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Snowdon DA, McGill S, Altmann C, Brooks K, Everard T, Le Fevre K, Andrew NE. Client and service factors associated with changes in health-related quality of life following community rehabilitation. Disabil Rehabil 2023; 45:512-522. [PMID: 35179439 DOI: 10.1080/09638288.2022.2037747] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To identify client and service factors associated with changes in health-related quality of life following community rehabilitation. METHODS We conducted a retrospective observational cohort study within a community rehabilitation program. Health-related quality of life was measured using the EuroQol five Dimensions, five response level version (EQ-5D-5L). Our primary outcome was the Visual Analogue Scale (VAS) rating of overall health. Analyses were stratified by diagnostic group: traumatic orthopaedic, elective orthopaedic, neurological, medical, and other. The association between client and service factors and discharge VAS scores, adjusted for baseline scores were determined using multivariable regression. RESULTS EQ-5D-5L data were available for 981 of 1350 participants. Treatment intensity was associated with a seven-point increase (β = 7.22, 95%CI 2.28-12.2, p = 0.004) in VAS scores for traumatic orthopaedic participants. For neurological participants, there was a positive interaction between comorbidities and intensity of therapy (β = 7.9, 95%CI 2.75-13.1, p = 0.003), indicating that greater therapy intensity in those with higher comorbidity scores was associated with an improvement in VAS scores. Age was negatively associated with VAS scores for traumatic orthopaedic participants and socioeconomic status was positively associated with VAS scores for elective orthopaedic participants. CONCLUSIONS Treatment intensity is a modifiable service factor that may positively influence health-related quality of life.Implications for rehabilitationIn addition to providing information on client progress towards attainment of individual treatment goals, routine collection of patient reported outcome measures within a community rehabilitation program can elicit information that can inform rehabilitation service improvement.Clients of a community rehabilitation program with a neurological or medical condition demonstrate the least improvement in overall health profile and may require additional rehabilitation or supports.Across all diagnostic groups, problems with anxiety and depression were least likely to improve following receipt of community rehabilitation. Improving access to psychological services and associated referral pathways in community rehabilitation services could improve these outcomes.Initiatives aimed at increasing intensity of therapy such as targeted triage and resource allocation, may improve health-related quality of life for clients of a community rehabilitation program with traumatic orthopaedic conditions.For clients with a neurological condition, initiatives aimed at increasing intensity of therapy may improve health-related quality of life in more complex patients with comorbid health conditions.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
| | - Scott McGill
- Community Rehabilitation Program, Rosebud, Australia
- Community Rehabilitation Program, Mornington, Australia
| | | | | | - Tori Everard
- Community Rehabilitation Program, Rosebud, Australia
| | - Kate Le Fevre
- Community Rehabilitation Program, Rosebud, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
- Academic Unit, Peninsula Health, Frankston, Australia
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2
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McPhail SM, Amarasena S, Stuart KA, Hayward K, Gupta R, Brain D, Hartel G, Rahman T, Clark PJ, Bernardes CM, Skoien R, Mckillen B, Lee A, Pillay L, Lin L, Khaing MM, Horsfall L, Powell EE, Valery PC. Assessment of health-related quality of life and health utilities in Australian patients with cirrhosis. JGH OPEN 2020; 5:133-142. [PMID: 33490623 PMCID: PMC7812472 DOI: 10.1002/jgh3.12462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
Background and Aim Health‐related quality‐of‐life measurements are important to understand lived experiences of patients who have cirrhosis. These measures also inform economic evaluations by modelling quality‐adjusted life years (QALYs). We aimed to describe health‐related quality of life, specifically multiattribute utility (scale anchors of death = 0.00 and full health = 1.00), across various stages and etiologies of cirrhosis. Methods Face‐to‐face interviews were used to collect Short Form 36 (SF‐36) questionnaire responses from CirCare study participants with cirrhosis (June 2017 to December 2018). The severity of cirrhosis was assessed using the Child‐Pugh score classified as class A (5–6 points), B (7–9), or C (10–15) and by the absence (“compensated”) versus presence (“decompensated”) of cirrhosis‐related complications. Results Patients (n = 562, average 59.8 years [SD = 11.0], male 69.9%) had a range of primary etiologies (alcohol‐related 35.2%, chronic hepatitis C 25.4%, non‐alcoholic fatty liver disease (NAFLD) 25.1%, chronic hepatitis B 5.9%, “other” 8.4%). Significantly lower (all P < 0.001) mean multiattribute utility was observed in the health states of patients with decompensated (mean = 0.62, SD = 0.15) versus compensated cirrhosis (mean = 0.68, SD = 0.12), Child‐Pugh class C (mean = 0.59, SD = 0.15) or B (mean = 0.63, SD = 0.15) versus A (mean = 0.68, SD = 0.16), and between those of working age (18–64 years; mean = 0.64, SD = 0.16) versus those aged 65+ years (mean = 0.70, SD = 0.16). The greatest decrements in health‐related quality of life relative to Australian population norms were observed across physical SF‐36 domains. Conclusions Persons with more advanced cirrhosis report greater life impacts. Estimates from this study are suitable for informing economic evaluations, particularly cost‐utility modelling, which captures the benefits of effective prevention, surveillance, and treatments on both the quality and quantity of patients' lives.
