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Laroiya I, Tan M, Kaehne A, Shetty G. A prospective study evaluating patient reported outcome measures in patients who have undergone chest wall perforator flaps. J Plast Reconstr Aesthet Surg 2024; 91:79-82. [PMID: 38402816 DOI: 10.1016/j.bjps.2024.02.044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/18/2023] [Accepted: 02/04/2024] [Indexed: 02/27/2024]
Abstract
AIMS To evaluate Patient Reported Outcome Measures (PROMs) and surgical outcomes in patients undergoing Chest Wall Perforator Flaps (CWPFs). METHODS This was an observational single cohort study using an audit approach and a survey instrument. 84 patients who had undergone CWPFs in the last 5 years at the Department of Breast Surgery, City Hospital Birmingham, were identified from a pre-existing database. Surgical outcomes were recorded. Patients were contacted telephonically or in person at the time of follow-up and were asked to fill up a PROMs questionnaire. RESULTS Out of 84 patients, 58 patients chose to respond. The average age of the patients was 51.3 years (±8.2 years). The average follow-up was 15.4 months (±9.9 months). The most common histological subtype was Infiltrating ductal carcinoma (IDC)-Not otherwise specified 34/58 (58.6%). Majority of the patients had T2 cancers-28/58 (48.3%). 26/58 (44.8%) were node negative. Eight patients (13.7%) had post-operative complications. No patient had total/partial flap loss. Nine patients (15.5%) had margin re-excision. One patient developed distant metastasis while 1 patient developed a second primary. Fifty-one patients (88%) were either satisfied or very satisfied with the post-operative appearance of the breasts. Thirty-six patients (62%) had no/little persistent pain or tenderness post-surgery. Eighty-six per cent (38/44) of the patients undergoing Lateral Intercostal Artery Perforator (LICAP) Flap and 16/18 (89%) of patients undergoing Anterior Intercostal Artery Perforator (AICAP) flap had no/little difficulty in carrying out normal activities at follow up. CONCLUSION CWPFs are associated with a low complication rate and a high patient satisfaction rate.
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Affiliation(s)
- Ishita Laroiya
- Sandwell and West Birmingham NHS Trust, City Hospital, Dudley Road, Birmingham B18 7QH, UK; Department of General Surgery, PGIMER, Chandigarh, India
| | - Melissa Tan
- Sandwell and West Birmingham NHS Trust, City Hospital, Dudley Road, Birmingham B18 7QH, UK
| | - Axel Kaehne
- Medical Scholl, Edge Hill University, Ormskirk, UK
| | - Geeta Shetty
- Sandwell and West Birmingham NHS Trust, City Hospital, Dudley Road, Birmingham B18 7QH, UK; Manipal Academy of Higher Education (MAHE) & Kasturba Medical College, Mangalore, India.
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Milte R, Jemere D, Lay K, Hutchinson C, Thomas J, Murray J, Ratcliffe J. A scoping review of the use of visual tools and adapted easy-read approaches in Quality-of-Life instruments for adults. Qual Life Res 2023; 32:3291-3308. [PMID: 37344727 PMCID: PMC10624740 DOI: 10.1007/s11136-023-03450-w] [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] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Self-Reporting using traditional text-based Quality-of-Life (QoL) instruments can be difficult for people living with sensory impairments, communication challenges or changes to their cognitive capacity. Adapted communication techniques, such as Easy-Read techniques, or use of pictures could remove barriers to participation for a wide range of people. This review aimed to identify published studies reporting adapted communication approaches for measuring QoL, the methodology used in their development and validation among adult populations. METHODS A scoping review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews checklist was undertaken. RESULTS The initial search strategy identified 13,275 articles for screening, with 264 articles identified for full text review. Of these 243 articles were excluded resulting in 21 studies for inclusion. The majority focused on the development of an instrument (12 studies) or a combination of development with some aspect of validation or psychometric testing (7 studies). Nineteen different instruments were identified by the review, thirteen were developed from previously developed generic or condition-specific quality of life instruments, predominantly aphasia (7 studies) and disability (4 studies). Most modified instruments included adaptations to both the original questions, as well as the response categories. CONCLUSIONS Studies identified in this scoping review demonstrate that several methods have been successfully applied e.g. with people living with aphasia post-stroke and people living with a disability, which potentially could be adapted for application with more diverse populations. A cohesive and interdisciplinary approach to the development and validation of communication accessible versions of QOL instruments, is needed to support widespread application, thereby reducing reliance on proxy assessors and promoting self-assessment of QOL across multiple consumer groups and sectors.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Digisie Jemere
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Kiri Lay
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jolene Thomas
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Joanne Murray
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Kaya T, Yılmaz G, Zraick RI, Konrot A, Cangi ME. Reliability and validity of the Turkish voice handicap index-partner (VHI-P-TR). J Commun Disord 2023; 106:106380. [PMID: 37738707 DOI: 10.1016/j.jcomdis.2023.106380] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE This study examines the Turkish validity, reliability and diagnostic performance of the Voice Handicap Index-Partner (VHI-P-TR), which is used to obtain the perceptions of communication partners of individuals with dysphonia about the functional, physical and emotional handicap resulting from the patient experiencing dysphonia. METHOD The study included 160 individuals with dysphonia and their communication partners. First, translation, back translation, expert validity and pilot study were performed in the scale adaptation process. Then, a confirmatory factor analysis (CFA) was conducted to assess the construct validity of the VHI-P-TR. Correlations between the VHI-P-TR and Voice Handicap Index (VHI-TR) scores of dysphonic individuals were examined to evaluate the concurrent validity of the VHI-P-TR. To assess the reliability of the VHI-P-TR, a test-retest analysis was performed, and internal consistency coefficients (α) were calculated. A receiver operating characteristic (ROC) analysis was conducted to determine the cut-off point for the VHI-P scores. RESULTS A high positive correlation was found between the participants' VHI-P-TR and VHI-TR total and subscales mean scores (r's > 0.782; p < 0.01). The VHI-P-TR had high internal consistency regarding for its subscales and total score (α's > 0.94; p < 0.01). Factor loadings of all VHI-P-TR items were higher than 0.30 and their error variances were lower than 0.90. In addition, factor loadings were statistically significant for all the items (p < 0.05). The data fit the model well according to all CFA indices except for GFI (scale = 0.69). An adequate sensitivity and specificity were achieved for the VHI-P-TR, and the cut-off point was found as 11.50 for the total score and ranged from 2.50 to 5.50 for the subscales. CONCLUSION The VHI-P-TR is a valid and reliable measurement tool with high diagnostic performance in all subscales and total score, and has high levels of agreement with the VHI-TR.
