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Ishaque S, Roberts RM, Karnon J, Thomas D, Salter AB. Adaptation and content validation of measure yourself medical outcomes profile (MYMOP) for 7-11 year-old children. Qual Life Res 2024; 33:2401-2416. [PMID: 38874698 PMCID: PMC11390820 DOI: 10.1007/s11136-024-03702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The Measure Yourself Medical Outcome Profile (MYMOP) is an individualised tool designed for adults but used with children without any evidence of validation in this population. Individualised instruments are patient-specific rather than disease-specific and therefore can be applied across various health conditions. This study sought to adapt, and content validate the MYMOP for application in 7-11 year old children. METHODS There were two main phases of the four iterations: expert consultation (three rounds) and interviews with child-parent pairs at the Outpatient clinics of a Children's Hospital. Thematic analysis was undertaken using an inductive, interpretative approach. RESULTS Four paediatricians completed the first survey, five paediatricians participated in the focus group, and four paediatric health-related quality of life (HRQOL) research experts completed the second survey. Several changes were recommended to the MYMOP by the expert groups. Twenty-five children (17 general medicine, and 8 diabetes/endocrine clinic) aged 7-11 years completed the draft paediatric MYMOP (P-MYMOP) and were interviewed. Results demonstrated that the majority of participants were able to identify their own problems and activity limitations, and all participants understood the 7-point faces scale. Most parents and children perceived that the P-MYMOP would be useful to complete before clinic appointments. CONCLUSIONS The P-MYMOP is the first content-validated generic individualised HRQOL measure for children 7-11 years old. Given that validation is an iterative process, further research to assess its feasibility, reliability, and construct validity is required.
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Affiliation(s)
- S Ishaque
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - R M Roberts
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - J Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - D Thomas
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - A B Salter
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Meyer T, Schumann P, Weydt P, Petri S, Weishaupt JH, Weyen U, Koch JC, Günther R, Regensburger M, Boentert M, Wiesenfarth M, Koc Y, Kolzarek F, Kettemann D, Norden J, Bernsen S, Elmas Z, Conrad J, Valkadinov I, Vidovic M, Dorst J, Ludolph AC, Hesebeck-Brinckmann J, Spittel S, Münch C, Maier A, Körtvélyessy P. Clinical and patient-reported outcomes and neurofilament response during tofersen treatment in SOD1-related ALS-A multicenter observational study over 18 months. Muscle Nerve 2024; 70:333-345. [PMID: 39031772 DOI: 10.1002/mus.28182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/26/2024] [Accepted: 06/01/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION/AIMS In amyotrophic lateral sclerosis (ALS) caused by SOD1 mutations (SOD1-ALS), tofersen received accelerated approval in the United States and is available via expanded access programs (EAP) outside the United States. This multicenter study investigates clinical and patient-reported outcomes (PRO) and serum neurofilament light chain (sNfL) during tofersen treatment in an EAP in Germany. METHODS Sixteen SOD1-ALS patients receiving tofersen for at least 6 months were analyzed. The ALS progression rate (ALS-PR), as measured by the monthly change of the ALS functional rating scale-revised (ALSFRS-R), slow vital capacity (SVC), and sNfL were investigated. PRO included the Measure Yourself Medical Outcome Profile (MYMOP2), Treatment Satisfaction Questionnaire for Medication (TSQM-9), and Net Promoter Score (NPS). RESULTS Mean tofersen treatment was 11 months (6-18 months). ALS-PR showed a mean change of -0.2 (range 0 to -1.1) and relative reduction by 25%. Seven patients demonstrated increased ALSFRS-R. SVC was stable (mean 88%, range -15% to +28%). sNfL decreased in all patients except one heterozygous D91A-SOD1 mutation carrier (mean change of sNfL -58%, range -91 to +27%, p < .01). MYMOP2 indicated improved symptom severity (n = 10) or yet perception of partial response (n = 6). TSQM-9 showed high global treatment satisfaction (mean 83, SD 16) although the convenience of drug administration was modest (mean 50, SD 27). NPS revealed a very high recommendation rate for tofersen (NPS +80). DISCUSSION Data from this EAP supported the clinical and sNfL response to tofersen in SOD1-ALS. PRO suggested a favorable patient perception of tofersen treatment in clinical practice.
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Affiliation(s)
- Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Peggy Schumann
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Patrick Weydt
- Department for Neuromuscular Disorders, Bonn University, Bonn, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Bonn, Bonn, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jochen H Weishaupt
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, Bochum, Germany
| | - Jan C Koch
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Dresden, Dresden, Germany
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Boentert
- Department of Neurology, Münster University Hospital, Münster, Germany
| | | | - Yasemin Koc
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Kolzarek
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Dagmar Kettemann
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jenny Norden
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Bernsen
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Zeynep Elmas
- Department of Neurology, Ulm University, Ulm, Germany
| | - Julian Conrad
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Ivan Valkadinov
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Maximilian Vidovic
- Department of Neurology, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Dorst
- Department of Neurology, Ulm University, Ulm, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Ulm, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Research Site Ulm, Ulm, Germany
| | - Jasper Hesebeck-Brinckmann
- Neurology Department, Division for Neurodegenerative Diseases, Mannheim Center for Translational Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Christoph Münch
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Péter Körtvélyessy
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Taimeh D, Ni Riordain R, Fedele S, Leeson R. The development and cognitive testing of a patient-reported experience measure for patients with chronic pain of temporomandibular disorders. J Oral Pathol Med 2023; 52:843-848. [PMID: 37406660 DOI: 10.1111/jop.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION The importance of the patients' clinical experience has been reinforced several times over the last decade by healthcare organisations and policy makers. Routine gathering of experience data can help in enhancing patient-centred care and provide guidance to quality improvement schemes. Patient-reported experience measures can help to that end. The aim of this study was to develop a patient-reported experience measure to evaluate the experience of patients with temporomandibular disorders while receiving healthcare. METHODS Input from several sources was utilised to develop the tool; previous literature, patients with temporomandibular disorders, and experts in the field. A qualitative study was conducted following the COnsensus-based Standards for the selection of health Measurement Instruments guidance to generate the items of the questionnaire, which subsequently underwent cognitive testing. RESULTS Seventeen patients took part in the qualitative study, in addition to six healthcare professionals. The preliminary questionnaire consisted of 28 questions with six response options. CONCLUSIONS This patient-reported experience measure is a brief tool to evaluate the clinical experience of patients with temporomandibular disorders. Patients' involvement ensured face and content validity of the questionnaire, in addition to the relevance, comprehensibility and comprehensiveness of the items.
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Affiliation(s)
- Dina Taimeh
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, University of Jordan, Amman, Jordan
| | - Richeal Ni Riordain
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Cork University Dental School and Hospital, Cork, Ireland
| | - Stefano Fedele
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
- Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Rachel Leeson
- Department of Maxillofacial Medicine and Surgery, UCL Eastman Dental Institute, University College London, London, UK
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Cabo F, Browne N. The Development, Validity, and Responsiveness of a Patient-Centred Outcome Measurement Tool for Evaluating Integrative Medicine Interventions. Int J Ther Massage Bodywork 2023; 16:20-34. [PMID: 37662632 PMCID: PMC10442220 DOI: 10.3822/ijtmb.v16i3.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Background The paper sets out the development, validity, and responsiveness of the Integrative Medicine Treatment Evaluation Form (IMTEF), which has been designed to measure the effects of complementary and integrative therapy (CIT) interventions in cancer and palliative care (PC) patients in a National Health Service (NHS) hospital setting. Treatment evaluation is essential for ensuring safety and quality of services, for meeting NHS governance requirements. It also helps to add to the evidence base for complementary and integrative therapies through collecting data about treatments. Methods A number of different Patient Reported Outcome Measures (PROMs) tools were reviewed in order to design the IMTEF, which details questions that captures both quantitative and qualitative data. The IMTEF was reviewed by patients and a range of health care practitioners. Results IMTEF's validity is supported by feedback from health care practitioners and patients, by its ability to detect different degrees of change in relation to change scores, and by its correlations with Visual Analog Scale (VAS) scores. Conclusion The IMTEF can be used to assess the effects of therapeutic bodywork and CITs when many of the patients do not have the capacity or the time to answer many questions, and when therapists do not know in advance the number of treatments that patients will be able to receive. Because of the way it is structured, it can also assess the effects after a number of sessions.
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Affiliation(s)
- Fernando Cabo
- Complementary Therapies Department, Barts Health NHS Trust, Margaret Centre, Whipps Cross Hospital, London, United Kingdom
| | - Neil Browne
- Complementary Therapies Department, Barts Health NHS Trust, Margaret Centre, Whipps Cross Hospital, London, United Kingdom
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Kubala JT, Pannill HL, Fasczewski KS, Rivera LA, Bouldin ED, Howard JS. Comparing the Primary Concerns of Injured Collegiate Athletes With the Content of Patient-Reported Outcome Measures. J Athl Train 2023; 58:252-260. [PMID: 35622954 PMCID: PMC10176840 DOI: 10.4085/1062-6050-0516.21] [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] [Indexed: 11/09/2022]
Abstract
CONTEXT Patient-reported outcome measures (PROMs) have been endorsed for providing patient-centered care. However, PROMs must represent their target populations. OBJECTIVE To identify the primary concerns of collegiate athletes experiencing injury and compare those with the content of established PROMs. DESIGN Cross-sectional study. SETTING Collegiate athletic training facilities. PATIENTS OR OTHER PARTICIPANTS Collegiate athletes experiencing injury (N = 149). MAIN OUTCOME MEASURE(S) Open-ended responses to the Measure Yourself Medical Outcome Profile were used to identify primary concerns, which were linked to International Classification of Functioning, Disability and Health taxonomy codes. Items of the Patient-Reported Outcomes Measurement Information System; modified Disablement of the Physically Active Scale; Lower Extremity Functional Scale; Knee injury and Osteoarthritis Outcome Score (KOOS); International Knee Documentation Committee Subjective Knee Form (IKDC); Foot and Ankle Ability Measure; Disabilities of the Arm, Shoulder, and Hand; Functional Arm Scale for Throwers; and Kerlan-Jobe Orthopaedic Clinic questionnaire were linked to International Classification of Functioning, Disability and Health codes. We calculated χ2 single-sample goodness-of-fit tests to determine if 70% of the content was shared between PROMs and participant-generated codes. RESULTS Participant-generated concerns were primarily related to sport participation (16%) and pain (23%). Chi-square tests showed that the Lower Extremity Functional Scale and Foot and Ankle Ability Measure presented significant content differences, with common participant-generated lower extremity responses at all levels. The Patient-Reported Outcomes Measurement Information System; modified Disablement of the Physically Active Scale; KOOS; IKDC; Disabilities of the Arm, Shoulder and Hand; Functional Arm Scale for Throwers; and Kerlan-Jobe Orthopaedic Clinic questionnaire did not have significant content differences for level 2 codes; still, significant differences were present for level 3 analyses except for the KOOS and IKDC (P < .001). All measures except the IKDC contained significant superfluous content (P < .05). CONCLUSIONS The presence of significant content differences supports clinician-perceived barriers regarding the relevance of established PROMs. However, the IKDC was a relevant and efficient PROM for evaluating the primary concerns of collegiate athletes experiencing lower extremity injury. Clinicians should consider using patient-generated measures to support coverage of patient-specific concerns in care.
