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Cuperus LJA, van Zelst CM, Kerstjens HAM, Hendriks RW, Rutten-van Molken MPMH, Muilwijk-Kroes JB, Braunstahl GJ, In 't Veen JCCM. Measuring burden of disease in both asthma and COPD by merging the ACQ and CCQ: less is more? NPJ Prim Care Respir Med 2024; 34:8. [PMID: 38702303 PMCID: PMC11068875 DOI: 10.1038/s41533-024-00364-z] [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: 09/26/2023] [Accepted: 04/10/2024] [Indexed: 05/06/2024] Open
Abstract
Symptoms of asthma and COPD often overlap, and both diseases can co-exist in one patient. The asthma control questionnaire (ACQ) and clinical COPD questionnaire (CCQ) were developed to assess disease burden in respectively asthma or COPD. This study explores the possibility of creating a new questionnaire to assess disease burden in all obstructive lung diseases by integrating and reducing questions of the ACQ and CCQ. Data of patients with asthma, COPD and asthma-COPD overlap (ACO) were collected from a primary and secondary care center. Patients completed ACQ and CCQ on the same day. Linear regression tested correlations. Principal Component Analysis (PCA) was used for item reduction. The secondary cohort with asthma and COPD patients was used for initial question selection (development cohort). These results were reproduced in the primary care cohort and secondary cohort of patients with ACO. The development cohort comprised 252 patients with asthma and 96 with COPD. Correlation between ACQ and CCQ in asthma was R = 0.82, and in COPD R = 0.83. PCA determined a selection of 9 questions. Reproduction in primary care data (asthma n = 1110, COPD n = 1041, ACO = 355) and secondary care data of ACO patients (n = 53) resulted in similar correlations and PCA-derived selection of questions. In conclusion, PCA determined a selection of nine questions of the ACQ and CCQ: working title 'the Obstructive Lung Disease Questionnaire'. These results suggest that this pragmatic set of questions might be sufficient to assess disease burden in obstructive lung disease in both primary as secondary care.
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Affiliation(s)
- Liz J A Cuperus
- Pulmonology Department, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands.
- Pulmonology Department, Erasmus Medical Center, Rotterdam, the Netherlands.
- Pulmonology Department, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Cathelijne M van Zelst
- Pulmonology Department, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
- Pulmonology Department, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Huib A M Kerstjens
- Pulmonology Department, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rudi W Hendriks
- Pulmonology Department, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Gert-Jan Braunstahl
- Pulmonology Department, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
- Pulmonology Department, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johannes C C M In 't Veen
- Pulmonology Department, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
- Pulmonology Department, Erasmus Medical Center, Rotterdam, the Netherlands
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Abstract
PURPOSE OF REVIEW The review provides an overview of the results of asthma clinical trials published in peer review journals in the last 18 months that evaluated patient-reported outcomes (PROs). RECENT FINDINGS In the last 10 years, health care moved toward a patient-centered approach, which includes patients' perspectives reflecting the impact of a disease and its treatment. SUMMARY Surprisingly, among the almost 300 clinical trials published in the last one and a half year, PRO evaluation was performed in only 20 studies, and none of them held in a real-life setting. The effort of applying the scientific methods of PRO investigations in asthma clinical trials following a rigorous and systematic approach needs to be highly improved to allow better understanding of patient reported factors. Some recommendations are drawn particularly about PRO assessment in personalized medicine research. The ability of an individual PRO to evaluate choice of treatment and its effectiveness remains to be achieved.
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Martins T, Peixoto MJ, Araújo F, Rodrigues M, Pires F. [Development of the short version of the informal caregiver burden assessment questionnaire]. Rev Esc Enferm USP 2015; 49:236-44. [PMID: 25992822 DOI: 10.1590/s0080-623420150000200008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/19/2014] [Indexed: 11/21/2022] Open
Abstract
OBJETIVE to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION Confirmatory factor analysis revealed a good fit with the advocated theoretical model.
