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Kozlowska O, Tallett A, Bond S, Mansbridge SE, Aveyard H, Jenkinson C, Dudbridge A, McRobert N, Lumb A, Rea R, Tan GD, Walthall H. Developing and exploring the validity of a patient reported experience measure for adult inpatient diabetes care. Diabet Med 2024; 41:e15266. [PMID: 38150334 DOI: 10.1111/dme.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
AIM To develop and explore the validity of a Patient Reported Experience Measure (PREM) for adult inpatient diabetes care. METHOD 27 in-depth interviews were conducted to inform the development of the 42-item PREM which was cognitively tested with 10 people. A refined 38-item PREM was piloted with 228 respondents completing a paper (n = 198) or online (n = 30) version. The performance of the PREM was evaluated by exploring (i) uptake/number of responses and (ii) survey validity by investigating whether the PREM data were of adequate quality and delivered useful information. RESULTS The PREM had low drop-out or missing data rates suggesting it was appropriately constructed. Analysis of item frequencies and variances, and problem score calculations concluded that questions provided sufficient score differentiation. CONCLUSIONS This new PREM allows for experiences of inpatient diabetes care to be measured, understood and reported on to help identify priority areas for improving care quality.
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Affiliation(s)
- Olga Kozlowska
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | | | - Samuel Bond
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | - Sarah E Mansbridge
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- Oxford Institute of Applied Health Research, Oxford Brookes University, Oxford, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Nicky McRobert
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Garry D Tan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Helen Walthall
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Jones GL, Budds K, Taylor F, Musson D, Raymer J, Churchman D, Kennedy SH, Jenkinson C. A systematic review to determine use of the Endometriosis Health Profiles to measure quality of life outcomes in women with endometriosis. Hum Reprod Update 2024; 30:186-214. [PMID: 38007607 PMCID: PMC10905511 DOI: 10.1093/humupd/dmad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/06/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified. OBJECTIVE AND RATIONALE The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women's QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show? SEARCH METHODS The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms 'EHP30', 'EHP5', 'EHP-30', 'EHP-5', 'endometriosis health profile 30', and 'endometriosis health profile 5'. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). OUTCOMES The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs' robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the 'control and powerlessness' domain post-intervention, followed by 'pain'. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review. WIDER IMPLICATIONS Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research.
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Affiliation(s)
- Georgina L Jones
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Kirsty Budds
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Francesca Taylor
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Danielle Musson
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | | | - Stephen H Kennedy
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Walthall H, Strickland LH, Jenkinson C. The development of a patient reported outcome measure for fatigue and breathlessness for patients with chronic heart failure (OxFAB). Heart Lung 2023; 58:116-124. [PMID: 36493523 DOI: 10.1016/j.hrtlng.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fatigue and breathlessness are the two most common and distressing symptoms for patients with chronic heart failure. They affect a patient's quality of life and ability to undertake activities of daily living. Currently there are no symptom specific measures for fatigue and breathlessness available or developed and validated for use with this patient group and no questionnaire that incorporates both symptoms into one measure. OBJECTIVE To develop a patient-reported outcome measure for patients with chronic heart failure for their fatigue and breathlessness symptoms. METHODS A three-staged, approach was used. In stage One in-depth qualitative patient-interviews on factors of fatigue and breathlessness in chronic heart failure were undertaken to provide question themes. Items from these interviews were generated and pilot questionnaires developed and tested. In Stage Two, exploratory factor analysis with item reduction and final testing of the questionnaire was performed. Stage Three involved validation testing. RESULTS In Stage One, issues raised in interviews (n = 25) were used to generate items. Pilot questionnaires were developed and tested. Items were refined in the context of cognitive debrief interviews (n = 7) for possible inclusion in the final measure. Final testing of questionnaire properties with item reduction was carried out in Stage Two (n = 112). Validity and reliability were assessed in Stage Three (n = 96). Psychometric testing showed positive results, in internal consistency (Cronbach's alpha ranging from 0.8 to 0.94) and test-retest (no difference in means), content validity and relevance to patients. CONCLUSIONS This questionnaire could be useful in the assessment of fatigue and breathlessness in patients living with chronic heart failure.
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Affiliation(s)
- Helen Walthall
- Oxford University Hospitals NHS Foundation Trust Headley Way, Oxford, OX3 9DU, UK; NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office Room 4503, Corridor B, Level 4, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Louise H Strickland
- Oxford University Hospitals NHS Foundation Trust Headley Way, Oxford, OX3 9DU, UK; NIHR Oxford Biomedical Research Centre, Clinical Informatics Research Office Room 4503, Corridor B, Level 4, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Headington, Oxford, OX3 7DQ, UK
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Nwolise C, Corrie P, Fitzpatrick R, Gupta A, Jenkinson C, Middleton M, Matin R. Burden of cancer trial participation: A qualitative sub-study of the INTERIM feasibility RCT. Chronic Illn 2023; 19:81-94. [PMID: 34787471 PMCID: PMC9841458 DOI: 10.1177/17423953211060253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/23/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A qualitative sub-study was carried out within a larger phase II feasibility trial, to identify and describe the burden experienced by advanced melanoma patients participating in a clinical trial and the factors affecting their capacity to cope with the burden. METHODS Semi-structured interviews were conducted with fourteen patients with advanced melanoma recruited from National Health Service hospitals in the United Kingdom. Qualitative analysis was undertaken using a framework analysis approach. Normalisation process theory was applied to the concept of research participation burden in order to interpret and categorise findings. RESULTS Burdens of participation were identified as arising from making sense of the trial and treatment; arranging transport, appointment and prescriptions; enacting management strategies and enduring side effects; reflecting on trial documents and treatment efficacy, and emotional and mental effects of randomisation and treatment side effects. Factors reported as influencing capacity include personal attributes and skills, physical and cognitive abilities and support network. DISCUSSION This is the first study to highlight the substantial burden faced by patients with advanced melanoma in a clinical trial and factors that may lessen or worsen the burden. Consideration of identified burdens during trial design and execution will reduce the burden experienced by research participants.
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Affiliation(s)
- Chidiebere Nwolise
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Applied Research
Collaboration Oxford, Oxford, UK
| | - Pippa Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS
Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Applied Research
Collaboration Oxford, Oxford, UK
| | | | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
| | - Mark Middleton
- University of Oxford Department of
Oncology, Cancer Research UK Oxford
Centre, Oxford, UK
| | - Rubeta Matin
- Dermatology Department, Churchill Hospital, Oxford, UK
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5
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Harrison CJ, Plummer OR, Dawson J, Jenkinson C, Hunt A, Rodrigues JN. Computerized adaptive testing for the Oxford Hip, Knee, Shoulder, and Elbow scores : accurate measurement from fewer, and more patient-focused, questions. Bone Jt Open 2022; 3:786-794. [PMID: 36222103 PMCID: PMC9626870 DOI: 10.1302/2633-1462.310.bjo-2022-0073.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS The aim of this study was to develop and evaluate machine-learning-based computerized adaptive tests (CATs) for the Oxford Hip Score (OHS), Oxford Knee Score (OKS), Oxford Shoulder Score (OSS), and the Oxford Elbow Score (OES) and its subscales. METHODS We developed CAT algorithms for the OHS, OKS, OSS, overall OES, and each of the OES subscales, using responses to the full-length questionnaires and a machine-learning technique called regression tree learning. The algorithms were evaluated through a series of simulation studies, in which they aimed to predict respondents' full-length questionnaire scores from only a selection of their item responses. In each case, the total number of items used by the CAT algorithm was recorded and CAT scores were compared to full-length questionnaire scores by mean, SD, score distribution plots, Pearson's correlation coefficient, intraclass correlation (ICC), and the Bland-Altman method. Differences between CAT scores and full-length questionnaire scores were contextualized through comparison to the instruments' minimal clinically important difference (MCID). RESULTS The CAT algorithms accurately estimated 12-item questionnaire scores from between four and nine items. Scores followed a very similar distribution between CAT and full-length assessments, with the mean score difference ranging from 0.03 to 0.26 out of 48 points. Pearson's correlation coefficient and ICC were 0.98 for each 12-item scale and 0.95 or higher for the OES subscales. In over 95% of cases, a patient's CAT score was within five points of the full-length questionnaire score for each 12-item questionnaire. CONCLUSION Oxford Hip Score, Oxford Knee Score, Oxford Shoulder Score, and Oxford Elbow Score (including separate subscale scores) CATs all markedly reduce the burden of items to be completed without sacrificing score accuracy.Cite this article: Bone Jt Open 2022;3(10):786-794.
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Affiliation(s)
- Conrad J. Harrison
- Methodology Oxford Limited, London, UK,Correspondence should be sent to Conrad J. Harrison. E-mail:
| | | | - Jill Dawson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Audrey Hunt
- Universal Research Solutions, Columbia, Missouri, USA
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Morley D, Dummett S, Kelly L, Jenkinson C. Test-retest reliability of the PDQ-Carer. Parkinsonism Relat Disord 2022; 102:16-18. [DOI: 10.1016/j.parkreldis.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
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Gray R, Jenkinson C, Clarke CE. Commentary on Long-term Effectiveness of Adjuvant Treatment in Parkinson Disease-Reply. JAMA Neurol 2022; 79:726-727. [PMID: 35759259 DOI: 10.1001/jamaneurol.2022.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Richard Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Carl E Clarke
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
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8
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Nwolise C, Rembielak A, Fitzpatrick R, Jenkinson C, Marsden J, Fairbrother P, Proby CM, Harwood CA, Matin RN. Adjuvant radiotherapy in patients with high-risk cutaneous Squamous Cell Carcinoma After surgery (SCC-AFTER): Patient and carer views regarding a proposed clinical trial. Clin Exp Dermatol 2022; 47:1875-1876. [PMID: 35722934 DOI: 10.1111/ced.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Chidiebere Nwolise
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Agata Rembielak
- Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | | | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jerry Marsden
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Charlotte M Proby
- Division of Molecular and Clinical Medicine, Ninewells Hospital & Medical School, University of Dundee, UK
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Sriram V, Jenkinson C, Peters M. Carers using assistive technology in dementia care at home: a mixed methods study. BMC Geriatr 2022; 22:490. [PMID: 35672662 PMCID: PMC9173970 DOI: 10.1186/s12877-022-03167-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Informal carers support persons with dementia to live at home, even with deteriorating physical, social and cognitive issues. This study aims to examine the experiences and impact of Assistive Technology (AT) on carers, providing care for a person with dementia. Methods This is an explanatory sequential mixed methods study. The quantitative phase was an online and postal survey using the Carers Assistive Technology Experience Questionnaire and Short Form-12 (SF-12) questionnaire, with carers of persons with dementia in the UK, who used AT. The qualitative phase involved in-depth telephone interviews with a purposive sample of survey respondents and was analysed using hermeneutic phenomenology to develop, compare and explain the findings of the survey. Results The survey included data from 201 carers. Smartphones (45.5%) and tablet computers (45.0%) were the most frequently used AT. Multiple AT were used in the care of persons with dementia predominantly for safety (78.5%), communication (66.0%), and reminders (62.5%). The SF-12 indicated that carers in the 46–65 age group and carers who were not extremely satisfied with AT had lower mental component scores whilst carers who lived with the person with dementia and older carers had lower physical component scores. Twenty-three carers participated in the interviews, and 5 themes with 14 sub-themes were identified. The interviews helped confirm data from the survey on the impact of AT on the physical, mental and social wellbeing of the carers. It helped describe reasons for satisfaction with AT; how AT was used in daily life and strengthened caring relationships and how wider support systems enhanced the care of a person with dementia using AT. Conclusions This study describes the use of AT in the real-world context. AT supplements the care provided to people with dementia in the community. Appropriate use, access to AT and abilities of the carer can enhance the support provided through AT to both carers and the person with dementia. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03167-4.
