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Paramanandam VS, Lensen S, Gabes M, Kann G, Donhauser T, Waters NF, Li AD, Peate M, Susanto NS, Caughey LE, Rangoonwal F, Liu J, Condron P, Obalowu IA, Archer DF, Bell RJ, Christmas M, Davies M, Davis SR, Giblin K, Iliodromiti S, Jaisamrarn U, Khandelwal S, Kiesel L, Aggarwal N, Mitchell CM, Mishra GD, Nappi RE, Panay N, Roberts H, Rozenberg S, Shifren J, Simon JA, Stute P, Vincent AJ, Wolfman W, Hickey M. Recommended measurement instruments for genitourinary symptoms associated with menopause: the COMMA (Core outcomes in menopause) consortium. Menopause 2024; 31:591-599. [PMID: 38743907 DOI: 10.1097/gme.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The aim of the study is to identify appropriate definitions and patient-reported outcome measures (PROMs) for each of the eight core outcomes previously selected for genitourinary symptoms associated with menopause: pain with sex, vulvovaginal dryness, vulvovaginal discomfort or irritation, discomfort or pain when urinating, change in most bothersome symptom, distress, bother or interference of genitourinary symptoms, satisfaction with treatment, and side effects. METHODS We conducted a systematic review to identify possible definitions and PROMs, including their measurement properties. Identified definitions and relevant PROMs with acceptable measurement properties were entered into an international consensus process involving 28 participants from 10 countries to achieve final recommendations for each core outcome. RESULTS A total of 87 publications reporting on 34 PROMs were identified from 21,207 publications screened. Of these 34 PROMs, 29 were not considered to sufficiently map onto the core outcomes, and 26 of these also had insufficient measurement properties. Therefore, only five PROMs corresponding to two core outcomes were considered for recommendation. We recommend the PROMIS Scale v2.0 - Sexual Function and Satisfaction: Vaginal Discomfort with Sexual Activity to measure the outcome of "pain with sexual activity" and the Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire to measure "distress, bother or interference" from genitourinary symptoms. Six definitions of "side effects" were identified and considered. We recommend that all trials report adverse events in study participants, which is a requirement of Good Clinical Practice. CONCLUSIONS Suitable PROMs and definitions were identified to measure three of eight core outcomes. Because of the lack of existing measures, which align with the core outcomes and have evidence of high-quality measurement properties, future work will focus on developing or validating PROMs for the remaining five core outcomes.
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Affiliation(s)
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Niamh F Waters
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Anna D Li
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Nipuni S Susanto
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Lucy E Caughey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Fatema Rangoonwal
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Jingbo Liu
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Patrick Condron
- University Library, The University of Melbourne, Parkville, Australia
| | | | - David F Archer
- Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Melanie Davies
- Institute for Women's Health, University College London, UK
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karen Giblin
- Red Hot Mamas North America, Inc., Bridgewater, New Jersey, United States
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health, QMUL, London, UK
| | - Unnop Jaisamrarn
- Menopause Research Group, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Neelam Aggarwal
- Department of Gynaecology and Obstetrics, PostGraduate Institute of Medical Education & Research, Chandigarh, India
| | - Caroline M Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Gita D Mishra
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, St Lucia, Australia
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's & Chelsea and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Serge Rozenberg
- Department of Ob-Gyn CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Amanda J Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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Hassanein MM, Huri HZ, Baig K, Abduelkarem AR, Al-Momani M. Development and validation of the genitourinary syndrome of menopause symptoms and vaginal treatments acceptability questionnaire (GSM-SVTAQ): An electronic patient-reported outcomes measure. Int J Gynaecol Obstet 2024; 164:613-623. [PMID: 37702968 DOI: 10.1002/ijgo.15106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES To develop and validate an electronic, patient-reported outcomes measure (PROM) specific for genitourinary syndrome of menopause (GSM) patients. The PROM aimed to accurately assess the burden of GSM symptoms, their impact on health-related and sexual quality of life, and the acceptability of vaginal treatments. METHODS The study encompassed a comprehensive three-stage approach to the development and validation of the PROM. Initially, during the preliminary design stage, the necessity for a new PROM was recognized, an expert panel was formed, and semi-structured qualitative interviews were carried out with GSM patients. In the second stage, the study used the five-step pre-validation methodology established by Prior et al. to generate and refine the PROM items. The third and final stage encompassed the determination of scale and item content validity indexes to ensure validity. Additionally, the reliability of each construct was evaluated using Cronbach's α. RESULTS The resulting PROM was named GSM-SVTAQ (GSM-symptoms and vaginal treatments acceptability questionnaire). It demonstrated excellent validity in assessing symptoms burden, health-related and sexual quality of life, and vaginal treatment acceptability, with high content validity indices and strong internal consistency. The scale content validity indices and Cronbach's α coefficients for the three domains were (0.926, 0.939), (0.875, 0.947), and (0.824, 0.855), respectively. CONCLUSION The GSM-SVTAQ stands as the first GSM-specific, valid, and reliable PROM capable of comprehensively measuring the three components of GSM and the acceptability of vaginal treatments. Its implementation has the potential to significantly enhance patient care and outcomes in GSM management.
