Clinical measurement, longitudinal.
To assess the test-retest reliability, construct validity, and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with a primary shoulder ...complaint.
Health measurement outcomes have become increasingly important for evaluating treatment. Patient-specific questionnaires are useful tools for determining treatment goals and evaluating treatment in individual patients. These questionnaires have not yet been validated in patients with nonspecific shoulder pain.
Patients completed the PSFS, the numeric pain rating scale, and the Shoulder Pain and Disability Index at baseline, and after 1 week and 4 to 6 weeks. Test-retest reliability was determined using intraclass correlation coefficients. To assess convergent validity, change scores of the PSFS were correlated with the numeric pain rating scale and Shoulder Pain and Disability Index change scores. Responsiveness was assessed by calculating the area under the curve, the minimal clinically important change, and minimal detectable change, using the global rating of change as an external criterion.
Fifty patients (37 men; mean age, 47.7 years) participated in the study. Reliability was high (intraclass correlation coefficient = 0.87; 95% confidence interval CI: 0.72, 0.94). The correlations between the change scores of the PSFS and those of the Shoulder Pain and Disability Index and numeric pain rating scale were 0.45 (95% CI: 0.17, 0.80) and 0.55 (95% CI: 0.29, 0.73), respectively. The area under the curve for the PSFS was 0.67 (95% CI: 0.51, 0.83). The minimal detectable change and minimal clinically important change were 0.97 and 1.29 points, respectively.
These results suggest that the PSFS is a reliable, valid, and responsive instrument that can be used as an evaluative instrument in patients with a primary shoulder complaint.
Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep and ...increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1–12 years, admitted to a tertiary center, and compared this with home 6–8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58%) consented to participate. Key determinants of sleep included pain, number of previous admissions, (underlying) chronic illness, and environment-, staff-, and disease-related factors. Parents reported lower perceived sleep quality in the hospital compared to at home, 97-min (SE 9) lower TST, 100-min (5) longer WASO, more difficulties with falling asleep, lower sleep satisfaction, and more awakenings. Actigraphy outcomes revealed shorter TST (20 min (6)), but better sleep efficiency and fewer awakenings in the hospital.
Conclusion
: Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children.
This study estimated when it is safe to stop follow-up visits after cessation of amblyopia treatment and to identify factors associated with deterioration of visual acuity.
Study patients included ...282 patients aged 7 to 13 years who were monitored for deterioration after cessation of amblyopia treatment (median follow-up: 3.9 years).
Six (2.1%) patients lost 2 or more logarithm of the minimum angle of resolution levels of visual acuity and 77 (27.3%) patients lost 1 or more Snellen lines of visual acuity. Good compliance with re-treatment stopped further deterioration and lost visual acuity was regained (average follow-up after re-treatment: 3.3 years). Life table analysis indicated that 95% of the cases that deteriorated occurred within 24 months after cessation of treatment. Multivariable analysis corrected for duration of treatment uncovered factors independently associated with deterioration.
A clinically important risk of deterioration of visual acuity was found during the first 2 years after cessation of amblyopia treatment. Follow-up time longer than 2 years is recommended in the presence of a developing risk factor such as increasing anisometropia. With prompt re-treatment and good compliance, deterioration can be stopped and visual acuity can be restored.
Abstract
Background
Intensive care unit (ICU) stays often lead to reduced physical functioning. Change in physical functioning in patients in the ICU is inadequately assessed through available ...instruments. The de Morton Mobility Index (DEMMI), developed to assess mobility in elderly hospitalized patients, is promising for use in patients who are critically ill.
Objective
The aim of this study was to evaluate the clinimetric properties of the DEMMI for patients in the ICU.
Design
A prospective, observational reliability and validity study was conducted.
Methods
To evaluate interrater and intrarater reliability (intraclass correlation coefficients), patients admitted to the ICU were assessed with the DEMMI during and after ICU stay. Validity was evaluated by correlating the DEMMI with the Barthel Index (BI), the Katz Index of Independence in Activities of Daily Living (Katz ADL), and manual muscle testing (MMT). Feasibility was evaluated based on the percentage of participants in which the DEMMI could be assessed, the floor and ceiling effects, and the number of adverse events.