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Affiliation(s)
- Vimal Sriram
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
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10
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Gray R, Patel S, Ives N, Rick C, Woolley R, Muzerengi S, Gray A, Jenkinson C, McIntosh E, Wheatley K, Williams A, Clarke CE. Long-term Effectiveness of Adjuvant Treatment With Catechol-O-Methyltransferase or Monoamine Oxidase B Inhibitors Compared With Dopamine Agonists Among Patients With Parkinson Disease Uncontrolled by Levodopa Therapy: The PD MED Randomized Clinical Trial. JAMA Neurol 2021; 79:131-140. [PMID: 34962574 PMCID: PMC8715387 DOI: 10.1001/jamaneurol.2021.4736] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Question Is adding a dopamine reuptake inhibitor (DRI), either a monoamine oxidase type B (MAO-B) inhibitor or a catechol-O-methyltransferase (COMT) inhibitor, to levodopa therapy more effective than adding a dopamine agonist and, if a DRI is more effective, which DRI class (MAO-B or COMT) is preferable for improving patient-rated quality of life among those with motor complications of Parkinson disease (PD) that are uncontrolled by levodopa therapy? Findings In this randomized clinical trial involving 500 people with PD, no statistically significant difference was found in Parkinson’s Disease Questionnaire mobility scores between adjuvant therapy with dopamine agonists vs DRIs; however, scores were a mean of 4.2 points better with MAO-B inhibitors compared with COMT inhibitors. Meaning In this study, patient-rated quality of life was worse with the addition of COMT inhibitors compared with MAO-B inhibitors or dopamine agonists as adjuvant treatment for people with PD uncontrolled by levodopa therapy. Importance Many people with Parkinson disease (PD) develop motor complications that are uncontrolled by levodopa dose adjustment. Among these patients, it is uncertain which drug class is more effective as adjuvant therapy. Objective To compare the long-term effects on patient-rated quality of life of adding a dopamine agonist vs a dopamine reuptake inhibitor (DRI), either a monoamine oxidase type B (MAO-B) inhibitor or a catechol-O-methyltransferase (COMT) inhibitor, to levodopa therapy for the treatment of patients with motor complications of PD. Design, Setting, and Participants This pragmatic semifactorial (2 × 1) randomized clinical trial recruited from 64 neurology and geriatric clinics (62 in the United Kingdom, 1 in the Czech Republic, and 1 in Russia) between February 23, 2001, and December 15, 2009. A total of 500 patients with idiopathic PD who developed uncontrolled motor complications and did not have dementia were randomly assigned on a 1:1:1 basis using a computerized minimization program. Data were analyzed between 2017 and 2020. Interventions Open-label dopamine agonist, MAO-B inhibitor, or COMT inhibitor. Main Outcomes and Measures Primary outcomes were scores on the 39-item Parkinson’s Disease Questionnaire (PDQ-39) mobility domain and cost-effectiveness. Outcomes were assessed before study entry, at 6 and 12 months after randomization, and annually thereafter. Repeated-measures and log rank analyses were used in an intention-to-treat approach. Results Among 500 participants, the mean (SD) age was 73.0 (8.2) years; 314 participants (62.8%) were men. Over a median of 4.5 years (range, 0-13.3 years) of follow-up, the participants in the dopamine agonist group had a mean PDQ-39 mobility score that was 2.4 points (95% CI, −1.3 to 6.0 points) better than that of the combined MAO-B and COMT groups; however, this difference was not significant (P=.20). With regard to DRIs, participants in the MAO-B group had mean PDQ-39 mobility scores that were 4.2 points (95% CI, 0.4-7.9 points; P=.03) better than those of the COMT group and EuroQol 5-dimension 3-level (EQ-5D-3L) utility scores that were 0.05 points (95% CI, 0.003-0.09 points; P=.04) better than the COMT group. Nonsignificant improvements were found in the PDQ-39 summary index (mean difference, 2.2 points; 95% CI, −0.2 to 4.5 points; P=.07) along with nonsignificant reductions in dementia (rate ratio [RR], 0.70; 95% CI, 0.47-1.03; P = .07) and mortality (RR, 0.76; 95% CI, 0.56-1.03; P=.07). When dopamine agonists were compared with MAO-B inhibitors only, the outcomes were similar. Conclusions and Relevance In this study, patient-rated quality of life was inferior when COMT inhibitors were used as adjuvant treatment compared with MAO-B inhibitors or dopamine agonists among people with PD who experienced motor complications that were uncontrolled by levodopa therapy. The MAO-B inhibitors produced equivalent disease control, suggesting that these agents may be underused as adjuvant therapy. Trial Registration isrctn.org Identifier: ISRCTN69812316; EU Clinical Trials Register Identifier: 2005-001813-16
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Affiliation(s)
- Richard Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Caroline Rick
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Sharon Muzerengi
- Department of Neurology, University Hospital, Birmingham, United Kingdom
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences. University of Birmingham, Birmingham, UK
| | - Adrian Williams
- Department of Neurology, University Hospital, Birmingham, United Kingdom
| | - C E Clarke
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
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Abstract
Background informal carers provide the majority of the support for persons with dementia living at
home. Restrictions imposed due to COVID-19 have had a profound impact on the daily life
of the entire population. This study provides insight into the impact of these
restrictions on carers of people with dementia living at home. Design qualitative semi-structured interviews. Participants purposive sample of carers who provide at least 10 hours of care a week for the person
with dementia living at home. Setting UK. Results twenty-three carers were interviewed, and thematic analysis identified three main
themes—Changes to daily life, impact on carer health and wellbeing and reduced support
from health and social support networks. The results highlight the impact of
restrictions imposed on daily life and routines due to the pandemic, wellbeing of
carers, reduced social support, lack of access to health and care professionals and
respite for carers. The restrictions have had negative consequences on carers’
wellbeing, and they have experienced difficulties in accessing formal care services and
respite care. Conclusion carers attempt to continue to provide physical, emotional and practical support for
persons with dementia in the community throughout the COVID-19 restrictions. To prevent
a future carer crisis, carers need better support systems including formal carer
services, telecare solutions that work for them and additional support for respite, as
the restrictions from this pandemic continue.
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Affiliation(s)
- Vimal Sriram
- Address correspondence to: Vimal Sriram, Health Services Research Unit,
Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old
Road Campus, Oxford OX3 7LF, UK. Tel: 00441865 743762.
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of
Population Health, University of Oxford, Richard Doll
Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of
Population Health, University of Oxford, Richard Doll
Building, Old Road Campus, Oxford OX3 7LF, UK
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Strickland LH, Rahman A, Jenkinson C, Pandit HG, Murray DW. Early Recovery Following Total and Unicompartmental Knee Arthroplasty Assessed Using Novel Patient-Reported Measures. J Arthroplasty 2021; 36:3413-3420. [PMID: 34120796 DOI: 10.1016/j.arth.2021.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The early postoperative recovery period following unicompartmental (UKA) and total knee arthroplasty (TKA) is an important area for research with increasingly sensitive metrics and new technologies. This study uses 2 recently developed patient-reported scores to compare the recovery following UKA and TKA. METHODS Two consecutive cohorts of 37 UKAs and 33 TKAs completed the Oxford Arthroplasty Early Recovery Score (OARS) and the Oxford Arthroplasty Early Change Score (OACS) on days 1, 2, 3, 7, 14, and week 6. The Short Form-36 version 2 was also completed on weeks 1, 2, and 6. Improvements within cohorts and comparisons between cohorts were assessed. RESULTS For both UKA and TKA the speed of recovery was rapid early on and then progressively decreased. At all time points, the UKA cohort reported similar or significantly better scores than the TKA cohort. The overall OARS (P < .001) showed that UKA recovered, shown as improvement on the OARS, 2-3 times faster than TKA. OARS subscales demonstrated that UKA had better Function/Mobility (P = .003) particularly early in the recovery, and better Nausea/Feeling Unwell (P < .001) and Fatigue/Sleep (P = .009) later in the recovery. UKA also had less pain at 2 weeks (P = .03). There was no significant difference between UKA and TKA OACS. UKA had significantly better scores in 3 of the 8 Short Form-36 domains, with the largest difference being in Role-Emotional (P = .003). CONCLUSION The OARS is useful for the assessment of postoperative recovery. This study provides direct evidence that recovery following UKA is better and 2-3 times faster than following TKA. All differences may be explained by the less invasive nature of UKA.
