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Oliveira R, Pedras S, Pimenta R, Silva I. Contributions for the Validation of the European Portuguese Version of the Vascular Quality of Life-6 Questionnaire for Peripheral Artery Disease. ACTA MEDICA PORT 2024; 37:436-444. [PMID: 38848704 DOI: 10.20344/amp.20760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/04/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is an occlusive atherosclerotic disease of the arteries of the extremities of the body that affects more than 230 million people worldwide. The most common symptom is intermittent claudication, described as leg pain which occurs mainly while walking. The symptoms impair the ambulation and functional capacity of patients, leading to loss of mobility, disease deterioration, increased risk of other cardiovascular diseases, and lower quality of life (QoL). Therefore, the aim of this study was to perform a cross-cultural adaptation and validation of the VascuQol-6 questionnaire for the Portuguese population to obtain a quick, sensitive, and easy-to-use way to assess the QoL of Portuguese patients diagnosed with PAD. METHODS The Vascular Quality of Life-6 Questionnaire (VascuQoL-6) was adapted and translated into European Portuguese using standard validation methodology, including 115 patients with a mean age of 64.67 (7.23) years, with PAD with IC stable for more than three months; and ABI < 0.9 at rest. VascuQoL-6, SF-36, International Physical Activity Questionnaire (IPAQ), and the PAD Knowledge Questionnaire (PADKQ) were used. Reliability, construct validity analysis through convergent and discriminant validity, known-group validity, and responsiveness analysis were tested. RESULTS The Cronbach's alpha was 0.64 and the average inter-item correlation was 0.27, indicating acceptable internal consistency. VascuQoL-6 was positively associated with SF-36 Physical Component Summary and Mental Component Summary scores (r = 0.64, p < 0.01 and r = 0.42, p < 0.01, respectively). In turn, there was no significant correlation between VascuQoL-6 scores and the PADKQ or IPAQ. A statistically significant difference between groups according to IC severity [F(2.47) = 8.35, p < 0.001] was found. A paired samples t-test showed differences between VascuQol-6 scores before a walking program (M = 15.65, SD = 3.09), and after a walking program (M = 17.41, SD = 2.71), t(67) = 3.94, p ≤ 0.001. CONCLUSION The VascuQoL-6 is a six-item instrument to assess the QoL associated with PAD with good psychometric properties, convergent and discriminant validity with SF-36, PADKQ and IPAQ. The instrument proved to have known group validity and responsiveness.
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Affiliation(s)
- Rafaela Oliveira
- Angiology & Vascular Surgery Department. Unidade Local de Saúde de Santo António. Porto; Health School. Instituto Politécnico de Porto. Porto. Portugal
| | - Susana Pedras
- Angiology & Vascular Surgery Department. Unidade Local de Saúde de Santo António. Porto. Portugal
| | - Rui Pimenta
- Center for Health Studies and Research (CEIS). Faculdade de Economia. Universidade de Coimbra. Coimbra; Centre for Innovative Biomedicine and Biotechnology (CiBB). Coimbra; Associated Laboratory for Green Chemistry of the Network of Chemistry and Technology (LAQV@REQUIMTE). Escola Superior de Saúde. Instituto Politécnico do Porto. Porto. Portugal
| | - Ivone Silva
- Angiology & Vascular Surgery Department. Unidade Local de Saúde de Santo António. Porto; Unit for Multidisciplinary Research in Biomedicine (UMIB). Institute of Biomedical Sciences Abel Salazar. Universidade do Porto. Porto; Laboratory for Integrative and Translational Research in Population Health (ITR). Universidade do Porto. Porto. Portugal
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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Sandberg A, Bäck M, Cider Å, Jivegård L, Sigvant B, Nordanstig J. Impact of walk advice alone or in combination with supervised or home-based structured exercise on patient-reported physical function and generic and disease-specific health related quality of life in patients with intermittent claudication, a secondary analysis in a randomized clinical trial. Health Qual Life Outcomes 2023; 21:114. [PMID: 37872617 PMCID: PMC10594797 DOI: 10.1186/s12955-023-02198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Supervised exercise is an integral part of the recommended first-line treatment for patients with intermittent claudication (IC). By reflecting the patients' perspectives, patient-reported outcome measurements provide additional knowledge to the biomedical endpoints and are important outcomes to include when evaluating exercise interventions in patients with IC. We aimed to evaluate the one-year impact of three strategies: unsupervised Nordic pole walk advice (WA), WA + six months of home-based structured exercise (HSEP) or WA + six months of hospital-based supervised exercise (SEP) on health-related quality of life and patient-reported physical function in patients with IC. METHODS This secondary exploratory analysis of a multi-center, randomized clinical trial compared three exercise strategies. The primary outcome of the secondary analysis was the one-year change in the 36-Item Short-Form (SF-36). Secondary outcomes were three- and six-months SF-36 changes alongside three, six- and 12-months changes in the disease-specific Vascular Quality of Life instrument (VascuQoL) and the Patient-Specific Functional Scale (PSFS). The Kruskal-Wallis test with Bonferroni-adjusted post-hoc tests were used for between-group comparisons. Effect size calculations were used to describe the size of observed treatment effects, and the clinical meaningfulness of observed changes in the VascuQoL summary score at one year was studied using established minimally important difference (MID) thresholds. RESULTS A total of 166 patients with IC, mean age: 72.1 (SD 7.4) years, 41% women, were randomized. No significant between-group differences were observed over time for the SF-36 or the PSFS scores whereas some significant between-group differences were observed in the VascuQoL domain and summary scores over time, favoring SEP and/or HSEP over WA. The observed SF-36 and VascuQoL domain and summary score effect sizes were small to moderate, and many domain score effect sizes also remained unchanged over time. A significantly higher proportion of the patients in the SEP group reached the VascuQoL summary score MID of improvement in one year. CONCLUSION Clinically important improvements were observed in SEP using the VascuQoL, while we did not observe any significant between-group differences using the SF-36. Whereas effect sizes for the observed changes over time were generally small, a significantly higher proportion of patients in SEP reached the VascuQoL MID of improvement. TRIAL REGISTRATION NCT02341716, January 19, 2015 (retrospectively registered).
