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Tractenberg RE, Groah SL, Frost JK, Yumoto F, Rounds AK, Ljungberg IH. Urinary Symptoms Among People With Neurogenic Lower Urinary Tract Dysfunction (NLUTD) Vary by Bladder Management. Top Spinal Cord Inj Rehabil 2023; 29:31-43. [PMID: 38076287 PMCID: PMC10644852 DOI: 10.46292/sci22-00065] [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] [Indexed: 12/18/2023]
Abstract
Objectives To determine whether assessment and decision-making around urinary symptoms in people with neurogenic lower urinary tract dysfunction (NLUTD) should depend on bladder management. Methods Three surveys of urinary symptoms associated with NLUTD (USQNBs) were designed specific to bladder management method for those who manage their bladders with indwelling catheter (IDC), intermittent catheter (IC), or voiding (V). Each was deployed one time to a national sample. Subject matter experts qualitatively assessed the wording of validated items to identify potential duplicates. Clustering by unsupervised structural learning was used to analyze duplicates. Each item was classified into mutually exclusive and exhaustive categories: clinically actionable ("fever"), bladder-specific ("suprapubic pain"), urine quality ("cloudy urine"), or constitutional ("leg pain"). Results A core of 10 "NLUTD urinary symptoms" contains three clinically actionable, bladder-specific, and urine quality items plus one constitutional item. There are 9 (IDC), 11 (IC), and 8 (V) items unique to these instruments. One decision-making protocol applies to all instruments. Conclusion Ten urinary symptoms in NLUTD are independent of bladder management, whereas a similar number depend on bladder management. We conclude that assessment of urinary symptoms for persons with NLUTD should be specific to bladder management method, like the USQNBs are.
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Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
- Department of Neurology, Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
| | - Suzanne L. Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Jamie K. Frost
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
| | - Futoshi Yumoto
- Collaborative for Research on Outcomes and –Metrics, Georgetown University, Washington, DC
| | - Amanda K. Rounds
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
| | - Inger H. Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
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Sinnott Jerram KA, Dunn J, Smaill R, Middleton J. A Mixed Methods Approach as a Channel to Interpret Outcomes Research and Lived Experience Enquiry of Upper Extremity Elective Surgery for Tetraplegia. J Pers Med 2023; 13:jpm13030394. [PMID: 36983576 PMCID: PMC10058672 DOI: 10.3390/jpm13030394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Cervical spinal cord injury (SCI) causing tetraplegia is extremely disabling. In such circumstances, restoration of upper extremity (UE) function is considered the highest priority. The advent of early nerve transfer (NT) procedures, in addition to more traditional tendon transfers (TT), warranted in-depth consideration given the time-limited nature of NT procedures. Potential surgery candidates may not yet have come to terms with the permanence of their disability. A mixed methods convergent design was utilized for concurrent analysis of the Aotearoa/New Zealand upper limb registry data from the clinical assessments of all individuals considering UE surgery, regardless of their final decision. The International Classification of Functioning, Disability and Health (ICF) taxonomy guided data interpretation during the three-phased study series. It was the integration of the findings using the Stewart Model of care drawn from palliative health that enabled the interpretation of higher order messages. It is clear the clinical assessment and selection processes in use require reconsideration given the complexities individuals face following onset of SCI. We draw attention to the higher order cognitive demands placed on individuals, the requirement for SCI peer involvement in decision making and the need for acknowledgment of interdependence as a relational construct when living with tetraplegia.