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Affiliation(s)
- Mohammed M Hassanein
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hasniza Zaman Huri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kauser Baig
- Department of Obstetrics and Gynecology, University Hospital Sharjah, Sharjah, United Arab Emirates
| | - Abduelmula R Abduelkarem
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Marwan Al-Momani
- Department of Mathematics, College of Science, University of Sharjah, Sharjah, United Arab Emirates
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Wang J, Liao Y, You Y, Liang W, Wan L, Yang H, Liu J, Li Y, Wang X, Nie G. Acupuncture and Chinese herbal medicine for menopausal mood disorder: a randomized controlled trial. Climacteric 2023; 26:392-400. [PMID: 36921619 DOI: 10.1080/13697137.2023.2187284] [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: 01/10/2023] [Revised: 02/05/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE This study aimed to analyze the effectiveness of acupuncture combined with Chinese herbal medicine (CHM) on mood disorder symptoms for menopausal women. METHODS A total of 95 qualified Chinese participants were randomly assigned to one of three groups: 31 in the acupuncture combined with CHM group (combined group), 32 in the acupuncture combined with CHM placebo group (acupuncture group) and 32 in the CHM combined with sham acupuncture group (CHM group). The patients were treated for 8 weeks and followed up for 4 weeks. The data were collected using the Greene Climacteric Scale (GCS), self-rating depression scale (SDS), self-rating anxiety scale (SAS) and safety index. RESULTS The three groups each showed significant decreases in the GCS, SDS and SAS after treatment (p < 0.05). Furthermore, the effect on the GCS total score and the anxiety domain lasted until the follow-up period in the combined group (p < 0.05). Within the three groups, there was no difference in GCS and SAS between the three groups after treatment (p > 0.05). However, the combined group showed significant improvement in the SDS, compared with both the acupuncture group and the CHM group at 8 weeks and 12 weeks (p < 0.05). No obvious abnormal cases were found in any of the safety indexes. CONCLUSIONS The results suggest that either acupuncture, or CHM or combined therapy offer safe improvement of mood disorder symptoms for menopausal women. However, the combination therapy was associated with more stable effects in the follow-up period and a superior effect on improving depression symptoms.
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Affiliation(s)
- J Wang
- The Second Clinical Medical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Y Liao
- The Second Clinical Medical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Y You
- The Second Clinical Medical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - W Liang
- The Second Clinical Medical College of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - L Wan
- Department of Psychology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - H Yang
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - J Liu
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Y Li
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - X Wang
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - G Nie
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Wu S, Shi Y, Zhao Q, Men K. The relationship between physical activity and the severity of menopausal symptoms: a cross-sectional study. BMC Womens Health 2023; 23:212. [PMID: 37118747 PMCID: PMC10147361 DOI: 10.1186/s12905-023-02347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE To investigate the relationship between physical activity and the severity of menopausal symptoms in middle-aged women in northwest China. METHODS This was a cross-sectional online survey study. Using a snowball sampling method, 468 women aged 45 to 60 were recruited from northwest China and their demographic information was collected. The modified Kupperman Menopausal Index scale and International Physical Activity Questionnaire short form were used in this study. Random forest was used to rank the importance of variables and select the optimal combination. The direction and relative risk (odds ratio value) of selected variables were further explained with an ordinal logistic regression model. RESULTS The prevalence of menopausal syndromes was 74.8% and more than one-half of the participants had moderate or severe symptoms (54.3%). The Mantel-Haenszel linear-by-linear chi-square test showed a strong and negative correlation between physical activity level and the severity of menopausal symptoms (P < 0.001). Random forest demonstrated that the physical activity level was the most significant variable associated with the severity of menopausal symptoms. Multiple random forest regressions showed that the out-of-bag error rate reaches the minimum when the top 4 variables (physical activity level, menopausal status, perceived health status, and parity) in the importance ranking form an optimal variable combination. Ordinal logistic regression analysis showed that a higher physical activity level and a satisfactory perceived health status might be protective factors for menopausal symptoms (odds ratio (OR) < 1, P < 0.001); whereas perimenopausal or postmenopausal status and 2 parities might be risk factors for menopausal symptoms (OR > 1, P < 0.001). CONCLUSIONS There is a strong negative correlation between physical activity and the severity of menopausal symptoms. The results have a clinical implication that the menopausal symptoms may be improved by the moderate-to-high level physical activity in the lives of middle-aged women.