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Affiliation(s)
- Tuğba Kaya
- University of Health Sciences, Speech and Language Deparment, İstanbul, Türkiye.
| | - Göksu Yılmaz
- Uskudar University, Speech and Language Deparment, İstanbul, Türkiye
| | - Richard I Zraick
- University of Central Florida, School of Communication Sciences and Disorders, Orlando, United States of America
| | - Ahmet Konrot
- Uskudar University, Speech and Language Deparment, İstanbul, Türkiye
| | - Mehmet Emrah Cangi
- University of Health Sciences, Speech and Language Deparment, İstanbul, Türkiye
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Oude Voshaar M, Terwee CB, Haverman L, van der Kolk B, Harkes M, van Woerden CS, van Breda F, Breukink S, de Hoop I, Vermeulen H, de Graaf E, Hazelzet J, van Leiden B, Stienen J, Hoekstra M, Bart H, van Bommel H, Determann D, Verburg M, van der Wees P, Beurskens AJ. Development of a standard set of PROs and generic PROMs for Dutch medical specialist care : Recommendations from the Outcome-Based Healthcare Program Working Group Generic PROMs. Qual Life Res 2023; 32:1595-1605. [PMID: 36757571 PMCID: PMC10172289 DOI: 10.1007/s11136-022-03328-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Accepted: 12/13/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE The added value of measuring patient-reported outcomes (PROs) for delivering patient-centered care and assessment of healthcare quality is increasingly evident. However, healthcare system wide data collection initiatives are hampered by the proliferation of patient-reported outcome measures (PROMs) and conflicting data collection standards. As part of a national initiative of the Dutch Ministry of Health, Welfare and Sport we developed a consensus-based standard set of generic PROs and PROMs to be implemented across Dutch medical specialist care. METHODS A working group of mandated representatives of umbrella organizations involved in Dutch medical specialist care, together with PROM experts and patient organizations worked through a structured, consensus-driven co-creation process. This included literature reviews, online expert and working group meetings, and feedback from national patient- and umbrella organizations. The 'PROM-cycle' methodology was used to select feasible, valid, and reliable PROMs to obtain domain scores for each of the PROs included in the set. RESULTS Eight PROs across different domains of health were ultimately endorsed: symptoms (pain & fatigue), functioning (physical, social/participation, mental [anxiety & depression]), and overarching (quality of life & perceived overall health). A limited number of generic PROMs was endorsed. PROMIS short forms were selected as the preferred instruments for all PROs. Several recommendations were formulated to facilitate healthcare system level adoption and implementation of the standard set. CONCLUSIONS We developed a consensus-based standard set of Generic PROMs and a set of recommendations to facilitate healthcare system wide implementation across Dutch medical specialist care.
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Affiliation(s)
- Martijn Oude Voshaar
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands.
- Department of Medical Cell BioPhysics & TechMed Center, University of Twente, Enschede, The Netherlands.
| | - Caroline B Terwee
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Amsterdam, the Netherlands
- Methodology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lotte Haverman
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
- Dutch Society of Medical Specialists, Amphia Hospital, Utrecht, The Netherlands
- Dutch Nurses' Association, Amphia Hospital, Utrecht, The Netherlands
| | - Bas van der Kolk
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | - Marleen Harkes
- Dutch Society of Medical Specialists, Amphia Hospital, Utrecht, The Netherlands
| | | | - Fenna van Breda
- Dutch Society of Medical Specialists, Amphia Hospital, Utrecht, The Netherlands
| | - Stephanie Breukink
- Dutch Society of Medical Specialists, Amphia Hospital, Utrecht, The Netherlands
| | - Irma de Hoop
- Dutch Nurses' Association, Amphia Hospital, Utrecht, The Netherlands
| | - Hester Vermeulen
- Dutch Nurses' Association, Amphia Hospital, Utrecht, The Netherlands
| | - Evelien de Graaf
- Dutch Nurses' Association, Amphia Hospital, Utrecht, The Netherlands
| | - Jan Hazelzet
- Dutch Federation of University Medical Centres, Utrecht, The Netherlands
| | | | - Jozette Stienen
- Dutch Hospital Association &, Amphia Hospital, Breda, The Netherlands
| | | | - Hans Bart
- The Netherlands Patients Federation, Utrecht, The Netherlands
| | - Hester van Bommel
- Pharos - Dutch Centre of Expertise On Health Disparities, Utrecht, The Netherlands
| | - Domino Determann
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | - Mariët Verburg
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
| | - Philip van der Wees
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare and Department of Rehabilitation, Nijmegen, The Netherlands
| | - Anna J Beurskens
- National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Yee E, Franke M, Smith G. Evaluation of the Multiple Assessment Subjective Shoulder Score (MASSS). A pilot study. Orthop Traumatol Surg Res 2022; 108:103313. [PMID: 35537681 DOI: 10.1016/j.otsr.2022.103313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study compares an entirely patient reported modification of the Constant-Murley Score (CS) (the Multiple Assessment Subjective Shoulder Score [MASSS]), with the CS in symptomatic patients with non-instability shoulder pathology. HYPOTHESIS The hypothesis is that the sub scores and overall score of the MASSS will be well correlated and in high agreement to the corresponding scores of the CS. MATERIALS AND METHODS The MASSS, the CS and adjusted-CS (a-CS) were administered to 74 patients. The MASSS replaced the strength and ROM domains of the CS with SANE scores. Correlations, differences, agreement, test-retest reliability, and internal consistency were assessed using Pearson's R test, paired t-test, Bland-Altman method, intraclass correlations (ICC) and Cronbach's alpha. RESULTS Correlation between MASSS and CS (0.834) and a-CS (0.824) were excellent. Total MASSS (54.0) was higher than CS (41.8) (p<0.001) and a-CS (47.8) (p<0.05). MASSS strength and ROM domains were higher than those of the CS (Strength: 13.4 v 5.3 [p<0.001], ROM: 24.8 v 20.8 [p<0.001]. There was a floor effect for the strength domain of the CS (46.7% minimum score), but not the MASSS (0% minimum score). MASSS internal consistency (0.626-0.734) was better than the CS (0.401-0.643). Test re-test reliability of the total MASSS (ICC 0.93) and the strength (ICC 0.90) and ROM (ICC 0.86) domains was excellent. DISCUSSION The MASSS has several advantages over the CS. Although the correlation of the total MASSS with the CS and a-CS was high, there was poor agreement in the strength and the ROM domains and therefore the MASSS value is not interchangeable with the CS, but rather should be considered as an alternative. LEVEL OF EVIDENCE II; Prospective cohort study.
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Adeola BA, Ivana D, Orlando R, Wu VS, Anthony A, Geoff P D, Afaf G. Supporting cancer patients to self-manage: Extent of use and perceptions of "trusted" online self-management resources. Patient Educ Couns 2022; 105:2240-2247. [PMID: 35351325 DOI: 10.1016/j.pec.2022.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/21/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Online resources can support patient self-management practices, but are not systematically used in routine clinical practice. We evaluated cancer patients' satisfaction with, and use of, tailored online resources. METHODS Patients completed monthly validated electronic patient reported outcome measures (ePROMs) of distress, unmet needs and symptoms. Patients with ePROM scores above pre-determined thresholds received an email directing them to relevant online self-management resources. Perceptions and experiences with these resources were evaluated via an online survey 3, 6 and 9 months after their initial monthly ePRO; and a subset of patients was also interviewed. Webpage use was monitored through Google Analytics and ClickMeter. RESULTS Overall, 221 patients completed evaluation surveys and 31 completed interviews. Patients spent 0-10 min on average accessing resources, with 93% indicating they would reuse them. The most viewed page was physical wellbeing (n = 680); exercise and nutrition resources were most popular; and 69% of patients were satisfied with information content, reporting resources were easy to understand and navigate. CONCLUSIONS Online resources are perceived as acceptable and useful. Design and delivery recommendations can improve their support of self-management. PRACTICE IMPLICATIONS Incorporating automated online self-management resources into routine clinical workflows is a viable model to support routine follow up care.
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Affiliation(s)
- Bamgboje-Ayodele Adeola
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia; South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Durcinoska Ivana
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia.
| | - Rincones Orlando
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia.
| | - Verena Shuwen Wu
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia.
| | - Arnold Anthony
- Illawarra Shoalhaven Local Health District, NSW, Australia.
| | - Delaney Geoff P
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia; South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; South Western Sydney Local Health District, NSW, Australia.
| | - Girgis Afaf
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia; South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia.