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Affiliation(s)
- Anna Sandberg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Vita Stråket 13, Gothenburg, 413 45, Sweden.
| | - Maria Bäck
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Vita Stråket 13, Gothenburg, 413 45, Sweden
| | - Åsa Cider
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Vita Stråket 13, Gothenburg, 413 45, Sweden
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jivegård
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Health Technology Assessment Centre Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgitta Sigvant
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Central Hospital in Karlstad, Region Varmland, Karlstad, Sweden
| | - Joakim Nordanstig
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Arndt H, Behrendt CA. Was ist eine Lebensstil limitierende Claudicatio? Patientenberichtete Endpunkte in der Behandlung der peripheren arteriellen Verschlusskrankheit (PAVK). GEFÄSSCHIRURGIE 2022. [DOI: 10.1007/s00772-022-00963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Arndt H, Nordanstig J, Bertges DJ, Budtz-Lilly J, Venermo M, Espada CL, Sigvant B, Behrendt CA. A Delphi Consensus on Patient Reported Outcomes for Registries and Trials Including Patients with Intermittent Claudication: Recommendations and Reporting Standard. Eur J Vasc Endovasc Surg 2022; 64:526-533. [PMID: 35985529 DOI: 10.1016/j.ejvs.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to develop a core set of patient reported outcome quality indicators (QIs) for the treatment of patients with intermittent claudication (IC), that allow a broad international implementation across different vascular registries and within trials. METHODS A rigorous modified two stage Delphi technique was used to promote consensus building on patient reported outcome QIs among an expert panel consisting of international vascular specialists, patient representatives, and registry members of the VASCUNET and the International Consortium of Vascular Registries. Potential QIs identified through an extensive literature search or additionally proposed by the panel were validated by the experts in a preliminary survey and included for evaluation. Consensus was reached if ≥ 80% of participants agreed that an item was both clinically relevant and practical. RESULTS Participation rates in two Delphi rounds were 66% (31 participants of 47 invited) and 90% (54 of 60), respectively. Initially, 145 patient reported outcome QIs were documented. Following the two Delphi rounds, 18 quality indicators remained, all of which reached consensus regarding clinical relevance. The VascuQoL questionnaire (VascuQoL-6), currently the most common patient reported outcome measurement (PROM) used within vascular registries, includes a total of six items. Five of these six items also matched with high rated indicators identified in the Delphi study. Consequently, the panel recommends the use of the VascuQoL-6 survey as a preferred core PROM QI set as well as an optional extension of 12 additional patient reported QIs that were also identified in this study. CONCLUSION The current recommendation based on the Delphi consensus building approach, strengthens the international harmonisation of registry data collection in relation to patient reported outcome quality. Continuous and standardised quality assurance will ensure that registry data may be used for future quality benchmarking studies and, ultimately, positively impact the overall quality of care provided to patients with peripheral arterial occlusive disease.
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Affiliation(s)
- Helene Arndt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Joakim Nordanstig
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
| | | | - Maarit Venermo
- Vascular Surgery, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Cristina Lopez Espada
- Department of Vascular Surgery, University Hospital Virgen de las Nieves, Granada, Spain
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
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Arman EB, Augustin M, Mohr N, Debus SE, Breuer P, Blome C. Development and validation of a disease-specific quality of life questionnaire for patients with peripheral artery disease (QOLPAD). J Patient Rep Outcomes 2022; 6:54. [PMID: 35622190 PMCID: PMC9142721 DOI: 10.1186/s41687-022-00451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study was to develop and validate a short and feasible questionnaire to measure health-related quality of life (HRQoL) in patients with peripheral artery disease (PAD). The content of the new instrument is intended to correspond with the simultaneously developed instrument Patient Benefit Index for PAD (PBI-PAD), which evaluates treatment goals and benefits in this patient group. METHODS Fifty patients stated their disease burden on free-text questionnaires, which was used by an interdisciplinary expert panel to develop 12 items for the new instrument, named Quality of Life questionnaire for patients with peripheral artery disease (QOLPAD). The validity of the instrument was tested in patients from Germany with PAD stages I to IV who completed the QOLPAD, EuroQol questionnaire (EQ-5D-3L; EuroQol visual analogue scale (EQ VAS)), and Vascular Quality of Life questionnaire (VascuQoL) before (baseline) and three months after (follow-up) treatment. RESULTS One hundred and three patients were included at baseline (mean age: 68.6 years; 68% male), among whom, 57 provided data at follow-up. Most patients (86.4%) rated the completion of QOLPAD as being easy. Internal consistency was satisfactory, with a Cronbach's alpha of 0.74 (baseline) and 0.84 (follow-up). Convergent validity was indicated by significant correlations with the EQ-5D-3L (baseline: - 0.62; follow-up: - 0.81), EQ VAS (baseline: - 0.44, follow-up: - 0.79), VascuQoL global score (baseline: - 0.77; follow-up: - 0.87), global rating of impairment (baseline: 0.64; follow-up: 0.71), and PAD stage (baseline: 0.40; follow-up: 0.67). Sensitivity to change was confirmed by significant correlations of change in the QOLPAD with changes in convergent criteria; however, the high number of dropouts limits the generalizability of this finding. CONCLUSION This study provided evidence that the QOLPAD is internally consistent and valid in patients receiving treatment for PAD in Germany.
