Telephone reliability of the Frenchay Activity Index and EQ-5D amongst older adults

Standardised data collection from people with dementia over the telephone: A qualitative study of the experience of DETERMIND programme researchers in a pandemic

There is a notable lack of evidence on what constitutes good practice in remote quantitative data collection from research participants with dementia. During the COVID-19 pandemic face-to-face research became problematic, especially where participants were older and more at risk of infection. The DETERMIND-C19 study, a large cohort study of people with dementia, switched to telephone data collection over this period. This paper explores the experiences of researchers who collected quantitative data over the telephone from people with dementia during the first COVID-19 lockdowns in England. The aim was to learn from these experiences, share insights and inform future research practice across disciplines. Seven DETERMIND researchers were interviewed about the processes and challenges of collecting quantitative data from people with dementia over the telephone compared to face-to-face. Data were analysed using reflexive thematic analysis. Two themes were developed: first the telephone adds an extra layer of confusion to an already cognitively complex interaction. Second, researchers found it difficult to recognise subtle cues that signalled participants' rising emotion over the telephone in time to prevent distress. The researchers employed strategies to support participants which may not have conformed to the strict conventions of structured interviewing, but which were informed by person-oriented principles. Whilst in practice this may be a common approach to balancing the needs of participants and the requirements of quantitative research, it is rare for studies to openly discuss such trade-offs in the literature. Honest, reflective reporting is required if the practice of remote data collection from people with dementia is to progress ethically and with integrity.

A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease

BACKGROUND

Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality.

METHODS

Outpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m2 were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records.

RESULTS

Ninety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI.

CONCLUSIONS

Frailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants.

Intravenous vs. intraosseous vascular access during out-of-hospital cardiac arrest - protocol for a randomised clinical trial

Objective

During cardiac arrest, current guidelines recommend attempting intravenous access first and to consider intraosseous access if intravenous access is unsuccessful or impossible. However, these recommendations are only based on very low-certainty evidence. Therefore, the "Intravenous vs Intraosseous Vascular Access During Out-of-Hospital Cardiac Arrest" (IVIO) trial aims to determine whether there is a difference in patient outcomes depending on the type of vascular access attempted during out-of-hospital cardiac arrest. This current article describes the clinical IVIO trial.

Methods

The IVIO trial is an investigator-initiated, randomised trial of intravenous vs. intraosseous vascular access during adult non-traumatic out-of-hospital cardiac arrest in Denmark. The intervention will consist of minimum two attempts (if unsuccessful on the first attempt) to successfully establish intravenous or intraosseous vascular access during cardiac arrest. The intraosseous group will be further randomised to the humeral or tibial site. The primary outcome is sustained return of spontaneous circulation and key secondary outcomes include survival and survival with a favourable neurological outcome at 30 days. A total of 1,470 patients will be included.

Results

The trial started in March 2022 and the last patient is anticipated to be included in the spring of 2024. The primary results will be reported after 90-day follow-up and are anticipated in mid-2024.

Conclusion

The current article describes the design of the Danish IVIO trial. The findings of this trial will help inform future guidelines for selecting the optimal vascular access route during out-of-hospital cardiac arrest.

Resuscitation Preferences of Older Acutely Admitted Medical and Mentally Competent Patients with One and Six Months Follow-up

AIM

Determining patients' cardiopulmonary resuscitation (CPR) preferences in the emergency department (ED) is common practice but the stability of these preferences and their recollection by patients has been questioned. Therefore, this study assessed the stability and recall of CPR preferences of older patients at and following ED discharge.

METHODS

This survey-based cohort study was conducted between February and September 2020 at three EDs in Denmark. It consecutively asked mentally competent patients aged 65 years or older who were admitted to hospital through the ED and then one and six months later "In your current state of health, do you wish that physicians should try to intervene if your heart stops beating?" Possible responses were confined to "definitely yes", "definitely no", "uncertain", and "prefer not to answer".

RESULTS

In total, 3688 patients admitted to hospital via the ED patients were screened, 1766 were eligible and 491 (27.8%) were included: median age was 76 (IQR 71-82) years, and 257 (52.3%) were men. One third of patients who expressed definite yes or no preferences in ED had changed their preference at one month follow-up. Only 90 (27.4%) and 94 (35.7%) patients recalled their preferences at one and six months follow-up, respectively.

CONCLUSION

and Relevance In this study, one-in-three older ED patients who initially expressed definite resuscitation preferences had changed their minds at one month follow-up. Preferences were more stable at six months but only a minority were able to recall their preferences.

Associations between everyday activities and arterial spin labeling-derived cerebral blood flow: A longitudinal study in community-dwelling elderly volunteers

Cerebral blood flow (CBF) is critical for brain metabolism and function. Age-related changes in CBF are associated with increased risk of neurocognitive disorders and vascular events such as stroke. Identifying correlates and positive modifiers of age-related changes in CBF before the emergence of incipient clinical decline may inform public health advice and clinical practice. Former research has been inconclusive regarding the association between regular physical activity and CBF, and there is a lack of studies on the association between level of everyday activities and CBF, in older adults. To investigate these relationships, 118 healthy community-dwelling adults (65-89 years) underwent pseudo-continuous arterial spin labeling (ASL) MRI, neurocognitive, physical, and activity assessments at baseline. Eighty-six participants completed a follow-up ASL MRI, on average 506 (SD = 113) days after the baseline scan. Cross-sectional analysis revealed credible evidence for positive associations between time spent on low intensity physical activity and CBF in multiple cortical and subcortical regions, time spent on moderate to vigorous intensity physical activity and accumbens CBF, participation in social activity and CBF in multiple cortical regions, and between reading and thalamic CBF, indicating higher regional CBF in more active adults. Longitudinal analysis revealed anecdotal evidence for an interaction between time and baseline level of gardening on occipital and parietal CBF, and baseline reading on pallidum CBF, indicating more change in CBF in adults with lower level of activity. The findings support that malleable lifestyle factors contribute to healthy brain aging, with relevance for public health guidelines.

Client and service factors associated with changes in health-related quality of life following community rehabilitation

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.

Long-term outcomes of major trauma patients with concussion

INTRODUCTION

Concussion may be sustained in the setting of injuries to multiple body regions and persistent effects of concussion may impact recovery. This project aimed to evaluate the association between concussion and 6-month and 12-month functional outcomes in survivors after major trauma.

METHODS

This was a registry-based cohort study that included adult patients with major trauma who presented to hospital between 01 Jan 2008 and 31 Dec 2017 and survived to hospital discharge. We excluded patients presenting with a Glasgow Coma Scale score <13 and those diagnosed with other intracranial injuries. Additionally, from the non-concussed group, patients with fractured skull and/or face were excluded, with the assumption that such patients may have had undiagnosed concussion. A good recovery was considered for Glasgow Outcome Scale-Extended (GOS-E) scores of 7 or 8. In addition, we assessed for patient reported anxiety and/or depression measured using the 3-level EuroQol 5 dimensions questionnaire. A modified mixed effects Poisson models with random intercepts for participant was used to assess the association between concussion and outcome.

RESULTS

There were 28,161 eligible patients and 12,822 met inclusion criteria. Concussion was diagnosed in 1860 patients (14.5%; 95%CI: 13.9-15.1). There was no association between concussion and good recovery at 12 months (aRR 1.05 (95%CI: 0.99-1.11). There was no association between concussion and anxiety and/or depression at 12 months (aRR 1.03; 95%CI: 0.99-1.07).

