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Cahill PT, Ferro MA, Ng S, Turkstra LS, Campbell WN. Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework. BMC Health Serv Res 2024; 24:347. [PMID: 38491356 PMCID: PMC10943816 DOI: 10.1186/s12913-024-10821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Establishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context. METHODS Using a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately. RESULTS We identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve. CONCLUSIONS The seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Mark A Ferro
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
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Baudendistel ST, Haussler AM, Rawson KS, Earhart GM. Minimal clinically important differences of spatiotemporal gait variables in Parkinson disease. Gait Posture 2024; 108:257-263. [PMID: 38150946 PMCID: PMC10878409 DOI: 10.1016/j.gaitpost.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Assessment of gait function in People with Parkinson Disease (PwPD) is an important tool for monitoring disease progression in PD. While comprehensive gait analysis has become increasingly popular, only one study, Hass et al. (2014), has established minimal clinically important differences (MCID) for one spatiotemporal variable (velocity) in PwPD. RESEARCH QUESTION What are the MCIDs for velocity and additional spatiotemporal variables, including mean, variability, and asymmetry of step length, time, and width? METHODS As part of a larger clinic-based initiative, 382 medicated, ambulatory PwPD walked on an instrumented walkway during routine clinical visits. Distribution and anchor-based methods (Unified Parkinson's Disease Rating Scale-III, Modified Hoehn and Yahr, and the mobility subsection of the Parkinson Disease Questionnaire) were used to calculate MCIDs for variables of interest in a cross-sectional approach. RESULTS Distribution measures for all variables are presented. Of nine gait variables, four were significantly associated with every anchor and pooled to the following values: velocity (8.2 cm/s), step length mean (3.6 cm), step length variability (0.7%), and step time variability (0.67%). SIGNIFICANCE The finalized MCID for velocity (8.2 cm/s) was nearly half of the MCID of 15 cm/s reported by Hass et al., potentially due to differences in calculations. These results allow for evaluations of effectiveness of interventions by providing values that are specific to changes in gait for PwPD. Alterations of methodology including different versions of clinical or walking assessments, and/or different calculation and selection of gait variables necessitate careful reasoning when using presented MCIDs.
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Affiliation(s)
- Sidney T Baudendistel
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, United States
| | - Allison M Haussler
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, United States
| | - Kerri S Rawson
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, United States; Department of Neurology, Washington University School of Medicine in St. Louis, United States
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, United States; Department of Neurology, Washington University School of Medicine in St. Louis, United States; Department of Neuroscience, Washington University School of Medicine in St. Louis, United States.
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Alolayan WR, Rieger JM, Yoon MN. Head and neck cancer treatment outcome priorities: A multi-perspective concept mapping study. PLoS One 2023; 18:e0294712. [PMID: 38033014 PMCID: PMC10688684 DOI: 10.1371/journal.pone.0294712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
With the increasing focus on patient-centred care, this study sought to understand priorities considered by patients and healthcare providers from their experience with head and neck cancer treatment, and to compare how patients' priorities compare to healthcare providers' priorities. Group concept mapping was used to actively identify priorities from participants (patients and healthcare providers) in two phases. In phase one, participants brainstormed statements reflecting considerations related to their experience with head and neck cancer treatment. In phase two, statements were sorted based on their similarity in theme and rated in terms of their priority. Multidimensional scaling and cluster analysis were performed to produce multidimensional maps to visualize the findings. Two-hundred fifty statements were generated by participants in the brainstorming phase, finalized to 94 statements that were included in phase two. From the sorting activity, a two-dimensional map with stress value of 0.2213 was generated, and eight clusters were created to encompass all statements. Timely care, education, and person-centred care were the highest rated priorities for patients and healthcare providers. Overall, there was a strong correlation between patient and healthcare providers' ratings (r = 0.80). Our findings support the complexity of the treatment planning process in head and neck cancer, evident by the complex maps and highly interconnected statements related to the experience of treatment. Implications for improving the quality of care delivered and care experience of head and cancer are discussed.
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Affiliation(s)
- Waad R. Alolayan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jana M. Rieger
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Minn N. Yoon
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Novel insights regarding the measurement properties of the SCOPA-AUT. BMC Neurol 2022; 22:478. [PMID: 36514012 PMCID: PMC9746092 DOI: 10.1186/s12883-022-03008-2] [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] [Received: 10/19/2021] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Scale for Outcomes in Parkinson's disease for Autonomic symptoms (SCOPA-AUT) is an instrument intended to assess overall and domain-specific autonomic symptom burden. In this study the SCOPA-AUT is translated into Swedish and its measurement properties are assessed. METHODS Following translation the SCOPA-AUT was field-tested regarding comprehensibility, relevance, and respondent burden (n = 20). It was then tested according to Rasch measurement theory using data from 242 persons with PD, of whom 162 completed SCOPA-AUT at baseline and 1-2 years later, giving a total of 404 data points for analysis. RESULTS The Swedish SCOPA-AUT took a mean of 6 min to complete and was considered easy to use and relevant by respondents. SCOPA-AUT exhibited acceptable Rasch model fit, represents more severe levels of dysautonomia than that reported by the sample, and response categories were not working as expected for 17 items. Local dependency was identified and followed a pattern resembling the suggested subscales. Accounting for the subscale structure eliminated local dependency and reduced the initially inflated reliability from 0.81 to 0.68. CONCLUSIONS The SCOPA-AUT is useful as a clinical check-list but requires further developmental work in order to meet more rigorous standards as an outcome measurement instrument.