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Affiliation(s)
| | - Heather L Pannill
- Rehabilitation Services, Appalachian Regional Healthcare System, Boone, NC
| | - Kimberly S Fasczewski
- Department of Public Health and Exercise Science, Appalachian State University, Boone, NC
| | - Laurie A Rivera
- Department of Rehabilitation Science, Appalachian State University, Boone, NC
| | - Erin D Bouldin
- Department of Internal Medicine, University of Utah, Salt Lake City
| | - Jennifer S Howard
- Department of Rehabilitation Science, Appalachian State University, Boone, NC
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Mukuria C, Connell J, Carlton J, Peasgood T, Scope A, Clowes M, Rand S, Jones K, Brazier J. Qualitative Review on Domains of Quality of Life Important for Patients, Social Care Users, and Informal Carers to Inform the Development of the EQ-HWB. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:492-511. [PMID: 35365298 DOI: 10.1016/j.jval.2021.11.1371] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To identify the themes to inform the content of a new generic measure, the EQ-HWB (EQ Health and Wellbeing), that can be used in economic evaluation across health, social care, and public health, based on the views of users and beneficiaries of these services including informal carers. METHODS A qualitative review was undertaken. Systematic and citation searches were undertaken focusing on qualitative evidence of the impact on quality of life from reviews for selected health conditions, informal carers, social care users, and primary qualitative work used in the development of selected measures. A subset of studies was included in the review. Framework analysis and synthesis were undertaken based on a conceptual model. RESULTS A total of 42 reviews and 24 primary studies were selected for inclusion in the review. Extraction and synthesis resulted in 7 high-level themes (with subthemes): (1) feelings and emotions (sadness, anxiety, hope, frustration, safety, guilt/shame); (2) cognition (concentration, memory, confusion, thinking clearly); (3) self-identity (dignity/respect, self-esteem); (4) "coping, autonomy, and control" relationships; (5) social connections (loneliness, social engagement, stigma, support, friendship, belonging, burden); (6) physical sensations (pain, discomfort, sleep, fatigue); and (7) activity (self-care, meaningful activities, mobility, communication, hearing, vision). Apart from physical sensations, most of the other themes and subthemes were relevant across both health and social care, including for informal carers. CONCLUSIONS The findings from this broad review identified themes that go beyond health and that are relevant to patients, informal carers, and social care users. The themes and subthemes informed the domains for the EQ-HWB.
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Affiliation(s)
- Clara Mukuria
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK.
| | - Janice Connell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Tessa Peasgood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - Karen Jones
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
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van der Kluit MJ, Tent S, Dijkstra GJ, de Rooij SE. Goal-based outcomes of hospitalisation of older adults are predicted by gender, confidence, quality of life and type of goals. Eur Geriatr Med 2022; 13:1377-1389. [PMID: 36203080 PMCID: PMC9722898 DOI: 10.1007/s41999-022-00698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/13/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Although patient-reported outcome measures (PROMs) might reflect relevant outcomes from patient perspective, they do not always reflect what the individual patient finds important. Our objectives were to assess which PROM was best suited to evaluate patient-relevant outcomes of hospitalisation and to assess which factors predicted this PROM. METHODS A longitudinal study was conducted among hospitalised older patients. Three PROMs were compared with the anchor question 'How much have you benefited from the admission?': a general quality of life measure: EQ-5D; a measure of daily functioning: Katz-15 and a goal-based measure: achievement of self-defined goals. Predictors were examined using logistic regression analyses. RESULTS We had 185 cases with baseline and follow-up. Accomplishment of self-defined goals showed a large correlation with the anchor question, whereas EQ-5D and Katz-15 showed no significant correlations. The final regression model had four predictors: being man, having higher confidence in goal achievement and good/excellent quality of life increased the odds for goal accomplishment, while having goals in the category alleviating complaints reduced the odds. CONCLUSION Accomplishment of individual goals represented the benefit experienced by participants best. Subjective indicators of health and functioning are better predictors of goal accomplishment than objective ones. According to participant experience, the hospital appeared successful in managing disease-specific problems, but less successful in ameliorating complaints. Medical decision-making should not only be based on medical indicators, but the input of the patient is at least as important. Quality of life, goals and confidence should be discussed. More attention is needed for symptom experience.
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Affiliation(s)
- Maria Johanna van der Kluit
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700 RB Groningen, Netherlands
| | - Sanne Tent
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700 RB Groningen, Netherlands
| | - Geke J. Dijkstra
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands ,Department of Health Sciences, Applied Health Research, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sophia E. de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700 RB Groningen, Netherlands ,Amstelland Hospital, Amstelveen, Netherlands
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Hudon C, Danish A, Lambert M, Howse D, Cassidy M, Dumont-Samson O, Porter J, Rubenstein D, Sabourin V, Doucet S, Ramsden VR, Bisson M, Schwarz C, Chouinard MC. Reconciling validity and challenges of patient comfort and understanding: Guidelines to patient-oriented questionnaires. Health Expect 2021; 25:2147-2154. [PMID: 34668630 PMCID: PMC9615088 DOI: 10.1111/hex.13373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patient‐reported outcome measures (PROMs) are widely recognized as important tools for achieving a patient‐centred approach in health research. While PROMs are subject to several stages of validation during development, even questionnaires with robust psychometric properties may challenge patient comfort and understanding. Aim Building on the experience of patient engagement in the PriCARE research programme, this paper outlines the team's response to concerns raised by patient partners regarding the administration of the questionnaire. Methods Based on a participatory action research design and the patient engagement framework in the Strategy for Patient‐Oriented Research of the Canadian Institutes of Health Research, PriCARE team members worked together to discuss concerns, review the questionnaires and come up with solutions. Data were collected through participant observation of team meetings. Results This paper demonstrates how patient partners were engaged in PriCARE and integrated into the programme's governance structure, focusing on the challenges that they raised regarding the questionnaires and how these were addressed by PriCARE team members in a six‐step approach: (1) Recognizing patient partner concerns, discussing concerns and reframing the challenges; (2) Detailing and sharing evidence of the validity of the questionnaires; (3) Evaluating potential solutions; (4) Searching the literature for guidelines; (5) Creating guidelines; and (6) Sharing and refining guidelines. Conclusion This six‐step approach demonstrates how research teams can integrate patient partners as equal members, develop meaningful collaboration through recognition of individual experiences and expertise and ensure that the patient perspective is taken into consideration in research and healthcare innovation. Patient or Public Contribution All patient partners from the PriCARE programme were actively involved in the six‐step approach. They were also involved in the preparation of the manuscript.
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Affiliation(s)
- Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de recherche du centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Alya Danish
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University, St. John's, Canada
| | - Monique Cassidy
- Department of Interdisciplinary Studies, University of New Brunswick, Saint John, Canada
| | - Olivier Dumont-Samson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathieu Bisson
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada
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Meyer T, Maier A, Uzelac Z, Hagenacker T, Günther R, Schreiber-Katz O, Weiler M, Steinbach R, Weyen U, Koch JC, Kettemann D, Norden J, Dorst J, Wurster C, Ludolph AC, Stolte B, Freigang M, Osmanovic A, Petri S, Grosskreutz J, Rödiger A, Griep R, Gaudlitz M, Walter B, Münch C, Spittel S. Treatment expectations and perception of therapy in adult patients with spinal muscular atrophy receiving nusinersen. Eur J Neurol 2021; 28:2582-2595. [PMID: 33960080 DOI: 10.1111/ene.14902] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE This was an investigation of treatment expectations and of the perception of therapy in adult patients with 5q-associated spinal muscular atrophy (5q-SMA) receiving nusinersen. METHODS A prospective, non-interventional observational study of nusinersen treatment in adult 5q-SMA patients was conducted at nine SMA centers in Germany. The functional status, treatment expectations and perceived outcomes were assessed using the Amyotrophic Lateral Sclerosis Functional Rating Scale-extended (ALS-FRS-ex), the Measure Yourself Medical Outcome Profile (MYMOP2), the Treatment Satisfaction Questionnaire for Medication (TSQM-9) and the Net Promoter Score (NPS). RESULTS In all, 151 patients were included with a median age of 36 years (15-69 years). SMA type 3 (n = 90, 59.6%) prevailed, followed by type 2 (33.8%) and type 1 (6.6%). In SMA types 1-3, median ALS-FRS-ex scores were 25, 33 and 46 (of 60 scale points), respectively. MYMOP2 identified distinct treatment expectations: head verticalization (n = 13), bulbar function (n = 16), arm function (n = 65), respiration (n = 15), trunk function (n = 34), leg function (n = 76) and generalized symptoms (n = 77). Median symptom severity decreased during nusinersen treatment (median observational period 6.1 months, 0.5-16 months) from 3.7 to 3.3 MYMOP2 score points (p < 0.001). The convenience of drug administration was critical (49.7 of 100 TSQM-9 points, SD 22); however, the overall treatment satisfaction was high (74.3, SD 18) and the recommendation rating very positive (NPS +66). CONCLUSIONS Nusinersen was administered across a broad range of ages, disease durations and motor function deficits. Treatment expectations were highly differentiated and related to SMA type and functional status. Patient-reported outcomes demonstrated a positive perception of nusinersen therapy in adult patients with 5q-SMA.
