251
|
Chen ML, Lin CC, Rosenthal LS, Opal P, Kuo SH. Rating scales and biomarkers for CAG-repeat spinocerebellar ataxias: Implications for therapy development. J Neurol Sci 2021; 424:117417. [PMID: 33836316 DOI: 10.1016/j.jns.2021.117417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 01/18/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a group of dominantly-inherited cerebellar ataxias, among which CAG expansion-related SCAs are most common. These diseases have very high penetrance with defined disease progression, and emerging therapies are being developed to provide either symptomatic or disease-modifying benefits. In clinical trial design, it is crucial to incorporate biomarkers to test target engagement or track disease progression in response to therapies, especially in rare diseases such as SCAs. In this article, we review the available rating scales and recent advances of biomarkers in CAG-repeat SCAs. We divided biomarkers into neuroimaging, body fluid, and physiological studies. Understanding the utility of each biomarker will facilitate the design of robust clinical trials to advance therapies for SCAs.
Collapse
Affiliation(s)
- Meng-Ling Chen
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Chih-Chun Lin
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Puneet Opal
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Cellular and Molecular Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA.
| |
Collapse
|
252
|
Chan SWW, Chien CW, Wong AYL, Pang MYC. Translation and psychometric validation of the traditional Chinese version of patient-reported outcomes measurement information system Pediatric-25 Profile version 2.0 (PROMIS-25) in Chinese Children with Cancer in Hong Kong. Qual Life Res 2021; 30:1779-1791. [PMID: 33770335 DOI: 10.1007/s11136-021-02759-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To translate and cross-cultural validate the PROMIS Pediatric-25 Profile 2.0 (PROMIS-25) into traditional Chinese, and to investigate its psychometric properties in children with cancer in Hong Kong. METHODS The Functional Assessment of Chronic Illness Therapy translation methodology was adopted in this study. Three panel members evaluated the semantic equivalence and content validity. The psychometric properties were tested with 103 children with cancer (10-18 years). Internal consistency and structural validity were examined by Cronbach's alpha and Rasch analysis. Convergent and divergent validity were assessed by correlating it with traditional Chinese pediatric quality of life inventory™ 4.0 domains (traditional Chinese PedsQL™ 4.0), traditional Chinese Health Questionnaire-9 (C-PHQ-9), and the numeric pain rating scale (NPRS). RESULTS The semantic equivalence score and content validity index were both 100%. All domains indicated good internal consistency (α = 0.83-0.88) and unidimensionality (variance explained > 55.5% and 1st contrast eigenvalues < 2.0). All items showed good item fit (0.6-1.4). For convergent validity, the traditional Chinese PROMIS-25 domains demonstrated moderate-to-large correlations with traditional Chinese PedsQL™ 4.0 domains (r ≥ ± 0.69), C-PHQ-9 Item-4 and total score (r = 0.75-0.80), except NPRS (r = 0.44). For divergent validity, traditional Chinese PROMIS-25 had low correlations with traditional Chinese PedsQL™ 4.0 domains (r < ± 0.21), C-PHQ-9 item-4 (r = 0.3), and NPRS (r = - 0.12). The traditional Chinese PROMIS-25 fatigue domain was weakly correlated with NPRS (r = 0.39). CONCLUSION The traditional Chinese PROMIS-25 is semantically and conceptually like the original PROMIS-25 with satisfactory internal consistency, structural validity, and construct validity.
Collapse
Affiliation(s)
- Stephen W W Chan
- Allied Health Department (Physiotherapy), Hong Kong Children's Hospital, HKSAR, China.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, HKSAR, China
| | - C W Chien
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, HKSAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, HKSAR, China.
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, HKSAR, China
| |
Collapse
|
253
|
Weiss J, Goldschmidt J, Andric Z, Dragnev KH, Gwaltney C, Skaltsa K, Pritchett Y, Antal JM, Morris SR, Daniel D. Effects of Trilaciclib on Chemotherapy-Induced Myelosuppression and Patient-Reported Outcomes in Patients with Extensive-Stage Small Cell Lung Cancer: Pooled Results from Three Phase II Randomized, Double-Blind, Placebo-Controlled Studies. Clin Lung Cancer 2021; 22:449-460. [PMID: 33895103 DOI: 10.1016/j.cllc.2021.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chemotherapy-induced myelosuppression (CIM) and its sequalae cause significant side effects and harm to quality of life. Trilaciclib is an intravenous CDK4/6 inhibitor that is administered prior to chemotherapy to protect hematopoietic stem and progenitor cells from chemotherapy-induced damage (myeloprotection). PATIENTS AND METHODS Data from three randomized, double-blind, placebo-controlled studies (NCT02499770, NCT03041311, and NCT02514447) were pooled to evaluate the effects of trilaciclib administered prior to standard-of-care chemotherapy (first-line etoposide plus carboplatin [E/P], first-line E/P plus atezolizumab, and second-/third-line topotecan) in patients with extensive-stage small cell lung cancer (ES-SCLC). The primary endpoints were duration of severe neutropenia (absolute neutrophil count < 0.5 × 109 cells/L) in cycle 1 and occurrence of severe neutropenia. Additional prespecified endpoints further assessed the effect of trilaciclib on myeloprotection, health-related quality of life (HRQoL), antitumor efficacy, and safety. RESULTS Of 242 randomized patients, 123 received trilaciclib and 119 received placebo. Compared with placebo, administration of trilaciclib prior to chemotherapy resulted in significant decreases in most measures of multilineage CIM. The reduction in hematologic toxicity translated into the reduced need for supportive care interventions and hospitalizations due to CIM or sepsis and improvements in HRQoL domains related to the protected cell lineages, including fatigue, physical wellbeing, and functional wellbeing. Antitumor efficacy was similar for patients receiving trilaciclib or placebo. CONCLUSION Administering trilaciclib prior to chemotherapy resulted in clinically meaningful reductions in CIM and its consequences and improved patient HRQoL, with no impact on the antitumor efficacy of three individual chemotherapy regimens used in the first- or second-/third-line treatment of ES-SCLC.
Collapse
Affiliation(s)
- Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
| | | | - Zoran Andric
- University Hospital Medical Center Bezanijska Kosa, Bezanijska Kosa, Belgrade, Serbia
| | | | | | | | | | | | | | - Davey Daniel
- Sarah Cannon Research Institute, Nashville, TN; Chattanooga Oncology Hematology Associates, Chattanooga, TN
| |
Collapse
|
254
|
Scheepers ERM, van Huis-Tanja LH, Emmelot-Vonk MH, Hamaker ME. Study objectives in clinical trials in older patients with solid malignancies: do we measure what matters? Qual Life Res 2021; 30:1833-1839. [PMID: 33704648 DOI: 10.1007/s11136-021-02791-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We set out to determine study objectives of clinical trials which included older patients with the four most common malignancies, to assess the extent to which the inclusion of patient-related outcomes (PROs) has changed over the last fifteen years. METHOD A search of the National Institutes of Health clinical trial registry was performed to identify currently recruiting or completed phase II or III clinical trials started between 2005 and 2020, which addressed chemotherapy or immunotherapy in patients aged > 65 years with the four most common solid malignancies. Trial characteristics and study objectives were extracted from the registry website. RESULTS Compared to disease- and treatment-related outcomes, PROs were the least measured outcomes. Of the 1,663 trials, PROs were addressed in only 21% of all trials, in which quality of life as primary objective was found in less than 1% of all trials. Compared to all trials, trials exclusively for older patients addressed more often PROs (respectively, 30% vs 21%, p < 0.001). Over the last fifteen years, there was an incremental trend in the reporting of PROs from 17 to 24% of all trials (p = 0.007). CONCLUSION Despite a slight incremental trend over the past 15 years, PROs appear to be underrepresented in clinical trials which include patients with a solid malignancy. In order to provide physicians and older patients with cancer realistic information about the impact of chemo- or immunotherapy on quality of life or functioning, researchers should strongly consider including PROs in their future clinical trials.
Collapse
Affiliation(s)
- E R M Scheepers
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, Postbus, 80250, 3508 TG, The Netherlands.
| | - L H van Huis-Tanja
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, Postbus, 80250, 3508 TG, The Netherlands
| | - M H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| |
Collapse
|
255
|
Health-related quality of life in the randomized phase III trial of brigatinib vs crizotinib in advanced ALK inhibitor-naive ALK + non-small cell lung cancer (ALTA-1L). Lung Cancer 2021; 155:68-77. [PMID: 33744781 DOI: 10.1016/j.lungcan.2021.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/29/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In ALTA-1 L, first-line brigatinib versus crizotinib significantly prolonged progression-free survival in advanced ALK-positive (ALK+) non-small cell lung cancer (NSCLC). We report health-related quality of life (HRQOL) outcomes from ALTA-1 L. MATERIALS AND METHODS HRQOL was assessed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and lung cancer-specific module (QLQ-LC13). HRQOL time to worsening, change from baseline, and duration of improvement were analyzed. RESULTS EORTC QLQ-C30 and QLQ-LC13 compliance was >90 % for both groups (n = 131 each). Brigatinib versus crizotinib significantly delayed time to worsening in the EORTC QLQ-C30 global health status (GHS)/QOL (median: 26.74 vs 8.31 months; hazard ratio [HR]: 0.70; 95 % CI: 0.49, 1.00; log-rank P = 0.0485); emotional functioning, social functioning, fatigue, nausea and vomiting, appetite loss, and constipation scales (log-rank P < 0.05); delays in time to worsening for the physical, role, and cognitive functioning scales were not statistically significant. Mean change from baseline showed greater improvement in GHS/QOL and most EORTC QLQ-C30 functional and symptom scales with brigatinib versus crizotinib. Among patients with GHS/QOL improvement, brigatinib had longer duration of improvement versus crizotinib (median: not reached vs 11.99 months); similar results were seen in the physical, role, emotional, and social functioning; fatigue; nausea and vomiting; and appetite loss scales. Median time to worsening in dyspnea (QLQ-LC13) was 23.98 versus 8.25 months (brigatinib vs crizotinib; HR: 0.64; 95 % CI: 0.39, 1.05). CONCLUSION Brigatinib significantly delayed time to worsening and prolonged duration of improvement in GHS/QOL versus crizotinib, supported by improvement in functional and symptom scores. These preliminary analyses suggest brigatinib is the first ALK inhibitor with better HRQOL versus another ALK inhibitor in ALK inhibitor-naive advanced ALK + NSCLC.
Collapse
|
256
|
Advancements and critical steps for statistical analyses in blood pressure response to resistance training in hypertensive older women: a methodological approach. Blood Press Monit 2021; 26:135-145. [PMID: 33394597 DOI: 10.1097/mbp.0000000000000505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Repeated measures analysis of covariance and three-way analysis of variance with repeated measures are common statistical methods. For a valid interpretation of blood pressure (BP) response to exercise, a variety of additional statistical methods must be implemented. Four additional statistical methods are presented: technical error of measurement (SEM), smallest real difference (SRD), magnitude-based inference and mixed effect modeling technique (MEM). The aim of this perspective article is to demonstrate how to apply already known statistical analyses regarding BP responsiveness in order to improve interpretation and achieve higher reliability for future studies in exercise science. METHODS A total of 27 hypertensive older women (aged 68.37 ± 5.55 years) participated in the present study. A whole-body resistance training (RT) program was performed on two nonconsecutive days per week for 10 weeks. BP was monitored during the 10-week RT intervention and after 15 weeks of detraining. First, individuals were classified as high and low responders, then statistical methods to analyze data included the use of SEM, SRD, magnitude-based inference and MEM. RESULTS When magnitude-based inference was used to classify responsiveness, most participants displayed a trivial response. Decrements in SBP between 1 and 10 mmHg were not clinically meaningful but fell within the measurement error of the SBP measurements. Baseline SBP and time of training predicted post-SBP response. CONCLUSION Changes over time and declines in SBP might not be a SRD and fell in the SEM. Moreover, SBP responsiveness was the result of inappropriate control of covariates such as period of training.
