Validation of a vascular access specific quality of life measure (VASQoL)

Background: A self-administered 11 item vascular access specific quality of life measure (VASQoL) was previously derived from detailed qualitative interviews with adult patients with kidney failure who have experienced vascular access using the Capabilities Approach as a theoretical base. This study reports the psychometric validation of the VASQoL measure including its reliability, content validity and responsiveness to change. Methods: Cognitive interviews were conducted with 23 adult patients with kidney failure after completion of the VASQoL measure. Focus group discussion with a vascular access professional multidisciplinary team was undertaken ( n = 8) and subsequently a further 101 adult kidney failure patients with vascular access (TCVC, AVF or AVG) completed the digital VASQoL measure, EQ-5D and SF-36 questionnaires in a longitudinal study with prospectively recorded vascular access events. Results: Transcript analysis of cognitive interviews after VASQoL completion indicated that the content was comprehensive and well understood by participants. Assessment of Internal reliability for the VASQoL measure was high (Cronbach’s alpha 0.858). Test-retest reliability of the overall VASQoL measure was high (intra class correlation coefficient 0.916). In those patients who experienced a vascular access event, significant differences were observed in paired analysis of the VASQoL physical domain questions and vascular access function domain questions and in the EQ-5D usual activities, pain and anxiety domains. In those with no vascular access event, variation was observed in longitudinal analysis in VASQoL questions relating to worry about VA function and capability domains, whilst no variation was observed in the EQ5D measure. Conclusion: The VASQoL measure has good internal consistency, test-retest reliability, convergent validity and responsiveness to change for clinically relevant vascular access outcomes. This provides a validated, vascular access specific quality of life measure that can be used in future trials of vascular access, evaluation of new technologies and routine use as a patient reported outcome measure (PROM).

Confirmatory Factor Analysis and Responsiveness to Change of the Persian Version of the Breastfeeding Self-Efficacy Short Form Scale

IntroductionThe Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) is a 14-item measure designed to assess a mother's confidence in successful breastfeeding of her baby. This study aimed to determine the confirmatory factor analyses (CFA) and responsiveness to change of the Persian version of the BSES-SF.MethodsThis study was performed in two phases: In the first phase, 400 women were recruited, and then in another phase, 110 pregnant women at 35–37 weeks gestation were randomly selected and assigned into two equal groups (n = 55). Educational intervention was implemented, and data were gathered in the third trimester and at 2 weeks postpartum.ResultsThe BSES-SF presented a one-dimensional structure with factor loadings of > 0.40 for CFA and Cronbach's alpha coefficient of 0.92. BSES-SF scores in the intervention group (56.76 ± 4.65) were significantly higher than the control group (48.94 ± 4.85).ConclusionBSES-SF can be a valid, responsive, and reliable measure of self-efficacy in response to breastfeeding challenges.

Responsiveness to change in health status of the EQ-5D in patients treated for depression and anxiety

Purpose The EQ-5D is a commonly used generic measure of health but evidence on its responsiveness to change in mental health is limited. This study aimed to explore EQ-5D responsiveness in patients receiving treatment for depression and anxiety.Methods Patient data (N = 416) were collected at baseline and at end of treatment in an observational study in a Norwegian outpatient clinic. Responsiveness in the EQ-5D was compared to change in the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Effect sizes (Cohen’s d), Standardised response mean (SRM), and Spearman’s correlation were calculated. Patients were classified as “Recovered”, “Improved”, or “Unchanged” during treatment using the BDI-II and the BAI. ROC analyses determined whether the EQ-5D could correctly classify patient outcomes.Results Effect sizes were large for the BAI, the BDI-II, the EQ-5D value and the EQ VAS, ranging from d = 1.07 to d = 1.84. SRM ranged from .93 – 1.67. Spearman’s correlation showed moderate agreement between the EQ-5D value and the BDI-II (rs = - .48), and the BAI (rs = - .41). The EQ-5D consistently identified “Recovered” patients versus “Improved” or “Unchanged” in the ROC analyses with AUROC ranging from .72 – .84.ConclusionThe EQ-5D showed good agreement with clinical measures evaluating symptom change, and correctly identifying recovered patients. These findings indicate that the EQ-5D may be appropriately responsive to change in patients with depression and anxiety disorders, although replication in other clinical samples is needed.