CONCLUSIONS

Concussion was sustained among 14.5% of included patients in the setting of major trauma but not associated with longer-term adverse outcomes using GOS-E. Concussed patients did not report differential rates of anxiety and/or depression.

Meeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation were positively associated with performance of outdoor community activities 8 weeks after discharge

PURPOSE

To assess whether meeting criteria for community ambulation and ambulatory self-confidence on discharge from inpatient rehabilitation are associated with participation in community activities.

METHODS

Prospective longitudinal observational study design. Participants were assessed within 48-hours of discharge on ability to complete tasks reflective of community ambulation (walking 315 m, ascending/descending three stairs, a ramp, and a street curb and walking at 0.44 m/s) and ambulatory self-confidence. At 8 weeks post-discharge frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Multivariable regression analysis determined factors associated with total and outdoor FAI score.

RESULTS

Seventy-four of 79 participants were followed up at 8 weeks post-discharge. Meeting all ambulation criteria was positively associated with FAI outdoor score (β = 1.85, 95%CI 0.01-3.69, p = 0.049). Ambulatory self-confidence was positively associated with FAI outdoor score (β = 0.03, 95%CI 0-0.05, p = 0.032) and FAI total score (β = 0.05, 95%CI 0-0.1, p = 0.040). Age (β= -0.22, 95%CI -0.36 to -0.08, p = 0.003) and living alone (β = 3.36, 95%CI 0.10-6.61, p = 0.044) were associated with FAI total score.

CONCLUSIONS

Capacity to meet ambulation criteria and ambulatory self-confidence are modifiable factors that could be targeted during rehabilitation to improve participation in community activities.Implications for rehabilitationMeeting community ambulation criteria and confidence with walking on discharge from inpatient rehabilitation are positively associated with performance of outdoor community activities 8 weeks after discharge.Capacity to meet community ambulation criteria and ambulatory confidence may be useful measures for rehabilitation teams to consider when discharging patients home.Meeting ambulation criteria and ambulatory confidence are modifiable factors that could be addressed through targeted therapy to improve community integration following hospitalisation.

Functional status of community-dwelling older adults after inpatient rehabilitation

Background/aims:

Factors that influence functional ability in older adults after rehabilitation are not well understood. The aim of this study was to investigate how older people function in their community after being discharged from inpatient rehabilitation.

Methods

A cross-sectional study was undertaken of community-dwelling older adults (n=86, 75 ± 6 years) discharged from rehabilitation in the previous 12 months. Basic functional independence was assessed using the Functional Independence Measure and complex functional independence was assessed using the Frenchay Activities Index. Multiple regression analyses were conducted to assess any association between predetermined factors and function.

Results

Functional Independence Measure scores and physical activity levels after being discharged accounted for 50% of the variance in basic function (R2=0.50, F=40.75, P<0.001). Frenchay Activities Index scores, physical activity, age, sex and migrant status accounted for 68% of variance in complex function (R2=0.68, F=29.75, P<0.001).

Conclusions

Clinicians are encouraged to implement strategies to improve function at discharge from rehabilitation and to promote physical activity among older people at risk of poor function following rehabilitation.

Are in Person and Telephone Interviews Equivalent Modes of Administrating the CAT, the FACIT-FS and the SGRQ in People With COPD?

Background: The COVID-19 pandemic brought numerous challenges, namely in routine assessment of people with chronic obstructive pulmonary disease (COPD). The COPD Assessment Test (CAT), the Functional Assessment of Chronic Illness-Fatigue-Subscale (FACIT-FS) and the St. George's respiratory questionnaire (SGRQ) are important patient-reported outcome measures used to assess people with COPD, but its face-to-face application has been compromised. The telephone interview offers a simple and effective alternative, yet uncertainty regarding its equivalence remains. This study aimed to establish the reliability and validity of the CAT, the FACIT-FS and the SGRQ administered by telephone interview in people with COPD.

Methods: Data from an observational prospective study including people with COPD were analyzed. Participants answered to the CAT, FACIT-FS and SGRQ questionnaires in person and by telephone, with a maximum interval of 48-h. Participants were randomly selected to answer first to the in-person questionnaire followed by telephone or vice versa. Reliability measures included internal consistency with Cronbach's alpha, test-retest reliability with the intraclass correlation coefficient (ICC_2,1), test-retest measurement error with the standard error of measurement (SEM) and agreement with the Bland and Altman 95% limits of agreement. Validity was assessed with the Spearman correlation (rho).

Results: Fifty-five people with COPD (44 men; 68.1 ± 7.9 years; FEV₁: 59.1 ± 20.3% predicted) were included. Similar internal consistency was observed between in person vs. telephone interview for the CAT (0.82 vs. 0.84), the FACIT-FS (0.83 vs. 0.84) and the SGRQ (0.92 vs. 0.93). Test-retest reliability was excellent, with an ICC_2,1 of 0.77 (95% CI: 0.65; 0.86), 0.86 (95% CI: 0.77; 0.92) and 0.94 (95% CI: 0.90; 0.96) for the CAT, FACIT-FS and SGRQ total scores, respectively. The SEM showed a low level of associated measurement error and the Bland and Altman plots illustrated a good level of agreement between both modes of administration, with no evidence of systematic bias. Robust positive correlations (rho 0.87–0.94, p < 0.001) were found for the CAT, FACIT-FS and SGRQ total scores applied by both methods.

Conclusion: The telephonic administration of the CAT, the FACIT-FS and the SGRQ are a valid and reliable alternative approach to in person interviews for monitoring symptoms and health-related quality of life in people with COPD. The telephone might be an important add-on for personalized assessment and management of COPD thru remote monitoring.

Economic Burden and Impact on Quality of Life of Herpes Zoster in Spanish Adults Aged 50 Years or Older: A Prospective Cohort Study

Introduction

The economic burden of herpes zoster (HZ), including its most common complication, postherpetic neuralgia (PHN), and its impact on health-related quality of life (HRQL) is not well described in Spain. The aim of this study was to estimate HZ-related healthcare costs and impact on HRQL in Spanish adults aged 50 years or older.

Methods

A prospective, observational study was performed with patients with HZ recruited through four general practitioner networks in Spain (NCT01521286). HRQL data were collected using the EuroQoL-5 Dimension (EQ-5D) questionnaire; HZ-related pain and associated interference with activities of daily living (ADL) were assessed using the Zoster Brief Pain Inventory (ZBPI) questionnaire at days 0 (HZ rash onset), 15, 30, 60, and 90; patients with PHN were assessed up until day 270. Medical resource utilization was recorded throughout study follow-up. Work loss for patients/caregivers was also assessed. Costs were calculated from both the payer and societal perspectives.

Results

A total of 545 patients with Hz were included, of whom 25 developed PHN. During days 0–30 post HZ diagnosis, the mean EQ-5D utility score was 0.738, equating to a utility loss of 0.138. Sleep was the ADL most affected component. The mean costs for HZ in the overall cohort were €240 and €296 from the payer/societal perspective, respectively; €187/€242 for patients with HZ without any HZ-related complications; and €571/€712 for patients who developed PHN. The majority of costs were incurred during days 0–30.

Conclusions

In Spain, HZ and HZ-related complications such as PHN reduce patient HRQL and increase the economic burden for both payers and society in general.