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Connecting real-world digital mobility assessment to clinical outcomes for regulatory and clinical endorsement-the Mobilise-D study protocol. PLoS One 2022; 17:e0269615. [PMID: 36201476 PMCID: PMC9536536 DOI: 10.1371/journal.pone.0269615] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions. METHODS/DESIGN The Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson's Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chosen to obtain generalizable clinical findings, including diverse clinical, cultural, geographical, and age representation. The disease cohorts include a broad and heterogeneous range of subject characteristics with varying chronic care needs, and represent different trajectories of mobility disability. DISCUSSION The results of Mobilise-D will provide longitudinal data on the use of digital mobility outcomes to identify, stratify, and monitor disability. This will support the development of widespread, cost-effective access to optimal clinical mobility management through personalised healthcare. Further, Mobilise-D will provide evidence-based, direct measures which can be endorsed by regulatory agencies and health technology assessment bodies to quantify the impact of disease-modifying interventions on mobility. TRIAL REGISTRATION ISRCTN12051706.
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A Social Media Listening Study to Understand the Unmet Needs and Quality of Life in Adult and Pediatric Amblyopia Patients. Ophthalmol Ther 2022; 11:2183-2196. [PMID: 36175822 DOI: 10.1007/s40123-022-00571-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Amblyopia is an important cause of monocular vision impairment worldwide, and it negatively impacts patients' quality of life (QoL). Understanding patients' perspectives may help to optimize treatment outcomes and improve treatment adherence. METHODS This was a non-interventional, retrospective analysis of social media data available in the public domain posted by patients and caregivers on selected social media channels (Twitter®, forums, blogs, and news) from 12 countries between July 2018 and June 2020. RESULTS Approximately 2662 conversations relevant to the research objective were analyzed. The patient journey for adults and children was constructed based on the conversations. Eyeglasses, eye patches, contact lenses, and vision exercises were the common treatment options for amblyopia. Patients also reported vision improvement with emerging technologies such as digital therapeutics. Amblyopia and its treatment had a negative impact on QoL, and increased caregiver burden. Insurance coverage, long appointment waiting times, and recurring expenses of treatment options were reported as barriers to treatment. Non-compliance, switching between treatment options or technology, or discontinuation of treatment options was found to emanate from various issues including no improvement of the condition, discomfort with the treatment option, bullying, dissatisfaction with healthcare professional (HCP) recommendation, cost of treatment/issues with insurance coverage, side effects, and/or other unspecified reasons. The need for regular eye examinations, better diagnostic tests, awareness of the disease, awareness amongst HCPs about treatment options, and the need for better health insurance coverage policies emerged as unmet needs. CONCLUSION This social media listening study generated insights on patients with amblyopia and their caregivers regarding the patient journey, treatment options, reasons for non-compliance, reasons for switching HCPs, barriers to treatment, and unmet needs. Further qualitative research is required to validate the findings.
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Saleh HK, Folkeard P, Van Eeckhoutte M, Scollie S. Premium versus entry-level hearing aids: using group concept mapping to investigate the drivers of preference. Int J Audiol 2021; 61:1003-1017. [PMID: 34883040 DOI: 10.1080/14992027.2021.2009923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the difference in outcome measures and drivers of user preference between premium and entry-level hearing aids using group concept mapping. DESIGN A single-blind crossover trial was conducted. Aided behavioural outcomes measured were loudness rating, speech/consonant recognition, and speech quality. Preference between hearing aids was measured with a 7-point Likert scale. Group concept mapping was utilised to investigate preference results. Participants generated statements based on what influenced their preferences. These were sorted into categories with underlying themes. Participants rated each statement on a 5-point Likert scale of importance. STUDY SAMPLE Twenty-three adult participants (mean: 62.4 years; range: 24-78) with mild to moderately severe bilateral SNHL (PTA500-4000 Hz > 20 dB HL). RESULTS A total of 83 unique statements and nine distinct clusters, with underlying themes driving preference, were generated. Clusters that differed significantly in importance between entry-level and premium hearing aid choosers were: Having access to smartphone application-based user-controlled settings, the ability to stream calls and music, and convenience features such as accessory compatibility. CONCLUSION This study has identified non-signal-processing factors which significantly influenced preference for a premium hearing aid over an entry-level hearing aid, indicating the importance of these features as drivers of user preference.
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Affiliation(s)
- Hasan K Saleh
- Health & Rehabilitation Sciences, Western University, London, Ontario, Canada.,National Centre for Audiology, Western University, London, Ontario, Canada
| | - Paula Folkeard
- National Centre for Audiology, Western University, London, Ontario, Canada
| | - Maaike Van Eeckhoutte
- National Centre for Audiology, Western University, London, Ontario, Canada.,Hearing Systems, Department of Health Technology, Technical University of Denmark, Kongens, Lyngby.,Ear, Nose, Throat (ENT) & Audiology Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Susan Scollie
- National Centre for Audiology, Western University, London, Ontario, Canada.,Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Emmanouilidis S, Hackney ME, Slade SC, Heng H, Jazayeri D, Morris ME. Dance Is an Accessible Physical Activity for People with Parkinson's Disease. PARKINSON'S DISEASE 2021; 2021:7516504. [PMID: 34721836 PMCID: PMC8556098 DOI: 10.1155/2021/7516504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/16/2021] [Accepted: 08/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the outcomes of face-to-face, digital, and virtual modes of dancing for people living with Parkinson's disease (PD). DESIGN Systematic review informed by Cochrane and PRIMSA guidelines. Data Sources. Seven electronic databases were searched: AMED, Cochrane, PEDro, CINHAL, PsycINFO, EMBASE, and MEDLINE. METHODS Eligible studies were randomised controlled trials (RCT) and other trials with quantitative data. The PEDro scale evaluated risk of bias for RCTs. Joanna Briggs Institute instruments were used to critically appraise non-RCTs. The primary outcome was the feasibility of dance interventions, and the secondary outcomes included gait, balance, quality of life, and disability. RESULTS The search yielded 8,327 articles after duplicates were removed and 38 met the inclusion criteria. Seven were at high risk of bias, 20 had moderate risk of bias, and 11 had low risk of bias. There was moderately strong evidence that dance therapy was beneficial for balance, gait, quality of life, and disability. There was good adherence to digital delivery of dance interventions and, for people with PD, online dance was easy to access. CONCLUSION Dancing is an accessible form of exercise that can benefit mobility and quality of life in people with PD. The COVID-19 pandemic and this review have drawn attention to the benefits of access to digital modes of physical activity for people living with chronic neurological conditions.
