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Bola R, Guo M, Karimuddin A, Liu G, Phang PT, Crump T, Sutherland JM. An examination of rectal prolapse surgery patients' quality of life and symptoms using patient-reported outcome instruments: A prospective cohort study. Am J Surg 2024; 231:113-119. [PMID: 38355344 DOI: 10.1016/j.amjsurg.2024.02.014] [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: 11/10/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND We measured changes in self-reported health and symptoms attributable to rectal prolapse surgery using patient-reported outcome (PRO) measures. METHODS A prospectively recruited cohort of patients scheduled for rectal prolapse repair in Vancouver, Canada between 2013 and 2021 were surveyed before and 6-months after surgery using seven PROs: the EuroQol Five-Dimension Instrument (EQ-5D-5L), Generalized Anxiety Disorder Scale (GAD-7), Pain Intensity, Interference with Enjoyment of Life and General Activity (PEG), Patient Health Questionnaire (PHQ-9), Fecal Incontinence Severity Index (FISI), Gastrointestinal Quality of Life Index (GIQLI), and the Fecal Incontinence Quality of Life Scale (FIQL). RESULTS We included 46 participants who reported improvements in health status (EQ-5D-5L; p < 0.01), pain interference (PEG; p < 0.01), depressive symptoms (PHQ-9; p = 0.01), fecal incontinence severity (FISI; p < 0.01), gastrointestinal quality of life (GIQLI; p < 0.01), and fecal incontinence quality of life (FIQL) related to lifestyle (p = 0.02), coping and behaviour (p = 0.02) and depression and self-perception (p = 0.01). CONCLUSION Surgical repair of rectal prolapse improved patients' quality of life with meaningful improvements in fecal incontinence severity and pain, and symptom interference with daily activities.
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Affiliation(s)
- Rajan Bola
- Faculty of Medicine, University of British Columbia, Vancouver, Canada; Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Michael Guo
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada; Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Ahmer Karimuddin
- Department of Surgery, Faculty of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Terry Phang
- Department of Surgery, Faculty of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Trafford Crump
- Department of Surgery, McGill University, Montreal, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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Wang Y, Jia Q, Wang H, Zou K, Li L, Yu B, Wang L, Wang Y. Revised Chinese resident health literacy scale for the older adults in China: simplified version and initial validity testing. Front Public Health 2023; 11:1147862. [PMID: 37265518 PMCID: PMC10231683 DOI: 10.3389/fpubh.2023.1147862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 06/03/2023] Open
Abstract
Objective This study aimed to develop a short version of the Chinese Resident Health Literacy Scale focused on older adults in China, and further assess the reliability and validity of this short version. Methods The data was from a cross-sectional community-based older adults health survey conducted in 2020. The total of 5,829 older adults were randomly divided into two parts using for the simplification and assessment of the scale, respectively. Item Response Theory (IRT) and Differential Item Functioning (DIF) were used for item analysis and scale simplification. Cronbach's alpha and McDonald's omega were used to assess the reliability and three factors Confirmatory Factor Analysis (CFA) was used to assess the validity, which were compared to the original version. Moreover, Multi-group Confirmatory Factor Analysis (MCFA) was used to test the model invariance of the short version across groups of gender, age groups, level of education, and cognitive status. Results The simplified version consisted of 27 items taken from 50 original items, of them 11 items from the dimension of knowledge and attitudes, 9 items from the dimension of behavior and lifestyle, and 7 items from the dimension of health-related skills. The overall Cronbach's alpha and McDonald's omega were both 0.87 (95%CI: 0.86-0.88). The goodness-of-fits of CFA in simplified version were still acceptable in CFI, TLI, GFI, and RMSEA, even improved in CFI, TLI, and GFI compared to those of original version. Also, the model was stable and invariant in MCFA across gender, cognitive status, and educational level groups. Conclusion In this study, we formed a simplified instrument for measuring health literacy focused on older adults in China. This short version might be more suitable for the priority recommendation in extended tracking of the dynamic changes on the levels of health literacy in the whole life cycle in public health settings. Further research might be to identify the cut-off values to distinguish the older adults with different levels of health literacy.
