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Conradsen I, Bang-Hansen VE, Sørensen AN, Rytter HM. Return to work in persons with persistent postconcussion symptoms: a survey study examining the perspectives of employees and managers. Brain Inj 2024:1-10. [PMID: 38828860 DOI: 10.1080/02699052.2024.2361620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To examine challenges in return to work (RTW) for persons with persistent postconcussion symptoms (PPCS) experienced by the affected employees and their managers. METHODS A survey of employees (S-E) and two surveys of managers (S-M1, S-M2) executed 4 months apart to capture the time perspective. Inclusion: Adults aged 18-66 with PPCS > 4 weeks, employed at the time of mTBI who returned to work within the previous year. Managers involved in their RTW process. OUTCOME MEASURES Work status, working hours, work functioning (Work Role Functioning Questionnaire, WRFQ), work productivity. RESULTS Ninety-two employees and 66 managers were recruited. Three-fourths of the employees had returned to work but only one-third worked under similar conditions. Weekly working hours decreased from 36,3 hours (SD = 10,5) before mTBI to 17,6 hours (SD = 9,7). Employees had difficulties with tasks 43% of time (WRFQ). They needed more breaks, struggled with multitasking and work speed. About 65.9% experienced affected work productivity. Managers reported lack of knowledge and difficulties assessing the number of working hours and suitable tasks. CONCLUSIONS Most employees returned to work but only a minority worked under similar conditions as before mTBI. Employees and managers struggled to estimate workload. The affected employees and their workplaces need a long-term RTW support.
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Affiliation(s)
- Irene Conradsen
- The Danish Concussion Center, Center for Rehabilitation of Brain Injury, Copenhagen, Denmark
| | | | - Alexander N Sørensen
- The Danish Concussion Center, Center for Rehabilitation of Brain Injury, Copenhagen, Denmark
| | - Hana Malá Rytter
- The Danish Concussion Center, Center for Rehabilitation of Brain Injury, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, University Hospital Bispebjerg - Frederiksberg, Copenhagen, Denmark
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Simadibrata DM, Lesmana E, Amangku BR, Wardoyo MP, Simadibrata M. Left lateral decubitus sleeping position is associated with improved gastroesophageal reflux disease symptoms: A systematic review and meta-analysis. World J Clin Cases 2023; 11:7329-7336. [PMID: 37969463 PMCID: PMC10643078 DOI: 10.12998/wjcc.v11.i30.7329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND A limited number of studies have demonstrated that sleeping in the left lateral decubitus (LLD) decreases nocturnal reflux in patients with gastroesophageal reflux disease (GERD) compared to right lateral decubitus (RLD) and supine. AIM This systematic review summarizes the association between sleeping in the LLD position and nocturnal reflux in patients with GERD. METHODS Studies published up to July 17, 2023, in MEDLINE, EMBASE, and CENTRAL were searched. Eligible studies were randomized and nonrandomized studies assessing the effect of sleeping in LLD compared to RLD and supine in reducing nocturnal reflux in GERD patients. Outcomes include the acid exposure time (AET) (% time in pH<4), acid clearance time (ACT) (in sec/episode), number of reflux episodes, and improvement in N-GSSIQ scores. RESULTS Two nonrandomized studies showed decreased AET and ACT in LLD sleep position in comparison to RLD (mean difference [MD] -2.03 [95%CI: -3.62 to -0.45]; -81.84 [95%CI: -127.48 to -36.20], respectively) and supine position (MD -2.71 [95%CI: -4.34 to -1.09]; -74.47 [95%CI: -116.26 to -32.69], respectively). There was no difference in AET and ACT between RLD sleep position and supine. Furthermore, one randomized controlled trial investigating the use of electronic sleep positional therapy, which increased the duration of LLD sleep and decreased the duration of RLD sleep compared to sham, showed nocturnal symptoms improvement (improved N-GSSIQ score, increased reflux-free nights, and resolution of nocturnal reflux symptoms). CONCLUSION Current evidence suggests that sleeping on the left side could reduce nocturnal reflux and improve GERD-related quality of life, therefore warranting interventions that promote LLD sleep position.
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Affiliation(s)
- Daniel Martin Simadibrata
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Elvira Lesmana
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
| | - Bagus Ramasha Amangku
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
| | - Muhammad Prasetio Wardoyo
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
| | - Marcellus Simadibrata
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Jakarta 10430, Indonesia
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Ford JH, Ye W, Ayer DW, Mi X, Bhandari S, Buse DC, Lipton RB. Validation and meaningful within-patient change in work productivity and activity impairment questionnaire (WPAI) for episodic or chronic migraine. J Patient Rep Outcomes 2023; 7:34. [PMID: 37016181 PMCID: PMC10073392 DOI: 10.1186/s41687-023-00552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND No available studies demonstrate validity and meaningful change thresholds of Work Productivity and Activity Impairment (WPAI) questionnaire in patients with migraine. In this post-hoc analysis, we assessed reliability, validity, responsiveness, and meaningful within-patient change from baseline to Month 3 for Work Productivity and Activity Impairment (WPAI) domain scores in patients with episodic migraine (EM) or chronic migraine (CM). METHOD The Phase 3, multicenter, randomized, double-blind, placebo-controlled CONQUER study (NCT03559257, N = 462) enrolled patients with EM or CM who failed two to four categories of prior preventive medication in past ten years. The analyses were performed for WPAI domain scores (absenteeism, presenteeism, overall work productivity, and non-work-related activity impairment). Migraine Specific Quality of Life Questionnaire version 2.1 (MSQv2.1) domain scores (Role Function-Restrictive [RFR] and Role Function-Preventive [RFP]), and monthly migraine headache days were used as anchors. Responder criteria were changes from baseline to Month 3 for each of these anchors and were defined as: increase in MSQ-RFR by ≥ 25.71 points and MSQ-RFP by ≥ 20.00 points and a 50% reduction in monthly migraine headache days. Assessments were performed for overall population, and patients with EM or CM. The meaningful change threshold was determined based on Youden index, Phi coefficient and sensitivity. RESULTS Of 462 randomized patients, 444 who completed WPAI questionnaire were included in post-hoc analysis. Test-retest reliability over 3 months in a stable subgroup revealed moderate correlations for non-work-related Activity Impairment (ICC = 0.446) presenteeism (ICC = 0.438) and a fair correlation for overall work productivity loss (ICC = 0.360). At baseline, all correlations between WPAI domain scores and continuous anchor variables exceeded recommended threshold of ≥ 0.30, except for WPAI domain scores with number of monthly migraine headache days. Patients achieving pre-specified responsiveness thresholds for monthly migraine headache days, and MSQ-RFP, MSQ-RFR from baseline to Month 3 (responders) showed significant improvements in WPAI domain scores compared with non-responders (P < 0.001). The meaningful change thresholds of -20 (% unit) were identified for WPAI domain scores. CONCLUSION In conclusion, WPAI has sufficient validity, reliability, responsiveness, and appropriate interpretation standards to assess the impact of EM or CM on presenteeism and overall work productivity loss and non-work-related activity impairment. TRIAL REGISTRATION NCT number of CONQUER study, NCT03559257.
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Affiliation(s)
- Janet H Ford
- Eli Lilly and Company, 893 Delaware St, Indianapolis, IN, 46225, USA
| | - Wenyu Ye
- Eli Lilly and Company, 893 Delaware St, Indianapolis, IN, 46225, USA.
| | - David W Ayer
- Eli Lilly and Company, 893 Delaware St, Indianapolis, IN, 46225, USA
| | - Xiaojuan Mi
- TechData Services Company, King of Prussia, PA, USA
| | - Swati Bhandari
- Eli Lilly and Company, 893 Delaware St, Indianapolis, IN, 46225, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Headache Center, Montefiore Medical Center, Bronx, NY, USA
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Presence of refractory GERD-like symptoms following laparoscopic fundoplication is rarely indicative of true recurrent GERD. Surg Endosc 2023:10.1007/s00464-023-09930-x. [PMID: 36813925 DOI: 10.1007/s00464-023-09930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Laparoscopic fundoplication (LF) is the gold standard for gastroesophageal reflux disease (GERD). Recurrent GERD is a known complication; however, the incidence of recurrent GERD-like symptoms and long-term fundoplication failure is rarely reported. Our objective was to identify the rate of recurrent pathologic GERD in patients with GERD-like symptoms following fundoplication. We hypothesized that patients with recurrent GERD-like symptoms refractory to medical management do not have evidence of fundoplication failure as indicated by a positive ambulatory pH study. METHODS This is a retrospective cohort study of 353 consecutive patients undergoing LF for GERD between 2011 and 2017. Baseline demographics, objective testing, GERD-HRQL scores, and follow-up data were collected in a prospective database. Patients with return visits to clinic following routine post-operative visits were identified (n = 136, 38.5%), and those with a primary complaint of GERD-like symptoms (n = 56, 16%) were included. The primary outcome was the proportion of patients with a positive post-operative ambulatory pH study. Secondary outcomes included proportion of patients with symptoms managed with acid-reducing medications, time to return to clinic, and need for reoperation. P values < 0.05 were considered significant. RESULTS Fifty-six (16%) patients returned during the study period for an evaluation of recurrent GERD-like symptoms with a median interval of 51.2 (26.2-74.7) months. Twenty-four patients (42.9%) were successfully managed expectantly or with acid-reducing medications. Thirty two (57.1%) presented with GERD-like symptoms and failure of management with medical acid suppression and underwent repeat ambulatory pH testing. Of these, only 5 (9%) were found to have a DeMeester score of > 14.7, and three (5%) underwent recurrent fundoplication. CONCLUSION Following LF, the incidence of GERD-like symptoms refractory to PPI therapy is much higher than the incidence of recurrent pathologic acid reflux. Few patients with recurrent GI symptoms require surgical revision. Evaluation, including objective reflux testing, is critical to evaluating these symptoms.
