Global Rating Of Satisfaction Research Articles

Is device guided training targeted to the craniocervical flexor and extensor muscles efficacious? A preliminary randomized controlled trial in a cervicogenic headache population

BackgroundSpecific neck exercise is effective in the management of cervicogenic headache (CH). The Spinertial device was designed to facilitate craniocervical flexion and extension training, but its efficacy, judged on change in headache impact, has not been tested. ObjectiveTo compare guided and progressive resisted specific neck exercise targeted to the craniocervical flexors and extensors (SNE-fe) performed with Spinertial device to progressive SNE-fe without the device in a cohort with CH. DesignRandomised controlled trial. MethodsTwenty-eight participants with CH were randomly allocated to the Spinertial group (SG) or SNE-fe exercise group without the device (EG). Both groups performed 12 sessions of SNE-fe over six-weeks. The primary outcome was headache impact (HIT-6). Secondary outcomes were the craniocervical flexion test (CCFT), upper cervical (UCS) and lower cervical range of movement, flexion rotation test (FRT) analysed as more or less restricted side (MRS, LRS), the self-reported global rating of change (GROC-scale) and satisfaction with the exercise program (PACES). Outcomes were measured at baseline, post-intervention (T1) and after 1-month (T2). ResultsSignificant between-groups differences were found favouring the SG for HIT-6 (T1 p = 0.010, d = 0.5; T2 p < 0.004, d = 0.4), CCFT, UCS ROM, FRT MRS, FRT LRS, PACES and GROC-scale (T1: all p < 0.01; T2: all p < 0.01). Effects sizes were large (>0.8) at T1 and T2. No between-groups differences were found for lower cervical ROM. ConclusionTraining with the Spinertial was more effective than SNE without the device for improving the impact of headache, the endurance of deep neck flexors and UCS ROM in participants with CH.

Developing a patient satisfaction measure for imaging-based patient information during clinical consultations

Different types of medical imaging are increasingly being used to explain specific aspects of injuries to patients during consultations. However, there are no validated questionnaires available yet that specifically measure patients’ satisfaction with the use of such images. The objective of this study was to develop and evaluate a patient-centred measure of satisfaction with the use of medical imaging modalities in clinical treatment. A preliminary 22-item version of the Questionnaire for Patient Satisfaction with Imaging (QPSI) was developed based on extant literature and interviews with trauma patients. Final item selection and psychometric evaluations were conducted amongst a sample of 106 hospital trauma patients who were shown medical images of their injuries. The psychometric analyses resulted in a final 13-item questionnaire comprising two subscales that measure the importance of seeing the images (9 items) and the clearness of the image (4 items). Both subscales showed adequate internal consistency (α = 0.84 and 0.75). The subscales were weakly intercorrelated (ρ = 0.34) and were both significantly and independently associated with patients’ global ratings of satisfaction with the use of imaging. The final two-dimensional QPSI is an innovative, reliable and valid questionnaire for measuring patients’ satisfaction with imaging-based information during clinical consultations.

The Days Add Up: Daily Marital Discord and Depressive Reactivity Linked to Past-Month Depressed Mood and Marital Risk across 10 Years.

Marital discord fuels depression, according to decades of research. Most prior studies in this area have focused on macro-longitudinal change in depression over the course of years, and on global ratings of marital satisfaction. Less work has examined fluctuations in depressed mood and marital discord in daily life, and none has investigated associations of short-term patterns with longer-term depressed mood and marital outcomes. Using data from participants in the Midlife in the U.S. (MIDUS) project, the current study examined daily associations between marital discord and depressed mood, as well as their links to concurrent and prospective patterns of past-month depressed mood and marital risk. Results showed that, on average, depressed mood rose on days when individuals had an argument or tension with their spouse (i.e., marital discord). More frequent daily marital discord was also associated with greater past-month depressed mood and marital risk, above and beyond prior levels. Those with larger depressive mood responses to discord in daily life (i.e., greater reactivity) exhibited higher concurrent past-month depressed mood and greater 10-year increases in depressed mood. As the first study to link daily marital patterns to concurrent and prospective changes in depressed mood and marital outcomes, this investigation uncovered two novel processes-daily marital discord and depressive reactivity-as important for understanding long-term patterns of marital risk and depression.