Trail Registration

ClinicalTrials.gov identifier NCT01521286.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01717-7.

Design and rationale of a routine clinical care pathway and prospective cohort study in older patients needing intensive treatment

BACKGROUND

Treatment decisions concerning older patients can be very challenging and individualised treatment plans are often required in this very heterogeneous group. In 2015 we have implemented a routine clinical care pathway for older patients in need of intensive treatment, including a comprehensive geriatric assessment (CGA) that was used to support clinical decision making. An ongoing prospective cohort study, the Triaging Elderly Needing Treatment (TENT) study, has also been initiated in 2016 for participants in this clinical care pathway, to study associations between geriatric characteristics and outcomes of treatment that are relevant to older patients. The aim of this paper is to describe the implementation and rationale of the routine clinical care pathway and design of the TENT study.

METHODS

A routine clinical care pathway has been designed and implemented in multiple hospitals in the Netherlands. Patients aged ≥70 years who are candidates for intensive treatments, such as chemotherapy, (chemo-)radiation therapy or major surgery, undergo frailty screening based on the Geriatric 8 (G-8) questionnaire and the Six-Item Cognitive Impairment Test (6CIT). If screening reveals potential frailty, a CGA is performed. All patients are invited to participate in the TENT study. Clinical data and blood samples for biomarker studies are collected at baseline. During follow-up, information about treatment complications, hospitalisations, functional decline, quality of life and mortality is collected. The primary outcome is the composite endpoint of functional decline or mortality at 1 year.

DISCUSSION

Implementation of a routine clinical care pathway for older patients in need of intensive treatment provides the opportunity to study associations between determinants of frailty and outcomes of treatment. Results of the TENT study will support individualised treatment for future patients.

TRIAL REGISTRATION

The study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 . Date of registration: 22-10-2019.

Health-related quality of life and health utility score of patients with gastric cancer: A multi-centre cross-sectional survey in China

OBJECTIVE

To evaluate the health-related quality of life (HRQoL) and health state utility scores of gastric cancer patients in daily life at different clinical stages after treatment, and to explore influencing factors associated with HRQoL.

METHODS

Gastric cancer patients discharged from hospitals and healthy controls identified by screening were recruited. The three-level EQ-5D was employed to assess HRQoL and was scored using two Chinese-specific tariffs published in 2014 and 2018.

RESULTS

A total of 1,399 patients and 2,179 healthy controls were recruited. The likelihood of reporting problems in the five dimensions for patients was 4.0-23.8 times higher than controls. Based on the 2014/2018 tariff, the mean EQ-5D utility score was 0.321/0.163 lower than controls, and the mean utility scores of each patient subgroup were 0.077/0.039 (high-grade intraepithelial neoplasia/carcinoma in situ), 0.254/0.121 (Stage I), 0.249/0.123 (Stage II), 0.353/0.182 (Stage III) and 0.591/0.309 (Stage IV) lower than controls (all statistically significant). Age, occupation, duration of illness, other chronic disease status and therapeutic regimen had a significant impact upon different aspects of HRQoL in patients.

CONCLUSIONS

Gastric cancer significantly impaired patients' HRQoL in daily life after treatment. More advanced cancer stages were associated with larger decrements on health state utility.

Twelve-month health outcomes for bicyclists and car occupants after a non-catastrophic traffic crash injury

OBJECTIVE

In this inception cohort study, we investigated differences in health outcomes for bicyclists (cyclists) and car occupants (car driver and passengers) at 12months after a non-catastrophic traffic injury. We also aimed to determine the independent predictors of key health outcomes among cyclists.

METHODS

Of the 2019 participants at baseline, 299 were cyclists and 927 were car occupants; 229 cyclists and 489 car occupants were followed up 12months after the injury. A telephone-administered questionnaire was used to obtain information on socio-economic, pre-injury health and injury-related characteristics. The survey also included tools on health outcomes: quality of life (SF-36 and EQ-5D-3L scales), pain severity, general psychological distress, trauma-related distress and pain catastrophizing.

RESULTS

After adjusting for all potential confounders, general psychological distress scores and trauma-related distress scores were 2.05 and 0.60 units lower for cyclists than car occupants (P=0.01 and P<0.0001, respectively) at 12-month follow-up. Cyclists showed greater improvement than car occupants over 12months in mean pain severity ratings and SF-12 physical component summary (PCS) score (both P<0.0001) but had lower mean pain severity and similar PCS scores at baseline. However, cyclists showed less improvement in SF-12 mental component summary (MCS) scores (P=0.03) than car occupants but had higher mean MCS scores at baseline. Pre-injury and baseline quality-of-life scores and pain catastrophizing as well as injury involving the head or face were significant predictors of overall psychological functioning, general psychological distress and trauma-related distress in cyclists at 12months.

CONCLUSIONS

Cyclists demonstrated better recovery than car occupants at 12months after sustaining a traffic crash injury. Prognostic indicators of long-term physical functioning and psychological well-being in cyclists were related to pre-injury and baseline quality of life and pain factors and injury location.

Pragmatic cluster randomised double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute non-specific neck pain: a mixed-methods protocol

INTRODUCTION

Non-specific neck pain causes pain and disability and contributes substantial socioeconomic burden internationally. Up to 50% of adults experience neck pain annually, leading to reduced the quality of life. An active behavioural physiotherapy intervention (ABPI) may be feasible to manage patients with acute non-specific neck pain to prevent transition to chronicity. A recent pilot and feasibility trial investigating an acute whiplash-associated disorder population found potential value of the ABPI with 95% of participants fully recovered (Neck Disability Index: NDI ≤4, compared with 17% in the standard physiotherapy arm); supporting a definitive trial. Qualitative findings from the physiotherapists supported the potential of the ABPI in a non-specific neck pain population.

METHODS AND ANALYSIS

Two phases: (1) Pragmatic cluster randomised double-blind, parallel 2-arm (ABPI vs standard physiotherapy intervention) pilot and feasibility trial to evaluate the procedures and feasibility of the ABPI for the management of acute non-specific neck pain. Six physiotherapy departments from six public hospitals in Thailand will be recruited and cluster randomised by a computer-generated randomisation sequence with block sampling. Sixty participants (30 each arm, 10 per hospital) will be assessed at baseline and 3 months following baseline for NDI, Numerical Rating Scale for pain intensity, cervical range of motion, fear-avoidance beliefs questionnaire and EuroQol-5 dimensions 5 levels outcomes, and (2) Embedded qualitative study using semistructured interviews to explore acceptability of the ABPI to participants (n=12) and physiotherapists (n=3). Descriptive analysis of the quantitative data and interpretative phenomenological analysis to code and analyse qualitative data (deductive and inductive) will inform feasibility for a future definitive trial.

ETHICS AND DISSEMINATION

This trial is approved by the Naresuan University Institutional Review Board (NUIRB_0380/61).

TRIAL REGISTRATION NUMBER AND STATUS

TCTR20180607001; Recruiting commenced 1 February 2019.

An online intervention for improving stroke survivors' health-related quality of life: study protocol for a randomised controlled trial

Background

Recurrent stroke is a major contributor to stroke-related disability and costs. Improving health-risk behaviours and mental health has the potential to significantly improve recovery, enhance health-related quality of life (HRQoL), independent living, and lower the risk of recurrent stroke. The primary aim will be to test the effectiveness of an online intervention to improve HRQoL among stroke survivors at 6 months’ follow-up. Programme effectiveness on four health behaviours, anxiety and depression, cost-effectiveness, and impact on other hospital admissions will also be assessed.

