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Reliability and validity of the Japanese version of the Pediatric Quality of Life Inventory Infant Scales. J Patient Rep Outcomes 2022; 6:10. [PMID: 35092532 PMCID: PMC8800985 DOI: 10.1186/s41687-022-00416-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PedsQL Infant Scales (PedsQL-I) are used to assess parent-reported health-related quality of life for children younger than 2 years. We determined the feasibility, reliability, and validity of the Japanese version of the PedsQL-I. METHODS A total of 183 participants (parents) with infants aged 1-30 months were recruited from 8 day care centers and one pediatric clinic. Participants completed the PedsQL-I (infants aged 1-18 months), the PedsQL-I and the PedsQL-Toddler version (infants aged 19-30 months), and the Kessler-6 psychological distress scale (all participants). We determined feasibility, internal consistency, test-retest reliability, concurrent validity, convergent and discriminant validity, known-groups validity with regard to acute and chronic illness, and relative and transitional validity with PedsQL-Toddler for the use in infants aged 25-30 months. RESULTS All subscales were internally consistent (Cronbach's alpha for 1-12 months: 0.88-0.98 and for 13-24 months: 0.85-0.97); test-retest reliability was acceptable (intra-class correlation coefficients > 0.40); and all scales were concurrently valid with the PedsQL-Toddler version (Pearson's product-moment correlation coefficient for the total score = 0.74). The scales' convergent and discriminant validity were acceptable (scaling success rate > 80%). Validation for known-groups showed that the Physical Health Summary score was sensitive to acute and chronic disease, the Psychosocial Health Summary score was sensitive to neither acute nor chronic disease, and the total score was sensitive to acute disease. Relative validity showed a ratio of 1.74 for the squared t values for the total score. CONCLUSIONS The PedsQL-I is suitable for assessing health-related quality of life in infants aged 1-24 months in prospective studies.
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Marino P, Sfumato P, Joly F, Fizazi K, Oudard S, Culine S, Habibian M, Boher JM, Gravis G. Q-TWiST analysis of patients with metastatic castrate naive prostate cancer treated by androgen deprivation therapy with or without docetaxel in the randomised phase III GETUG-AFU 15 trial. Eur J Cancer 2017; 84:27-33. [DOI: 10.1016/j.ejca.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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Jensen RE, Moinpour CM, Potosky AL, Lobo T, Hahn EA, Hays RD, Cella D, Smith AW, Wu XC, Keegan TH, Paddock LE, Stroup AM, Eton DT. Responsiveness of 8 Patient-Reported Outcomes Measurement Information System (PROMIS) measures in a large, community-based cancer study cohort. Cancer 2017; 123:327-335. [PMID: 27696377 PMCID: PMC5222745 DOI: 10.1002/cncr.30354] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) was a National Institutes of Health-funded initiative to develop measures of symptoms and function. Responsiveness is the degree to which a measure can detect underlying changes over time. The objective of the current study was to document the responsiveness of 8 PROMIS measures in a large, population-based cancer cohort. METHODS The Measuring Your Health study recruited 2968 patients who were diagnosed with 1 of 7 cancers between 2010 and 2012 through 4 Surveillance, Epidemiology, and End Results registries. Participants completed a baseline survey (6-13 months after diagnosis) and a 6-month follow-up survey. Changes in 8 PROMIS scores were compared with global ratings of transition, changes in performance status, and clinical events. RESULTS Measures were responsive to 6-month declines and improvements in performance status with small to large effect sizes (ES) (Cohen d = 0.34-0.71; P < .01). Mean changes and effect sizes were larger for participants who reported declines compared with those who reported improvements. Small-to-medium ES were observed in patients who reported being "a little" worse (d = 0.31-0.56), and medium-to-large ES were observed in those who reported being "a lot" worse (d = 0.53-0.72). Hospitalized participants reported significant score increases, resulting in worsening of pain (d = 0.51), fatigue (d = 0.35), and depression (d = 0.57; all P < .01). Cancer recurrence and progression were associated with smaller increases in pain, fatigue, and sleep disturbance (d = 0.22-0.27). CONCLUSIONS The current results indicated that all 8 PROMIS measures were sensitive to patient-perceived worsening and improvement and to major clinical events. These findings will be able to inform the design and interpretation of future research studies and clinical initiatives administering PROMIS measures. Cancer 2017;123:327-335. © 2016 American Cancer Society.
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Affiliation(s)
- Roxanne E. Jensen
- Department of Oncology, Georgetown University, Washington DC
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Washington, DC
| | | | - Arnold L. Potosky
- Department of Oncology, Georgetown University, Washington DC
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Washington, DC
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center Washington, DC
| | | | - Ron D. Hays
- UCLA Department of Medicine, Los Angeles, CA
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Xiao-Cheng Wu
- LSU Health Sciences Center School of Public Health, Louisiana Tumor Registry, New Orleans, LA
| | - Theresa H.M. Keegan
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Lisa E. Paddock
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, NJ
- Rutgers School of Public Health and Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - David T. Eton
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Soutello ALS, Rodrigues RCM, Jannuzzi FF, São-João TM, Martinix GG, Nadruz W, Gallani MCBJ. Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL. Arq Bras Cardiol 2015; 104:299-307. [PMID: 25993593 PMCID: PMC4415866 DOI: 10.5935/abc.20150009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/05/2014] [Indexed: 01/19/2023] Open
Abstract
Introductions In the care of hypertension, it is important that health professionals
possess available tools that allow evaluating the impairment of the
health-related quality of life, according to the severity of hypertension
and the risk for cardiovascular events. Among the instruments developed for
the assessment of health-related quality of life, there is the
Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial
(MINICHAL) recently adapted to the Brazilian culture. Objective To estimate the validity of known groups of the Brazilian version of the
MINICHAL regarding the classification of risk for cardiovascular events,
symptoms, severity of dyspnea and target-organ damage. Methods Data of 200 hypertensive outpatients concerning sociodemographic and clinical
information and health-related quality of life were gathered by consulting
the medical charts and the application of the Brazilian version of MINICHAL.
