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Selles WDL, Miyamoto GC, Santos EDC, Carmo CRL, Moura GM, Santos GMF, Lopes GDS, Silva DW, Pereira LJF, Lunardi AC. Effectiveness of Aerobic Training for Adverse Symptoms Related to Chemotherapy During Treatment: Protocol for a Randomized Controlled Trial With Cost-Effectiveness Assessment. JMIR Res Protoc 2024; 13:e60828. [PMID: 39163116 DOI: 10.2196/60828] [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: 05/23/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND One strategy to prevent adverse effects resulting from chemotherapy treatment is to perform physical exercises during treatment. However, there is still no consensus on the best type and intensity of exercise, nor when it should be started. Most studies have been carried out in patients with breast cancer, usually a few weeks after starting chemotherapy, on an outpatient basis 2 to 3 times a week. The main differences in our study are that we carried out physical training in hospitalized patients undergoing a cycle of chemotherapy for cancer treatment and that this training was carried out 5 times a week and was not restricted to a specific type of cancer. OBJECTIVE We aimed to evaluate the effects of aerobic training on symptoms related to chemotherapy (nausea, vomiting, asthenia, and sensation of weakness), fatigue, mobility, clinical complications, and length of hospital stay of patients during the drug treatment cycle. We also evaluated patient satisfaction with the proposed intervention, the adverse effects of aerobics training, and the cost-effectiveness of this intervention. METHODS This is a controlled and randomized trial with blinded evaluation that will include 94 hospitalized patients with cancer for 1 or more cycles of chemotherapy. The intervention group will perform aerobic training during a cycle of chemotherapy. The control group will receive a booklet with guidelines for staying active during the hospitalization period. The groups will be compared using a linear mixed model for fatigue, mobility, and chemotherapy-related symptoms before and after the intervention. The length of hospital stay will also be compared between groups using Kaplan-Meier survival analysis. The incidence of complications will be compared using the χ2 test. Cost-effectiveness and cost-utility analyses will be performed for the impact of exercise and quality-adjusted life years with the EQ-5D-3L-21 quality of life trials. The implementation variables (acceptability, suitability, and feasibility) will be evaluated by frequencies. RESULTS The clinical trial registration was approved in March 2023. Recruitment and data collection for the trial are ongoing, and the results of this study are likely to be published in late 2025. CONCLUSIONS Chemotherapy has side effects that negatively impact the quality of life of patients with cancer. Aerobic exercise can reduce these side effects in a simple and inexpensive way. The field of work of physical therapists could be expanded to oncology if the intervention works. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos RBR-6b4zwx3; https://tinyurl.com/39c4c7wz. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/60828.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Adriana Claudia Lunardi
- Master's and Doctorate Program, Universidade Cidade de São Paulo, Sao Paulo, Brazil
- Department of Physical Therapy, University of Sao Paulo, Sao Paulo, Brazil
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Galvão EL, de Pina Carvalho J, Machado de Assis TS, Freire ML, Cota G, Nascimento Silva S. Quality of life of patients with cutaneous leishmaniasis: A comparative analysis of the EQ-5D-3L and CLIQ questionnaires. PLoS One 2024; 19:e0298988. [PMID: 38394079 PMCID: PMC10889894 DOI: 10.1371/journal.pone.0298988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To evaluate the performance of the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ) using the EuroQol-5 Dimension (EQ-5D-3L) as a reference standard (criterion validation); to evaluate the responsiveness of the instruments and estimate a cut-off point for the CLIQ to be able to discriminate between high and low impacts of cutaneous leishmaniasis on patients. METHODS Between 2020 and 2022, a longitudinal validation study was conducted at a reference centre for leishmaniasis in Brazil. The EQ-5D-3L and CLIQ questionnaires were administered before, during and after treatment for cutaneous leishmaniasis. The correlation between the instruments was assessed using Spearman's correlation coefficient, responsiveness was assessed using the Wilcoxon test, and CLIQ cut-off points were proposed based on results of the EQ-5Q-3L, dichotomized between patients reporting no problems' and 'some or extreme problems'. RESULTS There were satisfactory correlation coefficients between the two instruments before (-0.596) and during treatment (-0.551) and a low correlation between the instruments after the end of treatment (-0.389). In general, the responsiveness of the instruments was satisfactory. The CLIC scores that maximized sensitivity and specificity for recognizing impaired health status before and during treatment were 7 points and 17 points, respectively. However, at the end of treatment, based on the results for the EQ-5D-3L, the CLIC was not able to discriminate between individuals with high and low impacts of the disease. CONCLUSION The CLIQ corresponds well with the EQ-5D-3L when applied before and during treatment but does not seem to be appropriate for follow-up evaluations after the end of treatment.
