Assessment Of Patient Well-being Research Articles

A Rasch analysis of the Q-LES-Q-SF questionnaire in a cohort of patients with neuropathic pain

Aim: The purpose of this paper is to establish measurement properties of the Quality of Life Enjoyment and Satisfaction Questionnaire short form (Q-LES-Q-SF) employing the Rasch Masters Partial Credit Model. Patients and methods: Consecutive patients with neuropathy (N = 1,301) were interviewed by 86 out patient care neurologists. The physicians recorded patient's gender, age, education, main and associated diagnosis, length of main disease, the Clinical Global Impression (CGI)-Severity scale, and patients filled in the Q-LES-Q-SF questionnaire. Results: The findings establish that a) the instrument is unidimensional; b) 5-point scale categories progress monotonically; c) the construct quality of life was adequately operationalized; d) there was neither floor nor ceiling effect; e) the scale is adequately well targeted; f) there was no differential item functioning found from the viewpoint of gender, age and CGI with exception of the item reflecting sexual drive, interest and/or performance - older patients were less satisfied with their sexual life. Conclusions: Our analysis brought reliable evidence that the Q-LES-Q-SF questionnaire satisfactorily approximates resemblance between theoretical expectations of the Rasch model and our data, and that the instrument appears to be a reliable instrument for assessment of wellbeing in patients with neuropathy.

Introduction to Patient-Reported Outcomes Perspectives Series.

Patient-reported outcomes (PROs) are defined as measurements of any aspect of a patient’s health status that come directly from the patient ( i.e. , without the interpretation of the patient’s responses by a physician or anyone else) ([1][1]). Although assessment of patient wellbeing and symptom

(109) Assessment of self-reported pain and disability and performance on functional tests among osteoarthritis patients: are performance-based measures in the clinic necessary?

Osteoarthritis (OA) is related to increased pain and decreased physical function. Assessment of patient well-being, however, typically relies on patient self-report. Exclusive focus on self-report of subjects’ impressions of what they can do may not be consistent with their actual capacities to perform tasks in everyday life. This study examined relationships among self-reported pain and disability, pre- to post functional test changes in pain and actual performance of functional tests. Subjects with OA pain of the knee (n=38) completed the Pain Disability Index (PDI) and a visual analog scale (VAS) assessing overall pain intensity prior to starting any procedures.

Abstract 19519: Patient Health Questionnaire-9 Correlates with Kansas City Cardiomyopathy Questionnaire and Minnesota Living with Heart Failure Questionnaire in Measuring Heart Failure Patient Well-Being and Predicting Outcomes

Introduction: The assessment of patient well-being and correlation with outcomes is especially difficult, particularly with HF patients. Currently, the time-consuming Kansas City Cardiomyopathy Questionnaire (KCCQ) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) are typically used only in research protocols; conversely, the PHQ-9 is a much simpler questionnaire that can be completed and scored in a typical clinical setting. Hypothesis: We hypothesized that the scores of the PHQ-9 correlate with the scores of the KCCQ and MLHFQ, and that for clinical purposes, it may be beneficial to substitute the longer questionnaires with the PHQ-9. Methods: Using data obtained through the Vanderbilt Main Heart Registry, we compared patient scores on the KCCQ and MLHFQ in each depression category (none, mild, moderate, moderately-severe, and severe) in 294 patients with heart failure, as defined by patient PHQ-9 scores. We also assessed survival data for the patients that have been followed up to two years with annual PHQ-9 scores to evaluate the correlation between depression category and mortality. Results: The study group (N=294) was 55 years (range 18-90) and 60% male, most with symptomatic HF (93% ≥ NYHA II)( Table 1.). Twenty-five percent of patients with severe depression are deceased. Preliminary results indicate there is a direct correlation between PHQ-9 category and corresponding KCCQ (p < 0.001) and MLHFQ (p < 0.001) scores (Figure 1.). Conclusion: Our findings suggest that the PHQ-9 can be readily used as a screen for depression and quality of life in HF patient in the clinical setting. Additionally, PHQ-9 score appears highly correlated to major outcomes.

