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Reimer C, Ali-Thompson S, Althawadi R, O'Brien N, Hickey A, Moran CN. Reliability of proxy reports on patient reported outcomes measures in stroke: An updated systematic review. J Stroke Cerebrovasc Dis 2024; 33:107700. [PMID: 38570060 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES With the rising global burden of stroke-related morbidity, and increased focus on patient-centered healthcare, patient reported outcome measures (PROMs) are increasingly used to inform healthcare decision-making. Some stroke patients with cognitive or motor impairments are unable to respond to PROMs, so proxies may respond on their behalf; the reliability of which remains unclear. The aim of the study is to update a 2010 systematic review to investigate the inter-rater reliability of proxy respondents answering PROMs for stroke patients. MATERIALS AND METHODS Studies on the reliability of proxy respondents in stroke were searched within CINAHL, Embase, PsycInfo, and WoS databases (01/07/22, 08/07/22). Fifteen studies were included for review. ICC and k-statistic were extracted for PROMs scales and categorized as poor (=0.40), moderate (0.41-0.60), substantial (0.61-0.80), or excellent (>0.80). Bias was assessed using the CCAT. RESULTS Five studies reported PROMs with inter-rater reliability scores ranging from = 0.40 to >0.80. Two studies reported activities of daily living (ADLs) scores ranging from 0.41 to 0.80 and 8 studies reported quality of life (QoL) measures with scores ranging from = 0.40 to >0.80. Subcategories of these scales included physical (ICC/k-statistic 0.41- >0.8), cognitive (ICC/k-statistic 0.40-0.80), communication (ICC/k-statistic <0.4-0.80,) and psychological (ICC/k-statistic <0.40-0.60) measures. CONCLUSIONS Proxy respondents are reliable sources for PROM reports on physical domains in ADLs, PROMs and QoL scales. Proxy reports for measures of communication and psychological domains had greater variability in reliability scores, ranging from poor to substantial; hence, caution should be applied when interpreting proxy reports for these domains.
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Affiliation(s)
- Claire Reimer
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Sherlissa Ali-Thompson
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Raseel Althawadi
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Niall O'Brien
- Teaching & Learning Support, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Anne Hickey
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
| | - Catherine Nora Moran
- Dept. Health Psychology, RCSI University of Medicine & Health Sciences, Dublin, Ireland.
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2
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Mourits BMP, den Hartog SJ, de Graaf JA, Roozenbeek B, Post MWM, Visser-Meily JMA, Scholten EWM. Exploring patients' experience using PROMs within routine post-discharge follow-up assessment after stroke: a mixed methods approach. J Patient Rep Outcomes 2024; 8:46. [PMID: 38668901 PMCID: PMC11052975 DOI: 10.1186/s41687-024-00724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Patient Reported Outcomes Measures (PROMs) are being used increasingly to measure health problems in stroke clinical practice. However, the implementation of these PROMs in routine stroke care is still in its infancy. To understand the value of PROMs used in ischemic stroke care, we explored the patients' experience with PROMs and with the consultation at routine post-discharge follow-up after stroke. METHODS In this prospective mixed methods study, patients with ischemic stroke completed an evaluation questionnaire about the use of PROMs and about their consultation in two Dutch hospitals. Additionally, telephone interviews were held to gain in-depth information about their experience with PROMs. RESULTS In total, 63 patients completed the evaluation questionnaire of which 10 patients were also interviewed. Most patients (82.2-96.6%) found completing the PROMs to be feasible and relevant. Half the patients (49.2-51.6%) considered the PROMs useful for the consultation and most patients (87.3-96.8%) reported the consultation as a positive experience. Completing the PROMs provided 51.6% of the patients with insight into their stroke-related problems. Almost 75% of the patients found the PROMs useful in giving the healthcare provider greater insight, and 60% reported discussing the PROM results during the consultation. Interviewed patients reported the added value of PROMs, particularly when arranging further care, in gaining a broader insight into the problems, and in ensuring all important topics were discussed during the consultation. CONCLUSIONS Completing PROMs appears to be feasible for patients with stroke attending post-discharge consultation; the vast majority of patients experienced added value for themselves or the healthcare provider. We recommend that healthcare providers discuss the PROM results with their patients to improve the value of PROMs for the patient. This could also improve the willingness to complete PROMs in the future.
