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Mameniškienė R, Puteikis K. Can family members reliably assess mood and suicidal ideation in individuals with epilepsy? Epilepsy Behav 2023; 149:109537. [PMID: 37976790 DOI: 10.1016/j.yebeh.2023.109537] [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: 08/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Routine detection of depression, anxiety and suicidal ideation in people with epilepsy (PWE) remains suboptimal. We investigated the level of agreement between PWE and their proxies when evaluating these psychiatric symptoms. METHODS From October 2021 to March 2022, we conducted a cross-sectional anonymous survey at Vilnius University Hospital Santaros Klinikos (Vilnius, Lithuania). Persons accompanying PWE completed different scales measuring symptoms of depression and anxiety and evaluated suicidal ideation among PWE (defined as a non-zero score of the suicide item of the Beck depression inventory (BDI) or as a score > 1 of the item 4 of the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E). Agreement between PWE and their proxies was measured using the Wilcoxon test for paired samples and Pearson's correlation analysis. RESULTS The study included 140 PWE (mean age 41.0 ± 18.1, 71 (50.7 %) female) and 140 proxies (mean age 49.0 ± 15.01, 105 (75.0 %) female, 57 (40.7 %) were parents, 51 (36.4 %) - spouses, 15 (10.7 %) - partners, 11 (7.9 %) - children and 6 (4.3 %) - siblings of PWE). There were no statistical differences in paired scores of the BDI, Hospital Anxiety and Depression scale, Generalized Anxiety Disorder scale-7, and the NDDI-E (p > 0.05). Proxies reported statistically higher scores on the Geriatric Depression Scale (Z = - 2.026, p = 0.043) than PWE. The correlation between PWE and proxy evaluations for all instruments was moderate (varying from r = 0.500 to r = 0.688, p < 0.001). For most psychometric scales proxies became less accurate with higher scale scores for anxiety and depression and tended to underestimate the level of such symptoms (correlation between scale results and signed (PWE - proxy) mismatch varied from r = 0.368 to r = 0.641, p < 0.001). The measure of proxy-PWE agreement on suicidal ideation was low (Cohen's Κ = 0.192, p = 0.025); proxies missed 63 % (NDDI-E) to 70 % (BDI) of cases of suicidal ideation. CONCLUSION Companions of PWE provided comparable reports of participant anxiety and depression on a group level but tended to underestimate psychiatric symptoms as their scale scores became higher. Proxies significantly underreported suicidal ideation in those people who did express it. While proxy reporting should not be used interchangeably on an individual level, its use in group studies may be useful and ought to be investigated further.
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Affiliation(s)
- Rūta Mameniškienė
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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Weiss DJ, Wang C, Suen KY, Basford J, Cheville A. Can Proxy Ratings Supplement Patient Report to Assess Functional Domains Among Hospitalized Patients? Arch Phys Med Rehabil 2022; 103:S34-S42.e4. [PMID: 34678294 PMCID: PMC9018891 DOI: 10.1016/j.apmr.2021.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To (1) characterize the agreement between patient and proxy responses on a multidimensional computerized adaptive testing measure of function, and to (2) determine whether patient, proxy, or multidimensional computerized adaptive testing score characteristics identify when a proxy report can be used as a substitute for patient report in clinical decision making. DESIGN A psychometric study of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Testing (FAMCAT) and its 3 scales (Applied Cognition, Daily Activity, and Basic Mobility). SETTING An upper midwestern quaternary academic medical center PARTICIPANTS: A total of 300 pairs of patients (average age 60.9 years; range, 19-89) hospitalized on general medical services or readmitted to surgical services for postoperative complications and their proxies (average age 60.5 years; range, 20-88). INTERVENTION Not applicable. MAIN OUTCOME MEASURES There were 3 outcomes: (1) agreement between patient and proxy scores on the FAMCAT domains, as well as age and sex, analyzed with univariate and multivariate analysis of variance (MANOVA); (2) associations of patient-proxy relationship and FAMCAT score characteristics with patient-proxy score agreement; and (3) presence of psychometrically significant intra-dyad differences in FAMCAT scores. RESULTS The results of the MANOVA and follow-up ANOVAs indicated that there were no statistically significant differences in FAMCAT scale scores between patient and proxy estimates for either the Daily Activity or Basic Mobility scales. There were significant differences for the Applied Cognition scale (P<.005) between mean patient and proxy scores, with proxies rating patients as functioning at a higher level (mean=0.42) than patients did themselves (mean=0.00). However, psychometrically significant intra-dyadic Applied Cognition score differences occurred in only 14% of dyads, compared with 25% in the other 2 scales. Sex and age were associated with patient-proxy agreement, but the patterns were not sufficiently consistent to permit generalizations regarding the likely validity of a proxy's scores. CONCLUSIONS Patient and proxy FAMCAT Daily Activity and Basic Mobility scores did not differ significantly, and proxy reporting offers a creditable surrogate for patient report on these domains. Low rates of psychometrically significant intra-dyadic score differences suggest that proxy report may serve as a low-resolution screen for functional deficits in all FAMCAT domains. Approximately half the proxies provided multi-domain profile ratings on the 3 scales that did not differ significantly from these of the associated patients, but more research is needed to identify situations in which proxy profiles could be used in place of those provided by patients.
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Affiliation(s)
| | - Chun Wang
- University of Washington, Seattle, WA
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Houben F, Ghysels R, Mennen D, Bosmans R, Nuyts E, Spooren A. A tool for measuring burden in activities and participation of clients with acquired brain injury: the FINAH-instrument. Brain Inj 2020; 34:1245-1252. [PMID: 32755421 DOI: 10.1080/02699052.2020.1802658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE The objective of this study was to design an instrument to screen for burden in the daily life of both the client with acquired brain injury (ABI) and their nonprofessional caregiver. RESEARCH DESIGN Exploratory research Methods and Procedures: Based on a survey amongst stakeholder organizations, the FINAH-instrument is designed as a digital self-assessment questionnaire, based on ICF-framework. A test survey of the FINAH instrument is conducted on both clients, nonprofessional caregivers and healthcare professionals. MAIN OUTCOMES AND RESULTS The relative burden per item for clients and nonprofessional caregivers is most prominent in the domains of fatigue, cognitive and emotional consequences, self-care and mobility. The estimation of burden for clients and nonprofessional caregiver by healthcare professionals showed an overall 65% correct estimation by the healthcare professional. 19% of the items showed underestimation of burden, while 16% showed overestimation. CONCLUSIONS These results show that FINAH can ameliorate the estimation of the health care professional on the self-assessed burden of clients and nonprofessional caregivers, thus substantiating a more client-centred approach.
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Affiliation(s)
- Frederik Houben
- Department of Healthcare, PXL University College , Hasselt, Belgium
| | - Rudi Ghysels
- Department of Healthcare, PXL University College , Hasselt, Belgium
| | - Danny Mennen
- Department of Neurology, Adelante Centre of Expertise in Rehabilitation and Audiology , Hoensbroek, The Netherlands
| | - Roel Bosmans
- Department of Technology, PXL University College , Hasselt, Belgium
| | - Erik Nuyts
- Department of Healthcare, PXL University College , Hasselt, Belgium.,Faculty of Architecture and Arts, Hasselt University , Hasselt, Belgium
| | - Annemie Spooren
- Department of Healthcare, PXL University College , Hasselt, Belgium.,Faculty of Rehabilitation Sciences, Hasselt University , Hasselt, Belgium
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Chang EM, Gillespie EF, Shaverdian N. Truthfulness in patient-reported outcomes: factors affecting patients' responses and impact on data quality. Patient Relat Outcome Meas 2019; 10:171-186. [PMID: 31354371 PMCID: PMC6573779 DOI: 10.2147/prom.s178344] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022] Open
Abstract
The use of patient-reported outcome (PRO) measures in research and clinical care has expanded dramatically, reflective of an increasing recognition of patient-centeredness as an important aspect of high-quality health care. Given this rapid expansion, ensuring that data collected using PRO measures is of high quality is crucial for their continued successful application. Because of the subjective nature of the outcomes assessed, there are many factors that may influence patients' responses and thus challenge the overall quality of the data. In this review, we discuss the multiple factors that may affect patients' responses on PRO measures. These factors may arise during instrument development and administration or secondary to patient-level response behaviors. We further examine the relevant literature to delineate how these factors may impact data quality and review methods for accounting for these factors. Consideration of such factors is critical to ensuring data collected truthfully reflects patients' evaluations and provides accurate conclusions.