The Mann-Whitney test was used to compare health-related quality of life in
relation to symptoms and target-organ damage. The Kruskal-Wallis test and
ANOVA with ranks transformation were used to compare health-related quality
of life in relation to the classification of risk for cardiovascular events
and intensity of dyspnea, respectively. Results The MINICHAL was able to discriminate health-related quality of life in
relation to symptoms and kidney damage, but did not discriminate
health-related quality of life in relation to the classification of risk for
cardiovascular events. Conclusion The Brazilian version of the MINICHAL is a questionnaire capable of
discriminating differences on the health‑related quality of life regarding
dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.
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Affiliation(s)
| | | | | | | | | | - Wilson Nadruz
- Universidade Estadual de Campinas, Campinas, SP, Brazil
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Richardson J, Khan MA, Iezzi A, Maxwell A. Comparing and Explaining Differences in the Magnitude, Content, and Sensitivity of Utilities Predicted by the EQ-5D, SF-6D, HUI 3, 15D, QWB, and AQoL-8D Multiattribute Utility Instruments. Med Decis Making 2014; 35:276-91. [DOI: 10.1177/0272989x14543107] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Cost utility analysis permits the comparison of disparate health services by measuring outcomes in comparable units, namely, quality-adjusted life-years, which equal life-years times the utility of the health state. However, comparability is compromised when different utility instruments predict different utilities for the same health state. The present paper measures the extent of, and reason for, differences between the utilities predicted by the EQ-5D-5L, SF-6D, HUI 3, 15D, QWB, and AQoL-8D. Methods. Data were obtained from patients in seven disease areas and members of the healthy public in six countries. Differences between public and patient utilities were estimated using each of the instruments. To explain discrepancies between the estimates, the measurement scales and content of the instruments were compared. The sensitivity of instruments to independently measured health dimensions was measured in pairwise comparisons of all combinations of the instruments. Results. The difference between public and patient utilities varied with the choice of instrument by more than 50% for every disease group and in four of the seven groups by more than 100%. Discrepancies were associated with differences in both the instrument content and their measurement scales. Pairwise comparisons of instruments found that variation in the sensitivity to physical and psychosocial dimensions of health closely reflected the items in the instrument's descriptive systems. Discussion. Results indicate that instruments measure related but different constructs. They imply that commonly used instruments systematically discriminate against some classes of services, most notably mental health services. Differences in the instrument scales imply the need for transformations between the instruments to increase the comparability of measurement.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
| | - Munir A. Khan
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
| | - Angelo Iezzi
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
| | - Aimee Maxwell
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
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Martinez-Martin P, Rodriguez-Blazquez C, Frades-Payo B. Specific patient-reported outcome measures for Parkinson’s disease: analysis and applications. Expert Rev Pharmacoecon Outcomes Res 2014; 8:401-18. [DOI: 10.1586/14737167.8.4.401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Dubois CA, D’Amour D, Pomey MP, Girard F, Brault I. Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. BMC Nurs 2013; 12:7. [PMID: 23496961 PMCID: PMC3600011 DOI: 10.1186/1472-6955-12-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 02/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing's contribution most often remains invisible to policy-makers and managers. The objectives of this study were: 1) to develop a theoretically based framework to conceptualize nursing care performance; 2) to analyze how the different components of the framework have been operationalized in the literature; and 3) to develop a pool of indicators sensitive to various aspects of nursing care that can be used as a basis for designing a performance measurement system. METHODS We carried out a systematic review of published literature across three databases (MEDLINE, EMBASE and CINAHL), focusing on literature between 1990 and 2008. Screening of 2,103 papers resulted in final selection of 101 papers. A detailed template was used to extract the data. For the analysis, we used the method of interpretive synthesis, focusing first on 31 papers with theoretical or conceptual frameworks; the remaining 70 articles were used to strengthen and consolidate the findings. RESULTS Current conceptualizations of nursing care performance mostly reflect a system perspective that builds on system theory, Donabedian's earlier works on healthcare organization, and Parsons' theory of social action. Drawing on these foundational works and the evidence collated, the Nursing Care Performance Framework (NCPF) we developed conceptualizes nursing care performance as resulting from three nursing subsystems that operate together to achieve three key functions: (1) acquiring, deploying and maintaining nursing resources, (2) transforming nursing resources into nursing services, and (3) producing changes in patients' conditions. Based on the literature review, these three functions are operationalized through 14 dimensions that cover 51 variables. The NCPF not only specifies core aspects of nursing performance, it also provides decision-makers with a conceptual tool to serve as a common ground from which to define performance, devise a common and balanced set of performance indicators for a given sector of nursing care, and derive benchmarks for this sector. CONCLUSIONS The NCPF provides a comprehensive, integrated and theoretically based model that allows performance evaluation of both the overall nursing system and its subsystems. Such an approach widens the view of nursing performance to embrace a multidimensional perspective that encompasses the diverse aspects of nursing care.