Does subscapularis integrity influence outcome following latissimus dorsi tendon transfer for irreparable cuff tears? A comparative series of 48 patients

BackgroundLatissimus dorsi tendon transfer (LDTT) remains a surgical option for massive irreparable rotator cuff tears. Despite a lack of comparative studies, subscapularis insufficiency has been reported as a contraindication. This study investigated the clinical outcome at a minimum 2-years post-surgery, in patients undergoing LDTT with varied subscapularis integrity. MethodsThis retrospective study included 48 patients, of which 22 underwent LDTT with an intact subscapularis (age 56.9 years, review time 79.6 months, males 68.2%) and 26 with partial (16 patients) or full-thickness (10 patients) subscapularis tearing (age 57.4 years, review time 73.3 months, males 73.1%) between 2004 and 2018. Pre-operative imaging ascertained subscapularis status. Outcomes included the Upper Extremity Functional Index (UEFI), Global Rating of Change (GRC) and patient satisfaction. ResultsNo significant group differences were observed in age (p = 0.617) or review time (p = 0.555), nor the UEFI (intact 69.6, not intact 67.0, p = 0.265) or GRC (intact 3.6, not intact 2.9, p = 0.265). High levels of patient satisfaction were observed in both groups for pain relief, improving the ability to undertake daily and recreational activities, and overall satisfaction (intact 95.5–100.0%, not intact 92.3–96.2%). ConclusionLDTT resulted in encouraging clinical scores and high satisfaction levels, irrespective of the degree of untreated, underlying subscapularis integrity. Level of evidenceTherapeutic Level III.

Validity and reliability of global ratings of satisfaction with epilepsy surgery.

We aimed to assess the reliability and validity of single-item global ratings (GR) of satisfaction with epilepsy surgery. We recruited 240 patients from four centers in Canada and Sweden who underwent epilepsy surgery ≥1year earlier. Participants completed a validated questionnaire on satisfaction with epilepsy surgery (the ESSQ-19), plus a single-item GR of satisfaction with epilepsy surgery twice, 4-6weeks apart. They also completed validated questionnaires on quality of life, depression, health state utilities, epilepsy severity and disability, medical treatment satisfaction and social desirability. Test-retest reliability of the GR was assessed with the intra-class correlation coefficient (ICC). Construct and criterion validity were examined with polyserial correlations between the GR measure of satisfaction and validated questionnaires and with the ESSQ-19summary score. Non-parametric rank tests evaluated levels of satisfaction, and ROC analysis assessed the ability of GRs to distinguish among clinically different patient groups. Median age and time since surgery were 42years (IQR 32-54) and 5years (IQR 2-8), respectively. The GR demonstrated good to excellent test-retest reliability (ICC=0.76; 95% CI 0.67-0.84) and criterion validity (0.85; 95% CI 0.81-0.89), and moderate correlations in the expected direction with instruments assessing quality of life (0.59; 95% CI 0.51-0.63), health utilities (0.55; 95% CI 0.45-0.65), disability (-0.51; 95% CI -0.41, -0.61), depression (-0.48; 95% CI -0.38, -0.58), and epilepsy severity (-0.48; 95% CI -0.38, -0.58). As expected, correlations were lower for social desirability (0.40; 95% CI 0.28-0.52) and medical treatment satisfaction (0.33; 95% CI 0.21-0.45). The GR distinguished participants who were seizure-free (AUC 0.75; 95% CI 0.67-0.82), depressed (AUC 0.75; 95% CI 0.67-0.83), and self-rated as having more severe epilepsy (AUC 0.78; 95% CI 0.71-0.85) and being more disabled (AUC 0.82; 95% CI 0.74-0.90). The GR of epilepsy surgery satisfaction showed good measurement properties, distinguished among clinically different patient groups, and appears well-suited for use in clinical practice and research.