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Affiliation(s)
- Ebru-Berrin Arman
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Nicole Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Sebastian E. Debus
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Peter Breuer
- Department of Vascular and Endovascular Surgery, Asklepios Klinik Wandsbek, Hamburg, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
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Defining Clinically Meaningful Thresholds for Patient-Reported Outcomes in Knee Arthroplasty. J Arthroplasty 2022; 37:837-844.e3. [PMID: 35134515 DOI: 10.1016/j.arth.2022.01.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For primary knee arthroplasties, clinically meaningful thresholds of patient-reported outcomes that associate with patient satisfaction have not been defined appropriately. METHODS In this retrospective study of 26,720 primary total knee replacements registered in the Dutch Arthroplasty Register (2016-2018), receiver operating curve analysis was used to define minimal clinically important changes (MCICs) and patient acceptable symptom states (PASSs) with the anchor satisfaction. Patient-reported outcome measures were pain, European Quality of Life 5 Dimensions, Knee disability and Osteoarthritis Outcome Score, and Oxford Knee Score (OKS). Independent analyses were performed for groups, which showed statistically significant interactions with the (change in) score to achieve satisfaction in logistic regression. RESULTS In this cohort, 84.9% completed the anchor questions, of whom 71.3% with a satisfaction score ≥8. Good discriminative abilities (area under the receiving operator curve >0.8) for PASS were achieved by OKS ≥38.5, pain in activity ≤2.5, Knee disability and Osteoarthritis Outcome Score ≤33, and Quality of Life-Index ≥0.813. Discriminative abilities for MCIC were not good. If assessed per baseline tercile, discrimination improved (area under the receiving operator curve >0.8) and yielded different MCICs per preoperative tercile (preoperative OKS ≤19: MCIC ≥19.5; pre-OKS 20-27: MCIC ≥14.5; pre-OKS ≥28: MCIC ≥8.5). For MCIC, the tercile method produced an 11% improved accuracy compared to one threshold for every patient. For the PASS scores, tercile-specific did not improve the accuracy of predicting satisfaction. Demographics were not clinically relevant in determining thresholds. CONCLUSION Estimating the likelihood of satisfaction with surgery is critical in shared decision-making. Patients with more preoperative symptom severity require larger changes to report satisfaction. Both in the clinic and in science, such differences must be considered when predictions of satisfaction are attempted.
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Philipp R, Lebherz L, Thomalla G, Härter M, Appelbohm H, Frese M, Kriston L. Psychometric properties of a patient-reported outcome set in acute stroke patients. Brain Behav 2021; 11:e2249. [PMID: 34124861 PMCID: PMC8413767 DOI: 10.1002/brb3.2249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Impairments after stroke may affect multiple domains of health-related quality of life (HRQoL). Patient-reported outcome measures (PROMs) have proven valuable in measuring patients' well-being. We examine the psychometric properties of a standard set of PROMs assessing global health, anxiety, and depression, and functioning in a German health care setting. METHOD We included inpatients at the Department of Neurology at the University Medical Center Hamburg-Eppendorf, diagnosed with stroke. Following the stroke-specific standard set of the International Consortium for Health Outcome Measurement, we collected demographic and clinical information at baseline, and PROMs for global health (PROMIS-10), three items for self-reported functioning, anxiety, and depression (PHQ-4) at 90 days follow-up. We calculated confirmatory factor analyses to test factorial validity and correlation analyses to test construct validity. We further conducted item and reliability analyses. RESULTS In a sample of 487 patients (mean age, SD: 71.1, 12.6; 47% female) with mild and moderate symptoms, model fit for the PROMIS-10 was acceptable for the two-factor and single-factor models. Factor loadings ranged from 0.52 to 0.94. The postulated single-factor model for functioning was saturated with zero degrees of freedom. Factor loadings ranged from 0.90 to 0.96. For the PHQ-4, the two-factor model showed excellent model fit. Factor loadings ranged from 0.78 to 0.87. Internal consistency was acceptable to good. Construct validity was generally confirmed. CONCLUSIONS The PROMIS-10 is a valid and reliable instrument to measure HRQoL among German stroke patients. While the PHQ-4 was confirmed as a screening measure for mental disorders, further research is needed on items assessing self-reported functioning. Results are limited to patients showing minimal functional deficits.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Appelbohm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Frese
- Office for Quality Management and Clinical Process Management, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Raja A, Spertus J, Yeh RW, Secemsky EA. Assessing health-related quality of life among patients with peripheral artery disease: A review of the literature and focus on patient-reported outcome measures. Vasc Med 2021; 26:317-325. [PMID: 33295253 PMCID: PMC8169614 DOI: 10.1177/1358863x20977016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Peripheral artery disease (PAD) is a progressive atherosclerotic disease associated with high rates of morbidity and mortality. Symptomatic PAD typically presents with claudication, and symptom severity strongly associates with reduced health-related quality of life (HRQoL). Existing treatment strategies for PAD are aimed at reducing symptom severity and improving functional outcomes. However, there is a need to incorporate patient-reported outcome measures (PROMs) into PAD treatment and research in order to provide more patient-centered care. This review will discuss the impact of PAD on HRQoL, existing PROMs available to assess PAD-related HRQoL, utilization of PROMs in research studies and registries, and challenges and solutions related to the integration of PROMs into research and clinical settings.
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Affiliation(s)
- Aishwarya Raja
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John Spertus
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Robert W Yeh
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Michaels J, Wilson E, Maheswaran R, Radley S, Jones G, Tong TS, Kaltenthaler E, Aber A, Booth A, Buckley Woods H, Chilcott J, Duncan R, Essat M, Goka E, Howard A, Keetharuth A, Lumley E, Nawaz S, Paisley S, Palfreyman S, Poku E, Phillips P, Rooney G, Thokala P, Thomas S, Tod A, Wickramasekera N, Shackley P. Configuration of vascular services: a multiple methods research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Vascular services is changing rapidly, having emerged as a new specialty with its own training and specialised techniques. This has resulted in the need for reconfiguration of services to provide adequate specialist provision and accessible and equitable services.
Objectives
To identify the effects of service configuration on practice, resource use and outcomes. To model potential changes in configuration. To identify and/or develop electronic data collection tools for collecting patient-reported outcome measures and other clinical information. To evaluate patient preferences for aspects of services other than health-related quality of life.
Design
This was a multiple methods study comprising multiple systematic literature reviews; the development of a new outcome measure for users of vascular services (the electronic Personal Assessment Questionnaire – Vascular) based on the reviews, qualitative studies and psychometric evaluation; a trade-off exercise to measure process utilities; Hospital Episode Statistics analysis; and the development of individual disease models and a metamodel of service configuration.
Setting
Specialist vascular inpatient services in England.
Data sources
Modelling and Hospital Episode Statistics analysis for all vascular inpatients in England from 2006 to 2018. Qualitative studies and electronic Personal Assessment Questionnaire – Vascular evaluation with vascular patients from the Sheffield area. The trade-off studies were based on a societal sample from across England.
Interventions
The data analysis, preference studies and modelling explored the effect of different potential arrangements for service provision on the resource use, workload and outcomes for all interventions in the three main areas of inpatient vascular treatment: peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. The electronic Personal Assessment Questionnaire – Vascular was evaluated as a potential tool for clinical data collection and outcome monitoring.