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Affiliation(s)
- K. Anne Sinnott Jerram
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Camperdown, NSW 2006, Australia
- Burwood Academy Trust, Christchurch 8083, New Zealand
- Correspondence: ; Tel.: +64-21994878
| | - Jennifer Dunn
- Department of Orthopedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch 8011, New Zealand
| | | | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health, Sydney Medical School-Northern, The University of Sydney, Camperdown, NSW 2006, Australia
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Groah S, Tractenberg RE, Frost JK, Rounds A, Ljungberg I. Independence of Urinary Symptoms and Urinary Dipstick Results in Voiders With Neurogenic Bladder. Top Spinal Cord Inj Rehabil 2022; 28:116-128. [PMID: 35521057 PMCID: PMC9009195 DOI: 10.46292/sci21-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Urinary symptoms and urinary tract infection (UTI) are frequent and burdensome problems associated with neurogenic lower urinary tract dysfunction. Objectives To determine whether an association exists between urinary symptoms and urine dipstick results among individuals with spinal cord injury (SCI) or multiple sclerosis (MS). Methods Prospective 12-month cohort study of 76 participants with SCI or MS who manage their bladders by voiding. Eligibility criteria included adults ≥18 years old, at least three UTIs since diagnosis, and residence in the United States. Participants completed the Urinary Symptoms Questionnaire for Neurogenic Bladder-Voider version (USQNB-V) biweekly (26 assessments) and tested their urine by dipstick at the same time. Symptom burden was estimated based on endorsements of USQNB-V symptoms classified as clinically actionable (9), bladder function (8), and urine quality (4). Urine dipstick results assessed were leukocyte esterase (LE) and nitrite (NIT). Results Participants were stratified into four groups based on etiology of neurologic dysfunction and whether they ever experienced any urinary symptoms (USx): SCI+USx (n = 14), SCI+NoUSx (n = 5), MS+USx (n = 32), and MS+NoUSx (n = 25). In descending order, symptom burden was greatest for the MS+USx group, followed by both SCI groups; it was lowest for MS+NoUSx. We assessed multiple definitions of "positive" dipstick and found evidence of independence of USQNB-V symptoms and urinary dipstick results with each definition. In each group, the median (and majority) of strong positive dipsticks did not coincide with any symptoms. Conclusion Among people with SCI or MS who void, self-administered urine dipstick results and urinary symptom reporting contribute independent information for clinical decision making.
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Affiliation(s)
- Suzanne Groah
- MedStar National Rehabilitation Hospital, Washington, DC
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and Metrics, Silver Spring, Maryland
- Departments of Neurology, Rehabilitation Medicine, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC
| | - Jamie K. Frost
- Collaborative for Research on Outcomes and Metrics, Silver Spring, Maryland
| | - Amanda Rounds
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Inger Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC
- MedStar Health Research Institute, Hyattsville, Maryland
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Villegas L, Amaral S. Patient-Reported Outcomes in Children With Chronic Kidney Disease. Semin Nephrol 2021; 41:476-484. [PMID: 34916009 DOI: 10.1016/j.semnephrol.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patient-reported outcomes (PROs) are quantitative assessments of a patient's perspective on their health and are derived directly from the patient, as opposed to clinician interpretation. PROs can serve as unique tools to improve health care providers' understanding of the patient's daily lived experience and highlight salient domains that are specific to children with chronic kidney disease (CKD). As such, PROs fill an important gap in achieving optimal health and well-being for children with CKD. However, several knowledge gaps remain in the implementation of PROs within both the clinical and research realms. This review provides a broad overview of PRO development, implementation for children with CKD, and highlights future directions and challenges.
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Affiliation(s)
- Leonela Villegas
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Sandra Amaral
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Epidemiology, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
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Tractenberg RE, Frost JK, Yumoto F, Rounds AK, Ljungberg IH, Groah SL. Reliability of the Urinary Symptom Questionnaires for people with neurogenic bladder (USQNB) who void or use indwelling catheters. Spinal Cord 2021; 59:939-947. [PMID: 34345005 PMCID: PMC8486337 DOI: 10.1038/s41393-021-00665-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a descriptive psychometrics study. OBJECTIVES Neurogenic lower urinary tract dysfunction (NLUTD), also called Neurogenic Bladder (NB), is a common and disruptive condition in a variety of neurologic diagnoses. Our team developed patient-centered instruments, Urinary Symptom Questionnaires for people with neurogenic bladder (USQNB), specific to people with NLUTD who manage their bladders with intermittent catheterization (IC), indwelling catheters (IDC), or who void (V). This article reports evidence of reliability of the IDC and V instruments. SETTING Online surveys completed by individuals in the United States with NLUTD due to spinal cord injury (SCI), or multiple sclerosis (MS) who manage their bladder with IDC (SCI, n = 306), or by voiding (SCI, n = 103; MS, n = 383). METHODS Reliability estimates were based on endorsement of the items on the USQNB-IDC and USQNB-V. Reliability evidence was representativeness of these symptoms for a national sample (by determining if endorsement > 10%); internal consistency estimates (by Cronbach's alpha and item correlation coefficient, ICC); and interrelatedness of the items (by inferred Bayesian network, BN). We also tested whether a one-factor conceptualization of "urinary symptoms in NLUTD" was supportable for either instrument. RESULTS All items were endorsed by >20% of our samples. Urine quality symptoms tended to be the most commonly endorsed on both instruments. Cronbach's alpha and ICC estimates were high (>0.74), but not suggestive of redundancy. BNs showed interpretable associations among the items, and did not discover uninterpretable or unexpected associations. Neither instrument fit a one-factor model, as expected. CONCLUSIONS The USQNB-IDC and USQNB-V instruments show sufficient, multidimensional reliability for implementation and further study.