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Affiliation(s)
- Louise H Strickland
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Azmi Rahman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Hemant G Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Oxford Orthopaedic Engineering Centre (OOEC), University of Oxford, Botnar Research Centre, Oxford, United Kingdom
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Sriram V, Jenkinson C, Peters M. Carers' experiences of assistive technology use in dementia care: a cross sectional survey. BMC Geriatr 2021; 21:471. [PMID: 34433416 PMCID: PMC8385483 DOI: 10.1186/s12877-021-02417-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Assistive Technology (AT) supports persons with dementia and their carers (family, friends and neighbours), yet little is known about experiences and the impact of AT on carers. We report on an exploratory survey that examined the types, uses, costs and impact of AT on carers as well as their quality of life. Methods A cross-sectional survey using the Carers Assistive Technology Experience Questionnaire collected data from carers in the UK, who used at least one AT in the previous year and provided more than 10 h of care for a person with dementia, living at home. Carers completed the questionnaire online or on paper and information on AT, socio-demographic details, and Short-Form Health Survey (SF-12) data were collected. Descriptive and inferential statistics were used to report results and draw conclusions. Results Data from 201 carers was analysed. Smartphones and tablet computers were the most frequently used AT. AT were used predominantly for safety, communication, and reminders. Carers usually make decisions on buying and continued use of AT. Multiple AT devices were used in the care of persons with dementia and number of AT used was associated with perceived satisfaction. Satisfaction with AT was not related to age, living arrangements and relationship of carers. From the SF-12, Mean Physical Component Score was 49.19 (95%CI- 47.75 to 50.63) and Mental Component Score was 45.37 (95%CI- 43.93 to 46.80). Women, carers in the 46–65 age group and carers who were not extremely satisfied with AT had lower MCS scores. Carers who lived with the person with dementia and older carers had lower PCS scores. Conclusions Carers report that AT has a beneficial impact. Carers use multiple ATs, perceive AT to be satisfactory and recommend AT use to others. To support carers, we recommend establishment of centrally funded information sources and a loan store for AT. Further research on incremental addition of AT and changes to formal/paid care because of using AT should be undertaken. Practitioners, academics, manufactures and policy makers should consider the experiences of carers in research, development and use of AT to facilitate improved community living of people with dementia. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02417-1.
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Affiliation(s)
- Vimal Sriram
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
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Morley D, Dummett S, Kelly L, Jenkinson C. Development of an Exercise-Specific Parkinson's Disease Questionnaire: The PDQ-Exercise. Mov Disord 2021; 36:2156-2161. [PMID: 33991139 DOI: 10.1002/mds.28644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/16/2021] [Accepted: 04/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Exercise is now a significant and key component in the management of Parkinson's disease. However, no self-report, Parkinson's-specific measure of exercise currently exists. OBJECTIVE To develop a patient-reported outcome measure (PROM) for use in studies and clinical trials that aim to assess the efficacy of exercise therapy for people with Parkinson's (PwP). METHODS Participants were recruited via Parkinson's UK. To generate meaningful items, PwP participated in exploratory cognitive interviews. To pretest the items generated, PwP took part in two rounds of cognitive debrief interviews. Items were subsequently tested through an online survey that also included the eight-item Parkinson's Disease Questionnaire (PDQ-8) and Oxford Participation and Activities Questionnaire (Ox-PAQ). RESULTS Twenty PwP were interviewed for item generation. Analyses identified issues related to adopting and maintaining exercise, resulting in the generation of 10 items. Fourteen PwP took part in subsequent cognitive debrief interviews. Following the first 10 interviews, one item was removed, and minor adjustments were made to the wording of two items. Four final interviews verified that no further adjustments were required. Consequently, nine items were included in the validation survey, which was fully completed by 398 PwP. Inspection of floor and ceiling effects resulted in the removal of two further items. A principal component analysis identified a single seven-item factor explaining 61.6% of variance. Further analyses indicated that the measure demonstrates sound reliability and validity. CONCLUSIONS Results indicate that the PDQ-Exercise is an acceptable, reliable, and valid PROM. Further assessment of its psychometric properties is in progress. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- David Morley
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sarah Dummett
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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McIntosh E, Kent S, Gray A, Clarke CE, Williams A, Jenkinson C, Ives N, Patel S, Rick C, Wheatley K, Gray R. Cost-Effectiveness of Dopamine Agonists and Monoamine Oxidase B Inhibitors in Early Parkinson's Disease. Mov Disord 2021; 36:2136-2143. [PMID: 33960511 DOI: 10.1002/mds.28623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The PD MED study reported small but persistent benefits in patient-rated mobility scores and quality of life from initiating therapy with levodopa compared with levodopa-sparing therapies in early Parkinson's disease (PD). OBJECTIVES The objective was to estimate the cost-effectiveness of levodopa-sparing therapy (dopamine agonists or monoamine oxidase type B inhibitors compared with levodopa alone. METHODS PD MED is a pragmatic, open-label randomized, controlled trial in which patients newly diagnosed with PD were randomly assigned between levodopa-sparing therapy (dopamine agonists or monoamine oxidase type B inhibitors ) and levodopa alone. Mean quality-adjusted life-years and costs were calculated for each participant. Differences in mean quality-adjusted life-years and costs between levodopa and levodopa-sparing therapies and between dopamine agonists and monoamine oxidase type B inhibitors were estimated using linear regression. RESULTS Over a mean observation period of 4 years, levodopa was associated with significantly higher quality-adjusted life-years (difference, 0.18; 95% CI, 0.05-0.30; P < 0.01) and lower mean costs (£3390; £2671-£4109; P < 0.01) than levodopa-sparing therapies, the difference in costs driven by the higher costs of levodopa-sparing therapies. There were no significant differences in the costs of inpatient, social care, and institutional care between arms. There was no significant difference in quality-adjusted life-years between those allocated dopamine agonists and monoamine oxidase type B inhibitors (0.02; -0.17 to 0.13 in favor of dopamine agonists; P = 0.81); however costs were significantly lower for those allocated monoamine oxidase type B inhibitors (£2321; £1628-£3015; P < 0.01) because of the higher costs of dopamine agonists. There were no significant differences between arms for other costs. CONCLUSIONS Initial treatment with levodopa is highly cost-effective compared with levodopa-sparing therapies. Monoamine oxidase type B inhibitors, as initial levodopa-sparing therapy was more cost-effective, with similar quality-adjusted life-years but lower costs than dopamine agonists. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Seamus Kent
- University of Oxford, Oxford, United Kingdom
| | | | - Carl E Clarke
- University of Birmingham, Birmingham, United Kingdom.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Adrian Williams
- University of Birmingham, Birmingham, United Kingdom.,Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | | | - Natalie Ives
- University of Birmingham, Birmingham, United Kingdom
| | - Smitaa Patel
- University of Birmingham, Birmingham, United Kingdom
| | - Caroline Rick
- University of Nottingham, Nottingham, United Kingdom
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Huynh K, Kempegowda P, Tamblyn J, O' Reilly MW, Mueller JW, Hewison M, Jenkinson C. Development of a LC-MS/MS method to measure serum 3-sulfate and 3-glucuronide 25-hydroxyvitamin D3 metabolites; comparisons to unconjugated 25OHD in pregnancy and polycystic ovary syndrome. Steroids 2021; 169:108812. [PMID: 33636208 DOI: 10.1016/j.steroids.2021.108812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/30/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
Vitamin D status is routinely assessed by measuring circulating concentrations of 25-hydroxyvitamin D (25OHD2 or 25OHD3). However as deconjugation is not routinely incorporated into sample treatment prior to analysis, conjugated forms of 25OHD (particularly the more abundant 25OHD3) are often not considered in determining serum concentrations of total 25OHD. Two major circulating conjugated forms of 25OHD3 are 25-hydroxyvitamin D3-3-sulfate (25OHD3-S) and 25-hydroxyvitamin D3-3-glucuronide (25OHD3-G). Incorporating these two conjugated metabolites into the measurement of vitamin D status could improve our understanding of vitamin D status in health, particularly if there are changes in sulfation and glucuronidation activities. The aim of this study was to develop a liquid chromatography tandem-mass spectrometry (LC-MS/MS) targeted method for measurement of 25OHD3-S and 25OHD3-G in serum to enable comparisons with circulating levels of the free 25OHD3 form. We developed and validated a new LC-MS/MS method that measured both 25OHD3-S and 25OHD3-G following a solid phase extraction sample preparation method. Partial separation of analytes by LC, and the separation of analytes by the optimized multiple reaction monitoring transitions enabled the quantitation of both 25OHD3-S and 25OHD3-G in the single method. Serum concentrations of 25OHD3-S (24.7 ± 11.8 ng/mL) and 25OHD3-G (2.4 ± 1.2 ng/mL) were shown to be a significant proportion of circulating vitamin D metabolites in healthy donor serums. These levels of 25OHD3-S and 25OHD3-G closely associated with 25OHD3 concentrations, r = 0.728, p = 0.001 and r = 0.632, p = 0.006 respectively. However in serum from pregnant women and non-pregnant women with polycystic ovary syndrome (PCOS) significant differences in the ratios between conjugated and free 25OHD3 were observed between pregnancy groups (25OHD3/25OHD3-S and 25OHD3/25OHD3-G p < 0.001), and between healthy and PCOS subjects (25OHD3/25OHD3-G p < 0.050). Development of this novel high-throughput LC-MS/MS method indicates that 25OHD3-S and 25OHD3-G are substantial components of circulating vitamin D metabolites. The concentrations of these metabolites relative to conventional 25OHD3 may vary in different physiological and pathophysiological settings, and may therefore play an unrecognized but important role in the actions of vitamin D.
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Affiliation(s)
- K Huynh
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - P Kempegowda
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - J Tamblyn
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - M W O' Reilly
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Department of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - J W Mueller
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - M Hewison
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - C Jenkinson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
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Abstract
UNLABELLED We describe the use of rapid cycle tests of change to pretest and develop a Carers Assistive Technology Experience Questionnaire for a survey of informal carers of persons with dementia. The Plan-Do-Study-Act (PDSA) cycle is a commonly used improvement process in healthcare settings. We used this method for conducting rapid cycle tests of change through cognitive interviews to pretest the questionnaire. The items for the questionnaire were developed based on an earlier systematic review and qualitative study. PDSA cycles were used incrementally with learning from each cycle used to inform subsequent changes to the questionnaire prior to testing on the next participant. DESIGN Qualitative with use of cognitive interviews through rapid cycle tests of change. SETTING UK. RESULTS Nine participants were recruited based on eligibility criteria and purposive sampling. Cognitive interviewing using think aloud and concurrent verbal probing was used to test the comprehension, recall, decision and response choice of participants to the questionnaire. Seven PDSA cycles involving the participants helped identify problems with the questionnaire items, instructions, layout and grouping of items. Participants used a laptop, smartphone and/or tablet computer for testing the electronic version of the questionnaire and one participant also tested the paper version. A cumulative process of presenting items in the questionnaire, anticipating problems with specific items and learning from the unanticipated responses from participants through rapid cycle tests of change allowed rich learning and reflection to progressively improve the questionnaire. CONCLUSION Using rapid cycle tests of change in the pretesting questionnaire phase of research provided a structure for conducting cognitive interviews. Learning and reflections from the rapid testing and revisions made to the questionnaire helped improve the process of reaching the final version of the questionnaire, that the authors were confident would measure what was intended, rapidly and with less respondent burden.