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Affiliation(s)
- Eric M Chang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Motl RW, Sandroff BM, McAuley E. Naturally occurring change in Multiple Sclerosis Walking Scale-12 scores over time in multiple sclerosis. Neurodegener Dis Manag 2018; 8:315-322. [PMID: 30226109 DOI: 10.2217/nmt-2018-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study examined the trajectory and pattern of naturally occurring change in perceived walking impairment over a 30-month period in relapsing-remitting multiple sclerosis (RRMS). PATIENTS & METHODS Two hundred and sixty-nine persons with RRMS completed the 12-item Multiple Sclerosis Walking Scale (MSWS-12) every 6 months over a 30-month period. Data were analyzed using latent growth curve modeling and latent class growth curve modeling. RESULTS Latent growth curve modeling demonstrated that a linear trajectory adequately described the group-level pattern of change in MSWS-12 scores over time. Latent class growth curve modeling supported a three-class model for describing the heterogeneity of changes in MSWS-12 scores over time. CONCLUSION Walking impairment does change over time in RRMS, and this can be described by three patterns of change trajectories that differed based on initial status of walking impairment.
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Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA 35294
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA 35294
| | - Edward McAuley
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA 61801
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Zittan E, Kabakchiev B, Kelly OB, Milgrom R, Nguyen GC, Croitoru K, Steinhart AH, Silverberg MS. Development of the Harvey-Bradshaw Index-pro (HBI-PRO) Score to Assess Endoscopic Disease Activity in Crohn's Disease. J Crohns Colitis 2017; 11:543-548. [PMID: 28453763 DOI: 10.1093/ecco-jcc/jjw200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a need for better, less-invasive disease activity indices that provide a representative assessment of endoscopic disease activity. We developed a new clinical score that incorporates the Harvey-Bradshaw index [HBI] with modified patient-reported outcomes [PROp] and physician [clinician]-reported outcomes [PROc] and assessed its ability to measure endosopic disease activity in ileocolonic Crohn's disease [CD]. METHODS A cohort of 88 CD patients undergoing colonoscopy was accrued in a prospective fashion. In total, 48 of the subjects were CD cases and 40 had already undergone a post-operative ileocolonic resection [post-op CD]. Each patient underwent multiple, endoscopist-blinded assessments including: HBI score, a PROp question asking for patient perception of disease activity status, a PROc question for clinician perception of disease activity status and C-reactive protein [CRP]. Active endoscopic disease was defined as Simple Endoscopic Score for CD [SES-CD] ≥ 3 for CD subjects and Rutgeerts score > i1 for post-op CD subjects. RESULTS Clinical remission as defined by the HBI did not accurately reflect endoscopic remission as defined by the SES-CD (area under the curve [AUC] = 0.54). Combining the HBI with PROp and PROc scores and then further adding CRP significantly improved the correlation with SES-CD [AUC = 0.78 and AUC = 0.88, respectively, p < 0.00001]. In post-op CD, HBI-defined remission also performed poorly against endoscopic remission defined by the Rutgeerts score [AUC = 0.52]. Combining HBI with PROp and the PROc scores and then further adding CRP did not significantly improve the model [AUC = 0.65 and AUC = 0.61, respectively, p = NS]. CONCLUSION In CD, the HBI correlates poorly with endoscopic disease activity. However, the HBI-PRO score, which incorporated PROp, PROc, CRP and HBI, significantly improved its ability to predict endoscopic activity in ileocolonic CD without prior surgery.