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Affiliation(s)
- Endi Lanza Galvão
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, State of Minas Gerais, Brazil
- Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, State of Minas Gerais, Brazil
| | - Janaína de Pina Carvalho
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, State of Minas Gerais, Brazil
| | - Tália Santana Machado de Assis
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, State of Minas Gerais, Brazil
- Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, State of Minas Gerais, Brazil
| | - Mariana Lourenço Freire
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, State of Minas Gerais, Brazil
| | - Gláucia Cota
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, State of Minas Gerais, Brazil
| | - Sarah Nascimento Silva
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, State of Minas Gerais, Brazil
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Graever L, Issa AFC, da Fonseca VBP, Melo MM, da Silva GPDC, da Nóbrega ICP, Savassi LCM, Dias MB, Gomes MK, Lapa e Silva JR, Guimarães RM, Seródio RC, Frølich A, Gudbergsen H, Jakobsen JC, Dominguez H. Telemedicine Support for Primary Care Providers versus Usual Care in Patients with Heart Failure: Protocol of a Pragmatic Cluster Randomised Trial within the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5933. [PMID: 37297537 PMCID: PMC10253100 DOI: 10.3390/ijerph20115933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Heart failure is a prevalent condition and a frequent cause of hospital readmissions and poor quality of life. Teleconsultation support from cardiologists to primary care physicians managing patients with heart failure may improve care, but the effect on patient-relevant outcomes is unclear. We aim to evaluate whether collaboration through a novel teleconsultation platform in the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) project, tested on a previous feasibility study, can improve patient-relevant outcomes. We will conduct a parallel-group, two-arm, cluster-randomised superiority trial with a 1:1 allocation ratio, with primary care practices from Rio de Janeiro as clusters. Physicians from the intervention group practices will receive teleconsultation support from a cardiologist to assist patients discharged from hospitals after admission for heart failure. In contrast, physicians from the control group practices will perform usual care. We will include 10 patients per each of the 80 enrolled practices (n = 800). The primary outcome will be a composite of mortality and hospital admissions after six months. Secondary outcomes will be adverse events, symptoms frequency, quality of life, and primary care physicians' compliance with treatment guidelines. We hypothesise that teleconsulting support will improve patient outcomes.