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Affiliation(s)
- Vimal Sriram
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Schulz-Moore JS, Bismark M, Jenkinson C, Mello MM. Assessing Patients' Experiences with Medical Injury Reconciliation Processes: Item Generation for a Novel Survey Questionnaire. Jt Comm J Qual Patient Saf 2021; 47:376-384. [PMID: 33836941 DOI: 10.1016/j.jcjq.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many health care organizations want to improve their responses to patients who suffer medical injuries. Their ability to understand how well they meet patients' needs is limited by the lack of suitable instruments for assessing injured patients' experiences. METHODS This study aimed to generate items for a patient experience questionnaire that medical facilities can use to assess how well resolution met patients' needs. The Medical Injury Reconciliation Experiences Survey (MIRES) was based on findings from previous studies of New Zealand and American patients' experiences of non-litigation resolution of medical injuries. The researchers performed a content analysis of 24 transcripts from a stratified random sample of 92 interviews from the prior studies. Themes were extracted to develop a draft questionnaire, which was revised following feedback from experts. Cognitive debriefing interviews were conducted with 24 New Zealand and American injured patients. RESULTS There were 40 items in the following domains: perceptions of communications with health care providers after the injury (15 items), perceptions of remedial gestures (11 items), indicia of the patient's overall satisfaction with the reconciliation process (4 items), the nature and impacts of the injury (5 items), and patients' characteristics (5 items). Participants' feedback about the questionnaire was predominantly positive. Their suggestions led to 37 revisions. CONCLUSION The MIRES was comprehensible and acceptable to this group of post-injury patients. While further testing is desirable, the MIRES offers promise as a practicable approach that health care organizations can use to assess how well their reconciliation processes met patients' needs.
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Jenkinson C, Wood T. P60 Open Source Software for Cardiothoracic Research – Breaking Down Barriers. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Strickland LH, Murray DW, Pandit HG, Jenkinson C. Development of a patient-reported outcome measure (PROM) and change measure for use in early recovery following hip or knee replacement. J Patient Rep Outcomes 2020; 4:91. [PMID: 33159610 PMCID: PMC7648815 DOI: 10.1186/s41687-020-00262-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Background Hip and knee replacement are effective procedures for end-stage arthritis that has not responded to medical management. However, until now, there have been no validated, patient-reported tools to measure early recovery in this growing patient population. The process of development and psychometric evaluation of the Oxford Arthroplasty Early Recovery Score (OARS), a 14-item patient-reported outcome measure (PROM) measuring health status, and the Oxford Arthroplasty Early Change Score (OACS) a 14-item measure to assess change during the first 6 weeks following surgery is reported. Patients and methods A five-phased, best practice, iterative approach was used. From a literature based starting point, qualitative interviews with orthopaedic healthcare professionals, were then performed ascertaining if and how clinicians would use such a PROM and change measure. Analysis of in-depth patient-interviews in phase one identified important patient-reported factors in early recovery which were used to provide questionnaire themes. In Phase two, candidate items from Phase One interviews were generated and pilot questionnaires developed and tested. Exploratory factor analysis with item reduction and final testing of the questionnaires was performed in phase three. Phase Four involved validation testing. Results Qualitative interviews (n = 22) with orthopaedic healthcare professionals, helped determine views of potential users, and guide structure. In Phase One, factors from patient interviews (n = 30) were used to find questionnaire themes and generate items. Pilot questionnaires were developed and tested in Phase Two. Items were refined in the context of cognitive debrief interviews (n = 34) for potential inclusion in the final tools. Final testing of questionnaire properties with item reduction (n = 168) was carried out in phase three. Validation of the OARS and OACS was performed in phase four. Both measures were administered to consecutive patients (n = 155) in an independent cohort. Validity and reliability were assessed. Psychometric testing showed positive results, in terms of internal consistency and sensitivity to change, content validity and relevance to patients and clinicians. In addition, these measures have been found to be acceptable to patients throughout early recovery with validation across the 6 week period. Conclusions These brief, easy-to-use tools could be of great use in assessing recovery pathways and interventions in arthroplasty surgery.
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Affiliation(s)
- Louise H Strickland
- Oxford Orthopaedic Engineering Centre (OOEC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX37LD, England.
| | - David W Murray
- Oxford Orthopaedic Engineering Centre (OOEC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX37LD, England
| | - Hemant G Pandit
- Oxford Orthopaedic Engineering Centre (OOEC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX37LD, England.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Chapel Allerton Hospital, Leeds, LS7 4SA, England
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Headington, Oxford, OX37LF, England
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Kelly L, Jenkinson C, Morley D. Web-Based and mHealth Technologies to Support Self-Management in People Living With Type 2 Diabetes: Validation of the Diabetes Self-Management and Technology Questionnaire (DSMT-Q). JMIR Diabetes 2020; 5:e18208. [PMID: 32673214 PMCID: PMC7380900 DOI: 10.2196/18208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A growing number of web-based and mobile health (mHealth) technologies have been developed to support type 2 diabetes self-management. Little is known about individuals' experiences with these technologies and how they support self-management. Appropriate tools are needed to understand how web-based and mHealth interventions may impact self-management. OBJECTIVE This study aimed to develop an instrument, the Diabetes Self-Management and Technology Questionnaire (DSMT-Q), to assess self-management among people living with type 2 diabetes who use web-based and mHealth technologies. METHODS A total of 36 candidate questionnaire items, drafted previously, were refined using cognitive debriefing interviews (n=8), expert consultation, and public patient involvement feedback. Item reduction steps were performed on survey data (n=250), and tests of validity and reliability were subsequently performed. RESULTS Following amendments, patients and experts found 21 items relevant and acceptable for inclusion in the instrument. Survey participants included 104 (41.6%) women and 146 (58.4%) men. Two subscales with high construct validity, internal consistency, and test-retest reliability were identified: "Understanding individual health and making informed decisions" and "Confidence to reach and sustain goals." CONCLUSIONS Analyses confirmed good psychometric properties in the DSMT-Q scales. This tool will facilitate the measurement of self-management in people living with type 2 diabetes who use web-based or mHealth technologies.
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Affiliation(s)
- Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Harris Manchester College, Oxford, United Kingdom
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Harris Manchester College, Oxford, United Kingdom
| | - David Morley
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Harris Manchester College, Oxford, United Kingdom
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Crocker H, Jenkinson C, Peters M. Healthcare experiences and quality of life of adults with coeliac disease: a cross-sectional study. J Hum Nutr Diet 2020; 33:741-751. [PMID: 32383338 DOI: 10.1111/jhn.12757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Coeliac disease affects many aspects of quality of life and treatment can be burdensome. Access to healthcare services is necessary for the diagnosis and management of coeliac disease. The present study aimed to investigate the healthcare experiences of adults with coeliac disease and explore the relationship between experiences and quality of life. METHODS A cross-sectional postal survey was sent to 800 members of Coeliac UK and contained questions about diagnosis, dietary advice, follow-up appointments, prescriptions, knowledge and information provision, and quality of life [Coeliac Disease Assessment Questionnaire (CDAQ)]. Descriptive statistics were calculated. A total problem score summarised the number of problems experienced with healthcare services. Multiple linear regression analyses were conducted to investigate experiential and demographic factors associated with quality of life. RESULTS An average of 5.5 problems with healthcare services was reported, with females reporting significantly more problems than males (6.5 versus 5.0, P = 0.003). The total problem score was significantly related to the CDAQ overall index score and all CDAQ dimension scores (stigma, dietary burden, symptoms, social isolation, and worries and concerns) (P < 0.001). The analyses highlighted four key areas of healthcare experiences that were significantly related to quality of life: information provision, general practioners' knowledge, communication with health professionals and access to prescriptions. CONCLUSIONS Poorer experiences of healthcare services in coeliac disease are related to worse quality of life. Improving services in the four key areas identified may help adults with coeliac disease to achieve a better quality of life.
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Affiliation(s)
- H Crocker
- Nuffield Department of Population Health, University of Oxford, Headington, Oxford, UK
| | - C Jenkinson
- Nuffield Department of Population Health, University of Oxford, Headington, Oxford, UK
| | - M Peters
- Nuffield Department of Population Health, University of Oxford, Headington, Oxford, UK
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Hartman L, Jenkinson C, Morley D. Young People's Response to Parental Neurological Disorder: A Structured Review. Adolesc Health Med Ther 2020; 11:39-51. [PMID: 32273785 PMCID: PMC7105371 DOI: 10.2147/ahmt.s237807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/08/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction A significant paucity of literature exists relating to the impact on children of parental neurological disorder, with the exception of multiple sclerosis. The wider literature in this field (parental cancer, depression, alcoholism, HIV/AIDS) exhibits the many potential challenges young people might experience during serious parental illness. Given this, a literature review of parental neurological disorder is long overdue. Methods This review is structured around the World Health Organisation (WHO) classification of neurological disorders. The WHO identifies 10 common neurological disorders; dementia, epilepsy, headache, multiple sclerosis, neuroinfections, neurological disorders associated with malnutrition, pain associated with neurological disorders, Parkinson's disease, stroke, and traumatic brain injury. A comprehensive search of the MEDLINE database was performed using key terms for each of the 10 conditions. Results for each condition were divided in to "negative", "positive and/or neutral" and "other" child responses. Results The search yielded a total of 6247 titles, of which 184 underwent a full-text assessment. Sixty-five met all eligibility criteria and were thus included in the review. A number of negative issues emerged across parental conditions including the prevalence of child mood disorders, parent-child role reversal, children's need for information on the parental condition, the importance of family cohesion, the negative effect of parental psychopathology and differences between male and female children. A limited number of positive outcomes were evident in a minority of parental conditions. Outcomes measured and methodologies employed were highly heterogeneous. Conclusion Children generally respond negatively to parental neurological disorder. Responses varied between neurological disorders, suggesting the need for parental disease-specific guidance and clinical management where required.
