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Robles E, Angelone C, Ondé D, Vázquez C. Somatic symptoms in the general population of Spain: Validation and normative data of the Patient Health Questionnaire-15 (PHQ-15). J Affect Disord 2024; 362:762-771. [PMID: 39029703 DOI: 10.1016/j.jad.2024.07.087] [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: 04/15/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE The Patient Health Questionnaire (PHQ-15) has been widely used to assess somatic symptoms. This study aimed to analyze the psychometric properties of the Spanish version of the PHQ-15, its structure and score distribution across demographic variables in a Spanish sample. In addition, we examined variations in somatic symptoms among different demographic subgroups. METHOD 1495 individuals from the Spanish population answered a series of self-reported measures, including PHQ-15. To examine the factorial structure of the PHQ-15, Confirmatory Factor Analysis (CFA) was performed. Additionally, a bifactor CFA model was examined using the Exploratory Structural Equation Modeling (ESEM) framework. RESULTS Women showed more somatic symptoms than men, and younger individuals showed more somatic symptoms than the older ones. It was also revealed positive associations between somatic symptoms and levels of depression, anxiety, and suspiciousness, while negative associations were found between somatic symptoms and perceived resilience and happiness. Regarding the factorial structure of the PHQ-15, although the one-factor and bifactor models were suitable, the bifactor model underscores the presence of a robust general factor. LIMITATIONS It is a cross-sectional study, not including non-institutionalized individuals. CONCLUSION Somatic symptoms are more frequent in women and younger individuals. Furthermore, the presence of physical symptoms is associated to other psychological aspects, such as depression or anxiety. Finally, bifactor model was the most appropriate to explain the factorial structure of the PHQ-15.
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Affiliation(s)
- Elena Robles
- School of Psychology, Complutense University, Madrid, Spain
| | - Chiara Angelone
- School of Psychology and Education, University of Bologna, Bologna, Italy
| | - Daniel Ondé
- School of Psychology, Complutense University, Madrid, Spain
| | - Carmelo Vázquez
- School of Psychology, Complutense University, Madrid, Spain.
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2
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Peng W, Mo C, Luo Y, Tang S, Liu M. Demographics moderated the association of symptom burden with falls and fall-related outcomes. Arch Gerontol Geriatr 2024; 117:105190. [PMID: 37713934 DOI: 10.1016/j.archger.2023.105190] [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: 06/07/2023] [Revised: 08/06/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES To examine whether (1) prior-year symptom burden predicted later-year falls and fall-related outcomes and (2) demographics moderated the longitudinal effects of symptom burden on falls and fall-related outcomes among community-dwelling older adults. METHODS We used 2011-2018 National Health and Aging Trends Study data that included 9,060 community-dwelling older adults (contributed 34,327 observations). Falls and fall-related outcomes included self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. Symptom burden was defined as the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue, and calculated the number of symptoms (range from 0 to 6). Binomial logistic regression was used to examine the associations between symptom burden and falls and fall-related outcomes and the moderation effects of demographic factors. RESULTS The majority of the sample were aged between 65 and 79 years old (57.7%), non-Hispanic White (70.5%), and female (58.4%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.10-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.20, 95% CI: 1.18-1.23), and FOF limiting activity (AOR: 1.24, 95% CI: 1.20-1.28). Age, race/ethnicity, education, and living arrangement statistically significantly moderated the relationships between symptom burden and falls and fall-related outcomes. CONCLUSIONS Symptom burden predicted falls, multiple falls, FOF and FOF limiting activity, and demographics may differentially modify this risk. Individually tailored symptom assessment and management plans should be incorporated into fall risk assessment and interventions for community-dwelling older adults living.
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Affiliation(s)
- Wenting Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Cen Mo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yuqian Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, China.
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3
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Fiedorowicz JG, Guthrie E, Löwe B. Seryan Atasoy, 2023 EAPM Elsevier Young Investigator Award recipient, on stability of somatic symptoms. J Psychosom Res 2023; 173:111497. [PMID: 37743219 DOI: 10.1016/j.jpsychores.2023.111497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Bernd Löwe
- University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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4
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Knuutila M, Jansson A, Rautiainen L, Pitkälä KH. Associations of use of smartphone and internet technologies with loneliness. J Am Geriatr Soc 2023; 71:3329-3331. [PMID: 37624106 DOI: 10.1111/jgs.18546] [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: 05/14/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 08/26/2023]
Abstract
See the Reply by Umoh et al.