Methods/design

An open-label randomised controlled trial is planned. A total of 530 adults will be recruited across one national and one regional stroke registry and block randomised to the intervention or minimal care control group. The intervention group will receive access to the online programme Prevent 2nd Stroke (P2S); the minimal care control group will receive an email with Internet addresses of generic health sites designed for the general population. The primary outcome, HRQoL, will be measured using the EuroQol-5D. A full analysis plan will compare between groups from baseline to follow-up.

Discussion

A low-cost per user option to supplement current care, such as P2S, has the potential to increase HRQoL for stroke survivors, and reduce the risk of second stroke.

Trial registration

Australian and New Zealand Clinical Trials Registry, ID: ACTRN12617001205325p. Registered on 17 August 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3604-0) contains supplementary material, which is available to authorized users.

Activity limitations and participation restrictions in people with multiple sclerosis: a detailed 10-year perspective

AIM

To conduct a detailed investigation into changes in activity limitations and participation restrictions over 10 years in people with mild, moderate and severe multiple sclerosis.

METHODS

This study was a 10-year longitudinal study of 264 people with multiple sclerosis living in Stockholm County, Sweden. Ten-year changes in personal and instrumental activities in daily living were assessed using the Katz Activities in Daily Living Index Extended and participation in social/lifestyle activities using the Frenchay Activities Index.

RESULTS

While people with moderate multiple sclerosis, compared to baseline, demonstrated significantly higher proportions of dependency in most activities of personal and instrumental activities in daily living at the 10-year follow-up, the mild group primarily increased their dependency in instrumental activities and the severe group in personal activities. Significantly higher proportions of the moderate group showed restricted participation in domestic and outdoor activities whereas the mild group only showed restrictions in a few domains of participation. A majority of people with severe multiple sclerosis showed restricted participation in all social/lifestyle activities at baseline and the 10-year follow-up.

CONCLUSIONS

Prominent long-term increases in activity limitations and participation restrictions occurred across the spectrum of disease severity but was most pronounced in those more moderately affected. Implications for rehabilitation This study provides guidance with regard to specific activities that are prone to deteriorate across 10 years and thereby reflect important targets and outcomes for interventions. Increases in activity limitations and participation restrictions were most pronounced in those moderately affected by multiple sclerosis. Those mildly affected by multiple sclerosis primarily increased their dependency in instrumental activities of daily living while those severely affected increased their dependency in personal activities of daily living.

A cluster randomised, double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute whiplash-associated disorder (WAD)II

Whiplash-associated disorder (WAD) causes substantial social and economic burden, with ≥70% patients classified as WADII (neck complaint and musculoskeletal sign(s)). Effective management in the acute stage is required to prevent development of chronicity; an issue for 60% of patients. An Active Behavioural Physiotherapy Intervention (ABPI) was developed to address both physical and psychological components of WAD. The ABPI is a novel complex intervention designed through a rigorous sequential multiphase project to prevent transition of acute WAD to chronicity. An external pilot and feasibility cluster randomised double-blind (assessor, participants) parallel two-arm clinical trial was conducted in the UK private sector. The trial compared ABPI versus standard physiotherapy to evaluate trial procedures and feasibility of the ABPI for managing acute WADII in preparation for a future definitive trial. Six private physiotherapy clinics were recruited and cluster randomised using a computer-generated randomisation sequence. Twenty-eight (20 ABPI, 8 standard physiotherapy) participants [median age 38.00 (IQR = 21.50) years] were recruited. Data were analysed descriptively with a priori establishment of success criteria. Ninety-five percent of participants in the ABPI arm fully recovered (Neck Disability Index ≤4, compared to 17% in the standard physiotherapy arm); required fewer treatment sessions; and demonstrated greater improvement in all outcome measures (pain intensity, Cervical Range of Motion, Pressure Pain Threshold, EuroQol-5 Dimensions) except for the Impact of Events Scale and Fear Avoidance Beliefs Questionnaire. The findings support the potential value of the ABPI, and that an adequately powered definitive trial to evaluate effectiveness (clinical, cost) is feasible with minor modifications to procedures.

Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial

QUESTION

What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program?

DESIGN

A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon.

PARTICIPANTS

People with chronic health conditions who had completed a 6-week exercise program at a community health service.

INTERVENTIONS

One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks.

OUTCOME MEASURES

Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L).

RESULTS

Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach.

CONCLUSION

The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently.

REGISTRATION

ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2018) Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial. Journal of Physiotherapy 64: 48-54].

Associations between community-based physiotherapy for musculoskeletal injury and health related quality of life (EQ-5D): a multi-centre retrospective analysis

Background

Community-based musculoskeletal physiotherapy is used to improve function and health related quality of life (HRQoL). The purpose of this retrospective, multi-centre observational study was to determine the association between community-based physiotherapy management for musculoskeletal disorders and changes in HRQoL.

Methods

Four thousand one hundred twelve patients’ data were included in the study. Patients were included if they received a single period of treatment for a musculoskeletal injury or disorder. Patients were only included if they were being treated for a single morbidity. Patients received standard physiotherapy appropriate to their specific disorder, which could include health education/advice, exercise therapy, manual therapy, taping, soft tissue techniques, electrotherapy and/or acupuncture. Health related quality of life was assessed using the EQ-5D index.

Results

EQ-5D improved by 0.203 across all patients (d = 1.10). When grouped by anatomical site of symptom, the largest increases in EQ-5D was in foot pain (0.233; d = 1.29) and lumbar pain (0.231; d = 1.13). Improvements in EQ-5D greater than the minimum clinically important difference (MCID) were seen in 68.4% of all patients. The highest proportion of patients with positive responses to treatment were in ankle pain (74.2%) and thoracic pain (73.4%). The hand (40.5%), elbow (34.7%), and hip (33.9%) showed the greatest proportion of patients that did not respond to treatment.

Conclusions

Community-based musculoskeletal physiotherapy is associated with improved health related quality of life. A randomised controlled trial is needed to determine any causal relationship between community-based physiotherapy and health related quality of life improvements.

Health-related quality of life 24 months after sustaining a minor musculoskeletal injury in a road traffic crash: A prospective cohort study

OBJECTIVES

A better understanding of the long-term factors that independently predict poorer quality of life following mild to moderate musculoskeletal injuries is needed. We aimed to establish the predictors of quality of life (including sociodemographic, health, psychosocial, and pre-injury factors) 24 months after a noncatastrophic road traffic injury.

METHODS

In a prospective cohort study of 252 participants with mild/moderate injury sustained in a road traffic crash, quality of life was measured 24 months following the baseline survey. A telephone-administered questionnaire obtained information on various potential explanatory variables. Health-related quality of life was measured using the European Quality of Life-5 Dimensions (EQ-5D) and Medical Outcomes Survey Short Form-12 (SF-12). Multivariable linear regression analyses determined the associations between explanatory variables and quality of life measures.