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Affiliation(s)
- Rochelle E Tractenberg
- Collaborative for Research on Outcomes and-Metrics, Washington, DC, USA.
- Departments of Neurology, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, USA.
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | - Jamie K Frost
- Collaborative for Research on Outcomes and-Metrics, Washington, DC, USA
| | - Futoshi Yumoto
- Collaborative for Research on Outcomes and-Metrics, Washington, DC, USA
| | - Amanda K Rounds
- MedStar National Rehabilitation Hospital, Washington, DC, USA
- MedStar Health Research Health Institute, Hyattsville, MD, USA
| | - Inger H Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC, USA
- MedStar Health Research Health Institute, Hyattsville, MD, USA
| | - Suzanne L Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
- MedStar National Rehabilitation Hospital, Washington, DC, USA
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Validity of the Urinary Symptom Questionnaires for people with neurogenic bladder (USQNB) who void or use indwelling catheters. Spinal Cord 2021; 59:948-958. [PMID: 34349234 DOI: 10.1038/s41393-021-00666-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Descriptive Psychometrics Study OBJECTIVES: Neurogenic lower urinary tract dysfunction (NLUTD), or "neurogenic bladder" is a common and disruptive condition for individuals with spinal cord injury (SCI) and disease (including multiple sclerosis, MS). Our team has developed patient-centered instruments of urinary symptoms specific to patients with NLUTD, across bladder management methods. Validity evidence is needed to support the use of two new instruments, Urinary Symptom Questionnaires for people with Neurogenic Bladder (USQNB) for those who manage their bladder with indwelling catheters (IDC), or who void (V). SETTING Online surveys completed by individuals in the United States with NLUTD due to either SCI or MS who manage their bladder with indwelling catheters (SCI, n = 306; MS, n = 8), or by voiding (SCI, n = 103; MS, n = 383). A total of n = 381 USQNB-IDC respondents (five control groups), and 351 USQNB-V respondents (four control groups), contributed to our convergent and divergent validity evidence. METHODS Data were collected online to estimate key aspects of psychometric validity (content, reflection of the construct to be measured; face, recognizability of the contents as representing the construct to be measured; structural, the extent to which the instrument captures recognizable dimensions of the construct to be measured). Divergent and convergent validity evidence was derived from multiple control groups, while evidence of criterion validity was derived from attribution of each item to their experience "with a UTI". RESULTS Evidence of face, content, criterion, convergent, and divergent validity was compiled for each instrument. CONCLUSIONS The instruments demonstrate adequate, multi-dimensional, validity evidence to recommend their use for decision-making by patients, clinicians, and researchers.
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A Swiss Health Care Professionals' Perspective on the Meaning of Interprofessional Collaboration in Health Care of People with MS-A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126537. [PMID: 34204475 PMCID: PMC8297392 DOI: 10.3390/ijerph18126537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory autoimmune disease of the central nervous system mainly of adults ranging from 20 to 45 years of age. The risk of developing MS is 50% higher in women than in men. Most people with MS (PwMS) experience a spectrum of symptoms such as spasticity, continence dysfunctions, fatigue, or neurobehavioral manifestations. Due to the complexity of MS and the variety of patient-centered needs, a comprehensive approach of interprofessional collaboration (IPC) of multiple health care professionals (HCP) is necessary. The aim of this qualitative study was to explore the meaning of IPC in the comprehensive care of PwMS from a HCP perspective. Focus groups (FG) with HCP were conducted, recorded, and transcribed verbatim. The sample contained HCP from three MS clinics in different phases of care and rehabilitation. Four main categories emerged: (a) experience with IPC, (b) relevant aspects for IPC in patients’ treatment, (c) differences in in- and outpatient settings, and (d) influence of patient perspective. IPC plays a crucial role in HCP perspective when treating PwMS, which can benefit from an IPC therapeutic approach because HCP work together in a patient-centered way. The inpatient setting of HCP strongly supports the implementation of IPC. This prerequisite does not exist in outpatient settings.
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Abstract
PURPOSE OF REVIEW Patient-reported outcome measures are increasingly important measures of patient experience, which can increase research robustness, maximise economic value and improve patient outcomes. This review outlines the benefits, challenges and practicalities of incorporating patient-reported outcome measures in clinical trials. RECENT FINDINGS Patient-reported outcome measures are often the best way of measuring patient symptoms and quality of life. Patient-reported outcome measures can help reduce observer bias, engage patients in the research process, and inform health service resource planning. A range of tools exist to help facilitate clinicians and researchers in selecting and utilising patient reported outcome measures. Key issues to consider when selecting an appropriate tool include the development, format and psychometric properties of the patient-reported outcome measures. The use of patient-reported outcome measures allow us to better understand the patient experience and their values. A range of tools exist to help facilitate the use of patient-reported outcome measures. This article outlines how we can incorporate patient-reported outcome measures in clinical trials.