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Affiliation(s)
- B M P Mourits
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - S J den Hartog
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - B Roozenbeek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - E W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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3
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Brouns B, Meesters JJL, de Kloet AJ, Vliet Vlieland TPM, Houdijk S, Arwert HJ, van Bodegom-Vos L. What works and why in the implementation of eRehabilitation after stroke - a process evaluation. Disabil Rehabil Assist Technol 2024; 19:345-359. [PMID: 35730242 DOI: 10.1080/17483107.2022.2088867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Implementation of an eRehabilitation intervention named Fit After Stroke @Home (Fast@home) - including cognitive/physical exercise applications, activity-tracking, psycho-education - after stroke resulted in health-related improvements. This study investigated what worked and why in the implementation. METHODS Implementation activities (information provision, integration of Fast@home, instruction and motivation) were performed for 14 months and evaluated, using the Medical Research Council framework for process evaluations which consists of three evaluation domains (implementation, mechanisms of impact and contextual factors). Implementation activities were evaluated by field notes/surveys/user data, it's mechanisms of impact by surveys and contextual factors by field notes/interviews among 11 professionals. Surveys were conducted among 51 professionals and 73 patients. User data (n = 165 patients) were extracted from the eRehabilitation applications. RESULTS Implementation activities were executed as planned. Of the professionals trained to deliver the intervention (33 of 51), 25 (75.8%) delivered it. Of the 165 patients, 82 (49.7%) were registered for Fast@home, with 54 patient (65.8%) using it. Mechanisms of impact showed that professionals and patients were equally satisfied with implementation activities (median score 7.0 [IQR 6.0-7.75] versus 7.0 [6.0-7.5]), but patients were more satisfied with the intervention (8.0 [IQR 7.0-8.0] versus 5.5 [4.0-7.0]). Guidance by professionals was seen as most impactful for implementation by patients and support of clinical champions and time given for training by professionals. Professionals rated the integration of Fast@home as insufficient. Contextual factors (financial cutbacks and technical setbacks) hampered the implementation. CONCLUSION Main improvements of the implementation of eRehabilitation are related to professionals' perceptions of the intervention, integration of eRehabilitation and contextual factors.Implication for rehabilitationTo increase the use of eRehabilitation by patients, patients should be supported by their healthcare professional in their first time use and during the rehabilitation process.To increase the use of eRehabilitation by healthcare professionals, healthcare professionals should be (1) supported by a clinical champion and (2) provided with sufficient time for learning to work and getting familiar with the eRehabilitation program.Integration of eRehabilitation in conventional stroke rehabilitation (optimal blended care) is an important challenge and a prerequisite for the implementation of eRehabilitation in the clinical setting.
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Affiliation(s)
- Berber Brouns
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jorit J L Meesters
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Arend J de Kloet
- Faculty of Health, Nutrition and Sports, The Hague University for Applied Sciences, The Hague, the Netherlands
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Sander Houdijk
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
| | - Henk J Arwert
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague and Leiden, The Netherlands
- Department of Rehabilitation, Haaglanden Medical Center, the Hague, the Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
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4
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Zhou X, Wang Y, Zhou L. Social participation, resilience, and coping tendency in a sample of stroke survivors: a multi-centre cross-sectional study in China. J Rehabil Med 2024; 56:jrm12448. [PMID: 38175146 PMCID: PMC10785685 DOI: 10.2340/jrm.v56.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To investigate the association between resilience and social participation and examine the mediation of resilience on coping strategies and social participation. DESIGN A multi-centre cross-sectional study performed from April to July 2022. PARTICIPANTS The study sample comprised 239 stroke survivors (53.1% male). The mean age of participants was 65.4 years. METHODS The study was conducted at 3 neurorehabilitation centres in Shanghai, China. The Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P) was used to measure both objective and subjective social participation. Resilience was evaluated using the Connor-Davidson Resilience Scale (CD-RISC), while positive coping tendency was assessed using the Simplified Coping Style Questionnaire (SCSQ). Multivariate linear regression was employed, taking into account confounding factors. In cases where a significant interaction effect was observed, simple slope analysis was conducted to explore the relationship between positive coping tendency and social participation at different levels of resilience. RESULTS The mean scores of social participation frequency, restriction, and satisfaction were 21.80 ± 15.13, 38.92 ± 26.48, and 63.34 ± 22.35, respectively. Higher resilience level was independently associated with higher social participation frequency (B = 0.210, p < 0.001), less participation restriction (B = 0.584, p < 0.001), and higher participation satisfaction (B = 0.250, p < 0.001). Moreover, higher resilience was correlated with more positive coping tendency. More positive coping tendency was related to higher social participation frequency and less participation restriction, but not to social participation satisfaction. Furthermore, individuals at different resilience levels moderated the effect of positive coping tendency on social participation frequency. CONCLUSION This study underlines the importance of resilience as a potential intervention in enhancing both objective and subjective social participation in stroke survivors, and provides insights into increasing the efficacy of positive coping strategies on social participation.
