed: 11/05/2022]
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139
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Forster A, Airlie J, Birch K, Cicero R, Cundill B, Ellwood A, Godfrey M, Graham L, Green J, Hulme C, Lawton R, McLellan V, McMaster N, Farrin A. Research Exploring Physical Activity in Care Homes (REACH): study protocol for a randomised controlled trial. Trials 2017; 18:182. [PMID: 28424088 PMCID: PMC5395795 DOI: 10.1186/s13063-017-1921-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background As life expectancy increases and the number of older people, particularly those aged 85 years and over, expands there is an increase in demand for long-term care. A large proportion of people in a care home setting spend most of their time sedentary, and this is one of the leading preventable causes of death. Encouraging residents to engage in more physical activity could deliver benefits in terms of physical and psychological health, and quality of life. This study is the final stage of a programme of research to develop and preliminarily test an evidence-based intervention designed to enhance opportunities for movement amongst care home residents, thereby increasing levels of physical activity. Methods/design This is a cluster randomised feasibility trial, aiming to recruit at least 8–12 residents at each of 12 residential care homes across Yorkshire, UK. Care homes will be randomly allocated on a 1:1 basis to receive either the intervention alongside usual care, or to continue to provide usual care alone. Assessment will be undertaken with participating residents at baseline (prior to care home randomisation) and at 3, 6, and 9 months post-randomisation. Data relating to changes in physical activity, physical function, level of cognitive impairment, mood, perceived health and wellbeing, and quality of life will be collected. Data at the level of the home will also be collected and will include staff experience of care, and changes in the numbers and types of adverse events residents experience (for example, hospital admissions, falls). Details of National Health Service (NHS) usage will be collected to inform the economic analysis. An embedded process evaluation will obtain information to test out the theory of change underpinning the intervention and its acceptability to staff and residents. Discussion This feasibility trial with embedded process evaluation and collection of health economic data will allow us to undertake detailed feasibility work to inform a future large-scale trial. It will provide valuable information to inform research procedures in this important but challenging area. Trial registration ISRCTN registry, ISRCTN16076575. Registered on 25 June 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1921-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK.
| | - Jennifer Airlie
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK.,School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Karen Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Robert Cicero
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Bonnie Cundill
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Alison Ellwood
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust and University of Leeds, Bradford, UK
| | - Liz Graham
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - John Green
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Vicki McLellan
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Nicola McMaster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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140
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Rood J, Nauta I, Witte B, Stam F, van Zuuren F, Manenschijn A, Huijgens P, Verdonck-de Leeuw I, Zweegman S. Shared decision-making and providing information among newly diagnosed patients with hematological malignancies and their informal caregivers: Not “one-size-fits-all”. Psychooncology 2017; 26:2040-2047. [DOI: 10.1002/pon.4414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 12/18/2022]
Affiliation(s)
- J.A.J. Rood
- Department of Hematology; VU University Medical Center; Amsterdam the Netherlands
- Department of Internal medicine; Northwest Clinics; Alkmaar the Netherlands
| | - I.H. Nauta
- Department of Hematology; VU University Medical Center; Amsterdam the Netherlands
| | - B.I. Witte
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam the Netherlands
| | - F. Stam
- Department of Internal medicine; Northwest Clinics; Alkmaar the Netherlands
| | - F.J. van Zuuren
- Department of Clinical Psychology; University of Amsterdam; Amsterdam the Netherlands
| | - A. Manenschijn
- Department of Internal Medicine; Isala; Zwolle the Netherlands
| | - P.C. Huijgens
- Department of Hematology; VU University Medical Center; Amsterdam the Netherlands
| | - I.M. Verdonck-de Leeuw
- Department of Clinical Psychology; VU University Medical Center; Amsterdam the Netherlands
| | - S. Zweegman
- Department of Hematology; VU University Medical Center; Amsterdam the Netherlands
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141
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Sullivan FM, Farmer E, Mair FS, Treweek S, Kendrick D, Jackson C, Robertson C, Briggs A, McCowan C, Bedford L, Young B, Vedhara K, Gallant S, Littleford R, Robertson J, Sewell H, Dorward A, Sarvesvaran J, Schembri S. Detection in blood of autoantibodies to tumour antigens as a case-finding method in lung cancer using the EarlyCDT®-Lung Test (ECLS): study protocol for a randomized controlled trial. BMC Cancer 2017; 17:187. [PMID: 28284200 PMCID: PMC5346215 DOI: 10.1186/s12885-017-3175-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer is the most common cause of cancer related death worldwide. The majority of cases are detected at a late stage when prognosis is poor. The EarlyCDT®-Lung Test detects autoantibodies to abnormal cell surface proteins in the earliest stages of the disease which may allow tumour detection at an earlier stage thus altering prognosis. The primary research