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Woolf B, Pedder H, Rodriguez-Broadbent H, Edwards P. Silence is golden, but my measures still see-why cheaper-but-noisier outcome measures in large simple trials can be more cost-effective than gold standards. Trials 2024; 25:532. [PMID: 39128997 PMCID: PMC11318131 DOI: 10.1186/s13063-024-08374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of using cheaper-but-noisier outcome measures, such as a short questionnaire, for large simple clinical trials. BACKGROUND To detect associations reliably, trials must avoid bias and random error. To reduce random error, we can increase the size of the trial and increase the accuracy of the outcome measurement process. However, with fixed resources, there is a trade-off between the number of participants a trial can enrol and the amount of information that can be collected on each participant during data collection. METHODS To consider the effect on measurement error of using outcome scales with varying numbers of categories, we define and calculate the variance from categorisation that would be expected from using a category midpoint; define the analytic conditions under which such a measure is cost-effective; use meta-regression to estimate the impact of participant burden, defined as questionnaire length, on response rates; and develop an interactive web-app to allow researchers to explore the cost-effectiveness of using such a measure under plausible assumptions. RESULTS An outcome scale with only a few categories greatly reduced the variance of non-measurement. For example, a scale with five categories reduced the variance of non-measurement by 96% for a uniform distribution. We show that a simple measure will be more cost-effective than a gold-standard measure if the relative increase in variance due to using it is less than the relative increase in cost from the gold standard, assuming it does not introduce bias in the measurement. We found an inverse power law relationship between participant burden and response rates such that a doubling the burden on participants reduces the response rate by around one third. Finally, we created an interactive web-app ( https://benjiwoolf.shinyapps.io/cheapbutnoisymeasures/ ) to allow exploration of when using a cheap-but-noisy measure will be more cost-effective using realistic parameters. CONCLUSION Cheaper-but-noisier questionnaires containing just a few questions can be a cost-effective way of maximising power. However, their use requires a judgement on the trade-off between the potential increase in risk of information bias and the reduction in the potential of selection bias due to the expected higher response rates.
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Affiliation(s)
- Benjamin Woolf
- Department of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK.
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Faculty of Epidemiology and Population Health, London, School of Hygiene and Tropical Medicine , London, UK.
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK.
| | - Hugo Pedder
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Phil Edwards
- Faculty of Epidemiology and Population Health, London, School of Hygiene and Tropical Medicine , London, UK
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Yaran M, Kent AE, İlhanlı İ. The validity and reliability of the Turkish version of the Community Integration Measure in patients with chronic stroke. Disabil Rehabil 2024; 46:3457-3461. [PMID: 37578095 DOI: 10.1080/09638288.2023.2246368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To translate and cross-culturally adapt The Community Integration Measure into Turkish (CIM-T) and to assess its reliability and validity in patients with chronic stroke. PATIENTS AND METHODS Fifty participants completed the CIM-T, Community Integration Questionnaire (CIQ) and the London Handicap Scale (LHS). All participants completed the CIM-T questionnaire twice in 7 days. The internal consistency of the CIM-T was assessed using Cronbach's alpha, while the Intraclass Correlation Coefficient (ICC) was used to evaluate test-retest reliability. The convergent validity of CIM-T was determined with CIQ and LHS by using Pearson's and Spearman's correlation coefficient analysis. RESULTS The CIM-T demonstrated high internal consistency (Cronbach's α = 0.955) and test-retest reliability (ICC= 0.992). The CIM-T showed a good correlation with CIQ (R = 0.727, p < 0.001) and LHS (R = 0.694, p < 0.001). CONCLUSION The Turkish version of CIM is a valid and reliable instrument for assessing chronic stroke patients. It is a preferable scale for the clinical evaluation of Turkish-speaking patients with chronic stroke.
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Affiliation(s)
- Mahmut Yaran
- Faculty of Health Sciences, Department of Orthotics and Prosthetics, Ondokuz Mayıs University, Samsun, Turkey
| | - Ali Erman Kent
- Faculty of Health Sciences, Department of Audiology, Ondokuz Mayıs University, Samsun, Turkey
| | - İlker İlhanlı
- Faculty of Medicine, Department of Physical Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Silva DP, Coelho M, Soares T, Vale TC, Correia Guedes L, Maciel ROH, Antunes AP, Camargos ST, Valadas A, Godinho C, Maia DP, Pita Lobo P, Maia RD, Teodoro T, Rieder CR, Velon AG, Tumas V, Barbosa ER, Teive HA, Ferraz HB, Rosas MJ, Calado A, Lampreia T, Simões R, Vila‐Chã N, Costa MM, Rodrigues AM, Caniça V, Cardoso F, Ferreira JJ. Handicap as a Measure of Perceived-Health Status in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1172-1180. [PMID: 37635780 PMCID: PMC10450228 DOI: 10.1002/mdc3.13826] [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: 01/04/2023] [Revised: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Handicap is a patient-centered measure of health status that encompasses the impact of social and physical environment on daily living, having been assessed in advanced and late-stage Parkinson's Disease (PD). Objective To characterize the handicap of a broader sample of patients. Methods A cross-sectional study of 405 PD patients during the MDS-UPDRS Portuguese validation study, using the MDS-UPDRS, Unified Dyskinesias Rating Scale, Nonmotor symptoms questionnaire, PDQ-8 and EQ-5D-3L. Handicap was measured using the London Handicap Scale (LHS). Results Mean age was 64.42 (±10.3) years, mean disease duration 11.30 (±6.5) years and median HY 2 (IQR, 2-3). Mean LHS was 0.652 (±0.204); "Mobility," "Occupation" and "Physical Independence" were the most affected domains. LHS was significantly worse in patients with longer disease duration, older age and increased disability. In contrast, PDQ-8 did not differentiate age groups. Handicap was significantly correlated with disease duration (r = -0.35), nonmotor experiences of daily living (EDL) (MDS-UPDRS-I) (r = -0.51), motor EDL (MDS-UPDRS-II) (r = -0.69), motor disability (MDS-UPDRS-III) (r = -0.49), axial signs of MDS-UPDRS-III (r = -0.55), HY (r = -0.44), presence of nonmotor symptoms (r = -0.51) and PDQ-8 index (r = -0.64) (all P < 0.05). Motor EDL, MDS-UPDRS-III and PDQ-8 independently predicted Handicap (adjusted R 2 = 0.582; P = 0.007). Conclusions The LHS was easily completed by patients and caregivers. Patients were mild-moderately handicapped, which was strongly determined by motor disability and its impact on EDL, and poor QoL. Despite correlated, handicap and QoL seem to differ in what they measure, and handicap may have an added value to QoL. Handicap seems to be a good measure of perceived-health status in a broad sample of PD.
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Affiliation(s)
- Daniela Pimenta Silva
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
| | - Miguel Coelho
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | | | | | - Leonor Correia Guedes
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | | | - Ana Patrícia Antunes
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
| | | | - Anabela Valadas
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM)
| | - Débora Palma Maia
- Movement Disorders UnitFederal University of Minas GeraisBelo HorizonteBrazil
| | - Patrícia Pita Lobo
- Department of Neurosciences and Mental HealthHospital de Santa Maria, CHULNLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
| | - Raphael Doyle Maia
- Movement Disorders Unit, Hospital Universitário Cassiano Antônio MoraesFederal University of Espírito SantoEspírito SantoBrazil
| | - Tiago Teodoro
- Instituto de Medicina MolecularLisbonPortugal
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals National Health Service Foundation TrustLondonUnited Kingdom
- Neuroscience Research Centre, Institute of Molecular and Clinical SciencesSt. George's University of LondonLondonUK
| | - Carlos R. Rieder
- Movement Disorders UnitHospital Santa Casa de Misericórdia de Porto AlegrePorto AlegreBrazil
- Federal University of Health Sciences of Porto AlegrePorto AlegreBrazil
| | - Ana Graça Velon
- Serviço de Neurologia do Centro Hospitalar de Trás‐os‐Montes e Alto DouroVila RealPortugal
| | - Vítor Tumas
- Department of Neuroscience and Behavior Sciences, Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Faculdade de MedicinaDepartamento de Neurologia, Centro de Distúrbios do MovimentoSão PauloBrazil
| | - Hélio A.G. Teive
- Department of NeurologyUniversidade Federal do ParanáCuritibaBrazil
| | | | | | - Ana Calado
- Serviço de Neurologia do Centro Hospitalar de Lisboa CentralLisbonPortugal
| | - Tânia Lampreia
- Serviço de NeurologiaHospital Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Rita Simões
- Serviço de NeurologiaHospital Beatriz ÂngeloLisbonPortugal
| | - Nuno Vila‐Chã
- Serviço de Neurologia do Hospital de Santo António, Centro Hospitalar Universitário do PortoPortoPortugal
| | - Maria Manuela Costa
- Serviço de NeurologiaHospital Pedro HispanoMatosinhosPortugal
- Serviço de NeurologiaHospital das Forças ArmadasPortoPortugal
| | | | | | - Francisco Cardoso
- Movement Disorders UnitFederal University of Minas GeraisBelo HorizonteBrazil
| | - Joaquim J. Ferreira
- CNS – Campus NeurológicoTorres VedrasPortugal
- Laboratory of Clinical Pharmacology, Faculty of MedicineUniversity of LisbonLisbonPortugal
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Kleftouris G, Tosounidis TH, Panteli M, Gathen M, Giannoudis PV. Endovis Nail versus Dynamic Hip Screw for Unstable Pertrochanteric Fractures: A Feasibility Randomised Control Trial including Patients with Cognitive Impairment. J Clin Med 2023; 12:4237. [PMID: 37445271 DOI: 10.3390/jcm12134237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
A prospective, feasibility, randomised study was performed to compare intramedullary versus extramedullary fixation of unstable pertrochanteric fractures and to assess the feasibility of including patients with dementia. From July 2016 to November 2017, 60 consecutive patients with an unstable pertrochanteric (OTA/AO 31-A2) fracture were randomized to either receive a short cephalomedullary nail (Endovis EBA2, Citieffe) or a dynamic hip screw (DHS, Zimmer Biomet). Primary feasibility measures included randomisation, recruitment, and retention rates. Secondary outcomes included peri-operative parameters, patient-reported outcomes and radiographic outcomes. Patients were followed-up at two, four, and twelve weeks. There was no difference in the randomisation rate between patients with and without cognitive impairment. Significantly more patients without cognitive impairment attended the 12-week follow-up. The overall recruitment rate was 0.9 patients per week. Patients treated with the nail had less pain at 2 weeks and less neck collapse, medialisation, and leg shortening at all time points. The rest of secondary outcomes were similar. Patients with dementia can successfully be enrolled in a randomised trial on hip fractures. Patients treated with the Endovis nail had lower levels of pain at two weeks and better radiographic outcomes.