Results
One hundred fifteen participants were included (Acute Physiology and Chronic Health Evaluation II APACHE II mean score=15.2 and Sepsis-related Organ Failure Assessment SOFA mean score=7). Interrater reliability was .93 in the ICU and .97 on the wards, whereas intrarater reliability during the ICU stay was .68. Validity (Spearman rho coefficient) during the ICU stay was .56, −.45, and .57 for the BI, Katz ADL, and MMT, respectively. The DEMMI showed low floor and ceiling effects (2.6%) during and after ICU discharge. There were no major adverse events.
Limitations
Rapid changes in participants' health status may have led to underestimation of intrarater reliability.
Conclusion
The DEMMI was found to be clinically feasible, reliable, and valid for measuring mobility in an ICU population. Therefore, the DEMMI should be considered a preferred instrument for measuring mobility in patients during and after their ICU stay.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
At present, there is no validated patient-reported outcome measure (PROM) for patients with medial tibial stress syndrome (MTSS).
Our aim was to select and validate previously generated items and ...create a valid, reliable and responsive PROM for patients with MTSS: the MTSS score.
A prospective cohort study was performed in multiple sports medicine, physiotherapy and military facilities in the Netherlands. Participants with MTSS filled out the previously generated items for the MTSS score on 3 occasions. From previously generated items, we selected the best items. We assessed the MTSS score for its validity, reliability and responsiveness.
The MTSS score was filled out by 133 participants with MTSS. Factor analysis showed the MTSS score to exhibit a single-factor structure with acceptable internal consistency (α=0.58) and good test-retest reliability (intraclass correlation coefficient=0.81). The MTSS score ranges from 0 to 10 points. The smallest detectable change in our sample was 0.69 at the group level and 4.80 at the individual level. Construct validity analysis showed significant moderate-to-large correlations (r=0.34-0.52, p<0.01). Responsiveness of the MTSS score was confirmed by a significant relation with the global perceived effect scale (β=-0.288, R(2)=0.21, p<0.001).
The MTSS score is a valid, reliable and responsive PROM to measure the severity of MTSS. It is designed to evaluate treatment outcomes in clinical studies.
Aim
To describe the development of the parent‐rated Hand‐Use‐at‐Home questionnaire (HUH) assessing the amount of spontaneous use of the affected hand in children with unilateral paresis, and to test ...its internal structure, unidimensionality, and validity.
Method
Parents of children with unilateral cerebral palsy (CP) and professionals participated in the development of the HUH. To examine internal validity, data of 322 children (158 males, 164 females; mean age 6y 7mo, standard deviation SD 2y 1mo) with unilateral CP (n=131) or neonatal brachial plexus palsy (NBPP) (n=191) were collected. Rasch analysis was used to examine discriminative capacity of the 5‐category rating scale as well as unidimensionality and hierarchy of the item set. Additionally, data of 55 children with typical development (24 males, 31 females; 6y 9mo, SD 2y 5mo) were used to examine construct validity.
Results
The 5‐category rating scale was disordered in all items and was collapsed to obtain the best discriminating sum score. Ten misfitting or redundant items were removed. Eighteen hierarchically ordered bimanual items fitted the unidimensional model within acceptable range. The HUH significantly discriminated between the three groups (children with typical development, NBPP, unilateral CP; H(2)=118.985, p<0.001), supporting its construct validity.
Interpretation
The HUH is a valid instrument to assess the amount of spontaneous use of the affected hand in children with unilateral upper‐limb paresis.
Resumen
Desarrollo y propiedades psicométricas del cuestionario Uso de la Mano en el Hogar Hand Use at Home para evaluar el grado de compromiso de uso de manos afectadas en niños con parálisis unilateral
Objetivo
Describir el desarrollo del Cuestionario Uso de la Mano en el Hogar (UMH) Hand Use at Home evaluado por los padres para evaluar la cantidad de uso espontáneo de la mano comprometida en niños con paresia unilateral, y evaluar las siguientes propiedades psicométricas: estructura interna, unidimensionalidad y validez.
