1
|
Story KM, Robb SL, Bravata DM, Damush TM, Bair MJ. Telehealth Engaged Music for Pain Outcomes: A Music and Imagery Proof-of-concept Study with Veterans. J Music Ther 2024; 61:288-310. [PMID: 38787579 DOI: 10.1093/jmt/thae011] [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: 01/25/2023] [Revised: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
Music therapy interventions target biopsychosocial outcomes and are a non-pharmacological option for integrated pain management. To date, most music and pain studies have focused on acute pain, passive music experiences, and in-person delivery. The purpose of this study was to examine feasibility and acceptability and determine proof-of-concept for a newly developed telehealth music imagery (MI) intervention for Veterans with chronic pain. A single-group proof-of-concept pilot study was conducted with Veterans with chronic pain (n = 8). Feasibility was assessed through examination of recruitment, retention, and session/measure completion rates; acceptability through participant interviews; and whether the intervention resulted in clinically meaningful change scores (pre- to post-intervention) on measures of pain, anxiety, and depression at the individual level. For Veterans who passed eligibility screening, we had an enrollment rate of 89%, with good retention (75%). Overall, participating Veterans found the intervention acceptable, identified specific challenges with technology, and recommended an increased number of sessions. Preliminary outcome data for pain, anxiety, and depression were mixed, with some Veterans reporting clinically meaningful improvements and others reporting no change or worsening symptoms. Findings informed modifications to the telehealth MI intervention and the design of a larger pilot randomized controlled trial to assess feasibility and acceptability of the modified intervention in a larger population of Veterans with chronic pain using additional measures and a control condition.
Collapse
Affiliation(s)
- Kristin M Story
- Department of Veterans Affairs (VA), Richard L. Roudebush VA Medical Center; Center for Health Information and Communication, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sheri L Robb
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Dawn M Bravata
- Department of Veterans Affairs (VA), Richard L. Roudebush VA Medical Center; Center for Health Information and Communication, Indianapolis, IN, USA
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Teresa M Damush
- Department of Veterans Affairs (VA), Richard L. Roudebush VA Medical Center; Center for Health Information and Communication, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew J Bair
- Department of Veterans Affairs (VA), Richard L. Roudebush VA Medical Center; Center for Health Information and Communication, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
2
|
Tam S, Al-Antary N, Adjei Boakye E, Springer K, Poisson LM, Su WT, Grewal J, Zatirka T, Ryan M, Movsas B, Chang SS. Differences in Patient-Reported Outcome Measures in Patients With Cancer Six Months Before Death. JCO Oncol Pract 2024:OP2300720. [PMID: 39250724 DOI: 10.1200/op.23.00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/21/2024] [Accepted: 08/02/2024] [Indexed: 09/11/2024] Open
Abstract
PURPOSE Patient-reported outcome measures (PROMs) provide a direct report of the patient's perspective, complementary to clinician assessment. Currently, understanding the real-time changes in PROM scores near the end of life remains limited. This study evaluated differences in mean PROM scores between patients with cancer within 6 months before death compared with surviving patients with cancer. METHODS This retrospective case-control study uses the National Institutes of Health's Patient-Reported Outcomes Measurement Information System computer adaptive testing instruments to assess pain interference, physical function, fatigue, and depression. Patients dying within 6 months of PROM completion were selected as cases and matched to controls 1:3 by age at PROM completion, sex, cancer disease site, and cancer stage at diagnosis. Generalized estimating equation models assessed the difference in mean PROM score in cases compared with controls. RESULTS A total of 461 cases and 1,270 controls from September 2020 to January 2023 were included. After adjustment for ethnicity, Charlson Comorbidity Index, and census tract median household income, significant differences in mean scores were demonstrated. Physical function domain showed the largest difference, with cases averaging 6.52 points lower than controls (95% CI, -8.25 to -4.80). Fatigue and pain interference domains showed a rise in PROMs scores by 4.83 points (95% CI, 2.94 to 6.72) and 4.33 points (95% CI, 2.53 to 6.12), respectively. CONCLUSION Compared with controls, patients dying within 6 months of PROM completion demonstrated worse PROM scores in the four domains assessed. These findings suggest the utility of routinely collected PROMs as a real-time indicator of the terminal stage of life among patients with cancer to allow for earlier intervention with supportive oncology services.
Collapse
Affiliation(s)
- Samantha Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI
| | - Nada Al-Antary
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI
| | - Eric Adjei Boakye
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI
| | - Kylie Springer
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI
| | - Laila M Poisson
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI
| | - Wan-Ting Su
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI
| | - Jeewanjot Grewal
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
| | - Theresa Zatirka
- Division of Clinical and Quality Transformation, Transformation Consulting, Henry Ford Health, Detroit, MI
| | - Michael Ryan
- Division of Supportive Oncology Services, Henry Ford Health, Detroit, MI
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI
| | - Steven S Chang
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI
| |
Collapse
|
3
|
Lewis G, Irving G, Wilding J, Hardy K. Evaluating the impact of differing completion rates of a face-to-face DIABETES self-management education programme on Patient Reported Outcome measures (DIABETES PRO): A feasibility trial protocol. Diabet Med 2024:e15430. [PMID: 39235931 DOI: 10.1111/dme.15430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/07/2024]
Abstract
INTRODUCTION Structured diabetes self-management education (DSME) is internationally recommended for people with type 2 diabetes to support self-management and to prevent associated long-term complications. 'Attendance' at DSME is currently benchmarked as having completed a registration form and at least one active engagement with programme content, and 'completion' measured against ≥60% completion, despite landmark trials reporting outcomes based on the full completion of a programme. Little is known about the effectiveness of DSME on the psychological and emotional health of people with diabetes who complete less than the full DSME programme. We report a protocol for a single-centre randomised feasibility study to assess the impact of differing completion rates of a face-to-face DSME programme on patient reported outcomes of self-care, diabetes distress and quality of life in people with type 2 diabetes. METHODS A randomised feasibility study in 120 people with type 2 diabetes due to attend a secondary care diabetes clinic in the North West UK for DSME. Participants will be randomised into one of the four groups: Group 1 full DSME programme, Group 2 60%, Group 3 10% and Group 4 0% (delayed education). Psychometric questionnaire scores will be evaluated at baseline and 3-4 months post-intervention. Measures of feasibility (eligibility, recruitment and retention rates) will be reported. ETHICS AND DISSEMINATION The DIABETES-PRO study was approved by the London-Surrey Borders Research Ethics Committee (24/LO/0235). Results will be shared with study participants and published in peer-reviewed journals. TRIAL REGISTRATION Clinicaltrials.gov NCT06419907.
Collapse
Affiliation(s)
- Gemma Lewis
- Department of Diabetes and Endocrinology, St Helens Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Greg Irving
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - John Wilding
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kevin Hardy
- Department of Diabetes and Endocrinology, St Helens Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK
| |
Collapse
|
4
|
Simonsson R, Bittar J, Kaarre J, Zsidai B, Sansone M, Piussi R, Musahl V, Irrgang J, Samuelsson K, Senorski EH. Demographic and surgical characteristics in patients who do not achieve minimal important change in the KOOS Sport/Rec and QoL after ACL reconstruction: a comparative study from the Swedish National Knee Ligament Registry. BMJ Open 2024; 14:e083803. [PMID: 39237278 PMCID: PMC11381709 DOI: 10.1136/bmjopen-2023-083803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVES This study aimed to compare demographic and surgical characteristics between patients who do and do not achieve minimal important change (MIC) in the Knee injury and Osteoarthritis Outcome Score (KOOS) Sports and Recreation (Sport/Rec) and Quality of Life (QoL) subscales 1 year after anterior cruciate ligament reconstruction. DESIGN Comparative cross-sectional. SETTING The MIC for the KOOS Sport/Rec subscale was ≥12.1 and ≥18.3 for the KOOS QoL subscale from before surgery to 1-year follow-up using data from the Swedish National Knee Ligament Registry. PARTICIPANTS In total 16 131 patients were included: 11 172 (69%) with no MIC for the Sport/Rec scale, and 10 641 (66%) for the QoL. RESULTS Patients with no MIC for Sport/Rec and QoL had a higher body mass index (BMI) (24.8±3.5 vs 24.6±3.3 and 24.7±3.5 vs 24.6±3.2, respectively, p<0.0001), were younger (years) at time of surgery (28.5±10.3 vs 29.1±10.8 and 27.4±9.8 vs 29.7±11.0, respectively, p=0.0002 and <0.0001), had longer time from injury to surgery (months) (Sports/Rec 22.0±38.5 vs 19.3±36.6, respectively, p=0.0002), and greater rates of concomitant cartilage injuries especially to the lateral femoral condyle (22.7% vs 19.4% and 23.3% vs 19.0%, respectively, p=0.001 and p=0.005) compared with patients who achieved the MIC. A smaller proportion of patients treated with a hamstring tendon autograft had no MIC (91.4%) compared with patients with MIC (94.1%). CONCLUSIONS Patients with no MIC for KOOS Sport/Rec and QoL subscales had a higher BMI, longer time from injury to surgery and were younger at the time of surgery compared with patients who did achieve MIC. Although differences were small, they may reframe management strategies with patients who have these characteristics.
Collapse
Affiliation(s)
| | - Judy Bittar
- Department of Orthopaedics, University of Gothenburg, Goteborg, Sweden
| | - Janina Kaarre
- Department of Orthopaedics, Medical sciences, Goteborg, Sweden
| | - Bálint Zsidai
- Department of Orthopaedics, Medical sciences, Goteborg, Sweden
| | | | - Ramana Piussi
- University of Gothenburg, Goteborg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James Irrgang
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Eric Hamrin Senorski
- University of Gothenburg, Goteborg, Sweden
- Neuroscience and physiology, Health and rehabilitation, Goteborg, Sweden
| |
Collapse
|
5
|
Parsons SK, Murphy-Banks R, Rodday AM, Roth ME, Miller K, Linendoll N, Chan R, Crosswell HE, Xiang Q, Freyer DR. Financial distress and medical financial hardship among young adult survivors of blood cancer. JNCI Cancer Spectr 2024; 8:pkae071. [PMID: 39153000 PMCID: PMC11401610 DOI: 10.1093/jncics/pkae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/16/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The long-term financial impact of cancer care has not been adequately addressed in young adults. As part of a remote intervention study, we describe medical financial distress and hardship among young adult survivors of blood cancer at study entry. METHODS Young adults were recruited from 6 US hospitals. Using a Research Electronic Data Capture link, young adults confirmed their eligibility-namely, currently 18 to 39 years of age, blood cancer diagnosis 3 or more years ago, off active treatment, and not on parent's insurance. Following consent, the baseline assessment was sent. The primary outcome measure, the Personal Financial Wellness Scale, measured financial distress (scored as severe, 1-2; high, 3-4; average, 5-6; and low to no, 7-10). Medical financial hardship encompassed material hardship, psychological impact, and coping behaviors. Descriptive summary statistics and linear regression were used. RESULTS Among the 126 participants, 54.5% came from minority racial or ethnic groups. Median time since diagnosis was 10 years (interquartile range = 6-16 years), with 56% having received a diagnosis when they were between 18 and 39 years of age. The overall mean (standard deviation) Personal Financial Wellness Scale score was 5.1 (2.4), but 49% reported severe or high distress. In multivariable analysis, female sex, Hispanic ethnicity, and lower income were strongly associated with worse Personal Financial Wellness Scale scores. Among participants with severe financial distress (n = 26), 72% reported 2 or more household material hardships, had worse scores across all psychological domains, and altered survivorship care because of cost (68%). CONCLUSIONS Nearly half of long-term young adult cancer survivors reported severe or high levels of financial distress. Individuals with severe or high distress also reported more medical financial hardship than other participants. This finding highlights the need for ongoing financial intervention in this vulnerable population. CLINICALTRIALS.GOV NCT05620979.
Collapse
Affiliation(s)
- Susan K Parsons
- Division of Hematology and Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Rachel Murphy-Banks
- Division of Hematology and Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Michael E Roth
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kimberly Miller
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nadine Linendoll
- Division of Hematology and Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Randall Chan
- Department of Pediatrics, Los Angeles General Medical Center, Los Angeles, CA, USA
| | - Howland E Crosswell
- AYA Cancer Care Program, Bon Secours Mercy, St Francis Cancer Center, Greenville, SC, USA
| | - Qingyan Xiang
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population and Public Health Sciences, Cancer and Blood Disease Institute, Children's Hospital Los Angeles & University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| |
Collapse
|
6
|
Golden AP, Hogan KK, Morris JB, Pickens BB. The Impact of Blood Flow Restriction Training on Tibial Bone Stress Injury Rehabilitation: An Exploratory Case Series. Int J Sports Phys Ther 2024; 19:1126-1137. [PMID: 39229454 PMCID: PMC11368450 DOI: 10.26603/001c.122641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024] Open
Abstract
Background Lower extremity bone stress injuries (BSI) are common injuries among athletes and military members. Typical management involves a period of restricted weightbearing which can have rapid detrimental effects upon both muscle and bone physiology. Few studies have investigated the effect of blood flow restriction (BFR) training on bone in the rehabilitative setting. Purpose The purpose of this study was to investigate the effects of lower extremity exercise with the addition of BFR upon bone mineral density, bone mineral content, and lean body mass in military members with tibial BSIs. Study Design Case series. Methods Twenty military members with MRI-confirmed tibial BSI were recruited to complete lower extremity exercise with the addition of BFR twice per week for four weeks. The BFR cuff was applied proximally to the participant's involved limb while they performed gluteal, thigh, and leg resistance exercises. Outcomes were assessed at baseline and four weeks. The primary outcomes were whole leg bone mineral density (BMD), bone mineral content (BMC), and lean body mass (LM) as measured by dual-energy x-ray absorptiometry. Secondary outcomes included thigh and leg circumference measures and patient-reported outcomes, including the Lower Extremity Functional Scale (LEFS), Patient-Reported Outcomes Measurement Information System 57 (PROMIS-57), and Global Rating of Change (GROC). Results No significant differences were found in BMD (p=0.720) or BMC (p=0.749) between limbs or within limbs over time. LM was generally less in the involved limb (p=0.019), however there were no significant differences between or within limbs over time (p=0.404). For thigh circumference, significant main effects were found for time (p=0.012) and limb (p=0.015), however there was no significant interaction effect (p=0.510). No significant differences were found for leg circumference (p=0.738). Participants showed significant mean changes in LEFS (15.15 points), PROMIS physical function (8.98 points), PROMIS social participation (7.60 points), PROMIS anxiety (3.26 points), and PROMIS pain interference (8.39 points) at four weeks. Conclusion The utilization of BFR in the early rehabilitative management of tibial BSI may help mitigate decrements in both bone and muscle tissue during periods of decreased physical loading. Level of Evidence 4.