Main outcome measures
Systematic reviews assessed quality and psychometric properties of published outcome measures for vascular disease and the relationship between volume and outcome in vascular services. The electronic Personal Assessment Questionnaire – Vascular development considered face and construct validity, test–retest reliability and responsiveness. Models were validated using case studies from previous reconfigurations and comparisons with Hospital Episode Statistics data. Preference studies resulted in estimates of process utilities for aneurysm treatment and for travelling distances to access services.
Results
Systematic reviews provided evidence of an association between increasing volume of activity and improved outcomes for peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. Reviews of existing patient-reported outcome measures did not identify suitable condition-specific tools for incorporation in the electronic Personal Assessment Questionnaire – Vascular. Reviews of qualitative evidence, primary qualitative studies and a Delphi exercise identified the issues to be incorporated into the electronic Personal Assessment Questionnaire – Vascular, resulting in a questionnaire with one generic and three disease-specific domains. After initial item reduction, the final version has 55 items in eight scales and has acceptable psychometric properties. The preference studies showed strong preference for endovascular abdominal aortic aneurysm treatment (willingness to trade up to 0.135 quality-adjusted life-years) and for local services (up to 0.631 quality-adjusted life-years). A simulation model with a web-based interface was developed, incorporating disease-specific models for abdominal aortic aneurysm, peripheral arterial disease and carotid artery disease. This predicts the effects of specified reconfigurations on workload, resource use, outcomes and cost-effectiveness. Initial exploration suggested that further reconfiguration of services in England to accomplish high-volume centres would result in improved outcomes, within the bounds of cost-effectiveness usually considered acceptable in the NHS.
Limitations
The major source of evidence to populate the models was Hospital Episode Statistics data, which have limitations owing to the complexity of the data, deficiencies in the coding systems and variations in coding practice. The studies were not able to address all of the potential barriers to change where vascular services are not compliant with current NHS recommendations.
Conclusions
There is evidence of potential for improvement in the clinical effectiveness and cost-effectiveness of vascular services through further centralisation of sites where major vascular procedures are undertaken. Preferences for local services are strong, and this may be addressed through more integrated services, with a range of services being provided more locally. The use of a web-based tool for the collection of clinical data and patient-reported outcome measures is feasible and can provide outcome data for clinical use and service evaluation.
Future work
Further evaluation of the economic models in real-world situations where local vascular service reconfiguration is under consideration and of the barriers to change where vascular services do not meet NHS recommendations for service configuration is needed. Further work on the electronic Personal Assessment Questionnaire – Vascular is required to assess its acceptability and usefulness in clinical practice and to develop appropriate report formats for clinical use and service evaluation. Further studies to assess the implications of including non-health-related preferences for care processes, and location of services, in calculations of cost-effectiveness are required.
Study registration
This study is registered as PROSPERO CRD42016042570, CRD42016042573, CRD42016042574, CRD42016042576, CRD42016042575, CRD42014014850, CRD42015023877 and CRD42015024820.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jonathan Michaels
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Wilson
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ravi Maheswaran
- Department of Public Health, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Radley
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Thai-Son Tong
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eva Kaltenthaler
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ahmed Aber
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - James Chilcott
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rosie Duncan
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Munira Essat
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edward Goka
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aoife Howard
- Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - Anju Keetharuth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elizabeth Lumley
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Shah Nawaz
- Department of Vascular Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzy Paisley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Edith Poku
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Patrick Phillips
- Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gill Rooney
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steven Thomas
- Department of Vascular Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angela Tod
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Nyantara Wickramasekera
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Phil Shackley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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11
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Biswas MP, Capell WH, McDermott MM, Jacobs DL, Beckman JA, Bonaca MP, Hiatt WR. Exercise Training and Revascularization in the Management of Symptomatic Peripheral Artery Disease. JACC Basic Transl Sci 2021; 6:174-188. [PMID: 33665516 PMCID: PMC7907537 DOI: 10.1016/j.jacbts.2020.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023]
Abstract
In the management of symptomatic peripheral artery disease, aerobic exercise therapy and lower extremity revascularization are the mainstays of therapy. In this structured review, the most effective therapies, with 6 to 18 months of follow-up, indicated that exercise therapy and lower extremity revascularization each independently improve peak walking performance. The combination of therapies was superior to either therapy alone and may decrease the need for subsequent revascularization. Further research is needed to evaluate the long-term durability of these interventions, their impacts on subsequent invasive procedures, and predictors of response.
Exercise therapy and lower extremity revascularization both improve walking performance in symptomatic patients with peripheral artery disease. The combination of therapies provides greater benefit than either alone and may reduce the need for subsequent revascularization procedures, but further trials with longer follow-up are needed for the outcome of subsequent revascularization.
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Key Words
- 6MW, 6-minute walk
- CMS, Centers for Medicare and Medicaid Services
- ET, exercise therapy
- HBE, home-based exercise
- LER, lower extremity revascularization
- MCID, minimum clinically important difference
- PAD, peripheral artery disease
- PRO, patient-reported outcome
- PWD, peak walking distance
- PWT, peak walking time
- SET, supervised exercise training
- SF-36, Medical Outcomes Short Form–36
- VascuQOL, Vascular Quality of Life
- WIQ, Walking Impairment Questionnaire
- evidence
- exercise therapy (supervised exercise training, home-based exercise programs)
- lower extremity revascularization
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Affiliation(s)
- Minakshi P Biswas
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - Warren H Capell
- CPC Clinical Research, Aurora, Colorado, USA.,Division of Endocrinology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary M McDermott
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald L Jacobs
- Division of Vascular Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joshua A Beckman
- Division of Cardiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Marc P Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
| | - William R Hiatt
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,CPC Clinical Research, Aurora, Colorado, USA
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12
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Rymer JA, Mulder H, Smolderen KG, Hiatt WR, Conte MS, Berger JS, Norgren L, Mahaffey KW, Baumgartner I, Fowkes FG, Katona BG, Rockhold F, Jones WS, Patel MR. Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial. J Am Heart Assoc 2020; 9:e016573. [PMID: 32924754 PMCID: PMC7792388 DOI: 10.1161/jaha.120.016573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There are limited data on health status instruments in patients with peripheral artery disease and cardiovascular and limb events. We evaluated the relationship between health status changes and cardiovascular and limb events. Methods and Results In an analysis of the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) trial, we examined the characteristics of 13 801 patients by tertile of health status instrument scores collected in the trial (EuroQol 5-Dimensions [EQ-5D], EQ visual analog scale [VAS], and peripheral artery questionnaire). We assessed the association between the baseline health status measurements and major adverse cardiovascular events, major adverse limb events, and lower-extremity revascularization procedures during trial follow-up and the association between 12-month health status change scores and subsequent end points during follow-up. There were 13 217 (95%) patients with EQ-5D scores, 13 533 (98%) with VAS scores, and 4431 (32%) with peripheral artery questionnaire scores. Patients in the lowest baseline EQ-5D tertile (0 to <0.69) were more likely to be female with severe claudication compared with the highest tertile (0.79-1.0; P<0.01). Patients in the lowest VAS (0-60) and peripheral artery questionnaire (0-49) tertiles had lower ankle-brachial indices compared with the highest tertiles (80-100 and 76-108, respectively; P<0.01). There was a significant association between baseline EQ-5D, VAS, and peripheral artery questionnaire scores and adjusted major adverse cardiovascular events, major adverse limb events, and lower-extremity revascularization (P<0.05). Improved EQ-5D and VAS scores over 12 months were associated with reduced risk of subsequent major adverse cardiovascular events or lower-extremity revascularization (all P<0.01). Conclusions Although health status instruments are rarely used in clinical practice, these measures are associated with outcomes, including major adverse cardiovascular events, major adverse limb events, and lower-extremity revascularization. Further research is needed to determine the relationship between changes in these instruments, revascularization, and outcomes.