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Davison SN, Klarenbach S, Manns B, Schnick-Makaroff K, Buzinski R, Corradetti B, Short H, Johnson JA. Patient-reported outcome measures in the care of in-centre hemodialysis patients. J Patient Rep Outcomes 2021; 5:93. [PMID: 34637030 PMCID: PMC8511202 DOI: 10.1186/s41687-021-00365-3] [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: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
Kidney failure requiring dialysis is associated with high symptom burden and low health-related quality of life (HRQL). Patient-reported outcome measures (PROMs) are standardized instruments that capture patients’ symptom burden, level of functioning, and HRQL. The routine use of PROMs can be used to monitor aspects of patients’ health that may otherwise be overlooked, inform care planning, and facilitate the introduction of treatments. Incorporating PROMs into clinical practice is an appropriate strategy to engage patients and enhance their role in decisions regarding their care and outcomes. However, the implementation of PROMs measurement and associated interventions can be challenging given the nature of clinical practice in busy hemodialysis units, the variations in organization and clinical workflow across units, as well as regional programs. Implementing PROMs and linking these with actionable treatment aids to alleviate bothersome symptoms and improve patients’ wellbeing is key to improving patients’ health. Other considerations in implementing PROMs within a hemodialysis setting include integration into electronic medical records, purchase and configuration of electronic tools (i.e., tablets), storage and disinfection of such tools, and ongoing IT resources. It is important to train clinicians on the practical elements of using PROMs, however there is also a need to engage clinicians to use PROMs on an ongoing basis. This article describes how PROMs have been implemented at in-centre hemodialysis units in Alberta, Canada, addressing each of these elements.
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Affiliation(s)
- Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, 11-113L Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, 11-113L Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Braden Manns
- Department of Medicine and Department of Community Health Sciences, University of Calgary, O'Brien Institute of Public Health, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Kara Schnick-Makaroff
- Faculty of Nursing, University of Alberta, 5-295 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | | | | | - Hilary Short
- Alberta PROMs and EQ-5D Research and Support Unity, School of Public Health, University of Alberta, Shing Centre for Health Research Innovation, 2-040 Li Ka, Edmonton, AB, T6G 2E1, Canada
| | - Jeffrey A Johnson
- Alberta PROMs and EQ-5D Research and Support Unity, School of Public Health, University of Alberta, Shing Centre for Health Research Innovation, 2-040 Li Ka, Edmonton, AB, T6G 2E1, Canada
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van Muilekom MM, Luijten MAJ, van Oers HA, Terwee CB, van Litsenburg RRL, Roorda LD, Grootenhuis MA, Haverman L. From statistics to clinics: the visual feedback of PROMIS® CATs. J Patient Rep Outcomes 2021; 5:55. [PMID: 34245390 PMCID: PMC8272760 DOI: 10.1186/s41687-021-00324-y] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background To reduce the burden of completing Patient-Reported Outcome Measures (PROMs), PROMIS® Computerized Adaptive Tests (CATs) are being implemented in pediatric clinical practice. We aimed to develop recommendations for visual feedback options for PROMIS CATs on individual item and domain score level as an evidence-based feedback recommendation for PROMIS CATs is lacking. Methods Focus groups were held with clinicians who use the KLIK PROM portal. Literature-based feedback options were provided to initiate group discussion. Data was analyzed using thematic coding method. Additionally, a questionnaire was sent out to assess patients’ (12-18y) and parents’ (child 0-18y) preference for individual item feedback. Data was analyzed using descriptive statistics. Results Six focus groups were held (N = 28 clinicians). Regarding individual item feedback, showing the complete item bank, with only responses to administered items in traffic light colors was preferred. For domain scores, line graphs were preferred, including numerical (T-)scores, reference and cut-off lines, and traffic light colors. Separate graphs per domain, ranked in order of importance and harmonization of directionality (‘higher = better’) were considered important. Questionnaire results (N = 31 patients/N = 131 parents) showed that viewing their own item responses was preferred above receiving no item feedback by 58.1% of the patients and 77.1% of the parents. Conclusions Based on the outcomes and after discussion with the Dutch-Flemish PROMIS National Center, recommendations for PROMIS CAT feedback options were developed. PROMIS CATs can now be used in clinical practice to help clinicians monitor patient outcomes, while reducing the burden of completing PROMs for patients significantly.
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Affiliation(s)
- Maud M van Muilekom
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - Michiel A J Luijten
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.,Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hedy A van Oers
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - Caroline B Terwee
- Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Raphaële R L van Litsenburg
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | | | - Lotte Haverman
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
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Yu JY, Goldberg T, Lao N, Feldman BM, Goh YI. Electronic forms for patient reported outcome measures (PROMs) are an effective, time-efficient, and cost-minimizing alternative to paper forms. Pediatr Rheumatol Online J 2021; 19:67. [PMID: 33941208 PMCID: PMC8091685 DOI: 10.1186/s12969-021-00551-z] [Citation(s) in RCA: 11] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) provide valuable insight on patients' well-being and facilitates communication between healthcare providers and their patients. The increased integration of the technology within the healthcare setting presents the opportunity to collect PROMs electronically, rather than on paper. The Childhood Health Assessment Questionnaire (CHAQ) and Quality of My Life (QoML) are common PROMs collected from pediatric rheumatology patients. The objectives of this study are to (a) determine the equivalence of the paper and electronic forms (e-form) of CHAQ and QoML questionnaires; (b) identify potential benefits and barriers associated with using an e-form to capture PROMs; and (c) gather feedback on user experience. METHODS Participants completed both a paper and an e-form of the questionnaires in a randomized order, following which they completed a feedback survey. Agreement of the scores between the forms were statistically analyzed using the intraclass correlation coefficient (ICC) (95 % Confidence Interval (CI)) and bias was assessed using a Bland-Altman plot. Completion and processing times of the forms were compared using mean and median measures. Quantitative analysis was performed to assess user experience ratings, while comments were qualitatively analyzed to identify important themes. RESULTS 196 patients participated in this project. Scores on the forms had high ICC agreement > 0.9. New patients took longer than returning patients to complete the forms. Overall, the e-form was completed and processed in a shorter amount of time than the paper form. 83 % of survey respondents indicated that they either preferred the e-form or had no preference. Approximately 10 % of respondents suggested improvements to improve the user interface. CONCLUSIONS E-forms collect comparable information in an efficient manner to paper forms. Given that patients and caregivers indicated they preferred completing PROMs in this manner, we will implement their suggested changes and incorporate e-forms as standard practice for PROMs collection in our pediatric rheumatology clinic.