Collapse
Affiliation(s)
- Andrew P Golden
- Army-Baylor University Doctoral Fellowship in Orthopaedic Manual Physical Therapy, Fort Sam Houston, TX 78234, USA
| | - Kathleen K Hogan
- Special Warfare Human Performance Squadron, San Antonio, TX 78236, USA
| | - Jamie B Morris
- Army-Baylor University Doctoral Fellowship in Division 1 Sports Physical Therapy, West Point, NY 10996, USA
| | - Bryan B Pickens
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA
| |
Collapse
|
7
|
Pozzar RA, Enzinger AC, Howard C, Tavormina A, Matulonis UA, Campos S, Liu JF, Horowitz N, Konstantinopoulos PA, Krasner C, Wall JA, Sciacca K, Meyer LA, Lindvall C, Wright AA. Feasibility and acceptability of a nurse-led telehealth intervention (BOLSTER) to support patients with peritoneal carcinomatosis and their caregivers: A pilot randomized clinical trial. Gynecol Oncol 2024; 188:1-7. [PMID: 38851039 PMCID: PMC11368606 DOI: 10.1016/j.ygyno.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Patients with advanced gynecologic (GYN) and gastrointestinal (GI) cancers frequently develop peritoneal carcinomatosis (PC), which limits prognosis and diminishes health-related quality of life (HRQoL). Palliative procedures may improve PC symptoms, yet patients and caregivers report feeling unprepared to manage ostomies, catheters, and other complex needs. Our objectives were to (1) assess the feasibility of an efficacy trial of a nurse-led telehealth intervention (BOLSTER) for patients with PC and their caregivers; and (2) assess BOLSTER's acceptability, potential to improve patients' HRQoL and self-efficacy, and potential impact on advance care planning (ACP). METHODS Pilot feasibility RCT. Recently hospitalized adults with advanced GYN and GI cancers, PC, and a new complex care need and their caregivers were randomized 1:1 to BOLSTER or enhanced discharge planning (EDP). We defined feasibility as a ≥ 50% approach-to-consent ratio and acceptability as ≥70% satisfaction with BOLSTER. We assessed patients' HRQoL and self-efficacy at baseline and six weeks, then compared the proportion experiencing meaningful improvements by arm. ACP documentation was identified using natural language processing. RESULTS We consented 77% of approached patients. In the BOLSTER arm, 91.0% of patients and 100.0% of caregivers were satisfied. Compared to EDP, more patients receiving BOLSTER experienced improvements in HRQoL (68.4% vs. 40.0%) and self-efficacy for managing symptoms (78.9% vs. 35.0%) and treatment (52.9% vs. 42.9%). The BOLSTER arm had more ACP documentation. CONCLUSIONS BOLSTER is a feasible and acceptable intervention with the potential to improve patients' HRQoL and promote ACP. An efficacy trial comparing BOLSTER to usual care is underway. TRIAL REGISTRATION ClinicalTrials.gov: NCT03367247; PI: Wright.
Collapse
Affiliation(s)
- Rachel A Pozzar
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Andrea C Enzinger
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | | | - Ursula A Matulonis
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Susana Campos
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Joyce F Liu
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Neil Horowitz
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Carolyn Krasner
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jaclyn A Wall
- University of Alabama, Birmingham, AL, United States
| | - Kate Sciacca
- Dana Farber Cancer Institute, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Larissa A Meyer
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Charlotta Lindvall
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Alexi A Wright
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| |
Collapse
|
8
|
Sierevelt IN, van Kampen PM, Terwee CB, Nolte PA, Kerkhoffs GMMJ, Haverkamp D. The minimal important change is not a universal fixed value across diagnoses when using the FAOS and FAAM in patients undergoing elective foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc 2024; 32:2406-2419. [PMID: 38860725 DOI: 10.1002/ksa.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE This study aimed to calculate region and diagnosis-specific minimal important changes (MICs) of the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) in patients requiring foot and ankle surgery and to assess their variability across different foot and ankle diagnoses. METHODS The study used routinely collected data from patients undergoing elective foot and ankle surgery. Patients had been invited to complete the FAOS and FAAM preoperatively and at 3-6 months after surgery, along with two anchor questions encompassing change in pain and daily function. Patients were categorised according to region of pathology and subsequent diagnoses. MICs were calculated using predictive modelling (MICPRED) and receiver operating characteristic curve (MICROC) method and evaluated according to strict credibility criteria. RESULTS Substantial variability of the MICs between forefoot and ankle/hindfoot region was observed, as well as among specific foot and ankle diagnoses, with MICPRED and MICROC values ranging from 7.8 to 25.5 points and 9.4 to 27.8, respectively. Despite differences between MICROC and MICPRED estimates, both calculation methods exhibited largely consistent patterns of variation across subgroups, with forefoot conditions systematically showing smaller MICs than ankle/hindfoot conditions. Most MICs demonstrated high credibility; however, the majority of the MICs for the FAOS symptoms subscale and forefoot conditions exhibited insufficient or low credibility. CONCLUSION The MICs of the FAOS and FAAM vary across foot and ankle diagnoses in patients undergoing elective foot and ankle surgery and should not be used as a universal fixed value, but recognised as contextual parameters. This can help clinicians and researchers in more accurate interpretation of the FAOS and FAAM change scores. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Spaarnegasthuis Academy, Hoofddorp, The Netherlands
| | - Paulien M van Kampen
- Department of Research and Innovation, Bergman Clinics, Naarden, The Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter A Nolte
- Department of Orthopedic Surgery, Spaarnegasthuis Academy, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands
| |
Collapse
|
9
|
McLachlan LM, Engster S, Winger JG, Haupt A, Levin-Decanini T, Decker M, Noll RB, Yu JA. Self-Reported Well-Being of Family Caregivers of Children with Medical Complexity. Acad Pediatr 2024; 24:1133-1140. [PMID: 38609015 PMCID: PMC11343666 DOI: 10.1016/j.acap.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/08/2024] [Accepted: 04/06/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Provide an in-depth and psychometrically rigorous profile of the emotional well-being and sleep-related health of family caregivers of children with medical complexity (CMC). METHODS Cross-sectional survey study of family caregivers of CMC receiving care from a pediatric complex care center between May 2021 and March 2022. Patient Reported Outcomes Measurement Information System Short-Forms (PROMIS-SF) assessed global mental health, emotional distress (anxiety, depression, anger), psychological strengths (self-efficacy, emotional regulation, meaning and purpose), and sleep-related health (fatigue, sleep-related impairment). Student's t-tests compared the sample's mean T-scores to US population norms. Pearson's correlation coefficient (ρ) examined associations between measures of psychological strengths and emotional distress. Unadjusted linear regression analyses explored relationships between well-being outcomes and child and caregiver characteristics. RESULTS Compared to US population norms, caregivers of CMC (n = 143) reported significantly lower global mental health and emotional regulation ability as well as elevated symptoms of anxiety, depression, anger, fatigue, and sleep-related impairment (all P < .01). Whereas participants reported a significantly higher sense of meaning and purpose (P < .05), levels of self-efficacy were not significantly different from population norms. We observed moderate-to-strong inverse relationships between psychological strengths and emotional distress (ρ range, -0.39 to -0.69); with the strongest inverse associations found between emotional regulation ability and emotional distress. In exploratory analyses, caregiver race and ethnicity, socioeconomic status, and child health insurance type were significantly associated with caregiver well-being. CONCLUSION Family caregivers of CMC report poor well-being, most notably, increased symptoms of anxiety and reduced global mental health and sleep-related health.
Collapse
Affiliation(s)
| | - Stacey Engster
- Jose F. Alvarado and Associates (S Engster), Salisbury, Md
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences (JG Winger), Duke University School of Medicine, Durham, NC; Duke Cancer Institute (JG Winger), Duke University Health System, Durham, NC
| | - Alicia Haupt
- Complex Care Center (A Haupt and M Decker), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Tal Levin-Decanini
- Complex Care Center (T Levin-Decanini), General Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Michael Decker
- Complex Care Center (A Haupt and M Decker), UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Robert B Noll
- Department of Pediatrics (A Haupt, M Decker, and RB Noll), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Justin A Yu
- Divisions of Pediatric Supportive and Palliative Care and Hospital Medicine (JA Yu), University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.
| |
Collapse
|
10
|
Heide M, Mørk M, Fenne Hoksrud A, Brox JI, Røe C. Responsiveness of specific and generic patient-reported outcome measures in patients with plantar fasciopathy. Disabil Rehabil 2024; 46:4300-4306. [PMID: 37855657 DOI: 10.1080/09638288.2023.2267438] [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: 03/31/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To evaluate and compare responsiveness characteristics for the Foot Function Index revised short form (FFI-RS), RAND-12 Health Status Inventory (RAND-12), and Numeric Rating Scale (NRS), in patients with plantar fasciopathy receiving non-surgical treatment. MATERIALS AND METHODS This study was conducted on a sub-group of patients from an ongoing randomised controlled trial. One-hundred fifteen patients were included. The patient-reported outcome measures (PROMs) were applied at baseline and after 6 months. Responsiveness was calculated using standardised response mean and area under the receiver operating characteristic (ROC) curve. ROC curves were used to compute the minimal important change (MIC) for the outcome measures. RESULTS The region specific FFI-RS had best responsiveness and the NRS at rest had lowest responsiveness. CONCLUSION FFI-RS were marginally more responsive than the other PROMs. Responsiveness and MIC estimates should be regarded as indicative rather than fixed estimates.
Collapse
Affiliation(s)
- Marte Heide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Nydalen, Norway
| | - Marianne Mørk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Nydalen, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Aasne Fenne Hoksrud
- Norwegian Olympic and Paralympics Committee and Confederation of Sports, Oslo, Norway
| | - Jens Ivar Brox
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Nydalen, Norway
| | - Cecilie Røe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Nydalen, Norway
| |
Collapse
|
11
|
Bottine A, Grandjean J, Standaert M, Abdellaoui A, Reychler G. A systematic review of the psychometric properties of the Leicester Cough Questionnaires based on the COSMIN guidelines. Respir Med 2024; 231:107739. [PMID: 39029808 DOI: 10.1016/j.rmed.2024.107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/24/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Chronic cough affects around 10 % of the general adult population, impairing all aspects of quality of life. RESEARCH QUESTION What are the Leicester Cough Questionnaire's psychometric properties? STUDY DESIGN AND METHODS Electronic searches of PubMed, CINAHL, and ScienceDirect databases were conducted from inception until October 1rst 2022. All full-text articles, published in French or English, aimed at evaluating the LCQ's content validity or psychometric properties were included. The COSMIN Risk of Bias checklist was applied to assess their methodological quality and results. Results were qualitatively summarised and rated by a modified GRADE approach. RESULTS 40 studies were included accounting for 8731 adults, subject to cough or a respiratory condition. Chronic cough (>8 weeks) was the most represented. The LCQ's total score is relevant and comprehensible for the assessment of the impact of cough on QoL. The original 3-factor model showed a satisfactory model fit. Good convergent validity was found for the total and physical domain scores. These scores demonstrate good internal consistency and test retest reliability, with some variability noted and they are responsive to change. Recent estimates of MID thresholds were 1.7 and 0.4 for total and domain scores respectively. The quality of the studies is globally poor. INTERPRETATION The LCQ is a valid outcome to assess the intra-individual impact of cough on QoL and to detect large changes in quality of life mainly in a short-term clinical trial setting. CLINICAL TRIAL REGISTRATION The protocol was registered with PROSPERO (CRD42022355191).
Collapse
Affiliation(s)
- Anne Bottine
- Département de kinésithérapie, VINCI, 1200, Brussels, Belgium.
| | | | - Marie Standaert
- Département de kinésithérapie, VINCI, 1200, Brussels, Belgium.
| | - Aldjia Abdellaoui
- Institut Formation Masso-Kinésithérapie (IFMK), 1702 Rue de St-Priest, 34090, Montpellier, France.
| | - Gregory Reychler
- Département de kinésithérapie, VINCI, 1200, Brussels, Belgium; Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium; Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Avenue Hippocrate 55, 1200, Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| |
Collapse
|
12
|
Sands BE, Panés J, Feagan BG, Zhang H, Vetter ML, Mathias SD, Huang KHG, Johanns J, Germinaro M, Sahoo A, Terry NA, Han C. Qualitative and Psychometric Evaluation of 29-Item Patient-Reported Outcomes Measurement Information System® to Assess General Health-Related Quality of Life in Patients With Moderately to Severely Active Inflammatory Bowel Disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1225-1234. [PMID: 38843977 DOI: 10.1016/j.jval.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES To evaluate content validity and psychometric properties of the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29) to determine its suitability in inflammatory bowel disease (IBD) clinical trials. METHODS Content validity of PROMIS-29 was evaluated using qualitative interviews, including concept elicitation and cognitive debriefing, among patients living with Crohn's disease (Crohn's disease n = 20) or ulcerative colitis (UC, n = 19). PROMIS-29 validity, reliability, and responsiveness were assessed using data from phase II clinical trials of Crohn's disease (N = 360) and UC (N = 518). RESULTS Common (≥74%) symptoms reported in qualitative interviews were increased stool frequency, fatigue, abdominal pain/cramping, blood/mucus in stool, bowel urgency, and diarrhea. Disease impact aligned with PROMIS-29 content (depression, anxiety, physical function, pain interference, fatigue, sleep disturbance, and ability to participate in social roles/activities). Cognitive debriefing indicated that PROMIS-29 instructions were easily understood, items were relevant, and the recall period was appropriate. Psychometric evaluations demonstrated that PROMIS-29 scores indicating worse symptoms/functioning were associated with lower health-related quality of life and greater disease activity and severity. PROMIS-29 domain scores correlated (rs ≥ 0.40) with IBD Questionnaire domains and EuroQol-5-Dimension-5-Level dimensions measuring similar concepts. Test-retest reliability among patients with stable disease was moderate-to-excellent (0.64-0.94) for nearly all domains in all studies. PROMIS-29 was responsive to change in disease status from baseline to week 12. Thresholds for clinically meaningful improvement ranged from ≥3 to ≥8, depending on domain. CONCLUSIONS PROMIS-29 is valid, reliable, and responsive for assessing general health-related quality of life and treatment response in IBD clinical trials.
Collapse
Affiliation(s)
- Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julian Panés
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Brian G Feagan
- Western University and Alimentiv Inc, London, ON, Canada
| | - Hongyan Zhang
- Janssen Research and Development, LLC, Spring House, PA, USA
| | - Marion L Vetter
- Janssen Research and Development, LLC, Spring House, PA, USA
| | | | | | - Jewel Johanns
- Janssen Research and Development, LLC, Spring House, PA, USA
| | | | - Aparna Sahoo
- Janssen Research and Development, LLC, Spring House, PA, USA
| | - Natalie A Terry
- Janssen Research and Development, LLC, Spring House, PA, USA
| | | |
Collapse
|
13
|
Burton W, Wayne PM, Litrownik D, Long CR, Vining R, Rist P, Kilgore K, Lisi A, Kowalski MH. Integrating Chiropractic Care and Tai Chi Training for the Treatment of Chronic Nonspecific Neck Pain in Nurses: A Single-Arm Mixed-Methods Pilot Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39169834 DOI: 10.1089/jicm.2024.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Objectives: Chronic nonspecific neck pain (CNNP) is prevalent among health care workers, with particularly high rates among nurses. Nurses experiencing CNNP often report decreased job satisfaction, increased absenteeism, and reduced productivity. In recent years, nonpharmacologic approaches have gained attention as effective treatments for the management of CNNP, with exercise and manual therapies representing two of the most common. Early evidence shows that multimodal treatments may be more effective than unimodal strategies. The purpose of this current study was to assess the feasibility and observe the clinical outcomes of combined multimodal chiropractic care (MCC) and Tai Chi (TC) for CNNP in nurses. Methods: A single-arm mixed-methods pilot trial was conducted including 16 weeks of MCC and TC in nurses with self-reported CNNP. Feasibility outcomes were recruitment, retention, and adherence to the interventions. Clinical outcomes of interest included neck pain and related disabilities. Secondary outcomes of interest were functional, affective, and work-related performance. Qualitative interviews were also conducted. Results: Of the 59 screened, 36 met the eligibility criteria, and 21 were enrolled. The retention rate was 71.4%, and adherence rates were 85.3% for MCC and 62.5% for TC classes. Multiple pain and disability-related outcomes exhibited modest improvement from baseline to 16-week follow-up. Qualitative analysis identified six emergent themes: (1) neck pain being an inherent part of nursing, (2) nurses push through their pain, (3) MCC relieves pain and is instructive for preventing pain, (4) TC provides overall relaxation, (5) both interventions increased body awareness and improved posture, and (6) scheduling difficulties were a key obstacle for participating. Conclusions: Observed reductions in neck pain and disability suggest the potential utility of combined MCC and TC interventions for managing CNNP. Along with qualitative feedback regarding facilitators and barriers to participation, the findings support and inform a future randomized trial evaluating the combined benefits of MCC and TC for CNNP in nurses. Clinical Trial Registration #NCT06523036.