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Affiliation(s)
| | | | - Marie-Pascale Pomey
- Department of Health Administration, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Francine Girard
- Faculty of Nursing, University of Montreal, Montreal, Canada
| | - Isabelle Brault
- Faculty of Nursing, University of Montreal, Montreal, Canada
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Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. BMC Nurs 2013. [PMID: 23496961 DOI: 10.1186/1472‐6955‐12‐7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing's contribution most often remains invisible to policy-makers and managers. The objectives of this study were: 1) to develop a theoretically based framework to conceptualize nursing care performance; 2) to analyze how the different components of the framework have been operationalized in the literature; and 3) to develop a pool of indicators sensitive to various aspects of nursing care that can be used as a basis for designing a performance measurement system. METHODS We carried out a systematic review of published literature across three databases (MEDLINE, EMBASE and CINAHL), focusing on literature between 1990 and 2008. Screening of 2,103 papers resulted in final selection of 101 papers. A detailed template was used to extract the data. For the analysis, we used the method of interpretive synthesis, focusing first on 31 papers with theoretical or conceptual frameworks; the remaining 70 articles were used to strengthen and consolidate the findings. RESULTS Current conceptualizations of nursing care performance mostly reflect a system perspective that builds on system theory, Donabedian's earlier works on healthcare organization, and Parsons' theory of social action. Drawing on these foundational works and the evidence collated, the Nursing Care Performance Framework (NCPF) we developed conceptualizes nursing care performance as resulting from three nursing subsystems that operate together to achieve three key functions: (1) acquiring, deploying and maintaining nursing resources, (2) transforming nursing resources into nursing services, and (3) producing changes in patients' conditions. Based on the literature review, these three functions are operationalized through 14 dimensions that cover 51 variables. The NCPF not only specifies core aspects of nursing performance, it also provides decision-makers with a conceptual tool to serve as a common ground from which to define performance, devise a common and balanced set of performance indicators for a given sector of nursing care, and derive benchmarks for this sector. CONCLUSIONS The NCPF provides a comprehensive, integrated and theoretically based model that allows performance evaluation of both the overall nursing system and its subsystems. Such an approach widens the view of nursing performance to embrace a multidimensional perspective that encompasses the diverse aspects of nursing care.
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Skirko JR, Weaver EM, Perkins J, Kinter S, Sie KCY. Modification and evaluation of a Velopharyngeal Insufficiency Quality-of-Life instrument. ACTA ACUST UNITED AC 2012; 138:929-35. [PMID: 23069823 DOI: 10.1001/2013.jamaoto.122] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To modify the existing 45-item Velopharyngeal Insufficiency (VPI) Quality-of-Life (QOL) instrument (VPIQL), to assess the modified instrument for reliability, and to provide further validation. DESIGN Validation convenience sample from a previously conducted pilot study. SETTING Two academic tertiary referral medical centers. PARTICIPANTS Deidentified data were used from 29 patients with VPI and 29 control patients aged 5 to 17 years and their parents. MAIN OUTCOME MEASURES Patients and parents completed the VPIQL and a generic pediatric QOL instrument (Pediatric Quality of Life Inventory, Version 4 [PedsQL4-0]). Twenty-two items were removed from the VPIQL for ceiling effects, floor effects, and redundancy to produce the modified instrument: the VPI Effects on Life Outcomes instrument (VELO). The VELO was tested for internal consistency (Cronbach α), discriminant validity (paired t test with control patients), and concurrent validity (Pearson correlation with the PedsQL4-0). These analyses were also completed for the parents. RESULTS The 45-item VPIQL was reduced to the 23-item VELO, which had excellent internal consistency (Cronbach α, .96 for parents and .95 for patients with VPI). The VELO also discriminated well between the patients with VPI and the control patients, with a mean (SD) score that was significantly lower (worse) for patients with VPI (67.6 [23.9]) than for control patients (97.0 [5.2]) (P < .001). The VELO total score was significantly correlated with the PedsQL4.0 (r = 0.73) among the patients with VPI. Similar results were seen in parent responses. CONCLUSIONS The VELO is a 23-item QOL instrument that was designed to measure and follow QOL in patients with VPI, with less burden than the original VPIQL. The VELO demonstrates internal consistency, discriminant validity, and concurrent validity with the PedsQL4-0.
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Affiliation(s)
- Jonathan R Skirko
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, 1959 Pacific St NE, PO Box 356515, Seattle, WA 98195, USA.
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Campos M, de Rezende CHA, Farnese VDC, da Silva CHM, Morales NMDO, Pinto RDMC. Translation, Cross-Cultural Adaptation, and Validation of the Parkinson's Disease Quality of Life Questionnaire (PDQL), the "PDQL-BR", into Brazilian Portuguese. ISRN NEUROLOGY 2011; 2011:954787. [PMID: 22389837 PMCID: PMC3263559 DOI: 10.5402/2011/954787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/12/2011] [Indexed: 11/29/2022]
Abstract
Translate, culturally adapt, and validate the “Parkinson's Disease Quality of Life” (PDQL) BR, into Brazilian Portuguese. Fifty-two patients answered the PDQL-BR. Twenty-one patients answered the PDQL-BR again 14 days later. The UPDRS and HY scale was applied. Validation was evaluated using psychometric properties, checking the quality of the data, reliability, and validity. Quality of the data was evaluated based on occurrence of ceiling and floor effects. Reliability was evaluated based on: internal consistency of an item, homogeneity, and reproducibility. Validation was checked through the evaluation of convergent and discriminatory validation. There was no ceiling and floor effect. When evaluating reliability, items 20, 30, and 37 showed correlation of 0.34, 0.26, and 0.37, respectively, to your scale; the other items was higher than 0.4. The alpha Cronbach coefficient was higher than 0.7 for most domains. There was good reproducibility. There were no meaningful changes in the PDQL-BR translation and cross-cultural adaptation.
