Epidural Steroids for Lumbosacral Radicular Syndrome Compared to Usual Care: Quality of Life and Cost Utility in General Practice

ObjectiveTo determine whether early and more frequent mobilization after stroke affects health-related quality of life.MethodsA Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006–2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from −0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0.ResultsNo significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07–0.81) and usual care (median 0.49, IQR 0.08–0.81) groups was identified (p = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age.ConclusionsEarlier and more frequent mobilization after stroke did not influence quality of life.Clinical trial registrationanzctr.org.au; ACTRN12606000185561Classification of evidenceThis study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.

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A Two-Arm Randomized Pilot Study to Evaluate the Impact of a Mobile Health App on Quality of Life in Patients on Oral Anti-Cancer Medications (Preprint)

10.2196/preprints.11830 ◽

2018 ◽

Author(s):

Nils Fischer ◽

Stephen Agboola ◽

Ramya Palacholla ◽

Mursal Atif ◽

Joseph Kvedar ◽

...

Keyword(s):

Quality Of Life ◽

Usual Care ◽

Cancer Patients ◽

Intervention Group ◽

Continuous Variable ◽

Care Quality ◽

Control Group ◽

Anti Cancer ◽

The Impact

BACKGROUND CORA is a personalized smartphone-based self-management app designed to help cancer patients on oral anti-cancer medications manage medication, medication side-effects, and symptoms with the overall goal of improving their quality of life. OBJECTIVE To evaluate the effect of CORA on quality of life in patients on oral anti-cancer medications. METHODS Eighty-four patients were randomized to either an intervention group that received CORA plus usual care or a control group that received usual care. Quality of life was measured using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale administered at enrollment, 6 and 12 weeks. Engagement with the app was assessed by determining the unique days using the app. We evaluated the effect of engagement on FACIT-F both as a continuous variable (days using the app) and as a categorical outcome (low, medium, and high). Group differences for all outcomes over the study period were assessed using repeated measures mixed model analysis. RESULTS Relative to the control group, the intervention group improved FACIT-F by 0.36 (95% CI 0.10-0.61) P=.006 per week over the study period. As a continuous variable, each additional day using the app was significantly associated with an improved FACIT-F score per week in the study [0.0060 (95% CI -0.000034-0.012), P=.05]. Within the intervention group that used the app, those who were most engaged with the app were significantly more likely to improve their quality of life over the study relative to the least engaged group [0.37 per week (95% CI 0.19-1.94), P=.05]. CONCLUSIONS CORA may have significantly improved quality of life (FACIT-F) in cancer patients over 12 weeks. Smartphone applications may positively impact health and behavioral outcomes in cancer patients on oral anti-cancer medications.

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Supportive care & quality of life

European Journal of Cancer ◽

10.1016/s0959-8049(01)80264-1 ◽

2001 ◽

Vol 37 ◽

pp. 280-282

Keyword(s):

Quality Of Life ◽

Supportive Care ◽

Care Quality

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Impact of Institutional - and Individual -Level Discrimination on Medical Care & Quality of Life among Breast Cancer Survivors

10.21236/ada516473 ◽

2009 ◽

Author(s):

Scarlett L. Gomez

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivors ◽

Medical Care ◽

Breast Cancer Survivors ◽

Care Quality ◽

Individual Level

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Impact of Institutional - and Individual - Level Discrimination on Medical Care & Quality of Life Among Breast Cancer Survivors

10.21236/ada542282 ◽

2010 ◽

Author(s):

Scarlett L. Gomez

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivors ◽

Medical Care ◽

Breast Cancer Survivors ◽

Care Quality ◽

Individual Level

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Randomized controlled study of the impact of a participatory patient care plan among primary care patients with common chronic diseases: a one-year follow-up study

BMC Health Services Research ◽

10.1186/s12913-021-06716-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nina Tusa ◽

Hannu Kautiainen ◽

Pia Elfving ◽

Sanna Sinikallio ◽

Pekka Mäntyselkä

Keyword(s):

Quality Of Life ◽

Patient Care ◽

Usual Care ◽

Care Plan ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Disease Specific

Abstract Backround Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension. Methods The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017–2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up. Results A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes. Conclusions During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline. Trial registration ClinicalTrials.gov Identifier: NCT02992431. Registered 14/12/2016

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Effectiveness of comprehensive geriatric assessment intervention on quality of life, caregiver burden and length of hospital stay: a systematic review and meta-analysis of randomised controlled trials

BMC Geriatrics ◽

10.1186/s12877-021-02319-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhongyi Chen ◽

Zhaosheng Ding ◽

Caixia Chen ◽

Yangfan Sun ◽

Yuyu Jiang ◽

...

