Patient Reported Outcome Measurement (PROM) under real-life conditions of non-curable cancer outpatients with the Integrated Palliative Outcome Scale (IPOS) and NCCN-Distress Thermometer - A mixed methods study

Objective

Prospective cohort study to test the real-life feasibility of longitudinal patient-reported outcome measurement PROM (Integrated Palliative Outcome Scale IPOS, and NCCN Distress Thermometer DT) required for outpatients with non-curable lung or prostate cancer in comprehensive cancer centers.

Methods

Assessment with paper-based IPOS and DT was observed for 15 months. We analyzed response to patients' distress (requests for supportive and palliative services) following PROM. Focus groups to comprehensively explore the user experience of patients, informal caregivers and health care professionals (HCP) supplemented the analysis.

Results

Ninety-seven percent (125/129) of the patients received a questionnaire once, but quarterly assessment as recommended by certification committees was achieved only in 50% and 31% of prostate and lung cancer patients. Although both instruments were well accepted, only IPOS showed a high content validity, because some patients had difficulties in understanding the DT. Patients felt comfortable with completing the PROM, and HCP found PROM helped to structure the patient encounter. Due to organizational deficiencies in the handling of the instruments and operationalization of reactions to identified distress, the referrals to supportive and palliative services were rare.

Conclusion

To facilitate consequences from PROM it should be a standardized intervention rather than assessment alone.

Innovation

The patient perspective improves the implementation of PROM under real-life clinical conditions.

Development of a conceptual model for research on cyclical variation of patient reported outcome measurements (PROMs) in patients with chronic conditions: a scoping review

Background

Although circadian, seasonal, and other cycles have been observed for a number of chronic conditions, their impact on patient reported outcomes measurements (PROMs) has not been systematically explored, rendering our understanding of the effect of time of measurement on PROM scores very limited. The aim was to conduct a scoping review to determine what is known about how intra-individual cyclical variation might affect the way individuals with chronic conditions respond to patient-reported outcome measures.

Methods

A protocol of a systematic scoping review was registered on PROSPERO (CRD42017058365). We developed a search strategy based on previous relevant reviews and implemented it in: MEDLINE, Embase, PsycINFO, and CINAHL. No restrictions were placed on article types and backward and forward citation searches were conducted. Screening and data extraction were independently completed by up to four reviewers. An adapted version of CASP criteria was used to appraise the quality of included articles. Concepts that were important in understanding the impact of cyclical variation on PROM scores were elicited from the papers and iteratively refined through discussion amongst the authors.

Results

2420 references resulted from the searches, with 33 articles meeting the inclusion criteria. Most study designs included observational research (particularly ecological momentary assessment), 2 were RCTs and 2 were systematic reviews. Studies mainly focused on specific health conditions: mental health, respiratory and musculoskeletal. There was a lack of qualitative research and theoretical framework to explore these concepts more fully. Five overarching concepts emerged: variation in outcomes, variation of scores, psychological status, individual factors, and environmental/situational factors. A conceptual model was developed outlining the relationships between these concepts.

Conclusions

There is empirical evidence that supports cyclical variation in PROM scores across different chronic conditions, with potential very significant implications for administration and interpretation of PROMs. The proposed conceptual model can support further research in this area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00395-x.

Assessing disease activity using the pediatric Crohn’s disease activity index: Can we use subjective or objective parameters alone?

BACKGROUND

The pediatric Crohn’s disease activity index (PCDAI) is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.

AIM

To examine which items on the PCDAI drive assessment of disease activity, and how subgroups of subjective and objective items reflect change in disease state over time.

METHODS

Selective raw data from three prospectively collected datasets were combined, including 703 children with full PCDAI data at baseline, at 3-mo (Q1, n = 670), and 1-year (Q4, n = 474). Change in individual PCDAI scores from baseline to Q1 and to Q4 were examined using the non-weighted PCDAI.

RESULTS

Abdominal pain, well-being, weight, and stooling had the highest change scores over time. Objective indicators including albumin, abdominal exam, and height velocity followed. Change scores for well-being and abdominal exam did not explain significant variance at Q1 but were significant predictors at Q4 (P < 0.001 and P < 0.05). Subjective and objective subgroups of items predicted less variance (18% and 22%) on total PCDAI scores at Q1 and Q4 compared to the full PCDAI, or a composite scale (both 32%) containing significant predictors.

CONCLUSION

Although subjective items on the PCDAI change the most over time, the full PCDAI or a smaller composite of items including a combination of subjective and objective components classifies disease activity better than a subgroup of either subjective or objective items alone. Reliance on subjective or objective items as stand-alone proxies for disease activity measurement could result in misclassification of disease state.

Higher patellofemoral compressive force does not affect anterior knee pain in anatomical bi-cruciate retaining total knee arthroplasty: In vivo prospective analysis of guided motion prosthesis

BACKGROUND

The purposes of the present study are 1) to measure intraoperative patellofemoral compressive force in patients undergoing anatomical bi-cruciate retaining total knee arthroplasty and to assess the relationship between intraoperative patellofemoral compressive force and patient reported outcome measurements and 2) to compare patellofemoral compressive force and patient reported outcome measurements among patients who underwent anatomical bi-cruciate retaining, cruciate retaining, and bi-cruciate stabilized total knee arthroplasty.

METHODS

Twenty-two patients with varus osteoarthritis of the knee who underwent anatomical bi-cruciate retaining total knee arthroplasty, 20 patients who underwent cruciate retaining total knee arthroplasty, and 24 patients who underwent bi-cruciate stabilized total knee arthroplasty were assessed. Patient reported outcome measurements were evaluated at 1.5 years after surgery.