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Affiliation(s)
- Marcos Campos
- Department of Post Graduate Health Sciences, School of Medicine, Federal University of Uberlandia, Avenue Pará No. 1720, 38405-320 Uberlandia, MG, Brazil
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[Pediatric health-related quality of life instrument. Part I: general guidelines for selection]. VOJNOSANIT PREGL 2008; 65:469-72. [PMID: 18672704 DOI: 10.2298/vsp0806469s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
<zakljucak> Ubrzan razvoj koncepta kvaliteta zivota u pedijatriji omogucio je razvoj velikog broja upitnika za njegovu procenu. Odabir pravog upitnika zahtevan je i slozen proces i svi koji ce ga koristiti moraju pri selekciji da obrate paznju na niz zahteva. Selekciju odredjuju precizno postavljen cilj, adekvatan dizajn procene (ili dizajn studije), odredjene karakteristike ispitanika i karakteristike upitnika. Ovi koraci, sa svim svojim elementima, znacajno su zavisni i medjusobno povezani. Ukoliko neki od njih bude izostavljen, neadekvatan upitnik moze biti znacajan izvor greske u proceni kvaliteta zivota, a narocito u poredjenju podataka dobijenih iz drugih izvora. Stoga, vazno je razumeti da kombinacija ovih atributa odredjuje populaciju za procenu, nacin i tip procene, rezultate i zakljucke procene, a ne samo upitnik za merenje kvaliteta zivota.
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Honer WG, Thornton AE, Sherwood M, MacEwan GW, Ehmann TS, Williams R, Kopala LC, Procyshyn R, Barr AM. Conceptual and methodological issues in the design of clinical trials of antipsychotics for the treatment of schizophrenia. CNS Drugs 2007; 21:699-714. [PMID: 17696571 DOI: 10.2165/00023210-200721090-00001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Schizophrenia is one of the most severe and disabling psychiatric disorders. Antipsychotic drugs offer considerable benefits in controlling symptoms and preventing relapse. The strategy for the present review of clinical trials was to ask 'What are the features of schizophrenia and the existing treatments of the illness that have implications for future clinical trials'? Six key facts were identified.First, schizophrenia is genetically 'complex'. Trials may benefit from designs including genetically related illnesses, by focussing on cross-cutting aspects of the phenotype such as psychosis or cognitive dysfunction, and by collecting information on possible moderators and mediators of treatment response.Second, schizophrenia affects multiple neurotransmitter systems. Multiple signalling pathways may need to be considered, with different time courses of response. Outcome measures from clinical trials could be collected at more frequent intervals, particularly in the early phase of response.Third, the clinical features used to define the illness are a mix of symptoms and social-occupational dysfunction, yet treatment response is often defined only by changes in symptoms. Multiple measures of functioning need to be collected at baseline and at the endpoint of trials. Consensus definitions for response, remission, relapse, recovery and recurrence need to be developed.Fourth, schizophrenia is often highly disabling. Linking treatment response in clinical trials to measures of quality-adjusted life-years will allow comparison with other medical illnesses using common metrics.Fifth, the general health and care of individuals with schizophrenia is often poor. 'Complex' interventions, which include, but are not limited to, antipsychotic medications, need to be designed and tested for the problems facing these patients.Finally, large gaps exist between clinical trials, practice guidelines and patterns of practice. Trials need to be designed to investigate widely used approaches such as antipsychotic polypharmacy, where actual practice diverges from evidence-based guidelines.
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Affiliation(s)
- William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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Raat H, Mangunkusumo RT, Mohangoo AD, Juniper EF, Van Der Lei J. Internet and written respiratory questionnaires yield equivalent results for adolescents. Pediatr Pulmonol 2007; 42:357-61. [PMID: 17335011 PMCID: PMC2737624 DOI: 10.1002/ppul.20576] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study compared results from Internet and written questionnaires about respiratory symptoms in order to find out if both forms of the survey yielded the same answers. One thousand seventy-one students, ages 13 to 17, were asked to complete either an Internet or a written questionnaire. The demographic characteristics of the participants equalled those of the general Dutch adolescent population. Participants were randomly assigned to fill out an electronic or written questionnaire. In addition to eight items from the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, two items on doctor visits (medical attention) regarding asthma or allergic disease during the past 12 months were included. The participation rate was 87%. The Internet version of the questionnaire showed fewer missing answers than the written version, but this was not statistically significant. The respiratory items did not show statistically significant score differences between the Internet and written modes of administration, and there was no visible trend for higher respectively lower scores by either mode of questionnaire administration. From these results, we conclude that respiratory questionnaires may be provided to adolescents electronically rather than on paper, since both approaches yielded equal results. To generalize these findings, we recommend repeated studies in other settings.