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Affiliation(s)
- Xuan Zhou
- School of nursing, Naval Medical University, Shanghai, China.
| | - Ying Wang
- Department of nursing, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Lanshu Zhou
- School of nursing, Naval Medical University, Shanghai, China
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Silveira Bianchim M, Crane E, Jones A, Neukirchinger B, Roberts G, Mclaughlin L, Noyes J. The implementation, use and impact of patient reported outcome measures in value-based healthcare programmes: A scoping review. PLoS One 2023; 18:e0290976. [PMID: 38055759 DOI: 10.1371/journal.pone.0290976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/08/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Value-Based Healthcare (VBHC) focuses on the value of patient outcomes and is achieved by ensuring resources already available are managed to realise the best possible individual and population health outcomes. Patient reported outcome measures (PROMs) measure the impact of illnesses from the patient perspective. We conducted a scoping review to understand how PROMs were implemented and used, and their impact in the context of VBHC. METHODS Arksey and O'Malley's overarching framework supplemented by principles from mixed-methods Framework Synthesis were used. CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, Web of Science, Google Scholar and reference lists were searched. An a priori data extraction framework was created using the review question and objectives as key domains against which to extract data. Mixed-methods data were organised, integrated and preserved in original format and reported for each domain. RESULTS Forty-three studies were included with 60,200 participants. Few studies reported a well-developed programme theory and we found little robust evidence of effect. PROMs were universally considered to have the potential to increase patient satisfaction with treatment and services, enhance patient awareness of symptoms and self-management, and improve health outcomes such as quality of life and global health status. Evidence is currently limited on how PROMs work and how best to optimally implement PROMs to achieve the target outcome. Implementation challenges commonly prevented the realisation of optimal outcomes and patients generally needed better and clearer communication about why PROMs were being given and how they could optimally be used to support their own self-management. CONCLUSION PROMSs have yet to demonstrate their full potential in a VBHC context. Optimal PROMs implementation is poorly understood by clinicians and patients. Future studies should explore different models of PROM implementation and use within VBHC programmes to understand what works best and why for each specific context, condition, and population.
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Affiliation(s)
| | - Ellie Crane
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Anwen Jones
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | | | - Gareth Roberts
- Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Leah Mclaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
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6
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Glimmerveen A, Holewijn S, Vermeer S. Association between clinician reported outcome and patient reported outcome measures one year after stroke. J Stroke Cerebrovasc Dis 2023; 32:107156. [PMID: 37178516 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES Patient reported outcome measures (PROM) are increasingly important in the evaluation of care. In this study we evaluate patient PROM in stroke patients and the association with clinical reported outcomes. MATERIALS AND METHODS Of 3706 first-ever stroke patients, 1861 were discharged home and invited to fill out PROM at discharge, 90 days and one-year after stroke. PROM include mental and physical health and patients' self-reported functionals status, all available via International Consortium for Health Outcomes Measurement. Clinician reported measures as NIHSS, Barthel index were collected during hospital admission and modified Rankin Scale (mRS) 90 days after stroke. PROM compliance was evaluated. Clinician reported measures were related to PROM. RESULTS 844 (45%) of the invited stroke patients filled out PROM. In general, those patients were younger and less severely affected (higher Barthel index and lower mRS). Compliance after enrolment is about 75%. Barthel index and mRS correlated with all PROM at 90 days and one-year. In age and gender adjusted multiple regression analysis, mRS was a consistent predictor for all PROM subsets, and Barthel index holds predictive value for physical health and patients' self-reported functional status. CONCLUSIONS Participation rate to fill out PROM is only 45% among stroke patients who were discharged home, and compliance rate is around 75% up one-year follow-up. PROM associated with the clinician reported functional outcome measures Barthel index, and mRS score. Low mRS score is a consistent predictor of better PROM at one year. We propose to use mRS in stroke care evaluation, until PROM participation improves.
