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Cheng LJ, Engel L, Chen LA, Soh SZY, Koh GCH, Luo N. Using EQ-5D for Proxy Assessment of Health-Related Quality of Life in Residential Care Facilities: A Systematic Review of Feasibility and Psychometric Properties. J Am Med Dir Assoc 2024; 25:104870. [PMID: 38043585 DOI: 10.1016/j.jamda.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES The accurate assessment of Health-Related Quality of Life (HRQoL) in residents of residential care facilities (RCF) necessitates the use of proxy-reported instruments that possess robust psychometric properties. Generally, these instruments are modified versions of self-reported tools, with adjustments made to pronouns and instructions to better suit the respondent. Among such tools, the EQ-5D has emerged as a prominent instrument for evaluating HRQoL within RCF settings. This review aimed to synthesize evidence on psychometric properties of the proxy version of EQ-5D. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Residents in RCF. METHODS An extensive search was conducted across 8 databases, covering articles from inception to May 29, 2023. We included a total of 20 articles reporting data that can be used to evaluate psychometric properties of this instrument in RCF. The quality appraisal employed the COSMIN Risk of Bias checklist, and data synthesis followed COSMIN methodology. RESULTS Most of the included studies were conducted in Europe, with 75% using nursing staff as proxies. Missing data rates were 5% for EQ-5D and 26% for EQ VAS. Evidence of moderate certainty on construct validity of the EQ-5D index was inconsistent, although the EQ VAS showed sufficient construct validity supported by high certainty. EQ-5D index responsiveness evidence was limited, characterized by low certainty and inconsistency. Proxy-resident agreement ranged from poor to moderate, and improved with repeated administration for the "mobility" and "usual activities" dimensions. The lowest agreement was observed when staff served as proxies or the proxy-proxy perspective was adopted. CONCLUSIONS AND IMPLICATIONS This review offers an overview of the psychometric properties of EQ-5D as a proxy HRQoL measure in RCF. The suboptimal evidence on psychometric properties of EQ-5D indicated the need for more validation studies and cautious use of the instrument in RCF.
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Affiliation(s)
- Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Le Ann Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sonia Zhi Yi Soh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Dean's Office and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Hospital, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Tsui TCO, Torres SC, Bielecki JM, Mitsakakis N, Trudeau ME, Bremner KE, Davis AM, Krahn MD. A scoping review to create a framework for the steps in developing condition-specific preference-based instruments de novo or from an existing non-preference-based instrument: use of item response theory or Rasch analysis. Health Qual Life Outcomes 2024; 22:38. [PMID: 38745165 PMCID: PMC11094879 DOI: 10.1186/s12955-024-02253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND There is no widely accepted framework to guide the development of condition-specific preference-based instruments (CSPBIs) that includes both de novo and from existing non-preference-based instruments. The purpose of this study was to address this gap by reviewing the published literature on CSPBIs, with particular attention to the application of item response theory (IRT) and Rasch analysis in their development. METHODS A scoping review of the literature covering the concepts of all phases of CSPBI development and evaluation was performed from MEDLINE, Embase, PsychInfo, CINAHL, and the Cochrane Library, from inception to December 30, 2022. RESULTS The titles and abstracts of 1,967 unique references were reviewed. After retrieving and reviewing 154 full-text articles, data were extracted from 109 articles, representing 41 CSPBIs covering 21 diseases or conditions. The development of CSPBIs was conceptualized as a 15-step framework, covering four phases: 1) develop initial questionnaire items (when no suitable non-preference-based instrument exists), 2) establish the dimensional structure, 3) reduce items per dimension, 4) value and model health state utilities. Thirty-nine instruments used a type of Rasch model and two instruments used IRT models in phase 3. CONCLUSION We present an expanded framework that outlines the development of CSPBIs, both from existing non-preference-based instruments and de novo when no suitable non-preference-based instrument exists, using IRT and Rasch analysis. For items that fit the Rasch model, developers selected one item per dimension and explored item response level reduction. This framework will guide researchers who are developing or assessing CSPBIs.
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Affiliation(s)
- Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada.
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.
| | - Sofia C Torres
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
| | - Nicholas Mitsakakis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Maureen E Trudeau
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
| | - Aileen M Davis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON, Canada
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Abraham K, Kanters TA, Wagg AS, Huige N, Hutt E, Al MJ. Benefits of a digital health technology for older nursing home residents. A de-novo cost-effectiveness model for digital health technologies to aid in the assessment of toileting and containment care needs. PLoS One 2024; 19:e0295846. [PMID: 38166006 PMCID: PMC10760782 DOI: 10.1371/journal.pone.0295846] [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: 05/23/2023] [Accepted: 11/30/2023] [Indexed: 01/04/2024] Open
Abstract
The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.