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Affiliation(s)
- Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia.,Clinical Informatics Directorate Metro South Health Brisbane Queensland Australia
| | - Samath Amarasena
- Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Katherine A Stuart
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia
| | - Kelly Hayward
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Rohit Gupta
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia.,Clinical Informatics Directorate Metro South Health Brisbane Queensland Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - Tony Rahman
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Paul J Clark
- Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Queensland Australia
| | - Christina M Bernardes
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Richard Skoien
- Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Benjamin Mckillen
- Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Andrew Lee
- Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Queensland Australia
| | - Leshni Pillay
- Department of Gastroenterology and Hepatology Logan Hospital Brisbane Queensland Australia
| | - Lei Lin
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Myat Myat Khaing
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Leigh Horsfall
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
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3
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Richter A, Lornudd C, von Thiele Schwarz U, Lundmark R, Mosson R, Eskner Skoger U, Hirvikoski T, Hasson H. Evaluation of iLead, a generic implementation leadership intervention: mixed-method preintervention-postintervention design. BMJ Open 2020; 10:e033227. [PMID: 31932392 PMCID: PMC7045007 DOI: 10.1136/bmjopen-2019-033227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The present study aimed to evaluate the iLead intervention and to investigate whether or not transfer of training can be supported by contextualising the intervention (recruiting all managers from one branch of the organisation while focusing on one implementation case, as well as training senior management). DESIGN A pre-evaluation-postevaluation design was applied using mixed methods with process and effect surveys and interviews to measure the effects on three levels. SETTING Healthcare managers from Stockholm's regional healthcare organisation were invited to the training. PARTICIPANTS 52 managers participated in the iLead intervention. Group 1 consisted of 21 managers from different organisations and with different implementation cases. Group 2, representing the contextualised group, consisted of 31 managers from the same organisation, working on the same implementation case, where senior management also received training. INTERVENTION iLead is an intervention where healthcare managers are trained in implementation leadership based on the full-range leadership model. PRIMARY OUTCOME MEASURES Reactions, knowledge and implementation leadership are measured. RESULTS Quantitative and qualitative analyses indicate that iLead was perceived to be of high quality and capable of increasing participants' knowledge. Mixed effects were found regarding changes in behaviours. The contextualisation did not have a boosting effect on behaviour change. Hence, group 2 did not increase its active implementation leadership in comparison with group 1. CONCLUSIONS iLead introduces a new approach to how implementation leadership can be trained when knowledge of effective leadership for implementations is combined with findings on the importance of environmental factors for the transfer of training. Even though managers reported general positive effects, transfer was not facilitated through the contextualisation of the intervention. There is a need to further develop approaches to help participants subsequently apply the learnt skills in their work environment.
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Affiliation(s)
- Anne Richter
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Caroline Lornudd
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Robert Lundmark
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - Rebecca Mosson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | | | - Tatja Hirvikoski
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm, Sweden
- Habilitation & Health, Region Stockholm, Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Farlie MK, Keating JL, Molloy E, Bowles KA, Neave B, Yamin J, Weightman J, Saber K, Haines TP. The Balance Intensity Scales for Therapists and Exercisers Measure Balance Exercise Intensity in Older Adults: Initial Validation Using Rasch Analysis. Phys Ther 2019; 99:1394-1404. [PMID: 31309981 PMCID: PMC6821236 DOI: 10.1093/ptj/pzz092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/17/2018] [Accepted: 02/20/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Balance Intensity Scales (BIS) have been developed to measure the intensity of balance exercise in older adults. OBJECTIVE The objective was to determine whether the BIS for therapists (BIS-T) and for exercisers (BIS-E) are unidimensional measures of balance exercise intensity, able to be refined using the Rasch model into a hierarchical item order, and appropriately targeted for the older adult population with a variety of diagnoses in a range of exercise testing settings. DESIGN This was a scale development study using a pragmatic mixed-methods approach. METHODS Older adult exercisers (n = 108) and their therapists (n = 33) were recruited from a large metropolitan health service and rated balance exercise tasks on the BIS-T and BIS-E in a single session. RESULTS Scores on both the BIS items and global effort ratings for therapists and exercisers had good correlation and demonstrated unidimensionality. The BIS-T and BIS-E demonstrated a hierarchical distribution of items that fit the Rasch model. The Person Separation Index was moderate (0.62) for the BIS-T but poor (0.33) for the BIS-E. LIMITATIONS The limitations were that therapists in this study underprescribed high-intensity balance tasks. CONCLUSIONS Initial validation of the BIS-T and the BIS-E demonstrated that these scales can be used for the measurement of balance exercise intensity in older adult populations. The BIS-T items and global effort ratings are recommended for use by therapists, and the global effort ratings are recommended for use by exercisers. Ongoing validation of both scales using high-intensity balance task ratings and different populations of older adults is recommended.