Método
Padres de niños con parálisis cerebral unilateral (PC) y profesionales participaron en el desarrollo del UMH. Para examinar la validez interna, se recolectaron los datos de 322 niños (158 varones, 164 mujeres, edad media 6 años y 7 meses, desviación estándar DE 2 años 1 mes) con PC unilateral (n=131) o Parálisis del Plexo Braquial Neonatal (PPBN) (n=191). Se utilizó el análisis de Rasch para examinar la capacidad discriminativa de la escala de evaluación de 5 categorías, así como la unidimensionalidad y jerarquía del conjunto de ítems. Adicionalmente, se utilizaron datos de 55 niños con desarrollo típico (24 varones, 31 mujeres; 6 años 9 meses, DE 2 años 5 meses) para examinar la validez de constructo.
Resultados
Los ítems de la escala de calificación de 5 categorías no presento un patrón uniforme, por lo tanto, los ítems se reagruparon para obtener la mejor suma de puntuación discriminativa. Se eliminaron diez artículos desajustados o redundantes. Dieciocho elementos bimanuales ordenados jerárquicamente cumplieron los requisitos del modelo unidimensional dentro del rango aceptable. El Cuestionario UMH discriminó significativamente entre los tres grupos (niños con desarrollo típico, PPBN, PC unilateral, H(2)=118,985, p<0.001), apoyando su validez de constructo.
Interpretación
El Cuestionario UMH es un instrumento válido para evaluar la cantidad de uso espontáneo de la mano comprometida en niños con paresia unilateral de miembros superiores.
Resumo
Desenvolvimento e propriedades psicométricas do questionário Hand‐Use‐at‐Home para avaliar quantidade de uso da mão afetada em crianças com paralisia unilateral
Objetivo
Descrever o desenvolvimento do questionário respondido pelos pais Uso da mão em casa – UMC (Hand‐Use‐at‐Home HUH) para avaliar a quantidade de uso espontâneo da mão afetada em crianças com paralisia unilateral, e testar sua estrutura interna, unidimensionalidade, e validade.
Método
Pais de crianças com paralisia cerebral (PC) unilateral e profissionais participaram no desenvolvimento da UMC. Para examinar a validade interna, os dados de 322 crianças (158 do sexo masculino, 164 do sexo feminino; média de idade 6 anos e 7 meses, desvio padrão DP 2 anos e 1 mês) com PC unilateral (n=131) ou paralisia neonatal do plexo braquial (PNPB) (n=191) foram coletados. A análise Rasch foi usada para examinar a capacidade discriminativa da escala de 5 categorias, bem como sua unidimensionalidade e hierarquia do conjunto de itens. Adicionalmente, os dados de 55 crianças com desenvolvimento típico (24 do sexo masculino, 31 do sexo feminino; 6 anos e 9 meses, DP 2 anos e 5 meses) foram usados para examinar a validade de construto.
Resultados
A escala em 5 categorias foi desordenada em todos os itens e colapsada para obter o melhor escore discriminativo. Dez itens não adequados ou redundantes foram removidos. Dezoito itens bimanuais hierarquicamente organizados atenderam ao modelo unidimensional dentro de uma variação aceitável. A UMC discriminou os três grupos significativamente (crianças com desenvolvimento típico, PNPB, PC unilateral; H(2)=118,985, p<0.001), o que dá suporte à sua validade de construto.
Interpretação
A UMC é um instrumento válido para avaliar a quantidade de uso espontâneo da mão afetada em crianças com paralisia unilateral do membro superior.
What this paper adds
Parent‐rated amount of hand‐use is a valuable addition to clinical assessment.
The unidimensional Hand‐Use‐at‐Home questionnaire (HUH) has 18 hierarchically ordered items that assess spontaneous (affected) hand‐use in play and self‐care activities at home.
Construct validity of the HUH was established for children with unilateral paresis aged 3 to 10 years.
This article is commented on by Klingels on page 885 of this issue.
This article's has been translated into Spanish and Portuguese.
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Abstract only
Background
Although guidelines advocate conservative treatment, it is unclear how GPs manage patients with a suspected meniscal tear.
Aim
To provide a clear understanding of the ...frequency of patients that are conservatively treated or are referred to secondary care, and whether this management is associated with age, trauma and locking complaints, and varied between general practices.
Method
Data was extracted from a GP database of routinely collected data. Subjects of 18–75 years old who attended their GP from 2005 up to and including 2015 in the area of Amsterdam with suspected meniscal tear were included. Groups were defined as 1) conservative treatment, 2) referral to secondary care after conservative treatment and 3) instant referral.