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Affiliation(s)
- H Raat
- Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Raat H, Landgraf JM, Oostenbrink R, Moll HA, Essink-Bot ML. Reliability and validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) in a general population and respiratory disease sample. Qual Life Res 2007; 16:445-60. [PMID: 17111231 PMCID: PMC2792359 DOI: 10.1007/s11136-006-9134-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 09/26/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate feasibility, internal consistency, test-retest reliability, and concurrent and discriminative validity of the Infant and Toddler Quality of Life Questionnaire (ITQOL) for parents of pre-school children with 12 scales (103-items) covering physical and psychosocial domains and impact of child health on parents, in comparison with the TNO-AZL Pre-school Children Quality of Life Questionnaire (TAPQOL). METHODS Parents of children from a random general population sample (2 months-4 years old; n = 500) and of an outpatient clinic sample of children with respiratory disease (5 months-[Formula: see text] years old; n = 217) were mailed ITQOL and TAPQOL questionnaires; a retest was sent after two weeks. RESULTS Feasibility: The response was >or=80% with few missing and non-unique ITQOL-answers (<2%) in both study populations. Some ITQOL-scales (3-4 scales) showed a ceiling effect (>25% at maximum score). Internal consistency: All Cronbach's alpha >0.70. Test-retest Intraclass Correlation Coefficients (ICCs) were moderate or adequate (>or=0.50; p < 0.01) for 10 ITQOL-scales. VALIDITY ITQOL-scales, with a few exceptions, correlated better with predefined parallel TAPQOL scales than with non-parallel scales. Five to eight ITQOL-scales discriminated clearly between children with few and with many parent-reported chronic conditions, between children with and without doctor-diagnosed respiratory disease and with a low and a high parent-reported medical consumption (p < 0.05). CONCLUSIONS This study supported the evidence that the ITQOL is a feasible instrument with adequate psychometric properties. The study provided reference ITQOL scores for gender/age subgroups. We recommend repeated evaluations of the ITQOL in varied populations, especially among very young children, including repeated assessments of test-retest characteristics and evaluations of responsiveness to change. We recommend developing and evaluating a shortened ITQOL version.
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Affiliation(s)
- Hein Raat
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, ZH, 3000, CA, The Netherlands.
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Atkinson MJ, Lohs J, Kuhagen I, Kaufman J, Bhaidani S. A promising method for identifying cross-cultural differences in patient perspective: the use of Internet-based focus groups for content validation of new patient reported outcome assessments. Health Qual Life Outcomes 2006; 4:64. [PMID: 16995935 PMCID: PMC1630423 DOI: 10.1186/1477-7525-4-64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 09/22/2006] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This proof of concept (POC) study was designed to evaluate the use of an Internet-based bulletin board technology to aid parallel cross-cultural development of thematic content for a new set of patient-reported outcome measures (PROs). METHODS The POC study, conducted in Germany and the United States, utilized Internet Focus Groups (IFGs) to assure the validity of new PRO items across the two cultures--all items were designed to assess the impact of excess facial oil on individuals' lives. The on-line IFG activities were modeled after traditional face-to-face focus groups and organized by a common 'Topic' Guide designed with input from thought leaders in dermatology and health outcomes research. The two sets of IFGs were professionally moderated in the native language of each country. IFG moderators coded the thematic content of transcripts, and a frequency analysis of code endorsement was used to identify areas of content similarity and difference between the two countries. Based on this information, draft PRO items were designed and a majority (80%) of the original participants returned to rate the relative importance of the newly designed questions. FINDINGS The use of parallel cross-cultural content analysis of IFG transcripts permitted identification of the major content themes in each country as well as exploration of the possible reasons for any observed differences between the countries. Results from coded frequency counts and transcript reviews informed the design and wording of the test questions for the future PRO instrument(s). Subsequent ratings of item importance also deepened our understanding of potential areas of cross-cultural difference, differences that would be explored over the course of future validation studies involving these PROs. CONCLUSION The use of IFGs for cross-cultural content development received positive reviews from participants and was found to be both cost and time effective. The novel thematic coding methodology provided an empirical platform on which to develop culturally sensitive questionnaire content using the natural language of participants. Overall, the IFG responses and thematic analyses provided a thorough evaluation of similarities and differences in cross-cultural themes, which in turn acted as a sound base for the development of new PRO questionnaires.