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Affiliation(s)
- Melanie K Farlie
- Graduate Certificate Health Professional Education, Allied Health Research Unit, Monash Health, Kingston Centre, Warrigal Rd, Cheltenham, Victoria, 3192 Australia,Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Victoria, Australia,Address all correspondence to Dr Farlie at:
| | | | - Elizabeth Molloy
- Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | - Jussyan Weightman
- Graduate Certificate Health Professional Education, Allied Health Research Unit, Monash Health
| | - Kelly Saber
- Faculty of Medicine, Nursing, and Health Sciences, Monash University,Graduate Certificate Health Professional Education, Allied Health Research Unit, Monash Health
| | - Terry P Haines
- Faculty of Medicine, Nursing, and Health Sciences, Monash University,Graduate Certificate Health Economics, Allied Health Research Unit, Monash Health
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5
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Bowyer A, Royse C. A matter of perspective - Objective versus subjective outcomes in the assessment of quality of recovery. Best Pract Res Clin Anaesthesiol 2018; 32:287-294. [PMID: 30522719 DOI: 10.1016/j.bpa.2018.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/16/2018] [Indexed: 01/31/2023]
Abstract
Current post-operative recovery assessment exists as a dichotomy, maintaining objectivity whilst providing relevance to patient-centred care. Both objective and subjective measures are utilised in modern recovery assessment and are best viewed as complimentary. At institutional and provider levels, performance indicators are utilised as surrogates for quality of recovery but only if these indicators are assessed in the clinical context from which they are derived. Patient-reported outcomes prioritise the patient's perspective of symptoms and care, which are the most important aspects at the time of assessment but are limited by their susceptibility to response shift and recall bias. Ideally, quality of recovery is assessed using objective measures in concert with measures of clinical complexity and in parallel with patient-reported outcomes.
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Affiliation(s)
- Andrea Bowyer
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Grattan St, Parkville, 3052, Australia.
| | - Colin Royse
- Department of Surgery, University of Melbourne, Level 6, Centre for Medical Research, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
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6
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Gane EM, McPhail SM, Hatton AL, Panizza BJ, O’Leary SP. Predictors of health-related quality of life in patients treated with neck dissection for head and neck cancer. Eur Arch Otorhinolaryngol 2017; 274:4183-4193. [DOI: 10.1007/s00405-017-4754-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/20/2017] [Indexed: 01/29/2023]
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7
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Jabrayilov R, Emons WHM, de Jong K, Sijtsma K. Longitudinal measurement invariance of the Dutch Outcome Questionnaire-45 in a clinical sample. Qual Life Res 2017; 26:1473-1481. [PMID: 28194617 PMCID: PMC5420380 DOI: 10.1007/s11136-017-1500-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 12/03/2022]
Abstract
Purpose In the absence of measurement invariance across measurement occasions, change scores based on pretest–posttest measurements may be inaccurate representations of real change on the latent variable. In this study, we examined whether measurement invariance held in the Dutch version of Outcome Questionnaire-45 (OQ-45). Method Using secondary data analysis of a sample of N = 540 Dutch outpatients, we tested the stability of the factorial structure (gamma change) and the metric and scalar invariance (beta change) across pretest and posttest measurements using a combination of factor analysis and item response theory methodology. Results Results revealed a stable factorial structure from pretest to posttest and minor violations of metric invariance for two items in the Dutch OQ-45. Conclusion Even though for two items the assumption of invariance was violated, results suggest that the effects of these violations on practical change assessment using the OQ-45 were negligible.
