Patient-reported outcomes (PROs) versus patient-reported outcome measures (PROMs)-Is there a difference?

Marginal changes at bone-level implants supporting dental prostheses with or without intermediate standardised abutments after 36 months: Randomised controlled clinical trial

OBJECTIVE

The objective of this study is to evaluate the changes at marginal bone level at implants restored with screw-retained prosthesis connected directly to the implants or with an intermediate abutment, after 3-year follow-up.

MATERIAL AND METHODS

Thirty-six partially edentulous patients received 72 implants. Each patient received 2 implants and a 2-4-unit screw-retained implant-prosthesis. The test group implants received a screw-retained prosthesis connected directly to the implant shoulder, the control group prosthesis were connected through a 3-mm standardised intermediate abutment. Clinical and radiological data were recorded at baseline and at 6-, 12-, and 36-month follow-up.

RESULTS

At 36 months, the mean marginal bone loss was 0.13 ± 0.18 mm for the control group and 0.20 ± 0.24 for the test group, with no significant differences between groups (p > .05). Clinical variables (Probing Pocket Depth, Bleeding on Probing and Plaque Index) at 36 months also showed no significant difference between groups. Minor complications frequency was 6.7% in the control group and 5.3% in test group. None of the groups suffered from mayor complications. Patient Reported Outcomes (PROs) showed a General Satisfaction mean score in the control group of 9.40 (SD 0.82) and 9.37 (SD 1.06) in the test group with no significant differences between groups.

CONCLUSIONS

Bone-level implants restored with screw-retained partial prostheses with or without intermediate abutments showed similar radiographic and clinical outcomes after 3 years.

Review of patient-reported outcomes (PROs) and non-PROs in randomized controlled trials addressing head/neck cancers

BACKGROUND

To assess the frequency of patient-reported outcomes (PROs) and non-PROs in randomized controlled trials (RCTs) addressing head/neck cancers.

METHODS

We included RCTs about interventions to treat head/neck cancers. PubMed was searched on September 16, 2022 and included studies published during three periods (2000-2002, 2010-2012, and 2020-2022). Data on types of outcomes and instruments to measure them were extracted and organized into PROs and non-PROs, and temporal trends for reporting outcomes were determined.

RESULTS

There was a reduction in the frequency of non-PROs (40% to 22%) and an increase in PROs (5% to 19%) over 20 years. The frequency of reporting both non-PROs and PROs seemed to be stable over the same period (55% to 58%). A great variety of instruments to measure PROs and non-PROs was identified.

CONCLUSIONS

There has been a growth in the types of PROs in more recent years, and they were more frequently reported in RCTs. However, head/neck cancer trials with a combination of PROs and non-PROs were the most prevalent.

Psychometric validity of the Shirom-Melamed Burnout Measure and the Burnout Assessment Tool: a systematic review

In the absence of internationally recognised standardised criteria, several patient-reported outcome measures (PROMs) have been developed to measure occupational burnout. The aim of this study was to extend our 2021 review of the psychometric validity of five PROMs to the Shirom-Melamed Burnout Measure (SMBM) and the Burnout Assessment Tool (BAT). To do that we ran a systematic literature search in the MEDLINE, PsycINFO, and Embase databases following our previous methodological framework and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN). We assessed the level of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guideline. We identified 694 publications on SMBM and 421 on BAT, but the final review includes eight papers on SMBM and three on BAT. Of the seven psychometric properties assessed for SMBM, content, structural, and criterion validity were rated as insufficient, whereas the quality of evidence for construct and internal consistency was high and moderate, respectively. Of the nine psychometric properties assessed for BAT, content, structural, criterion, and construct validity was moderate and internal consistency was high. One limitation of this study is that we did not assess cross-cultural validity, because the number of studies reviewed is too small and content validity can only be assessed based on the original PROM version rather than translation. To conclude, BAT is superior to SMBM in terms of psychometric validity, but the quality of evidence for some properties is low or very low, suggesting a need for additional validation studies.

Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) of the Shoulder Disability Questionnaire (SDQ) in Patients Undergoing Rotator Cuff Repair

The Shoulder Disability Questionnaire (SDQ) is a Patient-Reported Outcome Measure (PROM) applied to evaluate shoulder surgery outcomes. The purpose of this study is to identify the accurate Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom State (PASS) values for the SDQ score. A total of 35 patients (21 women and 16 men, mean age 76.6 ± 3.2 years) were followed up at 6 months postoperatively. To assess the patient's health satisfaction and symptoms, anchor questions were used. The MCID and SCB values of the SDQ score for patients who underwent arthroscopic rotator cuff repair from inception to final follow-up were 40.8 and 55.6, respectively. A change of 40.8 in the SDQ score at 6 months after surgery shows that patients achieved a minimum clinically important improvement in their state of health, and a 55.6 change in the SDQ score reflects a substantial clinically important improvement. The PASS cut-off of the SDQ score at 6 months postoperatively ranged from 22.5 to 25.8. If an SDQ score of 22.5 or more is attained after surgery, the health condition can be recognized as acceptable by the majority of patients. These cut-offs will help with understanding specific patient results and allow clinicians to personally assess patient improvement after rotator cuff repair.

Marginal changes at bone-level implants supporting fixed screw-retained partial implant prostheses with or without intermediate standardised abutments: 1-year results of a randomised controlled clinical trial

OBJECTIVE

To compare marginal changes at bone-level implants restored with screw-retained implant prosthesis with or without intermediate standardised abutments, after 1 year of follow-up.

MATERIALS AND METHODS

Thirty-six partially edentulous patients received 72 implants. Each patient received 2 implants and a 2- to 4-unit screw-retained implant-prosthesis. The test group received implants consisting of a screw-retained prosthesis connected directly to the implant shoulder, while the prostheses in the control group were connected through a 3-mm standardised intermediate abutment. Clinical and radiological data were recorded at baseline and at 3, 6 and 12 months in follow-up visits.

RESULTS

At 12 months, the marginal bone loss was 0.17 ± 0.24 mm for the test group (19 patients) and 0.09 ± 0.15 mm for the control group (17 patients), with no statistically significant differences (p > .05). The mean probing pocket depth was 2.96 mm ± 0.46 for the test group and 2.86 ± 0.62 mm for the control group. The test and control groups showed bleeding on probing levels of 18.86 ± 14.12% and 13.73 ± 17.66%, respectively. All patients scored below 25% on the plaque index levels.

CONCLUSIONS

Restoration of bone-level implants with fixed screw-retained partial prostheses with or without intermediate abutments presented similar radiographic and clinical outcomes after 1 year.

ASSESSMENT OF THE FREQUENCY OF REPORTING DENTAL PATIENT-REPORTED OUTCOMES (dPROs) IN A SAMPLE OF RANDOMIZED CONTROLLED TRIALS ON ROOT COVERAGE PROCEDURES

OBJECTIVE

Dental patient-reported outcomes (dPROs) are important for understanding the impact of proposed therapies on patients' oral health. The aims of the present study were to investigate the frequency of the reporting of dPROs in randomized controlled trials (RCTs) of root coverage procedures and to assess associations between the study/article characteristics and the reporting level of the dPROs.

METHODS

The PubMed database was searched for RCTs of root coverage procedures in March 16, 2022 and articles published up to March 2022 were included. Information on the types of outcomes and the characteristics of the studies/articles were extracted and reported as frequencies and percentages. Univariate and multivariate binary logistic regression analyses were performed to investigate the associations between the study/article characteristics and the reporting level of dPROs.

RESULTS

The search initially identified 387 articles, and after applying the eligibility criteria, 135 articles reporting 135 RCTs were included. A combination of dPROs and non-dPROs was reported in 61.5% of the selected trials, while 37.8% of the trials reported only non-dPROs. Pain or discomfort was the most frequently reported dPRO (n = 58, 43% of the RCTs). More recently published RCTs reported more dPROs. The country of the first author (odds ratio [OR]: 4.39; 95% CI: 1.76-10.95; P < .01), protocol registration (OR: 0.36; 95% CI: 0.16-0.83; P = .02), and RCT type (OR: 0.38; 95% CI: 0.17-0.83; P = .02) were significantly associated with the reporting level of the dPROs.

