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Gottschalk S, König HH, Nejad M, Dams J. Measurement properties of the EQ-5D in populations with a mean age of ≥ 75 years: a systematic review. Qual Life Res 2023; 32:307-329. [PMID: 35915354 PMCID: PMC9911506 DOI: 10.1007/s11136-022-03185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Healthcare interventions for middle-old and oldest-old individuals are often (economically) evaluated using the EQ-5D to measure health-related quality of life (HrQoL). This requires sufficient measurement properties of the EQ-5D. Therefore, the current study aimed to systematically review studies assessing the measurement properties of the EQ-5D in this population. METHODS The databases PubMed, Cochrane library, Web of Science, Embase, and EconLit were searched for studies providing empirical evidence of reliability, validity, and/or responsiveness of the EQ-5D-3L and EQ-5D-5L in samples with a mean age ≥ 75 years. Studies were selected by two independent reviewers, and the methodological quality was assessed using the COSMIN Risk of Bias checklist. Results were rated against updated criteria for good measurement properties (sufficient, insufficient, inconsistent, indeterminate). The evidence was summarized, and the quality of evidence was graded using a modified GRADE approach. RESULTS For both EQ-5D versions, high-quality evidence for sufficient convergent validity was found. Known-groups validity was sufficient for the EQ-5D-5L (high-quality evidence), whereas the results were inconsistent for the EQ-5D-3L. Results regarding the reliability were inconsistent (EQ-5D-3L) or entirely lacking (EQ-5D-5L). Responsiveness based on correlations of change scores with instruments measuring related/similar constructs was insufficient for the EQ-5D-3L (high-quality evidence). For the EQ-5D-5L, the available evidence on responsiveness to change in (Hr)QoL instruments was limited. CONCLUSION Since the responsiveness of the EQ-5D in a population of middle-old and oldest-old individuals was questionable, either using additional instruments or considering the use of an alternative, more comprehensive instrument of (Hr)QoL might be advisable, especially for economic evaluations.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Mona Nejad
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Judith Dams
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Dickenson E, Griffin XL, Achten J, Mironov K, O'Connor H, Parsons N, Murphy M, Wyse M, Mason J, Appelbe D, Athwal A, Griffin D. Randomised controlled trial comparing intraoperative cell salvage and autotransfusion with standard care in the treatment of hip fractures: a protocol for the WHITE 9 study. BMJ Open 2022; 12:e062338. [PMID: 35676006 PMCID: PMC9185657 DOI: 10.1136/bmjopen-2022-062338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION People who sustain a hip fracture are typically elderly, frail and require urgent surgery. Hip fracture and the urgent surgery is associated with acute blood loss, compounding patients' pre-existing comorbidities including anaemia. Approximately 30% of patients require a donor blood transfusion in the perioperative period. Donor blood transfusions are associated with increased rates of infections, allergic reactions and longer lengths of stay. Furthermore, there is a substantial cost associated with the use of donor blood. Cell salvage and autotransfusion is a technique that recovers, washes and transfuses blood lost during surgery back to the patient. The objective of this study is to determine the clinical and cost effectiveness of intraoperative cell salvage, compared with standard care, in improving health related quality-of-life of patients undergoing hip fracture surgery. METHODS AND ANALYSIS Multicentre, parallel group, two-arm, randomised controlled trial. Patients aged 60 years and older with a hip fracture treated with surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either undergo cell salvage and autotransfusion or they will follow the standard care pathway. Otherwise, all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: EuroQol-5D-5L HRQoL at 4 months post injury. Secondary outcomes will include complications, postoperative delirium, residential status, mobility, allogenic blood use, mortality and resource use. ETHICS AND DISSEMINATION NHS ethical approval was provided on 14 August 2019 (19/WA/0197) and the trial registered (ISRCTN15945622). After the conclusion of this trial, a manuscript will be prepared for peer-review publication. Results will be disseminated in lay form to participants and the public. TRIAL REGISTRATION NUMBER ISRCTN15945622.
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Affiliation(s)
| | - Xavier Luke Griffin
- Bone and Joint Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Honorary Trauma and Orthopaedic Surgeon, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Juul Achten
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katy Mironov
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Heather O'Connor
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Mike Murphy
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - Matthew Wyse
- Consultant Anaesthetist, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Duncan Appelbe
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amrita Athwal
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Damian Griffin
- Warwick Medical School, University of Warwick, Coventry, UK
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Soto-Vidal C, Calvo-Fuente V, Muriel-García A, Gallego-Izquierdo T, González-Alted C, Pacheco-da-Costa S. Responsiveness of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10034. [PMID: 34639337 PMCID: PMC8507955 DOI: 10.3390/ijerph181910034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the responsiveness of the Spanish version of the Newcastle Stroke-specific Quality of Life measure (NEWSQOL) to assess quality of life in Spanish people after suffering a stroke. DESIGN A prospective observational study was conducted to assess the responsiveness of the Spanish version of NEWSQOL. The sample contained 128 patients who filled in the questionnaires before and after a physical therapy intervention. The responsiveness was assessed with p-values using the effect size (ES) and the standardized response means (SRMs) of the change. Besides, two other external criteria were used to distinguish patients who improved with the treatment from those who remained stable. This classification was based on one functional independence measure (the Barthel Index) and one disability measure (the modified Rankin Scale). RESULTS There was a statistically significant correlation (Spearman's coefficient = p < 0.01) between the domains of the Spanish version of NEWSQOL in relation to the Barthel Index and the modified Rankin Scale. All domains showed between marked-to-mild change responsiveness except sleep and relationships; mobility (ES 0.66 and SRM 0.92) and activities of daily living (ES 0.75 and SRM 0.87) were markedly responsive; communication (ES 0.38 and SRM 0.61) was moderately responsive; and pain, vision, cognition, feelings, emotions and fatigue were mildly responsive (ES 0.21-0.41 and SRM 0.23-0.44). CONCLUSION The Spanish version of NEWSQOL shows between marked and mild responsiveness to measure the perception of QoL in post-stroke patients. Therefore, its use can be suitable for evaluation studies, clinical trials and clinical practice.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Alfonso Muriel-García
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | | | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
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Osteoporosis treatment rate following hip fracture in a community hospital. Arch Osteoporos 2021; 16:8. [PMID: 33409668 DOI: 10.1007/s11657-020-00861-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Treatment rates for osteoporosis after a major osteoporotic fracture are unacceptably low. We evaluate the effectiveness of an ortho-geriatric team (OGT) in initiating pharmacologic therapy for osteoporosis post-hip fracture. The OGT was able to achieve a higher treatment rate for patients post-hip fracture in comparison to usual care provided by the primary care hospitalist. Potential reasons for delaying or not proceeding with drug therapy include patient concern regarding potential rare side effects of antiresorptive therapy including osteonecrosis of the jaw and atypical femoral fracture. These events however are rare, and in this study, only 3% of hip fractures were atypical femoral fractures. INTRODUCTION Currently, a significant care gap for osteoporosis therapy exists post-hip fracture despite advances in pharmacologic therapy. We evaluate the effectiveness of the OGT at the Oakville Trafalgar Memorial Hospital (OTMH), Ontario, Canada, in reducing the care gap and initiating pharmacologic therapy in hip fracture patients prior to hospital discharge. We also evaluated the incidence of atypical femoral fracture (AFF) separately. METHODS A retrospective chart review of patients 59 years and older with a hip fracture admitted to OTMH from January 1, 2016, to February 1, 2017, was conducted. The primary outcome was the proportion of hip fracture patients discharged from the hospital with appropriate treatment for their underlying osteoporosis. A sub-analysis was completed reporting the incidence of AFF among older adults. RESULTS A total of 197 patients with a hip fracture were identified, 134/197 (68%) patients were seen by the OGT, 98/134 (73%) of these patients were started on pharmacologic therapy prior to discharge, and 120/134 (89%) of patients seen by the OGT were on treatment within 3 months of discharge following assessment in the complex osteoporosis clinic. Sixty-three patients of the 197 (63/197) (32%) of the hip fracture patients were seen by a hospitalist, and treatment rates prior to discharge were 5%. Only 6/197 patients had experienced an AFF during the study period, and all patients with an atypical femoral fracture had been on long-term bisphosphonate therapy. All of the patients with an AFF had thigh or groin pain for several weeks to months prior to the development of the atypical femoral fracture, providing an opportunity to stop therapy and possibly prevent the development of a complete AFF. CONCLUSION The OGT was able to initiate anti-osteoporosis therapy in significantly more patients in comparison to usual care, and higher treatment rates are possible with an OGT.
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Lavigne M, Vendittoli PA, Virolainen P, Corten K, Martinez M, Zicat B, Peter V, Bloem R, Miazzolo N, Remes V. Large head ceramic-on-ceramic bearing in primary total hip arthroplasty: average 3-year follow-up of a multicentre study. Hip Int 2020; 30:711-717. [PMID: 31296057 DOI: 10.1177/1120700019863376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgeons are increasingly using larger femoral head sizes in total hip arthroplasty (THA) to improve stability and reduce the rate of dislocation, 1 of the leading causes of revision surgery. Large ceramic head sizes up to 48 mm can now be used with monoblock acetabular components. National registries have shown promising results at short-term with large diameter ceramic-on-ceramic THA, with very low revision rates.This study reports on the average 3-year follow up of a press-fit monoblock large diameter acetabular shell with a pre-assembled ceramic liner, with emphasis on the radiographic outcome, complications related to the implantation of the cup, and the patient's clinical outcome. METHODS 170 hips in 169 patients were reviewed at an average 38 ± 5.8 months following surgery. RESULTS The radiographic review revealed no acetabular cup loosening, no osteolysis and no cup migration. 1 acetabular cup was revised for malposition. The patient clinical outcome and the satisfaction rate were excellent. At 3 years, 7.1% of patients complained of groin pain and 3.5% spontaneously reported hip joint generated noise. 1 patient sustained a non-recurrent traumatic hip dislocation 2 years post surgery. CONCLUSIONS New technology should be introduced cautiously on the market. This is especially true for the large diameter ceramic monoblock acetabular component used in this study since it involves a new acetabular component design. At short term, we have not identified new modes of failure with this implant. Longer follow-up is still needed to assess the safety of large ceramic bearing in THA.