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Affiliation(s)
- Lilian Hartman
- Lincoln College, University of Oxford, Oxford OX1 3DR, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - David Morley
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Abstract
OBJECTIVE Assistive technology (AT) can help carers (family, friends and neighbours) and people with dementia to stay well and safely at home. There are important gaps in what we know about experience of using AT from the perspective of carers of persons with dementia. This study investigates carers' experience of using AT in supporting and caring for persons with dementia who live at home. DESIGN Qualitative phenomenological study with semi-structured interviews to achieve data saturation and thematic analysis to identify key themes. SETTING Community-based within the UK. PARTICIPANTS Twenty-three (14 women, 9 men) adult carers of persons with dementia who have used at least one AT device. RESULTS All participants reported benefiting to varying degrees from using AT. There were 5 themes and 18 subthemes that highlighted reasons for using AT and use of AT over time. Providing care for a person with dementia, motivation for using AT, changes to roles and routines, carer knowledge and skills for using AT and social, environmental and ethical considerations were the main themes. This study showed that AT can provide reassurance and support for carers of persons with dementia but there are difficulties with acquiring and continued use of AT as dementia progresses. CONCLUSIONS Carers consider AT as an adjunct to care they provided in caring for a person with dementia. Use of AT should be considered in the personal, social and environmental context of persons with dementia and their carers. Further research and policy interventions are needed to address best use of resources and guidance on data sharing and data protection while using AT.
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Affiliation(s)
- Vimal Sriram
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
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Almoajil H, Dawes H, Hopewell S, Toye F, Jenkinson C, Theologis T. Development of a core outcome set for lower limb orthopaedic surgical interventions in ambulant children and young people with cerebral palsy: a study protocol. BMJ Open 2020; 10:e034744. [PMID: 32139490 PMCID: PMC7059521 DOI: 10.1136/bmjopen-2019-034744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal deformities and gait deviations are common features in ambulatory cerebral palsy (CP). Deformity correction through lower limb orthopaedic surgery is the standard form of care aimed at improving or preserving motor function. Current research on CP care does not always take into account individual patients' expectations and needs. There is a wide range of outcome domains and outcome measures used to assess outcome from treatment. This can lead to reporting bias and make it difficult to compare and contrast studies. A core outcome set (COS) would enhance the efficiency, relevance and overall quality of CP orthopaedic surgery research. The aim of this study is to establish a standardised COS for use in evaluating lower limb orthopaedic surgery for ambulatory children and young people with CP. METHODS/ANALYSIS A set of outcomes domains and outcome measures will be developed as follows: (1) a qualitative evidence synthesis to identify relevant outcomes from children and young people and family perspective; (2) a scoping review to identify relevant outcomes and outcome measures; (3) qualitative research to explore the experience of key stakeholders; (4) prioritisation of outcome domains will be achieved through a two-round Delphi process with key stakeholders; (5) a final COS will be developed at a consensus meeting with representation from key stakeholder groups. ETHICS AND DISSEMINATION Ethical approval for this study was granted in the UK by the Oxfordshire Research Ethics Committee B (REC reference 19/SC/0357). Informed consent will be obtained from participants taking part in the qualitative research and Delphi process. Study findings will be published in an open access journal and presented at relevant national and international conferences. Charities and associations will be engaged to promote awareness of the project COS results. TRIAL REGISTRATION NUMBER COMET registration: 1236. PROSPERO REGISTRATION NUMBER CRD42018089538.
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Affiliation(s)
- Hajar Almoajil
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Physical Therapy, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Francine Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tim Theologis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Paediatric Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Peters M, Crocker H, Jenkinson C, Violato M. Withdrawing gluten-free food from prescriptions in England: a mixed-methods study to examine the impact of policy changes on quality of life. J Hum Nutr Diet 2019; 33:453-464. [PMID: 31876360 PMCID: PMC7383817 DOI: 10.1111/jhn.12728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Some local areas in England stopped have gluten‐free prescriptions for coeliac disease. An explanatory mixed‐methods study has investigated the impact of these changes. Methods A cross‐sectional survey with 1697 participants was followed by 24 qualitative interviews. The survey included questions on the use of prescriptions and healthcare services, as well as the Coeliac Disease Assessment Questionnaire (CDAQ) to assess quality of life. The survey data were analysed by descriptive statistics, analysis of variance and regression analysis, and the interviews were analysed by thematic analysis. Findings from the interviews guided the survey analysis. Results Dietary burden was significantly different between prescribing and nonprescribing areas, with little impact on other aspects of quality of life. Survey participants in nonprescribing areas who felt more impacted by the prescription changes reported a lower quality of life. Satisfaction with and use of services was lower in nonprescribing areas. Interviews indicated that, after initial frustrations, most people adapted to the changed prescription policy. However, there was a clear preference for gluten‐free prescriptions to be available, in particular for staple foods. Conclusions The main quality of life impact was on Dietary burden. It is encouraging that most participants in the present study maintained a good quality of life. However, issues of worse experiences of care, lower follow‐up opportunities and inequity arose, and these should be taken into consideration in decisions on gluten‐free food prescriptions. The new guidelines for the National Health Service in England have retained prescriptions for bread and flour mixes, which is more limited than the range of staple foods preferred in the present study.
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Affiliation(s)
- M Peters
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - H Crocker
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - C Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, Jenkinson C, Kennedy SH, Zondervan KT. Reprint of: Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2019; 112:e137-e152. [PMID: 31623725 DOI: 10.1016/j.fertnstert.2019.08.082] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jenkinson C, Kelly L, Dummett S, Morley D. The Oxford Participation and Activities Questionnaire (Ox-PAQ): development of a short form and index measure. Patient Relat Outcome Meas 2019; 10:227-232. [PMID: 31551659 PMCID: PMC6677376 DOI: 10.2147/prom.s210416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/09/2019] [Indexed: 11/23/2022]
Abstract
Background The Oxford Participation and Activities Questionnaire (Ox-PAQ) is a 23-item patient-reported outcome measure (PROM) theoretically grounded in the World Health Organisation International Classification of Functioning, Disability and Health. Initial validation of the Ox-PAQ identified three domains; routine activities (14 items), emotional well-being (5 items) and social engagement (4 items). The purpose of the analyses reported here were to determine whether an overall index score can be calculated from the measure, and then to determine whether a shorter form measure can replicate results on the index score. Methods Two surveys of people with long term conditions were undertaken. In the first study, higher order factor analysis is used to determine that a single index score can be calculated for the Ox-PAQ. Regression analyses are used to determine a sub-set of items selected for the Short Form Ox-PAQ (SF-Ox-PAQ). In the second study, results on the Ox-PAQ Single Index and SF-Ox-PAQ Single Index are compared with results from another generic measure, the EuroQol EQ-5D-5l. Results Higher order factor analysis confirmed that a single index score can be created from the Ox-PAQ. Further, linear regression indicated 14 items could reliably and accurately produce this index. The two methods of creating the index were highly correlated (ICC =0.99). The two indices were found to provide almost identical levels of correlation with EQ-5D-5L scores. Conclusion Results indicate that the Ox-PAQ can be summed to provide an index score, and, furthermore, a sub set of fourteen items can very closely replicate the results gained from the original parent form.
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Affiliation(s)
- Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Sarah Dummett
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - David Morley
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Morley D, Jenkinson C. Use of the Oxford Participation and Activities Questionnaire in chronic obstructive pulmonary disease. Chron Respir Dis 2019; 16:1479973119862218. [PMID: 31362521 PMCID: PMC6668172 DOI: 10.1177/1479973119862218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- David Morley
- 1 Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- 1 Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Sriram V, Jenkinson C, Peters M. Informal carers' experience and outcomes of assistive technology use in dementia care in the community: a systematic review protocol. Syst Rev 2019; 8:158. [PMID: 31269995 PMCID: PMC6610817 DOI: 10.1186/s13643-019-1081-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/28/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dementia is one of the greatest health and care priorities globally. Caring for persons with dementia is a challenge and often leads to negative psychological, physiological and financial consequences for informal carers (family members or friends). Many informal carers experience moderate to severe levels of burden. Advances in technology have the potential to assist persons with dementia and their carers, through assistive technology (AT) devices such as electronic medication dispensers, robotic devices and motion detectors. However, little is known about informal carers' experience and the impact of these technologies on them. This review aims to investigate the outcomes and experience of carers of persons with dementia, who live at home and use AT. METHOD MEDLINE, Embase, CINAHL, AMED, ALOIS, PsycINFO, Trial registries and OpenGrey databases will be searched for studies of any design that have investigated carer experience and/or outcomes of AT use for persons with dementia living at home. Manual searches from reference lists of relevant papers will also be undertaken. Outcomes of interest are carers' self-reported outcomes (which include perceived burden, quality of life and wellbeing) and carer experiences (such as usefulness, benefits and disadvantages of AT and impact on caregiver/care receiver relationship). Two independent reviewers will screen identified papers with pre-defined eligibility criteria and extract data using a bespoke extraction form. Discrepancies will be resolved in discussion with a third reviewer. A synthesis of eligible studies and summary will be provided. DISCUSSION A systematic review of quantitative, qualitative and mixed methods evidence of informal carers' experience of AT use in dementia in the community will be carried out. It is anticipated that this will highlight (1) investigations on impact of AT use on carers, (2) outcome measures and experience questionnaires that have been used and (3) the types of studies carried out so far on this topic. The results from the review will be presented in a summary matrix of common types (e.g. mobile phones, alarms) and uses (e.g. communication, safety, personal care) of AT in dementia care and also identify AT that is not usually available through government or health system funding. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017082268 .