Evaluating satisfaction with the quality and provision of end-of-life care for patients from diverse ethnocultural backgrounds

BackgroundRecently immigrated and ethnic minority patients in Ontario, Canada are more likely to receive aggressive life-prolonging treatment at the end of life in comparison to other patients. To explore this finding further, this survey-based observational study aimed to evaluate satisfaction with the quality of end-of-life care for patients from diverse ethnocultural backgrounds.MethodsThe End-of-Life Satisfaction Survey was used to measure satisfaction with the quality of inpatient end-of-life care from the perspective of next-of-kin of recently deceased patients at Sunnybrook Health Sciences Centre in Toronto, Ontario (between March 2012 to May 2019). The primary outcome was the global rating of satisfaction. Associations with patient ethnicity, patient religion, level of religiosity/spirituality, language/communication barriers, and location of death were assessed using univariable and multivariable modified Poisson regression. Secondary outcomes included differences in satisfaction and rates of dying in intensive care units (ICU) among patient population subgroups, and identification of high priority areas for quality-of-care improvement.ResultsThere were 1,543 respondents. Patient ethnicities included Caucasian (68.2%), Mediterranean (10.5%), East Asian (7.6%), South Asian (3.5%), Southeast Asian (2.1%) and Middle Eastern (2.0%); religious affiliations included Christianity (66.6%), Judaism (12.3%) and Islam (2.1%), among others. Location of death was most commonly in ICU (38.4%), hospital wards (37.0%) or long-term care (20.0%). The mean(SD) rating of satisfaction score was 8.30(2.09) of 10. After adjusting for other covariates, satisfaction with quality of end-of-life care was higher among patients dying in ICU versus other locations (relative risk [RR] 1.51, 95%CI 1.05-2.19, p=0.028), lower among those who experienced language/communication barriers (RR 0.49 95%CI 0.23-1.06, p=0.069), and lower for Muslim patients versus other religious affiliations (RR 0.46, 95%CI 0.21-1.02, p=0.056). Survey items identified as highest priority areas for quality-of-care improvement included communication and information giving; illness management; and healthcare provider characteristics such as emotional support, doctor availability and time spent with patient/family.ConclusionSatisfaction with quality-of-care at the end of life was higher among patients dying in ICU and lower among Muslim patients or when there were communication barriers between families and healthcare providers. These findings highlight the importance of measuring and improving end-of-life care across the ethnocultural spectrum.

An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care.

PurposeThis study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices.Materials and MethodsPatients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period.ResultsOf 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model.ConclusionThe ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.

Determining the feasibility of a trial to evaluate the effectiveness of phototherapy versus placebo at reducing pain during physical activity\xa0for people with knee osteoarthritis: a pilot randomized controlled trial\xa0