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Affiliation(s)
- Leonardo Graever
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Aurora Felice Castro Issa
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | - Marcelo Machado Melo
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | | | | | | | - Maria Kátia Gomes
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | - Jose Roberto Lapa e Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | | | | | - Anne Frølich
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Henrik Gudbergsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark & Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, 2200 Copenhagen, Denmark;
| | - Helena Dominguez
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
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Ng APP, Liu KSN, Cheng WHG, Wong CKH, Cheng JKY, Lam JSM, Or CK, Tse ETY, Lam CLK. Feasibility and acceptability of electronic EQ-5D-5L for routine measurement of HRQOL in patients with chronic musculoskeletal problems in Hong Kong primary care. Health Qual Life Outcomes 2022; 20:137. [PMID: 36127713 PMCID: PMC9487025 DOI: 10.1186/s12955-022-02047-0] [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: 05/06/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information on HRQOL can enhance patient diagnosis and management but it is rarely available in routine clinical practice. This mixed-method study evaluated the feasibility and acceptability of the electronic EQ-5D-5L measurement of HRQOL in patients with chronic musculoskeletal problems in primary care. METHODS In three primary care clinics, 665 patients with musculoskeletal problems completed the electronic EQ-5D-5L and Visual Analogue Scale (e-EQ-5D-5L/VAS), and a questionnaire on socio-demographics, perceived ease of use (PEOU), and perceived usefulness (PU) at baseline and two follow-ups. Patient completion and response rates, and time to complete the e-EQ-5D-5L/VAS were measured. During the same consultations, 49 doctors reviewed the e-EQ-5D-5L/VAS reports and completed a clinician questionnaire on PEOU, PU, and time spent to address each report. Individual interviews along with focus group discussions were conducted on patients, doctors, and research assistants for further exploration. RESULTS Mean completion time reduced from baseline to first and second follow-up (120.66, 83.99, and 105.22 s, respectively). Completion and response rates were high at each follow-up visit (> 99.8% and > 91.11%, respectively). Doctors needed less than 2 min to read the report but felt the time required to address the report was a significant barrier. Some patients had difficulties using e-platforms, in understanding or answering questions; but, PEOU improved with time (p < 0.001). Most patients found the e-platforms useful (> 85.3%). Clinicians agreed a great majority of the reports were easy to use (76.0-85.1%) and useful (69.2-72.0%), particularly aiding with a holistic view of the patient's musculoskeletal problem. CONCLUSION The e-EQ-5D-5L/VAS is a feasible and acceptable measurement of HRQOL of patients with chronic musculoskeletal problems in routine primary care in Hong Kong which can assist real-time management decisions. TRIAL REGISTRATION NCT03609762.
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Affiliation(s)
- Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Rd, Futian District, Shenzhen, 518009, Guangdong Province, China.,Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China
| | - Kiki Sze Nga Liu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China
| | - Will Ho Gi Cheng
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.,Laboratory of Data Discovery for Health (D²4H), Hong Kong Science and Technology Park, Hong Kong SAR, Sha Tin, China
| | - John King Yiu Cheng
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China
| | - Joyce Sau Mei Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, Faculty of Engineering, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Rd, Futian District, Shenzhen, 518009, Guangdong Province, China.,Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Rd, Futian District, Shenzhen, 518009, Guangdong Province, China. .,Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3rd Floor, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China.
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5
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Lam CLK, Tse ETY, Wong CKH, Lam JSM, Chen SS, Bedford LE, Cheung JPY, Or CK, Kind P. A pilot study on the validity and psychometric properties of the electronic EQ-5D-5L in routine clinical practice. Health Qual Life Outcomes 2021; 19:266. [PMID: 34922564 PMCID: PMC8684117 DOI: 10.1186/s12955-021-01898-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background Electronic measurement of health-related quality of life (HRQOL) may facilitate timely and regular assessments in routine clinical practice. This study evaluated the validity and psychometric properties of an electronic version of the EQ-5D-5L (e-EQ-5D-5L) in Chinese patients with chronic knee and/or back problems.