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Affiliation(s)
- Teresa Martins
- Escola Superior de Enfermagem do Porto, Oporto, Portugal
| | | | - Fátima Araújo
- Escola Superior de Enfermagem do Porto, Oporto, Portugal
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Cave AJ, Atkinson L, Tsiligianni IG, Kaplan AG. Assessment of COPD wellness tools for use in primary care: an IPCRG initiative. Int J Chron Obstruct Pulmon Dis 2012; 7:447-56. [PMID: 22927752 PMCID: PMC3422123 DOI: 10.2147/copd.s29868] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
COPD is considered a complex disease and global problem that is predicted to be the third most common cause of death by 2030. While managing this chronic condition, primary health care practitioners are faced with the ongoing challenge of achieving good quality of life and overall "wellness" for those affected. As such, a practical tool for monitoring quality of life in a clinical setting is required. However, due to the wide variety of general and disease-specific tools from which to choose, primary health care practitioners are given minimal guidance as to which tool may be most appropriate. To address these challenges, the International Primary Care Respiratory Group (IPCRG) proposed the creation of a user's guide for primary health care practitioners to assess "wellness" in COPD patients in an everyday clinical setting. This short report outlines the process by which the IPCRG Users' Guide to COPD "Wellness" Tools was developed. It also describes why this guide has the potential to be of great value in guiding primary health care practitioners to improve patient wellness.
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Affiliation(s)
- Andrew J Cave
- Department of Family Medicine, University of Alberta, Edmonton, Canada.
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Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JWH, Karagiannis K, Siafakas N, Tzanakis N. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ). BMC Pulm Med 2012; 12:20. [PMID: 22607459 PMCID: PMC3431277 DOI: 10.1186/1471-2466-12-20] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/03/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two simple questionnaires, in comparison with the St. George Respiratory Questionnaire (SGRQ). METHODS We administered the CAT, CCQ and SGRQ in patients with COPD stage I-IV during three visits. Spirometry, 6 MWT, MRC scale, BODE index, and patients perspectives on questionnaires were recorded in all visits. Standard Error of Measurement (SEM) was used to calculate the Minimal Clinical Important Difference (MCID) of all questionnaires. RESULTS We enrolled 90 COPD patients. Cronbach's alpha for both CAT and CCQ was high (0.86 and 0.89, respectively). Patients with severe COPD reported worse health status compared to milder subgroups. CAT and CCQ correlated significantly (rho =0.64, p < 0.01) and both with the SGRQ (rho = 0.65; CAT and rho = 0.77; CCQ, p < 0.01). Both questionnaires exhibited a weak correlation with lung function (rho = -0.35;CAT and rho = -0.41; CCQ, p < 0.01). Their reproducibility was high; CAT: ICC = 0.94 (CI 0.92-0.96), total CCQ ICC = 0.95 (0.92-0.96) and SGRQ = 0.97 (CI 0.95-0.98). The MCID calculated using the SEM method showed results similar to previous studies of 3.76 for the CAT, 0.41 for the CCQ and 4.84 for SGRQ. Patients suggested both CAT and CCQ as easier tools than SGRQ in terms of complexity and time considerations. More than half of patients preferred CCQ instead of CAT. CONCLUSIONS The CAT and CCQ have similar psychometric properties with a slight advantage for CCQ based mainly on patients' preference and are both valid and reliable questionnaires to assess health status in COPD patients.
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Affiliation(s)
- Ioanna G Tsiligianni
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Thys van der Molen
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Despoina Moraitaki
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Ilaine Lopez
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Janwillem WH Kocks
- Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
- GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands
| | - Konstantinos Karagiannis
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Nikolaos Siafakas
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece
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Williams K, Frei A, Vetsch A, Dobbels F, Puhan MA, Rüdell K. Patient-reported physical activity questionnaires: a systematic review of content and format. Health Qual Life Outcomes 2012; 10:28. [PMID: 22414164 PMCID: PMC3349541 DOI: 10.1186/1477-7525-10-28] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 03/13/2012] [Indexed: 01/24/2023] Open
Abstract
Background Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations. Methods Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers. Results 104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories. Conclusions A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.