BackgroundAlthough practice guidelines recommend physical activity and exercise for the management of knee osteoarthritis, pain is a common barrier to participation. Phototherapy has been shown to reduce pain intensity for people with knee osteoarthritis, but it is unclear if it reduces pain during physical activity or contributes to improved rehabilitation outcomes.ObjectiveThe aim of this study is to assess the feasibility of performing a fully powered randomized controlled trial (RCT) comparing an active phototherapy intervention versus placebo on pain during physical activity for people with knee osteoarthritis.MethodsA pilot RCT was conducted to test the feasibility of a trial comparing 8-sessions (4 weeks) of active phototherapy versus placebo. People were able to participate if they (1) were an English speaking adult (> 18 years of age), (2) had received a diagnosis of knee osteoarthritis from a physician, and (3) self-reported experiencing pain and disability related to their knee osteoarthritis for > 3 months. Primary outcomes were the feasibility of participant recruitment, retention, assessment procedures, and maintaining high treatment fidelity. Secondary outcomes piloted for a full trial included pain during physical activity (primary outcome of full trial); self-reported pain severity, physical function, stiffness, adherence to prescribed exercise, global rating of change, patient satisfaction, and adverse events; 6-min walk test; and pressure pain threshold.ResultsTwenty participants (4 men; 16 women) with knee osteoarthritis and a mean age of 63.95 (SD: 9.27) years were recruited over a 3-week period (6.7 participants per week). Fifteen out of 20 (75%) of participants completed the primary outcome assessment at 4 weeks and 19/20 (95%) of participants were retained and completed the final 16-week assessment. Overall, 89% of all assessment items were completed by participants across all time-points. Fifteen out of 20 participants (75%) completed all 8 treatment sessions. Treatment fidelity was 100% for all completed treatment sessions. No adverse events were reported by participants in either group.ConclusionsResults suggest that the trial methodology and intervention are feasible for implementation in a fully powered randomized controlled trial to determine the effectiveness of phototherapy at reducing pain during physical activity for people with knee osteoarthritis.Trial registrationClinicalTrials.gov, NCT04234685, January 21, 2020–Retrospectively registered.

Measuring the quality of nursing clinical placements and the development of the Placement Evaluation Tool (PET) in a mixed methods co-design project

BackgroundThe quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia.MethodsAn exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019–20, to confirm validity, reliability and feasibility.ResultsThe PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students’ comments, the tool was deemed applicable and feasible.ConclusionsThe PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.

Feasibility of a Randomized Controlled Trial of Paediatric Interdisciplinary Pain Management Using Home-Based Telehealth.

PurposeChronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care.Patients and MethodsParent–adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11–17) had experienced primary pain for >3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention.ResultsEighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5–9 and Hybrid-PIPP median 8.5, range 5–10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported.ConclusionThe study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications.RegistrationANZTR(ACTRN2614000489695).

Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial.

In people with carpal tunnel syndrome who are waitlisted for surgical consultation, does a therapist-led care pathway involving education, splinting and exercises reduce the need for surgery and improve patient outcomes? A multicentre, randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis. One hundred and five people with electrodiagnostically confirmed carpal tunnel syndrome on a waitlist for surgical consultation and recruited from four public hospitals in Australia. The experimental group (n= 52) received a one-off group session of education, splinting, and nerve and tendon gliding exercises. The control group (n= 53) continued on the waitlist without additional care. The primary outcome measures were conversion to surgery by 24 weeks, the global rating of change (GROC) scale and patient satisfaction. Secondary outcomes included symptom severity and functional limitation. At 24 weeks, conversion to surgery was 59% in the experimental group and 80% in the control group (risk difference-0.21, 95% CI-0.38 to-0.03). More participants in the experimental group identified as improved at 6 weeks (20% vs 4%; risk difference 0.15, 95% CI 0.03 to 0.28) but not at 24 weeks (24% vs 10%; risk difference 0.14, 95% CI-0.01 to 0.29). The intervention was also estimated to be beneficial on some measures of satisfaction, symptom severity and functional limitation. The study's estimates of the benefits came with some uncertainty, which makes it unclear whether the wider population of people awaiting carpal tunnel surgery would consider that the benefits make the intervention worthwhile. No serious adverse effects were reported. A therapist-led pathway reduced conversion to carpal tunnel surgery and increased perceived improvement and satisfaction in people who were already on a waitlist for surgical consultation. ACTRN12613001095752.