Collapse
|
257
|
Parewa M, Burman AS, Brahma A, Rutten L, Sadhukhan S, Misra P, Gupta B, Saklani N, Michael J, Basu A, Ali SS, Koley M, Saha S. Individualized Homeopathic Medicines in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled, Pilot Trial. Complement Med Res 2021; 28:407-418. [PMID: 33662951 DOI: 10.1159/000514524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evidence favoring homeopathy in generalized anxiety disorder (GAD) remains scarce. The objective of this pilot trial was to test feasibility of a definitive trial in future. We also experimented whether individualized homeopathic medicines (IH) plus psychological counseling (PC) can produce significantly different effects beyond placebo plus PC in the treatment of GAD. METHODS A double-blind, randomized, placebo-controlled, parallel arm, pilot trial was conducted on 62 GAD patients at the National Institute of Homoeopathy, India. GAD-7 questionnaire and Hamilton Anxiety Scale (HAM-A) were used as the primary and secondary outcomes, respectively, measured at baseline and 3 months. Patients received either IH plus PC (n = 31) or identical-looking placebo plus PC (n = 31). Intention-to-treat sample was analyzed to detect group differences using unpaired t tests. RESULTS Recruitment and retention rates were 56 and 90%, respectively. Mean age was 31.5 years; 56.5% were male. GAD-7 reductions were non-significantly higher in IH than placebo (p = 0.122). Group differences on HAM-A favored IH significantly (p = 0.018). Effect sizes were small to medium. Calcarea carbonica was the most frequently indicated medicine. No serious adverse events happened. CONCLUSIONS A small but positive direction of anxiolytic effect was observed favoring homeopathy over placebo. A definitive trial appeared feasible in future.
Collapse
Affiliation(s)
- Maneet Parewa
- Department of Repertory, National Institute of Homoeopathy, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India,
| | - Avijit Shee Burman
- Department of Forensic Medicine and Toxicology, National Institute of Homoeopathy, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Arabinda Brahma
- Consultant Psychiatrist, Kolkata Police Hospital and Bharat Sevasram Sangha Hospital, Kolkata, India
| | - Lex Rutten
- Independent Researcher, VHAN, Dutch Association of Homeopathic Physicians, Breda, The Netherlands
| | - Satarupa Sadhukhan
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Pankhuri Misra
- Department of Materia Medica, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Bharti Gupta
- Department of Pediatrics, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Nitin Saklani
- Department of Repertory, National Institute of Homoeopathy, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - James Michael
- Department of Organon of Medicine and Homoeopathic Philosophy, National Institute of Homoeopathy, Ministry of AYUSH, Government of India, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Kolkata, India
| | - Anamika Basu
- House Staff, Mahesh Bhattacharyya Homoeopathic Medical College & Hospital, Government of West Bengal, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Howrah, India
| | - Sk Swaif Ali
- House Staff, Mahesh Bhattacharyya Homoeopathic Medical College & Hospital, Government of West Bengal, affiliated to The West Bengal University of Health Sciences, Government of West Bengal, Howrah, India
| | | | | |
Collapse
|
258
|
Nordqvist SF, Boesen VB, Rasmussen ÅK, Feldt-Rasmussen U, Hegedüs L, Bonnema SJ, Cramon PK, Watt T, Groenvold M, Bjorner JB. Determining minimal important change for the thyroid-related quality of life questionnaire ThyPRO. Endocr Connect 2021; 10:316-324. [PMID: 33617467 PMCID: PMC8052573 DOI: 10.1530/ec-21-0026] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/10/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE ThyPRO is the standard thyroid patient-reported outcome (PRO). The change in scores that patients perceive as important remains to be ascertained. The purpose of this study was to determine values for minimal important change (MIC) for ThyPRO. METHODS A total of 435 patients treated for benign thyroid diseases completed ThyPRO at baseline and 6 weeks following treatment initiation. At 6 weeks follow-up, patients also completed Global Rating of Change items. For each 0-100 scale, two MIC values were identified: An MIC for groups, using the receiver operating characteristic (ROC) curve method and an MIC for individual patients, using the Reliable Change Index. RESULTS ROC analyses provided group-MIC estimates of 6.3-14.3 (score range 0-100). Evaluation of area under the curve (AUC) supported the robustness for 9 of 14 scales (AUC > 0.7). Reliable Change Index estimates of individual-MIC were 8.0-21.1. For all scales but two, the individual-MIC values were larger than the group-MIC values. CONCLUSIONS Interpretability of ThyPRO was improved by the establishment of MIC values, which was 6.3-14.3 for groups and 8.0-21.1 for individuals. Thus, estimates of which changes are clinically relevant, are now available for future studies. We recommend using MIC values found by ROC analyses to evaluate changes in groups of patients, whereas MIC values identified by a dual criterion, including the reliability of changes, should be used for individual patients, for example, to identify individual responders in clinical studies or practice.
Collapse
Affiliation(s)
- Selma Flora Nordqvist
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Victor Brun Boesen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Per Karkov Cramon
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Torquil Watt
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Herlev Gentofte Hospital, Copenhagen, Denmark
- Correspondence should be addressed to T Watt:
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- National Research Centre for the Working Environment, Copenhagen, Denmark
- QualityMetric Incorporated, LLC, Johnston, Rhode Island, USA
| |
Collapse
|
259
|
Health-related quality of life of people living with HIV/AIDS: the role of social inequalities and disease-related factors. Health Qual Life Outcomes 2021; 19:63. [PMID: 33632270 PMCID: PMC7905594 DOI: 10.1186/s12955-021-01702-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 02/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background Health-related quality of life (HRQoL) serves as a direct measure of individuals’ health, life expectancy and the impact that the utilization of health care has on quality of life. The purpose of this study is to assess the HRQoL of people living with HIV (PLHIV), and to ascertain its association with the social inequalities and clinical determinants among people living with HIV in Benishangul Gumuz Regional State, Ethiopia. Methods A cross-sectional study was conducted between December 2016 and February 2017; 390 people at two referral hospitals and three health centers participated in the study. The Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS Global 10) was used to measure key HRQoL domains. Global Physical Health (GPH) and Global Mental Health (GPH) summary scores were employed. GPH and GMH summary scores below 50 (the standardized mean score) were determined as poor HRQoL. Bivariate and multivariate logistic regression analyses were used to identify factors associated with GPH and GMH summary scores. Results This study included 259 (66.4%) females and 131 (33.6%) males. The GPH summary scores ranged from 16.2 to 67.7 with a mean of 48.8 (SD = 8.9). Almost 44.6% of the study population has a GPH summary score of below 50; the GMH summary scores ranged from 28.4 to 67.6 with a mean of 50.8 (SD = 8.1). About 41.8% of the study population has a GMH summary score of below 50. Unemployment, household food insecurity and comorbidities with HIV were associated with both poor GPH and poor GMH summary scores. Age below 25 years and being a member of Christian fellowship were inversely associated with poor GPH. The least wealth index score and CD4 count below 350 cells/mL were also associated with poor GMH. Conclusion Overall, socioeconomic inequalities and HIV-related clinical factors play an important role in improving the HRQoL of PLHIV. Many of these determinants are alterable risk factors. Appropriate strategies can improve the holistic management of chronic HIV care and maximize PLHIVs’ HRQoL. Such strategies require the adoption of comprehensive interventions, including policies and programmes that would improve the health, wellbeing and livelihood of PLHIV.
Collapse
|
260
|
Harbeck N, Schneeweiss A, Thuss-Patience P, Miller K, Garbe C, Griesinger F, Eberhardt WEE, Klussmann JP, Wollenberg B, Grimm MO, Zander T, Lüftner D. Neoadjuvant and adjuvant end-points in health technology assessment in oncology. Eur J Cancer 2021; 147:40-50. [PMID: 33611103 DOI: 10.1016/j.ejca.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
Health technology assessment (HTA) of clinical and economic value of a new intervention is an integral step in providing the access of patients to innovative cancer care and treatment. Overall survival (OS) is the preferred criterion for demonstrating the therapeutic efficacy in HTA given its direct clinical and patient relevance. However, with often long life expectancy of patients with early cancer, analysis of OS becomes less practical. Partially due to this reason, pathological complete response (pCR) and time-to-event end-points like disease-free survival are frequently incorporated into the pivotal clinical trials in the neoadjuvant and adjuvant settings. However, there exists a discrepancy between different national HTA bodies regarding the acknowledgement of patient relevance of these end-points. In this article, we analysed the perspectives of patients on different aspects of end-points used in clinical trials in early cancer. Gathered evidence strongly suggests that complete tumour eradication and reduced risk of recurrence provide important psychological benefits thus signifying that pCR and time-to-event end-points are directly relevant to patients. Additionally, we reviewed opinions on patient relevance of neoadjuvant and adjuvant therapy end-points adopted by HTA bodies during the recent evaluations. We found that improvements in end-points used in the adjuvant setting were commonly considered as valuable to patients. In contrast, opinions on patient relevance of neoadjuvant therapy end-points varied between the national HTA bodies. Universal acknowledgement of patient relevance of therapeutic end-points for early cancer by HTA bodies is necessary to balance the inequality in uptake of innovative therapies into national healthcare systems.
Collapse
Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center, University of Munich (LMU), 81377 Munich, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division of Gynecologic Oncology, University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany
| | - Peter Thuss-Patience
- Department of Hematology, Oncology and Tumor Immunology, Campus Virchow-Klinikum, Charité University Hospital Berlin, 12203 Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité University Hospital Berlin, 12203 Berlin, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital, University Department Internal Medicine-Oncology, University of Oldenburg, 26121 Oldenburg, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Jens P Klussmann
- Department of Otolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, University Hospital MRI, Technical University Munich, 81675 Munich, Germany
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Zander
- Department of Internal Medicine I, University Hospital Cologne, 50924 Cologne, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumour Immunology, Charité Campus Benjamin Franklin, University Medicine Berlin, 12200 Berlin, Germany.
| |
Collapse
|
261
|
Garassino MC, Paz-Ares L, Hui R, Faivre-Finn C, Spira A, Planchard D, Özgüroğlu M, Daniel D, Vicente D, Murakami S, Langer C, Senan S, Spigel D, Rydén A, Zhang Y, O'Brien C, Dennis PA, Antonia SJ. Patient-reported outcomes with durvalumab by PD-L1 expression and prior chemoradiotherapy-related variables in unresectable stage III non-small-cell lung cancer. Future Oncol 2021; 17:1165-1184. [PMID: 33583206 DOI: 10.2217/fon-2020-1102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: We retrospectively investigated the impact of tumor PD-L1 expression and prior chemoradiotherapy (CRT)-related variables on patient-reported outcomes (PROs) from PACIFIC. Patients & methods: PACIFIC was a Phase III study of durvalumab versus placebo after CRT in patients with unresectable, stage III non-small-cell lung cancer. If available, pre-CRT tumor tissue was tested for PD-L1 tumor-cell expression, scored at prespecified (25%) and post-hoc (1%) cut-offs. PROs were assessed using EORTC QLQ C30/-LC13. Results: Similar to the intent-to-treat (ITT) population, most PROs remained stable over time across PD-L1 and CRT subgroups, with few clinically relevant differences between treatment arms. Time to deterioration was generally similar to the ITT population. Conclusion: Neither PD-L1 expression nor prior CRT-related variables influenced PROs with durvalumab therapy. Clinical trial registration: NCT02125461 (ClinicalTrials.gov).
