Health-related Outcome Measures Research Articles

The effectiveness of telehealth for a caregiver wellness program

Introduction This study compared outcomes of a telehealth and in-person delivered caregiver wellness program called Powerful Tools for Caregivers (PTC). Methods A total of 11 pairs of PTC class leaders delivered in-person and telehealth PTC classes. Caregiver participants completed a health-related questionnaire one week before, one week after, and six months after completing the program. A split-plot, mixed-design analysis of variance (ANOVA) and t tests were used to examine attendance and health-related outcome measures: depression as measured by the Center for Epidemiological Studies Depression Scale-Revised (CESD-R), caregiver experience as measured by the Bakas Caregiving Outcomes scale (BCOS), caregiver self-efficacy, and number of negative self-care behaviors. Results A total of 72 caregivers attended PTC in-person and 42 attended via telehealth. Mean attendance was 4.97 ± 1.21 for the in-person group and 5.21 ± 0.071 for the telehealth group, with no significant difference between delivery formats t(112) = 1.074, p = 0.285; 23 caregivers completed all three assessment periods for ANOVA. Interaction of group and time was non-significant for all outcome measures and the main effect of group was only significant for CESD-R scores at pre-PTC assessment, indicating that there were no differences between the two delivery formats for outcomes at post test or six months. The effect of time was significant for all outcome measures, indicating both in-person and telehealth participants improved on health-related outcomes over time. Discussion Telehealth is an effective delivery format for PTC – a traditionally in-person caregiver wellness program. This trial was registered [ClinicalTrials.gov identifier: NCT03800238].

Physiotherapy and related management for childhood obesity: A systematic scoping review.

IntroductionDespite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.MethodA scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via “file:pdf”. A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.ResultsFrom the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.ConclusionWhen managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews

BackgroundSedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes.MethodsOverview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised.ResultsHundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions.ConclusionThere is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns.Trial registrationRegistered in PROSPERO (CRD42019120295) on 10th January 2019.

Role of the exercise of high intensity intervals (HIIT) in health in the older adults: A systematic review of randomized clinical trials

Despite growing interest in high-intensity interval training as a time-effective way for older adults to improve their health, there is little consensus regarding the better way to plan a HIIT intervention. Given the loss of function and health problems of an older adult population, the identification and characterization of interventions and strategies is a fundamental prerequisite. The goals of this review are examining high-intensity interval training as a way to improve health, and finding out the highestintensity viable HIIT protocol. Studies were included in this systematic review if: (1) they studied a population of older adults; (2) prescribed an intervention that can be described as high intensity; and (3) reported health-related outcome measures. The resulting 14 papers were included in our study. The present review found that high-intensity interval training is an effective tool to improve indicators of body composition as well as cardiometabolic and cardiovascular health, with 90-95% HRmax cycle ergometer sessions held two-three times a week, with a minimum session length of 40 minutes, in an intervention at least 12-week long, effecting significant improvements on the health of participants. Recommendations regarding optimal exercise duration and rest intervals must remain ambiguous given the scarcity of published literature and the methodology and limitations of those studies that are already available

Delphi consensus on core criteria set selecting among health-related outcome measures (HROM) in primary health care

ObjectivesThere has been a lack of consensus on which criteria are important when selecting health-related outcome measures (HROM), especially in primary health care A Delphi consensus was undertaken to identify core criteria for selecting among different HROM and contextual factors affecting decision-making. Study Design and SettingA Delphi survey using standard methodology (consensus set as 75% agreement) was sent to primary care practitioners, administrators, policymakers, researchers and experts in HROM development. Criteria (n = 35) were selected from a targeted literature search; questions probed contextual factors that may influence selection of core criteria including the following: 1) weighting, 2) clinical contexts, and 3) core areas. ResultsParticipants (n = 45) achieved consensus on 17 items in round 1 (plus four new criteria), with one more item in round 2. Unequal weighting of criteria was favored, and the type of clinical scenario did not influence selection of HROM. ConclusionEighteen core criteria from 39 were identified for inclusion in a core set, reflected predominately aspects of feasibility and acceptability. This is the first study providing evidence that contextual factors affect selection of HROM in a core criteria set. Care in primary health care is complex, and therefore, the items not reaching consensus may reflect this heterogeneity.

Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis

Homelessness is a global public health concern, and traumatic brain injury (TBI) could represent an underappreciated factor in the health trajectories of homeless and marginally housed individuals. We aimed to evaluate the lifetime prevalence of TBI in this population, and to summarise findings on TBI incidence and the association between TBI and health-related or functioning-related outcomes. For this systematic review and meta-analysis, we searched without date restrictions for original research studies in English that reported data on the prevalence or incidence of TBI, or the association between TBI and one or more health-related or function-related outcome measures. Studies were included if they had a group or clearly identifiable subgroup of individuals who were homeless, marginally housed, or seeking services for homeless people. With use of random-effects models, we calculated pooled estimates of the lifetime prevalence of any severity of TBI and the lifetime prevalence of moderate or severe TBI. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. We then summarised findings from all studies that evaluated TBI incidence and the association between TBI and health-related or functioning-related outcomes. All statistical analyses were done using R version 3.5.1. The study is registered with PROSPERO, number CRD42019119678. Of 463 potentially eligible studies identified by the search, 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The lifetime prevalence of any severity of TBI in homeless and marginally housed individuals (18 studies, n=9702 individuals) was 53·1% (95% CI 46·4-59·7; I2=97%) and the lifetime prevalence of moderate or severe TBI (nine studies, n=5787) was 22·5% (13·5-35·0; I2=99%). The method used to ascertain TBI history, the age of the sample, and the sample size significantly moderated estimated lifetime prevalence of any severity of TBI. TBI was consistently associated with poorer self-reported physical and mental health, higher suicidality and suicide risk, memory concerns, and increased health service use and criminal justice system involvement. The lifetime prevalence of TBI is high among homeless and marginally housed individuals, and a history of TBI is associated with poorer health and general functioning. Health-care providers and public health officials should have an increased awareness of the burden of TBI in this population. Prospective and longitudinal studies are needed to better understand how the health of this population is affected by TBI. Canadian Institutes of Health Research.

Identity and treatment adherence in predominantly ethnic minority teens and young adults with type 1 diabetes.

The demands of diabetes care can place substantial burden on youth with type 1 diabetes (T1D), who must manage their treatment in conjunction with the developmentally typical tasks of adolescence. How diabetes affects the normative task of identity development deserves further exploration. A sample of 83 participants (ages 13-21) completed a qualitative interview about life with diabetes and a battery of validated psychosocial measures. Individual interviews were analyzed using content analysis to create criteria for whether a teen had incorporated their T1D in relation to their identity. Convergent validity was assessed by comparing identity groups on various validated measures of psychosocial characteristics and health-related outcomes. Analysis of covariances (ANCOVAs) were used to determine whether identity status had a significant relationship to health outcomes. Results indicated that youth who were categorized as incorporating their T1D into their identities demonstrated significantly greater perceived social competency (P = .014), greater diabetes-specific self-esteem (P < .001), better self-care (P = .002), and more life satisfaction (P = .001) than those who had not incorporated T1D. Incorporation was also associated with better glycemic control (P = .003). Identity remained significantly associated with the above psychosocial and health-related outcomes even when controlling for covariates of gender and method of insulin delivery (Ps < .01). Successful incorporation of diabetes is associated with better biomedical and psychosocial outcomes in teens with T1D. Further research is warranted to assess influences on identity as well as how to encourage and support incorporation in this at-risk population.

A validation study of the ICECAP-O in informal carers of people with dementia from eight European Countries

PurposeThe pressure on healthcare budgets remains high, partially due to the ageing population. Economic evaluation can be a helpful tool to inform resource allocation in publicly financed systems. Such evaluations frequently use health-related outcome measures. However, in areas such as care of older people, improving health outcomes is not necessarily the main focus of care interventions and broader outcome measures, including outcomes for those providing informal care, may be preferred when evaluating such interventions. This paper validates a recently introduced well-being measure, the ICECAP-O, in a population of informal carers for people with dementia from eight European countries.MethodsConvergent and discriminant validity tests were performed to validate the ICECAP-O using data obtained in a sample of 451 respondents from Germany, Ireland, Italy, the Netherlands, Norway, Portugal, Sweden and the UK. These respondents completed a number of standardized questionnaires within the framework of the Actifcare project.ResultsThe ICECAP-O performed well among informal carers, in terms of both convergent and discriminant validity. In the multivariate analysis, it was found to be significantly associated with the age of the person with dementia, EQ-5D-5L health problem index of the person with dementia, carer–patient relationship, care recipient CDR, carer LSNS Score, the PAI score, and Perseverance Time.ConclusionThe ICECAP-O appears to be a valid measure of well-being in informal carers for people with dementia. The ICECAP-O may therefore be useful as an outcome measure in economic evaluations of interventions aimed at such informal carers, when these aim to improve well-being beyond health.