Health-Related Quality of Life Impairments and Benefits 15-19 Years after Lung or Heart Transplant

Growing numbers of patients are entering the very late term period (15+ yrs) of survivorship after cardiothoracic transplant (CTx). Their health-related quality of life (HRQOL) is unknown. We examined (a) degree of late-term HRQOL impairment in multiple domains, (b) HRQOL benefit in areas of personal growth and life satisfaction, and (c) demographic, psychosocial, and clinical correlates of HRQOL. Among 178 lung and 126 heart recipients from a single-site prospective study during the first 2 yrs post-CTx, we recontacted survivors 15-19 yrs post-CTx. We used validated scales to assess HRQOL impairments (SF-36) and benefits (personal growth from transplant experience [Post-Traumatic Growth Inventory]; having new life goals [Life Engagement Scale]; global life satisfaction rating). We examined HRQOL outcomes' associations with other patient characteristics using multivariable regression. Of 82 survivors, 64 (84%) were assessed (n=29 lung, 35 heart recipients; M±SD=16±1 y post-CTx, range 15-19; 61% male; age 66±11). They were impaired in physical functional HRQOL domains, relative to norms (Fig 1). Mean mental health and social functioning were similar to or better than norms. Personal growth, and life engagement and satisfaction averaged higher than the scales' midpoints (p<.05) and exceeded norms. More concurrent dyspnea symptoms, poorer family caregiver support, and low feelings of self-efficacy were associated (p<.05) with greater HRQOL impairment and less HRQOL benefit. Other factors (eg, demographics, lung v heart transplant, chronic graft rejection) did not predict these outcomes. Despite physical functional HRQOL impairments in the late years after CTx, mental and social HRQOL is strikingly high and other HRQOL benefits are prominent. Because patients with more dyspnea and poorer psychosocial resources appear at risk for more HRQOL impairment and less HRQOL benefit, interventions targeting such individuals may help to maximize their HRQOL.

Cultural Adaptation and Validation of the Portuguese Version of the CANHELP Lite Bereavement Questionnaire.

Background: Satisfaction with care is an important outcome measure in end-of-life care. Validated instruments are necessary to evaluate and disseminate interventions that improve satisfaction with care at the end of life, contributing to improving the quality of care offered at the end of life to the Portuguese population. The purpose of this study was to perform a cross-cultural adaptation and psychometric analysis of the Portuguese version of the CANHELP Lite Bereavement Questionnaire. Methods: Methodological research with an analytical approach that includes translation, semantic, and cultural adaptation. Results: The Portuguese version comprised 24 items. A panel of experts and bereaved family members found it acceptable and that it had face and content validity. A total of 269 caregivers across several care settings in the northern region of Portugal were recruited for further testing. The internal consistency analysis of the adapted instrument resulted in a global alpha value of 0.950. The correlation between the adapted CANHELP questionnaire and a global rating of satisfaction was of 0.886 (p < 0.001). Conclusions: The instrument has good psychometric properties. It was reliable and valid in assessing caregivers’ satisfaction with end-of-life care and can be used in both clinical and research settings.

Effectiveness of Combined Behavioral and Drug Therapy for Overactive Bladder Symptoms in Men