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Affiliation(s)
- Mia Knuutila
- Social Services and Health Care, City of Helsinki, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Anu Jansson
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Finnish Association for the Welfare of Older Adults, Helsinki, Finland
| | - Laura Rautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Finnish Association for the Welfare of Older Adults, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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5
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Durieux BN, Zverev SR, Tarbi EC, Kwok A, Sciacca K, Pollak KI, Tulsky JA, Lindvall C. Development of a keyword library for capturing PRO-CTCAE-focused "symptom talk" in oncology conversations. JAMIA Open 2023; 6:ooad009. [PMID: 36789287 PMCID: PMC9912707 DOI: 10.1093/jamiaopen/ooad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Objectives As computational methods for detecting symptoms can help us better attend to patient suffering, the objectives of this study were to develop and evaluate the performance of a natural language processing keyword library for detecting symptom talk, and to describe symptom communication within our dataset to generate insights for future model building. Materials and Methods This was a secondary analysis of 121 transcribed outpatient oncology conversations from the Communication in Oncologist-Patient Encounters trial. Through an iterative process of identifying symptom expressions via inductive and deductive techniques, we generated a library of keywords relevant to the Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) framework from 90 conversations, and tested the library on 31 additional transcripts. To contextualize symptom expressions and the nature of misclassifications, we qualitatively analyzed 450 mislabeled and properly labeled symptom-positive turns. Results The final library, comprising 1320 terms, identified symptom talk among conversation turns with an F1 of 0.82 against a PRO-CTCAE-focused gold standard, and an F1 of 0.61 against a broad gold standard. Qualitative observations suggest that physical symptoms are more easily detected than psychological symptoms (eg, anxiety), and ambiguity persists throughout symptom communication. Discussion This rudimentary keyword library captures most PRO-CTCAE-focused symptom talk, but the ambiguity of symptom speech limits the utility of rule-based methods alone, and limits to generalizability must be considered. Conclusion Our findings highlight opportunities for more advanced computational models to detect symptom expressions from transcribed clinical conversations. Future improvements in speech-to-text could enable real-time detection at scale.
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Affiliation(s)
- Brigitte N Durieux
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Samuel R Zverev
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA,NYU School of Medicine, New York University, New York, New York, USA
| | - Elise C Tarbi
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA,Department of Nursing, University of Vermont, Burlington, Vermont, USA
| | - Anne Kwok
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kate Sciacca
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA,Department of Palliative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Cancer Prevention and Control Program, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA,Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Corresponding Author: Charlotta Lindvall, MD, PhD, Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, LW670, Boston, MA 02215, USA;
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Lehti TE, Knuutila M, Öhman H, Kautiainen H, Karppinen H, Tilvis R, Strandberg T, Pitkälä KH. Changes in symptom burden from 2019 to 2021 amongst community-dwelling older adults in Finland. Age Ageing 2023; 52:6974847. [PMID: 36626321 PMCID: PMC9831265 DOI: 10.1093/ageing/afac317] [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: 04/28/2022] [Revised: 10/11/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Symptom burden causes suffering amongst older adults and is associated with healthcare visits and prognosis. AIMS We evaluated the prevalence of 10 symptoms and changes in symptom burden amongst home-dwelling older adults in 2019 and 2021 using Finnish cohort data. We analysed factors associated with symptom burden increase during follow-up. METHODS Altogether 1,637 people aged 75+ participated in the Helsinki Ageing Study postal survey in 2019, where they reported the presence of 10 common symptoms over the past 2 weeks. Of them, 785 participated in a follow-up in 2021, where the same symptoms were queried. We compared the prevalence of various symptoms and symptom burden scores in the 2-year interval and evaluated factors associated with increased symptom burden during this time. RESULTS Of participants, 33% reported at least one daily symptom in 2019 versus 44% in 2021. Symptom burden increased by a mean ratio of 1.29 between 2019 and 2021. The most common symptoms were joint pain, back pain, urinary incontinence and fatigue. The prevalence of four symptoms increased between 2019 and 2021: joint pain, urinary incontinence, dizziness and shortness of breath. Higher age, reduced functional capacity and comorbidities were associated with higher odds of symptom burden increase during follow-up. Psychological well-being (PWB) was strongly associated with lower odds of symptom burden increase in the logistic regression model. CONCLUSIONS Symptom burden increased in our cohort aged 75+ between 2019 and 2021 before and during the COVID-19 pandemic. PWB was associated with lower odds of acquiring additional symptoms over time.