RESULTS

Mean SF-12 physical component summary (PCS) and mental component summary (MCS) scores increased by 7.3 and 2.5 units, respectively, from baseline to 24-month follow-up. Each 10-year increase in baseline age was independently associated with 3.1-unit (P < .001) and 1.5-unit (P = .001) decrease in EQ Visual Analogue Scale (VAS) and SF-12 PCS scores at follow-up, respectively. Poor/fair compared to excellent pre-injury health was associated with a 0.16-, 21.3-, and 11.5-unit decrease in EQ-5D summary (P = .03), VAS scores (P = .001), and SF-12 PCS scores (P < .001), respectively. Baseline pain severity ratings and pain catastrophizing scores were inversely associated with 24-month EQ VAS scores (both P < .001). Each unit increase in baseline pain score (P = .001) and pain catastrophizing score (P = .02) was associated with a 1.0- and 4.6-unit decrease in SF-12 MCS scores at 24 months, respectively. Other observed predictors of quality of life measures (EQ-5D summary and/or VAS scores and/ or SF-12 MCS) included marital status, smoking, hospital admission, pre-injury health (anxiety/depression and chronic illness), and whiplash injury.

CONCLUSION

Sociodemographic indicators, pre-injury health, and biopsychosocial correlates were independently associated with health-related quality of life 24 months following a noncatastrophic road traffic crash injury.

Quality of Acute Care and Long-Term Quality of Life and Survival

Background and Purpose—

Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke.

Methods—

Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received.

Results—

There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43–0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50–27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38–0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54–0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%–19%).

Conclusions—

Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.

An equivalence study: Are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey?

Background

To determine if the EuroQol Health Related Quality of Life survey produces equivalent results when administered by phone interview or patient-completed forms.

Methods

People awaiting hip or knee arthroplasty at a major metropolitan hospital participated. They were randomly assigned to receive the EuroQol Health Related Quality of Life survey via telephone, followed by a patient completed form 1 week later, or vice versa. Equivalence was determined using two one-sided tests (TOST) based on minimal clinically-important differences for the visual analogue scale (VAS) and the summary Utility Index. Cohen’s Kappa scores were computed to determine agreement for the individual EuroQoL Likert scale items.

Results

Seventy-six from 90 (84%) participants completed the survey twice. Based on limits set at ±7 and ±0.11 for the VAS and Utility Index, respectively, equivalence was established between the two methods of administration for both the VAS (mean difference 0.05 [90% CI −3.76–3.67]) and the Utility Index (mean difference 0.06 [90% CI 0.02–0.11]). Varying levels of agreement, ranging from slight to substantial (κ = 0.17–0.67), were demonstrated for the individual health domains. The order of telephone and patient-completed survey administration had no significant effect on results.

Conclusions

Equivalent results are obtained between telephone and patient-completed administration for the VAS and Utility Index of the EuroQol Survey in people with advanced hip or knee osteoarthritis. The limits of agreement for the individual health domains vary which prevents the accurate interpretation of real change in these items across modes.

To dance or not to dance? A comparison of balance, physical fitness and quality of life in older Irish set dancers and age-matched controls

OBJECTIVE

The objective of this study is to determine if older adults regularly participating in Irish set dancing have superior balance, physical fitness and quality of life compared to age-matched controls.

STUDY DESIGN

This study used a community-based, observational cross-sectional design.

METHODS

Regular set dancers (n = 39) and age-matched controls (n = 33) were recruited. Participants were assessed using the physical activity scale for the elderly (physical activity levels), mini-BESTest (balance) and senior fitness test (battery of functional fitness tests). Quality of life was also assessed using the EuroQol EQ visual analogue scale.

RESULTS

When controlling for between-group differences in levels of physical activity (ANCOVA analysis), the dancers had significantly better balance, functional capacity and quality of life (all P < 0.05) compared to controls. No differences between the groups were observed in other measures of functional fitness.

CONCLUSION

The findings of this study suggest regular participation in set dancing is associated with health benefits for older adults. These results may inform future studies prospectively examining the role of set dancing for falls prevention, emotional well-being and cognitive function in community-dwelling older adults.

Predictors of time to claim closure following a non-catastrophic injury sustained in a motor vehicle crash: a prospective cohort study

Background

Research suggests that exposure to the compensation system (including time to case closure) could adversely influence a persons’ recovery following injury. However, the long-term predictors of time to claim closure following minor road traffic injuries remain unclear. We aimed to assess a wide spectrum of factors that could influence time to claim closure (socio-demographic, compensation-related, health, psychosocial and pre-injury factors) over 24 months following a non-catastrophic injury.

Methods

Prospective cohort study of 364 participants involved in a compensation scheme following a motor vehicle crash. We used a telephone-administered questionnaire to obtain information on potential explanatory variables. Information on time to claim closure was obtained from an insurance regulatory authority maintained database, and was classified as the duration between the crash date and claim settlement date, and categorized into < 12 (early), > 12–24 (medium) and > 24 months (late).

Results

Just over half of claimants (54 %) had settled their claim by 12 months, while 17 % and 30 % took > 12–24 months and > 24 months for claim closure, respectively. Whiplash at baseline was associated with claim closure time of > 12–24 months versus < 12 months: multivariable-adjusted OR 2.38 (95 % CI 1.06–5.39). Claimants who were overweight/obese versus normal/underweight at the time of injury were ~3.0-fold more likely to settle their claim at > 12–24 months than < 12 months. Consulting a lawyer was associated with a 10.4- and 21.0-fold increased likelihood of settling a claim at > 12–24 months and > 24 months, respectively. Each 1-unit increase in Orebro Musculoskeletal Pain Screening Questionnaire scores at baseline was associated with greater odds of both medium (> 12–24 months) and delayed claim settlement date (> 24 months): multivariable-adjusted OR 1.04 (95 % CU 1.01–1.07) and 1.02 (95 % CI 1.00–1.05), respectively.

Conclusions

Around a third of claimants with a minor injury had not settled by 24 months. Health-related factors and lawyer involvement independently influenced time to claim closure.

Describing and comparing the characteristics of injured bicyclists and other injured road users: a prospective cohort study

Background

We aimed to establish the frequency and characteristics (e.g. socioeconomic, pre-injury, and crash-related parameters) of injured bicyclists and other injured road users.

Methods

748 participants aged ≥17 years who had sustained a minor or non-catastrophic injury in a land-transport crash, were interviewed after presenting to a metro hospital emergency department in New South Wales, Australia. A telephone-administered questionnaire obtained information on socio-economic, pre-injury health, and crash-related characteristics. These factors were then compared between injured bicyclists and other road users (car driver/passengers, motorcyclists/pillion and pedestrians/skateboarders). Cycling injury severity was characterized by three metrics (sustaining multiple injuries; hospital admission for ≥12 h; and sustaining a head/neck and/or facial injury).

Results

In this cohort of people with injuries, 238 (32 %) were bicyclists. Frequency of cycling injuries were significantly different between age-groups among men (p = 0.0002), and were more common in men aged 45–59. Bicyclists were more likely to be aged 45–59, married, have university/tertiary qualifications and have a professional occupation compared to other road users (all p <0.0001). Bicyclists compared to participants involved in other types of land transport crashes were more likely to self-report excellent general health (p = 0.01), and were less likely to report a great/overwhelming perceived danger of death or 15.0 % versus 23–41 %; p <0.0001). Frequency of upper extremity and lower extremity injuries in bicyclists were 81.9 % and 60.5 %, respectively. Explanatory variables significantly associated with injury severity metrics were age, education level, paid work status and perceived danger of death/disability in the crash.

Conclusions

Minor cycling injuries were a relatively common cause of mild-moderate injury presentations to metro emergency departments. A wide spectrum of socio-demographic-, pre-injury-, and crash-related characteristics were related to cycling injuries.