CONCLUSIONS

Researchers in recent years seem to be paying more attention to the importance of dPROs. RCTs in which the first authors were from developed countries, registered trials, and RCTs with a parallel design were more likely to report dPROs than RCTs with first authors from developing countries, unregistered trials, and RCTs with a split-mouth design.

Employing cognitive interviewing to evaluate, improve and validate items for measuring the health-related quality of life of women diagnosed with ovarian cancer

Background

Use of patient-reported outcome measures in clinical settings facilitate the delivery of better health care to improve patient health outcomes. Previously collected qualitative data indicated themes that could inform items for a health-related quality of life measure. This study investigated the content validity of items for inclusion in a new health-related quality of life measure suitable for patients with ovarian cancer.

Methods

Cognitive interviewing techniques were used with fourteen women diagnosed with ovarian cancer and at different times since diagnosis, to evaluate items derived from the previously collected qualitative dataset. A set of draft items was administered via telephone, Zoom and WhatsApp app together with questions on item meaning and wording. Interviews were transcribed and thematically analysed.

Results

Four broad themes emerged in relation to the questionnaire construction and comprehension of items: intent and clarity, wording, relevance and context, and overall questionnaire construct. All draft items were adjusted based on the interview findings. A final set of 38 health-related quality of life items comprised 7 items describing physical health and functioning, 21 describing emotional wellbeing and 10 items describing social wellbeing; each rated on a five-point frequency response scale.

Conclusion

The items reflected a range of personal experiences associated with the patient clinical journey, creating a health-related quality of life tool specific to women diagnosed with ovarian cancer. The cognitive interviewing process established content validity for the tool, thereby, preparing it for field testing and evaluation of its psychometric properties. This study highlighted the fundamental role of cognitive interviewing during health-related quality of life questionnaire development to ensure that item content is grounded in patient feelings, functioning and meaning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01966-w.

The Potential Role of Dental Patient-Reported Outcomes (dPROs) in Evidence-Based Prosthodontics and Clinical Care: A Narrative Review

Oral health problems are associated with poor quality of life, with the potential to cause functional, aesthetic, nutritional, and psychological difficulties, in addition to pain and suffering. Traditionally, dental treatment outcomes are measured using purely clinical parameters; however, this may be ineffective as these parameters cannot adequately capture the full impact of poor oral health on the patient, or their respective coping strategies. From this perspective, there are significant benefits when the patient's perception of their care is considered, and included in treatment planning and delivery. The impacts perceived by the patient on their treatment outcomes can be measured using patient-reported outcomes (PROS), or more specifically with dPROS, focused on dental patient-reported outcomes. Although there are some instruments available for measuring these outcomes in clinical trials, very little information is available for explaining the context in which these outcomes are considered, and also how to capture this information using appropriate instruments, specially in evidence-based dental practice. This article aims to review the literature, seeking to describe what has been considered about assessing patient's outcomes, as well as how to measure them, and explore the potential benefits of using dPROS in evidence-based prosthodontics and clinical care of partially and fully edentulous patients.

Intraoral scanning reduces procedure time and improves patient comfort in fixed prosthodontics and implant dentistry: a systematic review

OBJECTIVES

The primary aim of this systematic review was to evaluate whether intraoral scanning (IOS) is able to reduce working time and improve patient-reported outcome measures (PROMs) compared to conventional impression (CI) techniques, taking into account the size of the scanned area. The secondary aim was to verify the effectiveness of IOS procedures based on available prosthodontic outcomes.

MATERIALS AND METHODS

Electronic and manual literature searches were performed to collect evidence concerning the outcomes of IOS and CI performed during the treatment of partially and complete edentulous patients for tooth- or implant-supported restorations. Qualitative analysis was conducted to evaluate the time efficiency and PROMs produced by the two different techniques. Clinical prosthodontic outcomes were analyzed among the included studies when available.

RESULTS

Seventeen studies (9 randomized controlled trials and 8 prospective clinical studies) were selected for qualitative synthesis. The 17 included studies provided data from 430 IOS and 370 CI performed in 437 patients. A total of 7 different IOS systems and their various updated versions were used for digital impressions. The results demonstrated that IOS was overall faster than CI independent of whether quadrant or complete-arch scanning was utilized, regardless of the nature of the restoration (tooth or implant supported). IOS was generally preferred over CI regardless of the size of the scanned area and nature of the restoration (tooth- or implant-supported). Similar prosthodontic outcomes were reported for workflows implementing CI and IOS.