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Affiliation(s)
- Tuuli E Lehti
- Address correspondence to: Tuuli E. Lehti, Tukholmankatu 8 B, FI-00290 Helsinki, Finland.
| | - Mia Knuutila
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland,Social Services and Health Care, City of Helsinki, Helsinki, Finland,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Hanna Öhman
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Helena Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Reijo Tilvis
- Geriatric Unit, Department of Internal Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Strandberg
- Geriatric Unit, Department of Internal Medicine, University of Helsinki, Helsinki, Finland,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Kaisu H Pitkälä
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Atasoy S, Hausteiner-Wiehle C, Sattel H, Johar H, Roenneberg C, Peters A, Ladwig KH, Henningsen P. Gender specific somatic symptom burden and mortality risk in the general population. Sci Rep 2022; 12:15049. [PMID: 36065007 PMCID: PMC9445038 DOI: 10.1038/s41598-022-18814-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/19/2022] [Indexed: 11/21/2022] Open
Abstract
Gender specific all-cause mortality risk associated with a high somatic symptom burden (SSB) in a population-based cohort was investigated. The study population included 5679 women and 5861 men aged 25-74 years from the population-based MONICA/KORA Cohort. SSB was assessed following the Somatic Symptom Scale-8 and categorized as very high (≥ 95th percentile), high (60-95th percentile), moderate (30-60th percentile), and low (≤ 30th percentile). The impact of SSB on all-cause mortality risk within a mean follow-up period of 22.6 years (SD 7.1; 267,278 person years) was estimated by gender-specific Cox regression models adjusted for sociodemographic, lifestyle, somatic and psychosocial risk factors, as well as pre-existing medical conditions. Approximately 5.7% of men and 7.3% of women had very high SSB. During follow-up, 3638 (30.6%) mortality cases were observed. Men with a very-high SSB had 48% increased relative risk of mortality in comparison to men with a low SSB after adjustment for concurrent risk factors (1.48, 95% CI 1.20-1.81, p < .0001), corresponding to 2% increased risk of mortality for each 1-point increment in SSB (1.02; 95% CI 1.01-1.03; p = 0.03). In contrast, women with a very high SSB had a 22% lower risk of mortality (0.78, 95% CI 0.61-1.00, p = 0.05) and women with high SSB had an 18% lower risk of mortality (0.82; 95% CI 0.68-0.98, p = 0.03) following adjustment for concurrent risk factors. The current findings indicate that an increasing SSB is an independent risk factor for mortality in men but not in women, pointing in the direction of critical gender differences in the management of SSB, including women's earlier health care utilization than men.
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Affiliation(s)
- Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Marburg, Germany.
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Constanze Hausteiner-Wiehle
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
- Department of Neurology, BG Trauma Center, Murnau, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Casper Roenneberg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts Der Isar, University Hospital Rechts Der Isar, Technische Universität München, Langerstr. 3, 81676, Munich, Germany
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8
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Lehti TE, Öhman H, Knuutila M, Kautiainen H, Karppinen H, Tilvis R, Strandberg T, Pitkälä KH. Symptom burden in community-dwelling older people: temporal trends in the Helsinki Aging Study. Aging Clin Exp Res 2021; 33:3065-3071. [PMID: 34216378 PMCID: PMC8595189 DOI: 10.1007/s40520-021-01918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
Background Changes in older people’s symptoms across recent decades have not been investigated. Aims We analyzed temporal trends in symptom burden by comparing data from independent, cross-sectional cohorts retrieved in 1989, 1999, 2009, and 2019. Furthermore, we compared the association between symptom burden and psychological wellbeing (PWB) in older men and women. Methods The Helsinki Aging Study recruited a random sample of people aged 75, 80, and 85 in 1989, and random samples aged 75, 80, 85, 90, and 95 in 1999, 2009, and 2019 (four study waves). Altogether, 6263 community-dwelling people answered the questions concerning symptoms in the questionnaire surveys. The symptoms inquired in all study waves were dizziness, back pain, joint pain, chest pain, shortness of breath, and loss of appetite. Symptom burden was calculated according to the number of symptoms and their frequency (score range: 0–6). PWB and the Charlson comorbidity index were calculated. Results Symptom burden decreased in both men and women aged 75 and 80 from 1989 to 2019. Changes in cohorts aged 85 + were nonsignificant. There was a significant difference in symptom burden between men and women in all ages with men having fewer symptoms. PWB decreased with increasing symptom burden. Men had greater PWB than women up to severe levels of symptom burden. Conclusions Symptom burden decreased from 1989 to 2019 in cohorts aged 75–80, whereas changes remained nonsignificant in cohorts aged 85 +. To our knowledge, this is the first study to examine temporal trends in symptom burden.