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Affiliation(s)
- Martin Lavigne
- Hôpital Maisonneuve Rosemont, University of Montreal affiliated hospital, Montreal, Canada
| | | | | | | | | | - Bernard Zicat
- The Mater Hospital, Concord Hospital, Sydney, Australia
| | - Viju Peter
- Royal Liverpool and Broadgreen University Teaching Hospitals, Liverpool, UK
| | - Rolf Bloem
- Reinier de Graaf Groep, Delft, The Netherlands
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Halaweh H. Correlation between Health-Related Quality of Life and Hand Grip Strength among Older Adults. Exp Aging Res 2020; 46:178-191. [PMID: 31928183 DOI: 10.1080/0361073x.2020.1716157] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: With advanced age, the progressive loss of muscle strength estimated by the handgrip strength (HGS) may result in a poorer health-related quality of life (HRQoL). Studying this association becomes a vital area of research for promoting aging-well. The aim of this study was to examine the correlation between HRQoL and HGS among community-dwelling older adults above 60 years old.Methods: Participants comprised of 176 older adults (mean age: 68.15 ± 6.74). The HGS was tested with Jamar® Dynamometer, and the EuroQuol-5 Dimensions 5Levels (EQ-5D-5L) questionnaire was used to assess HRQoL.Results: Both HGS and HRQoL were negatively correlated with age (p < .001). Lower values of HGS and HRQoL were recorded among older adults who had diagnosed with one or more chronic diseases (p < .001). Significant correlations were recorded between HGS and functioning, and subjective well-being domains of EQ-5D-5L. A relatively higher association was recorded between the functioning variables of EQ-5D-5L and HGS compared to subjective well- being variables.Conclusion: Handgrip strength is a simple and practical measure in identifying older adults at risk of physical decline. Maintaining handgrip strength may contribute to improving HRQoL, and can add an imperative dimension to promote aging-well in older adults ≥60 years old.
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Affiliation(s)
- Hadeel Halaweh
- Department of Physiotherapy & Rehabilitation, Faculty of Health Professions, Al-Quds University, East Jerusalem, State of Palestine.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Hulsbæk S, Ban I, Aasvang TK, Jensen JEB, Kehlet H, Foss NB, Bandholm T, Kristensen MT. Preliminary effect and feasibility of physiotherapy with strength training and protein-rich nutritional supplement in combination with anabolic steroids in cross-continuum rehabilitation of patients with hip fracture: protocol for a blinded randomized controlled pilot trial (HIP-SAP1 trial). Trials 2019; 20:763. [PMID: 31870451 PMCID: PMC6929304 DOI: 10.1186/s13063-019-3845-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/24/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A 2014 Cochrane review evaluating the effect of anabolic steroids after hip fracture concluded that the quality of the studies was insufficient to draw conclusions on the effects and recommended further high-quality trials in the field. Therefore, the aim of this pilot trial is to determine the preliminary effect and feasibility of a 12-week multimodal intervention consisting of physiotherapy (with strength training), protein-rich nutritional supplement and anabolic steroid on knee-extension muscle strength and function 14 weeks after hip fracture surgery. METHODS We plan to conduct a randomized, placebo-controlled pilot trial with 48 patients operated for acute hip fracture. The patients are randomized (1:1) to either (1) physiotherapy with protein-rich nutritional supplement plus anabolic steroid or (2) physiotherapy with protein-rich nutritional supplement plus placebo. Outcome assessments will be carried out blinded at baseline (3-10 days after surgery) and at 14 weeks after entering the trial. Primary outcome is the change from baseline to follow-up in maximal isometric knee-extension muscle strength in the fractured limb. Secondary outcomes are physical performance test, patient-reported outcomes, and measures of body composition. DISCUSSION If the trial is found feasible and the results show an indication of anabolic steroid being a relevant addition to further enhance the recovery of muscle strength and function in an enhanced recovery after surgery program, this trial will constitute the basis of a larger confirmatory trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT03545347. Preregistered on 4 June 2018.
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Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Ilija Ban
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Tobias Kvanner Aasvang
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Jens-Erik Beck Jensen
- Department of Endocrinology, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology 721, Copenhagen University Hospital, Rigshospitalet Ole Maaløes vej 26, 2100 Copenhagen Ø, Denmark
| | - Nicolai Bang Foss
- Department of Anesthesiology, Copenhagen University Hospital, Amager-Hvidovre and Institute of Clinical Medicine, University of Copenhagen, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
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Fernandez MA, Achten J, Lerner RG, Mironov K, Parsons N, Dritsaki M, Png ME, McGibbon A, Gould J, Griffin X, Costa ML. Randomised controlled trial comparing hydroxyapatite coated uncemented hemiarthroplasty with cemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: a protocol for the WHITE 5 study. BMJ Open 2019; 9:e033957. [PMID: 31822548 PMCID: PMC6924810 DOI: 10.1136/bmjopen-2019-033957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Hip fracture is a serious injury in adults, especially those aged over 60 years. The most common type of hip fracture (displaced intracapsular) is treated for the majority of patients with a partial hip replacement (hemiarthroplasty). The hemiarthroplasty implant can be fixed to the bone with or without bone cement. Cement is the current recommended technique but recently some risks have been identified, which could potentially be avoided by using uncemented implants. Controversy, therefore, remains about which type of hemiarthroplasty offers patients the best outcomes.This is the protocol for a multicentre randomised controlled trial comparing cemented hemiarthroplasty versus uncemented hemiarthroplasty for patients 60 years and over with a displaced intracapsular hip fracture. METHODS AND ANALYSIS Multicentre (a minimum of seven UK hospitals), multisurgeon, parallel group, two-arm, superiority, randomised controlled trial. Patients aged 60 years and older with a displaced intracapsular hip fracture treated with hemiarthroplasty surgery are eligible. Participants will be randomly allocated on a 1:1 basis to either a cemented hemiarthroplasty or a modern hydroxyapatite coated uncemented hemiarthroplasty. Otherwise all care will be in accordance with the National Institute for Health and Care Excellence guidance. A minimum of 1128 patients will be recruited to obtain 90% power to detect a 0.075-point difference in the primary endpoint: health-related quality of life (EuroQol 5 dimensions 5 levels) at 4 months postinjury. The treatment effect will be estimated using a two-sided t-test adjusted for age, gender and cognitive impairment based on an intention-to-treat analysis. Secondary outcomes include mortality, complications including revision surgery and cause, mobility status, residential status, health-related quality of life at 1 and 12 months and health resource use. A within-trial economic analysis will be conducted. ETHICS, DISSEMINATION AND FUNDING Wales Research Ethics Committee 5 approved the feasibility phase on 2 December 2016 (16/WA/0351) and the definitive trial on 22 November 2017 (17/WA/0383). This study is sponsored by the University of Oxford and funded by the National Institute for Health Research, Research for Patient Benefit (PB-PG-0215-36043 and PB-PG-1216-20021). A manuscript for a peer-reviewed journal will be prepared and the results shared with patients via local mechanisms at participating centres. TRIAL REGISTRATION NUMBER ISRCTN18393176.