Collapse
Affiliation(s)
| | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense & CNIO, Madrid, 28041, Spain
| | - Rina Hui
- Westmead Hospital & the University of Sydney, Sydney, NSW, 2145, Australia
| | - Corinne Faivre-Finn
- The University of Manchester & The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Alex Spira
- Virginia Cancer Specialists Research Institute, Fairfax, VA, & US Oncology Research, The Woodlands, TX 22031, USA
| | - David Planchard
- Institut Gustave Roussy, Department of Medical Oncology, Thoracic Group, Villejuif, 94805, France
| | - Mustafa Özgüroğlu
- Istanbul University - Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, 34320, Turkey
| | - Davey Daniel
- Sarah Cannon Research Institute/Tennessee Oncology, Chattanooga, TN 37203, USA
| | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, 41009, Spain
| | | | - Corey Langer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, 1081, The Netherlands
| | - David Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN 3720231, USA
| | | | | | | | | | - Scott J Antonia
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| |
Collapse
|
262
|
Jarmoszewicz K, Nowicka-Sauer K, Wera K, Meslin-Kuźniak A, Beta S, Pietrzykowska M. Predictors of patient-reported health following cardiac surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:278-285. [PMID: 33565744 DOI: 10.23736/s0021-9509.21.11452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patient-reported health status is one of the most important aspects of cardiovascular outcomes. The aim of this study was to assess patient-reported health and its determinants following cardiac surgery. METHODS Cross-sectional study was performed among 128 patients (mean age: 66.02; 35.9% women). Three months after surgery patients filled in The Short Form 12 Health Survey (SF-12) and Brief-Illness Perception Questionnaire (B-IPQ). Patient-reported health was assessed using SF-12 General Health component. RESULTS The mean General Health score was 47.34 (SD=20.94). General Health was significantly positively correlated with SF-12 Physical and Mental Component Summary (P<0.01). Significant negative correlations were noted between General Health and European System for Cardiac Operative Risk Factor (EuroSCORE) (P=0.012) and Body Mass Index (BMI) (P=0.026). Higher scores on B-IPQ Consequences, Timeline, Identity, Emotional Response (P<0.01) and Concern (P=0.03) were related to worse General Health. Higher perceived effectiveness of surgery (P<0.01) and Treatment control (P=0.003) were associated with higher General Health score. More negative illness perception was significantly related to lower General Health (P<0.01). No significant associations between General Health and mode and weight of the procedure, myocardial infarction, previous percutaneous coronary intervention, New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) class and postsurgical complications were noted. Structural equation modeling (SEM) revealed that illness perception domains, BMI and EuroSCORE are the main determinants of General Health. CONCLUSIONS Modifiable factors, especially illness perception are important determinants of patient-reported health after cardiac surgery. Evaluation of illness perception seems vital since it may lead to address patients' concerns and improve outcomes.
Collapse
Affiliation(s)
| | - Katarzyna Nowicka-Sauer
- Department of Cardiac Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland - .,Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Kamil Wera
- Department of Cardiology, Mikołaj Kopernik Specialist Municipal Hospital in Toruń, Toruń, Poland
| | - Anna Meslin-Kuźniak
- Private Practitioner in Psychotherapy, Neurologopedic Therapy and Sensory Integration, Gdańsk, Poland
| | - Sebastian Beta
- Department of Cardiac Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Małgorzata Pietrzykowska
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
263
|
Shogren KA, Dean EE, Burke KM, Raley SK, Taylor JL. Goal Attainment Scaling: A Framework for Research and Practice in the Intellectual and Developmental Disabilities Field. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:7-21. [PMID: 33543273 DOI: 10.1352/1934-9556-59.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/17/2020] [Indexed: 06/12/2023]
Abstract
Goal setting and attainment is often a targeted outcome in the intellectual and developmental disabilities field; however, standardizing the measurement of attainment of individualized goals is challenging. The purpose of this article is to introduce a four-domain framework that provides a series of questions to research and evaluation teams in planning for the use of goal attainment scaling (GAS) as an outcome measure at the individual or aggregate level. We intend to stimulate discussion and ongoing work to further systematize how GAS is used in (a) intervention research to establish evidence-based practices and (b) practice to assess the extent to which interventions and supports lead to intended outcomes. The goal is to promote a clear planning process to inform data collection on individualized goal attainment outcomes that are rooted in goals and outcomes valued by people with intellectual and developmental disabilities.
Collapse
Affiliation(s)
| | - Evan E Dean
- Karrie A. Shogren and Evan E. Dean, University of Kansas
| | | | | | | |
Collapse
|
264
|
Shogren KA, Rifenbark GG, Hagiwara M. Self-Determination Assessment in Adults With and Without Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:55-69. [PMID: 33543274 DOI: 10.1352/1934-9556-59.1.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/16/2020] [Indexed: 06/12/2023]
Abstract
This article analyzes the reliability and factor structure of the Self-Determination Inventory: Adult Report (SDI:AR) in adults with and without intellectual disability. There is a critical need for contemporary assessment tools given the emphasis on self-determination outcomes in disability supports and services. The findings suggest that the same set of items can be used across adults with and without intellectual disability. However, there are significant differences in overall self-determination across adults with and without intellectual disability, with adults with intellectual disability scoring lower on the SDI:AR. Implications for research and practice are discussed.
Collapse
Affiliation(s)
- Karrie A Shogren
- Karrie A. Shogren, Graham G. Rifenbark, and Mayumi Hagiwara, University of Kansas
| | - Graham G Rifenbark
- Karrie A. Shogren, Graham G. Rifenbark, and Mayumi Hagiwara, University of Kansas
| | - Mayumi Hagiwara
- Karrie A. Shogren, Graham G. Rifenbark, and Mayumi Hagiwara, University of Kansas
| |
Collapse
|
265
|
Winders T, Maspero J, Callan L, Al-Ahmad M. Perspectives on decisions for treatment and care in severe asthma. World Allergy Organ J 2021; 14:100500. [PMID: 33537114 PMCID: PMC7817505 DOI: 10.1016/j.waojou.2020.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background Severe asthma is a subtype of asthma that can be hard to control, resulting in an exceptional impact on an individual's quality of life. The aim of this review article is to explore the misalignment of perceptions of severe asthma among different stakeholders to identify how to reduce burden and improve delivery of care. Results The misalignment of perspectives is best reflected in randomised controlled trials (RCTs) in asthma treatments, which are often designed for regulatory approval with a focus on exacerbations with no direct input from the individuals that the treatments are designed for. Based on a literature review and the clinical experience of the authors to overcome this disparity, the goals of people with severe asthma need to be incorporated throughout their care, from study design to the day-to-day management of their condition. Improved education for individuals and their support network will provide them with resources and knowledge so that they can effectively communicate their needs to other stakeholders involved in their care. Conclusion/recommendation A collaborative effort from all stakeholders is essential to ensure efficient management of asthma and a reduction in asthma burden on individuals and society.
Collapse
Affiliation(s)
- Tonya Winders
- Allergy & Asthma Network/Global Allergy & Airways Patient Platform (GAAPP), Vienna, VA, USA
| | - Jorge Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Luke Callan
- Global Market Access and Pricing, AstraZeneca UK Ltd., Cambridge, UK
| | - Mona Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
266
|
Moss MCL, Aggarwal A, Qureshi A, Taylor B, Guerrero-Urbano T, Van Hemelrijck M. An assessment of the use of patient reported outcome measurements (PROMs) in cancers of the pelvic abdominal cavity: identifying oncologic benefit and an evidence-practice gap in routine clinical practice. Health Qual Life Outcomes 2021; 19:20. [PMID: 33451330 PMCID: PMC7810193 DOI: 10.1186/s12955-020-01648-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients' quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically. METHODS A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion. RESULTS A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting. CONCLUSIONS This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.
Collapse
Affiliation(s)
- Miss Charlotte L Moss
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London, SE1 9RT, UK.
| | - Ajay Aggarwal
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Asad Qureshi
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin Taylor
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, Great Maze Pond, London, SE1 9RT, UK
| |
Collapse
|
267
|
Reginster JY, Beaudart C, Al-Daghri N, Avouac B, Bauer J, Bere N, Bruyère O, Cerreta F, Cesari M, Rosa MM, Cooper C, Cruz Jentoft AJ, Dennison E, Geerinck A, Gielen E, Landi F, Laslop A, Maggi S, Prieto Yerro MC, Rizzoli R, Sundseth H, Sieber C, Trombetti A, Vellas B, Veronese N, Visser M, Vlaskovska M, Fielding RA. Update on the ESCEO recommendation for the conduct of clinical trials for drugs aiming at the treatment of sarcopenia in older adults. Aging Clin Exp Res 2021; 33:3-17. [PMID: 32737844 PMCID: PMC7897619 DOI: 10.1007/s40520-020-01663-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND In 2016, an expert working group was convened under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and formulated consensus recommendations for the conduct of clinical trials for drugs to prevent or treat sarcopenia. AIMS The objective of the current paper is to provide a 2020 update of the previous recommendations in accordance with the evidence that has become available since our original recommendations. METHODS This paper is based on literature reviews performed by members of the ESCEO working group and followed up with face to face meetings organized for the whole group to make amendments and discuss further recommendations. RESULTS The randomized placebo-controlled double-blind parallel-arm drug clinical trials should be the design of choice for both phase II and III trials. Treatment and follow-up should run at least 6 months for phase II and 12 months for phase III trials. Overall physical activity, nutrition, co-prescriptions and comorbidity should be recorded. Participants in these trials should be at least 70-years-old and present with a combination of low muscle strength and low physical performance. Severely malnourished individuals, as well as bedridden patients, patients with extremely limited mobility or individuals with physical limitations clearly attributable to the direct effect of a specific disease, should be excluded. Multiple outcomes are proposed for phase II trials, including, as example, physical performance, muscle strength and mass, muscle metabolism and muscle-bone interaction. For phase III trials, we recommend a co-primary endpoint of a measure of functional performance and a Patient Reported Outcome Measure. CONCLUSION The working group has formulated consensus recommendations on specific aspects of trial design, and in doing so hopes to contribute to an improvement of the methodological robustness and comparability of clinical trials. Standardization of designs and outcomes would advance the field by allowing better comparison across studies, including performing individual patient-data meta-analyses, and different pro-myogenic therapies.
Collapse
Affiliation(s)
- Jean-Yves Reginster
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | - Charlotte Beaudart
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium.