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Affiliation(s)
- Katharina Abraham
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Tim Andre Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Adrian Stuart Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Gothenburg Continence Research Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicole Huige
- Essity Hygiene and Health AB, Gothenburg, Sweden
| | - Edward Hutt
- Medica Market Access Ltd, Tonbridge, United Kingdom
| | - Maiwenn Johanna Al
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Milte R, Crocker M, Lay K, Ratcliffe J, Mulhern B, Norman R, Viney R, Khadka J. Feasibility of self-reported health related quality of life assessment with older people in residential care: insights from the application of eye tracking technology. Qual Life Res 2023; 32:3557-3569. [PMID: 37474850 PMCID: PMC10624716 DOI: 10.1007/s11136-023-03488-w] [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] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Increasingly there are calls to routinely assess the health-related quality of life (HRQoL) of older people receiving aged care services, however the high prevalence of dementia and cognitive impairment remains a challenge to implementation. Eye-tracking technology facilitates detailed assessment of engagement and comprehension of visual stimuli, and may be useful in flagging individuals and populations who cannot reliably self-complete HRQoL instruments. The aim of this study was to apply eye-tracking technology to provide insights into self-reporting of HRQoL among older people in residential care with and without cognitive impairment. METHODS Residents (n = 41), recruited based on one of three cognition subgroups (no, mild, or moderate cognitive impairment), completed the EQ-5D-5L on a computer with eye tracking technology embedded. Number and length of fixations (i.e., eye gaze in seconds) for key components of the EQ-5D-5L descriptive system were calculated. RESULTS For all dimensions, participants with no cognitive impairment fixated for longer on the Area of Interest (AOI) for the response option they finally chose, relative to those with mild or moderate cognitive impairment. Participants with cognitive impairment followed similar fixation patterns to those without. There was some evidence that participants with cognitive impairment took longer to complete and spent relatively less time attending to the relevant AOIs, but these differences did not reach statistical significance generally. CONCLUSIONS This exploratory study applying eye tracking technology provides novel insights and evidence of the feasibility of self-reported HRQoL assessments in older people in aged care settings where cognitive impairment and dementia are highly prevalent.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Matthew Crocker
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Kiri Lay
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Richard Norman
- Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jyoti Khadka
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Ellison TS, Cappa SF, Garrett D, Georges J, Iwatsubo T, Kramer JH, Lehmann M, Lyketsos C, Maier AB, Merrilees J, Morris JC, Naismith SL, Nobili F, Pahor M, Pond D, Robinson L, Soysal P, Vandenbulcke M, Weber CJ, Visser PJ, Weiner M, Frisoni GB. Outcome measures for Alzheimer's disease: A global inter-societal Delphi consensus. Alzheimers Dement 2023; 19:2707-2729. [PMID: 36749854 PMCID: PMC11010236 DOI: 10.1002/alz.12945] [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: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We aim to provide guidance on outcomes and measures for use in patients with Alzheimer's clinical syndrome. METHODS A consensus group of 20 voting members nominated by 10 professional societies, and a non-voting chair, used a Delphi approach and modified GRADE criteria. RESULTS Consensus was reached on priority outcomes (n = 66), measures (n = 49) and statements (n = 37) across nine domains. A number of outcomes and measurement instruments were ranked for: Cognitive abilities; Functional abilities/dependency; Behavioural and neuropsychiatric symptoms; Patient quality of life (QoL); Caregiver QoL; Healthcare and treatment-related outcomes; Medical investigations; Disease-related life events; and Global outcomes. DISCUSSION This work provides indications on the domains and ideal pertinent measurement instruments that clinicians may wish to use to follow patients with cognitive impairment. More work is needed to develop instruments that are more feasible in the context of the constraints of clinical routine.
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Affiliation(s)
| | - Stefano F. Cappa
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | | | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | | | - Constantine Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University and Medicine, Baltimore, USA
| | - Andrea B. Maier
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - John C. Morris
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sharon L. Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Flavio Nobili
- UO Clinica Neurologica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Child and Mother Health, University of Genoa, Genova, Italy
| | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- European Society of Geriatric Medicine, Dementia Special Interest Group
| | - Mathieu Vandenbulcke
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, Belgium
| | | | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
- Alzheimer Center, Department of Neurology, Neuroscience Campus Amsterdam, Amsterdam University Medical Center, VU Medical Center, Amsterdam, Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Michael Weiner
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Department of Readaptation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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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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Hussain H, Keetharuth A, Rowen D, Wailoo A. Convergent validity of EQ-5D with core outcomes in dementia: a systematic review. Health Qual Life Outcomes 2022; 20:152. [DOI: 10.1186/s12955-022-02062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/24/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objectives
To explore through a systematic review, the convergent validity of EQ-5D (EQ-5D-3L and EQ-5D-5L (total score and dimensions)) with core outcomes in dementia and investigate how this may be impacted by rater-type; with the aim of informing researchers when choosing measures to use in dementia trials.
Methods
To identify articles relevant to the convergent validity of EQ-5D with core dementia outcomes, three databases were electronically searched to September 2022. Studies were considered eligible for inclusion within the review if they included individual level data from people with dementia of any type, collected self and/or proxy reported EQ-5D and collected at least one core dementia outcome measure. Relevant data such as study sample size, stage of dementia and administration of EQ-5D was extracted, and a narrative synthesis was adopted.
Results
The search strategy retrieved 271 unique records, of which 30 met the inclusion criteria for the review. Twelve different core outcome measures were used to capture dementia outcomes: cognition, function, and behaviour/mood across the studies. Most studies used EQ-5D-3L (n = 27). Evidence related to the relationship between EQ-5D and measures of function and behaviour/mood was the most robust, with unanimous directions of associations, and more statistically significant findings. EQ-5D dimensions exhibited associations with corresponding clinical outcomes, whereby relationships were stronger with proxy-EQ-5D (than self-report).
Conclusion
Measuring health-rated quality of life in dementia populations is a complex issue, particularly when considering balancing the challenges associated with both self and proxy report. Published evidence indicates that EQ-5D shows evidence of convergent validity with the key dementia outcomes, therefore capturing these relevant dementia outcomes. The degree of associations with clinical measures was stronger when considering proxy-reported EQ-5D and differed by EQ-5D dimension type. This review has revealed that, despite the limited targeted psychometric evidence pool and reliance on clinical and observational studies, EQ-5D exhibits convergent validity with other dementia outcome measures.