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Affiliation(s)
- Miguel Antonio Fernandez
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
- Trauma & Orthopaedic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Juul Achten
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | | | - Katy Mironov
- Oxford Trauma, NDORMS, University of Oxford, Oxford, UK
| | - Nicholas Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Melina Dritsaki
- Oxford Clinical Trial Unit, NDORMS, University of Oxford, Oxford, UK
| | - May E Png
- Oxford Clinical Trial Unit, NDORMS, University of Oxford, Oxford, UK
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Barker A, Cameron P, Flicker L, Arendts G, Brand C, Etherton-Beer C, Forbes A, Haines T, Hill AM, Hunter P, Lowthian J, Nyman SR, Redfern J, Smit DV, Waldron N, Boyle E, MacDonald E, Ayton D, Morello R, Hill K. Evaluation of RESPOND, a patient-centred program to prevent falls in older people presenting to the emergency department with a fall: A randomised controlled trial. PLoS Med 2019; 16:e1002807. [PMID: 31125354 PMCID: PMC6534288 DOI: 10.1371/journal.pmed.1002807] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Falls are a leading reason for older people presenting to the emergency department (ED), and many experience further falls. Little evidence exists to guide secondary prevention in this population. This randomised controlled trial (RCT) investigated whether a 6-month telephone-based patient-centred program-RESPOND-had an effect on falls and fall injuries in older people presenting to the ED after a fall. METHODS AND FINDINGS Community-dwelling people aged 60-90 years presenting to the ED with a fall and planned for discharge home within 72 hours were recruited from two EDs in Australia. Participants were enrolled if they could walk without hands-on assistance, use a telephone, and were free of cognitive impairment (Mini-Mental State Examination > 23). Recruitment occurred between 1 April 2014 and 29 June 2015. Participants were randomised to receive either RESPOND (intervention) or usual care (control). RESPOND comprised (1) home-based risk assessment; (2) 6 months telephone-based education, coaching, goal setting, and support for evidence-based risk factor management; and (3) linkages to existing services. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy, and quality of life. Assessors blind to group allocation collected outcome data via postal calendars, telephone follow-up, and hospital records. There were 430 people in the primary outcome analysis-217 randomised to RESPOND and 213 to control. The mean age of participants was 73 years; 55% were female. Falls per person-year were 1.15 in the RESPOND group and 1.83 in the control (incidence rate ratio [IRR] 0.65 [95% CI 0.43-0.99]; P = 0.042). There was no significant difference in fall injuries (IRR 0.81 [0.51-1.29]; P = 0.374). The rate of fractures was significantly lower in the RESPOND group compared with the control (0.05 versus 0.12; IRR 0.37 [95% CI 0.15-0.91]; P = 0.03), but there were no significant differences in other secondary outcomes between groups: ED presentations, hospitalisations or falls risk, falls efficacy, and quality of life. There were two deaths in the RESPOND group and one in the control group. No adverse events or unintended harm were reported. Limitations of this study were the high number of dropouts (n = 93); possible underreporting of falls, fall injuries, and hospitalisations across both groups; and the relatively small number of fracture events. CONCLUSIONS In this study, providing a telephone-based, patient-centred falls prevention program reduced falls but not fall injuries, in older people presenting to the ED with a fall. Among secondary outcomes, only fractures reduced. Adopting patient-centred strategies into routine clinical practice for falls prevention could offer an opportunity to improve outcomes and reduce falls in patients attending the ED. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
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Affiliation(s)
- Anna Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Leon Flicker
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
- Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Glenn Arendts
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Caroline Brand
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne EpiCentre, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne EpiCentre, Melbourne Health, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
- Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
- Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | | | - Judy Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole, United Kingdom
| | - Julie Redfern
- Westmead Applied Research Centre, University of Sydney, Westmead, New South Wales, Australia
| | | | - Nicholas Waldron
- Health Networks Branch, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Ellen MacDonald
- Emergency Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Renata Morello
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Keith Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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10
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Liberal transfusion strategy to prevent mortality and anaemia-associated, ischaemic events in elderly non-cardiac surgical patients - the study design of the LIBERAL-Trial. Trials 2019; 20:101. [PMID: 30717805 PMCID: PMC6360712 DOI: 10.1186/s13063-019-3200-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/16/2019] [Indexed: 01/28/2023] Open
Abstract
Background Perioperative anaemia leads to impaired oxygen supply with a risk of vital organ ischaemia. In healthy and fit individuals, anaemia can be compensated by several mechanisms. Elderly patients, however, have less compensatory mechanisms because of multiple co-morbidities and age-related decline of functional reserves. The purpose of the study is to evaluate whether elderly surgical patients may benefit from a liberal red blood cell (RBC) transfusion strategy compared to a restrictive transfusion strategy. Methods The LIBERAL Trial is a prospective, randomized, multicentre, controlled clinical phase IV trial randomising 2470 elderly (≥ 70 years) patients undergoing intermediate- or high-risk non-cardiac surgery. Registered patients will be randomised only if Haemoglobin (Hb) reaches ≤9 g/dl during surgery or within 3 days after surgery either to the LIBERAL group (transfusion of a single RBC unit when Hb ≤ 9 g/dl with a target range for the post-transfusion Hb level of 9–10.5 g/dl) or the RESTRICTIVE group (transfusion of a single RBC unit when Hb ≤ 7.5 g/dl with a target range for the post-transfusion Hb level of 7.5–9 g/dl). The intervention per patient will be followed until hospital discharge or up to 30 days after surgery, whichever occurs first. The primary efficacy outcome is defined as a composite of all-cause mortality, acute myocardial infarction, acute ischaemic stroke, acute kidney injury (stage III), acute mesenteric ischaemia and acute peripheral vascular ischaemia within 90 days after surgery. Infections requiring iv antibiotics with re-hospitalisation are assessed as important secondary endpoint. The primary endpoint will be analysed by logistic regression adjusting for age, cancer surgery (y/n), type of surgery (intermediate- or high-risk), and incorporating centres as random effect. Discussion The LIBERAL-Trial will evaluate whether a liberal transfusion strategy reduces the occurrence of major adverse events after non-cardiac surgery in the geriatric population compared to a restrictive strategy within 90 days after surgery. Trial registration ClinicalTrials.gov (identifier: NCT03369210). Electronic supplementary material The online version of this article (10.1186/s13063-019-3200-3) contains supplementary material, which is available to authorized users.
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11
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Kümin M, Harper CM, Reed M, Bremner S, Perry N, Scarborough M. Reducing Implant Infection in Orthopaedics (RIIiO): a pilot study for a randomised controlled trial comparing the influence of forced air versus resistive fabric warming technologies on postoperative infection rates following orthopaedic implant surgery in adults. Trials 2018; 19:640. [PMID: 30454034 PMCID: PMC6245696 DOI: 10.1186/s13063-018-3011-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/21/2018] [Indexed: 11/30/2022] Open
Abstract
Background Approximately 70,000 to 75,000 proximal femoral fracture repairs take place in the UK each year. Hemiarthroplasty is the preferred treatment for adults aged over 60 years. Postoperative infection affects up to 3% of patients and is the single most common reason for early return to theatre. Ultraclean ventilation was introduced to help mitigate the risk of infection, but it may also contribute to inadvertent perioperative hypothermia, which itself is a risk for postoperative infection. To counter this, active intraoperative warming is used for all procedures that take 30 min or more. Forced air warming (FAW) and resistive fabric warming (RFW) are the two principal techniques used for this purpose; they are equally effective in prevention of inadvertent perioperative hypothermia, but it is not known which is associated with the lowest infection rates. Deep surgical site infection doubles operative costs, triples investigation costs and quadruples ward costs. The Reducing Implant Infection in Orthopaedics (RIIiO) study seeks to compare infection rates with FAW versus RFW after hemiarthroplasty for hip fracture. A cost-neutral intervention capable of reducing postoperative infection rates would likely lead to a change in practice, yield significant savings for the health economy, reduce overall exposure to antibiotics and improve outcomes following hip fracture in the elderly. The findings may be transferable to other orthopaedic implant procedures and to non-orthopaedic surgical specialties. Methods RIIiO is a parallel group, open label study randomising hip fracture patients over 60 years of age who are undergoing hemiarthroplasty to RFW or FAW. Participants are followed up for 3 months. Definitive deep surgical site infection within 90 days of surgery, the primary endpoint, is determined by a blinded endpoint committee. Discussion Hemiarthroplasty carries a risk of deep surgical site infection of approximately 3%. In order to provide 90% power to demonstrate an absolute risk reduction of 1%, using a 5% significance level, a full trial would need to recruit approximately 8630 participants. A pilot study is being conducted in the first instance to demonstrate that recruitment and data management strategies are appropriate and robust before embarking on a large multi-centre trial. Trial registration ISRCTN, ISRCTN74612906. Registered on 27 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3011-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Kümin
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher Mark Harper
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - Mike Reed
- Northumbria Healthcare NHS Foundation Trust, Hexham, UK
| | | | - Nicky Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Matthew Scarborough
- Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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12
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Kanis JA, Johansson H, Odén A, Harvey NC, Gudnason V, Sanders KM, Sigurdsson G, Siggeirsdottir K, Fitzpatrick LA, Borgström F, McCloskey EV. Characteristics of recurrent fractures. Osteoporos Int 2018; 29:1747-1757. [PMID: 29947869 PMCID: PMC6076437 DOI: 10.1007/s00198-018-4502-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/04/2018] [Indexed: 02/05/2023]
Abstract
The present study, drawn from a sample of the Icelandic population, quantified high immediate risk and utility loss of subsequent fracture after a sentinel fracture (at the hip, spine, distal forearm and humerus) that attenuated with time. INTRODUCTION The risk of a subsequent osteoporotic fracture is particularly acute immediately after an index fracture and wanes progressively with time. The aim of this study was to quantify the risk and utility consequences of subsequent fracture after a sentinel fracture (at the hip, spine, distal forearm and humerus) with an emphasis on the time course of recurrent fracture. METHODS The Reykjavik Study fracture registration, drawn from a sample of the Icelandic population (n = 18,872), recorded all fractures of the participants from their entry into the study until December 31, 2012. Medical records for the participants were manually examined and verified. First sentinel fractures were identified. Subsequent fractures, deaths, 10-year probability of fracture and cumulative disutility using multipliers derived from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) were examined as a function of time after fracture, age and sex. RESULTS Over 10 years, subsequent fractures were sustained in 28% of 1498 individuals with a sentinel hip fracture. For other sentinel fractures, the proportion ranged from 35 to 38%. After each sentinel fracture, the risk of subsequent fracture was highest in the immediate post fracture interval and decreased markedly with time. Thus, amongst individuals who sustained a recurrent fracture, 31-45% did so within 1 year of the sentinel fracture. Hazard ratios for fracture recurrence (population relative risks) were accordingly highest immediately after the sentinel fracture (2.6-5.3, depending on the site of fracture) and fell progressively over 10 years (1.5-2.2). Population relative risks also decreased progressively with age. The utility loss during the first 10 years after a sentinel fracture varied by age (less with age) and sex (greater in women). In women at the age of 70 years, the mean utility loss due to fractures in the whole cohort was 0.081 whereas this was 12-fold greater in women with a sentinel hip fracture, and was increased 15-fold for spine fracture, 4-fold for forearm fracture and 8-fold for humeral fracture. CONCLUSION High fracture risks and utility loss immediately after fracture suggest that treatment given as soon as possible after fracture would avoid a higher number of new fractures compared with treatment given later. This provides the rationale for very early intervention immediately after a sentinel fracture.
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Affiliation(s)
- J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia.
| | - H Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - A Odén
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - V Gudnason
- Icelandic Heart Association Research Institute, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - K M Sanders
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - G Sigurdsson
- Icelandic Heart Association Research Institute, Kopavogur, Iceland
| | - K Siggeirsdottir
- Icelandic Heart Association Research Institute, Kopavogur, Iceland
| | | | - F Borgström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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13
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Svedbom A, Borgstöm F, Hernlund E, Ström O, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jürisson M, Kallikorm R, Lember M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Solodovnikov A, Tamulaitiene M, Thomas T, Toroptsova N, Uusküla A, Tosteson ANA, Jönsson B, Kanis JA. Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporos Int 2018; 29:557-566. [PMID: 29230511 DOI: 10.1007/s00198-017-4317-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months. INTRODUCTION The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture. METHODS Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture. RESULTS Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types. CONCLUSIONS Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.