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Bernard Avouac
- Department of Rheumatology, CHU Henri Mondor, Creteil, France
| | - Jürgen Bauer
- Center for Geriatric Medicine and Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Nathalie Bere
- European Medicines Agency, Amsterdam, The Netherlands
| | - Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | | | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Miguel Rosa
- Departamento de Neurociências/Laboratório de Farmacologia Clínica E Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Anton Geerinck
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | - Evelien Gielen
- Division of Geriatrics, UZ Leuven, Leuven, Belgium
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart Rome, Milan, Italy
| | - Andrea Laslop
- Scientific Office, Federal Office for Safety in Health Care, Vienna, Austria
| | | | | | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Cornel Sieber
- Institute for Biomedicine of Aging Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Kantonsspital Winterthur, Winterthur, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Bruno Vellas
- Department of Internal and Geriatrics Medicine, Gerontopole, CHU de Toulouse, UMR 1027 INSERM, University Toulouse III, Toulouse, France
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Marjolein Visser
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mila Vlaskovska
- Medical Faculty, Department of Pharmacology and Toxicology, Medical University Sofia, Sofia, Bulgaria
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center On Aging, Tufts University, Boston, USA
| |
Collapse
|
268
|
Venderbos LDF, Deschamps A, Dowling J, Carl EG, Remmers S, van Poppel H, Roobol MJ. Europa Uomo Patient Reported Outcome Study (EUPROMS): Descriptive Statistics of a Prostate Cancer Survey from Patients for Patients. Eur Urol Focus 2020; 7:987-994. [PMID: 33281109 DOI: 10.1016/j.euf.2020.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 11/14/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Europa Uomo initiated the Europa Uomo Patient Reported Outcome Study (EUPROMS) to collect prostate cancer (PCa) patient-reported outcome (PRO) data as a primary endpoint. OBJECTIVE To inform future PCa patients about the impact of PCa treatment through self-reported PRO data of fellow patients collected outside a clinical trial setting. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional survey was conducted among PCa patients currently receiving or having received treatment. The EUPROMS survey contained the EQ-5D-5 L (generic health), the EORTC-QLQ-C30 (cancer-specific quality of life (QoL), and the Expanded Prostate cancer Index Composite short form 26 (EPIC-26; prostate-specific health) questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics were used to assess the demographic and clinical characteristics, and to analyze the PROs of EQ-5D-5L, EORTC-QLQ-C30, and EPIC-26. RESULTS AND LIMITATIONS Between August 21 and November 19, 2019, 2943 men from 24 European countries completed the EUPROMS survey. The median age of the respondents was 71 yr (interquartile range 65-75 yr); 81.9% was living with a spouse. In total, 1937 (65.8%) men underwent a single treatment, and 636 (21.6%), 300 (10.2%), and 70 (2.4%) underwent two, three, and four treatments, respectively. Fatigue scores are highest for men who underwent radiotherapy or chemotherapy. Progression of disease leads to more insomnia. Surgery affects urinary incontinence the most. Self-reported sexual function amounts to 27/100, with the lowest scores being reported for men who underwent surgery and radiotherapy (15/100). Overall, patients who received two or more treatments reported lower scores for all indices. CONCLUSIONS The EUPROMS survey provided a cross-sectional picture of the current PCa patient population and their reported QoL. Initial treatment is often followed by subsequent treatments, affecting mainly sexual function, as well as fatigue and insomnia. QoL of men undergoing chemotherapy is worse for almost all domains. These data can inform physicians and patients on the true impact of PCa treatment. PATIENT SUMMARY Patient-reported quality of life in the Europa Uomo Patient Reported Outcome Study (EUPROMS) survey-a more informal setting as compared with clinical trials-reveals that prostate cancer treatment affects mainly sexual function, fatigue, and insomnia.
Collapse
Affiliation(s)
- Lionne D F Venderbos
- Department of Urology, Erasmus University Medical Center Rotterdam, The Netherlands.
| | | | | | | | - Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center Rotterdam, The Netherlands
| | | | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center Rotterdam, The Netherlands
| |
Collapse
|
269
|
Gilchrist F, Marshman Z. Patient-reported Outcomes (PROs) in clinical trials in paediatric dentistry. Int J Paediatr Dent 2020; 31 Suppl 1:31-37. [PMID: 33458920 DOI: 10.1111/ipd.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 01/13/2023]
Abstract
Patient-reported outcomes (PROs) are reports directly from patients without interpretation by clinicians or others and captured using validated patient-reported outcome measures (PROMs). These measures are increasingly employed in clinical practice and can be incorporated into clinical trials. Benefits of using PROs include reducing observer bias; eliciting unique views on aspects important to patients and increasing public accountability. Despite inclusion in clinical trials PRO data is often under-reported and the results may not be adopted into clinical practice due to concerns about the data generated. This review discusses what PROs are and how to measure them; the benefits of using PROs; how to choose an appropriate PROM to answer the research question; considerations for using PROs in paediatric dentistry and reporting guidelines. Finally, some examples of how PROs have been included in paediatric dentistry trials are given along with discussion of the development of core outcome sets and how these may improve reporting of PROs in the future.
Collapse
Affiliation(s)
- Fiona Gilchrist
- Paediatric Dentistry, University of Sheffield, Sheffield, UK
| | - Zoe Marshman
- Dental Public Health, University of Sheffield, Sheffield, UK
| |
Collapse
|
270
|
Dias-Barbosa C, Matos R, Vernon M, Carney CE, Krystal A, Puelles J. Content validity of a sleep numerical rating scale and a sleep diary in adults and adolescents with moderate-to-severe atopic dermatitis. J Patient Rep Outcomes 2020; 4:100. [PMID: 33226517 PMCID: PMC7683746 DOI: 10.1186/s41687-020-00265-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 11/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background The intense itching associated with atopic dermatitis (AD) often causes patients to experience severe sleep disturbance. Here, we describe the results of a two-phase concept elicitation and cognitive interview study to establish the content validity of a sleep disturbance numerical rating scale (SD NRS) and a Consensus Sleep Diary adapted for adults and adolescents with moderate-to-severe AD (CSD-AD©). Results In phase I, a concept elicitation conducted in 20 adults and 10 adolescents with moderate-to-severe AD revealed that the following sleep-related issues were important and relevant: nighttime awakening (87%), trouble falling asleep (73%), feeling unrested (53%), daytime fatigue or sleepiness (53%), and feeling as if they did not get enough sleep (33%). The frequency and extent of sleep disturbance varied substantially from day to day due to varying degrees of itching and flares, medication use, and changes in the weather. All participants understood the SD NRS question, with most finding it easy or very easy to understand (100% of adults and 90% of adolescents) and most understanding the anchors as intended (95% of adults, and 100% of adolescents). Most participants (94% of adults, and 90% of adolescents) indicated that they would consider a one- or two-point change meaningful on the SD NRS. The CSD-AD© was revised based on participant feedback, and tested during phase II in a convenience sample of six adults and four adolescents from phase I. The changes made to the CSD-AD© were confirmed to be relevant and understandable. All patients were able to provide an answer to each item in the CSD-AD©, and most were able to estimate the duration of nighttime awakenings, daytime naps, and dozing. Conclusions The study supported the content validity of the SD NRS and CSD-AD© in adults and adolescents with moderate-to-severe AD. It also emphasized the importance of using these instruments daily when assessing the benefit of a new treatment on sleep quality in this population. Supplementary Information Supplementary information accompanies this paper at 10.1186/s41687-020-00265-y.
Collapse
Affiliation(s)
| | - Rodolfo Matos
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MA, 20814, USA.
| | - Margaret Vernon
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MA, 20814, USA
| | - Colleen E Carney
- Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada
| | - Andrew Krystal
- University of California, San Francisco, Weill Institute for Neurosciences, 401 Parnassus Avenue, San Francisco, CA, 94143-0984, USA
| | - Jorge Puelles
- Galderma, World Trade Center, Avenue Gratta-Paille 2, 1018, Lausanne, Switzerland
| |
Collapse
|
271
|
Feasibility of an Enhanced Recovery After Surgery (ERAS) pathway for major head and neck oncologic surgery. Am J Otolaryngol 2020; 41:102679. [PMID: 32836043 DOI: 10.1016/j.amjoto.2020.102679] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Enhanced Recovery After Surgery (ERAS) protocols are gaining traction in the field of head and neck surgery following success in other specialties. Various institutions have reported on the feasibility of implementation and early outcomes in their centers. We report our experience of setting up an ERAS program in a high-volume tertiary cancer care center, including the challenges faced and overcome. METHODS With multidisciplinary input, an ERAS protocol was developed consisting of pre-, intra-, and post-operative interventions based on current evidence. We then assessed an initial series of 104 patients on the ERAS protocol and tracked the compliance rates for various interventions. RESULTS Compliance rates to interventions including pre-operative medication (84.6%), multimodal analgesia (84.6%95.1%), early removal of urinary catheters (76.0%) and early mobilization (56.7%) show a wide variation. However, response rates in the assessment of patient-reported outcomes are low. We discuss factors surrounding the feasibility of implementing an ERAS protocol and tracking outcomes in a diverse, high volume center. DISCUSSION While there are challenges in implementation, results indicate that a successful ERAS pathway in major head and neck oncologic surgery is feasible. Engaging shareholders and making full use of technology in the form of electronic medical systems are essential to this success. IMPLICATIONS FOR PRACTICE ERAS pathways should be encouraged in head and neck surgery, given their proven feasibility in a range of institutions. Further study is needed to confirm this program's impact on outcomes.
Collapse
|
272
|
Hart LC. Improving Transition to Adult Care for Those With Developmental Disabilities: An Unclear Path. Pediatrics 2020; 146:peds.2020-024398. [PMID: 33046585 DOI: 10.1542/peds.2020-024398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Laura C Hart
- Primary Care Pediatrics, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| |
Collapse
|
273
|
Jin J, Xia W, Connolly A, Hill AG. Symptom-based scoring for haemorrhoidal disease: a systematic review. Colorectal Dis 2020; 22:1518-1527. [PMID: 32639663 DOI: 10.1111/codi.15253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022]
Abstract
AIM Haemorrhoidal disease can severely affect a patient's quality of life. Its classification is commonly based on morphology of the degree of prolapse; however, this does not take into account the symptoms and impact on the quality of life. The aim of this systematic review was to determine the most appropriate instruments that classify the severity of disease according to symptoms. METHOD A PRISMA-compliant search was conducted in December 2019 to identify studies that described the validation of a haemorrhoidal symptom score. The measurement properties of the scoring systems were assessed based on the consensus-based standards for the selection of health status measurement instruments (COSMIN) methodology for systematic reviews for patient-reported outcome measures. RESULTS A total of 5288 articles were identified, with five articles included. Three studies developed a scoring system based on a set of core symptoms for a cohort of patients and validated the score against treatment outcomes. One study developed a disease-specific quality of life questionnaire based on symptoms to evaluate disease burden. One study combined both quality of life and symptom measures and tested measurement properties on two cohorts of patients. Only one study demonstrated satisfactory valid, reliable and responsive measurement criteria. CONCLUSION A single study demonstrated sufficient quality in measurement properties to be recommended for clinical use. Further studies in this area should utilize consensus-based standards for designing and reporting validation research to ensure that the appropriate evidence base is acquired if any further patient-reported outcome measures are to be recommended.