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Affiliation(s)
- Sara Emmanouilidis
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria, Australia
| | - Madeleine E. Hackney
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, USA
- Atlanta Veterans Affairs Centre for Visual & Neurocognitive Rehabilitation, Decatur, GA, USA
| | - Susan C Slade
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria, Australia
| | - Hazel Heng
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria, Australia
| | - Dana Jazayeri
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria, Australia
| | - Meg E. Morris
- Academic and Research Collaborative in Health, La Trobe University, Bundoora, Victoria, Australia
- Victorian Rehabilitation Centre, Glen Waverley, Victoria, Australia
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Polhemus A, Delgado-Ortiz L, Brittain G, Chynkiamis N, Salis F, Gaßner H, Gross M, Kirk C, Rossanigo R, Taraldsen K, Balta D, Breuls S, Buttery S, Cardenas G, Endress C, Gugenhan J, Keogh A, Kluge F, Koch S, Micó-Amigo ME, Nerz C, Sieber C, Williams P, Bergquist R, Bosch de Basea M, Buckley E, Hansen C, Mikolaizak AS, Schwickert L, Scott K, Stallforth S, van Uem J, Vereijken B, Cereatti A, Demeyer H, Hopkinson N, Maetzler W, Troosters T, Vogiatzis I, Yarnall A, Becker C, Garcia-Aymerich J, Leocani L, Mazzà C, Rochester L, Sharrack B, Frei A, Puhan M. Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes. NPJ Digit Med 2021; 4:149. [PMID: 34650191 PMCID: PMC8516969 DOI: 10.1038/s41746-021-00513-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023] Open
Abstract
Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Gavin Brittain
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Michaela Gross
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachele Rossanigo
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Diletta Balta
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gabriela Cardenas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Christoph Endress
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Alison Keogh
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Felix Kluge
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - M Encarna Micó-Amigo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Chloé Sieber
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Parris Williams
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magda Bosch de Basea
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Ellen Buckley
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Lars Schwickert
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Kirsty Scott
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Sabine Stallforth
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Janet van Uem
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrea Cereatti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University hospitals Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
| | - Alison Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Letizia Leocani
- Department of Neurology, San Raffaele University, Milan, Italy
| | - Claudia Mazzà
- Insigneo Institute, Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, England
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Wolffsohn JS, Leteneux-Pantais C, Chiva-Razavi S, Bentley S, Johnson C, Findley A, Tolley C, Arbuckle R, Kommineni J, Tyagi N. Social Media Listening to Understand the Lived Experience of Presbyopia: Systematic Search and Content Analysis Study. J Med Internet Res 2020; 22:e18306. [PMID: 32955443 PMCID: PMC7536603 DOI: 10.2196/18306] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Presbyopia is defined as the age-related deterioration of near vision over time which is experienced in over 80% of people aged 40 years or older. Individuals with presbyopia have difficulty with tasks that rely on near vision. It is not currently possible to stop or reverse the aging process that causes presbyopia; generally, it is corrected with glasses, contact lenses, surgery, or the use of a magnifying glass. OBJECTIVE This study aimed to explore how individuals used social media to describe their experience of presbyopia with regard to the symptoms experienced and the impacts of presbyopia on their quality of life. METHODS Social media sources including Twitter, forums, blogs, and news outlets were searched using a predefined search string relating to symptoms and impacts of presbyopia. The data that were downloaded, based on the keywords, underwent manual review to identify relevant data points. Relevant posts were further manually analyzed through a process of data tagging, categorization, and clustering. Key themes relating to symptoms, impacts, treatment, and lived experiences were identified. RESULTS A total of 4456 social media posts related to presbyopia were identified between May 2017 and August 2017. Using a random sampling methodology, we selected 2229 (50.0%) posts for manual review, with 1470 (65.9%) of these 2229 posts identified as relevant to the study objectives. Twitter was the most commonly used channel for discussions on presbyopia compared to forums and blogs. The majority of relevant posts originated in Spain (559/1470, 38.0%) and the United States (426/1470, 29.0%). Of the relevant posts, 270/1470 (18.4%) were categorized as posts written by individuals who have presbyopia, of which 37 of the 270 posts (13.7%) discussed symptoms. On social media, individuals with presbyopia most frequently reported experiencing difficulty reading small print (24/37, 64.9%), difficulty focusing on near objects (15/37, 40.5%), eye strain (12/37, 32.4%), headaches (9/37, 24.3%), and blurred vision (8/37, 21.6%). 81 of the 270 posts (30.0%) discussed impacts of presbyopia-emotional burden (57/81, 70.4%), functional or daily living impacts (46/81, 56.8%), such as difficulty reading (46/81, 56.8%) and using electronic devices (21/81, 25.9%), and impacts on work (3/81, 3.7%). CONCLUSIONS Findings from this social media listening study provided insight into how people with presbyopia discuss their condition online and highlight the impact of presbyopia on individuals' quality of life. The social media listening methodology can be used to generate insights into the lived experience of a condition, but it is recommended that this research be combined with prospective qualitative research for added rigor and for confirmation of the relevance of the findings.