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Affiliation(s)
- Astrid Glimmerveen
- Department of Neurology, Rijnstate Hospital, P.O. box 9555, 6800 TA, Arnhem, the Netherlands; Department of Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, P.O. box 217, 7500 AE, Enschede, the Netherlands.
| | - Suzanne Holewijn
- Department of Surgery and Vascular Center, Rijnstate Hospital, P.O. box 9555, 6800 TA, Arnhem, the Netherlands
| | - Sarah Vermeer
- Department of Neurology, Rijnstate Hospital, P.O. box 9555, 6800 TA, Arnhem, the Netherlands; Department of Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, P.O. box 217, 7500 AE, Enschede, the Netherlands
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7
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Baker C, Foster AM, D'Souza S, Godecke E, Shiggins C, Lamborn E, Lanyon L, Kneebone I, Rose ML. Management of communication disability in the first 90 days after stroke: a scoping review. Disabil Rehabil 2022; 44:8524-8538. [PMID: 34919449 DOI: 10.1080/09638288.2021.2012843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke. PURPOSE To explore the scope of literature for the management of communication disability in the first 90 days after stroke. MATERIALS AND METHODS A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF). RESULTS A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia). CONCLUSION A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required.IMPLICATIONS FOR REHABILITATIONInterdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes.There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning.Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care).
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Affiliation(s)
- Caroline Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia
| | - Abby M Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Speech Pathology Department, Monash Health, Melbourne, Australia.,School of Primary & Allied Health Care, Monash University, Melbourne, Australia
| | - Sarah D'Souza
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Medical and Health Science, Edith Cowan University, Joondalup, Australia
| | - Ciara Shiggins
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,School of Health Sciences, University of East Anglia, Norwich, UK
| | - Edwina Lamborn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lucette Lanyon
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Ian Kneebone
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadlands, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Beck da Silva Etges AP, Marcolino MAZ, Ogliari LA, de Souza AC, Zanotto BS, Ruschel R, Safanelli J, Magalhães P, Diegoli H, Weber KT, Araki AP, Nunes A, Ponte Neto OM, Nabi J, Martins SO, Polanczyk CA. Moving the Brazilian Ischemic Stroke Pathway to a Value-Based Care: Introduction of a Risk-Adjusted Cost Estimate Model for Stroke Treatment. Health Policy Plan 2022; 37:1098-1106. [PMID: 35866723 DOI: 10.1093/heapol/czac058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
The unsustainable increases in healthcare expenses and waste have motivated the migration of reimbursement strategies from volume to value. Value-based health care requires detailed comprehension of cost information at the patient level. This study introduces a clinical risk- and outcome-adjusted cost estimate model for stroke care sustained on time-driven activity-based costing (TDABC). In a cohort and multicenter study, a TDABC tool was developed to evaluate the costs per stroke patient, allowing us to identify and describe differences in cost by clinical risk at hospital arrival, treatment strategies, and modified Rankin Score (mRS) at discharge. The clinical risk was confirmed by multivariate analysis and considered patients' National Institute for Health Stroke Scale and age. Descriptive cost analyses were conducted, followed by univariate and multivariate models to evaluate the risk levels, therapies, and mRS stratification effect in costs. Then, the risk-adjusted cost estimate model for ischemic stroke treatment was introduced. All the hospitals collected routine prospective data from consecutive patients admitted with ischemic stroke diagnosis confirmed. A total of 822 patients were included. The median cost was I$2,210 (IQR: I$1,163-4,504). Fifty percent of the patients registered a favorable outcome mRS (0-2), costing less at all risk levels, while patients with the worst mRS (5-6) registered higher costs. Those undergoing mechanical thrombectomy had an incremental cost for all three risk levels, but this difference was lower for high-risk patients. Estimated costs were compared to observed costs per risk group, and there were no significant differences in most groups, validating the risk and outcome adjusted cost estimate model. By introducing a risk-adjusted cost estimate model, this study elucidates how healthcare delivery systems can generate local cost information to support value-based reimbursement strategies employing the data collection instruments and analysis developed in this study.
