Commentary: Uncertainty in the Relationship Between Sagittal Alignment and Patient-Reported Outcomes

Neurosurgery ◽  
2019 ◽  
Author(s):  
Zach Pennington ◽  
Daniel M Sciubba
Keyword(s):  
Patient Reported Outcomes ◽  
Sagittal Alignment ◽  
Patient Reported ◽  
The Relationship

Uncertainty in the Relationship Between Sagittal Alignment and Patient-Reported Outcomes

Neurosurgery ◽  
2019 ◽  
Author(s):  
Peter D Angevine ◽  
David Bray ◽  
Michael Cloney ◽  
Hani Malone
Keyword(s):  
Patient Reported Outcomes ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Senior Author ◽  
High Density ◽  
Individual Values ◽  
Sagittal Vertical Axis ◽  
Heterogeneous Effects ◽  
Patient Reported ◽  
The Relationship

Abstract BACKGROUND Previous studies have reported correlations and precise quantitative relationships between sagittal alignment and health-related quality-of-life (HRQOL) scores. These studies have not reported the extent of uncertainty in these relationships. OBJECTIVE To explore the uncertainty in the overall relationships between sagittal alignment and HRQOL and in the predictions of individual patient pain and disability. METHODS A retrospective analysis of all new adult patients with long-cassette radiographs and complete outcomes questionnaires presenting to the senior author from 2012 to 2014 was performed. Univariable maximum a posteriori linear regression analyses using Bayesian methods were performed. High-density probability intervals for mean regression relationships and for individual values were calculated using minimally informative prior distributions. RESULTS A total of 134 patients satisfied inclusion criteria and were included. For Oswestry Disability Index (ODI) vs pelvic incidence-lumbar lordosis (LL), the 90% high-density probability interval ranged from –0.04 to 0.23, indicating that both the magnitude and direction of the relationship were uncertain. For both ODI vs sagittal vertical axis and ODI vs LL, there was uncertainty in the magnitude of the slope. Wide regions of uncertainty were also seen for predicting individual patient scores. CONCLUSION We report the previously unpublished degree of uncertainty in the mean quantitative relationships between radiographic sagittal alignment and patient-reported outcomes and in individual patient outcomes scores. Based on these results, establishing treatment thresholds or predicting an individual's outcome is unreliable. Further research efforts should be focused on developing multilevel hierarchical models incorporating parameter uncertainty and heterogeneous effects.

Objective and Subjective Outcomes in Patients with Hearing Aids: A Cross-Sectional, Comparative, Associational Study

2021 ◽  
pp. 1-9
Author(s):  
Xunyi Wang ◽  
Yun Zheng ◽  
Gang Li ◽  
Jingzhe Lu ◽  
Yan Yin
Keyword(s):  
Hearing Aids ◽  
Patient Reported Outcomes ◽  
Cross Sectional ◽  
Patient Reported ◽  
Objective Tests ◽  
The Difference ◽  
Potential Factors ◽  
Positive Correlations ◽  
The Relationship ◽  
Subjective Outcomes

<b><i>Introduction:</i></b> Outcome assessment for hearing aids (HAs) is an essential part of HA fitting and validation. There is no consensus about the best or standard approach for evaluating HA outcomes. And, the relationship between objective and subjective measures is ambiguous. This study aimed to determine the outcomes after HA fitting, explore correlations between subjective benefit and acoustic gain improvement as well as objective audiologic tests, and investigate several variables that may improve patients’ perceived benefits. <b><i>Methods:</i></b> Eighty adults with bilateral symmetrical hearing loss using HAs for at least 1 month were included in this study. All subjects completed the pure tone average (PTA) threshold and word recognition score (WRS) tests in unaided and aided conditions. We also administered the Chinese version of International Outcome Inventory for Hearing Aids (IOI-HA), to measure participants’ subjective benefits. Objective HA benefit (acoustic gain improvement) was defined as the difference in thresholds or scores between aided and unaided conditions indicated with ΔPTA and ΔWRS. Thus, patients’ baseline hearing levels were taken into account. Correlations were assessed among objective audiologic tests (PTA and WRS), acoustic gain improvement (ΔPTA and ΔWRS), multiple potential factors, and IOI-HA overall scores. <b><i>Results:</i></b> PTA decreased significantly, but WRS did not increase when aided listening was compared to unaided listening. Negative correlations between PTAs and IOI-HA scores were significant but weak (<i>r</i> = −0.370 and <i>r</i> = −0.393, all <i>p</i> &#x3c; 0.05). Significant weak positive correlations were found between WRSs and IOI-HA (<i>r</i> = 0.386 and <i>r</i> = 0.309, all <i>p</i> &#x3c; 0.05). However, there was no correlation among ΔPTA, ΔWRS, and IOI-HA (<i>r</i> = 0.056 and <i>r</i> = −0.086, all <i>p</i> &#x3e; 0.05). Moreover, 2 nonaudiological factors (age and daily use time) were significantly correlated with IOI-HA (<i>r</i> = −0.269 and <i>r</i> = 0.242, all <i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> Correlations among objective audiologic tests, acoustic gain, and subjective patient-reported outcomes were weak or absent. Subjective questionnaires and objective tests do not reflect the same hearing capability. Therefore, it is advisable to evaluate both objective and subjective outcomes when analyzing HA benefits on a regular basis and pay equal attention to nonaudiological and audiological factors.