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Affiliation(s)
- Thomas Meyer
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Zeljko Uzelac
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Tim Hagenacker
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Dresden, Dresden, Germany
| | | | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Steinbach
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Ute Weyen
- Department of Neurology, Center for ALS and other Motor Neuron Disorders, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Jan Christoph Koch
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Dagmar Kettemann
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jenny Norden
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE), Research Site Ulm, Ulm, Germany
| | - Benjamin Stolte
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | - Maren Freigang
- Department of Neurology, Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Julian Grosskreutz
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Annekathrin Rödiger
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Ramona Griep
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | | | - Bertram Walter
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Münch
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Susanne Spittel
- Department of Neurology, Center for ALS, SMA and other Motor Neuron Disorders, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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10
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Williams H, Steinberg S, Berzin R. The Development of a Digital Patient-Reported Outcome Measurement for Adults With Chronic Disease (The Parsley Symptom Index): Prospective Cohort Study. JMIR Form Res 2021; 5:e29122. [PMID: 33999007 PMCID: PMC8235288 DOI: 10.2196/29122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background The monitoring and management of chronic illness has always been a challenge. Patient-reported outcome measures (PROMs) can be powerful tools for monitoring symptoms and guiding treatment of chronic diseases, but the available PROM tools are either too broad or too disease specific for the needs of a primary care practice focused on longitudinal care. Objective In this study we describe the development and preliminary validation of the Parsley Symptom Index (PSI). Methods This prospective cohort study took place from January 5, 2018, to June 05, 2020, among a sample of 4621 adult patients at Parsley Health. After a review of literature, followed by binning and winnowing of potential items, a 45-item PROM that also served as a review of systems (ROS) was developed. The PSI was deployed and completed by patients via an online portal. Construct and face validity was performed by clinicians, tested on patients, and feasibility was measured by response rate, completion rate, and percentage of missing data. Results The response rate for 12,175 collected PSIs was 93.72% (4331/4621) with a 100% item completion rate. A confirmatory factor analysis confirmed the model structure was satisfactory by a Comparative Fit Index of 0.943, Tucker–Lewis index of 0.938, and root mean square error of approximation of 0.028. Conclusions A 45-item ROS-style PROM designed to capture chronic disease symptoms was developed, and preliminary validation suggests that the PSI can be deployed, completed, and helpful to both patients and clinicians.
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Affiliation(s)
- Hants Williams
- School of Health Technology and Management, Stony Brook University, Stony Brook, NY, United States
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11
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Gengler I, Kavoosi TA, McCann AC, Trope M, Lindsey BA, Speth MM, Sassler AM, Seiden AM, Phillips KM, Sedaghat AR. Patient perspectives on recall period and response options in patient-reported outcome measures for chronic rhinosinusitis symptomatology: A pilot study. Clin Otolaryngol 2021; 46:1021-1027. [PMID: 33780598 DOI: 10.1111/coa.13774] [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] [Received: 01/05/2021] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) for assessment of chronic rhinosinusitis (CRS) employ a variety of recall periods and response scales for reporting CRS symptom burden. CRS patient perspective is unknown with respect to recall periods and response scales in PROMs. DESIGN Cross-sectional study. SETTING Tertiary rhinology clinic. PARTICIPANTS Sixty three adults with CRS. MAIN OUTCOME MEASURES Participants were asked to choose which CRS symptom recall period-1 day, 2 weeks, 1 month or greater than 1 month-was most reflective of their current disease state and best to base treatment recommendations (including surgery) upon. Participants were also asked to report which of six response scales (one visual analogue scale [VAS] and five Likert scales ranging from four to eight items) were easiest to use and understand, and most preferred. RESULTS A majority of participants felt the current state of their CRS symptoms was best reflected by a recall period of 2 weeks to 1 month; however, patients preferred that recommendations about treatments, including endoscopic sinus surgery, be determined by symptoms experienced over at least a one-month period. Participants generally found the VAS and seven-item Likert scale to be the easiest to use and understand, and their most preferred scales. No patient characteristics associated with preferences for recall periods or response scales. CONCLUSION Future PROMs for CRS symptoms should consider assessment of symptoms over a one-month time frame and use either a VAS or seven-item Likert response scale to optimally balance reflection of current disease state, need for intervention and patient preference.
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Affiliation(s)
- Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tazheh A Kavoosi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Adam C McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michal Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brentley A Lindsey
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marlene M Speth
- Klinik für Hals-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Alfred M Sassler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allen M Seiden
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Davis TRC, Tan W, Harrison EF, Hollingworth W, Karantana A, Mills N, Hepburn T, Sprange K, Duley L, Blazeby JM, Bainbridge CG, Murali SR, Montgomery AA. A randomised feasibility trial comparing needle fasciotomy with limited fasciectomy treatment for Dupuytren's contractures. Pilot Feasibility Stud 2020; 6:7. [PMID: 32021696 PMCID: PMC6993423 DOI: 10.1186/s40814-019-0546-y] [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: 08/20/2019] [Accepted: 12/20/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study is to assess the feasibility of conducting a large, multicentre randomised controlled trial (RCT) comparing needle fasciotomy with limited fasciectomy for treatment of Dupuytren’s contractures. Design The design of this study is a parallel, two-arm, multicentre, randomised feasibility trial with embedded QuinteT Recruitment Intervention. Participants Patients aged 18 years or over who were referred from primary to secondary care for treatment of a hand with Dupuytren’s contractures of one or more fingers of more than 30° at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints and well-defined cord(s). Patients were excluded if they had undergone previous Dupuytren’s contracture surgery on the same hand. Methods Potential participants were screened for eligibility. Recruited participants randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy and followed-up for up to 6 months after treatment. Data on recruitment rates, completion of follow-up, and procedure costs were collected. Four patient reported outcome measures (PROMs) and objective outcome measures were collected before intervention and 6 weeks and 6 months afterwards. Results One hundred and fifty-three of 267 (57%) primary-care referrals for Dupuytren’s contractures met the eligibility criteria for the study. Seventy-one of the 153 (46%) agreed to participate and were randomly allocated to treatment with needle fasciotomy or limited fasciectomy. Sixty-seven of these underwent their allocated treatment, two were crossovers from limited fasciectomy to needle fasciotomy, and two (both allocated limited fasciectomy) received no treatment. Fifty-nine participants (85%) completed 6-month follow-up PROMs. Participants felt the MYMOP, PEM and URAM PROMs allowed them to better describe how their treatment affected their hand function than the DASH PROM. The estimated costs of limited fasciectomy (in an operating theatre) and needle fasciotomy (in a clinic room) were £777 and £111 respectively. Conclusion A large RCT comparing treatment of Dupuytren’s contractures by needle fasciotomy and limited fasciectomy is feasible. Data from this study will help determine the number of sites and duration of recruitment required to complete an adequately powered RCT and will assist the selection of PROMs in future studies on the treatment of Dupuytren’s contractures. (Level 1 feasibility study). Trial registration Trial registered with ISRCTN (registration number: ISRCTN11164292), date assigned - 28/08/2015.
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Affiliation(s)
- T R C Davis
- 1Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH UK
| | - W Tan
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - E F Harrison
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - W Hollingworth
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - A Karantana
- 4Centre for Evidence Based Hand Surgery, Academic Orthopaedics Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, NG7 2UH UK
| | - N Mills
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - T Hepburn
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - K Sprange
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - L Duley
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
| | - J M Blazeby
- 3Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - C G Bainbridge
- 5Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE UK
| | - S R Murali
- 6Wrightington, Wigan and Leigh NHS Foundation Trust, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP UK
| | - A A Montgomery
- 2Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
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Personalised Medicine Using N-of-1 Trials: Overcoming Barriers to Delivery. Healthcare (Basel) 2019; 7:healthcare7040134. [PMID: 31694150 PMCID: PMC6956166 DOI: 10.3390/healthcare7040134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/21/2022] Open
Abstract
In this paper we discuss the value of N-of-1 trials in personalising health care. We describe the challenges faced in implementing N-of-1 trials in the United Kingdom’s National Health Service and suggest how making greater use of these personalised trials might be facilitated.
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14
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Rowen D, Carlton J, Elliott J. PROM Validation Using Paper-Based or Online Surveys: Data Collection Methods Affect the Sociodemographic and Health Profile of the Sample. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:845-850. [PMID: 31426923 DOI: 10.1016/j.jval.2019.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/10/2018] [Accepted: 03/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study examines the impact of data collection method on the sociodemographic and health profile of samples of people with diabetes who complete either an online or postal patient-reported outcome measure (PROM) validation survey. METHODS A longitudinal survey of people with diabetes was conducted using online and postal survey versions. The survey consisted of sociodemographic and health questions, a health and self-management PROM (Health and Self-Management in Diabetes [HASMID]), and 5-level version of EQ-5D. Dose adjustment for normal eating Online, Diabetes UK, and social media were used to recruit online survey participants. A panel of patients at a local National Health Service Trust was randomly allocated to participate in either survey version (two-thirds to postal version). Participants were asked to complete the survey again approximately 3 months later. RESULTS A total of 2784 participants completed the survey (1908 online, 876 postal). The samples (online versus postal) differed; the online sample was younger, with a larger proportion of women and respondents with type 1 diabetes. There were significant differences in sociodemographic characteristics by type of diabetes across data collection mode. The proportion of respondents who responded again at point 2 was higher in the postal sample (525 postal, 698 online). CONCLUSION The sociodemographic and health profile of samples of people with diabetes differed depending on whether they completed the online or postal survey. Differences are likely due to different recruitment methods and differences in those choosing to respond to different survey versions. Future PROM validation surveys should select data collection methods carefully because these can affect sample characteristics and results.
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Affiliation(s)
- Donna Rowen
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Jill Carlton
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jackie Elliott
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Trust, Diabetes and Endocrine Centre, Northern General Hospital, Sheffield, UK
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Meyer R, Drewniak D, Hovorka T, Schenk L. Questioning the Questionnaire: Methodological Challenges in Measuring Subjective Quality of Life in Nursing Homes Using Cognitive Interviewing Techniques. QUALITATIVE HEALTH RESEARCH 2019; 29:972-986. [PMID: 30516431 DOI: 10.1177/1049732318812042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although the concept of subjective quality of life in the nursing home setting is seen as a promising approach to discovering opportunities for improvement from the resident's perspective, it appears problematic in classical surveys that self-reported quality ratings on the basis of satisfaction questions tend to turn out overly positive. The aim of this article is to analyze how people in residential care facilities interpret and process response stimuli received from a questionnaire on subjective quality of life. In this analysis, we aim to gain methodological insights into the way a survey instrument on subjective quality of life can adequately represent individual ratings, as well as expectations regarding different aspects of quality of life. To test the feasibility of the proposed approach, we employed a range of probing techniques from the cognitive interviewing approach. The result is a promising design principle for constructing survey instruments to measure subjective quality of life.