Physiotherapists’ and Physiotherapy Assistants’ Perspectives on Using Three Physical Function Measures in the Intensive Care Unit: A Mixed-Methods Study

Purpose: We sought to understand physiotherapists’ and physiotherapist assistants’ perspectives on using three physical function measures in the intensive care unit (ICU) setting: the Activity Measure for Post-Acute Care Inpatient Mobility Short Form, the Johns Hopkins Highest Level of Mobility scale, and the Functional Status Score for the Intensive Care Unit. Method: A six-item questionnaire was developed and administered to physiotherapists and physiotherapist assistants working in adult ICUs at one U.S. teaching hospital. A single semi-structured focus group was conducted with seven physiotherapists, recruited using purposive sampling to include participants with a range of clinical experience. Results: Of 22 potential participants, 18 physiotherapists and 2 physiotherapist assistants completed the questionnaire. Seven physiotherapists participated in the focus group. The questionnaire found favourable perspectives on the use of the three physical function measures in clinical practice, and the focus group identified five themes related to clinicians’ experience with using them: (1) ease of scoring, (2) usefulness in inter-professional communication, (3) general ease of use, (4) responsiveness to change in physical function, and (5) generalizability across patients. Conclusions: The most frequently discussed themes in this study were ease of scoring and usefulness in inter-professional communication, highlighting their importance in designing and selecting physical function measures for clinical use in the ICU setting.

Evaluation of NHS Practitioner Health: capturing mental health outcomes using five instruments

Background NHS Practitioner Health is the England wide programme providing mental health and addiction healthcare to doctors and dentists. Outcomes are assessed using five measures. Aims To contribute to a service evaluation of NHS Practitioner Health. To determine responsiveness to change and compare outcome measures. Method Measures were completed at baseline and 6 months: Generalized Anxiety Disorder Assessment (GAD-7), Perceived Stress Scale (PSS), Patient Health Questionaire-9 (PHQ-9), Warwick-Edinburgh Mental Wellbeing scale (WEMWBS), Psychological Outcome Profiles (PSYCHLOPS). Responsiveness to change was determined using effect size with improvement threshold ≥0.80. Instruments were compared using Bland–Altman plots. Results Our sample, n = 402; with 14 (3.5%) excluded for missing data; final sample, n = 388. All measures showed strong mean effect sizes: PSYCHLOPS 1.86 (95%CI 1.73–1.99), 75.8% ≥0.80; PSS 1.48 (1.34–1.62), 64.4% ≥0.80; WEMWBS 1.24 (1.13–1.35), 58.2% ≥0.80; GAD-7 1.07 (0.96–1.18), 52.8% ≥0.80; PHQ-9 0.86 (0.76–0.96), 52.8% ≥0.80. Findings were largely unchanged after stratification by diagnosis, presenting problem or therapy type. Fifty (12.9%) participants did not reach the threshold for improvement on any instrument. Bland–Altman plots indicated generally strong agreement between measures; combining PSYCHLOPS with WEMWBS maximised capture of improvement with only 3.6% of patients lying outside limits of agreement; GAD-7 was most likely to duplicate recovery scores of other measures. Conclusions Patients attending the NHS Practitioner Health service demonstrated high levels of improvement in mental health scores. The patient-generated instrument produced higher change scores than standardised instruments. Combining PSYCHLOPS and WEMWBS captured 96% of patients with above threshold improvement; GAD-7 added little to overall recovery measurement.