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Affiliation(s)
- George Kleftouris
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK
| | - Theodoros H Tosounidis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Michalis Panteli
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK
| | - Martin Gathen
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK
- NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds LS7 4SA, UK
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Sagar R, Sen MS, Kumar N, Chawla N. Longitudinal assessment of disability amongst patients of bipolar and unipolar depressive disorders presenting to a tertiary care center in North India. Int J Soc Psychiatry 2023; 69:70-77. [PMID: 34996324 DOI: 10.1177/00207640211070158] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess and compare the changes in disability scores associated with Bipolar Depression (BD) and Unipolar Depression (UD) over 1 year. METHODS A longitudinal study was taken up in adults diagnosed with unipolar or bipolar depressive disorder with current depressive episode. Diagnosis was made according to Schedule for Clinical Assessment in Neuropsychiatry. Severity scoring was done using Hamilton's Depression (HAM-D) rating scale and Hamilton's Anxiety (HAM-A) rating scale. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) and London handicap Scale (LHS) at baseline, 6 and 12 months. RESULTS Sixty participants were recruited (42 UD and 18 BD). No significant differences were seen in socio-demographic parameters, except higher education levels and males being overrepresented in UD. Significant differences at baseline were seen in HAM-D (p = .001) and HAM-A (p = .003) scores. The extent of disability was seen to correlate with severity of illness only in case of BD at baseline. No significant differences were seen in the IDEAS scores at baseline. IDEAS score improved at each follow-up assessment (p < .001). LHS showed significant improvement over time in UD (p < .001), but not BD (p = .076). Percentage individuals meeting cut-off for benchmark disability (>40%) were comparable at baseline but were significantly more in the BD at 12-months (p = .049). CONCLUSION AND IMPLICATIONS Disability in psychiatry occurs equally amongst unipolar and bipolar depressive disorders and tends to improve over time, although the level of improvement may differ. It may not always correspond to severity of illness. These factors should be considered while certifying disability.
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Affiliation(s)
- Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mahadev Singh Sen
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Nishtha Chawla
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Conjoint Analysis: A Research Method to Study Patients’ Preferences and Personalize Care. J Pers Med 2022; 12:jpm12020274. [PMID: 35207762 PMCID: PMC8879380 DOI: 10.3390/jpm12020274] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
This article aims to describe the conjoint analysis (CA) method and its application in healthcare settings, and to provide researchers with a brief guide to conduct a conjoint study. CA is a method for eliciting patients’ preferences that offers choices similar to those in the real world and allows researchers to quantify these preferences. To identify literature related to conjoint analysis, a comprehensive search of PubMed (MEDLINE), EMBASE, Web of Science, and Google Scholar was conducted without language or date restrictions. To identify the trend of publications and citations in conjoint analysis, an online search of all databases indexed in the Web of Science Core Collection was conducted on the 8th of December 2021 without time restriction. Searching key terms covered a wide range of synonyms related to conjoint analysis. The search field was limited to the title, and no language or date limitations were applied. The number of published documents related to CA was nearly 900 during the year 2021 and the total number of citations for CA documents was approximately 20,000 citations, which certainly shows that the popularity of CA is increasing, especially in the healthcare sciences services discipline, which is in the top five fields publishing CA documents. However, there are some limitations regarding the appropriate sample size, quality assessment tool, and external validity of CA.
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Orman Z, Thrift AG, Olaiya MT, Ung D, Cadilhac DA, Phan T, Nelson MR, Srikanth VK, Vuong J, Bladin CF, Gerraty RP, Fitzgerald SM, Frayne J, Kim J. Quality of life after stroke: a longitudinal analysis of a cluster randomized trial. Qual Life Res 2022; 31:2445-2455. [DOI: 10.1007/s11136-021-03066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
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De Sousa Peixoto R, Krstic L, Hill SCL, Foss AJE. Predicting quality of life in AMD patients-insights on the new NICE classification and on a bolt-on vision dimension for the EQ-5D. Eye (Lond) 2021; 35:3333-3341. [PMID: 33526850 DOI: 10.1038/s41433-021-01414-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/25/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIMS Health-related quality of life (HRQoL) in age-related macular degeneration (AMD) is difficult to estimate as most generic tools underestimate vision. Our aim was to measure the effect of AMD on generic and visual quality of life and how it relates to handicap. We also aimed to validate the NG82 NICE AMD classification. Finally, we studied if a bolt-on visual domain increased the EQ-5D sensitivity to AMD. PATIENTS AND METHODS Ninety-six patients with AMD participated in this observational cross-sectional study. Visual (VF-14) and generic questionnaires (EQ-5D) with VIS, and the London handicap scale (LHS) was used to quantify HRQoL and handicap. ANOVA and regression analysis were used to identify significant associations. RESULTS Visual dysfunction in AMD has a significant effect in VF-14 (P < 0.001), LHS (p < 0.001), and EQ-5D (p = 0.015). The EQ-5D was less sensitive than the VF-14 and LHS and was not significantly correlated with the VIS bolt-on domain (p = 0.608). On the other hand, VIS was significantly associated with visual acuity (p < 0.001), AMD diagnosis (p = 0.005), VF-14 (p < 0.001), and LHS (p < 0.001). The new AMD classification was a good predictor of visual HRQoL and had an excellent association with visual acuity in the best eye. CONCLUSION This article shows that visual impairment is associated with lower HRQoL and with an increased handicap. It also suggests that a visual dimension may increase the EQ-5D sensitivity in AMD. There was a relationship between visual impairment and handicap with the items of the new NICE AMD classification, which supports its use.
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Affiliation(s)
- Ricardo De Sousa Peixoto
- Department of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Lazar Krstic
- Department of Medical Education, University of Nottingham, Nottingham, UK
| | - Sophie C L Hill
- Department of Ophthalmology, Greenland Clinical Centre, Auckland, New Zealand
| | - Alexander J E Foss
- Department of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Veillard D, Baumstarck K, Edan G, Debouverie M, Wiertlewski S, De Sèze J, Clavelou P, Pelletier J, Verny C, Chauvin K, Cosson ME, Loundou A, Auquier P. Assessing the experience of the quality of care of patients living with multiple sclerosis and their caregivers: The MusiCare questionnaire. Eur J Neurol 2021; 28:910-920. [PMID: 33326668 DOI: 10.1111/ene.14685] [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: 10/12/2020] [Revised: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Patients with a chronic illness, such as multiple sclerosis (MS), and their natural caregivers have a specific experience of healthcare and health services. These experiences need to be assessed to evaluate the quality of care. Our objective was to develop a French-language questionnaire to evaluate the quality of care as experienced by MS patients and their natural caregivers. METHODS Eligible patients had been diagnosed with MS according to the McDonald criteria. Eligible caregivers were individuals designated by the patients. The MusiCare questionnaire was developed in two standard phases: (i) item generation, based on interviews with patients and caregivers; and (ii) validation, consisting of validity, reliability, external validity, reproducibility, and responsiveness measures. RESULTS In total, 1088 patients (n = 660) and caregivers (n = 488) were recruited. The initial 64-item version of MusiCare was administered to a random subsample (n = 748). The validation process generated a 35-item questionnaire. Internal consistency and scalability were satisfactory. Testing of the external validity revealed expected associations between MusiCare scores and sociodemographic and clinical data. The questionnaire showed good reproducibility and responsiveness. CONCLUSIONS The availability of a reliable and validated French-language self-report questionnaire probing the experience of the quality of care for MS will allow the feedback of patients and caregivers to be incorporated into a continuous healthcare quality-improvement strategy.
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Affiliation(s)
- David Veillard
- Public Health and Epidemiology Department, Rennes University Hospital, Rennes, France.,Public Health: Quality of Life and Chronic Diseases EA3279, Aix-Marseille University, Marseille, France
| | - Karine Baumstarck
- Public Health: Quality of Life and Chronic Diseases EA3279, Aix-Marseille University, Marseille, France
| | - Gilles Edan
- Clinical Neuroscience Centre, CIC-P 1414 INSERM, Rennes University Hospital, Rennes, France
| | - Marc Debouverie
- CIC-EC Inserm CIC 1433, Nancy University Hospital, Nancy, France
| | | | - Jérôme De Sèze
- Neurology Department, Strasbourg University Hospital, Strasbourg, France
| | - Pierre Clavelou
- Neurology Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean Pelletier
- Neurology Department, Marseille University Hospital AP-HM, Marseille, France
| | - Christophe Verny
- Neurology Department, Angers University Hospital, Angers, France
| | - Karine Chauvin
- Public Health and Epidemiology Department, Rennes University Hospital, Rennes, France
| | | | - Anderson Loundou
- Public Health: Quality of Life and Chronic Diseases EA3279, Aix-Marseille University, Marseille, France
| | - Pascal Auquier
- Public Health: Quality of Life and Chronic Diseases EA3279, Aix-Marseille University, Marseille, France
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Denu ZA, Yassin MO, Bisetegn TA, Biks GA, Gelaye KA. The 12 items Amharic version WHODAS-2 showed cultural adaptation and used to measure disability among road traffic trauma victims in Ethiopia. BMC Psychol 2021; 9:1. [PMID: 33388086 PMCID: PMC7777354 DOI: 10.1186/s40359-020-00492-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adapting and translating already developed tools to different cultures is a complex process, but once done, it increases the validity of the construct to be measured. This study aimed to assess the 12 items WHODAS-2 and test its psychometric properties among road traffic injury victims in Ethiopia. This study aimed to translate the 12 items WHODAS- 2 interview-based tools into Amharic and examine the psychometric properties of the new version among road traffic injury victims. METHODS The 12 items WHODAS 2 was first translated into Amharic by two experts. Back translation was done by two English experts. A group of experts reviewed the forward and backward translation. A total of 240 patients with road traffic injury completed the questionnaires at three selected Hospitals in Amhara Regional State. Internal consistency was; assessed using Chronbach's alpha, convergent, and divergent validity, which were; tested via factor analysis. Confirmatory factor analysis (CFA); was computed, and the model fit; was examined. RESULTS The translated Amharic version 12 -items WHODAS-2 showed that good cross-cultural adaptation and internal consistency (Chronbach's α =0.88). The six factor structure best fits data (model fitness indices; CFI = 0.962, RMSEA = 0.042, RMR = 0.072, GFI = 0.961, chi-square value/degree of freedom = 1.42, TLI = 0.935 and PCLOSE = 0.68). Our analysis showed that from the six domains, mobility is the dominant factor explaining 95% of variability in disability. CONCLUSION The 12 items interview-based Amharic version WHODAS-2; showed good cultural adaptation at three different settings of Amhara Regional State and can be used to measure dis-ability following a road traffic injury.