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Kim JS, Seo SI, Kang SH, Lee SK, Kim AR, Park HW, Kim BT, Song GS. Effects of Tegoprazan Versus Esomeprazole on Nighttime Heartburn and Sleep Quality in Gastroesophageal Reflux Disease: A Multicenter Double-blind Randomized Controlled Trial. J Neurogastroenterol Motil 2023; 29:58-64. [PMID: 36581325 PMCID: PMC9837551 DOI: 10.5056/jnm22104] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/27/2022] [Accepted: 08/31/2022] [Indexed: 12/31/2022] Open
Abstract
Background/Aims Patients with gastroesophageal reflux disease (GERD) frequently experience nighttime heartburn and sleep disturbance. Tegoprazan is a new potassium-competitive acid blocker that can rapidly block acid secretion. This study aims to evaluate the efficacy of tegoprazan compared with esomeprazole in relieving nighttime heartburn and sleep disturbances. Methods Patients with erosive esophagitis, nighttime heartburn, and sleep disturbances were randomized to receive tegoprazan 50 mg or esomeprazole 40 mg for 2 weeks. The primary endpoint was time to first nighttime heartburn-free interval. The percentage of nighttime heartburn-free days was also compared between the 2 groups. Results A total of 46 patients were enrolled in this study. Time to the first nighttime heartburn-free interval was shorter with tegoprazan than with esomeprazole but the difference was not statistically significant (1.5 days vs 3 days, P = 0.151). The percentage of nighttime heartburn-free days was higher in the tegoprazan group but the difference was insignificant (57.8% vs 43.1%, P = 0.107). Adverse events occurred in 2 patients. They were mild in severity. Conclusions Tegoprazan may induce faster relief of nighttime heartburn symptoms and may improve sleep disorders associated with nighttime heartburn. Further large-scale studies are required to validate our findings.
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Affiliation(s)
- Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Yonsei Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea,Correspondence: Sang Kil Lee, MD, PhD, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Korea, Tel: +82-2-2228-1996, Fax: +82-2-393-6884, E-mail:
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Sleep Positional Therapy for Nocturnal Gastroesophageal Reflux: A Double-Blind, Randomized, Sham-Controlled Trial. Clin Gastroenterol Hepatol 2022; 20:2753-2762.e2. [PMID: 35301135 DOI: 10.1016/j.cgh.2022.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Experimental studies have suggested that sleep position plays a role in the occurrence of nocturnal gastroesophageal reflux and the left lateral decubitus position is most favorable. The aim of this study was to evaluate the effect of a novel electronic sleep positional therapy wearable device on sleep position and nocturnal reflux symptoms. METHODS We performed a double-blind, randomized, sham-controlled trial in patients with nocturnal symptoms of gastroesophageal reflux. Patients were advised to sleep in the left lateral decubitus position and were assigned randomly (1:1) to an electronic sleep positional therapy wearable device, programmed to either produce a vibration when in the right lateral position (intervention) or only during the first 20 minutes (sham). The primary outcome was treatment success, defined as a 50% or more reduction in the nocturnal reflux score. Secondary outcomes included change in sleep position and reflux symptoms. RESULTS One hundred patients were randomized. In the intention-to-treat analysis, the rate of treatment success was 44% in the intervention group (22 of 50) vs 24% in the sham group (12 of 50) (risk difference, 20%; 95% CI, 1.8%-38.2%; P = .03). Treatment led to a significant avoidance of sleeping in the right lateral decubitus position (intervention 2.2% vs sham 23.5%; P = .000) and increased time sleeping in the left lateral decubitus position (intervention 60.9% vs sham 38.5%; P = .000). More reflux-free nights were observed in the intervention group (intervention 9 nights [interquartile range, 6-11 nights] vs sham 6 nights [interquartile range, 3-9 nights]; P = .01). CONCLUSIONS Sleep positional therapy using an electronic wearable device promotes sleeping in the left lateral decubitus position and effectively alleviates nocturnal reflux symptoms compared with sham treatment (https://www.trialregister.nl, NL8655).
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Lee SW, Chang CS. Impact of Overlapping Functional Gastrointestinal Disorders on the Quality of Life in Patients With Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2021; 27:176-184. [PMID: 33795540 PMCID: PMC8026382 DOI: 10.5056/jnm19006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/04/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) and functional gastrointestinal disorders (FGIDs), including irritable bowel syndrome and functional dyspepsia, are common afflictions within the general population. Both conditions have a considerable impact on the daily health related quality of life (HRQoL) of affected individuals. Risk factors surrounding any impaired HRQoL in patients with GERD involve those of younger age, obesity, an increase in reflux symptom frequency, and overlapping FGIDs. The risk factors for subjects experiencing an overlap in FGIDs and GERD involve those who are female, younger age, cigarette smoking, non-erosive reflux disease, more GERD symptoms, and psychological performances including anxiety, somatization, and more frequent healthcareseeking behavior. The overlap of GERD and FGIDs is associated with a worsening of both physical and mental health, an increase in bothersome symptoms, impaired functional capacity, and a higher likelihood of consulting a physician. Acid secretion suppressors could offer therapeutic efficacy to some patients experiencing overlapping GERD and FGIDs.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
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HADS-depression score is a mediator for illness perception and daily life impairment in Takayasu's arteritis. Clin Rheumatol 2021; 40:4109-4116. [PMID: 33839991 DOI: 10.1007/s10067-021-05719-2] [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: 11/17/2020] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION/OBJECTIVES The aim of this study was to evaluate the relationships among the disease activity, illness perception, daily life performance, anxiety and depression status as potential mediators in Takayasu's arteritis (TAK) patients. METHOD In this cross-sectional study, 77 TAK patients were included. Data were collected by a clinical examination and a structured questionnaire regarding patient reported outcome measures (PROMs). Indian Takayasu's Arteritis Activity Score2010 (ITAS2010) was used to assess the disease activity (0: inactive vs ≥ 1: active). Illness Perception Questionnaire-Revise (IPQ-R), Work Productivity and Activity Impairment (WPAI) and Hospital Anxiety and Depression Scale (HADS) as PROMs were used to understand for the patient' perspective. After preliminary analysis, complex relationships among these variables were evaluated by mediation analyses in the study. RESULTS WPAI-Daily impairment score, HADS-A and HADS-D scores as well as IPQ-R Consequence score were found be high in active TAK patients (p = 0.008; p = 0.001; p = 0.031; p = 0.001). HADS-D score was also correlated with WPAI-Daily impairment score and IPQ-R Consequence score (p < 0.05). In mediation analysis, IPQ-R Consequence score was directly mediated by disease activity (ITAS2010) (p = 0.0173) and indirectly mediated through HADS-D score (p = 0.0003). Similarly, HADS-D score was associated with poor WPAI-Daily impairment score in the mediation analysis in the indirect path (p = 0.0069). Disease activity (ITAS2010) also increased WPAI-Daily impairment score in direct path (p = 0.043). CONCLUSIONS Active TAK patients perceived their illness more seriously and experienced more impairment in their daily life. Depression status as the mediator influenced them poorly. These interactions could give clues to improve PROMs in the clinical practice. Key Points •IIness perception, disease activity, mental status and daily life performance, assessed as patient-reported outcome measures, have a complex relationship in Takayasu's arteritis. •IPQ-R Consequence score, WPAI-Daily impairment score, HADS-Depression and HADS-Anxiety scores were found be high in active TAK patients. •In mediation analysis, IPQ-R Consequence score was directly mediated by disease activity and indirectly mediated through HADS-D score. Similarly, disease activity increased WPAI-Daily impairment score in direct and HADS-D in indirect paths.
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Teich N, Bläker M, Holtkamp-Endemann F, Jörgensen E, Stallmach A, Hohenberger S. Effect of Originator Infliximab Treatment on Disease-Related Hospitalizations, Work Productivity and Activity Impairment, and Health Resource Utilization in Patients with Crohn's Disease in a Real-Life Setting: Results of a Prospective Multicenter Study in Germany. Inflamm Intest Dis 2020; 6:48-60. [PMID: 33850839 DOI: 10.1159/000512159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Infliximab (IFX) therapy is efficacious for inducing and maintaining symptomatic remission in patients with Crohn's disease (CD), but whether this benefit results in reduced hospitalization rates and therefore may improve patients' quality of life in an economically sensible way is conflicting so far. Methods We conducted a noninterventional, multicenter, open-label, prospective study to evaluate the effect of originator IFX treatment on patient-reported outcomes and disease-related hospitalizations in adult CD patients in Germany treated for the first time with IFX according to label. Results Two hundred and ninety-four patients were included in the study. We observed a statistically significant reduction in the number of CD-related hospitalizations from the year before baseline (mean 1.00 per patient, SD ± 0.93) to the mean value of the 1st (0.62, SD ± 0.95) and 2nd year (0.32, SD ± 0.75) of the observation period (p < 0.0001). After 3 months of IFX therapy, work productivity and activity increased by an average of 12.6 and 17.1%, respectively. Patient's clinical outcome was markedly improved as the total CD activity index (CDAI) sum score continuously decreased from baseline to month 24 and the mean score of the total inflammatory bowel disease questionnaire (IBDQ) changed substantially from 141 at baseline to 172 after 24 months of IFX treatment. Additionally, the number of work incapacity days declined. Recently, no new safety issues of IFX have been identified. Conclusion In this large, prospective, multicenter study on disease-related hospitalization rates, work productivity, capacity for daily activities, and HRQoL in patients with CD, IFX significantly reduces their hospitalization rates and improves work productivity, daily activity, and quality of life over 24 months.
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Affiliation(s)
- Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany
| | - Michael Bläker
- Gastroenterologie/Gastropraxis Eppendorfer Baum, Hamburg, Germany
| | | | | | - Andreas Stallmach
- Klinik für Innere Medizin IV, Gastroenterologie, Hepatologie, Infektiologie, Interdisziplinäre Endoskopie, Universitätsklinikum Jena, Jena, Germany
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Individual, Workplace, and Combined Effects Modeling of Employee Productivity Loss. J Occup Environ Med 2020; 61:469-478. [PMID: 30985409 DOI: 10.1097/jom.0000000000001573] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Systematically and simultaneously investigate a wide range of influences on workplace productivity loss. METHODS Data were collected from 31,950 employees in the UK. Influences of employees' socioeconomic characteristics, lifestyle, commuting, physical and mental health, well-being, and job and workplace environment were assessed using structural equation models, allowing systematic decomposition of the complex network of influences and creating new, deeper insights. RESULTS Mental health, physical health, job characteristics, and support from organization are the most important (direct or indirect) determinants of employees' productivity. 93% of the indirect influences are mediated through mental and/or physical health. Some influences that appear as strong predictors in simple models lose most of their explanatory power in more complex models with additional explanatory variables. CONCLUSIONS There is a need for a more tailored strategy to improve employees' wellbeing as well as the overall organizational, work, and management culture.
