Design: General practitioners (GPs) handed out the MDI to patients aged 18–65 years on clinical suspicion of depression.
Setting: Thirty-seven general practices in the Central Denmark Region participated in the study.
Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.
Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.
Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1–3) and after dichotomization of items according to diagnostic procedure.
Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
- Key points
The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice.
This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system
The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
Minor problems with measurement structure should be addressed in future revisions of the MDI.
Design: General practitioners (GPs) handed out the MDI to patients aged 18–65 years on clinical suspicion of depression.
Setting: Thirty-seven general practices in the Central Denmark Region participated in the study.
Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.
Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.
Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1–3) and after dichotomization of items according to diagnostic procedure.
Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
- Key points
The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice.
This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system
The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
Minor problems with measurement structure should be addressed in future revisions of the MDI.
Methods: We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35?years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year.
Results: Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost?=??$17,255; incremental effect?=?1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care.
Conclusions: The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods.
- Implications for Rehabilitation
Ongoing rehabilitation following stroke is imperative for optimal recovery.
Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.
The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.
Design: Qualitative and semi-structured interviews.
Setting: Australian burn and rehabilitation units.
Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings.
Results: The data portrayed the health professionals’ perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care.
Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes.
- Implications for rehabilitation
Burn care and rehabilitation remains a complex and challenging area of care.
Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase.
Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.
Design: A prospective cohort study.
Setting: The cardiac ward at Aarhus University Hospital, Denmark.
Intervention: A socially differentiated CR intervention in addition to the standard CR program.
Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N?=?379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network.
Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status.
Results: No significant long-term effect of the intervention was found.
Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
- Key points
The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors.
Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking.
General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
Design: Nationwide population-based, cross-sectional survey. Data was collected in 2012.
Setting: The general Danish population.
Subjects: A total of 48,910 randomly selected men aged 20+.
Main Outcome Measures: (1) Odds ratios for reporting LUTS by lifestyle and SES, and (2) Odds ratios for GP contact with bothersome LUTS by lifestyle and SES.
Results: 23,240 men participated (49.8%). Nocturia was the most commonly experienced LUTS (49.8%). Incontinence was most often reported as bothersome (64.1%) and nocturia less often reported as bothersome (34.2%). Only about one third of the men reporting a bothersome LUTS contacted their GP. Odds for reporting LUTS significantly increased with increasing age, obesity, and lack of labor market affiliation. Increasing age and symptom burden significantly increased the odds for GP contact regarding bothersome LUTS. No overall associations were found between lifestyle, SES, and GP contact.
Conclusion: Bothersome LUTS are common among Danish men. Concern and influence of LUTS on daily activities are important determinants of GP contact, yet only one in three bothersome LUTS are discussed with a GP. Advanced age and symptom burden were significantly associated with GP contact.
Implications: Information on treatment options for LUTS might be desirable among Danish men regardless of SES and lifestyle.
- Key points
Urological symptoms are common among men in the Danish population and are often managed without contacting healthcare professionals.
Increasing age and symptom burden significantly increase the likelihood of consulting a general practitioner regarding bothersome urological symptoms
Healthcare-seeking behavior with bothersome urological symptoms is not influenced by lifestyle or socioeconomic status among Danish men;
Information about available, effective treatment options for urological symptoms might be desirable among men regardless of socioeconomic status and lifestyle
Aim: Examine the predictive validity of the Occupational Therapy – Driver Off Road Assessment Battery for on-road performance among people with stroke.
Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive.
Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%).
Conclusion: The three cognitive subtests from the Occupational Therapy – Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke.
- Implications for Rehabilitation:
Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving.
The Occupational Therapy – Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment.
Scores on four of the Occupational Therapy – Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.
Design: Prospective diagnostic study using paired samples.
Setting/Intervention: Three general practices in Copenhagen. Each woman delivered FVU and MSU samples from the same void. As a reference standard, 8?ml of MSU was sent for culture at the Microbiology Department.
Patients: 117 women with one or more symptoms of UTI.
Main outcome measures: Sensitivity, specificity and agreement with the reference standard of FVU and MSU with different time delays (zero vs. one vs. four hours) as compared to reference standard (MSU at time zero in boric acid tubes).