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Affiliation(s)
- Ruslan Jabrayilov
- University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Wilco H. M. Emons
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences (TSB), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Kim de Jong
- Institute of Psychology, Clinical Psychology Unit, Universiteit Leiden, PO Box 9555, 2300 RB Leiden, The Netherlands
| | - Klaas Sijtsma
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences (TSB), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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8
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Methodological considerations for research on ethnopolitical violence. Dev Psychopathol 2016; 29:71-77. [PMID: 27871339 DOI: 10.1017/s0954579416001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The methodological and epistemological challenges that research on ethnopolitical violence faces are examined. This research area is fundamentally important for political reasons and for understanding, as well as subsequent interventions to ameliorate, youths' responses to ethnopolitical violence. Advances in methods are reviewed that can overcome the obstacles placed by the various challenges. These issues are discussed in the context of the articles that comprise this Special Section.
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9
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McPhail SM. Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manag Healthc Policy 2016; 9:143-56. [PMID: 27462182 PMCID: PMC4939994 DOI: 10.2147/rmhp.s97248] [Citation(s) in RCA: 283] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person-specific factors (including social disadvantage and age), which represent important considerations for health service planning. Important priorities for research include economic evaluations of interventions, services, or health system approaches that can remediate the burden of multimorbidity in safe and cost-effective ways.
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Affiliation(s)
- Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health; Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
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10
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Development and validation of the ankle fracture outcome of rehabilitation measure (A-FORM). J Orthop Sports Phys Ther 2014; 44:488-99, B1-2. [PMID: 24853921 DOI: 10.2519/jospt.2014.4980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Delphi panel and cohort study. OBJECTIVE To develop and refine a condition-specific, patient-reported outcome measure, the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), and to examine its psychometric properties, including factor structure, reliability, and validity, by assessing item fit with the Rasch model. BACKGROUND To our knowledge, there is no patient-reported outcome measure specific to ankle fracture with a robust content foundation. METHODS A 2-stage research design was implemented. First, a Delphi panel that included patients and health professionals developed the items and refined the item wording. Second, a cohort study (n = 45) with 2 assessment points was conducted to permit preliminary maximum-likelihood exploratory factor analysis and Rasch analysis. RESULTS The Delphi panel reached consensus on 53 potential items that were carried forward to the cohort phase. From the 2 time points, 81 questionnaires were completed and analyzed; 38 potential items were eliminated on account of greater than 10% missing data, factor loadings, and uniqueness. The 15 unidimensional items retained in the scale demonstrated appropriate person and item reliability after (and before) removal of 1 item (anxious about footwear) that had a higher-than-ideal outfit statistic (1.75). The "anxious about footwear" item was retained in the instrument, but only the 14 items with acceptable infit and outfit statistics (range, 0.5-1.5) were included in the summary score. CONCLUSION This investigation developed and refined the A-FORM (Version 1.0). The A-FORM items demonstrated favorable psychometric properties and are suitable for conversion to a single summary score. Further studies utilizing the A-FORM instrument are warranted. J Orthop Sports Phys Ther 2014;44(7):488-499. Epub 22 May 2014. doi:10.2519/jospt.2014.4980.
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Driessens S, Diserens-Chew T, Burton C, Lassig E, Hartley C, McPhail S. A retrospective cohort investigation of active range of motion within one week of open reduction and internal fixation of distal radius fractures. J Hand Ther 2014; 26:225-30; quiz 231. [PMID: 23770202 DOI: 10.1016/j.jht.2013.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 02/09/2023]
Abstract
UNLABELLED Distal radius fractures stabilized by open reduction internal fixation (ORIF) have become increasingly common. There is currently no consensus on the optimal time to commence range of motion (ROM) exercises post-ORIF. A retrospective cohort review was conducted over a five-year period to compare wrist and forearm range of motion outcomes and number of therapy sessions between patients who commenced active ROM exercises within the first seven days and from day eight onward following ORIF of distal radius fractures. One hundred and twenty-one patient cases were identified. Clinical data, active ROM at initial and discharge therapy assessments, fracture type, surgical approaches, and number of therapy sessions attended were recorded. One hundred and seven (88.4%) cases had complete datasets. The early active ROM group (n = 37) commenced ROM a mean (SD) of 4.27 (1.8) days post-ORIF. The comparator group (n = 70) commenced ROM exercises 24.3 (13.6) days post-ORIF. No significant differences were identified between groups in ROM at initial or discharge assessments, or therapy sessions attended. The results from this study indicate that patients who commenced active ROM exercises an average of 24 days after surgery achieved comparable ROM outcomes with similar number of therapy sessions to those who commenced ROM exercises within the first week. LEVEL OF EVIDENCE 2B, retrospective cohort.
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Affiliation(s)
- Susan Driessens
- Logan Hospital, Queensland Health, Logan City, Queensland, Australia.