Collapse
Affiliation(s)
- Wren Burton
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter M Wayne
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dan Litrownik
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Cynthia R Long
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA, USA
| | - Robert Vining
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, Davenport, IA, USA
| | - Pamela Rist
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen Kilgore
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
| | - Anthony Lisi
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Matthew H Kowalski
- Brigham and Women's Hospital and Harvard Medical School, Osher Center for Integrative Health, Boston, MA, USA
| |
Collapse
|
14
|
McConnell KM, Zaleta AK, Saracino R, Miller M. Interdisciplinary provider visits attenuate relationship between patient concerns and distress in older adults with cancer. Qual Life Res 2024:10.1007/s11136-024-03760-7. [PMID: 39162969 DOI: 10.1007/s11136-024-03760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE This study examined the relationship between multidimensional patient concerns and anxiety and depression in a national sample of older adults with cancer (OACs ≥ 65 years) and the buffering effect of visiting providers across disciplines (e.g., oncology, allied health, primary care, mental health) on these relationships. METHODS Participants completed a cross-sectional survey through the Cancer Support Community's Cancer Experience Registry (CER), an online community-based research initiative. Eligible participants were 65 years and older and diagnosed with cancer in the past five years. Participants completed self-report measures of (1) the severity of their concerns across multiple domains, (2) anxiety and depression, and (3) whether they received care for "symptoms and side effects" from various providers. RESULTS The sample consisted of 277 OACs; 45% endorsed elevated anxiety and 31% endorsed elevated depression. The most severe concerns were in the domains of body image and healthy lifestyle and symptom burden and impact. More severe concerns were associated with higher levels of anxiety and depression. The relationship between concern severity and distress was weaker in OACs who saw a palliative care, mental health, physical or occupational therapy provider, pharmacist, or primary care provider relative to OACs who did not. A visit with an oncology provider did not moderate most relationships between concerns and distress. CONCLUSIONS The relationship between OACs' concerns and distress was attenuated by treatment with a specialty provider. Interdisciplinary team care may be a vital component of comprehensive patient-centered care for OACs.
Collapse
Affiliation(s)
- Kelly M McConnell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rebecca Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Miller
- Cancer Support Community, Research and Training Institute, Washington, DC, USA.
- Inova Life With Cancer, Inova Schar Cancer Institute, 8081 Innovation Park Drive, Fairfax, VA, 22031, USA.
| |
Collapse
|
15
|
Clarke NA, Wong B, Lawrance R, Ingelgård A, Griebsch I, Cella D, Trigg A. Validity, reliability, responsiveness, and clinically meaningful change threshold estimates of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16). J Patient Rep Outcomes 2024; 8:97. [PMID: 39145900 PMCID: PMC11327234 DOI: 10.1186/s41687-024-00776-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: 07/10/2023] [Accepted: 08/01/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancers in women. Patient-reported outcome measures are used to evaluate patients' health-related quality of life in clinical breast cancer studies. This study evaluated the structure, validity, reliability, and responsiveness of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) subscales in a clinical trial featuring patients with advanced/metastatic breast cancer (aBC), and estimated NFBSI-16 meaningful change thresholds. METHODS Data from 101 patients with aBC enrolled in a phase II trial (Xenera-1) were included for psychometric evaluation of the NFBSI-16. Subscale structure was evaluated by assessing inter-item correlations, item-total correlations, and internal consistency (cycles 2 and 5). Validity was assessed using scale-level convergent validity (cycles 2 and 5) and known-groups (Baseline). Reliability was analysed via test-retest at cycles 3-4, and responsiveness to improvement and worsening was evaluated at cycles 5, 7, and 9. Meaningful change thresholds were estimated using anchor-based methods (supported by distribution-based methods) at cycles 5, 7, and 9. RESULTS NFBSI-16 internal consistency was acceptable, but item-total correlations suggested that its subscales and the GP5 item (side-effect of treatment) scores may be preferred over a total score. Convergent and known-groups evidence supported NFBSI-16 validity. Test-retest reliability was good to excellent for Total and DRS-P (disease-related symptoms: physical) scales, and moderate for the GP5 item. Responsiveness to worsening was generally demonstrated, but responsiveness to improvement could not be demonstrated due to limited observed improvement. Anchor-based meaningful change thresholds were estimated for DRS-P and Total scores. CONCLUSION This study provides evidence that the NFBSI-16 has desirable psychometric properties for use in clinical studies in aBC. It also provides estimates of group- and individual-level meaningful change thresholds to facilitate score interpretation in future aBC research.
Collapse
Affiliation(s)
- Nathan A Clarke
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK.
| | - Brendon Wong
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Rachael Lawrance
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Anders Ingelgård
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Ingolf Griebsch
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Andrew Trigg
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| |
Collapse
|
16
|
Hurtado C, Rojas-Gualdrón DF, Pérez Giraldo GS, Villegas Arbelaez E, Mantilla SEM, Campuzano-Sierra M, Ospina-Patino S, Arroyave-Bustamante M, Uribe-Vizcarra V, Restrepo-Arbelaez D, Cardona P, Llano-Piedrahita J, Vásquez-Builes S, Agudelo-Quintero E, Vélez-Arroyave J, Menges S, Jimenez M, Miller J, Quique YM, Koralnik IJ. Neurologic manifestations of Long COVID in Colombia: a comparative analysis of post-hospitalization vs. non-hospitalized patients. Front Hum Neurosci 2024; 18:1450110. [PMID: 39192882 PMCID: PMC11347330 DOI: 10.3389/fnhum.2024.1450110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024] Open
Abstract
Objective To analyze patient-reported outcomes, cognitive function, and persistent symptoms in patients with neurologic post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC) in Colombia. Methods We recruited patients with laboratory-confirmed COVID-19 and PASC symptoms lasting more than 6 weeks at the CES University and CES Clinic (Medellín, Colombia). We included 50 post-hospitalization Neuro-PASC (PNP) and 50 non-hospitalized Neuro-PASC (NNP) patients. Long-COVID symptoms, cognitive (NIH Toolbox v2.1-Spanish for 18+), patient-reported (PROMIS) outcomes, and relevant medical history were evaluated. Statistical analyses were performed via generalized linear models. Results Overall, brain fog (60%), myalgia (42%), and numbness or tingling (41%) were the most common neurological symptoms, while fatigue (74%), sleep problems (46%), and anxiety (44%) were the most common non-neurological symptoms. Compared to NNP, PNP patients showed a higher frequency of abnormal neurological exam findings (64% vs. 42%, p = 0.028). Both groups had impaired quality of life (QoL) in domains of cognition, fatigue, anxiety depression and sleep disturbance, and performed worse on processing speed and attention than a normative population. In addition, NNP patients performed worse on executive function than PNP patients (T-score 42.6 vs. 48.5, p = 0.012). PASC symptoms of anxiety and depression were associated with worse QoL and cognitive outcomes. Brain fog and fatigue remained persistent symptoms across all durations of Long COVID. Conclusion Our findings highlight the high incidence and heterogeneity of the neurologic symptoms and impacts of Long COVID even more than 2 years from disease onset. Early detection, emotional support and targeted management of Neuro-PASC patients are warranted.
Collapse
Affiliation(s)
| | | | - Gina S. Pérez Giraldo
- Neurology Department, Medical University of South Carolina, Charleston, SC, United States
| | | | | | | | | | | | | | | | - Paul Cardona
- School of Medicine, CES University, Medellín, Colombia
| | | | | | | | | | | | - Millenia Jimenez
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Janet Miller
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Igor J. Koralnik
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
17
|
Shaw C, Longworth L, Bennett B, McEntee-Richardson L, Shaw JW. A scoping review of the use of minimally important difference of EQ-5D utility index and EQ-VAS scores in health technology assessment. Health Qual Life Outcomes 2024; 22:63. [PMID: 39135171 PMCID: PMC11321174 DOI: 10.1186/s12955-024-02272-9] [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: 04/24/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVES Estimates of minimally important differences (MID) can assist interpretation of data collected using patient-reported outcomes (PRO), but variability exists in the emphasis placed on MIDs in health technology assessment (HTA) guidelines. This study aimed to identify to what extent information on the MID of a commonly used PRO, the EQ-5D, is required and utilised by selected HTA agencies. METHODS Technology appraisal (TA) documents from HTA agencies in England, France, Germany, and the US between 2019 and 2021 were reviewed to identify documents which discussed MID of EQ-5D data as a clinical outcome assessment (COA) endpoint. RESULTS Of 151 TAs utilising EQ-5D as a COA endpoint, 58 (38%) discussed MID of EQ-5D data. Discussion of MID was most frequent in Germany, in 75% (n = 12/16) of Gemeinsamer Bundesausschuss (G-BA) and 44% (n = 34/78) of Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, (IQWiG) TAs. MID was predominantly applied to the EQ-VAS (n = 50), most frequently using a threshold of > 7 or > 10 points (n = 13). G-BA and IQWiG frequently criticised MID analyses, particularly the sources of MID thresholds for the EQ-VAS, as they were perceived as being unsuitable for assessing the validity of MID. CONCLUSION MID of the EQ-5D was not frequently discussed outside of Germany, and this did not appear to negatively impact decision-making of these HTA agencies. While MID thresholds were often applied to EQ-VAS data in German TAs, analyses were frequently rejected in benefit assessments due to concerns with their validity. Companies should pre-specify analyses of continuous data in statistical analysis plans to be considered for treatment benefit assessment in Germany.
Collapse
Affiliation(s)
- Caroline Shaw
- Putnam, Portland House, New Bridge Street West, Newcastle upon Tyne, NE1 8AP, UK.
| | - Louise Longworth
- Putnam, Portland House, New Bridge Street West, Newcastle upon Tyne, NE1 8AP, UK
| | - Bryan Bennett
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Limited, Uxbridge, UK
- Patient-Centred Outcomes, Jazz Pharmaceuticals, Oxford, UK
| | | | - James W Shaw
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Lawrenceville, NJ, USA
| |
Collapse
|
18
|
Griffiths EA, Min JS, Lee WN, Yu JC, Patel Y, Myren KJ, Dingli D. Patient-reported outcomes and daily activity assessed with a digital wearable device in patients with paroxysmal nocturnal hemoglobinuria treated with ravulizumab: REVEAL, a prospective, observational study. Health Qual Life Outcomes 2024; 22:62. [PMID: 39123253 PMCID: PMC11313122 DOI: 10.1186/s12955-024-02279-2] [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: 02/27/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, chronic blood disorder. Symptoms such as fatigue can have a substantial impact on patients' physical activity levels, sleep, quality of life, and work productivity. Ravulizumab treatment can reduce thrombosis risk, improve survival and quality of life, and reduce fatigue in PNH, but information is limited on how it impacts sleep and physical activity. Here, data on resting heart rate, daily physical activity, and sleep in ravulizumab-treated patients with PNH were passively collected via a digital wearable activity-tracking device and patient-reported outcome (PRO) data were collected via weekly surveys in the same cohort. METHODS REVEAL was a 32-week prospective observational cohort study in individuals with PNH receiving ravulizumab in the USA. A wrist-worn Fitbit™ collected data on resting heart rate, daily step count, and sleep duration from eligible patients. Patients also completed the following electronic weekly surveys: Functional Assessment of Chronic Illness Therapy (FACIT) - Fatigue, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health, PROMIS Global Mental Health, PROMIS Sleep-Related Impairment and Sleep Disturbance, and Work Productivity and Activity Impairment Questionnaire - Specific Health Problem (WPAI-SHP). Data collected from the activity trackers and surveys were compared against US general population values reported in the literature. RESULTS Twenty-eight ravulizumab-treated patients were included (median age: 34 years; 54% female). PRO scores were within US general population normative values, including FACIT-Fatigue (40.0), PROMIS Global Physical Health (51.0), Global Mental Health (51.0), Sleep-Related Impairment (50.0), and Sleep Disturbance (49.0). Similarly, mean resting heart rate (67 bpm), daily step count (7476), and sleep duration (7.7 h) were within the range of US general population values. Daily step count was positively correlated with PROMIS Global Physical and Mental Health scores. CONCLUSIONS This was the first study to use digital monitoring technology to collect data on physical activity and sleep in patients with PNH. The findings indicate that ravulizumab treatment enables patients with PNH to achieve activity levels (heart rate, sleep duration, step count) and quality of life that are comparable to those of the US general population. A weak positive correlation was identified between patient-reported physical and mental health and daily physical activity levels.
Collapse
Affiliation(s)
| | - Jae S Min
- Evidation Health, San Mateo, CA, USA
| | | | - Jeffrey C Yu
- Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Yogesh Patel
- Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Karl-Johan Myren
- Health Economics and Outcome Research, Alexion Pharmaceuticals, Inc., Stockholm, Sweden
| | - David Dingli
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
19
|
Tighe CA, Phares A, Weiner DK, Beehler GP, VanSwearingen J, Harvey AG, Hilgeman MM, Buysse DJ, Forman DE. Adapting and Evaluating the Feasibility and Acceptability of a Behavioral Intervention to Promote Sleep Health in Cardiac Rehabilitation. Behav Sleep Med 2024:1-16. [PMID: 39120442 DOI: 10.1080/15402002.2024.2386602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
OBJECTIVES Study objectives were to: 1) iteratively adapt the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for patients in cardiac rehabilitation (CR; Phase 1) and 2) conduct a preliminary single group pre-post intervention test to a) evaluate procedural feasibility and intervention acceptability and b) to explore preliminary pre-post changes in self-reported sleep, disability, and health-related quality of life (HRQoL; Phase 2). METHOD In Phase 1, 12 individuals in CR and six content experts completed interviews to inform TranS-C adaptations. Interviews were analyzed using rapid qualitative analysis. In Phase 2, eight individuals in CR completed a baseline assessment, the adapted TranS-C intervention, and a post-intervention assessment. Intervention acceptability was assessed via questionnaire and interview. Sleep, disability, and HRQoL outcomes were assessed using questionnaires. Descriptive statistics were calculated for quantitative measures; interviews were analyzed using rapid qualitative analysis. RESULTS Phase 1 participants were receptive to the premise and structure of the adapted intervention. In Phase 2, participants endorsed positive attitudes toward the intervention. Seven of eight participants demonstrated improvements in sleep outcomes. Disability and HRQoL results did not consistently improve. CONCLUSION The adapted TranS-C intervention was acceptable to CR patients and could yield improvements in subjective sleep outcomes. Larger-scale testing in CR is warranted.