question is: Does using the EarlyCDT®-Lung Test to identify those at high risk of lung cancer, followed by X-ray and computed tomography (CT) scanning, reduce the incidence of patients with late-stage lung cancer (III & IV) or unclassified presentation (U) at diagnosis, compared to standard practice? METHODS A randomised controlled trial of 12 000 participants in areas of Scotland targeting general practices serving patients in the most deprived quintile of the Scottish Index of Multiple Deprivation. Adults aged 50-75 who are at high risk of lung cancer and healthy enough to undergo potentially curative therapy (Performance Status 0-2) are eligible to participate. The intervention is the EarlyCDT®-Lung Test, followed by X-ray and CT in those with a positive result. The comparator is standard clinical practice in the UK. The primary outcome is the difference, after 24 months, between the rates of patients with stage III, IV or unclassified lung cancer at diagnosis. The secondary outcomes include: all-cause mortality; disease specific mortality; a range of morbidity outcomes; cost-effectiveness and measures examining the psychological and behavioural consequences of screening. Participants with a positive test result but for whom the CT scan does not lead to a lung cancer diagnosis will be offered 6 monthly thoracic CTs for 24 months. An initial chest X-ray will be used to determine the speed and the need for contrast in the first screening CT. Participants who are found to have lung cancer will be followed-up to assess both time to diagnosis and stage of disease at diagnosis. DISCUSSION The study will determine the clinical and cost effectiveness of EarlyCDT®-Lung Test for early lung cancer detection and assess its suitability for a large-scale, accredited screening service. The study will also assess the potential psychological and behavioural harms arising from false positive or false negative results, as well as the potential benefits to patients of true negative EarlyCDT lung test results. A cost-effectiveness model of lung cancer screening based on the results of the EarlyCDT Lung Test study will be developed. TRIAL REGISTRATION NCT01925625 . August 19, 2013.
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Affiliation(s)
- F. M. Sullivan
- Gordon F. Cheesbrough Research Chair & Director of UTOPIAN, Department of Family and Community Medicine University of Toronto, North York General Hospital, 4001 Leslie St LE140, Toronto, ON M2K 1E1 Canada
| | - Eoghan Farmer
- School of Medicine,, St Andrews University, St Andrews, UK
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Denise Kendrick
- School of Medicine, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK
| | - Cathy Jackson
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH UK
| | - Andrew Briggs
- Health Economics & Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Laura Bedford
- School of Medicine, Division of Primary Care, Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Ben Young
- School of Medicine, Division of Primary Care, Medical School, Queen’s Medical Centre, Nottingham, UK
| | - Kavita Vedhara
- School of Medicine, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK
| | - Stephanie Gallant
- Clinical Trial Manager, Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Roberta Littleford
- Senior Clinical Trial Manager, Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - John Robertson
- Graduate Entry Medicine & Health School (GEMS), University of Nottingham, Royal Derby Hospital, Nottingham, UK
| | - Herb Sewell
- Division of Immunology, School of Life Sciences, Queens Medical Centre, Nottingham, UK
| | | | - Joseph Sarvesvaran
- The Queen Elizabeth University Hospital Glasgow, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Stuart Schembri
- Consultant Respiratory Physician, Ninewells Hospital, Dundee, UK
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142
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Eom K, Penkunas MJ, Chan AWM. Effect of caregiving relationship and formal long-term care service use on caregiver well-being. Geriatr Gerontol Int 2017; 17:1714-1721. [PMID: 28276179 DOI: 10.1111/ggi.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/13/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
AIM Despite efforts to revise the traditional long-term care (LTC) model, informal caregivers continue to provide a substantial amount of support to older adults as front-line care providers. The present study aimed to understand the effect of informal caregiving on caregivers' well-being in Singapore with respect to different types of patient-caregiver relationships. Second, this study examined the association between formal LTC service use and caregivers' well-being. METHODS Two waves of data for 781 dyads of patients with LTC needs and their caregivers from a longitudinal study were analyzed. Multilevel regression models were used to examine the association between caregivers' well-being (self-rated general health, stress level and quality of life) and LTC service use among different patient-caregiver relationships. RESULTS Spousal caregivers reported significantly lower quality of life compared with adult children caregivers. Non-immediate family caregivers showed better overall well-being compared with spouse and adult children caregivers. Caregivers of patients referred to nursing homes reported higher levels of stress and poorer self-rated general health compared with caregivers of patients referred to community-based services. Spouse and non-immediate family caregivers of patients who utilized nursing home or home-based services presented poorer self-rated general health than caregivers of the patients who did not use any formal services. CONCLUSIONS Developing a better understanding of the associations between well-being and formal LTC service use for different types of patient-caregiver relationships is critical for policy makers and healthcare providers who aim to create holistic systems of care. Geriatr Gerontol Int 2017; 17: 1714-1721.