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Affiliation(s)
| | - F Borgstöm
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | | | - O Ström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | - V Alekna
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - M L Bianchi
- Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - P Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez and Faculty of Medicine UNAM, Mexico City, Mexico
| | - M D Curiel
- Servicio de Medicina Interna/Enfermedades Metabolicas Oseas, Fundacion Jimenez Diaz, Madrid, Spain
- Catedra de Enfermedades Metabolicas Óseas, Universidad Autonoma, Madrid, Spain
| | - H P Dimai
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - M Jürisson
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - R Kallikorm
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Lember
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - O Lesnyak
- Ural State Medical University, Yekaterinburg, Russia
- North West Mechnikov State Medical University, St. Petersburg, Russia
| | - E McCloskey
- Academic Unit of Bone Metabolism, Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - K M Sanders
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - M Tamulaitiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - T Thomas
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Service de Rhumatologie, CHU de Saint-Etienne, Université de Lyon, Saint-Etienne, France
| | - N Toroptsova
- FSBSI "Scientific Research Institute of Rheumatology named after V.A.Nasonova, Moscow, Russia
| | - A Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, PA, USA
| | - B Jönsson
- Stockholm School of Economics, Stockholm, Sweden
| | - J A Kanis
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
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14
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Haywood KL, Brett J, Tutton E, Staniszewska S. Patient-reported outcome measures in older people with hip fracture: a systematic review of quality and acceptability. Qual Life Res 2016; 26:799-812. [DOI: 10.1007/s11136-016-1424-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/24/2023]
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15
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Morello RT, Morris RL, Hill KD, Haines TP, Arendts G, Redfern J, Etherton-Beer CD, Lowthian JA, Brand CA, Liew D, Watts JJ, Barker AL. RESPOND: a programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for an economic evaluation. Inj Prev 2016; 23:124-130. [PMID: 28330932 DOI: 10.1136/injuryprev-2016-042169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Falls remain common for community-dwelling older people and impose a substantial economic burden to the healthcare system. RESPOND is a novel falls prevention programme that aims to reduce secondary falls and fall injuries among older people who present to a hospital emergency department (ED) with a fall. The present protocol describes a prospective economic evaluation examining the incremental cost-effectiveness of the RESPOND programme, compared with usual care practice, from the Australian health system perspective. METHODS AND DESIGN This economic evaluation will recruit 528 participants from two major tertiary hospital EDs in Australia and will be undertaken alongside a multisite randomised controlled trial. Outcome and costing data will be collected for all participants over the 12-month trial. It will compare the RESPOND falls prevention programme with usual care practice (current community-based falls prevention practices) to determine its incremental cost-effectiveness according to three intermediate clinical outcomes: (1) falls prevented, (2) fall injuries prevented and (3) injurious falls prevented. In addition, utilities will be derived from a generic quality-of-life measure (EQ-5D-5L) and used to calculate the 'incremental cost per quality-adjusted life years gained'. DISCUSSION The results of this study will provide healthcare decision makers with evidence to assist with setting spending thresholds for preventive health programmes and inform selection of emergency and community service models of care. TRIAL REGISTRATION NUMBER The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684); Pre-results.
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Affiliation(s)
- R T Morello
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - R L Morris
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - T P Haines
- Department of Physiotherapy, Monash University, Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - G Arendts
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, Western Australia, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia.,Western Australian Institute for Medical Research, Perth, Western Australia, Australia
| | - J A Lowthian
- Pre-Hospital, Emergency and Trauma Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - D Liew
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J J Watts
- Centre for Population Health Research, Deakin University, Melbourne, Victoria, Australia
| | - A L Barker
- Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Honkavaara N, Al-Ani AN, Campenfeldt P, Ekström W, Hedström M. Good responsiveness with EuroQol 5-Dimension questionnaire and Short Form (36) Health Survey in 20-69 years old patients with a femoral neck fracture: A 2-year prospective follow-up study in 182 patients. Injury 2016; 47:1692-7. [PMID: 27282691 DOI: 10.1016/j.injury.2016.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND EQ-5D and SF-36 are two questionnaires used to measure health related quality of life (HRQoL). The responsiveness of these instruments has previously been evaluated in elderly populations with hip fracture but not in a younger population. The purpose was to evaluate the responsiveness of SF-36 and EQ-5D in a younger population with femoral neck fracture. METHODS 182 patients aged 20-69 were consecutively included. HRQoL was measured by EQ-5D and SF-36 at 4, 12 and 24 months. Pain and function were measured by Harris Hip Score (HHS) on the same occasions. The responsiveness of EQ-5D and SF-36 was evaluated by calculation of two effect sizes; standardized effect size (SES) and standardized response mean (SRM), and by analysing how changes in score correlated to changes in function and subjective state of health. External responsiveness was also evaluated by calculating receiver operating characteristic curve and area under the curve. RESULTS SES was large at four months for both EQ-5D and SF-36 (1.09 and 0.83 respectively) and moderate at the 12- and 24-month follow-ups. The correlation between changes (4-24 months) in HHS and changes in HRQoL were 0.44 for EQ-5D and 0.37 for SF-36. EQ-5D and SF-36 were both more sensitive than HHS in their ability to predict subjective improvements after a hip fracture. CONCLUSIONS The effect sizes and the ability to follow and predict the external standard indicates that both EQ-5D and SF-36 have good internal and external responsiveness in this younger population with femoral neck fracture. The generic HRQoL questionnaires were superior to a hip-specific instrument in predicting the patients' subjective feelings of an improved state of health. EQ-5D is simple to administer and shows similar responsiveness as SF-36 and may be sufficient to use as an outcome measure in clinical trials.
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Affiliation(s)
- Niklas Honkavaara
- Karolinska Institutet, Department of Clinical Science Intervention and Technology (CLINTEC), Department of Orthopaedics, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Amer N Al-Ani
- Karolinska Institutet, Department of Clinical Science Intervention and Technology (CLINTEC), Department of Orthopaedics, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
| | - Pierre Campenfeldt
- Karolinska Institutet, Department of Clinical Science Intervention and Technology (CLINTEC), Department of Orthopaedics, Norrtälje Hospital TioHundra AB
| | - Wilhelmina Ekström
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Department of Orthopaedics Karolinska University Hospital Solna, Stockholm, Sweden
| | - Margareta Hedström
- Department of Orthopaedics, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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17
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Gjertsen JE, Baste V, Fevang JM, Furnes O, Engesæter LB. Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskelet Disord 2016; 17:265. [PMID: 27387741 PMCID: PMC4936302 DOI: 10.1186/s12891-016-1111-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported health-related quality of life is an important outcome measure when assessing the quality of hip fracture surgery. The frequently used EQ-5D index score has unfortunately important limitations. One alternative can be to assess the distribution of each of the five dimensions of the patients' descriptive health profile. The objective of this paper was to investigate health-related quality of life (HRQoL) after hip fractures. METHODS Data from hip fracture operations from 2005 through 2012 were obtained from The Norwegian Hip Fracture Register. Patient reported HRQoL, (EQ-5D-3L) was collected from patients preoperatively and at four and twelve months postoperatively n = 10325. At each follow-up the distribution of the EQ-5D-3L and mean pain VAS was calculated. RESULTS Generally, a higher proportion of patients reported problems in all 5 dimensions of the EQ-5D-3L at all follow-ups compared to preoperative. Also a high proportion of patients with no preoperative problems reported problems after surgery; At 4 and 12 months follow-ups 71 % and 58 % of the patients reported walking problems, and 65 % and 59 % of the patients reported pain respectively. Patients with femoral neck fractures and the youngest patients (age < 70 years) reported least problems both preoperatively and at all follow-ups. CONCLUSIONS A hip fracture has a dramatic impact on the patients' HRQoL, and the deterioration in HRQoL sustained also one year after the fracture. Separate use of the descriptive profile of the EQ-5D is informative when assessing quality of life after hip fracture surgery.
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Affiliation(s)
- Jan-Erik Gjertsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway. .,Department of Clinical Medicine, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
| | - Valborg Baste
- Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway
| | - Jonas M Fevang
- Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway
| | - Ove Furnes
- Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
| | - Lars Birger Engesæter
- Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
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18
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Payakachat N, Ali MM, Tilford JM. Can The EQ-5D Detect Meaningful Change? A Systematic Review. PHARMACOECONOMICS 2015; 33:1137-54. [PMID: 26040242 PMCID: PMC4609224 DOI: 10.1007/s40273-015-0295-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The EQ-5D is one of the most frequently used, generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required. OBJECTIVE This study systematically reviewed and synthesized evidence on the responsiveness of the EQ-5D to detect meaningful change in health status for clinical research and economic evaluations. METHODS We searched the EuroQol website, PubMed, PsychINFO, and EconLit databases to identify studies published in English from the inception of the EQ-5D until August 15, 2014 using keywords that were related to responsiveness. Studies that used only the EQ-VAS were excluded from the final analysis. Narrative synthesis was conducted to summarize evidence on the responsiveness of the EQ-5D by conditions or physiological functions. RESULTS Of 1401 studies, 145 were included in the narrative synthesis and categorized into 19 categories for 56 conditions. The EQ-5D was found to be responsive in 25 conditions (45 %) with the magnitude of responsiveness varying from small to large depending on the condition. There was mixed evidence of responsiveness in 27 conditions (48 %). Only four conditions (7 %) (i.e., alcohol dependency, schizophrenia, limb reconstruction, and hearing impairment) were identified where the EQ-5D was not responsive. CONCLUSION The EQ-5D is an appropriate measure for economic evaluation and health technology assessment in conditions where it has demonstrated evidence of responsiveness. In conditions with mixed evidence of responsiveness, researchers should consider using the EQ-5D with other condition-specific measures to ensure appropriate estimates of effectiveness. These conditions should be a main focus for future research using the new EQ-5D version with five response levels.