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Affiliation(s)
- Roger Meyer
- 1 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science
| | - Daniel Drewniak
- 1 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science
- 2 University of Zurich, Zurich, Switzerland
| | - Torsten Hovorka
- 1 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science
| | - Liane Schenk
- 1 Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science
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16
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Grundy A, Keetharuth AD, Barber R, Carlton J, Connell J, Taylor Buck E, Barkham M, Ricketts T, Robotham D, Rose D, Kay J, Hanlon R, Brazier J. Public involvement in health outcomes research: lessons learnt from the development of the recovering quality of life (ReQoL) measures. Health Qual Life Outcomes 2019; 17:60. [PMID: 30975153 PMCID: PMC6458599 DOI: 10.1186/s12955-019-1123-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background To provide a model for Public involvement (PI) in instrument development and other research based on lessons learnt in the co-production of a recently developed mental health patient reported outcome measure called Recovering Quality of Life (ReQoL). While service users contributed to the project as research participants, this paper focuses on the role of expert service users as research partners, hence referred to as expert service users or PI. Methods At every stage of the development, service users influenced the design, content and face validity of the measure, collaborating with other researchers, clinicians and stakeholders who were central to this research. Expert service users were integral to the Scientific Group which was the main decision-making body, and also provided advice through the Expert Service User Group. Results During the theme and item generation phase (stage 1) expert service users affirmed the appropriateness of the seven domains of the Patient Reported Outcome Measure (activity, hope, belonging and relationships, self-perception, wellbeing, autonomy, and physical health). Expert service users added an extra 58 items to the pool of 180 items and commented on the results from the face and content validity testing (stage 2) of a refined pool of 88. In the item reduction and scale generation phase (stage 3), expert service users contributed to discussions concerning the ordering and clustering of the themes and items and finalised the measures. Expert service users were also involved in the implementation and dissemination of ReQoL (stage 4). Expert service users contributed to the interpretation of findings, provided inputs at every stage of the project and were key decision-makers. The challenges include additional work to make the technical materials accessible, extra time to the project timescales, including time to achieve consensus from different opinions, sometimes strongly held, and extra costs. Conclusion This study demonstrates a successful example of how PI can be embedded in research, namely in instrument development. The rewards of doing so cannot be emphasised enough but there are challenges, albeit surmountable ones. Researchers should anticipate and address those challenges during the planning stage of the project.
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Affiliation(s)
- Andrew Grundy
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Rosemary Barber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Janice Connell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Michael Barkham
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Thomas Ricketts
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Diana Rose
- King's College London, Institute of Psychiatry, London, UK
| | - John Kay
- Sheffield Hallam University, Sheffield, UK
| | | | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Dannecker EA, Warne-Griggs MD, Royse LA, Hoffman KG. Listening to Patients' Voices: Workarounds Patients Use to Construct Pain Intensity Ratings. QUALITATIVE HEALTH RESEARCH 2019; 29:484-497. [PMID: 29890886 DOI: 10.1177/1049732318773714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study analyzed patients' perspectives about a measure of current, usual, and extreme pain and a measure of activity-related pain. Thirty-one patients with osteoarthritis participated in focus groups. Researchers completed thematic analysis of transcripts using coding software and an inductive approach. Three emerging themes were that many factors affected patients' perceptions and ratings of pain intensity, patients used different approaches to construct pain ratings, and patients interpreted maximal response anchors differently. Particularly, novel findings were that patients evaluated pain fluctuation, location, duration, and quality when constructing pain intensity ratings. Also, activity items helped patients to remember pain and provided a valued context for communicating pain experiences. However, the activities needed to be sufficiently described and personally relevant. These findings further clarify the challenges patients face and the workarounds they use when rating pain intensity. The patients' suggestions for improved administration methods and items warrant future investigation.
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Ersoy Ö, Temel YE, Alptekin HK. Validity and reliability of the measure yourself medical outcome profile 2 (MYMOP2) questionnaire among Turkish patients having anorectal disorders. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 30:28-32. [PMID: 30457556 DOI: 10.5152/tjg.2018.17859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Measure Yourself Medical Outcome Profile 2 (MYMOP2) is a patient-generated outcome measure allowing patients to select the problems that are the most important to them and that they want to address, and it measures the effects of the problem from a wide range of health care interventions. This study aimed to translate the questionnaire into Turkish language (Turkish MYMOP-TMYMOP) and add this clinically useful measure to Turkish medical practice by assessing its validity and reliability. MATERIALS AND METHODS Fifty volunteers with anorectal disorders were prospectively included into the study. Each patient was enrolled into a pelvic floor training biofeedback program, specific to their anorectal symptomatology. The subjects were administered both the Nottingham Health Profile and the TMYMOP2 questionnaires before the treatment session (initial visit) and at the control follow-up visits (the first and second months, via e-mail or telephone calls). RESULTS The TMYMOP2 questionnaire was shown to be moderately valid (the Pearson correlation coefficient score between the total scores of the subgroups of the two questionnaires were 0.335 and 0.642, respectively, p<0.05) and highly reliable (the Cronbach's alfa coefficient score between the total scores of the subgroups of the two questionnaires were 0.77, 0.82, and 0.88 in the beginning and at the first and second month follow-up visits, respectively). CONCLUSION The TMYMOP2 was shown to be a low-to-moderately valid and a highly reliable scale. Because it is brief and short to complete, it might be an important and free-to-use tool to measure the diseases, and it can enhance the patient-centered care within the Turkish health care context.
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Affiliation(s)
- Özdal Ersoy
- Acibadem Fulya Hospital, Center for Hemorrhoids and Anorectal Diseases, İstanbul, Turkey; Department of Internal Medicine, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Yasemin Ecem Temel
- Acibadem Fulya Hospital, Center for Hemorrhoids and Anorectal Diseases, İstanbul, Turkey
| | - Hasan Kerem Alptekin
- Department of Physiotherapy and Rehabilitation, Bahçesehir University School of Health Sciences, İstanbul, Turkey
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Individualized health-related quality of life instrument Measure Yourself Medical Outcome Profile (MYMOP) and its adaptations: a critical appraisal. Qual Life Res 2018; 28:879-893. [DOI: 10.1007/s11136-018-2046-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2018] [Indexed: 11/25/2022]
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Meyer R, Spittel S, Steinfurth L, Funke A, Kettemann D, Münch C, Meyer T, Maier A. Patient-Reported Outcome of Physical Therapy in Amyotrophic Lateral Sclerosis: Observational Online Study. JMIR Rehabil Assist Technol 2018; 5:e10099. [PMID: 30425026 PMCID: PMC6256108 DOI: 10.2196/10099] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022] Open
Abstract
Background Physical therapy is an essential component of multidisciplinary treatment in amyotrophic lateral sclerosis (ALS). However, the meaning of physical therapy beside preservation of muscular strength and functional maintenance is not fully understood. Objective The purpose of this study was to examine patients’ perception of physical therapy during symptom progression using an internet assessment approach. Methods A prospective, longitudinal, observational study was performed. Recruitment took place in an ALS center in Berlin, Germany. Online self-assessment was established on a case management platform over 6 months. Participants self-assessed the progression of the disease with the ALS Functional Rating Scale-Revised (ALSFRS-R) and tracked the efficacy of targeted physical therapy using Measure Yourself Medical Outcome Profile (MYMOP). We used the net promoter score (NPS) to inquire into recommendation levels of physical therapy. Results Forty-five participants with ALS were included in the study. Twenty-seven (60.0%) started the online assessment. The mean duration of physical therapy sessions per week was 142.7 minutes (SD 60.4) with a mean frequency of 2.9 (SD 1.2) per week. As defined by MYMOP input, the most concerning symptoms were reported in the legs (62.2%), arms (31.1%), and less frequently in the torso (6.7%). As expected for a progressive disease, there was a functional decline of 3 points in the ALSFRS-R at the end of the observation period (n=20). Furthermore, the MYMOP showed a significant loss of 0.8 in the composite score, 0.9 in the activity score and 0.8 in the targeted symptom. In spite of functional decline, the recommendation for physical therapy jumped from a baseline value of 20 NPS points to a very high 50 points at the end of study (P=.05). Conclusions Physical therapy is perceived as an important treatment method by patients with ALS. Despite functional deterioration, patients are satisfied with physical therapy and recommend this intervention. The results also underline how the meaning of physical therapy changes throughout the disease. Physical therapy in ALS has to be regarded as a supportive and palliative health care intervention beyond functional outcome parameters.
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Affiliation(s)
- Robert Meyer
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanne Spittel
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - Laura Steinfurth
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Funke
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dagmar Kettemann
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
| | - André Maier
- Center for ALS and other Motor Neuron Disorders, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Kristoffersen AE, Stub T, Knudsen-Baas O, Udal AH, Musial F. Self-Reported Effects of Energy Healing: A Prospective Observational Study With Pre-Post Design. Explore (NY) 2018; 15:115-125. [PMID: 30262161 DOI: 10.1016/j.explore.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Healing is reported to be used by 16.8% of the population, however utilization may be considerably higher in selected patient groups. The aim of this study was to map the symptoms the participants reported when visiting a healer for the first time, and to evaluate the subjectively experienced benefits and risks from the healing sessions. METHOD Data were obtained from the Measure Yourself Medical Outcome Profile (MYMOP) questionnaire. One-hundred adults who, for the first time, referred themselves to a healer in southern Norway between January 2016 and January 2017 were included in the study. Eligible for analyses were 92 participants who fulfilled their treatment plan and returned both the baseline (pre) and post-treatment questionnaire. The occurring symptoms were grouped according to their nature into four symptom groups: pain, psychological problems, fatigue and other. With regard to the observational character of the study, all results were described and interpreted descriptively and exact p-values were given and interpreted as measures of effect. RESULTS The participants who visited the healers in this study were mainly women (80%) with chronic disease (82%), with pain, fatigue and/or psychological problems as main complaints. They experienced an improvement of symptoms, well-being and improved activity level of approximately 50% regardless of the nature of the complaints. Women reported more improvement than men did. The pre-post changes was found after an average of 4.1 treatments. Forty percent of the participants reported adverse effects, which occurred directly after the healing session, generally lasting for less than one day. CONCLUSION The study participants reported substantial improvement of, and major reduction of the burden of symptoms, improved well-being and activity level after healing sessions. Due to the observational nature of the study, no interpretations about specificity of the descriptive results or the mechanisms of effect can be made.