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Affiliation(s)
- Mark J Atkinson
- Worldwide Health Outcomes Research, La Jolla Laboratories, Pfizer Inc., San Diego, CA 92121, USA
- Health Services Research Center, USCD School of Medicine, La Jolla, CA 92093, USA
| | - Jan Lohs
- Lohs Research Group, Qualitative Marketing Research, 2170 West Freeman Road, Palatine, IL 60067, USA
| | - Ilka Kuhagen
- IKM International Qualitative Marketing Research, Ludwig-Ganghoferstr. 33, D-85551 Kirchheim/München, Germany
| | - Julie Kaufman
- Kaufman Associates, 6 Fennwood Drive, Atherton, CA 94027, USA
| | - Shamsu Bhaidani
- President and Chief Technical Officer, FocusForums™, Calgary, Alberta T3K 6J1, Canada
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Raat H, Botterweck AM, Landgraf JM, Hoogeveen WC, Essink-Bot ML. Reliability and validity of the short form of the child health questionnaire for parents (CHQ-PF28) in large random school based and general population samples. J Epidemiol Community Health 2005; 59:75-82. [PMID: 15598731 PMCID: PMC1763365 DOI: 10.1136/jech.2003.012914] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVES This study assessed the feasibility, reliability, and validity of the 28 item short child health questionnaire parent form (CHQ-PF28) containing the same 13 scales, but only a subset of the items in the widely used 50 item CHQ-PF50. DESIGN Questionnaires were sent to a random regional sample of 2040 parents of schoolchildren (4-13 years); in a random subgroup test-retest reliability was assessed (n = 234). Additionally, the study assessed CHQ-PF28 score distributions and internal consistencies in a nationwide general population sample of (parents of) children aged 4-11 (n = 2474) from Statistics Netherlands. MAIN RESULTS Response was 70%. In the school and general population samples seven scales showed ceiling effects. Both CHQ summary measures and one multi-item scale showed adequate internal consistency in both samples (Cronbach's alpha>0.70). One summary measure and one scale showed excellent test-retest reliability (intraclass correlation coefficient >0.70); seven scales showed moderate test-retest reliability (intraclass correlation coefficient 0.50-0.70). The CHQ could discriminate between a subgroup with no parent reported chronic conditions (n = 954) and subgroups with asthma (n = 134), frequent headaches (n = 42), and with problems with hearing (n = 38) (Cohen's effect sizes 0.12-0.92; p<0.05 for 39 of 42 comparisons). CONCLUSIONS This study showed that the CHQ-PF28 resulted in score distributions, and discriminative validity that are comparable to its longer counterpart, but that the internal consistency of most individual scales was low. In community health applications, the CHQ-PF28 may be an acceptable alternative for the longer CHQ-PF50 if the summary measures suffice and reliable estimates of each separate CHQ scale are not required.
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Affiliation(s)
- Hein Raat
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands.
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Bunge EM, Essink-Bot ML, Kobussen MPHM, van Suijlekom-Smit LWA, Moll HA, Raat H. Reliability and validity of health status measurement by the TAPQOL. Arch Dis Child 2005; 90:351-8. [PMID: 15781921 PMCID: PMC1720358 DOI: 10.1136/adc.2003.048645] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In addition to clinical measures in the evaluation of paediatric interventions, health related quality of life (HRQoL) is an important outcome. The TAPQOL (TNO-AZL Preschool children Quality of Life) was developed to measure HRQoL in preschool children. It is a generic instrument consisting of 12 scales that cover the domains physical, social, cognitive, and emotional functioning. AIMS To evaluate the feasibility, score distribution, internal consistency, test-retest reliability, and discriminative and concurrent validity of the TAPQOL multi-item scales in preschool children, aged 2-48 months. Also to evaluate the feasibility, reliability, and validity separately for infants (2-12 months old) and toddlers (12-48 months old). METHODS Parents of a random general population sample of 500 preschool children were sent a questionnaire by mail. A random subgroup of 159 parents who participated received a retest after two weeks. RESULTS The response rate was 83% at the test and 75% at the retest. There were few missing answers. Six scales showed ceiling effects. Nine scales had Cronbach's alphas >0.70. In general, score distributions and Cronbach's alphas were comparable for infants and toddlers. Test-retest showed no significant differences in mean scale scores; two scales had intra-class correlations <0.50. Five scales showed significant differences between children with no conditions versus children with two or more parent reported chronic conditions. CONCLUSION Results showed that the TAPQOL is a feasible instrument to measure HRQoL and support the reliability and discriminative validity of the majority of its scales for infants as well as toddlers.
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Affiliation(s)
- E M Bunge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands.
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Cook KF, Roddey TS, O'Malley KJ, Gartsman GM. Development of a Flexilevel Scale for use with computer-adaptive testing for assessing shoulder function. J Shoulder Elbow Surg 2005; 14:90S-94S. [PMID: 15726093 DOI: 10.1016/j.jse.2004.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In a 5-year study, a self-report measure of shoulder function-the Flexilevel Scale of Shoulder Function (FLEX-SF)-was developed by use of item response theory. A large pool of candidate items (N = 68) was developed. A questionnaire that included the 68 items, another scale of shoulder function, and clinical and demographic questions were administered to 400 persons with shoulder complaints. Patients' responses to the 68 items were calibrated by use of Andrich's rating scale model. Thirty-three items were selected from the pool and subdivided into three overlapping testlets targeting low, medium, and high shoulder function. A table translates raw scores on testlets to a common mathematical metric. The validity and reliability of the FLEX-SF was evaluated in a longitudinal study of 199 patients. The FLEX-SF scores were highly reliable and exhibited excellent validity (including responsiveness). We report on a simulation of a computer-adaptive test of shoulder function. This simulation is based on the developmental items we tested for use in the FLEX-SF. The results indicate that greater measurement efficiency can be achieved with a computer-adaptive test format.