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Affiliation(s)
- James S Wolffsohn
- Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | | | | | - Sarah Bentley
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, United Kingdom
| | - Chloe Johnson
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, United Kingdom
| | - Amy Findley
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, United Kingdom
| | - Chloe Tolley
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, United Kingdom
| | - Rob Arbuckle
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, United Kingdom
| | - Jyothi Kommineni
- Novartis Business Services, Product Lifecycle Services, Hyderabad, India
| | - Nishith Tyagi
- Novartis Business Services, Product Lifecycle Services, Hyderabad, India
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Mulvaney CA, Duarte GS, Handley J, Evans DJ, Menon S, Wyse R, Emsley HC. GLP-1 receptor agonists for Parkinson's disease. Cochrane Database Syst Rev 2020; 7:CD012990. [PMID: 32700772 PMCID: PMC7390475 DOI: 10.1002/14651858.cd012990.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive disorder characterised by both motor and non-motor problems. Glucagon-like peptide-1 (GLP-1) receptor agonists, licensed for treatment of type 2 diabetes, work by stimulating GLP-1 receptors in the pancreas, which triggers the release of insulin. GLP-1 receptors have been found in the brain. Insulin signalling in the brain plays a key role in neuronal metabolism and repair and in synaptic efficacy, but insulin signalling is desensitised in the brain of people with PD. Researchers are exploring the neuroprotective effects of GLP-1 receptor agonists in neurodegenerative disorders such as PD. OBJECTIVES To evaluate the effectiveness and safety of GLP-1 receptor agonists for Parkinson's disease. SEARCH METHODS We searched the Cochrane Movement Disorders Group trials register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; and Ovid MEDLINE and Embase. We also searched clinical trials registries, and we handsearched conference abstracts. The most recent search was run on 25 June 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with PD that compared GLP-1 receptor agonists with conventional PD treatment, placebo, or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We rated the quality of evidence using GRADE. We resolved discrepancies between the two data extractors by consultation with a third review author. MAIN RESULTS Through our searches, we retrieved 99 unique records, of which two met our inclusion criteria. One double-blind study of exenatide versus placebo randomised 62 participants, who self-administered exenatide or placebo for 48 weeks and were followed up at 60 weeks after a 12-week washout. One single-blind study of exenatide versus no additional treatment randomised 45 participants; participants in the intervention group self-administered exenatide for 12 months, and all participants were followed up at 14 months and 24 months following absence of exenatide for 2 months and 12 months, respectively. These trials had low risk of bias, except risk of performance bias was high for Aviles-Olmos 2013. Exenatide versus placebo Primary outcomes We found low-certainty evidence suggesting that exenatide improves motor impairment as assessed by the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III in the off-medication state (mean difference (MD) -3.10, 95% confidence interval (CI) -6.11 to -0.09). The difference in scores was slightly greater when scores were adjusted for baseline severity of the condition (as reported by study authors) (MD -3.5, 95% CI -6.7 to -0.3), exceeding the minimum clinically important difference (MCID). We found low-certainty evidence suggesting that exenatide has little or no effect on health-related quality of life (HRQoL) as assessed by the Parkinson's Disease Questionnaire (PDQ)-39 Summary Index (SI) (MD -1.80, 95% CI -6.95 to 3.35), the EuroQol scale measuring health status in five dimensions (EQ5D) (MD 0.07, 95% CI -0.03 to 0.16), or the EQ5D visual analogue scale (VAS) (MD 5.00, 95% CI -3.42 to 13.42). Eight serious adverse events (SAEs) were recorded, but all were considered unrelated to the intervention. Low-certainty evidence suggests that exenatide has little or no effect on weight loss (risk ratio (RR) 1.25, 95% CI 0.89 to 1.76). Exenatide versus no treatment Primary outcomes at 14 months We found very low-certainty evidence suggesting that exenatide improves motor impairment as assessed by MDS-UPDRS Part III off medication (MD -4.50, 95% CI -8.64 to -0.36), exceeding the MCID. We are uncertain whether exenatide improves HRQoL as assessed by the PDQ-39 SI (MD 3.50, 95% CI -2.75 to 9.75; very low-quality evidence). We found very low-certainty evidence suggesting that exenatide has little or no effect on the number of SAEs (RR 1.60, 95% 0.40 to 6.32). We found very low-certainty evidence suggesting that exenatide may lead to weight loss (MD -2.40 kg, 95% CI -4.56 to -0.24). Primary outcomes at 24 months We found evidence as reported by study authors to suggest that exenatide improves motor impairment as measured by MDS-UPDRS Part III off medication (MD 5.6 points, 95% CI 2.2 to 9.0). Exenatide may not improve HRQoL as assessed by the PDQ-39 SI (P = 0.682) and may not result in weight loss (MD 0.1 kg, 95% CI 3.0 to 2.8). AUTHORS' CONCLUSIONS Low- or very low-certainty evidence suggests that exenatide may improve motor impairment for people with PD. The difference in motor impairment observed between groups may persist for some time following cessation of exenatide. This raises the possibility that exenatide may have a disease-modifying effect. SAEs were unlikely to be related to treatment. The effectiveness of exenatide for improving HRQoL, non-motor outcomes, ADLs, and psychological outcomes is unclear. Ongoing studies are assessing other GLP-1 receptor agonists.
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Affiliation(s)
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular, Lisboa, Portugal
| | - Joel Handley
- Lancaster Medical School, Lancaster University, Lancaster, UK
- Department of Neurology, Salford Royal Hospital, Salford, UK
| | - David Jw Evans
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Suresh Menon
- Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Hedley Ca Emsley
- Lancaster Medical School, Lancaster University, Lancaster, UK
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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12
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Smith F, Alexandersson P, Bergman B, Vaughn L, Hellström A. Fourteen years of quality improvement education in healthcare: a utilisation-focused evaluation using concept mapping. BMJ Open Qual 2019; 8:e000795. [PMID: 31909214 PMCID: PMC6937017 DOI: 10.1136/bmjoq-2019-000795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/13/2019] [Accepted: 11/28/2019] [Indexed: 01/07/2023] Open
Abstract
Background The need for training in quality improvement for healthcare staff is well acknowledged, but long-term outcomes of such training are hard to evaluate. Behaviour change, improved organisational performance and results are sought for, but these variables are complex, multifactorial and difficult to assess. Aim The purpose of this article is to explore the personal and organisational outcomes identified by participants over 14 years of university-led QI courses for healthcare professionals. Method Inspired by the Kirkpatrick model for evaluation, we used concept mapping, a structured mixed method that allows for richness of data to be captured and visualised by inviting stakeholders throughout the process. In total, 331 previous course participants were included in the study by responding to two prompts, and 19 stakeholders taking part in the analysis process by doing the sorting. Result Two maps, one for personal outcomes and one for organisational outcomes, show clusters of the responses from previous course participants and how the outcomes relate to each other in meta-clusters. Both maps show possible long-term outcomes described by the previous course participants. Conclusion The results of this study indicate that it is possible that training in quality improvement with a strong experiential pedagogical approach fosters a long-term improvement capability for the course participants and, even more important, a long-term improvement capability (and increased improvement skill) in their respective organisations.