Results: All three POC tests performed on MSU were significantly more in agreement with the reference than when performed on FVU when analysis was done immediately. The error rate was 16% for MSU vs. 23% for FVU with POC culture, 27% vs. 40% with microscopy and 25% vs. 33% with dipstick testing. Delay of analysis up to four hours did not decrease agreement with the reference.
Conclusion/Implication: MSU samples should be used in general practice for optimal accuracy of POC tests. Analysis can be delayed up to four hours.
- Key points
Point-of-care tests (dipstick testing, microscopy and culture) for diagnosing urinary tract infection performed on mid-stream urine samples are significantly more accurate than when performed on first-void urine samples.
Delay of analysis up to four hours did not decrease the accuracy of any of the point-of-care tests.
Point-of-care culture was more accurate than dipstick and microscopy both when performed on mid-stream urine and first-void urine
The main contaminant in first-void urine samples was Enterococci spp., which contributed to the majority of false positives.
Objective: The aim of this study was to translate and adapt the scale and to test the translated version for comprehension and suitability in Danish general practice setting.
Design and method: The process involved forward translation, backward translation, and field tests. The field tests included cognitive debriefing interviews. In all 30 general practitioners and 5 non-general practitioners participated in the process of translation. After using the scale among 1652 general practitioners statistical analysis was carried out to test internal consistency.
Setting: The study was carried out in general practice in Denmark.
Results: Several changes made during the process in order to achieve a Danish version that is acceptable, understandable and still capable of measuring medical engagement comparable of the original English version. Analysis of scale internal consistency using Cronbach’s alpha revealed acceptable reliability for all three meta-scales, which ranged from 0.69 to 0.81. The overall tool achieved a Cronbach’s alpha of 0.89.
Conclusion: The Danish version of the Medical Engagement Scale is a valid and reliable tool that is acceptable and relevant for general practice in Denmark.
- Key points
This study describes the cross-cultural adaptation of the Medical Engagement Scale from a UK primary healthcare setting to a Danish primary healthcare setting.
The process produced a relevant and acceptable questionnaire measuring medical engagement.
Internal consistency revealed acceptable reliability
The translation of the scale provides the possibility to use this scale for practical and academic purposes.
Methods: Before and after 12?weeks of high-intense concurrent training (interval and strength training, 5 sessions per 2?weeks, n?=?16) body composition, resting blood pressure and heart rate, 2-h oral glucose tolerance (insulin sensitivity, glycosylated hemoglobin, blood glucose and insulin concentrations), blood lipids (high- and low-density lipoprotein, total cholesterol, triglyceride levels) and C-reactive protein were analyzed.
Results: Twelve weeks of high-intense concurrent training significantly improved resting heart rate (?6%), 2-h blood glucose concentrations (?13%) and insulin sensitivity (?24%). Blood pressure, body composition, blood lipids and C-reactive protein did not seem to be affected.
Conclusions: Under the conditions of this pilot study, 12?weeks of concurrent high-intense interval and strength training improved resting heart rate, 2-h glucose and insulin sensitivity in multiple sclerosis but did not affect blood C-reactive protein levels, blood pressure, body composition and blood lipid profiles. Further, larger and controlled research investigating the effects of high-intense concurrent training on cardiovascular risk factors in multiple sclerosis is warranted.
- Implications for rehabilitation
High-intensity concurrent training improves cardiovascular fitness.
This pilot study explores the impact of this training on cardiovascular risk factors in multiple sclerosis.
Despite the lack of a control group, high-intense concurrent training does not seem to improve cardiovascular risk factors in multiple sclerosis.
Design: A qualitative study employing a participatory design approach, with an inductive analytical thematic approach utilising semi-structured interviews. Empirical data was analysed using the qualitative data analysis software (QDAS) Nvivo.
Setting: General practices in Denmark.
Subjects: Eight interviews were conducted with an average duration of 60?min. The interviewees were GPs from different geographical settings and different organisational structures, varying in age and professional interests.
Main outcome measures: Barriers and facilitators for future use of the HIT application for patients with LBP.