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Affiliation(s)
- Ana Paula Beck da Silva Etges
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Miriam Allein Zago Marcolino
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leonardo Alves Ogliari
- Programa de Pós-graduação em Engenharia de Produção da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Bruna Stella Zanotto
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Renata Ruschel
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil
| | | | | | | | - Karina Tavares Weber
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Paula Araki
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Altacílio Nunes
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octávio Marques Ponte Neto
- Neurology Division, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Sheila Ouriques Martins
- Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Faculdade de Medicina Universidade Federal do Rio Grande do Sul
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS)- CNPq/Brazil (project: 465518/2014-1), Porto Alegre, Brazil.,Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital Moinhos de Vento, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre, Faculdade de Medicina Universidade Federal do Rio Grande do Sul
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9
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Joundi RA, Adekanye J, Leung AA, Ronksley P, Smith EE, Rebchuk AD, Field TS, Hill MD, Wilton SB, Bresee LC. Health State Utility Values in People With Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e024296. [PMID: 35730598 PMCID: PMC9333363 DOI: 10.1161/jaha.121.024296] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 12/25/2022]
Abstract
Background Health state utility values are commonly used to provide summary measures of health-related quality of life in studies of stroke. Contemporaneous summaries are needed as a benchmark to contextualize future observational studies and inform the effectiveness of interventions aimed at improving post-stroke quality of life. Methods and Results We conducted a systematic search of the literature using Medline, EMBASE, and Web of Science from January 1995 until October 2020 using search terms for stroke, health-related quality of life, and indirect health utility metrics. We calculated pooled estimates of health utility values for EQ-5D-3L, EQ-5D-5L, AQoL, HUI2, HUI3, 15D, and SF-6D using random effects models. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression by key subgroups. We screened 14 251 abstracts and 111 studies met our inclusion criteria (sample size range 11 to 12 447). EQ-5D-3L was reported in 78% of studies (study n=87; patient n=56 976). The pooled estimate for EQ-5D-3L at ≥3 months following stroke was 0.65 (95% CI, 0.63-0.67), which was ≈20% below population norms. There was high heterogeneity (I2>90%) between studies, and estimates differed by study size, case definition of stroke, and country of study. Women, older individuals, those with hemorrhagic stroke, and patients prior to discharge had lower pooled EQ-5D-3L estimates. Conclusions Pooled estimates of health utility for stroke survivors were substantially below population averages. We provide reference values for health utility in stroke to support future clinical and economic studies and identify subgroups with lower healthy utility. Registration URL: https://www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42020215942.
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Affiliation(s)
- Raed A. Joundi
- Department of Clinical NeurosciencesUniversity of CalgaryAlbertaCanada
- Division of NeurologyHamilton Health SciencesMcMaster University & Population Health Research InstituteHamiltonOntarioCanada
| | | | | | | | | | | | - Thalia S. Field
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | | | - Lauren C. Bresee
- Department of Community Health SciencesUniversity of CalgaryAlbertaCanada
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10
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van Staalduinen DJ, van den Bekerom P, Groeneveld S, Kidanemariam M, Stiggelbout AM, van den Akker-van Marle ME. The implementation of value-based healthcare: a scoping review. BMC Health Serv Res 2022; 22:270. [PMID: 35227279 PMCID: PMC8886826 DOI: 10.1186/s12913-022-07489-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study was to identify and summarize how value-based healthcare (VBHC) is conceptualized in the literature and implemented in hospitals. Furthermore, an overview was created of the effects of both the implementation of VBHC and the implementation strategies used. Methods A scoping review was conducted by searching online databases for articles published between January 2006 and February 2021. Empirical as well as non-empirical articles were included. Results 1729 publications were screened and 62 were used for data extraction. The majority of the articles did not specify a conceptualization of VBHC, but only conceptualized the goals of VBHC or the concept of value. Most hospitals implemented only one or two components of VBHC, mainly the measurement of outcomes and costs or Integrated Practice Units (IPUs). Few studies examined effects. Implementation strategies were described rarely, and were evaluated even less. Conclusions VBHC has a high level of interpretative variability and a common conceptualization of VBHC is therefore urgently needed. VBHC was proposed as a shift in healthcare management entailing six reinforcing steps, but hospitals have not implemented VBHC as an integrative strategy. VBHC implementation and effectiveness could benefit from the interdisciplinary collaboration between healthcare and management science. Trial registration This scoping review was registered on Open Science Framework https://osf.io/jt4u7/ (OSF | The implementation of Value-Based Healthcare: a Scoping Review). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07489-2.
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Affiliation(s)
- Dorine J van Staalduinen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands. .,Institute of Public Administration, Leiden University, Turfmarkt 99, 2511 DP, The Hague, The Netherlands.