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Affiliation(s)
- T E Lehti
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
- Social Services and Health Care, Helsinki, Finland.
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland.
- , Tukholmankatu 8 B, Biomedicum 2 B, 00290, Helsinki, Finland.
| | - H Öhman
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Knuutila
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Social Services and Health Care, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - H Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - R Tilvis
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T Strandberg
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - K H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Primary Health Care Unit, Helsinki University Hospital, Helsinki, Finland
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Regauer V, Seckler E, Grill E, Ippisch R, Jahn K, Bauer P, Müller M. Development of a complex intervention to improve mobility and participation of older people with vertigo, dizziness and balance disorders in primary care: a mixed methods study. BMC FAMILY PRACTICE 2021; 22:89. [PMID: 33980155 PMCID: PMC8117292 DOI: 10.1186/s12875-021-01441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vertigo, dizziness and balance disorders (VDB) are common in older people and cause restrictions in mobility and social participation. Due to a multifactorial aetiology, health care is often overutilised, but many patients are also treated insufficiently in primary care. The purpose of this study was to develop a care pathway as a complex intervention to improve mobility and participation in older people with VDB in primary care. METHODS The development process followed the UK Medical Research Council guidance using a mixed-methods design with individual and group interviews carried out with patients, physical therapists (PTs), general practitioners (GPs), nurses working in community care and a multi-professional expert panel to create a first draft of a care pathway (CPW) and implementation strategy using the Consolidated Framework of Implementation Research and the Expert recommendations for Implementing Change. Subsequently, small expert group modelling of specific components of the CPW was carried out, with GPs, medical specialists and PTs. The Behaviour Change Wheel was applied to design the intervention´s approach to behaviour change. To derive theoretical assumptions, we adopted Kellogg´s Logic Model to consolidate the hypothesized chain of causes leading to patient-relevant outcomes. RESULTS Individual interviews with patients showed that VDB symptoms need to be taken more seriously by GPs. Patients demanded age-specific treatment offers, group sessions or a continuous mentoring by a PT. GPs required a specific guideline for diagnostics and treatment options including psychosocial interventions. Specific assignment to and a standardized approach during physical therapy were desired by PTs. Nurses favoured a multi-professional documentation system. The structured three-day expert workshop resulted in a first draft of CPW and potential implementation strategies. Subsequent modelling resulted in a CPW with components and appropriate training materials for involved health professionals. A specific implementation strategy is now available. CONCLUSION A mixed-methods design was suggested to be a suitable approach to develop a complex intervention and its implementation strategy. We will subsequently test the intervention for its acceptability and feasibility in a feasibility study accompanied by a comprehensive process evaluation to inform a subsequent effectiveness trial. TRIAL REGISTRATION The research project is registered in "Projektdatenbank Versorgungsforschung Deutschland" (Project-ID: VfD_MobilE-PHY_17_003910; date of registration: 30.11.2017).
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Affiliation(s)
- Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
| | - Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Marchioninistraße 17, 81377 Munich, Germany
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Richard Ippisch
- Practice Centre Neurology, Psychiatry and Psychotherapy Germering, Josef-Kistler-Straße 10, 82110 Germering, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Schoen Clinic Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences, Development and Technology Transfer, Cen-Tre for Research, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences, Development and Technology Transfer, Cen-Tre for Research, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
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