Context-Aware Systems for Chronic Disease Patients: Scoping Review.

BackgroundContext-aware systems, also known as context-sensitive systems, are computing applications designed to capture, interpret, and use contextual information and provide adaptive services according to the current context of use. Context-aware systems have the potential to support patients with chronic conditions; however, little is known about how such systems have been utilized to facilitate patient work.ObjectiveThis study aimed to characterize the different tasks and contexts in which context-aware systems for patient work were used as well as to assess any existing evidence about the impact of such systems on health-related process or outcome measures.MethodsA total of 6 databases (MEDLINE, EMBASE, CINAHL, ACM Digital, Web of Science, and Scopus) were scanned using a predefined search strategy. Studies were included in the review if they focused on patients with chronic conditions, involved the use of a context-aware system to support patients’ health-related activities, and reported the evaluation of the systems by the users. Studies were screened by independent reviewers, and a narrative synthesis of included studies was conducted.ResultsThe database search retrieved 1478 citations; 6 papers were included, all published from 2009 onwards. The majority of the papers were quasi-experimental and involved pilot and usability testing with a small number of users; there were no randomized controlled trials (RCTs) to evaluate the efficacy of a context-aware system. In the included studies, context was captured using sensors or self-reports, sometimes involving both. Most studies used a combination of sensor technology and mobile apps to deliver personalized feedback. A total of 3 studies examined the impact of interventions on health-related measures, showing positive results.ConclusionsThe use of context-aware systems to support patient work is an emerging area of research. RCTs are needed to evaluate the effectiveness of context-aware systems in improving patient work, self-management practices, and health outcomes in chronic disease patients.

Protocol for a Delphi consensus exercise to identify a core set of criteria for selecting health related outcome measures (HROM) to be used in primary health care

BackgroundPromoting the collection and use of health related outcome measures (HROM) in daily practice has long been a goal for improving and assessing the effectiveness of care provided to patients. However, there has been a lack of consensus on what criteria to use to select outcomes or instruments, particularly in the context of primary health care settings where patients present with multiple concurrent health conditions and interventions are whole-health and person-focused. The purpose of this proposed study is to undertake a formal consensus exercise to establish criteria for selecting HROM (including patient-reported (PRO or PROM), observer-reported (ObsR)), clinician-reported (ClinRO) and performance related outcomes (PerfO) for use in shared decision-making, or in assessing, screening or monitoring health status in primary health care settings.MethodsA Delphi consensus online survey will be developed. Criteria for the Delphi panel participants to consider were selected from a targeted literature search. These initial criteria (n = 35) were grouped into four categories within which items will be presented in the Delphi survey, with the option to suggest additional items. Panel members invited to participate will include primary health care practitioners and administrators, policy-makers, researchers, and experts in HROM development; patients will be excluded. Standard Delphi methodology will be employed with an expectation of at least 3 rounds to achieve consensus (75% agreement). As the final list of criteria for selecting HROM emerges, panel members will be asked to provide opinions about potential weighting of items. The Delphi survey was approved by the Ethics Committee in the Faculty of Health Sciences at McMaster University.DiscussionPrevious literature establishing criteria for selecting HROM were developed with a focus on patient reported outcomes, psychological/ behavioural outcomes or outcomes for minimum core outcome sets in clinical trials. Although helpful, these criteria may not be applicable and feasible for application in a primary health care context where patients with multi-morbidity and complex interventions are typical and the constraints of providing health services differ from those in research studies. The findings from this Delphi consensus study will address a gap for establishing consensus on criteria for selecting HROM for use across primary health care settings.

Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: tumor and deformity: 248. Can postoperative cSVA, C2 slope and T1 slope be predicted accurately in cervical deformity surgery?