scholarly journals Patient-Reported Disease-Modifying Therapy Adherence in the Clinic: A Reliable Metric?

2018 ◽  
Vol 4 (2) ◽  
pp. 205521731877789 ◽  
Author(s):  
Devon S Conway ◽  
Maria Cecilia Vieira ◽  
Nicolas R Thompson ◽  
Kaila N Parker ◽  
Xiangyi Meng ◽  
...  
Keyword(s):  
Regression Models ◽  
Patient Reported Outcomes ◽  
Patient Reporting ◽  
Lesion Formation ◽  
Logistic Regression Models ◽  
Disease Modifying Therapy ◽  
Patient Reported ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
The Relationship

Background Adherence to multiple sclerosis (MS) disease-modifying therapy (DMT) is commonly assessed through patient reporting, but patient-reported adherence is rarely studied. Objective To determine rates of DMT adherence reported from patient to clinician, reasons for nonadherence, and relationships between adherence and outcomes. Methods We identified relapsing–remitting MS patients on DMT for ≥3 months. DMT adherence was defined as taking ≥80% of doses. Linear and logistic regression models were created used to determine the association of baseline adherence with several patient reported outcomes and the timed 25-foot walk at 6 months, 1 year, 2 years, and 3 years after the index visit. Results The analysis included 1148 patients, of whom 501 had data at 6 months, 544 at 1 year, 331 at 2 years, and 247 at 3 years. Baseline adherence was 94.9% and overall adherence was 93.1%. Forgetting was the most common reason for missed doses. In the adjusted models, adherence was not associated with the outcomes. Conclusions Higher than expected adherence and a lack of association between adherence and outcomes suggests patient reported adherence may not be reliable. Further research is needed to clarify the relationship between patient-reported adherence and relapses or new lesion formation.

Does improved radiographic alignment truly enhance dynamic functional balance?

2021 ◽  
Author(s):  
R Haddas ◽  
S Kisinde ◽  
D Mar ◽  
I Lieberman
Keyword(s):  
Patient Reported Outcomes ◽  
Added Value ◽  
Functional Balance ◽  
Radiographic Measurements ◽  
Patient Reported ◽  
Before And After ◽  
Gait Abnormalities ◽  
The Relationship ◽  
Radiographic Alignment

Prospective, concurrent-cohort study. To establish the relationship between radiographic alignment parameters and functional CoE measurements at one week before and at three months after realignment surgery in ADS patients. Adult degenerative scoliosis (ADS) represents a significant healthcare burden with exceedingly high and increasing prevalence, particularly among the elderly. Radiographic alignment measures and patient-reported outcomes currently serve as the standard means to assess spinal alignment, deformity, and stability. Neurological examinations have served as qualitative measures for indicating muscle strength, motor deficits, and gait abnormalities. Three-Dimensional motion analysis is increasingly being used to identify and measure gait and balance instability. Recently, techniques have been established to quantify balance characteristics described by Dubousset as the “cone of economy” (CoE). The relationship between radiographic alignment parameters and CoE balance measures of ADS patients before and after realignment surgery is currently unknown. 29 ADS patients treated with realignment surgery. Patients were evaluated at one week before realignment surgery and at their three-month follow-up examination. During each evaluation, patients completed self-reported outcomes (visual analog scales for pain, Oswestry Disability Index, SRS22r) and a functional balance test. Mean changes in dependent measures from before to after surgery were compared using paired t-tests. Pearson correlations were used to test for significant correlations between changes in radiographic and CoE measures. Significant improvements were found for all patient-reported outcomes, in several radiographic measures, and in CoE measures. Improvements of scoliosis Cobb angle, coronal pelvic tilt, lumbar lordosis, and thoracic kyphosis showed significant correlations with CoE sway and total distance measures at both the center of mass and center of the head. Improved radiographic alignment measures significantly correlated with improved CoE balance measures among ADS patients treated with realignment surgery at their three-month follow-up. These findings indicate that functional balance evaluations when used in conjunction with radiographic measurements, may provide a more robust and improved patient-specific sensitivity for postoperative assessments. CoE balance may represent a new measure of added value for surgical intervention of ADS.