| | - Petra van den Bekerom
- Institute of Public Administration, Leiden University, Turfmarkt 99, 2511 DP, The Hague, The Netherlands
| | - Sandra Groeneveld
- Institute of Public Administration, Leiden University, Turfmarkt 99, 2511 DP, The Hague, The Netherlands
| | - Martha Kidanemariam
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands
| | - M Elske van den Akker-van Marle
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300RC, Leiden, The Netherlands
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11
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de Graaf JA, Volkers EJ, Schepers VPM, Visser-Meily JMA, Post MWM. Validity of the Utrecht scale for evaluation of rehabilitation-participation restrictions scale in a hospital-based stroke population 3 months after stroke. Top Stroke Rehabil 2021; 29:516-525. [PMID: 34315356 DOI: 10.1080/10749357.2021.1956047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background:The Utrecht Scale for Evaluation of Rehabilitation-Participation Restrictions scale (USER-P-R) is a promising patient-reported outcome measure, but has currently not been validated in a hospital-based stroke population. Objective:To examine psychometric properties of the USER-P-R in a hospital-based stroke population 3 months after stroke onset. Methods:Cross-sectional study including 359 individuals with stroke recruited through 6 Dutch hospitals. The USER-P-R, EuroQol 5-dimensional 5-level questionnaire (EQ-5D-5 L), Patient Reported Outcomes Measurement Information System 10-Question Global Health Short Form (PROMIS-10), modified Rankin Scale (mRS) and two items on perceived decrease in health and activities post-stroke were administered in a telephone interview 3 months after stroke. The internal consistency, distribution, floor/ceiling effects, convergent validity and discriminant ability of the USER-P-R were calculated. Results:Of all participants, 96.9% were living at home and 50.9% experienced no or minimal disabilities (mRS 0-1). The USER-P-R showed high internal consistency (α = 0.90) and a non-normal left-skewed distribution with a ceiling effect (21.4% maximum scores). A substantial proportion of participants with minimal disabilities (mRS 1) experienced restrictions on USER-P-R items (range 11.9-48.5%). The USER-P-R correlated strongly with the EQ-5D-5 L, PROMIS-10 and mRS. The USER-P-R showed excellent discriminant ability in more severely affected individuals with stroke, whereas its discriminant ability in less affected individuals was moderate. Conclusions:The USER-P-R shows good measurement properties and provides additional patient-reported information, proving its usefulness as an instrument to evaluate participation after 3 months in a hospital-based stroke population.
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Affiliation(s)
- Joris A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Eline J Volkers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P M Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
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12
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Wu L, Wang C, Liu J, Guo J, Wei Y, Wang K, Miao P, Wang Y, Cheng J. Voxel-Mirrored Homotopic Connectivity Associated With Change of Cognitive Function in Chronic Pontine Stroke. Front Aging Neurosci 2021; 13:621767. [PMID: 33679376 PMCID: PMC7929989 DOI: 10.3389/fnagi.2021.621767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/18/2021] [Indexed: 12/14/2022] Open
Abstract
Recent neuroimaging studies have shown the possibility of cognitive impairment after pontine stroke. In this study, we aimed to use voxel-mirrored homotopic connectivity (VMHC) to investigate changes in the cognitive function in chronic pontine stroke. Functional MRI (fMRI) and behavioral assessments of cognitive function were obtained from 56 patients with chronic pontine ischemic stroke [28 patients with left-sided pontine stroke (LP) and 28 patients with right-sided pontine stroke (RP)] and 35 matched healthy controls (HC). The one-way ANOVA test was performed for the three groups after the VMHC analysis. Results showed that there were significant decreases in the bilateral lingual gyrus (Lingual_L and Lingual_R) and the left precuneus (Precuneus_L) in patients with chronic pontine ischemic stroke compared to HCs. However, in a post-hoc multiple comparison test, this difference remained only between the HC and RP groups. Moreover, we explored the relationship between the decreased z-values in VMHC and the behavior-task scores using a Pearson's correlation test and found that both scores of short-term memory and long-term memory in the Rey Auditory Verbal Learning Test were positively correlated with z-values of the left lingual gyrus (Lingual_L), the right lingual gyrus (Lingual_R), and the left precuneus (Precuneus_L) in VMHC. Besides that, the z-values of Precuneus_L in VMHC were also negatively correlated with the reaction time for correct responses in the Flanker task and the spatial memory task. In conclusion, first, the lingual gyrus played an important role in verbal memory. Second, the precuneus influenced the working memory, both auditory-verbal memory and visual memory. Third, the right-sided stroke played a greater role in the results of this study. This study provides a basis for further elucidation of the characteristics and mechanisms of cognitive impairment after pontine stroke.
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Affiliation(s)
- Luobing Wu
- Henan Key Laboratory of Magnetic Resonance Function and Molecular Imaging, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Caihong Wang
- Henan Key Laboratory of Magnetic Resonance Function and Molecular Imaging, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingchun Liu
- Tianjin Key Laboratory of Functional Imaging, Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Guo
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Ying Wei
- Henan Key Laboratory of Magnetic Resonance Function and Molecular Imaging, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaiyu Wang
- GE Healthcare MR Research, Beijing, China
| | - Peifang Miao
- Henan Key Laboratory of Magnetic Resonance Function and Molecular Imaging, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Wang
- Henan Key Laboratory of Magnetic Resonance Function and Molecular Imaging, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Henan Key Laboratory of Magnetic Resonance Function and Molecular Imaging, Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Depla AL, Crombag NM, Franx A, Bekker MN. Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives. BMC Health Serv Res 2021; 21:113. [PMID: 33530989 PMCID: PMC7852077 DOI: 10.1186/s12913-021-06121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR). METHODS In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained. RESULTS Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set's direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care. CONCLUSIONS This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.