The Dance Functional Outcome Survey (DFOS) is Reliable, Valid, and Responsive in Pediatric Dancers

The Dance Functional Outcome Survey (DFOS) is a dance-specific questionnaire developed for use with ballet and modern dancers at all training levels. To date, no study has assessed the psychometric properties of the DFOS in pediatric dancers. The purposes of this study were to determine: 1. the reliability of the DFOS when used with healthy and injured pediatric dancers; 2. the validity of the DFOS com- pared to a well-established generic scale, the Pediatric Quality of Life Inventory Physical Function Scale (PedsQL-PFS); and 3. the sensitivity and responsiveness to change of the DFOS in injured dancers. One hundred and two dancers completed the DFOS twice within 10 days. Intra-class correlation coefficients (ICCs) were used to assess test-retest reliability. In a sample of 148 dancers, construct validity was explored by comparing the DFOS to the PedsQL-PFS using Pearson correlations, and Exploratory Factor Analysis (EFA) and Cronbach's alpha were used for internal consistency analyses. A sub-set of 22 injured dancers was employed to examine responsiveness using repeated measures analysis of variance (p < 0.05). The DFOS demonstrated high test-retest reliability (ICC ≥ 0.90). The DFOS total score, activities of daily living (ADL), and dance technique sub-scores had strong construct validity compared to the PedsQL-PFS (r ≥ 0.79). Cronbach's alpha was high ( α = 0.92), indicating excellent internal consistency. There were significant differences across time in DFOS scores (p < 0.001), demonstrating responsiveness to change. There were no floor or ceiling effects. Thus, the DFOS demonstrates excellent reliability, strong validity, and good responsiveness over time and is a viable tool for assessing function in pediatric dancers.

Responsiveness and Minimal Clinically Important Difference of the Five Times Sit-to-Stand Test in Patients with Stroke

This study aimed to analyze the responsiveness of the 5STS test among stroke patients and to estimate the MCIDs (minimal clinically important differences) for different severity levels of community ambulation and stages of recovery. The 5STS and comparator instruments (gait speed and Functional Ambulatory Category (FAC)) were evaluated at baseline. These measures were repeated at 4 (Stage 1) and 8 weeks (Stage 2), together with the Global Rating of Change (GROC). The MCIDs were calculated with two anchor-based methods using the GROC as the external criterion. Responsiveness to change for the 5STS was estimated analyzing the correlation with changes in the two comparator instruments and their capacity to discriminate improvement. For the 5STS test, while the MCIDs of the limited community ambulators were similar in the two stages (around 3 s), those of the household ambulators decreased from 1.9 s to 0.72 s. Spearman’s rho coefficients showed an acceptable correlation between changes in 5STS and changes for both the FAC and gait speed changes in both stages of recovery. Our study revealed that the 5STS is responsive to functional changes in patients with stroke and that their degree of severity and stage of recovery influence the MCID values of the 5STS.

Pediatric Simple Knee Value: a simple patient-reported outcome measure for the knee

Purpose The pediatric Simple Knee Value (pedi-SKV) is an outcome score in which paediatric patients are asked ‘How would you rate your knee today as a percentage of normal (0% to 100% scale with 100% being normal)?’. The primary aim of this study was to validate the pedi-SKV by measuring its correlation with validated knee function scores used most often in paediatric orthopaedics. Methods This prospective study was conducted at a teaching hospital to evaluate the pedi-SKV’s validity. A total of 44 paediatric patients (ten to 15 years old), were enrolled prior to anterior cruciate ligament reconstruction as well as 17 healthy controls. A survey form consisting of the Lysholm, International Knee Documentation Committee Pediatric Form (Pedi-IKDC) and pedi-SKV was given to subjects twice (enrolment and six months postoperatively). The criterion validity of the pedi-SKV was determined by correlating it to existing knee functional scores. Responsiveness to change was evaluated by comparing the pedi-SKV scores before and after surgery (enrolment visit and six-month postoperative visit). Discriminative ability was evaluated by comparing the pedi-SKV distribution in patients versus controls. Results There was a strong and significant correlation between the pedi-SKV and the Lysholm and Pedi-IKDC (p < 0.0001). The pedi-SKV had a good responsiveness to change (p < 0.0001 for the pedi-SKV before versus six months postoperatively). Like the other knee-specific functional sores (p < 0.0001), the pedi-SKV was able to distinguish between patients and controls (p < 0.0001). Conclusion The pedi-SKV is a valid outcome measure that is strongly correlated with the Lysholm and Pedi-IKDC. This is a novel simple score that can be used by physicians in their daily practice. Level of evidence II