Methods 151 Chinese subjects completed an electronic version of the Chinese (Hong Kong) EQ-5D-5L when they attended a primary care or orthopedics specialist out-patient clinic in Hong Kong. They also completed the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a Pain Rating Scale, and a structured questionnaire on socio-demographics, co-morbidities and health service utilization. 32 subjects repeated the e-EQ-5D-5L two weeks after the baseline. 102 subjects completed e-EQ-5D-5L and 99 completed the Global Rating on Change Scale at three-month clinic follow up. Construct validity was assessed by the association of EQ-5D-5L scores with external criterion of WOMAC scores. We tested mean differences of WOMAC scores between adjacent response levels of the EQ-5D-5L dimensions by one-way ANOVA, test–retest reliability by intra-class correlation, sensitivity by known group comparisons and responsiveness by changes in EQ-5D-5L scores over 3 months. Results There was an association between EQ-5D-5L and WOMAC scores. Mean WOMAC scores increased with the increase in adjacent response levels of EQ-5D-5L dimensions. Test–retest intraclass correlation coefficient (ICC) of EQ-5D-5L utility and EQ-VAS scores were 0.76 and 0.83, respectively, indicating good reliability. There were significant differences in the proportions reporting limitations in the EQ-5D-5L dimensions, the utility and VAS scores between the mild and severe pain groups (utility = 0.28, p = 0.001; VAS = 11.46, p < 0.001), and between primary care and specialist out-patient clinic patients (utility = 0.15, p = 0.001; VAS = 10.21, p < 0.001), supporting sensitivity. Among those reporting ‘better’ global health at three-months, their EQ-5D-5L utility and EQ-VAS scores were significantly increased from baseline (utility = 0.18, p < 0.001; VAS = 10.75, p = 0.005). Conclusions The electronic version of the EQ-5D-5L is valid, reliable, sensitive and responsive in the measurement of HRQOL in Chinese patients with chronic knee or back pain in routine clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01898-3.
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Affiliation(s)
- Cindy Lo Kuen Lam
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, SAR, China
| | - Emily Tsui Yee Tse
- Department of Family Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China. .,Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, SAR, China.
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, SAR, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Joyce Sau Mei Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, SAR, China
| | - Sikky Shiqi Chen
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, SAR, China
| | - Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Calvin Kalun Or
- Industrial and Manufacturing Systems Engineering, Faculty of Engineering, The University of Hong Kong, Hong Kong, SAR, China
| | - Paul Kind
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
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Kamonseki DH, Haik MN, Ribeiro LP, de Almeida RF, de Almeida LA, Fonseca CL, Camargo PR. Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain. PLoS One 2021; 16:e0260452. [PMID: 34852000 PMCID: PMC8635377 DOI: 10.1371/journal.pone.0260452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/09/2021] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain. METHODS Individuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient(3,1) and internal consistency with Cronbach's alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC). RESULTS Exploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach's alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC. CONCLUSION FABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.
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Affiliation(s)
- Danilo Harudy Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Melina Nevoeiro Haik
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Larissa Pechincha Ribeiro
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Rafaela Firmino de Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | - Lucas Araújo de Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
| | | | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Universidade Federal de São Carlos (UFSCar), São Carlos, (SP), Brazil
- * E-mail:
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Moro ET, Pinto PCC, Neto AJMM, Hilkner AL, Salvador LFP, Silva BRD, Souto IG, Boralli R, Bloomstone J. Quality of recovery in patients under low- or standard-pressure pneumoperitoneum. A randomised controlled trial. Acta Anaesthesiol Scand 2021; 65:1240-1247. [PMID: 34097759 DOI: 10.1111/aas.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of low-pressure pneumoperitoneum seems to be capable of reducing complications such as post-operative pain. However, the quality of evidence supporting this conclusion is low. Both the lack of investigator blinding to both intra-abdominal pressure and to method of neuromuscular blockade represent key sources of bias. Hence, this prospective, randomised, and double-blind study aimed to compare the quality of recovery (Questionnaire QoR-40) of patients undergoing laparoscopic cholecystectomy under low-pressure and standard-pressure pneumoperitoneum. We tested the hypothesis that low pneumoperitoneum pressure enhances the quality of recovery following LC. METHODS Eighty patients who underwent elective laparoscopic cholecystectomy were randomly divided into two groups, a low-pressure (10 mm Hg) pneumoperitoneum group and a standard-pressure (14 mm Hg) pneumoperitoneum group. For all participants, the value of the insufflation pressure was kept hidden and only the nurse responsible for the operating room was aware of it. Deep neuromuscular blockade was induced for all cases [train-of-four (TOF) = 0; post-tetanic count (PTC) > 0]. The quality of recovery was assessed on the morning of first post-operative day. RESULTS No difference was found in either total score or in its different dimensions according to the QoR-40 questionnaire. The patients in the low-pressure pneumoperitoneum group experienced more pain during forced coughing measured at 4 hours (median difference [95% CI], 1 [0-2]; P = .030), 8 hours (1 [0-2]; P = .030) and 12 hours (0 [0-1] P = .025) after discharge from the post-anaesthesia care unit, when compared with those in the standard-pressure pneumoperitoneum group. CONCLUSION We thus conclude that the use of low-pressure pneumoperitoneum during elective laparoscopic cholecystectomy does not improve the quality of recovery.