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Ramadhan M, Schrag A. The Validity of Health-Related Quality of Life Instruments in Patients With Late-Stage Parkinson's Disease. J Geriatr Psychiatry Neurol 2022; 36:225-232. [PMID: 36264078 PMCID: PMC10114249 DOI: 10.1177/08919887221119963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the validity of health-related quality of life (Hr-QoL) measures in patients with late-stage Parkinson's disease (PD). METHODS We analysed data from patients with late-stage PD and their carers who were assessed with a range of clinical measures and the EQ-5D-3 L. The DEMQOL-Proxy was completed for 157 patients with a diagnosis of dementia and the PDQ-8 by 401 patients without dementia. Convergent validity was assessed using correlations with measures of Parkinson's severity, independence and cognitive function, and construct validity using correlations with patients' own EQ-5D-3 L scores. In addition, we assessed divergent validity using correlations with carers' own EQ-5D index, EQ-VAS and Zarit caregiver burden scores. RESULTS In patients without dementia, both the PDQ-8 and EQ-5D-3 L correlated with measures of disease severity, dependence and carer burden scores, and PDQ-8 scores moderately with EQ-5D-3 L and EQ-5D-3 L VAS scores. In patients with dementia, EQ-5D-3 L scores correlated with disease severity, cognition and dependence scores, but DEMQOL-Proxy scores were moderately associated only with patients' dependence and carers' own EQ-5D-3 L scores but not patients' disease severity, EQ-5D-3 L or cognitive scores. CONCLUSIONS The PDQ-8 and EQ-5D-3 L have adequate validity in late stage PD without dementia, but in those with PD and dementia the EQ-5D-3 L may be preferable to the DEMQOL-Proxy.
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Affiliation(s)
- Mouhammed Ramadhan
- Clinical Neurosciences, Clinical and Movement Neurosciences, 61554UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Anette Schrag
- Clinical Neurosciences, Clinical and Movement Neurosciences, 61554UCL Queen Square Institute of Neurology, University College London, London, UK
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Keetharuth AD, Hussain H, Rowen D, Wailoo A. Assessing the psychometric performance of EQ-5D-5L in dementia: a systematic review. Health Qual Life Outcomes 2022; 20:139. [PMID: 36171595 PMCID: PMC9520934 DOI: 10.1186/s12955-022-02036-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND EQ-5D is widely used for valuing changes in quality of life for economic evaluation of interventions for people with dementia. There are concerns about EQ-5D-3L in terms of content validity, poor inter-rater agreement and reliability in the presence of cognitive impairment, but there is also evidence to support its use with this population. An evidence gap remains regarding the psychometric properties of EQ-5D-5L. OBJECTIVES To report psychometric evidence around EQ-5D-5L in people with dementia. METHODS A systematic review identified primary studies reporting psychometric properties of EQ-5D-5L in people with dementia. Searches were completed up to November 2020. Study selection, data extraction and quality assessment were undertaken independently by at least 2 researchers. RESULTS Evidence was extracted from 20 articles from 14 unique studies covering a range of dementia severity. Evidence of known group validity from 5 of 7 studies indicated that EQ-5D-5L distinguishes severity of disease measured by cognitive impairment, depression, level of dependence and pain. Convergent validity (9 studies) showed statistically significant correlations of weak and moderate strengths, between EQ-5D-5L scores and scores on other key measures. Statistically significant change was observed in only one of 6 papers that allowed this property to be examined. All seven studies showed a lack of inter-rater reliability between self and proxy reports with the former reporting higher EQ-5D-5L scores than those provided by proxies. Five of ten studies found EQ-5D-5L to be acceptable, assessed by whether the measure could be completed by the PwD and/or by the amount of missing data. As dementia severity increased, the feasibility of self-completing EQ-5D-5L decreased. Three papers reported on ceiling effects, two found some evidence in support of ceiling effects, and one did not. CONCLUSIONS EQ-5D-5L seems to capture the health of people with dementia on the basis of known-group validity and convergent validity, but evidence is inconclusive regarding the responsiveness of EQ-5D-5L. As disease progresses, the ability to self-complete EQ-5D-5L is diminished.
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Affiliation(s)
- Anju D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK.
| | - Hannah Hussain
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Sheffield, S14DA, UK
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11
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Burton E, Hill K, Ellis KA, Hill AM, Lowry M, Moorin R, McVeigh JA, Jacques A, Erickson KI, Tate J, Bernard S, Orr CF, Bongiascia L, Clarnette R, Clark ML, Williams S, Lautenschlager N. Balance on the Brain: a randomised controlled trial evaluating the effect of a multimodal exercise programme on physical performance, falls, quality of life and cognition for people with mild cognitive impairment-study protocol. BMJ Open 2022; 12:e054725. [PMID: 35437246 PMCID: PMC9016395 DOI: 10.1136/bmjopen-2021-054725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Exercise and physical activity have been shown to improve cognition for people living with mild cognitive impairment (MCI). There is strong evidence for the benefits of aerobic exercise and medium evidence for participating in regular strength training for people with MCI. However, people living with MCI fall two times as often as those without cognitive impairment and the evidence is currently unknown as to whether balance training for people with MCI is beneficial, as has been demonstrated for older people without cognitive impairment. The aim of this study is to determine whether a balance-focused multimodal exercise intervention improves balance and reduces falls for people with MCI, compared with a control group receiving usual care. METHODS AND ANALYSIS This single blind randomised controlled trial (Balance on the Brain) will be offered to 396 people with MCI living in the community. The multimodal exercise intervention consists of two balance programmes and a walking programme to be delivered by physiotherapists over a 6-month intervention period. All participants will be followed up over 12 months (for the intervention group, this involves 6-month intervention and 6-month maintenance). The primary outcomes are (1) balance performance and (2) rate of falls. Physical performance, levels of physical activity and sedentary behaviour, quality of life and cognition are secondary outcomes. A health economic analysis will be undertaken to evaluate the cost-effectiveness of the intervention compared with usual care. ETHICS AND DISSEMINATION Ethics approval has been received from the South Metropolitan Health Service Human Research Ethics Committee (HREC), Curtin University HREC and the Western Australia Department of Health HREC; and approval has been received to obtain data for health costings from Services Australia. The results will be disseminated through peer-review publications, conference presentations and online platforms. TRIAL REGISTRATION NUMBER ACTRN12620001037998; Australian New Zealand Clinical Trials Registry (ANZCTR).