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Affiliation(s)
- Anne L Depla
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Neeltje M Crombag
- Department of Development and Regeneration, KU Leuven University, Leuven, Belgium
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
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14
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DE Graaf JA, Visser-Meily JM, Schepers VP, Baars A, Kappelle LJ, Passier PE, Wermer MJ, DE Wit DC, Post MW. Comparison between EQ-5D-5L and PROMIS-10 to evaluate health-related quality of life 3 months after stroke: a cross-sectional multicenter study. Eur J Phys Rehabil Med 2021; 57:337-346. [PMID: 33448750 DOI: 10.23736/s1973-9087.21.06335-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although the use of patient-reported outcome measures to assess Health-Related Quality of Life (HRQoL) has been advocated, it is still open to debate which patient-reported outcome measure should be preferred to evaluate HRQoL after stroke. AIM To compare the measurement properties (including concurrent validity and discriminant ability) between the 5-dimensional 5-level EuroQol (EQ-5D-5L) and the Patient-Reported Outcomes Measurement Information System 10-Question Global Health Short Form (PROMIS-10) to evaluate HRQoL 3 months after stroke. DESIGN Cross-sectional study. SETTING Neurology outpatient clinics in 6 Dutch hospitals. POPULATION The participants 360 consecutive individuals with stroke. Their median age was 71 years, 143 (39.7%) were female and 335 (93.0%) had suffered an ischemic stroke. METHODS The EQ-5D-5L, PROMIS-10, modified Rankin Scale and two items on experienced decrease in health and activities post-stroke were administered by a stroke nurse or nurse practitioner through a telephone interview 3 months after stroke. The internal consistency, distribution, floor/ceiling effects, inter-correlations and discriminant ability (using the modified Rankin Scale and experienced decrease in health and in activities post-stroke as external anchors) were calculated for both the EQ-5D-5L and PROMIS-10. RESULTS Ninety-six percent of the participants were living at home and 50.9% experienced minimal or no disabilities (modified Rankin Scale 0-1) 3 months after stroke. A ceiling effect and a non-normal left skewed distribution were observed in the EQ-5D-5L. The PROMIS-10 showed higher internal consistency (α=0.90) compared to the EQ-5D-5L (α=0.75). Both the EQ-5D-5L and the PROMIS-10 were strongly correlated with the modified Rankin Scale (r=0.62 and 0.60 respectively). The PROMIS-10 showed better discriminant ability in less affected individuals with stroke, whereas the EQ-5D-5L showed slightly better discriminant ability in more affected individuals with stroke. CONCLUSIONS Both EQ-5D-5L and PROMIS-10 prove to be useful instruments to evaluate HRQoL in patients who are living at home 3 months after stroke. CLINICAL REHABILITATION IMPACT The clinical rehabilitation impact depended on the setting and underlying goal which patient-reported outcome measure is preferred to evaluate HRQoL 3 months after stroke. The PROMIS-10 should be preferred to detect differences in less affected stroke patients, whereas the EQ-5D-5L provides slightly more information in more affected stroke patients.