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Affiliation(s)
- SongWen Wu
- Department of Public Health, Xi'an Medical College, 1st Weiyang Rd, Xi'an, Shaanxi Province, 710021, China
| | - Yi Shi
- Shaanxi Provincial Centre for Disease Control and Prevention, Xi'an, 710054, China
| | - Qiao Zhao
- Department of Gynecology and Obstetrics, Xi'an Medical College, Xi'an, 710021, China
| | - Ke Men
- Department of Public Health, Xi'an Medical College, 1st Weiyang Rd, Xi'an, Shaanxi Province, 710021, China.
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Su H, Li H, Zhang H, Yang X, Wang C. Menopausal symptoms and quality of life in female survivors treated with hematopoietic stem cell transplantation. Front Psychiatry 2023; 14:1050959. [PMID: 36926465 PMCID: PMC10011465 DOI: 10.3389/fpsyt.2023.1050959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES To assess the severity of menopausal symptoms and the correlation among different quality of life questionnaires and compare the quality of life of patients who underwent hematopoietic stem cell transplantation (HSCT) for hematological disorders with the norm group in order to facilitate personalized and directed therapeutic intervention for patients. METHODS We recruited women who had premature ovarian failure (POF) after HSCT for hematologic diseases in the gynecological endocrinology outpatient clinic of Peking University People's Hospital. Women with HSCT were included in the study if they had 6 months of spontaneous amenorrhea with serum follicle-stimulating hormone levels greater than 40 mIU/mL taken 4 weeks apart. The patients who had other causes of POF were excluded. During the survey, all women were required to fill out the questionnaires [Quality of Life Questionnaire (MENQOL), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and 36-item Short-Form (SF-36)] online. We analyzed the severity of menopausal symptoms, anxiety, and depression in Participants. In addition, differences on the SF-36 scale scores between the study group and norm groups were examined. RESULTS In total, 227 (93.41%) patients completed the survey and were analyzed. The severity of all symptoms is "none and mild" in MRS, MENQOL, GAD-7, and PHQ-9. On the MRS, the most common symptoms were irritability, physical and mental exhaustion, and sleep problems. The severest symptoms were sexual problems (53, 73.82%), followed by sleep problems (44, 19.38%) and mental and physical exhaustion (39, 17.18%). In the MENQOL, the most common symptoms were psychosocial and physical symptoms. The severest symptoms were sexual symptoms (35, 48.75%) followed by psychosocial symptoms (23, 10.13%). Moderate-severe scores were shown in 11.89% (27) and 18.72% (42) cases in the GAD-7 and PHQ-9, respectively. Based on SF-36, in comparison with the norm group, the HSCT participants had higher vitality scores and lower role physical, physical functioning, and role emotional scores aged 18-45. In addition, the HSCT participants had lower mental health scores aged 18-25, and lower general health scores aged 25-45. No strong correlation was observed between questionnaires in our study. CONCLUSION Overall, menopausal symptoms are milder in female patients after HSCT. There is no single scale that comprehensively assesses the patient's quality of life after HSCT. We need to assess the severity of various symptoms in patients using different scales.