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Affiliation(s)
- Elissa Burton
- Curtin School of Allied Health, Curtin University-Perth City Campus, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
| | - Kathryn A Ellis
- The Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- School of Allied Health, Western Australian Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia
| | - Meggen Lowry
- Next Step Health, Brisbane, Queensland, Australia
| | - Rachael Moorin
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Joanne A McVeigh
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Angela Jacques
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Kirk I Erickson
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Western Australia, Australia
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Joel Tate
- Department of Rehabilitation and Aged Care, Armadale Health Service, Armadale, Western Australia, Australia
| | - Sarah Bernard
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Geriatric Acute and Rehabilitation Medicine, Sir Charles Gairdner Hospital Group, Perth, Western Australia, Australia
| | - Carolyn F Orr
- Cognitive Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Luke Bongiascia
- Physiotherapy Department, Adult Community and Allied Health Directorate, Rockingham Peel Group, Rockingham, Western Australia, Australia
| | - Roger Clarnette
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Melanie L Clark
- Neurosciences Unit, North Metropolitan Health Service Mental Health, Public Health and Dental Services, Perth, Western Australia, Australia
| | - Shannon Williams
- Neurogenetic Clinic and Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nicola Lautenschlager
- Academic Unit of Psychiatry of Old Age, University of Melbourne, Melbourne, Victoria, Australia
- NorthWestern Mental Health, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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12
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Li X, Li Q, Straker JK, O Neill L, Zhang C, Ingman S. Validation of the Chinese version of the resident satisfaction in long-term care facilities. Geriatr Nurs 2022; 44:125-130. [PMID: 35144081 DOI: 10.1016/j.gerinurse.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Accurate measurements of resident satisfaction in long-term care settings can provide administrators with valuable information to improve the quality of care. However, such assessment has been insufficient in long-term care facilities of China due to limited validated measuring instruments. We aim to translate and validate a Chinese version of the resident satisfaction assessment based upon the Ohio Long-term Care Resident Satisfaction Survey (OLCRSS). METHOD An external specialist team assessed the translated items of OLCRSS and provided content validation scores (CVI). Criterion-related validity was determined by measuring the correlation between the Chinese version OLCRSS, a global satisfaction, a quality-of-life questionnaire, and a depression measurement. The reliability was assessed by Cronbach alpha and intra-class correlation coefficients. We conducted an exploratory factor analysis to examine the structure of the Chinese version OLCRSS. A total of 172 older adults recruited from Shanghai, China, participated in this study. RESULTS The Chinese version OLCRSS demonstrated excellent validity, with the CVI = 1.0, ICC = .96, p < .001, and a Cronbach alpha = .96. The Chinese version OLCRSS was significantly correlated with quality of life (r=.267 p < 0.01), with the global satisfaction (r=.309, p < 0.01), and had negative correlation with depressive symptoms (r = -.044, P = .498). The exploratory factor analysis implied a slightly different structural relationship between items. Possible explanations were discussed in the discussion section. CONCLUSIONS The Chinese version OLCRSS is a valid and potentially useful instrument for assessing resident satisfaction in long-term care facilities among the older Chinese population and Chinese contexts.
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Affiliation(s)
- Xiaoli Li
- College of Health and Public Service, University of North Texas, 410 S. Avenue C, Denton, TX 76201, United States.
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Jane K Straker
- Scripps Gerontology Center, Miami University, Oxford, Ohio, United States
| | - Liam O Neill
- College of Health and Public Service, University of North Texas, 410 S. Avenue C, Denton, TX 76201, United States
| | - Chi Zhang
- School of Economics, Shandong University, Jinan, China
| | - Stan Ingman
- College of Health and Public Service, University of North Texas, 410 S. Avenue C, Denton, TX 76201, United States
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13
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Kelly C, Hulme C, Graham L, Ellwood A, Patel I, Cundill B, Farrin A, Goodwin M, Hull K, Fisher J, Forster A. Inter-rater reliability of care home staff's proxy judgements with residents' assessments of their own health-related quality of life: an analysis of the PATCH trial EQ-5D data. Age Ageing 2021; 50:1314-1320. [PMID: 33822852 PMCID: PMC8244559 DOI: 10.1093/ageing/afab053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES to compare care staff proxies with care home residents' self-assessment of their health-related quality of life (HRQoL). METHODS we assessed the degree of inter-rater reliability between residents and care staff proxies for the EQ-5D-5L index, domains and EQ Visual Analogue Scale at baseline, 3 months and 6 months, collected as part of the PATCH trial. We calculated kappa scores. Interpreted as <0 no agreement, 0-0.2 slight, 0.21-0.60 fair to moderate and >0.6 substantial to almost perfect agreement. Qualitative interviews with care staff and researchers explored the challenges of completing these questions. RESULTS over 50% of the HRQoL data from residents was missing at baseline compared with a 100% completion rate by care staff proxies. A fair-to-moderate level of agreement was found for the EQ-5D-5L index. A higher level of agreement was achieved for the EQ-5D-5L domains of mobility and pain. Resident 'non-completers' were more likely to: be older, have stayed a longer duration in the care home, have lower Barthel Index and Physical Activity and Mobility in Residential Care (PAM-RC) scores, a greater number of co-morbidities and have joined the trial through consultee agreement. Interviews with staff and researchers indicated that it was easier to rate residents' mobility levels than other domains, but in general it was difficult to obtain data from residents or to make an accurate proxy judgement for those with dementia. CONCLUSIONS whilst assessing HRQoL by care staff proxy completion provides a more complete dataset, uncertainty remains as to how representative these values are for different groups of residents within care homes.