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Affiliation(s)
- Eduardo T. Moro
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Persio C. C. Pinto
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Antônio J. M. M. Neto
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Augusto L. Hilkner
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Luis F. P. Salvador
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Beatriz R. D. Silva
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Isabella G. Souto
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Renata Boralli
- Department of Surgery School of Medical and Health Sciences Pontifical Catholic University of São Paulo São Paulo Brazil
| | - Joshua Bloomstone
- University of Arizona College of Medicine Phoenix AZ USA
- Division of Surgery and Interventional Sciences University College London London England
- Envision Physician Services Plantation FL USA
- Outcomes Research Consortium Cleveland OH USA
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Rodrigues DLG, Belber GS, Padilha FVDQ, Spinel LF, Moreira FR, Maeyama MA, Pinho APNM, Júnior ÁA. Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial). JMIR Res Protoc 2021; 10:e23679. [PMID: 33475516 PMCID: PMC7861994 DOI: 10.2196/23679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although the Brazilian Unified Health System (SUS) offers universal health coverage, access to quality care is often limited by social inequality and location. Although telemedicine has been shown to be an important tool in the efforts to overcome this problem, because it can provide access to specialist care and break the geographical barriers to health care, there are no national studies demonstrating its use in public health. OBJECTIVE This study aims to test the hypothesis that remote consultation can be as effective as standard face-to-face consultation for type 2 diabetes mellitus in the Brazilian public health system and to assess the associated costs related to teleconsultation in public health scenarios, for patients referred from Primary Health Care units of the SUS for specialist care. METHODS This is a pragmatic, phase 2, unicentric, open-label, noninferiority, blinded allocation, data-blinded, centrally randomized clinical trial. The inclusion criteria will be adults, both sexes, ≥18 years old, glycated hemoglobin (HbA1c) ≥8%. Outcomes will be evaluated by assessing symptoms, laboratory exams, anthropometric measurements, blood pressure, adverse events, and satisfaction level for 6 months. The costs of the teleconsultation will be assessed using the time-driven activity-based costing (TDABC) method to compare the costs with the face-to-face consultations. The noninferiority margin was set at 0.5%. Assuming an SD of 1.3% for both groups, true difference between the means of zero, and a type I error level of 5% (one-sided), it was estimated that 117 individuals per group would be necessary to achieve 90% power. Statistical analysis of the efficacy will be done using intention-to-treat and per-protocol approaches. RESULTS The results from this trial will be reported according to the CONSORT guidelines. The trial was approved by the institutional review board on October 5, 2019. Data collection started in January 2019 and is expected to finish in 2022. At the time of manuscript submission, 18 participants were recruited. CONCLUSIONS Our expectations are that providing remote access to health care will result in improvements in the health and quality of life of patients with type 2 diabetes and reduce costs and that both patients and clinicians will benefit from and be satisfied with this technology. TRIAL REGISTRATION Registro Brasileiro de Ensaios Clínicos RBR-8gpgyd; https://ensaiosclinicos.gov.br/rg/RBR-8gpgyd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23679.