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Affiliation(s)
- Richard G McGee
- The Central Coast Clinical School, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Department of Paediatrics, Gosford Hospital, Holden St, Gosford, NSW, 2250, Australia.
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9
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The association between urine neutrophil gelatinase-associated lipocalin and UTI in people with neurogenic lower urinary tract dysfunction. Spinal Cord 2020; 59:959-966. [DOI: 10.1038/s41393-020-00552-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/08/2022]
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10
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Tractenberg RE, Groah SL, Rounds AK, Davis EF, Ljungberg IH, Frost JK, Schladen MM. Clinical Profiles and Symptom Burden Estimates to Support Decision-Making Using the Urinary Symptom Questionnaire for People with Neurogenic Bladder (USQNB) using Intermittent Catheters. PM R 2020; 13:229-240. [PMID: 32860333 DOI: 10.1002/pmrj.12479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/11/2020] [Accepted: 08/20/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the scoring approach, considering interpretability, validity, and use, of a new patient-centered patient reported outcome (PRO), the Urinary Symptom Questionnaire for Neurogenic Bladder-Intermittent Catheter version (USQNB-IC). DESIGN Subject matter experts (researchers, clinicians, a consumer, a psychometrician) classified USQNB-IC items. Profiles were then composed based on self-management decisions made by patients; patient management decisions made by clinicians; and research-oriented decisions made by investigators. Participants in an 18-month pilot study completed the USQNB-IC every week. Differences in decisions based on traditional 'total scores' and profiles were examined. Validity was defined based on alignment of scoring method with decisions. SETTING A new set of patient-centered PROs enable monitoring and decision-making around urinary signs and symptoms among people with neurogenic bladder (NB). PARTICIPANTS Classifications of USQNB-IC items by subject matter experts. Utility of the classifications and profiles that were created was assessed using weekly responses from the 6-month baseline period from 103 participants in a pilot study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Classification of the 29 symptoms resulted in four categories with exchangeability within-category and nonexchangeability across categories. The burden of each symptom type is one approach to scoring the USQNB-IC. Five profiles, based on these categories, emerged based on, and supportive of, decisions to be made according to symptoms, representing a categorical approach to scoring the USQNB-IC. RESULTS USQNB-IC items are not all exchangeable. Four symptom classifications comprise within-class exchangeable items. Five profiles emerged to summarize these items to promote decision-making and identification of change over time. Both ways to "score" the USQNB-IC are described and discussed. CONCLUSIONS "Profiling" promotes valid and interpretable decisions by patients and clinicians, based on a patient's urinary symptoms with the USQNB-IC cross-sectionally and longitudinally. Alternatively, four subsets of the 29 USQNB-IC symptoms can be used as continuous outcomes representing "burden" in clinical management or research.