Collapse
Affiliation(s)
- Caitlan A Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychology, Providence College, Providence, RI, USA
| | - Angela Phares
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gregory P Beehler
- Center for Integrated Healthcare, VA Center for Integrated Healthcare, Buffalo, NY, USA
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA
| | - Jessie VanSwearingen
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allison G Harvey
- Psychology Department, University of California Berkeley, Berkeley, CA, USA
| | - Michelle M Hilgeman
- Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- Department of Medicine, Division of Gerontology, Geriatrics, & Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology and Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Daniel J Buysse
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel E Forman
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
20
|
Cella D, Kuharic M, Peipert JD, Bedjeti K, Garcia SF, Yanez B, Hirschhorn LR, Coughlin A, Morken V, O'Connor M, Linder JA, Jordan N, Ackermann RT, Amagai S, Kircher S, Mohindra N, Aggarwal V, Weitzel M, Nelson EC, Elwyn G, Van Citters AD, Barnard C. Shared decision-making and disease management in advanced cancer and chronic kidney disease using patient-reported outcome dashboards. J Am Med Inform Assoc 2024:ocae180. [PMID: 39093939 DOI: 10.1093/jamia/ocae180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/22/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES To assess the use of a co-designed patient-reported outcome (PRO) clinical dashboard and estimate its impact on shared decision-making (SDM) and symptomatology in adults with advanced cancer or chronic kidney disease (CKD). MATERIALS AND METHODS We developed a clinical PRO dashboard within the Northwestern Medicine Patient-Reported Outcomes system, enhanced through co-design involving 20 diverse constituents. Using a single-group, pretest-posttest design, we evaluated the dashboard's use among patients with advanced cancer or CKD between June 2020 and January 2022. Eligible patients had a visit with a participating clinician, completed at least two dashboard-eligible visits, and consented to follow-up surveys. PROs were collected 72 h prior to visits, including measures for chronic condition management self-efficacy, health-related quality of life (PROMIS measures), and SDM (collaboRATE). Responses were integrated into the EHR dashboard and accessible to clinicians and patients. RESULTS We recruited 157 participants: 66 with advanced cancer and 91 with CKD. There were significant improvements in SDM from baseline, as assessed by collaboRATE scores. The proportion of participants reporting the highest level of SDM on every collaboRATE item increased by 15 percentage points from baseline to 3 months, and 17 points between baseline and 6-month follow-up. Additionally, there was a clinically meaningful decrease in anxiety levels over study period (T-score baseline: 53; 3-month: 52; 6-month: 50; P < .001), with a standardized response mean (SRM) of -0.38 at 6 months. DISCUSSION PRO clinical dashboards, developed and shared with patients, may enhance SDM and reduce anxiety among patients with advanced cancer and CKD.
Collapse
Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Maja Kuharic
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Robert J Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Ava Coughlin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Victoria Morken
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL 60141, United States
| | - Ronald T Ackermann
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Saki Amagai
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Nisha Mohindra
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Vikram Aggarwal
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Melissa Weitzel
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Cynthia Barnard
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| |
Collapse
|
21
|
Šuc A, Einfalt L, Šarabon N, Kastelic K. Validity and reliability of self-reported methods for assessment of 24-h movement behaviours: a systematic review. Int J Behav Nutr Phys Act 2024; 21:83. [PMID: 39095778 PMCID: PMC11295502 DOI: 10.1186/s12966-024-01632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Time spent in sleep, sedentary behaviour (SB), and physical activity are exhaustive and mutually exclusive parts of a 24-h day that need to be considered in a combination. The aim of this study was to identify validated self-reported tools for assessment of movement behaviours across the whole 24-h day, and to review their attributes and measurement properties. METHODS The databases PubMed, Scopus, and SPORTDiscus were searched until September 2023. Inclusion criteria were: (i) published in English language, (ii) per-reviewed paper, (iii) assessment of self-reported time spent in sleep, SB, and physical activity, (iv) evaluation of measurement properties of all estimates across the full 24-h day, and (v) inclusion of adolescents, adults, or older adults. The methodological quality of included studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments checklist. RESULTS Our search returned 2064 records. After studies selection, we included 16 articles that reported construct validity and/or test-retest reliability of 12 unique self-reported tools - eight questionnaires, three time-use recalls, and one time-use diary. Most tools enable assessment of time spent in sleep, and domain-specific SB and physical activity, and account that sum of behaviours should be 24 h. Validity (and reliability) correlation coefficients for sleep ranged between 0.22 and 0.69 (0.41 and 0.92), for SB between 0.06 and 0.57 (0.33 and 0.91), for light-intensity physical activity between 0.18 and 0.46 (0.55 and 0.94), and for moderate- to vigorous-intensity physical activity between 0.38 and 0.56 (0.59 and 0.94). The quality of included studies being mostly fair-to-good. CONCLUSIONS This review found that only a limited number of validated self-reported tools for assessment of 24-h movement behaviours are currently available. Validity and reliability of most tools are generally adequate to be used in epidemiological studies and population surveillance, while little is known about adequacy for individual level assessments and responsiveness to behavioural change. To further support research, policy, and practice, there is a need to develop new tools that resonate with the emerging 24-h movement paradigm and to evaluate measurement properties by using compositional data analysis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022330868.
Collapse
Affiliation(s)
- Anja Šuc
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Lea Einfalt
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
- InnoRenew CoE, Izola, Slovenia
| | - Kaja Kastelic
- InnoRenew CoE, Izola, Slovenia.
- Andrej Marušič Institute, University of Primorska, Koper, Slovenia.
| |
Collapse
|
22
|
Young CA, Chaouch A, Mcdermott CJ, Al-Chalabi A, Chhetri SK, Talbot K, Harrower T, Orrell RW, Annadale J, Hanemann CO, Scalfari A, Tennant A, Mills R. Dyspnea (breathlessness) in amyotrophic lateral sclerosis/motor neuron disease: prevalence, progression, severity, and correlates. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:475-485. [PMID: 38465877 DOI: 10.1080/21678421.2024.2322545] [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: 12/12/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Dyspnea, or breathlessness, is an important symptom in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). We examined the measurement properties of the Dyspnea-12. METHODS Rasch analysis enabled conversion of raw Dyspnea-12 scores to interval level metric equivalents. Converted data were used to perform trajectory modeling; those following different trajectories were compared for demographic, clinical, symptom, and functioning characteristics. Logistic regression examined differences between distinct trajectories. RESULTS In 1022 people, at baseline, mean metric Dyspnea-12 was 7.6 (SD 9.3). 49.8% had dyspnea, severe in 12.6%. Trajectory analysis over 28 months revealed three breathlessness trajectories: group 1 reported none at baseline/follow-up (42.7%); group 2 significantly increased over time (9.4%); group 3 had a much higher level at baseline which rose over follow-up (47.9%). Group 3 had worse outcomes on all symptoms, functioning and quality of life; compared to group 1, their odds of: respiratory onset sixfold greater; King's stage ≥3 2.9 greater; increased odds of being bothered by choking, head drop, fasciculations, and muscle cramps; fatigue and anxiety also elevated (p < .01). CONCLUSION Dyspnea is a cardinal symptom in ALS/MND and can be quickly measured using the Dyspnea-12. Raw scores can easily be converted to interval level measurement, for valid change scores and trajectory modeling. Dyspnea trajectories reveal different patterns, showing that clinical services must provide monitoring which is customized to individual patient need. Almost half of this large population had worsening dyspnea, confirming the importance of respiratory monitoring and interventions being integrated into routine ALS care.
Collapse
Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Amina Chaouch
- Greater Manchester Centre for Clinical Neurosciences, Salford, UK
| | | | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Department of Neurology, King's College Hospital, London, UK
| | | | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Joe Annadale
- Hywel Dda University Health Board, Carmarthen, UK
| | - C Oliver Hanemann
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Roger Mills
- Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
23
|
Zingelman S, Cadilhac DA, Kim J, Stone M, Harvey S, Unsworth C, O'Halloran R, Hersh D, Mainstone K, Wallace SJ. 'A Meaningful Difference, but Not Ultimately the Difference I Would Want': A Mixed-Methods Approach to Explore and Benchmark Clinically Meaningful Changes in Aphasia Recovery. Health Expect 2024; 27:e14169. [PMID: 39105687 DOI: 10.1111/hex.14169] [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: 04/01/2024] [Revised: 07/07/2024] [Accepted: 07/20/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Outcome measurement instruments (OMIs) are used to gauge the effects of treatment. In post-stroke aphasia rehabilitation, benchmarks for meaningful change are needed to support the interpretation of patient outcomes. This study is part of a research programme to establish minimal important change (MIC) values (the smallest change above which patients perceive themselves as importantly changed) for core OMIs. As a first step in this process, the views of people with aphasia and clinicians were explored, and consensus was sought on a threshold for clinically meaningful change. METHODS Sequential mixed-methods design was employed. Participants included people with post-stroke aphasia and speech pathologists. People with aphasia were purposively sampled based on time post-stroke, age and gender, whereas speech pathologists were sampled according to their work setting (hospital or community). Each participant attended a focus group followed by a consensus workshop with a survey component. Within the focus groups, experiences and methods for measuring meaningful change during aphasia recovery were explored. Qualitative data were transcribed and analysed using reflexive thematic analysis. In the consensus workshop, participants voted on thresholds for meaningful change in core outcome constructs of language, communication, emotional well-being and quality of life, using a six-point rating scale (much worse, slightly worse, no change, slightly improved, much improved and completely recovered). Consensus was defined a priori as 70% agreement. Voting results were reported using descriptive statistics. RESULTS Five people with aphasia (n = 4, > 6 months after stroke; n = 5, < 65 years; n = 3, males) and eight speech pathologists (n = 4, hospital setting; n = 4, community setting) participated in one of four focus groups (duration: 92-112 min). Four themes were identified describing meaningful change as follows: (1) different for every single person; (2) small continuous improvements; (3) measured by progress towards personally relevant goals; and (4) influenced by personal factors. 'Slightly improved' was agreed as the threshold of MIC on the anchor-rating scale (75%-92%) within 6 months of stroke, whereas after 6 months there was a trend towards supporting 'much improved' (36%-66%). CONCLUSION Our mixed-methods research with people with aphasia and speech pathologists provides novel evidence to inform the definition of MIC in aphasia rehabilitation. Future research will aim to establish MIC values for core OMIs. PATIENT OR PUBLIC CONTRIBUTION This work is the result of engagement between people with lived experience of post-stroke aphasia, including people with aphasia, family members, clinicians and researchers. Engagement across the research cycle was sought to ensure that the research tasks were acceptable and easily understood by participants and that the outcomes of the study were relevant to the aphasia community. This engagement included the co-development of a plain English summary of the results. Advisors were remunerated in accordance with Health Consumers Queensland guidelines. Interview guides for clinicians were piloted by speech pathologists working in aphasia rehabilitation.
Collapse
Affiliation(s)
- Sally Zingelman
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, St Lucia, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Marissa Stone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, St Lucia, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Sam Harvey
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, St Lucia, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| | - Carolyn Unsworth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Robyn O'Halloran
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Deborah Hersh
- Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Kathryn Mainstone
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, St Lucia, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Queensland, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre, The University of Queensland, St Lucia, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Queensland, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Meng CF, Lee YC, Schieir O, Valois MF, Butler MA, Boire G, Hazlewood G, Hitchon C, Keystone E, Tin D, Thorne C, Bessette L, Pope J, Bartlett SJ, Bykerk VP. Having More Tender Than Swollen Joints Is Associated With Worse Patient-Reported Outcomes in Patients With Early RA. J Clin Rheumatol 2024; 30:193-199. [PMID: 38689390 PMCID: PMC11388901 DOI: 10.1097/rhu.0000000000002091] [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] [Indexed: 05/02/2024]
Abstract
BACKGROUND/OBJECTIVE In patients with rheumatoid arthritis (RA), high tender-swollen joint differences (TSJDs) have been associated with worse outcomes. A better understanding of the phenotype and impact of high TSJD on patient-reported outcomes (PROs) in early RA may lead to earlier personalized treatment targeting domains that are important to patients today. Our objectives were to evaluate the impact of TSJD on updated PROs in patients with early RA over 1 year and to determine differences in associations by joint size. METHODS This longitudinal cohort study followed patients with active, early RA enrolled in the Canadian Early Arthritis Cohort between 2016 and 2022, who completed clinical assessments and PROMIS-29 measures over 1 year. Twenty-eight joint counts were performed and TSJDs calculated. Adjusted associations between TSJD and PROMIS-29 scores were estimated using separate linear-mixed models. Separate analyses of large versus small-joint TJSDs were performed. RESULTS Patients with early RA (n = 547; 70% female; mean [SD] age, 56 [15] years; mean [SD] symptom duration, 5.3 [2.9] months) were evaluated. A 1-point increase in TSJD was significantly associated with worse PROMIS T-scores in all domains: physical function (adjusted regression coefficient, -0.27; 95% confidence interval [CI], -0.39, -0.15), social participation (adjusted regression coefficient, -0.34; 95% CI, -0.50, -0.19), pain interference (adjusted regression coefficient, 0.49; 95% CI, 0.35, 0.64), sleep problems (adjusted regression coefficient, 0.29; 95% CI, 0.16, 0.43), fatigue (adjusted regression coefficient, 0.34; 95% CI, 0.18, 0.50), anxiety (adjusted regression coefficient, 0.23; 95% CI, 0.08, 0.38), and depression (adjusted regression coefficient, 0.20; 95% CI, 0.06, 0.35). Large-joint TSJD was associated with markedly worse PROs compared with small-joint TSJD. CONCLUSIONS Elevated TSJD is associated with worse PROs particularly pain interference, social participation, and fatigue. Patients with more tender than swollen joints, especially large joints, may benefit from earlier, targeted therapeutic interventions.
Collapse
Affiliation(s)
- Charis F Meng
- From the Hospital for Special Surgery, Division of Rheumatology, Weill Cornell Medical College, New York, NY
| | - Yvonne C Lee
- Northwestern University Feinberg School of Medicine, Medicine/Rheumatology, Chicago, Illinois
| | - Orit Schieir
- University of Toronto, Dalla Lana School of Public Health
| | | | - Margaret A Butler
- Hospital for Special Surgery, Division of Rheumatology, New York, NY
| | - Gilles Boire
- Université de Sherbrooke, Medicine, Quebec, Canada
| | - Glen Hazlewood
- University of Calgary, Department of Medicine, Alberta, Canada
| | - Carol Hitchon
- University of Manitoba, Department of Internal Medicine, Winnipeg, Canada
| | | | - Diane Tin
- University of Toronto, Ontario, Canada
| | - Carter Thorne
- Southlake Regional Health Centre, Centre of Arthritis Excellence, TAP Research Group, Ontario, Canada
| | | | - Janet Pope
- University of Western Ontario, London, Ontario, Canada
| | | | - Vivian P Bykerk
- Hospital for Special Surgery and Mount Sinai Hospital, Weill Cornell Medical College, New York, NY
| |
Collapse
|
25
|
Skatteboe S, Røe C, Heide M, Brox JI, Ignatius J, Bratsberg A, Wilhelmsen M, Bjørneboe J. Responsiveness and minimal important change of specific and generic patient-reported outcome measures for back patients: the Norwegian Neck and Back Register. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2960-2968. [PMID: 39007982 DOI: 10.1007/s00586-024-08394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/17/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To evaluate responsiveness and minimal important change (MIC) of Oswestry Disability Index (ODI), pain during activity on a numeric rating scale (NRSa) and health related quality of life (EQ-5D) based on data from the Norwegian neck and back registry (NNRR). METHODS A total of 1617 patients who responded to NNRR follow-up after both 6 and 12 months were included in this study. Responsiveness was calculated using standardized response mean and area under the receiver operating characteristic (ROC) curve. We calculated MIC with both an anchor-based and distribution-based method. RESULTS The condition specific ODI had best responsiveness, the more generic NRSa and EQ-5D had lower responsiveness. We found that the MIC for ODI varied from 3.0 to 9.5, from 0.4 to 2.5 for NRSa while the EQ5D varied from 0.05 to 0.12 depending on the method for calculation. CONCLUSION In a register based back pain population, the condition specific ODI was more responsive to change than the more generic tools NRSa and EQ5D. The variations in responsiveness and MIC estimates also indicate that they should be regarded as indicative, rather than fixed estimates.