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Affiliation(s)
| | - Claire Hulme
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Liz Graham
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- University of Leeds, Leeds, UK
| | | | - Ismail Patel
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bonnie Cundill
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | - Karen Hull
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Leeds Neurophysiotherapy, Leeds, UK
| | | | - Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- University of Leeds, Leeds, UK
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14
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Lima M, Rodrigues SR, Bezerra P, Rodrigues LP, Cancela JM. Monitorization of Timed Up and Go Phases in Elderly. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1836111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Miguel Lima
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
| | - Sílvia Rocha Rodrigues
- Escola Superior de Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Center, Sports Sciences Health and Human Development, CIDESD, Vila Real, Portugal
- Tumor & Microenvironment Interactions Group, Porto, Portugal
| | - Pedro Bezerra
- Escola Superior de Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Center, Sports Sciences Health and Human Development, CIDESD, Vila Real, Portugal
| | - Luís Paulo Rodrigues
- Escola Superior de Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Center, Sports Sciences Health and Human Development, CIDESD, Vila Real, Portugal
| | - José Maria Cancela
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
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15
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Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res 2020; 30:647-673. [PMID: 33284428 PMCID: PMC7952346 DOI: 10.1007/s11136-020-02688-y] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L. METHODS Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models. RESULTS Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health. CONCLUSIONS The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.
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Affiliation(s)
- You-Shan Feng
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany. .,Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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16
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Landeiro F, Mughal S, Walsh K, Nye E, Morton J, Williams H, Ghinai I, Castro Y, Leal J, Roberts N, Wace H, Handels R, Lecomte P, Gustavsson A, Roncancio-Diaz E, Belger M, Jhuti GS, Bouvy JC, Potashman MH, Tockhorn-Heidenreich A, Gray AM. Health-related quality of life in people with predementia Alzheimer's disease, mild cognitive impairment or dementia measured with preference-based instruments: a systematic literature review. Alzheimers Res Ther 2020; 12:154. [PMID: 33208190 PMCID: PMC7677851 DOI: 10.1186/s13195-020-00723-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obtaining reliable estimates of the health-related quality of life (HR-QoL) of people with predementia Alzheimer's disease [AD] (preclinical or prodromal AD), mild cognitive impairment (MCI) and dementia is essential for economic evaluations of related health interventions. AIMS To provide an overview of which quality of life instruments are being used to assess HR-QoL in people with predementia AD, MCI or dementia; and, to summarise their reported HR-QoL levels at each stage of the disease and by type of respondent. METHODS We systematically searched for and reviewed eligible studies published between January 1990 and the end of April 2017 which reported HR-QoL for people with predementia AD, MCI or dementia. We only included instruments which are preference-based, allowing index scores/utility values to be attached to each health state they describe based on preferences obtained from population surveys. Summary results were presented by respondent type (self or proxy), type of instrument, geographical location and, where possible, stage of disease. Health state utility values derived using the EuroQoL 5-Dimensions (EQ-5D) were meta-analysed by pooling reported results across all studies by disease severity (MCI, mild, mild to moderate, moderate, severe dementia, not specified) and by respondent (person with dementia, carer, general public, not specified), using a fixed-effects approach. RESULTS We identified 61 studies which reported HR-QoL for people with MCI or dementia using preference-based instruments, of which 48 used the EQ-5D. Thirty-six studies reported HR-QoL for mild and/or moderate disease severities, and 12 studies reported utility values for MCI. We found systematic differences between self-rated and proxy-rated HR-QoL, with proxy-rated utility valued being significantly lower in more severe disease states. CONCLUSIONS A substantial literature now exists quantifying the impact of dementia on HR-QoL using preference-based measures, giving researchers and modellers a firmer basis on which to select appropriate utility values when estimating the effectiveness and cost-effectiveness of interventions in this area. Further research is required on HR-QoL of people with preclinical and prodromal AD and MCI, possible differences by type of dementia, the effects of comorbidities, study setting and the informal caregiver's own HR-QoL, including any effect of that on their proxy-ratings.