Collapse
Affiliation(s)
- J Jin
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - W Xia
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - A Connolly
- Department of Surgery, Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand
| | - A G Hill
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand
| |
Collapse
|
274
|
Qiu T, Wang Y, Dabbous M, Hanna E, Han R, Liang S, Toumi M. Current state of developing advanced therapies for rare diseases in the European Union. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1835640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Tingting Qiu
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Yitong Wang
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Monique Dabbous
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Eve Hanna
- Department of Price, Reimbursement and Market Access, Creativ-ceutical, Paris, France
| | - Ru Han
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Shuyao Liang
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Mondher Toumi
- Department of Public Health, Aix-Marseille University, Marseille, France
| |
Collapse
|
275
|
Singh SA, Bakshi N, Mahajan P, Morris CR. What is the future of patient-reported outcomes in sickle-cell disease? Expert Rev Hematol 2020; 13:1165-1173. [PMID: 33034214 DOI: 10.1080/17474086.2020.1830370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a complex, chronic disease caused by abnormal polymerization of hemoglobin, which leads to severe pain episodes, fatigue, and end-organ damage. Patient reported outcomes (PROs) have emerged as a critical tool for measuring SCD disease severity and response to treatment. AREAS COVERED Authors review the key issues involved when deciding to use a PRO in a clinical trial. We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries.
Collapse
Affiliation(s)
- Sharon A Singh
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Michigan Medical School , Ann Arbor, MI, USA
| | - Nitya Bakshi
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University School of Medicine , Atlanta, GA, USA.,Department of Pediatrics, Children's Healthcare of Atlanta , Atlanta, GA, USA
| | - Prashant Mahajan
- Department of Emergency Medicine and Pediatrics, University of Michigan Medical School , Ann Arbor, MI, USA
| | - Claudia R Morris
- Department of Pediatrics, Children's Healthcare of Atlanta , Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine , Atlanta, GA, USA
| |
Collapse
|
276
|
Reaney M, Cline J, Wilson JC, Posey M. Generating Relevant Information from Patients in the Technology-Enhanced Era of Patient-Focused Drug Development: Opportunities and Challenges. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:11-16. [PMID: 33047221 DOI: 10.1007/s40271-020-00455-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
The era of patient-focused drug development (PFDD) brings with it a greater use of patient-reported outcome measures (PROMs) in clinical trials. This is facilitated through electronic technology designed to capture PROM data. However, PFDD goes beyond just PROMs, and technology has a key role in capturing timely and patient-relevant information through active and passive means to inform study endpoints. This brief paper aims to highlight four trends the authors have observed across the pharmaceutical industry in using technology to enhance PFDD: (1) capturing qualitative data from patients; (2) using digital health technology tools (DHTTs); (3) employing reactive technology-enabled clinical outcome assessments TeCOA; and (4) generating passive patient experience data. Opportunities and challenges associated with these trends are discussed, and a 'call to action' is made to consolidate learning and understanding across science, medical and technology disciplines, and to conduct collaborative research to improve the opportunities and minimize the challenges.
Collapse
Affiliation(s)
- Matthew Reaney
- IQVIA, 3 Forbury Place, 23 Forbury Road, Reading, RG1 2JH, UK.
| | | | | | | |
Collapse
|
277
|
Cheung WY, Kavan P, Dolley A. Quality of life in a real-world study of patients with metastatic colorectal cancer treated with trifluridine/tipiracil. Curr Oncol 2020; 27:e451-e458. [PMID: 33173384 PMCID: PMC7606042 DOI: 10.3747/co.27.6533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Quality of life (qol) is important for oncology patients, especially for those with late-stage disease. The present study was initiated to address the lack of published prospective data about the qol benefits of trifluridine/tipiracil (ftd/tpi) compared with best supportive care (bsc) in patients with refractory metastatic colorectal cancer (mcrc). Methods This prospective, cross-sectional, non-interventional study used multidimensional validated scales to evaluate patient-reported qol in two study cohorts of patients and also to measure differences in mcrc-related symptoms and pain in a real-world clinical setting. Results Our findings demonstrate that patients with refractory mcrc report better overall qol when treated with ftd/tpi than with bsc alone. In that population, statistically significant differences in mean qol measures favoured ftd/tpi over bsc for physical symptom distress, psychological distress, activity impairment, overall valuation of life, and symptomatology. The overall better qol for patients receiving ftd/tpi implies that treatment was well tolerated and was associated with a lower symptom burden. No significant differences for pain were observed between the groups. Conclusions This study suggests that ftd/tpi is a well-tolerated option for the treatment of patients with refractory mcrc, showcasing the value of capturing real-world qol data in routine clinical practice.
Collapse
Affiliation(s)
- W Y Cheung
- Section of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - P Kavan
- Department of Oncology, Faculty of Medicine, McGill University, Montreal, QC
| | - A Dolley
- Taiho Pharma Canada Inc., Oakville, ON
| |
Collapse
|
278
|
Puthucheary ZA, Gensichen JS, Cakiroglu AS, Cashmore R, Edbrooke L, Heintze C, Neumann K, Wollersheim T, Denehy L, Schmidt KFR. Implications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:577. [PMID: 32977833 PMCID: PMC7517819 DOI: 10.1186/s13054-020-03275-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients who survive critical illness suffer from a significant physical disability. The impact of rehabilitation strategies on health-related quality of life is inconsistent, with population heterogeneity cited as one potential confounder. This secondary analysis aimed to (1) examine trajectories of functional recovery in critically ill patients to delineate sub-phenotypes and (2) to assess differences between these cohorts in both clinical characteristics and clinimetric properties of physical function assessment tools. METHODS Two hundred ninety-one adult sepsis survivors were followed-up for 24 months by telephone interviews. Physical function was assessed using the Physical Component Score (PCS) of the Short Form-36 Questionnaire (SF-36) and Activities of Daily Living and the Extra Short Musculoskeletal Function Assessment (XSFMA-F/B). Longitudinal trajectories were clustered by factor analysis. Logistical regression analyses were applied to patient characteristics potentially determining cluster allocation. Responsiveness, floor and ceiling effects and concurrent validity were assessed within clusters. RESULTS One hundred fifty-nine patients completed 24 months of follow-up, presenting overall low PCS scores. Two distinct sub-cohorts were identified, exhibiting complete recovery or persistent impairment. A third sub-cohort could not be classified into either trajectory. Age, education level and number of co-morbidities were independent determinants of poor recovery (AUROC 0.743 ((95%CI 0.659-0.826), p < 0.001). Those with complete recovery trajectories demonstrated high levels of ceiling effects in physical function (PF) (15%), role physical (RP) (45%) and body pain (BP) (57%) domains of the SF-36. Those with persistent impairment demonstrated high levels of floor effects in the same domains: PF (21%), RP (71%) and BP (12%). The PF domain demonstrated high responsiveness between ICU discharge and at 6 months and was predictive of a persistent impairment trajectory (AUROC 0.859 (95%CI 0.804-0.914), p < 0.001). CONCLUSIONS Within sepsis survivors, two distinct recovery trajectories of physical recovery were demonstrated. Older patients with more co-morbidities and lower educational achievements were more likely to have a persistent physical impairment trajectory. In regard to trajectory prediction, the PF score of the SF-36 was more responsive than the PCS and could be considered for primary outcomes. Future trials should consider adaptive trial designs that can deal with non-responders or sub-cohort specific outcome measures more effectively.
Collapse
Affiliation(s)
- Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK.
| | - Jochen S Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,Institute of Family Medicine, University Hospital of the Ludwig Maximilian University, Munich, Germany.,Center of Sepsis Care and Control, Jena University Hospital, Jena, Germany
| | | | - Richard Cashmore
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - Lara Edbrooke
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia.,Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine Berlin, Berlin, Germany
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia.,Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Konrad F R Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,Center of Sepsis Care and Control, Jena University Hospital, Jena, Germany.,Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
| |
Collapse
|
279
|
Affiliation(s)
- Jan R Boehnke
- School of Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK.
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), The University of Sydney, Sydney, Australia
| |
Collapse
|
280
|
International guidance on the selection of patient-reported outcome measures in clinical trials: a review. Qual Life Res 2020; 30:21-40. [PMID: 32926299 DOI: 10.1007/s11136-020-02625-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are increasingly used in clinical trials to provide patients' perspectives regarding symptoms, health-related quality of life, and satisfaction with treatments. A range of guidance documents exist for the selection of patient-reported outcome measures (PROMs) in clinical trials, and it is unclear to what extent these documents present consistent recommendations. METHODS We conducted a targeted review of publications and regulatory guidance documents that advise on the selection of PROMs for use in clinical trials. A total of seven guidance documents from the US Food and Drug Administration, European Medicines Agency, and scientific consortia from professional societies were included in the final review. Guidance documents were analyzed using a content analysis approach comparing them with minimum standards recommended by the International Society for Quality of Life Research. RESULTS Overall there was substantial agreement between guidance regarding the appropriate considerations for PROM selection within a clinical trial. Variations among the guidance primarily related to differences in their format and differences in the perspectives and mandates of their respective organizations. Whereas scientific consortia tended to produce checklist or rating-type guidance, regulatory groups tended to use more narrative-based approaches sometimes supplemented with lists of criteria. CONCLUSION The consistency in recommendations suggests an emerging consensus in the field and supports use of any of the major guidance documents available to guide PROM selection for clinical trials without concern of conflicting recommendations. This work represents an important first step in the international PROTEUS Consortium's ongoing efforts to optimize the use of PROs in clinical trials.
Collapse
|
281
|
Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area. J Orthop Surg Res 2020; 15:395. [PMID: 32912202 PMCID: PMC7488251 DOI: 10.1186/s13018-020-01856-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways, and different treatment strategies are applied. The outcome is rarely investigated. METHODS This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics. RESULTS The VISA-A-G outcome scores improved significantly from preoperative to 6 months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18-73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10-73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups. A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836). CONCLUSIONS In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups. TRIAL REGISTRATION DRKS, DRKS00014266. Registered 06 April 2018. 'Retrospectively registered', https://www.drks.de/drks_web/navigate.do?navigationId=results .
Collapse
|
282
|
Saleh RR, Meti N, Ribnikar D, Goldvaser H, Ocana A, Templeton AJ, Seruga B, Amir E. Associations between safety, tolerability, and toxicity and the reporting of health-related quality of life in phase III randomized trials in common solid tumors. Cancer Med 2020; 9:7888-7895. [PMID: 32886422 PMCID: PMC7643655 DOI: 10.1002/cam4.3390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 01/09/2023] Open
Abstract
Background Anti‐cancer drugs are approved typically on the basis of efficacy and safety as evaluated in phase III randomized trials (RCTs). Health‐related quality of life (HRQoL) is a direct measure of patient benefit, but is under‐reported. Here we explore associations with reporting of HRQoL data in phase III RCTs in common solid tumors. Methods We searched ClinicalTrials.gov to identify phase III RCTs evaluating new drugs in adults with advanced cancers that completed accrual between January 2005 and October 2016. Data on HRQoL, safety, and tolerability comprising treatment‐related death, treatment discontinuation and commonly reported grade 3 or 4 adverse events (AEs) were extracted. Associations between these measures and reporting of HRQoL data were explored using logistic regression. Results Of 377 phase III RCTs identified initially, 143 studies were analysed and comprised 55% positive trials and 90% industry sponsored trials. HRQoL was listed as an endpoint in 59% trials; and of these, only 65% reported HRQoL data. There were higher odds of reporting HRQoL data for positive trials (OR 2.05, P = .04) and trials published in journals with higher impact factor (OR 1.35, P = .01). Reporting of HRQoL was not associated with treatment‐related death (OR 1.25, P = .40) or treatment discontinuation (OR 1.12, P = .61), but was positively associated with dyspnea and dermatological adverse events. Conclusions HRQoL is reported in only two‐thirds of RCTs that describe collecting such data. Reporting of HRQoL is associated with positive trial outcome and higher journal impact factor, but not associated with overall safety and tolerability of anti‐cancer drugs.