CONCLUSIONS

Within the limitations of this systematic review, IOS is faster than CI, independent of whether a quadrant or complete arch scan is conducted. IOS can improve the patient experience measured by overall preference and comfort and is able to provide reliable prosthodontic outcomes.

CLINICAL RELEVANCE

Reduced procedure working time associated with the use of IOS can improve clinical efficiency and the patient experience during impression procedures. Patient-reported outcome measures (PROMs) are an essential component of evidence-based dental practice as they allow the evaluation of therapeutic modalities from the perspective of the patient. IOS is generally preferred by patients over conventional impressions.

Tooth Loss Condition and Social Discrimination in Brazilian Healthcare Services

Objective: To explore factors associated with social discrimination against users of health services regarding dental aesthetic conditions.

Methods: Based on a Brazilian National Survey, multivariate Poisson regressions with robust variance were used to explore the association of outcome discrimination related to different motivations in health services and exposure to sociodemographic and dental variables. Effect modification by complete prosthesis wearing was assessed.

Results: Among the 60,200 people interviewed, 11.5% reported being discriminated against in health services. For women, a higher prevalence of discrimination was found among those in the age group of 30–44 years. For both sexes, discrimination was associated with black and brown skin color. Regarding dental characteristics, the higher the tooth loss was, the higher the prevalence of discrimination; however, complete prosthesis wearing presented as a protective factor. Social discrimination was the major motivation for reported discrimination and presented higher prevalence in edentulous individuals who did not wear prosthesis.

Conclusion: Dental loss may lead to self-reported discrimination in health care services. The prevalence of discrimination increases when tooth loss increases, and the major reason associated is social discrimination.

Comparing patient-reported outcomes and experiences among static, dynamic computer-aided, and conventional freehand dental implant placement: A randomized clinical trial

OBJECTIVE

The purpose of this study was to compare patient-reported outcomes and experiences (PROs and PREs) among three techniques of dental implant placement, including (a) conventional freehand, (b) dynamic, and (c) static computer-aided implant surgery (CAIS).

MATERIAL AND METHODS

Ninety patients were randomly assigned to have dental implant placed with one of the three protocols. Participants were asked to fill in a series of self-administered questionnaires assessing (1) preoperative expectations, (2) postoperative healing events during the first week after surgery, and (3) experiences and overall satisfaction with the procedures at 2 weeks. Differences within the groups were analyzed by Wilcoxson signed-rank test. Kruskal-Wallis test was used for comparisons among the three groups.

RESULTS

Eighty-eight patients completed the study. Patients' expectations on chewing difficulty, the postoperative experience of duration of pain, speaking limitations, and impact on routine activities were significantly different among groups (p = 0.04, 0.01, 0.038, and 0.046, respectively). Overall, patients appeared to significantly underestimate the duration of postoperative pain (p = 0.035) and swelling (p = 0.001). No significant difference in magnitude of postoperative pain, swelling, and painkiller consumption was found among the groups. The short-term functional limitations after surgery were deemed acceptable by most participants and 89% were satisfied by the overall procedure.

CONCLUSIONS

Surgical placement of dental implant with conventional freehand, static, and dynamic CAIS techniques did not result in any difference in the level of postoperative pain and swelling, and appeared to lead to equal levels of satisfaction as expressed by the patients postoperatively.

Self-Perceived Impact of Oral Health on the Quality of Life of Women Deprived of Their Liberty

Background

Prison units are marked by structural deficiencies, especially in relation to the female gender.

Objectives

To measure the self-perceived impact of oral health on the quality of life of Brazilian women in detention. Methodology. A survey was carried out conducted in the penitentiary at Juiz de Fora (Minas Gerais, Brazil) using an instrument with semistructured questions and validated scales, including the Oral Health Impact Profile-14. 99 women were interviewed. The analysis was based on a theoretical model of determination, with hierarchical blocks of variables. Bivariate analysis was done using the Mann–Whitney, test and multivariate analysis was used using linear regression. The significance level was set at 5%.