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Affiliation(s)
- Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Seher Mughal
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Katie Walsh
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Elsbeth Nye
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Jasmine Morton
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Harriet Williams
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Isaac Ghinai
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Yovanna Castro
- Global Access, Centre of Excellence, F. Hoffmann-La Roche Ltd, Bldg 1, CH-4070, Basel, Switzerland
| | - José Leal
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Old Road Campus, University of Oxford, Oxford, OX3 7LF, UK
| | - Helena Wace
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Ron Handels
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, Maastricht University, Maastricht, The Netherlands
- Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Pascal Lecomte
- Global Head Health Economic Modelling and Methodology, Novartis Pharma AG, 4002, Basel, Switzerland
| | - Anders Gustavsson
- Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | | | - Mark Belger
- Global Statistical Sciences, Eli Lilly and Company, Indianapolis, IN 46225, USA
| | - Gurleen S Jhuti
- Global Access, Centre of Excellence, F. Hoffmann-La Roche Ltd, Bldg 1, CH-4070, Basel, Switzerland
| | - Jacoline C Bouvy
- Science Policy and Research Programme, National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU, UK
| | | | | | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, Old Road Campus, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
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17
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Allan LM, Wheatley A, Smith A, Flynn E, Homer T, Robalino S, Beyer FR, Fox C, Howel D, Barber R, Connolly JA, Robinson L, Parry SW, Rochester L, Corner L, Bamford C. An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. Health Technol Assess 2020; 23:1-208. [PMID: 31661058 DOI: 10.3310/hta23590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. OBJECTIVES To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. DESIGN This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. SETTING This study was set in the community. PARTICIPANTS The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. INTERVENTIONS This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. MAIN OUTCOME MEASURES (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). RESULTS A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. CONCLUSIONS The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Wheatley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Smith
- Department of Occupational Therapy, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK
| | - Elizabeth Flynn
- Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barber
- Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Anthony Connolly
- Department of Emergency Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Steve Wayne Parry
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lynne Corner
- VOICE, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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18
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Pérez-Ros P, Vila-Candel R, Martin-Utrilla S, Martínez-Arnau FM. Health-Related Quality of Life in Community-Dwelling Older People with Cognitive Impairment: EQ-5D-3L Measurement Properties. J Alzheimers Dis 2020; 77:1523-1532. [PMID: 32925071 DOI: 10.3233/jad-200806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Assessing quality of life (QoL) in older people with cognitive impairment is a challenge. There is no consensus on the best tool, but a short, user-friendly scale is advised. OBJECTIVE This study aimed to assess the psychometric properties of the self-reported and generic EQ-5D (including the EQ index and EQ visual analog scale [VAS]) in community-dwelling older adults with cognitive impairment. METHODS Cross-sectional study analyzing the feasibility, acceptability, reliability, and validity of the EQ-5D based on 188 self-administered questionnaires in a sample of community-dwelling older adults with Mini-Mental State Examination (MMSE) scores of 10 to 24 points. RESULTS The EQ index was 0.69 (±0.27) and the EQ VAS was 63.8 (±28.54). Adequate measurement properties were found in acceptability and feasibility. Cronbach's alpha was 0.69. Good validity was observed in the correlation of each dimension of the EQ-5D with geriatric assessment scales. Higher validity was observed for the EQ index compared to the EQ VAS. CONCLUSION The EQ-5D scale could be a good tool for assessing health-related QoL in community-dwelling older adults with cognitive impairment, though it is necessary to assess the dimensions and the EQ index.
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Affiliation(s)
- Pilar Pérez-Ros
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,GRICPAL Research Group, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, Valencia, Spain
| | - Rafael Vila-Candel
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,Department of Obstetrics and Gynecology, Hospital Universitario de la Ribera, FISABIO, Valencia, Spain.,Department of Nursing, Faculty of Nursing and Podiatry, Universitat de València, Valencia, Spain
| | - Salvador Martin-Utrilla
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,GRICPAL Research Group, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,Palliative Care Unit, Valencia Institute of Oncology, Valencia, Spain
| | - Francisco M Martínez-Arnau
- Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, Valencia, Spain.,Department of Physiotherapy, Universitat de València, Valencia, Spain
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Engel L, Bucholc J, Mihalopoulos C, Mulhern B, Ratcliffe J, Yates M, Hanna L. A qualitative exploration of the content and face validity of preference-based measures within the context of dementia. Health Qual Life Outcomes 2020; 18:178. [PMID: 32527264 PMCID: PMC7291594 DOI: 10.1186/s12955-020-01425-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing the cost-effectiveness of interventions for people with dementia, based on cost per quality-adjusted life years (QALYs) gained, requires that the measures used to derive QALYs are preference-based whilst also being valid, feasible to use, comprehensible and acceptable for people with dementia. The aim of this study was to assess the content and face validity of six preference-based measures (PBMs) within the context of dementia. METHODS Qualitative focus groups and interviews were conducted with community-dwelling individuals with mild dementia and carers of people with dementia. After exploring participants' understanding of 'quality of life' (QoL), six PBMs were assessed for content and face validity: two measures assessing health-related QoL (EQ-5D-5L and AQoL-8D); two covering broader aspects of capability wellbeing and social care-related QoL (ICECAP-O and ASCOT); and two dementia-specific QoL measures (DEMQOL-U and AD-5D). A random mix of one health-related QoL measure, one wellbeing measure, and one dementia-specific measure was explored in each session. All sessions were audiotaped and transcribed verbatim. Data were analysed thematically. RESULTS Nine individuals with mild dementia and 17 carers of people with dementia participated across 4 focus groups and 10 interviews. Participants perceived 9 broad QoL domains as relevant to them: Activity, Autonomy, Cognition, Communication, Coping, Emotions, End-of-Life, Physical Functioning, and Relationships. These domains had limited overlap with the content of the six PBMs. Assessment of face validity was summarized into eight themes: (1) ambiguous questions, (2) double -barrelled questions, (3) difficult/abstract questions, (4) judgemental/confronting questions, (5) lack of relevance and comprehensiveness, (6) response options, (7) layout/format and (8) proxy-response. There was no clear preference for one of the six measures explored; participants identified advantages and disadvantages across all measures. Although particularly designed for individuals with dementia, dementia-specific QoL measures were not always favoured over non-specific measures. CONCLUSION Given the shortcomings of PBMs identified in this study, further empirical comparative analyses are necessary to guide the selection of PBMs for future dementia research.