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Affiliation(s)
- Huina Su
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Huiling Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Hua Zhang
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Chaohua Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
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Psychological and social health outcomes of physical activity around menopause: A scoping review of research. Maturitas 2022; 164:88-97. [DOI: 10.1016/j.maturitas.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 12/18/2022]
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Correlation among four questionnaires that evaluate menopausal symptoms. Menopause 2022; 29:700-706. [PMID: 35674650 DOI: 10.1097/gme.0000000000001965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The number of specific scales to measure menopausal symptoms has increased significantly in the last decades. However, the lack of standardization as well as prioritization of which scale should be used in exploring menopausal symptoms poses problems in most populations. Thus, we aimed at demonstrating the correlation among four questionnaires evaluating menopausal symptoms: the Menopause Rating Scale (MRS), Greene Climacteric Scale (GCS), Kupperman Menopausal Index, and Women's Health Questionnaire (WHQ). METHODS We recruited 336 women between 40 and 65 years of age who responded to all four questionnaires. For each questionnaire, we calculated the overall score and the subscale scores. We then compared variables using the Spearman rank correlation coefficient (Rho). RESULTS We found a very strong correlation (Rho > 0.80; P < 0.001) between all the questionnaires. The strongest correlations were those observed in the comparisons involving the GCS (Rho 0.92-0.95; P < 0.001), whereas the weakest ones were observed using the WHQ scale (Rho -0.86 to -0.89; P < 0.001). Like in the overall score analyses, vasomotor, somatic, and psychological symptoms demonstrated the strongest correlations in the GCS comparisons and the weakest correlations between the WHQ and MRS. CONCLUSIONS The MRS, GCS, Kupperman Menopausal Index, and WHQ assessed menopausal symptoms in a very similar way. We recommend further studies to adjust and improve the existing questionnaires, test their robustness in different settings, and ensure their applicability in research and clinical practice.
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Waldorff FB, Bang CW, Siersma V, Brodersen J, Lund KS. Factors associated with a clinically relevant reduction in menopausal symptoms of a standardized acupuncture approach for women with bothersome menopausal symptoms. BMC Complement Med Ther 2021; 21:29. [PMID: 33441145 PMCID: PMC7805030 DOI: 10.1186/s12906-021-03208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Little is known about factors associated with a clinically relevant reduction in menopausal symptoms through a brief acupuncture approach for women with moderate-to-severe menopausal symptoms. Methods Post hoc analysis of a randomized controlled trial where participants were allocated to early versus late standardized acupuncture. Both the early group and the late group are included in this study. The late group got an identical intervention parallel staged by 6 weeks. By means of the relative importance, the effect was evaluated for both early versus late women with a 6-week follow-up. We included four symptom subscales from the validated MenoScores Questionnaire: hot flushes, day and night sweats, general sweating, menopausal-specific sleeping problems, as well as an overall score, which is the sum of the four outcomes in the analysis. Results 67 women with moderate to severe menopausal symptoms were included of whom 52 (77.6%) experienced a clinically relevant reduction in any of the four surveyed symptom subscales or overall score. 48 (71.6%) women experienced a clinically relevant reduction in any of the vasomotor symptom subscales: hot flushes, day and night sweats, general sweating. Women with vocational education were most likely to experience improvement compared to women with higher education. Beyond education, other factors of some importance for a clinically relevant reduction were no alcohol consumption, two or more births and urinary incontinence. Conclusions Level of education was the most consistent factor associated with improvement. Beyond education, other factors of some importance were no alcohol consumption, two or more births and urinary incontinence. Trial registration This study was registered in ClinicalTrials.gov at April 21, 2016. The registration number is NCT02746497.
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Affiliation(s)
- Frans Boch Waldorff
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Department of Public Health, University of Southern Denmark, Research Unit of General Practice, Odense, Denmark.
| | - Christine Winther Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Sorø, Denmark
| | - Kamma Sundgaard Lund
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Comins JD, Brodersen J, Christensen KB, Jensen J, Hansen CF, Krogsgaard MR. Responsiveness, minimal important difference, minimal relevant difference, and optimal number of patients for a study. Scand J Med Sci Sports 2020; 31:1239-1248. [PMID: 33063386 DOI: 10.1111/sms.13855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 02/03/2023]
Abstract
Several terms are used to describe changes in PROM scores in relation to treatments. Whether the change is small, large, or relevant is defined in different ways, yet these change scores are used to recommend or oppose treatments. They are also used to calculate the necessary number of patients for a study. This article offers a theoretical explanation behind the terms responsiveness, minimal important difference (MID), minimal important change (MIC), minimal relevant difference (MIREDIF), and threshold of clinical importance. It also gives instructions on how these and the optimal number of patients for a study are calculated. Responses to two domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS), before and 1 year after reconstruction of the anterior cruciate ligament of 164 patients, are used to illustrate the calculations. This paper presents the most common methods used to calculate and interpret MID. Results vary substantially across domains, patient location on the scale, and health conditions. The optimal number of patients depends on the minimal relevant difference (MIREDIF), the standard error of the measure (SEM), the desired statistical power for the measurement, and the responsiveness of the measurement instrument (the PROM). There is often uncertainty surrounding the calculation and interpretation of responsiveness, MID, and MIREDIF, as these concepts are complex. When MID is used to evaluate research results, authors should specify how the MID was calculated, and its relevance for the study population. These measures should only be used after thorough consideration to justify healthcare decisions.