Collapse
Affiliation(s)
- Sigrid Skatteboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marte Heide
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Janica Ignatius
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Andrea Bratsberg
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Maja Wilhelmsen
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Norwegian Neck and Back Registry, University Hospital of North Norway, Tromsø, Norway
| | - John Bjørneboe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
26
|
Phongsaphakjarukorn N, Kanlayanaphotporn R, Jensen MP, Janwantanakul P. Responsiveness and clinically important differences of the PROMIS short form-depression 8a, anxiety 8a, and PASS-20 in individuals with chronic low back pain. Pain Rep 2024; 9:e1170. [PMID: 38910868 PMCID: PMC11191038 DOI: 10.1097/pr9.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Depression and anxiety are the most commonly reported mental health conditions. The Patient-Reported Outcomes Measurement Information System Short Form v1.0-Depression 8a (PROMIS-D-8a), Anxiety 8a (PROMIS-Anx8a), and Pain Anxiety Symptoms Scale-20 (PASS-20) measures were designed to assess depression, general anxiety, and pain-related anxiety, respectively. Objectives To examine the responsiveness and estimate the clinically important differences (CIDs) of the Thai version of these measures in individuals with chronic low back pain (CLBP). Methods The study sample comprised 144 participants with CLBP. Responsiveness was evaluated by calculating the change scores, effect sizes (ESs), standardized response means (SRMs), area under the curve (AUC), and correlations between the change scores and associated Global Perceived Effect (GPE). We also estimated CIDs by the difference in mean change score between improved and unchanged groups and standard error of measurement (SEM) for each measure. Results Statistically significant differences in the mean change scores, ESs, and SRMs supported the responsiveness of all measures. The AUCs achieved acceptable discriminatory ability (0.71-0.72) for moderate improvement but not for any improvement (0.65-0.68). The correlations between GPE and change scores on all measures were low (r ranging 0.28-0.33). The estimated CIDs for the PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 were 3.64, 4.20, and 8.80, respectively. Conclusion The PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 measures were sensitive for detecting clinical changes over time in individuals with CLBP. The CID values can be used as reference points for assessing meaningful improvements in the domains assessed by these scales in clinical and research practice.
Collapse
Affiliation(s)
| | - Rotsalai Kanlayanaphotporn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
27
|
Cheng LJ, Chen LA, Cheng JY, Herdman M, Luo N. Systematic review reveals that EQ-5D minimally important differences vary with treatment type and may decrease with increasing baseline score. J Clin Epidemiol 2024; 174:111487. [PMID: 39084578 DOI: 10.1016/j.jclinepi.2024.111487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/04/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES To provide an updated summary of published anchor-based Minimally Important Difference (MID) estimates for the EQ-5D index and EQ visual analog scale (EQ VAS) scores and identify factors influencing those estimates. STUDY DESIGN AND SETTING We systematically searched eight electronic databases from January 1990 to March 2023. We examined the association of baseline score, type of score change (improvement/worsening), data source, value set, disease/condition, treatment type (surgical/non-surgical), and type of anchor (clinical vs. self-rated) with MID estimates for the EQ-5D-3L and EQ-5D-5L indices, and EQ VAS. Significant variables were used to develop prediction formulas for MID by testing both linear and nonlinear regression models. RESULTS Of 6786 records reviewed, 47 articles were included for analysis. MID ranges for improved scores were -0.13 to 0.68 (EQ-5D-3L), 0.01-0.41 (EQ-5D-5L), and 0.42-23.0 (EQ VAS). Surgical intervention and lower baseline scores were associated with higher MIDs for both the EQ indices but not for EQ VAS. The nonlinear polynomial model outperformed the linear model in predicting the MIDs. MIDs based on deteriorated scores were insufficient for quantitative synthesis (mean: -0.02 for EQ-5D-3L; -0.04 for EQ-5D-5L; and -6.5 for EQ VAS). CONCLUSION This review revealed that the MID of EQ-5D index scores varies with baseline score and treatment type, indicating that use of a uniform MID may not be appropriate. We recommend using baseline score-adjusted and treatment type-specific EQ-5D MIDs, and call for more MID research, particularly in the context of assessing deterioration in health using this widely used generic health-status instrument.
Collapse
Affiliation(s)
- Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Le Ann Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jing Ying Cheng
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
| | - Michael Herdman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Health Outcomes Research, Office of Health Economics, London, UK
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
28
|
Van Citters AD, Aliaj E, Alvarez JA, Brown CD, Cary J, Cravens R, Frederick CA, Georgiopoulos AM, Goss CH, Kazmerski TM, King JR, Lawrence M, Lovell C, Roman C, Tillman L, Yu E. Wellness in the modulator era: An observational study of the impact of CFTR modulator therapy on the well-being of people with cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00779-3. [PMID: 39060182 DOI: 10.1016/j.jcf.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/03/2024] [Accepted: 06/15/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND People with cystic fibrosis (PwCF) have experienced substantial improvements in health following use of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies. However, less is known about how modulator therapies impact well-being. METHODS We used a cross-sectional observational study to identify relationships between CFTR modulator therapies, health-related quality of life (HRQoL), and well-being. Adult PwCF and caregivers of children with CF completed the Wellness in the Modulator Era (Well-ME) survey between June 22 and July 31, 2022. HRQoL was measured with PROMIS Global 10/Global 7 + 2 Parent Proxy. We used a mixed methods analysis to compare experiences and concerns of PwCF who currently (n = 665), no longer (n = 51), or never (n = 184) took modulator therapy. RESULTS Adult PwCF taking a modulator (n = 416) reported better PROMIS global physical health than those who no longer (n = 37) or never took a modulator (n = 94) and better PROMIS global mental health than those who never took a modulator. Caregiver-reported HRQoL was similar across children with CF who currently, no longer, or never took a modulator. PwCF taking a modulator reported larger improvements in physical health, quality of life, social well-being, and treatment burden than those who no longer or never took a modulator. Nearly one-quarter (23 %) of PwCF taking modulator therapy reported worsening of mental well-being. CONCLUSIONS This study expands our knowledge of well-being among PwCF in the CFTR modulator era as reported by patients and parents. Findings lay the groundwork for establishing future research priorities, policy efforts, and communications in areas that improve well-being for PwCF.
Collapse
Affiliation(s)
- Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Level 5 WTRB, One Medical Center Drive, Lebanon, NH, USA.
| | - Enid Aliaj
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Lipids, and Metabolism, Department of Medicine, Emory University, 101 Woodruff Cr NE, Atlanta, GA 30322, USA
| | - Cynthia D Brown
- Indiana University School of Medicine, Division of Pulmonary, Critical Care, Occupational and Sleep Medicine, 1120W. Michigan St, Indianapolis, IN 46202, USA
| | - Jamie Cary
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| | - Rachel Cravens
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Carla A Frederick
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences of the University of Buffalo, 1001 Main Street, Conventus Building, 4th floor, Buffalo, NY 14023, USA
| | - Anna M Georgiopoulos
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Yawkey 6900, 55 Fruit St., Boston, MA 02114, USA
| | - Christopher H Goss
- Division of Pulmonary, Critical Care, and Sleep Medicine Department of Medicine and Pediatrics, University of Washington Medical Center, Seattle, Washington, United States; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, University Center, 120 Lytton Avenue, Suite M060, Pittsburgh, PA, USA
| | - Joel R King
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Level 5 WTRB, One Medical Center Drive, Lebanon, NH, USA
| | - Melanie Lawrence
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Caitlyn Lovell
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Christina Roman
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| | - Laura Tillman
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - Elizabeth Yu
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100N, Bethesda, MD, USA
| |
Collapse
|
29
|
Pak SS, Scheid A, Hoang C, Fitzsimmons A, Topp KS. Implementation of High-Value Care for Physical Therapy Residents Through Systems-Based Practice Curriculum Development: Case Report. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00118. [PMID: 38978183 DOI: 10.1097/jte.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/30/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND PURPOSE Systems-based practice is a core competency for physical therapy residents, best acquired through experiential learning. Peer health professions are further along than physical therapy in implementing curricula that support systems-based practice. Clinical and practice data in residency programs could provide for education in high-value care (HVC) as a foundation for systems-based practice. Our purpose was to develop and assess a HVC curriculum incorporating reflective practice to help residents achieve competency in systems-based practice. CASE DESCRIPTION The Logic Model, which evaluates key components needed for success and sustainability, was used to identify resources for a curriculum in HVC. Two orthopedic physical therapy residents and 5 faculty mentors participated in didactic and mentoring sessions. A practice dashboard for each clinician was developed to facilitate resident-mentor discussions. Focus group input was used to refine the curriculum. The validated Systems Thinking Scale, the Quality Improvement Knowledge Application Tool Rubric, and the American Physical Therapy Association Residency Core Competency Score were used to assess residents' progress and to make comparisons to prior years' residents. OUTCOMES The residents demonstrated increases in systems thinking and quality-improvement knowledge and improvements in clinical outcomes and practice efficiencies. Three themes emerged from semistructured interviews: challenges to HVC, current approach in HVC, and future-oriented thinking in HVC in practice. DISCUSSION AND CONCLUSION This study demonstrates that HVC activities and a personalized clinical dashboard in a physical therapy residency program can facilitate experiential learning of systems-based practice, a core competency for value-centered, inclusive practice.
Collapse
Affiliation(s)
- Sang S Pak
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Alison Scheid
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Cathy Hoang
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Amber Fitzsimmons
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| | - Kimberly S Topp
- Sang S. Pak is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco, 1500 Owens St Suite 400, San Francisco, CA, 94158 . Please address all correspondence to Sang S. Pak
- Alison Scheid is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Cathy Hoang is an assistant professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Amber Fitzsimmons is an associate professor in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
- Kimberly S. Topp is a professor emeritus in the Department of Physical Therapy and Rehabilitation Science at the University of California San Francisco
| |
Collapse
|
30
|
Liu Y, Tan M, Hu K, Deng S, Jian L, Chen J, Zhang M, Kuang Y. Defining the Minimal Important Change and Meaningful Change Value of the Disease Activity Index for Psoriatic Arthritis: A Chinese Longitudinal Study. J Rheumatol 2024; 51:678-681. [PMID: 38490673 DOI: 10.3899/jrheum.2023-1085] [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] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To determine the minimal important change (MIC) and meaningful change value (MCV) of the Disease Activity Index for Psoriatic Arthritis (DAPSA) and the effect size (ES) of DAPSA. METHODS This was a retrospective cohort study, recruiting 106 patients who agreed to participate in the research from the Department of Dermatology, Xiangya Hospital, between November 1, 2019, and April 1, 2023. An anchor-based method using linear regression analyses was used to determine the MICs and MCVs of the DAPSA. The anchor question assessed whether the patient's well-being had changed since their previous visit, employing a 5-point Likert scale that ranged from "much improved" to "much deteriorated." RESULTS The overall MIC value was 8.4 (95% CI 0.01-16.75). The MIC improvement was 9.5 (95% CI 0.89-18.14) and MIC deterioration was 1.1 (95% CI -9.81 to 12.05). The overall MCV was 10.5 (95% CI 4.34-16.72). MCV improvement was 11.4 (95% CI 5.95-16.95) and MCV deterioration was 1.1 (95% CI -9.81 to 12.05). The ES was 0.6. CONCLUSION A change in DAPSA of 8.4 is indicative of an MIC, offering physicians an additional means to contextualize the patient's perception of disease activity during treatment, and a change in DAPSA of 10.5 is likely to be regarded as MCV. These values can enhance the utility of DAPSA in psoriatic arthritis clinical trials.
Collapse
Affiliation(s)
- Yijie Liu
- Y. Liu, BS, K. Hu, BS, S. Deng, BS, L. Jian, BS, J. Chen, MD, M. Zhang, MD, Y. Kuang, MD, Department of Dermatology, Xiangya Hospital, Central South University, and National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), and Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), and Department of Network Information Center, Xiangya Hospital, Central South University, Changsha
| | - Minjia Tan
- M. Tan, BS, Department of Dermatology, Xiangya Hospital, Central South University, Changsha, and Department of Dermatology, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Kun Hu
- Y. Liu, BS, K. Hu, BS, S. Deng, BS, L. Jian, BS, J. Chen, MD, M. Zhang, MD, Y. Kuang, MD, Department of Dermatology, Xiangya Hospital, Central South University, and National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), and Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), and Department of Network Information Center, Xiangya Hospital, Central South University, Changsha
| | - Sichun Deng
- Y. Liu, BS, K. Hu, BS, S. Deng, BS, L. Jian, BS, J. Chen, MD, M. Zhang, MD, Y. Kuang, MD, Department of Dermatology, Xiangya Hospital, Central South University, and National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), and Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), and Department of Network Information Center, Xiangya Hospital, Central South University, Changsha
| | - Lu Jian
- Y. Liu, BS, K. Hu, BS, S. Deng, BS, L. Jian, BS, J. Chen, MD, M. Zhang, MD, Y. Kuang, MD, Department of Dermatology, Xiangya Hospital, Central South University, and National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), and Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), and Department of Network Information Center, Xiangya Hospital, Central South University, Changsha
| | - Junchen Chen
- Y. Liu, BS, K. Hu, BS, S. Deng, BS, L. Jian, BS, J. Chen, MD, M. Zhang, MD, Y. Kuang, MD, Department of Dermatology, Xiangya Hospital, Central South University, and National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), and Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), and Department of Network Information Center, Xiangya Hospital, Central South University, Changsha
| | - Mi Zhang
- Y. Liu, BS, K. Hu, BS, S. Deng, BS, L. Jian, BS, J. Chen, MD, M. Zhang, MD, Y. Kuang, MD, Department of Dermatology, Xiangya Hospital, Central South University, and National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), and Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), and Department of Network Information Center, Xiangya Hospital, Central South University, Changsha;
| | - Yehong Kuang
- Y. Liu, BS, K. Hu, BS, S. Deng, BS, L. Jian, BS, J. Chen, MD, M. Zhang, MD, Y. Kuang, MD, Department of Dermatology, Xiangya Hospital, Central South University, and National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), and Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), and Department of Network Information Center, Xiangya Hospital, Central South University, Changsha;
| |
Collapse
|
31
|
You DS, Chong JL, Mackey SC, Poupore-King H. Utilizing a learning health system to capture real-world patient data: Application of the reliable change index to evaluate and improve the outcome of a pain rehabilitation program. Pain Pract 2024; 24:856-865. [PMID: 38465804 DOI: 10.1111/papr.13364] [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] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND OBJECTIVES The learning healthcare system (LHS) has been developed to integrate patients' clinical data into clinical decisions and improve treatment outcomes. Having little guidance on this integration process, we aim to explain (a) an applicable analytic tool for clinicians to evaluate the clinical outcomes at a group and an individual level and (b) our quality improvement (QI) project, analyzing the outcomes of a new outpatient pain rehabilitation program ("Back-in-Action": BIA) and applying the analysis results to modify our clinical practice. METHODS Through our LHS (CHOIR; https://choir.stanford.edu), we administered the Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ), and Patient-Reported Outcomes Measures (PROMIS)® before and after BIA. After searching for appropriate analytic tools, we decided to use the Reliable Change Index (RCI) to determine if an observed change in the direction of better (improvement) or worse (deterioration) would be beyond or within the measurement error (no change). RESULTS Our RCI calculations revealed that at least a 9-point decrease in the PCS scores and 10-point increase in the CPAQ scores would indicate reliable improvement. RCIs for the PROMIS measures ranged from 5 to 8 T-score points (i.e., 0.5-0.8 SD). When evaluating change scores of the PCS, CPAQ, and PROMIS measures, we found that 94% of patients showed improvement in at least one domain after BIA and 6% showed no reliable improvement. CONCLUSIONS Our QI project revealed RCI as a useful tool to evaluate treatment outcomes at a group and an individual level, and RCI could be incorporated into the LHS to generate a progress report automatically for clinicians. We further explained how clinicians could use RCI results to modify a clinical practice, to improve the outcomes of a pain program, and to develop individualized care plans. Lastly, we suggested future research areas to improve the LHS application in pain practice.