First-line behavioral and drug therapies for overactive bladder (OAB) symptoms in men are effective but not usually curative. To determine whether combining behavioral and drug therapies improves outcomes compared with each therapy alone for OAB in men and to compare 3 sequences for implementing combined therapy. In this 3-site, 2-stage, 3-arm randomized clinical trial, participants were randomized to 6 weeks of behavioral therapy alone, drug therapy alone, or combined therapy followed by step-up to 6 weeks of combined therapy for all groups. Participants were recruited from 3 outpatient clinics and included community-dwelling men 40 years or older with urinary urgency and 9 or more voids per 24 hours. Data were collected from July 2010 to July 2015 and analyzed from April 2016 to September 2019. Behavioral therapy consisted of pelvic floor muscle training with urge suppression strategies and delayed voiding. Drug therapy included an antimuscarinic (sustained-release tolterodine, 4 mg) plus an α-blocker (tamsulosin, 0.4 mg). Seven-day bladder diaries completed before and after each 6-week treatment stage were used to calculate reduction in frequency of urination (primary outcome) and other symptoms (ie, urgency, urgency incontinence, and nocturia). Other secondary outcomes included validated patient global ratings of improvement and satisfaction, Overactive Bladder Questionnaire score, and International Prostate Symptom Score. Of the 204 included men, 133 (65.2%) were white, and the mean (SD) age was 64.1 (11.1) years. A total of 21 men discontinued treatment and 183 completed treatment. Mean (SD) voids per 24 hours decreased significantly in all 3 groups from baseline to 6-week follow-up (behavioral therapy: 11.7 [2.4] vs 8.8 [2.1]; change, 2.9 [2.4]; percentage change, 24.7%; P < .001; drug therapy: 11.8 [2.5] vs 10.3 [2.7]; change, 1.5 [2.3]; percentage change, 12.7%; P < .001; combined therapy: 11.8 [2.4] vs 8.2 [2.3]; change, 3.6 [2.1]; percentage change, 30.5%; P < .001). Intention-to-treat analyses indicated that posttreatment mean (SD) voiding frequencies were significantly lower in those receiving combined therapy compared with drug therapy alone (8.2 [2.3] vs 10.3 [2.7]; P < .001) but not significantly lower compared with those receiving behavioral therapy alone (8.2 [2.3] vs 8.8 [2.1]; P = .19) and were lower for behavioral therapy alone compared with drug therapy alone (8.8 [2.1] vs 10.3 [2.7]; P < .001). At 12-week follow-up, after all groups had received combined therapy, improvements in mean (SD) voids per 24 hours were also greatest for those receiving initial combined therapy compared with baseline (behavioral therapy: 11.7 [2.4] vs 8.0 [2.2]; change, 3.7 [2.3]; percentage change, 31.6%; P < .001; drug therapy: 11.8 [2.5] vs 8.6 [2.3]; change, 3.2 [2.5]; percentage change, 27.1%; P < .001; combined therapy: 11.8 [2.4] vs 8.0 [2.2]; change, 3.8 [2.1]; percentage change, 32.2%; P < .001), but there were no statistically significant group differences on primary or secondary measures. Combining behavioral and drug therapy yields greater improvements in OAB symptoms than drug therapy alone but not behavioral therapy alone. When using a stepped approach, it is reasonable to begin with behavioral therapy alone. ClinicalTrials.gov identifier: NCT01175382.

A uniform data set for determining outcomes in allied health primary contact services in Australia.

The project aim was to develop and implement a set of metrics to capture and demonstrate the performance of newly established allied health primary contact services. Selection of the metrics and performance indicators was guided by an existing state-wide data collection system and from a review of the published literature. The metrics were refined after consultation with a working group of health service managers and clinicians. The data collection and reporting framework were developed for use in allied health primary contact services and implemented at public health facilities in Queensland, Australia. The set of metrics consists of 18 process and outcome measures. Patient-reported metrics include the global rating of change scale and patient satisfaction. Service metrics include wait times; referral source; triage category; diagnosis; occasions of service; referrals and investigations initiated; effects; care duration; discharge status; waitlist reinstatement reasons; treatment non-completion reasons; and expedited care. Safety, patient demographics and service improvement metrics were included. The metrics will enable analysis of the effectiveness of allied health primary contact services and will facilitate reporting, advocacy, service improvement, service continuity and research. The metrics are suitable for use by all providers of allied health primary contact services in hospital and primary care settings.