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Affiliation(s)
- Kirsten Eom
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Michael J Penkunas
- Center for Aging Research and Education, Duke-NUS Medical School, Singapore
| | - Angelique W M Chan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Center for Aging Research and Education, Duke-NUS Medical School, Singapore.,Department of Sociology, National University of Singapore, Singapore
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143
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Ramos-Goñi JM, Oppe M, Slaap B, Busschbach JJV, Stolk E. Quality Control Process for EQ-5D-5L Valuation Studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:466-473. [PMID: 28292492 DOI: 10.1016/j.jval.2016.10.012] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/07/2016] [Accepted: 10/16/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND The values of the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are elicited using composite time trade-off and discrete choice experiments. Unfortunately, data quality issues and interviewer effects were observed in the first few EQ-5D-5L valuation studies. To prevent these issues from occurring in later studies, the EuroQol Group established a cyclic quality control (QC) process. OBJECTIVES To describe this QC process and show its impact on data quality. METHODS A newly developed QC tool provided information about protocol compliance, interviewer effects, and mean values by health state severity. In a cyclic process, this information is initially used to evaluate whether new interviewers meet minimal quality requirements and later to provide feedback about how their performance may be improved. To investigate the impact of this cyclic process, we compared the quality of the data in Dutch and Spanish valuation studies that did not have this QC process with that in the follow-up studies in the same countries that used the QC process. Data quality was measured using protocol violations, variability between interviewers, the proportion of inconsistent responders, and clustering of composite time trade-off values. RESULTS In Spain, protocol violations were reduced from 87% in the valuation study to 5% in the follow-up study and in the Netherlands from 20% to 8%. In both countries, interviewers performed more homogeneously in the follow-up studies. The number of inconsistent respondents was reduced by 23.2% in Spain and 23.6% in the Netherlands. Values were less clustered in the follow-up studies. CONCLUSIONS The implementation of a strict QC process in EQ-5D-5L valuation studies increases interviewer protocol compliance and promotes data quality.
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Affiliation(s)
- Juan M Ramos-Goñi
- Executive Office, EuroQol Research Foundation, Rotterdam, The Netherlands.