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Affiliation(s)
- Lidia Engel
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
| | - Jessica Bucholc
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mark Yates
- Ballarat Health Services, Ballarat, Victoria, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Lloyd A, Schofield H, Adlard N. Cognitive decline may not be adequately captured in economic evaluations of multiple sclerosis: are new treatments being undervalued? Curr Med Res Opin 2020; 36:609-611. [PMID: 31955617 DOI: 10.1080/03007995.2020.1719393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Meads DM, Martin A, Griffiths A, Kelley R, Creese B, Robinson L, McDermid J, Walwyn R, Ballard C, Surr CA. Cost-Effectiveness of Dementia Care Mapping in Care-Home Settings: Evaluation of a Randomised Controlled Trial. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:237-247. [PMID: 31701483 PMCID: PMC7085468 DOI: 10.1007/s40258-019-00531-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Behaviours such as agitation impact on the quality of life of care-home residents with dementia and increase healthcare use. Interventions to prevent these behaviours have little evidence supporting their effectiveness or cost-effectiveness. We conducted an economic evaluation alongside a trial assessing Dementia Care Mapping™ (DCM) versus usual care for reducing agitation, and highlight methodological challenges of conducting evaluations in this population and setting. METHODS RCT data over 16 months from English care-home residents with dementia (intervention n = 418; control n = 308) were analysed. We conducted a cost-utility analysis from the healthcare provider perspective. We gathered resource use and utility (EQ-5D-5L and DEMQoL-Proxy-U) from people living with dementia and proxy informants (staff and relatives). Data were analysed using seemingly unrelated regression, accounting for care-home clustering and bootstrapping used to capture sampling uncertainty. RESULTS Costs were higher in the intervention arm than in the control arm (incremental = £1479) due in part to high cost outliers. There were small QALY gains (incremental = 0.024) in favour of DCM. The base-case ICER (£64,380 per QALY) suggests DCM is not cost-effective versus usual care. With the exception of analyses excluding high cost outliers, which suggested a potential for DCM to be cost-effective, sensitivity analyses corroborated the base-case findings. Bootstrapped estimates suggested DCM had a low probability (< 0.20 where λ = £20,000) of being cost-effective versus control. CONCLUSION DCM does not appear to be a cost-effective intervention versus usual care in this group and setting. The evaluation highlighted several methodological challenges relating to validity of utility assessments, loss to follow-up and compliance. Further research is needed on handling high-cost individuals and capturing utility in this group. ISRCTN reference 82288852.
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Affiliation(s)
- David M Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, University of Leeds, Leeds, UK.
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, University of Leeds, Leeds, UK
| | - Alys Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Rachael Kelley
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Joanne McDermid
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Rebecca Walwyn
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK
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22
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Froggatt K, Best A, Bunn F, Burnside G, Coast J, Dunleavy L, Goodman C, Hardwick B, Jackson C, Kinley J, Davidson Lund A, Lynch J, Mitchell P, Myring G, Patel S, Algorta GP, Preston N, Scott D, Silvera K, Walshe C. A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT. Health Technol Assess 2020; 24:1-140. [PMID: 31971506 PMCID: PMC7008353 DOI: 10.3310/hta24060] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. OBJECTIVES To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. DESIGN The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. SETTING Nursing homes in England providing care for people with dementia. PARTICIPANTS Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. INTERVENTION Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. MAIN OUTCOME MEASURES The two contender primary outcome measures were Comfort Assessment in Dying - End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data - health economic outcomes, medication/service use and intervention activity. RESULTS Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported. CONCLUSIONS A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification. FUTURE WORK In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context. TRIAL REGISTRATION Current Controlled Trials ISRCTN14948133. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katherine Froggatt
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ashley Best
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Frances Bunn
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Girvan Burnside
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Joanna Coast
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Claire Goodman
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Ben Hardwick
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Clare Jackson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | | | | | - Jennifer Lynch
- Department of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Paul Mitchell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gareth Myring
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shakil Patel
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - Guillermo Perez Algorta
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Kate Silvera
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Assessing the quality of life and well-being of older adults with physical and cognitive impairments in a German-speaking setting: A systematic review of validity and utility of assessments / Die Erfassung von Lebensqualität und Wohlbefinden älterer Menschen mit psychischen und kognitiven Einschränkungen: ein systematisches Literaturreview zur Validität und Praktikabilität deutschsprachiger Assessments. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
For health professionals working with older adults with physical and cognitive impairments, improving or maintaining clients’ quality of life and well-being is of crucial importance. The aim of this study was to evaluate validity and utility of assessments of quality of life and well-being in German suitable for this group of clients.
Methods
In an initial literature search, we identified potentially viable assessments based on existing systematic reviews. We then conducted a systematic literature search in the databases Medline, CINAHL, and PsycINFO using keywords related to validity, utility, client group, and German. Assessments for which sufficient evidence was found were evaluated regarding their validity and utility when used with older adults with physical and cognitive impairments.
Results
For 14 of 27 initially identified assessments, sufficient evidence was found to evaluate validity and utility with this client group. WHOQOL-BREF, WHOQOL-OLD, WHO-5, EUROHIS-QOL 8, SF-36, SF-12, EQ-5D, NHP, SEIQOL-DW, SWLS, PANAS, DQOL, QOL-AD, and QUALIDEM were evaluated based on 82 studies. Of these, WHOQOL-BREF, WHO-5, SF-36, SF-12, EQ-5D, NHP, QUALIDEM, QOL-AD and DQOL are presented here.
Conclusion
Assessments differed widely in the way they operationalized quality of life/well-being, use of self-evaluation or evaluation-by-proxy, and amount of available evidence for their validity and utility. On the basis of our results in regard to the assessments’ validity, utility, and appropriateness of operationalization of quality of life/well-being to the client group, three assessments were recommended for use: WHOQOL-BREF for self-evaluation, QUALIDEM for evaluation-by-proxy in case of severe dementia, and EQ-5D for cost-utility analyses.