Breast cancer patient reported outcomes, depression, and objective measures of breast cosmesis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 569-569
Author(s):  
Shauna McManus ◽  
Jolinta Y Lin ◽  
Manali A. Bhave ◽  
Gabrielle Brown ◽  
India Green ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Patient Reported Outcomes ◽  
Depressive Symptomatology ◽  
Cosmetic Outcome ◽  
Self Report ◽  
Objective Measures ◽  
Breast Asymmetry ◽  
Patient Reported ◽  
Prospective Longitudinal ◽  
The Relationship

569 Background: Patient-reported outcomes (PROs) of cosmesis after breast-conserving therapy (BCT) are increasingly emphasized as meaningful treatment endpoints but little is known about the relationship between objective measures, mood, and PROs following radiation (XRT). We hypothesized that pre-XRT depression, assessed by Inventory of Depressive Symptomatology Self-Report (IDS-SR), would influence PROs of breast cosmesis 1-year post-XRT independent of objective measures of breast asymmetry. Methods: 98 women were enrolled on two prospective longitudinal studies of breast cosmesis. Percentage breast retraction assessment (pBRA) was used as an objective measure of breast asymmetry pre- and 1 year post-XRT. At the same time points, pBRA was measured and compared with two different PRO ratings of cosmetic outcome (0-10 scale): 1) happiness with cosmesis and 2) perceived differences in treated vs. untreated breast. We performed univariate and multivariate analysis to evaluate the relationship between PROs, pBRA, IDS-SR scores, clinical, tumor, and treatment characteristics. Results: Among subjects, 50% were African American. Mean age was 56.45 years. At 1 year, 65.3% of patients were happy with their cosmetic outcome (Score > 8) although 59.5% noted moderate to severe differences in the treated vs. untreated breast (Score < 6). Mean pBRA increased from 7.20 (SD 3.88) pre-XRT to 9.69 (SD 6.22) confirming more breast asymmetry 1-year post-XRT. Prior to XRT, 23% of patients had moderate-to-severe depression (IDS-SR scores > 26). In multivariate analyses, 1 year PROs of happiness with cosmetic outcome did not correlate with pBRA (p = 0.3) but were strongly correlated with pre and post-XRT depression (all p < 0.05). Patients were more likely to perceive differences in breast texture or asymmetry (i.e. lower PRO ratings of asymmetry) if they had higher pBRA measurements at 1 year (all p = 0.004). Neither pre- nor post- XRT depression were associated with specific PRO ratings of breast asymmetry in multivariate analysis. Conclusions: Our study suggests that PROs may not always reflect the effects of cancer treatment. For patients treated with BCT, baseline depression strongly influenced patient reported happiness with overall cosmetic outcome 1 year post-XRT. Perceived differences in the treated vs. untreated breast correlated with objective measures of breast asymmetry. Our data suggests that this PRO may be more indicative of treatment-related toxicities than patient ratings of overall satisfaction and happiness with cosmetic outcome. Clinical trial information: NCT03167359 .

scholarly journals 1259. Household Income and Its Relationship with Patient-Reported Outcomes Among Older People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S453-S454
Author(s):  
Peter Mazonson ◽  
Jeff Berko ◽  
Theoren Loo ◽  
Lynsay MacLaren ◽  
Erik S Lowman
Keyword(s):  
Health Outcomes ◽  
Household Income ◽  
Patient Reported Outcomes ◽  
Income Group ◽  
People Living With Hiv ◽  
Annual Household Income ◽  
Patient Reported ◽  
Part Time ◽  
Living With Hiv ◽  
The Relationship