Collapse
Affiliation(s)
- Dokyoung S You
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jeanette L Chong
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Heather Poupore-King
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
32
|
Siwakoti K, Harmon C, Al-Obaidi M, Basu A, Williams GR. Association of frailty with health-related quality of life and survival among older adults with prostate cancer. J Geriatr Oncol 2024; 15:101812. [PMID: 38902148 DOI: 10.1016/j.jgo.2024.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Krishmita Siwakoti
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Christian Harmon
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arnab Basu
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
33
|
Noij LCE, Blankestijn JM, Lap CR, van Houten MA, Biesbroek G, der Zee AHMV, Abdel-Aziz MI, van Goudoever JB, Alsem MW, Brackel CLH, Oostrom KJ, Hashimoto S, Terheggen-Lagro SWJ. Clinical-based phenotypes in children with pediatric post-COVID-19 condition. World J Pediatr 2024; 20:682-691. [PMID: 38664324 PMCID: PMC11269322 DOI: 10.1007/s12519-024-00805-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/07/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Pediatric post coronavirus disease 2019 (COVID-19) condition (PPCC) is a heterogeneous syndrome, which can significantly affect the daily lives of children. This study aimed to identify clinically meaningful phenotypes in children with PPCC, to better characterize and treat this condition. METHODS Participants were children with physician-diagnosed PPCC, referred to the academic hospital Amsterdam UMC in the Netherlands between November 2021 and March 2023. Demographic factors and information on post-COVID symptoms, comorbidities, and impact on daily life were collected. Clinical clusters were identified using an unsupervised and unbiased approach for mixed data types. RESULTS Analysis of 111 patients (aged 3-18 years) revealed three distinct clusters within PPCC. Cluster 1 (n = 62, median age = 15 years) predominantly consisted of girls (74.2%). These patients suffered relatively more from exercise intolerance, dyspnea, and smell disorders. Cluster 2 (n = 33, median age = 13 years) contained patients with an even gender distribution (51.5% girls). They suffered from relatively more sleep problems, memory loss, gastrointestinal symptoms, and arthralgia. Cluster 3 (n = 16, median age = 11 years) had a higher proportion of boys (75.0%), suffered relatively more from fever, had significantly fewer symptoms (median of 5 symptoms compared to 8 and 10 for clusters 1 and 2 respectively), and experienced a lower impact on daily life. CONCLUSIONS This study identified three distinct clinical PPCC phenotypes, with variations in sex, age, symptom patterns, and impact on daily life. These findings highlight the need for further research to understand the potentially diverse underlying mechanisms contributing to post-COVID symptoms in children.
Collapse
Affiliation(s)
- Lieke C E Noij
- Department of Pediatric Pulmonology and Allergy, Amsterdam UMC, Location AMC, Emma Children's Hospital, Amsterdam University Medical Center, Room G2-222, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands.
| | | | - Coen R Lap
- Department of Pediatric Pulmonology and Allergy, Amsterdam UMC, Location AMC, Emma Children's Hospital, Amsterdam University Medical Center, Room G2-222, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - Giske Biesbroek
- Department of Pediatric Pulmonology and Allergy, Amsterdam UMC, Location AMC, Emma Children's Hospital, Amsterdam University Medical Center, Room G2-222, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | | | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mattijs W Alsem
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Caroline L H Brackel
- Department of Paediatric Pulmonology, Department of Paediatrics, Tergooi MC, Hilversum, The Netherlands
| | - Kim J Oostrom
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Simone Hashimoto
- Department of Pediatric Pulmonology and Allergy, Amsterdam UMC, Location AMC, Emma Children's Hospital, Amsterdam University Medical Center, Room G2-222, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology and Allergy, Amsterdam UMC, Location AMC, Emma Children's Hospital, Amsterdam University Medical Center, Room G2-222, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Alkan A, Carrier ME, Henry RS, Kwakkenbos L, Bartlett SJ, Gietzen A, Gottesman K, Guillot G, Lawrie-Jones A, Hudson M, Hummers LK, Malcarne VL, Mayes MD, Mouthon L, Richard M, Wojeck RK, Worron-Sauvé M, Benedetti A, Thombs BD. Minimal Detectable Changes of the Health Assessment Questionnaire-Disability Index, Patient-Reported Outcomes Measurement Information System-29 Profile Version 2.0 Domains, and Patient Health Questionnaire-8 in People With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Cross-Sectional Study. Arthritis Care Res (Hoboken) 2024. [PMID: 38932481 DOI: 10.1002/acr.25397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a rare, chronic autoimmune disorder associated with disability, diminished physical function, fatigue, pain, and mental health concerns. We assessed minimal detectable changes (MDCs) of the Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient-Reported Outcomes Measurement Information System-29 Profile version 2.0 (PROMIS-29v2.0) domains, and Patient Health Questionnaire (PHQ)-8 in people with SSc. METHODS Scleroderma Patient-Centered Intervention Network Cohort participants completed the HAQ-DI, PROMIS-29v2.0 domains, and PHQ-8 at baseline assessments from April 2014 until August 2023. We estimated MDC95 (smallest change that can be detected with 95% certainty) and MDC90 (smallest change that can be detected with 90% certainty) with 95% confidence intervals (CIs) generated via the percentile bootstrapping method resampling 1,000 times. We compared MDC estimates by age, sex, and SSc subtype. RESULTS A total of 2,571 participants were included. Most were female (n = 2,241; 87%), and 38% (n = 976) had diffuse SSc. Mean (±SD) age was 54.9 (±12.7) years and duration since onset of first non-Raynaud phenomenon symptom was 10.8 (±8.7) years. MDC95 estimate was 0.41 points (95% CI 0.40-0.42) for the HAQ-DI, between 4.88 points (95% CI 4.72-5.05) and 9.02 points (95% CI 8.80-9.23) for the seven PROMIS-29v2.0 domains, and 5.16 points (95% CI 5.06-5.26) for the PHQ-8. MDC95 estimates were not materially different across subgroups. CONCLUSION MDC95 and MDC90 estimates were precise and similar across age, sex, and SSc subtype groups. HAQ-DI MDC95 and MDC90 were substantially larger than previous estimates of HAQ-DI minimal important difference from several small studies. Minimally important differences of all measures should be evaluated in large studies using anchor-based methods.
Collapse
Affiliation(s)
- Afra Alkan
- Lady Davis Institute for Medical Research and McGill University, Montreal, Quebec, Canada, and Ankara Yildirim Beyazit University, Ankara, Turkey
| | | | - Richard S Henry
- Lady Davis Institute for Medical Research and McGill University, Montreal, Quebec, Canada
| | - Linda Kwakkenbos
- Radboud University and Radboud University Medical Center, Nijmegen, The Netherlands
| | - Susan J Bartlett
- McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Amy Gietzen
- National Scleroderma Foundation, Buffalo, New York
| | | | | | | | - Marie Hudson
- Lady Davis Institute for Medical Research and McGill University, Montreal, Quebec, Canada
| | - Laura K Hummers
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Luc Mouthon
- Hôpital Cochin and Université Paris Cité, Paris, France
| | | | | | | | - Andrea Benedetti
- McGill University and McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research and McGill University, Montreal, Quebec, Canada
| |
Collapse
|
35
|
Moskowitz JT, Jackson KL, Cummings P, Addington EL, Freedman ME, Bannon J, Lee C, Vu TH, Wallia A, Hirschhorn LR, Wilkins JT, Evans C. Feasibility, acceptability, and efficacy of a positive emotion regulation intervention to promote resilience for healthcare workers during the COVID-19 pandemic: A randomized controlled trial. PLoS One 2024; 19:e0305172. [PMID: 38913665 PMCID: PMC11195972 DOI: 10.1371/journal.pone.0305172] [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: 10/02/2023] [Accepted: 05/23/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Burnout poses a substantial, ongoing threat to healthcare worker (HCW) wellbeing and to the delivery of safe, quality healthcare. While systemic and organization-level changes in healthcare are critically important, HCWs also need individual-level skills to promote resilience. The objective of this trial is to test feasibility, acceptability, and efficacy of PARK, an online self-guided positive affect regulation intervention, in a sample of healthcare workers during the COVID-19 pandemic. DESIGN AND METHODS In the context of the unprecedented rise in burnout during the COVID-19 pandemic, we conducted a randomized waitlist-controlled trial of the Positive Affect Regulation sKills (PARK) program-a five-week, online, self-guided coping skills intervention nested within an ongoing cohort of HCWs. N = 554 healthcare workers were randomly assigned to receive the intervention immediately or to receive the intervention after approximately 12 weeks. Outcomes included change in burnout, emotional wellbeing (positive affect, meaning and purpose, depression, anxiety) and sleep over approximately 12 weeks. Analyses included mixed-effects linear regression models comparing change over time in outcomes between intervention and control conditions. RESULTS One third (n = 554) of the participants in the cohort of HCWs consented to participate and enrolled in PARK in April 2022. Compared to those who did not enroll, participants in the trial reported higher burnout, poorer emotional wellbeing, and poorer sleep at baseline (April, 2022; all ps < .05). Intent-to-treat analyses showed that participants randomly assigned to the intervention immediately (PARK-Now) improved significantly on anxiety (within-group change on PROMIS T-score = -0.63; p = .003) whereas those in the waitlist (PARK-Later) did not (within group T-score change 0.04, p = 0.90). The between-group difference in change, however, was not statistically significant (B = -0.67 p = 0.10). None of the other wellbeing outcomes changed significantly in the intervention group compared to the waitlist. Additional as-treated analyses indicated that those participants who completed all 5 of the weekly online lessons (N = 52; 9.4%) improved significantly more on the primary outcome of positive affect compared to those who enrolled in PARK but completed zero lessons (n = 237; 42.8%; B = 2.85; p = .0001). CONCLUSIONS Online self-guided coping skills interventions like PARK can be effective in targeted samples and future work will focus on adaptations to increase engagement and tailor PARK for HCWs who could most benefit.
Collapse
Affiliation(s)
- Judith Tedlie Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Kathryn L. Jackson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Peter Cummings
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Elizabeth L. Addington
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Melanie E. Freedman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Jacquelyn Bannon
- Institute for Public Health and Medicine, Center for Education in Health Sciences, Northwestern University, Chicago, IL, United States of America
| | - Cerina Lee
- Institute for Public Health and Medicine, Center for Education in Health Sciences, Northwestern University, Chicago, IL, United States of America
| | - Thanh Huyen Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Amisha Wallia
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Institute for Public Health and Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - John T. Wilkins
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Charlesnika Evans
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, United States of America
| |
Collapse
|
36
|
Ramalho RB, Casonato NA, Montilha VB, Chaves TC, Mattiello SM, Selistre LFA. Construct Validity and Responsiveness of Performance-based Tests in Individuals With Knee Osteoarthritis. Arch Phys Med Rehabil 2024:S0003-9993(24)01043-8. [PMID: 38851556 DOI: 10.1016/j.apmr.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES To assess the construct validity and responsiveness of 3 performance-based tests in individuals with knee osteoarthritis (KOA). DESIGN This study has a prospective cohort design. SETTING Assessments were administered at the Federal University of São Carlos (Brazil) by 3 different raters. PARTICIPANTS A total of 107 participants with KOA were aged ≥40 years (N=107). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE This study assessed the construct validity and responsiveness of 3 performance-based tests: 40-meter fast-paced walk test (40-m FPWT), 11-step stair climb test (11-step SCT), and 30-second chair stand test (30-s CST). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), sedentary behavior (activPAL), and numeric pain rating scale (NPRS) were used as comparator instruments. Measurements were obtained at baseline and after 6 months. The construct validity and responsiveness were calculated using Spearman correlation coefficient within predefined hypotheses based on a panel comprising 5 experts in the field of outcome measurement in KOA. RESULTS The three performance-based tests showed excellent (ICC>0.9) reliability (intra and inter); however, only the 40-m FPWT and 11-step SCT were considered valid and responsive because both confirmed >75% of the priori hypotheses. The 30-s CST was not considered valid or responsive because it has not confirmed ≥75% of the priori hypotheses. CONCLUSION The 3 performance-based tests are reliable for intra and inter assessments. The 40-m FPWT and 11-step SCT are both valid and responsive for measuring physical function in patients with KOA. The 30-s CST was not considered valid or responsive. Therefore, 40-m FPWT and 11-step SCT can detect changes over time and are indicated for functional assessment in clinical practice.
Collapse
Affiliation(s)
- Rebecca B Ramalho
- Physiotherapy Department of the Federal University of São Carlos, São Carlos, Brazil
| | - Natália A Casonato
- Physiotherapy Department of the Federal University of São Carlos, São Carlos, Brazil
| | - Vinicius B Montilha
- Physiotherapy Department of the Federal University of São Carlos, São Carlos, Brazil
| | - Thais C Chaves
- Physiotherapy Department of the Federal University of São Carlos, São Carlos, Brazil
| | - Stela M Mattiello
- Physiotherapy Department of the Federal University of São Carlos, São Carlos, Brazil
| | - Luiz F A Selistre
- Physiotherapy Department of the Federal University of São Carlos, São Carlos, Brazil.
| |
Collapse
|
37
|
Legemate CM, Middelkoop E, Carrière ME, van Zuijlen PPM, van Baar ME, van der Vlies CH. The minimal important change (MIC) and minimal clinically important difference (MCID) of the patient and observer scar assessment scale (POSAS) 2.0. Burns 2024:S0305-4179(24)00170-0. [PMID: 38902132 DOI: 10.1016/j.burns.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The Patient and Observer Scar Assessment Scale (POSAS) is frequently used to assess scar quality after burns. It is important to be aware of the minimal important change (MIC) and the minimal clinically important difference (MCID) to establish if a POSAS score represents a clinically relevant change or difference. The aim of this study is to explore the MIC and MCID of POSAS version 2.0. METHODS This prospective study included 127 patients with deep dermal burns that underwent split thickness skin grafting with a mean age of 44 years (range 0 - 87) and total body surface area burned of 10 % (range 0.5 - 55). POSAS data was obtained for one burn scar area at three, six, and 12 months after split skin grafting. At the second and third visits, patients rated the degree of clinical change in scar quality in comparison to the previous visit. At 12 months, they completed the POSAS for a second burn scar area and rated the degree of clinical difference between the two scar areas. Two anchor-based methods were used to determine the MIC and MCID. RESULTS MIC values of the patient POSAS ranged from - 0.59 to - 0.29 between three and six months and from - 0.75 to - 0.38 between six and 12 months follow-up. Both had a poor discriminatory value. MCID values ranged from - 0.39 and - 0.08, with a better discriminatory value. CONCLUSION Results suggest that patients consider minor differences (less than 0.75 on the 1-10 scale) in POSAS scores as clinically important scar quality changes. MCID values can be used to evaluate the effects of burn treatment and perform sample-size calculations.
Collapse
Affiliation(s)
- Catherine M Legemate
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands.
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - Michelle E Carrière
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Noord-Holland, the Netherlands; Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, Noord-Holland, the Netherlands
| | - Paul P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, Amsterdam, the Netherlands; Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, Noord-Holland, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - Margriet E van Baar
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
38
|
Vagnetti R, Camp N, Story M, Ait-Belaid K, Mitra S, Zecca M, Di Nuovo A, Magistro D. Instruments for Measuring Psychological Dimensions in Human-Robot Interaction: Systematic Review of Psychometric Properties. J Med Internet Res 2024; 26:e55597. [PMID: 38682783 PMCID: PMC11187516 DOI: 10.2196/55597] [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: 12/18/2023] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Numerous user-related psychological dimensions can significantly influence the dynamics between humans and robots. For developers and researchers, it is crucial to have a comprehensive understanding of the psychometric properties of the available instruments used to assess these dimensions as they indicate the reliability and validity of the assessment. OBJECTIVE This study aims to provide a systematic review of the instruments available for assessing the psychological aspects of the relationship between people and social and domestic robots, offering a summary of their psychometric properties and the quality of the evidence. METHODS A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across different databases: Scopus, PubMed, and IEEE Xplore. The search strategy encompassed studies meeting the following inclusion criteria: (1) the instrument could assess psychological dimensions related to social and domestic robots, including attitudes, beliefs, opinions, feelings, and perceptions; (2) the study focused on validating the instrument; (3) the study evaluated the psychometric properties of the instrument; (4) the study underwent peer review; and (5) the study was in English. Studies focusing on industrial robots, rescue robots, or robotic arms or those primarily concerned with technology validation or measuring anthropomorphism were excluded. Independent reviewers extracted instrument properties and the methodological quality of their evidence following the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. RESULTS From 3828 identified records, the search strategy yielded 34 (0.89%) articles that validated and examined the psychometric properties of 27 instruments designed to assess individuals' psychological dimensions in relation to social and domestic robots. These instruments encompass a broad spectrum of psychological dimensions. While most studies predominantly focused on structural validity (24/27, 89%) and internal consistency (26/27, 96%), consideration of other psychometric properties was frequently inconsistent or absent. No instrument evaluated measurement error and responsiveness despite their significance in the clinical context. Most of the instruments (17/27, 63%) were targeted at both adults and older adults (aged ≥18 years). There was a limited number of instruments specifically designed for children, older adults, and health care contexts. CONCLUSIONS Given the strong interest in assessing psychological dimensions in the human-robot relationship, there is a need to develop new instruments using more rigorous methodologies and consider a broader range of psychometric properties. This is essential to ensure the creation of reliable and valid measures for assessing people's psychological dimensions regarding social and domestic robots. Among its limitations, this review included instruments applicable to both social and domestic robots while excluding those for other specific types of robots (eg, industrial robots).