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Affiliation(s)
- Jennifer A Rymer
- Division of Cardiology Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
| | | | - Kim G Smolderen
- Vascular Medicine Outcomes Program Yale University New Haven CT
| | - William R Hiatt
- Division of Cardiology and Colorado Prevention Center University of Colorado School of Medicine Aurora CO
| | - Michael S Conte
- Division of Vascular Surgery University of California San Francisco San Francisco CA
| | | | - Lars Norgren
- Faculty of Medicine and Health Orebro University Orebro Sweden
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research Stanford University School of Medicine Stanford CA
| | - Iris Baumgartner
- Swiss Cardiovascular Center Inselspital Bern University Hospital University of Bern Switzerland
| | - F Gerry Fowkes
- Usher Institute of Population Health Sciences and Informatics University of Edinburgh United Kingdom
| | | | - Frank Rockhold
- Duke Clinical Research Institute Durham NC.,Department of Biostatistics and Bioinformatics Duke University Medical Center Durham NC
| | - W Schuyler Jones
- Division of Cardiology Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
| | - Manesh R Patel
- Division of Cardiology Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
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13
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Aber A, Phillips P, Lumley E, Radley S, Thomas SM, Nawaz S, Jones G, Michaels J. Mixed methods study to develop the content validity and the conceptual framework of the electronic patient-reported outcome measure for vascular conditions. BMJ Open 2020; 10:e034154. [PMID: 32784253 PMCID: PMC7418769 DOI: 10.1136/bmjopen-2019-034154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this paper is to describe the stages undertaken to generate the items and conceptual framework of a new electronic personal assessment questionnaire for vascular conditions. DESIGN A mixed methods study: First a survey of vascular clinicians was completed to identify the most common conditions treated in vascular clinics and wards. Quantitative systematic reviews were done to identify validated patient-reported outcome measures (PROMs) for direct inclsuion in the new instrument. However, due to scarcity of validated PROMs, the items of the new instrument were mainly based on a large qualitative study of patients and systematic reviews of the qualitative evidence . This was followed by a quantitative clinicians' consensus study and, finally, a qualitative face validity study with patients. PARTICIPANTS Vascular patients participated in the primary qualitative study and the face validity study. In the qualitative study, 55 patients were interviewed, and for the face validity, 19 patients gave feedback. Twelve clinicians completed the survey and 13 completed two cycles of the clinicians' consensus study. RESULTS The items and scales in the electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) were generated based on the results of five systematic reviews evaluating existing PROMs for possible inclusion in ePAQ-VAS, five systematic reviews of qualitative evidence, a primary qualitative study involving 55 patients and clinicians' input. One hundred and sixty-eight items were initially generated, of which 59 were eliminated by the expert panel due to repetition. The instrument was divided into one generic and three disease-specific sections (abdominal aortic aneurysm, carotid artery disease and lower limb vascular conditions). In each section, items were grouped together into putative scales. Fifty-five items were grouped across eight scales; the remaining items were kept as individual items, because of relevance to service users. CONCLUSIONS This multidimensional electronic questionnaire covers the most common vascular conditions. This is particularly important for patients presenting with mixed symptoms or multiple conditions. This tool captures symptomatology, health related quality of life (HRQoL) and other clinically relevant data, such as experience with services and comorbidities.
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Affiliation(s)
- Ahmed Aber
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | | | - Stephen Radley
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven M Thomas
- ScHARR, The University of Sheffield, Sheffield, UK
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Shah Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Jones
- Leeds Social Sciences School, Leeds Beckett University, Leeds, UK
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14
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Aber A, Phillips P, Hughes J, Keetharuth AD, Rooney G, Radley S, Walters S, Nawaz S, Jones G, Michaels J. Electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS): development and validity. Br J Surg 2020; 107:1004-1012. [DOI: 10.1002/bjs.11531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/25/2019] [Accepted: 01/15/2020] [Indexed: 11/06/2022]
Abstract
Abstract
Background
This paper describes the development and validation of an electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) that captures the symptomatology, quality of life and clinically relevant data of patients presenting to vascular services.
Methods
A two-stage survey was conducted in patients attending a tertiary vascular department. Patients completed the ePAQ-VAS remotely online, or on site using an electronic tablet. In the first stage of the survey, the responses were used to perform confirmatory factor analysis to assess the construct validity and remove redundant items. The internal reliability of disease-specific scales was investigated. In the second stage of the survey, the acceptability, known-group validity, test–retest reliability, and responsiveness of ePAQ-VAS was assessed.
Results
In total, 721 patients completed ePAQ-VAS. Their mean(s.d.) age was 63·5(15·7) years and 468 (64·9 per cent) were men. Some 553 patients (76·7 per cent) completed the questionnaire in clinic and the remainder completed the questionnaire online. The results of the confirmatory factor analysis confirmed the conceptual model for ePAQ-VAS structure and eliminated six items. Internal reliability was acceptable for all the scales (Cronbach's α greater than 0·7). The test–retest reliability measured by the intraclass correlation coefficient ranged from 0·65 to 0·99. The results showed that the instrument was responsive over time with the standardized response mean ranging from 0·69 to 1·60.