222 Biofeedback Therapy for Dyssynergic Defecation Is Effective Among Patients With Opioid Exacerbated Constipation

INTRODUCTION: Up to 90% of patients on opioids complain of constipation (Wurzelmann et al, 2007). Among opioid users, causes of chronic constipation can be multifactorial and related to other contributing factors such as dyssynergic defecation (DD). Biofeedback (BFB) therapy has been shown to be effective in patients with DD, but has not been studied among those who have DD and are on opioids. METHODS: This study was a retrospective analysis of patients enrolled in BFB for DD between 2015 to 2018 at a tertiary referral motility program. For patients that had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each BFB visit. RESULTS: 117 patients met criteria, of these, 20 patients were on active opioid therapy. Compared to those not on narcotic analgesics, opioids users were more likely to have a higher baseline defecation index (DI), intrarectal pressure divided by intra-anal pressure during simulated defecation (0.669 vs. 0.456 P &lt; 0.0007). Decreased rectal sensation at baseline was seen in 20% of opiate patients and 19% of those not on opioids (P = 1.0). Opiate users compared to those not on narcotic analgesics also had a lower baseline health rating on the SF-36 scale (3.9 vs. 3.4 1-5 Likert scale P = 0.05) and were more likely to withdraw before completing a full course of BFB (P &lt; 0.01). On stool diary, opiate users did not report a significant improvement in global bowel satisfaction rating (2.9 to 4.2, 10-point Likert scale P = 0.13), in contrast to non-opiate users who did repot improvement (2.7 to 4.9, P &lt; 0.0001). Opiate users, however, had a significant decrease in number of stooling medications used (1.8 to 1.1 P = 0.04). On HR-ARM, there was a greater change in DI among non-opiate users as compared to opiate users. After BFB, opiate users effectively normalized their dyssynergia (79% improved) (P &lt; 0.0001). Non-opiate users also showed significant improvement in normalizing their dyssynergia (74%) (P &lt; 0.0001). CONCLUSION: Patients with opioid exacerbated constipation and DD showed meaningful clinical improvement in both subjective outcomes as well as manometric parameters. While they had lower baseline health rating at the outset and did not report significant improvement in global bowel satisfaction rating, unlike the non-opioid users, they nevertheless clearly benefited from BFB therapy. Overall, this data suggests that opioid users with DD may benefit from enrollment in BFB therapy.

2113 Biofeedback Therapy With the Rao Protocol for Dyssynergic Defecation Is Effective Among Patients With Inflammatory Bowel Disease

INTRODUCTION: Dyssynergic defecation (DD) symptoms are common in patients with inflammatory bowel disease (IBD). Biofeedback (BFB) is a standard of care treatment for DD, however, few studies have evaluated its efficacy in IBD patients with DD. CASE DESCRIPTION/METHODS: This is a case series that looks at 5 patients with IBD who were enrolled in BFB for DD between 2015 to 2018 at a tertiary referral motility program. All patients had greater than two sessions, survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each DD BFB visit. The Rao protocol for BFB is a physician-led program that consists of an active phase with the number of sessions tailored to each patient’s progress, followed by refresher sessions. A solid state HR-ARM catheter is utilized with sensors in the rectum/pouch and anal canal. Stool retention simulation consists of inflation of a rectal balloon during manometry based BFB. A total of 5 patients were identified for this case series. The average age of the patients was 46 years. Of these 5 patients, 3 had Crohn’s disease and 2 had ulcerative colitis. After completion of BFB, IBD patients experienced a significant improvement in stool form (Bristol stool scale type 2 to 6, P = 0.01), rise in the defecation index (intrarectal/pouch pressure divided by intra-anal pressure during simulated defecation; 0.39 to 0.81, P = 0.04), and complete resolution of DD with a rectal balloon inflated to simulate stool present in the rectum/pouch on final BFB session (P &lt; 0.01). IBD patients did not report a significant improvement in global bowel satisfaction rating on a 10-point Likert scale (2.2 to 3.6, P = 0.22). DISCUSSION: Biofeedback with the Rao protocol in conjunction with use of HR-ARM catheters shows efficacy in the correction of dyssynergia pattern, leading to improvement in objective measures such as defecation index and stool form on diary in IBD patients. Subjective improvement in global bowel satisfaction rating was less than the non-IBD cohort. In conclusion, patients with IBD who are found to have DD should be given consideration for enrollment in a BFB program, which is a labor-intensive approach but has no adverse effects.