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Affiliation(s)
- Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #522, Little Rock, AR, 72205, USA.
| | - Mir M Ali
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Mick Tilford
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot #522, Little Rock, AR, 72205, USA
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Halaweh H, Willen C, Grimby-Ekman A, Svantesson U. Physical Activity and Health-Related Quality of Life Among Community Dwelling Elderly. J Clin Med Res 2015; 7:845-52. [PMID: 26491496 PMCID: PMC4596265 DOI: 10.14740/jocmr2307w] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Physical activity (PA) and health-related quality of life (HRQoL) are important factors for optimal health in the elderly. Studying the association between PA and HRQoL is becoming more essential as the number of elderly people increases worldwide. This study assesses the association between PA and HRQoL among community dwelling elderly above 60 years old. METHODS The study included 115 women and 61 men (mean age: 68.15 ± 6.74 years) recruited from the community and from public centers for the elderly. Data were collected using a background characteristics questionnaire (BCQ), a physical activity socio-cultural adapted questionnaire (PA-SCAQ), and the EuroQuol-5Dimensions-5Levels (EQ-5D-5L) questionnaire. Between groups, comparisons were based on the PA-SCAQ by dividing the participants into three PA groups: low (n = 74), moderate (n = 85), and high (n = 17). Kruskal-Wallis tests were performed on the ordinal variables of the three PA groups to determine differences between the groups according to categorical variables such as gender, body mass index (BMI), and the prevalence of comorbid conditions. Mann-Whitney U tests were performed on the ordinal variables of the EuroQuol-5Dimensions (EQ-5D), and the independent sample t-test was performed on the EQ visual analogue scale (EQ-VAS). Spearman's rank correlation coefficient was used to examine the correlation between the EQ-5D and level of PA. RESULTS Values in all dimensions of HRQoL were significantly higher (P < 0.05) in the moderate and high PA groups compared with the low PA group. Significant correlations were recorded between the five dimensions of HRQoL and the level of PA (P < 0.001). The low PA group showed higher prevalence of hypertension (64%, P < 0.001) and diabetes (50%, P < 0.001). CONCLUSION There were strong associations between higher levels of PA and all dimensions of HRQoL. Therefore, adopting a PA lifestyle may contribute to better HRQoL among community dwelling elderly above 60 years old.
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Affiliation(s)
- Hadeel Halaweh
- Department of Physiotherapy, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Carin Willen
- Department of Physiotherapy, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anna Grimby-Ekman
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ulla Svantesson
- Department of Physiotherapy, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Sweden
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Abstract
Hip fracture is a common injury associated with high mortality, long-term disability and huge socio-economic burden. Yet there has been relatively little research into best treatment, and evidence that has been generated has often been criticised for its poor quality. Here, we discuss the advances made towards overcoming these criticisms and the future directions for hip fracture research: how co-ordinating existing national infrastructures and use of now established clinical research networks will likely go some way towards overcoming the practical and financial challenges of conducting large trials. We highlight the importance of large collaborative pragmatic trials to inform decision/policy makers and the progress made towards reaching a consensus on a core outcome set to facilitate data pooling for evidence synthesis and meta-analysis. These advances and future directions are a priority in order to establish the high-quality evidence base required for this important group of patients.
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Affiliation(s)
- M A Fernandez
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Rd, Coventry, CV2 2DX, UK
| | - X L Griffin
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - M L Costa
- University of Oxford, Headley Way, Oxford, OX3 9DU, UK
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21
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Responsiveness of the EQ-5D to clinical change: is the patient experience adequately represented? Int J Technol Assess Health Care 2015; 30:10-19. [PMID: 24499622 DOI: 10.1017/s0266462313000640] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In many economic evaluations and reimbursement decisions, quality-adjusted life-years (QALYs) are used as a measure of benefit to assess effectiveness of novel therapies, often based on the EQ-5D 3-level questionnaire. As only five dimensions of physical and mental well-being are reflected in this tool, significant aspects of the patient experience may be missed. We evaluate the use of the EQ-5D as a measurement of clinical change across a wide range of disorders from dermatological (acne) to life-threatening (metastatic cancers). METHODS We analyze published studies on the psychometric properties of the EQ-5D 3-level questionnaire, extracting information on the Visual Analogue Scale versus Index score, Standardized Response Mean, and Effect Size. These are compared with ranges generally accepted to represent good responsiveness in the psychometric literature. RESULTS We find that only approximately one in five study populations report subjective health state valuation of patients within 5 percent of the score attributed by the EQ-5D index, and more than 40 percent of studies report unacceptable ceiling effects. In the majority of studies, responsiveness of the EQ-5D index was found to be poor to moderate, based on Effect Size (63 percent poor–moderate) and Standardized Response Mean (72 percent poor–moderate). CONCLUSIONS We conclude that the EQ-5D index does not adequately reflect patient health status across a range of conditions, and it is likely that a significant proportion of the subjective patient experience is not accounted for by the index. This has implications for economic evaluations of novel drugs based on evidence generated with the EQ-5D.
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Vokó Z, Németh R, Nagyjánosi L, Jermendy G, Winkler G, Hídvégi T, Kalotai Z, Kaló Z. Mapping the Nottingham Health Profile onto the Preference-Based EuroQol-5D Instrument for Patients with Diabetes. Value Health Reg Issues 2014; 4:31-36. [PMID: 29702803 DOI: 10.1016/j.vhri.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to derive a function that can map the Nottingham Health Profile (NHP) questionnaire onto a utility measure, the EuroQol five-dimensional (EQ-5D) questionnaire index, for diabetic patients. METHODS A cross-sectional study was performed on diabetic patients in Hungary with different complications in which quality of life was measured by using both the NHP questionnaire and the EQ-5D questionnaire. Ordinary stepwise-backward least-squares regression was used to develop a mapping function. Adjusted R2, Akaike's information criterion, and root mean square error were used to assess the performance of the model. The robustness of the models was tested using 10-fold cross-validation and bootstrapping. RESULTS The best-fitting models were those that contained all the NHP statements as predictors and a stepwise reduced version that contained only 19 statements. The latter model, however, showed considerable variability in the selection of predictors. The adjusted R2 of the former model was 0.68, the root mean square error was 174, and the Akaike's information criterion was -559.9. CONCLUSIONS The expected value of the EQ-5D questionnaire can be reasonably predicted on the basis of results of the NHP in patients with diabetes mellitus. The mapping function of the NHP onto the EQ-5D questionnaire is capable of estimating the expected EQ-5D questionnaire utility values in a group of patients with diabetes. The function's applicability for individual-level predictions, however, is limited. Further research is needed to find out whether mapping functions developed in Central-Eastern European countries are transferable to Western European countries.
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Affiliation(s)
- Zoltán Vokó
- Faculty of Social Sciences, Department of Health Policy & Health Economics, Institute of Economics, Eötvös Loránd University; Syreon Research Institute.
| | - Renáta Németh
- Faculty of Social Sciences, Department of Statistics, Eötvös Loránd University
| | | | - György Jermendy
- 3rd Department of Internal Medicine, Bajcsy-Zsilinszky Hospital
| | - Gábor Winkler
- 2nd Department of Internal Medicine - Diabetology, Saint John Hospital, Budapest, Hungary; Faculty of Health Care, Institute of Theoretical Health Sciences, University of Miskolc, Miskolc, Hungary
| | - Tibor Hídvégi
- Department of Metabolic Disorders, Endocrinology and Diabetology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | | | - Zoltán Kaló
- Faculty of Social Sciences, Department of Health Policy & Health Economics, Institute of Economics, Eötvös Loránd University; Syreon Research Institute
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Barker AL, Cameron PA, Hill KD, Flicker L, Haines TP, Lowthian JA, Waldron N, Arendts G, Redfern J, Forbes A, Brand CA, Etherton-Beer CD, Hill AM, Hunter P, Nyman SR, Smit D. RESPOND--A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial. Inj Prev 2014; 21:e1. [PMID: 24958769 DOI: 10.1136/injuryprev-2014-041271] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. DESIGN AND SETTING A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. PARTICIPANTS 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. METHODS Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. DISCUSSION RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited. TRIAL REGISTRATION NUMBER The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
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Affiliation(s)
- A L Barker
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P A Cameron
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University of Technology, Perth, Western Australia, Australia
| | - L Flicker
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - T P Haines
- Department of Physiotherapy, Monash University, and Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia
| | - J A Lowthian
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - N Waldron
- Health Networks Branch, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - G Arendts
- University of Western Australia, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - J Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - C A Brand
- Health Services Research Unit, Centre of Research Excellence in Patient Safety, Division of Health Services and Global Health Research, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - C D Etherton-Beer
- University of Western Australia, Perth, Western Australia, Australia Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia
| | - A M Hill
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - P Hunter
- Alfred Health, Melbourne, Victoria, Australia
| | - S R Nyman
- Bournemouth University Dementia Institute and Psychology Department, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - D Smit
- Alfred Health, Melbourne, Victoria, Australia
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Abstract
Objectives To study the measurement properties of a joint specific patient
reported outcome measure, a measure of capability and a general
health-related quality of life (HRQOL) tool in a large cohort of
patients with a hip fracture. Methods Responsiveness and associations between the Oxford Hip Score
(a hip specific measure: OHS), ICEpop CAPability (a measure of capability
in older people: ICECAP-O) and EuroQol EQ-5D (general health-related
quality of life measure: EQ-5D) were assessed using data available
from two large prospective studies. The three outcome measures were assessed
concurrently at a number of fixed follow-up time-points in a consecutive
sequence of patients, allowing direct assessment of change from
baseline, inter-measure associations and validity using a range
of statistical methods. Results ICECAP-O was not responsive to change. EQ-5D was responsive to
change from baseline, with an estimated standardised effect size
for the two datasets of 0.676 and 0.644 at six weeks and four weeks
respectively; this was almost as responsive to change as OHS (1.14 at
four weeks). EQ-5D correlated strongly with OHS; Pearson correlation
coefficients were 0.74, 0.77 and 0.70 at baseline, four weeks and
four months. EQ-5D is a moderately good predictor of death at 12
months following hip fracture. Furthermore, EQ-5D reported by proxies
(relatives and carers) behaves similarly to self-reported scores. Conclusions Our findings suggest that a general HRQOL tool such as EQ-5D
could be used to measure outcome for patients recovering from hip
fracture, including those with cognitive impairment. Cite this article: Bone Joint Res 2014;3:69–75.