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Neuberger EE, Abbass IM, Jones E, Engmann NJ. Work Productivity Outcomes Associated with Ocrelizumab Compared with Other Disease-Modifying Therapies for Multiple Sclerosis. Neurol Ther 2020; 10:183-196. [PMID: 33244713 PMCID: PMC8140023 DOI: 10.1007/s40120-020-00224-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022] Open
Abstract
Objective This study evaluated work and activity impairment in patients with multiple sclerosis (MS) treated with ocrelizumab (OCR) versus other disease-modifying therapies (DMTs). Methods Data were obtained from the Adelphi Real World Disease Specific Programme for Multiple Sclerosis. Patients with relapsing–remitting or secondary progressive MS who completed surveys in 2018 and 2019 and received ≥ 6 months of an eligible therapy, including OCR, injectable therapy, and oral therapy, were included. Outcomes were assessed using the patient-reported Work Productivity and Activity Impairment questionnaire. Doubly robust estimation, which combined propensity score weighting and regression modeling, was used to compare treatments, controlling for baseline clinical and demographic characteristics. Results This study included 630 patients (OCR, n = 90; injectable DMT, n = 224; oral DMT, n = 316) with a mean (standard deviation) age of 42 (11) years. A greater proportion of OCR-treated patients had an Expanded Disability Status Scale score of ≥ 3 at treatment initiation compared with those receiving oral and injectable DMTs (51 vs. 15% and 15%, respectively), and a smaller proportion of OCR-treated patients received treatment for ≥ 1 year (43 vs. 90% and 92%, respectively). OCR-treated patients had higher odds of employment [odds ratio (95% confidence interval) 3.4 (1.5–7.7) vs. oral DMT, 5.6 (2.6–12.0) vs. injectable DMT], lower overall work productivity loss [difference (95% confidence interval) − 10.0% (− 6.1 to − 15.0%) vs. oral DMT, − 13.0% (− 8.5 to − 17.0%) vs. injectable DMT] and lower activity impairment [difference (95% confidence interval) − 11% (− 7.1 to − 16.0%) vs. oral DMT, − 9.7% (− 5.0 to − 14.0%) vs. injectable DMT]. Conclusion This real-world evidence suggests that patients with MS treated with OCR experience lower work and activity impairment than patients treated with other DMTs. Electronic supplementary material The online version of this article (10.1007/s40120-020-00224-1) contains supplementary material, which is available to authorized users. Multiple sclerosis (MS) is the most common progressive neurological disease in young adults. It typically starts between the ages of 20 and 40 years—arguably some of the most productive years of an individual’s life—and it has a large impact on many aspects of everyday life for the rest of a person’s life. The reduction in the ability to do routine activities, including working, results in a large economic burden. Disease-modifying treatments (DMTs) available for MS, particularly high-efficacy DMTs, have been shown to improve work productivity. This study looked at work and activity impairment using the Work Productivity and Activity Impairment Questionnaire in patients with MS who were treated with ocrelizumab (OCR) or other DMTs for ≥ 6 months. A total of 630 patients with relapsing–remitting MS (RRMS) or secondary progressive MS (SPMS) from the Adelphi Real World Disease Specific Programme for Multiple Sclerosis were included in the study, including 90, 316 and 224 patients who completed ≥ 6 months of treatment with OCR, oral or injectable therapy. Compared with patients receiving oral or injectable DMTs, those receiving OCR had higher odds of employment [odds ratio (OR) vs. oral DMT 3.4; OR vs. injectable DMT 5.6], lower overall work productivity impairment (difference vs. oral DMT − 10%; difference vs. injectable DMT − 13%) and lower activity impairment (difference vs. oral DMT − 11%; difference vs. injectable DMT − 9.7%). These findings in patients with RRMS or SPMS being treated in the real world suggest that OCR may reduce the impact of MS disease on work productivity more than other DMTs.
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Brunner B, Igic I, Keller AC, Wieser S. Who gains the most from improving working conditions? Health-related absenteeism and presenteeism due to stress at work. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1165-1180. [PMID: 31309366 PMCID: PMC6803571 DOI: 10.1007/s10198-019-01084-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 06/24/2019] [Indexed: 05/26/2023]
Abstract
Work stress-related productivity losses represent a substantial economic burden. In this study, we estimate the effects of social and task-related stressors and resources at work on health-related productivity losses caused by absenteeism and presenteeism. We also explore the interaction effects between job stressors, job resources and personal resources and estimate the costs of work stress. Work stress is defined as exposure to an unfavorable combination of high job stressors and low job resources. The study is based on a repeated survey assessing work productivity and workplace characteristics among Swiss employees. We use a representative cross-sectional data set and a longitudinal data set and apply both OLS and fixed effects models. We find that an increase in task-related and social job stressors increases health-related productivity losses, whereas an increase in social job resources and personal resources (measured by occupational self-efficacy) reduces these losses. Moreover, we find that job stressors have a stronger effect on health-related productivity losses for employees lacking personal and job resources, and that employees with high levels of job stressors and low personal resources will profit the most from an increase in job resources. Productivity losses due to absenteeism and presenteeism attributable to work stress are estimated at 195 Swiss francs per person and month. Our study has implications for interventions aiming to reduce health absenteeism and presenteeism.
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Affiliation(s)
- Beatrice Brunner
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland
| | - Ivana Igic
- Department of Work and Organizational Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Anita C. Keller
- Department of Organizational Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland
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13
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Chen J, Taylor B, Winzenberg T, Palmer AJ, Kirk-Brown A, van Dijk P, Simpson S, Blizzard L, van der Mei I. Comorbidities are prevalent and detrimental for employment outcomes in people of working age with multiple sclerosis. Mult Scler 2019; 26:1550-1559. [DOI: 10.1177/1352458519872644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: More work is needed to understand the burden of comorbidities in people with multiple sclerosis (MS). Objective: To assess prevalence of 30 comorbidities and impacts of comorbidities on employment outcomes in a working-aged MS cohort. Methods: Participants were from the Australian MS Longitudinal Study ( n = 929). Information on specific comorbidity was obtained (whether or not each was present, doctor-diagnosed, limited their activities and being treated). Results: Comorbidities most frequently reported to limit activities were osteoarthritis (51%), migraines (40%), anxiety (33%), depression (29%) and allergies (18%). Mean MS-related work productivity loss in past 4 weeks was 1.3 days for those without comorbidities and 2.5 days for those with any comorbidity. The annual population costs of work productivity loss were highest for people with depression, allergies, anxiety, migraines and osteoarthritis. Higher number of comorbidities was associated with more work productivity loss and a higher likelihood of not working. These associations were substantially reduced after adjustment for MS symptom severity. Conclusions: Comorbidities substantially impact employment outcomes and these effects were mainly mediated through MS symptom severity. This suggests that optimal and simultaneous management of comorbidities may be a viable strategy to reduce MS symptom severity, which in turn could improve employment outcomes.
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Affiliation(s)
- Jing Chen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Kirk-Brown
- Department of Management, Monash University, Narre Warren, VIC, Australia
| | - Pieter van Dijk
- Department of Management, Monash University, Narre Warren, VIC, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Fujino Y, Liu N, Chimed-Ochir O, Okawara M, Ishimaru T, Kubo T. Cross-cultural validation of the work functioning impairment scale (WFun) among Japanese, English, and Chinese versions using Rasch analysis. J Occup Health 2019; 61:464-470. [PMID: 31254306 PMCID: PMC6842009 DOI: 10.1002/1348-9585.12072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 04/23/2019] [Accepted: 06/08/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives The work functioning impairment scale (WFun) was developed to measure the degree of work functioning impairment in Japanese workers based on the Rasch model. Given that the number of foreign workers employed in Japan and abroad has increased in recent years, a multilingual questionnaire is becoming increasingly necessary to investigate work functioning impairment in these workers. The purpose of this study was to verify the cross‐cultural validity of WFun between Japanese, Chinese, and English versions. Methods A cross‐sectional study was conducted in two stages. First, the Chinese and English versions of WFun were created. Second, an internet survey was conducted among 1000 Japanese, 400 Chinese, and 300 Americans. Estimates and standard errors of an individual's ability and item difficulty were calculated using the Rasch model. Differential item functioning (DIF) and differential test functioning (DTF) were also examined using Rasch model analyses. Results The effect size of DIF for one item in the English version exceeded 0.5 logit, indicating the presence of some DIF. In contrast, the effect sizes of DIF for all other items were below 0.5 logit, indicating that the influence of DIF was negligible. Furthermore, Rasch measurements according to the raw score for each version of WFun showed strong agreement among the three versions, with an intraclass correlation of 0.98 (95% confidence interval: 0.97‐0.99), indicating the absence of DTF. Conclusions Our findings indicate that the English, Chinese, and Japanese versions of WFun have good comparability.
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Affiliation(s)
- Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Odgerel Chimed-Ochir
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Okawara
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomohiro Ishimaru
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tatsuhiko Kubo
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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15
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Galliker S, Nicoletti C, Feer S, Irene Etzer-Hofer, Brunner B, Grosse Holtforth M, Melloh M, Dratva J, Elfering A. Quality of leadership and presenteeism in health professions education and research: a test of a recovery-based process model with cognitive irritation and impaired sleep as mediators. PSYCHOL HEALTH MED 2019; 25:239-251. [PMID: 31244323 DOI: 10.1080/13548506.2019.1634823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Presenteeism (PRES) includes working while feeling ill and constrained in performance. Compared with absence from work, PRES generates significantly higher cost estimates. Health problems and PRES are related to leadership quality. Hence, research on corporate health management needs to explore why leadership problems (LP) correspond to more frequent PRES.This study tests recovery after work as an underlying process with cognitive irritation (COGIRR) and sleep problems (SP) as simultaneous mediators and explores three mediation pathways (path one: LP→COGIRR→PRES; path two: LP→SP→PRES; and path three: LP→COGIRR→SP→PRES). Out of 293 employees of a university's school of health professions in German-speaking Switzerland, 211 completed a questionnaire. LP and PRES were found to be positively related (r(211) = .22, p < .01). The tests of mediation yielded no significant results for path one and two, but the third mediation path LP→COGIRR→SP→PRES was positive and differed significantly from zero (B = 0.83, CI95 = 0.33 to 1.69). According to our results, a recovery-based mediation model fits the empirical self-report data best. These results suggest that occupational health interventions should improve leadership quality to promote recovery after work in order to increase health and productivity by reduced PRES.