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Affiliation(s)
- Jennifer Y. Yu
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Talia Goldberg
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Nicholas Lao
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Brian M. Feldman
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada ,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada ,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Y. Ingrid Goh
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada
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10
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Braaksma C, Wolterbeek N, Veen MR, Prinsen CAC, Ostelo RWJG. Systematic review and meta-analysis of measurement properties of the Hip disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS) and the Knee Injury and Osteoarthritis Outcome Score - Physical Function Shortform (KOOS-PS). Osteoarthritis Cartilage 2020; 28:1525-1538. [PMID: 32827668 DOI: 10.1016/j.joca.2020.08.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate all evidence on measurement properties of the Hip disability and Osteoarthritis Outcome Score - Physical function Shortform (HOOS-PS) and the Knee Injury and Osteoarthritis Outcome Score - Physical function Shortform (KOOS-PS). DESIGN This study was conducted according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of PROMs. MEDLINE, EMBASE, The Cochrane Library, CINAHL and PsychINFO through February 2019 were searched. Eligible studies evaluated patients with hip or knee complaints and described a measurement property, interpretability, feasibility, or the development of either the HOOS-PS or KOOS-PS. RESULTS Twenty-three studies were included. For both questionnaires, the content validity was found inconsistent and the quality evidence was moderate for a sufficient reliability and high for an insufficient construct validity. The HOOS-PS had a high quality evidence of sufficient structural validity and internal consistency (pooled Cronbach's alpha 0.80; n = 3761) and low quality evidence of sufficient measurement error and indeterminate responsiveness. Concerning the KOOS-PS, the quality evidence was high for an insufficient responsiveness, moderate for an inconsistent structural validity and internal consistency and low for an inconsistent measurement error. CONCLUSIONS The inconsistent evidence for content validity implies that scores on the HOOS-PS and KOOS-PS may inadequately reflect physical functioning. Furthermore, there is evidence for insufficient construct validity and responsiveness in patients with knee osteoarthritis receiving conservative treatment. Using the HOOS-PS or KOOS-PS as outcome measurement instruments for comparing outcomes, measuring improvements or benchmarking in patients with hip or knee complaints or undergoing arthroplasty should only be done with great caution. REVIEW REGISTRATION PROSPERO number CRD42017069539.
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Affiliation(s)
- C Braaksma
- Department of Orthopaedic Surgery, Utrecht, the Netherlands.
| | - N Wolterbeek
- Department of Orthopaedic Surgery, Utrecht, the Netherlands
| | - M R Veen
- Department of Orthopaedic Surgery, Utrecht, the Netherlands
| | - C A C Prinsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands
| | - R W J G Ostelo
- Department of Health Sciences and the Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands
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11
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Spekreijse LS, Simons RWP, Winkens B, van den Biggelaar FJHM, Dirksen CD, Nuijts RMMA. Cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (the BICAT-NL study): study design of a prospective multicenter randomised controlled trial. BMC Ophthalmol 2020; 20:257. [PMID: 32600295 PMCID: PMC7323372 DOI: 10.1186/s12886-020-01521-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background Cataract surgery is one of the most frequently performed types of surgery. Most patients suffer from bilateral cataract and while cataract surgery of only one eye is effective in restoring functional vision, second-eye surgery leads to further improvements in health-related quality of life, and is cost-effective. At present, most patients undergo cataract surgery in both eyes on separate days as recommended in national guidelines, referred to as delayed sequential bilateral cataract surgery (DSBCS). An alternative procedure involves operating both eyes on the same day, but as separate procedures, known as immediately sequential bilateral cataract surgery (ISBCS). The aim of this study is to evaluate the effectiveness and costs of ISBCS compared to DSBCS, in order to test the hypothesis that ISBCS is non-inferior to DSBCS in terms of effectiveness and superior to ISBCS in terms of cost-effectiveness. Methods/design Multicenter non-inferiority randomised controlled clinical trial. Patients (18 years or older) with bilateral cataract and an indication for bilateral cataract surgery with an expected uncomplicated intraoperative and postoperative course are included in the study. Patients are randomly assigned to either ISBCS or DSBCS. The primary endpoint is the proportion of patients with a refractive outcome in the second eye within 1.0 dioptre from the target refraction, at 4 weeks after surgery. Secondary outcomes include corrected and uncorrected distance visual acuity, complications, patient reported outcomes (PROMs), cost-effectiveness, and budget impact. Follow-up visits are planned at 1 week after first-eye surgery and 4 weeks after second-eye surgery. At 3 months after first-eye surgery, the occurrence of complications is checked and patients fill in a final questionnaire. Discussion This study protocol describes the design of a multicenter non-inferiority randomised controlled trial. Current studies on ISBCS often lack information on safety regarding refractive outcomes. In addition, there is a lack of well-designed cost-effectiveness studies using established methods. The BICAT-NL study will provide more insight in refractive and cost-effectiveness outcomes for ISBCS compared to DSBCS. Trial registration This study was prospectively registered at Clinicaltrials.gov on January 17th 2018. (Identifier: NCT03400124.
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Affiliation(s)
- L S Spekreijse
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. .,School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
| | - R W P Simons
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - B Winkens
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - F J H M van den Biggelaar
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - C D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R M M A Nuijts
- Maastricht University Medical Center+, University Eye Clinic Maastricht, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.,Department of Ophthalmology, Zuyderland Medical Center, Heerlen, the Netherlands
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12
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Turner GM, Litchfield I, Finnikin S, Aiyegbusi OL, Calvert M. General practitioners' views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study. BMC Fam Pract 2020; 21:14. [PMID: 31980021 PMCID: PMC6979354 DOI: 10.1186/s12875-019-1077-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 07/23/2019] [Accepted: 12/30/2019] [Indexed: 12/30/2022]
Abstract
Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand how PROMs are currently being used in primary care, the barriers and facilitators of this use and if appropriate how it might be optimised. Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n = 66) or as screening/diagnostic tools (n = 62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barriers to PROM use including: time constraints; insufficient knowledge; lack of integration into clinical systems; and PROMs being mandated without consultation or explanation. Evidence of the benefit of PROMs is required to promote uptake and use of PROMs in primary care. Conclusion Implementation of PROMs in primary care requires integration with clinical systems, a bottom-up approach to PROM selection and system design involving meaningful consultation with patients and primary care clinicians and training/support for use.
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Affiliation(s)
- Grace M Turner
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK. .,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK.
| | - Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.
| | - Sam Finnikin
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, B15 2TT, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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13
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Carlton J, Peasgood T, Khan S, Barber R, Bostock J, Keetharuth AD. An emerging framework for fully incorporating public involvement (PI) into patient-reported outcome measures (PROMs). J Patient Rep Outcomes 2020; 4:4. [PMID: 31933005 PMCID: PMC6957651 DOI: 10.1186/s41687-019-0172-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 06/24/2019] [Accepted: 12/23/2019] [Indexed: 01/28/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are widely used in the United Kingdom (UK) and internationally to report and monitor patients’ subjective assessments of their symptoms and functional status and also their quality of life. Whilst the importance of involving the public in PROM development to increase the quality of the developed PROM has been highlighted this practice is not widespread. There is a lack of guidance on how public involvement (PI) could be embedded in the development of PROMs, where the roles can be more complex than in other types of research. This paper provides a timely review and sets out an emerging framework for fully incorporating PI into PROM development.
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Affiliation(s)
- J Carlton
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - T Peasgood
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - S Khan
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - R Barber
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - J Bostock
- University of Cambridge, Cambridge, UK.,University of Oxford, Oxford, UK.,Kings College London, London, UK
| | - A D Keetharuth
- University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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14
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van der Wees PJ, Verkerk EW, Verbiest MEA, Zuidgeest M, Bakker C, Braspenning J, de Boer D, Terwee CB, Vajda I, Beurskens A, van Dulmen SA. Development of a framework with tools to support the selection and implementation of patient-reported outcome measures. J Patient Rep Outcomes 2019; 3:75. [PMID: 31889232 PMCID: PMC6937349 DOI: 10.1186/s41687-019-0171-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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] [Received: 05/11/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patient reported outcomes (PROs) provide information on a patient's health status coming directly from the patient. Measuring PROs with patient reported outcome measures (PROMs) has gained wide interest in clinical practice for individual patient care, as well as in quality improvement, and for providing transparency of outcomes to stakeholders through public reporting. However, current knowledge of selecting and implementing PROMs for these purposes is scattered, and not readily available for clinicians and quality managers in healthcare organizations. The objective of this study is to develop a framework with tools to support the systematic selection, implementation and evaluation of PROs and PROMs in individual patient care, for quality improvement and public reporting. METHODS We developed the framework in a national project in the Netherlands following a user-centered design. The development process of the framework contained five iterative components: (a) identification of existing tools, (b) identification of user requirements and designing steps for selection and implementation of PROs and PROMs, (c) discussing a prototype of the framework during a national workshop, (d) developing a web version, (e) pre-testing of the framework. A total of 40 users with different perspectives (clinicians, patient representatives, quality managers, purchasers, researchers) have been consulted. RESULTS The final framework is presented as the PROM-cycle that consists of eight steps in four phases: (1) goal setting, (2) selecting PROs and PROMs, (3) developing and testing of quality indicator(s), (4) implementing and evaluating the PROM(s) and indicator(s). Users emphasized that the first step is the key element in which the why, for whom and setting of the PROM has to be defined. This information is decisive for the following steps. For each step the PROM-cycle provides guidance and tools, with instruments, checklists, methods, handbooks, and standards supporting the process. CONCLUSION We developed a framework to support the selection and implementation of PROs and PROMs. Each step provides guidance and tools to support the process. The PROM-cycle and its tools are publicly available and can be used by clinicians, quality managers, patient representatives and other experts involved in using PROMS. Through periodic evaluation and updates, tools will be added for national and international use of the PROM-cycle.