BACKGROUND CONTEXT Cervical malalignment is associated with severe disability. In cervical deformity surgery, failure to correct cSVA and C2 slope (C2S) is associated with poor clinical outcomes. Current surgical planning and intraoperative measurements are limited to cervical lordosis (CL) correction. We aim to develop a predictive model for postop cSVA, C2S and T1S using more than CL change. PURPOSE To propose reliable formulas that may be utilized to plan postoperative correction of C2S, T1S, and cSVA. STUDY DESIGN/SETTING Retrospective review of a prospectively collected cervical deformity database. PATIENT SAMPLE A total of 153 patients with cervical deformity. OUTCOME MEASURES Postoperative sagittal alignment parameters, health related outcome measures, and surgical parameters. METHODS A prospective database of operative CD patients was analyzed. Inclusion criteria were cervical kyphosis>10°, cervical scoliosis>10°, cSVA>4cm or CBVA>25°. The patients were randomly filtered to include 66.7% of the cohort for model development. Predictive models were developed to predict postop T1S, cSVA, and C2S using linear regression. The new predictive equations were validated in the remaining 33.3% of the cohort. RESULTS A total of 153 patients with CD met inclusion criteria. T1S changed significantly (32.4°–35.2°, p=.05) from baseline to 3M follow-up. The mean DJKA change was −6.59. A total of 101 patients were included in model development. To predict postop T1S, CL change and preT1S explained 62.4% of the variability of data (R2=0.624). By including DJKA, R2 improved to 0.724. When predicting postop cSVA, CL change and pre-opcSVA accounted for 57.2% of variability (R2=0.572). With change in DJKA, the R2 improved to 0.661. The model was optimized with the change in T1S (R2=0.777). Preop C2S and CL change lead to poor predictability in postop C2S (R2=0.348). Using change in DJKA, the R2 improved to 0.550. By including DJKA and T1S change, the model was optimized (R2=0.926).The formulas obtained from the predictive model were then simplified by utilizing the mean DJKA of the cohort used to develop the predictive formulas and by utilizing the calculated T1S change obtained from the first equation to yield the following equations: (1) PostOperative T1S=−0.207 + (0.95*Pre-Op T1S) + (1.15*CL Change) (2) PostOperative cSVA =5.803 + (Pre-Op cSVA) + (0.146*CL Change) – (0.028*Pre-Op T1S) (3) PostOperative C2S = 1.223 + (1.38*Pre-Op C2S) – (0.302*CL Change) – (0.053*Pre-OP T1S). These simplified equations were applied to the remaining 52 patients to validate their clinical application. Predicted postop alignments correlated to postop T1S, cSVA, and C2S (R=0.712, R=0.736, and R=0.584 respectively, p CONCLUSIONS Restoring sagittal alignment is critical to obtaining good postoperative outcomes following correction of CD. Current surgical planning and intraoperative measurements are currently limited to cervical lordosis (CL) correction. However, by predicting T1 Slope (T1S) change from baseline to 3 months postop and adding a correction factor for the change in distal junctional kyphosis angle (DJKA), cSVA and C2S can be predicted more accurately. The formulas proposed for the purposes of this study are simple, effective, and can be effectively utilized in a clinical setting to plan successful postoperative correction.

Saturday, September 29, 2018 9:00 am–10:00 am Impact of Adult Deformity Correction: 261. Can we define clinically relevant DJK in cervical deformity surgery?

BACKGROUND CONTEXT Recently, DJK has been described as a complication of CD correction. However, the current definition of DJK (arbitrarily set as a change in DJKA PURPOSE The traditional definition of DJK can be improved to have more clinical relevance in CD surgery. The purpose of this study is to propose a definition of DJK that has increased clinical importance and is predictive of clinical outcomes. STUDY DESIGN/SETTING Retrospective review of a prospective CD surgery database. PATIENT SAMPLE A total of 112 patients with cervical deformity. OUTCOME MEASURES Demographic information, postoperative sagittal alignment parameters, health related outcome measures and surgical parameters. METHODS A prospective database of operative CD patients was analyzed. Inclusion criteria were cervical kyphosis>10˚, cervical scoliosis>10˚, cSVA>4 cm or CBVA>25˚. DJKA was defined as the change kyphosis between LIV and LIV-2 from preoperative to postoperative. The maxDJKA was defined as the largest change in DJKA at any time point. “Traditional DJK” was defined as DJKA RESULTS A total of 112 patients were included. The mean maximum DJKA for the whole cohort was −9.00˚ (SD = 10.0). There were 41 traditional DJK (35.7%) and 11 Severe DJK (9.8%). Traditional DJK was not associated with any preoperative alignment parameters, but severe DJK was associated with an increased CTPA, C2S, cSVA and TSCL at baseline (p CONCLUSIONS The modified severe DJK definition demonstrated better specificity, precision and accuracy for DJK revision surgery. While there were no HRQL differences for either DJK definition, this has also been the case for PJK in thoracolumbar deformity outcomes. Severe DJK patients had the worst cervical alignment by cSVA and C2 slope with mean alignments well beyond the established thresholds for moderate disability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 3:35 PM – 5:05 PM Preserving Spinal Motion: 86. Successful clinical outcomes following surgery for severe cervical deformity are dependent upon achieving sufficient cervical sagittal alignment