Conclusion
ePAQ-VAS is a holistic data-collection process that is relevant to vascular service users and has potential to contribute to patient-focused care and the collection of aggregate data for service evaluation. A demonstration version of the final version of ePAQ can be viewed at http://demo-questionnaire.epaq.co.uk/home/project?id=VASC_1.7&page=1.
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Affiliation(s)
- A Aber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P Phillips
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - J Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Rooney
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - S Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - G Jones
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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15
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Schulte KL, Hardung D, Tiefenbacher C, Weiss T, Hoffmann U, Amendt K, Tepe G, Heuser L, Treszl A, Lau HJ, Pfannebecker T, Wegscheider K. Real-world outcomes of endovascular treatment in a non-selected population with peripheral artery disease - prospective study with 2-year follow-up. VASA 2019; 48:433-441. [PMID: 31159707 DOI: 10.1024/0301-1526/a000798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The study aimed to evaluate the outcomes of percutaneous transluminal angioplasty (PTA) in lower-extremity peripheral artery disease (PAD) patients. Patients and methods: A multi-centre, observational study was performed with 32 German and Austrian centres contributing data to the PTA registry. Data of 1,781 patients with lower-leg and pelvic PAD who were suitable for endovascular PTA treatment were contributed from participating centres. Data from 1,533 patients are reported here (1,055 male and 478 female). This study did not have exclusion criteria. Quality of life (QOL) questionnaire (EQ-5D) scores, Rutherford classification, mortality, patency rate and details of major adverse cardiovascular events were collected at 6-, 12-, 18-, and 24-month follow ups. Results: PTA with/without stenting achieved 90.3 %, 86.5 %, 82.7 %, and 71.9 % technical success (recanalisation achieving ≥ 70 % patency, no evidence of embolisation, recoiling or dissection) in iliac, femoral, popliteal, and below-the-knee arteries, respectively. Procedural/postprocedural complications occurred in 142 (9.3 %, 1 death) and 74 (4.8 %) patients. QOL, mobility, self-care, activity, and pain/discomfort scores improved (p < 0.01), anxiety/depression was insignificantly improved. During follow-up, 409 (26.7 %) patients were hospitalised for PAD, 281 (18.3 %) required reintervention, and 145 (9.5 %) died or needed amputation (n = 49; 3.2 %). Multivariate analysis demonstrated poorer outcomes in patients with comorbidities. Conclusions: PTA with/without stenting is effective, safe, and widely applicable, with few complications. It improves QOL, but not anxiety/depression.
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Affiliation(s)
| | - David Hardung
- Department of Angiology, St. Gertrauden Hospital, Berlin, Germany
| | | | - Thomas Weiss
- Vascular Center/Med. Clinic I, Henriettenstift, Hannover, Germany
| | - Ulrich Hoffmann
- Vascular Center/Angiology, Med. Clinic and Policlinic IV, Klinikum University München, Munich, Germany
| | - Klaus Amendt
- Vascular Center Oberrhein, Internal Medicine I, Diakonissen-Hospital, Mannheim, Germany
| | - Gunnar Tepe
- Institute of Diagnostic and Interventional Radiology, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Lothar Heuser
- Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Andras Treszl
- Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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16
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Petersohn S, Ramaekers BLT, Olie RH, Ten Cate-Hoek AJ, Daemen JWHC, Ten Cate H, Joore MA. Comparison of three generic quality-of-life metrics in peripheral arterial disease patients undergoing conservative and invasive treatments. Qual Life Res 2019; 28:2257-2279. [PMID: 30929124 PMCID: PMC6620242 DOI: 10.1007/s11136-019-02166-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine the effect of revascularisation for peripheral arterial disease (PAD) on QoL in the first and second year following diagnosis, to compare the effect depicted by Short Form Six Dimensions (SF-6D) and EuroQoL five Dimensions (EQ-5D) utilities, and Visual Analogue Scale (VAS) scores and to analyse heterogeneity in treatment response. METHODS Longitudinal data from 229 PAD patients were obtained in an observational study in southern Netherlands. Utility scores were calculated with the international (SF-6D) and Dutch (EQ-5D) tariffs. We analysed treatment effect at years 1 and 2 through propensity score-matched ANCOVAs. Thereby, we estimated the marginal means (EMMs) of revascularisation and conservative treatment, and identified covariates of revascularisation effect. RESULTS A year after diagnosis, 70 patients had been revascularised; the EMMs of revascularisation were 0.038, 0.077 and 0.019 for SF-6D, EQ-5D and VAS, respectively (always in this order). For conservative treatment these were - 0.017, 0.038 and 0.021. At 2-year follow-up, the EMMs of revascularisation were 0.015, 0.077 and 0.027, for conservative treatment these were - 0.020, 0.013 and - 0.004. Baseline QoL (and rest pain in year 2) were covariates of treatment effect. CONCLUSIONS We measured positive effects of revascularisation and conservative treatment on QoL a year after diagnosis, the effect of revascularisation was sustained over 2 years. The magnitude of effect varied between the metrics and was largest for the EQ-5D, which may be most suitable for QoL measurement in PAD patients. Baseline QoL influenced revascularisation effect, in clinical practice this may inform expected QoL gain in individual patients.
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Affiliation(s)
- Svenja Petersohn
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands.