Collapse
Affiliation(s)
- Ramy R Saleh
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Nicholas Meti
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Domen Ribnikar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Hadar Goldvaser
- Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alberto Ocana
- Experimental Therapeutics Unit, Medical Oncology Department, Hospital Clínico San Carlos, and IdISSC, Madrid, Spain.,Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain.,Centro Regional de Investigaciones Biomédicas, Castilla-La Mancha University, Ciudad Real, Spain
| | - Arnoud J Templeton
- Department of Oncology, St. Claraspital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Eitan Amir
- Division of Medical Oncology & Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
283
|
Gabes M. Are existing quality-of-life instruments in cutaneous T-cell lymphoma of sufficient quality? Br J Dermatol 2020; 184:195. [PMID: 32869313 DOI: 10.1111/bjd.19408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M Gabes
- Institute of Social Medicine and Health Economics, Otto von Guericke University, Magdeburg, Germany
| |
Collapse
|
284
|
Improved measurement of tinnitus severity: Study of the dimensionality and reliability of the Tinnitus Handicap Inventory. PLoS One 2020; 15:e0237778. [PMID: 32841249 PMCID: PMC7447004 DOI: 10.1371/journal.pone.0237778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 08/03/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The Tinnitus Handicap Inventory (THI) is widely used in clinical practice and research as a three-dimensional measure of tinnitus severity. Despite extensive use, its factor structure remains unclear. Furthermore, THI can be considered a reliable measure only if Cronbach's alpha coefficient and Classical Test Theory is used. The more modern and robust Item Response Theory (IRT) has so far not been used to psychometrically evaluate THI. In theory, IRT allows a more precise evaluation of THI's factor structure, reliability, and the quality of individual items. METHOD There were 1115 patients with tinnitus (556 women and 559 men), aged 19-84 years (M = 51.55; SD = 13.28). The dimensionality of THI was evaluated using several models of Confirmatory Factor Analysis and an Item Response Theory approach. Exploratory non-parametric Mokken scaling was applied to determine a unidimensional and robust scale. Several IRT polytomous models were used to assess the overall quality of THI. RESULTS The bifactor model had the best fit (RMSEA = 0.055; CFI = 0.976; SRMR = 0.040) and revealed one strong general factor and several weak specific factors. Mokken scaling generated a reliable unidimensional scale (Loevinger's H = 0.463). In order to refine THI we propose that five items be removed. The IRT Generalized Partial Credit Model generated good parameters in terms of item location (difficulty), discrimination, and information content of items. CONCLUSION Our findings support the use of THI to evaluate tinnitus severity in terms of it being a reliable unidimensional scale. However, clinicians and researchers should rely only on its overall score, which reflects global tinnitus severity. To improve its psychometric quality, several refinements of THI are proposed.
Collapse
|
285
|
Gresham G, Meinert JL, Gresham AG, Meinert CL. Assessment of Trends in the Design, Accrual, and Completion of Trials Registered in ClinicalTrials.gov by Sponsor Type, 2000-2019. JAMA Netw Open 2020; 3:e2014682. [PMID: 32845329 PMCID: PMC7450351 DOI: 10.1001/jamanetworkopen.2020.14682] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE ClinicalTrials.gov is a valuable resource that can be used to trace the state and nature of trials. Since its launch in 2000, more than 345 000 trials have been registered. Little is known about the characteristics and trends in clinical trials over time and how they differ by sponsor type. OBJECTIVE To assess trends in clinical trials registered in ClinicalTrials.gov over time and by sponsor type. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included clinical trials (interventional studies) registered in ClinicalTrials.gov from January 1, 2000, through December 31, 2019. The trials were grouped by lead sponsor: National Institutes of Health (NIH) and other US government agencies, industry, and other sources (foundations, universities, hospitals, clinics, and others). A static version of the Clinical Trials Transformation Initiative Aggregate Analysis of ClinicalTrials.gov database was downloaded on January 1, 2020, for analysis. MAIN OUTCOMES AND MEASURES ClinicalTrials.gov registration fields, including overall status, phase, intervention, number of sites, use of masking and randomization, sample size, and time to study completion by start year and lead sponsor (organization that provided funding or support for a clinical study). RESULTS A total of 245 999 clinical trials (interventional studies) were started between 2000 and 2019, of which 135 144 (54.9%) were completed. Among completed trials, 5113 (3.8%) were sponsored by the NIH or a US government agency, 48 668 (36.0%) by industry, and 81 363 (60.2%) by other sources. Most trials were single center (61.3%), randomized (65.6%), and phase 1 to 2 (35.5%) or did not have a US Food and Drug Administration-defined phase (38.4%), with fewer drug trials being conducted over time. Sample sizes were small (median, 60; interquartile range [IQR], 30-160) and diminished over time. Trial median completion times varied by lead sponsor: 3.4 years (IQR, 1.9-5.0 years) for NIH- and US government-sponsored trials, 1.2 years (IQR, 0.5-2.4 years) for industry trials, and 2.1 years (IQR, 1.1-3.7) for trials sponsored by other sources. CONCLUSIONS AND RELEVANCE The findings suggest that the composition and design of trials changed from 2000 to 2019 and differed substantially by sponsor type. Increased funding toward larger randomized clinical trials may be warranted to inform clinical decision-making and guide future research.
Collapse
Affiliation(s)
- Gillian Gresham
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
| | - Jill L Meinert
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
| | - Arthur G Gresham
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
| | - Curtis L Meinert
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
286
|
Oldenburger E, Oldenburger F, Coolbrandt A, Isebaert S, Neyens I, Sevenants A, Van Audenhove C, Haustermans K. The use of patient reported outcome measures (PROMs) in palliative radiotherapy: A topical review. Radiother Oncol 2020; 149:94-103. [DOI: 10.1016/j.radonc.2020.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/11/2023]
|
287
|
Pascoe M, Mahura O, Dean J. Health resources for South Africa: A scoping review. Health SA 2020; 25:1378. [PMID: 32832107 PMCID: PMC7433232 DOI: 10.4102/hsag.v25i0.1378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/07/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Healthcare is more effective when people are treated in their own language with respect for their culture. However, information about the availability and nature of health resources is fragmented and studies suggest few assessments, screening tools, or other health resources in many of South Africa's languages. AIM This scoping review identified health resources written in the eleven official languages of South Africa for health professionals to use for patient assessment and management. METH ODS Databases were searched and information about resources collated and analysed. RESULTS Two-hundred-and-fifty two unique resources were found (444 items, if different language versions of the same resource were counted separately). All official languages were represented. The most widely used (excluding English) were Afrikaans (118 resources), IsiXhosa (80) and IsiZulu (55). CONCLUSION Development of more health resources and critical evaluation of their validity and reliability remain important. This study contributes a preliminary database for South African health professionals, ultimately promoting improved service delivery.
Collapse
Affiliation(s)
- Michelle Pascoe
- Department of Health and Rehabilitation Sciences/Child Language Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Olebeng Mahura
- Department of Health and Rehabilitation Sciences/Child Language Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jessica Dean
- Department of Health and Rehabilitation Sciences/Child Language Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
288
|
Polhemus AM, Bergquist R, Bosch de Basea M, Brittain G, Buttery SC, Chynkiamis N, Dalla Costa G, Delgado Ortiz L, Demeyer H, Emmert K, Garcia Aymerich J, Gassner H, Hansen C, Hopkinson N, Klucken J, Kluge F, Koch S, Leocani L, Maetzler W, Micó-Amigo ME, Mikolaizak AS, Piraino P, Salis F, Schlenstedt C, Schwickert L, Scott K, Sharrack B, Taraldsen K, Troosters T, Vereijken B, Vogiatzis I, Yarnall A, Mazza C, Becker C, Rochester L, Puhan MA, Frei A. Walking-related digital mobility outcomes as clinical trial endpoint measures: protocol for a scoping review. BMJ Open 2020; 10:e038704. [PMID: 32690539 PMCID: PMC7371223 DOI: 10.1136/bmjopen-2020-038704] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Advances in wearable sensor technology now enable frequent, objective monitoring of real-world walking. Walking-related digital mobility outcomes (DMOs), such as real-world walking speed, have the potential to be more sensitive to mobility changes than traditional clinical assessments. However, it is not yet clear which DMOs are most suitable for formal validation. In this review, we will explore the evidence on discriminant ability, construct validity, prognostic value and responsiveness of walking-related DMOs in four disease areas: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease and proximal femoral fracture. METHODS AND ANALYSIS Arksey and O'Malley's methodological framework for scoping reviews will guide study conduct. We will search seven databases (Medline, CINAHL, Scopus, Web of Science, EMBASE, IEEE Digital Library and Cochrane Library) and grey literature for studies which (1) measure differences in DMOs between healthy and pathological walking, (2) assess relationships between DMOs and traditional clinical measures, (3) assess the prognostic value of DMOs and (4) use DMOs as endpoints in interventional clinical trials. Two reviewers will screen each abstract and full-text manuscript according to predefined eligibility criteria. We will then chart extracted data, map the literature, perform a narrative synthesis and identify gaps. ETHICS AND DISSEMINATION As this review is limited to publicly available materials, it does not require ethical approval. This work is part of Mobilise-D, an Innovative Medicines Initiative Joint Undertaking which aims to deliver, validate and obtain regulatory approval for DMOs. Results will be shared with the scientific community and general public in cooperation with the Mobilise-D communication team. REGISTRATION Study materials and updates will be made available through the Center for Open Science's OSFRegistry (https://osf.io/k7395).