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Affiliation(s)
| | | | | | | | | | | | | | - Álvaro Avezum Júnior
- Innovation, Research and Education Institute, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
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Japanese translation and validation of web-based questionnaires on overuse injuries and health problems. PLoS One 2020; 15:e0242993. [PMID: 33270675 PMCID: PMC7714361 DOI: 10.1371/journal.pone.0242993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/12/2020] [Indexed: 11/19/2022] Open
Abstract
This study aimed to translate and culturally adapt the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) and the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H) into the Japanese context. The validity and reliability of these translated questionnaires examining overuse injuries and health problems among Japanese university athletes were also examined. The translation was performed following an internationally recognized methodology. A total of 145 athletes were tracked over 10 consecutive weeks and four questions were added in the 10th week to examine the questionnaires’ content validity. Test-retest analysis for reliability was performed 24–72 hours after the 10th week of registration. Internal consistency was determined by calculating Cronbach’s a during the cohort study. No major disagreements were found in the translation process. The translated questionnaires had high acceptance and compliance, with an average response rate of over 80% throughout the 10-week cohort study. Most participants reported that the questionnaires were not difficult to complete, there were no items they wanted to change or add, and that the web-based technique worked effectively. Good test-retest reliability and high internal consistency was observed in the translated questionnaires. The translated questionnaires were found to be valid, reliable, and acceptable for medically monitoring Japanese athletes.
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Haik MN, Alburquerque-Sendín F, Fernandes RAS, Kamonseki DH, Almeida LA, Liebano RE, Camargo PR. Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis. Diagnostics (Basel) 2020; 10:diagnostics10110928. [PMID: 33182699 PMCID: PMC7696199 DOI: 10.3390/diagnostics10110928] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 01/10/2023] Open
Abstract
Biopsychosocial aspects seem to influence the clinical condition of rotator cuff related shoulder pain (RCRSP). However, traditional bivariate and linear analyses may not be sufficiently robust to capture the complex relationships among these aspects. This study determined which biopsychosocial aspects would better classify individuals with acute and chronic RCRSP and described how these aspects interact to create biopsychosocial phenotypes in individuals with acute and chronic RCRSP. Individuals with acute (<six months of pain, n = 15) and chronic (≥six months of pain, n = 38) RCRSP were included. Sociodemographic data, biological data related to general clinical health status, to shoulder clinical condition and to sensory function, and psychosocial data were collected. Outcomes were compared between groups and a decision tree was used to classify the individuals with acute and chronic RCRSP into different phenotypes hierarchically organized in nodes. Only conditioned pain modulation was different between the groups. However, the tree combined six biopsychosocial aspects to identify seven distinct phenotypes in individuals with RCRSP: three phenotypes of individuals with acute, and four with chronic RCRSP. While the majority of the individuals with chronic RCRSP have no other previous painful complaint besides the shoulder pain and low efficiency of endogenous pain modulation with no signs of biomechanical related pain, individuals with acute RCRSP are more likely to have preserved endogenous pain modulation and unilateral pain with signs of kinesiophobia.
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Affiliation(s)
- Melina N Haik
- Department of Physical Therapy, Center of Health and Sport Science (CEFID), Universidade do Estado de Santa Catarina, Rua Pascoal Simone 358, Florianópolis, SC 88080-350, Brazil
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
- Correspondence:
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain;
| | - Ricardo A S Fernandes
- Department of Electrical Engineering, Center for Exact Sciences and Technology (CCET), Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil;
| | - Danilo H Kamonseki
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
| | - Lucas A Almeida
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
| | - Richard E Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil;
| | - Paula R Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos, SP 13565-905, Brazil; (D.H.K.); (L.A.A.); (P.R.C.)