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Affiliation(s)
- Jonathan David Comins
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,The Research Unit for General Practice and Section of General Practice , Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice , Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Sorø, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health , University of Copenhagen, Copenhagen, Denmark
| | - Jonas Jensen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christian Fugl Hansen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Thestrup Hansen S, Kjerholt M, Friis Christensen S, Brodersen J, Hølge-Hazelton B. User experiences on implementation of patient reported outcome measures (PROMs)in a Haematological outpatient clinic. J Patient Rep Outcomes 2020; 4:87. [PMID: 33113030 PMCID: PMC7593370 DOI: 10.1186/s41687-020-00256-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background PROMs can help healthcare professionals gain an improved understanding of patients’ physical burdens, functional levels, and (health-related) quality of life throughout disease and medical treatment. The aim of this study was to investigate the barriers and potential opportunities PROMs may present in a haematological outpatient clinic from three different perspectives: patients, nurses and haematologists. Methods The present study synthesizes three previously published studies that separately explored the experiences of patients, nurses and haematologists when implementing PROMs. The studies were all guided by the qualitative methodology Interpretive Description, including a focused ethnographic approach, to develop implications for future practice. Results The overall themes that emerged from the analysis were “Structural similarities influence the adoption of PROMs” and “Different perspectives on the potential of PROMs.” Conclusion Across the different user groups in the haematological outpatient clinic, the use of PROMs was thwarted due to an unquestioned commitment to biomedical knowledge and the system’s rationality and norms: PROM data was not used in patient consultations. Nurses and haematologists expressed different preferences related to potential future PROMs and different objectives for PROMs in clinical practice. From the different perspectives of the patients, nurses and haematologists, PROMs were not compatible with clinical practice. Further research is recommended to develop PROMs validated for use in haematological outpatient clinics. Moreover, implementation strategies adjusted to the structural barriers of the system are crucial. Supplementary information Supplementary information accompanies this paper at 10.1186/s41687-020-00256-z.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark. .,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. .,Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark.
| | - Mette Kjerholt
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sarah Friis Christensen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- Section of General Practice and Research Unit for General practice, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Zealand Region, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,The Research Support Unit, Zealand University Hospital, Roskilde, Denmark
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Lund KS, Siersma V, Bang CW, Brodersen J, Waldorff FB. Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial. Acupunct Med 2020; 38:396-406. [PMID: 32517477 DOI: 10.1177/0964528420920280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Our objective was to investigate whether the effect of a brief and standardised acupuncture approach persists after the end of the acupuncture treatment (post-treatment effect) and whether the anticipation of future acupuncture treatment affects menopausal symptoms (pre-treatment effect). METHOD This study is a post hoc analysis of data from a randomised controlled trial where women with moderate to severe menopausal symptoms were offered weekly acupuncture treatment over five consecutive weeks and randomised (1:1) to an early intervention group that received treatment immediately and a late intervention group with a 6-week delay. The acupuncture style was Western medical, administered at CV3, CV4 and bilateral LR8, SP6 and SP9. Acupuncturists were general practitioners. The effect was evaluated repeatedly during and after the interventions using scales from the validated MenoScores Questionnaire (MSQ) for hot flushes (HF), day and night sweats (DNS), general sweating (GS) and menopausal-specific sleeping problems (MSSP) with a 26-week follow-up period (corresponding to 21 or 15 weeks post-treatment for the early and late intervention groups, respectively). Multivariable linear mixed models were used to analyse the extent and duration of effects. RESULTS Seventy participants were included in the study. Four participants dropped out. Furthermore, one participant was excluded from the short- and long-term follow-up analyses after the insertion of a hormonal intrauterine device, and nine participants were excluded from the long-term follow-up analysis due to the initiation of co-interventions. For each of the four outcomes, the effect was sustained up to 21 weeks post-treatment with an effect size that was only slightly diminished. A small, but significant, pre-treatment effect was observed in the HF scale scores. The same trend, although not significant, was observed in the DNS and MSSP scale scores. No serious harms were reported. CONCLUSION This study demonstrated that the overall effect of a brief and standardised acupuncture treatment on menopause-relevant outcomes was sustained up to 21 weeks post-treatment and that there was a small pre-treatment effect.