Risk factors for worsened quality of life in patients on mechanical ventilation. A prospective multicenter study

OBJECTIVE

To identify risk factors for worsened quality of life (QoL) and activities of daily living (ADL) at 3 and 12 months after discharge from the Intensive Care Unit (ICU) in patients on mechanical ventilation (MV).

DESIGN

A prospective, multicentric observational study was made.

SETTING

Three ICUs in Argentina.

PATIENTS

The study included a total of 84 out of 129 mainly clinical patients admitted between 2011-2012 and requiring over 24hours of MV.

INTERVENTIONS

No interventions were carried out.

VARIABLES

Quality of life was assessed with the EQ-5D (version for Argentina), and ADL with the Barthel index.

RESULTS

The EQ-5D and Barthel scores were assessed upon admission to the ICU (baseline) and after three months and one year of follow-up. Comorbidities, delirium, ICU acquired weakness (ICUAW), and medication received were daily assessed during ICU stay. The baseline QoL of the global sample showed a median index of [0.831 (IQR25-75% 0.527-0.931)], versus [0.513 (IQR0.245-0.838)] after three months and [0.850 (IQR0.573-1.00)] after one year. Significant differences were observed compared with QoL in the Argentinean general population [mean 0.880 (CI 0.872-0.888), p<0.001; p<0.001; p0.002]. Individual analysis showed that 67% of the patients had worsened their QoL at three months, while 33% had recovered their QoL. In the multivariate analysis, the variables found to be independent predictors of worsened QoL were a hospital stay ≥21 days [OR 12.57 (2.75-57.47)], age ≥50 years [OR 5.61 (1.27-24.83)], previous poor QoL [OR 0.11 (0.02-0.54)] and persistent ICUAW [OR 8.32 (1.22-56.74)]. Similar results were found for the worsening of ADL.

CONCLUSIONS

Quality of life is altered after critical illness, and its recovery is gradual over time. Age, length of hospital stay, previous QoL and persistent ICUAW seem to be risk factors for worsened QoL.

A systematic review of instruments for measuring outcomes in economic evaluation within aged care

BACKGROUND

This paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector.

METHODS

Online databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000.

RESULTS

The most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care.

CONCLUSION

In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.

Comparison of health outcomes between hospitalised and non-hospitalised persons with minor injuries sustained in a road traffic crash in Australia: a prospective cohort study

OBJECTIVES

This prospective cohort study aimed to investigate whether there are differences in health outcomes among persons with mild or moderate injuries who were hospitalised compared with those not hospitalised following a road traffic crash.

SETTING

Sydney Metropolitan, New South Wales, Australia.

PARTICIPANTS

Persons aged ≥18 years involved in a motor vehicle crash were surveyed at baseline (n=364), and at 12 (n=284) and 24 months (n=252). A telephone-administered questionnaire obtained information on a range of socioeconomic, and preinjury and postinjury psychological and heath characteristics of all participants.

PRIMARY OUTCOME MEASURE

Participants who reported admission to hospital for 24 h or more (but less than 7 days) after the crash were classified as being hospitalised; those admitted for less than 24 h were classified as non-hospitalised.

RESULTS

Around 1 in 5 participants (19.0%) were hospitalised for ≥24 h after the crash. After adjusting for age and sex, hospitalised participants compared with those not hospitalised had approximately 2.6 units (p=0.01) lower Short Form-12 Physical Component Summary (SF-12 PCS) scores (poorer physical well-being) and approximately 4.9 units lower European Quality of Life visual analogue scale (EQ-VAS) scores (p=0.05), 12 months later. After further adjusting for education level, whiplash, fracture and injury severity score, participants who were hospitalised had approximately 3.3 units lower SF-12 PCS (p=0.04), 12 months later. The association with EQ-VAS did not persist after multivariable adjustment. No significant differences were observed between the 2 groups in health outcomes at 24-month follow-up.

CONCLUSIONS

These findings indicate that long-term health status is unlikely to be influenced by hospitalisation status after sustaining a mild/moderate injury in a vehicle-related crash.

Functional status and quality of life after community-acquired bacteraemia: a matched cohort study

Severe bacterial infections may have a prolonged negative effect on subsequent functional status and health-related quality of life. We studied hospitalized patients for changes in functional status and quality of life within 1 year of community-acquired bacteraemia in comparison to blood-culture-negative controls. In a prospectively conducted matched cohort study at Aalborg University Hospital, north Denmark, during 2011-2014, we included 71 medical inpatients with first-time community-acquired bacteraemia. For each bacteraemia patient, we matched one blood-culture-negative inpatient control on age and gender. Functional status and quality of life before and after hospitalization were assessed by Barthel-20 and EuroQol-5D questionnaires. We computed the 3-month and 1-year risk for any deterioration in Barthel-20 score and EuroQol-5D index score, and for a deterioration of ≥10 points in EuroQol-5D visual analogue scale score, and used regression analyses to assess adjusted risk ratios (RR) with 95% CIs. Compared with controls, bacteraemia was associated with an increased 3-month risk for deterioration in functional status as assessed by Barthel-20 score (14% versus 3% with deterioration, adjusted RR 5.1; 95% CI 1.2-22.3). The difference was less after 1 year (11% versus 7% with deterioration, adjusted RR 1.6; 95% CI 0.5-4.5). After 3 months, quality of life had become worse in 37% of bacteraemia patients and 28% of controls by EuroQol-5D index score (adjusted RR 1.3; 95% CI 0.8-2.1), with similar findings after 1 year and by visual analogue scale. In conclusion, community-acquired bacteraemia is associated with increased risk for subsequent deterioration in functional status compared with blood-culture-negative controls, and with a high risk for deterioration in quality of life.

The Relationship between Visual Impairment and Health-Related Quality of Life in Korean Adults: The Korea National Health and Nutrition Examination Survey (2008-2012)

INTRODUCTION

To evaluate health-related quality of life (HRQoL) in Korean adults with visual impairment(VI) using various measures based on a nationally distributed sample.

METHODS

Using the Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2012) data, we compared EuroQol five-dimensional questionnaire (EQ-5D) and EQ-visual analogue scale (VAS) scores after adjusting for socio-demographic and psychosocial factors as well as for comorbidities with VI. Logistic regressions were used to elucidate determinants for the lowest quintile HRQoL scales according to VI severity. Uncorrected visual acuity (VA) which implies vision of ordinary life was measured using an international standard vision chart based on Snellen scale.

RESULTS

28,825 participants (sum of weights; 37,562,376) were included in the analysis. The mean EQ-5D and EQ-VAS scores were significantly lower in the VI groups than in the normal vision (defined as VA 20/20-20/25) group based on the better or worse seeing eye (P<.0001 and P<.0001, respectively). Participants with moderate (VA 20/80-20/160) and severe VI (VA ≤20/200) had higher scores of multivariate-adjusted odd ratios (aORs) for the lowest quintile than did the normal vision group which was particularly evident in the results from EQ-5D, whereas the results of the mild VI (VA 20/32-20/63) group did not identify significant differences from the normal vision group independent of classification according to the better or the worse seeing eye. Conversely, EQ-VAS revealed significantly higher score of multivariate-aORs for the lowest quintile in participants with mild VI either for the better or worse seeing eye.