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12
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Barclay R, Tate RB. Response shift recalibration and reprioritization in health-related quality of life was identified prospectively in older men with and without stroke. J Clin Epidemiol 2014; 67:500-7. [PMID: 24613499 DOI: 10.1016/j.jclinepi.2013.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 12/06/2013] [Accepted: 12/08/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To prospectively consider evidence for response shift (RS) in health-related quality of life (HRQL) in older men who experienced stroke or remained stroke free. RS is a change in the meaning of self-evaluation; this includes recalibration, reprioritization, and reconceptualization. STUDY DESIGN A cohort of 3,983 male World War II Royal Canadian Air Force recruits has been followed since 1948. There were three prospectively determined groups: stroke survivors (n = 168; mean age, 80.1 years); older stroke-free group (n = 254; mean age, 82.8 years); and younger stroke-free group (n = 323; mean age, 74.7 years). The Short Form-36 (SF-36) was used to evaluate HRQL. Longitudinal structural equation models were developed using SF-36 subscales and three latent variables. Measurement invariance over two time points for each of the three groups was evaluated to identify RS. RESULTS All RS models had reasonable fit: stroke [root mean square error of approximation (RMSEA), 0.069; 90% confidence interval (CI): 0.052, 0.086], older (RMSEA, 0.055; 90% CI: 0.041, 0.068), and younger (RMSEA, 0.062; 90% CI: 0.051, 0.074). Recalibration of physical function occurred in all three groups. Reprioritization of role limitations due to physical health happened in both stroke-free groups. CONCLUSION This study is unique in our ability to prospectively identify RS recalibration and reprioritization in HRQL in aging men with stroke and remaining free of stroke. Changes in the meaning of self-evaluation of HRQL occur not only with stroke but also in men who remain free of stroke.
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Affiliation(s)
- Ruth Barclay
- Department of Physical Therapy, School of Medical Rehabilitation, University of Manitoba, R106-771 McDermot Ave, Winnipeg, Manitoba, Canada R3E 0T6.
| | - Robert B Tate
- Department of Community Health Sciences, University of Manitoba, T148-770 Bannatyne Ave, Winnipeg, Manitoba, Canada R3E 0W3
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13
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Pettersson A, Turesson I, Persson C, Johansson B. Assessing patients' perceived bother from the gastrointestinal side effects of radiotherapy for localized prostate cancer: initial questionnaire development and validation. Acta Oncol 2014; 53:368-77. [PMID: 23957649 DOI: 10.3109/0284186x.2013.819994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present study reports on the development and first steps of validation of the Gastrointestinal Side Effects Questionnaire (GISEQ), a measure of patient-reported gastrointestinal symptoms following local radiotherapy to the prostate. The questionnaire design provides a novel approach of assessment of side effects of prostate radiotherapy, by enabling measurement of patient-perceived change in symptoms. MATERIAL AND METHODS The eight-item GISEQ was administered to 130 prostate cancer patients referred to radiotherapy. Patients completed the GISEQ at four, eight and 15 weeks after start of radiotherapy. The psychometric properties including validity, reliability, responsiveness and feasibility were evaluated. The EORTC QLQ-C30 and QLQ-PR25 were chosen as comparative measures. RESULTS Expert opinion supported content validity. For concurrent validity, correlation between the GISEQ and matching items in the EORTC questionnaires was moderate but significant (r > 0.41, p < 0.001). The responsiveness was adequate, indicated by changes in GISEQ scores over time corresponding to the effects of radiation. Internal consistency was satisfactory (overall Cronbach's α> 0.70). Sensitivity and specificity for items diarrhea, constipation and blood in stools ranged from 50% to 100% and from 68% to 100%, respectively. All items had a floor effect above 15%. The response rates ranged from 85% to 92% and missing items was < 0.8%, indicating good feasibility. CONCLUSIONS The GISEQ showed satisfactory internal consistency and adequate content validity, concurrent validity and responsiveness. It is brief, easy to use and can be quickly evaluated, making it useful not only for research but possibly also for clinical settings. Modification of response scale and extension of items are potential improvements. Further work is needed to strengthen the psychometric qualities of the GISEQ and to evaluate its clinical use and potential effects of response shift and recall bias.