Results: Through the inclusion of healthcare professionals in the design process, this study found that in order for GPs to recommend a HIT application it is essential to target the application towards their patients. Furthermore, GPs required that the HIT application should support patient self-management. Additionally, the content of the HIT application should support the initiated treatment and it should be easy for GPs to recommend the HIT application. Finally, healthcare professionals need to be involved in the design process.
Conclusion: When designing health IT applications for patients with LBP in general practice it is important to include both patients and GPs in the design process. GPs would be more willing to recommend a HIT application that: applies content in line with frequently used recommendations; targets patients; supports patients’ self-management; and supports the patients’ needs.
- KEY POINTS
Online information is currently applied in general practice to some patients with low back pain
Online information cannot replace the GP, but can rather be a bonding tool between the patient and the GP
It is important to address both GP and patient barriers to applying new technology and to consider the literacy level
Participatory methods could play a central role in the future development of online information material
Objective: To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings.
Background: Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported.
Methods: Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age?±?SD?=?36.7?±?11.1). Main outcome measures: Mobility Activities Measure scales for lower extremity; PF-10; and PSFS.
Results: All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively).
Conclusions: The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients’ mobility.
- Implications for rehabilitation
All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods.
Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale, especially during the first four weeks of treatment.
The summary measure also detected a higher percentage of participants with positive change that exceeded the minimal detectable change than the Patient-Specific Functional Scale and the Physical Functioning Scale at the first follow-up period.
By demonstrating their consistency and sensitivity to change, the three Mobility Activities Measures scales can now be considered in order to track patients’ functional progress.
Mobility Activities Measure can be therefore used in patients with musculoskeletal conditions across outpatient rehabilitation settings to provide estimates of change in mobility activities focusing on the lower extremity.
Design: A cross-sectional study.
Setting: Occupational health care in the region of Pori, Finland.
Subjects: 671 municipal employees (89% females) with a mean age of 49 (SD 10) years. Information about the study subjects was gathered from medical records, by physical examination and questionnaires containing information about physical and mental health, health behavior, work-related and sociodemographic factors. The number of sickness absence days was obtained from the records of the city of Pori.
Main outcome measures: The relationship of absenteeism rate with sociodemographic, health- and work-related risk factors.
Results: In the multivariate analysis, the mean number of chronic diseases (IRR 1.24, 95% CI 1.13 to 1.36), work ability (IRR 0.83, 95% CI 0.76 to 0.91), and length of years in education (IRR 0.90, 95% CI 0.85 to 0.95) remained as independent factors associated with absenteeism.
Conclusion: According to our results, chronic diseases, self-perceived work ability and length of years in education are the most important determinants of the rate of sickness absence. This implies that among working-aged people the treatment of chronic medical conditions is also worth prioritizing, not only to prevent complications, but also to avoid sickness absences.
- KEY POINTS
Various sociodemographic, health- and work- related risk factors have been shown to influence sickness absence.
The study aimed to find the most important determinants of absenteeism among several known risk factors in Finnish municipal employees.
Chronic diseases, self-perceived work ability and education years remained as the most important determinants of sickness absence rates.
Treatment of chronic medical conditions should be prioritized in order to reduce sickness absence rate.
Method: Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test.
Results: The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed.
Conclusion: Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future.
- Implications for rehabilitation
Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty:
??Enhances quadriceps strength.
??Alleviates pain.
??Enhances range of motion.
??Does not have any effect on basic functional mobility.
??Does not have any effect on knee girth.
Methods: t-Tests and ANOVA with post hoc Tukey tests were used to compare caregiving time, time pressure, and depression between parents. Multivariate logistic regression analysis was used to examine the effect of caregiving time and time pressure on depression in parents.
Results: Regarding depression, 58 (38.2%) respondents scored ≥16 on the Center for Epidemiological Studies – Depression scale. Respondents supporting a preschool child spent more time than those supporting adults did; those supporting adults reported less time pressure than those supporting individuals of other ages. Caregiving time’s effect on depression was not supported, whereas increased time pressure raised the risk of depression.