FINDINGS

Intraoperative patellofemoral compressive force was significantly lower with anatomical bi-cruciate retaining total knee arthroplasty than with cruciate retaining total knee arthroplasty at 60° to 140° of flexion and nearly equivalent to intraoperative patellofemoral compressive force with bi-cruciate stabilized total knee arthroplasty at all knee flexion angles examined. With anatomical bi-cruciate retaining total knee arthroplasty, there were no significant correlations between intraoperative patellofemoral compressive force and almost all patient reported outcome measurements except for 2011 Knee Society Score expectations, which was positively correlated with patellofemoral compressive force at 10° of flexion, and Patella score quadriceps strength, which was negatively correlated with patellofemoral compressive force at 60° of flexion.

INTERPRETATION

There were no significant correlations between intraoperative patellofemoral compressive force and anterior knee pain after anatomical bi-cruciate retaining total knee arthroplasty. Evidence level: 3.

Evaluation of joint awareness after acetabular fracture: Validation of the Forgotten Joint Score according to the COSMIN checklist protocol

BACKGROUND

A fracture of the acetabulum is an uncommon, but serious injury. Established outcome tools do not reflect the patient’s perspective after fracture of the hip joint. Originally designed for post-arthroplasty patients, the Forgotten Joint Score (FJS) is a patient-reported outcome measurement (PROM) tool evaluating the disease-specific health-related quality of life (HR-QoL).

AIM

To validate the FJS in patients after acetabular fracture.

METHODS

In a prospective mono-centric cohort study, we evaluated 100 patients at mean 5.2 ± 3.6 years after a fracture of the acetabulum. The validation study followed the complete COSMIN checklist protocol. For calculation of convergent validity, we used the Tegner-Activity Scale, the Western Ontario and McMaster Universities Osteoarthritis Index, the EuroQol-5D, and a subjective rating of change as an anchor variable.

RESULTS

We confirmed good internal consistency with a Cronbach‘s alpha of 0.95. With an intraclass correlation coefficient of 0.99 (95%CI: 0.97, 0.99), test-retest reliability of the FJS was excellent. Correlation coefficients between the questionnaires were moderate to high ranging from |0.56| to |0.83| (absolute value). No relevant floor or ceiling effects occurred. Standard error of measurement was 3.2 and smallest detectable change (SDC) was 8.8. Thus, changes greater than 8.8 points between two assessments denote a real change in FJS.

CONCLUSION

The FJS is a valid and reliable tool for evaluation of patient-reported outcome in posttraumatic condition after acetabular fracture. The SDC indicating a real clinical improvement was 8.8 points in the FJS. We could confirm responsiveness of the FJS and found no relevant floor- or ceiling effects.

Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry

BACKGROUND

The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD.

METHODS

Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD.

RESULTS

The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17-2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55-0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17-1.92), toileting (OR: 1.30, 95%CI: 1.05-1.61), and dressing (OR: 1.23, 95%CI: 1.02-1.48).

CONCLUSION

In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.

Dutch version of the Victorian Institute of Sports Assessment-Achilles questionnaire for Achilles tendinopathy: Reliability, validity and applicability to non-athletes

AIM

To translate the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire into the Dutch language (VISA-A-NL), and to assess its reliability, validity, and applicability to non-athletes.

METHODS

After translation according to a forward-backward protocol, 101 patients with complaints of Achilles tendinopathy were asked to fill out the VISA-A-NL at two time points together with visual analogue scale, the Foot and Ankle Outcome Score, and the Short Form-36 questionnaires. Reliability, internal consistency, construct validity, and content validity were tested.

RESULTS

The VISA-A-NL showed high reliability (0.97, 95%CI: 0.95-0.98). Cronbach’s alpha (internal consistency) was 0.80. It increased to 0.88 without activity domain. Correlation with other questionnaires was moderate or poorer.

CONCLUSION

The VISA-A-NL proved to be an excellent evaluation instrument for the Dutch physician. If applied to non-athletes, using a modified score (questions 1-6) should be considered.

Translation and validation of the 12-item Oxford knee score for use in Finland

Background

The focus in the reporting of results after total knee replacement (TKR) has changed from surgeon/radiologist-based scores to patient-reported outcome measures (PROMs). The questionnaires used in subjective outcome are often originally published in English and need to be validated in different languages. The aim of our study was to investigate the feasibility, validity, reliability, and responsiveness of the Finnish language version of the Oxford Knee Score (OKS-S) questionnaire.

Methods

The original OKS questionnaire was translated using a forward/backward protocol. The OKS-S questionnaire was sent to 225 patients who were scheduled to undergo TKR surgery. The assessment was repeated 1 year after the index operation. Half of the patients also received the RAND-36 questionnaire with the OKS-S questionnaire and the other half the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. 30 patients twice received the OKS-S questionnaire preoperatively for the test-retest assessment.

Results

Feasibility was acceptable with a response rate of 96% in both pre- and postoperative assessments. Correlation between OKS-S questionnaire and all domains of the KOOS questionnaire and the physical domains in the RAND-36 questionnaire was high, and confirmed both good criterion and convergent validity. Content validity was good since no ceiling or floor effect was observed. In the test-retest assessment, all but 2 patients were within the 95% limits of agreement. Responsiveness was large according to effect sizes.

Conclusions

Our data suggests that the OKS-S questionnaire is suitable for the assessment of both the preoperative status and the outcome of TKR in Finnish speaking patients.