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Affiliation(s)
- Anna Pettersson
- Department of Radiology, Oncology and Radiation Science, Uppsala University , Uppsala , Sweden
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14
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McPhail SM, Waite MC. Physical activity and health-related quality of life among physiotherapists: a cross sectional survey in an Australian hospital and health service. J Occup Med Toxicol 2014; 9:1. [PMID: 24405934 PMCID: PMC3896696 DOI: 10.1186/1745-6673-9-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/07/2014] [Indexed: 12/25/2022] Open
Abstract
Background Physiotherapists are a professional group with a high rate of attrition and at high risk of musculoskeletal disorders. The purpose of this investigation was to examine the physical activity levels and health-related quality of life of physiotherapists working in metropolitan clinical settings in an Australian hospital and health service. It was hypothesized that practicing physiotherapists would report excellent health-related quality of life and would already be physically active. Such a finding would add weight to a claim that general physical activity conditioning strategies may not be useful for preventing musculoskeletal disorders among active healthy physiotherapists, but rather, future investigations should focus on the development and evaluation of role specific conditioning strategies. Methods A questionnaire was completed by 44 physiotherapists from three inpatient units and three ambulatory clinics (63.7% response rate). Physical activity levels were reported using the Active Australia Survey. Health-related quality of life was examined using the EQ-5D instrument. Physical activity and EQ-5D data were examined using conventional descriptive statistics; with domain responses for the EQ-5D presented in a frequency histogram. Results The majority of physiotherapists in this sample were younger than 30 years of age (n = 25, 56.8%) consistent with the presence of a high attrition rate. Almost all respondents exceeded minimum recommended physical activity guidelines (n = 40, 90.9%). Overall the respondents engaged in more vigorous physical activity (median = 180 minutes) and walking (median = 135 minutes) than moderate exercise (median = 35 minutes) each week. Thirty-seven (84.1%) participants reported no pain or discomfort impacting their health-related quality of life, with most (n = 35,79.5%) being in full health. Conclusions Physical-conditioning based interventions for the prevention of musculoskeletal disorders among practicing physiotherapists may be better targeted to role or task specific conditioning rather than general physical conditioning among this physically active population. It is plausible that an inherent attrition of physiotherapists may occur among those not as active or healthy as therapists who cope with the physical demands of clinical practice. Extrapolation of findings from this study may be limited due to the sample characteristics. However, this investigation addressed the study objectives and has provided a foundation for larger scale longitudinal investigations in this field.
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Affiliation(s)
- Steven M McPhail
- Queensland University of Technology, School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Victoria Park Road, Kelvin Grove 4059, Queensland, Australia.
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15
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Physiotherapists have accurate expectations of their patients' future health-related quality of life after first assessment in a subacute rehabilitation setting. BIOMED RESEARCH INTERNATIONAL 2013; 2013:340371. [PMID: 24350262 PMCID: PMC3853800 DOI: 10.1155/2013/340371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/19/2013] [Indexed: 12/02/2022]
Abstract
Background. Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients' future health states are accurate. Methods. A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists' (n = 23) prediction of patients' discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n = 272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients' cognitive ability. Results. Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37–0.57 (58%–83%) across EQ-5D-3L domains in the lower cognition group and 0.53–0.68 (81%–85%) in the better cognition group. Conclusions. Physiotherapists in this subacute rehabilitation setting predicted their patients' discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition.
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16
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Meyer T, Richter S, Raspe H. Agreement between pre-post measures of change and transition ratings as well as then-tests. BMC Med Res Methodol 2013; 13:52. [PMID: 23537286 PMCID: PMC3626663 DOI: 10.1186/1471-2288-13-52] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/19/2013] [Indexed: 11/12/2022] Open
Abstract
Background Different approaches have been developed for measuring change. Direct measurement of change (transition ratings) requires asking a patient directly about his judgment about the change he has experienced (reported change). With indirect measures of change, the patients’ status is assessed at different time points and differences between them are calculated (measured change). When using the quasi-indirect approach (‘then-test’), patients are asked after an intervention to rate their statuses both before the intervention as well as at the time of the enquiry. Associations previous studies have found between the different approaches might be biased because transition ratings are generally assessed using a single, general item, while indirect measures of change are generally based on multi-item scales. We aimed to quantify the agreement between indirect and direct as well as indirect and quasi-indirect measures of change while using multi-item scales exclusively. We explored possible reasons for non-agreement (present-state bias, recall bias). Methods We re-analysed a data set originally collected to investigate the prognostic validity of different approaches of change measurements. Patients from a 3-week inpatient rehabilitation programme for either cardiac or musculoskeletal disorders filled in health-status questionnaires (which included scales for sleep function, physical function, and somatisation) both at admission and at discharge. The patients were then randomised to receive either an additional transition-rating or then-test questionnaire at discharge. Results Out of 426 patients, 395 (92.7%) completed all questionnaires. Correlation coefficients between indirect and quasi-indirect measures of change ranged from r = .60 to r = .71, compared to r = .37 to r = .48 between indirect and direct measures of change. Correlation coefficients between pre-test and retrospective pre-test (then-test) results ranged from r = .69 to r = .82, indicating a low level of recall bias. Pre-test variation accounted for a substantial amount of variance in transition ratings in addition to the post-test scores, indicating a low level of present-state bias. Conclusions Indirect and quasi-indirect measurements of change yielded comparable results indicating that recall bias does not necessarily affect quasi-indirect measurement of change. Quasi-indirect measurement might serve as a substitute for pre-post measurement under conditions still to be specified. Transition ratings reflect different aspects of change than indirect and quasi-indirect methods do, but are not necessarily biased by patients’ present states.