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Affiliation(s)
- Sibylle Galliker
- Department of Work and Organizational Psychology, University of Bern, Institute of Psychology, Bern, Switzerland
| | - Corinne Nicoletti
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Sonja Feer
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Irene Etzer-Hofer
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Beatrice Brunner
- School of Management and Law, Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Martin Grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, University of Bern, Institute of Psychology, Bern, Switzerland.,Division of Psychosomatic Medicine, Bern University Hospital, Bern, Switzerland
| | - Markus Melloh
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.,Curtin Medical School, Curtin University, Bentley, Australia.,UWA Medical School, The University of Western Australia, Perth, Australia
| | - Julia Dratva
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Achim Elfering
- Department of Work and Organizational Psychology, University of Bern, Institute of Psychology, Bern, Switzerland
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16
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Abstract
There has been a growing interest in presenteeism in recent years in both the occupational health and management fields. However, the term "presenteeism" was introduced in Japan relatively recently, and only limited knowledge on the subject has since been accumulated. This review will outline the current knowledge on presenteeism and discuss the significance of addressing presenteeism in occupational health in Japan. A common definition of presenteeism is the state that showing up at the office while having health problems, and some have added a decline in productivity. Several methods have been proposed to convert a degree of presenteeism into monetary value in terms of a health economics perspective, but there is no consistent method. A new approach is needed to evaluate and support workers who are experiencing presenteeism.
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17
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Yarlas A, Maher SM, Bayliss MS, Lovley A, Cappelleri JC, DiBonaventura MD. Psychometric validation of the work productivity and activity impairment questionnaire in ulcerative colitis: results from a systematic literature review. J Patient Rep Outcomes 2018; 2:62. [PMID: 30547275 PMCID: PMC6292832 DOI: 10.1186/s41687-018-0088-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/30/2018] [Indexed: 12/15/2022] Open
Abstract
Patients with ulcerative colitis, a type of inflammatory bowel disease, report negative impacts of disease symptoms on work-related outcomes, including absenteeism and presenteeism. As a way to better understand the impact of this disease and its treatment on work-related outcomes, the current review examines the use of the Work Productivity and Activity Impairment Questionnaire (WPAI), a patient-reported outcomes measure of absenteeism, presenteeism, and impairment in other activities, in studies of patients with ulcerative colitis. This review assesses the measurement properties of the WPAI in this patient population: its reliability, construct validity, ability to detect change, and responsiveness to effective treatments. Relevant data were extracted from 13 sources (journal articles and conference posters) identified following a systematic review of the published and gray literature. The evidence supports the WPAI as having test-retest reliability (reproducibility) over time; convergent validity, as indicated by moderate correlations with measures of quality of life and moderate-to-strong correlations with measures of disease activity; known-groups validity, as indicated by differences in WPAI scores between patients with active and inactive disease; ability (sensitivity) to detect change, as indicated by substantial improvement in scores for patients who achieve remission, accompanied by substantial worsening of scores for patients who relapse; and, responsiveness to treatment, with improvements in scores following treatments that reduce disease activity. Limitations included a lack of available evidence from randomized-controlled trials that could speak more directly to the WPAI's responsiveness to treatment. In conclusion, we recommend the use of the WPAI for measuring work outcomes in both observational studies and interventional trials that include patients with ulcerative colitis.
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Affiliation(s)
- Aaron Yarlas
- Optum, 1301 Atwood Avenue, Suite 311N, Johnston, RI 02919 USA
| | | | | | - Andrew Lovley
- Optum, 1301 Atwood Avenue, Suite 311N, Johnston, RI 02919 USA
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18
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Frändemark Å, Törnblom H, Jakobsson S, Simrén M. Work Productivity and Activity Impairment in Irritable Bowel Syndrome (IBS): A Multifaceted Problem. Am J Gastroenterol 2018; 113:1540-1549. [PMID: 30254230 DOI: 10.1038/s41395-018-0262-x] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients with irritable bowel syndrome (IBS) are more likely to be both absent from and impaired at work compared to non-IBS patients. We investigated the impact of IBS on work productivity and activity impairment and the relationship to disease specific and general health measures. METHOD In total, 525 patients with IBS completed questionnaires assessing work productivity and activity impairment, IBS symptom severity, IBS-related quality of life and GI-specific anxiety. In addition, 155 of the patients completed questionnaires assessing severity of somatic symptoms, depression, anxiety and fatigue. Uni- and bivariate analyses were performed, as well as linear regression to determine factors independently associated with the work productivity and activity impairment measures. RESULTS Of employed patients, 24.3% reported absenteeism and 86.8% reported presenteeism because of their IBS. With increasing severity of IBS symptoms and GI-specific anxiety, higher degrees of work impairment were seen. Work productivity impairment in IBS was also associated with low quality of life. GI-specific anxiety was independently associated with absenteeism (R2 = 0.23; p < 0.05), IBS-symptom severity and general fatigue with presenteeism (R2 = 0.40; p < 0.05), IBS-symptom severity, general fatigue and GI-specific anxiety with overall work loss (R2 = 0.50; p < 0.05), and IBS symptom severity and somatic symptoms with activity impairment (R2 = 0.38; p < 0.05). CONCLUSION Work impairment is a substantial problem in patients with IBS. A combination of IBS and somatic symptom severity, fatigue and psychological factors influence patients' ability to be present, active and productive at work. Based on this, a multidimensional treatment approach for patients with IBS seems logical.
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Affiliation(s)
- Åsa Frändemark
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Törnblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofie Jakobsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Centre for Person-Centered Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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19
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Work Absenteeism and Presenteeism Loss in Patients With Non-Cardiac Chest Pain. J Occup Environ Med 2018; 60:781-786. [DOI: 10.1097/jom.0000000000001363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Abstract
BACKGROUND AND AIMS Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood. MATERIALS AND METHODS Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were surveyed to assess QoL and pain using the Short Form 36 and McGill pain questionnaires. Part 2: 491 adult GP patients were surveyed to evaluate employment status, work and daily activities, medication use, physician visits, diagnostic testing, emergency room visits, and hospitalizations related to their GP symptoms. Both protocols received Institutional Review Board approval. RESULTS Part 1: 250 fully evaluable surveys were returned (63%). The mean age was 46.8 years (range, 18 to 84 y); 78% were women. Mean Short Form 36 scores for mental health (56.9) and social functioning (68.1) were analogous to scores for patients with serious chronic medical disorders and depression. Pain scores were lower in patients with idiopathic GP compared with diabetic GP. Part 2: 228 evaluable surveys were analyzed (58.3% response rate). The mean age was 49.6 (19 to 86 y); 77.2% were women. GP symptoms reduced daily activities in 67.5% and lowered annual income in 28.5%. In total, 11% were disabled due to GP symptoms. CONCLUSIONS GP reduces patients' QoL and places a significant financial burden on the health care system. Treatment strategies for GP patients should be broad based and incorporate pain management, psychological evaluation and management, and strategies to improve overall well-being with a return to work and daily activities.
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Gong EJ, Choi KD, Jung HK, Youn YH, Min BH, Song KH, Huh KC. Quality of life, patient satisfaction, and disease burden in patients with gastroesophageal reflux disease with or without laryngopharyngeal reflux symptoms. J Gastroenterol Hepatol 2017; 32:1336-1340. [PMID: 28052406 DOI: 10.1111/jgh.13716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/13/2016] [Accepted: 12/30/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM Patients with gastroesophageal reflux disease (GERD) have decreased health-related quality of life (HRQL). The quality of life in patients with laryngopharyngeal reflux (LPR) symptoms is also significantly impaired. However, the impact of LPR symptoms on HRQL in GERD patients has not been studied. METHODS A nationwide, random-sample, and face-to-face survey of 300 Korean patients with GERD was conducted from January to March 2013. Gastroesophageal reflux symptoms were assessed using the Rome III questionnaire, LPR symptoms using the reflux symptom index, and HRQL using the EuroQol five dimensions (EQ-5D) questionnaire. A structured questionnaire on patient satisfaction, sickness-related absences, and health-related work productivity was also used. RESULTS Among the 300 patients with GERD, 150 had LPR symptoms. The mean EQ-5D index was lower in patients with GERD and LPR symptoms than in those without LPR (0.88 vs 0.91, P = 0.002). A linear regression model showed that the severity of LPR symptoms was related to decreased HRQL and was independent of age, marital status, body mass index, or household income. The overall satisfaction rate regarding treatment was lower in patients with GERD and LPR (40.0% vs 69.1%, P = 0.040). GERD patients with LPR symptoms reported greater sickness-related absent hours per week (0.36 vs 0.02 h, P = 0.016) and greater percentages of overall work impairment than those without LPR (31.1% vs 20.8%, P < 0.001). CONCLUSIONS Gastroesophageal reflux disease patients with LPR symptoms have a poorer HRQL, a lower satisfaction rate, and a greater disease burden than those without LPR.