Results

33% experienced tooth loss after incarceration, (3.70 ± 3.26 lost teeth). 65.6% rated the dental service as fair/poor. The highest prevalence of oral health impact was for the domains of psychological discomfort (50.5%) and physical pain (40.4%). There is a negative impact on psychological discomfort: the number of dental consultations in the past year and self-perceived general health. There is an impact on physical pain: self-declared color and anxiety. Self-perceived general health had an impact on the domains of psychological disability and social disadvantage. Depression had an impact on the total score.

Conclusion

This study revealed a self-perceived impact of oral health on the quality of life of women inmates. We need to ensure high-quality access to dental treatment in prisons.

Psychometric properties of burnout measures: a systematic review

AIMS

Occupational Burnout (OB) is currently measured through several Patient-Reported Outcome Measures (PROMs) and some of them have become widely used in occupational health research and practice. We, therefore, aimed to review and grade the psychometric validity of the five OB PROMs considered as valid for OB measure in mental health professionals (the Maslach Burnout Inventory (MBI), the Pines' Burnout Measure (BM), the Psychologist Burnout Inventory (PBI), the OLdenburg Burnout Inventory (OLBI) and the Copenhagen Burnout Inventory (CBI)).

METHODS

We conducted systematic literature searches in MEDLINE, PsycINFO and EMBASE databases. We reviewed studies published between January 1980 and September 2018 following a methodological framework, in which each step of PROM validation, the reference method, analytical technics and result interpretation criteria were assessed. Using the COnsensus-based Standards for the selection of health Measurement Instruments we evaluated the risk of bias in studies assessing content and criterion validity, structural validity, internal consistency, reliability, measurement error, hypotheses testing and responsiveness of each PROM. Finally, we assessed the level of evidence for the validity of each PROM using the GRADE approach.

RESULTS

We identified 6541 studies, 19 of which were included for review. Fifteen studies dealt with MBI whereas BM, PBI, OLBI and CBI were each examined in only one study. OLBI had the most complete validation, followed by CBI, MBI, BM and PBI, respectively. When examining the result interpretation correctness, the strongest disagreement was observed for MBI (27% of results), BM (25%) and CBI (17%). There was no disagreement regarding PBI and OLBI. For OLBI and CBI, the quality of evidence for sufficient content validity, the crucial psychometric property, was moderate; for MBI, BM and PBI, it was very low.

CONCLUSION

To be validly and reliably used in medical research and practice, PROM should exhibit robust psychometric properties. Among the five PROMs reviewed, CBI and, to a lesser extent, OLBI meet this prerequisite. The cross-cultural validity of these PROMs was beyond the scope of our work and should be addressed in the future. Moreover, the development of a diagnostic standard for OB would be helpful to assess the sensitivity and specificity of the PROMs and further reexamine their validity.The study protocol was registered in PROSPERO (CRD 42019124621).

[Blood pressure telemonitoring and remote counseling in uncontrolled hypertension]

Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated.

AIM

Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN.

MATERIALS AND METHODS

A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN well state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective.

RESULTS

In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient).

CONCLUSION

According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.

Access to dental services and oral health-related quality of life in the context of primary health care

The aim of the present study was to evaluate the association between access to oral health care in the Primary Health Care (PHC) and Oral Health-Related Quality of Life (OHRQoL). The present study was a cross-sectional study, and the sample was composed of 412 users living in the areas covered by the public PHC services who visited a health unit for an oral exam or treatment in the last 24 months. Participants in the study responded to a home-based interview with questions that addressed socioeconomic status, behavioral, general health, dental prostheses, access to dental services in the PHC and their OHRQoL as measured by the Oral Health Impact Profile (OHIP-14) instrument. After the interview, a dental examination was performed to count the number of teeth. Chi-square tests, Student's t tests and multivariate analyses were performed using a hierarchical model and a Poisson regression with robust variance to evaluate the association between independent variables and OHRQoL. Access to oral health services in the PHC was statistically associated with OHRQoL, and the estimated prevalence rate was PR = 1.17 (CI 95% 1.00-1.37). In this study, the definition of access was based on the availability of dental consultations on demand. The study identified that lack of access to oral health services offered by the PHC was associated with a higher prevalence of impact on the quality of life of individuals.