Collapse
Affiliation(s)
- Ashley Marie Polhemus
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Magda Bosch de Basea
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Gavin Brittain
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK
| | | | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Laura Delgado Ortiz
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kirsten Emmert
- Department of Neurology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Judith Garcia Aymerich
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Heiko Gassner
- Department of Molecular Neurology, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | | | - Jochen Klucken
- Department of Molecular Neurology, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Sarah Koch
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Letizia Leocani
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - M Encarna Micó-Amigo
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - A Stefanie Mikolaizak
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - Paolo Piraino
- Department of Research & Early Development Statistics, Bayer AG, Berlin, Germany
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardegna, Italy
| | - Christian Schlenstedt
- Department of Neurology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Lars Schwickert
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - Kirsty Scott
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, Sheffield, UK
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, Sheffield, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Flanders, Belgium
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Alison Yarnall
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Claudia Mazza
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, Sheffield, UK
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, Sheffield, UK
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Baden-Württemberg, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Milo Alan Puhan
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Zürich, Switzerland
| |
Collapse
|
289
|
Pile K, Norager R, Skillecorn M, Gibson KA, Elderton S, Favorito W, Li Z, Mu R, Nakahara H, Kishimoto M, Hirata S, Kaneko Y, Lau CS, Tam LS, Chen YH, Chen P, Wahking B, Furtner D. Elevating the role of carers in rheumatoid arthritis management in the Asia-Pacific region. Int J Rheum Dis 2020; 23:898-910. [PMID: 32613764 PMCID: PMC7496573 DOI: 10.1111/1756-185x.13893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/01/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022]
Abstract
Aim Carers may offer valuable insight into the true health status of patients with rheumatoid arthritis (RA). This multinational, multi‐stakeholder, exploratory study in Australia, China and Japan aimed to enrich our understanding of the role and potential impact of carers on RA management. Method This study used a 2‐phase sequential mixed methods approach involving 3 key stakeholder groups: rheumatologists, RA patients and carers. The first phase involved an in‐depth qualitative exploratory survey (n = 30), which informed the development of the subsequent quantitative validation survey (n = 908). In both phases, patients and carers provided self‐assessments of disease and support parameters. Results In the qualitative phase, patients usually understated the amount of physical support required, compared to carers. Rheumatologists underestimated the amount of physical and emotional care required, compared to carers and patients; however, in the quantitative phase, rheumatologists overestimated the level of support provided by carers. Levels of support provided by carers increased as disease severity increased. Active participation of carers in clinical consultations and treatment decision‐making was deemed important by 55% of all patients and 82% of all carers. All stakeholders believed carers’ insights into the physical and emotional conditions of patients were useful and should be considered in clinical decision‐making. Over 95% of rheumatologists reported soliciting input from the carer. Conclusion Carers provide valuable input that can give clinicians greater insight into the patients’ physical and emotional states, and treatment adherence. Development of standardized carer‐reported outcomes that correlate with patient‐reported outcomes and clinical parameters will ensure clinical meaningfulness and external validity.
Collapse
Affiliation(s)
- Kevin Pile
- Department of Medicine, Western Sydney University, Sydney, NSW, Australia.,Campbelltown Hospital, South West Sydney Local Health District, Sydney, NSW, Australia
| | | | | | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Sydney, Australia
| | | | | | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Chak-Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pearly Chen
- Johnson & Johnson Pte Ltd, Singapore, Singapore
| | | | | |
Collapse
|
290
|
Cruz Rivera S, McMullan C, Jones L, Kyte D, Slade A, Calvert M. The impact of patient-reported outcome data from clinical trials: perspectives from international stakeholders. J Patient Rep Outcomes 2020; 4:51. [PMID: 32617713 PMCID: PMC7332593 DOI: 10.1186/s41687-020-00219-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are increasingly collected in clinical trials as they provide unique information on the physical, functional and psychological impact of a treatment from the patient's perspective. Recent research suggests that PRO trial data have the potential to inform shared decision-making, support pharmaceutical labelling claims and influence healthcare policy and practice. However, there remains limited evidence regarding the actual impact associated with PRO trial data and how to maximise PRO impact to benefit patients and society. Thus, our objective was to qualitatively explore international stakeholders' perspectives surrounding: a) the impact of PRO trial data, b) impact measurement metrics, and c) barriers and facilitators to effectively maximise the impact of PRO trial data upon patients and society. METHODS Semi-structured interviews with 24 international stakeholders were conducted between May and October 2018. Data were coded and analysed using reflexive thematic analysis. RESULTS International stakeholders emphasised the impact of PRO trial data to benefit patients and society. Influence on policy-impact, including changes to clinical healthcare practice and guidelines, drug approval and promotional labelling claims were common types of PRO impact reported by interviewees. Interviewees suggested impact measurement metrics including: number of pharmaceutical labelling claims and interviews with healthcare practitioners to determine whether PRO data were incorporated in clinical decision-making. Key facilitators to PRO impact highlighted by stakeholders included: standardisation of PRO tools; consideration of health utilities when selecting PRO measures; adequate funding to support PRO research; improved reporting and dissemination of PRO trial data by key opinion leaders and patients; and development of legal enforcement of the collection of PRO data. CONCLUSIONS Determining the impact of PRO trial data is essential to better allocate funds, minimise research waste and to help maximise the impact of these data for patients and society. However, measuring the impact of PRO trial data through metrics is a challenging task, as current measures do not capture the total impact of PRO research. Broader international multi-stakeholder engagement and collaboration is needed to standardise PRO assessment and maximise the impact of PRO trial data to benefit patients and society.
Collapse
Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura Jones
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| |
Collapse
|
291
|
Blum RA, Tomlinson AR, Jetté N, Kwon CS, Easton A, Yeshokumar AK. Assessment of long-term psychosocial outcomes in anti-NMDA receptor encephalitis. Epilepsy Behav 2020; 108:107088. [PMID: 32375094 DOI: 10.1016/j.yebeh.2020.107088] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to assess long-term psychosocial outcomes of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (anti-NMDARE). METHODS Adolescents and adults with self-reported anti-NMDARE were invited to complete an online survey distributed by relevant patient organizations. Demographic and clinical information was collected, including the diagnoses initially given for anti-NMDARE symptoms and posthospital care received. Patient-Reported Outcomes Measurement Information System (PROMIS) Psychosocial Impact Illness - Negative short form (Negative PSII) was administered to assess psychosocial outcome of anti-NMDARE. Associations between clinical factors and psychosocial outcomes were evaluated. RESULTS Sixty-one individuals with anti-NMDARE age 15 years and above participated. Mean age was 33.7 years (standard deviation [SD]: 12.8), and participants were predominantly female (90.2%, n = 55). Mean T-score on PROMIS Negative PSII was 60.7, >1 SD higher (worse psychosocial function) than that of the provided normalized sample enriched for chronic illness (50, SD: 10). Initial misdiagnosis of anti-NMDARE symptoms was associated with decreased odds (odds ratio [OR]: 0.11, p < 0.05), and follow-up with a psychiatrist after hospitalization with increased odds (OR: 8.46, p < 0.05), of return to work/school after illness. Younger age of symptom onset and presence of ongoing neuropsychiatric issues were predictive of worse Negative PSII scores (p < 0.05). CONCLUSION Individuals with anti-NMDARE demonstrate poor psychosocial outcomes, yet there are no current standards for long-term assessment or management of such symptoms in this population. These findings highlight the need for use of more comprehensive outcome measures that include assessment of psychosocial function and the importance of developing interventions that address this domain for individuals with anti-NMDARE.
Collapse
Affiliation(s)
- Raia A Blum
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Amanda R Tomlinson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA.
| | - Ava Easton
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK; The Encephalitis Society, 32 Castlegate, Malton YO17 7DT, North Yorkshire, UK.
| | - Anusha K Yeshokumar
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, USA; Autoimmune Encephalitis Alliance, 920 Urban Avenue, Durham, NC 27701, USA.
| |
Collapse
|
292
|
Dulko D. Quality of Life as an Important Clinical Research Treatment Trial Outcome to Guide Evidence-Based Practice. Worldviews Evid Based Nurs 2020; 17:334-336. [PMID: 32573928 DOI: 10.1111/wvn.12441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dorothy Dulko
- Graduate Program, College of Nursing, Walden University, Minneapolis, Minnesota, USA
| |
Collapse
|
293
|
McGregor G, Powell R, Kimani P, Underwood M. Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis. BMJ Open 2020; 10:e036089. [PMID: 32513887 PMCID: PMC7282413 DOI: 10.1136/bmjopen-2019-036089] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine the effect of contemporary exercise-based cardiac rehabilitation on generic and disease-specific health related quality of life for people with coronary artery disease. DESIGN Systematic review and meta-analysis. STUDY ELIGIBILITY CRITERIA Randomised controlled trials testing exercise-based cardiac rehabilitation versus no exercise control that recruited after 31 December 1999. On 30 July 2019, we searched the Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCO) databases. STUDY APPRAISAL AND SYNTHESIS Studies were screened for inclusion by two independent reviewers. Risk of bias was assessed using the Cochrane risk of bias tool. Data were reported as pooled means (95% CI for between-group difference. RESULTS We identified 24 studies (n=4890). We performed meta-analyses for 15 short-term and 9 medium-term outcomes (36-Item Short Form Survey Instrument (SF-36), EuroQol-5D (EQ-5D) and MacNew, a cardiac-specific outcome). Six short-term and five medium-term SF-36 domains statistically favoured exercise-based cardiac rehabilitation. Only for two short-term SF-36 outcomes, 'physical function' (mean difference 12.0, 95% CI 4.4 to 19.6) and 'role physical' (mean difference 16.9, 95% CI 2.4 to 31.3), did the benefit appear to be clinically important. Meta-analyses of the short-term SF-36 physical and mental component scores, EQ-5D and MacNew and the medium-term SF-36 physical component score, did not show statistically significant benefits. Only two studies had a low risk of bias (n=463 participants). CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS There is some evidence of a short-term benefit of contemporary exercise-based cardiac rehabilitation on quality of life for people with coronary artery disease. However, the contemporary data presented in this review are insufficient to support its routine use.
Collapse
Affiliation(s)
- Gordon McGregor
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, UK
| | - Richard Powell
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, UK
| | - Peter Kimani
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
294
|
Hall R, Trennery C, Chan R, Gater A, Bradley H, Sikirica MV, von Maltzahn R, Sousa AR, Nelsen LM. Understanding the Patient Experience of Severe, Recurrent, Bilateral Nasal Polyps: A Qualitative Interview Study in the United States and Germany. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:632-641. [PMID: 32389229 DOI: 10.1016/j.jval.2019.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/17/2019] [Accepted: 11/07/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To qualitatively explore patient experiences of severe, recurrent, bilateral nasal polyps (NP). METHODS A targeted literature review of published qualitative studies and online blogs describing patient experiences of NP was conducted. Semistructured concept elicitation interviews were conducted in the United States and Germany with participants ≥18 years with severe, recurrent, bilateral NP to explore their symptom experience and impacts on health-related quality of life (HRQoL; NCT03221192). A subset of 10 participants reported symptoms and impacts using a smartphone or tablet application (app) over a 10-day period. RESULTS A paucity of qualitative evidence regarding patient experience of NP was identified from the literature or blog review. Twenty-seven participant interviews were conducted. Thirty-six symptoms were identified, including 7 primary symptoms (nasal congestion [n = 27 of 27], breathing difficulties [n = 27 of 27], postnasal drip [n = 25 of 27], runny nose [n = 24 of 27], head/facial pressure [n = 23 of 27], loss of smell [n = 23 of 27], loss of taste [n = 22 of 27]) and 29 secondary symptoms (the most common were mucus/catarrh and nose bleeds [both n = 20 of 27]). Most symptoms were reported to vary both within and between days. Sixty impacts of severe NP were reported, including impacts on sleep (n = 22 of 27), physical functioning (n = 21 of 27), activities of daily living (n = 21 of 27), emotional well-being (n = 27 of 27), treatment (n = 23 of 27), social life (n = 26 of 27), and work (n = 19 of 27). Symptoms/impacts reported using the app were consistent with interview findings, although new symptoms were identified (ear pain, throat pain, nasal scabs, and nasal burning). These results supported the development of a conceptual model outlining concepts related to symptoms, impacts, and treatment of NP. CONCLUSIONS Severe, recurrent, bilateral NP are associated with a range of symptoms that have significant detrimental impact on HRQoL.