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Affiliation(s)
- Frida Smith
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden.,Regional Cancer Centre West, Gothenburg, Sweden
| | - Patrik Alexandersson
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Bo Bergman
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
| | - Lisa Vaughn
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andreas Hellström
- Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
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13
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Riggare S, Hägglund M. Precision Medicine in Parkinson's Disease - Exploring Patient-Initiated Self-Tracking. JOURNAL OF PARKINSONS DISEASE 2019; 8:441-446. [PMID: 30124453 PMCID: PMC6130409 DOI: 10.3233/jpd-181314] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Individually tailored healthcare, in the form of precision medicine, holds substantial potential for the future of medicine, especially for a complex disorder like Parkinson’s disease (PD). Patient self-tracking is an under-researched area in PD. Objective: This study aimed to explore patient-initiated self-tracking in PD and discuss it in the context of precision medicine. Methods: The first author used a smartphone app to capture finger-tapping data and also noted times for medication intakes. Results: Data were collected during four subsequent days. Only data from the first two days were complete enough to analyze, leading to the realization that the collection of data over a period of time can pose a significant burden to patients. From the first two days of data, a dip in finger function was observed around the time for the second medication dose of the day. Conclusions: Patient-initiated self-tracking enabled the first author to glean important insights about how her PD symptoms varied over the course of the day. Symptom tracking holds great potential in precision medicine and can, if shared in a clinical encounter, contribute to the learning of both patient and clinician. More work is needed to develop this field and extra focus needs to be given to balancing the burden of tracking for the patient against any expected benefit.
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Affiliation(s)
- Sara Riggare
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hägglund
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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14
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Perepezko K, Hinkle JT, Shepard MD, Fischer N, Broen MP, Leentjens AFG, Gallo J, Pontone GM. Social role functioning in Parkinson's disease: A mixed-methods systematic review. Int J Geriatr Psychiatry 2019; 34:1128-1138. [PMID: 31069845 PMCID: PMC6949188 DOI: 10.1002/gps.5137] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is a progressive neurodegenerative disease that often impedes activities of daily living (ADL) and social functioning. Impairment in these areas can alter social roles by interfering with employment status, household management, friendships, and other relationships. Understanding how PD affects social functioning can help clinicians choose management strategies that mitigate these changes. METHODS We conducted a mixed-methods systematic review of existing literature on social roles and social functioning in PD. A tailored search strategy in five databases identified 51 full-text reports that fulfilled the inclusion criteria and passed the quality appraisal. We aggregated and analyzed the results from these studies and then created a narrative summary. RESULTS Our review demonstrates how PD causes many people to withdraw from their accustomed social roles and experience deficits in corresponding activities. We describe how PD symptoms (eg, tremor, facial masking, and neuropsychiatric symptoms) interfere with relationships (eg, couple, friends, and family) and precipitate earlier departure from the workforce. Additionally, several studies demonstrated that conventional PD therapy has little positive effect on social role functioning. CONCLUSIONS Our report presents critical insight into how PD affects social functioning and gives direction to future studies and interventions (eg, couple counseling and recreational activities).
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Affiliation(s)
- Kate Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jared T. Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Medical Scientist Training Program, Baltimore, MD, USA
| | - Melissa D. Shepard
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martinus P.G. Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joe Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Wolff L, Benge J. Everyday Language Difficulties in Parkinson's Disease: Caregiver Description and Relationship With Cognition, Activities of Daily Living, and Motor Disability. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:165-173. [PMID: 31072160 DOI: 10.1044/2018_ajslp-18-0091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose Parkinson's disease (PD) impacts language in multiple ways, though important questions remain. The current article explores 2 main issues: what type of everyday language difficulties (ELDs) are noted by care partners and how do ELDs relate to cognition, daily activities, and motor disability in PD. Method Care partner reports of ELD were collected in 42 community-dwelling individuals with PD. Descriptive information of ELD was tallied, and the relationship of cognitive decline, activities of daily living (ADLs), and motor disability with ELD was evaluated. Results Forty-two percent of patients were described by care partners as having at least 1 consistent ELD, and the frequency of ELD increased in the presence of dementia, χ2(2) = 14.37, p = .0008. The most commonly described ELDs by caregivers were related to comprehension of instructions and deriving the point of conversations. ELD was correlated with worse cognition ( r s = -.524, p < .001), increased difficulty with daily activities ( r s = .634, p < .001), and increased motor dysfunction ( r s = .554, p < .001). Mild ADL decline (Functional Assessment Questionnaire score of 4); an area under the curve of .81 ( SE = .07) was highly specific to the presence of ELD (95.4%). Conclusions Care partners note a variety of ELDs in patients with PD, most commonly comprehension difficulties. These difficulties increase with overall cognitive decline but are described in 30%-40% of those without significant cognitive deficits. ADL difficulties correlate with functional, motoric, and cognitive status, with even mild functional declines predictive of the presence of ELD. Implications for research and practice in this population are discussed.