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Affiliation(s)
- Thorsten Meyer
- Integrative Rehabilitation Research Unit, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
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17
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McPhail SM, Dunstan J, Canning J, Haines TP. Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. BMC Musculoskelet Disord 2012; 13:224. [PMID: 23171034 PMCID: PMC3517753 DOI: 10.1186/1471-2474-13-224] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 11/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. METHODS A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. RESULTS Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. CONCLUSIONS The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome measure can be developed.
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Affiliation(s)
- Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Buranda Plaza, Corner Ipswich Road and Cornwall Street Buranda, Brisbane, Australia.
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18
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Abstract
OBJECTIVE to investigate how to interpret changes on the CASP-19 quality of life scale for older people, and whether it discriminates between, and is responsive to, relevant differences or changes in participants' circumstances. METHODS analysis of data from the English Longitudinal Study of Ageing for those completing CASP-19 in both Wave 1 and Wave 2 (n = 6,482). Cross-sectional and longitudinal comparisons, using multiple linear regression, of CASP-19 scores with respect to eight anchor variables. RESULTS cross-sectional comparisons found differences in mean CASP-19 scores at Wave 1 between categories of anchor variables varied from 1.9 for living alone to 8.0 for being able to walk ¼ mile with difficulty. Longitudinal comparisons of changes in CASP-19 found that subjects that had moved between categories of the anchor variables over 28 months, had changed their mean CASP-19 score by about 1 unit in the expected direction, compared with the unchanged category. These changes were statistically significant for six of the eight anchors. CONCLUSIONS the cross-sectional comparisons help interpret differences and indicate CASP-19 has discriminatory power. The longitudinal changes show that CASP-19 is responsive to changes in most anchor variables that reflect some aspects of quality of life.
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Affiliation(s)
- Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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19
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McPhail S, Haines T. Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge. Health Qual Life Outcomes 2012; 10:94. [PMID: 22901009 PMCID: PMC3495730 DOI: 10.1186/1477-7525-10-94] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 08/02/2012] [Indexed: 11/16/2022] Open
Abstract
Background Expectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients’ expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life. Methods A prospective longitudinal cohort investigation of agreement between patients’ anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients’ cognitive ability. Results Overall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses. Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.
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Affiliation(s)
- Steven McPhail
- Centre for Functioning and Health Research, Buranda, Brisbane, Australia.
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20
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Relative importance measures for reprioritization response shift. Qual Life Res 2012; 22:695-703. [PMID: 22700163 DOI: 10.1007/s11136-012-0198-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Response shift (RS), a change in the meaning of an individual's self-evaluation of a target construct, such as health-related quality of life (HRQOL), can affect the interpretation of change in measures of the construct collected over time. This study proposes new statistical methods to test for reprioritization RS, in which the relative importance of HRQOL domains changes over time. METHODS The methods use descriptive discriminant analysis or logistic regression models and bootstrap inference to test for change in relative importance weights (method 1) or ranks (method 2) for discriminating between patient groups at two occasions. The methods are demonstrated using data from the Manitoba Inflammatory Bowel Disease (IBD) Cohort Study (n = 388). Reprioritization of domains from the IBD Questionnaire (IBDQ) and SF-36 was investigated for groups with active and inactive disease symptoms. RESULTS The IBDQ bowel symptoms and SF-36 bodily pain domains had the highest ranks for group discrimination. Using Method 1, there was evidence of reprioritization RS in the IBDQ social functioning domain and the SF-36 bodily pain and social functioning domains. Method 2 did not detect change for any of the domains. CONCLUSIONS Compared to IBD patients without active disease symptoms, those with active symptoms were likely to change the meaning of their self-evaluations of pain and social interactions. Further research is needed to compare these new RS detection methods under a variety of data analytic conditions before recommendations about the optimal method can be made.