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Affiliation(s)
- Eun Jeong Gong
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Hoon Youn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Ho Song
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Kyu Chan Huh
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
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22
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Lee SW, Lee TY, Lien HC, Peng YC, Yeh HJ, Chang CS. Correlation Between Symptom Severity and Health-Related Life Quality of a Population With Gastroesophageal Reflux Disease. Gastroenterology Res 2017; 10:78-83. [PMID: 28496527 PMCID: PMC5412539 DOI: 10.14740/gr753w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a chronic disease with a negative impact on the quality of life. The aim of this study was to investigate the reflux symptoms and the health-related quality of life in a population with GERD. METHODS Data from patients with GERD, according to the Montreal definition, were collected between January and December 2009. The enrolled patients were classified by different reflux symptoms according to the modified Chinese GERDQ. The general demographic data, the modified GERD impact scores and the SF-36 questionnaire scores of these groups of patients were analyzed. RESULTS A total of 173 patients were enrolled, and the general data, endoscopic findings and lifestyle habits of the participants with different severity of heartburn or regurgitation were all similar. The patients with moderate severity of reflux symptoms had significant lower SF-36 scores than those with mild severity. The cases with advanced heartburn severity owned the lowest scores among all cases. The impact on the daily activity of each affected individual had a positive association with the stronger severity of reflux symptom. CONCLUSION The life quality of a population with GERD achieved the meaningful declination in participants with the moderate severity of heartburn or regurgitation. The severity of the reflux symptoms had a greater impact on the normal daily activity of the patients with GERD. The cases with advanced severity of heartburn had the worst well-being.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Teng-Yu Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Han-Chung Lien
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,Department of Internal Medicine, Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
| | - Yen-Chun Peng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,Department of Internal Medicine, Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
| | - Hong-Jeh Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,Department of Internal Medicine, Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
| | - Chi-Sen Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
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23
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Systematic Review of Health-Related Work Outcome Measures and Quality Criteria-Based Evaluations of Their Psychometric Properties. Arch Phys Med Rehabil 2017; 98:534-560. [DOI: 10.1016/j.apmr.2016.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/14/2016] [Accepted: 06/22/2016] [Indexed: 01/12/2023]
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24
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Tan JY, Yorke J, Harle A, Smith J, Blackhall F, Pilling M, Molassiotis A. Assessment of Breathlessness in Lung Cancer: Psychometric Properties of the Dyspnea-12 Questionnaire. J Pain Symptom Manage 2017; 53:208-215. [PMID: 27720789 DOI: 10.1016/j.jpainsymman.2016.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 12/26/2022]
Abstract
CONTEXT The Dyspnea-12 (D-12) Questionnaire is a well-validated instrument in respiratory illnesses for breathlessness assessment, but its psychometric properties have not been tested in lung cancer. OBJECTIVE To demonstrate the psychometric properties of the D-12 in lung cancer patients. METHODS Baseline data from a lung cancer feasibility trial were adopted for this analysis. D-12 and a series of patient-reported tools, including five Numeric Rating Scales (NRS), the Hospital Anxiety and Depression Scale (HADS), and the Lung Cancer Symptom Scale (LCSS), were used for the psychometric assessment. Spearman's correlation coefficients (rs) were used to estimate the convergent validity of the D-12 with the NRS, HADS, and LCSS. Exploratory factor analysis was performed to examine construct validity. Reliability was tested by Cronbach's alpha and item-to-total correlations. D-12 score difference between patients with or without anxiety, depression, and chronic obstructive pulmonary disease (COPD) was explored to identify its discriminate performance. RESULTS One hundred and one lung cancer patients were included. There were significantly positive correlations between the D-12 and the HADS, LCSS, and NRS measuring breathlessness severity and its associated affective distress. Factor analysis clearly identified two components (physical and emotional) of the D-12. Cronbach's alpha for D-12 total, physical, and emotional subscales was 0.95, 0.92, and 0.94, respectively. Patients with anxiety or depression demonstrated significantly higher D-12 scores than those without it, and patients with COPD reported significantly more severe breathlessness than those without COPD. CONCLUSION The D-12 is a valid and reliable self-reported questionnaire for use in breathlessness assessment in lung cancer patients.
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Affiliation(s)
- Jing-Yu Tan
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Amelie Harle
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jacky Smith
- Centre for Respiratory and Allergy, University Hospital South Manchester, Manchester, United Kingdom; Faculty of Medicine and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Fiona Blackhall
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Faculty of Medicine and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark Pilling
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| | - Alex Molassiotis
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom; School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Miller PSJ, Hill H, Andersson FL. Nocturia Work Productivity and Activity Impairment Compared with Other Common Chronic Diseases. PHARMACOECONOMICS 2016; 34:1277-1297. [PMID: 27581788 DOI: 10.1007/s40273-016-0441-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The International Continence Society defines nocturia as the need to void one or more times during the night, with each of the voids preceded and followed by sleep. The chronic sleep disturbance and sleep deprivation experienced by patients with nocturia affects quality of life, compromising both mental and physical well-being. This paper aims to characterise the burden of nocturia by comparing published data from patients with nocturia with data from patients with any of 12 other common chronic conditions, specifically focusing on its impact on work productivity and activity impairment, as measured by the instrument of the same name (WPAI). METHODS A systematic literature review of multiple data sources identified evaluable studies for inclusion in the analysis. Study eligibility criteria included use of the WPAI instrument in patients with one of a predefined list of chronic conditions. We assessed the quality of each included study using the Newcastle-Ottawa scale and extracted basic study information, work and activity impairment data. To assess how work and activity impairment from nocturia compares with impairment from other common chronic diseases, we conducted two data syntheses (pooled and unpooled). RESULTS The number of evaluable studies and the range of overall work productivity impairment reported, respectively, were as follows: nocturia (3; 14-39 %), overactive bladder (5; 11-41 %), irritable bowel syndrome/constipation (14; 21-51 %), gastroesophageal reflux disease (GERD) (13; 6-42 %), asthma/allergies (11; 6-40 %), chronic obstructive pulmonary disease (COPD) (7; 19-42 %), sleep problems (3; 12-37 %), arthritis (13; 21-69 %), pain (9; 29-64 %), depression (4; 15-43 %) and gout (2; 20-37 %). CONCLUSIONS The overall work productivity impairment as a result of nocturia is substantial and was found to be similar to impairment observed as a result of several other more frequently researched common chronic diseases. Greater awareness of the burden of nocturia, a highly bothersome and prevalent condition, will help policy makers and healthcare decision makers provide appropriate management of nocturia.
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Affiliation(s)
- Paul S J Miller
- Miller Economics Ltd., BioHub Alderley Edge, Alderley Park, SK10 4TG, UK.
| | - Harry Hill
- Centre for Health Economics, Institute of Population Health/School of Dentistry, University of Manchester, 4.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Fredrik L Andersson
- Global Health Economics and Outcomes Research, Ferring Pharmaceuticals A/S, Kay Fiskers Plads 11, 2300, Copenhagen, Denmark
- Center for Medical Technology Assessment (CMT), Linköping University, 581 83, Linköping, Sweden
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Bonavina L, Attwood S. Laparoscopic alternatives to fundoplication for gastroesophageal reflux: the role of magnetic augmentation and electrical stimulation of the lower esophageal sphincter. Dis Esophagus 2016; 29:996-1001. [PMID: 26676715 DOI: 10.1111/dote.12425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Reflux symptoms are very common, and despite modern medication they are a major cause of disease burden and loss of quality of life worldwide. Laparoscopic anti-reflux surgery is the only current effective alternative but suffers from the risks of long-term side effects. Surgery also suffers variation in standards and outcomes. Magnetic augmentation and electrical stimulation of the lower esophageal sphincter represent promising innovative procedures in the field.
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Affiliation(s)
- L Bonavina
- Department of Surgery, University of Milano Medical School, Milan, Italy
| | - S Attwood
- Department of Health Services Research, Durham University Medical School, Durham, UK
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Abstract
To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.
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Tang K. Estimating productivity costs in health economic evaluations: a review of instruments and psychometric evidence. PHARMACOECONOMICS 2015; 33:31-48. [PMID: 25169062 DOI: 10.1007/s40273-014-0209-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health economic evaluations (i.e. cost-effectiveness appraisal of an intervention) are useful aids for decision makers responsible for the allocation of scarce healthcare resources. The relevance of including health-related productivity costs (or benefits) in these evaluations is increasingly recognized and, as such, reliable and valid instruments to quantify productivity costs are needed. Over the years, a number of work productivity instruments have emerged in the literature, along with a growing body of psychometric evidence. The overall aim of this paper is to provide a review of available instruments with potential for estimating health-related productivity costs. This included the Health and Labor Questionnaire, Health and Work Performance Questionnaire, Health-Related Productivity Questionnaire Diary, Productivity and Disease Questionnaire, Quantity and Quality method, Stanford Presenteeism Scale 13, Valuation of Lost Productivity, Work and Health Interview, Work Limitations Questionnaire, Work Productivity and Activity Impairment Questionnaire, and Work Productivity Short Inventory. Critical discussions on the instruments' overall strengths and limitations, applicability for health economic evaluations, as well as the methodological quality of existing psychometric evidence were provided. Lastly, a set of reflective questions were proposed for users to consider when selecting an instrument for health economic evaluations.
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Affiliation(s)
- Kenneth Tang
- Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada,
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Yarlas A, Yen L, Hodgkins P. The relationship among multiple patient-reported outcomes measures for patients with ulcerative colitis receiving treatment with MMX ® formulated delayed-release mesalamine. Qual Life Res 2014; 24:671-83. [PMID: 25193617 PMCID: PMC4349951 DOI: 10.1007/s11136-014-0797-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 01/03/2023]
Abstract
Purpose Ulcerative colitis (UC) is associated with impaired health-related quality of life (HRQL) and work-related outcomes (WRO). This analysis examined correspondences among measures of HRQL and WRO in patients with UC, as well as the magnitude of each measure’s responsiveness to disease activity and treatment. Methods An open-label, prospective trial of delayed-release mesalamine tablets formulated with MMX® technology included 8 weeks of treatment for patients with active mild-to-moderate UC (n = 137) and 12 months of maintenance treatment for patients with quiescent UC (n = 206). Spearman correlations (ρ) measured inter-domain associations across measures of generic HRQL [12-item Short-Form Health Survey (SF-12v2)], disease-specific HRQL [Short Inflammatory Bowel Disease Questionnaire (SIBDQ)], and disease-specific WRO [Work Productivity and Activity Impairment for Specific Health Problems (WPAI:SHP)]. Responsiveness to disease activity and treatment was assessed for each instrument. Results Changes in scores from baseline to week 8 were moderately correlated across all instrument domains: 65 of 80 (81 %) between-instrument inter-domain correlations were of moderate magnitude (0.30 < ρ < 0.70), with an average magnitude of 0.42 [95 % confidence interval (CI) 0.38–0.46]. Associations between symptom measures were stronger for SIBDQ (|average ρ| = 0.41; 95 % CI 0.34–0.48) and WPAI:SHP (0.40; 0.30–0.47) than SF-12v2 (0.30; 0.27–0.34). SIBDQ was most sensitive to treatment [effect size (dz) for change from baseline to week 8 = 0.62; 95 % CI 0.35–0.89], followed by WPAI:SHP (dz = 0.43; 0.32–0.54) and SF-12v2 (dz = 0.33; 0.27–0.39). Conclusion While the SIBDQ showed the greatest overall responsiveness to disease activity and treatment, all three patient-reported outcomes instruments provided complementary interpretive information regarding the impact of UC treatment.