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Affiliation(s)
- Kate Williams
- Patient Reported Outcomes Centre of Excellence, Global Market Access, Primary Care Business Unit, Pfizer Ltd, Walton Oaks, Surrey, UK
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Frei A, Williams K, Vetsch A, Dobbels F, Jacobs L, Rüdell K, Puhan MA. A comprehensive systematic review of the development process of 104 patient-reported outcomes (PROs) for physical activity in chronically ill and elderly people. Health Qual Life Outcomes 2011; 9:116. [PMID: 22185607 PMCID: PMC3311097 DOI: 10.1186/1477-7525-9-116] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 12/20/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Capturing dimensions of physical activity relevant to patients may provide a unique perspective for clinical studies of chronically ill patients. However, the quality of the development of existing instruments is uncertain. The aim of this systematic review was to assess the development process of patient-reported outcome (PRO) instruments including their initial validation to measure physical activity in chronically ill or elderly patient populations. METHODS We conducted a systematic literature search of electronic databases (Medline, Embase, Psychinfo, Cinahl) and hand searches. We included studies describing the original development of fully structured instruments measuring dimensions of physical activity or related constructs in chronically ills or elderly. We broadened the population to elderly because they are likely to share physical activity limitations. At least two reviewers independently conducted title and abstract screening and full text assessment. We evaluated instruments in terms of their aim, items identification and selection, domain development, test-retest reliability, internal consistency, validity and responsiveness. RESULTS Of the 2542 references from the database search and 89 from the hand search, 103 full texts which covered 104 instruments met our inclusion criteria. For almost half of the instruments the authors clearly described the aim of the instruments before the scales were developed. For item identification, patient input was used in 38% of the instruments and in 32% adaptation of existing scales and/or unsystematic literature searches were the only sources for the generation of items. For item reduction, in 56% of the instruments patient input was used and in 33% the item reduction process was not clearly described. Test-retest reliability was assessed for 61%, validity for 85% and responsiveness to change for 19% of the instruments. CONCLUSIONS Many PRO instruments exist to measure dimensions of physical activity in chronically ill and elderly patient populations, which reflects the relevance of this outcome. However, the development processes often lacked definitions of the instruments' aims and patient input. If PROs for physical activity were to be used in clinical trials more attention needs to be paid to the establishment of content validity through patient input and to the assessment of their evaluative measurement properties.
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Affiliation(s)
- Anja Frei
- Horten Centre for Patient-oriented Research, University Hospital of Zurich, Switzerland
- Institute of General Practice and Health Services Research, University Hospital of Zurich, Switzerland
| | - Kate Williams
- Patient Reported Outcomes Centre of Excellence, Global Market Access, Primary Care Business Unit, Pfizer Ltd, Walton Oaks, Surrey, United Kingdom
| | - Anders Vetsch
- Horten Centre for Patient-oriented Research, University Hospital of Zurich, Switzerland
- Institute of General Practice and Health Services Research, University Hospital of Zurich, Switzerland
| | - Fabienne Dobbels
- Centre for Health Services and Nursing Research, post-doctoral researcher FWO Vlaanderen, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Laura Jacobs
- Respiratory Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katja Rüdell
- Patient Reported Outcomes Centre of Excellence, Global Market Access, Primary Care Business Unit, Pfizer Ltd, Walton Oaks, Surrey, United Kingdom
| | - Milo A Puhan
- Horten Centre for Patient-oriented Research, University Hospital of Zurich, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore (MD), USA
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Braido F, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, La Grutta S, Lombardi C, Maurer M, Pinto AM, Ridolo E, Senna GE, Terreehorst I, Todo Bom A, Bousquet J, Zuberbier T, Baiardini I. Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: a GA(2)LEN taskforce position paper. Allergy 2010; 65:959-68. [PMID: 20486919 DOI: 10.1111/j.1398-9995.2010.02383.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The GA(2)LEN taskforce on Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HRQoL) published in 2009 a position paper concerning PROS and HRQoL assessment in clinical trials on allergy. Because of the specificity of this topic in asthma and rhinitis, specific recommendations are needed. The aim of this position paper is to define PROs and their meaning in asthma and rhinitis research, explore the available tools to provide criteria for a proper choice, identify patient-related factor which could influence PROs assessment, define specific recommendations for assessment, analysis and results spreading, underline the unexplored areas and unmet needs. PROs assessment is gaining increasing importance, and it must be performed with a rigorous methodological procedure and using validated tools. This approach enables to better understand patient-related factors influencing clinical trials and real-life management outcomes, identify patients subgroups that can benefit from specific treatment and management plan and tailor treatment to address PROs (not only physician-defined targets) to improve asthma and rhinitis management.
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Affiliation(s)
- F Braido
- Allergy & Respiratory Disease Clinic, Ospedale S.Martino Genova, Genova, Italy.