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Affiliation(s)
- Agnete E Kristoffersen
- The National Research Center in Complementary and Alternative Medicine, (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway.
| | - Trine Stub
- The National Research Center in Complementary and Alternative Medicine, (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | | | | | - Frauke Musial
- The National Research Center in Complementary and Alternative Medicine, (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
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Zanchetta M, Maheu C, Racine L, Kaszap M, Jbilou J, Giguère S, Reece DA, Thélusma-Rémy M, Montgomery C, Xenocostas S, Parada H, Talbot Y, Mohamed M. [Validation of a questionnaire on health literacy among Francophones in situation of linguistic minority]. SANTE PUBLIQUE 2018; 30:177-186. [PMID: 30148305 DOI: 10.3917/spub.182.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study was designed to develop and test the qualitative validity of a French questionnaire. The questionnaire explored the mechanisms by which Francophone in situation of linguistic minority mobilize their social capital and cultural assets in terms of health literacy. METHODS We used evidence derived from a previous qualitative study in which we elaborated the characteristics of social capital and cultural assets. Drawing on models of social capital and self-determination of language behaviour in Francophone in situation of linguistic minority, 21 items were developed and assessed to confirm content validity. For this purpose, cognitive interviews were conducted with 92 natural experts. These cognitive interviews tested the linguistic and content validity of the instrument. Consultations with research professionals were also conducted to increase content validity. RESULTS Parsimony and simplicity were tested by application of the Flesch test. The results demonstrate that 19 questions (93%) corresponded to the general public, relatively simple, and everyday use categories. Natural experts confirmed the readability and simplicity of the questionnaire. CONCLUSION This study addressed a lack of simple and readable questionnaire for collecting data among Francophone in situation of linguistic minority. The findings underscore the lack of evidence related to the familiar construction of health literacy among members of this population.
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Harnessing the Power of Microbiome Assessment Tools as Part of Neuroprotective Nutrition and Lifestyle Medicine Interventions. Microorganisms 2018; 6:microorganisms6020035. [PMID: 29693607 PMCID: PMC6027349 DOI: 10.3390/microorganisms6020035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/02/2018] [Accepted: 04/20/2018] [Indexed: 12/11/2022] Open
Abstract
An extensive body of evidence documents the importance of the gut microbiome both in health and in a variety of human diseases. Cell and animal studies describing this relationship abound, whilst clinical studies exploring the associations between changes in gut microbiota and the corresponding metabolites with neurodegeneration in the human brain have only begun to emerge more recently. Further, the findings of such studies are often difficult to translate into simple clinical applications that result in measurable health outcomes. The purpose of this paper is to appraise the literature on a select set of faecal biomarkers from a clinician’s perspective. This practical review aims to examine key physiological processes that influence both gastrointestinal, as well as brain health, and to discuss how tools such as the characterisation of commensal bacteria, the identification of potential opportunistic, pathogenic and parasitic organisms and the quantification of gut microbiome biomarkers and metabolites can help inform clinical decisions of nutrition and lifestyle medicine practitioners.
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Abma IL, Rovers M, IJff M, Hol B, Westert GP, van der Wees PJ. The development of a patient-reported outcome measure for patients with obstructive sleep apnea: the Patient-Reported Apnea Questionnaire (PRAQ). J Patient Rep Outcomes 2017; 1:14. [PMID: 29757310 PMCID: PMC5934917 DOI: 10.1186/s41687-017-0021-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic condition that can have a wide range of consequences for a patient's health-related quality of life. Monitoring aspects of quality of life in clinical practice has the potential to improve the patient-centeredness of care for patients with OSA. The aim of this article is to describe the development of the Patient-Reported Apnea Questionnaire (PRAQ), a patient-reported outcome measure (PROM) that is designed for use in clinical practice on an individual patient level, as well as subsequent outcome measurement on an aggregate level. METHODS We used the items of available PROMs for OSA to create a new PROM with focus on its applicability in clinical practice. We used a tailored development process to come to a selection of domains and items. Patients and healthcare professionals were intensively involved in the development of the PRAQ via membership of the development team, online surveys and focus groups, as well as two rounds of cognitive validation. RESULTS This first version of the PRAQ consists of 43 items and 10 preliminary domains, and covers the aspects of quality of life that healthcare professionals and patients wish to discuss in clinical practice. Patients indicate that PRAQ is comprehensive and that its length is acceptable. Comprehensive patient involvement has ensured good content validity for the PRAQ. CONCLUSIONS This article shows how a PROM can be developed with a specific focus on its applicability in clinical practice.
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Affiliation(s)
- Inger L. Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ healthcare, PO box 9101, huispost 114, 6500 HB Nijmegen, The Netherlands
| | - Maroeska Rovers
- Radboud University Medical Center, Radboud Institute of Health Sciences, Departments for Health Evidence and Operating Rooms, Nijmegen, The Netherlands
| | | | - Bernard Hol
- Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - Gert P. Westert
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ healthcare, PO box 9101, huispost 114, 6500 HB Nijmegen, The Netherlands
| | - Philip J. van der Wees
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ healthcare, PO box 9101, huispost 114, 6500 HB Nijmegen, The Netherlands
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Wiering B, de Boer D, Delnoij D. Patient involvement in the development of patient-reported outcome measures: The developers' perspective. BMC Health Serv Res 2017; 17:635. [PMID: 28886742 PMCID: PMC5591531 DOI: 10.1186/s12913-017-2582-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/30/2017] [Indexed: 01/02/2023] Open
Abstract
Background Patient-reported outcome measures (PROMs) are increasingly used in health care. To capture the patient’s perspective, patient involvement in PROM development is needed. As earlier research showed varying degrees of patient involvement in PROM development, this study aimed to investigate why PROM developers do or do not involve patients, how patients can be successfully involved and what the negative aspects and benefits of patient involvement are. Methods PROM developers who, according to an earlier scoping review, involved patients in at least two phases of PROM development or did not involve patients at all, were contacted for a telephone interview. The interviews were recorded, transcribed and analysed using a general inductive approach. Results From the PROM developers who involved patients, 21 developers were interviewed and three answered questions via e-mail. Most developers considered patient involvement necessary to create a valid questionnaire and relied on guidelines, personal experience and practical considerations for choosing a qualitative method. Negative aspects of patient involvement were mainly time investment and budget impact. One developer who did not involve patients was interviewed. Two developers sent back answers via e-mail. These developers did not involve patients because of limited resources or because no benefits were expected. Conclusion Although PROM developers agree that patient involvement is necessary, a lack of resources can be a stumbling block. Most developers rely on guidelines, personal experience or practical considerations for choosing a qualitative method. Although this may be a good place to start, to optimize patient involvement developers should explicitly think about which methods would suit their study.
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Affiliation(s)
- Bianca Wiering
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
| | - Dolf de Boer
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Diana Delnoij
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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Measuring patient reported outcomes of acupuncture treatment on pain patients' health status. Complement Ther Clin Pract 2017; 28:192-199. [PMID: 28779929 DOI: 10.1016/j.ctcp.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/04/2017] [Accepted: 06/26/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The primary aim of this observational multicenter case series study was to assess patient reported outcome measures of health status following routine acupuncture treatment. DESIGN Via the patient reported 'MYMOP2-online' questionnaire 110 pain patients reported three times (baseline, after four weeks, after sixteen weeks) whether changes in health status occurred following un-standardized routine acupuncture treatment. RESULTS ANOVA for repeated measures showed that primary pain (-38.8%), secondary pain (-38.4%), limitation to daily functioning (-33.2%), subjective well-being (24.2%), and health status (34.0%) significantly improved between zero and four weeks (p < 0.001). The achieved health benefits persisted over the long term (sixteen weeks). Pain medication usage decreased by 44.5% in four weeks. The changes in health status could not be related to specific aspects of acupuncture treatment. CONCLUSION In this observational study pain patients self-reported a statistically significant and clinically relevant long-term improvement in health status following acupuncture treatments in routine practice.
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Wiering B, de Boer D, Delnoij D. Asking what matters: The relevance and use of patient-reported outcome measures that were developed without patient involvement. Health Expect 2017; 20:1330-1341. [PMID: 28675514 PMCID: PMC5689236 DOI: 10.1111/hex.12573] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 12/12/2022] Open
Abstract
Background Patient‐reported outcome measures (PROMs) are increasingly used to establish the value of health care. In order to reflect value, PROMs should measure outcomes that matter to patients. However, patients are not always involved in the development of PROMs. This study therefore aimed to investigate whether PROMs, which were developed without patient involvement, are relevant to patients and whether the level of importance allocated towards aspects of these PROMs varies between patient groups. Methods All patients from 20 Dutch hospitals undergoing hip or knee surgery in 2014 were invited to a PROMs survey. Participants were asked to rate the importance of each of the items in the HOOS‐Physical Function Short form or the KOOS‐Physical Function Short form, the EQ‐5D and the NRS pain. Results Most outcomes were considered important. However, 77.7% of hip surgery patients rated being able to run as unimportant. Being able to kneel (32.7%) or squat (39.6%) was not important to a considerable minority of knee surgery patients. Pain, especially during rest, was considered very important by both hip (68.2%) and knee (66.5%) surgery patients. Patients who were older, male, experienced overall bad health and psychological health considered many items from the PROMs less important than other patients. Discussion Patients differ in what they consider important. Health‐care professionals should explore patients’ preferences and discuss which treatment options best fit patients’ preferences. Additionally, if PROMs are used in performance measurement, further research is needed to look at whether and how variation in patient preferences can be taken into account.
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Affiliation(s)
- Bianca Wiering
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
| | - Dolf de Boer
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Diana Delnoij
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
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Persons with rheumatoid arthritis challenge the relevance of the health assessment questionnaire: a qualitative study of patient perception. BMC Musculoskelet Disord 2017; 18:189. [PMID: 28499372 PMCID: PMC5429524 DOI: 10.1186/s12891-017-1566-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/09/2017] [Indexed: 12/20/2022] Open
Abstract
Background The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. Methods The study used secondary data analysis. Persons with RA participated in semi-structured interviews in previous research projects. Thirty-nine interviews were included based on data fit, and thematic analysis applied. Results The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. Conclusions To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA.
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Elder CR, Debar LL, Ritenbaugh C, Rumptz MH, Patterson C, Bonifay A, Cowan P, Lancaster L, Deyo RA. Health Care Systems Support to Enhance Patient-Centered Care: Lessons from a Primary Care-Based Chronic Pain Management Initiative. Perm J 2017; 21:16-101. [PMID: 28406791 PMCID: PMC5391786 DOI: 10.7812/tpp/16-101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Supporting day-to-day self-care activities has emerged as a best practice when caring for patients with chronic pain, yet providing this support may introduce challenges for both patients and primary care physicians. It is essential to develop tools that help patients identify the issues and outcomes that are most important to them and to communicate this information to primary care physicians at the point of care. OBJECTIVE We describe our process to engage patients, primary care physicians, and other stakeholders in the context of a pilot randomized controlled trial of a patient-centered assessment process implemented in an everyday practice setting. We identify lessons on how to engage stakeholders and improve patient-centered care for those with chronic conditions within the primary care setting. METHODS A qualitative analysis of project minutes, interviews, and focus groups was conducted to evaluate stakeholder experiences. Stakeholders included patients, caregivers, clinicians, medical office support staff, health plan administrators, an information technology consultant, and a patient advocate. RESULTS Our stakeholders included many patients with no prior experience with research. This approach enriched the applicability of feedback but necessitated extra time for stakeholder training and meeting preparation. Types of stakeholders varied over the course of the project, and more involvement of medical assistants and Information Technology staff was required than originally anticipated. CONCLUSION Meaningful engagement of patient and physician stakeholders must be solicited in a well-coordinated manner with broad health care system supports in place to ensure full execution of patient-centered processes.