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Affiliation(s)
- Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - Eva W Verkerk
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Marjolein E A Verbiest
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | | | - Carla Bakker
- Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Federation of University Medical Centres (NFU), Utrecht, the Netherlands
| | - Jozé Braspenning
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Dolf de Boer
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ildikó Vajda
- VSOP Dutch Genetic Alliance, Soest, the Netherlands
- STZ-Dutch Association of Top Clinical Hospitals, Utrecht, the Netherlands
| | - Anna Beurskens
- Maastricht University, Maastricht, the Netherlands
- Zuyd University of applied sciences, Heerlen, the Netherlands
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Abstract
Improving the health-related quality of life (HRQoL) of patients is the fundamental aim of aesthetic breast surgery and its importance is increasingly recognised in breast cancer-related surgery. There has been growing acceptance of the value of assessing physical, psychological and social well-being through patient reported outcome measures (PROMs). It is important to consider the role of PROMs in relation to objective measures to ensure that the optimal assessment tools are selected when assessing outcomes in breast surgery. A narrative review was conducted of published articles identified on Ovid Medline by searching the terms: patient reported outcome measures, quality of life (QoL), functional outcomes, aesthetic outcomes, complications and breast surgery. Reference lists were also examined to find relevant articles not detected through the search. Survival and mortality are outcomes of immense importance in breast surgery that are not suitable for assessment through PROMs and should be measured objectively. Post-operative complication rates and markers of their severity are most appropriately assessed using objective measures, however, patients may provide valuable insights into the impact complications have on their QoL. All current assessment tools for assessing aesthetic outcome have inherent limitations, and thus it is likely that both subjective and objective measures are required to comprehensively assess aesthetic outcomes in breast surgery. Physical dysfunction can be assessed objectively, however, PROMs may better evaluate physical well-being, reflecting the real-life implications of a change in function. Psychological and social well-being is irrefutably personal in nature and best assessed through PROMs. There is no one optimal assessment tool for assessing breast surgery outcomes. Utilising a combination of PROMs and objective measures is necessary to accurately and comprehensively evaluate the impact and effectiveness of surgical breast interventions.
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Affiliation(s)
| | - Tristan Leech
- Monash University, Victoria, Australia.,Department of Surgery, Peninsula Health, Victoria, Australia
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16
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Manjra MA, Naude J, Birkholtz F, Glatt V, Tetsworth K, Hohmann E. The relationship between gait and functional outcomes in patients treated with circular external fixation for malunited tibial fractures. Gait Posture 2019; 68:569-74. [PMID: 30640157 DOI: 10.1016/j.gaitpost.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower extremity fractures have a profound negative effect on a patient's gait and outcomes. Correction of deformity, and with it normalization of objective gait parameters, may result in better subjective and objective functional outcomes in patients treated with circular external fixation for malunited tibial fractures. AIM The purpose of this study was to investigate the relationships between gait parameters, patient reported outcome measures (PROMs), and health related quality of life measures in patients treated with circular external fixation for the correction of deformity related to tibial malunions. METHODS This retrospective study included patients with posttraumatic tibial deformities, aged 14-65, with a minimum follow-up of 24 months following deformity correction. Patients with congenital deformities, head injuries, spinal cord injury, neurological disorders, or contralateral lower limb amputation were excluded. Functional outcomes were assessed by the Foot Function Index (FFI); Short Form 12 (SF-12); the EQ 5D; and the ASAMI score. Gait analysis was performed using Dartfish® and the Edinburgh Visual Gait Score (EVGS). The relationships between the EVGS and functional outcome scores were analyzed using Pearsons' moment correlations with Bonferroni corrections. RESULTS Eleven patients with a mean age of 42 (range 23-57) were analyzed. The mean EVGS was 2.6 ± 2.1, the mean FFI 29.6 ± 33.4, the mean EQ5 Index Value 0.7 ± 0.2, the mean EQ5 VAS 85.4 ± 19.5, the SF12 mean Physical Component Score (PCS) 46.7 ± 11.1, and the mean Mental Component Score (MCS) 55.2 ± 7.5. The following relationships were strong and significant: EVGS and FFI (r = 0.7; P = 0.02), EVGS and PCS (r = -0.82; P = 0.02), and FFI and EQ5 (r = -0.79, P = 0.05). SIGNIFICANCE The results of this study suggest that correction of deformity with realignment and restoration of normal anatomy was associated with improved functional outcomes and physical well-being. Patient reported quality of life is strongly associated with patient perceived functional outcome, but not with objective gait parameters.
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17
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Austevoll IM, Gjestad R, Grotle M, Solberg T, Brox JI, Hermansen E, Rekeland F, Indrekvam K, Storheim K, Hellum C. Follow-up score, change score or percentage change score for determining clinical important outcome following surgery? An observational study from the Norwegian registry for Spine surgery evaluating patient reported outcome measures in lumbar spinal stenosis and lumbar degenerative spondylolisthesis. BMC Musculoskelet Disord 2019; 20:31. [PMID: 30658613 PMCID: PMC6339296 DOI: 10.1186/s12891-018-2386-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background Assessment of outcomes for spinal surgeries is challenging, and an ideal measurement that reflects all aspects of importance for the patients does not exist. Oswestry Disability Index (ODI), EuroQol (EQ-5D) and Numeric Rating Scales (NRS) for leg pain and for back pain are commonly used patients reported outcome measurements (PROMs). Reporting the proportion of individuals with an outcome of clinical importance is recommended. Knowledge of the ability of PROMs to identify clearly improved patients is essential. The purpose of this study was to search cut-off criteria for PROMs that best reflect an improvement considered by the patients to be of clinical importance. Methods The Global Perceived Effect scale was utilized to evaluate a clinically important outcome 12 months after surgery. The cut-offs for the PROMs that most accurately distinguish those who reported ‘completely recovered’ or ‘much improved’ from those who reported ‘slightly improved’, unchanged’, ‘slightly worse’, ‘much worse’, or ‘worse than ever’ were estimated. For each PROM, we evaluated three candidate response parameters: the (raw) follow-up score, the (numerical) change score, and the percentage change score. Results We analysed 3859 patients with Lumbar Spinal Stenosis [(LSS); mean age 66; female gender 50%] and 617 patients with Lumbar Degenerative Spondylolisthesis [(LDS); mean age 67; 72% female gender]. The accuracy of identifying ‘completely recovered’ and ‘much better’ patients was generally high, but lower for EQ-5D than for the other PROMs. For all PROMs the accuracy was lower for the change score than for the follow-up score and the percentage change score, especially among patients with low and high PROM scores at baseline. The optimal threshold for a clinically important outcome was ≤24 for ODI, ≥0.69 for EQ-5D, ≤3 for NRS leg pain, and ≤ 4 for NRS back pain, and, for the percentage change score, ≥30% for ODI, ≥40% for NRS leg pain, and ≥ 33% for NRS back pain. The estimated cut-offs were similar for LSS and for LDS. Conclusion For estimating a ‘success’ rate assessed by a PROM, we recommend using the follow-up score or the percentage change score. These scores reflected a clinically important outcome better than the change score.