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Affiliation(s)
- Aaron Yarlas
- Life Sciences, Optum, 24 Albion Road, Building 400, Lincoln, RI, 02865, USA,
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Suzuki H, Matsuzaki J, Masaoka T, Inadomi JM. Greater loss of productivity among Japanese workers with gastro-esophageal reflux disease (GERD) symptoms that persist vs resolve on medical therapy. Neurogastroenterol Motil 2014; 26:764-71. [PMID: 24602100 DOI: 10.1111/nmo.12319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastro-esophageal reflux disease (GERD) impairs quality of life; however, the association between GERD and work productivity has not been well investigated in Japan. This study was designed to compare the impact of GERD on productivity between Japanese workers with GERD symptoms that persisted vs resolved on medical therapy. METHODS A cross-sectional Web-based survey was conducted in workers. The impact of GERD on work and daily productivity was evaluated using a Web-reported Work Productivity and Activity Impairment Questionnaire for patients with GERD and a GERD symptom severity Questionnaire. Demographic information, clinical history, and satisfaction with GERD medication were also ascertained. KEY RESULTS A total of 20 000 subjects were invited to the survey. After the exclusion of patients with a history of gastrointestinal (GI) malignancy, peptic ulcer, upper GI surgery, and unemployment, 650 participants were included in the analysis. Participants with persistent GERD symptoms reported a significantly greater losses of work productivity (11.4 ± 13.4 h/week), absenteeism (0.7 ± 3.1 h/week), presenteeism (10.7 ± 12.6 h/week), costs (20 100 ± 26 800 JPY/week), and lower daily productivity (71.3% [95% confidence interval, 69.0-73.7]) than those whose symptoms were alleviated with medications. The level of dissatisfaction with GERD medications among participants with persistent GERD symptoms was significantly correlated with loss of work and daily productivity (p < 0.001). CONCLUSIONS & INFERENCES GERD places a significant burden on work and daily productivity despite medical therapy. Ineffective GERD therapy is associated with greater productivity loss.
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Affiliation(s)
- H Suzuki
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Malaguarnera G, Pennisi M, Gagliano C, Vacante M, Malaguarnera M, Salomone S, Drago F, Bertino G, Caraci F, Nunnari G, Malaguarnera M. Acetyl-L-Carnitine Supplementation During HCV Therapy With Pegylated Interferon-α 2b Plus Ribavirin: Effect on Work Performance; A Randomized Clinical Trial. HEPATITIS MONTHLY 2014; 14:e11608. [PMID: 24910702 PMCID: PMC4030263 DOI: 10.5812/hepatmon.11608] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 08/02/2013] [Accepted: 09/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The health status of employees with chronic hepatitis C has major implications for organizations and labour market. OBJECTIVES To assess the effects of Acetyl-L-Carnitine administration on work productivity, daily activity, and fatigue in subjects with chronic hepatitis C treated with Pegylated-Interferon-α2b and Ribavirin. PATIENTS AND METHODS In this prospective, randomized, placebo controlled, double blind clinical trial, 30 subjects (Group A) with chronic hepatitis, received Pegylated-Interferon-α2b (1.5 mg/kg per week) plus Ribavirin and placebo, while 32 subjects (Group B) received the same dosage of Pegylated-Interferon-α2b plus Ribavirin plus 2g Acetyl-L-Carnitine twice per day, for 12 months. Work productivity loss, impairment in daily activities, presenteeism, absenteeism, have been assessed using the Work Productivity and Activity Impairment questionnaire. We also evaluated severity of fatigue, mental fatigue and physical fatigue. RESULTS Significant difference were observed in physical fatigue, mental fatigue and severity of fatigue, aspartate aminotransferase, alanine aminotransferase, and viremia after 12 months treatment. In Group B we observed a significant decrease of presenteeism and daily activity impairment after 6 months, 12 months and at follow up. A significant increase of work productivity was observed after 12 months and at follow up. CONCLUSIONS Office workers with chronic hepatitis C, treated with Pegylated-Interferon-α2b plus Ribavirin, had work performance loss. In subjects treated with Acetyl-L-Carnitine supplementation we observed increased daily activity and reduced presenteeism and fatigue. Acetyl-L-Carnitinegroup had a smaller reduction of productivity comparing to placebo group.
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Affiliation(s)
- Giulia Malaguarnera
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy
| | - Manuela Pennisi
- Department of Neurosciences, University of Catania, Catania, Italy
| | - Caterina Gagliano
- The Great Senescence Research Center, University of Catania, Catania, Italy
| | - Marco Vacante
- The Great Senescence Research Center, University of Catania, Catania, Italy
| | - Michele Malaguarnera
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy
- The Great Senescence Research Center, University of Catania, Catania, Italy
- Corresponding Author: Michele Malaguarnera, The Great Senescence Research Center, University of Catania, Catania, Italy. Tel: +39-957262008, Fax: +39-957262011, E-mail:
| | - Salvatore Salomone
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy
| | - Filippo Drago
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy
| | - Gaetano Bertino
- Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
| | - Filippo Caraci
- Department of Educational Sciences, University of Catania, Catania, Italy
- Institute for Research on Mental Retardation and Brain Aging, Troina, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy
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Abstract
The prevalence of gastroesophageal reflux disease (GERD) symptoms increased approximately 50% until the mid-1990s, when it plateaued. The incidence of complications related to GERD including hospitalization, esophageal strictures, esophageal adenocarcinoma, and mortality also increased during that time period, but the increase in esophageal adenocarcinoma has since slowed, and the incidence of strictures has decreased since the mid-1990s. GERD is responsible for the greatest direct costs in the United States of any gastrointestinal disease, and most of those expenditures are for pharmacotherapy. Risk factors for GERD include obesity, poor diet, lack of physical activity, consumption of tobacco and alcohol, and respiratory diseases.
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Affiliation(s)
- Joel H Rubenstein
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Joan W Chen
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI, USA
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Bolier EA, Kessing BF, Smout AJ, Bredenoord AJ. Systematic review: questionnaires for assessment of gastroesophageal reflux disease. Dis Esophagus 2013; 28:105-20. [PMID: 24344627 DOI: 10.1111/dote.12163] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of gastroesophageal reflux disease (GERD). Four well-defined dimensions are noticeable in these GERD questionnaires, which are symptoms, response to treatment, diagnosis, and burden on the quality of life of GERD patients. The aim of this review is to develop a complete overview of all available questionnaires, categorized per dimension of the assessment of GERD. A systematic search of the literature up to January 2013 using the Pubmed database and the Embase database, and search of references and conference abstract books were conducted. A total number of 65 questionnaires were extracted and evaluated. Thirty-nine questionnaires were found applicable for the assessment of GERD symptoms, three of which are generic gastrointestinal questionnaires. For the assessment of response to treatment, 14 questionnaires were considered applicable. Seven questionnaires with diagnostic purposes were found. In the assessment of quality of life in GERD patients, 18 questionnaires were found and evaluated. Twenty questionnaires were found to be used for more than one assessment dimension, and eight questionnaires were found for GERD assessment in infants and/or children. A wide variety of GERD questionnaires is available, of which the majority is used for assessment of GERD symptoms. Questionnaires differ in aspects such as design, validation and translations. Also, numerous multidimensional questionnaires are available, of which the Reflux Disease Questionnaire is widely applicable. We provided an overview of GERD questionnaires to aid investigators and clinicians in their search for the most appropriate questionnaire for their specific purposes.
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Affiliation(s)
- E A Bolier
- Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
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Meyer TK, Hu A, Hillel AD. Voice disorders in the workplace: Productivity in spasmodic dysphonia and the impact of botulinum toxin. Laryngoscope 2013; 123 Suppl 6:S1-14. [DOI: 10.1002/lary.24292] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Tanya K. Meyer
- Department of Otolaryngology; University of Washington; Seattle Washington
| | - Amanda Hu
- Department of Otolaryngology; Drexel University; Philadelphia Pennsylvania U.S.A
| | - Allen D. Hillel
- Department of Otolaryngology; University of Washington; Seattle Washington
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Structured diagnostic and treatment approach versus the usual primary care approach in patients with gastroesophageal reflux disease: a cluster-randomized multicenter study. J Clin Gastroenterol 2013; 47:e65-73. [PMID: 23426452 DOI: 10.1097/mcg.0b013e31827d7782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS To compare the clinical outcomes of gastroesophageal reflux disease (GERD) patients treated with an implemented new structured pathway (NSP) or according to existing local clinical practices [old clinical pathway (OCP)]. BACKGROUND GERD is a major challenge at the primary care level. STUDY Primary care centers (n=24) were cluster randomized to handle patients suffering from symptoms suggestive of GERD according to the NSP (n=97) or the OCP (n=134). In the NSP, the GerdQ questionnaire score was used both for diagnosis and management including treatment. We used validated questionnaires to evaluate disease symptoms, quality of life, and costs at inclusion and at follow-up 2 to 6 months later. RESULTS On the basis of the Reflux Disease Questionnaire, 56% of the patients treated with the NSP reported total symptom relief at the follow-up compared with 33% in the OCP group (P=0.0013). The reflux symptoms after treatment affected daily activities to a lesser extent in the patients in the NSP group compared with the OCP group (10% vs. 13%, respectively, P=0.01). The utility score of the EuroQoL-5D questionnaire improved more in the NSP group than in the OCP group (0.05 vs. 0.02, respectively, P<0.001). The patients in the NSP group had an approximately 50% lower average total cost for GERD-related health care resources compared with the OCP group [301 Swedish Kronor (SEK) vs. 588 SEK, respectively, NS]. CONCLUSIONS The management of GERD patients in primary care centers using a structured clinical pathway and the results of the GerdQ improves the clinical outcome compared with prevailing local routines (NCT00842387).
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Lacy BE, Weiser KT, Kennedy AT, Crowell MD, Talley NJ. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther 2013; 38:170-7. [PMID: 23725230 DOI: 10.1111/apt.12355] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 04/20/2013] [Accepted: 05/09/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although highly prevalent, little is known about the economic impact of functional dyspepsia (FD). AIMS To quantify FD patients' health care utilisation patterns and to estimate direct and indirect costs of FD to patients. METHODS ICD-9 codes identified adult patients with dyspepsia. A validated questionnaire was mailed to patients who met Rome III criteria for FD. RESULTS Three hundred and fifty-five patients met all inclusion criteria. The response rate was 63%. The respondents' mean age was 50 (14) years; 75% were women; 52% of respondents rated their FD as moderate. Patients reported 3 visits (mean) to their PCP over 12 months; 75% reported having blood work, 92% an EGD, 59% an ultrasound and 40% a CT scan. The direct cost of testing using Medicare reimbursement rates per patient was $582. To treat FD symptoms, 89% tried dietary changes, 89% over-the-counter medications, 87% prescription medications and 25% alternative therapies. Mean patient expenditure over the last year was $246 for OTC medications (range $0-12,000), $290 for co-payments (range $0-9,000) and $110 for alternative treatments (range $0-3,741). Total mean direct cost yearly to patients was $699. In the 7 days prior to completing the questionnaire, respondents reported a mean of 1.4 h absence from work. Extrapolating the results to the US population, we conservatively calculate the costs of FD were $18.4 billion in 2009. CONCLUSIONS Functional dyspepsia patients incur significant direct and indirect costs and work productivity is impaired by dyspeptic symptoms.