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Affiliation(s)
- Zewditu Abdissa Denu
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mensur Osman Yassin
- Department of Surgery, School of Medicine College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale Bisetegn
- Department of Health Communication and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health Policy and Management, Institute of Public health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Björk M, Bergström M, Sverker A, Brodin N. Measures of Participation in Persons With Musculoskeletal Conditions. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:486-498. [PMID: 33091247 DOI: 10.1002/acr.24226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Affiliation(s)
- M Björk
- Linköping University, Linköping, Sweden
| | - M Bergström
- Linköping University, Norrköping Campus, Norrköping, Sweden
| | - A Sverker
- Linköping University, Linköping, Sweden
| | - N Brodin
- Karolinska Institutet, Huddinge, Sweden, and Danderyd Hospital, Stockholm, Sweden
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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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13
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Scrivener K, Alava Bravo K, Greely B, Heidema M, Violi A, Young N. An ongoing physiotherapist-led exercise program in residential aged care: Description of participant satisfaction and outcomes. Australas J Ageing 2020; 39:359-365. [PMID: 32506741 DOI: 10.1111/ajag.12804] [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: 10/15/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study documents aged care residents' outcomes after, and satisfaction with, participation in a rehabilitation program conducted in a co-located gym. METHODS A mixed-method prospective cohort study was conducted. All residents who attended the program were invited to participate in the study. Demographic information and outcome measures (walking speed, mobility, ability to stand, exercise self-efficacy and health status) were documented on study commencement and again after 6 months. RESULTS Thirty-eight participants were included with an average age of 83 years (SD 13). The majority of participants (61%) required physical assistance for mobility. Compliance with scheduled sessions was 94%. Most (92%) participants would recommend the program. The majority of participants (55%) experienced improved walking speed as measured by the 5-metre walk test. CONCLUSIONS The results suggest that a rehabilitative program can maintain the physical status of aged care residents, despite the common decline in physical performance in this population.
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Affiliation(s)
- Katharine Scrivener
- Macquarie University, Sydney, NSW, Australia.,Concentric Rehabilitation Centre, Sydney, NSW, Australia
| | - Katherine Alava Bravo
- Macquarie University, Sydney, NSW, Australia.,Concentric Rehabilitation Centre, Sydney, NSW, Australia
| | | | | | - Angeline Violi
- Concentric Rehabilitation Centre, Sydney, NSW, Australia
| | - Nicholas Young
- Concentric Rehabilitation Centre, Sydney, NSW, Australia
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14
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Exploring the efficacy of housing alternatives for adults with an acquired brain or spinal injury: A systematic review. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Housing for people with acquired brain injury (ABI) or spinal cord injury (SCI) remains a significant issue in Australia and internationally. This review examined the current research evidence regarding the efficacy of housing alternatives for adults with ABI or SCI in relation to four principal outcomes of interest: the person’s (1) community integration/participation, (2) independence, (3) psychosocial well-being and (4) quality of life. The review also sought to identify how the reported efficacy of the housing alternatives might be impacted by individual factors.Method:For this systematic review, quantitative empirical, peer-reviewed research published after 1 January 2003 was sought. Ten journal articles met the eligibility criteria. None of the included studies comprised an adult SCI sample.Results:The research identified lower levels of community integration/participation, independence, psychosocial well-being and quality of life for adults (particularly younger adults) with ABI living in ‘structured settings’ (i.e., residential care) compared to those living in ‘home-like’ environments (i.e., private homes) and ‘disability-specific’ settings (i.e., shared supported accommodation, group homes, foster care homes, cluster units).Conclusion:More research is needed to compare ‘home-like’ and ‘disability-specific’ settings, and individual housing models more generally (i.e., living at home with friends vs with family vs living in shared supported accommodation vs living in residential care). This review identified a number of limitations in the current evidence base and several important directions for future research. Policymakers, architects, designers, builders, developers, funding agencies, international researchers as well as people with ABI or SCI and their families may benefit from the findings of this review.
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15
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Broussy S, Rouanet F, Lesaine E, Domecq S, Kret M, Maugeais M, Aly F, Dehail P, Bénard A, Wittwer J, Salamon R, Sibon I, Saillour-Glenisson F. Post-stroke pathway analysis and link with one year sequelae in a French cohort of stroke patients: the PAPASePA protocol study. BMC Health Serv Res 2019; 19:770. [PMID: 31665006 PMCID: PMC6820977 DOI: 10.1186/s12913-019-4522-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is a health problem with serious consequences, both in terms of mortality, and after-effects affecting patient quality of life. Stroke requires both urgent and chronic management involving the entire health care system. Although large variability in the management of stroke patients have been noticed, knowledge of the diversity and the scalability of post-stroke pathways, whether it is the care pathway or the life pathway, is currently not sufficient. Moreover the link between post-stroke pathways and patients sequelae have not been yet clearly defined. All this information would be useful to better target the needs to improve stroke patient management. The purposes are to identify the post-stroke life pathways components associated with sequelae (activity limitations – main purpose, cognitive disorders, anxio-depressive disorders, fatigue, participation restrictions) at 3 months and 1 year post-stroke, to define a typology of life pathways of patients during the post-stroke year and to analyze the social and geographical inequalities in the management of stroke. Methods Design: a prospective multicenter comparative cohort study with a follow up to 1 year after the acute episode. Participant centers: 13 hospitals in the Aquitaine region (France). Study population: patients diagnosed with a confirmed ischemic or hemorrhagic stroke included in the Aquitaine Observatory of Stroke (ObA2) cohort and voluntary to participate. Data sources are existing databases (ObA2 database and the French National Health Data System - SNDS) to collect information about care pathways, patient characteristics and stroke characteristics and Ad hoc surveys to collect information about life pathways and post-stroke sequelae. The endpoints of the study are post-stroke activity limitations evaluated by the modified Rankin score, other post-stroke sequelae (Cognitive disorders, anxio-depressive disorders, fatigue, restriction of participation) assessed by standardized and validated scales and Clusters of patients responding to pathways with common or similar characteristics.; Discussion By integrating a longitudinal dimension and relying on a large cohort, the project will make it possible to identify the sources of disturbances and the factors favorable to the outcome of the life pathways, important for the planning of the offer and the management of the public policies concerning stroke pathways. Trial registration ClinicalTrials.gov ID: NCT03865173, March 6th, 2019.
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Affiliation(s)
- S Broussy
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France. .,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
| | - F Rouanet
- Pôle des Neurosciences Cliniques (I.S., F.R.) CHU Bordeaux, Bordeaux, France
| | - E Lesaine
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - S Domecq
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - M Kret
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - M Maugeais
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France
| | - F Aly
- Physical and Rehabilitation Medicine Unit, EA4136, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - P Dehail
- Physical and Rehabilitation Medicine Unit, EA4136, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - A Bénard
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - J Wittwer
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - R Salamon
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France
| | - I Sibon
- Pôle des Neurosciences Cliniques (I.S., F.R.) CHU Bordeaux, Bordeaux, France.,Neurology, Stroke Unit, INCIA CNRS UMR 5287, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - F Saillour-Glenisson
- Université de Bordeaux, Institut de Santé Publique d'Epidémiologie et de Développement, Centre INSERM U1219 Bordeaux Population Health center, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
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16
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Chang FH, Ni P. Responsiveness and Predictive Validity of the Participation Measure-3 Domains, 4 Dimensions in Survivors of Stroke. Arch Phys Med Rehabil 2019; 100:2283-2292. [PMID: 31421097 DOI: 10.1016/j.apmr.2019.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the responsiveness and predictive validity of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D) in people receiving outpatient rehabilitation following stroke. DESIGN Prospective cohort observational study. SETTING Outpatient rehabilitation settings. PARTICIPANTS Volunteer patients (N=269) with stroke (mean age ± SD [y], 55.36±12.46; 70.26% male). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The PM-3D4D was designed to measure 3 domains (Productivity, Social, and Community) and 4 dimensions (Diversity, Frequency, Desire for change, and Difficulty) of participation in individuals with rehabilitation needs. All participants completed the PM-3D4D, the Participation Assessment with Recombined Tools-Objective (PART-O), the Participation Measure for Post-Acute Care (PM-PAC), and the EuroQol-5-Dimension (EQ-5D) at the baseline assessment and again following 3 months of outpatient rehabilitation. RESULTS Significant mean changes in scores were observed for most of the PM-3D4D subscales, with the largest score change observed in the Difficulty subscale (standardized response mean=0.57∼0.88). The minimal detectable change and meaningful clinically important differences were calculated for each subscale. The Frequency and Difficulty dimensions of the PM-3D4D demonstrated significantly greater responsiveness than the PART-O and PM-PAC, respectively. The baseline PM-3D4D scores, except for Desire for change subscales, were significantly correlated with the PART-O, PM-PAC, and EQ-5D scores after 3 months of rehabilitation. CONCLUSIONS This study provides evidence supporting the responsiveness and predictive validity of the PM-3D4D in survivors of stroke. Among all subscales of the PM-3D4D, the Difficulty dimensional scale demonstrated the greatest responsiveness. The Desire for change dimension of the PM-3D4D showed less responsiveness, and we recommend that it be used as a goal-setting tool rather than an outcome measure. The PM-3D4D can potentially be used to predict participation outcomes and the health-related quality of life following rehabilitation interventions.
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Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Pengsheng Ni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
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17
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Carrot B, Duclos J, Barry C, Radon L, Maria AS, Kaganski I, Jeremic Z, Barton-Clegg V, Corcos M, Lasfar M, Gerardin P, Harf A, Moro MR, Blanchet C, Godart N. Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study. Trials 2019; 20:249. [PMID: 31039797 PMCID: PMC6492384 DOI: 10.1186/s13063-019-3347-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/03/2019] [Indexed: 12/16/2022] Open
Abstract
Background Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. Methods One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. Discussion We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. Trial registration ClinicalTrials.gov, NCT03350594. Registered on 22 November 2017. IDRCB number 2016-A00818-43. Electronic supplementary material The online version of this article (10.1186/s13063-019-3347-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Carrot
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France.,CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France
| | - Jeanne Duclos
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Caroline Barry
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France
| | - Leslie Radon
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Department of Addiction, Eating Disorders Unit, Paul Brousse Hospital, Villejuif, France
| | - Anne-Solène Maria
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France
| | - Irène Kaganski
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Zorica Jeremic
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | | | - Maurice Corcos
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France.,Department of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France
| | - Malaïka Lasfar
- Department of Medical Pediatrics and Child and Adolescent Psychiatry, Rouen University Hospital and Rouvray Hospital, University of Rouen, Rouen, France
| | - Priscille Gerardin
- Department of Medical Pediatrics and Child and Adolescent Psychiatry, Rouen University Hospital and Rouvray Hospital, University of Rouen, Rouen, France
| | - Aurélie Harf
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Maison de Solenn, Maison des Adolescents, Hôpital Cochin, Paris, France
| | - Marie-Rose Moro
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Department of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France.,Maison de Solenn, Maison des Adolescents, Hôpital Cochin, Paris, France
| | - Corinne Blanchet
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Department of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France.,Maison de Solenn, Maison des Adolescents, Hôpital Cochin, Paris, France
| | - Nathalie Godart
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,UFR des Sciences de la Santé Simone Veil (UVSQ), Versailles, France.,Fondation de Santé des Etudiants de France, Paris, France
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18
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[Evaluation of permanent disability levels in occupational pulmonary diseases]. Rev Mal Respir 2019; 36:307-325. [PMID: 30902443 DOI: 10.1016/j.rmr.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/21/2022]
Abstract
Compensation for occupational pulmonary diseases requires the establishment of guidelines based on standardized and objective criteria, in order to provide compensation that is as fair as possible to patients who suffer from them. A review of the elements necessary for the examination of an individual file was carried out by a working group. It is accepted that respiratory functional exploration is the key element in assessing the level of permanent disability in all of these conditions, with the exception of thoracic malignancies. Guiding scales have been developed for the respiratory impairment of three types of conditions: occupational asthma, thoracic malignancy, and other respiratory diseases. Additional criteria for increasing the permanent disability level are also proposed in order to take into account professional prejudice, in particular the possibility or not of continuing the occupational activity, in the same job or after changing to another. For certain respiratory diseases, a periodic reassessment of the initially attributed permanent disability level is recommended as well as the initial one at the time of definitive cessation of occupational activity.