Keyword(s):

Quality Of Life ◽

Hospital Stay ◽

Usual Care ◽

Caregiver Burden ◽

Length Of Hospital Stay ◽

Sf 36 ◽

Subgroup Analyses ◽

Randomised Controlled ◽

Meta Analyses

Abstract Background Comprehensive geriatric assessment (CGA) interventions can improve functional ability and reduce mortality in older adults, but the effectiveness of CGA intervention on the quality of life, caregiver burden, and length of hospital stay remains unclear. The study aimed to determine the effectiveness of CGA intervention on the quality of life, length of hospital stay, and caregiver burden in older adults by conducting meta-analyses of randomised controlled trials (RCTs). Methods A literature search in PubMed, Embase, and Cochrane Library was conducted for papers published before February 29, 2020, based on inclusion criteria. Standardised mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs) was calculated using the random-effects model. Subgroup analyses, sensitivity analyses, and publication bias analyses were also conducted. Results A total of 28 RCTs were included. Overall, the intervention components common in different CGA intervention models were interdisciplinary assessments and team meetings. Meta-analyses showed that CGA interventions improved the quality of life of older people (SMD = 0.12; 95% CI = 0.03 to 0.21; P = 0.009) compared to usual care, and subgroup analyses showed that CGA interventions improved the quality of life only in participants’ age > 80 years and at follow-up ≤3 months. The change value of quality of life in the CGA intervention group was better than that in the usual care group on six dimensions of the 36-Item Short-Form Health Survey questionnaire (SF-36). Also, compared to usual care, the CGA intervention reduced the caregiver burden (SMD = − 0.56; 95% CI = − 0.97 to − 0.15, P = 0.007), but had no significant effect on the length of hospital stay. Conclusions CGA intervention was effective in improving the quality of life and reducing caregiver burden, but did not affect the length of hospital stay. It is recommended that future studies apply the SF-36 to evaluate the impact of CGA interventions on the quality of life and provide supportive strategies for caregivers as an essential part of the CGA intervention, to find additional benefits of CGA interventions.

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Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-046600 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046600

Author(s):

Anne-Marie Hill ◽

Rachael Moorin ◽

Susan Slatyer ◽

Christina Bryant ◽

Keith Hill ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Randomised Controlled Trial ◽

Usual Care ◽

Controlled Trial ◽

Informal Caregivers ◽

Care Recipient ◽

Care At Home ◽

Randomised Controlled

IntroductionThere are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers’ health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers’ health-related quality of life (HRQOL) after care recipients’ hospital discharge.Methods and analysisA multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient’s discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30–45 min telephone support sessions over 6 months. The primary outcome is caregivers’ HRQOL measured using the Assessment of Quality of Life—eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements.Ethics and disseminationParticipants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences.Trial registration numberACTRN12620000060943.

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E-health ecosystem with integrated and stepped psychosocial services for breast cancer survivors: study protocol of a multicentre randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-041548 ◽

2021 ◽

Vol 11 (3) ◽

pp. e041548

Author(s):

Cristian Ochoa-Arnedo ◽

Joan Carles Medina ◽

Aida Flix-Valle ◽

Dimitra Anastasiadou

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Randomised Controlled Trial ◽

Emotional Distress ◽

Controlled Trial ◽

Psychosocial Care ◽

Cost Utility ◽

Psychosocial Services ◽

Randomised Controlled

IntroductionPsychosocial interventions for patients with breast cancer (BC) have demonstrated their effectiveness at reducing emotional distress and improving quality of life. The current digitisation of screening, monitoring and psychosocial treatment presents the opportunity for a revolution that could improve the quality of care and reduce its economic burden. The objectives of this study are, first, to assess the effectiveness of an e-health platform with integrated and stepped psychosocial services compared with usual psychosocial care, and second, to examine its cost–utility.Methods and analysisThis study is a multicentre randomised controlled trial with two parallel groups: E-health intervention with integrated and stepped psychosocial services vs usual psychosocial care. An estimated sample of 338 patients with BC in the acute survival phase will be recruited from three university hospitals in Catalonia (Spain) and will be randomly assigned to one of two groups. All participants will be evaluated at the beginning of the study (T1: recruitment), 3 months from T1 (T2), 6 months from T1 (T3) and 12 months from T1 (T4). Primary outcome measures will include number of clinical cases detected, waiting time from detection to psychosocial intervention and proportion of cases successfully treated in the different steps of the intervention, as well as outcomes related to emotional distress, quality of life, post-traumatic stress and growth, treatment adherence and therapeutic alliance. Secondary outcomes will include the acceptability of the platform, patients’ satisfaction and usability. For the cost–utility analysis, we will assess quality-adjusted life years and costs related to healthcare utilisation, medication use and adherence, work absenteeism and infrastructure-related and transport-related costs.Ethics and disseminationThis study was approved by the Ethics committee of the Institut Català d’Oncologia network in Hospitalet, Spain. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences among the scientific community, workshops with patients and media press releases.Trial registration numberOnline Psychosocial Cancer Screening, Monitoring and Stepped Treatment in Cancer Survivors (ICOnnectat-B),NCT04372459.

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