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Affiliation(s)
- B E Lacy
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Kahrilas PJ, Howden CW, Wernersson B, Denison H, Nuevo J, Gisbert JP. Impact of persistent, frequent regurgitation on quality of life in heartburn responders treated with acid suppression: a multinational primary care study. Aliment Pharmacol Ther 2013; 37:1005-10. [PMID: 23557078 DOI: 10.1111/apt.12298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 02/26/2013] [Accepted: 03/12/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND In gastro-oesophageal reflux disease (GERD), heartburn responds well to acid suppression, but regurgitation is a common cause of incomplete treatment response. AIM To assess the prevalence and burden of persistent, frequent regurgitation in primary care patients with GERD treated with acid suppression. METHODS We analysed observational data from 134 sites across six European countries in patients diagnosed with GERD. Within 3 months of the index visit, symptoms were assessed using the Reflux Disease Questionnaire, and their impact on sleep and work productivity with the Quality of Life in Reflux and Dyspepsia questionnaire and the Work Productivity and Activity Impairment Questionnaire, respectively. Patients provided information on concomitant over-the-counter (OTC) GERD medication use. RESULTS Persistent, frequent (3-7 days/week) regurgitation was reported by 13.2% (153/1156) of GERD patients with no heartburn on acid suppression; the prevalence was very similar for patients with up to 2 days/week of ongoing mild heartburn. Among patients without heartburn, sleep disturbance of any type was reported by 50.7-60.1% with persistent, frequent regurgitation, compared with 38.1-51.1% and 14.4-19.2% of those with less frequent or no regurgitation respectively. Persistent, frequent regurgitation was associated with increased use of OTC medication and more hours of work missed, whether mild, infrequent heartburn was present or not. CONCLUSIONS Frequent regurgitation, which persisted in 12-13% of patients with no or infrequent, mild heartburn on acid suppression, negatively affected sleep and work productivity, and increased use of OTC medication. Persistent, frequent regurgitation is problematic for primary care patients with GERD.
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Affiliation(s)
- P J Kahrilas
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL, USA.
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Bruley des Varannes S, Ducrotté P, Vallot T, Garofano A, Bardoulat I, Carrois F, Ricci L. Gastroesophageal reflux disease: impact on work productivity and daily-life activities of daytime workers. A French cross-sectional study. Dig Liver Dis 2013; 45:200-6. [PMID: 23238032 DOI: 10.1016/j.dld.2012.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 10/30/2012] [Accepted: 11/06/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies have evaluated the impact of gastroesophageal reflux disease symptoms on work productivity and no French data are available. AIM To compare the impact of typical symptoms of nocturnal vs diurnal gastroesophageal reflux disease on work productivity and daily activities. METHODS A French prospective, multicenter, observational study was performed in primary care setting. Patient characteristics, symptomatology and treatment were reported. Work productivity loss was assessed using the work productivity and activity impairment questionnaire, predictors were identified using multivariate regression models, and estimated cost was calculated. RESULTS 716 eligible patients (mean age: 46.3 years) were included by 407 physicians. Nocturnal symptoms were reported in 50.8% of patients and exclusively diurnal symptoms in 49.2%. Mean work productivity and daily activities decreased by 31.4% and 32.6%, respectively (both p<0.001). Work productivity was influenced by symptom intensity, diurnal symptoms occurrence, regurgitation and diurnal sleepiness. The mean associated cost per patient/week (€313) was higher in patients with diurnal symptoms (without (€346) or with nocturnal (€312) symptoms) than in patients with exclusive nocturnal symptoms (€253) (p<0.001). CONCLUSION Gastroesophageal reflux disease incurs high work productivity loss especially in patients with diurnal symptoms. Further medico-economic analyses are needed to estimate the cost effectiveness ratio according to therapeutic strategies.
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Affiliation(s)
- Stanislas Bruley des Varannes
- Institut des Maladies de l'Appareil Digestif (IMAD), CHU Hôtel Dieu, 1 place Alexis Ricordeau, 44 093 Nantes, France
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Jones P, Miravitlles M, van der Molen T, Kulich K. Beyond FEV₁ in COPD: a review of patient-reported outcomes and their measurement. Int J Chron Obstruct Pulmon Dis 2012; 7:697-709. [PMID: 23093901 PMCID: PMC3476498 DOI: 10.2147/copd.s32675] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms and pathological consequences. Although primarily viewed as a respiratory disease, COPD has both pulmonary and extrapulmonary effects, which have an impact on many aspects of physical, emotional, and mental well-being. Traditional assessment of COPD relies heavily on measuring lung function, specifically forced expiratory volume in 1 second (FEV(1)). However, the evidence suggests that FEV(1) is a relatively poor correlate of symptoms such as breathlessness and the impact of COPD on daily life. Furthermore, many consequences of the disease, including anxiety and depression and the ability to perform daily activities, can only be described and reported reliably by the patient. Thus, in order to provide a comprehensive view of the effects of interventions in clinical trials, it is essential that spirometry is accompanied by assessments using patient-reported outcome (PRO) instruments. We provide an overview of patient-reported outcome concepts in COPD, such as breathlessness, physical functioning, and health status, and evaluate the tools used for measuring these concepts. Particular attention is given to the newly developed instruments emerging in response to recent regulatory guidelines for the development and use of PROs in clinical trials. We conclude that although data from the development and validation of these new PRO instruments are emerging, to build the body of evidence that supports the use of a new instrument takes many years. Furthermore, new instruments do not necessarily have better discriminative or evaluative properties than older instruments. The development of new PRO tools, however, is crucial, not only to ensure that key COPD concepts are being reliably measured but also that the relevant treatment effects are being captured in clinical trials. In turn, this will help us to understand better the patient's experience of the disease.
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Affiliation(s)
- Paul Jones
- Division of Clinical Science, University of London, London, UK.
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Work productivity and activity impairment in gastroesophageal reflux disease in Korean full-time employees: a multicentre study. Dig Liver Dis 2012; 44:286-91. [PMID: 22325831 DOI: 10.1016/j.dld.2011.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/25/2011] [Accepted: 10/30/2011] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The costs of gastroesophageal reflux disease have not been assessed in Asia, even though the prevalence of gastroesophageal reflux disease is gradually increasing. We evaluated work presenteeism and absenteeism as indirect costs of gastroesophageal reflux disease in Korea. METHODS This was a cross-sectional and multicentre study using patient-reported outcome instruments. A total of 1009 full-time employees who visited the gastrointestinal department for any reason (281 patients with gastroesophageal reflux disease and 728 controls) were included. Main outcomes were presenteeism and absenteeism measured as work productivity loss and monetary cost per week. RESULTS Absenteeism and presenteeism were significantly higher in the gastroesophageal reflux disease than the control group (1.49% vs. 0.46%, P=0.0010; 34.13% vs. 9.23%, P<0.0001). Loss of work productivity was significantly greater in the gastroesophageal reflux disease than the control group (33.09% vs. 9.02%; P<0.0001). This loss of work productivity difference between the two groups represented an additional productivity loss of 11.7h/week in the gastroesophageal reflux disease group compared with the control group. Assuming average hourly wages of $14.12, the weekly burden of gastroesophageal reflux disease reached $165.07 per person. CONCLUSIONS Gastroesophageal reflux disease was associated with substantial work productivity loss, mainly due to presenteeism rather than absenteeism, in Korean full-time employees.
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Association of Binge Eating With Work Productivity Impairment, Adjusted for Other Health Risk Factors. J Occup Environ Med 2012; 54:385-93. [DOI: 10.1097/jom.0b013e3182479f40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Toghanian S, Johnson DA, Stålhammar NO, Zerbib F. Burden of gastro-oesophageal reflux disease in patients with persistent and intense symptoms despite proton pump inhibitor therapy: A post hoc analysis of the 2007 national health and wellness survey. Clin Drug Investig 2012; 31:703-15. [PMID: 21756007 DOI: 10.2165/11595480-000000000-00000] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Research on the negative impact of gastro-oesophageal reflux disease (GORD) on the health-related quality of life (HR-QOL) and resource utilization of patients with persistent and intense GORD symptoms despite proton pump inhibitor (PPI) therapy is lacking. The aim of this study was to describe the population of patients with GORD with persistent moderate-to-severe symptoms despite ongoing PPI therapy, and to compare their HR-QOL and healthcare resource use with patients with low GORD symptom load during ongoing PPI therapy. METHODS In this post hoc analysis of the 2007 National Health and Wellness Survey (NHWS), PPI-compliant (≥22 days with PPI use in the past month) European (France, Germany and the UK) and US respondents with physician-diagnosed GORD were stratified into those with persistent and intense GORD symptoms, those with low symptom load, or an intermediate group. RESULTS 5672 PPI-compliant respondents were identified (persistent and intense symptoms, n = 1741; low symptom load, n = 1805; intermediate group, n = 2126). Respondents with persistent and intense symptoms had poorer HR-QOL than patients with a low symptom load, but none of the differences were statistically significant. Respondents with persistent and intense symptoms also reported lower work productivity (all countries; significant difference [p < 0.01] only in the US), greater activity impairment (all countries; significant difference [p < 0.01] only in the US) and more hours missed from work due to health problems (US, UK and Germany; significant difference [p < 0.01] only in the US). In the UK and US, respondents with persistent and intense symptoms reported significantly more visits to both primary-care physicians and specialists than respondents with a low symptom load (all p < 0.01). Additionally, US respondents with persistent and intense symptoms reported significantly more emergency room visits (p < 0.01). CONCLUSION The 2007 NHWS gives support to the hypothesis that persistent and intense GORD symptoms despite PPI therapy have a significant and negative impact on both HR-QOL and healthcare resource utilization. These findings outline the need for new treatment options for symptomatic GORD patients taking PPI therapy.