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Daudey L, Peters JB, Molema J, Dekhuijzen PNR, Prins JB, Heijdra YF, Vercoulen JH. Health status in COPD cannot be measured by the St George's Respiratory Questionnaire alone: an evaluation of the underlying concepts of this questionnaire. Respir Res 2010; 11:98. [PMID: 20649991 PMCID: PMC2919469 DOI: 10.1186/1465-9921-11-98] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 07/22/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Improving patients' health status is one of the major goals in COPD treatment. Questionnaires could facilitate the guidance of patient-tailored disease management by exploring which aspects of health status are problematic, and which aspects are not. Health status consists of four main domains (physiological functioning, symptoms, functional impairment, and quality of life), and at least sixteen sub-domains. A prerequisite for patient-tailored treatment is a detailed assessment of all these sub-domains. Most questionnaires developed to measure health status consist of one or a few subscales and measure merely some aspects of health status. The question then rises which aspects of health status are measured by these instruments, and which aspects are not covered. As it is one of the most frequently used questionnaires in COPD, we evaluated which aspects of health status are measured and which aspects are not measured by the St George's Respiratory Questionnaire (SGRQ). METHODS One hundred and forty-six outpatients with COPD participated. Correlations were calculated between the three sections of the SGRQ and ten sub-domains of the Nijmegen Integral Assessment Framework, covering Symptoms, Functional Impairment, and Quality of Life. As the SGRQ was not expected to measure physiological functioning, we did not include this main domain in the statistical analyses. Pearson's r > or = 0.70 was used as criterion for conceptual similarity. RESULTS The SGRQ sections Symptoms and Total showed conceptual similarity with the sub-domain Subjective Symptoms (main domain Symptoms). The sections Activity, Impacts and Total were conceptual similar to Subjective Impairment (main domain Functional Impairment). The SGRQ sections were not conceptual similar to other sub-domains of Symptoms, Functional Impairment, nor to any sub-domain of Quality of Life. CONCLUSIONS The SGRQ could facilitate the guidance of disease management in COPD only partially. The SGRQ is appropriately only for measuring problems in the sub-domains Subjective Symptoms and Subjective Impairment, and not for measuring problems in other sub-domains of health status, such as Quality of Life.
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Affiliation(s)
- Leonie Daudey
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Groesbeek, the Netherlands
| | - Jeannette B Peters
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Groesbeek, the Netherlands
| | - Johan Molema
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Groesbeek, the Netherlands
| | - PN Richard Dekhuijzen
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Groesbeek, the Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Yvonne F Heijdra
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Groesbeek, the Netherlands
| | - Jan H Vercoulen
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Groesbeek, the Netherlands
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Duvall K, Frank GW. Identifying Chronic Obstructive Pulmonary Disease in Primary Care of Urban Underserved Patients: Tools, Applications, and Challenges. J Natl Med Assoc 2010; 102:570-8. [DOI: 10.1016/s0027-9684(15)30623-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Johnson MJ, Oxberry SG, Cleland JG, Clark AL. Measurement of breathlessness in clinical trials in patients with chronic heart failure: the need for a standardized approach: a systematic review. Eur J Heart Fail 2010; 12:137-47. [DOI: 10.1093/eurjhf/hfp194] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Miriam J. Johnson
- Hull York Medical School and St Catherine's Hospice; Scarborough North Yorkshire YO12 5RE UK
- Department of Academic Cardiology; Hull York Medical School, Castle Hill Hospital; Hull East Yorkshire UK
| | - Stephen G. Oxberry
- Department of Academic Cardiology; Hull York Medical School, Castle Hill Hospital; Hull East Yorkshire UK
| | - John G.F. Cleland
- Department of Academic Cardiology; Hull York Medical School, Castle Hill Hospital; Hull East Yorkshire UK
| | - Andrew L. Clark
- Department of Academic Cardiology; Hull York Medical School, Castle Hill Hospital; Hull East Yorkshire UK
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Kimura M, Carandina DM. Desenvolvimento e validação de uma versão reduzida do instrumento para avaliação da Qualidade de Vida no Trabalho de enfermeiros em hospitais. Rev Esc Enferm USP 2009. [DOI: 10.1590/s0080-62342009000500008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo tem como objetivos desenvolver a versão reduzida de um instrumento para avaliação da Qualidade de Vida no Trabalho (QVT) de enfermeiros hospitalares e analisar a sua confiabilidade e validade. O estudo foi desenvolvido com uma amostra probabilística de 348 enfermeiros selecionados em quatro hospitais da cidade de São Paulo. Os métodos clinimétrico e psicométrico foram utilizados no processo de redução de itens, obtendo-se um instrumento com 31 itens e quatro domínios: Valorização e reconhecimento institucional; Condições de trabalho, segurança e remuneração; Identidade e imagem profissional e Integração com a equipe. Na análise da consistência interna, obtiveram-se coeficientes alfa de Cronbach de 0,94 para o total de itens e de 0,77 a 0,92 para os domínios. Estes resultados e os obtidos nas análises de validade convergente, de critério e discriminante sugerem que o instrumento reduzido é adequado para a mensuração da QVT de enfermeiros em hospitais.