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Affiliation(s)
- Joris A DE Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands -
| | - Johanna M Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, the Netherlands
| | - Vera P Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, the Netherlands
| | - Annette Baars
- Department of Rehabilitation, Rijnstate Hospital, Arnhem, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center of Utrecht, Utrecht, the Netherlands
| | - Patricia E Passier
- Department of Rehabilitation, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Marieke J Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniëlle C DE Wit
- Department of Rehabilitation, Franciscus Gasthuis and Vlietland Hospital, Rotterdam, the Netherlands
| | - Marcel W Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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15
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Bunketorp-Käll L, Pekna M, Pekny M, Samuelsson H, Blomstrand C, Nilsson M. Motor Function in the Late Phase After Stroke: Stroke Survivors' Perspective. Ann Rehabil Med 2020; 44:362-369. [PMID: 32986939 PMCID: PMC7655232 DOI: 10.5535/arm.20060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the association between observer-assessed functional status and perceived recovery in the late phase after stroke. The study also aimed to determine whether observer-assessed functional improvements as a result of horse-riding therapy (H-RT) are related to enhanced perception of stroke recovery. Methods This is a descriptive correlational study using data derived from a three-armed randomized controlled trial in which 123 individuals were enrolled, among whom 43 received H-RT for 12 weeks. The measures included the Modified Motor Assessment Scale, Berg Balance Scale, Timed Up and Go, timed 10-m walk, and perceived recovery from stroke indicated by item #9 in the Stroke Impact Scale (version 2.0). Spearman rank order correlation (rs) was used in the analyses. Results There were moderate to strong positive or negative correlations between all four observer-assessed motor variables and participants’ ratings of perceived late-phase stroke recovery at trial entrance, ranging from rs=-0.49 to rs=0.54 (p<0.001). The results of the correlational analyses of variable changes showed that, after the end of the H-RT intervention, both self-selected and fast gait speed improvement were significantly correlated with increments in self-rated stroke recovery (rs=-0.41, p=0.01 and rs=-0.38, p=0.02, respectively). Conclusion This study provided data supporting the association between individual ratings of self-perceived recovery after stroke and observer-assessed individual motor function. The results further demonstrate that enhancement in perceived stroke recovery after completing the intervention was associated with objectively measured gains in both self-selected and fast gait speed.
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Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Center for Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital, Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,University of Newcastle, Newcastle, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,University of Newcastle, Newcastle, Australia
| | - Hans Samuelsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,Centre for Rehab Innovations (CRI), University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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16
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Abstract
OBJECTIVE Few prospective studies have examined psychosocial symptoms in young adult stroke survivors. The purpose of this pilot study was to examine the feasibility of methods to assess and describe the presence of symptoms and their characteristics in young adult stroke survivors. METHODS A prospective descriptive design using PROMIS and NeuroQoL patient-reported outcomes was used. Stroke survivors aged 18 to 65 years admitted for acute ischemic stroke completed baseline measures before hospital discharge; the same measures were collected by telephone interview 6 months later. RESULTS Thirty patients were recruited, and 18 (60%) completed follow-up measures. There was wide variability in scores across patients for each patient-reported outcome that persisted at 6 months. NeuroQoL cognitive function was the only patient-reported outcome to have a statistically significant change from baseline to 6 months (P = .045). CONCLUSIONS It is feasible to recruit and retain young adult stroke survivors in a prospective study. Wide variability in scores across patients suggests different trajectories of recovery in the first 6 months after stroke. Neuroscience nurses can assess for these symptoms and provide individualized interventions to aid in self-management of burdensome symptoms.
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17
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Mehaffey JH, Hawkins RB, Charles EJ, Kron IL, Ailawadi G, Kern JA, Roeser ME, Kozower B, Teman NR. Impact of Complications After Cardiac Operation on One-Year Patient-Reported Outcomes. Ann Thorac Surg 2020; 109:43-48. [DOI: 10.1016/j.athoracsur.2019.05.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
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18
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Stiekema APM, Nijsse B, de Kort PLM, Spikman JM, Visser-Meily JMA, van Heugten CM. The relationship between social cognition and participation in the long term after stroke. Neuropsychol Rehabil 2019; 31:278-292. [PMID: 31854264 DOI: 10.1080/09602011.2019.1692670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Social cognitive impairments may play a role in participation restrictions after stroke. Understanding their relationship could inform treatment approaches to improve participation. We investigated the relationship between social cognition and participation in the long term after stroke. Of 395 patients participating in a large prospective cohort study, cross-sectional data were available at 3-4 years post-stroke of 118 patients on tests for emotion recognition, theory of mind, empathy, and behaviour regulation. Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation - Participation (USER-P). Bivariate and multivariate regression analysis were used to examine the relationship between social cognitive domains and participation. The majority suffered from minor stroke (83.1% scored NIHSS 0-4). Only behaviour regulation was related to participation restrictions in bivariate analysis, but social cognitive impairments did not predict participation restrictions in multivariate regression in this group. To conclude, in a sample of minor stroke patients with mild impairments in theory of mind, emotion recognition and behavioural control, there were no associations with restrictions in participation. Research should examine whether a relationship is present in patients with more severe stroke. In addition, measuring social aspects of participation is necessary to further unravel this relationship, to determine treatment targets for improving participation.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, Netherlands.,Alzheimer Center Limburg, Maastricht University, Maastricht, Netherlands
| | - Britta Nijsse
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
| | - Paul L M de Kort
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
| | - Jacoba M Spikman
- Department of Neurology, Subdepartment of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, Netherlands.,Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, Netherlands
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