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Affiliation(s)
- Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Christies gate 6, 5007 Bergen, Bergen, Norway. .,The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Sanviksleitet 1, 5036 Bergen, Bergen, Norway
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Oslo, Norway.,Faculty of Health Science, OsloMet - Oslo Metropolitan University, PO box 4 St. Olavs plass, 0130, Oslo, Oslo, Norway
| | - Tore Solberg
- The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.,Department of Neurosurgery, University Hospital of Northern Norway, Sykehusvegen 38, 90919 Tromsø, Tromsø, Norway
| | - Jens Ivar Brox
- The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Oslo, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Christies gate 6, 5007 Bergen, Bergen, Norway.,Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Christies gate 6, 5007 Bergen, Bergen, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Oslo, Norway
| | - Christian Hellum
- The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, 4950 Nydalen, 0424, Oslo, PB, Norway
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18
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Pascoal C, Brasil S, Francisco R, Marques-da-Silva D, Rafalko A, Jaeken J, Videira PA, Barros L, Dos Reis Ferreira V. Patient and observer reported outcome measures to evaluate health-related quality of life in inherited metabolic diseases: a scoping review. Orphanet J Rare Dis 2018; 13:215. [PMID: 30486833 PMCID: PMC6263554 DOI: 10.1186/s13023-018-0953-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 08/15/2018] [Accepted: 11/14/2018] [Indexed: 12/25/2022] Open
Abstract
Background Health-related Quality of Life (HrQoL) is a multidimensional measure, which has gained clinical and social relevance. Implementation of a patient-centred approach to both clinical research and care settings, has increased the recognition of patient and/or observer reported outcome measures (PROMs or ObsROMs) as informative and reliable tools for HrQoL assessment. Inherited Metabolic Diseases (IMDs) are a group of heterogeneous conditions with phenotypes ranging from mild to severe and mostly lacking effective therapies. Consequently, HrQoL evaluation is particularly relevant. Objectives We aimed to: (1) identify patient and/or caregiver-reported HrQoL instruments used among IMDs; (2) identify the main results of the application of each HrQoL tool and (3) evaluate the main limitations of HrQoL instruments and study design/methodology in IMDs. Methods A scoping review was conducted using methods outlined by Arksey and O’Malley. Additionally, we critically analysed each article to identify the HrQoL study drawbacks. Results Of the 1954 studies identified, 131 addressed HrQoL of IMDs patients using PROMs and/or ObsROMs, both in observational or interventional studies. In total, we identified 32 HrQoL instruments destined to self- or proxy-completion; only 2% were disease-specific. Multiple tools (both generic and disease-specific) proved to be responsive to changes in HrQoL; the SF-36 and PedsQL questionnaires were the most frequently used in the adult and pediatric populations, respectively. Furthermore, proxy data often demonstrated to be a reliable approach complementing self-reported HrQoL scores. Nevertheless, numerous limitations were identified especially due to the rarity of these conditions. Conclusions HrQoL is still not frequently assessed in IMDs. However, our results show successful examples of the use of patient-reported HrQoL instruments in this field. The importance of HrQoL measurement for clinical research and therapy development, incites to further research in HrQoL PROMs’ and ObsROMs’ creation and validation in IMDs. Electronic supplementary material The online version of this article (10.1186/s13023-018-0953-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlota Pascoal
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,CDG & Allies - Professionals and Patient Associations International Network (PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,Research Unit on Applied Molecular Biosciences (UCIBIO), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Lisbon, Portugal
| | - Sandra Brasil
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,CDG & Allies - Professionals and Patient Associations International Network (PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,Research Unit on Applied Molecular Biosciences (UCIBIO), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Lisbon, Portugal
| | - Rita Francisco
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,CDG & Allies - Professionals and Patient Associations International Network (PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,Research Unit on Applied Molecular Biosciences (UCIBIO), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Lisbon, Portugal
| | - Dorinda Marques-da-Silva
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,CDG & Allies - Professionals and Patient Associations International Network (PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,Research Unit on Applied Molecular Biosciences (UCIBIO), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Lisbon, Portugal
| | - Agnes Rafalko
- Glycomine, Inc, 953 Indiana St, San Francisco, CA, 94107, USA
| | - Jaak Jaeken
- Center for Metabolic Diseases, UZ and KU Leuven, Leuven, Belgium
| | - Paula A Videira
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,CDG & Allies - Professionals and Patient Associations International Network (PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,Research Unit on Applied Molecular Biosciences (UCIBIO), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Lisbon, Portugal
| | - Luísa Barros
- CDG & Allies - Professionals and Patient Associations International Network (PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.,Faculdade de Psicologia, Universidade de Lisboa, 1649-013, Lisbon, Portugal
| | - Vanessa Dos Reis Ferreira
- Portuguese Association for Congenital Disorders of Glycosylation (CDG), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal. .,CDG & Allies - Professionals and Patient Associations International Network (PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal.
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Ronen GM, Rosenbaum PL, Boyle MH, Streiner DL. Patient-reported quality of life and biopsychosocial health outcomes in pediatric epilepsy: An update for healthcare providers. Epilepsy Behav 2018; 86:19-24. [PMID: 30036765 DOI: 10.1016/j.yebeh.2018.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
In the 21st century, clinicians are expected to listen to, and understand their patients' views about, their conditions and the effects that these conditions have on their functioning, values, life goals, and welfare. The goals of this review are as follows: (i) to inform, update, and guide clinicians caring for children with epilepsy about developments in the content and new methods of research on patient-reported outcomes, quality of life, and functioning; and (ii) to discuss the value of using these concepts to explore the impact of diverse interventions that are implemented in daily practice. Drawing on the literature and our program of research over the past two decades, we focus on our current understanding of a variety of health concepts and recently acquired knowledge about their significance for the lives of patients and their families. We discuss the advantages of measuring patient-reported outcomes that tell us what is important to patients. We advise on what characteristics to look for when choosing a patient-reported measure, and the relevance of these considerations. In addition, we address gaps in research knowledge and the causes of confusion that have limited their use in our daily clinical practice.
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Affiliation(s)
- Gabriel M Ronen
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada.