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Affiliation(s)
- N Parsons
- University of Warwick, Statisticsand Epidemiology, Warwick Medical School, Coventry, CV47AL, UK
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25
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Liem IS, Kammerlander C, Suhm N, Blauth M, Roth T, Gosch M, Hoang-Kim A, Mendelson D, Zuckerman J, Leung F, Burton J, Moran C, Parker M, Giusti A, Pioli G, Goldhahn J, Kates SL. Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Injury 2013; 44:1403-12. [PMID: 23880377 DOI: 10.1016/j.injury.2013.06.018] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/25/2013] [Accepted: 06/17/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Osteoporotic fractures are an increasing problem in the world due to the ageing of the population. Different models of orthogeriatric co-management are currently in use worldwide. These models differ for instance by the health-care professional who has the responsibility for care in the acute and early rehabilitation phases. There is no international consensus regarding the best model of care and which outcome parameters should be used to evaluate these models. The goal of this project was to identify which outcome parameters and assessment tools should be used to measure and compare outcome changes that can be made by the implementation of orthogeriatric co-management models and to develop recommendations about how and when these outcome parameters should be measured. It was not the purpose of this study to describe items that might have an impact on the outcome but cannot be influenced such as age, co-morbidities and cognitive impairment at admission. METHODS Based on a review of the literature on existing orthogeriatric co-management evaluation studies, 14 outcome parameters were evaluated and discussed in a 2-day meeting with panellists. These panellists were selected based on research and/or clinical expertise in hip fracture management and a common interest in measuring outcome in hip fracture care. RESULTS We defined 12 objective and subjective outcome parameters and how they should be measured: mortality, length of stay, time to surgery, complications, re-admission rate, mobility, quality of life, pain, activities of daily living, medication use, place of residence and costs. We could not recommend an appropriate tool to measure patients' satisfaction and falls. We defined the time points at which these outcome parameters should be collected to be at admission and discharge, 30 days, 90 days and 1 year after admission. CONCLUSION Twelve objective and patient-reported outcome parameters were selected to form a standard set for the measurement of influenceable outcome of patients treated in different models of orthogeriatric co-managed care.
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Affiliation(s)
- I S Liem
- Department of Trauma Surgery and Sports Medicine, Tyrolean Geriatric Fracture Center, Medical University Innsbruck, Innsbruck, Austria
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26
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Miedel R, Törnkvist H, Ponzer S, Tidermark J. Musculoskeletal function and quality of life after an unstable trochanteric fracture treated with the trochanteric gamma nail. Arch Orthop Trauma Surg 2012; 132:1495-503. [PMID: 22710885 DOI: 10.1007/s00402-012-1568-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to report the musculoskeletal function and health-related quality of life (HRQoL) after an unstable trochanteric fracture treated with a cephalomedullary nail. METHODS One hundred and seventeen patients, mean age 84.1 years, were included in a 1-year prospective cohort study. Outcome measurements included musculoskeletal function according to the Short Musculoskeletal Function Assessment (SMFA) and HRQoL according to the EQ-5D. RESULTS Fourteen patients (12.0 %) were reoperated on, all but one being due to a secondary lag-screw penetration/cut-out. The need for revision surgery was significantly higher after a 4-part fracture according to the Jensen-Michaelsen classification as compared to after a 3-part fracture, i.e. 17 versus 6 % (p = 0.048). The reoperation was a hip replacement in 12 of the 14 patients, a total hip replacement (THR) in 10 and a hemiarthroplasty in 2. The SMFA dysfunction and bother indices in all patients showed a significant deterioration at 12 months compared to before the fracture, from 24.8 to 42.4 (p < 0.001) and 14.3 to 33.7 (p < 0.001), respectively. The EQ-5D(index) score decreased from 0.79 prefracture to 0.51 (p < 0.001). The final outcome for the patients who underwent reoperation with THR was surprisingly good with an SMFA dysfunction index of 43.4, a bother index of 36.6 and an EQ-5D(index) score of 0.58. CONCLUSIONS An unstable trochanteric fracture treated with a cephalomedullary nail had a substantial negative impact on the patient's musculoskeletal function and HRQoL. The need for revision surgery was significantly higher after a 4-part fracture compared to after a 3-part fracture. The by far most common fracture complication, i.e. a secondary lag-screw penetration/cut-out, was successfully treated with a THR.
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Affiliation(s)
- Ricard Miedel
- Section of Orthopaedics, Department of Clinical Science and Education, Karolinska Institutet, Stockholm Söder Hospital, Stockholm, Sweden.
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27
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Farag I, Sherrington C, Kamper SJ, Ferreira M, Moseley AM, Lord SR, Cameron ID. Measures of physical functioning after hip fracture: construct validity and responsiveness of performance-based and self-reported measures. Age Ageing 2012; 41:659-64. [PMID: 22798380 DOI: 10.1093/ageing/afs090] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES this study aimed to investigate the construct validity and responsiveness of performance-based and self-reported measures of strength, mobility and balance after hip fracture. DESIGN secondary analysis of clinical trial data. SUBJECTS a total of 148 older people undergoing hip fracture rehabilitation. METHODS correlation coefficients assessed construct validity. Internal responsiveness was assessed by calculating effect sizes (ES) I and II. Area under the receiver operating characteristic curve (AUC) assessed external responsiveness with change in EuroQol as the reference. RESULTS correlations between performance-based and self-reported measures were small to medium (strength r = 0.17, mobility r = 0.45 and balance r = 0.37). The most responsive performance-based measures included walking speed (ESI 1.7, ESII 1.2), Physical Performance and Mobility Examination (ESI 1.3, ESII 1.0) and chair-rise test (ESI 1.1, ESII 0.8). Self-reported mobility (ESI 0.8, ESII 0.6) and strength (ESI 0.8, ESII 0.6) were more responsive than self-reported balance (ESI 0.3, ESII 0.2). External responsiveness (AUC) was greatest for walking speed (0.72) and lowest for the measures of body sway (0.53). CONCLUSION self-reported and performance-based indices appear to assess different constructs and may provide complementary information about physical functioning in people after hip fracture. Measures of strength and mobility showed greater ability to detect change than measures of balance.
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Affiliation(s)
- I Farag
- George Institute for Global Health, University of Sydney, Sydney, Australia.
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28
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Galvagno SM. Assessing health-related quality of life with the EQ-5D: Is this the best instrument to assess trauma outcomes? Air Med J 2012; 30:258-63. [PMID: 21930080 DOI: 10.1016/j.amj.2011.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/08/2011] [Accepted: 04/05/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Samuel M Galvagno
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Olerud P, Tidermark J, Ponzer S, Ahrengart L, Bergström G. Responsiveness of the EQ-5D in patients with proximal humeral fractures. J Shoulder Elbow Surg 2011; 20:1200-6. [PMID: 22014617 DOI: 10.1016/j.jse.2011.06.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/06/2011] [Accepted: 06/13/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated the internal and external responsiveness of the EuroQol EQ-5D (EuroQol Group, Rotterdam, The Netherlands) health status component, defined as the instrument's ability to capture clinically important changes in patients with a proximal humeral fracture within the context of a prospective study. MATERIALS AND METHODS To evaluate the internal responsiveness of the EQ-5D, the observed change and the standardized response mean (SRM) in relation to the change in the EQ-5D(index) score were calculated. To calculate external responsiveness, an external criterion (EC) was constructed by using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Receiver operating characteristic (ROC) curves and logistic regression analysis were used in the evaluation. RESULTS The mean change score from prefracture status to the 4-month follow-up for the EQ-5D was -20.9 and the corresponding SRM was 0.90, indicating good internal responsiveness. The clearly improved or clearly deteriorated patients according to the EC (DASH) reported change scores of approximately 12 points in the EQ-5D, corresponding to moderately strong SRMs, which, together with the results of the ROC analyses and logistic regression, indicated a good external responsiveness. CONCLUSION The EQ-5D displayed good internal and external responsiveness in patients with proximal humeral fractures and can be recommended for use as a quality of life measure in patients with this particular injury.
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Affiliation(s)
- Per Olerud
- Department of Clinical Science and Education, Section of Orthopaedics, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
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30
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Hutchings L, Fox R, Chesser T. Proximal femoral fractures in the elderly: how are we measuring outcome? Injury 2011; 42:1205-13. [PMID: 21232743 DOI: 10.1016/j.injury.2010.12.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/03/2010] [Accepted: 12/16/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with proximal femoral fractures present a difficult problem to health care systems in view of their complex presentations and co-morbidities. Traditionally, the focus of outcome measurement for this patient group has been on mortality and surgical implant success. Increasing recognition of the need to diversify outcome measurements has led to the creation and use of a number of outcome scales. We sought to examine how these scales are being used in the current literature. METHODS Abstracts to over 4000 papers related to proximal femoral fracture research were screened to identify commonly used scales in the five main categories of general quality of life measures (QoL), Activities of Daily Living scales (ADL), mobility and physical performance scales, disease-specific scales and hip-specific scales. The 14 identified scales were then searched for directly, and papers analysed for scale usage, timing and interpretation. RESULTS ADL scales were the most commonly used group, followed by QoL measures, which are validated for elderly patients. Scale timing and use varied widely between studies. A large number of scales were found in addition to the 14 identified scales. None of the 14 identified scales were validated for the proximal femoral fracture population. DISCUSSION A good scale must be appropriate in content, method and clinical utility. Its method of application must be reliable, responsive, and validated for the population in question. Outcome scale usage was difficult to assess in proximal femoral fracture research due to difficulties in isolating the relevant research, and in differences in scale timing and interpretation. Scale prevalence was skewed by use by specific research groups. CONCLUSION There is no single unifying scale in widespread use for proximal femoral fracture patients. We would recommend the validation of commonly used scales for this population, and would advise the use of scales from more than one category to assess outcome.