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Affiliation(s)
- Charles R Elder
- Physician Lead for Integrative Medicine at Kaiser Permanente Northwest and an Affiliate Investigator at the Center for Health Research in Portland, OR.
| | - Lynn L Debar
- Senior Investigator at the Kaiser Permanente Center for Health Research in Portland, OR.
| | - Cheryl Ritenbaugh
- Professor Emerita in the Department of Family and Community Medicine and Anthropology at the University of Arizona in Tucson.
| | - Maureen H Rumptz
- Research Program Manager in the Science Programs Department of the Center for Health Research in Portland, OR.
| | - Charlotte Patterson
- Physician in the School of Community Medicine at the University of Bristol in the United Kingdom.
| | - Allison Bonifay
- Research Associate in the Behavior Assessment and Change Department at the Center for Health Research in Portland, OR.
| | - Penney Cowan
- Director of the American Chronic Pain Associate in Rocklin, CA.
| | - Lindsay Lancaster
- Assistant Professor at the School of Nursing at the University of Portland in OR.
| | - Richard A Deyo
- Professor of Family Medicine and Internal Medicine at the Oregon Institute for Occupational Health Sciences at Oregon Health and Science University in Portland. He is also a Clinical Investigator at the Center for Health Research in Portland, OR.
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Krug K, Kraus KI, Herrmann K, Joos S. Complementary and alternative medicine (CAM) as part of primary health care in Germany-comparison of patients consulting general practitioners and CAM practitioners: a cross-sectional study. Altern Ther Health Med 2016; 16:409. [PMID: 27776512 PMCID: PMC5078911 DOI: 10.1186/s12906-016-1402-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/11/2016] [Indexed: 12/01/2022]
Abstract
Background In Germany, complementary and alternative medicine (CAM) in primary health care is offered by general practitioners (GPs) and by natural health practitioners, so called ‘Heilpraktiker’ (HPs). Considering the steadily growing number of unregulated HPs, the aim of the study was to assess characteristics of patients consulting HPs in comparison to patients consulting GPs. Methods In a cross-sectional study, patients of randomly selected GPs and HPs were asked to complete a questionnaire about their health care status, health care behavior, and symptoms rated on the Measure Yourself Medical Outcome Profile (MYMOP-D). Patient groups were compared based on health care provider (HP, GP with high use of CAM (CAM-GP), and GP with no/little use of CAM (nCAM-GP)) using Kruskal-Wallis tests and analyses of variance (ANOVA). Results Altogether, 567 patients (91 of 11 HPs, 223 of 15 CAM-GPs, 253 of 19 nCAM-GPs) filled in the questionnaire. Patients of HPs had a higher education level and were more often female. The most common reason for encounter among all three groups were musculoskeletal problems (30.2–31.1 %). Patients seeing HPs reported more psychological (4.4 % vs. 17.8 %), but less respiratory problems (19.9 % vs. 7.8 %), and longer symptom duration (>5 years: 21.1 % vs. 40.7 %), than patients of nCAM-GPs. Conclusions The high percentage of patients with psychological illness and chronic health problems consulting HPs demonstrates the urgent need for action with regard to CAM therapy in primary care and regulation of natural health practitioners. Appropriate measures with regard to quality and patient safety should be taken given the growing numbers of HPs and the absence of a regulatory body. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1402-8) contains supplementary material, which is available to authorized users.
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Punja S, Bukutu C, Shamseer L, Sampson M, Hartling L, Urichuk L, Vohra S. N-of-1 trials are a tapestry of heterogeneity. J Clin Epidemiol 2016; 76:47-56. [DOI: 10.1016/j.jclinepi.2016.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 12/18/2015] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
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Lima PMB, Brito RFD, Farias RTFDB, Paiva GSD, Barbosa FT, Rodrigues CFDS, Silva PNCD. Cultural adaptation and reproducibility of the Measure Yourself Medical Outcome Profile (Mymop2). FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.002.ao04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The Measure Yourself Medical Outcome Profile (MYMOP 2) is being used as a generic tool to document its effectiveness, together with the evaluation of health systems and their interventions. Objective: To assess the cultural adaptation and reproducibility of the Measure Yourself Medical Outcome Profile (MYMOP2) questionnaire in a sample of patients undergoing cardiac surgery. Methods: The study sample consisted of 50 patients undergoing cardiac surgery for myocardial and valve revascularization, which were recruited from the cardiac ICU of a private hospital in Maceió, Alagoas. The MYMOP2 questionnaire was initially translated into Brazilian Portuguese. Cultural and conceptual adaptation were performed, so that patients were able to understand questions. All patients answered this instrument twice, on the same day, with two different interviewers, with an interval of 30 minutes between the interviews. After one day, the questionnaire was repeated on a second visit. This process was carried out with MYMOP and MYMOP2 FOLLOW UP. Reproducibility and validity were tested. Results: Cultural adaptations were made, so that the final version was obtained. Spearman correlation coefficient for MYMOP2 was 1 and FOLLOW UP was 0.794, p < 0.001. There were moderate correlations with the domains of the EQ-5D. MYMOP2 was validated and supported by a significant correlation between change scores and MYMOP2 change scores and the ability to detect an improvement in acute conditions. Conclusion: MYMOP2 questionnaire is reproducible, easy to understand and quick to apply. It should be included and used in any Brazilian study with the objective to assess disease impact over time.
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Wiering B, de Boer D, Delnoij D. Patient involvement in the development of patient-reported outcome measures: a scoping review. Health Expect 2016; 20:11-23. [PMID: 26889874 PMCID: PMC5217930 DOI: 10.1111/hex.12442] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 02/06/2023] Open
Abstract
Background Patient‐reported outcome measures (PROMs) measure patients’ perspectives on health outcomes and are increasingly used in health care. To capture the patient's perspective, it is essential that patients are involved in PROM development Objective This article reviews in what ways and to what extent patients are involved in PROM development and whether patient involvement has increased over time. Search strategy Literature was searched in PubMed, EMBASE, MEDLINE and the Cochrane Methodology Register. Inclusion criteria Studies were included if they described a new PROM development. Data extraction Basic information and information regarding patient involvement in development phases was recorded. Main results A total of 189 studies, describing the development of 193 PROMs, were included. Most PROMs were meant for chronic disease patients (n = 59) and measured quality of life (n = 28). In 25.9% of the PROM development studies, no patients were involved. Patients were mostly involved during item development (58.5%), closely followed by testing for comprehensibility (50.8%), while patient involvement in determining which outcome to measure was minimal (10.9%). Some patient involvement took place in the development of most PROMs, but in only 6.7% patients were involved in all aspects of the development. Patient involvement did not increase with time. Conclusions Although patient involvement in PROM development is essential to develop valid patient‐centred PROMs, patients are not always involved. When patients are involved, their level of involvement varies considerably. These variations suggest that further attention to building and/or disseminating consensus on requirements for patient involvement in PROM development is necessary.
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Affiliation(s)
- Bianca Wiering
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
| | - Dolf de Boer
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Diana Delnoij
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
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Evans M, Gregory A, Feder G, Howarth E, Hegarty K. "Even 'Daily' is Not Enough": How Well Do We Measure Domestic Violence and Abuse?-A Think-Aloud Study of a Commonly Used Self-Report Scale. VIOLENCE AND VICTIMS 2015; 31:3-26. [PMID: 26645540 DOI: 10.1891/0886-6708.vv-d-15-00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article explores the challenges of providing a quantitative measure of domestic violence and abuse (DVA), illustrated by the Composite Abuse Scale, a validated multidimensional measure of frequency and severity of abuse, used worldwide for prevalence studies and intervention trials. Cognitive "think-aloud" and qualitative interviewing with a sample of women who had experienced DVA revealed a tendency toward underreporting their experience of abuse, particularly of coercive control, threatening behavior, restrictions to freedom, and sexual abuse. Underreporting was linked to inconsistency and uncertainty in item interpretation and response, fear of answering truthfully, and unwillingness to identify with certain forms of abuse. Suggestions are made for rewording or reconceptualizing items and the inclusion of a distress scale to measure the individual impact of abuse. The importance of including qualitative methods in questionnaire design and in the interpretation of quantitative findings is highlighted.
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Gordon HA, Rucklidge JJ, Blampied NM, Johnstone JM. Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. J Child Adolesc Psychopharmacol 2015; 25:783-98. [PMID: 26682999 PMCID: PMC4702182 DOI: 10.1089/cap.2015.0105] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical effect and safety of a broad spectrum, 36 ingredient micronutrient (vitamins and minerals) in treating children with attention-deficit/hyperactivity disorder (ADHD). METHODS This open-label, on-off-on-off (reversal design) study followed 14 participants (8-12 years of age) with ADHD, diagnosed using standardized instruments, for 6 months with no dropouts. Following baseline assessment, including hematology and biochemistry screening, participants began an 8 week treatment phase with micronutrients titrated up to maximum dose (15 capsules/day). Treatment was withdrawn for 4 weeks, reinstated for a further 8 weeks, and then withdrawn for 4 weeks. Primary outcomes included the Conners' Parent Rating Scale, the Clinical Global Impressions Scale (CGI), and the Strengths and Difficulties Questionnaire - Parent version (SDQ). Secondary outcomes were mood and global functioning. RESULTS Modified Brinley plots revealed a reduction in ADHD symptoms, improved mood, and improved overall functioning during intervention phases, and deterioration in ADHD symptoms, mood, and overall functioning during the withdrawal phases. Reliable change analyses, Cohen's d and percent superiority effect sizes, 95% confidence intervals and t tests confirmed clinically and statistically significant change between the intervention and withdrawal phases, with large effect sizes observed pre- to post-exposure of micronutrients (d = 1.2-2.2) on ADHD symptoms during intervention phases. Seventy-one percent of participants showed at least a 30% decrease in ADHD symptoms by the end of the second treatment phase, and 79% were identified as "much improved" or "very much improved" at the end of the second phase (5 months) based on the clinician-rated CGI when considering functioning generally. The SDQ showed that these benefits occurred across other areas of functioning including emotional symptoms, conduct problems, and prosocial behaviours. The children's self-reports confirmed the improvements. Excellent adherence to treatment occurred throughout, side effects were mild and transitory, and no safety issues were identified through blood analyses. CONCLUSIONS This study demonstrates the clinical benefit, feasibility, and safety of broad-spectrum micronutrients in the treatment of childhood ADHD. Replications utilizing double-blind placebo-controlled studies are warranted. Trial is registered with the Australia and New Zealand Clinical Trial Registry: ACTRN12612000645853.