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Affiliation(s)
- Logan Wolff
- Department of Neurology, Baylor Scott & White Health, Temple, TX
| | - Jared Benge
- Department of Neurology, Baylor Scott & White Health, Temple, TX
- Plummer Movement Disorders Center, Baylor Scott & White Health, Temple, TX
- Department of Internal Medicine, Texas A&M College of Medicine, Temple
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16
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Buitenweg DC, Bongers IL, van de Mheen D, van Oers HAM, Van Nieuwenhuizen C. Worth a thousand words? Visual concept mapping of the quality of life of people with severe mental health problems. Int J Methods Psychiatr Res 2018; 27:e1721. [PMID: 29797745 PMCID: PMC6175345 DOI: 10.1002/mpr.1721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/22/2018] [Accepted: 04/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Conventional approaches to quality of life (QoL) measurement rely heavily on verbal, language-based communication. They require respondents to have significant cognitive and verbal ability, making them potentially unsuitable for people with severe mental health problems. To facilitate an alternative approach to QoL assessment, the current study aims to develop an alternative, visual representation of QoL for people with severe mental health problems. METHODS An alternative, visual adaptation of the concept mapping method was used to construct this visual representation of QoL. Eighty-two participants (i.e., patients, care professionals, and family members) contributed to this study. Results were processed statistically to construct the concept map. RESULTS The concept map contains 160 unique visual statements, grouped into 8 clusters labelled (1) Support and Attention, (2) Social Contacts, (3) Happiness and Love, (4) Relaxation and Harmony, (5) Leisure, (6) Lifestyle, (7) Finances, and (8) Health and Living. Examples of visual statements are pictures of family silhouettes, romantic couples, natural scenes, houses, sports activities, wallets and coins, smiley faces, and heart shapes. The clusters were interpreted and labelled by participants. CONCLUSIONS Almost all of the statements correspond to clusters found in previous (non-visual) QoL research. Hence, QoL domains can also be presented visually.
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Affiliation(s)
- David C Buitenweg
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,Centre for Child and Adolescent Psychiatry, GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - Ilja L Bongers
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,Centre for Child and Adolescent Psychiatry, GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - Dike van de Mheen
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,IVO Addiction Research Institute, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Hans A M van Oers
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Chijs Van Nieuwenhuizen
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,Centre for Child and Adolescent Psychiatry, GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
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17
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Mulvaney CA, Duarte GS, Menon S, Handley J, Emsley HC. GLP-1 receptor agonists for Parkinson's disease. Hippokratia 2018. [DOI: 10.1002/14651858.cd012990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Gonçalo S Duarte
- Faculdade de Medicina de Lisboa; Laboratório de Farmacologia Clínica e Terapêutica; Avenida Professor Egas Moniz Lisboa Lisboa Portugal 1649-028
- Instituto de Medicina Molecular; Clinical Pharmacology Unit; Av. Prof. Egas Moniz Lisboa Portugal 1649-028
| | - Suresh Menon
- McMaster University; Department of Medicine; 237 Barton Street East Mailbox 63 Hamilton Ontario Canada L8L 2X2
| | - Joel Handley
- Lancaster University; Lancaster Medical School; Lancaster UK LA1 4YG
- Salford Royal Hospital; Department of Neurology; Salford UK
| | - Hedley C.A. Emsley
- Lancaster University; Lancaster Medical School; Lancaster UK LA1 4YG
- Lancashire Teaching Hospitals NHS Foundation Trust; Department of Neurology; Department of Neurology, Royal Preston Hospital Sharoe Green Lane, Fulwood Preston UK PR2 9HT
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18
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Computer-Based Training in Eating and Nutrition Facilitates Person-Centered Hospital Care: A Group Concept Mapping Study. Comput Inform Nurs 2018; 36:199-207. [PMID: 29334516 DOI: 10.1097/cin.0000000000000416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Studies have shown that computer-based training in eating and nutrition for hospital nursing staff increased the likelihood that patients at risk of undernutrition would receive nutritional interventions. This article seeks to provide understanding from the perspective of nursing staff of conceptually important areas for computer-based nutritional training, and their relative importance to nutritional care, following completion of the training. Group concept mapping, an integrated qualitative and quantitative methodology, was used to conceptualize important factors relating to the training experiences through four focus groups (n = 43), statement sorting (n = 38), and importance rating (n = 32), followed by multidimensional scaling and cluster analysis. Sorting of 38 statements yielded four clusters. These clusters (number of statements) were as follows: personal competence and development (10), practice close care development (10), patient safety (9), and awareness about the nutrition care process (9). First and second clusters represented "the learning organization," and third and fourth represented "quality improvement." These findings provide a conceptual basis for understanding the importance of training in eating and nutrition, which contributes to a learning organization and quality improvement, and can be linked to and facilitates person-centered nutritional care and patient safety.