Collapse
Affiliation(s)
- Roberto Vagnetti
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Nicola Camp
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Matthew Story
- Department of Computing & Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Khaoula Ait-Belaid
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Suvobrata Mitra
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
| | - Alessandro Di Nuovo
- Department of Computing & Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Daniele Magistro
- Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| |
Collapse
|
39
|
Lurz J, Hengelhaupt L, Unterhuber M, Stenzel L, Hilbert S, Schöber AR, Dinov B, Darma A, Dagres N, Hindricks G, Lurz P, Bollmann A. App-Based Mental Training to Reduce Atrial Fibrillation-Related Symptoms After Pulmonary Vein Isolation: MENTAL AF Trial. J Am Heart Assoc 2024; 13:e033500. [PMID: 38780185 PMCID: PMC11255628 DOI: 10.1161/jaha.123.033500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Even after atrial fibrillation (AF) catheter ablation, many patients still experience relevant symptom burden. The objective of the MENTAL AF trial was to determine whether app-based mental training (MT) during the 3 months following pulmonary vein isolation reduces AF-related symptoms. METHODS AND RESULTS Patients scheduled for pulmonary vein isolation were enrolled and randomized 1:1 to either app-based MT or usual care. Of 174 patients, 76 in the MT and 75 in the usual care group were included in the final analysis. The intervention was delivered by a daily 10-minute app-based MT. The primary outcome was the intergroup difference of the mean AF6 sum score, an AF-specific questionnaire, during the 3-month study period. Secondary outcomes included quality-of-life measures such as the AFEQT (Atrial Fibrillation Effect on Quality of Life). Mean age (SD) was 61 (8.7) years and 61 (41%) were women. The mean AF6 sum score over the study period was 8.9 (6.9) points in the MT group and 12.5 (10.1) in the usual care group (P=0.011). This referred to a reduction in the AF6 sum score compared with baseline of 75% in MT and 52% for usual care (P<0.001). The change in the AFEQT Global Score was 22.6 (16.3) and 15.7 (22.1), respectively; P=0.026. CONCLUSIONS MENTAL AF showed that app-based MT as an adjunctive treatment tool following pulmonary vein isolation was feasible. App-based MT was found to be superior to standard care in reducing AF-related symptom burden and improving health-related quality of life. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04067427.
Collapse
Affiliation(s)
- Julia Lurz
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
- Department of CardiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Laura Hengelhaupt
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Matthias Unterhuber
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
- Department of CardiologySan Maurizio HospitalBolzanoItaly
| | - Lukas Stenzel
- Institute of Sport Science, Martin Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Sebastian Hilbert
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Anne Rebecca Schöber
- Department of CardiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Borislav Dinov
- Medical Clinic I, Cardiology and AngiologyMedical University of GiessenGiessenGermany
| | - Angeliki Darma
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | | | | | - Philipp Lurz
- Department of CardiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Andreas Bollmann
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| |
Collapse
|
40
|
Rand D, Assadi Khalil S, Schaham I, Doron N, Peri S, Zeilig G, Dudkiewicz I, Gross-Nevo RF, Barel H. U-Rate-UE; Measuring Perceived Recovery of the Affected Upper Extremity in Adults Post-stroke. Arch Phys Med Rehabil 2024; 105:1151-1157. [PMID: 38412898 DOI: 10.1016/j.apmr.2024.02.715] [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: 04/14/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To establish initial validity of "U-Rate-UE", a single-question scale regarding perceived recovery of the stroke affected upper extremity (UE). DESIGN A retrospective longitudinal study of data collected at rehabilitation admission, 6 weeks, and 6 months since stroke. SETTING Stroke rehabilitation and community-based. PARTICIPANTS A convenience sample of 87 individuals, median (interquartile range) age 71.5 (65-80) years, 15.0 (12-20) days post-stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The affected UE was assessed using the Fugl-Meyer Motor Assessment, grip strength, Action Research Arm Test, the Box and Block Test (BBT), and The Rating of Everyday Arm-Use in the Community and Home. Participants also rated how much they perceive that their affected UE recovered from the stroke using U-Rate-UE; 0-100 (no to full recovery). Longitudinal changes in U-Rate-UE ratings were assessed. In addition, at 6 weeks and 6 months post-stroke, the change in BBT was calculated and participants were grouped into achieved/did not achieve the minimal detectable change (MDC). Correlations between U-Rate-UE to the other UE assessments were assessed at all 3 timepoints. RESULTS Significant changes in U-Rate-UE were seen over time (P<.05). At 6 weeks and 6 months, participants who achieved BBT-MDC rated their recovery significantly higher than participants who did not. U-Rate-UE was moderately-strongly significantly correlated to UE assessments (rho=.61-.85, P<.001). CONCLUSIONS The U-Rate-UE is supported for use with UE assessments contributing to comprehensive clinical understanding of the recovery of the affected UE in adults post-stroke.
Collapse
Affiliation(s)
- Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Samar Assadi Khalil
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Schaham
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Noa Doron
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel
| | - Shelly Peri
- Department of Occupational Therapy, School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Zeilig
- Sheba Medical Center, Tel Hashomer, Israel; Faculty of Health Professions, Ono Academic College, Kiryat Ono, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Israel Dudkiewicz
- Sheba Medical Center, Tel Hashomer, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Haim Barel
- Bait Balev Rehabilitation Center - Maccabi Health Care Services Group, Bat-Yam, Israel
| |
Collapse
|
41
|
Young T, Velikova G, Liegl G, Rose M, Nolte S. EORTC QLQ-C30 normative data for the United Kingdom: Results of a cross-sectional survey of the general population. Eur J Cancer 2024; 204:113927. [PMID: 38429166 DOI: 10.1016/j.ejca.2024.113927] [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: 12/18/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE The cancer-specific health-related quality of life (HRQoL) questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC), the EORTC QLQ-C30, is a frequently applied questionnaire to assess cancer patients' self-reported health used as part of research and clinical practice. Normative data obtained from the general population can facilitate the interpretation of these data. Despite its frequent application, no detailed EORTC QLQ-C30 normative data have yet been published for the United Kingdom (UK). This study presents detailed EORTC QLQ-C30 normative data for the United Kingdom overall and by sex and age. METHODS The data are drawn from a larger published, international, cross-sectional online survey. For the recruitment, the sample was stratified by sex (males, females) and age in five age groups with a sample size of n = 100 per subgroup. RESULTS A total of N = 1026 UK respondents completed the survey (n = 517 females, n = 509 males). There were no clear subgroup patterns by sex or age; however, older patients tended to show higher (i.e., better) scores in emotional and social functioning; they also reported some of the lowest (i.e., best) scores for symptoms, such as insomnia, appetite loss, diarrhoea, nausea/vomiting or financial difficulties. CONCLUSION This paper provides EORTC QLQ-C30 general population normative data for the UK, further stratified by sex and age. These data will greatly support the interpretation of EORTC QLQ-C30 scale scores obtained from UK cancer patients, and also enable comparison with other detailed national normative datasets collected in the same project, across several other European countries and the US.
Collapse
Affiliation(s)
- Teresa Young
- East & North Hertfordshire NHS Trust including Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, United Kingdom.
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Gregor Liegl
- Center for Patient-Centered Outcomes Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Rose
- Center for Patient-Centered Outcomes Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Centre for Mental Health (DZPG) - - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandra Nolte
- Center for Patient-Centered Outcomes Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Melbourne Health Economics, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia; School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| |
Collapse
|
42
|
Farid AR, Liimakka AP, Parker EB, Smith JT, Melnic CM, Chen AF, Lange JK. Association of Pharmacologic Treatment of Depression/Anxiety With Initial Patient-Reported Outcome Measures in Patients With Hip and Knee Osteoarthritis. J Am Acad Orthop Surg 2024; 32:516-524. [PMID: 38595309 DOI: 10.5435/jaaos-d-23-00887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/27/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Depression and anxiety are common comorbidities that may exacerbate osteoarthritis (OA)-related pain. We aim to evaluate the effect of pharmacologic treatment of depression/anxiety on hip and knee patient-reported outcome measures (PROMs). METHODS A multi-institutional PROMs database was queried for patients with depression or anxiety and hip or knee OA who completed a PROMs questionnaire at an initial orthopaedic visit between January 2015 and March 2023. Data on demographics, comorbidities, and duration of pharmacologic treatment of depression/anxiety were obtained. Patients were stratified into three cohorts based on treatment duration. PROMs were compared across cohorts. RESULTS Two thousand nine hundred sixty patients who completed PROMs at their initial orthopaedic visit had both OA and depression/anxiety. One hundred thirty-four (4.5%) received pharmacologic treatment of depression/anxiety for < 1 year, versus 196 (6.6%) for more than 1 year. In unadjusted analyses, patients with pharmacologic treatment had significantly lower Patient-Reported Outcomes Measurement Information System (PROMIS)-Physical (39.8 [IQR 34.9, 44.9] vs 42.3 [37.4, 47.7], P < 0.001) and PROMIS-Mental (43.5 [36.3, 50.8] vs 48.3 [41.1, 53.3], P < 0.001) scores than those without treatment. After adjusting for demographics and comorbidities, only differences in PROMIS-Mental scores remained statistically significant, with pharmacologic treatment associated with lower scores (β = -2.26, 95% CI, [-3.29, -1.24], P < 0.001). On secondary analysis including duration of pharmacologic treatment, < 1 year of treatment was associated with significantly lower PROMIS-Mental scores than those not treated (β = -4.20, 95% CI [-5.77, -2.62], P < 0.001) while scores of patients with more than 1 year of treatment did not differ significantly from those without treatment. CONCLUSION :Our results indicate that pharmacologic treatment of depression/anxiety is associated with improved psychological health but not with improved physical symptoms related to OA. We observed a nonsignificant trend that patients with depression/anxiety who warrant pharmacologic treatment tend to have worse physical symptoms than those who do not; however, unadjusted analyses suggest this is a complex relationship beyond the isolated effect of pharmacologic treatment.
Collapse
Affiliation(s)
- Alexander R Farid
- From the Harvard Medical School, Boston, MA (Farid, Liimakka, and Parker), the Department of Orthopaedic Surgery, Division of Adult Reconstruction and Total Joint Arthroplasty, Brigham and Women's Hospital, Boston, MA (Liimakka, Chen, and Lange), the Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Brigham and Women's Hospital, Boston, MA (Parker and Smith), and the Department of Orthopaedic Surgery, Hip & Knee Replacement Service, Massachusetts General Hospital, Boston, MA (Melnic)
| | | | | | | | | | | | | |
Collapse
|
43
|
Sobba W, Lawrence KW, Haider MA, Thomas J, Schwarzkopf R, Rozell JC. The influence of body mass index on patient-reported outcome measures following total hip arthroplasty: a retrospective study of 3,903 Cases. Arch Orthop Trauma Surg 2024; 144:2889-2898. [PMID: 38796819 DOI: 10.1007/s00402-024-05381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The influence of obesity on patient-reported outcome measures (PROMs) following total hip arthroplasty (THA) is currently controversial. This study aimed to compare PROM scores for pain, functional status, and global physical/mental health based on body mass index (BMI) classification. METHODS Primary, elective THA procedures at a single institution between 2018 and 2021 were retrospectively reviewed, and patients were stratified into four groups based on BMI: normal weight (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), obese (30-39.99 kg/m2), and morbidly obese (> 40 kg/m2). Patient-Reported Outcome Measurement Information System (PROMIS) and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) scores were collected. Preoperative, postoperative, and pre/post- changes (pre/post-Δ) in scores were compared between groups. Multiple linear regression was used to assess for confounders. RESULTS We analyzed 3,404 patients undergoing 3,903 THAs, including 919 (23.5%) normal weight, 1,374 (35.2%) overweight, 1,356 (35.2%) obese, and 254 (6.5%) morbidly obese cases. HOOS, JR scores were worse preoperatively and postoperatively for higher BMI classes, however HOOS, JR pre/post-Δ was comparable between groups. All PROMIS measures were worse preoperatively and postoperatively in higher BMI classes, though pre/post-Δ were comparable for all groups. Clinically significant improvements for all BMI classes were observed in all PROM metrics except PROMIS mental health. Regression analysis demonstrated that obesity, but not morbid obesity, was independently associated with greater improvement in HOOS, JR. CONCLUSIONS Obese patients undergoing THA achieve lower absolute scores for pain, function, and self-perceived health, despite achieving comparable relative improvements in pain and function with surgery. Denying THA based on BMI restricts patients from clinically beneficial improvements comparable to those of non-obese patients, though morbidly obese patients may benefit from additional weight loss to achieve maximal functional improvement.
Collapse
Affiliation(s)
- Walter Sobba
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Muhammad A Haider
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Jeremiah Thomas
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA.
| |
Collapse
|
44
|
Tock WL, Johnson NA, Andersen RE, Salaciak M, Angelillo C, Loiselle CG, Hébert M, Maheu C. Pilot Randomized Controlled Trial of Lymfit: A Theory-Guided Exercise Intervention for Young Adults with Lymphoma. Healthcare (Basel) 2024; 12:1101. [PMID: 38891177 PMCID: PMC11171874 DOI: 10.3390/healthcare12111101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Despite the rapidly emerging evidence on the contributions of physical activity to improving cancer-related health outcomes, adherence to physical activity among young adults with lymphoma remains suboptimal. Guided by self-determination theory (SDT), the Lymfit intervention (a 12-week individualized exercise program with bi-weekly kinesiologist support and an activity tracker) aimed to foster autonomous motivation toward physical activity. This pilot randomized controlled trial aimed to evaluate the feasibility, acceptability, and preliminary effects of Lymfit. Young adults (N = 26; mean age of 32.1 years) with lymphoma who were newly diagnosed and those up to six months after completing treatment were recruited and randomly assigned one-to-one to either the intervention group (n = 13) or a wait-list control group (n = 13). All a priori feasibility benchmarks were met, confirming the feasibility of the study in terms of recruitment uptake, retention, questionnaire completion, intervention fidelity, missing data, Fitbit wear adherence, and control group design. The intervention acceptability assessment showed high ratings, with eight out of ten items receiving >80% high ratings. At post-intervention, an analysis of covariance models showed a clinically significant increase in self-reported physical activity levels, psychological need satisfaction, and exercise motivation in the intervention group compared to controls. Lymfit also led to meaningful changes in six quality-of-life domains in the intervention group, including anxiety, depression, fatigue, sleep disturbance, social roles and activities, and pain interference. The findings support Lymfit as a promising means to meet psychological needs and increase the autonomous motivation for physical activity in this group. A fully powered efficacy trial is warranted to assess the validity of these findings.