Commentary on an article by M.D. Daubs, MD, et al.: “Clinical Impression Versus Standardized Questionnaire: The Spinal Surgeonʼs Ability to Assess Psychological Distress”

The authors of this interesting study should be congratulated on a well-designed and executed clinical study that raises questions regarding the assessment of emotional well-being in patients with spinal disorders. This study attempted to determine whether spinal surgeons and other nonoperative spine specialists were able to accurately assess psychological distress in patients with spinal problems. The authors asked 400 new patients who presented with spinal disorders to complete the Distress and Risk Assessment Method (DRAM) psychological distress questionnaire and then determined in a blinded fashion how accurate eight physicians were in assessing the patients’ level of distress. In general, the physicians were better able to identify patients who had a relatively normal level of stress, but their ability to identify patients who were classified as having a high level of psychological distress was poor. Spinal surgeons seemingly were worse than the nonoperative physicians in their ability to identify patients in distress. The authors advocate that all spinal surgeons and specialists should utilize the DRAM to better identify patients in psychological distress in order to improve the clinical outcomes of those patients. On …

In reply to Mauer et al. “Statistical methodology is crucial in prognostic factor-analysis of health-related quality of life”

I would like to thank Dr. Mauer and researchers from the European Organisation for Research and Treatment of Cancer (EORTC) [1] for their important comments on our recent publication regarding health-related quality of life (QOL) in gastric cancer patients treated with first-line chemotherapy [2]. They express their opinion that the modeling strategy lacked clear selection criteria and validation. Clearly our analysis, which was conducted in a single center on a relatively small number of patients, did not establish a definitive causal relationship between baseline QOL and survival. However, there is agreement that QOL provides an assessment of patient well-being as well as of cancer survival [3]. As clinical researchers, we share Dr. Mauer’s conclusion that the results lacked adequate validation. Although external or internal validation of our final model can be readily performed these days, bootstrap is a computationally very expensive technique. The prognostic value of social functioning in our analysis, as shown in Fig. 1, was evident (the absolute difference of 1-year mortality was 0.27; 95% confidence interval [CI] of 0.8–0.87). Patients with major comorbidities or poor performance status were excluded from our randomized trials. The absolute survival advantage, therefore, most likely overestimate the advantage in the general population of gastric cancer patients. We also emphasize that our analysis represents only a small sample of patients and that patients treated with different chemotherapy regimens were included. What is clear at this time is that pretreatment measurement of QOL could help doctors in their clinical decisions as it relates to patients’ expected survival. In addition to providing prognostic information, QOL assessment may be useful to improve communication with the patient and help doctors to design tailored supportive care based on correct identification of the overall burden of symptoms, the relative importance given to each of them by the patient, and the patient’s expectations regarding treatment efficacy. Nevertheless, our results, as well as a recently published validation study by EORTC [4], may be helpful for clinical understanding of QOL in cancer patients.

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program

Objective: To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. Method: The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. Results: Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. Conclusion: These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.

Colonic Motility in Profoundly Disabled People: A comparison of massage and laxative therapy in the management of constipation

Summary This pilot study compared abdominal massage with laxative treatment in the management of constipation in 32 profoundly disabled, institutionalised adults. A randomised cross-over design was used. After an initial 16-day baseline measurement phase without any treatment, there followed two seven-week treatment phases separated by a one-week washout period. Each subject received seven weeks of massage and seven weeks on his or her previous laxative regimen. Primary outcome measures were gastro-intestinal and segmental transit times, measured at the end of the baseline phase and of each treatment phase. Secondary measures included stool frequency, size and consistency, the requirement for enemas and an assessment of patient well-being. The median value of total colonic transit time was 183 hours for the baseline phase and 159 hours for all treatment phases. There was no evidence of any statistically significant treatment differences between laxative and massage therapy for right, left or rectosigmoid segments either separately or in total. Analysis of secondary outcome measures also failed to find any treatment preferences. These results reveal the grossly abnormal colonic transit times of the study population at all times. The effects of laxative and massage therapy within this environment were not demonstrably different.

Antepartum fetal heart rate monitoring in multiple pregnancy.

The assessment of fetal wellbeing in patients with multiple pregnancy by nonstressed antepartum cardiotocography is technically feasible and of clinical value. In 50 patients (101 babies) who were monitored during the antepartum period, there were five patients in whom one of a pair of twins showed a non-reactive cardiotogram. Four of these babies died (two intrauterine deaths and two neonatal deaths). All of these five babies were growth retarded at birth. The cardiotocograms from the other 96 fetuses were 'reactive' and these babies were normal. Cardiotocography seems to be a better predictor of perinatal mortality and morbidity than serial urinary oestrogens or serial biparietal diameter measurements in multiple pregnancy.