Conclusions: The frequency of depression among parents supporting individuals with CP exceeded preceding findings. Time pressure due to support appears to directly predict depression. Total time spent caring appears unrelated to depression.
- Implications for Rehabilitation
It is necessary to prepare various community and family support systems in order to relieve parental caregivers’ burden and exhaustion.
Interventions should focus on parents with higher time pressure than parents with high caregiving time.
Physical and psychological difficulties experienced by parents supporting a child with a disability vary with the child’s life stage, meaning that families’ care burden partly depends on the age of the individual with disabilities.
Design: Comparative intervention study.
Setting: OOH services in two major Danish healthcare regions.
Intervention: Giving callers the option to bypass the telephone waiting line by introducing an EAB.
Participants: OOH service callers contacting during end of October to mid-December 2017.
Main outcome measures: Proportions of EAB use, waiting time and background information on participants in two settings differing on organisation structure, waiting time and triage personnel.
Results: In total, 97,791 out of 158,784 callers (61.6%) chose to participate. The EAB was used 2905 times out of 97,791 (2.97%, 95%CI 2.86; 3.08). Patient characteristics associated with increased EAB use were male gender, higher age, low education, being retired, and increasing announced estimated waiting time. In one region, immigrants used the EAB more often than native Danish callers.
Conclusion: Only about 3% of all callers chose to bypass the waiting line in the OOH service when given the option. This study suggests that the EAB could serve as a new and simple tool to reduce the waiting time for severely ill patients in an OOH service telephone triage setting.
- Key Points
Acute out-of-hours healthcare is challenged by overcrowding and increasing demand for services.
This study shows that only approximately 3% of callers chose to bypass the telephone waiting queue when given the opportunity through an emergency access button.
An emergency access button may serve as a new tool to help reduce the triage waiting time for severely ill patients in out-of-hours medical facilities.
Method: This study investigated the factors within the new product development process that hindered satisfactory product design outcomes, through working collaboratively with a leading provider based in the UK.
Results: This study identified that there are too many costly late-stage design changes; a critical and persistent problem area ripe for improvement. The findings from analyzing 30 recent devices, interviewing key stakeholders and observing on-going projects further revealed that one major cause of the issue was poor practice in defining and communicating the product design criteria and requirements.
Conclusions: Addressing the characteristics of the telehealthcare industry, such as multiple design commissioners and frequent deployment of design subcontracts, this paper argues that undertaking a robust process of creating the product design brief is the key to improving the outcomes of telehealthcare device design, particularly for the small and medium-sized enterprises dominating the sector.
- Implications for rehabilitation
Product design criteria and requirements are frequently ill-defined and ineffectively communicated to the designers within the processes of developing new telehealthcare devices.
The absence of a (robust) process of creating the design brief is the root cause of the identified issues in defining and communicating the design task.
Deploying a formal process of creating the product design brief is particularly important for the telehealthcare sector.
Methods: Cross-sectional validation study: After forward and back translation of the Dutch version of the Child Activity Limitation Interview 21-Child adolescents (11–21 years old) with chronic musculoskeletal pain completed an assessment. The assessment contained the Dutch Child Activity Limitation Interview, and questionnaires about demographics, pain intensity, functional disability, anxiety and depression. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain intensity, activity limitations, anxiety and depression as comparative constructs.
Results: Seventy-four adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 50% of the variance. Internal consistency was good (Cronbach’s α?=?0.91 total scale, α?=?0.90 Factor 1, α?=?0.80 Factor 2). All nine hypotheses were confirmed.
Conclusion: The Dutch version can be used to assess pain-related disability in Dutch-speaking adolescents comparable to the study sample. Scores on both subscales provide insight into the severity of the pain-related disability in both daily routine and more physically vigorous activities.
- Implications for Rehabilitation
Chronic pain is a disabling disorder which not only impacts physically but restricts quality of life.
This study provides clinicians a questionnaire to measure pain-related disability and quantify the impact of pain on the daily living of adolescents.
The advantage of the Dutch version of the Child Activity and Limitations Interview over other measurements is that it can distinguish limitations in daily activities from more physically vigorous activities.