BACKGROUND CONTEXT Cervical malalignment has been associated with increased disability. Both cSVA and C2S have been correlated to poor clinical outcomes. Surgical corrections of severe cervical deformities present considerable treatment challenges. Demographic, surgical and postoperative factors associated with failed radiographic and clinical outcomes have not been well established. PURPOSE To identify patients at risk of failure to restore sagittal alignment in cervical deformity corrective surgery. Additionally, to analyze how failure to restore sagittal alignment postoperatively affects patient reported outcomes and to determine the clinical significance of failure to correct malalignment. STUDY DESIGN/SETTING Retrospective review of a prospective cohort of consecutively enrolled cervical deformity patients. PATIENT SAMPLE Sixty-six patients with severe cervical deformity at baseline (defined as>4 cm cSVA or >20°C2 slope) with one year radiographic follow-up. OUTCOME MEASURES Postoperative sagittal alignment parameters, health-related outcome measures, and surgical parameters. METHODS A prospective database of operative CD patients (inclusion criteria: cervical kyphosis >10°, cervical scoliosis >10°, cSVA>4 cm or CBVA>25°) was analyzed. Inclusion was restricted to severe baseline cervical deformities (cSVA>4 cm or C2 Slope (C2S)>20°) and 1-year follow-up. Failed surgery was defined as cSVA>4 cm at 1 year while successful surgery was defined as cSVA 7). RESULTS Sixty-six patients with severe CD met inclusion criteria, including 41 failed (62%) surgery and 25 successful. Failed surgery patients had worse sagittal alignment at baseline and 1 year by cSVA, C2S, T1S, TS-CL, and CTPA (p CONCLUSIONS Baseline cervical malalignment, male gender and intra-operative blood loss were associated with failed radiographic outcomes in patients with severe cervical deformity. Failed surgery patients also had less improvement in NDI at 6 months and 1 year than successful surgeries. More patients with successful surgeries attained MCID for NDI at 6 months. In correcting severe CD, surgeons need to obtain optimal radiographic alignment to attain better clinical outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: spinal deformity analysis: 219. Surgical outcomes in rigid versus flexible cervical deformities

BACKGROUND CONTEXT Cervical deformity patients have been shown to have severe disability and poor health status. Little is known about how patients with fixed cervical deformity compare to those with flexible malalignment in disability and surgical outcomes. PURPOSE To elucidate disability and surgical outcomes in patients with rigid deformities of the cervical spine. STUDY DESIGN/SETTING Retrospective review of a prospective, consecutively enrolled database of operative cervical deformity patients. PATIENT SAMPLE A total of 127 CD patients. OUTCOME MEASURES Surgical parameters, health related outcome measures METHODS A prospective database of operative cervical deformity patients was analyzed. Inclusion criteria were cervical kyphosis (CK) >10°, cervical scoliosis (CS) >10°, cSVA >4cm or chin-brow vertical angle>25°. Patients were categorized as having fixed cervical deformity if they had less than 10° change in their cervical lordosis between flexion and extension and they were compared to flexible CD in terms of HRQL and surgical factors. Patients were sub analyzed based on the apex of their deformity if it was in the cervical spine (C) or the cervico-thoracic (CT) region. RESULTS A total of 127 patients met inclusion criteria including 32 rigid and 95 flexible CD patients. For the entire cohort, rigid CD was associated with worse preop alignment by TS-CL, T1S, cSVA, C2S, and cSVA (p CONCLUSIONS Patients with cervical deformity (CD) can have severe disability. Among 127 CD patients, deformities were classified as rigid or flexible. Rigid CD patients had worse baseline alignment but had similar impact on health-related quality of life (HRQL) measures. Patients with rigid deformities required longer fusions and higher osteotomy grades but they achieved similar improvements in HRQL without higher rates of complications. Patients with rigid cervical deformities have worse baseline cervical malalignment but are equally disabled when compared to those with flexible deformities. Rigid cervical deformities require greater osteotomy grades and more levels fused resulting in longer operative times and more blood loss. Despite more extensive surgeries, rigid cervical deformity patients have equivalent HRQL improvements.