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19
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Lareau SC, Blackstock FC. Functional status measures for the COPD patient: A practical categorization. Chron Respir Dis 2019; 16:1479973118816464. [PMID: 30789020 PMCID: PMC6318724 DOI: 10.1177/1479973118816464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/25/2018] [Indexed: 01/22/2023] Open
Abstract
The objective of this study is to review available functional status measures (FSMs) validated for use in the chronic obstructive pulmonary disease (COPD) population and categorizing the measures by their commonalities to formulate a framework that supports clinicians in the selection and application of FSMs. A literature review identifying valid and reliable measures of functional status for people with COPD was undertaken. Measures were thematically analyzed and categorized to develop a framework for clinical application. A variety of measures of activity levels exist, with 35 included in this review. Thematic categorization identified five categories of measures: daily activity, impact, surrogate, performance-based, and disability-based measures. The vast variety of FSMs available for clinicians to apply with people who have COPD may be overwhelming, and selection must be thoughtfully based on the nature of the population being studied/evaluated, and aims of evaluation being conducted, not simply as a standard measure used at the institution. Psychometric testing is a critical feature to a strong instrument and issues of reliability, validity, and responsiveness need to be understood prior to measurement use. Contextual nature of measures such as language used and activities measured is also important. A categorical framework to support clinicians in the selection and application of FSMs has been presented in this article.
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Affiliation(s)
- Suzanne Claire Lareau
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Felicity Clair Blackstock
- Department of Physiotherapy, School of Science and Health, Western Sydney University, Sydney, Australia
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Hollanders JJ, Schaëfer N, van der Pal SM, Oosterlaan J, Rotteveel J, Finken MJJ. Long-Term Neurodevelopmental and Functional Outcomes of Infants Born Very Preterm and/or with a Very Low Birth Weight. Neonatology 2019; 115:310-319. [PMID: 30836372 PMCID: PMC6604264 DOI: 10.1159/000495133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Birth weight (BW) is often used as a proxy for gestational age (GA) in studies on preterm birth. Recent findings indicate that, in addition to perinatal outcomes, subjects born very preterm (VP; GA < 32 weeks) differ from those with a very low birth weight (VLBW; BW < 1,500 g) in postnatal growth up to their final height. OBJECTIVE To study whether neurodevelopmental and functional outcomes at the age of 19 years differ in VP and/or VLBW subjects. METHODS 705 19-year-old subjects from the Project on Preterm and Small-for-Gestational-Age Infants (POPS) cohort were classified as (1) VP+/VLBW+ (n = 354), (2) VP+/VLBW- (n = 144), or (3) VP-/VLBW+ (n = 207), and compared with regard to IQ as assessed with the Multicultural Capacity Test-intermediate level; neuromotor function using Touwen's examination of mild neurologic dysfunction; hearing loss; self- and parent-reported behavioral and emotional functioning; educational achievement and occupation; and self-assessed health using the Health Utilities Index and the London Handicap Scale. RESULTS VP+/VLBW- infants, on average, had 3.8-point higher IQ scores (95% confidence interval [CI] 0.5-7.1), a trend towards higher educational achievement, 3.3-dB better hearing (95% CI 1.2-5.4), and less anxious behavior, attention problems, and internalizing behavior than to VP+/VLBW+ subjects. VP-/VLBW+ infants reported 1.8 increased odds (95% CI 1.2-2.6) of poor health compared to VP+/VLBW+ subjects. CONCLUSIONS At the age of 19 years, subjects born VP+/VLBW+, VP+/VLBW-, and VP-/VLBW+ have different neurodevelopmental and functional outcomes, although effect sizes are small. Hence, the terms VP and VLBW are not interchangeable. We recommend, at least for industrialized countries, to base inclusion in future studies on preterm populations on GA instead of on BW.
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Affiliation(s)
- Jonneke J Hollanders
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands,
| | - Nina Schaëfer
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jaap Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Joost Rotteveel
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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21
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Uemura JI, Tanikaga M, Tanaka M, Shimose M, Hoshino A, Igarashi G. Selection of Activity Items for Development of the Activity Card Sort-Japan Version. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 39:23-31. [PMID: 29973116 DOI: 10.1177/1539449218784729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Activity Card Sort (ACS) can both record the clients' participation and any changes, which is a useful tool for practitioners to establish tailored occupation-focused goals. However, there is a limitation to apply the ACS to Japanese older adults as it consists of culturally relevant activities in the United States. The aim of this study was to select activity items reflecting Japanese older adults' lifestyles and opinions to develop the Activity Card Sort-Japan Version (ACS-JPN). In the item selection process, a two-round questionnaire survey was conducted for community-dwelling Japanese older adults (Round 1: n = 177, M age = 69.9 years; Round 2: n = 178, M age = 74.9 years). Seventy-two activity items were finally included in the ACS-JPN and were classified into four domains. The ACS-JPN has some unique features compared with other ACS versions. This study only selected activity items. Further work on psychometric properties is needed.
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22
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Phan HT, Blizzard CL, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Heeley E, Otahal P, Vemmos K, Anderson C, Parmar P, Krishnamurthi R, Barker-Collo S, Feigin V, Bejot Y, Cabral NL, Carolei A, Sacco S, Chausson N, Olindo S, Rothwell P, Silva C, Correia M, Magalhães R, Appelros P, Kõrv J, Vibo R, Minelli C, Gall SL. Factors contributing to sex differences in functional outcomes and participation after stroke. Neurology 2018; 90:e1945-e1953. [DOI: 10.1212/wnl.0000000000005602] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/23/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.MethodsIndividual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993–2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0–100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis.ResultsIn unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RRunadjusted 1.32, 95% confidence interval [CI] 1.18–1.48; 5 years: RRunadjusted 1.31, 95% CI 1.16–1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RRadjusted 1.08, 95% CI 0.97–1.20; 5 years: RRadjusted 1.05, 95% CI 0.94–1.18). Women also had greater participation restriction than men (pooled MDunadjusted −5.55, 95% CI −8.47 to −2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted −2.48, 95% CI −4.99 to 0.03).ConclusionsWorse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.
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23
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Farzad M, Layeghi F, Hosseini SA, Hamidreza K, Asgari A. Are the Domains Considered by ICF Comprehensive Enough to Conceptualize Participation in the Patient with Hand Injuries? J Hand Microsurg 2018; 9:139-153. [PMID: 29302138 DOI: 10.1055/s-0037-1608693] [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: 02/04/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022] Open
Abstract
Background Although participation is a core concept in multiple models of disability, there is no consensus on its definition. Objective The aim of this study was to extract participation domains based on review of theories, available outcome measures, and interviews with experts and the person with hand injuries to compare with the ICF domains of participation. Methods A qualitative approach using a deductive content analysis was employed to extend definitions of participation from theories. Later on, inductive qualitative method using semistructured interview with five experts in different fields and 30 patients with different hand injuries was used. Coding was performed with extracted domains from the content of data, and finally, the extracted domains were compared with the ICF domains of participation. Results Some of the extracted domains were not considered in ICF. Conclusion Subjective participation is the main forbearance part. Role, leisure, domestic life, environment, and others are also main missing meanings. This limitation can hinder measuring disability and health.
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Affiliation(s)
- Maryam Farzad
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereydoun Layeghi
- Department of Clinical Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyyed Ali Hosseini
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Khanke Hamidreza
- Department of Clinical Science and Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Asgari
- Department of Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Mohammadi E, Allahyari T, Darvishpoor Kakhaki A, Saraei H. Determining Psychometric Properties of Iranian Active Aging Measurement Instrument. SALMAND 2018. [DOI: 10.21859/sija.12.4.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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26
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Thammaiah S, Manchaiah V, Easwar V, Krishna R, McPherson B. The Participation Scale: psychometric properties of a South Indian translation with hearing-impaired respondents. Disabil Rehabil 2017; 40:2650-2657. [DOI: 10.1080/09638288.2017.1347208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Spoorthi Thammaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Audiology India, Mysore, Karnataka, India
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Audiology India, Mysore, Karnataka, India
- Department of Behavioral Science and Learning, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Vijayalakshmi Easwar
- Audiology India, Mysore, Karnataka, India
- National Centre for Audiology Western University, London, ON, Canada
| | - Rajalakshmi Krishna
- Audiology India, Mysore, Karnataka, India
- All India Institute of Speech and Hearing, University of Mysore, Mysore, Karnataka, India
| | - Bradley McPherson
- Division of Speech and Hearing Sciences, Faculty of Education, The University of Hong Kong, Hong Kong, China
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27
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Olaiya MT, Cadilhac DA, Kim J, Nelson MR, Srikanth VK, Andrew NE, Bladin CF, Gerraty RP, Fitzgerald SM, Phan T, Frayne J, Thrift AG. Long-term unmet needs and associated factors in stroke or TIA survivors. Neurology 2017; 89:68-75. [DOI: 10.1212/wnl.0000000000004063] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/03/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To extensively investigate long-term unmet needs in survivors of stroke or TIA and to identify factors associated with these unmet needs.Methods:Community-dwelling adults were invited to participate in a survey ≥2 years after discharge for stroke/TIA. Unmet needs were assessed across 5 domains: activities and participation, environmental factors, body functions, post–acute care, and secondary prevention. Factors associated with unmet needs were determined with multivariable negative binomial regression.Results:Of 485 participants invited to complete the survey, 391 (81%) responded (median age 73 years, 67% male). Most responders (87%) reported unmet needs in ≥1 of the measured domains, particularly in secondary prevention (71%). Factors associated with fewer unmet needs included older age (incident rate ratio [IRR] 0.62, 95% confidence interval [CI] 0.50–0.77), greater functional ability (IRR 0.33, 95% CI 0.17–0.67), and reporting that the general practitioner was the most important in care (IRR 0.69, 95% CI 0.57–0.84). Being depressed (IRR 1.61, 95% CI 1.23–2.10) and receiving community services after stroke (IRR 1.45, 95% CI 1.16–1.82) were associated with more unmet needs.Conclusions:Survivors of stroke/TIA reported considerable unmet needs ≥2 years after discharge, particularly in secondary prevention. The factors associated with unmet needs could help guide policy decisions, particularly for tailoring care and support services provided after discharge.