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Affiliation(s)
- Heather A Gordon
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Neville M Blampied
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Jeanette M Johnstone
- Departments of Neurology and Psychiatry, Oregon Health & Science University, Portland, Oregon
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Fibert P. Case report of a 16 year old youth with diagnoses of attention deficit hyperactivity disorder (ADHD), Asperger's syndrome and dyslexia receiving homoeopathic and tautopathic treatment. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Corbett M, Heirs M, Rose M, Smith A, Stirk L, Richardson G, Stark D, Swinson D, Craig D, Eastwood A. The delivery of chemotherapy at home: an evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundRecent policy and guidance has focused on chemotherapy services being offered closer to home, but the clinical and economic implications of this are uncertain.ObjectivesTo compare the impact of delivering intravenous chemotherapy in different settings on a range of outcomes, including quality of life, safety and costs.DesignMultimethods approach: systematic review of clinical effectiveness, qualitative and cost-effectiveness studies; description of the patient pathway and brief survey of current provision; and development of a decision model to explore aspects of cost-effectiveness.SettingProvision of intravenous chemotherapy.ParticipantsChemotherapy patients.InterventionsSetting in which chemotherapy was administered (home, community or outpatient).Outcome measuresSafety, quality of life, preference, satisfaction, opinions/experiences, social functioning, clinical outcomes, costs and resource/organisational issues.Data sourcesSixteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from inception to October 2013 for published and unpublished studies.Review methodsTwo reviewers independently screened potentially relevant studies, extracted data and quality assessed the included studies. Study validity was evaluated using appropriate quality assessment tools. Clinical effectiveness and cost-effectiveness studies were summarised narratively, and qualitative studies were synthesised using meta-ethnography.ResultsOf the 67 eligible studies, 25 were comparative, with nine including a concurrent economic evaluation. Although some of the 10 randomised trials were designed to minimise avoidable biases, slow recruitment rates and non-participation of eligible patients for setting-related reasons meant that trial sample sizes were small and populations were inherently biased to favour the home or community settings. There was little evidence to suggest differences between settings in terms of quality of life, clinical outcomes, psychological outcomes or adverse events. All nine economic evaluations were judged as having low or uncertain quality, providing limited evidence to draw overall conclusions. Most were cost–consequence analyses, presenting cost outcomes alongside trial results but deriving no summary measure of benefit. Poor resource use reporting and use of different perspectives across settings made results difficult to compare. Seventeen qualitative studies (450 participants) were judged as moderate to good quality, although all compared new or proposed services with existing outpatient facilities and biased samples were used. The three main lines of argument were barriers to service provision, satisfaction with chemotherapy and making compromises to maintain normality. Most patients made explicit trade-offs between the time and energy required for outpatient chemotherapy, which reduced quality of life, and an increased sense of safety. A patient pathway was described, informed by expert advice and a brief survey of NHS and private providers, which identified wide variation in the ways in which home and community chemotherapy was delivered. Considering limitations of the available data and variation in provision, cost-effectiveness modelling results were not robust and were viewed as exploratory only; the results were highly unstable.ConclusionsPrimary studies comparing settings for administering intravenous chemotherapy appear difficult to conduct. Consequently, few robust conclusions can be made about the clinical effectiveness and cost-effectiveness. Qualitative studies indicate that the patient time and energy required for outpatient chemotherapy reduces quality of life. A nested randomised controlled trial within a larger observational cohort of patients is proposed to enhance recruitment and improve generalisability of results. Future economic evaluations require detailed patient characteristic, resource use, cost and quality-of-life data, although their results are likely to have limited generalisability.Study registrationThis study is registered as PROSPERO CRD42013004851.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Morag Heirs
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Micah Rose
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Smith
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lisa Stirk
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Daniel Stark
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | - Daniel Swinson
- St James’s Institute of Oncology, Leeds Teaching Hospitals Foundation NHS Trust, Leeds, UK
| | - Dawn Craig
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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Wakefield ML. Case report: the effects of massage therapy on a woman with thoracic outlet syndrome. Int J Ther Massage Bodywork 2014; 7:7-14. [PMID: 25452819 PMCID: PMC4240700 DOI: 10.3822/ijtmb.v7i4.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Thoracic outlet syndrome (TOS) refers to a group of conditions resulting from compression of the neurovascular structures of the thoracic outlet. The parameters for physical therapy include myofascial release (MFR), neuromuscular therapy (NMT), muscle strengthening, and stretching. This case study examined the effects of neuromuscular therapy, massage, and other manual therapies on a 56-year-old female presenting with bilateral numbness over the forearms and hands on waking. Numbness occurred most days, progressing to “dead rubbery” forearms and hands once or twice a month. Methods The treatment plan was implemented over eight weeks and consisted of six, 50-minute bodywork sessions. Several nonbodywork strategies were also employed to address potential contributing factors to the TOS symptomology experienced by the client. Objective measurements included posture analysis (PA), range of movement (ROM), and Roos and Adson’s tests. The Measure Your Own Medical Outcome Profile (MYMOP2), a client-generated measure of clinical outcome, was used to measure clinical change. Results MYMOP2 overall profile score results demonstrated an improvement of 2.25 from pretreatment to post-treatment measurement. Clinically meaningful change was measured by the individual and was indicative of substantial symptom improvement where a score change of over one was considered as meaningful. Conclusions A course of massage was effective for numbness symptoms in an individual with TOS, and results lasted over a year without additional treatments. Further research is needed to fully understand the effects of massage for TOS symptoms.
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Hermann K, Kraus K, Herrmann K, Joos S. A brief patient-reported outcome instrument for primary care: German translation and validation of the Measure Yourself Medical Outcome Profile (MYMOP). Health Qual Life Outcomes 2014; 12:112. [PMID: 25927343 PMCID: PMC5011785 DOI: 10.1186/s12955-014-0112-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measure Yourself Medical Outcome Profile (MYMOP) is a patient-generated outcome instrument capable of measuring effects from a wide range of health care interventions. This paper reports the translation of this instrument into German (MYMOP-D) and the assessment of validity and sensitivity to change for the MYMOP-D. The instrument was piloted in a German primary care context. METHODS The translation process was conducted according to international guidelines. Recruited patients of both general practitioners and non-medical Complementary and Alternative Medicine (CAM) practitioners ("Heilpraktiker") in the German state of Baden-Wuerttemberg completed a questionnaire comprised of the MYMOP-D and the EQ-5D. Responses were analysed to assess construct validity. For assessing the instrument's sensitivity to change, patients received the MYMOP-D again after four weeks at which point they were also asked for their subjective views on change of symptoms. Correlation between MYMOP-D and EQ-5D and sensitivity to change as gradient in score change and as standardized response mean (SRM) were calculated. RESULTS 476 patients from general practices and 91 patients of CAM practitioners were included. Construct validity of the MYMOP-D was given with a correlation of r = .47 with the EQ-5D. Sensitivity to change for subjective change of symptoms could only be analysed for improvement or no change of symptoms, as only 12 patients reported deterioration of symptoms. Results showed the expected smooth gradient with 2.2, 1.3, and 0.5 points of change for large, little improvement and no change, respectively. SRM for MYMOP-D Profile Score was 0.88. CONCLUSIONS The MYMOP-D shows excellent construct validity. It is able to detect changes when symptoms in patients improve or remain unchanged. Deterioration of symptoms could not be evaluated due to too few data. With its brevity and simplicity, it might be an important tool for enhancing patient-centred care in the German health care context.
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Affiliation(s)
- Katja Hermann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, 69115, Heidelberg, Germany.
| | - Katharina Kraus
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, 69115, Heidelberg, Germany.
| | - Kathrin Herrmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, 69115, Heidelberg, Germany.
| | - Stefanie Joos
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, 69115, Heidelberg, Germany.
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Holmberg C, Karner JJ, Rappenecker J, Witt CM. Clinical trial participants' experiences of completing questionnaires: a qualitative study. BMJ Open 2014; 4:e004363. [PMID: 24662446 PMCID: PMC3975744 DOI: 10.1136/bmjopen-2013-004363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To improve clinical study developments for elderly populations, we aim to understand how they transfer their experiences into validated, standardised self-completed study measurement instruments. We analysed how women (mean 78±8 years of age) participating in a randomised controlled trial (RCT) cognised study instruments used to evaluate outcomes of the intervention. SETTING The interview study was nested in an RCT on chronic neck pain using common measurement instruments situated in an elderly community in Berlin, Germany, which comprised of units for independent and assisted-living options. PARTICIPANTS The sample (n=20 women) was selected from the RCT sample (n=117, 95% women, mean age 76 (SD±8) years). Interview participants were selected using a purposive sampling list based on the RCT outcomes. OUTCOMES We asked participants about their experiences completing the RCT questionnaires. Interviews were analysed thematically, then compared with the questionnaires. RESULTS Interviewees had difficulties in translating complex experiences into a single value on a scale and understanding the relationship of the questionnaires to study aims. Interviewees considered important for the trial that their actual experiences were understood by trial organisers. This information was not transferrable by means of the questionnaires. To rectify these difficulties, interviewees used strategies such as adding notes, adding response categories or skipping an item. CONCLUSIONS Elderly interview participants understood the importance of completing questionnaires for trial success. This led to strategies of completing the questionnaires that resulted in 'missing' or ambiguous data. To improve data collection in elderly populations, educational materials addressing the differential logics should be developed and tested. Pilot testing validated instruments using cognitive interviews may be particularly important in such populations. Finally, when the target of an intervention is a subjective experience, it seems important to create a method by which participants can convey their personal experiences. These could be nested qualitative studies. TRIAL REGISTRATION NUMBER ISRCTN77108101807.
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Affiliation(s)
- Christine Holmberg
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julia J Karner
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Rappenecker
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute of Complementary and Integrative Medicine, University Hospital Zürich, Zürich, Switzerland
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Assessing spiritual well-being in residents of nursing homes for older people using the FACIT-Sp-12: a cognitive interviewing study. Qual Life Res 2014; 23:1701-11. [PMID: 24470288 DOI: 10.1007/s11136-014-0627-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To detect any problems with completion of the Functional Assessment of Chronic Illness Therapy Spiritual Well-being Scale (FACIT-Sp-12), to analyse the causes of such problems and to propose solutions to overcome them. METHODS We audio-recorded face-to-face interviews with 17 older people living in one of three nursing homes in London, UK, while they completed FACIT-Sp-12. We used cognitive interviewing methods to explore residents' responses. Our analysis was based on the Framework approach to qualitative analysis. We developed the framework of themes a priori. These comprised: comprehension of the question; retrieval from memory of relevant information; decision processes; and response processes. RESULTS Ten residents completed the FACIT-Sp-12 with no missing data. Most problems involved comprehension and/or selecting response options. Twelve residents had problems with comprehension of at least one question, particularly with abstract concepts (e.g. harmony, productivity), or where there were assumptions inherent in the questions (e.g. they had an illness). When residents had problems comprehending the question, they also found it difficult to select a response. Thirteen residents had difficulties selecting responses (e.g. categories did not reflect their views or were not meaningful in the context of the statement). Some chose not to respond, others responded to the question as they understood it. CONCLUSIONS The FACIT-Sp-12 could provide valuable insights into the spiritual concerns of nursing home residents; however, data may be neither valid nor reliable if they do not comprehend the questions as intended and respond appropriately. Providing clear and detailed instructions, including definitions of abstract concepts, may improve the validity of this measure for this population.