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Affiliation(s)
- Rochelle E Tractenberg
- Collaborative for Research on Outcomes and -Metrics, Silver Spring, MD, USA.,Departments of Neurology and Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, USA
| | - Suzanne L Groah
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, USA.,MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Amanda K Rounds
- MedStar National Rehabilitation Hospital, Washington, DC, USA
| | | | - Inger H Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC, USA.,MedStar Health Research Health Institute, Hyattsville, MD, USA
| | - Jamie K Frost
- Collaborative for Research on Outcomes and -Metrics, Silver Spring, MD, USA
| | - Manon M Schladen
- Department of Rehabilitation Medicine, Georgetown University, Washington, DC, USA.,MedStar National Rehabilitation Hospital, Washington, DC, USA.,MedStar Health Research Health Institute, Hyattsville, MD, USA
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Tractenberg RE, Groah SL, Frost JK, Rounds AK, Davis E, Ljungberg IH, Schladen MM. Effects of Intravesical Lactobacillus Rhamnosus GG on Urinary Symptom Burden in People with Neurogenic Lower Urinary Tract Dysfunction. PM R 2020; 13:695-706. [PMID: 32798286 DOI: 10.1002/pmrj.12470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To test the effectiveness of intravesical Lactobacillus rhamnosus GG (LGG) to reduce the burden of urinary symptoms for individuals with spinal cord injury and disease (SCI/D) with neurogenic lower urinary tract dysfunction (NLUTD) who manage their bladders with intermittent catheterization (IC). DESIGN A three-phase study (6 months each in baseline, intervention, and washout). Participants self-managed following the Self-Management Protocol using Probiotics (SMP-Pro), completing the online Urinary Symptom Questionnaire for Neurogenic Bladder-IC version (USQNB-IC) weekly. SETTING Nationwide (United States). PARTICIPANTS Ninety-six adults and seven children with SCI/D. INTERVENTIONS In response to one or both of the SMP-Pro trigger urinary symptoms, "cloudier" or "foul smelling" urine, participants self-administered using a clean urinary catheter an LGG+ Normal Saline instillate once or twice in a 30-hour period. MAIN OUTCOME MEASURES Change in USQNB-IC burden was adjusted individually according to the previous phase for four symptom types. Adjusted changes in burden between the intervention and washout phases were analyzed using one-sample t-tests. Holm correction was applied for the four types of symptoms: A, clinically actionable; B1, bladder function; B2, urine quality; and C, other. RESULTS During the intervention phase, participants met SMP-Pro instillation criteria 3.83 times on average (range 1-20). An average of 5.6 doses of LGG were instilled. For those who instilled at least once, burdens of type A and B2 symptoms were significantly improved at washout (both adjusted P < .05). CONCLUSIONS Self-instilled LGG seemed to improve "clinically actionable" (A) and "urine quality" (B2) symptom burden. No changes were observed for those who did not instill. This first-in-human clinical trial supports ongoing research of intravesical LGG, and the SMP-Pro for urinary symptoms.
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Affiliation(s)
- Rochelle E Tractenberg
- Collaborative for Research on Outcomes and -Metrics, Silver Spring, MD, USA.,Departments of Neurology and Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Suzanne L Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA.,MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Jamie K Frost
- Collaborative for Research on Outcomes and -Metrics, Silver Spring, MD, USA
| | - Amanda K Rounds
- MedStar National Rehabilitation Hospital, Washington, DC, USA.,MedStar Health Research Health Institute, Hyattsville, MD, USA
| | - Elizabeth Davis
- MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Inger H Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC, USA.,MedStar Health Research Health Institute, Hyattsville, MD, USA
| | - Manon M Schladen
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA.,MedStar National Rehabilitation Hospital, Washington, DC, USA.,MedStar Health Research Health Institute, Hyattsville, MD, USA
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12
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Mead KH, Raskin S, Willis A, Arem H, Murtaza S, Charney L, Pratt-Chapman M. Identifying patients' priorities for quality survivorship: conceptualizing a patient-centered approach to survivorship care. J Cancer Surviv 2020; 14:939-958. [PMID: 32607715 DOI: 10.1007/s11764-020-00905-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/14/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE This study explored cancer survivors' experiences with and priorities for cancer survivorship care to describe a patient-centered approach to quality survivorship care. METHODS We conducted 22 focus groups with 170 adult survivors of breast, prostate, and colorectal cancer from six cities across the country and online. We used thematic analysis to identify participants' principles and priorities for quality survivorship care. RESULTS Based on our analysis of a limited group of cancer survivors, we identified two core principles that underlie participants' expectations for survivorship care and 11 practice priorities that reflect opportunities to improve patient-centeredness at the individual, interpersonal, and organizational levels. The principles reflect participants' desire to be better prepared for and equipped to accept and manage their chronic care needs post-cancer treatment. The priorities reflect practices that patients, providers, and cancer centers can engage in to ensure survivors' goals for post-treatment care are met. CONCLUSIONS Results from the study suggest the need to expand conceptualization of high-quality survivorship care. The survivor principles and practice priorities identified in this study challenge the field to organize a more patient-centered survivorship care system that empowers and respects patients and provides a holistic approach to survivors' chronic and long-term needs. IMPLICATIONS FOR CANCER SURVIVORS Quality cancer survivorship care must reflect patients' priorities. The findings from this study can be used to develop a patient-centered framework for survivorship care that can be used in conjunction with quality guidelines to ensure survivorship care is organized to achieve both clinical and patient-centered outcomes.
