Symptom-based Outcome Measures Research Articles

Cervical spine characteristics differ in competitive combat athletes compared with active control participants

BackgroundInjury to the head and neck are common in combat sport athletes. Impairments of the cervical spine have been found in some athletes who participate in sports with high forces and collisions. There is a lack of research on the effects of combat sports on the cervical spine. ObjectiveThe primary study aim was to investigate differences in cervical spine characteristics between combat athletes and a similarly aged active control group. The secondary aim was to investigate the relationship between symptom-based outcome measures and characteristics of the cervical spine. DesignCross-sectional. Method40 male adult combat sport athletes and 40 male adult control participants were recruited from 4 combat sport clubs and a university campus, Australia. Cervical spine assessments were conducted at a private physiotherapy clinic. The Neck Disability Index and the Post-Concussion Symptom Scale were used as symptom-based outcome measures. ResultsCombat sport athletes had a reduced range of cervical motion, but greater isometric strength and endurance compared with a control group (p < 0.05). The Neck Disability Index and Post-Concussion Symptom Scale were negatively correlated with cervical spine range of motion and isometric strength, meaning that higher scores correlated with a reduction in function. ConclusionsDifferences were observed in characteristics of the cervical spine in combat sport athletes compared with a control group. Higher symptom-based outcome scores correlated with reduced range of motion and strength of cervical spine muscles. Further investigation to establish clinical cut-off scores for functional impairment may be warranted.

Resilience in 2021-Descriptive Analysis of Individuals Accessing Virtual Mental Health Services: Retrospective Observational Study.

BackgroundPsychological resilience has been extensively studied by developmental researchers, and there is a growing body of literature regarding its role in psychiatry and psychopathology research and practice. This study contributes to this growing literature by providing real-world evidence on the relationship between resilience and clinical symptoms among a large sample of employed Americans.ObjectiveThis study aimed to describe resilience levels in individuals accessing Ginger, a virtual mental health system, in addition to the association of resilience with demographic characteristics, baseline depression, and anxiety symptoms.MethodsWe conducted a retrospective observational study of 9165 members who signed up for Ginger and completed a baseline survey between January 1 and August 5, 2021. We used multivariate regression models to test for associations between baseline resilience and other member characteristics.ResultsBaseline resilience scores centered on a mean of 23.84 (SD 6.56) and median of 24 (IQR 8) out of 40, with 81.0% (7424/9165) of the sample having low resilience at baseline. Despite having relatively higher resilience scores, members with no or mild depression or anxiety still had low resilience scores on average. Self-reported suicidal ideation was associated with lower resilience.ConclusionsOverall, members had low baseline resilience, similar to resilience levels observed in trauma survivors in prior studies. Younger members and those with higher levels of depression and anxiety at intake reported lower levels of resilience at baseline. Notably, members with no or mild depression or anxiety still had low resilience scores on average, suggesting a need for mental health support among individuals who might not typically be recommended for treatment based on traditional clinical assessments, such as the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder scale (GAD-7). Two suggestions for topics of future research are to develop treatment recommendations based on the Connor-Davidson Resilience Scale and to understand the interaction between resilience levels and symptom-based outcome measures, such as the PHQ-9 and the GAD-7.

Vestibular and oculomotor function in male combat sport athletes

ObjectivesTo investigate for differences in vestibulo-ocular function between active male combat sport athletes and a healthy control group. In addition, to explore the relationship between symptom-based outcome measures with vestibulo-ocular function. DesignCross-sectional. Methods40 male adult combat sport athletes and 40 active male control participants were recruited from 4 martial arts schools and a University campus in Queensland, Australia. All participants completed a standardised protocol which was used to assess vestibulo-ocular function. The protocol included 3 components: 1) oculomotor function, 2) benign paroxysmal positional vertigo screening, and 3) vestibulo-ocular reflex function. The Post-Concussion Symptom Scale, Vestibular/Ocular Motor Screening tool and Dizziness Handicap Inventory were used as symptom-based outcome measures. ResultsMore combat sport athletes had oculomotor abnormalities than control group participants. There were no between group differences in benign paroxysmal positional vertigo, vestibulo-ocular reflex function and the video-head impulse test gain (ms). Combat sport athletes had higher symptom-based outcome scores. The Vestibular/Ocular Motor Screening tool and Dizziness Handicap Inventory were found to have moderate positive relationships with the total number of abnormalities detected in the combat sport group. ConclusionsVestibulo-ocular function is imperative for combat sport athletes to perform evasive manoeuvres and land their own strikes. The present study findings may aid clinicians in the identification of combat sport athletes with underlying vestibulo-ocular dysfunction, prompting further investigation.