CONCLUSIONS

The severity of VI was definitely associated with impaired HRQoL compared with the normal vision population. The analyses presented here elicited even mild VI could potentially deteriorate the health-related quality of life (or subjective perception of health quality) and therefore, therapeutic approaches should also focus on the subjective perception and better management of health condition.

Prognostic indicators of social outcomes in persons who sustained an injury in a road traffic crash

INTRODUCTION

There is a lack of longitudinal studies with adequate sample size and follow-up period which have objectively assessed social outcomes among those with mild or moderate musculoskeletal injury or that are not limited to hospital inpatients. We aimed to address this gap by prospectively assessing the potential predictors of return to pre-injury work and daily activities.

METHODS

Persons with mild/moderate musculoskeletal injuries from a vehicle-related crash were surveyed within the first 3 months after the crash (baseline; n=364), and at 12 (n=284) and 24 months (n=252). Participants self-reported return to work, and whether it was return to full or modified duties at work. Analyses were restricted to 170 participants who reported being in pre-injury paid work and had provided information at either 12 months only or at both 12 and 24 months. Return to usual activities was assessed using the European Quality of Life-5 Dimensions (EQ-5D) scale 'Usual Activities' dimension.

RESULTS

Twenty-four months after injury 82% (n=121) had returned to work. After multivariable adjustment, not being admitted to hospital was associated with 44% higher likelihood of returning to work at 24 months. Not having any pre-injury chronic illness was associated with returning to work after 24 months, multivariable-adjusted risk ratio (RR), 1.21 (95% confidence intervals, CI: 1.02-1.45). Each 1-SD increase in Medical Outcomes Survey Short Form-12 Mental Component Summary (SF-12 MCS) score at baseline was associated with returning to work at 24 months RR 1.13 (95% CI: 1.02-1.25). Younger age, higher SF-12 physical component summary (PCS), and EQ-5D visual analogue scale (VAS) scores were mutually independent predictors of returning to usual activities 24 months later.

CONCLUSION

A range of bio-psychosocial factors, particularly quality of life measures, independently predicted social outcomes including return to work and return to usual daily activities. These determinants could be measured early in the recovery process and be potentially amenable to intervention.

A comparison of health outcomes in older versus younger adults following a road traffic crash injury: a cohort study

Background

Given the aging demographics of most developed countries, understanding the public health impact of mild/moderate road traffic crash injuries in older adults is important. We aimed to determine whether health outcomes (pain severity and quality of life measures) over 24 months differ significantly between older (65+) and younger adults (18–64).

Methods

Prospective cohort study of 364, 284 and 252 participants with mild/moderate injury following a vehicle collision at baseline, 12 and 24 months, respectively. A telephone-administered questionnaire obtained information on socio-economic, pre- and post-injury psychological and heath characteristics.

Results

At baseline, there were 55 (15.1%) and 309 (84.9%) participants aged ≥65 and 18–64 years, respectively. At 12- and 24-month follow-up, older compared to younger participants who had sustained a mild/moderate musculoskeletal injury had lower physical functioning (3.9-units lower Short Form-12 Physical Composite Score, multivariable-adjusted p = 0.03 at both examinations). After multivariable adjustment, older (n = 45) versus younger (n = 207) participants had lower self-perceived health status (8.1-units lower European Quality of Life-5 Dimensions Visual Acuity Scale scores at 24 months, p = 0.03), 24 months later.

Conclusions

Older compared to younger participants who sustained a mild/moderate injury following a road-traffic crash demonstrated poorer physical functioning and general health at 24 months.

Presence and predictors of persistent pain among persons who sustained an injury in a road traffic crash

BACKGROUND

There is a paucity of prospective studies with long follow-up that have examined a wide range of correlates associated with persistent pain outcomes in persons who sustained a mild or moderate injury in a road traffic crash. This study aimed to establish the independent predictors of pain severity over 24 months.

METHODS

A total of 364, 284 and 252 persons with mild/moderate musculoskeletal injuries sustained in a vehicle-related crash participated in telephone interviews in the subacute phase, and at 12 and 24 months, respectively. The numeric rating scale (NRS) assessed pain severity. Pain-Related Self-Statements Scale-Catastrophizing (PRSS-Catastrophizing) and the Short Form Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) were also administered.

RESULTS

After multivariable adjustment, each 1 SD increase in Short Form-12 Physical Component Score (SF-12 PCS) in the subacute phase was associated with 0.73 (p = 0.002) and 1.11 (p < 0.0001) decrease in NRS scores after 12 and 24 months, respectively. Each unit increase in the PRSS-Catastrophizing score in the subacute phase was associated with 0.54 (p = 0.001) and 0.43 (p = 0.03) increase in NRS scores 12 and 24 months later, respectively. Subacute phase OMPSQ scores were positively associated with NRS scores at 12- and 24-month follow-ups (p < 0.0001).

CONCLUSIONS

Self-perceived physical well-being, pain-related work disability and pain catastrophizing could play a role in determining long-term pain-related outcomes following traffic-related injuries.

Validation of a Chinese version of the Frenchay Activities Index in patients with traumatic limb injury

PURPOSE

The Frenchay Activities Index (FAI) is a frequently used measure that assesses instrumental activities of daily living (IADL). However, the measurement properties of the FAI are largely unknown for patients with traumatic limb injuries. The purpose of this study was to examine the measurement properties of a Chinese version of the FAI, including score distribution, internal consistency, construct validity, predictive validity, and responsiveness in patients with traumatic limb injuries.

METHODS

We performed a secondary data analysis, primarily using non-parametric item response theory, on a data set. The FAI and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were administered via telephone interview to a cohort of patients at 3, 6, and 12 months after injury. Totals of 342 patients' data (at 3 months after injury), 1,010 patients' data (6 months), and 987 patients' data (12 months) were available for analysis.

RESULTS

After the deletion of 5 items (i.e., travel outings, gardening, household/car maintenance, reading books, and gainful work), the 10-item revised FAI (R-FAI) formed a unidimensional construct. The R-FAI exhibited a unidimensional construct at each of the 3 time points. The R-FAI had sufficient score distribution, internal consistency, predictive validity, and responsiveness in patients with limb injuries.

CONCLUSIONS

Our results support the conclusion that the R-FAI has satisfactory measurement properties. The R-FAI is useful for assessing IADL in patients with limb injuries.

Reliability of a wellness inventory for use among adolescent females aged 12-14 years

Background

The wellness construct has application in a number of fields including education, healthcare and counseling, particularly with regard to female adolescents. The effective measurement of wellness in adolescents can assist researchers and practitioners in determining lifestyle behaviors in which they are lacking. Behavior change interventions can then be designed which directly aid in the promotion of these areas.

Methods

The 5-Factor Wellness Inventory (designed to measure the Indivisible Self model of wellness) is a popular instrument for measuring the broad aspects of wellness amongst adolescents. The instrument comprises 97 items contributing to 17 subscales, five dimension scores, four context scores, total wellness score, and a life satisfaction index. This investigation evaluated the test-retest (intra-rater) reliability of the 5F-Wel instrument in repeated assessments (seven days apart) among adolescent females aged 12–14 years. Percentages of exact agreement for individual items, and the number of respondents who scored within ±5, ±7.5 and ±10 points for total wellness and the five summary dimension scores were calculated.