Can the health related quality of life measure QOLIBRI- overall scale (OS) be of use after stroke? A validation study

BackgroundBrief measures of health-related quality of life (HRQOL) that assess both patient-reported functioning and well-being after stroke are scarce. The objective of this study was to examine reliability and validity of one of these measures, the patient-reported Quality of Life after Brain Injury–Overall Scale (QOLIBRI-OS), in patients after stroke.MethodsStroke survivors were examined prospectively using survey methods.Core survey data (n = 125) and retest data (n = 36) were obtained at 3 and 12 months, respectively. Item properties (distribution, floor and ceiling effects), psychometric properties (reliability and model fit), and validity (correlations with established measures of anxiety, depression and HRQOL) of the QOLIBRI-OS were examined.ResultsMissing responses on the questionnaire were low (0.5%). All items were positively skewed. No floor effects were present, whereas five out of six items showed ceiling effects. The summary QOLIBRI-OS score exhibited no floor or ceiling effects, and had excellent internal consistency (Cronbach’s α =0.93). All item-total correlations were high (0.73–0.88). The test-retest reliability of single items varied from 0.74 to 0.91 and was 0.93 for the overall score. The confirmatory factor analysis yielded an excellent fit for a five-item version and provided tentative support for the original six-item version. The convergent validity correlations were in the hypothesized directions, thus supporting the construct validity.ConclusionsThe brief QOLIBRI-OS is a valid and reliable brief health-related outcome measure that is appropriate for screening HRQOL in patients after stroke.

Cultural and linguistic transferability of the multi-dimensional OxCAP-MH capability instrument for outcome measurement in mental health: the German language version

BackgroundMental health conditions affect aspects of people’s lives that are often not captured in common health-related outcome measures. The OxCAP-MH self-reported, quality of life questionnaire based on Sen’s capability approach was developed in the UK to overcome these limitations. The aim of this study was to develop a linguistically and culturally valid German version of the questionnaire.MethodsFollowing forward and back translations, the wording underwent cultural and linguistic validation with input from a sample of 12 native German speaking mental health patients in Austria in 2015. Qualitative feedback from patients and carers was obtained via interviews and focus group meetings. Feedback from mental health researchers from Germany was incorporated to account for cross-country differences.ResultsNo significant item modifications were necessary. However, changes due to ambiguous wordings, possibilities for differential interpretations, politically unacceptable expressions, cross-country language differences and differences in political and social systems, were needed. The study confirmed that all questions are relevant and understandable for people with mental health conditions in a German speaking setting and transferability of the questionnaire from English to German speaking countries is feasible.ConclusionsProfessional translation is necessary for the linguistic accuracy of different language versions of patient-reported outcome measures but does not guarantee linguistic and cultural validity and cross-country transferability. Additional context-specific piloting is essential. The time and resources needed to achieve valid multi-lingual versions should not be underestimated. Further research is ongoing to confirm the psychometric properties of the German version.

Meta-analysis of Cochlear Implantation Outcomes Evaluated With General Health-related Patient-reported Outcome Measures.