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Affiliation(s)
- Kamma Sundgaard Lund
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christine Winther Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Koege, Denmark
| | - Frans Boch Waldorff
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Thestrup Hansen S, Kjerholt M, Friis Christensen S, Hølge-Hazelton B, Brodersen J. Haematologists' experiences implementing patient reported outcome measures (PROMs) in an outpatient clinic: a qualitative study for applied practice. J Patient Rep Outcomes 2019; 3:74. [PMID: 31884569 PMCID: PMC6935381 DOI: 10.1186/s41687-019-0166-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The patient-doctor relationship is crucial to provide person-centred care, allowing the alleviation of symptom burden caused by disease or treatment. Implementing Patient Reported Outcome Measures (PROMs) is suggested to inform the decision-making process and lead to initiation of care. Yet there are knowledge gaps regarding how meaningful it is to incorporate PROMs in clinical settings. The aim of this study was to investigate haematologists' experiences when PROMs were implemented in an outpatient setting. METHODS Fourteen participant observations, 13 individual interviews and three in-depth interviews were conducted with haematologists, guided by the qualitative methodology Interpretive Description. Analysis was inspired by Habermas' critical theoretical framework. RESULTS The haematologists included were characterised by dichotomous experiences with PROMs, either resistant to or supporting their implementation. None were observed to elaborate on PROMs during consultations: instead, primary attention was spent discussing the hematological agenda dictated by the system. CONCLUSION The use of PROMs for individualized care was linked with extensive uncertainties and PROMs were not requested by the haematologists. To improve individualized care, other approaches may be more suitable. If PROMs are to be incorporated into future clinical practice, they should be tested tothe specific patient group and involve relevant users.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark.
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Mette Kjerholt
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sarah Friis Christensen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- The Research Support Unit, Zealand University Hospital, Roskilde, Denmark
| | - John Brodersen
- Department of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre of Research & Education in General Practice, Primary Health Care Research Unit, Copenhagen, Region Zealand, Denmark
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Lund KS, Siersma V, Brodersen J, Waldorff FB. Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study). BMJ Open 2019; 9:e023637. [PMID: 30782712 PMCID: PMC6501989 DOI: 10.1136/bmjopen-2018-023637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of a standardised brief acupuncture approach for women with moderate-to-severe menopausal symptoms. DESIGN Randomised and controlled, with 1:1 allocation to the intervention group or the control group. The assessor and the statistician were blinded. SETTING Nine Danish primary care practices. PARTICIPANTS 70 women with moderate-to-severe menopausal symptoms and nine general practitioners with accredited education in acupuncture. INTERVENTION The acupuncture style was western medical with a standardised approach in the predefined acupuncture points CV-3, CV-4, LR-8, SP-6 and SP-9. The intervention group received one treatment for five consecutive weeks. The control group was offered treatment after 6 weeks. MAIN OUTCOME MEASURES Outcomes were the differences between the randomisation groups in changes to mean scores using the scales in the MenoScores Questionnaire, measured from baseline to week 6. The primary outcome was the hot flushes scale; the secondary outcomes were the other scales in the questionnaire. All analyses were based on intention-to-treat analysis. RESULTS 36 participants received the intervention, and 34 participants were in the control group. Four participants dropped out before week 6. The acupuncture intervention significantly decreased hot flushes: Δ -1.6 (95% CI [-2.3 to -0.8]; p<0.0001), day-and-night sweats: Δ -1.2 (95% CI [-2.0 to -0.4]; p=0.0056), general sweating: Δ -0.9(95% CI [-1.6 to -0.2]; p=0.0086), menopausal-specific sleeping problems: Δ -1.8 (95% CI [-2.7 to -1.0]; p<0.0001), emotional symptoms: Δ -3.4 (95% CI [-5.3 to -1.4]; p=0.0008), physical symptoms: Δ -1.7 (95% CI [-3 to -0.4]; p=0.010) and skin and hair symptoms: Δ -1.5 (95% CI [-2.5 to -0.6]; p=0.0021) compared with the control group at the 6-week follow-up. The pattern of decrease in hot flushes, emotional symptoms, skin and hair symptoms was already apparent 3 weeks into the study. Mild potential adverse effects were reported by four participants, but no severe adverse effects were reported. CONCLUSIONS The standardised and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention. No severe adverse effects were reported. TRIAL REGISTRATION NUMBER NCT02746497; Results.
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Affiliation(s)
- Kamma Sundgaard Lund
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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