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Affiliation(s)
- Karon F Cook
- Houston Veterans Affairs Parkinson's Research and Educational Center, Houston VAMC, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
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Monfared AAT, Lelorier J. Accuracy and validity of using medical claims data to identify episodes of hospitalizations in patients with COPD. Pharmacoepidemiol Drug Saf 2005; 15:19-29. [PMID: 16136613 DOI: 10.1002/pds.1131] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE In Quebec, MED-ECHO database can be used to estimate inhospital length of stay (LOS) and number of hospitalizations (NOH) both accurately and reliably. However, access to MED-ECHO database is time-consuming. Quebec medical claims database (RAMQ) can be used as an alternative source to estimate these measures. Considering MED-ECHO as the 'gold standard,' this study examined the validity of using RAMQ medical claims to estimate LOS and NOH. METHODS We used a cohort of 3768 elderly patients with chronic obstructive pulmonary disease (COPD) between 1990 and 1996 and identified those with inhospital claims. Inhospital LOS was defined as the total number of days with inhospital claims. Various grace periods (1-15 days) between consecutive claims were considered for the estimation of LOS and NOH. RAMQ and MED-ECHO databases were linked using unique patient identifiers. Estimates obtained from RAMQ data were compared to those from MED-ECHO using various measures of central tendency and predictive error estimates. RESULTS Overall, 32.7% of patients were hospitalized at least once during the study period based on RAMQ claims, as compared to 32.0% in MED-ECHO ( p-value = 0.51). The best estimates [mean (p-value)] were found to be those obtained when using a 7-day grace period. RAMQ versus MED-ECHO estimates were: 12.2 versus 13.5 days (< 0.001) for LOS and 3.6 versus 3.7 times (0.36) for NOH. CONCLUSIONS RAMQ medical claims can be used as a reliable source to estimate LOS and NOH, particularly when time and resources are restricted. RAMQ, however, should be used with caution since slight underestimations may occur.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Pharmacoepidemiology and Pharmacoeconomics Research Unit, Centre de Recherche, Campus Hôtel-Dieu, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Raat H, Bonsel GJ, Hoogeveen WC, Essink-Bot ML. Feasibility and reliability of a mailed questionnaire to obtain visual analogue scale valuations for health states defined by the Health Utilities Index Mark 3. Med Care 2004; 42:13-8. [PMID: 14713735 DOI: 10.1097/01.mlr.0000102297.06535.e7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To establish the generalizability (external validity) of the Health Utilities Index Mark 3 (HUI3) as a single-summary score generic outcome measure in numerous countries/subgroups (including children), repeated studies of community preferences should be performed in various settings. In performing multiple HUI3 studies, a mailed questionnaire approach, if feasible and reliable, might be substituted for oral interviews. In the present study, we assessed the feasibility and reliability of a mailed questionnaire approach originally developed for the EQ-5D, for the purpose of collecting Visual Analogue Scale (VAS) valuations from parents as surrogate responders for 65 pediatric HUI3 health states and for the state of being dead. Untransformed mean VAS scores of the health states and scores converted into preliminary Standard Gamble (SG)-utilities were compared with Canadian and French multiattribute utility estimates. A random sample of 1920 parents of schoolchildren (aged 4 to 13) received a mailed questionnaire. Each parent was asked to rate 6 HUI3 health states on a 0 to 100 VAS. Response was 70%. Mean completion time was 20 minutes (SD 9). The questionnaire was rated difficult by only 9%. The current format was, however, inappropriate for valuing the state of being dead. Interrater reliability of health state valuations was.87. Spearman's rank correlations, Pearson-R correlations and intra class correlation coefficients (ICCs) between untransformed VAS valuations and Canadian/French utility estimates were > or =.87. However, preliminary SG-utilities showed diminished ICCs (.71 to.72). The data support the feasibility and reliability of mailed HUI3 valuation questionnaires to a considerable extent, but further methodological studies regarding other formats and different populations are recommended.
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Affiliation(s)
- Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Hellmann DB, Uhlfelder ML, Stone JH, Jenckes MW, Cid MC, Guillevin L, Moreland L, Dellaripa PF, Hoffman GS, Merkel PA, Spiera R, Brown L, Hernández-Rodríguez J, Rubin HR. Domains of health-related quality of life important to patients with giant cell arteritis. Arthritis Care Res (Hoboken) 2003; 49:819-25. [PMID: 14673969 DOI: 10.1002/art.11464] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine aspects of quality of life (QOL) important to people with giant cell arteritis (GCA). METHODS We explored the domains of QOL affected by GCA in audiotaped focus groups. We then created an Importance Rating Questionnaire (IRQ) by constructing questions related to the domains most frequently mentioned. Of 214 GCA patients to whom the IRQ was sent, 145 (68%) responded. We calculated frequencies of responses and then ranked items by the proportion selecting the top category of importance and also according to a mean item rank. We compared the domains of QOL covered by the IRQ with those in the Short Form 12 (SF-12). RESULTS The highest rated QOL item was "losing sight in both eyes permanently." Of the top 20 items, 12 were in domains not covered directly by the SF-12. CONCLUSION We have identified aspects of QOL important to GCA patients. Assessment of QOL in GCA should include vision and other domains that are not included in standard QOL questionnaires.
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Affiliation(s)
- David B Hellmann
- Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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Terwee CB, Dekker FW, Wiersinga WM, Prummel MF, Bossuyt PMM. On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation. Qual Life Res 2003; 12:349-62. [PMID: 12797708 DOI: 10.1023/a:1023499322593] [Citation(s) in RCA: 458] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A lack of clarity exists about the definition and adequate approach for evaluating responsiveness. An overview is presented of different categories of definitions and methods used for calculating responsiveness identified through a literature search. Twenty-five definitions and 31 measures were found. When applied to a general and a disease-specific quality of life questionnaire large variation in results was observed, partly explained by different goals of existing methods. Four major issues are considered to claim the usefulness of an evaluative health-related quality of life (HRQL) instrument. Their relation with responsiveness is discussed. The confusion about responsiveness arises mostly from a lack of distinction between cross-sectional and longitudinal validity and from a lack of distinction between responsiveness defined as the effect of treatment and responsiveness defined as the correlation of changes in the instrument with changes in other measures. All measures of what is currently called responsiveness can be looked at as measures of longitudinal validity or as measures of treatment effect. The latter ones tell us little about how well the instrument serves its purpose and are only of use in interpreting score changes. We therefore argue that the concept of responsiveness can be rejected as a separate measurement property of an evaluative instrument.