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Affiliation(s)
- Lynn Hutchings
- Department of Trauma & Orthopaedics, Frenchay Hospital, North Bristol NHS Trust, United Kingdom.
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31
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Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:101-14. [PMID: 21858567 DOI: 10.1007/s00586-011-1921-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/17/2011] [Accepted: 07/09/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE Patient-orientated outcome questionnaires are essential to evaluate treatment success. To compare different treatments, hospitals, and surgeons, standardised questionnaires are required. The present study examined the validity and responsiveness of the Core Outcome Measurement Index for neck pain (COMI-neck), a short, multidimensional outcome instrument. METHODS Questionnaires were completed by patients with degenerative problems of the cervical spine undergoing cervical disc arthroplasty before (N = 89) and 3 months after (N = 75) surgery. The questionnaires comprised the EuroQol-Five Dimension (EQ-5D), the North American Spine Society Cervical Spine Outcome Assessment Instrument (NASS-cervical) and the COMI-neck. RESULTS The COMI and NASS-cervical scores displayed no notable floor or ceiling effects at any time point whereas for the EQ-5D, the highest values [corrected] were reached in around 32.5% of patients at follow-up. With one exception (symptom-specific well-being), the individual COMI items and the COMI summary score correlated to the expected extent (R = 0.4-0.8) with the scores of the chosen reference questionnaires. The area under the curve (AUC) generated by ROC analysis was significantly higher for the COMI (0.96) than for any other instrument/subscale when self reported treatment outcome was used as the external criterion, dichotomised as "good" (operation helped a lot/helped) versus "poor" (operation helped only a little/didn't help/made things worse). The COMI had a high effect size (standardised response mean; SRM) (2.34) for the good global outcome group and a low SRM for the poor outcome group (0.34). The EQ-5D and the NASS-cervical lacked this ability to differentiate between the two groups, showing less distinct SRMs for good and poor outcome groups. CONCLUSIONS This study provides evidence that the COMI-neck is a valid and responsive questionnaire in the population of patients examined. Further investigations should examine its applicability in other patient groups with less severe neck pain or undergoing other treatment modalities.
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Musculoskeletal function and quality of life in elderly patients after a subtrochanteric femoral fracture treated with a cephalomedullary nail. J Orthop Trauma 2011; 25:208-13. [PMID: 21399469 DOI: 10.1097/bot.0b013e3181eaaf52] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To report the musculoskeletal function and health-related quality of life in elderly patients after a subtrochanteric fracture treated with a single lag screw cephalomedullary nail. DESIGN Prospective cohort study with a minimum 1-year follow-up. SETTING University hospital. PATIENTS Fifty-three patients, mean age 82 years (range, 61-94 years), with a subtrochanteric fracture of the femur. INTERVENTION Fixation with a long Gamma cephalomedullary nail. MAIN OUTCOME MEASUREMENTS Reoperation rate, musculoskeletal function (Short Musculoskeletal Function Assessment), and health-related quality of life (EuroQol-5D). RESULTS Six patients (11%) were reoperated on, five as a result of technical failures and one as a result of an ipsilateral fracture of the distal femur. The Short Musculoskeletal Function Assessment Dysfunction Index increased from 18 before the fracture to 46 at 4 months and 43 at 12 months. The corresponding values for the Short Musculoskeletal Function Assessment Bother Index were 10 before the fracture and 43 and 40 at 4 and 12 months (P < 0.001 between follow-ups and before fracture for both indices). The EuroQol-5Dindex score decreased from 0.85 to 0.49 at 4 months and remained at almost the same level at 12 months, 0.52 (P < 0.001 between follow-ups and before fracture). CONCLUSIONS A subtrochanteric fracture treated with a single lag screw cephalomedullary nail had a substantial negative impact on the patient's musculoskeletal function according to the Short Musculoskeletal Function Assessment as well as on the patient's health-related quality of life. However, the need for revision surgery was comparatively low.
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Hedbeck CJ, Tidermark J, Ponzer S, Blomfeldt R, Bergström G. Responsiveness of the short musculoskeletal function assessment (SMFA) in patients with femoral neck fractures. Qual Life Res 2010; 20:513-21. [DOI: 10.1007/s11136-010-9784-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2010] [Indexed: 11/24/2022]
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Gjertsen JE, Vinje T, Engesaeter LB, Lie SA, Havelin LI, Furnes O, Fevang JM. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am 2010; 92:619-28. [PMID: 20194320 DOI: 10.2106/jbjs.h.01750] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Internal fixation and arthroplasty are the two main options for the treatment of displaced femoral neck fractures in the elderly. The optimal treatment remains controversial. Using data from the Norwegian Hip Fracture Register, we compared the results of hemiarthroplasty and internal screw fixation in displaced femoral neck fractures. METHODS Data from 4335 patients over seventy years of age who had internal fixation (1823 patients) or hemiarthroplasty (2512 patients) to treat a displaced femoral neck fracture were compared at a minimum follow-up interval of twelve months. One-year mortality, the number of reoperations, and patient self-assessment of pain, satisfaction, and quality of life at four and twelve months were analyzed. Subanalyses of patients with cognitive impairment and reduced walking ability were done. RESULTS In the arthroplasty group, only contemporary bipolar prostheses were used and uncemented prostheses with modern stems and hydroxyapatite coating accounted for 20.8% (522) of the implants. There were no differences in one-year mortality (27% in the osteosynthesis group and 25% in the arthroplasty group; p = 0.76). There were 412 reoperations (22.6%) performed in the osteosynthesis group and seventy-two (2.9%) in the hemiarthroplasty group during the follow-up period. After twelve months, the osteosynthesis group reported more pain (mean score, 29.9 compared with 19.2), higher dissatisfaction with the operation result (mean score, 38.9 compared with 25.7), and a lower quality of life (mean score, 0.51 compared with 0.60) than the arthroplasty group. All differences were significant (p < 0.001). For patients with cognitive impairment, hemiarthroplasty provided a better functional outcome (less pain, higher satisfaction with the result of the operation, and higher quality of life as measured on the EuroQol visual analog scale) at twelve months (p < 0.05). CONCLUSIONS Displaced femoral neck fractures in the elderly should be treated with hemiarthroplasty.
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Affiliation(s)
- J-E Gjertsen
- Department of Orthopaedic Surgery, Haukeland University Hospital, 5021 Bergen, Norway.
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Kostka T, Jachimowicz V. Relationship of quality of life to dispositional optimism, health locus of control and self-efficacy in older subjects living in different environments. Qual Life Res 2010; 19:351-61. [PMID: 20146007 DOI: 10.1007/s11136-010-9601-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the relationship of dispositional optimism, health locus of control and self-efficacy to quality of life (QOL) in older subjects differing in level of disability and institutionalisation. METHODS The study was conducted in the three groups of subjects aged > or = 65: 110 relatively healthy community-dwelling elderly, 102 independent elders who voluntarily decided to live in veteran home and 112 inhabitants of a long-term care home. Life orientation test-revised (LOT-R), multidimensional health locus of control (MHLC) and generalised self-efficacy scale (GSES) together with a multidimensional assessment were performed with each subject. QOL was assessed using the Euroqol 5D questionnaire, the Nottingham health profile and the satisfaction with life scale (SWLS). RESULTS QOL generally decreased with growing level of dependence and institutionalisation. LOT-R, MHLC and GSES were important and independent correlates of QOL in all three environments of older subjects. The relationship of education, smoking habit, physical activity, strength and mobility measures to psychological characteristics was different in the three groups of elders. LOT-R, MHLC Powerful Others, MHLC Chance and GSES were the most important QOL correlates in veteran home group, while MHLC Internal was most significant in long-term care home inhabitants. CONCLUSIONS Data of this cross-sectional study suggests that the veteran home elderly, as a group 'in transition' between community and institution, should be the first target of psychological preventive and health-promoting measures aimed at improving QOL in older population.
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Affiliation(s)
- Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Pl. Hallera 1, 90-647, Lodz, Poland.
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Outcome After Injury—A Systematic Literature Search of Studies Using the EQ-5D. ACTA ACUST UNITED AC 2009; 67:883-90. [DOI: 10.1097/ta.0b013e3181ae6409] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quality of life after dislocation of hip arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up. Qual Life Res 2009; 18:1177-84. [PMID: 19714486 DOI: 10.1007/s11136-009-9531-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE A primary arthroplasty constitutes a standard procedure in the treatment of patients with displaced fractures of the femoral neck. Although dislocation of the prosthesis remains a significant clinical problem, there are no previous reports on its influence on health-related quality of life (HRQoL). We analysed how a dislocation of the hip arthroplasty influenced the patients' HRQoL. METHODS In total 319 consecutive patients with a displaced fracture of the femoral neck treated with a primary arthroplasty were included in a prospective cohort study. We used a mixed-effects model regression analysis to evaluate factors of importance for HRQoL (EQ-5D(index) score) during the first 12 months following surgery. RESULTS A dislocation of the arthroplasty occurred in 21 of the 319 patients (7%), 8 of whom had a single dislocation and 13 recurrent dislocations. At 4 months, the EQ-5D(index) score displayed a significantly worse outcome for patients with recurrent dislocations compared to patients with no dislocation (P = 0.001), and a trend towards a worse outcome for patients with a single dislocation (P = 0.08). At 12 months, the mean EQ-5D(index) score of patients with recurrent dislocations was still substantially lower (P = 0.001), while the EQ-5D(index) score for patients with a single dislocation had returned to a level similar to that of patients with no dislocation. Our analysis of the EQ-5D dimensions indicates that the difference was mainly due to perceived difficulties in self-care and usual activities and increased problems with anxiety/depression. CONCLUSIONS A recurrent dislocation of the hip arthroplasty in the treatment of patients with femoral neck fractures seems to result in a persisting deterioration in the HRQoL, while patients with a single dislocation seem to experience only a temporary deterioration.
