A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Background Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. Methods Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. Results Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046). Conclusions A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

Fund Managers Adding Values? Measuring Performance without Benchmark – A Study of Indian Mutual Fund Schemes

This paper calculates the Portfolio Change Measure (PCM) developed by Grinblatt and Titman for a sample of 744 equity schemes of Indian mutual funds over a minimum period of more than 2 years and less than 11 years. PCM, based on holding of assets, is a measure which is free from ‘benchmark’ biases arising out of usage of a ‘benchmark’ portfolio. So by using PCM as a measure, this paper, without using any benchmark, attempts to assess whether the selected mutual fund managers were able to add value and exhibit superior skills on the average and thus making a case for active fund management over a passive buy and hold strategy. Using the monthly holding statement of each individual scheme’s portfolio, rolling PCM has been calculated on a monthly basis with a rolling window of one year. The results of our analysis, supported by robustness checks, which includes time periods of pre-and post-Global Financial Crisis, shows strong evidence of active fund management adding value in the stock selection and hence in return generating process, thus justifying the possession of superior skill or superior information of fund managers at an aggregate level. Finally, using Quantile Regression we identify some characteristics of the scheme like scheme size and ownership category, which influence PCM significantly.

Development of a patient-reported outcome measure (PROM) and change measure for use in early recovery following hip or knee replacement

Background Hip and knee replacement are effective procedures for end-stage arthritis that has not responded to medical management. However, until now, there have been no validated, patient-reported tools to measure early recovery in this growing patient population. The process of development and psychometric evaluation of the Oxford Arthroplasty Early Recovery Score (OARS), a 14-item patient-reported outcome measure (PROM) measuring health status, and the Oxford Arthroplasty Early Change Score (OACS) a 14-item measure to assess change during the first 6 weeks following surgery is reported. Patients and methods A five-phased, best practice, iterative approach was used. From a literature based starting point, qualitative interviews with orthopaedic healthcare professionals, were then performed ascertaining if and how clinicians would use such a PROM and change measure. Analysis of in-depth patient-interviews in phase one identified important patient-reported factors in early recovery which were used to provide questionnaire themes. In Phase two, candidate items from Phase One interviews were generated and pilot questionnaires developed and tested. Exploratory factor analysis with item reduction and final testing of the questionnaires was performed in phase three. Phase Four involved validation testing. Results Qualitative interviews (n = 22) with orthopaedic healthcare professionals, helped determine views of potential users, and guide structure. In Phase One, factors from patient interviews (n = 30) were used to find questionnaire themes and generate items. Pilot questionnaires were developed and tested in Phase Two. Items were refined in the context of cognitive debrief interviews (n = 34) for potential inclusion in the final tools. Final testing of questionnaire properties with item reduction (n = 168) was carried out in phase three. Validation of the OARS and OACS was performed in phase four. Both measures were administered to consecutive patients (n = 155) in an independent cohort. Validity and reliability were assessed. Psychometric testing showed positive results, in terms of internal consistency and sensitivity to change, content validity and relevance to patients and clinicians. In addition, these measures have been found to be acceptable to patients throughout early recovery with validation across the 6 week period. Conclusions These brief, easy-to-use tools could be of great use in assessing recovery pathways and interventions in arthroplasty surgery.

Translation and psychometric evaluation of the German version of the Organisational Readiness for Implementing Change measure (ORIC): a cross-sectional study

ObjectivesTo translate the Organisational Readiness for Implementing Change measure into German and assess its psychometric properties.DesignCross-sectional psychometric study based on secondary analysis of baseline data from a shared decision-making implementation study.SettingThree departments within one academic cancer centre in Hamburg, Germany.ParticipantsFor comprehensibility assessment of the translated ORIC version, we conducted cognitive interviews with healthcare professionals (HCPs, n=11). Afterwards, HCPs (n=230) filled out the measure.Primary and secondary outcome measuresThe original English version of the ORIC was translated into German using a team translation protocol. Based on comprehensibility assessment via cognitive interviews with HCPs, the translated version was revised. We analysed acceptance (completion rate), factorial structure (exploratory factor analysis (EFA), confirmatory factor analysis (CFA), model fit), item characteristics (item difficulties, corrected item-total correlations, inter-item correlations) and internal consistency (Cronbach’s α).ResultsTranslation and cognitive testing of the German ORIC was successful except for item 10, which showed low comprehensibility as part of content validity in cognitive interviews. Completion rate was >97%. EFA and CFA provided a one-factorial structure. Item difficulties ranged between 55.98 and 65.32, corrected item-total-correlation ranged between 0.665 and 0.774, inter-item correlations ranged between 0.434 and 0.723 and Cronbach’s α was 0.93.ConclusionsThe German ORIC is a reliable measure with high completion rates and satisfying psychometric properties. A one-factorial structure of the German ORIC was confirmed. Item 10 showed limited comprehensibility and therefore reduces content validity of the measure. The German ORIC can be used to analyse organisational readiness for change as a precursor for implementation success of various interventions.

Adverbs of Change, Aspect, and Underspecification

Adverbs of change, such as quickly or slowly, are known to give rise to a number of interpretations. For example, Selena ran quickly says that the rate of running is high while Selena quickly noticed the plane implies that the distance between the event of noticing the plane and some previous event is short. Existing accounts (e.g. Cresswell 1978; Rawlins 2013) take rate readings as primary but struggle to derive additional interpretations. By contrast, I argue that adverbs of change measure the temporal distance between two salient events (or event parts) that are compositionally or contextually available. The main claim of the paper is that adverbs of change have a single if underspecified semantics and that the different interpretations arise through interaction with aspectual and discourse structure.