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Affiliation(s)
- K Holly Mead
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA.
| | - Sarah Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin St., Richmond, VA, 23284, USA
| | - Anne Willis
- Cystic Fibrosis Foundation, 4550 Montgomery Ave., Bethesda, MD, 20814, USA
| | - Hannah Arem
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Sarah Murtaza
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Laura Charney
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., Washington, DC, 20052, USA
| | - Mandi Pratt-Chapman
- George Washington University Cancer Center, George Washington University, 2600 Virginia Ave., NW, #300, Washington, DC, 20037, USA
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Tate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F, Cameron AP, Santacruz BG, Jakeman LB, Kennelly MJ, Kirshblum S, Krassioukov A, Krogh K, Mulcahey MJ, Noonan VK, Rodriguez GM, Spungen AM, Tulsky D, Post MW. Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med 2020; 43:141-164. [PMID: 32105586 PMCID: PMC7054930 DOI: 10.1080/10790268.2019.1706033] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: To provide an overview of clinical assessments and diagnostic tools, self-report measures (SRMs) and data sets used in neurogenic bladder and bowel (NBB) dysfunction and recommendations for their use with persons with spinal cord injury /disease (SCI/D).Methods: Experts in SCI/D conducted literature reviews, compiled a list of NBB related assessments and measures, reviewed their psychometric properties, discussed their use in SCI/D and issued recommendations for the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS) Common Data Elements (CDEs) guidelines.Results: Clinical assessments included 15 objective tests and diagnostic tools for neurogenic bladder and 12 for neurogenic bowel. Following a two-phase evaluation, eight SRMs were selected for final review with the Qualiveen and Short-Form (SF) Qualiveen and the Neurogenic Bowel Dysfunction Score (NBDS) being recommended as supplemental, highly-recommended due to their strong psychometrics and extensive use in SCI/D. Two datasets and other SRM measures were recommended as supplemental.Conclusion: There is no one single measure that can be used to assess NBB dysfunction across all clinical research studies. Clinical and diagnostic tools are here recommended based on specific medical needs of the person with SCI/D. Following the CDE for SCI studies guidelines, we recommend both the SF-Qualiveen for bladder and the NBDS for bowel as relatively short measures with strong psychometrics. Other measures are also recommended. A combination of assessment tools (objective and subjective) to be used jointly across the spectrum of care seems critical to best capture changes related to NBB and develop better treatments.
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Affiliation(s)
- Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Giulia I. Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Kim D. Anderson
- Department of Physical Medicine and Rehabilitation, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fin Biering-Sorensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Lyn B. Jakeman
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael J. Kennelly
- Department of Urology, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Steve Kirshblum
- Rutgers New Jersey Medical School, Kessler Foundation, Kessler Institution for Rehabilitation, West Orange, New Jersey, USA
| | - Andrei Krassioukov
- International collaboration On Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Klaus Krogh
- Department of Clinical Medicine, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - M. J. Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vanessa K. Noonan
- The Praxis Spinal Institute, The Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Gianna M. Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Ann M. Spungen
- VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York, USA
| | - David Tulsky
- Department of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Marcel W. Post
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, University of Utrecht and De Hoogstraat, Utrecht, the Netherlands
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14
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Noland D, Raj S. Academy of Nutrition and Dietetics: Revised 2019 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition in Integrative and Functional Medicine. J Acad Nutr Diet 2019; 119:1019-1036.e47. [DOI: 10.1016/j.jand.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 02/07/2023]
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15
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Groah SL, Rounds AK, Ljungberg IH, Sprague BM, Frost JK, Tractenberg RE. Intravesical Lactobacillus rhamnosus GG is safe and well tolerated in adults and children with neurogenic lower urinary tract dysfunction: first-in-human trial. Ther Adv Urol 2019; 11:1756287219875594. [PMID: 31620195 PMCID: PMC6777056 DOI: 10.1177/1756287219875594] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Urinary symptoms are common for people with neurogenic lower urinary tract dysfunction (NLUTD). No nonprescription approach has been proven safe and effective for self-management of urinary symptoms. Our objective was to describe the safety and tolerability of Lactobacillus rhamnosus GG (LGG®) instilled intravesically for self-management of inflammatory urinary symptoms in adults and children with NLUTD due to spinal cord injury or disease (SCI/D) and who use intermittent catheterization (IC). METHODS A total of 103 individuals with SCI/D enrolled in an 18-month study consisting of three 6-month stages: baseline (weekly observation of urinary symptoms); intervention (self-instilled intravesical LGG® in response to more cloudy or foul-smelling urine); and washout (weekly observation of urinary symptoms). Urinary symptoms were assessed using the Urinary Symptom Questionnaire for people with neurogenic bladder using intermittent catheters (USQNB-IC). Safety was based on serious adverse events and adverse events (S/AEs) and trends in symptoms. Tolerability was defined as the independence of AE experience and willingness to use/pay for this intervention. RESULTS A total of 74 (77%) adults and 6 (86%) of children completed the study, of whom 64 instilled LGG® for a total of 357 instillations (range 1-41 per person). There were 59 S/AEs, 44% (26/59) of which were categorized as infectious genitourinary. There was no statistical relationship between S/AEs and use or dose of the intervention. CONCLUSIONS One or two doses of self-instilled intravesical LGG® in response to more cloudy or foul-smelling urine was safe and well tolerated among this sample of adults and children with SCI/D who have NLUTD and use IC.