Using blocked fractional factorial designs to construct discrete choice experiments for healthcare studies.

Discrete choice experiments (DCEs) are increasingly used for studying and quantifying subjects preferences in a wide variety of healthcare applications. They provide a rich source of data to assess real-life decision-making processes, which involve trade-offs between desirable characteristics pertaining to health and healthcare and identification of key attributes affecting healthcare. The choice of the design for a DCE is critical because it determines which attributes' effects and their interactions are identifiable. We apply blocked fractional factorial designs to construct DCEs and address some identification issues by utilizing the known structure of blocked fractional factorial designs. Our design techniques can be applied to several situations including DCEs where attributes have different number of levels. We demonstrate our design methodology using two healthcare studies to evaluate (i) asthma patients' preferences for symptom-based outcome measures and (ii) patient preference for breast screening services. Copyright © 2016 John Wiley & Sons, Ltd.

Role of overweight and obesity in low back disorders among men: a longitudinal study with a life course approach

ObjectivesTo assess the association between being overweight or obese with low back pain (LBP) and clinically defined low back disorders across the life course.DesignA longitudinal and cross-sectional study.SettingA nationwide health...

Adjuvant antiviral therapy for recurrent respiratory papillomatosis

This is an update of a Cochrane Review originally published in Issue 4, 2005 of The Cochrane Library and previously updated in 2010.Recurrent respiratory papillomatosis is a condition characterised by benign papillomatous (wart-like) growths in the upper airway. It can affect both adults and children causing airway obstruction and voice change. Treatment usually involves repeated surgical debulking of the papillomata. Several agents have been proposed as adjuvants to surgical debulking, including antivirals, administered systemically or injected into the lesions. To assess the effectiveness of antiviral agents as adjuvant therapy in the management of recurrent respiratory papillomatosis in children and adults. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 24 February 2012. Randomised controlled trials. We identified 143 references from the searches. Forty-three were appropriate for retrieval and assessed for eligibility by the authors. One randomised controlled trial met the inclusion criteria, involving 19 participants. We contacted the authors to obtain additional data to facilitate the review. The included study was a single-institution, randomised, double-blind, placebo-controlled trial of intralesional cidofovir administered at the time of surgical debulking. Adults (n = 15) and children (n = 4) were included. We judged the study to have a reasonably low risk of bias. After a 12-month trial period, no difference was found between the cidofovir and placebo groups. Both groups showed a significant reduction in disease extent (as assessed at the time of surgery using the Derkay Scoring System), but no significant change in health-related quality of life. There is insufficient evidence to support the efficacy of antiviral agents as adjuvant therapy in the management of recurrent respiratory papillomatosis in children or adults. The included randomised controlled trial showed no advantage of intralesional cidofovir over placebo at 12 months. The study was limited by a small sample size and a change in the cidofovir concentration midway through the trial, from 0.3 mg/ml in children and 0.75 mg/ml in adults, to 5 mg/ml in both adults and children. An adequately powered randomised controlled trial of intra-lesional cidofovir, consistently using higher concentrations of cidofovir in comparison with injected placebo, would be required to determine effectiveness convincingly. Future studies must include health-related quality of life and symptom-based outcome measures.

Impact of topical nasal steroid therapy on symptoms of nasal polyposis

Topical steroid therapy is an important strategy in the management of chronic rhinosinusitis (CRS) with nasal polyposis. The objective of this study was to determine the impact of topical steroid therapy on nasal symptoms in patients with nasal polyposis. Systematic review with meta-analysis using standardized methodology. Study inclusion criteria included: randomized, placebo controlled trials, nasal polyposis, and topical steroid therapy. Exclusion criteria included: failure to report at least one symptom-based outcome measure, concurrent use of systemic steroids, or mixed CRS cohorts (polyp and nonpolyp patients). Quantitative analysis was performed using a random effect model. The PRISMA guidelines for meta-analysis reporting were followed. A total of 19 studies fulfilled eligibility. Seven studies were excluded from the meta-analysis due to significant heterogeneity in outcome reporting. A total of 12 studies were combined for quantitative analysis and demonstrated a pooled risk ratio of 1.72 (95% confidence interval, 1.41-2.09), indicating a significant improvement in nasal symptoms. All three topical steroid preparations (fluticasone, mometasone, and budesonide) resulted in symptom improvement. All seven studies excluded from the meta-analysis qualitatively confirmed the overall findings. Topical nasal steroid therapy improves nasal symptoms in CRS patients with nasal polyposis. Future studies will need to evaluate the impact on quality of life, preferably using validated disease-specific instruments.

Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)

Idiopathic acute vestibular dysfunction (vestibular neuritis) is the second most common cause of peripheral vertigo after benign paroxysmal positional vertigo (BPPV) and accounts for 7% of the patients who present at outpatient clinics specialising in the treatment of dizziness. The exact aetiology of the condition is unknown and the effects of corticosteroids on the condition and its recovery are uncertain. To assess the effectiveness of corticosteroids in the management of patients with idiopathic acute vestibular dysfunction (vestibular neuritis). We searched the Cochrane ENT Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 28 December 2010. Randomised controlled trials comparing corticosteroids with placebo, no treatment or other active treatments, for adults diagnosed with idiopathic acute vestibular dysfunction. Two authors independently selected studies from the search results and extracted data. Three authors independently assessed risk of bias. Four trials, involving a total of 149 participants, compared the effectiveness of oral corticosteroids against placebo. All the trials were small and of low methodological quality. Although there was an overall significant effect of corticosteroids compared with placebo medication on complete caloric recovery at one month (risk ratio (RR) of 2.81; 95% confidence interval (CI) 1.32 to 6.00, P = 0.007), no significant effect was seen on complete caloric recovery at 12 months (RR 1.58; 95% CI 0.45 to 5.62, P = 0.48), or on the extent of caloric recovery at either one month (mean difference (MD) 9.60%; 95% CI -20.66 to 39.86, P = 0.53) or at 12 months (MD 6.83%; 95% CI -27.69 to 41.36, P = 0.70). In addition, there was no significant difference between corticosteroids and placebo medication in the symptomatic recovery of vestibular function following idiopathic acute vestibular dysfunction with respect to vertigo at 24 hours (RR 0.39; 95% CI 0.04 to 3.57, P = 0.40) and use of the Dizziness Handicap Inventory score at one, three, six and 12 months. Overall, there is currently insufficient evidence from these trials to support the administration of corticosteroids to patients with idiopathic acute vestibular dysfunction. We found no trials with a low risk of methodological bias that used the highest level of diagnostic criteria and outcome measures. We recommend that future studies should include health-related quality of life and symptom-based outcome measures, in addition to objective measures of vestibular improvement, such as caloric testing and electronystagmography.

Symptom-Based Outcome Measure for Nonulcer Dyspepsia

Sander, Guilherme B. M.D.; Mazzoleni, Luiz Edmundo M.D., Ph.D.; Ott, Eduardo A. M.D.; Francesconi, Carlos Fernando M.D., Ph.D. Author Information

Symptom-Based Outcome Measures for Dyspepsia and GERD Trials: A Systematic Review

Symptom assessment using questionnaires has been recommended as the primary outcome measure in clinical gastroesophageal reflux and dyspepsia trials. Questionnaires should have proven reliability, validity, and responsiveness, and may assess the frequency and/or severity of dyspepsia symptoms. Although a number of measures have been developed, it remains unclear which of these should be used in new trials. To describe existing questionnaire outcome measures that assess symptoms of gastroesophageal reflux dyspepsia for use in clinical trials. Studies were identified from Medline, Embase, the Cochrane library, and reference lists. The inclusion criterion was that the study assessed a questionnaire, which measured the frequency or severity of dyspepsia or gastroesophageal reflux symptoms, in a sample of patients. No direct comparison between questionnaires was possible due to methodological heterogeneity. Thirty-seven studies describing 26 questionnaires met the inclusion criteria. Twelve were unidimensional (assessed symptoms only) and 14 were multidimensional (also assessed quality of life). Eleven questionnaires assessed both frequency and severity of dyspepsia, and 10 had proven reliability, validity, and responsiveness. No studies compared different questionnaires. Future gastroesophageal reflux and dyspepsia clinical trials should use unidimensional or multidimensional outcome measures that assess both the frequency and severity of symptoms, and have proven reliability, validity, and responsiveness. Further research is necessary to compare existing outcome measures to determine which are the most reliable, valid, and responsive instruments.