Determine the change in general health-related quality of life (HRQOL) after cochlear implantation and association with speech recognition. Meta-analysis. Search was performed following the PRISMA statement using PubMed, Medline, Scopus, and CINAHL. Studies on adult cochlear implant (CI) patients measuring HRQOL before and after cochlear implantation were included. Standardized mean difference (SMD) for each measure and pooled effects were determined. A meta-analysis of correlations was also performed between all non-disease-specific patient-reported outcome measures (PROMs) and speech recognition after cochlear implantation. Twenty-two articles met criteria for meta-analysis of HRQOL improvement, but 15 (65%) were excluded due to incomplete statistical reporting. From the seven articles with 274 CI patients that met inclusion criteria, pooled analyses showed a medium positive effect of cochlear implantation on HRQOL (SMD = 0.79). Subset analysis of the HUI-3 measure showed a large effect (SMD = 0.84). Nine articles with 550 CI patients met inclusion criteria for meta-analysis of correlations between non-disease specific PROMs and speech recognition after cochlear implantation. Pooled analysis showed a low correlation between non-disease-specific PROMs and word recognition in quiet (r = 0.35), sentence recognition in quiet (r = 0.40), and sentence recognition in noise (r = 0.32). Although regularly used, HRQOL measures are not intended to measure nor do they accurately reflect the complex difficulties facing CI patients. Only a medium positive effect of cochlear implantation on HRQOL was observed along with a low correlation between non-disease-specific PROMs and speech recognition. The use of such instruments in this population may underestimate the benefit of cochlear implantation.

High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes.

There is an increasing body of evidence underpinning high-intensity exercise as an effective and time-efficient intervention for improving health in cancer survivors. The aim of this study was to, (1) evaluate the efficacy and (2) the safety of high-intensity exercise interventions in improving selected health outcomes in cancer survivors. Design Systematic review. Data sources Google Scholar and EBSCO, CINAHL Plus, Computers and Applied Sciences Complete, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition, MEDLINE, Web of Science and SPORTDiscuss from inception up until August 2017. Eligibility criteria Randomized controlled trials of high-intensity exercise interventions in cancer survivors (all cancer types) with health-related outcome measures. The guidelines adopted for this review were the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The search returned 447 articles, of which nine articles (n = 531 participants mean, age 58 ± 9.5years) met the eligibility criteria. Exercise interventions of between 4 and 18 weeks consisting of high-intensity interval bouts of up to 4-min were compared with a continuous moderate intensity (CMIT) intervention or a control group. High-intensity exercise interventions elicited significant improvements in VO2 max, strength, body mass, body fat and hip and waist circumference compared with CMIT and/or control groups. The studies reviewed showed low risk in participating in supervised high-intensity exercise interventions. Mixed mode high-intensity interventions which included both aerobic and resistance exercises were most effective improving the aerobic fitness levels of cancer survivors by 12.45-21.35%, from baseline to post-intervention. High-intensity exercise interventions improved physical and physiological health-related outcome measures such as cardiovascular fitness and strength in cancer survivors. Given that high-intensity exercise sessions require a shorter time commitment, it may be a useful modality to improve health outcomes in those who are time poor. The risk of adverse events associated with high-intensity exercise was low.

BRain health and healthy AgeINg in retired rugby union players, the BRAIN Study: study protocol for an observational study in the UK

IntroductionRelatively little is known about the long-term health of former elite rugby players, or former sportspeople more generally. As well as the potential benefits of being former elite sportspersons, there...

Quality of life outcomes following pediatric lung transplantation.

Compared to other solid organs, survival after lung transplantation (LTx) is still poor. Discussions on survival benefits following LTx in children, however, have largely concentrated on medical outcome data. Little research describes quality of life (QoL) of pediatric LTx recipients, which is partly due to the small number of pediatric LTxs performed. Only two centers worldwide performed >10 pediatric LTxs in 2013, making data on QoL in this population difficult to obtain. The primary objective was to examine the impact of LTx on QoL of pediatric recipients. LTx recipients aged 8-17 years and their parents were recruited from a Canadian pediatric transplant centre. Participants completed the PedsQL 4.0 Generic Core Scales, a validated health-related QoL patient-reported outcome measure for children and adolescents, pre-transplant and two times post-transplant. Pre-LTx QoL scores were compared with initial assessment scores post-LTx and changes in QoL over time were described. Correlations between self- and proxy-reports were also discussed. Ten pediatric LTx recipients (six male, mean age = 13.3 years) and their parents were enrolled. Assessments were completed pre-LTx (mean months = 4.8) and two times post-LTx (mean months 8.7 and 24.6, respectively). Pre- and post-transplant total scores differed significantly for both self- and proxy-report, which remained consistent at a second assessment post-transplant (P = 0.018 and 0.028, respectively). Findings highlight the importance of QoL outcomes when exploring LTx as a treatment option. Future research should explore long-term QoL outcomes post-LTx and examine standardized integration of patient-reported outcomes into clinical practice.