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Frihagen F. On the diagnosis and treatment of femoral neck fractures. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009; 80:1-26. [PMID: 19919380 DOI: 10.1080/17453690610046611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ekström W, Németh G, Samnegård E, Dalen N, Tidermark J. Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury 2009; 40:371-6. [PMID: 19232590 DOI: 10.1016/j.injury.2008.09.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 08/28/2008] [Accepted: 09/24/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND The subtrochanteric fracture constitutes approximately 5-10% of all hip fractures. This particular fracture type, owing to its configuration and instability, poses significant challenges to the fixation method, especially in elderly patients with varying degrees of osteoporosis. There has been a gradual change in the operative techniques used to stabilise these fractures leading to the current widespread use of cephalomedullary nails. In contrast to the field of research on patients with the more common femoral neck and trochanteric fractures, few studies have evaluated the health-related quality of life (HRQoL) in patients with subtrochanteric fractures. OBJECTIVE To report the long-term outcome for patients with subtrochanteric fractures treated with a cephalomedullary nail with special regard to the HRQoL. SETTING Four university hospitals. DESIGN A prospective cohort study with a 2-year follow-up. PATIENTS AND METHODS Eighty-seven consecutive elderly patients with a subtrochanteric fracture treated with a cephalomedullary nail. Main outcome measurements were mortality rate, reoperation rate, pain at the hip, walking ability, activities of daily living (ADL) function and HRQoL assessed with the EQ-5D (EQ-5D(index) score). RESULTS The EQ-5D(index) score decreased from 0.73 before fracture to 0.53 at 4 and 12 months and to 0.52 at 24 months. At the final follow-up 80% of the patients reported no or only limited pain at the hip, 46% had regained their prefracture walking ability, 48% their prefracture level of ADL function and 71% had living conditions similar to those before the fracture. The reoperation rate was 8%. The mortality rate was 8% at 4 months, 14% at 12 months and 25% at 24 months. CONCLUSIONS A subtrochanteric fracture in elderly patients had a substantial negative effect on both their short and long-term HRQoL. Although pain at the hip was not a major problem there was an obvious deterioration in walking ability and ADL function. However, the rate of revision surgery was comparatively low which confirms that the cephalomedullary nail constitutes a safe treatment for elderly patients with a subtrochanteric fracture. The data on HRQoL obtained in this study can be used in future healthcare evaluations and to calculate quality-adjusted life-years (QALYs).
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Affiliation(s)
- Wilhelmina Ekström
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital Solna, Sweden.
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Abstract
OBJECTIVE The aim of this study was to report the long-term outcome for patients with stable trochanteric fractures, especially regarding the health-related quality of life (HRQoL). DESIGN A prospective cohort study with a 2-year follow-up. SETTING Four university hospitals. PATIENTS One hundred forty-eight consecutive patients with stable trochanteric fractures, that is, a 2-part fracture (J-M 1 and 2) according to the Jensen-Michaelsen classification, treated with a sliding hip screw. MAIN OUTCOME MEASUREMENTS Mortality rate, reoperation rate, pain at the hip, walking ability, activities of daily living (ADL) function, and HRQoL assessed with the EuroQol-5D (EQ-5D index score). RESULTS The 2-year mortality rate was 29%. The reoperation rate was 3%. At the final follow-up, 81% of the patients reported no or only limited pain at the hip, 55% had regained their prefracture walking ability, and 66% their prefracture level of ADL function. The EQ-5D index score decreased from 0.69 before the fracture to 0.57 at 4 months, 0.59 at 12 months, and 0.66 at 24 months. CONCLUSIONS Besides the expected mortality rate, the results of the study confirm a low reoperation rate and a good outcome regarding pain at the hip and only limited deterioration in HRQoL after a stable trochanteric fracture. However, a considerable number of the patients experienced deterioration in their walking ability and ADL function. The data on HRQoL obtained in this study can be used in future healthcare evaluations and to calculate quality-adjusted life years.
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Jerant A, Chapman BP, Franks P. Personality and EQ-5D scores among individuals with chronic conditions. Qual Life Res 2008; 17:1195-204. [PMID: 18839336 DOI: 10.1007/s11136-008-9401-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 09/18/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Personality is associated with self-rated health, but prior studies have not examined associations with preference-based measures. We hypothesized similar associations would exist with preference-based health. METHODS We analyzed baseline data from chronically ill individuals enrolled in a self-management intervention. We conducted regression analyses with the EQ-5D summary index score and dimension scores (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) as dependent variables, The key independent variables were NEO-Five Factor Inventory (NEO-FFI) personality factors (Neuroticism, Conscientiousness, Extraversion, Openness, Agreeableness), adjusting for age, gender, educational level, minority status, and chronic conditions. RESULTS Of 415 participants, 245 (59%) had > or =2 chronic conditions, 384 (94%) completed the NEO-FFI and 397 (96%) the EQ-5D. After adjustment, Neuroticism was associated with EQ-5D summary index scores [-0.04 per 1 SD increase in Neuroticism (95% CI -0.06, -0.01)]. Neuroticism [AOR 2.99 (95% CI 2.06, 4.35; P < 0.001)] and Openness [1.32 (95% CI 1.00, 1.75; P = 0.05)] were associated with worse anxiety/depression scores, while Conscientiousness was associated with better usual activities scores [0.66 (95% CI 0.49, 0.89; P = 0.01)]. CONCLUSIONS The associations between personality factors and self-rated health appear to extend to preference-based measures. Future studies should explore whether personality affects preference-based health estimates in cost-effectiveness analyses.
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Affiliation(s)
- Anthony Jerant
- Department of Family & Community Medicine, University of California Davis School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817, USA.
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Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordsletten L. Outcome after femoral neck fractures: a comparison of Harris Hip Score, Eq-5d and Barthel Index. Injury 2008; 39:1147-56. [PMID: 18656868 DOI: 10.1016/j.injury.2008.03.027] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 03/15/2008] [Accepted: 03/19/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the discriminatory ability and responsiveness of the Harris Hips Score, the Barthel Index and the Eq-5d (Euroqol) in an unselected population of patients with displaced femoral neck fracture. METHODS Data were collected at 4 and 12 months after surgery from a population of 222 patients. Patients with complete data sets who suffered a serious complication (n=23) were compared with patients with no complication (n=56). The assessment scales' ability to discriminate between the groups was calculated, as was the change score and the standardised response mean. RESULTS All scales were able to discriminate between the complications group and the non-complications group at 4 months, but only Harris Hip Score had independent explanatory ability in a logistic regression analysis. All scales showed a positive change score for the complications group from 4 to 12 months. The standardised response mean was 0.75 for Harris Hip Score, 0.40 for Barthel Index, 0.46 for the Eq-5d index score, and 0.57 for the Eq-5d visual analogue scale. Barthel Index had a marked ceiling effect with 51/79 (65%) scoring 19 or 20 at 4 months. The response rate was 71-87% for Eq-5d and 96-98% for Harris Hip Score and Barthel Index. CONCLUSION All the scales may be used for this patient group, but Harris Hip Score performed better than the other scales.
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Affiliation(s)
- Frede Frihagen
- Orthopaedic Centre, Ullevaal University Hospital, Oslo, Norway.
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Frihagen F, Nordsletten L, Madsen JE. Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 2007; 335:1251-4. [PMID: 18056740 PMCID: PMC2137068 DOI: 10.1136/bmj.39399.456551.25] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare the functional results after displaced fractures of the femoral neck treated with internal fixation or hemiarthroplasty. DESIGN Randomised trial with blinding of assessments of functional results. SETTING University hospital. PARTICIPANTS 222 patients; 165 (74%) women, mean age 83 years. Inclusion criteria were age above 60, ability to walk before the fracture, and no major hip pathology, regardless of cognitive function. INTERVENTIONS Closed reduction and two parallel screws (112 patients) and bipolar cemented hemiarthroplasty (110 patients). Follow-up at 4, 12, and 24 months. MAIN OUTCOME MEASURES Hip function (Harris hip score), health related quality of life (Eq-5d), activities of daily living (Barthel index). In all cases high scores indicate better function. RESULTS Mean Harris hip score in the hemiarthroplasty group was 8.2 points higher (95% confidence interval 2.8 to 13.5 points, P=0.003) at four months and 6.7 points (1.5 to 11.9 points, P=0.01) higher at 12 months. Mean Eq-5d index score at 24 months was 0.13 higher in the hemiarthroplasty group (0.01 to 0.25, P=0.03). The Eq-5d visual analogue scale was 8.7 points higher in the hemiarthroplasty group after 4 months (1.9 to 15.6, P=0.01). After 12 and 24 months the percentage scoring 95 or 100 on the Barthel index was higher in the hemiarthroplasty group (relative risk 0.67, 0.47 to 0.95, P=0.02. and 0.63, 0.42 to 0.94, P=0.02, respectively). Complications occurred in 56 (50%) patients in the internal fixation group and 16 (15%) in the hemiarthroplasty group (3.44, 2.11 to 5.60, P<0.001). In each group 39 patients (35%) died within 24 months (0.98, 0.69 to 1.40, P=0.92) CONCLUSIONS Hemiarthroplasty is associated with better functional outcome than internal fixation in treatment of displaced fractures of the femoral neck in elderly patients. TRIAL REGISTRATION NCT00464230.
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Affiliation(s)
- Frede Frihagen
- Orthopaedic Centre, Ulleval University Hospital, Oslo, Norway, and Faculty of Medicine, University of Oslo, Norway.
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