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Affiliation(s)
- Suzanne L. Groah
- MedStar National Rehabilitation Hospital, 102
Irving St, NW, Washington, DC 20010, USA
- Department of Rehabilitation Medicine,
Georgetown University Medical Center, Washington, DC, USA
| | - Amanda K. Rounds
- MedStar National Rehabilitation Hospital,
Washington, DC, USA
- MedStar Health Research Health Institute,
Hyattsville, MD, USA
| | - Inger H. Ljungberg
- MedStar National Rehabilitation Hospital,
Washington, DC, USA
- MedStar Health Research Health Institute,
Hyattsville, MD, USA
| | - Bruce M. Sprague
- Division of Urology, Children’s National Health
System, Washington, DC, USA
| | - Jamie K. Frost
- Collaborative for Research on Outcomes and
Metrics and Departments of Neurology and Biostatistics, Bioinformatics &
Biomathematics, Georgetown University Medical Center, Washington, DC,
USA
| | - Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and
Metrics and Departments of Neurology and Biostatistics, Bioinformatics &
Biomathematics, Georgetown University Medical Center, Washington, DC,
USA
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16
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Tractenberg RE, Groah SL, Rounds AK, Ljungberg IH, Schladen MM. Preliminary validation of a Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC): A patient-centered patient reported outcome. PLoS One 2018; 13:e0197568. [PMID: 29990375 PMCID: PMC6038997 DOI: 10.1371/journal.pone.0197568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/04/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We developed a Urinary Symptom Questionnaire for individuals with neurogenic bladder due to spinal cord injury (SCI) and spina bifida (SB) who manage their bladders with intermittent catheterization, the USQNB-IC. This project followed an approach to patient-centered patient reported outcomes development that we created and published in 2017, specifically to ensure the primacy of the patient's perspective and experience. PARTICIPANTS Two sets of responses were collected from individuals with neurogenic bladder due to either SCI (n = 336) and SB (patients, n = 179; and caregivers of patients with NB, n = 66), and three sets of "controls", individuals with neurogenic bladder who do not have a history of UTIs (n = 49) individuals with chronic mobility impairments (neither SCI nor SB) and without neurogenic bladder (n = 46), and those with no mobility impairment, no neurogenic bladder, and no history of UTIs (n = 64). METHOD Data were collected from all respondents to estimate these psychometric or measurement domains characterizing a health related PRO: Reliability (minimization of measurement error; internal consistency or interrelatedness of the items; and maximization of variability that is due to "true" difference between levels of the symptoms across patients), and validity (content, reflection of the construct to be measured; face, recognizability of the contents as representing the construct to be measured; structural, the extent to which the instrument captures recognizable dimensions of the construct to be measured; and criterion, association with a gold standard). RESULTS Evidence from these five groups of respondents suggest the instrument has face, content, criterion, convergent, and divergent validity, as well as reliability. The items were all more descriptive of our patient (focus) groups and were only weakly endorsed by the control groups. CONCLUSIONS The instrument is unique in its emphasis on, and origination from, the lived experiences of patients with neurogenic bladder who use intermittent catheterization; this preliminary psychometric evidence suggests the instrument could be useful for research and in the clinic. These results justify further development of the instrument, including formal exploration of the scoring and estimation of responsivity of these items to clinical interventions as well as patient-directed self care.