Evidence in the Psychological Therapies: A Critical Guide for Practitioners

Back to table of contents Previous article Next article Book ReviewsFull AccessEvidence in the Psychological Therapies: A Critical Guide for PractitionersNorman A. Clemens, M.D.Norman A. ClemensSearch for more papers by this author, M.D.Published Online:1 Feb 2002https://doi.org/10.1176/appi.ps.53.2.216AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Psychotherapy does not fare well in the world of evidence-based medicine. It is complex and notoriously difficult to measure meaningfully. Even the goals and end points of treatment are hard to pin down. Simplistic, symptom-based outcome measures miss the essence of the treatment approach. Applying the rigors of evidence-based medicine to an enterprise that is fundamentally humanistic and based on relationships is like mixing oil and water.This slim volume tackles the challenge head-on by exhaustively addressing the nature of evidence and its application to the world of psychotherapy. The result is a thought-provoking text that strips away oversimplifications and misapplications of evidence-based medicine that threaten the field of psychotherapy.Given the serious philosophical and technical issues covered, this book is not an easy read. However, good writing and a British perspective considerably lighten the burden. The book is a well-integrated collection of essays written from various viewpoints by psychotherapy researchers and practitioners in the United Kingdom. Lucid expositions of complex issues hold the reader's attention as the story unfolds.Several aspects of the British point of view will capture the attention of U.S. readers. The politics and bureaucracy of psychotherapy under the National Health Service are glimpsed from time to time. Contributors show a healthy skepticism about DSM-IV's superficial, symptom-oriented categorization of mental illness, with its Band-Aid approach to accounting for the complexity of real-life disorders through the concept of comorbidity. These authors recognize that prevalent categorical, diagnosis-focused, narrow interpretations of evidence leave many studies of effective psychotherapy, particularly psychodynamic psychotherapy, out of consideration in evidence-based guidelines.The contributors represent both psychodynamic and cognitive-behavioral fields of practice, but U.S. readers will find it refreshing to see much less of a divide between clinical and theoretical approaches in the United Kingdom than we are accustomed to in the United States. An essay on cognitive analytical psychotherapy bridges the gap nicely. For me, as a psychoanalyst who has found the American Psychiatric Association (APA) practice guidelines disquieting in their rigid application of evidence-based medicine to favor manual-based psychotherapies supported by highly circumscribed short-term studies over valuable, widely practiced psychotherapeutic approaches, this book was a breath of fresh air.As the title suggests, Evidence in the Psychological Therapies is about evidence, not the current findings of research on psychotherapy. Early chapters stretch the reader's thinking about the nature of evidence. A fascinating explication of the historical development of concepts of evidence in jurisprudence is worth reading for its own sake.The book includes a searching critique of randomized controlled trials—now viewed as the gold standard—and an essay on the single-case method in research. A chapter on working hypotheses in psychoanalytic psychotherapy is followed by one on hypothesis testing in cognitive-behavioral therapy.The book ends with a discussion of practice-based evidence, which APA members will recognize as the Practice Research Network. The effect is to draw practitioners and researchers closer together in an effort to strengthen the true evidence base for psychotherapy.Dr. Clemens is clinical professor of psychiatry at the Case Western Reserve University School of Medicine.edited by Chris Mace, Stirling Moorey, and Bernard Roberts; Philadelphia, Brunner-Routledge, 2001, 218 pages, $64.95 hardcover, $29.95 softcover FiguresReferencesCited byDetailsCited byChildren and Youth Services Review, Vol. 26, No. 11 Volume 53Issue 2 February 2002Pages 216-216 Metrics PDF download History Published online 1 February 2002 Published in print 1 February 2002

Symptom-based outcome measures for asthma: the use of discrete choice methods to assess patient preferences

This paper reports on an application of discrete choice modelling to the measurement of patient preferences over asthma symptoms. A sample of patients with moderate to severe asthma was asked to choose between a series of pairs of scenarios characterised by different combinations of asthma symptoms. Their responses were analysed using a random effects ordered probit model. The results implied that patients weighted some symptoms more highly than others. Discrete choice modelling proved to be a useful approach for developing preference based outcome measures, although the results show how, in contexts where preferences over health care outcomes based on symptoms or some measure of health status are involved, a conventional linear additive model may not always be suitable.

Housing and health: does installing heating in their homes improve the health of children with asthma?

The objective of this study was to evaluate the use of NHS money to improve health by improving housing conditions. A pilot study assessing health outcomes before and after improving housing conditions was conducted, studying 72 children with previously diagnosed asthma living in 59 damp houses in Cornwall. The intervention was the installation of central heating. This improved the energy efficiency of the housing. The children's health was a symptom-based outcome measure for asthma and time lost from school. Improvements comprised installation of gas central heating in 28/59 (47%) houses, electric storage heaters in 22/59 (37%), solid fuel central heating in 7/59 (12%) and oil-fired central heating in 2/59 (4%) houses. Energy efficiency improved by a mean of 2.1 on the National Home Energy Rating scale (95% CI 1.68–2.47, P<0.001) in the 37/59 (62%) houses for which two readings were available. Initially, 69/72 (92%) children's bedrooms were unheated and 44/72 (61%) were damp; following improvements, the proportions were 10/72 (14%) and 15/72 (21%) respectively. All respiratory symptoms were significantly reduced after intervention; the greatest reduction was seen in nocturnal cough from a median score of 3 (most nights) to 1 (on one or several nights) ( P<0.001) in the previous month. School-age children lost significantly less time from school for asthma in the previous 3 months (9.3 days per 100 school days before intervention and 2.1 days afterwards, P<0.01) but not for other reasons (1.4 days per 100 school days before and 3.2 after, P>0.05). In conclusion, this study provides the first evaluation of health outcomes following housing improvements. Lack of a comparison group means that effects of age, season and biased reporting cannot be eliminated. More work is needed to substantiate these results. Public Health (2000) 114, 434–439.