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Chiu MH, Hwang HF, Lee HD, Chien DK, Chen CY, Lin MR. Effect of fracture type on health-related quality of life among older women in Taiwan. Arch Phys Med Rehabil 2012; 93:512-9. [PMID: 22373936 DOI: 10.1016/j.apmr.2011.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate changes in health-related quality of life (HRQOL) during the first year after injury in elderly Taiwanese women who had fractured a hip, vertebra, distal forearm, or multiple sites. DESIGN Longitudinal cohort study. SETTING Personal or telephone interviews of patients from 3 teaching hospitals. PARTICIPANTS Women (N=347; mean age ± SD, 78.0±6.6y) who had sustained a fracture of the hip, vertebra, or distal forearm due to a fall participated in the baseline assessment, in which both current and prefracture HRQOL data were collected. At 6 and 12 months after the fracture, 285 and 254 women, respectively, completed the follow-up assessments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The 4 domains of physical capacity, psychological well-being, social relationships, and environment of the brief version of the World Health Organization Quality of Life questionnaire were assessed. RESULTS After adjusting for prefracture HRQOL scores and baseline characteristics, women with a hip fracture showed a significant improvement in physical capacity (3.5 points) and a significant decline in social relationships (-3.7 points). Relative to women with a hip fracture at 12 months after injury, those with a vertebral fracture exhibited significantly greater improvement (5.2 points) in physical capacity; those with a distal forearm fracture had significantly greater improvements in physical capacity (11.5 points), psychological well-being (8.4 points), social relationships (7.2 points), and environment (10.9 points), while those with multiple fractures displayed significantly greater improvement in physical capacity (16.5 points), psychological well-being (13.3 points), and environment (10.3 points). CONCLUSIONS Among the 4 fracture types in elderly women, hip fractures may result in the smallest improvement in the physical domain and the greatest declines in the psychological, social, and environmental domains during the first year. The magnitude of the impact of each fracture type varied across different domains.
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Affiliation(s)
- Ming-Huang Chiu
- Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan, R.O.C
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Abstract
The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
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McPhail S, Beller E, Haines T. Reference bias: presentation of extreme health states prior to EQ-VAS improves health-related quality of life scores. a randomised cross-over trial. Health Qual Life Outcomes 2010; 8:146. [PMID: 21126374 PMCID: PMC3014890 DOI: 10.1186/1477-7525-8-146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 12/02/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Clinical practice and clinical research has made a concerted effort to move beyond the use of clinical indicators alone and embrace patient focused care through the use of patient reported outcomes such as health-related quality of life. However, unless patients give consistent consideration to the health states that give meaning to measurement scales used to evaluate these constructs, longitudinal comparison of these measures may be invalid. This study aimed to investigate whether patients give consideration to a standard health state rating scale (EQ-VAS) and whether consideration of good and poor health state descriptors immediately changes their self-report. METHODS A randomised crossover trial was implemented amongst hospitalised older adults (n = 151). Patients were asked to consider descriptions of extremely good (Description-A) and poor (Description-B) health states. The EQ-VAS was administered as a self-report at baseline, after the first descriptors (A or B), then again after the remaining descriptors (B or A respectively). At baseline patients were also asked if they had considered either EQ-VAS anchors. RESULTS Overall 106/151 (70%) participants changed their self-evaluation by ≥ 5 points on the 100 point VAS, with a mean (SD) change of +4.5 (12) points (p < 0.001). A total of 74/151 (49%) participants did not consider the best health VAS anchor, of the 77 who did 59 (77%) thought the good health descriptors were more extreme (better) then they had previously considered. Similarly 85/151 (66%) participants did not consider the worst health anchor of the 66 who did 63 (95%) thought the poor health descriptors were more extreme (worse) then they had previously considered. CONCLUSIONS Health state self-reports may not be well considered. An immediate significant shift in response can be elicited by exposure to a mere description of an extreme health state despite no actual change in underlying health state occurring. Caution should be exercised in research and clinical settings when interpreting subjective patient reported outcomes that are dependent on brief anchors for meaning. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (#ACTRN12607000606482) http://www.anzctr.org.au.
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Affiliation(s)
- Steven McPhail
- Centre for Functioning and Health Research, Ipswich Road, Woolloongabba, Queensland, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
- Queensland University of Technology, School of Public Health and Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
| | - Elaine Beller
- Bond University, Centre for Research in Evidence-Based Practice, Gold Coast, Queensland, Australia
| | - Terry Haines
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
- Southern Health, Allied Health Research Unit, Kingston Centre, Cnr Warrigal and Kingston Roads, Cheltenham, Victoria, Australia
- Monash University, Physiotherapy Department, School of Primary Health Care, Monash University Peninsular Campus, Victoria, Australia
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McPhail S, Haines T. Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients. Health Qual Life Outcomes 2010; 8:65. [PMID: 20618978 PMCID: PMC2912788 DOI: 10.1186/1477-7525-8-65] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 07/10/2010] [Indexed: 11/10/2022] Open
Abstract
Background Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced. Methods A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement. Results Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%). Conclusions Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.
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Affiliation(s)
- Steven McPhail
- Centre for Functioning, Disability and Health Research, Queensland Health, Buranda Plaza, Corner of Ipswich Road and Cornwall Street, Brisbane, Australia.
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