| | - Mark Oppe
- Executive Office, EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Bernhard Slaap
- Executive Office, EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Jan J V Busschbach
- Section of Medical Psychology, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Elly Stolk
- Executive Office, EuroQol Research Foundation, Rotterdam, The Netherlands; Institute for Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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144
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Knott RJ, Black N, Hollingsworth B, Lorgelly PK. Response-Scale Heterogeneity in the EQ-5D. HEALTH ECONOMICS 2017; 26:387-394. [PMID: 26756822 DOI: 10.1002/hec.3313] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/03/2015] [Accepted: 12/08/2015] [Indexed: 06/05/2023]
Abstract
This paper discusses two types of response-scale heterogeneity, which may impact upon the EQ-5D. Response-scale heterogeneity in reporting occurs when individuals systematically differ in their use of response scales when responding to self-assessments. This type of heterogeneity is widely observed in relation to other self-assessed measures but is often overlooked with regard to the EQ-5D. Analogous to this, preference elicitation involving the EQ-5D could be subject to a similar type of heterogeneity, where variations across respondents may occur in the interpretations of the levels (response categories) being valued. This response-scale heterogeneity in preference elicitation may differ from variations in preferences for health states, which have been observed in the literature. This paper explores what these forms of response-scale heterogeneity may mean for the EQ-5D and the potential implications for researchers who rely on the instrument as a measure of health and quality of life. We identify situations where they are likely to be problematic and present potential avenues for overcoming these issues. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rachel J Knott
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Nicole Black
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | | | - Paula K Lorgelly
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
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Ludwig K, von der Schulenburg JMG, Greiner W. Valuation of the EQ-5D-5L with composite time trade-off for the German population - an exploratory study. Health Qual Life Outcomes 2017; 15:39. [PMID: 28219389 PMCID: PMC5319015 DOI: 10.1186/s12955-017-0617-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 02/09/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The EuroQol Group has extended the severity levels of the EQ-5D from three to five (EQ-5D-5L). There are valuation studies worldwide planned in order to convert the EQ-5D-5L health states into a single preference-based summary score based on country-specific value sets of social health status preference valuations. The EuroQol Group developed an internationally standardised EQ-5D-5L valuation protocol. Based on the experiences of the first wave of valuation studies applying the protocol, a number of modifications to the implementation of composite time trade-off (cTTO) were proposed and tested in an exploratory study in Germany. METHODS The aim of the study is to test the improved EQ-5D-5L valuation protocol 1.1 and the implementation of three modifications: (1) introduction of ranking task, (2) separating time trade-off (TTO) tasks for health states "Better Than Dead"(BTD)/"Worse Than Dead" (WTD), (3) allow for removal of problematic valuations from the cTTO data (the feedback module). Data were collected in computer assisted personal interviews with 200 members of the German general public. RESULTS In comparison to the first wave of valuation studies a higher data quality can be observed in both study arms: increasing number of WTD valuations, reduced inconsistencies for health state 55555 as well as higher values for mild health states. Comparing both study arms, mean observed cTTO value for severity 6 is higher in the test arm. The proportion of inconsistent cTTO responses is lower in the test arm than in the control arm and is further reduced by the feedback module. The ranking task prolongs the interview without the desired effect. CONCLUSIONS Both study arms yielded higher data quality in comparison to the first wave of EQ-5D-5L valuation studies. The valuation protocol combined with an intensive interviewer training and close data monitoring showed a high feasibility and acceptability to the respondents of the general population as well as the interviewers in Germany. Based on the results of this study and other countries, the separation of TTO tasks for health states BTD/WTD and the feedback module will be implemented in the valuation study for the EQ-5D-5L for Germany.
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Affiliation(s)
- Kristina Ludwig
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, Germany.
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Straße 1, 30159, Hannover, Germany.
| | | | - Wolfgang Greiner
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, Germany
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Mitchell PM, Al-Janabi H, Byford S, Kuyken W, Richardson J, Iezzi A, Coast J. Assessing the validity of the ICECAP-A capability measure for adults with depression. BMC Psychiatry 2017; 17:46. [PMID: 28148234 PMCID: PMC5289054 DOI: 10.1186/s12888-017-1211-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effectiveness and cost-effectiveness are increasingly important considerations in determining which mental health services are funded. Questions have been raised concerning the validity of generic health status instruments used in economic evaluation for assessing mental health problems such as depression; measuring capability wellbeing offers a possible alternative. The aim of this study is to assess the validity of the ICECAP-A capability instrument for individuals with depression. METHODS Hypotheses were developed using concept mapping. Validity tests and multivariable regression analysis were applied to data from a cross-sectional dataset to assess the performance of ICECAP-A in individuals who reported having a primary condition of depression. The ICECAP-A was collected alongside instruments used to measure: 1. depression using the depression scale of the Depression, Anxiety and Stress Scale (DASS-D of DASS-21); 2. mental health using the Kessler Psychological Distress Scale (K10); 3. generic health status using a common measure collected for use in economic evaluations, the five level version of EQ-5D (EQ-5D-5L). RESULTS Hypothesised associations between the ICECAP-A (items and index scores) and depression constructs were fully supported in statistical tests. In the multivariable analysis, instruments designed specifically to measure depression and mental health explained a greater proportion of the variation in ICECAP-A than the EQ-5D-5L. CONCLUSION The ICECAP-A instrument appears to be suitable for assessing outcome in adults with depression for resource allocation purposes. Further research is required on its responsiveness and use in economic evaluation. Using a capability perspective when assessing cost-effectiveness could potentially re-orientate resource provision across physical and mental health care services.