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:781-801. [PMID: 31512086 DOI: 10.1007/s40258-019-00512-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
- Healthy Ageing Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Martin A, Meads D, Griffiths AW, Surr CA. How Should We Capture Health State Utility in Dementia? Comparisons of DEMQOL-Proxy-U and of Self- and Proxy-Completed EQ-5D-5L. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1417-1426. [PMID: 31806199 DOI: 10.1016/j.jval.2019.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/07/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Dementia-specific and proxy-completed preference-based measures have been proposed for use in intervention studies involving people living in residential care, in instances where generic, self-reported preference-based measures have been deemed inappropriate. OBJECTIVE This study was conducted to investigate the construct validity, criterion validity, and responsiveness of DEMQOL-Proxy-U and of self- and proxy-completed EQ-5D-5L. METHODS The analysis used a 3-wave, individual-level data set of 1004 people living with dementia in residential care that included self-completed EQ-5D-5L and formal-carer and informal-carer proxy-completed EQ-5D-5L and DEMQOL-Proxy-U utility values, in addition to other nonutility cognitive measures (Functional Assessment Staging [FAST], Clinical Dementia Rating [CDR], Cohen-Mansfield Agitation Inventory [CMAI]) and health-related quality of life (HRQOL) measures (nursing home version of the Quality of Life with Alzheimer's disease scale [QOL-AD-NH], Quality of Life in Late-Stage Dementia [QUALID] scale). Construct validity, criterion validity, and responsiveness were assessed using correlation, Bland-Altman plots, and panel data regression models. RESULTS Self-completed EQ-5D-5L failed to reflect clinically important differences and changes in FAST, CDR, and CMAI but did capture the resident's own view of HRQOL (QOL-AD-NH). As dementia severity increased, collection of EQ-5D-5L-proxy and DEMQOL-Proxy-U data was more feasible than collection of self-completed EQ-5D-5L. These formal-carer and informal-carer proxy measures also better reflected changes in FAST, CDR, and CMAI but did not capture the resident's own view of HRQOL (QOL-AD-NH), despite adequately capturing the proxy's own view of the resident's HRQOL (QUALID). This indicates discrepancies between a proxy's view and resident's view of the impact that tangible declines in health, cognition, or functional abilities have on HRQOL. The EQ-5D-5L-proxy and DEMQOL-Proxy-U were generally poor substitutes. Regardless of which proxy completed it, the EQ-5D-5L-proxy was typically more responsive than the DEMQOL-Proxy-U to changes in CDR, FAST, and CMAI, indicating that use of the DEMQOL-Proxy-U is not always justified. CONCLUSION Disparities in the measurement properties of different utility measures mean that choices about how to measure utility in trials could affect economic evaluation outcomes and hence how resources are allocated for dementia care.
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Affiliation(s)
- Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Alys W Griffiths
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, England, UK
| | - Claire A Surr
- Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, England, UK
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Ratcliffe J, Hutchinson C, Milte R. Personalisation and the disability sector: What can health economics contribute to inform decision-making? Disabil Health J 2019; 12:7-10. [DOI: 10.1016/j.dhjo.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/21/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
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Cations M, Crotty M, Fitzgerald JA, Kurrle S, Cameron ID, Whitehead C, Thompson J, Kaambwa B, Hayes K, de la Perrelle L, Radisic G, Laver KE. Agents of change: establishing quality improvement collaboratives to improve adherence to Australian clinical guidelines for dementia care. Implement Sci 2018; 13:123. [PMID: 30249276 PMCID: PMC6154830 DOI: 10.1186/s13012-018-0820-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/12/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dissemination of clinical practice guidelines alone is insufficient to create meaningful change in clinical practice. Quality improvement collaborative models have potential to address the evidence-practice gap in dementia care because they capitalise on known knowledge translation enablers and incorporate optimal approaches to implementation. Non-pharmacological interventions focused on promoting independence are effective and favoured by people with dementia and their carers but are not routinely implemented. The objective of this translational project is to assess the impact of quality improvement collaboratives (QICs) on adherence to non-pharmacological recommendations from the Clinical Practice Guidelines for Dementia in Australia. METHODS This project will employ an interrupted time-series design with process evaluation to assess the impact, uptake, feasibility, accessibility, cost, and sustainability of the QICs over 18 months. Thirty clinicians from across Australia will be invited to join the QICs to build their capacity in leading innovation in dementia care. Clinicians will participate in a training program and be supported to develop and implement a quality improvement project unique to their service context using plan-do-study-act cycles. Regular online meetings with their peers in the QIC will facilitate benchmarking and problem-solving. Clinicians will describe their practice via monthly checklists, and guideline adherence will be determined against a set of defined criteria. Phone interviews with up to 180 client dyads will be used to assess satisfaction with care and client outcomes. Clinician interviews and field note data will be used to explore implementation and costs. Involvement of people with dementia and carers will be embedded in the study design, conduct, and reporting, in addition to clinical and industry expertise. DISCUSSION The quality of dementia care in Australia is largely dependent on the clinician involved and the extent to which they apply best available evidence in their practice. This study will determine the elements of this multifaceted implementation strategy that contributed to guideline adherence and client outcomes. The findings will inform future translational approaches to improving care and outcomes for people with dementia and their carers. TRIAL REGISTRATION Registered with the Australian New Zealand Clinical Trials Registry 21 February 2018 ( ACTRN12618000268246 ).
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Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Janna Anneke Fitzgerald
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- Griffith Business School, Griffith University, Gold Coast, Queensland Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- Northern Clinical School, The University of Sydney, Camperdown, New South Wales Australia
| | - Ian D. Cameron
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Jane Thompson
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
| | - Kate Hayes
- Griffith Business School, Griffith University, Gold Coast, Queensland Australia
- Healthcare and Hospital Process Improvement, Brisbane, Queensland Australia
| | - Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Kate E. Laver
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
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Harrison SL, Bradley C, Milte R, Liu E, Kouladjian O’Donnell L, Hilmer SN, Crotty M. Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study. BMC Geriatr 2018; 18:60. [PMID: 29478410 PMCID: PMC6389148 DOI: 10.1186/s12877-018-0752-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/19/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Psychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a 'standard model' of care. METHODS Participants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy. RESULTS Overall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): - 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (- 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-Proxy-Utility scores (- 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (- 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001). CONCLUSIONS An increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.
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Affiliation(s)
- Stephanie L. Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
| | - Clare Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Infection & Immunity – Aboriginal Health, SAHMRI, PO Box 11060, Adelaide, SA 5001 Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Institute for Choice, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000 Australia
| | - Lisa Kouladjian O’Donnell
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Sarah N. Hilmer
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
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