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Renske H Olie
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Arina J Ten Cate-Hoek
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Jan-Willem H C Daemen
- Department of Vascular surgery, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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17
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Debus ES, Kriston L, Schwaneberg T, Hischke S, Rieß HC, Härter M, Marschall U, Federrath H, Behrendt CA. Rationale and methods of the IDOMENEO health outcomes of the peripheral arterial disease revascularisation study in the GermanVasc registry. VASA 2018; 47:499-505. [DOI: 10.1024/0301-1526/a000730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract. Background: Atherosclerotic disease of the lower extremity arteries (PAD) remains a significant burden on global healthcare systems with increasing prevalence. Various guidelines on the diagnosis and treatment of patients with PAD are available but they often lack a sufficient evidence base for high-grade recommendations since randomized and controlled trials (RCT) remain rare or are frequently subject to conflicts of interest. This registry trial aims to evaluate the outcomes of catheter-based endovascular revascularisations vs. open-surgical endarterectomy vs. bypass surgery for symptomatic PAD on medical and patient-reported outcomes. Methods and design: The study is a prospective non-randomized multicentre registry trial including invasive revascularisations performed in 10 000 patients treated for symptomatic PAD at 30 to 40 German vascular centres. All patients matching the inclusion criteria are consecutively included for a recruitment period of six months (between May and December 2018) or until 10 000 patients have been included in the study registry. There are three follow-up measures at three, six, and 12 months. Automated completeness and plausibility checks as well as independent site visit monitoring will be performed to assure high internal and external validity of the study data. Study endpoints include relevant major cardiovascular and limb events and patient-reported outcomes from two Delphi studies with experts in vascular medicine and registry-based research. Discussion: It remains unclear if results from RCT can reflect daily treatment practice. Furthermore, great costs and complexity make it challenging to accomplish high quality randomized trials in PAD treatment. Prospective registry-based studies to collect real-world evidence can help to overcome these limitations.
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Affiliation(s)
- Eike Sebastian Debus
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Schwaneberg
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Hischke
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Christian Rieß
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hannes Federrath
- Working Group Security in Distributed Systems, Department of Computer Science, University of Hamburg, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Working Group GermanVasc, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Patient-Reported Outcome Measures in Carotid Artery Revascularization: Systematic Review and Psychometric Analysis. Ann Vasc Surg 2018; 50:275-283. [DOI: 10.1016/j.avsg.2017.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 11/23/2022]
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19
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Aber A, Lumley E, Phillips P, Woods HB, Jones G, Michaels J. Themes that Determine Quality of Life in Patients with Peripheral Arterial Disease: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:489-502. [DOI: 10.1007/s40271-018-0307-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Pokharel Y, Jones PG, Graham G, Collins T, Regensteiner JG, Murphy TP, Cohen D, Spertus JA, Smolderen K. Racial Heterogeneity in Treatment Effects in Peripheral Artery Disease: Insights From the CLEVER Trial (Claudication: Exercise Versus Endoluminal Revascularization). Circ Cardiovasc Qual Outcomes 2018; 11:e004157. [PMID: 29643064 PMCID: PMC5901766 DOI: 10.1161/circoutcomes.117.004157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Yashashwi Pokharel
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.).
| | - Philip G Jones
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Garth Graham
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Tracie Collins
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Judith G Regensteiner
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Timothy P Murphy
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - David Cohen
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - John A Spertus
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
| | - Kim Smolderen
- Department of Medicine, University of Missouri-Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.)
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21
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Abstract
Synopsis Claudication from peripheral artery disease (PAD) may mimic or coexist with musculoskeletal conditions and represents an important diagnostic consideration in patients over 50 years of age. Physical therapists are optimally positioned to recognize this condition by incorporating a vascular history and physical examination in appropriately selected patients. Recognition of PAD is important both from the standpoint of addressing the ischemic risk to the limb and because PAD is associated with high cerebrovascular and cardiovascular risk. Therefore, multidisciplinary management of patients with PAD is essential. Extensive evidence supports treatment of PAD-related claudication with supervised exercise, and physical therapists are well positioned to play an important role in this treatment. J Orthop Sports Phys Ther 2017;47(12):957-964. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7442.
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22
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Hoben M, Knopp-Sihota JA, Nesari M, Chamberlain SA, Squires JE, Norton PG, Cummings GG, Stevens BJ, Estabrooks CA. Health of health care workers in Canadian nursing homes and pediatric hospitals: a cross-sectional study. CMAJ Open 2017; 5:E791-E799. [PMID: 29162609 PMCID: PMC5741427 DOI: 10.9778/cmajo.20170080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Poor health of health care workers affects quality of care, but research and health data for health care workers are scarce. Our aim was to compare physical/mental health among health care worker groups 1) within nursing homes and pediatric hospitals, 2) between the 2 settings and 3) with the physical/mental health of the Canadian population. METHODS Using cross-sectional data collected as part of the Translating Research in Elder Care program and the Translating Research on Pain in Children program, we examined the health of health care workers. In nursing homes, 169 registered nurses, 139 licensed practical nurses, 1506 care aides, 145 allied health care providers and 69 managers were surveyed. In pediatric hospitals, 63 physicians, 747 registered nurses, 155 allied health care providers, 49 nurse educators and 22 managers were surveyed. After standardization of the data for age and sex, we applied analyses of variance and general linear models, adjusted for multiple testing. RESULTS Nursing home workers and registered nurses in pediatric hospitals had poorer mental health than the Canadian population. Scores were lowest for registered nurses in nursing homes (mean difference -4.4 [95% confidence interval -6.6 to -2.6]). Physicians in pediatric hospitals and allied health care providers in nursing homes had better physical health than the general population. We also found important differences in physical/mental health for care provider groups within and between care settings. INTERPRETATION Mental health is especially poor among nursing home workers, who care for a highly vulnerable and medically complex population of older adults. Strategies including optimized work environments are needed to improve the physical and mental health of health care workers to ameliorate quality of patient care.