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Affiliation(s)
- Vimal Sriram
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF UK
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF UK
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Jenkinson C, Moldoveanu Z, Komers R, Hall S, Huang Z, Knoppova B, Rizk D, Julian B, Ferguson B, Novak J. SAT-010 PROTECTIVE EFFECTS OF SPARSENTAN FROM PROLIFERATIVE GLOMERULAR INJURY INDUCED BY ADMINISTRATION OF HUMAN IMMUNE COMPLEXES IN A MURINE MODEL OF EXPERIMENTAL IgA NEPHROPATHY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sriram V, Jenkinson C, Peters M. Informal carers' experience of assistive technology use in dementia care at home: a systematic review. BMC Geriatr 2019; 19:160. [PMID: 31196003 PMCID: PMC6567448 DOI: 10.1186/s12877-019-1169-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background Dementia is a health and care priority globally. Caring for persons with dementia is a challenge and can lead to negative psychological, physiological and financial consequences for informal carers. Advances in technology have the potential to assist persons with dementia and their carers, through assistive technology devices such as electronic medication dispensers, robotic devices trackers and motion detectors. However, little is known about carers’ experience and the impact of these technologies on them. This review aims to investigate the outcomes and experience of carers of persons with dementia, who live at home and use assistive technology. Methods A systematic search in seven databases and manual searches were carried out using pre-defined inclusion and exclusion criteria to identify studies on carers of persons with dementia involving the use of assistive technology. The search identified 56 publications with quantitative, qualitative and mixed-method designs. Results The studies reported positive and negative findings and focused on a wide variety of assistive technology devices. There were large differences in the uses of assistive technology, outcome measures used and the quality of studies. Knowledge and acceptance, competence to use and ethical issues when using assistive technology were themes that emerged from the studies. Carers generally appreciated using assistive technology and their experience of use varied. Conclusions The intention of this systematic review is to list and classify the various types of assistive technology used by carers of persons with dementia and explores the positive and negative aspects, knowledge, acceptance and ethical issues in the use of assistive technology by carers of persons with dementia. We recommend the use of a standard and person-centred system of classifying and naming assistive technology devices and systems and for future research efforts in assistive technology to incorporate a family/carer centred model. Systematic review registration PROSPERO - CRD42017082268. Electronic supplementary material The online version of this article (10.1186/s12877-019-1169-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vimal Sriram
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
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Beentjes CHL, Taylor-King JP, Bayani A, Davis CN, Dunster JL, Jabbari S, Mirams GR, Jenkinson C, Kilby MD, Hewison M, Tamblyn JA. Defining vitamin D status using multi-metabolite mathematical modelling: A pregnancy perspective. J Steroid Biochem Mol Biol 2019; 190:152-160. [PMID: 30926429 PMCID: PMC7614536 DOI: 10.1016/j.jsbmb.2019.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/11/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022]
Abstract
Vitamin D deficiency is linked to adverse pregnancy outcomes such as pre-eclampsia (PET) but remains defined by serum measurement of 25-hydroxyvitamin D3 (25(OH)D3) alone. To identify broader changes in vitamin D metabolism during normal and PET pregnancies we developed a relatively simple but fully parametrised mathematical model of the vitamin D metabolic pathway. The data used for parametrisation were serum vitamin D metabolites analysed for a cross-sectional group of women (n = 88); including normal pregnant women at 1 st (NP1, n = 25) and 3rd trimester (NP3, n = 21) and pregnant women with PET (n = 22), as well as non-pregnant female controls (n = 20). To account for the effects various metabolites have upon each other, data were analysed using an ordinary differential equation model of the vitamin D reaction network. Information obtained from the model was then also applied to serum vitamin D metabolome data (n = 50) obtained from a 2nd trimester pregnancy cohort, of which 25 prospectively developed PET. Statistical analysis of the data alone showed no significant difference between NP3 and PET for serum 25(OH)D3 and 24,25(OH)2D3 concentrations. Conversely, a statistical analysis informed by the reaction network model revealed that a better indicator of PET is the ratios of vitamin D metabolites in late pregnancy. Assessing the potential predicative value, no significant difference between NP3 and PET cases at 15 weeks gestation was found. Mathematical modelling offers a novel strategy for defining the impact of vitamin D metabolism on human health. This is particularly relevant within the context of pregnancy, where major changes in vitamin D metabolism occur across gestation, and dysregulated metabolism is evidenced in women with established PET.
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Affiliation(s)
- C H L Beentjes
- Mathematical Institute, University of Oxford, Oxford, UK
| | - J P Taylor-King
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, CB3 OAS, UK; Institute of Molecular Systems Biology, Department of Biology, ETHZ, CH-8093, Zurich, Switzerland
| | - A Bayani
- Department of Physics and Mathematics, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - C N Davis
- MathSys CDT, Mathematics Institute, University of Warwick, Coventry, UK
| | - J L Dunster
- Institute for Cardiovascular and Metabolic Research, University of Reading, UK
| | - S Jabbari
- School of Mathematics and Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - G R Mirams
- Centre for Mathematical Medicine & Biology, Mathematical Sciences, University of Nottingham, UK
| | - C Jenkinson
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M D Kilby
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Fetal Medicine Centre, Birmingham Women's & Children's Foundation Trust, Edgbaston, Birmingham, UK
| | - M Hewison
- Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - J A Tamblyn
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Women's & Newborn Health, Birmingham Health Partners, Birmingham Women's & Children's Foundation Hospital, Edgbaston, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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Morley D, Dummett S, Kelly L, Jenkinson C. Measuring improvement in health-status with the Oxford Participation and Activities Questionnaire (Ox-PAQ). Patient Relat Outcome Meas 2019; 10:153-156. [PMID: 31191061 PMCID: PMC6529023 DOI: 10.2147/prom.s198619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/06/2019] [Indexed: 01/22/2023]
Abstract
Background: The Oxford Participation and Activities Questionnaire (Ox-PAQ) is a recently validated 23-item generic patient reported outcome measure that is theoretically grounded in the World Health Organisation International Classification of Functioning, Disability and Health (ICF), as well as fully FDA compliant. The measure comprises three domains, Routine Activities (14 items), Emotional Well-Being (5 items) and Social Engagement (4 items), and has been shown to be both valid and reliable. The aim of this study was to make a preliminary assessment of the sensitivity to the change of the Ox-PAQ. Methods: Three hundred and seventy three people with either chronic pulmonary obstructive disease, motor neurone disease, multiple sclerosis or Parkinson’s disease completed the Ox-PAQ electronically on two occasions, six months apart. Participants completed an additional four questions during the second administration of the Ox-PAQ in order to assess any relevant changes since baseline. For each of the three Ox-PAQ domains, the minimally important difference (MID) and effect size (ES) was calculated from those participants indicating small, but meaningful positive improvement. Results: Two hundred and ninety respondents were entered into the final analysis, 77.74% of the original sample. For those indicating “slight improvement” in Routine Activities (n=19), an MID of 7.51 and an ES of 0.32 was calculated. For Emotional Well-Being (n=26), the MID was 10.77 and the ES 0.44. For Social Engagement (n=16), the MID was 5.47 and the ES 0.28. Conclusion: Data presented provides MID improvement and effect sizes for Ox-PAQ domains that will act as preliminary guidance for those powering clinical trials assessing activity and participation. Future research with larger samples will provide further sensitivity to change data for the Ox-PAQ.
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Affiliation(s)
- David Morley
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Sarah Dummett
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Larner DP, Jenkinson C, Chun RF, Westgate CSJ, Adams JS, Hewison M. Free versus total serum 25-hydroxyvitamin D in a murine model of colitis. J Steroid Biochem Mol Biol 2019; 189:204-209. [PMID: 30710745 PMCID: PMC6502676 DOI: 10.1016/j.jsbmb.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/03/2018] [Accepted: 01/24/2019] [Indexed: 01/04/2023]
Abstract
Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease have been linked to vitamin D-deficiency. Using a dextran sodium sulphate (DSS)-induced model of IBD we have shown previously that mice raised on vitamin D-deficient diets from weaning have lower serum 25-hydroxyvitamin D (25OHD) levels and develop more severe colitis compared to vitamin D-sufficient counterparts. We have also shown in vitro that immune responses to 25OHD may depend on 'free' rather than total serum concentrations of 25OHD. To investigate the possible effects of free versus total 25OHD on anti-inflammatory immune responses in vivo we have studied DSS-induced colitis in wild type C57BL/6 mice raised from weaning on diets containing vitamin D2 (D2) or vitamin D3 (D3) only (both 1000 IU/kg feed). 25OHD2 has lower binding affinity for the vitamin D binding protein than 25OHD3 which results in higher levels of free 25OHD2 relative to free 25OHD3 in mice raised on a D2-only diet. Total serum 25OHD concentrations, measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), showed that D2 mice had significantly lower levels of 25OHD than D3 mice (6.85 ± 2.61 nmol/L vs. 49.16 ± 13.8 nmol/L for D2 and D3 respectively). Despite this, direct ELISA measurement showed no difference in free serum 25OHD levels between D2 and D3 mice (13.62 ± 2.26 pmol/L vs. 14.11 ± 2.24 pmol/L for D2 and D3 respectively). Analysis of DSS-induced colitis also showed no difference in weight loss or disease progression between D2 and D3 mice. These data indicate that despite D2-fed mice being vitamin D-deficient based on serum total 25OHD concentrations, these mice showed no evidence of increased inflammatory colitis disease relative to vitamin D-sufficient D3 mice. We therefore propose that free, rather than total serum 25OHD, may be a better marker of immune responses to vitamin D in vivo.
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Affiliation(s)
- D P Larner
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK
| | - C Jenkinson
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK
| | - R F Chun
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - C S J Westgate
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK
| | - J S Adams
- Dept of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - M Hewison
- Institute of Metabolism and Systems Research, the University of Birmingham, Birmingham, B15 2TT, UK.
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Abstract
Aims: Explore the experience of living with fatigue in persons with advanced heart failure. Design: Single-setting, qualitative interview study. Methods: In-depth interviews were conducted from November 2012 - June 2013. Participant responses to open-ended questions were analysed using thematic analysis. Inclusion criteria: 18 years and older, diagnosis of New York Heart Association class III-IV heart failure with reduced ejection fraction and able to participate in interviews in their own language. Exclusion criteria was cognitive deficit Twenty-three participated in the study. Results: Participants (age 72.5 ± 9.5 years, 10/23 female), identified experiencing fatigue daily with 14/23 reporting it as their worst symptom or combined worst symptom with breathlessness. Three key themes were identified: fatigue as a physical barrier, psychological response to fatigue, and living with fatigue as a part of daily life. Conclusion: As heart failure progresses fatigue influences patients' daily life and may negatively affect self-care abilities however patients strive to adapt to these limitations.