Collapse
Affiliation(s)
- Rebecca Hall
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Claire Trennery
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Robert Chan
- Clinical Sciences, GlaxoSmithKline R&D, Stockley Park, Uxbridge, England, UK
| | - Adam Gater
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Helena Bradley
- Patient-Centered Outcomes, Adelphi Values, Bollington, Cheshire, England, UK
| | - Mirko V Sikirica
- Value Evidence and Outcomes, GlaxoSmithKline, Philadelphia, PA, USA
| | - Robyn von Maltzahn
- Patient Centred Outcomes, Value Evidence and Outcomes, GlaxoSmithKline, London, England, UK.
| | - Ana R Sousa
- Clinical Sciences, GlaxoSmithKline R&D, Stockley Park, Uxbridge, England, UK
| | - Linda M Nelsen
- Patient Centred Outcomes, Value Evidence and Outcomes, GlaxoSmithKline, Philadelphia, PA, USA
| |
Collapse
|
295
|
Ahmed S, Barbera L, Bartlett SJ, Bebb DG, Brundage M, Bryan S, Cheung WY, Coburn N, Crump T, Cuthbertson L, Howell D, Klassen AF, Leduc S, Li M, Mayo NE, McKinnon G, Olson R, Pink J, Robinson JW, Santana MJ, Sawatzky R, Moxam RS, Sinclair S, Servidio-Italiano F, Temple W. A catalyst for transforming health systems and person-centred care: Canadian national position statement on patient-reported outcomes. Curr Oncol 2020; 27:90-99. [PMID: 32489251 PMCID: PMC7253746 DOI: 10.3747/co.27.6399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.
Collapse
Affiliation(s)
- S Ahmed
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - L Barbera
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - S J Bartlett
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - D G Bebb
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - M Brundage
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Bryan
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - W Y Cheung
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - N Coburn
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - T Crump
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - L Cuthbertson
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - D Howell
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - A F Klassen
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Leduc
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - M Li
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - N E Mayo
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - G McKinnon
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - R Olson
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - J Pink
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - J W Robinson
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - M J Santana
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - R Sawatzky
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - R S Moxam
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Sinclair
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - F Servidio-Italiano
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - W Temple
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| |
Collapse
|
296
|
Fisher L, Polonsky W, Bowyer V, Hessler D. When patient-reported experience does not match change in clinical outcomes: A perplexing view from the inside of a diabetes distress intervention. J Diabetes Complications 2020; 34:107533. [PMID: 31955952 PMCID: PMC8713470 DOI: 10.1016/j.jdiacomp.2020.107533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022]
Abstract
AIMS To assess between-group differences in participant experiences in a two-arm diabetes distress (DD) reduction RCT and to determine their relationship to clinical outcomes (reductions in DD and HbA1C). METHODS For high DD adults with Type 1 diabetes and HbA1c ≥7.5% participating in T1-REDEEM, we evaluated post intervention 5-point ratings of overall program "helpfulness" and program component "helpfulness," along with open-ended feedback statements using 10 qualitative codes. We compared responses of those in OnTrack, a distressed-focused intervention, with KnowIt, an education/management intervention. RESULTS Those in OnTrack reported significantly higher levels of overall program helpfulness and greater helpfulness of each component of the program, greater group support, far fewer negative experiences, and more active and meaningful group engagement than those who participated in KnowIt. Ratings of helpfulness were unrelated to reductions in DD and HbA1C in both study arms. As previously reported, these findings occurred despite significant reductions in both DD and HbA1C in both arms with no between-group differences. CONCLUSIONS Findings highlight the importance of addressing the personal experience of diabetes interventions in clinical care as separate, distinct outcomes. Personal experience may not always be related to changes in traditional clinical indicators.
Collapse
Affiliation(s)
- Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA.
| | - William Polonsky
- University of California, San Diego, San Diego, CA, USA; Behavioral Diabetes Institute, San Diego, CA, USA
| | - Vicky Bowyer
- University of California, San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
297
|
Patient- and 3D morphometry-based nose outcomes after skeletofacial reconstruction. Sci Rep 2020; 10:4246. [PMID: 32144392 PMCID: PMC7060327 DOI: 10.1038/s41598-020-61233-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/18/2020] [Indexed: 02/08/2023] Open
Abstract
Patient satisfaction with the shape and appearance of their nose after orthognathic surgery-based skeletofacial reconstruction is an important, but often overlooked, outcome. We assessed the nose-related outcomes through a recently developed patient-reported outcome instrument and a widely adopted 3D computer-based objective outcome instrument, to verify any correlation in the results produced by these tools. We collected FACE-Q nose appearance reports (2 scales) and 3D nasal morphometry (10 parameters) from patients with class III skeletal pattern and congenital cleft lip palate deformity (n = 23) or developmental dentofacial deformity (n = 23) after (>12 months) skeletofacial reconstruction. The cleft and dentofacial cohorts demonstrated significantly (p < 0.001) poorer satisfaction scores with regard to the FACE-Q nostrils scale than the normal age-, gender-, and ethnicity-matched subjects (n = 107), without any significant difference in FACE-Q nose scale. The cleft cohort had significantly (p < 0.001) smaller nasal length, nasal tip projection, and columellar angle and greater nasal protrusion, alar width, and columellar-labial angle values than the dentofacial and normal cohorts; however, there were no significant differences between the dentofacial versus normal cohorts. The FACE-Q nose and nostrils scales were significantly (p < 0.001; r = -0.26-0.27) correlated to the results of the 3D morphometric analysis, with regard to nasal length, alar width, columella angle, and columellar-labial angle parameters. This study revealed differences in satisfaction with the appearance of the nose according to the type of underlying deformity, and demonstrated a significant correlation (low correlation coefficients) between the patient-reports and 3D image-based outcome measure tools, which has implications for multidisciplinary-centered research, auditing, and clinical care.
Collapse
|
298
|
Stauder R, Lambert J, Desruol-Allardin S, Savre I, Gaugler L, Stojkov I, Siebert U, Chevrou-Séverac H. Patient-reported outcome measures in studies of myelodysplastic syndromes and acute myeloid leukemia: Literature review and landscape analysis. Eur J Haematol 2020; 104:476-487. [PMID: 31985078 PMCID: PMC7217037 DOI: 10.1111/ejh.13389] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study aims to describe the use of patient-reported outcome measures (PROMs) in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) studies and the PROMs landscape. METHODS A comprehensive literature review was performed in Medline/Embase (since 2000) and ClinicalTrials.gov (since 2013) to identify PROMs used in MDS and AML clinical studies. Additionally, PROMs included in approved drug labels since 2000 were reviewed. RESULTS Overall, 112 different PROMs were used in 168 published MDS studies and 152 PROMs were used in 172 AML studies. From ClinicalTrials.gov, 16 different PROMs were used in 22 ongoing registered studies in MDS, and 24 were reported in 41 AML studies. The most frequently used PROMs were cancer-specific (eg, EORTC QLQ-C30, FACT-An) or generic (SF-36, EQ-5D) instruments, whereas MDS- and AML-specific instruments (eg, QUALMS and QOL-E in MDS; FACT-Leu and EORTC QLQ-Leu in AML) were used in a minority of studies. Two EMA-approved drugs for MDS included PROMs in their label. EORTC QLQ-C30 is by far the most frequently used cancer-specific PROM in both MDS and AML studies. CONCLUSIONS This research indicated an underuse of AML/MDS-specific PROMs for these two indications in clinical studies and labeling claims. However, AML/MDS-specific instruments in development might be considered in future studies.
Collapse
Affiliation(s)
- Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | - Lona Gaugler
- Celgene, A Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Igor Stojkov
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria.,Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
299
|
Haslam A, Herrera-Perez D, Gill J, Prasad V. Patient Experience Captured by Quality-of-Life Measurement in Oncology Clinical Trials. JAMA Netw Open 2020; 3:e200363. [PMID: 32129865 PMCID: PMC7057133 DOI: 10.1001/jamanetworkopen.2020.0363] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Quality of life (QoL) is an important consideration in cancer medicine, especially because drugs are becoming more costly and may only result in modest gains in overall survival. However, there has been no descriptive analysis for the points at which QoL is measured in cancer trials. OBJECTIVE To estimate the prevalence of studies that measure QoL at different points and see how many studies measure QoL for the entirety of a patient's life. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis includes all articles on oncology clinical trials in the 3 highest-impact oncology journals, published between July 2015 and June 2018, that reported QoL outcomes. MAIN OUTCOMES AND MEASURES Data were abstracted on when QoL was assessed and the characteristics of these studies. RESULTS For all 149 studies that met inclusion criteria, QoL assessment was high during treatment (104 articles [69.8%]), during follow-up (81 articles [54.4%]), and after the end of the intervention (68 articles [45.6%]). In 5 of the 149 studies (3.4%), QoL was assessed until death, including in only 1 of the 74 studies on metastatic or incurable cancers. Among these 5 studies, only 1 (20%) used a drug intervention, 1 (20%) used a behavioral intervention, and 2 (40%) used a radiation intervention; only 1 of 5 was in the metastatic setting. The number of studies that reported a positive QoL outcome (ie, QoL outcome was more favorable in the intervention group than in the control group) was between 42 of 81 articles (51.9%) and 16 of 28 articles (57.1%) for most QoL assessment points but only 1 of 5 articles (20%) for studies measuring QoL until death. CONCLUSIONS AND RELEVANCE This study found that most clinical trials assessed QoL during the treatment or intervention and often during a given amount of follow-up but infrequently assessed QoL on disease progression and rarely followed QoL until the end of the patient's life. Most studies reporting QoL until the end of life reported worse QoL outcomes for the intervention group than the control group. Future research and policy recommendations should consider not just short-term QoL outcomes but QoL outcomes throughout the patient's cancer care.
Collapse
Affiliation(s)
- Alyson Haslam
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | | | - Jennifer Gill
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
- Center for Health Care Ethics, Oregon Health & Science University, Portland
- Division of General Medicine, Department of Medicine, Oregon Health & Science University, Portland
| |
Collapse
|
300
|
Forsbrand MH, Turkiewicz A, Petersson IF, Sennehed CP, Stigmar K. Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain. Scand J Prim Health Care 2020; 38:92-100. [PMID: 32000558 PMCID: PMC7054906 DOI: 10.1080/02813432.2020.1717081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain.Design: WorkUp - a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750).Intervention: Structured physiotherapy with the workplace dialogue 'Convergence Dialogue Meeting' (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy.Subjects: Adults, 18-67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included (n = 352).Outcome measures: Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up.Results: The mean differences in outcomes between intervention and reference group were; -0.76 (95% confidence interval (CI): -2.39, 0.88; FRI), 0.02 (95% CI: -0.04, 0.08; EQ-5D-3L) and -0.05 (95% CI: -0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS.Conclusion: Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study.Key pointsIn earlier analysis of the primary outcome (work ability measured by absenteeism) in this trial, a positive effect was found when the workplace intervention 'Convergence Dialogue Meeting' (CDM) was added to structured physiotherapy for patients with neck or back pain.By contrast, in this new analysis of secondary outcomes (self-reported function, health and perceived work ability), there was no added effect of CDM above structured physiotherapy alone, although patients in both the intervention and reference group improved over time.The addition of CDM to physiotherapy is therefore justified by its specific effect on behavior (work absence) rather than any effect on clinical outcomes.
Collapse
Affiliation(s)
- Malin H Forsbrand
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Ingemar F Petersson
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Charlotte Post Sennehed
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Kjerstin Stigmar
- Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
| |
Collapse
|