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Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations. Pain 2017; 157:1836-1850. [PMID: 27058676 DOI: 10.1097/j.pain.0000000000000577] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although pain reduction is commonly the primary outcome in chronic pain clinical trials, physical functioning is also important. A challenge in designing chronic pain trials to determine efficacy and effectiveness of therapies is obtaining appropriate information about the impact of an intervention on physical function. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and Outcome Measures in Rheumatology (OMERACT) convened a meeting to consider assessment of physical functioning and participation in research on chronic pain. The primary purpose of this article is to synthesize evidence on the scope of physical functioning to inform work on refining physical function outcome measurement. We address issues in assessing this broad construct and provide examples of frequently used measures of relevant concepts. Investigators can assess physical functioning using patient-reported outcome (PRO), performance-based, and objective measures of activity. This article aims to provide support for the use of these measures, covering broad aspects of functioning, including work participation, social participation, and caregiver burden, which researchers should consider when designing chronic pain clinical trials. Investigators should consider the inclusion of both PROs and performance-based measures as they provide different but also important complementary information. The development and use of reliable and valid PROs and performance-based measures of physical functioning may expedite development of treatments, and standardization of these measures has the potential to facilitate comparison across studies. We provide recommendations regarding important domains to stimulate research to develop tools that are more robust, address consistency and standardization, and engage patients early in tool development.
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Coelho M, Abreu D, Correia-Guedes L, Lobo PP, Fabbri M, Godinho C, Domingos J, Albuquerque L, Freitas V, Pereira JM, Cattoni B, Carvalho H, Reimão S, Rosa MM, Ferreira AG, Ferreira JJ. Disability in Activities of Daily Living and Severity of Dyskinesias Determine the Handicap of Parkinson's Disease Patients in Advanced Stage Selected to DBS. JOURNAL OF PARKINSONS DISEASE 2017; 7:255-261. [PMID: 28157106 DOI: 10.3233/jpd-160848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is scarce data on the level of handicap in Parkinson's disease (PD) and none in advanced stage PD. OBJECTIVE To assess the handicap in advanced stage PD patients with disabling levodopa-induced motor complications selected to deep brain stimulation (DBS). METHODS Data was prospectively recorded during routine evaluation for DBS. Handicap was measured using London Handicap Scale (LHS) (0 = maximal handicap; 1 = no handicap). Disease severity was evaluated using the Hoehn & Yahr scale and the UPDRS/MDS-UPDRS, during off and on after a supra-maximal dose of levodopa. Schwab and England Scale (S&E) was scored in off and on. Dyskinesias were scored using the modified Abnormal Involuntary Movement Scale (mAIMS). Results concern cross-sectional assessment before DBS. RESULTS 100 PD patients (mean age 61 (±7.6); mean disease duration 12.20 (±4.6) years) were included. Median score of motor MDS-UPDRS was 54 in off and 25 in on. Mean total LHS score was 0.56 (±0.14). Patients were handicapped in several domains with a wide range of severity. Physical Independence and Social Integration were the most affected domains. Determinants of total LHS score were MDS-UPDRS part II off (β= -0.271; p = 0.020), S&E on (β= 0.264; p = 0.005) and off (β= 0.226; p = 0.020), and mAIMS on (β= -0.183; p = 0.042) scores (R2 = 29.6%). CONCLUSIONS We were able to use handicap to measure overall health condition in advanced stage PD. Patients were moderately to highly handicapped and this was strongly determined by disability in ADL and dyskinesias. Change in handicap may be a good patient-centred outcome to assess efficiency of DBS.
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Affiliation(s)
- Miguel Coelho
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Daisy Abreu
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Leonor Correia-Guedes
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Patricia Pita Lobo
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Margherita Fabbri
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Catarina Godinho
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Josefa Domingos
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Luisa Albuquerque
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Language Research Laboratory, Instituto de Medicina Molecular, Lisbon, Portugal
| | - Vanda Freitas
- Language Research Laboratory, Instituto de Medicina Molecular, Lisbon, Portugal
| | - João Miguel Pereira
- Department of Neurosciences, Service of Psychiatry and Mental Health, Hospital Santa Maria, Lisbon, Portugal
| | - Begona Cattoni
- Department of Neurosciences, Service of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal
| | - Herculano Carvalho
- Department of Neurosciences, Service of Neurosurgery, Hospital Santa Maria, Lisbon, Portugal
| | - Sofia Reimão
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Department of Neurosciences, Service of Neurological Imaging, Hospital Santa Maria, Lisbon, Portugal
| | - Mário M Rosa
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Joaquim J Ferreira
- Department of Neurosciences, Service of Neurology, Hospital Santa Maria, Lisbon, Portugal.,Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Breeman LD, van der Pal S, Verrips GHW, Baumann N, Bartmann P, Wolke D. Neonatal treatment philosophy in Dutch and German NICUs: health-related quality of life in adulthood of VP/VLBW infants. Qual Life Res 2016; 26:935-943. [PMID: 27660072 DOI: 10.1007/s11136-016-1410-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Although survival after very preterm birth (VP)/very low birth weight (VLBW) has improved, a significant number of VP/VLBW individuals develop physical and cognitive problems during their life course that may affect their health-related quality of life (HRQoL). We compared HRQoL in VP/VLBW cohorts from two countries: The Netherlands (n = 314) versus Germany (n = 260) and examined whether different neonatal treatment and rates of disability affect HRQoL in adulthood. METHOD To analyse whether cohorts differed in adult HRQoL, linear regression analyses were performed for three HRQoL outcomes assessed with the Health Utilities Index 3 (HUI3), the London Handicap Scale (LHS), and the WHO Quality of Life instrument (WHOQOL-BREF). Stepwise hierarchical linear regression was used to test whether neonatal physical health and treatment, social environment, and intelligence (IQ) were related to VP/VLBW adults' HRQoL and cohort differences. RESULTS Dutch VP/VLBW adults reported a significantly higher HRQoL on all three general HRQoL measures than German VP/VLBW adults (HUI3: .86 vs .83, p = .036; LHS: .93 vs. .90, p = .018; WHOQOL-BREF: 82.8 vs. 78.3, p < .001). Main predictor of cohort differences in all three HRQoL measures was adult IQ (p < .001). CONCLUSIONS Lower HRQoL in German versus Dutch adults was related to more cognitive impairment in German adults. Due to different policies, German VP/VLBW infants received more intensive treatment that may have affected their cognitive development. Our findings stress the importance of examining effects of different neonatal treatment policies for VP/VLBW adults' life.
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Affiliation(s)
- Linda D Breeman
- Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK.,Department of Youth & Family, Utrecht University, Utrecht, The Netherlands
| | | | | | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK. .,Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.
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31
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Ballert CS, Hopfe M, Kus S, Mader L, Prodinger B. Using the refined ICF Linking Rules to compare the content of existing instruments and assessments: a systematic review and exemplary analysis of instruments measuring participation. Disabil Rehabil 2016; 41:584-600. [PMID: 27414962 DOI: 10.1080/09638288.2016.1198433] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Existing instruments measuring participation may vary with respect to various aspects. This study aimed to examine the comparability of existing instruments measuring participation based on the International Classification of Functioning, Disability and Health (ICF) by considering aspects of content, the perspective adopted and the categorization of response options. METHODS A systematic literature review was conducted to identify instruments that have been commonly used to measure participation. Concepts of identified instruments were then linked to the ICF following the refined ICF Linking Rules. Aspects of content, perspective adopted and categorization of response options were documented. RESULTS Out of 315 instruments identified in the full-text screening, 41 instruments were included. Concepts of six instruments were linked entirely to the ICF component Activities and Participation; of 10 instruments still 80% of their concepts. A descriptive perspective was adopted in most items across instruments (75%), mostly in combination with an intensity rating. An appraisal perspective was found in 18% and questions from a need or dependency perspective were least frequent (7%). CONCLUSION Accounting for aspects of content, perspective and categorization of responses in the linking of instruments to the ICF provides detailed information for the comparison of instruments and guidance on narrowing down the choices of suitable instruments from a content point of view. Implications for Rehabilitation For clinicians and researchers who need to identify a specific instrument for a given purpose, the findings of this review can serve as a screening tool for instruments measuring participation in terms of the following: • Their content covered based on the ICF. • The perspective adopted in the instrument (e.g., descriptive, need/dependency or appraisal). • The categorization of their response options (e.g., intensity or frequency).
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Affiliation(s)
- Carolina S Ballert
- a Swiss Paraplegic Research, ICF Unit , Nottwil , Switzerland.,b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
| | - Maren Hopfe
- a Swiss Paraplegic Research, ICF Unit , Nottwil , Switzerland.,b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
| | - Sandra Kus
- c Department of Medical Informatics, Biometry and Epidemiology - IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health , Ludwig-Maximilians-University (LMU) , Munich , Germany
| | - Luzius Mader
- b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland
| | - Birgit Prodinger
- a Swiss Paraplegic Research, ICF Unit , Nottwil , Switzerland.,b Department of Health Sciences and Health Policy , University of Lucerne , Lucerne , Switzerland.,d ICF Research Branch a Cooperation Partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI) , Nottwil , Switzerland
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Vazirinejad R, Lilley JM, Ward CD. The ‘Impact on Participation and A utonomy’: acceptability of the English version in a multiple sclerosis outpatient setting. Mult Scler 2016; 9:612-5. [PMID: 14664475 DOI: 10.1191/1352458503ms936oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To elicit the opinion of multiple sclerosis (MS) patients about the acceptability of a newly designed participation questionnaire - the ‘Impact on Participatio n and A utonomy’ (IPA), 35 MS outpatients who had completed an English version of the IPA questionnaire (IPA-E) were interviewed. Patients were recruited consecutively from outpatients attending the MS clinic. They were invited to answer 15 short questions during a 20-minute interview after signing a consent form and completing the IPA -E questionnaire. C ompletion time of the IPA -E questionnaire was 19.3 ± 4.7 minutes. Most respondents believed that the IPA -E items were easy or very easy to understand (83%), relevant (more than 74%), not embarrassing (more than 97%) and 94% considered that no items should be removed. Three additional topics were suggested: ‘looking after children’, ‘the extent of information on current services’ and information about ‘treatment progress’. A mong the eight domains of the IPA, most respondents considered mobility to be the most important and education the least important. The IPA -E was found to be acceptable and relevant to a sample of MS outpatients, although it could have been enhanced by items on parental or family roles.