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Affiliation(s)
- Paul Mark Mitchell
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, UK ,0000 0004 0380 7336grid.410421.2The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,0000 0004 0417 1173grid.416201.0UK Renal Registry, Southmead Hospital Bristol, Bristol, UK
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Sarah Byford
- 0000 0001 2322 6764grid.13097.3cKing’s Health Economics, King’s College London, London, UK
| | - Willem Kuyken
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jeff Richardson
- 0000 0004 1936 7857grid.1002.3Centre for Health Economics, Monash University, Melbourne, Australia
| | - Angelo Iezzi
- 0000 0004 1936 7857grid.1002.3Centre for Health Economics, Monash University, Melbourne, Australia
| | - Joanna Coast
- 0000 0004 1936 7603grid.5337.2School of Social and Community Medicine, University of Bristol, Bristol, UK ,0000 0004 0380 7336grid.410421.2The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Abstract
INTRODUCTION The new, five-level version of the EQ-5D (EQ-5D-5L) questionnaire has better psychometric properties than the standard three-level version (EQ-5D-3L), including a reduced ceiling effect. Currently, there are few existing population norms for the EQ-5D-5L. The aims of this study were to provide population norms for the EQ-5D-5L in Poland, based on a representative sample of adults, and to compare those with norms from other countries. MATERIAL AND METHODS Members of the general public, selected through multistage stratified sampling, filled in paper-and-pencil EQ-5D-5L questionnaires in the presence of an interviewer. EQ-5D-5L index values were estimated using an interim value set, based on a crosswalk methodology. Descriptive statistics were calculated for the EQ-5D-5L index. The distribution of answers was obtained for the descriptive part of the EQ-5D-5L. RESULTS The sample was representative of the Polish population in terms of age, gender, geographical region, education, and socio-professional group. Population norms were developed based on 3963 questionnaires with no missing data. At least one slight, moderate, severe, and extreme health limitation was reported by 61.5%, 31.1%, 12.4%, and 1.6% of the respondents, respectively. Polish society is characterized by poorer health, as compared to its direct neighbor, Germany, especially with regard to the individuals' perception of pain, as well as anxiety and depression. CONCLUSIONS Polish population norms for the EQ-5D-5L should encourage clinicians, economists, and policymakers in Poland to use this questionnaire on a broader scale.
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Affiliation(s)
- Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Hansen TB, Zwisler AD, Berg SK, Sibilitz KL, Thygesen LC, Kjellberg J, Doherty P, Oldridge N, Søgaard R. Cost–utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care. Eur J Prev Cardiol 2017; 24:698-707. [DOI: 10.1177/2047487317689908] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Dorthe Zwisler
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Centre for Rehabilitation and Palliative Care, University of Southern Denmark and University Hospital of Odense, Odense, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine Lærum Sibilitz
- The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jakob Kjellberg
- National Institute for Regional and Local Government Research, Copenhagen, Denmark
| | | | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Liu Y, Vollmer T, Havrdova E, Riester K, Lee A, Phillips G, Wang P, Sabatella G. Impact of daclizumab versus interferon beta-1a on patient-reported outcomes in relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2017; 11:18-24. [DOI: 10.1016/j.msard.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/07/2016] [Accepted: 11/10/2016] [Indexed: 12/21/2022]
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Lange R, Beckmann A, Neumann T, Krane M, Deutsch MA, Landwehr S, Kötting J, Welz A, Zahn R, Cremer J, Figulla HR, Schuler G, Holzhey DM, Funkat AK, Heusch G, Sack S, Pasic M, Meinertz T, Walther T, Kuck KH, Beyersdorf F, Böhm M, Möllmann H, Hamm CW, Mohr FW. Quality of Life After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2016; 9:2541-2554. [DOI: 10.1016/j.jcin.2016.09.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
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