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Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and –Metrics; and Department of Neurology; Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, United States of America
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Suzanne L. Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States of America
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
| | - Amanda K. Rounds
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
| | - Inger H. Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
- MedStar Health Research Health Institute, Hyattsville, Maryland, United States of America
| | - Manon M. Schladen
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States of America
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
- MedStar Health Research Health Institute, Hyattsville, Maryland, United States of America
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17
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Buzzetti R, Galici V, Cirilli N, Majo F, Graziano L, Costa S, Bonacina S, Carrubba M, Davì G, Gagliano S, Cazzarolli C, Ficili F, Alghisi F, Samaja M, Magazzù G. Defining research priorities in cystic fibrosis. Can existing knowledge and training in biomedical research affect the choice? J Cyst Fibros 2018; 18:378-381. [PMID: 29551462 DOI: 10.1016/j.jcf.2018.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
The aim of this report is to assess whether the research issues priorities are perceived differently according to the Stakeholders (SH)'s individual knowledge of research topics and degree of training in biomedical research. Four groups of SH were enrolled in this study: 1. Skilled SH, specifically trained in biomedicine; 2. Unskilled untrained SH who responded to a written questionnaire in 2015; 3. SH who were trained for one year in a course delivered by professionals; 4. Untrained SH who responded to an online questionnaire in 2017. The large ranking order variability observed among groups addresses the question that the choices are markedly influenced by the SH's backgrounds. Such results emphasize the need to consider the education level and the delivery of ad hoc training activities by professionals to broaden the base of SH who may be considered qualified to transfer the Patient Centered Outcome Research principles into practice.
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Affiliation(s)
| | | | - Natalia Cirilli
- Cystic Fibrosis Centre, Mother-Child Department, United Hospitals, Ancona, Italy
| | - Fabio Majo
- Cystic Fibrosis Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Graziano
- Cystic Fibrosis Center Policlinico Umberto I, Rome, Italy, and Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy
| | | | | | | | | | | | - Clizia Cazzarolli
- Physical Therapist, Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Federico Alghisi
- Cystic Fibrosis Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michele Samaja
- Stakeholder, Department of Health Science, University of Milan, Italy.
| | - Giuseppe Magazzù
- Cystic Fibrosis Center Messina, Italy; Department of Adult and Child Human Pathology, University of Messina, Italy
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18
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Maugest L, McGovern EM, Mazalovic K, Doulazmi M, Apartis E, Anheim M, Bourdain F, Benchetrit E, Czernecki V, Broussolle E, Bonnet C, Falissard B, Jahanshahi M, Vidailhet M, Roze E. Health-Related Quality of Life Is Severely Affected in Primary Orthostatic Tremor. Front Neurol 2018; 8:747. [PMID: 29379467 PMCID: PMC5775514 DOI: 10.3389/fneur.2017.00747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/27/2017] [Indexed: 12/17/2022] Open
Abstract
Background Primary orthostatic tremor (POT) is a movement disorder characterized by unsteadiness upon standing still due to a tremor affecting the legs. It is a gradually progressive condition with limited treatment options. Impairments in health-related quality of life (HQoL) seem to far exceed the physical disability associated with the condition. Methods A multi-center, mixed-methodology study was undertaken to investigate 40 consecutive patients presenting with POT to four movement disorder centers in France. HQoL was investigated using eight quantitative scales and a qualitative study which employed semi-structured interviews. Qualitative data were analyzed with a combination of grounded-theory approach. Results Our results confirm that HQoL in POT is severely affected. Fear of falling was identified as the main predictor of HQoL. The qualitative arm of our study explored our initial results in greater depth and uncovered themes not identified by the quantitative approach. Conclusion Our results illustrate the huge potential of mixed methodology in identifying issues influencing HQoL in POT. Our work paves the way for enhanced patient care and improved HQoL in POT and is paradigmatic of this modern approach for investigating HQoL issues in chronic neurological disorders.
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Affiliation(s)
- Lucie Maugest
- Département de Neurologie, EA 4184, Hôpital universitaire de Dijon, Dijon, France
| | - Eavan M McGovern
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Katia Mazalovic
- Département de Médecine générale, Faculté de Médecine, Université de Bourgogne, Dijon, France
| | - Mohamed Doulazmi
- Sorbonne Universités, UPMC Univ Paris 06, UMR8256, INSERM, CNRS, Institut de Biologie Paris Seine, Adaptation Biologique et Vieillissement, Paris, France
| | - Emmanuelle Apartis
- Département de Neurophysiologie, Hôpital de Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathieu Anheim
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch-Graffenstaden, France.,Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Frédéric Bourdain
- Département de Neurologie, Centre médico-chirurgical Foch, Suresnes, France
| | - Eve Benchetrit
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Virginie Czernecki
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Broussolle
- Département de Neurologie, Service de Mouvements anormaux, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon I, Faculté de Médecine Lyon Sud Charles Mérieux, Institut des Sciences Cognitives Marc Jeannerod, CNRS UMR 5229, Lyon, France
| | - Cecilia Bonnet
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Falissard
- CESP, Univ. Paris-Sud, Université Paris-Saclay, UVSQ, INSERM U1178, Paris, France
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom
| | - Marie Vidailhet
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC Université Paris, Paris, France
| | - Emmanuel Roze
- Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC Université Paris, Paris, France
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