Housing and health does installing heating in their homes improve the health of children with asthma?

The objective of this study was to evaluate the use of NHS money to improve health by improving housing conditions. A pilot study assessing health outcomes before and after improving housing conditions was conducted, studying 72 children with previously diagnosed asthma living in 59 damp houses in Cornwall. The intervention was the installation of central heating. This improved the energy efficiency of the housing. The children's health was a symptom-based outcome measure for asthma and time lost from school. Improvements comprised installation of gas central heating in 28/59 (47%) houses, electric storage heaters in 22/59 (37%), solid fuel central heating in 7/59 (12%) and oil-fired central heating in 2/59 (4%) houses. Energy efficiency improved by a mean of 2.1 on the National Home Energy Rating scale (95% CI 1.68–2.47, P<0.001) in the 37/59 (62%) houses for which two readings were available. Initially, 69/72 (92%) children's bedrooms were unheated and 44/72 (61%) were damp; following improvements, the proportions were 10/72 (14%) and 15/72 (21%) respectively. All respiratory symptoms were significantly reduced after intervention; the greatest reduction was seen in nocturnal cough from a median score of 3 (most nights) to 1 (on one or several nights) (P<0.001) in the previous month. School-age children lost significantly less time from school for asthma in the previous 3 months (9.3 days per 100 school days before intervention and 2.1 days afterwards, P<0.01) but not for other reasons (1.4 days per 100 school days before and 3.2 after, P>0.05). In conclusion, this study provides the first evaluation of health outcomes following housing improvements. Lack of a comparison group means that effects of age, season and biased reporting cannot be eliminated. More work is needed to substantiate these results. Public Health (2000) 114, 434–439.

Looking at a symptom-based outcome measure for asthma

Looking at a symptom-based outcome measure for asthma

Acute appendicitis and dietary fibre

<h3>Objectives</h3> To assess the association between being overweight or obese with low back pain (LBP) and clinically defined low back disorders across the life course. <h3>Design</h3> A longitudinal and cross-sectional study. <h3>Setting</h3> A nationwide health survey supplemented with data from records of prior compulsory military service. <h3>Participants</h3> Premilitary health records (baseline) were searched for men aged 30–50 years (n=1385) who participated in a national health examination survey (follow-up). <h3>Methods and outcome measures</h3> Height and weight were measured at baseline and follow-up, and waist circumference at follow-up. Weight at the ages of 20, 30, 40 and 50 years were ascertained, when applicable. Repeated measures of weight were used to calculate age-standardised mean body mass index (BMI) across the life course. The symptom-based outcome measures at follow-up included prevalence of non-specific and radiating LBP during the previous 30 days. The clinically defined outcome measures included chronic low back syndrome and sciatica. <h3>Results</h3> Baseline BMI (20 years) predicted radiating LBP in adulthood, with the prevalence ratio (PR) being 1.26 (95% CI 1.08 to 1.46) for one SD (3.0 kg/m²) increase in BMI. Life course BMI was associated with radiating LBP (PR=1.23; 95% CI 1.03 to 1.48 per 1 unit increment in Z score, corresponding to 2.9 kg/m²). The development of obesity during follow-up increased the risk of radiating LBP (PR=1.91, 95% CI 1.03 to 3.53). Both general and abdominal obesity (defined as waist-to-height ratio) were associated with radiating LBP (OR=1.64, 95% CI 1.02 to 2.65 and 1.44, 95% CI 1.02 to 2.04). No associations were seen for non-specific LBP. <h3>Conclusions</h3> Our findings imply that being overweight or obese in early adulthood as well as during the life course increases the risk of radiating but not non-specific LBP among men. Taking into account the current global obesity epidemic, emphasis should be placed on preventive measures starting at youth and, also, measures for preventing further weight gain during the life course should be implemented.