Collapse
Affiliation(s)
- Wing Lam Tock
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H3A 2M7, Canada; (C.G.L.); (C.M.)
| | - Nathalie A. Johnson
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada;
- Department of Medicine, Jewish General Hospital, Montréal, QC H3T 1E2, Canada
| | - Ross E. Andersen
- Department of Kinesiology and Physical Education, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H2W 1S4, Canada; (R.E.A.); (C.A.)
| | - Matthew Salaciak
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H3G 2M1, Canada;
| | - Christopher Angelillo
- Department of Kinesiology and Physical Education, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H2W 1S4, Canada; (R.E.A.); (C.A.)
| | - Carmen G. Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H3A 2M7, Canada; (C.G.L.); (C.M.)
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada;
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3T2, Canada
| | - Maude Hébert
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada;
| | - Christine Maheu
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H3A 2M7, Canada; (C.G.L.); (C.M.)
| |
Collapse
|
45
|
Lippi L, de Sire A, Folli A, Curci C, Calafiore D, Lombardi M, Bertolaccini L, Turco A, Ammendolia A, Fusco N, Spaggiari L, Invernizzi M. Comprehensive Pulmonary Rehabilitation for Patients with Malignant Pleural Mesothelioma: A Feasibility Pilot Study. Cancers (Basel) 2024; 16:2023. [PMID: 38893142 PMCID: PMC11171244 DOI: 10.3390/cancers16112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Malignant pleural mesothelioma (MPM) represents a significant health burden, with limited treatment options and poor prognosis. Despite advances in pharmacological and surgical interventions, the role of rehabilitation in MPM management remains underexplored. This study aims to assess the feasibility of a tailored pulmonary rehabilitation intervention addressing physical and respiratory function in MPM patients. A prospective pilot study was conducted on surgically treated MPM patients referred to a cardiopulmonary rehabilitation service. The intervention comprised multidisciplinary educational sessions, physical rehabilitation, and respiratory physiotherapy. Feasibility was evaluated based on dropout rates, adherence to the rehabilitation program, safety, and patient-reported outcomes. Twelve patients were initially enrolled, with seven completing the study. High adherence to physical (T1: 93.43%, T2: 82.56%) and respiratory (T1: 96.2%, T2: 92.5%) rehabilitation was observed, with minimal adverse events reported. Patient satisfaction remained high throughout the study (GPE scores at T1: 1.83 ± 1.17; T2: 2.0 ± 1.15), with improvements noted in physical function, pain management, and health-related quality of life. However, some issues, such as time constraints and lack of continuous supervision, were reported by participants. This pilot study demonstrates the feasibility and potential benefits of a tailored pulmonary rehabilitation intervention in MPM patients. Despite its promising outcomes, further research with larger samples is warranted to validate its efficacy and integrate rehabilitation as a component into the multidisciplinary management of MPM.
Collapse
Affiliation(s)
- Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, 1085 Budapest, Hungary;
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.F.); (A.T.); (M.I.)
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy; (C.C.); (D.C.)
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy; (C.C.); (D.C.)
| | - Mariano Lombardi
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (M.L.); (N.F.); (L.S.)
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Alessio Turco
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.F.); (A.T.); (M.I.)
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Fusco
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (M.L.); (N.F.); (L.S.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20122 Milan, Italy
| | - Lorenzo Spaggiari
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (M.L.); (N.F.); (L.S.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20122 Milan, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.F.); (A.T.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| |
Collapse
|
46
|
Dalaei F, Dijkhorst PJ, Möller S, de Vries CEE, Poulsen L, Voineskos SH, Kaur MN, Thomsen JB, van Veen RN, Juhl CB, Andries A, Støving RK, Cano SJ, Klassen AF, Pusic AL, Sørensen JA. Minimal important difference in weight loss following bariatric surgery: Enhancing BODY-Q interpretability. Clin Obes 2024:e12675. [PMID: 38777325 DOI: 10.1111/cob.12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/04/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
BODY-Q is a patient-reported outcome measure for comprehensive assessment of outcomes specific to patients undergoing bariatric surgery. The clinical utility of BODY-Q is hampered by the lack of guidance on score interpretation. This study aimed to determine minimal important difference (MID) for assessment of BODY-Q. Prospective BODY-Q data from Denmark and the Netherlands pre- and post-bariatric surgery were collected. Two distribution-based methods were used to estimate MID by 0.2 standard deviations of baseline scores and the mean standardized response change of scores from baseline to 3-years postoperatively. In total, 5476 assessments from 2253 participants were included of which 1628 (72.3%) underwent Roux-en-Y gastric bypass, 586 (26.0%) sleeve gastrectomy, 33 (1.5%) gastric banding, and 6 (0.03%) other surgeries. The mean age was 45.1 ± 10.9 with a mean BMI of 46.6 ± 9.6. Baseline MID ranged from 1 to 4 in health-related quality of life (HRQL) and from 2 to 8 in appearance scales. The mean change of scores ranged from 4 to 5 in HRQL and from 4 to 7 in the appearance scales. The estimated MID for the change in BODY-Q HRQL and appearance scales ranged from 3 to 8 and is recommended for use to interpret BODY-Q scores and assess treatment effects in bariatric surgery.
Collapse
Affiliation(s)
- Farima Dalaei
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- OPEN: Open Patient data Explorative Network, Odense, Denmark
| | - Phillip J Dijkhorst
- Department of Surgery, OLVG West Hospital & Dutch Obesity Clinic (NOK), Amsterdam, The Netherlands
| | - Sören Möller
- OPEN: Open Patient data Explorative Network, Odense, Denmark
- Odene University Hospital and University of Southern Denmark, Odense, Denmark
| | - Claire E E de Vries
- Department of Surgery, OLVG West Hospital & Dutch Obesity Clinic (NOK), Amsterdam, The Netherlands
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Lotte Poulsen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Sophocles H Voineskos
- Division of Plastic Surgery, Department of Surgery, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Manraj N Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jørn Bo Thomsen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | | | - Claus B Juhl
- Hospital of Southwest Jutland, Institute for Regional Health Research, University of Southern Denmark and Steno Diabetes Center, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Alin Andries
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - René K Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | | | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Jens A Sørensen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
47
|
Bayoumi T, Burger JA, van der List JP, Sierevelt IN, Spekenbrink-Spooren A, Pearle AD, Kerkhoffs GMMJ, Zuiderbaan HA. Comparison of the early postoperative outcomes of cementless and cemented medial unicompartmental knee arthroplasty. Bone Jt Open 2024; 5:401-410. [PMID: 38767223 PMCID: PMC11103876 DOI: 10.1302/2633-1462.55.bjo-2024-0007.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Aims The primary objective of this registry-based study was to compare patient-reported outcomes of cementless and cemented medial unicompartmental knee arthroplasty (UKA) during the first postoperative year. The secondary objective was to assess one- and three-year implant survival of both fixation techniques. Methods We analyzed 10,862 cementless and 7,917 cemented UKA cases enrolled in the Dutch Arthroplasty Registry, operated between 2017 and 2021. Pre- to postoperative change in outcomes at six and 12 months' follow-up were compared using mixed model analyses. Kaplan-Meier and Cox regression models were applied to quantify differences in implant survival. Adjustments were made for patient-specific variables and annual hospital volume. Results Change from baseline in the Oxford Knee Score (OKS) and activity-related pain was comparable between groups. Adjustment for covariates demonstrated a minimally greater decrease in rest-related pain in the cemented group (β = -0.09 (95% confidence interval (CI) -0.16 to -0.01)). Cementless fixation was associated with a higher probability of achieving an excellent OKS outcome (> 41 points) (adjusted odds ratio 1.2 (95% CI 1.1 to 1.3)). The likelihood of one-year implant survival was greater for cemented implants (adjusted hazard ratio (HR) 1.35 (95% CI 1.01 to 1.71)), with higher revision rates for periprosthetic fractures of cementless implants. During two to three years' follow-up, the likelihood of implant survival was non-significantly greater for cementless UKA (adjusted HR 0.64 (95% CI 0.40 to 1.04)), primarily due to increased revision rates for tibial loosening of cemented implants. Conclusion Cementless and cemented medial UKA led to comparable improvement in physical function and pain reduction during the initial postoperative year, albeit with a greater likelihood of achieving excellent OKS outcomes after cementless UKA. Anticipated differences in early physical function and pain should not be a decisive factor in the choice of fixation technique. However, surgeons should consider the differences in short- and long-term implant survival when deciding which implant to use.
Collapse
Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A. Burger
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Charité – Department of Orthopaedic Surgery, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - Jelle P. van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Inger N. Sierevelt
- Xpert Clinics, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Andrew D. Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
48
|
Turci AM, Spavieri JHP, Lima TCD, Silva APD, Cristofolletti A, Chaves TC. Which Scale to Assess Pain Self-efficacy Shows Better Measurement Properties in Chronic Low Back Pain? A Head-To-Head Comparison Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01003-7. [PMID: 38763345 DOI: 10.1016/j.apmr.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/12/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To compare the quality of the measurement properties of Pain Self-Efficacy Questionnaire (PSEQ)-10, PSEQ-4, PSEQ-2, Chronic Pain Self-Efficacy Scale (CPSS) long-form, and CPSS short-form (CPSS-SF) in patients with chronic low back pain (CLBP). DESIGN Cross-sectional and longitudinal studies (measurement properties). SETTING Outpatient rehabilitation. PARTICIPANTS Participants (N=245) with nonspecific CLBP (18-60y, 63% women) were enrolled in this study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain self-efficacy questionnaires were administered on 3 occasions: baseline assessment, 1 week after the first assessment (reliability), and after an 8-week exercise program (responsiveness). The intraclass correlation coefficient (ICC) and Cronbach α were used to assess reliability and internal consistency, respectively. Pearson correlation and confirmatory factor analyses were used to assess construct validity. The area under the curve and hypothesis testing were used to assess responsiveness. RESULTS No difference was observed for all the questionnaires regarding internal consistency (Cronbach α>.7), criterion validity (r>.88), and reliability (ICC>.7). The scales confirmed >75% of the hypotheses for the construct validity, except for CPSS-SF. PSEQ-2 did not meet the criterion for structural validity. PSEQ-10 met all the criteria for good measurement properties according to Consensus-Based Standards for the Selection of Health Measurement Instruments. CONCLUSIONS It was not possible to calculate structural validity for PSEQ-2, CPSS-SF did not meet the criterion for suitable hypothesis testing for construct validity, and all the questionnaires did not show suitable measurement error, except for the PSEQ-10. Hence, the PSEQ-10 was the unique scale that met all the criteria for good measurement properties for assessing pain self-efficacy in CLBP.
Collapse
Affiliation(s)
- Aline Mendonça Turci
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo
| | - Juliana Homem Padilha Spavieri
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Department of Physical Therapy, University Federal of São Carlos, São Paulo, Brazil
| | - Thamiris Costa de Lima
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Department of Physical Therapy, University Federal of São Carlos, São Paulo, Brazil
| | - Alexsander Pereira da Silva
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo
| | - Amanda Cristofolletti
- Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo
| | - Thais Cristina Chaves
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Laboratory of Research on Movement and Pain (LabMovePain), Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo; Department of Physical Therapy, University Federal of São Carlos, São Paulo, Brazil.
| |
Collapse
|
49
|
Pergolotti M, Wood KC, Kendig TD, Mayo S. Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors across 12 Diagnosis Types in the United States. Cancers (Basel) 2024; 16:1927. [PMID: 38792004 PMCID: PMC11119581 DOI: 10.3390/cancers16101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Compared to adults without cancer, cancer survivors report poorer health-related quality of life (HRQOL), which is associated with negative treatment outcomes and increased healthcare use. Cancer-specialized physical and occupational therapy (PT/OT) could optimize HRQOL; however, the impact among survivors with non-breast malignancies is unknown. This retrospective (2020-2022), observational, study of medical record data of 12 cancer types, examined pre/post-HRQOL among cancer survivors who completed PT/OT. PROMIS® HRQOL measures: Global Health (physical [GPH] and mental [GMH]), Physical Function (PF), and Ability to Participate in Social Roles and Activities (SRA) were evaluated using linear mixed effect models by cancer type, then compared to the minimal important change (MIC, 2 points). Survivors were 65.44 ± 12.84 years old (range: 19-91), male (54%), with a median of 12 visits. Improvements in GPH were significant (p < 0.05) for all cancer types and all achieved MIC. Improvements in GMH were significant for 11/12 cancer types and 8/12 achieved MIC. Improvements in PF were significant for all cancer types and all achieved the MIC. Improvements in SRA were significant for all cancer types and all groups achieved the MIC. We observed statistically and clinically significant improvements in HRQOL domains for each of the 12 cancer types evaluated.
Collapse
Affiliation(s)
- Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA 17055, USA; (K.C.W.); (T.D.K.); (S.M.)
- Department of Occupational Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kelley C. Wood
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA 17055, USA; (K.C.W.); (T.D.K.); (S.M.)
| | - Tiffany D. Kendig
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA 17055, USA; (K.C.W.); (T.D.K.); (S.M.)
| | - Stacye Mayo
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA 17055, USA; (K.C.W.); (T.D.K.); (S.M.)
| |
Collapse
|
50
|
Ragamin A, Zhang J, Pasmans SGMA, Schappin R, Romeijn GLE, van Reusel MA, Oosterhaven JAF, Schuttelaar MLA. The construct validity, responsiveness, reliability and interpretability of the Recap of atopic eczema questionnaire (RECAP) in children. Br J Dermatol 2024; 190:867-875. [PMID: 38262143 DOI: 10.1093/bjd/ljae017] [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: 09/06/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The Recap of atopic eczema questionnaire (RECAP) was developed to measure eczema control in patients with atopic dermatitis (AD). The measurement properties of RECAP have not yet been validated in caregivers of children with AD. OBJECTIVES To assess the construct validity, responsiveness, reliability and interpretability of the Dutch proxy version of RECAP. METHODS A prospective validation study was conducted in children (aged < 12 years) with AD and their caregivers (in a Dutch tertiary hospital). At three timepoints (T0 = baseline; T1 = after 1-7 days; T2 = after 4-8 weeks) RECAP and multiple reference instruments were completed by caregivers of child patients. Single- and change-score validity (responsiveness) were tested with a priori hypotheses on correlations with reference instruments. Intraclass correlation coefficients (ICCagreement) and standard error of agreement (SEMagreement) were reported. Bands for perceived eczema control were proposed. The smallest detectable change (SDC) and minimally important change (MIC) were determined. Two anchor-based methods based on receiver operating characteristic curve (ROC) and predictive modelling were used to determine the MIC. RESULTS A total of 231 children with AD and their caregivers participated. Of our a priori hypotheses for single-score and change-score validity, 77% and 80% were confirmed, respectively. A stronger correlation than hypothesized was found for all rejected hypotheses.Excellent reliability was found (ICCagreement = 0.94, 95% confidence interval 0.90-0.96). The SEMagreement was 1.9 points. The final banding was 0-1 (completely controlled), 2-7 (mostly controlled), 8-12 (moderately controlled), 13-18 (a little controlled) and 19-28 (not at all controlled). A cutoff point of ≥ 8 was selected to identify children whose AD is not under control. The SDC was 5.3 and the MIC values were 1.5 and 3.6 for the ROC and predictive modelling approaches, respectively. No floor or ceiling effects were observed. CONCLUSIONS The proxy version of RECAP is a valid, reliable and responsive measurement instrument for measuring eczema control in children with AD. An improvement of ≥ 6 points can be regarded as a real and important change in children with AD.
Collapse
Affiliation(s)
- Aviël Ragamin
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Dermatology, Centre of Paediatric Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Junfen Zhang
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Dermatology, Centre of Paediatric Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Renske Schappin
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Dermatology, Centre of Paediatric Dermatology, Sophia Children's Hospital, Erasmus MC University Medical Centre Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Geertruida L E Romeijn
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maroos A van Reusel
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jart A F Oosterhaven
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|