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Affiliation(s)
- Reza Vazirinejad
- Division of Rehabilitation and Ageing, University of Nottingham School of Community Health Sciences, Nottingham, UK.
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Detmar SB, Hosli EJ, Chorus AMJ, van Beekum T, Vogels T, Mourad-Baars PEC, Engelberts AC, Groothuis-Oudshoorn CGM, Verrips GHW. The development and validation of a handicap questionnaire for children with a chronic illness. Clin Rehabil 2016; 19:73-80. [PMID: 15704511 DOI: 10.1191/0269215505cr825oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction: This paper describes the development and initial psychometric evaluation of the Handicap Scale for Children (HSC). This questionnaire is based on the London Handicap Scale (LHS), a valid and reliable utility instrument for measuring social participation in adults. Methods: A multidisciplinary research group was involved in developing the HSC. The questionnaire was tested in 114 children with a chronic disease and 239 healthy children in the 8-18 age range. Relating the Health Utility Index Mark 3 (HUI3) attributes to corresponding HSC scores tested the assumption that a negative health status would lead to participation problems. Results: Questionnaire development resulted in a five-dimension questionnaire: mobility, physical independence, daily activities, social integration and orientation. Each dimension included one item with a six-point response scale. A higher score indicates greater handicap. Feasibility testing with 10 children showed that none of the children experienced difficulties in filling in the questionnaire. Conceptual validity, measured by correlations between the dimensions of the HSC and HUI3, was satisfactory. As expected, moderate correlation coefficients between predefined pairs of HUI and HSC attributes were found; other correlation coefficients were low. Criterion validity was also satisfactory, as shown by large differences between the healthy and the chronically ill group and by several criteria within the chronically ill group. Conclusion: Based on this initial evaluation, the questionnaire seems feasible and valid for use with children in the age range 8-18 years.
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Affiliation(s)
- S B Detmar
- TNO Prevention and Health, Leiden, The Netherlands.
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Smith J, Forster A, Young J. A randomized trial to evaluate an education programme for patients and carers after stroke. Clin Rehabil 2016; 18:726-36. [PMID: 15573828 DOI: 10.1191/0269215504cr790oa] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: To evaluate the effectiveness of an education programme for patients and carers recovering from stroke. Design: Randomized controlled trial. Subjects and setting: One hundred and seventy patients admitted to a stroke rehabilitation unit and 97 carers of these patients. Interventions: The intervention group received a specifically designed stroke information manual and were invited to attend education meetings every two weeks with members of their multidisciplinary team. The control group received usual practice. Measures: Primary outcome was knowledge of stroke and stroke services. Secondary outcomes were handicap (London Handicap Scale), physical function (Barthel Index), social function (Frenchay Activities Index), mood (Hospital Anxiety and Depression Scale) and satisfaction (Pound Scale). Carer mood was measured by the General Health Questionnaire-28. Results: There was no statistical evidence for a treatment effect on knowledge but there were trends that favoured the intervention. The education programme was associated with a significantly greater reduction in patient anxiety score at both three months (p=0.034) and six months (p=0.021) and consequently fewer ‘cases’ (Hospital Anxiety and Depression Scale anxiety subscale score ≥ 11). There were no other significant statistical differences between the patient or carer groups for other outcomes, although there were trends in favour of the education programme. Conclusion: An education programme delivered within a stroke unit did not result in improved knowledge about stroke and stroke services but there was a significant reduction in patient anxiety at six months post stroke onset.
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Affiliation(s)
- Jane Smith
- Bradford Elderly Care and Rehabilitation Research Department, St Luke's Hospital, Bradford, UK.
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Whitehead C, Miller M, Crotty M. Falls in community-dwelling older persons following hip fracture: impact on self-efficacy, balance and handicap. Clin Rehabil 2016; 17:899-906. [PMID: 14682563 DOI: 10.1191/0269215503cr695oa] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the four-month outcomes of fallers and nonfallers as well as those with slow gait speed in patients with hip fracture successfully discharged back to the community. Design: Prospective study with four-month follow-up data. Setting: Community sample of survivors of hip fracture who have completed their rehabilitation programme. Subjects: A consecutive sample of 73 community-dwelling, cognitively intact older adults admitted to hospital following a fall-related hip fracture and available to complete a follow-up assessment at four months. Main outcome measures: At baseline, data collection consisted of the Modified Barthel Index (MBI), Mini Mental State Examination (MMSE), sociodemographics and medical history. At four months follow-up, data collection consisted of the MBI, London Handicap Scale (LHS), Berg Balance Scale (BBS), a 10-metre timed walk test, Falls Efficacy Scale (FES) and the Activities Balance Confidence (ABC) scale. Participants were also asked to recall if they had fallen in the four months since their fracture. Results: Seventy-three participants had complete data for evaluation. There was minimal disability with a mean MBI of 91.2 but there was some residual handicap with a mean LHS of 0.67. Those who had fallen had lower selfefficacy (FES) and greater handicap (LHS). Those with slower gait speed were more handicapped (LHS), had lower self-efficacy (FES and ABC) and lower balance scores (BBS). Conclusions: Measuring ADL disability alone loses valuable information in community-dwelling survivors of hip fracture. Falls after hip fracture should be a target for treatment and our data give some weight to the idea of a fall fracture cycle. Gait speed, which may re‘ect lower limb strength, is also a target for therapeutic interventions. These measures should be included in clinical practice.
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Affiliation(s)
- Craig Whitehead
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daw Park, SA, Australia.
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Lemmens J, I S M van Engelen E, Post MWM, Beurskens AJHM, Wolters PMJC, de Witte LP. Reproducibility and validity of the Dutch Life Habits Questionnaire (LIFE-H 3.0) in older adults. Clin Rehabil 2016; 21:853-62. [PMID: 17875565 DOI: 10.1177/0269215507077599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To examine the reproducibility, the discriminant and convergent validity and feasibility of the Dutch translation of the self-administered Life Habits Questionnaire (LIFE-H). Design: Three cross-sectional community-based studies on clinimetric properties of a measurement instrument. Subjects: Older adults (n = 85) with functional limitations due to various chronic illnesses and healthy older adults (n = 40). Measurement protocol: Participants of the reproducibility study (n = 35) filled out the LIFE-H twice in a two-week time period. In the discriminant validity study (n = 120), LIFE-H scores of healthy and ill subjects were compared. In the convergent validity study (n = 63), correlations were examined between LIFE-H, the Impact on Participation and Autonomy questionnaire and the London Handicap Scale. Results: The test—retest reliability showed a satisfactory intraclass correlation coefficient for the total overall score (0.80) but not for the categories scores. The discriminant validity study showed significant differences between the healthy and ill subjects for the 10 separate categories (P < 0.01) and the total score (P < 0.001). The correlations between the LIFE-H categories and total scores and the Impact on Participation and Autonomy Questionnaire (0.80—0.82) and London Handicap Scale (0.89—0.92) were strong. Feasibility testing showed that the subjects experienced difficulties due to the long and fairly complex instructions and structure of the LIFE-H. Conclusions: The clinimetric properties of the LIFE-H were moderate to good. The validity of LIFE-H was as good as the validity of the Impact on Autonomy and Participation and the London Handicap Scale, but the latter questionnaires were shorter and much easier to administer.
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Affiliation(s)
- Jessie Lemmens
- Department of Speech Therapy, Centre of Expertise on Autonomy and Participation, Zuyd University, Heerlen, The Netherlands.
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Skinner A, Turner-Stokes L. The use of standardized outcome measures in rehabilitation centres in the UK. Clin Rehabil 2016; 20:609-15. [PMID: 16894804 DOI: 10.1191/0269215506cr981oa] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim: To identify the standardized outcome measures currently used in routine clinical practice in rehabilitation centres in the UK. Design: Cross-sectional survey by postal questionnaire. Participants: All UK consultant members of the British Society of Rehabilitation Medicine (BSRM) ( n = 180). Results: A total of 108 (60%) responses were received, representing 83 different rehabilitation services. Of these, 71 (86%) collected at least one standardized measure. The Barthel Index and the UK Functional Independence Measure and/or Functional Assessment Measure (FIM9 ± FAM) were the most popular global outcome measures: 83% of units measured one or other of these. The Northwick Park Dependency Scale (NPDS) and Care Needs Assessment (NPCNA) ( n = 21, 28%) were used for the more dependent patients. Depression and pain scores were more commonly used than general health measures. Sixty (72%) units routinely assessed outcome through the achievement of set goals, but only four transformed data to a goal attainment scale. Outcome measure scores were routinely reported in discharge summaries by 72% of units. Conclusions: The survey demonstrated quite widespread use of outcome assessments in routine clinical rehabilitation within the UK, with an encouraging level of common measurement in some areas of practice. The results have been used to update the BSRM ‘basket of recommended measures’.
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Holliday RC, Antoun M, Playford ED. A Survey of Goal-Setting Methods Used in Rehabilitation. Neurorehabil Neural Repair 2016; 19:227-31. [PMID: 16093413 DOI: 10.1177/1545968305279206] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. This survey provides a description of the goal-setting methods that are currently being used in community and inpatient rehabilitation centers across the United Kingdom. Given current policy, emphasis was placed on finding out how much patient involvement in the goal-setting process exists, concentrating on how such involvement may be facilitated. Design. A postal survey design was used to access a large sample size over a broad geographical area. The questionnaire was piloted at a British Society for Rehabilitation Medicine (BSRM) meeting; subsequently, some response categories were expanded. The questionnaire was approved by the BSRM Research and Clinical Standards committee. Questionnaires were coded to track responses from individuals. The received data were anonymized and analyzed using a statistics package for social science (SPSS) database. Subjects. Members of the BSRM were selected for this survey because this represents one of the most comprehensive listings of rehabilitation services in the United Kingdom. Results. The survey had a 60% response rate. A problem-orientated approach to goal setting was most commonly reported, with rehabilitation teams defining, formulating, and evaluating the goals. Patients were supplied with limited information about goal setting during their rehabilitation admission, although 60% of respondents reported giving patients a copy of their goals. Thirty percent of respondents used goals as a measure of rehabilitation effectiveness. Standardized goal-setting measures were not commonly used. Conclusion. These data demonstrate that individual disciplines tend to discuss potential goals with their patients during treatment sessions and then formulate goals on the basis of the discussion. There is scope to develop and refine the approach to goal setting so the patients have more opportunities to engage in the goal-setting process.