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Affiliation(s)
- C B Terwee
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Sywak MS, Knowlton ST, Pasieka JL, Parsons LL, Jones J. Do the National Institutes of Health consensus guidelines for parathyroidectomy predict symptom severity and surgical outcome in patients with primary hyperparathyroidism? Surgery 2002; 132:1013-9; discussion 1019-20. [PMID: 12490849 DOI: 10.1067/msy.2002.128693] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The National Institutes of Health (NIH) consensus guidelines for parathyroidectomy in primary hyperparathyroidism were developed addressing only the classic symptoms and physiologic markers of hyperparathyroidism. The purpose of this study was to assess whether NIH guidelines predict the severity of all symptoms and the outcome of operation. METHODS Symptom severity measurements using a disease-specific outcome tool called the parathyroidectomy assessment of symptoms (PAS) scores were previously obtained in patients with hyperparathyroidism. Patients were retrospectively stratified into 2 groups: group A, in which 1 or more of the NIH guidelines were met; and group B. in which operation was performed without any of the NIH criteria. For comparison, group C consisted of patients with non-toxic thyroid disease. PAS scores were collected preoperatively, and at 7 days, 3 months, and 12 months postoperatively. RESULTS There were 95 patients in group A, 22 in group B, and 58 in group C. The median preoperative PAS scores for group A (354) and B (301) were not significantly different, however, both were more symptomatic than group C (176, P <.01). After parathyroidectomy, patients in both group A and B had a significant improvement in their PAS scores (A=177 and B=130, P <.05). CONCLUSIONS Patients with no NIH criteria for operation are equally symptomatic compared with those who meet the NIH guidelines. Parathyroidectomy significantly improved these symptoms whether or not the patient met the NIH consensus guidelines.
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Affiliation(s)
- Mark S Sywak
- Department of Surgery, Divisions of General Surgery and Surgical Oncology, University of Calgary, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9
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Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, Stein RE. Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 2002; 11:193-205. [PMID: 12074258 DOI: 10.1023/a:1015291021312] [Citation(s) in RCA: 1687] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The field of health status and quality of life (QoL) measurement - as a formal discipline with a cohesive theoretical framework, accepted methods, and diverse applications--has been evolving for the better part of 30 years. To identify health status and QoL instruments and review them against rigorous criteria as a precursor to creating an instrument library for later dissemination, the Medical Outcomes Trust in 1994 created an independently functioning Scientific Advisory Committee (SAC). In the mid-1990s, the SAC defined a set of attributes and criteria to carry out instrument assessments; 5 years later, it updated and revised these materials to take account of the expanding theories and technologies upon which such instruments were being developed. This paper offers the SAC's current conceptualization of eight key attributes of health status and QoL instruments (i.e., conceptual and measurement model; reliability; validity; responsiveness; interpretability; respondent and administrative burden; alternate forms; and cultural and language adaptations) and the criteria by which instruments would be reviewed on each of those attributes. These are suggested guidelines for the field to consider and debate; as measurement techniques become both more familiar and more sophisticated, we expect that experts will wish to update and refine these criteria accordingly.
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Abstract
Hand surgeons currently are challenged with the task of measuring and establishing the connection between the diagnosis and treatment of health-related quality-of-life problems. Although true quality of life cannot be measured directly, instruments in the form of questionnaires have been developed that use self-reporting to account for functional performance, health status, and health-related quality of life. Instruments must be reliable, valid, responsive, and appropriate. Misunderstanding these properties often hinders interpreting the recent stream of outcome studies in the literature. Most physicians are not sure what if any outcome information should be collected routinely or if any outcome instrument is diagnostically useful. Currently there is no convincing evidence to support the routine use of patient-based outcome measures in hand surgeons' practices. Those hand surgeons who would like to carry out an outcome study should consider seeking help from others with expertise in outcomes design and analysis.
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Affiliation(s)
- R M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA 95817, USA
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Abstract
Although it is well documented that obesity is strongly associated with morbidity and mortality, less is known about the impact of obesity on functional status and health-related quality of life (HRQL). However, in recent years research has been conducted to estimate the impact of obesity on HRQL, and to determine the effects of weight reduction on HRQL. The majority of published studies indicate that obesity impairs HRQL, and that higher degrees of obesity are associated with greater impairment. Obesity-associated decrements on HRQL tend to be most pronounced on physical domains of functioning. Studies of the effect of obesity surgery among morbidly obese patients indicate that this procedure produces significant and sustained improvements in the majority of HRQL indices; among mild-to-moderately obese persons, modest weight reduction derived from lifestyle modification also appears to improve HRQL, at least in the short term. Additional research is needed to (1) further characterize the effect that obesity has on HRQL; (2) estimate the short- and long-term effects of various methods of weight reduction (e.g. surgery, lifestyle modification) on HRQL; (3) improve both the conceptualization and measurement of HRQL to incorporate the personal preferences and values of the patient; and (4) develop ways to enhance and sustain positive changes in HRQL, even if weight maintenance is elusive.
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Affiliation(s)
- K R Fontaine
- Division of Gerontology, Department of Medicine, University of Maryland School of Medicine, Geriatric Research Education and Clinical Center (GRECC), Baltimore VA Medical Center, Baltimore, MD, USA.
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