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Affiliation(s)
- Helen Walthall
- a Oxford School of Nursing and Midwifery , Oxford Brookes University , Oxford , UK
| | - Theresa Floegel
- b College of Nursing , East Carolina University , Greenville , NC , USA
| | - Mary Boulton
- a Oxford School of Nursing and Midwifery , Oxford Brookes University , Oxford , UK.,c NIHR Research Design Service South Central , Oxford , UK
| | - Crispin Jenkinson
- d Health Services Research and Health Service Research Unit , University of Oxford , Oxford , UK
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Strickland LH, Kelly L, Hamilton TW, Murray DW, Pandit HG, Jenkinson C. Health Care Professionals' Perceptions of the Arthroplasty Patient Experience: Planning Phase in the Development of a Patient-Reported Outcome Measure. J Perianesth Nurs 2019; 34:376-385. [DOI: 10.1016/j.jopan.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/23/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
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Jenkinson C, Merry C, Gilfillan I, Pavey W, Raisis A, Dunne B, Van Laeken E, Vincent V, Baird P, Prince S, Ho K. A Bovine Ex Vivo Model of the Donor Heart: The Effect of Preservation Solutions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rombach I, Gray AM, Jenkinson C, Murray DW, Rivero-Arias O. Correction to: multiple imputation for patient reported outcome measures in randomised controlled trials: advantages and disadvantages of imputing at the item, subscale or composite score level. BMC Med Res Methodol 2018; 18:107. [PMID: 30326839 PMCID: PMC6192362 DOI: 10.1186/s12874-018-0563-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Crocker H, Jenkinson C, Peters M. Quality of life in coeliac disease: item reduction, scale development and psychometric evaluation of the Coeliac Disease Assessment Questionnaire (CDAQ). Aliment Pharmacol Ther 2018; 48:852-862. [PMID: 30125953 PMCID: PMC6220785 DOI: 10.1111/apt.14942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/27/2018] [Accepted: 07/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A better understanding of coeliac disease can be achieved by assessing health-related quality of life alongside clinical factors. Existing patient-reported outcome measures (PROMs) evaluating quality of life in coeliac disease have not been developed in accordance with the US Food and Drug Administration guidelines. AIM To develop a PROM in accordance with best practice guidelines, capturing all aspects of quality of life important to adults with coeliac disease. METHODS Candidate items for the Coeliac Disease Assessment Questionnaire (CDAQ) were refined through item appraisal, expert review, cognitive interviews, and a translatability assessment. A cross-sectional survey determined further item reduction and the CDAQ's structure. The final CDAQ was administered alongside the Short Form Health Survey Version 2 (SF?36v2) in a second survey to assess construct validity and test-retest reliability. RESULTS Pre-testing the 64 candidate items revealed a range of issues which guided their refinement and reduction, resulting in the final CDAQ with 32 items representing 5 subscales: stigma (eight items), dietary burden (eight items), symptoms (five items), social isolation (five items), and worries and concerns (six items). Cronbach's alpha ranged between 0.82 and 0.88 for all domains. Further results showed CDAQ scores were more strongly correlated with the SF-36v2's mental health dimensions, as expected. Intraclass correlation coefficients ranged from 0.79 to 0.89. CONCLUSION The CDAQ is a reliable and valid coeliac-specific measure that captures all aspects of quality of life important to adults with coeliac disease. Further work is underway to assess the CDAQ's responsiveness to change.
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Affiliation(s)
- Helen Crocker
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Crispin Jenkinson
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Michele Peters
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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Rombach I, Gray AM, Jenkinson C, Murray DW, Rivero-Arias O. Multiple imputation for patient reported outcome measures in randomised controlled trials: advantages and disadvantages of imputing at the item, subscale or composite score level. BMC Med Res Methodol 2018; 18:87. [PMID: 30153796 PMCID: PMC6114240 DOI: 10.1186/s12874-018-0542-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/19/2018] [Indexed: 01/11/2023] Open
Abstract
Background Missing data can introduce bias in the results of randomised controlled trials (RCTs), but are typically unavoidable in pragmatic clinical research, especially when patient reported outcome measures (PROMs) are used. Traditionally applied to the composite PROMs score of multi-item instruments, some recent research suggests that multiple imputation (MI) at the item level may be preferable under certain scenarios. This paper presents practical guidance on the choice of MI models for handling missing PROMs data based on the characteristics of the trial dataset. The comparative performance of complete cases analysis, which is commonly used in the analysis of RCTs, is also considered. Methods Realistic missing at random data were simulated using follow-up data from an RCT considering three different PROMs (Oxford Knee Score (OKS), EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L), 12-item Short Form Survey (SF-12)). Data were multiply imputed at the item (using ordinal logit and predicted mean matching models), sub-scale and score level; unadjusted mean outcomes, as well as treatment effects from linear regression models were obtained for 1000 simulations. Performance was assessed by root mean square errors (RMSE) and mean absolute errors (MAE). Results Convergence problems were observed for MI at the item level. Performance generally improved with increasing sample sizes and lower percentages of missing data. Imputation at the score and subscale level outperformed imputation at the item level in small sample sizes (n ≤ 200). Imputation at the item level is more accurate for high proportions of item-nonresponse. All methods provided similar results for large sample sizes (≥500) in this particular case study. Conclusions Many factors, including the prevalence of missing data in the study, sample size, the number of items within the PROM and numbers of levels within the individual items, and planned analyses need consideration when choosing an imputation model for missing PROMs data. Electronic supplementary material The online version of this article (10.1186/s12874-018-0542-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Morley D, Dummett S, Kelly L, Jenkinson C. Administering the Routine Activities domain of the Oxford Participation and Activities Questionnaire as a stand-alone scale: the Oxford Routine Activities Measure. Patient Relat Outcome Meas 2018; 9:239-243. [PMID: 30100772 PMCID: PMC6065595 DOI: 10.2147/prom.s160263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The recently validated Oxford Participation and Activities Questionnaire (Ox-PAQ) is a 23-item patient-reported outcome measure, theoretically grounded in the World Health Organization International Classification of Functioning, Disability and Health. The measure is specifically designed to assess participation and activity in people experiencing a range of health conditions. Initial validation of the Ox-PAQ identified three domains: Routine Activities (14 items), Emotional Well-Being (5 items), and Social Engagement (4 items). The purpose of the analysis reported here was to assess whether the Routine Activities domain of Ox-PAQ could be validated for use as a stand-alone measure without compromising its psychometric integrity. Methods Three hundred and seventy-three patients with a diagnosis of either chronic obstructive pulmonary disease, multiple sclerosis, or Parkinson’s disease were administered the Ox-PAQ in an online survey. The 14 items of the Routine Activities domain of the Ox-PAQ were subject to factor analytic techniques and assessed for reliability and validity. Results Three hundred and forty-one patients fully completed the survey, a completion rate of 91.4%. The 14 items loaded onto one single factor with an eigenvalue of 9.29 explaining 66.35% of variance. Reliability was confirmed through corrected item-total correlations ranging from 0.880 to 0.594 and a Cronbach’s alpha value of 0.96. Validity was demonstrated through significant differences in scores between the three disease groups assessed. Conclusion Results indicate that the Ox-PAQ Routine Activities domain can be legitimately adopted as a stand-alone measure, the Oxford Routine Activities Measure, where researchers wish to focus primarily on the activity component of the Ox-PAQ. It should, however, be emphasized that where a full assessment of all areas of activity and participation highlighted as important during the development of the Ox-PAQ is required, all three domains of the full measure should be administered.
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Affiliation(s)
- David Morley
- Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| | - Sarah Dummett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| | - Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK,
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Morley D, Jenkinson C. Adhering to best practice guidelines in outcomes measurement. Neurosci Biobehav Rev 2018; 94:196-197. [PMID: 30086325 DOI: 10.1016/j.neubiorev.2018.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
Abstract
Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.
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Affiliation(s)
- David Morley
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom.
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom
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Crocker H, Jenkinson C, Peters M. Quality of life in coeliac disease: qualitative interviews to develop candidate items for the Coeliac Disease Assessment Questionnaire. Patient Relat Outcome Meas 2018; 9:211-220. [PMID: 30013408 PMCID: PMC6038864 DOI: 10.2147/prom.s149238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Coeliac-specific measures have been criticized for not complying with current guidance on the development of patient-reported outcome measures (PROMs). The aim of this study was to develop a measure to assess health-related quality of life in adults with coeliac disease (CD), in accordance with current guidance for PROM development. Methods In-depth qualitative interviews were conducted with adults with CD. A thematic analysis was undertaken to develop a coding framework. All interviews were analyzed according to this framework. Interviewing continued until data saturation was achieved. Candidate items were developed on the basis of the interview findings. Results The analysis revealed 6 themes: 1) symptoms, 2) gluten-free diet, 3) emotional health, 4) impact on activities, 5) relationships, and 6) financial issues. Data saturation was reached after 8 interviews, but a total of 23 interviews were conducted to include a wide enough range of diverse participants. From the themes, 64 candidate items (9 for symptoms, 15 for emotional health, 16 for gluten-free diet, 7 for relationships, 12 for impact on activities, and 5 for financial issues) were developed to form the first draft of the Coeliac Disease Assessment Questionnaire (CDAQ). Conclusion The 64 items reflect all the issues of importance to people with CD. Next, these items will be pretested and refined to lead to a shorter draft version of the CDAQ before it is administered in a survey to produce a final version with subscales.
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Affiliation(s)
- Helen Crocker
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK,
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Rombach I, Jenkinson C, Gray AM, Murray DW, Rivero-Arias O. Comparison of statistical approaches for analyzing incomplete longitudinal patient-reported outcome data in randomized controlled trials. Patient Relat Outcome Meas 2018; 9:197-209. [PMID: 29950913 PMCID: PMC6016604 DOI: 10.2147/prom.s147790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Purpose Missing data are a potential source of bias in the results of RCTs, but are often unavoidable in clinical research, particularly in patient-reported outcome measures (PROMs). Maximum likelihood (ML), multiple imputation (MI), and inverse probability weighting (IPW) can be used to handle incomplete longitudinal data. This paper compares their performance when analyzing PROMs, using a simulation study based on an RCT data set. Methods Realistic missing-at-random data were simulated based on patterns observed during the follow-up of the knee arthroscopy trial (ISRCTN45837371). Simulation scenarios covered different sample sizes, with missing PROM data in 10%–60% of participants. Monotone and nonmonotone missing data patterns were considered. Missing data were addressed by using ML, MI, and IPW and analyzed via multilevel mixed-effects linear regression models. Root mean square errors in the treatment effects were used as performance parameters across 1,000 simulations. Results Nonconvergence issues were observed for IPW at small sample sizes. The performance of all three approaches worsened with decreasing sample size and increasing proportions of missing data. MI and ML performed similarly when the MI model was restricted to baseline variables, but MI performed better when using postrandomization data in the imputation model and also in nonmonotone versus monotone missing data scenarios. IPW performed worse than ML and MI in all simulation scenarios. Conclusion When additional postrandomization information is available, MI can be beneficial over ML for handling incomplete longitudinal PROM data. IPW is not recommended for handling missing PROM data in the simulated scenarios.