Results

Overall, 46 (95.8%) participants responded with complete data and were included in the analysis. Item agreement ranged from 47.8% to 100% across the 97 items (median 69.9%, interquartile range 60.9%-73.9%). The percentage of respondents who scored within ±5, ±7.5 and ±10 points for total wellness at the re-assessment was 87.0%, 97.8% and 97.8% respectively. The percentage of respondents who scored within ±5, ±7.5 and ±10 for the domain scores at the reassessment ranged between 54.3-76.1%, 78.3-95.7% and 89.1-95.7% respectively across the five dimensions.

Conclusions

These findings suggest there was considerable variation in agreement between the two assessments on some individual items. However, the total wellness score and the five dimension summary scores remained comparatively stable between assessments.

Age, physical inactivity, obesity, health conditions, and health-related quality of life among patients receiving conservative management for musculoskeletal disorders

Background

Musculoskeletal conditions and insufficient physical activity have substantial personal and economic costs among contemporary aging societies. This study examined the age distribution, comorbid health conditions, body mass index (BMI), self-reported physical activity levels, and health-related quality of life of patients accessing ambulatory hospital clinics for musculoskeletal disorders. The study also investigated whether comorbidity, BMI, and self-reported physical activity were associated with patients’ health-related quality of life after adjusting for age as a potential confounder.

Methods

A cross-sectional survey was undertaken in three ambulatory hospital clinics for musculoskeletal disorders. Participants (n=224) reported their reason for referral, age, comorbid health conditions, BMI, physical activity levels (Active Australia Survey), and health-related quality of life (EQ-5D). Descriptive statistics and linear modeling were used to examine the associations between age, comorbidity, BMI, intensity and duration of physical activity, and health-related quality of life.

Results

The majority of patients (n=115, 51.3%) reported two or more comorbidities. In addition to other musculoskeletal conditions, common comorbidities included depression (n=41, 18.3%), hypertension (n=40, 17.9%), and diabetes (n=39, 17.4%). Approximately one-half of participants (n=110, 49.1%) self-reported insufficient physical activity to meet minimum recommended guidelines and 150 (67.0%) were overweight (n=56, 23.2%), obese (n=64, 28.6%), severely obese (n=16, 7.1%), or very severely obese (n=14, 6.3%), with a higher proportion of older patients affected. A generalized linear model indicated that, after adjusting for age, self-reported physical activity was positively associated (z=4.22, P<0.001), and comorbidities were negatively associated (z=−2.67, P<0.01) with patients’ health-related quality of life.

Conclusion

Older patients were more frequently affected by undesirable clinical attributes of comorbidity, obesity, and physical inactivity. However, findings from this investigation are compelling for the care of patients of all ages. Potential integration of physical activity behavior change or other effective lifestyle interventions into models of care for patients with musculoskeletal disorders is worthy of further investigation.

Physical activity and health-related quality of life among physiotherapists: a cross sectional survey in an Australian hospital and health service

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.

Exploring older adults' patterns and perceptions of exercise after hip fracture

PURPOSE

To identify exercise patterns and perceived barriers, enablers, and motivators to engaging in exercise for older adults following hip fracture.

METHOD

Telephone interviews were conducted with older adults (aged 62-97 y) within 1 year after hip fracture. Participants were asked about basic demographic information; level of mobility before hip fracture; current level of mobility; and barriers, enablers, and motivators to participating in exercise.

RESULTS

A total of 32 older adults successfully recovering after hip fracture completed the telephone interviews. Participants reported few problems with their mobility, and all were engaging in exercise. There were few reported barriers to exercise; the most common were health-related concerns (pain, fatigue, illness, or injury). The most frequently reported enablers were intrinsic factors (determination, seeing improvements, and making exercise part of their daily routine); in particular, the most common motivator to exercise was recovery of function to improve mobility and complete daily and leisure activities.

CONCLUSIONS

This study highlights the responses of a group of older adults recovering well after hip fracture. Older adults engage in exercise despite the potential limitations associated with a hip fracture. Participants' responses underscore the importance of intrinsic factors and suggest avenues for future investigation.

Physiotherapists have accurate expectations of their patients' future health-related quality of life after first assessment in a subacute rehabilitation setting

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.

Pitfalls in the use of kappa when interpreting agreement between multiple raters in reliability studies

OBJECTIVE

To compare different reliability coefficients (exact agreement, and variations of the kappa (generalised, Cohen's and Prevalence Adjusted and Biased Adjusted (PABAK))) for four physiotherapists conducting visual assessments of scapulae.

DESIGN

Inter-therapist reliability study.

SETTING

Research laboratory.

PARTICIPANTS

30 individuals with no history of neck or shoulder pain were recruited with no obvious significant postural abnormalities.

MAIN OUTCOME MEASURES

Ratings of scapular posture were recorded in multiple biomechanical planes under four test conditions (at rest, and while under three isometric conditions) by four physiotherapists.

RESULTS

The magnitude of discrepancy between the two therapist pairs was 0.04 to 0.76 for Cohen's kappa, and 0.00 to 0.86 for PABAK. In comparison, the generalised kappa provided a score between the two paired kappa coefficients. The difference between mean generalised kappa coefficients and mean Cohen's kappa (0.02) and between mean generalised kappa and PABAK (0.02) were negligible, but the magnitude of difference between the generalised kappa and paired kappa within each plane and condition was substantial; 0.02 to 0.57 for Cohen's kappa and 0.02 to 0.63 for PABAK, respectively.

CONCLUSIONS

Calculating coefficients for therapist pairs alone may result in inconsistent findings. In contrast, the generalised kappa provided a coefficient close to the mean of the paired kappa coefficients. These findings support an assertion that generalised kappa may lead to a better representation of reliability between three or more raters and that reliability studies only calculating agreement between two raters should be interpreted with caution. However, generalised kappa may mask more extreme cases of agreement (or disagreement) that paired comparisons may reveal.

Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial

BACKGROUND

Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.

METHODS

This was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged ≥18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.

RESULTS

We randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n = 496) or usual care Monday to Friday rehabilitation (n = 500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P = 0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P = 0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P = 0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio = 0.81, 95% CI 0.61 to 1.08).

CONCLUSIONS

Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12609000973213 Please see related commentary: http://www.biomedcentral.com/10.1186/1741-7015-11-199.

Life impact of ankle fractures: qualitative analysis of patient and clinician experiences

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.

Use of Condition-Specific Patient-Reported Outcome Measures in Clinical Trials among Patients with Wrist Osteoarthritis: A Systematic Review

Background. This paper aimed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer-reviewed evidence supporting their reliability, validity, and responsiveness to change. Methods. A systematic review of randomised controlled trials among people with wrist osteoarthritis was undertaken. Studies reporting reliability, validity, or responsiveness were identified using a systematic reverse citation trail audit procedure. Psychometric properties of the instruments were examined against predefined criteria and summarised. Results. Thirteen clinical trials met inclusion criteria. The most common patient-reported outcome was the disabilities of the arm, shoulder, and hand questionnaire (DASH). The DASH, the Michigan Hand Outcomes Questionnaire (MHQ), the Patient Evaluation Measure (PEM), and the Patient-Reported Wrist Evaluation (PRWE) had evidence supporting their reliability, validity, and responsiveness. A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis Hand Index as another suitable instrument that had favourable reliability, validity, and responsiveness. Conclusions. The DASH, MHQ, and AUSCAN Osteoarthritis Hand Index instruments were supported by the most favourable empirical evidence for validity, reliability, and responsiveness. The PEM and PRWE also had favourable empirical evidence reported for these elements. Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted.

Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge

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.