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Michael H Boyle
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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20
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Isa F, Turner GM, Kaur G, Kyte D, Slade A, Pankhurst T, Kerecuk L, Keeley T, Ferguson J, Calvert M. Patient-reported outcome measures used in patients with primary sclerosing cholangitis: a systematic review. Health Qual Life Outcomes 2018; 16:133. [PMID: 29976215 PMCID: PMC6034220 DOI: 10.1186/s12955-018-0951-6] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary Sclerosing Cholangitis (PSC) is a rare chronic, cholestatic liver condition in which patients can experience a range of debilitating symptoms. Patient reported outcome measures (PROMs) could provide a valuable insight into the impact of PSC on patient quality of life and symptoms. A previous review has been conducted on the quality of life instruments used in liver transplant recipients. However, there has been no comprehensive review evaluating PROM use or measurement properties in PSC patients' to-date. The aim of the systematic review was to: (a) To identify and categorise which PROMs are currently being used in research involving the PSC population (b) To investigate the measurement properties of PROMs used in PSC. METHODS A systematic review of Medline, EMBASE and CINAHL, from inception to February 2018, was undertaken. The methodological quality of included studies was assessed using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) checklist. RESULTS Thirty-seven studies were identified, which included 36 different PROMs. Seven PROMs were generic, 10 disease-specific, 17 symptom-specific measures and 2 measures on dietary intake. The most common PROMs were the Short form-36 (SF-36) (n = 15) and Chronic liver disease questionnaire (CLDQ) (n = 6). Only three studies evaluated measurement properties, two studies evaluated the National Institute of Diabetes Digestive and Kidney Diseases Liver Transplant (NIDDK-QA) and one study evaluated the PSC PRO; however, according to the COSMIN guidelines, methodological quality was poor for the NIDDK-QA studies and fair for the PSC PRO study. CONCLUSION A wide variety of PROMs have been used to assess health-related quality of life and symptom burden in patients with PSC; however only two measures (NIDDK-QA and PSC PRO) have been formally validated in this population. The newly developed PSC PRO requires further validation in PSC patients with diverse demographics, comorbidities and at different stages of disease; however this is a promising new measure with which to assess the impact of PSC on patient quality of life and symptoms.
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Affiliation(s)
- Fatima Isa
- Public Health England, 5 St Philips Place, Birmingham, B3 2PW UK
| | - Grace M. Turner
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Geetinder Kaur
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Anita Slade
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
| | | | | | - Thomas Keeley
- PAREXEL International, Evergreen House North, 160 Euston Road, London, NW1 2DX UK
| | - James Ferguson
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
- University Hospital Birmingham, Birmingham, B15 2TH UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, B15 2TT UK
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21
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Downing J, Namisango E, Harding R. Outcome measurement in paediatric palliative care: lessons from the past and future developments. Ann Palliat Med 2018; 7:S151-S163. [PMID: 30180720 DOI: 10.21037/apm.2018.04.02] [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] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/20/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The need for paediatric palliative care (PPC) globally is great yet there is limited evidence of the quality or outcomes of the care provided. The lack of an outcome measure for PPC has been consistently cited as one reason for the lack of robust evidence in the field. Thus recommendations have been made for the development of locally relevant, validated tools to measure outcomes for children. METHODS This paper reviews relevant outcomes and quality measures in PPC, the current state of science on outcome measurement for children and young people (CYP) with life-limiting and life-threatening conditions and the development of the African Children's Palliative Outcome Scale (C-POS). Lessons learnt from the past are presented before looking ahead at the need for future developments in outcome measures in PPC. A narrative review was undertaken and authors have drawn upon reflective insights from their collective experiences. RESULTS Outcomes can be measured in a variety of ways, and due to the multi-dimensional nature of PPC, outcomes can be complex and hard to measure. Whilst there are a variety of outcome measures for use in adult palliative care, a similar range of tools does not exist in PPC. Literature reviews have confirmed the absence of a multi-dimensional PPC outcome measurement tool. Following on from their success in developing an outcome scale for adults in Africa, the African Palliative Care Association (APCA) have developed a multi-dimensional outcome tool for PPC-the African C-POS. Tool development and validation followed the COSMIN guidance. The draft C-POS consists of 12 questions, 8 in Section A for the child, and 4 in Section B for the parents/carers. The tool has been developed across eight African countries and is the first specifically designed, multi-dimensional outcome measure for PPC. Lessons have been learnt in the development of outcome scales in palliative care, including those specifically for PPC such as: undertaking research in PPC; the definition of PPC; if you ask a child what their concerns are they will tell you; do you use child and or proxy report? do you have different tools for different ages? what methods of scoring should be used? is it an outcome tool, an assessment tool or both? the length of the outcome measure; the length of time it takes to develop; and, it won't be perfect. Whilst progress has occurred through the development of the C-POS there is still a long way to go in the development of outcome measures for PPC. Future developments include: finalization and publication of the African C-POS; utilization of the C-POS in clinical practice, research and audit; collation and review of data sets; and the development of C-POS in different settings. CONCLUSIONS The measurement of outcomes in PPC is an imperative. Whilst there are challenges in developing outcome tools and utilizing them in practice, these should not prevent us from advancing the field. The development of the first outcome measure for PPC the African C-POS is a key milestone in the ongoing development and utilization of outcome measures for PPC.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, South Africa; Makerere University, Kampala, Uganda; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK.
| | - Eve Namisango
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK; African Palliative Care Association, Kampala, Uganda
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
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22
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Wong D, Cao S, Ford H, Richardson C, Belenko D, Tang E, Ugenti L, Warsmann E, Sissons A, Kulandaivelu Y, Edwards N, Novak M, Li M, Mucsi I. Exploring the use of tablet computer-based electronic data capture system to assess patient reported measures among patients with chronic kidney disease: a pilot study. BMC Nephrol 2017; 18:356. [PMID: 29212466 PMCID: PMC5719517 DOI: 10.1186/s12882-017-0771-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 06/05/2017] [Accepted: 11/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background Collecting patient reported outcome measures (PROMs) via computer-based electronic data capture system may improve feasibility and facilitate implementation in clinical care. We report our initial experience about the acceptability of touch-screen tablet computer-based, self-administered questionnaires among patients with chronic kidney disease (CKD), including stage 5 CKD treated with renal replacement therapies (RRT) (either dialysis or transplant). Methods We enrolled a convenience sample of patients with stage 4 and 5 CKD (including patients on dialysis or after kidney transplant) in a single-centre, cross-sectional pilot study. Participants completed validated questionnaires programmed on an electronic data capture system (DADOS, Techna Inc., Toronto) on tablet computers. The primary objective was to evaluate the acceptability and feasibility of using tablet-based electronic data capture in patients with CKD. Descriptive statistics, Fischer’s exact test and multivariable logistic regression models were used for data analysis. Results One hundred and twenty one patients (55% male, mean age (± SD) of 58 (±14) years, 49% Caucasian) participated in the study. Ninety-two percent of the respondents indicated that the computer tablet was acceptable and 79% of the participants required no or minimal help for completing the questionnaires. Acceptance of tablets was lower among patients 70 years or older (75% vs. 95%; p = 0.011) and with little previous computer experience (81% vs. 96%; p = 0.05). Furthermore, a greater level of assistance was more frequently required by patients who were older (45% vs. 15%; p = 0.009), had lower level of education (33% vs. 14%; p = 0.027), low health literacy (79% vs. 12%; p = 0.027), and little previous experience with computers (52% vs. 10%; p = 0.027). Conclusions Tablet computer-based electronic data capture to administer PROMs was acceptable and feasible for most respondents and could therefore be used to systematically assess PROMs among patients with CKD. Special consideration should focus on elderly patients with little previous computer experience, since they may require more assistance with completion. Electronic supplementary material The online version of this article (10.1186/s12882-017-0771-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorothy Wong
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Shen Cao
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Heather Ford
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Candice Richardson
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Dmitri Belenko
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Evan Tang
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Luca Ugenti
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Eleanor Warsmann
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Amanda Sissons
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Yalinie Kulandaivelu
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Nathaniel Edwards
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Hospital, Toronto, ON, Canada
| | - Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada. .,Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11-PMB-188, Toronto, ON, M5G 2N2, Canada.
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Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, Dyar R, Darlington AS. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res 2017; 26:1659-1672. [PMID: 28251543 PMCID: PMC5486886 DOI: 10.1007/s11136-017-1520-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [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] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. RESULTS 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. CONCLUSION The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.