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Humphrey L, Willgoss T, Trigg A, Meysner S, Kane M, Dickinson S, Kitchen H. A comparison of three methods to generate a conceptual understanding of a disease based on the patients' perspective. J Patient Rep Outcomes 2017; 1:9. [PMID: 29757313 PMCID: PMC5934934 DOI: 10.1186/s41687-017-0013-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background The Food and Drug Administration patient-reported outcome (PRO) guidance provides standards for PRO development, but these standards bring scientific and logistical challenges which can result in a lengthy and expensive instrument development process. Thus, more pragmatic methods are needed alongside traditional approaches. Methods Partnering with the National Ankylosing Spondylitis (AS) Society, we compared three methods for eliciting patient experiences: 1) concept elicitation (CE) interviews with 12 individuals with AS, 2) “group concept mapping” (GCM) with 16 individuals with AS, 3) a social media review (SMR) of AS online chatrooms. Three conceptual models were developed and compared to explore data breadth/depth, as well as the practicalities and patient-centeredness. Results Overlap in concepts was observed between conceptual models; 35% of symptoms were identified by all methods. The SMR approach identified the most concepts (n = 23), followed by CE interviews (n = 18), and GCM (n = 15). Eight symptoms were uniquely identified using GCM and SMR. Eliciting in-depth data was challenging for SMR as detail was not always provided. Insight into the relationships between symptoms was obtained as a “concept map” in GCM, via effective probing within interviews, and through the subject’s descriptions in SMR. Practical investment varied; CE interviews were the most resource intensive, whereas SMR was the least. Individuals in GCM and CE interviews reported high engagement. Conclusions Primary CE interviews achieved the greatest depth in conceptual understanding of patient experience; however, novel methods (GCM, SMR) provide complementary approaches for identifying measurement concepts. Each method has strengths and weaknesses and should be selected based on specific research objectives. Electronic supplementary material The online version of this article (10.1186/s41687-017-0013-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Humphrey
- Clinical Outcomes Solutions, LLC, Unit 68, Basepoint, Shearway Business Park, Shearway Road, Folkestone, Manchester, CT194RH UK
| | | | | | | | - Mary Kane
- Concept Systems, Inc, Ithaca, NY USA
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20
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Rosqvist K, Hagell P, Odin P, Ekström H, Iwarsson S, Nilsson MH. Factors associated with life satisfaction in Parkinson's disease. Acta Neurol Scand 2017; 136:64-71. [PMID: 27726132 DOI: 10.1111/ane.12695] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To identify factors associated with life satisfaction (LS) in people with Parkinson's disease (PD), including a specific focus on those with late-stage PD. MATERIAL AND METHODS The study included 251 persons with PD (median age 70 years; PD duration 8 years). Analyses involved the total sample and a subsample with late-stage PD, that is Hoehn and Yahr stages IV and V (n=62). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Simple logistic regression analyses were performed for both the total sample and for the subsample with late-stage PD. For the total sample, a multivariable logistic regression analysis was also performed. RESULTS In the total sample, 12 of the 20 independent variables were significantly associated with LS: need of help with ADL; walking difficulties; number of non-motor symptoms (NMS); fatigue; depressive symptoms; general self-efficacy; motor symptoms; pain; PD severity; freezing episodes; gender (woman); and fluctuations. When controlling for age and gender in the multivariable logistic regression model, depressive symptoms were negatively associated with high LS and general self-efficacy was positively associated with high LS. In late-stage PD, simple logistic regression analyses (controlling for age and gender) identified the following factors as associated with LS: number of NMS, general self-efficacy, walking difficulties and fatigue. CONCLUSIONS This study provides new knowledge on factors associated with LS in a PD sample, including those with late-stage PD. As the ultimate goal for PD care should be improvement in LS, the results have direct clinical implication.
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Affiliation(s)
- K. Rosqvist
- Faculty of Medicine; Department of Clinical Sciences Lund; Neurology; Lund University; Lund Sweden
| | - P. Hagell
- The PRO-CARE Group; School of Health and Society; Kristianstad University; Kristianstad Sweden
| | - P. Odin
- Faculty of Medicine; Department of Clinical Sciences Lund; Neurology; Lund University; Lund Sweden
- Department of Neurology; Skåne University Hospital; Lund Sweden
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - H. Ekström
- Faculty of Medicine; Department of Health Sciences; Lund University; Lund Sweden
| | - S. Iwarsson
- Faculty of Medicine; Department of Health Sciences; Lund University; Lund Sweden
| | - M. H. Nilsson
- Faculty of Medicine; Department of Health Sciences; Lund University; Lund Sweden
- Memory Clinic; Skåne University Hospital; Malmö Sweden
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Nilsson MH, Iwarsson S, Thordardottir B, Haak M. Barriers and Facilitators for Participation in People with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:983-92. [PMID: 26599298 DOI: 10.3233/jpd-150631] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Activity performance is marked by the degenerative nature of Parkinson's disease (PD), but few qualitative studies have focused on how people with PD perceive participation in life situations. OBJECTIVE To identify and describe barriers and facilitators for participation from the perspective of people with PD. METHODS Qualitative data was obtained by the focus group method using a semi-structured interview guide. Participants were recruited by purposeful sampling until saturation was reached. Homogeneity within each focus group was based on self-rated PD severity (mild, moderate, severe). Nine focus groups (three per PD severity level) included a total of 29 participants. RESULTS Complex dynamics between the individual and the physical and social environment create barriers and facilitators for participation as described in the four categories which emerged out of the focus group discussions. The category Ambiguity of attitudes and the support of others describes how attitudes and support of other people act both as facilitators and barriers for participation. PD specific complexity of the body and physical environment interaction describes barriers for participation. Facilitators emerged in the two categories PD expertise in health care and social services and Information and education foster PD specific understanding. CONCLUSIONS Our findings imply several potential means to facilitate participation for people with PD, taking the person as well as the environment into account in person-centred interventions. This involves aspects such as having access to PD specific expertise, increasing the knowledge and thereby the understanding of PD as well as providing support for maintained work-life.
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Hagell P, Edfors E, Hedin G, Westergren A, Hammarlund CS. Group concept mapping for evaluation and development in nursing education. Nurse Educ Pract 2016; 20:147-53. [DOI: 10.1016/j.nepr.2016.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/12/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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Skempes D, Bickenbach J. Developing human rights based indicators to support country monitoring of rehabilitation services and programmes for people with disabilities: a study protocol. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:25. [PMID: 26404637 PMCID: PMC4582732 DOI: 10.1186/s12914-015-0063-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/11/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rehabilitation care is fundamental to health and human dignity and a human right enshrined in the United Nations Convention on the Rights of Persons with Disabilities. The provision of rehabilitation is important for reducing the need for formal support and enabling persons with disabilities to lead an independent life. Increasingly scholars and advocacy groups voice concerns over the significant barriers facing people with disabilities in accessing appropriate and quality rehabilitation. A growing body of research highlights a "respond-need" gap in the provision of rehabilitation and assistive technologies and underscore the lack of indicators for assessing performance of rehabilitation systems and monitoring States compliance with human rights standards in rehabilitation service planning and programming. While research on human rights and health monitoring has increased exponentially over the last decade far too little attention has been paid to rehabilitation services. The proposed research aims to reduce this knowledge gap by developing a human rights based monitoring framework with indicators to support human rights accountability and performance assessment in rehabilitation. METHODS/DESIGN Concept mapping, a stakeholder-driven approach will be used as the core method to identify rights based indicators and develop the rehabilitation services monitoring framework. Concept mapping requires participants from various stakeholders groups to generate a list of the potential indicators through on line brainstorming, sort the indicators for conceptual similarity into clusters and rate them against predefined criteria. Multidimensional scaling and hierarchical cluster data analysis will be performed to develop the monitoring framework while bridging analysis will provide useful insights about patterns of agreement or disagreement among participants views on indicators. DISCUSSION This study has the potential to influence future practices on data collection and measurement of compliance with human rights standards in rehabilitation service delivery and organization. The development of a valid and universally applicable set of indicators will have a profound impact on the design and implementation of evidence informed disability policies and programs as it can support countries in strengthening performance measurement through documentation of comparative information on rehabilitation care systems. Most importantly, the resulting indicators can be used by disabled people's organizations as well as national and international institutions to define a minimal standard for monitoring and reporting progress on the implementation of the Convention on the Rights of Persons with Disabilities in the area of rehabilitation.