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Trujols J, Iraurgi I, Oviedo-Joekes E, Guàrdia-Olmos J. A critical analysis of user satisfaction surveys in addiction services: opioid maintenance treatment as a representative case study. Patient Prefer Adherence 2014; 8:107-17. [PMID: 24482571 PMCID: PMC3905099 DOI: 10.2147/ppa.s52060] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Satisfaction with services represents a key component of the user's perspective, and user satisfaction surveys are the most commonly used approach to evaluate the aforementioned perspective. The aim of this discursive paper is to provide a critical overview of user satisfaction surveys in addiction treatment and harm reduction services, with a particular focus on opioid maintenance treatment as a representative case. METHODS We carried out a selective critical review and analysis of the literature on user satisfaction surveys in addiction treatment and harm reduction services. RESULTS Most studies that have reported results of satisfaction surveys have found that the great majority of users (virtually all, in many cases) are highly satisfied with the services received. However, when these results are compared to the findings of studies that use different methodologies to explore the patient's perspective, the results are not as consistent as might be expected. It is not uncommon to find that "highly satisfied" patients report significant problems when mixed-methods studies are conducted. To understand this apparent contradiction, we explored two distinct (though not mutually exclusive) lines of reasoning, one of which concerns conceptual aspects and the other, methodological questions. CONCLUSION User satisfaction surveys, as currently designed and carried out in addiction treatment and harm reduction services, do not significantly help to improve service quality. Therefore, most of the enthusiasm and naiveté with which satisfaction surveys are currently performed and interpreted - and rarely acted on in the case of nonoptimal results - should be avoided. A truly participatory approach to program evaluation is urgently needed to reshape and transform patient satisfaction surveys.
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Affiliation(s)
- Joan Trujols
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Bilbao, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Bilbao, Spain
- Correspondence: Joan Trujols, Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Sant Antoni Maria Claret 167, 08025 Barcelona, Spain, Tel +34 93 553 7665, Fax +34 93 553 7666, Email
| | - Ioseba Iraurgi
- DeustoPsych – Unidad de Investigación, Desarrollo e Innovación en Psicología y Salud, Universidad de Deusto, Bilbao, Spain
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada
| | - Joan Guàrdia-Olmos
- Departament de Metodologia de les Ciències del Comportament, Facultat de Psicologia, Institut de Recerca en Cervell, Cognició i Conducta (IR3C), Universitat de Barcelona, Barcelona, Spain
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Jones R. Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities. MEDICINE 2.0 2013; 2:e9. [PMID: 25075244 PMCID: PMC4084763 DOI: 10.2196/med20.2559] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/24/2013] [Accepted: 08/16/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users. OBJECTIVE The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities. METHODS Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system. RESULTS the patient ehealth readiness questionnaire (perq) includes questions used to calculate four subscores: patients' perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities. CONCLUSIONS PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further.
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Affiliation(s)
- Ray Jones
- University of Plymouth Faculty of Health, Education, and Society Plymouth United Kingdom
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Hunter J, Leeder S. Patient questionnaires for use in the integrative medicine primary care setting—A systematic literature review. Eur J Integr Med 2013. [DOI: 10.1016/j.eujim.2013.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Integrative medicine outcomes: What should we measure? Complement Ther Clin Pract 2013; 19:20-6. [DOI: 10.1016/j.ctcp.2012.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 10/01/2012] [Accepted: 10/10/2012] [Indexed: 01/09/2023]
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Trujols J, Portella MJ, Iraurgi I, Campins MJ, Siñol N, de Los Cobos JP. Patient-reported outcome measures: are they patient-generated, patient-centred or patient-valued? J Ment Health 2013; 22:555-62. [PMID: 23323928 DOI: 10.3109/09638237.2012.734653] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In the past two decades, there has been a growing interest in the development of a more patient-centred approach to assessing treatment outcomes. This interest has resulted in the increasing use of patient-reported outcome measures (PROMs) in both clinical trials and usual clinical practice. AIMS To briefly discuss the paucity of efficacy and effectiveness studies in the field of mental health (exemplified by schizophrenia, depression and opioid dependence) that significantly incorporate the patient's perspective. The limited concordance between the perspectives of patients and clinicians in outcome assessment is also addressed. Finally, we propose a new PROM classification system based on the degree to which these instruments incorporate the patient's perspective. CONCLUSIONS PROMs may differ little from traditional instruments unless they truly incorporate the patient's perspective and not just the perspectives of clinicians and researchers. Efforts to develop new PROMs that provide a more patient-centred outcome assessment should use qualitative and participatory methods to capture and incorporate patient perspectives and values.
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Affiliation(s)
- Joan Trujols
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau , Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau) , Barcelona , Spain
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Pitfalls in the interpretation of standardised quality of life instruments for individual patients? A qualitative study in colorectal cancer. Qual Life Res 2012; 22:1879-88. [DOI: 10.1007/s11136-012-0303-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 01/22/2023]
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Ritenbaugh C, Nichter M, Nichter MA, Kelly KL, Sims CM, Bell IR, Castañeda HM, Elder CR, Koithan MS, Sutherland EG, Verhoef MJ, Warber SL, Coons SJ. Developing a patient-centered outcome measure for complementary and alternative medicine therapies I: defining content and format. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 11:135. [PMID: 22206345 PMCID: PMC3293761 DOI: 10.1186/1472-6882-11-135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 12/29/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately. METHODS From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation. RESULTS The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains. CONCLUSIONS This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.
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Affiliation(s)
- Cheryl Ritenbaugh
- Department of Family & Community Medicine, The University of Arizona, Tucson AZ, USA
- School of Anthropology, The University of Arizona, Tucson AZ, USA
| | - Mimi Nichter
- School of Anthropology, The University of Arizona, Tucson AZ, USA
| | - Mark A Nichter
- School of Anthropology, The University of Arizona, Tucson AZ, USA
| | - Kimberly L Kelly
- Department of Family & Community Medicine, The University of Arizona, Tucson AZ, USA
- School of Anthropology, The University of Arizona, Tucson AZ, USA
| | - Colette M Sims
- Department of Family & Community Medicine, The University of Arizona, Tucson AZ, USA
| | - Iris R Bell
- Department of Family & Community Medicine, The University of Arizona, Tucson AZ, USA
| | - Heide M Castañeda
- Department of Anthropology, University of South Florida, Tampa FL, USA
| | - Charles R Elder
- Kaiser Permanente Center for Health Research, Portland OR, USA
| | - Mary S Koithan
- College of Nursing, The University of Arizona, Tucson AZ, USA
| | | | - Marja J Verhoef
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sarah L Warber
- Department of Family Medicine, University of Michigan, Ann Arbor MI, USA
| | - Stephen J Coons
- Patient-Reported Outcome Consortium, Critical Path Institute, Tucson AZ, USA
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49
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Bergh I, Kvalem IL, Aass N, Hjermstad MJ. What does the answer mean? A qualitative study of how palliative cancer patients interpret and respond to the Edmonton Symptom Assessment System. Palliat Med 2011; 25:716-24. [PMID: 21248179 DOI: 10.1177/0269216310395985] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The Edmonton Symptom Assessment System (ESAS) is a well-known self-reporting tool for symptom assessment in palliative care. Research has shown that patients experience difficulties in the scoring and interpretation, which may lead to suboptimal treatment. The aims were to examine how palliative care cancer patients interpreted and responded to the ESAS. Eleven patients (3 F/8 M), median age 65 (34-95) with mixed diagnoses were interviewed by means of cognitive interviewing, immediately after having completed the ESAS. The highest mean scores were found with tiredness (6.3) and oral dryness (5.7). The results showed that sources of error were related to interpretation of symptoms and differences in the understanding and use of the response format. The depression and anxiety symptoms were perceived as difficult to interpret, while the appetite item was particularly prone to misunderstandings. Contextual factors, such as mood and time of the day, influenced the answers. Lack of information and feedback from staff influenced the scores. Some patients stated that they scored at random because they did not understand why and how the ESAS was used. The patients' interpretation must be considered in order to minimize errors. The ESAS should always be reviewed with the patients after completion to improve symptom management, thereby strengthening the usability of the ESAS.
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Affiliation(s)
- Irmelin Bergh
- Department of Oncology, Oslo University Hospital, Norway.
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50
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Selman LE, Williams J, Simms V. A mixed-methods evaluation of complementary therapy services in palliative care: yoga and dance therapy. Eur J Cancer Care (Engl) 2011; 21:87-97. [PMID: 21880079 DOI: 10.1111/j.1365-2354.2011.01285.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
To inform service provision and future research, we evaluated two complementary therapy services: yoga classes and dance therapy [The Lebed Method (TLM)]. Both were run as 6-week group courses. Patients completed the Measure Yourself Concerns and Wellbeing questionnaire pre- and post-course. Mean change over time was calculated for patient-nominated concern and well-being scores. Qualitative data regarding factors affecting health other than the therapy and benefits of the service were analysed using content analysis. Eighteen patients participated (mean age 63.8 years; 16 female; 14 cancer diagnoses); 10 were doing yoga, five TLM, and three both yoga and TLM; 14 completed more than one assessed course. Patients' most prevalent concerns were: mobility/fitness (n= 20), breathing problems (n= 20), arm, shoulder and neck problems (n= 18), difficulty relaxing (n= 8), back/postural problems (n= 8), fear/anxiety (n= 5). Factors affecting patients' health other than the therapy were prevalent and predominantly negative (e.g. treatment side effects). Patients reported psycho-spiritual, physical and social benefits. Concern scores improved significantly (P < 0.001) for both therapies; improved well-being was clinically significant for yoga. Evaluations of group complementary therapy services are feasible, can be conducted effectively and have implications for future research. Yoga and TLM may be of benefit in this population.
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Affiliation(s)
- L E Selman
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London, UK.
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