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Affiliation(s)
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica Robinson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, UK
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Absolom K, Holch P, Warrington L, Samy F, Hulme C, Hewison J, Morris C, Bamforth L, Conner M, Brown J, Velikova G. Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID): a randomised controlled trial in systemic cancer treatment. BMC Cancer 2017; 17:318. [PMID: 28482877 PMCID: PMC5421322 DOI: 10.1186/s12885-017-3303-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/25/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND eRAPID (electronic patient self-Reporting of Adverse-events: Patient Information and aDvice) is an internet based system for patients to self-report symptoms and side effects (adverse events or AE) of cancer treatments. eRAPID allows AE reporting from home and patient reported data is accessible via Electronic Patient Records (EPR) for use in routine care. The system can generate alerts to clinical teams for severe AE and provides patient advice on managing mild AEs. The overall aims of eRAPID are to improve the safe delivery of cancer treatments, enhance patient care and standardise AE documentation. METHODS The trial is a prospective randomised two-arm parallel group design study with repeated measures and mixed methods. Participants (adult patients with breast cancer on neo-adjuvant or adjuvant chemotherapy, colorectal and gynaecological cancer receiving chemotherapy) are randomised to receive the eRAPID intervention or usual care over 18 weeks of treatment. Participants in the intervention arm receive training in using the eRAPID system to provide routine weekly adverse event reports from home. Hospital staff can access eRAPID reports via the EPR and use the information during consultations or phone calls with patients. Prior to commencing the full trial an internal pilot phase was conducted (N = 87 participants) to assess recruitment procedures, consent and attrition rates, the integrity of the intervention information technology and establish procedures for collecting outcome data. The overall target sample for the trial is N = 504. The primary outcome of the trial is quality of life (FACT-G) with secondary outcomes including health economics (costs to patients and the NHS), process of care (e.g. contacts with the hospital, number of admissions, clinic appointments and changes to treatment/medications) and patient self-efficacy. Outcome data is collected at baseline, 6, 12, 18 weeks and 12 months. The intervention is also being evaluated via end of study interviews with patient participants and clinical staff. DISCUSSION The pilot phase was completed in February 2016 and recruitment and attrition rates met criteria for continuing to the full trial. Recruitment recommenced in May 2016 and is planned to continue until December 2017. Overall findings will determine the value of the eRAPID intervention for supporting the care of patients receiving systemic cancer treatment. TRIAL REGISTRATION Current Controlled Trials ISRCTN88520246 . Registered 11 September 2014.
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Affiliation(s)
- Kate Absolom
- Section of Patient Centred Outcomes Research (PCOR), Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Patricia Holch
- Section of Patient Centred Outcomes Research (PCOR), Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Psychology Group, School of Social Sciences, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Lorraine Warrington
- Section of Patient Centred Outcomes Research (PCOR), Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Faye Samy
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Carolyn Morris
- Patient Representative, eRAPID systemic treatment workgroup, Leeds, UK
| | - Leon Bamforth
- Leeds Teaching Hospitals NHS Trust, St James’s Institute of Oncology, Leeds, UK
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Galina Velikova
- Section of Patient Centred Outcomes Research (PCOR), Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, St James’s Institute of Oncology, Leeds, UK
| | - on behalf of the eRAPID systemic treatment work group
- Section of Patient Centred Outcomes Research (PCOR), Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Psychology Group, School of Social Sciences, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Patient Representative, eRAPID systemic treatment workgroup, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, St James’s Institute of Oncology, Leeds, UK
- School of Psychology, University of Leeds, Leeds, UK
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25
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Kool M, van der Sijp JRM, Kroep JR, Liefers GJ, Jannink I, Guicherit OR, Vree R, Bastiaannet E, van de Velde CJH, Marang-van de Mheen PJ. Importance of patient reported outcome measures versus clinical outcomes for breast cancer patients evaluation on quality of care. Breast 2016; 27:62-8. [PMID: 27026219 DOI: 10.1016/j.breast.2016.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/13/2015] [Revised: 11/12/2015] [Accepted: 02/29/2016] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Given increasing numbers of breast cancer survivors, there is an increased focus on quality of life and quality of care. This study aims to investigate whether clinical or patient reported outcomes are most important for perceived quality of care by breast cancer patients. METHODS Overall, 606 patients aged 18 years or older, who underwent breast cancer surgery 9-18 months ago in five hospitals in the Netherlands, were invited to complete an internet-based questionnaire. Patients were asked to judge a random selection of 24 patient profiles and choose which of 2 presented patients had received the best quality of care, using conjoint analysis. The individual relative importance (RI) for each outcome was estimated using Hierarchical Bayes Estimation, and averaged over all patients to assess which outcomes were most important. RESULTS Complete data were available for 350 patients (58%). Avoiding severe breast symptoms was most important for good quality of care according to patients (RI 23.22 [95% Confidence Interval (95% CI) 22.32-24.12]), followed by a 2 year longer disease free survival (18.30 [17.38-19.22]). However, the importance differed by age: younger patients (<50 years) assigned higher importance to longer disease free survival (21.99 [19.52-24.46]) than older patients (65 + years) (15.03 [13.88-16.18]). CONCLUSION Avoiding severe breast symptoms rather than 2 year longer disease free survival is considered most important in our population of breast cancer patients for evaluation of quality of care. These data should thus be included in both information provision prior to treatment choices and post treatment quality of care evaluation.
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Affiliation(s)
- Melissa Kool
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Judith R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilse Jannink
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - Onno R Guicherit
- Department of Surgery, Bronovo Hospital, The Hague, The Netherlands
| | - Robbert Vree
- Department of Surgery, Diaconessenhuis, Leiden, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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White SH, Roberts S, Kuiper JH. The cemented twin-peg Oxford partial knee replacement survivorship: a cohort study. Knee 2015; 22:333-7. [PMID: 26003214 DOI: 10.1016/j.knee.2015.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 10/31/2014] [Revised: 02/09/2015] [Accepted: 03/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND A new twin-peg version of the Oxford knee was introduced in 2003. However, until now there has been no information about its survivorship. The aim of this study was to determine the survivorship, and the patients' perception of outcome over time. METHODS A cohort of all patients treated from 2003 until 2009 using the twin-peg Oxford partial knee was contacted. The main indication for treatment was anteromedial osteoarthritis (AMOA). The Oxford Knee Score (OKS), American Knee Society Functional (AKS-F) score and satisfaction rate were obtained, and the time-to-failure was used to perform a survival analysis. RESULTS There were 249 patients treated, with 288 medial cemented implants. Of these, 248 patients with 287 implants could be contacted and implant survival or failure was verified. Their mean age was 67years (range: 34-94). The mean follow-up time was 5.1years (maximum: 9.2). The nine years cumulative implant survival rate for all cases using revision for any reason to define failure was 98% (95% CI, 84 to 100). There were no cases of femoral loosening. The mean OKS was 22 pre-operatively, 41 at two years, and 41 at final review, at which point 96% of patients were very or fairly pleased with the result. CONCLUSION The survivorship of the twin-peg knee was better than that of the single peg knee at our centre, and appeared no worse than the results of the single peg knee at the originating centre. It can offer secure femoral fixation, sustained clinical benefit and patient satisfaction. LEVEL OF EVIDENCE Level IV case-series.
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Affiliation(s)
- Stephen H White
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, United Kingdom.
| | - Sharon Roberts
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, United Kingdom.
| | - Jan Herman Kuiper
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire SY10 7AG, United Kingdom; Institute for Science and Technology in Medicine, Keele University, United Kingdom.
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