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Sander GB, Mazzoleni LE, Francesconi CFDM, Balbinotto G, Mazzoleni F, Wortmann AC, Cardoso IDQ, Klamt AL, Milbradt TC. Influence of organic and functional dyspepsia on work productivity: the HEROES-DIP study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:S126-S129. [PMID: 21839884 DOI: 10.1016/j.jval.2011.05.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Dyspepsia is defined as persistent or recurrent abdominal pain or discomfort centered in the upper abdomen. Dyspepsia represents up to 8.3% of all primary care physician visits and causes huge economic costs to patients and to the economy as a whole. The aim of this study was to measure the influence of dyspepsia on work productivity of people within the Brazilian workforce. METHODS Adult patients were enrolled if they met the Roma III criteria for uninvestigated dyspepsia. All patients answered a demographic questionnaire. Productivity impairment was measured by the Work Productivity and Activity Impairment questionnaire. Subjects underwent upper gastrointestinal endoscopy and were classified as having functional or organic dyspepsia. The study protocol was approved by the Ethics Committee of Hospital de Clínicas de Porto Alegre, Brazil. RESULTS Eight hundred fifty patients with dyspepsia were evaluated: 628 were women (73.9%); mean age was 46.4 ± 12.9 years; 387 (45.5%) were active workers. Among active workers, 32.2% mentioned that dyspepsia had caused absenteeism from work during the preceding week and 78% reported a reduction of the work productivity (presenteeism). The lost work productivity score was 35.7% among all employed patients. The affect on work productivity was similar between patients with functional or organic dyspepsia. CONCLUSIONS Our study showed an important influence of dyspepsia on work productivity. We did not find any statistically significant difference on the influence on work between patients with organic dyspepsia and functional dyspepsia. The social impact of these findings is underscored by taking into account the prevalence (up to 40%) of this condition in Brazil.
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Affiliation(s)
- Guilherme Becker Sander
- Universidade Federal do Rio Grande do Sul, School of Medicine, Programa de Pós-graduação: Ciências em Gastroenterologia e Hepatologia, Porto Alegre, Brazil.
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Patel VD, Watanabe JH, Strauss JA, Dubey AT. Work productivity loss in patients with dry eye disease: an online survey. Curr Med Res Opin 2011; 27:1041-8. [PMID: 21417803 DOI: 10.1185/03007995.2011.566264] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the impact of dry eye disease (DED) on productivity. RESEARCH DESIGN AND METHODS A cross-sectional, web-based survey was administered to 9034 individuals who are part of the Harris Interactive Online dry eye panel. Patients (≥ 18 years of age) were included if they were currently employed, a United States resident, had a patient-reported physician-diagnosed dry eye, and scored 13 or higher on the Ocular Surface Disease Index (OSDI). Work productivity and impairment in daily activity was measured using the validated Work Productivity and Activity Impairment (WPAI) Questionnaire. Comparisons were made across disease severity groups: mild, moderate, severe. RESULTS Reduced productivity while at work was reported by patients in all three severity groups. Patients with moderate (18%) and severe (35%) disease had significantly greater reductions in productivity than patients with mild (11%) disease, P < 0.05. Impairment in ability to perform daily activities was significantly greater among respondents with severe disease (34%) than respondents with moderate (19%) or mild (12%) disease, P < 0.05. CONCLUSION DED is associated with work productivity loss and impairment of daily activities. These results should be interpreted in the context of limitations related to online survey research.
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Affiliation(s)
- V D Patel
- Allergan, Inc., Irvine, CA 92612, USA.
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Mouli VP, Ahuja V. Questionnaire based gastroesophageal reflux disease (GERD) assessment scales. Indian J Gastroenterol 2011; 30:108-17. [PMID: 21785994 DOI: 10.1007/s12664-011-0105-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 06/15/2011] [Indexed: 02/04/2023]
Abstract
Questionnaire based assessment scales for gastroesophageal reflux disease (GERD) have been utilized for assessment of the patient's symptomatology, assessment of symptom severity and frequency, assessment of health-related quality of life and for assessment of response to treatment. A multitude of unidimensional and multidimensional questionnaires exist for making symptom assessment and monitoring quality of life in GERD. Many of the scales meet some of the parameters of an ideal evaluative GERD specific assessment instrument. Yet, there are certain shortcomings and challenges which are faced in development of GERD questionnaires. This review discusses the features of an ideal symptom assessment instrument, examines the strengths and weaknesses of currently available questionnaires.
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Affiliation(s)
- V Pratap Mouli
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110 029, India
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Ekesbo R, Sjöstedt S, Sörngård H. Effects of structured follow-up and of more effective acid inhibitory treatment in the management of GORD patients in a Swedish primary-care setting: a randomized, open-label study. Clin Drug Investig 2011; 31:181-9. [PMID: 21288053 DOI: 10.2165/11586330-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Despite the high prevalence of gastro-oesophageal reflux disease (GORD) and the documented impact of GORD symptoms on individual health-related quality of life (HR-QOL) and on socioeconomic factors, structured management of GORD has had a low priority in Swedish routine primary health care. OBJECTIVE The primary objective of this study (IMPROVE) was to evaluate the effects of a structured follow-up and management regimen for primary-care GORD patients with symptomatic breakthrough despite standard proton pump inhibitor (PPI) treatment. Patients received either an increased dose of current PPI treatment or were switched to the more effective acid inhibitor esomeprazole. METHODS GORD patients with symptomatic breakthrough despite standard PPI treatment were identified through medical records and by a postal survey using the GERD Impact Scale (GIS) questionnaire. Patients rated the severity and frequency of GORD symptoms, general health status (EuroQol Group 5-Dimension Self-Report Questionnaire) and the impact of GORD symptoms on work productivity (Work Productivity and Activity Impairment) before and 4 weeks following randomization to open-label treatment with either increased acid suppressive therapy or an adjusted, higher dosage of the PPI previously used. The patients' valuation, in monetary terms, of the treatment they received pre-study versus the treatment given during the study was documented through willingness-to-pay (WTP) questions. RESULTS Following more effective acid suppression, 66.3% of the study population experienced complete relief of heartburn, with no difference between the groups; HR-QOL was restored to a level comparable to that of a normal Swedish population and ability to work efficiently was significantly improved. Access to a better acid suppressive treatment was highly valuable to the patients in terms of WTP. CONCLUSION An improved GORD management strategy including structured follow-up of treatment given and initiation of more effective acid inhibitor therapy when symptoms persist will be of great benefit to GORD patients. [ClinicalTrials.gov Identifier: NCT00272701].
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Nuevo J, Tafalla M, Zapardiel J, Gisbert JP. [Use of health resources and loss of productivity in gastroesophageal reflux disease: results of a cross-sectional study in a primary care setting in Spain]. Aten Primaria 2011; 43:474-81. [PMID: 21382650 DOI: 10.1016/j.aprim.2010.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/19/2010] [Accepted: 09/07/2010] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To evaluate healthcare resource use and productivity in patients with gastro-esophageal reflux disease (GERD) and the influence of disease severity on these two factors. DESIGN Sub-analysis of the Spanish population of a multinational study with a 4-month retrospective period for the identification and selection of patients, and a clinical visit to obtain clinical information and data on use of healthcare resources, carried out between October 2007 and January 2008. POPULATION A total of 477 patients attending a Primary Care centre, with a medical consultation for GERD. MAIN VARIABLES Use of healthcare resources, changes in productivity based on the Work Productivity and Activity Impairment Questionnaire for GERD patients (WPAI-GERD). RESULTS Despite having received pharmacological treatment at the baseline visit, after a median of 5.1 months follow-up (range 2.1-8.1), up to 15.9% (95% CI; 12.8-19.5) patients still showed clinically relevant GERD symptoms. Direct medical costs per year associated with diagnostic tests and medical consultations in patients with or without clinically relevant GERD symptoms were 666 € (SD: 2,097 €) and 370 € (SD: 2,060 €), respectively. The mean annual cost of reduced productivity (17%) was 5,316 € (SD: 8,615 €). This cost was 4 times higher for patients with clinically relevant GERD symptoms than for patients with no relevant symptoms (15,188 € [SD: 11,206 €] vs 3,926 € [SD: 7,232 €]). CONCLUSION Patients with GERD use significant healthcare resources, attributable to associated medical costs and marked reduction in productivity, even though they receive pharmacological treatment.
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Affiliation(s)
- Javier Nuevo
- Departamento Médico, AstraZeneca Farmacéutica Spain, S.A., España.
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The effect of dexlansoprazole MR on nocturnal heartburn and GERD-related sleep disturbances in patients with symptomatic GERD. Am J Gastroenterol 2011; 106:421-31. [PMID: 21224838 DOI: 10.1038/ajg.2010.458] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Nocturnal heartburn and related sleep disturbances are common among patients with gastroesophageal reflux disease (GERD). This study evaluated the efficacy of dexlansoprazole MR 30 mg in relieving nocturnal heartburn and GERD-related sleep disturbances, improving work productivity, and decreasing nocturnal symptom severity in patients with symptomatic GERD. METHODS Patients (N=305) with frequent, moderate-to-very severe nocturnal heartburn and associated sleep disturbances were randomized 1:1 in a double-blind fashion to receive dexlansoprazole MR or placebo once daily for 4 weeks. The primary end point was the percentage of nights without heartburn. Secondary end points were the percentage of patients with relief of nocturnal heartburn and of GERD-related sleep disturbances over the last 7 days of treatment. At baseline and week 4/final visit, patients completed questionnaires that assessed sleep quality, work productivity, and the severity and impact of nocturnal GERD symptoms. RESULTS Dexlansoprazole MR 30 mg (n=152) was superior to placebo (n=153) in median percentage of nights without heartburn (73.1 vs. 35.7%, respectively; P<0.001). Dexlansoprazole MR was significantly better than placebo in percentage of patients with relief of nocturnal heartburn and GERD-related sleep disturbances (47.5 vs. 19.6%, 69.7 vs. 47.9%, respectively; P<0.001), and led to significantly greater improvements in sleep quality and work productivity and decreased nocturnal symptom severity. Adverse events were similar across treatment groups. CONCLUSIONS In patients with symptomatic GERD, dexlansoprazole MR 30 mg is significantly more efficacious than placebo in providing relief from nocturnal heartburn, in reducing GERD-related sleep disturbances and the consequent impairments in work productivity, and in improving sleep quality/quality of life.
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Stull DE, van Hanswijck de Jonge P, Houghton K, Kocun C, Sandor DW. Development of a Frequent Heartburn Index. Qual Life Res 2011; 20:1023-34. [DOI: 10.1007/s11136-010-9840-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2010] [Indexed: 01/23/2023]
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