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Affiliation(s)
- Matthias Hoben
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Jennifer A Knopp-Sihota
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Maryam Nesari
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Stephanie A Chamberlain
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Janet E Squires
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Peter G Norton
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Greta G Cummings
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Bonnie J Stevens
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
| | - Carole A Estabrooks
- Affiliations: Faculty of Nursing (Hoben, Nesari, Chamberlain, Cummings, Estabrooks), University of Alberta, Edmonton, Alta.; Faculty of Health Disciplines (Knopp-Sihota), Athabasca University, Athabasca, Alta.; School of Nursing (Squires), Faculty of Health Sciences, University of Ottawa; Clinical Epidemiology Program (Squires), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Norton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Lawrence S. Bloomberg Faculty of Nursing (Stevens), University of Toronto, Toronto, Ont
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23
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Poku E, Aber A, Phillips P, Essat M, Buckley Woods H, Palfreyman S, Kaltenthaler E, Jones G, Michaels J. Systematic review assessing the measurement properties of patient-reported outcomes for venous leg ulcers. BJS Open 2017; 1:138-147. [PMID: 29951616 PMCID: PMC5989950 DOI: 10.1002/bjs5.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/14/2017] [Indexed: 12/21/2022] Open
Abstract
Background A variety of instruments have been used to assess outcomes for patients with venous leg ulcers. This study sought to identify, evaluate and recommend the most appropriate patient‐reported outcome measures (PROMs) for English‐speaking patients with venous leg ulcers. Methods This systematic review used a two‐stage search approach. Electronic searches of major databases including MEDLINE were completed in October 2015, and then updated in July 2016. Additional studies were identified from citation checking. Study selection, data extraction and quality assessment were undertaken independently by at least two reviewers. Evaluation and summary of measurement properties of identified PROMs were done using standard and adapted study‐relevant criteria. Results Ten studies with data for four generic PROMS and six condition‐specific measures were identified. No generic PROM showed adequate content and criterion validity; however, the EuroQoL Five Dimensions (EQ‐5D™), Nottingham Health Profile (NHP) and 12‐item Short‐Form Health Survey (SF‐12®) had good acceptability. In general, the EQ‐5D™ showed poor responsiveness in patients with venous leg ulcers. Most condition‐specific PROMs demonstrated poor criterion and construct validity. Overall, there was some evidence of internal consistency for the Venous Leg Ulcer Quality of Life (VLU‐QoL) and the Sheffield Preference‐based Venous Ulcer questionnaire (SPVU‐5D). Test–retest reliability was satisfactory for the Venous Leg Ulcer Self‐Efficacy Tool (VeLUSET). Conclusion The NHP and VLU‐QoL questionnaire seemed the most suitable PROMs for use by clinicians. However, a valid condition‐specific PROM is still required.
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Affiliation(s)
- E Poku
- School of Health and Related Research University of Sheffield Sheffield UK
| | - A Aber
- School of Health and Related Research University of Sheffield Sheffield UK
| | - P Phillips
- School of Health and Related Research University of Sheffield Sheffield UK
| | - M Essat
- School of Health and Related Research University of Sheffield Sheffield UK
| | - H Buckley Woods
- School of Health and Related Research University of Sheffield Sheffield UK
| | - S Palfreyman
- Edmonton Clinic Health Academy, University of Alberta Edmonton, Alberta Canada
| | - E Kaltenthaler
- School of Health and Related Research University of Sheffield Sheffield UK
| | - G Jones
- School of Social Sciences Leeds Beckett University Leeds UK
| | - J Michaels
- School of Health and Related Research University of Sheffield Sheffield UK
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24
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Larsen ASF, Reiersen AT, Jacobsen MB, Kløw NE, Nordanstig J, Morgan M, Wesche J. Validation of the Vascular quality of life questionnaire - 6 for clinical use in patients with lower limb peripheral arterial disease. Health Qual Life Outcomes 2017; 15:184. [PMID: 28938901 PMCID: PMC5610461 DOI: 10.1186/s12955-017-0760-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/18/2017] [Indexed: 12/03/2022] Open
Abstract
Background The VascuQoL-6 (VQ-6) health-related quality of life questionnaire, a short version of the disease-specific VascuQoL-25, was developed for clinical practice and use in vascular registries. The study purpose was to evaluate the validity and reliability of VQ-6. Methods VQ-6 was translated to Norwegian with linguistic validation and face value evaluation, and consecutive patients with intermittent claudication (IC) or critical limb ischemia (CLI) were included. All patients completed VQ-6 and Short Form-36 (SF-36), and were evaluated with ankle-brachial index (ABI) measurement pre- and post-exercise, a constant load treadmill test and clinical consultation at baseline and after 4 weeks. Correlation analysis, change statistics and receiver operator characteristics (ROC) curves were used to evaluate reliability, validity and responsiveness to change. Results One hundred seventy-one patients with peripheral arterial disease (PAD) were included, 70 (41%) female. 147 (86%) of the patients suffered from IC. The reliability of VQ-6 was good, Cronbachs-α 0.82. The ability of VQ-6 to differentiate between IC and CLI was good, area under the curve (AUC) 0.754. There was good correlation between SF-36 physical domains and component scores and VQ-6 score (r = 0.55–0.62) and excellent responsiveness to change after treatment, standard response mean (SRM) 1.12. The clinical anchors of ABI at rest, treadmill walking performance and Fontaine class improvement were less responsive to change than VQ-6, SF-36 and the vascular surgeon’s evaluation. Conclusions VQ-6 is reliable and valid, and can be used to evaluate PAD treatment in clinical practice and in vascular registries. Further research is necessary to determine the clinically important change over time. Trial registration ISRCTN14846962 (retrospectively registered).
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Affiliation(s)
- Anne Sofie F Larsen
- Department of Radiology, Ostfold Hospital Trust, PB300, 1714, Grålum, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | | | - Morten B Jacobsen
- Department of internal medicine, Ostfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils-Einar Kløw
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Joakim Nordanstig
- Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mark Morgan
- Tauranga Public Hospital, Cameron Road, Tauranga, New Zealand
| | - Jarlis Wesche
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Vascular and Thoracic Surgery, Akershus University Hospital, Lørenskog, Norway
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25
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Jones G. Raising the profile of pilot and feasibility studies in relation to the development, evaluation and implementation of patient-reported outcome measures. Pilot Feasibility Stud 2017; 4:3. [PMID: 28791179 PMCID: PMC5473962 DOI: 10.1186/s40814-017-0151-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 01/13/2023] Open
Abstract
This editorial introduces a new special series on the pilot and feasibility testing of patient-reported outcome measures (PROMs) in the on-line open access journal Pilot and Feasibility Studies. Pilot and feasibility studies are typically implemented to address issues of uncertainty before undertaking a larger definitive study such as a randomised controlled trial or large scale survey. This editorial considers the role that such pilot and feasibility testing plays in relation to the development, evaluation and implementation of PROMs. This is often an essential element of PROM research but is typically overlooked-especially within current methodological guidance, reporting space and also debate. This editorial aims to open up a dialogue about the role of pilot and feasibility testing in relation to PROMs. It highlights some of the areas in PROMs research where these types of studies have been carried out and discusses the ways in which the PROM community may be better supported and encouraged to integrate this element of the research process into their PROM-based work.
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Affiliation(s)
- Georgina Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE UK
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