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Affiliation(s)
- Rosaline C Holliday
- Rehabilitation Group, Institute of Neurology, University College London, Queen Square, London, National Hospital for Neurology and Neurosurgery, Queen Square, London
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Liggett J, Carmichael KLC, Smith A, Sellbom M. Validation of Self-Report Impairment Measures for Section III Obsessive–Compulsive and Avoidant Personality Disorders. J Pers Assess 2016; 99:1-14. [DOI: 10.1080/00223891.2016.1185613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Shaw L, Leyshon R, Liu M. Validating the Potential of the International Classification of Functioning, Disability and Health to Identify Barriers to and Facilitators of Consumer Participation. The Canadian Journal of Occupational Therapy 2016. [DOI: 10.1177/000841740707405s04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Occupational therapists need tools to identify barriers and facilitators to participation in societal roles. Purpose. The purpose of this study was to examine the potential of the International Classification of Functioning, Disability and Health (ICF) two-level classification for use in occupational therapy. Methods. A secondary analysis of an existing dataset was conducted to identify participation barriers and facilitators that mapped to the ICF and those that did not. Results. A broad range of factors was captured across the components of the ICF. Findings also revealed enabling and disabling factors thatwere not evident in the ICF. Practice Implications. The ICF can support the identification of a broad range of external barriers and facilitators relevant to participation and of interest to occupational therapy. However, therapists must use other strategies to gain a comprehensive understanding of the nature, extent and consequences of barriers and facilitators that may exist in a given context.
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Batsis JA, Germain CM, Vásquez E, Zbehlik AJ, Bartels SJ. Physical Activity Predicts Higher Physical Function in Older Adults: The Osteoarthritis Initiative. J Phys Act Health 2016; 13:6-16. [PMID: 25831551 PMCID: PMC4596795 DOI: 10.1123/jpah.2014-0531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Physical activity reduces mobility impairments in elders. We examined the association of physical activity on risk of subjective and objective physical function in adults with and at risk for osteoarthritis (OA). METHODS Adults aged ≥ 60 years from the longitudinal Osteoarthritis Initiative, a prospective observational study of knee OA, were classified by sex-specific quartiles of Physical Activity Score for the Elderly scores. Using linear mixed models, we assessed 6-year data on self-reported health, gait speed, Late-Life Function and Disability Index (LLFDI) and chair stand. RESULTS Of 2252 subjects, mean age ranged from 66 to 70 years. Within each quartile, physical component (PCS) of the Short Form-12 and gait speed decreased from baseline to follow-up in both sexes (all P < .001), yet the overall changes across PASE quartiles between these 2 time points were no different (P = .40 and .69, males and females, respectively). Decline in PCS occurred in the younger age group, but rates of change between quartiles over time were no different in any outcomes in either sex. LLFDI scores declined in the 70+ age group. Adjusting for knee extensor strength reduced the strength of association. CONCLUSIONS Higher physical activity is associated with maintained physical function and is mediated by muscle strength, highlighting the importance of encouraging physical activity in older adults with and at risk for OA.
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Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Cusick A, Lannin N, Kinnear BZ. Upper limb spasticity management for patients who have received Botulinum Toxin A injection: Australian therapy practice. Aust Occup Ther J 2015; 62:27-40. [PMID: 25649033 DOI: 10.1111/1440-1630.12142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM To describe Australian physiotherapy and occupational therapy practice for patients who receive upper-limb Botulinum Toxin-A (BoNT-A). METHOD Anonymous online survey asking about practice experience. Convenience sample of 128 BoNT-A experienced occupational therapists and physiotherapists. RESULTS The primary work setting was multidisciplinary inpatient or outpatient rehabilitation services where therapists had automatic referral to BoNT-A patients. Patients expected BoNT-A to improve functional movement, reduce hypertonicity, increase passive range, reduce pain, improve appearance and hand hygiene. Most patients were injected in multidisciplinary public hospital clinics and had median 2 pre-injection (range 0-30) and 8 post-injection (range 0-50) therapy sessions. Biceps, flexor digitorum profundus/superficialis and brachoradialis were most frequently injected. Injectors used therapist assessment information to select sites 68% of the time; only 44% of services had assessment protocols. Standardised therapy assessments examined motor performance, pain and function in that order of frequency. The greater the awareness and perceived relevance of an assessment the more often therapists used it. All therapists set goals, most collaboratively, and these mirrored patient expectations. The most common treatments were stretch, task-specific functional training, strength training and home programmes. CONCLUSION While trends in Australian assessment, goals and treatment practice were observed, greater consistency could be achieved if therapy practice guidelines existed. The gap is exacerbated by the absence of Australian BoNT-A organisation and process of care spasticity management guidelines. This creates an environment where practice variability is inevitable. Recommendations to improve local service quality are made.
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Affiliation(s)
- Anne Cusick
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
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Batsis JA, Zbehlik AJ, Pidgeon D, Bartels SJ. Dynapenic obesity and the effect on long-term physical function and quality of life: data from the osteoarthritis initiative. BMC Geriatr 2015; 15:118. [PMID: 26449277 PMCID: PMC4599326 DOI: 10.1186/s12877-015-0118-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/05/2015] [Indexed: 12/18/2022] Open
Abstract
Background Obesity is associated with functional impairment, institutionalization, and increased mortality risk in elders. Dynapenia is defined as reduced muscle strength and is a known independent predictor of adverse events and disability. The synergy between dynapenia and obesity leads to worse outcomes than either independently. We identified the impact of dynapenic obesity in a cohort at risk for and with knee osteoarthritis on function. Methods We identified adults aged ≥ 60 years from the Osteoarthritis Initiative. Obesity was defined as a body mass index ≥ 30 kg/m2. Dynapenia was classified using the lowest sex-specific tertile of knee extensor strength. Participants were grouped according to obesity and knee strength: dynapenic obesity; dynapenia without obesity; obesity without dynapenia; and no dynapenia nor obesity. Four-year data was available. Self-reported activities of daily living (ADL) were assessed at follow-up. Outcomes of gait speed, 400 m walk distance, Late-life Disability and Function Index (LLFDI), and Short-Form (SF)-12 were analyzed using mixed effects and logistic regression models. Results Of 2025 subjects (56.3 % female), mean age was 68.2 years and 182 (24.1 %) had dynapenic obesity. Dynapenic obesity was associated with reduced gait speed, LLFDI-limitations, and SF-12 physical score in both sexes and in the 400 m walk in men only (all p < 0.001). A time*group interaction was significant for dynapenic obese men in the 400 m walk distance only. Odds of ADL limitations in dynapenic obesity was OR 2.23 [1.42:3.50], in dynapenia 0.98 [0.66:1.46], and in obesity 1.98 [1.39:2.80] in males. In females, odds were 2.45 [1.63:3.68], 1.60 [1.15:2.22], and 1.47 [1.06:2.04] respectively. Conclusion Dynapenic obesity may be a risk factor for functional decline suggesting the need to target subjects with low knee strength and obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0118-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA. .,Centers for Health and Aging, Dartmouth College, Lebanon, NH, 03756, USA. .,Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA. .,Dartmouth Weight and Wellness Center, Lebanon, NH, 03756, USA. .,Health Promotion Research Center at Dartmouth, Lebanon, NH, 03756, USA. .,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, NH, 03756, USA.
| | - Alicia J Zbehlik
- Centers for Health and Aging, Dartmouth College, Lebanon, NH, 03756, USA. .,Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA. .,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, NH, 03756, USA. .,Section of Rheumatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Dawna Pidgeon
- Department of Rehabilitation, Lebanon, NH, 03756, USA.
| | - Stephen J Bartels
- Centers for Health and Aging, Dartmouth College, Lebanon, NH, 03756, USA. .,Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA. .,Dartmouth Weight and Wellness Center, Lebanon, NH, 03756, USA. .,Health Promotion Research Center at Dartmouth, Lebanon, NH, 03756, USA. .,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, NH, 03756, USA. .,Department of Community and Family Medicine, Lebanon, NH, 03756, USA.
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Goh HT, Ramachandram K, Ahmad-Fauzi A, Subamanian P. Test-Retest Reliability and Validity of the Malay Version Life Habits Assessment (LIFE-H 3.1) to Measure Social Participation in Adults With Physical Disabilities. J Geriatr Phys Ther 2015; 39:132-9. [PMID: 26288234 DOI: 10.1519/jpt.0000000000000064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Social participation restriction is a common barrier encountered by older adults and individuals with physical disabilities. To best direct the limited resource to support social services for individuals with disability, there is a need to objectively measure social participation restriction. A number of tools to measure levels of social participation are available, but none of them has been translated into the Malay language. This cross-sectional study examined the test-retest reliability and concurrent validity of the Life Habits Assessment (LIFE-H 3.1) that had been translated and culturally adapted to the Malay language. METHODS Seventy-five individuals with physical disabilities (age, mean [standard deviation] = 58 [10] years; 49 males) participated in this study. Participants were interviewed twice with the Malay version LIFE-H 3.1, approximately 1 week apart. The Barthel Index (BI) and the World Health Organization Assessment of Quality of Life-Brief version (WHOQoL-BREF) were administered in the first interview as well. Intraclass correlation coefficients and the Bland-Altman Bias D were used to examine test-retest reliability. The Spearman correlation coefficients were computed to quantify the correlation between the Malay version LIFE-H 3.1 and the BI and the WHOQoL-BREF, respectively, to examine the concurrent validity of the Malay version LIFE-H 3.1. Furthermore, standard error of measurement and minimal detectable change were calculated. RESULTS The Malay version LIFE-H 3.1 had excellent test-retest reliability as evidenced by good to excellent intraclass correlation coefficients (0.71-0.95) and minimal Bland-Altman biases (0.01-0.12). The correlations between the Malay version LIFE-H 3.1 and the BI were fair to good (r = 0.28-0.69). The correlations between the Malay version LIFE-H 3.1 and the WHOQoL-BREF were weak to fair, ranging from 0.02 to 0.57. CONCLUSIONS The Malay version LIFE-H 3.1 demonstrates excellent test-retest reliability and satisfactory validity. This questionnaire is an appropriate tool to assess social participation in rehabilitation for native Malay language speakers.