Results
We retrieved 394 records. One hundred and twenty-two (31%) subjects were treated conservatively, 107 (27%) were referred after conservative treatment and 165 (42%) subjects were instantly referred to secondary care. This implies that of all subjects with a suspected meniscal tear, 69% were referred to secondary care of which more than 60% instantaneously. Subjects >40 years of age were more often referred than subjects ≤40 years (
P
= 0.013). Significant variation between GP practices occurred as initial referral and referral after conservative treatment ranged between 56% to 84% (
P
= 0.011).
Conclusion
In Dutch GP practices, the majority of patients with suspicion meniscal tear are referred to secondary care. Older subjects are more frequently referred than younger subjects. The management of such patients varies substantially between GP practices. Findings emphasize the need for individualized risk predictions to guide decisions regarding the management of suspected meniscal tears.
Background:
Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis IPAA. Identification of patients at high risk of leakage may influence ...surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA.
Methods:
Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease IBD were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure.
Results:
A total of 640 patients 56.9% male were included, with a median age of 38 years interquartile range 29–48; 96 15.0% patients developed anastomotic leakage. Multivariable regression analysis demonstrated that being overweight (body mass index BMI > 25, (odds ratio OR 1.92; 95% confidence interval CI 1.15 – 3.18), and American Society of Anesthesiologists classification ASA score > 2 OR 1.91; 95% CI 1.03 – 3.54 were independent risk factors for anastomotic leakage in patients who underwent a completion proctectomy. A disease course of > 5 years OR 2.34; 95% CI 1.42 – 3.87 and concurrent combination of anti-tumour necrosis factor TNF and steroids OR 6.40; 95% CI 1.76 – 23.20 were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA.
Conclusions:
Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.
In dermatology, the clinical use of health-related quality of life (HRQL) scores is impeded by lack of empirically and clinically based interpretation of these scores. We aimed to facilitate the ...interpretation of Skindex-29 domain and overall scores by identifying clinically meaningful cut-off scores, using patient-based anchors. Consecutively included dermatology outpatients completed the Skindex-29 and four sets of anchor-based questions, such as questions on the impact of skin disease on HRQL, on global disease severity, and on psychiatric morbidity. Pearson's correlations and receiver operating characteristic analysis were used to identify the optimal Skindex-29 cut-off scores corresponding to severely impaired HRQL. A total of 339/434 patients completed the questionnaires (response rate 78%), of which 322 could be used for data analysis. Cut-off scores associated with the patient-based anchors on the impact of skin disease on HRQL showed the highest accuracy (area under the curve ranged from 0.83 to 0.91). The corresponding Skindex-29 cut-off scores for severely impaired HRQL were as follows: ≥52 points on symptoms, ≥39 on emotions, ≥37 on functioning, and ≥44 on the overall score. The estimated cut-off scores can be used in clinical practice to identify patients with (very) severely impaired HRQL.
Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) has thus far only been tested for diminishing behavior problems in the US. This study tested relative efficacy of MTFC-P on multiple ...outcomes against treatment as usual in the Netherlands (TAU; Study I), and regular foster care (Study II). The sample included 55 children that received MTFC-P, 23 children received TAU and 30 children from regular foster care (RFC). Changes in behavioral and relationship functioning, trauma symptoms, hypothalamic-adrenal-pituitary (HPA-) axis functioning, and caregiving stress were assessed via questionnaires, interviews, and salivary cortisol. Outcomes of Study I were evaluated using a randomized controlled design and quasi-experimental design, outcomes of Study II according to non-equivalent group comparison. No evidence was found for relative efficacy of MTFC-P over TAU. A treatment effect was found on trauma symptoms, in favor of TAU. Outcomes of Study II revealed that whereas caregiving stress and secure base distortions were significantly more severe at baseline in MTFC-P compared to RFC, post treatment differences were no longer significant. However, percentages of symptoms of disinhibited attachment and attachment disorder were nearly equal between groups at baseline, while post treatment percentages indicated significantly more symptoms in MTFC. In addition, results revealed a significant difference in the severity of externalizing problems post treatment, in favor of RFC. The results obtained within this study indicate that children in MTFC-P and usual treatment foster care in the Dutch context improved similarly, thus not showing the same advantages that MTFC-P has demonstrated in the US. Results should be interpreted with caution due to lower than planned power. Findings underscore the challenges of testing novel treatments across contexts with highly different child welfare provisions.
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