Abstract Background Socioeconomic factors have been identified as a root cause of a wide range of health outcomes. However, there are no studies that describe the impact of these factors on patient-reported outcomes (PROs) among older (age 50+) people living with HIV (PLWH). This study examines the relationship between annual household income, sociodemographic factors, and several PROs among older PLWH. Methods A cross-sectional analysis examined the relationships between self-reported annual household income, sociodemographic information, and validated PROs. Statistical differences within sociodemographic groups were determined using chi-squared tests, and within PROs using bivariate risk ratios. Results Of 922 participants, the median age was 58 years (range: 50–88). The majority of participants were male (89%), gay (79%), and white (70%). Fifty-five percent reported an annual household income of less than $50,000 per year and 45% reported a household income of $50,000 or greater. Among people in the lower-income group, 33% were working full or part time, 24% were retired, and 43% were disabled, whereas among people in the higher income group, 76% were working full or part time, 19% were retired, and 5% were disabled (Table 1). Bivariate analysis showed that while there was not a significant relationship between age and income, income was significantly associated with work status, race, gender, education, relationship status, sexual orientation, and having enough money to meet basic needs. People with lower household income were significantly more likely to be depressed, anxious, and lonely, and to have 4 or more comorbid conditions (Table 2). They were also less likely to have high resilience, high social well-being, and high quality of life. Conclusion To the best of our knowledge, this is the first examination of the relationship between self-reported annual household income and PROs among older PLWH. In these bivariate analyses, income was positively associated with desirable PROs, and negatively associated with undesirable PROs. To be successful, programs designed to improve health outcomes for older PLWH must take into account the economic challenges faced by many in this group. Disclosures All authors: No reported disclosures.

scholarly journals A Factor Analysis Approach for Clustering Patient Reported Outcomes

2016 ◽  
Vol 55 (05) ◽  
pp. 431-439 ◽  
Author(s):  
Maria Thor ◽  
Caroline Olsson ◽  
Viktor Skokic ◽  
Rebecka Jörnsten ◽  
David Alsadius ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Quantitative Analysis ◽  
Side Effects ◽  
Radiation Dose ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Dose Volume ◽  
Patient Reported ◽  
Symptom Group ◽  
The Relationship

SummaryBackground: In the field of radiation oncology, the use of extensive patient reported outcomes is increasingly common to meas -ure adverse side effects after radiotherapy in cancer patients. Factor analysis has the potential to identify an optimal number of latent factors (i.e., symptom groups). However, the ultimate goal of treatment response modeling is to understand the relationship between treatment variables such as radiation dose and symptom groups resulting from FA. Hence, it is crucial to identify clinically more relevant symptom groups and improved response variables from those symptom groups for a quantitative analysis. Objectives: The goal of this study is to design a computational method for finding clinically relevant symptom groups from PROs and to test associations between symptom groups and radiation dose. Methods: We propose a novel approach where exploratory factor analysis is followed by confirmatory factor analysis to determine the relevant number of symptom groups. We also propose to use a combination of symptoms in a symptom group identified as a new response variable in linear regression analysis to investigate the relationship between the symptom group and dose-volume variables. Results: We analyzed patient-reported gastrointestinal symptom profiles from 3 datasets in prostate cancer patients treated with radiotherapy. The final structural model of each dataset was validated using the other two datasets and compared to four other existing FA methods. Our systematic EFA-CFA approach provided clinically more relevant solutions than other methods, resulting in new clinically relevant outcome variables that enabled a quantitative analysis. As a result, statistically significant correlations were found between some dose- volume variables to relevant anatomic structures and symptom groups identified by FA. Conclusions: Our proposed method can aid in the process of understanding PROs and provide a basis for improving our understanding of radiation-induced side effects.

scholarly journals The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

2021 ◽  
Vol 28 (3) ◽  
pp. 2248-2259
Author(s):  
Fiona Wu ◽  
Oloruntobi Rotimi ◽  
Roberto Laza-Cagigas ◽  
Tarannum Rampal
Keyword(s):  
Cancer Treatment ◽  
Patient Reported Outcomes ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Dietary Advice ◽  
Post Intervention ◽  
Home Based ◽  
Patient Reported ◽  
Training Exercises ◽  
The Relationship

Patients awaiting cancer treatment were classified as “vulnerable” and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.

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