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Pieterse AJ, Cup EHC, Knuijt S, Hendricks HT, van Engelen BGM, van der Wilt GJ, Oostendorp RAB. Development of a tool to guide referral of patients with neuromuscular disorders to allied health services. Part one. Disabil Rehabil 2009; 30:855-62. [PMID: 17852320 DOI: 10.1080/09638280701403437] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Reasons for referral of patients with chronic, slowly progressive neuromuscular disorders (NMD) to occupational therapy (OT), physical therapy (PT) and speech therapy (ST) are often unclear. One-off consultations by OT, PT and ST can help patients and physicians to decide if therapy is needed. We present a construct for a questionnaire, the Perceived Limitations in Activities and Needs Questionnaire (PLAN-Q). Its aim is to signal problems and needs of patients with chronic, slowly progressive NMD with a view to referral for one-off consultations by OT, PT and ST. We report on the construct, item pool, response options and the item reduction procedure as the first development stages for the PLAN-Q. METHODS The International Classification of Functioning, Disability and Health (ICF) served as source for items and response options. Five clinical health professionals of the Neuromuscular Center Nijmegen (NMCN) formed an expert panel. They were asked to reach consensus on construct, item pool and response options. Subsequently a sample of patients with NMD (n=21) that attended the NMCN was asked for their approval of the concept questionnaire. Data of a large cohort (n=208) of patients with a broad variety of chronic NMD were used to carry out item reduction. RESULTS The expert panel reached consensus on the selection of 56 items covering eight activity categories relevant to OT, PT, and ST. They also reached consensus on response options regarding 'capacity' and 'need for therapy or advice'. The patient sample approved the concept PLAN-Q. The item reduction procedure resulted in a reduction to 25 items covering eight activity categories. CONCLUSION The PLAN-Q has proceeded through the first stages of development and is now ready for further assessment of reliability and validity.
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Peters JB, Daudey L, Heijdra YF, Molema J, Dekhuijzen PNR, Vercoulen JH. Development of a battery of instruments for detailed measurement of health status in patients with COPD in routine care: the Nijmegen Clinical Screening Instrument. Qual Life Res 2009; 18:901-12. [PMID: 19543807 PMCID: PMC2724638 DOI: 10.1007/s11136-009-9502-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 06/07/2009] [Indexed: 11/20/2022]
Abstract
Purpose To compose a battery of instruments that provides a detailed assessment of health status (HS) in COPD but that is applicable and clinically meaningful in routine care. Methods In a previous study, we developed the Nijmegen Integral Assessment Framework (NIAF) that organizes existing tests and instruments by the sub-domains of HS they measure. Based on clinical and statistical criteria (correlation coefficients and Cronbach alpha’s) we selected for each sub-domain instruments from the NIAF. A COPD-study group was used to determine c-scores, and two control groups were used to determine the score ranges indicating normal functioning versus clinically relevant problems for each sub-domain. Existing questionnaire completion software (TestOrganiser) was adapted to enhance clinical applicability. Results The NCSI measures eleven sub-domains of physiological functioning, symptoms, functional impairment, and quality of life. The TestOrganiser automatically processes the data and produces the graphical PatientProfileChart, which helps to easily interpret results. This envisages the problem areas and discrepancies between the different sub-domains. Conclusion The NCSI provides a valid and detailed picture of a patient’s HS within 15–25 min. In combination with the PatientProfileChart, the NCSI can be used perfectly in routine care as screening instrument and as a guide in patient-tailored treatment.
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Affiliation(s)
- Jeannette Bernadette Peters
- Department of Medical Psychology, Radboud University Nijmegen Medical Center, Nijmeegsebaan 31, Postbus 66, 6560 AB, Groesbeek, The Netherlands.