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Affiliation(s)
- Eran Zittan
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Boyko Kabakchiev
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Orlaith B Kelly
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Raquel Milgrom
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Geoffrey C Nguyen
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Kenneth Croitoru
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - A Hillary Steinhart
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Mark S Silverberg
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
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Sonder JM, Balk LJ, van der Linden FAH, Bosma LVAE, Polman CH, Uitdehaag BMJ. Toward the use of proxy reports for estimating long-term patient-reported outcomes in multiple sclerosis. Mult Scler 2014; 21:1865-71. [PMID: 25257617 DOI: 10.1177/1352458514544078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/25/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessment of disease impact in multiple sclerosis (MS) is usually driven by information obtained directly from patients using patient-reported outcomes. However, when patients' response in longitudinal studies is less reliable or missing, proxy respondents may be used. OBJECTIVE The objective of this paper is to evaluate whether long-term patient scores can be reliably estimated using scores obtained from proxies. METHODS Baseline, six-month and two-year data were collected from 155 patients and proxies on the physical scale of the Multiple Sclerosis Impact Scale (MSIS-29). Linear regression analyses were performed with the patient two-year scores as outcome, proxy two-year scores as predictor and other variables that could contribute to a better prediction of the patient follow-up score. RESULTS The patient follow-up score could be predicted rather accurately (R(2) = 0.74) using the patient baseline score and the proxy follow-up score. The correlation between observed and predicted scores was 0.86. The model performed well in different follow-up durations and even better in an external cohort. CONCLUSION A simple model of a constant value (intercept), the patient baseline score and the proxy follow-up score can predict patients' follow-up score on the physical impact of MS.
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Sonder JM, Balk LJ, Bosma LVAE, Polman CH, Uitdehaag BMJ. Do patient and proxy agree? Long-term changes in multiple sclerosis physical impact and walking ability on patient-reported outcome scales. Mult Scler 2014; 20:1616-23. [DOI: 10.1177/1352458514529173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Patient-reported outcome scales (PROs) are useful in monitoring changes in multiple sclerosis (MS) over time. Although these scales are reliable and valid measures in longitudinal studies in MS patients, it is unknown what the impact is when obtaining longitudinal data from proxies. Objective: The objective of this paper is to compare longitudinal changes in patient and proxy responses on PROs assessing physical impact of MS and walking ability. Methods: In a prospective observational study, data on the Multiple Sclerosis Impact Scale (MSIS-29 physical) and Multiple Sclerosis Walking Scale (MSWS-12) were obtained from 137 patient-proxy couples at baseline and at two-year follow-up. Demographic and disease-related variables explaining agreement or disagreement between patients and proxies were investigated using linear regression analyses. Results: Full agreement was found in 56% (MSIS) and 62% (MSWS) of the patient-proxy couples. Complete disagreement was very rare for both scales (2% MSIS, 5% MSWS). When patients were more positive than proxies, a higher age, longer disease duration, longer patient-proxy relationship and increased levels of depression, anxiety and caregiver burden in proxies were observed. Conclusion: In the majority of the patient-proxy couples there was agreement. Proxies can serve as a valuable source of information, but caution remains essential when using scores from proxies.
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Affiliation(s)
- Judith M Sonder
- Department of Neurology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Lisanne J Balk
- Department of Neurology, VU University Medical Center, The Netherlands
| | | | - Chris H Polman
- Department of Neurology, VU University Medical Center, The Netherlands
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