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Gassner L, Wild C, Walter M. Clinical effectiveness and safety of self-expandable implantable bulking agents for faecal incontinence: a systematic review. BMC Gastroenterol 2022; 22:389. [PMID: 35978293 PMCID: PMC9386976 DOI: 10.1186/s12876-022-02441-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this systematic review is to evaluate whether self-expandable implantable vs non-self-expandable injectable bulking agents (second-line therapies) are equal/superior in terms of effectiveness (severity, quality of life [QoL]) and safety (adverse events) for faecal incontinence (FI). METHODS A systematic review was conducted, and five databases were searched (Medline via Ovid, Embase, Cochrane Library, University of York Centre for Reviews and Dissemination, and International Network of Agencies for Health Technology database). In-/exclusion criteria were predefined according to the PICOS scheme. The Institute of Health Economics risk of bias (RoB) tool assessed studies' internal validity. According to the Grading of Recommendations, Assessment, Development and Evaluation approach, the strength of evidence for safety outcomes was rated. A qualitative synthesis of the evidence was used to analyse the data. RESULTS The evidence consists of eight prospective single-arm, before-after studies (166 patients) fulfilling the inclusion criteria for assessing clinical effectiveness and safety of implantable bulking agents. FI severity statistically significantly improved in five of seven studies rated by the Cleveland Clinic FI Score and in three of five studies measured by the Vaizey score. Statistically significant improved disease-related QoL was found in one of five studies measured by the FI QoL Score and in one of two studies rated by the American Medical Systems score. Procedure-related adverse events occurred in 16 of 166 patients (i.e., intraoperative complications, anal discomfort and pain). Device-related adverse events occurred in 48 of 166 patients, including prostheses' dislodgement and removed/extruded prostheses. Studies were judged with moderate/high RoB. The strength of evidence for safety was judged to be very low. CONCLUSION Implantable bulking agents might be an effective and safe minimally invasive option in FI treatment if conservative therapies fail. FI severity significantly improved, however, effects on QoL need to be explored in further studies. Due to the uncontrolled nature of the case series, comparative studies need to be awaited.
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Affiliation(s)
- Lucia Gassner
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Garnisongasse 7/20, 1090, Vienna, Austria. .,University of Vienna, Vienna, Austria.
| | - Claudia Wild
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Melanie Walter
- HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Garnisongasse 7/20, 1090, Vienna, Austria
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Gray TG, Vickers H, Krishnaswamy P, Jha S. A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine. Int Urogynecol J 2021; 32:2033-2092. [PMID: 34037815 DOI: 10.1007/s00192-021-04810-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/17/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are widely used in clinical practice and research in urogynaecology. There is no consensus on which PROMs should be used. No unifying document identifies all available PROMs and compares the psychometric properties of these. METHODS Systematic review of the literature following PRISMA guidelines. Studies where women had been administered an English-language PROM which assessed pelvic-floor symptomatology and psychometric properties had been reported were included. RESULTS 85 PROMs assessing pelvic-floor symptoms in a urogynaecology population were identified. 43 PROMs assessed lower urinary tract symptoms in 95 studies, four PROMS assessed vaginal symptoms in seven studies, 20 PROMs assessed bowel symptoms in 27 studies and three PROMs assessed sexual symptoms in seven studies. 15 PROMs assessed two or more of these symptom areas in 60 studies. PROMs with the with the best available psychometric evidence within these five areas were (urinary symptoms) the Incontinence Quality-of-Life questionnaire (I-QOL aka ICIQ-UIqol) and International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), (bowel symptoms) the Accidental Bowel Leakage Evaluation (ABLE) questionnaire and the International Consultation on Incontinence Bowel questionnaire (ICIQ-B), (vaginal symptoms) the Pelvic Organ Prolapse Symptom Score (POPSS), (sexual symptoms) the Pelvic organ prolapse- urinary Incontinence Sexual function Questionnaire- IUGA revised (PISQ-IR) and (comprehensive PROMs) the Australian Pelvic Floor Questionnaire and the Electronic Personal Assessment Questionnaire-Pelvic-Floor (ePAQ-PF). CONCLUSIONS Multiple PROMs with robust psychometric properties are available. Some widely used PROMs have weak evidence. Formal recommendations on which English-language PROMs to use within clinical practice and research in urogynaecology are required.