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Bausewein C, Farquhar M, Booth S, Gysels M, Higginson IJ. Measurement of breathlessness in advanced disease: A systematic review. Respir Med 2007; 101:399-410. [PMID: 16914301 DOI: 10.1016/j.rmed.2006.07.003] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 06/30/2006] [Accepted: 07/04/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a plethora of assessment tools available to measure breathlessness, the most common and disabling symptom of advanced cardio-respiratory disease. The aim of this systematic review was to identify all measures available via standard search techniques and review their usefulness for patients with advanced disease. METHODS A systematic literature search was performed in Medline. All studies focusing on the development or evaluation of tools for measuring breathlessness in chronic respiratory disease, cardiac disease, cancer, or MND were identified. Their characteristics with regard to validity, reliability, appropriateness and responsiveness to change were described. The tools were then examined for their usefulness in measuring significant aspects of breathlessness in advanced disease. RESULTS Thirty-five tools were initially identified, two were excluded. Twenty-nine were multidimensional of which 11 were breathlessness-specific and 18 disease-specific. Four tools were unidimensional, measuring the severity of breathlessness. The majority of disease-specific scales were validated for chronic obstructive pulmonary disease (COPD), few were applicable in other conditions. No one tool assessed all the dimensions of this complex symptom, which affects the psychology and social functioning of the affected individual and their family--most focused on physical activity. CONCLUSION As yet there is no one scale that can accurately reflect the far-reaching effects of breathlessness on the patient with advanced disease and their family. Therefore, at present, we would recommend combining a unidimensional scale (e.g. VAS) with a disease-specific scale (where available) or a multidimensional scale in conjunction with other methods (such as qualitative techniques) to gauge psychosocial and carer distress for the assessment of breathlessness in advanced disease.
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Affiliation(s)
- C Bausewein
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Weston Education Centre, Denmark Hill, Cutcombe Road, London SE5 9RJ, UK.
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Tan J, Fung KY, Khan S. Condensation and validation of a 4-item index of the Acne-QoL. Qual Life Res 2006; 15:1203-10. [PMID: 16972158 DOI: 10.1007/s11136-006-0063-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The 19-item Acne-QoL is a validated psychometric instrument designed for use in clinical trials. OBJECTIVE The purpose of this study was to develop a condensed version of the Acne-QoL as an alternative measure of psychosocial impact for use in routine clinical practice. METHODS Four condensed versions of the Acne-QoL were evaluated by regression analysis in a subset of 434 patients. The version with four items most broadly representative of acne-specific quality of life combined with a high level of correlation to Acne-QoL total score was selected for further validation in two different patient samples. RESULTS The patient ranked condensation, representing items from each domain of greatest patient-perceived importance and relevance was selected for further analysis (Acne-Q(4)). The Acne-Q(4) explained 98.5% of the variation in total score of Acne-QoL. Validation of the Acne-Q(4) in a follow-up group and an independent subset of patients resulted in Pearson correlation coefficients of 0.967 (p<0.001). Construct validity of the Acne-Q(4) was confirmed by demonstrating a similar relationship as the Acne-QoL to acne severity. LIMITATIONS There is less breadth and detail of QoL information in the Acne-Q(4) than in the Acne-QoL. The analysis relied on a total score for Acne-QoL, which the original developers did not validate. CONCLUSIONS The Acne-Q(4) is accurately reflective of the parent instrument and may facilitate the psychometric evaluation of the impact of facial acne on patients in routine clinical practice by its practicality.
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Affiliation(s)
- Jerry Tan
- Department of Medicine, University of Western Ontario, London, ON, Canada
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Perkins AJ, Stump TE, Monahan PO, McHorney CA. Assessment of differential item functioning for demographic comparisons in the MOS SF-36 health survey. Qual Life Res 2006; 15:331-48. [PMID: 16547771 DOI: 10.1007/s11136-005-1551-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate whether items of the Medical Outcomes Study (MOS) 36-Item Short-Form Health Status Survey (SF-36) exhibited differential item functioning (DIF) with respect to age, education, race, and gender. METHODS The data for this study come from two large national datasets, the MOS and the 1990 National Survey of Functional Health Status (NSFHS). We used logistic regression to identify items exhibiting DIF. RESULTS We found DIF to be most problematic for age comparisons. Items flagged for age DIF were vigorous activities, bend/kneel/stoop, bathing or dressing, limited in kind of work, health in general, get sick easier than others, expect health to get worse, felt calm and peaceful, and all four vitality items. Items flagged for education DIF include vigorous activities, health in general, health is excellent, felt calm and peaceful, and been a happy person. Vigorous activities, walk more than a mile, health in general, and expect health to get worse were identified as DIF when comparing African-Americans with whites. No items were identified for gender DIF. CONCLUSIONS We found several consistent patterns of DIF using two national datasets with different population characteristics. In the current study, the effect of DIF rarely transferred to the scale level. Further research is needed to corroborate these results and determine qualitatively why DIF may occur for these specific items.
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Affiliation(s)
- Anthony J Perkins
- Indiana University Center for Aging Research, 1050 Wishard Blvd, RG6, Indianapolis, IN 46202, USA.
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