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Casamali FFC, Schuch FB, Scortegagna SA, Legnani E, De Marchi ACB. Accordance and reproducibility of the electronic version of the WHOQOL-BREF and WHOQOL-OLD questionnaires. Exp Gerontol 2019; 125:110683. [PMID: 31398444 DOI: 10.1016/j.exger.2019.110683] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 12/05/2018] [Accepted: 08/05/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Evidence of the validity of instruments for assessing health-related quality of life (QOL) are fundamental to grant interpretations and direct actions at the level of promotion and health care. PURPOSE To verify the agreement and reproducibility of the QOL assessment instruments WHOQOL-Bref and WHOQOL-Old, in paper (PV) and electronic version (EV), called WHOQOL-Bref web and WHOQOL-Old web, respectively. SUBJECTS AND METHOD A cross-sectional study was performed with 98 elderly people, separated into two groups, from Tapejara-RS, Brazil, during 2016 and 2017. The WHOQOL-bref and WHOQOL-old instruments applied in the PV and EV were answered individually. RESULTS The Intraclass Correlation Coefficient (ICC) observed in the accordance and reproducibility of the overall WHOQOL-Bref and WHOQOL-Old scores were higher than 0.90, respectively. The ICC was higher than 0.80 for most of the WHOQOL-Bref and WHOQOL domains, except for the domains Physical (WHOQOL-Bref: ICC = 0.67) and Autonomy (WHOQOL-Old: ICC = 0.78). CONCLUSION The web versions of the WHOQOL-bref and WHOQOL-old questionnaires presented good evidence of accordance and reproducibility.
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Affiliation(s)
- Flávia Fernanda Cunha Casamali
- Graduate Program in Human Aging, College of Physical Education and Physiotherapy, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil.
| | - Felipe Barreto Schuch
- Department of sports methods and techniques, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil.
| | - Silvana Alba Scortegagna
- Graduate Program in Human Aging, College of Physical Education and Physiotherapy, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil.
| | - Elto Legnani
- Graduate Program in Human Aging, College of Physical Education and Physiotherapy, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil; Graduate in Physical Education, Federal University of Technology (UTFPR), Curitiba, PR, Brazil.
| | - Ana Carolina Bertoletti De Marchi
- Graduate Program in Human Aging, College of Physical Education and Physiotherapy, University of Passo Fundo (UPF), Passo Fundo, RS, Brazil.
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Psychometric performance assessment of Malay and Malaysian English version of EQ-5D-5L in the Malaysian population. Qual Life Res 2018; 28:153-162. [PMID: 30317426 DOI: 10.1007/s11136-018-2027-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the psychometric properties and performance of Malay and English versions of the EQ-5D-5L descriptive instrument in the general Malaysian population. METHODS 1137 members of the Malaysian general public were sampled in this national study. Respondents were recruited by quota sampling of urbanicity, gender, age, and ethnicity. In face-to-face interviews, respondents first answered the EQ-5D-5L questionnaire administered using the EQ-Valuation Technology software, and then completed the EQ-5D-3L questionnaire on paper. A subgroup of the respondents were given paper form of EQ-5D-5L for completion within 2 weeks for test-retest reliability. Ceiling effects, response redistribution, informativity, and convergent validity were compared between EQ-5D-5L and ED-5D-3L separately by Malay and English language versions. RESULTS The proportion of 'full health' responses (11111) drastically decreased by 25.55% and 15.74% in the Malay and English language versions indicating lower ceiling effects in EQ-5D-5L. Inconsistencies from response redistribution was below 6% for all dimensions across languages. The measure of relative informativity was comparatively higher in EQ-5D-5L than in EQ-5D-3L in both language versions, with the exception of dimensions mobility and pain/discomfort in the English version. Convergent validity in terms of correlation with EQ-VAS was relatively better for EQ-5D-5L dimensions, with pain/discomfort of the Malay version having the strongest correlation (|r| = 0.37). Also, reliability testing revealed moderate to poor agreements on all 5L dimensions. CONCLUSIONS EQ-5D-5L fared better in terms of psychometric performance compared to EQ-5D-3L for both language versions. This encourages the application of the EQ-5D-5L in health-related research in Malaysia.
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