Development and validation of a French questionnaire concerning patients\u2019 perspectives of the quality of palliative care: the QUALI-PALLI-Patient

BackgroundIndicators for the quality of palliative care are a priority of caregivers and managers to allow improvement of various care settings and their comparison. The involvement of patients and families is of paramount, although this is rarely achieved in practice. No validated assessment tools are available in French. Simple cultural adaption of existing questionnaires may be insufficient, due to the varying organization of care in different countries.The purpose of this study was to develop and validate a new instrument to measure the quality of palliative care and satisfaction from the patient point of view.MethodsResults from a qualitative study were used by a multi-professional workgroup to construct an initial set of 42 items exploring six domains. A cross-sectional survey was conducted in seven hospitals, encompassing three care settings: two palliative care units, one palliative care hospital, and four standard medical units with a mobile palliative care team. All items were assessed for acceptability. We conducted exploratory structural analysis using Principal Component Analysis (PCA), and evaluated external validity by comparison against global rating of satisfaction and the MD Anderson Symptom Inventory (MDASI) questionnaire.ResultsA total of 214 patients completed the questionnaire. After removing 7 items from the response distribution, PCA identified eight interpretable domains from the 35 final items: availability of caregivers, serenity, quality of information, pain management, caregivers’ listening skills, psychosocial and spiritual aspects, possibility to refuse (care or volunteers), and respect for the patient. Internal consistency was good or acceptable for all subscales (Cronbach’s α 0.5–0.84), except the last one (0.15). Factorial structure was found globally maintained across subgroups defined by age, sex, Palliative Performance Scale (PPS ≥ 60%, 40–50% and ≤ 30%), and care settings. General satisfaction was inversely correlated with the 2 scores of the MDASI questionnaire: symptoms’ severity and impact on life. Each subscale, except “possibility to refuse”, correlated with general satisfaction.ConclusionsQuali-Palli-Pat appears to be a valid, reliable, and well-accepted French tool to explore the quality of care and the satisfaction of palliative care patients. It should be confirmed in a wider sample of care settings.Trial registrationclinicaltrials.gov NCT02814682, registration date 28.6.2016.

An alternative methodology for evaluating the service quality of urban taxis

This paper proposes an alternative methodology to evaluate the service quality of urban taxis and develops a level-of-service (LOS) standard for taxi customers to monitor performance. A customer satisfaction survey was conducted from January to March 2013 in Hong Kong, with the respondents invited to give specific satisfaction ratings for ten service aspects individually and a global satisfaction rating for the overall taxi service quality, as well as to rank the important aspects that influence the given global rating. The ten service aspects related to the amount of time consumed when taking taxis, services and facilities provided for finding taxis, internal environments of taxis, and personal services provided by taxi drivers. An enhanced linear regression model was developed to identify the priority areas for improvement of urban taxi service quality. Based on the numerical score of overall taxi service quality, a six-level LOS standard, similar to academic grading, is introduced accordingly to improve the general public's understanding of the current service level. This paper discusses the potential policy implications to enhance the taxi service quality in Hong Kong, which can be applied to other metropolitan cities that provide similar urban taxi services.

Study of the level of satisfaction of users of the dental service of an institution of the contributory regime in Cali, June - August 2010

Objective: To determine the level of satisfaction of users of dentistry of an institution of contributory regime at the city of Cali.&#x0D; Methods: This is a cross-sectional study. The calculated sample size was 242 patients obtained by simple random probability sampling. The dates were analyzed in the statistical package Epi-info v. 5.4.&#x0D; Results: Female gender predominated with 62,8% (CI 95%: 56,4 – 68,9); the more prevalent type of membership was contributor with 60,7% (CI 95%: 54,3 – 66,9). Despite of limitations of Health Mandatory Plan in dentistry area, the global rating of satisfaction was 4.1 in a scale from 1 to 5.&#x0D; Conclusions: The level of satisfaction of the users of dentistry service at the surveyed institution was 82%. Today the knowledge of level of satisfaction of users of health services is an important tool for the administration, researching, and marketing of these services.