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Affiliation(s)
- Hui-Ting Goh
- 1Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 2Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Batsis JA, Zbehlik A, Barre LK, Bynum JPW, Pidgeon D, Bartels SJ. Impact of obesity on disability, function, and physical activity: data from the Osteoarthritis Initiative. Scand J Rheumatol 2015; 44:495-502. [PMID: 26083472 PMCID: PMC4651723 DOI: 10.3109/03009742.2015.1021376] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Older adults with obesity are at risk for osteoarthritis (OA) and are predisposed to functional decline and disability. We examined the association between obesity and disability, physical activity, and quality of life at 6 years. METHOD Using data from the longitudinal Osteoarthritis Initiative (OAI), we analysed older adults (age ≥ 60 years) with a body mass index (BMI) at baseline ≥ 18.5 kg/m(2) (n = 2378) using standard BMI categories. Outcomes were assessed at the 6-year follow-up and included: the Late-Life Function and Disability Index (LLDI), the 12-item Short Form Health Survey (SF-12), and the Physical Activity Scale for the Elderly (PASE). Linear regression predicted outcomes based on BMI category, adjusting for age, sex, race, education, smoking, cohort status, radiographic knee OA, co-morbidity scores, and baseline scores when available. RESULTS Follow-up data were available for 1727 (71.9%) participants (mean age 67.9 ± 5.3 years; 61.6% female). At baseline, obese subjects compared to overweight and normal were on a greater number of medications (4.28 vs. 3.63 vs. 3.32), had lower gait speeds (1.22 vs. 1.32 vs. 1.36 m/s), higher Charlson scores (0.59 vs. 0.37 vs. 0.30), and higher Western Ontario and McMaster University OA Index (WOMAC) scores (right: 14.8 vs. 10.3 vs. 7.5; left: 14.4 vs. 9.9 vs. 7.5). SF-12 scores at 6 years were lower in obese patients than in overweight or normal [99.5 (95% CI 98.7-100.4) vs. 101.1 (95% CI 100.4-101.8) vs. 102.8 (95% CI 101.8-103.8)], as were PASE scores [115.1 (95% CI 110.3-119.8) vs. 126.2 (95% CI 122.2-130.2) vs. 131.4 (95% CI 125.8-137.0)]. The LLDI limitation component demonstrated differences in obese compared to overweight or normal [78.6 (95% CI 77.4-79.9) vs. 81.2 (95% CI 80.2-82.3) vs. 82.5 (95% CI 81.1-84.0)]. CONCLUSIONS Obesity was associated with worse physical activity scores, lower quality of life, and higher risk of 6-year disability.
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Affiliation(s)
- John A. Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
| | - Alicia Zbehlik
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- Section of Rheumatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
| | - Laura K. Barre
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
| | - Julie PW Bynum
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
| | - Dawna Pidgeon
- Department of Physical Medicine and Rehabilitation, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756
| | - Stephen J. Bartels
- Centers for Health and Aging, Dartmouth College, 43 Centerra, Lebanon, NH, 03756
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
- The Dartmouth Institute, Dartmouth College, 43 Centerra, Lebanon, NH 03756
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Beauchamp MK, Bean JF, Ward RE, Kurlinski LA, Latham NK, Jette AM. How Should Disability Be Measured in Older Adults? An Analysis from the Boston Rehabilitative Impairment Study of the Elderly. J Am Geriatr Soc 2015; 63:1187-91. [PMID: 26032351 DOI: 10.1111/jgs.13453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine and compare the predictive validity and responsiveness of the Late-Life Function and Disability Instrument (LLFDI) frequency and limitation dimensions in assessing two critical dimensions of disability: frequency of and limitations in performance of major life roles. DESIGN Secondary analysis of 2-year follow-up data from the Boston Rehabilitative Impairment Study of the Elderly. SETTING Primary care. PARTICIPANTS Community-dwelling older adults (≥65) (n = 430) at risk of mobility decline. MEASUREMENTS The LLFDI frequency and limitation dimensions, self-rated health, hospitalizations, and emergency department (ED) visits over 2 years. Responsiveness measures included effect size (ES) estimates and minimal detectable change (MDC) scores. RESULTS The LLFDI frequency dimension predicted low self-rated health (odds ratio (OR) = 0.51, P < .001), hospitalizations (OR = 0.68, P < .001), and ED visits (OR = 0.73, P = .003) over 2 years, whereas the limitation dimension did not. The absolute ES was 0.63 for the frequency dimension and 0.81 for the limitation dimension. The proportion of subjects with a decline greater than or equal to the MDC was 10.6% for the frequency dimension and 14.2% for the limitation dimension. For participants who improved greater than or equal to the MDC, the proportion was 1.7% for the frequency dimension and 15.3% for the limitation dimension. CONCLUSION Frequency of participation in major life roles was a better predictor of adverse outcomes than perceived limitations, although limitations appeared to be more responsive to meaningful change. These results can be used to guide the selection of the most appropriate metric for measuring disability in geriatric research.
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Affiliation(s)
- Marla K Beauchamp
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts
| | - Jonathan F Bean
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Rachel E Ward
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts
| | | | - Nancy K Latham
- Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts
| | - Alan M Jette
- Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts
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Barclay RE, Stevenson TJ, Poluha W, Ripat J, Nett C, Srikesavan CS. Interventions for improving community ambulation in individuals with stroke. Cochrane Database Syst Rev 2015; 2015:CD010200. [PMID: 25767912 PMCID: PMC6465042 DOI: 10.1002/14651858.cd010200.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Community ambulation refers to the ability of a person to walk in their own community, outside of their home and also indoors in private or public locations. Some people choose to walk for exercise or leisure and may walk with others as an important aspect of social functioning. Community ambulation is therefore an important skill for stroke survivors living in the community whose walking ability has been affected. OBJECTIVES To determine: (1) whether interventions improve community ambulation for stroke survivors, and (2) if any specific intervention method improves community ambulation more than other interventions. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), PubMed (1946 to November 2013), EMBASE (1980 to November 2013), CINAHL (1982 to November 2013), PsycINFO (1887 to November 2013), Scopus (1960 to November 2013), Web of Science (1900 to November 2013), SPORTDiscus (1975 to November 2013), and PEDro, CIRRIE and REHABDATA (November 2013). We also searched ongoing trials registers (November 2013) and reference lists, and performed a cited reference search. SELECTION CRITERIA Selection criteria included parallel-group randomised controlled trials (RCTs) and cross-over RCTs, studies in which participants are adult (aged 18 years or more) stroke survivors, and interventions that were aimed at improving community ambulation. We defined the primary outcome as participation; secondary outcomes included activity level outcomes related to gait and self-efficacy. DATA COLLECTION AND ANALYSIS One review author independently screened titles. Two review authors screened abstracts and full text articles, with a third review author was available to resolve any disagreements. Two review authors extracted data and assessed risk of bias. All outcomes were continuous. The analysis for the primary outcome used the generic inverse variance methods for meta-analysis, using the standardised mean difference (SMD) and standard error (SE) from the participation outcomes. Analyses for secondary outcomes all used SMD or mean difference (MD). We completed analyses for each outcome with all studies, and by type of community ambulation intervention (community or outdoor ambulation practice, virtual practice, and imagery practice). We considered trials for each outcome to be of low quality due to some trial design considerations, such as who knew what group the participants were in, and the number of people who dropped out of the studies. MAIN RESULTS We included five studies involving 266 participants (136 intervention; 130 control). All participants were adult stroke survivors, living in the community or a care home. Programmes to improve community ambulation consisted of walking practice in a variety of settings and environments in the community, or an indoor activity that mimicked community walking (including virtual reality or mental imagery). Three studies were funded by government agencies, and two had no funding.From two studies of 198 people there was low quality evidence for the effect of intervention on participation compared with control (SMD, 0.08, 95% confidence interval (CI) -0.20 to 0.35 (using inverse variance). The CI for the effect of the intervention on gait speed was wide and does not exclude no difference (MD 0.12, 95% CI -0.01 to 0.24; four studies, 98 participants, low quality evidence). We considered the quality of the evidence to be low for all the remaining outcomes in our review: Community Walk Test (MD -6.35, 95% CI -21.59 to 8.88); Walking Ability Questionnaire (MD 0.53, 95% CI -5.59 to 6.66); Six-Minute Walk Test (MD 39.62 metres, 95% CI -8.26 to 87.51) and self-efficacy (SMD 0.32, 95% CI -0.09 to 0.72). We downgraded the quality of the evidence because of a high risk of bias and imprecision. AUTHORS' CONCLUSIONS There is currently insufficient evidence to establish the effect of community ambulation interventions or to support a change in clinical practice. More research is needed to determine if practicing outdoor or community walking will improve participation and community ambulation skills for stroke survivors living in the community.
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Affiliation(s)
- Ruth E Barclay
- University of ManitobaDepartment of Physical Therapy, College of Rehabilitation ScienceR106‐771 McDermot AvenueWinnipegCanadaR3E 0T6
| | - Ted J Stevenson
- St Boniface General HospitalRehabilitation Services409 TacheWinnipegCanadaR2H 2A6
| | - William Poluha
- University of ManitobaSciences and Technology LibraryWinnipegCanadaR3T 2N2
| | - Jacquie Ripat
- University of ManitobaDepartment of Occupational Therapy, College of Rehabilitation ScienceWinnipegCanada
| | - Cristabel Nett
- University of ManitobaDepartment of Physical Therapy, College of Rehabilitation ScienceR106‐771 McDermot AvenueWinnipegCanadaR3E 0T6
| | - Cynthia S Srikesavan
- University of ManitobaApplied Health Sciences PhD Program, School of Medical RehabilitationR106‐771McDermot AvenueWinnipegCanadaR3E 0T6
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Kawata AK, Kleinman L, Harding G, Ramachandran S. Evaluation of patient preference and willingness to pay for attributes of maintenance medication for chronic obstructive pulmonary disease (COPD). PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 7:413-26. [PMID: 24890711 PMCID: PMC4240911 DOI: 10.1007/s40271-014-0064-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD is characterized by poor treatment adherence, and patient medication preferences may contribute to adherence. Methods A discrete choice experiment with an internet panel drawn from the USA was used to evaluate preference and willingness to pay (WTP) of COPD patients for long-acting maintenance medications. Key attributes derived from earlier qualitative research (brief literature review and focus groups) with COPD patients on maintenance therapy included symptom relief, speed of feeling medication start to work, inhaler ease of use, rescue medication use, side effects, and monthly out-of-pocket co-pay. Patients were presented with hypothetical medications with different profiles and asked which they preferred. Utilities and marginal WTP in monthly co-pay dollars were estimated for all patients and by severity. Results Utilities for 515 participants were in the expected direction and highest for the most favorable attribute levels. Each attribute evaluated was important, and participants were willing to pay a premium to obtain each benefit. On average, WTP was as high as $US64 for complete symptom relief, $US59 for no side effects, $US32 to rarely use rescue medication, $US16 for a quick and easy to use inhaler, and $US13 for feeling medication work quickly (within 5 min; average WTP $US18/month for patients with severe/very severe COPD). Conclusion As expected, efficacy and safety were most valued by patients; however, this study showed that other COPD medication attributes, such as rescue medication, ease of use, and feeling medication work quickly, are also important in patient preferences.
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Affiliation(s)
- Ariane K Kawata
- Evidera, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD, 20814, USA,
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Barker S, Horton M, Kent RM, Tennant A. Development of a Self-Report Scale of Spasticity. Top Stroke Rehabil 2015; 20:485-92. [DOI: 10.1310/tsr2006-485] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Unsworth CA. Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) to Measure Outcomes for Clients Following Stroke. Top Stroke Rehabil 2015; 15:351-64. [DOI: 10.1310/tsr1504-351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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