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Affiliation(s)
- Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kelly L, Sizmur S, Käsbauer S, King J, Cooper R, Jenkinson C, Graham C. The Relational Aspects of Care Questionnaire: item reduction and scoring using inpatient and accident and emergency data in England. Patient Relat Outcome Meas 2018; 9:173-181. [PMID: 29950911 PMCID: PMC6016282 DOI: 10.2147/prom.s157213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Relational Aspects of Care Questionnaire (RAC-Q) is an electronic instrument which has been developed to assess staff's interactions with patients when delivering relational care to inpatients and those accessing accident and emergency (A&E) services. The aim of this study was to reduce the number of questionnaire items and explore scoring methods for "not applicable" response options. PATIENTS AND METHODS Participants (n=3928) were inpatients or A&E attendees across six participating hospital trusts in England during 2015-2016. The instrument, consisting of 20 questionnaire items, was administered by trained hospital volunteers over a period of 10 months. Items were subjected to exploratory factor analysis to confirm unidimensionality, and the number of items was reduced using a range of a priori psychometric criteria. Two alternative approaches to scoring were undertaken, one treated "not applicable" responses as missing data, while the second adopted a problem score approach where "not applicable" was considered "no problem with care." RESULTS Two short-form RAC-Qs with alternative scoring options were identified. The first (the RAC-Q-12) contained 12 items, while the second scoring option (the RAC-Q-14) contained 14 items. Scores from both short forms correlated highly with the full 20-item parent form score (RAC-Q-12, r=0.93 and RAC-Q-14, f=0.92), displayed high internal consistency (Cronbach's α: RAC-Q-12=0.92 and RAC-Q-14=0.89) and had high levels of agreement (intraclass correlation coefficient [ICC]=0.97 for both scales). CONCLUSION The RAC-Q is designed to offer near-real-time feedback on staff's interactions with patients when delivering relational care. The new short-form RAC-Qs and their respective method of scoring are reflective of scores derived using the full 20-item parent form. The new short-form RAC-Qs may be incorporated into inpatient surveys to enable the comparison of ward or hospital performance. Using either the RAC-Q-12 or the RAC-Q-14 offers a method to reduce missing data and response fatigue.
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Affiliation(s)
- Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Steve Sizmur
- Research Division, Picker Institute Europe, Oxford, UK
| | | | - Jenny King
- Research Division, Picker Institute Europe, Oxford, UK
| | - Robyn Cooper
- Research Division, Picker Institute Europe, Oxford, UK
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chris Graham
- Research Division, Picker Institute Europe, Oxford, UK
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Kelly L, Jenkinson C, Morley D. Experiences of Using Web-Based and Mobile Technologies to Support Self-Management of Type 2 Diabetes: Qualitative Study. JMIR Diabetes 2018; 3:e9. [PMID: 30291098 PMCID: PMC6238842 DOI: 10.2196/diabetes.9743] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 01/28/2023] Open
Abstract
Background The prevalence of type 2 diabetes is rising, placing increasing strain on health care services. Web-based and mobile technologies can be an important source of information and support for people with type 2 diabetes and may prove beneficial with respect to reducing complications due to mismanagement. To date, little research has been performed to gain an insight into people’s perspectives of using such technologies in their daily management. Objective The purpose of this study was to understand the impact of using Web-based and mobile technologies to support the management of type 2 diabetes. Methods In-depth interviews were conducted with 15 people with type 2 diabetes to explore experiences of using Web-based and mobile technologies to manage their diabetes. Transcripts were analyzed using the framework method. Results Technology supported the users to maintain individualized and tailored goals when managing their health. A total of 7 themes were identified as important to participants when using technology to support self-management: (1) information, (2) understanding individual health and personal data, (3) reaching and sustaining goals, (4) minimizing disruption to daily life, (5) reassurance, (6) communicating with health care professionals, and (7) coordinated care. Conclusions Patients need to be supported to manage their condition to improve well-being and prevent diabetes-related complications from arising. Technologies enabled the users to get an in-depth sense of how their body reacted to both lifestyle and medication factors—something that was much more difficult with the use of traditional standardized information alone. It is intended that the results of this study will inform a new questionnaire designed to assess self-management in people using Web-based and mobile technology to manage their health.
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Affiliation(s)
- Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - David Morley
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Graham C, Käsbauer S, Cooper R, King J, Sizmur S, Jenkinson C, Kelly L. An evaluation of a near real-time survey for improving patients’ experiences of the relational aspects of care: a mixed-methods evaluation. Health Serv Deliv Res 2018. [DOI: 10.3310/hsdr06150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The Francis Report (of 2013) provided many recommendations to improve compassionate care in NHS organisations, including more widespread use of real-time feedback (RTF) to collect patient experience data. This research directly addressed these recommendations and aimed to provide an evidence-based toolkit to support NHS quality improvements.
Objectives
To develop and validate a survey of compassionate care for use in near real time on elderly care wards and accident and emergency (A&E) departments. This research also evaluated the effectiveness of the RTF approach for improving relational aspects of care and provides suggestions for how the approach can be used by other hospitals to strengthen compassionate care.
Design
The research utilised a mixed-methods design, using quantitative, qualitative and participatory research approaches to collect patients’ experiences of relational care and the views of NHS staff in an effort to evaluate the processes and impacts of near real-time feedback (NRTF) data collection. Data sources included a NRTF patient experience survey, weekly volunteer diaries, staff interviews and surveys, workshops and meetings with case study sites.
Setting
The research was carried out across six case study sites across England, in wards that predominantly serve elderly patients and in A&E departments.
Participants
The 3928 participants in the patient experience survey were inpatients on elderly care wards, or persons who had sought medical care in A&E. Frontline staff, service leads, senior management and volunteers also took part in surveys (n = 274) and interviews (n = 82) designed to understand the staff perspectives and opinions of collecting patient experience data.
Interventions
A patient experience survey was implemented using a tablet computer-based methodology, facilitated by trained volunteers. Responses were used alongside feedback from staff to evaluate the use of a NRTF approach as a method for improving patient experiences of relational aspects of care.
Main outcome measures
The patient experience survey measured relational aspects of care. Another outcome measure was improvements to care as planned, implemented and reported by staff.
Results
A small but statistically significant improvement (p = 0.044) in relational aspects of care over the course of the study was noted overall. Staff implemented a variety of improvements to enhance communication with patients.
Limitations
Maintaining volunteer and staff engagement throughout the study was difficult. Few surveys were completed per ward or department each week. This made examining trends in patient experiences over time challenging.
Conclusions
Near real-time feedback offers an effective approach for monitoring and improving relational aspects of care.
Future work
Staff frequently expressed a view that volunteers’ interactions with patients while administering the survey were themselves beneficial to patients. Future research should examine the impact of volunteer interactions with patients on their experiences of relational aspects of care.
Study registration
The project is registered on the Clinical Research Network portfolio under the primary trial identification number 18449.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | | | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Morley D, Dummett S, Kelly L, Fitzpatrick R, Jenkinson C. Predictors of activity and participation across neurodegenerative conditions: a comparison of people with motor neurone disease, multiple sclerosis and Parkinson's disease. BMC Neurol 2018; 18:19. [PMID: 29454326 PMCID: PMC5816512 DOI: 10.1186/s12883-018-1024-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Comparisons between neurological conditions have the potential to inform service providers by identifying particular areas of difficulty experienced by affected individuals. This study aimed to identify predictors of activity and participation in people with motor neurone disease (MND), people with multiple sclerosis (MS) and people with Parkinson’s Disease (PD). Methods The Oxford Participation and Activities Questionnaire (Ox-PAQ) and Medical Outcomes Study 36-Item Short Form Survey (MOS SF-36) were administered by postal survey to 386 people with a confirmed diagnosis of MND, MS or PD. Data analyses focused on stepwise regression analyses in order to identify predictors of activity and participation in the three conditions assessed. Results Three hundred and thirty four participants completed the survey, a response rate of 86.5%. Regression analyses identified multiple predictors of activity and participation dependent on Ox-PAQ domain and disease group, the most prominent being social and physical functioning as measured by the MOS SF-36. Conclusions Results indicate that the physical and social consequences of neurological illness are of greatest relevance to people experiencing the conditions assessed. Whilst the largely inevitable physical implications of disease take hold, emphasis should be placed on the avoidance of social withdrawal and isolation, and the maintenance of social engagement should become a significant priority.
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Affiliation(s)
- David Morley
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK. .,Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Sarah Dummett
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
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Peters M, Kelly L, Potter CM, Jenkinson C, Gibbons E, Forder J, Fitzpatrick R. Quality of life and burden of morbidity in primary care users with multimorbidity. Patient Relat Outcome Meas 2018; 9:103-113. [PMID: 29497339 PMCID: PMC5818872 DOI: 10.2147/prom.s148358] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose The aim of this study was to assess the quality of life, number of diseases and burden of morbidity of multimorbid primary care users and whether a simple disease count or a multimorbidity burden score is more predictive of quality of life. Patients and methods Primary care patients with at least 1 of 11 specified chronic conditions were invited to participate in a postal survey. Participants completed the Disease Burden Impact Scale (DBIS) questionnaire, the five dimension-five level Euro-Qol (EQ-5D-5L) and standard demographics questions. The DBIS asks participants to self-report chronic conditions and to rate the impact of each condition. Descriptive statistics and analysis of variance were used to determine quality of life, count of diseases and burden of morbidity. Multiple linear regression analyses determined whether disease count or the DBIS, adjusted for demographics, was more predictive of the EQ-5D-5L scores. Results Thirty-one percent (n=917) responded, from which 69 were excluded as they reported no or only one condition, leaving 848 (92%) in the analysis. Slightly more women (50.9%) participated; the mean age was 67.0 (SD 13.9) and the mean number of conditions was 6.5 (SD 3.49). The mean scores were: DBIS 15.5 (SD 12.00; score range 0–140, with higher scores indicating higher multimorbidity burden), EQ-5D-5L score 0.69 (SD 0.28; score range −0.28 [a state worse than death] to 1 [best possible health state]) and EQ-5D Visual Analog Scale (EQ-VAS) 65.44 (SD 23.66; score range 0–100 with higher scores meaning better health). The model using the DBIS score was more predictive of the EQ-5D-5L score and EQ-VAS than the model using the disease count (R2adj=0.53 using DBIS and R2adj=0.42 using disease count for EQ-5D-5L score, and R2adj=0.44 using DBIS versus R2adj=0.34 using disease count for EQ-VAS). All models were statistically significant (p<0.001). Conclusion The DBIS is a useful measure for assessing multimorbidity from the perspective of primary care users in particular, as it is more predictive of health outcomes than a simple count of conditions.
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Affiliation(s)
- Michele Peters
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | - Laura Kelly
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | - Caroline M Potter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | - Julien Forder
- Personal Social Services Research Unit, School of Social Policy Sociology and Social Research, University of Kent, Canterbury, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford
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