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Affiliation(s)
- Dimitrios Skempes
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Guido A. Zaech Institute (GZI), CH-6207, Nottwil, Switzerland.
- Human Rights in Patients Care Program, Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Guido A. Zaech Institute (GZI), CH-6207, Nottwil, Switzerland.
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Clinically meaningful parameters of progression and long-term outcome of Parkinson disease: An international consensus statement. Parkinsonism Relat Disord 2015; 21:675-82. [PMID: 25952959 DOI: 10.1016/j.parkreldis.2015.04.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/09/2015] [Accepted: 04/27/2015] [Indexed: 02/03/2023]
Abstract
Parkinson disease (PD) is associated with a clinical course of variable duration, severity, and a combination of motor and non-motor features. Recent PD research has focused primarily on etiology rather than clinical progression and long-term outcomes. For the PD patient, caregivers, and clinicians, information on expected clinical progression and long-term outcomes is of great importance. Today, it remains largely unknown what factors influence long-term clinical progression and outcomes in PD; recent data indicate that the factors that increase the risk to develop PD differ, at least partly, from those that accelerate clinical progression and lead to worse outcomes. Prospective studies will be required to identify factors that influence progression and outcome. We suggest that data for such studies is collected during routine office visits in order to guarantee high external validity of such research. We report here the results of a consensus meeting of international movement disorder experts from the Genetic Epidemiology of Parkinson's Disease (GEO-PD) consortium, who convened to define which long-term outcomes are of interest to patients, caregivers and clinicians, and what is presently known about environmental or genetic factors influencing clinical progression or long-term outcomes in PD. We propose a panel of rating scales that collects a significant amount of phenotypic information, can be performed in the routine office visit and allows international standardization. Research into the progression and long-term outcomes of PD aims at providing individual prognostic information early, adapting treatment choices, and taking specific measures to provide care optimized to the individual patient's needs.
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Thordardottir B, Nilsson MH, Iwarsson S, Haak M. "You plan, but you never know"--participation among people with different levels of severity of Parkinson's disease. Disabil Rehabil 2014; 36:2216-24. [PMID: 24670191 DOI: 10.3109/09638288.2014.898807] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to improve our understanding of important aspects of participation in everyday life for people with different levels of severity of Parkinson's disease (PD). METHODS A qualitative design was used, with empirical data obtained from focus groups. The participants had all been diagnosed with PD at least one year prior to the start of the study. Purposeful sampling was used to ensure that both sexes, with variations in age, marital status, living arrangements, education and employment, were represented. Recruitment continued until saturation was reached and resulted in 29 participants. Homogeneity within each focus group was based on self-rated PD severity (mild, moderate or severe). FINDINGS The aspects that influence participation at different stages of PD are that those with PD stand out in public, as a result of disease-specific features, and that the disease is unpredictable. Planning was highlighted as a strategy that is required to support participation and cope with stress and to compensate for the fact that everyday activities demanded a great deal of time and energy. CONCLUSION These findings are of importance to the development of rehabilitation interventions that support people with PD in maintaining their participation in everyday life, throughout the course of the disease.
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Affiliation(s)
- Björg Thordardottir
- Department of Health Sciences, Faculty of Medicine, Lund University , Lund , Sweden
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Conceptualizing and prioritizing clinical trial outcomes from the perspectives of people with Parkinson's disease versus health care professionals: a concept mapping study. Qual Life Res 2014; 23:1687-700. [PMID: 24390766 DOI: 10.1007/s11136-013-0614-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Focusing clinical investigations on outcomes that are meaningful from an end-user perspective is central in clinical research, particularly in chronic disorders such as Parkinson's disease (PD). However, little is known about how end-users such as people with PD (PwPD) and health care professionals (HCPs) view and prioritize therapeutic outcomes. PURPOSE To compare the perspectives of PwPD and HCPs regarding prioritized areas for outcome measurement in clinical PD trials. METHODS Concept mapping was used to identify prioritized outcomes (statements) through focus groups (n = 27; 12 PwPD, 12 HCPs, three researchers), statement sorting and importance rating (n = 38; 19 PwPD, 19 HCPs), followed by quantitative (multidimensional scaling, cluster analysis, procrustes analysis) and qualitative analysis. RESULTS Sorting of 99 statements by PwPD and HCPs yielded 2D maps (PwPD/HCPs stress values, 0.31/0.21) with eight clusters per group. The correlation between raw sorting data of PwPD and HCPs was 0.80, and there was a significant concordance (m 12 = 0.53; P < 0.001; i.e., r = 0.68) between the spatial arrangements in their respective maps. Qualitatively, the maps from the two groups represented partially different perspectives. There were no significant differences between PwPD and HCP item importance ratings. CONCLUSION Although similarities dominated, there were differences in how the relationships between items were perceived by the two groups, emanating from different perspectives, i.e., the clinical biomedical ("disease") versus the lived experience ("illness"). This study illustrates the clinical importance of attention to the perspective of PwPD; taking this into account is likely to provide evidence from clinical investigations that are meaningful and interpretable for end-users.
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