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Affiliation(s)
- Thomas G Gray
- Department of Urogynaecology and Pelvic Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, c/o Secretary, Room 27.3.024, Level Three, West Block, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| | - Holly Vickers
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Priyanka Krishnaswamy
- Department of Urogynaecology, Queen Elizabeth University Hospital, G51 4TF, Glasgow, UK
| | - Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Sutherland JM, Karimuddin A, Liu G, Crump T, Akbar H, Phang T, Redfern K, Manoharan S, Brown CJ, Raval MJ. Health and quality of life among a cohort of patients having lateral internal sphincterotomy for anal fissures. Colorectal Dis 2020; 22:1658-1666. [PMID: 32533887 DOI: 10.1111/codi.15191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/23/2022]
Abstract
AIM The aim of this study is to report changes in health-related quality of life attributable to lateral internal sphincterotomy for treatment of anal fissure. There is very little evidence on whether the overall health-related quality of life of patients is detrimentally affected by the condition, or which aspects of self-perceived health status improve after lateral internal sphincterotomy. This study will articulate which aspects of health tend to improve and guide postoperative expectations appropriately. Knowledge gained from this study may also identify gaps in an individual patient's episode of care. METHOD Patients were prospectively identified when they consented to surgical treatment of their anal fissure and were contacted by phone to participate. Participants completed a number of patient-reported outcomes preoperatively and 6 months postoperatively. Faecal incontinence-related quality of life, pain and depression were measured at both time points. The severity of faecal incontinence was measured at both times. RESULTS Participants reported high levels of pain preoperatively. Postoperatively, improvement in pain exceeded the threshold of clinical relevance (P < 0.01). Thirty-five per cent of participants reported significant effects of faecal incontinence preoperatively, while 26% did so postoperatively. Participants with multiple comorbidities were more likely to report faecal incontinence postoperatively than preoperatively. CONCLUSION This study reports that lateral internal sphincterotomy improved pain symptoms without adverse effects on continence. Not all domains of health-related quality of life were similarly positively affected by anal fissure repair.
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Affiliation(s)
- J M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Karimuddin
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - G Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - H Akbar
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Phang
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Redfern
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - S Manoharan
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - C J Brown
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - M J Raval
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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You X, Wu J, Wang Y, Liu Q, Chen D, Zhao X, Zhou Y, Wu X, Wang D. Single vs. double purse-string anastomosis during laparoscopic low anterior rectal resection (SINGLE-DOUBLE trial): study protocol for a randomized controlled trial. Trials 2019; 20:292. [PMID: 31138321 PMCID: PMC6537314 DOI: 10.1186/s13063-019-3411-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 05/06/2019] [Indexed: 01/21/2023] Open
Abstract
Background An inappropriate anastomosis method during laparoscopic anterior rectal resection can increase the risk of anastomotic complications and affect surgical, economic, and oncological outcomes. The aim of this study is to compare the incidence of anastomotic complications and the surgical, economic, and oncological outcomes following single versus double purse-string anastomosis during laparoscopic total mesorectal excision (TME) for low rectal cancer. Methods/design This randomized controlled trial (the SINGLE–DOUBLE study) will randomly assign middle and low rectal adenocarcinoma patients to receive either single or double purse-string anastomosis during laparoscopic low anterior rectal resection. Patients will be eligible for inclusion only if they (1) have adenocarcinoma confirmed by preoperative colonoscopy and biopsy, (2) have a tumor situated less than 12 cm from the anal verge, (3) do not have the anal sphincter involved, and (4) do not have distant metastases. The primary endpoint measure will be the incidence of anastomotic complications (leakage, narrowing, and bleeding). The secondary endpoints will be surgical, economic, and oncological outcomes. A total of 500 patients will be enrolled in the study. Sample size calculation was based on previous reports and our retrospective analysis. Discussion This randomized single-center controlled trial is expected to demonstrate which anastomosis method (single or double purse-string anastomosis) is better for reducing complications and improving prognosis in rectal cancer patients undergoing laparoscopic TME for low or middle rectal cancer. Trial registration Registration number: ChiCTR1800016116. Protocol Registration Receipt: May 13, 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3411-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaolan You
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), 366 Taihu Road. Hailing District, Taizhou, Jiangsu, 225300, China.
| | - Jian Wu
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), 366 Taihu Road. Hailing District, Taizhou, Jiangsu, 225300, China
| | - Yuanjie Wang
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), 366 Taihu Road. Hailing District, Taizhou, Jiangsu, 225300, China
| | - Qinghong Liu
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), 366 Taihu Road. Hailing District, Taizhou, Jiangsu, 225300, China
| | - Dehu Chen
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), 366 Taihu Road. Hailing District, Taizhou, Jiangsu, 225300, China
| | - Xiaojun Zhao
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), 366 Taihu Road. Hailing District, Taizhou, Jiangsu, 225300, China
| | - Yan Zhou
- Department of Gastrointestinal Surgery, The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People's Hospital), 366 Taihu Road. Hailing District, Taizhou, Jiangsu, 225300, China
| | - Xiaoqing Wu
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University (Subei People's Hospital of Jiangsu Province), 98 West Nantong Road. Hanjiang District, Yangzhou, Jiangsu, 225003, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University (Subei People's Hospital of Jiangsu Province), 98 West Nantong Road. Hanjiang District, Yangzhou, Jiangsu, 225003, China
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